One Health Surveillance: A Matrix to Evaluate Multisectoral Collaboration

The international community and governmental organizations are actively calling for the implementation of One Health (OH) surveillance systems to target health hazards that involve humans, animals, and their environment. In our view, the main characteristic of a OH surveillance system is the collaboration across institutions and disciplines operating within the different sectors to plan, coordinate, and implement the surveillance process. However, the multisectoral organizational models and possible collaborative modalities implemented throughout the surveillance process are multi-fold and depend on the objective and context of the surveillance. The purpose of this study is to define a matrix to evaluate the quality and appropriateness of multisectoral collaboration through an in-depth analysis of its organization, implementation, and functions. We developed a first list of evaluation attributes based on (i) the characteristics of the organization, implementation, and functionality of multisectoral surveillance systems; and (ii) the existing attributes for the evaluation of health surveillance systems and OH initiatives. These attributes were submitted to two rounds of expert-opinion elicitation for review and validation. The final list of attributes consisted of 23 organizational attributes and 9 functional attributes, to which 3 organizational indexes were added measuring the overall organization of collaboration. We then defined 75 criteria to evaluate the level of satisfaction for the attributes and indexes. The criteria were scored following a four-tiered scoring grid. Graphical representations allowed for an easy overview of the evaluation results for both attributes and indexes. This evaluation matrix is the first to allow an in-depth analysis of collaboration in a multisectoral surveillance system and is the preliminary step toward the creation of a fully standalone tool for the evaluation of collaboration. After its practical application and adaptability to different contexts are field-tested, this tool could be very useful in identifying the strengths and weaknesses of collaboration occurring in a multisectoral surveillance system

Guidance for evaluating integrated surveillance of antimicrobial use and resistance

Antimicrobial resistance (AMR) resulting from antimicrobial use (AMU) is an emerging threat to global health. One of the key elements for a better understanding and management of AMU and AMR is to develop effective and efficient integrated surveillance systems that consider the complex epidemiology of these issues and the impacts of resistance on humans, animals and the environment. Consequently, for this project, an international consortium of experts from multiple fields called CoEvalAMR was formed with the objectives to study user needs, characterise and compare existing tools for the evaluation of integrated AMU and AMR surveillance, apply them to case studies, and elaborate guidance on the purpose-fit selection and the use of the tools. For the comparison of evaluation tools, questions were extracted from existing tools and attributed to themes, to assess the user needs, interviews were conducted with national key stakeholders, and we applied a series of different evaluation tools to understand and document their strengths and weaknesses. The guidance was refined iteratively. From 12 evaluation tools, 1117 questions/indicators were extracted and attributed to seven emerging themes. Twenty-three experts were interviewed, who suggested to increase the ease-of-use, grant open access, provide web-based interfaces and allow results to be automatically generated. Respondents also wished for tools providing the flexibility to conduct a rapid review, or an in-depth analysis of the surveillance system, depending on the evaluation objectives. The case studies emphasised that proper evaluations require adequate resources, typically requiring the involvement of several assessors and/or stakeholders, and can take weeks or months to complete. The resulting web-based guidance comprises six main sections: 1. Introduction to surveillance evaluation, 2. Evaluation of surveillance for AMU and AMR, 3. Evaluation tools, 4. Support for selecting an evaluation tool, 5. Case studies and 6. Directory of existing tools. The audience for the guidance is personnel working in public, private, and non-governmental organisations, from public health, animal health, plant health and environmental health, at local, national and international levels. We conclude that the field is challenged by opposing user needs for reduction and simplicity versus system approaches allowing the synthesis of that knowledge to sufficiently reflect the complexity of AMU and AMR ecology for real-world decisions. The CoEvalAMR web platform allows a better understanding of the different evaluation tools and assists users in the selection of an approach that corresponds to their evaluation needs. The CoEvalAMR consortium continues to address remaining gaps and consolidate evaluation tools and approaches in the future

In vivo antiviral efficacy of prenylation inhibitors against hepatitis delta virus

Hepatitis delta virus (HDV) can dramatically worsen liver disease in patients coinfected with hepatitis B virus (HBV). No effective medical therapy exists for HDV. The HDV envelope requires HBV surface antigen proteins provided by HBV. Once inside a cell, however, HDV can replicate its genome in the absence of any HBV gene products. In vitro, HDV virion assembly is critically dependent on prenyl lipid modification, or prenylation, of its nucleocapsid-like protein large delta antigen. To overcome limitations of current animal models and to test the hypothesis that pharmacologic prenylation inhibition can prevent the production of HDV virions in vivo, we established a convenient mouse-based model of HDV infection capable of yielding viremia. Such mice were then treated with the prenylation inhibitors FTI-277 and FTI-2153. Both agents were highly effective at clearing HDV viremia. As expected, HDV inhibition exhibited duration-of-treatment dependence. These results provide the first preclinical data supporting the in vivo efficacy of prenylation inhibition as a novel antiviral therapy with potential application to HDV and a wide variety of other viruses

Effects of deletion of the Streptococcus pneumoniae lipoprotein diacylglyceryl transferase gene lgt on ABC transporter function and on growth in vivo

Lipoproteins are an important class of surface associated proteins that have diverse roles and frequently are involved in the virulence of bacterial pathogens. As prolipoproteins are attached to the cell membrane by a single enzyme, prolipoprotein diacylglyceryl transferase (Lgt), deletion of the corresponding gene potentially allows the characterisation of the overall importance of lipoproteins for specific bacterial functions. We have used a Δlgt mutant strain of Streptococcus pneumoniae to investigate the effects of loss of lipoprotein attachment on cation acquisition, growth in media containing specific carbon sources, and virulence in different infection models. Immunoblots of triton X-114 extracts, flow cytometry and immuno-fluorescence microscopy confirmed the Δlgt mutant had markedly reduced lipoprotein expression on the cell surface. The Δlgt mutant had reduced growth in cation depleted medium, increased sensitivity to oxidative stress, reduced zinc uptake, and reduced intracellular levels of several cations. Doubling time of the Δlgt mutant was also increased slightly when grown in medium with glucose, raffinose and maltotriose as sole carbon sources. These multiple defects in cation and sugar ABC transporter function for the Δlgt mutant were associated with only slightly delayed growth in complete medium. However the Δlgt mutant had significantly reduced growth in blood or bronchoalveolar lavage fluid and a marked impairment in virulence in mouse models of nasopharyngeal colonisation, sepsis and pneumonia. These data suggest that for S. pneumoniae loss of surface localisation of lipoproteins has widespread effects on ABC transporter functions that collectively prevent the Δlgt mutant from establishing invasive infection

How to apply the One Health concept to improve surveillance of health hazards at the human-animal-environment interface?

Le concept One Health (Une seule santé) reconnaît une interconnexion entre la santé animale, la santé humaine et la santé des écosystèmes. Il encourage des efforts collaboratifs entre secteurs et disciplines pour aborder plus efficacement les problématiques sanitaires à l'interface homme-animal-environnement. En matière de surveillance sanitaire, ce concept est très largement promu car il laisse présager une amélioration de la performance épidémiologique et économique de la surveillance. Cependant, les systèmes de surveillance continuent le plus souvent à opérer en silo avec des dispositifs sectoriels très peu connectés. Nous pensons que le manque d’opérationnalisation de la surveillance One Health relève en partie de la persistance de confusions et d’incertitudes sur son application pratique et sur sa valeur ajoutée par rapport à la juxtaposition de dispositifs sectoriels fonctionnant indépendamment.Dans ce contexte, nous avons développé un cadre conceptuel et méthodologique pour favoriser la mise en oeuvre du concept One Health dans le domaine de la surveillance. Pour cela, nous avons tout d’abord caractérisé la surveillance One Health et ses contextes d’application en conduisant une revue systématique de littérature des systèmes One Health existants, suivie d’une élicitation d’opinions d’experts. Puis, nous avons mobilisé deux approches, l’analyse des acteurs et la modélisation d’accompagnement, pour développer et tester de nouvelles méthodes pour aider les acteurs de la surveillance dans la mise en oeuvre du concept One Health. Enfin, nous avons défini des attributs spécifiques pour développer un outil d’évaluation de la qualité et de la pertinence de la collaboration mise en oeuvre dans un système de surveillance pour répondre aux objectifs collaboratifs. Ces travaux participent, en synergie avec des travaux conduits par d’autres équipes de recherche, à la promotion de la surveillance One Health.The One Health concept recognizes that human health, animal health and environmental health areinterconnected and promotes multisectoral and multidisciplinary collaboration to efficiently manage health issues atthe human-animal-environment interface. One Health surveillance is strongly encouraged as it suggests theenhanced performance and cost-effectiveness of surveillance. Nevertheless, surveillance systems continue to bedeveloped and operated in a highly sectoral approach. We argue that the challenging operationalization of OneHealth surveillance is partly due to the existence of confusion and uncertainty regarding its practical application aswell as its added value comparing to sectoral surveillance components operating independently.In this context, we developed a conceptual and methodological framework to help the implementation ofOne Health surveillance. First, we characterised One Health surveillance and its application contexts using asystematic literature review of existing One Health surveillance systems followed by an expert opinion elicitation.Then, we mobilized two approaches, stakeholder analysis and companion modelling, to develop and apply twoinnovative methods to facilitate the application of the One Health concept by surveillance actors. Finally, weidentified specific attributes to support the development of a tool aiming at evaluating the quality andappropriateness of implemented collaboration to meet the collaborative objectives. Along with other projects led byresearch teams across the world, our research work contributes to the promotion of One Health surveillance

Comment mettre en oeuvre le concept "One Health" pour améliorer la surveillance des dangers sanitaires à l'interface homme-animal-environnement ?

The One Health concept recognizes that human health, animal health and environmental health areinterconnected and promotes multisectoral and multidisciplinary collaboration to efficiently manage health issues atthe human-animal-environment interface. One Health surveillance is strongly encouraged as it suggests theenhanced performance and cost-effectiveness of surveillance. Nevertheless, surveillance systems continue to bedeveloped and operated in a highly sectoral approach. We argue that the challenging operationalization of OneHealth surveillance is partly due to the existence of confusion and uncertainty regarding its practical application aswell as its added value comparing to sectoral surveillance components operating independently.In this context, we developed a conceptual and methodological framework to help the implementation ofOne Health surveillance. First, we characterised One Health surveillance and its application contexts using asystematic literature review of existing One Health surveillance systems followed by an expert opinion elicitation.Then, we mobilized two approaches, stakeholder analysis and companion modelling, to develop and apply twoinnovative methods to facilitate the application of the One Health concept by surveillance actors. Finally, weidentified specific attributes to support the development of a tool aiming at evaluating the quality andappropriateness of implemented collaboration to meet the collaborative objectives. Along with other projects led byresearch teams across the world, our research work contributes to the promotion of One Health surveillance.Le concept One Health (Une seule santé) reconnaît une interconnexion entre la santé animale, la santé humaine et la santé des écosystèmes. Il encourage des efforts collaboratifs entre secteurs et disciplines pour aborder plus efficacement les problématiques sanitaires à l'interface homme-animal-environnement. En matière de surveillance sanitaire, ce concept est très largement promu car il laisse présager une amélioration de la performance épidémiologique et économique de la surveillance. Cependant, les systèmes de surveillance continuent le plus souvent à opérer en silo avec des dispositifs sectoriels très peu connectés. Nous pensons que le manque d’opérationnalisation de la surveillance One Health relève en partie de la persistance de confusions et d’incertitudes sur son application pratique et sur sa valeur ajoutée par rapport à la juxtaposition de dispositifs sectoriels fonctionnant indépendamment.Dans ce contexte, nous avons développé un cadre conceptuel et méthodologique pour favoriser la mise en oeuvre du concept One Health dans le domaine de la surveillance. Pour cela, nous avons tout d’abord caractérisé la surveillance One Health et ses contextes d’application en conduisant une revue systématique de littérature des systèmes One Health existants, suivie d’une élicitation d’opinions d’experts. Puis, nous avons mobilisé deux approches, l’analyse des acteurs et la modélisation d’accompagnement, pour développer et tester de nouvelles méthodes pour aider les acteurs de la surveillance dans la mise en oeuvre du concept One Health. Enfin, nous avons défini des attributs spécifiques pour développer un outil d’évaluation de la qualité et de la pertinence de la collaboration mise en oeuvre dans un système de surveillance pour répondre aux objectifs collaboratifs. Ces travaux participent, en synergie avec des travaux conduits par d’autres équipes de recherche, à la promotion de la surveillance One Health