Evaluating Integrated Surveillance for Antimicrobial Use and Resistance in England: A Qualitative Study.

Integrated surveillance systems for antimicrobial use (AMU) and antimicrobial resistance (AMR) require regular evaluation to ensure the effectiveness and efficiency of the system. An important step in the evaluation is to choose an appropriate tool for the purpose of the evaluation. The "Integrated Surveillance System Evaluation" (ISSE) framework is a conceptual framework that was developed to evaluate One Health (OH) integration in surveillance system for AMU/AMR. This study aimed to evaluate the performance and value of integrated surveillance system for AMU/AMR in England by applying the ISSE framework, which was used to develop data collection protocols and define the study design. A qualitative study using semi-structured interviews was conducted to collect the data and analyse it thematically. Eighteen stakeholders from human, animal, food and environment sectors that are involved in AMU/AMR surveillance were interviewed. Four main themes emerged from the analysis: (1) Cross-sectoral integration in the surveillance system for AMU/AMR; (2) Production of OH outputs and outcomes; (3) Drivers and barriers to cross-sectoral collaboration; and 4) Need for more cross-sectoral collaboration. The findings showed that there were links between integrated surveillance information, decision making and interventions. However, there were only few OH examples, such as the UK AMR contingency plan, where the potential of cross-sectoral collaboration was fully exploited. A lot of the benefits described were related to the generation of information and increase in knowledge and understanding without links to how the information generated was used. While these intangible benefits have a value on their own, being able to link surveillance information and mitigation measures would help to enhance the value of integrated surveillance. In terms of improvement, the main areas identified were the development of more harmonised methods for data collection and analysis, provision of resources dedicated to cross-sectoral collaboration, improved coordination, and collection of surveillance data from the environment and from companion animals. By identifying links between OH surveillance information produced and various outputs and outcomes; this study helped to understand the wider benefits of integrated surveillance for AMU/AMR in England and provided insights on how the system could be improved and efficiency increased

Control of public health hazards in pork- current status of knowledge and future challenges.

The range of public health hazards that may occur in pork is very broad including both microbiological pathogens as well as chemical substances. Major international incidents recently highlighted the importance of managing risk at an international level. Control programmes targeted at selected pathogens have been introduced in a significant number of countries over the past years. Most notably, the control of Salmonella along the pork production chain represents a substantial effort of pork producers and veterinary services to reduce public health risk. But the control of traditional hazards such as Trichinella also still require substantial resources, while new hazards such as bacteria with resistance against antimicrobials also demand increasing attention. As funds available for risk management are limited, priorities need to be set. To set the right priorities will be a key challenge for the effective and efficient control of pork-related hazards in increasingly global food systems. Also, there is currently a lack of intervention strategies with proven effectiveness against a number of major pork-borne pathogens such as Campylobacter. Control of such hazards can only progress if technically and economically feasible strategies are available. An additional challenge for pork industries but also governments is risk communication, specifically the prevention of negative market impact by unsubstantiated risks perceived by consumers

Zoonotic pathogens and antimicrobial resistance in ‘animal-friendly’ pig production systems in Switzerland

In a cross-sectional study, the impact of ‘animal-friendly’ housing systems on the prevalence of Salmonella species, Campylobacter species, and Yersinia enterocolitica in finishing pigs and pork was investigated. Furthermore, antimicrobial resistance patterns of isolated campylobacter strains were analysed. In faecal samples of two out of 88 fattening pig farms salmonellae were isolated. All 865 samples of pork were found to be negative. Campylobacter was isolated on 98.9 % of the farms but only from 0.2 % of the pork samples. Yersiniae were found in samples of 63.3 % of the farms and in 15.4 % of pork samples. For all three bacteria, there was no statistically significant difference in the prevalence between conventional and ‘animal-friendly’ housing systems. In ‘animal-friendly’ farms, antimicrobial resistance of campylobacter isolates to fluoroquinolones and streptomycin was significantly less frequent than in conventional farms. Furthermore, fewer isolates had resistance to three or more antimicrobials in ‘animal-friendly’ farms

A qualitative assessment of the probability of human exposure to Trichinella spp. in Switzerland

Trichinellosis is a zoonotic disease caused by Trichinella spp. Pork is a potential source of infection for humans. A qualitative assessment was conducted to assess the probability of human exposure to Trichinella spp. in Switzerland via the consumption of pork. For the assessment, both the wildlife cycle and the domestic cycle were taken into account. The probability of occurrence of Trichinella infections in domestic pigs was assessed negligible under controlled housing systems due to biosecurity measures. Free-range pigs were assessed to have a very low probability of being infected. Pork from free-range pigs that were not tested for Trichinella spp. was estimated to carry a very low probability for human exposure to Trichmella spp

Comparing the demonstration of freedom from Trichinella infection of domestic pigs by traditional and risk-based surveillance

Traditionally, the routine artificial digestion test is applied to assess the presence of Trichinella larvae in pigs. However, this diagnostic method has a low sensitivity compared to serological tests. The results from artificial digestion tests in Switzerland were evaluated over a time period of 15 years to determine by when freedom from infection based on these data could be confirmed. Freedom was defined as a 95% probability that the prevalence of infection was below 0·0001%. Freedom was demonstrated after 12 years at the latest. A new risk-based surveillance approach was then developed based on serology. Risk-based surveillance was also assessed over 15 years, starting in 2010. It was shown that by using this design, the sample size could be reduced by at least a factor of 4 when compared with the traditional testing regimen, without lowering the level of confidence in the Trichinella-free status of the pig populatio

Assigning Defined Daily Doses Animal: a European multi-country experience

In order to be able to compare antimicrobial usage data between countries with a uniform quantification method a Defined Daily Dose Animal (DDDA) per active substance was defined. Information of 731 antimicrobial products licensed for use in porcine medicine in four EU countries was used to establish mean DDDAs for 83 unique active substances (AS) including combinations of different AS. Common DDDAs were defined in spite of large variations in the authorized dosages for the same active substances and administration routes. These DDDAs will be used to quantify and compare antimicrobial usage in pig production in four EU countries

Evaluation of safety assurance measures for Salmonella in pork production in Switzerland

The safety of foods of animal origins is provided in Switzerland through various sampling strategies and production processes throughout the production chain. Dispersion and heterogeneity of the information on the implementation of these safety assurance measures hinder a general overview and make an evaluation of the level of the safety provided difficult. A full inventory of the elements implicated in the pork production system was conducted. Information on sampling strategies and production processes was collected. The level of safety assurance provided regarding Salmonella was evaluated at every step of the pork production chain by integrating this information using a semi-quantitative method. The results showed that in the pork production chain, the level of safety assurance varied between production steps. Weaknesses were detected, especially in compound feed production and animal production. Results of this analysis will be used to improve the existing implemented safety assurance measures

A review of bovine tuberculosis at the wildlife-livestock-human interface in sub-Saharan Africa

Infection of wild animals by bovine tuberculosis (bTB) is raising concern worldwide. This article reviews the current epidemiological situation, risk of emergence and control options at the wildlife-livestock-human interface in sub-Saharan Africa. In livestock, bTB has been confirmed in the majority of countries from all parts of the continent. Wildlife infection is confirmed in seven countries from southern and eastern Africa, apparently spreading in the southern Africa region. Mycobacterium bovis has been isolated from 17 wild mammal species, although only four are suspected to play a role as maintenance host. Zoonotic risks are a concern, but no direct spillover from wildlife to humans has been documented, and no case of bTB spillback from wildlife to livestock has been confirmed. In this paper we assess the main risk factors of bTB spillover at the wildlife-livestock-human interface and suggest several research themes which could improve the control of the disease in the African contex