The TAP manual : an in-depth guide for planning and implementing tailoring antimicrobial resistance programmes

The Tailoring Antimicrobial Resistance Programmes (TAP) Manual is inspired by the Tailoring Immunization Programmes (TIP) guide and was developed at the WHO Regional Office for Europe to support countries in using a behavioural insights approach to identify appropriate and feasible interventions to begin tackling antimicrobial resistance in their contexts. The TAP Manual is accompanied by a user-friendly TAP Quick Guide and TAP Toolbox. This Manual was prepared by Marie Louise Wright (formerly WHO Regional Office for Europe) and Sahil Warsi (WHO Regional Office for Europe) under the technical guidance of Ketevan Kandelaki (WHO Regional Office for Europe) and Danilo Lo Fo Wong (WHO Regional Office for Europe). Input and review were provided by Siff Malue Nielsen (WHO Regional Office for Europe), Katrine Bach Habersaat (WHO Regional Office for Europe), Nils Fietje (WHO Regional Office for Europe) and Masse Helstrom (WHO Regional Office for Europe). Significant contributions for the technical concept were made by Karen Mah (WHO headquarters), Ponnu Padiyara (WHO headquarters), Chantal den Daas (National Institute for Public Health and the Environment, the Netherlands) and Anja Schreijer (Public Health Service, Amsterdam, the Netherlands). This document was produced with the financial assistance of the European Union. The views expressed herein can in no way be taken to reflect the official opinion of the European Union

Linking Illness to Food: Summary of a Workshop on Food Attribution

To identify and prioritize effective food safety interventions, it is critical not only to identify the pathogens responsible for illness, but also to attribute cases of foodborne disease to the specific food vehicle responsible. A wide variety of such “food attribution” approaches and data are used around the world, including the analysis of and extrapolation from outbreak and other surveillance data, case-control studies, microbial subtyping and source-tracking methods, and expert judgment, among others. The Food Safety Research Consortium sponsored the Food Attribution Data Workshop in October 2003 to discuss the virtues and limitations of these approaches and to identify future options for the collection of food attribution data in the United States. This discussion paper summarizes workshop discussions and identifies challenges that affect progress in this critical component of a risk-based approach to improving food safety.foodborne illness, food attribution, outbreaks, case-control studies, microbial fingerprinting, microbial subtyping, FoodNet

Quantitative risk assessment of the introduction and transmission of Salmonella infection in the stable-to table chain of pork production

In Denmark, the presence of Salmonella is monitored at various stages of pork production. The main purpose is to identify producers for whom intervention measures are required, due to unacceptable levels of Salmonella. Commonly, the compiling and presentation of data from the monitoring programs is made public in the form of simple descriptive figures in e.g. annual reports. To make more efficient use of this vast source of information, routinely collected data is being utilized to develop a probabilistic risk assessment model to simulate the dynamics of Salmonella contantination throughout the stable-to-table chain of pork production. In addition, results obtained from several national and international research projects, a survey of Danish butchers and relevant literature sources were made available

Salmonella-prevalences in Danish organic, free-range, conventional and breeding herds

The results from the Danish serological Salmonella surveillance on meat juice from slaughter pigs in the herd types: conventional herds, organic herds, free-range herds and breeder herds were compared. Seropositive samples were found in all herd types. The relative risk for a sample to be seropositive in free-range herds was 1.7 compared to conventional herds (p=O,OOOI) when confounder control for herd size was applied. An apparent increased risk in organic herds and reduced risk in breeder herds were not statistically significant. The analysis of results from organic herds was based on relatively few samples. Due to the expected increase in number of alternative production systems and difficulties in application of the full panel of recommendations for reduction of the Salmonella infection in these herds, future studies should focus on identification of specific Salmonella risk factors within alternative production systems and develop new tools based on this knowledge

Quantification of Salmonella and Yersinia on pork carcasses by simulation modelling

Stagnation in the success of control programmes in pig production in Denmark has led to an increased interest in the development of alternative control strategies such as decontamination of carcasses to further decrease the attribution of pork meat to human foodborne illness. This project sets out to develop a model for quantitative estimation of slaughterhouse output of Salmonella and Yersinia . Distributions of the occurrence of Salmonefla, Yersinia and E. coli on pork carcasses are based on the analysis of paired faecal samples and carcass swabs from 2880 animals originating from four abattoirs. By combining the estimated quantity of faecal contamination of carcasses with a semi-quantitative distribution of the number of Safmoneffa or Yersinia per gram faeces, an output distribution describing the number of Salmonella or Yersinia bacteria per carcass can be established. In order to validate the model, carcass swabs, analysed for Salmonefla and Yersinia serve as control. After the model has been validated, the effect of various decontamination methods on human exposure to foodborne pathogens in pork will be evaluated in both economic terms as well as with regard to public health impact

Associated deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in Switzerland, 2010 to 2019.

BackgroundCassini et al. (2019) estimated that, in 2015, infections with 16 different antibiotic-resistant bacteria resulted in ca 170 disability-adjusted life-years (DALYs) per 100,000 population in the European Union and European Economic area (EU/EEA). The corresponding estimate for Switzerland was about half of this (87.8 DALYs per 100,000 population) but still higher than that of several EU/EEA countries (e.g. neighbouring Austria (77.2)).AimIn this study, the burden caused by the same infections due to antibiotic-resistant bacteria ('AMR burden') in Switzerland from 2010 to 2019 was estimated and the effect of the factors 'linguistic region' and 'hospital type' on this estimate was examined.MethodsNumber of infections, DALYs and deaths were estimated according to Cassini et al. (2019) whereas separate models were built for each linguistic region/hospital type combination.ResultsDALYs increased significantly from 3,995 (95% uncertainty interval (UI): 3;327-4,805) in 2010 to 6,805 (95% UI: 5,820-7,949) in 2019. Linguistic region and hospital type stratifications significantly affected the absolute values and the slope of the total AMR burden estimates. DALYs per population were higher in the Latin part of Switzerland (98 DALYs per 100,000 population; 95% UI: 83-115) compared with the German part (57 DALYs per 100,000 population; 95% UI: 49-66) and in university hospitals (165 DALYs per 100,000 hospitalisation days; 95% UI: 140-194) compared with non-university hospitals (62 DALYs per 100,000 hospitalisation days; 95% UI: 53-72).ConclusionsThe AMR burden estimate in Switzerland has increased significantly between 2010 and 2019. Considerable differences depending on the linguistic region and the hospital type were identified - a finding which affects the nationwide burden estimation

Associated deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in Switzerland, 2010 to 2019

Background: Cassini et al. (2019) estimated that, in 2015, infections with 16 different antibiotic-resistant bacteria resulted in ca 170 disability-adjusted life-years (DALYs) per 100,000 population in the European Union and European Economic area (EU/EEA). The corresponding estimate for Switzerland was about half of this (87.8 DALYs per 100,000 population) but still higher than that of several EU/EEA countries (e.g. neighbouring Austria (77.2)). Aim: In this study, the burden caused by the same infections due to antibiotic-resistant bacteria ('AMR burden') in Switzerland from 2010 to 2019 was estimated and the effect of the factors 'linguistic region' and 'hospital type' on this estimate was examined.MethodsNumber of infections, DALYs and deaths were estimated according to Cassini et al. (2019) whereas separate models were built for each linguistic region/hospital type combination. Results: DALYs increased significantly from 3,995 (95% uncertainty interval (UI): 3;327-4,805) in 2010 to 6,805 (95% UI: 5,820-7,949) in 2019. Linguistic region and hospital type stratifications significantly affected the absolute values and the slope of the total AMR burden estimates. DALYs per population were higher in the Latin part of Switzerland (98 DALYs per 100,000 population; 95% UI: 83-115) compared with the German part (57 DALYs per 100,000 population; 95% UI: 49-66) and in university hospitals (165 DALYs per 100,000 hospitalisation days; 95% UI: 140-194) compared with non-university hospitals (62 DALYs per 100,000 hospitalisation days; 95% UI: 53-72). Conclusions: The AMR burden estimate in Switzerland has increased significantly between 2010 and 2019. Considerable differences depending on the linguistic region and the hospital type were identified - a finding which affects the nationwide burden estimation

Salmonella Control Programs in Denmark

We describe Salmonella control programs of broiler chickens, layer hens, and pigs in Denmark. Major reductions in the incidence of foodborne human salmonellosis have occurred by integrated control of farms and food processing plants. Disease control has been achieved by monitoring the herds and flocks, eliminating infected animals, and diversifying animals (animals and products are processed differently depending on Salmonella status) and animal food products according to the determined risk. In 2001, the Danish society saved U.S.$25.5 million by controlling Salmonella. The total annual Salmonella control costs in year 2001 were U.S.$14.1 million (U.S.$0.075/kg of pork and U.S.$0.02/kg of broiler or egg). These costs are paid almost exclusively by the industry. The control principles described are applicable to most industrialized countries with modern intensive farming systems