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

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 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

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

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

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

Modelling the within-herd transmission of in closed pig herds.

BACKGROUND A discrete time, stochastic, compartmental model simulating the spread of within a batch of industrially raised pigs was developed to understand infection dynamics and to assess the impact of a range of husbandry practices. A 'disease severity' index was calculated based on the ratio between the cumulative numbers of acutely and chronically diseased and infectious pigs per day in each age category, divided by the length of time that pigs spent in this age category. This is equal to the number of pigs per day, either acutely or chronically infectious and diseased, divided by the number of all pigs per all days in the model. The impact of risk and protective factors at batch level was examined by adjusting 'acclimatisation of gilts', 'length of suckling period', 'vaccination of suckling pigs against ', 'contact between fattening pigs of different age during restocking of compartments' and 'co-infections in fattening pigs'. RESULTS The highest 'disease severity' was predicted, when gilts do not have contact with live animals during their acclimatisation, suckling period is 28 days, no vaccine is applied, fatteners have contact with pigs of other ages and are suffering from co-infections. Pigs in this scenario become diseased/infectious for 26.1 % of their lifetime. Logistic regression showed that vaccination of suckling pigs was influential for 'disease severity' in growers and finishers, but not in suckling and nursery pigs. Lack of contact between gilts and other live pigs during the acclimatisation significantly influenced the 'disease severity' in suckling pigs but had less impact in growing and finishing pigs. The length of the suckling period equally affected the severity of the disease in all age groups with the strongest association in nursery pigs. The contact between fatteners of different groups influenced the course of infection among finishers, but not among other pigs. Finally, presence of co-infections was relevant in growers and finishers, but not in younger pigs. CONCLUSION The developed model allows comparison of different prevention programmes and strategies for controlling transmission of

Potential alternatives to antimicrobials in pig production based on perceived effectiveness, feasibility and return on investment

Based on a questionnaire returned by 111 pig health experts from six European countries a list of potential alternatives to antimicrobials was ranked. These althernatives provide input for further studies to find strategies to reduce the widely discussed use of antimicrobials and the potential risk from antimicrobial resistance

Eliciting expert knowledge on Salmonella enterica dynamics in swine at the pre-harvest level

A workshop was conducted to elicit expert knowledge on infection status and transmission of salmonella in pigs at the farm of origin, during transport and during lairage. Thirty-six experts from II countries filled in a paper-and-pencil questionnaire during an international conference. The group of US and Danish experts were large enough to be analysed separately. The results indicated that experts from all countries agreed on the risk of salmonella introduction related to live animals and the significance of general hygiene and all-in/all-out management for salmonella control. However, workshop participants from Denmark put more weight on factors related to feed while experts from the USA rated factors related to rodents and people contact higher. The experts believed that 1/3 of the infected pigs from a chronically infected farm would be shedders. There were differences in risk perception between experts from Denmark and the USA regarding contamination during Jairage and transport as well as regarding incidence of salmonella shedding during transport and Jairage. In conclusion, the results reflect the differences in the level of salmonella infection and control between countries. The study does not allow differentiation between true differences in salmonella dynamics between countries or differences in perception only

First reported case of fatal tuberculosis in a wild African elephant with past human-wildlife contact

Tuberculosis is emerging/re-emerging in captive elephant populations, where it causes morbidity and deaths, although no case of TB in wild African elephants has been reported. In this paper we report the first case of fatal TB in an African elephant in the wild. The infection with Mycobacterium tuberculosis was confirmed by post-mortem and histological examinations of a female sub-adult elephant aged >12 years that died in Tsavo East National Park, Kenya, while under treatment. This case is unique in that during its lifetime the elephant had contact with both humans and wild elephants. The source of the infection was unclear because the elephant could have acquired the infection in the orphanage or in the wild. However, our results show that wild elephants can maintain human TB in the wild and that the infection can be fata