A qualitative analysis of the unwritten rules influencing antibiotic prescribing practices among French poultry veterinarians.

Background: It is now recognized that a better understanding of prescriber behaviour is needed to improve antimicrobial stewardship programmes. Most studies conducted in the livestock sector have focused on farmers' perspectives, while the prescribing habits of veterinarians have remained overlooked. Objective: Our study explored the psychosocial determinants associated with antibiotic prescribing practices in the French poultry sector by analysing the informal norms and unwritten rules that influence veterinarians' prescribing decisions. Methods: A qualitative study was conducted in four French regions in February 2021. Using the biographical narrative interpretive method, semi-structured interviews were conducted with 16 poultry veterinarians with varying professional experience. Three main themes were retained for data analysis: (i) compliance with and deviations from prescribing recommendations, (ii) the influence of fellow veterinarians on antibiotic decisions and (iii) the key role of veterinary corporate groups. Results: When prescribing antibiotics, junior veterinarians were strongly influenced by senior veterinarians who acted as role models driving clinical practices. Prescribing habits were shared through peer networks in which veterinarians participated throughout their careers. Finally, veterinary corporate groups helped to shape veterinarians' prescribing habits by promoting existing guidelines and even producing in-house recommendations. Conclusions: We show that, in parallel with official guidelines, prescribing habits circulate among veterinarians and are shared in professional circles. Therefore, antimicrobial stewardship interventions should focus not only on official guidelines and communication channels, but also unwritten professional rules and organizations influencing veterinarians' prescribing practices.

A systematic review of mechanistic models used to study avian influenza virus transmission and control.

The global spread of avian influenza A viruses in domestic birds is causing increasing socioeconomic devastation. Various mechanistic models have been developed to better understand avian influenza transmission and evaluate the effectiveness of control measures in mitigating the socioeconomic losses caused by these viruses. However, the results of models of avian influenza transmission and control have not yet been subject to a comprehensive review. Such a review could help inform policy makers and guide future modeling work. To help fill this gap, we conducted a systematic review of the mechanistic models that have been applied to field outbreaks. Our three objectives were to: (1) describe the type of models and their epidemiological context, (2) list estimates of commonly used parameters of low pathogenicity and highly pathogenic avian influenza transmission, and (3) review the characteristics of avian influenza transmission and the efficacy of control strategies according to the mechanistic models. We reviewed a total of 46 articles. Of these, 26 articles estimated parameters by fitting the model to data, one evaluated the effectiveness of control strategies, and 19 did both. Values of the between-individual reproduction number ranged widely: from 2.18 to 86 for highly pathogenic avian influenza viruses, and from 4.7 to 45.9 for low pathogenicity avian influenza viruses, depending on epidemiological settings, virus subtypes and host species. Other parameters, such as the durations of the latent and infectious periods, were often taken from the literature, limiting the models' potential insights. Concerning control strategies, many models evaluated culling (n = 15), while vaccination received less attention (n = 6). According to the articles reviewed, optimal control strategies varied between virus subtypes and local conditions, and depended on the overall objective of the intervention. For instance, vaccination was optimal when the objective was to limit the overall number of culled flocks. In contrast, pre-emptive culling was preferred for reducing the size and duration of an epidemic. Early implementation consistently improved the overall efficacy of interventions, highlighting the need for effective surveillance and epidemic preparedness.

"It's a habit. They've been doing it for decades and they feel good and safe.": A qualitative study of barriers and opportunities to changing antimicrobial use in the Indonesian poultry sector.

Interventions to change antimicrobial use (AMU) practices can help mitigate the risk of antimicrobial resistance (AMR) development. However, changing AMU practices can be challenging due to the complex nature of the factors influencing AMU-related behaviours. This study used a qualitative approach to explore the factors that influenced decision-making on AMU by farmers and other actors in the Indonesian poultry sector. Thirty-five semi-structured interviews were conducted with farmers, technical services staff from the private sector, and representatives of associations, universities, and international organisations in Central Java, West Java, and East Java. Thematic analysis identified three patterns of influence on AMU: how farmers used information to make AMU-related decisions, the importance of farmers' social and advisory networks, and the motivations driving changes in AMU behaviours. Key barriers identified included a lack of shared understanding around when to use antibiotics, financial pressures in the poultry sector, and a lack of engagement with government veterinary services. Potential opportunities identified included high farmer awareness of AMU, identification of private sector actors and peer networks as the stakeholders with established relationships of trust with farmers, and the importance of farmers' conceptions of good farming practices, which could be engaged with to improve AMU practices.

Monitoring biosecurity in poultry production: an overview of databases reporting biosecurity compliance from seven European countries.

Compliance with required on-farm biosecurity practices reduces the risk of contamination and spread of zoonotic and economically important diseases. With repeating avian influenza epidemics in the poultry industry, the need to monitor and improve the overall level of biosecurity is increasing. In practice, biosecurity compliance is assessed by various actors (e.g., academic, private and public institutions), and the results of such assessments may be recorded and gathered in databases which are seldom shared or thoroughly analyzed. This study aimed to provide an inventory of databases related to the assessment of biosecurity in poultry farms in seven major poultry-producing European countries to highlight challenges and opportunities associated with biosecurity data collection, sharing, and use. The institutions in charge of these databases were contacted and interviewed using a structured questionnaire to gather information on the main characteristics of the databases and the context of their implementation. A total of 20 databases were identified, covering the gamut of poultry species and production types. Most databases were linked to veterinary health authorities or academia, and to a lesser extent interbranch organizations. Depending on the institutions in charge, the databases serve various purposes, from providing advice to enforcing regulations. The quality of the biosecurity data collected is believed to be quite reliable, as biosecurity is mostly assessed by trained farm advisors or official veterinarians and during a farm visit. Some of the databases are difficult to analyze and/or do not offer information concerning which biosecurity measures are most or least respected. Moreover, some key biosecurity practices are sometimes absent from certain databases. Although the databases serve a variety of purposes and cover different production types, each with specific biosecurity features, their analysis should help to improve the surveillance of biosecurity in the poultry sector and provide evidence on the benefits of biosecurity.

Impact of palmiped farm density on the resilience of the poultry sector to highly pathogenic avian influenza H5N8 in France.

We analysed the interplay between palmiped farm density and the vulnerability of the poultry production system to highly pathogenic avian influenza (HPAI) H5N8. To do so, we used a spatially-explicit transmission model, which was calibrated to reproduce the observed spatio-temporal distribution of outbreaks in France during the 2016-2017 epidemic of HPAI. Six scenarios were investigated, in which the density of palmiped farms was decreased in the municipalities with the highest palmiped farm density. For each of the six scenarios, we first calculated the spatial distribution of the basic reproduction number (R0), i.e. the expected number of farms a particular farm would be likely to infect, should all other farms be susceptible. We also ran in silico simulations of the adjusted model for each scenario to estimate epidemic sizes and time-varying effective reproduction numbers. We showed that reducing palmiped farm density in the densest municipalities decreased substantially the size of the areas with high R0 values (> 1.5). In silico simulations suggested that reducing palmiped farm density, even slightly, in the densest municipalities was expected to decrease substantially the number of affected poultry farms and therefore provide benefits to the poultry sector as a whole. However, they also suggest that it would not have been sufficient, even in combination with the intervention measures implemented during the 2016-2017 epidemic, to completely prevent the virus from spreading. Therefore, the effectiveness of alternative structural preventive approaches now needs to be assessed, including flock size reduction and targeted vaccination.

Different kettles of fish: Varying patterns of antibiotic use on pig, chicken and fish farms in Lao PDR and implications for antimicrobial resistance strategies.

The rapid intensification of the livestock sector in Southeast Asia has been found to be associated with an expanding use of antibiotics (ABU) and the rise of antimicrobial resistance (AMR) in both humans and livestock. This study aimed to explore the views and practices of commercial pig, poultry and fish farmers regarding antibiotics in Lao People's Democratic Republic, where data on antibiotic use and AMR remain scarce. A multistage cluster sampling method, based on the random selection of villages in two provinces of Vientiane, was used. A total of 364 farmers, corresponding to 454 farm units, were surveyed using a questionnaire and farm visits. This study found a widespread use of antibiotics (261 out of the 454 farm units used antibiotics). The predominance of antibiotics considered critically important antibiotics for human medicine was of great concern. Results from a logistic regression model showed that antibiotics were found less frequently in fish farm units compared to pig and poultry farm units, and more frequently in specialized farms than in livestock-fish farms. Multiple factor analysis and hierarchical cluster analysis revealed three profiles of farmers, each with distinct patterns on knowledge, attitudes and practices regarding ABU and AMR. Cluster 1 held a positive attitude regarding preventive measures and information about antibiotics. In cluster 2, there was a view that antibiotics should be used for prophylactic treatment such as disease prevention. Cluster 3 was characterized by farmers with weak knowledge who were unfamiliar with antibiotics and uncertain about details concerning antibiotic use. This cluster was associated with a significantly lower use of antibiotics than the two other clusters in the regression model. The results of this study may help the Laotian government to adapt strategies to control AMR by focusing on the use of critical antibiotics and prophylactic treatments and by tailoring measures to farmers' profiles.

Two major epidemics of highly pathogenic avian influenza virus H5N8 and H5N1 in domestic poultry in France, 2020-2022.

The spread of highly pathogenic avian influenza (HPAI) viruses worldwide has serious consequences for animal health and a major economic impact on the poultry production sector. Since 2014, Europe has been severely hit by several HPAI epidemics, with France being the most affected country. Most recently, France was again affected by two devastating HPAI epidemics in 2020-21 and 2021-22. We conducted a descriptive analysis of the 2020-21 and 2021-22 epidemics, as a first step towards identifying the poultry sector's remaining vulnerabilities regarding HPAI viruses in France. We examined the spatio-temporal distribution of outbreaks that occurred in France in 2020-21 and 2021-22, and we assessed the outbreaks' spatial distribution in relation to the 2016-17 epidemic and to the two 'high-risk zones' recently incorporated into French legislation to strengthen HPAI prevention and control. There were 468 reported outbreaks during the 2020-21 epidemic and 1375 outbreaks during the 2021-22 epidemic. In both epidemics, the outbreaks' distribution matched extremely well that of 2016-17, and most outbreaks (80.6% and 68.4%) were located in the two high-risk zones. The southwestern high-risk zone was affected in both epidemics, while the western high-risk zone was affected for the first time in 2021-22, explaining the extremely high number of outbreaks reported. As soon as the virus reached the high-risk zones, it started to spread between farms at very high rates, with each infected farm infecting between two and three other farms at the peaks of transmission. We showed that the spatial distribution model used to create the two high-risk zones was able to predict the location of outbreaks for the 2020-21 and 2021-22 epidemics. These zones were characterized by high poultry farm densities; future efforts should, therefore, focus on reducing the density of susceptible poultry in highly dense areas.

Phylodynamic analysis of the highly pathogenic avian influenza H5N8 epidemic in France, 2016-2017.

In 2016-2017, France experienced a devastating epidemic of highly pathogenic avian influenza (HPAI) H5N8, with more than 400 outbreaks reported in poultry farms. We analyzed the spatiotemporal dynamics of the epidemic using a structured-coalescent-based phylodynamic approach that combined viral genomic data (n = 196; one viral genome per farm) and epidemiological data. In the process, we estimated viral migration rates between départements (French administrative regions) and the temporal dynamics of the effective viral population size (Ne) in each département. Viral migration rates quantify viral spread between départements and Ne is a population genetic measure of the epidemic size and, in turn, is indicative of the within-département transmission intensity. We extended the phylodynamic analysis with a generalized linear model to assess the impact of multiple factors-including large-scale preventive culling and live-duck movement bans-on viral migration rates and Ne. We showed that the large-scale culling of ducks that was initiated on 4 January 2017 significantly reduced the viral spread between départements. No relationship was found between the viral spread and duck movements between départements. The within-département transmission intensity was found to be weakly associated with the intensity of duck movements within départements. Together, these results indicated that the virus spread in short distances, either between adjacent départements or within départements. Results also suggested that the restrictions on duck transport within départements might not have stopped the viral spread completely. Overall, we demonstrated the usefulness of phylodynamics in characterizing the dynamics of a HPAI epidemic and assessing control measures. This method can be adapted to investigate other epidemics of fast-evolving livestock pathogens.

Biosecurity measures in French poultry farms are associated with farm type and location.

The severe impact of recently reported Highly Pathogenic Avian Influenza (HPAI) outbreaks have emphasized the need to better monitor biosecurity practices among the different French poultry production systems. Between October 2016 and September 2018, a large national cross-sectional study was carried out in France to assess biosecurity levels in high-risk poultry farms and identify farm biosecurity profiles, using Multiple Correspondence and Hierarchical Cluster Analyses. Results indicate that there is substantial room for improvement in cleaning and disinfection, anteroom management and delimitation of farm and production units for more than 50 % of the 1,004 analyzed farms. The farm biosecurity profile showing the highest level of biosecurity included commercial intensive poultry farms (gallinaceous poultry farms, in North-Western France), and those with a recent history of HPAI outbreak (duck farms, in South-Western France). The farms biosecurity profiles showing the lowest level of biosecurity included farms with multiple species (duck and gallinaceous poultry) or multiple production types (broilers and egg-layers), located in regions with a lower poultry density and without a recent history of HPAI outbreak. Outcomes provide support to adapt biosecurity improvement and inspection plans.

What can phylodynamics bring to animal health research?

Infectious diseases are a major burden to global economies, and public and animal health. To date, quantifying the spread of infectious diseases to inform policy making has traditionally relied on epidemiological data collected during epidemics. However, interest has grown in recent phylodynamic techniques to infer pathogen transmission dynamics from genetic data. Here, we provide examples of where this new discipline has enhanced disease management in public health and illustrate how it could be further applied in animal health. In particular, we describe how phylodynamics can address fundamental epidemiological questions, such as inferring key transmission parameters in animal populations and quantifying spillover events at the wildlife-livestock interface, and generate important insights for the design of more effective control strategies.

Determinants of biosecurity practices in French duck farms after a H5N8 Highly Pathogenic Avian Influenza epidemic: The effect of farmer knowledge, attitudes and personality traits.

Biosecurity is crucial for infectious disease prevention, more importantly in the absence of vaccination. The need for improving the implementation of biosecurity practices was highlighted in French duck farms following the 2016-2017 H5N8 Highly Pathogenic Avian Influenza (HPAI) epidemic. Farmers have multiple reasons for not implementing biosecurity practices: external (time, money) and internal (socio-psychological). The purpose of this study was to determine how sets of socio-psychological factors (i.e. knowledge on biosecurity and avian influenza transmission, attitudes, personality traits, social background) affect the adoption of on-farm biosecurity practices. Biosecurity practices and socio-psychological determinants were assessed during 127 duck farm visits, in South West France, using both questionnaires and on-farm observations. Factorial analysis of mixed data (FAMD) and hierarchical clustering analysis (HCA) identified three groups of farmers with different socio-psychological profiles: the first group was characterized by minimal knowledge, negative attitudes towards biosecurity, little social pressure and a low level of conscientiousness. The second group was characterized by more extensive experience in poultry production, higher stress and social pressure. The third group was characterized by less experience in poultry production, better knowledge and positive attitudes towards biosecurity, increased self-confidence and orientation towards action. The first group had a significantly lower adoption of biosecurity measures than the two other groups. A better understanding of the factors involved in farmers' decision-making could improve the efficiency of interventions aiming at improving and maintaining the level of on-farm biosecurity in the duck industry.

Transition Pathways Toward the Prudent Use of Antimicrobials: The Case of Free-Range Broiler Farmers in France.

Reducing antimicrobial use (AMU) on farms is key for controlling the rise of resistant bacteria that have the potential capacity to infect humans via direct animal contact or via the food chain or the environment. To reduce AMU, antimicrobials must be used in a prudent and rational manner. Extensive efforts have been made recently to identify the cognitive and behavioral barriers to the appropriate use of antimicrobials by various livestock sector stakeholders. However, most studies carried out thus far have only partly captured the dynamic and systemic dimension of the processes involved in changes of practices related to AMU on farms. To shed light on the transition pathways implemented to reduce AMU, a qualitative study was conducted in France based on 28 semi-structured interviews with farmers, technicians and veterinarians from the free-range broiler production sector. Based on the thematic analysis of verbatims, we identified technical improvements which are key contributors to reduced AMU. We also highlighted some gaps in knowledge regarding AMU and antimicrobial resistance. We found that, rather than individual motivations alone, the extent to which farmers are embedded in collective organizations is decisive for changes in practices, and downstream operators (distributors and slaughterers) play a key role in the beginning of AMU transition pathways. As a result, we show that change in AMU requires a global rethinking of the overall socio-technical system rather than modifications of a single element in a farming system. Our results also highlight that transition pathways toward reduced AMU cannot just rely on trigger events, but also involves medium or long-term processes, with actors' experiences and practices being modified on an incremental basis over time. Our study sheds light on the need for multi and trans-disciplinary research involving the social sciences to analyze interactions between stakeholders and the collective actions implemented to tackle the challenge of AMU reduction.

Biosecurity risk factors for highly pathogenic avian influenza (H5N8) virus infection in duck farms, France.

Highly pathogenic avian influenza (HPAI) subtype H5N8 outbreaks occurred in poultry farms in France in 2016-2017, resulting in significant economic losses and disruption to the poultry industry. Current evidence on associations between actual on-farm biosecurity risk factors and H5N8 occurrence is limited. Therefore, a retrospective matched case-control study was undertaken to investigate the inter-relationships between on-farm biosecurity practices and H5N8 infection status to provide new insights regarding promising targets for intervention. Data were collected on 133 case and 133 control duck farms (i.e. the most affected species) located in one area of the country that was mostly affected by the disease. Data were analysed using Additive Bayesian Networks which offer a rich modelling framework by graphically illustrating the dependencies between variables. Factors indirectly and directly positively associated with farm infection were inadequate management of vehicle movements (odds ratio [OR] 9.3, 95% credible interval [CI] 4.0-22.8) and inadequate delimitation of farm and units (OR 3.0, 95% CI 1.6-5.8), respectively. Inadequate disposal of dead birds was instead negatively associated with the outcome (OR 0.1, 95% CI 0.0-0.3). The findings highlight that reinforcing farm access control systems and reducing the number of visitors are key biosecurity measures to control farm vulnerability to H5N8 infection and could help setting priorities in biosecurity practices to prevent outbreaks' re-occurrence.

Role of Live-Duck Movement Networks in Transmission of Avian Influenza, France, 2016-2017.

The relative roles that movement and proximity networks play in the spread of highly pathogenic avian influenza (HPAI) viruses are often unknown during an epidemic, preventing effective control. We used network analysis to explore the devastating epidemic of HPAI A(H5N8) among poultry, in particular ducks, in France during 2016-2017 and to estimate the likely contribution of live-duck movements. Approximately 0.2% of live-duck movements could have been responsible for between-farm transmission events, mostly early during the epidemic. Results also suggest a transmission risk of 35.5% when an infected holding moves flocks to another holding within 14 days before detection. Finally, we found that densely connected groups of holdings with sparse connections between groups overlapped farmer organizations, which represents important knowledge for surveillance design. This study highlights the importance of movement bans in zones affected by HPAI and of understanding transmission routes to develop appropriate HPAI control strategies.

Epidemiological assessment of the factors associated with antimicrobial use in French free-range broilers.

BACKGROUND: Although the poultry sector accounts for a major portion of global antimicrobial consumption, few studies have explored the factors which influence antimicrobial use (AMU) in poultry farms in Europe. We performed a matched case-control study in traditional free-range broiler farms in France during 2016 to evaluate the effect of technical factors and farmers' perceptions of health problems on the probability of AMU. In total, 52 cases (defined as flocks treated with antimicrobials when chickens were between 1 and 42 days old), were included. Another 208 controls (untreated flocks the same ages as the case flocks), were randomly selected and paired with a matching case (same farmer organization and placement date). On-farm questionnaires were administered. Multivariable logistic regression modeling was conducted; seven variables were significant in the final model. RESULTS: Two factors were associated with a lower probability of AMU: the use of chicken paper topped with starter feed (OR = 0.3; 95% CI = [0.1; 0.9]) and the use of herbal drugs as a prophylaxis (OR = 0.1; 95% CI = [0.01; 0.5]). A higher probability of AMU was associated with farmers perceiving the cumulative mortality of chicks between 1 and 10 days old as normal (OR = 10.1; 95% CI = [1.7; 59]) or high (OR = 58.7; 95% CI = [9.6; 372.3]). A higher probability of AMU also was associated with farmers detecting a health problem (OR = 12.5, 95% CI = [4.2; 36.9]) and phone calls between farmers and their technicians (OR = 5.9; 95% CI = [2.3; 14.8]) when chicks are between 11 to 42 days old. Two additional factors (litter thickness and cleaning/disinfecting) were significant and highlighted the importance of technical factors such as biosecurity. CONCLUSIONS: Our results suggest that to reduce AMU, technical training should be provided to farmers to improve how farms are monitored and to reinforce preventive health measures. Training also should address how farmers assess warning criteria like daily mortality rates, which when overestimated often lead to antimicrobial treatment.

Highly pathogenic avian influenza H5N8 in south-west France 2016-2017: A modeling study of control strategies.

In the winter 2016-2017 the largest epidemic of highly pathogenic avian influenza (HPAI) ever recorded in the European Union spread to all 28 member states. France was hit particularly hard and reported a total of 484 infected premises (IPs) by March 2017. We developed a mathematical model to analyze the spatiotemporal evolution of the epidemic and evaluate the impact of control strategies. We estimated that farms rearing ducks were on average 2.5 times more infectious and 5.0 times more susceptible to HPAI than farms rearing other avian species. The implementation of surveillance zones around IPs reduced transmission by a factor of 1.8 on average. Compared to the strengthening of pre-emptive culling measures enforced by French authorities in February 2017, we found that a faster depopulation of diagnosed IPs would have had a larger impact on the total number of infections. For example, halving the time delay from detection to slaughter of infected animals would have reduced the total number of IPs by 52% and total cull numbers by 50% on average. This study showcases the possible contribution of modeling to inform and optimize control strategies during an outbreak.

A spatial assessment of Nipah virus transmission in Thailand pig farms using multi-criteria decision analysis.

BACKGROUND: Thailand's Central Plain is identified as a contact zone between pigs and flying foxes, representing a potential zoonotic risk. Nipah virus (NiV) has been reported in flying foxes in Thailand, but it has never been found in pigs or humans. An assessment of the suitability of NiV transmission at the spatial and farm level would be useful for disease surveillance and prevention. Multi-criteria decision analysis (MCDA), a knowledge-driven model, was used to map contact zones between local epizootic risk factors as well as to quantify the suitability of NiV transmission at the pixel and farm level. RESULTS: Spatial risk factors of NiV transmission in pigs were identified by experts as being of three types, including i) natural host factors (bat preferred areas and distance to the nearest bat colony), ii) intermediate host factors (pig population density), and iii) environmental factors (distance to the nearest forest, distance to the nearest orchard, distance to the nearest water body, and human population density). The resulting high suitable areas were concentrated around the bat colonies in three provinces in the East of Thailand, including Chacheongsao, Chonburi, and Nakhonnayok. The suitability of NiV transmission in pig farms in the study area was quantified as ranging from very low to medium suitability. CONCLUSIONS: We believe that risk-based surveillance in the identified priority areas may increase the chances of finding out NiV and other bat-borne pathogens and thereby optimize the allocation of financial resources for disease surveillance. In the long run, improvements of biosecurity in those priority areas may also contribute to preventing the spread of potential emergence of NiV and other bat-borne pathogens.

Biosecurity practices on foie gras duck farms, Southwest France.

On-farm biosecurity can be assessed by analyzing patterns of practices to better tailor technical advice to producers. Given their close contact with environmental and wildlife disease reservoirs, free-range duck farms are exposed to multiple risk factors of pathogen exposure that are rare or absent in indoor production. The recurrent emergence of Highly Pathogenic Avian Influenza (HPAI) viruses in Southeast Asia and Europe has emphasized the importance of farm-level biosecurity on free-range duck farms. This study was conducted on 46 French duck farms. The farms were visited and an 80-question survey was administered to assess biosecurity practices. Patterns of practices were explored with multiple correspondence analysis and hierarchical cluster analysis. Farms were assigned to one of three clusters in which specific farm types were overrepresented: farms specialized in rearing to grow-out phases and open-circuit full cycle (i.e., all production phases on the farm) farms in cluster 1, closed-circuit full cycle farms in cluster 2, and farms specialized in gavage in cluster 3. Differences in practices might be linked with differences in production constraints. This study provides a baseline assessment of biosecurity practices on foie gras duck farms in Southwest France and will help efforts to adapt biosecurity programs to farm types.

Spatio-temporal patterns of highly pathogenic avian influenza virus subtype H5N8 spread, France, 2016 to 2017.

IntroductionFrance is one of Europe's foremost poultry producers and the world's fifth largest producer of poultry meat. In November 2016, highly pathogenic avian influenza (HPAI) virus subtype H5N8 emerged in poultry in the country. As of 23 March 2017, a total of 484 confirmed outbreaks were reported, with consequences on animal health and socio-economic impacts for producers. Methods: We examined the spatio-temporal distribution of outbreaks that occurred in France between November 2016 and March 2017, using the space-time K-function and space-time permutation model of the scan statistic test. Results: Most outbreaks affected duck flocks in south-west France. A significant space-time interaction of outbreaks was present at the beginning of the epidemic within a window of 8 km and 13 days. This interaction disappeared towards the epidemic end. Five spatio-temporal outbreak clusters were identified in the main poultry producing areas, moving sequentially from east to west. The average spread rate of the epidemic front wave was estimated to be 5.5 km/week. It increased from February 2017 and was negatively associated with the duck holding density. Conclusion: HPAI-H5N8 infections varied over time and space in France. Intense transmission events occurred at the early stages of the epidemic, followed by long-range jumps in the disease spread towards its end. Findings support strict control strategies in poultry production as well as the maintenance of high biosecurity standards for poultry holdings. Factors and mechanisms driving HPAI spread need to be further investigated.