Farm biosecurity measures to prevent hepatitis E virus infection in finishing pigs on endemically infected pig farms.

Hepatitis E virus (HEV) can be transmitted from pigs to humans and cause liver inflammation. Pigs are a major reservoir of HEV and most slaughter pigs show evidence of infection by presence of antibodies (ELISA) or viral RNA (PCR). Reducing the number of HEV infected pigs at slaughter would likely reduce human exposure, yet how this can be achieved, is unknown. We aimed to identify and quantify the effect of biosecurity measures to deliver HEV negative batches of pigs to slaughter. A case-control study was performed with Dutch pig farms selected based on results of multiple slaughter batches. Case farms delivered at least one PCR and ELISA negative batch to slaughter (PCR-ELISA-), indicating absence of HEV infection, and control farms had the highest proportion of PCR and/or ELISA positive batches (PCR+ELISA+), indicating high within-farm transmission. Data about biosecurity and housing were collected via a questionnaire and an audit. Variables were selected by regularization (LASSO regression) and ranked, based the frequency of variable selection. The odds ratios (OR) for the relation between case-control status and the highest ranked variables were determined via grouped logistic regression. Thirty-five case farms, with 10 to 60% PCR-ELISA- batches, and 38 control farms with on average 40% PCR+ELISA+ batches, were included. Rubber and steel floor material in fattening pens had the highest ranking and increased the odds of a PCR-ELISA- batch by 5.87 (95%CI 3.03-11.6) and 7.13 (95%CI 3.05-16.9) respectively. Cleaning pig driving boards weekly (OR 1.99 (95%CI 1.07-3.80)), and fly control with predatory flies (OR 4.52 (95%CI 1.59-13.5)) were protective, whereas a long fattening period was a risk. This study shows that cleaning and cleanability of floors and fomites and adequate fly control are measures to consider for HEV control in infected farms. Yet, intervention studies are needed to confirm the robustness of these outcomes.

Evaluation of Non-Invasive Sampling Methods for Detection of Hepatitis E Virus Infected Pigs in Pens.

Pigs are a reservoir of hepatitis E virus (HEV), which causes hepatitis in humans. To study the epidemiology of HEV in pig farms, sampling methods are currently used that cause discomfort to pigs, such as rectal sampling. In line with the 3Rs principle, we aimed to evaluate non-invasive methods to detect pens with HEV-shedding pigs. Twenty-eight pens of one farm were sampled cross-sectionally. Individual rectal swabs (IRS) were collected to determine prevalence within pens. Four pen-level samples were compared: a pool of IRS per pen (P), boot socks (BS), oral fluid (OF) and pooled faecal droppings (FD). Each sample was tested by RT-PCR and the sensitivity and specificity of each method was determined by Bayesian latent class analysis. According to IRS, 19/28 pens were HEV positive. BS had a sensitivity of 95% and detected HEV in pens with 10% of pigs shedding; however, specificity was below 30%. FD were comparably accurate to P, with a sensitivity and specificity of 94% and 86%, respectively. BS sampling is thus advised to detect early shedding of HEV or pen contamination, and FD to determine the duration of shedding. This study demonstrates that non-invasive sampling can replace rectal swabs in research on HEV in pigs.

A Comprehensive Sampling Study on SARS-CoV-2 Contamination of Air and Surfaces in a Large Meat Processing Plant Experiencing COVID-19 Clusters in June 2020.

OBJECTIVE: We aimed to assess SARS-CoV-2 contamination of air and surfaces to gain insight into potential occupational exposure in a large meat processing plant experiencing COVID-19 clusters. Methods: Oro-nasopharyngeal SARS-CoV-2 screening was performed in 76 workers. Environmental samples ( n = 275) including air, ventilation systems, sewage, and swabs of high-touch surfaces and workers' hands were tested for SARS-CoV-2 RNA by real-time quantitative polymerase chain reaction. Results: Twenty-seven (35.5%) of the (predominantly asymptomatic) workers tested positive with modest to low viral loads (cycle threshold ≥ 29.7). Six of 203 surface swabs, 1 of 12 personal air samples, and one of four sewage samples tested positive; other samples tested negative. Conclusions: Although one third of workers tested positive, environmental contamination was limited. Widespread SARS-CoV-2 transmission via air and surfaces was considered unlikely within this plant at the time of investigation while strict COVID-19 control measures were already implemented.

Repeated cross-sectional sampling of pigs at slaughter indicates varying age of hepatitis E virus infection within and between pig farms.

Humans can become infected with hepatitis E virus (HEV) by consumption of undercooked pork. To reduce the burden of HEV in humans, mitigation on pig farms is needed. HEV is found on most pig farms globally, yet within-farm seroprevalence estimates vary considerably. Understanding of the underlying variation in infection dynamics within and between farms currently lacks. Therefore, we investigated HEV infection dynamics by sampling 1711 batches of slaughter pigs from 208 Dutch farms over an 8-month period. Four farm types, conventional, organic, and two types with strict focus on biosecurity, were included. Sera were tested individually with an anti-HEV antibody ELISA and pooled per batch with PCR. All farms delivered seropositive pigs to slaughter, yet batches (resembling farm compartments) had varying results. By combining PCR and ELISA results, infection moment and extent per batch could be classified as low transmission, early, intermediate or late. Cluster analysis of batch infection moments per farm resulted in four clusters with distinct infection patterns. Cluster 1 farms delivered almost exclusively PCR negative, ELISA positive batches to slaughter (PCR-ELISA+), indicating relatively early age of HEV infection. Cluster 2 and 3 farms delivered 0.3 and 0.7 of batches with intermediate infection moment (PCR+ELISA+) respectively and only few batches with early infection. Cluster 4 farms delivered low transmission (PCR-ELISA-) and late infection (PCR+ELISA-) batches, demonstrating that those farms can prevent or delay HEV transmission to farm compartments. Farm type partly coincided with cluster assignment, indicating that biosecurity and management are related to age of HEV infection.

Potential risk factors for the presence of anti-Toxoplasma gondii antibodies in finishing pigs on conventional farms in the Netherlands.

BACKGROUND: The parasite Toxoplasma gondii (T. gondii) causes a substantial human disease burden worldwide. Ingesting improperly cooked pork containing T. gondii is considered one of the major sources of human infection in Europe and North America. Consequently, control of T. gondii infections in pigs is warranted. The European Food Safety Authority advised to perform serological monitoring of pigs and to conduct farm audits for the presence of risk factors. Serological monitoring was implemented in several Dutch slaughterhouses, one to six blood samples (a total of 5134 samples) were taken from each delivery of finishing pigs and samples were tested for the presence of anti-T. gondii antibodies. Using these test results, a cross-sectional study was initiated to assess the association between the within-herd T. gondii seroprevalence and the presence of risk factors for T. gondii infections at 69 conventional finishing pig farms in the Netherlands. RESULTS: A multivariable model showed significant (P ≤ 0.05) association with twelve potential risk factors: type of farm, presence of dogs, presence of ruminants, use of boots, use of shower and farm clothing, mode of rodent control, bedding accessibility for rodents, presence of cats, type of drinking water, heating of the feed, use of goat whey and shielding of birds. CONCLUSIONS: Serological monitoring of finishing pigs for T. gondii in slaughterhouses can be used to identify the presence of T. gondii risk factors on Dutch conventional finishing pig farms and seems a valuable tool to guide and monitor the control of T. gondii in pork production.

Experimental and field investigations of exposure, replication and transmission of SARS-CoV-2 in pigs in the Netherlands.

In order to assess the risk of SARS-CoV-2 infection, transmission and reservoir development in swine, we combined results of an experimental and two observational studies. First, intranasal and intratracheal challenge of eight pigs did not result in infection, based on clinical signs and PCR on swab and lung tissue samples. Two serum samples returned a low positive result in virus neutralization, in line with findings in other infection experiments in pigs. Next, a retrospective observational study was performed in the Netherlands in the spring of 2020. Serum samples (N =417) obtained at slaughter from 17 farms located in a region with a high human case incidence in the first wave of the pandemic. Samples were tested with protein micro array, plaque reduction neutralization test and receptor-binding-domain ELISA. None of the serum samples was positive in all three assays, although six samples from one farm returned a low positive result in PRNT (titers 40-80). Therefore we conclude that serological evidence for large scale transmission was not observed. Finally, an outbreak of respiratory disease in pigs on one farm, coinciding with recent exposure to SARS-CoV-2 infected animal caretakers, was investigated. Tonsil swabs and paired serum samples were tested. No evidence for infection with SARS-CoV-2 was found. In conclusion, Although in both the experimental and the observational study few samples returned low antibody titer results in PRNT infection with SARS-CoV-2 was not confirmed. It was concluded that sporadic infections in the field cannot be excluded, but large-scale SARS-CoV-2 transmission among pigs is unlikely.

Added Value of Meat Inspection Data for Monitoring of Dairy Cattle Health in the Netherlands.

Meat inspection records of one large cattle slaughterhouse were analyzed to evaluate the added value of slaughterhouse data for cattle health surveillance in the Netherlands. Data were available from January 2015 to September 2018, consisting of 467,361 meat inspection records. Analyses included (1) an assessment of the representativeness of the cattle herds in the slaughterhouse data in relation to the cattle herd population in the Netherlands, and (2) multivariable analyses to quantify associations between meat inspection findings and farm of origin characteristics, and the trends in time of the findings in slaughtered cattle. Ninety percent of the meat inspection records originated from dairy cattle therefore this paper only presents the results of dairy herds (N = 422,194 cattle). The dairy herds in the slaughterhouse data seemed representative for the Dutch dairy population although their regional coverage differed from the distribution of dairy herds in the Netherlands. Non-dairy herds were underrepresented in the slaughterhouse data which stresses the importance of the inclusion of data from other slaughterhouses that may be more specialized in slaughtering beef cattle. Inspection records were categorized into 15 indicators related to ante-mortem and post-mortem findings. Following multivariable analyses, seven indicators were deemed of added value to existing cattle health surveillance components, as they provided either new information or information regarding specific health problems.

Effectiveness and costs of interventions to reduce the within-farm Toxoplasma gondii seroprevalence on pig farms in the Netherlands.

BACKGROUND: The parasite Toxoplasma gondii (T. gondii) is recognized as one of the major foodborne pathogens with a high human disease burden. To control T. gondii infections in pigs, European Food Safety Agency (EFSA) advises serological testing of pigs and audits of pig farms to identify risk factors for T. gondii infection. In line with this approach, the aim of the current study was to assess the effectiveness and costs of intervention measures implemented to reduce the T. gondii seroprevalence on finishing pig farms in the Netherlands. A crossover clinical trial was conducted at five case farms were their own control and the cross-over moment was the implementation of interventions to reduce risk factors. Each of the case farms had a farm-specific intervention strategy with one principal intervention measure (neutering of cats, professional rodent control or covering food storage). RESULTS: All finishing pig farms (n = 5) showed a reduction in T. gondii seroprevalence within one year of implementing the intervention strategy. Cat neutering (n = 3) and feed coverage (n = 1) showed statistically significant reductions in seroprevalence. Rodent control (n = 1) did not show a statistically significant reduction. The estimated reduction in seroprevalence in response to the neutering of cats and feed coverage were 67 and 96 %, respectively. CONCLUSIONS: Our work demonstrates that it is possible to reduce the within-farm T. gondii seroprevalence within one year after interventions were implemented to reduce T. gondii risk factors. This information is essential and encouraging for policy makers, food business operators, and farmers to implement in their risk assessment and to apply to food safety control systems.

Quarter of pig farmers readily viewed information on Toxoplasma gondii infection in pigs provided in a data exchange system of a Dutch slaughter company.

Toxoplasma gondii (T. gondii) is a food safety hazard causing a substantial human disease burden. Because infected pig meat is estimated to attribute 12 % to this disease burden, it is important to control T. gondii infection in pigs. Providing pig farmers with information on T. gondii infection in general, and more specific on the status on their farm, could motivate them to take actions. In this study, we analysed the strategy pig farmers used to view specific T. gondii information provided for the first time on webpages in an existing data exchange system of a Dutch pig slaughter company. The available information for farmers comprised a webpage displaying the farm-level T. gondii seroprevalence and a webpage with information on risk sources and control measures for T. gondii infection in pigs and on human health consequences of a T. gondii infection. A total of 1404 owners of pig farms logged in the data exchange system. Of these, a quarter viewed the webpage with information on T. gondii seroprevalence, and about of third of them also viewed the webpage with the information on risk sources and control measures. T. gondii seroprevalence exceeded 2.0 % at only 0.6 % of these 1404 farms. The seroprevalence level on a particular farm neither influenced the likelihood of the farmer viewing the webpage with the T. gondii seroprevalence, nor the likelihood of them continuing to the webpage with the additional information. In the days when the pop-up message was included, the number of views registered on the seroprevalence and the additional information webpages rose nine and two times, respectively. Since the majority of views was in the period with a pop-up message pointing to this information we conclude that a targeted pop-up might help to transfer needed information to farmers with higher T. gondii seroprevalence at farm-level. More general, our study provides valuable insight into pig farmers' viewing strategies of new information on food safety hazards provided in a slaughter data exchange system.

Description and determinants of the faecal resistome and microbiome of farmers and slaughterhouse workers: A metagenome-wide cross-sectional study.

BACKGROUND: By studying the entire human faecal resistome and associated microbiome, the diversity and abundance of faecal antimicrobial resistance genes (ARGs) can be comprehensively characterized. Prior culture-based studies have shown associations between occupational exposure to livestock and carriage of specific antimicrobial resistant bacteria. Using shotgun metagenomics, the present study investigated 194 faecal resistomes and bacteriomes from humans occupationally exposed to ARGs in livestock (i.e. pig and poultry farmers, employees and family members and pig slaughterhouse workers) and a control population (Lifelines cohort) in the Netherlands. In addition, we sought to identify determinants for the human resistome and bacteriome composition by applying a combination of multivariate (NMDS, PERMANOVA, SIMPER and DESeq2 analysis) and multivariable regression analysis techniques. RESULTS: Pig slaughterhouse workers and pig farmers carried higher total ARG abundances in their stools compared to broiler farmers and control subjects. Tetracycline, ß-lactam and macrolide resistance gene clusters dominated the resistome of all studied groups. No significant resistome alpha diversity differences were found among the four populations. However, the resistome beta diversity showed a separation of the mean resistome composition of pig and pork exposed workers from broiler farmers and controls, independent of their antimicrobial use. We demonstrated differences in resistome composition between slaughter line positions, pig versus poultry exposed workers, as well as differences between farmers and employees versus family members. In addition, we found a significant correlation between the bacteriome and resistome, and significant differences in the bacteriome composition between and within the studied subpopulations. Finally, an in-depth analysis of pig and poultry farms - of which also farm livestock resistomes were analysed - showed positive associations between the number of on-farm working hours and human faecal AMR loads. CONCLUSION: We found that the total normalized faecal ARG carriage was larger in persons working in the Dutch pork production chain compared to poultry farmers and controls. Additionally, we showed significant differences in resistome and bacteriome composition of pig and pork exposed workers compared to a control group, as well as within-population (farms, slaughterhouse) compositional differences. The number of on-farm working hours and the farm type (pig or broiler) that persons live or work on are determinants for the human faecal resistome. Overall, our results may suggest direct or indirect livestock contact as a determinant for human ARG carriage. Future studies should further focus on the connection between the human and livestock resistome (i.e. transmission routes) to substantiate the evidence for livestock-associated resistome acquisition.

Behavioural factors of Dutch pig producers related to control of toxoplasma gondii infections in pigs.

Toxoplasma gondii (T. gondii) is a food safety hazard which causes a substantial human disease burden. Infected pig meat is a common risk source of toxoplasmosis. Therefore, it is important to control T. gondii infections in pigs. Improving farm management to control the introduction risk likely contributes to that aim. A pig producer only implements control measures when he or she is aware of the underlying problem, wants to solve it, and is able to solve it. If a pig producer is not implementing appropriate control measures, behavioural change interventions can be introduced to overcome constraining behavioural factors. To aid in designing behaviour change interventions, this study analysed behavioural factors of Dutch pig producers in terms of capability, opportunity and motivation to control T. gondii infections in pigs. Key risk sources analysed focused on the life cycle of T. gondii, with cats as primary host, rodents as intermediate host, and uncovered feed as an important risk source. A survey was conducted among Dutch pig producers. Responses were analysed using descriptive and cluster analysis. Results showed that around 80% of the 67 responding pig producers was aware of key risk sources of T. gondii infections in pigs. Respondents also rated risk sources that are not known to increase the risk of T. gondii infections in pigs as somewhat important. Many respondents did not know about potential consequences of a T. gondii infection in pigs on human health. Two third expected some impact on pig performance, which is incorrect because T. gondii generally does not make pigs ill. Most respondents indicated to have the motivation and opportunity to control the risk sources cats, rodents and uncovered feed. Three pig producer clusters were identified: one with higher capability to control rodents, one with lower motivation to control rodents and cats and to cover feed storages, and one with lower scores on the importance of rodent control for pigs, human health and farm profit. We conclude that, although many pig producers have knowledge about risk sources for and consequences of T. gondii infections in pigs, the public health impact and risks of T. gondii infections in pigs are not yet common knowledge among all Dutch pig producers. Furthermore, Dutch pig producers differ in opportunity and motivation to control T. gondii infections. Targeted interventions to address these specific constraining behavioural factors can help to improve the control of T. gondii infections in pigs.

Occupational Exposure and Carriage of Antimicrobial Resistance Genes (tetW, ermB) in Pig Slaughterhouse Workers.

OBJECTIVES: Slaughterhouse staff is occupationally exposed to antimicrobial resistant bacteria. Studies reported high antimicrobial resistance gene (ARG) abundances in slaughter pigs. This cross-sectional study investigated occupational exposure to tetracycline (tetW) and macrolide (ermB) resistance genes and assessed determinants for faecal tetW and ermB carriage among pig slaughterhouse workers. METHODS: During 2015-2016, 483 faecal samples and personal questionnaires were collected from workers in a Dutch pig abattoir, together with 60 pig faecal samples. Human dermal and respiratory exposure was assessed by examining 198 carcass, 326 gloves, and 33 air samples along the line, next to 198 packed pork chops to indicate potential consumer exposure. Samples were analyzed by qPCR (tetW, ermB). A job exposure matrix was created by calculating the percentage of tetW and ermB positive carcasses or gloves for each job position. Multiple linear regression models were used to link exposure to tetW and ermB carriage. RESULTS: Workers are exposed to tetracycline and macrolide resistance genes along the slaughter line. Tetw and ermB gradients were found for carcasses, gloves, and air filters. One packed pork chop contained tetW, ermB was non-detectable. Human faecal tetW and ermB concentrations were lower than in pig faeces. Associations were found between occupational tetW exposure and human faecal tetW carriage, yet, not after model adjustments. Sampling round, nationality, and smoking were determinants for ARG carriage. CONCLUSION: We demonstrated clear environmental tetracycline and macrolide resistance gene exposure gradients along the slaughter line. No robust link was found between ARG exposure and human faecal ARG carriage.

Large-scale serological screening of slaughter pigs for Toxoplasma gondii infections in The Netherlands during five years (2012-2016): Trends in seroprevalence over years, seasons, regions and farming systems.

Toxoplasma gondii is the causative agent of the parasitic disease toxoplasmosis, which is an important foodborne zoonosis. Eating undercooked meat of infected animals, including pigs, has been considered the major transmission route of T. gondii to humans. Therefore, it is urgent to develop and implement intervention measures in the pork meat chain to reduce risks of acquiring a T. gondii infection. Proposed measures for control of T. gondii in pigs include serological testing of pigs and audits of pig farms on risk factors for T. gondii infection. So far, these ideas have not been tested in practice. In order to generate knowledge about the epidemiology and seroprevalence of T. gondii, as a basis for developing a surveillance system, we studied the long term seroprevalence over years, farming systems and regions, and seasonal patterns of T. gondii seroprevalence in Dutch slaughter pigs. During a five year study period from 2012 to 2016, serum samples were routinely collected in five Dutch pig slaughterhouses. The sera were tested in an ELISA for the presence of antibodies against Toxoplasma. In total 226,340 serum samples were collected and tested during the study period. The observed seroprevalence varied over years, with the highest overall seroprevalence in 2014 (2.8%) and the lowest in 2016 (1.4%). A higher seroprevalence was observed in pigs from organic farms compared to pigs from conventional farms. The overall risk of infection was on average 2.63 times significantly (p < 0.001) higher for organically raised pigs than for conventionally raised pigs. A seasonal pattern in seroprevalence was observed: the results showed a dominant annual periodicity with a seroprevalence peak in winter around week 1 and a minimum seroprevalence in summer around week 27. To our knowledge, this is the first large scale study on the seroprevalence of T. gondii in slaughter pigs. In comparison to other European serological studies, the observed seroprevalence seems to be relatively low. However, care is needed when comparing the results with other studies because of differences in test setup, the number of samples and time period of sampling. The results can be used as a starting point for developing a surveillance system for T. gondii, and for implementation of intervention measures.

Large-scale serological screening of slaughter pigs for Toxoplasma gondii infections in The Netherlands during five years (2012-2016): Trends in seroprevalence over years, seasons, regions and farming systems.

Toxoplasma gondii is the causative agent of the parasitic disease toxoplasmosis, which is an important foodborne zoonosis. Eating undercooked meat of infected animals, including pigs, has been considered the major transmission route of T. gondii to humans. Therefore, it is urgent to develop and implement intervention measures in the pork meat chain to reduce risks of acquiring a T. gondii infection. Proposed measures for control of T. gondii in pigs include serological testing of pigs and audits of pig farms on risk factors for T. gondii infection. So far, these ideas have not been tested in practice. In order to generate knowledge about the epidemiology and seroprevalence of T. gondii, as a basis for developing a surveillance system, we studied the long term seroprevalence over years, farming systems and regions, and seasonal patterns of T. gondii seroprevalence in Dutch slaughter pigs. During a five year study period from 2012 to 2016, serum samples were routinely collected in five Dutch pig slaughterhouses. The sera were tested in an ELISA for the presence of antibodies against Toxoplasma. In total 226,340 serum samples were collected and tested during the study period. The observed seroprevalence varied over years, with the highest overall seroprevalence in 2014 (2.8%) and the lowest in 2016 (1.4%). A higher seroprevalence was observed in pigs from organic farms compared to pigs from conventional farms. The overall risk of infection was on average 2.63 times significantly (p < 0.001) higher for organically raised pigs than for conventionally raised pigs. A seasonal pattern in seroprevalence was observed: the results showed a dominant annual periodicity with a seroprevalence peak in winter around week 1 and a minimum seroprevalence in summer around week 27. To our knowledge, this is the first large scale study on the seroprevalence of T. gondii in slaughter pigs. In comparison to other European serological studies, the observed seroprevalence seems to be relatively low. However, care is needed when comparing the results with other studies because of differences in test setup, the number of samples and time period of sampling. The results can be used as a starting point for developing a surveillance system for T. gondii, and for implementation of intervention measures.

Prioritisation of food-borne parasites in Europe, 2016.

Background and aimsPriority setting is a challenging task for public health professionals. To support health professionals with this and in following a recommendation from the Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO), 35 European parasitologists attended a workshop from 8-12 February 2016 to rank food-borne parasites (FBP) in terms of their importance for Europe and regions within Europe. Methods: Countries were divided into European regions according to those used by the European Society of Clinical Microbiology and Infectious Diseases. We used the same multicriteria decision analysis approach as the FAO/WHO, for comparison of results, and a modified version, for better regional representation. Twenty-five FBP were scored in subgroups, using predefined decision rules. Results: At the European level, Echinococcus multilocularis ranked first, followed by Toxoplasma gondii and Trichinella spiralis. At the regional level, E. multilocularis ranked highest in Northern and Eastern Europe, E. granulosus in South-Western and South-Eastern Europe, and T. gondii in Western Europe. Anisakidae, ranking 17th globally, appeared in each European region's top 10. In contrast, Taenia solium, ranked highest globally but 10th for Europe. Conclusions: FBP of importance in Europe differ from those of importance globally, requiring targeted surveillance systems, intervention measures, and preparedness planning that differ across the world and across Europe.

A summary index for antimicrobial resistance in food animals in the Netherlands.

BACKGROUND: The Dutch government has set targets for reduction of antimicrobial usage in food animals, stipulating a 50% reduction in usage (on a weight basis) in 2013 as compared to 2009 and a 70% decrease in 2015. A monitoring program has been instituted to evaluate the impact on antimicrobial resistance (AMR). The Dutch Ministry of Public Health Welfare and Sports has expressed the need for a summary index to present the results of the monitoring data concisely to policy makers. METHODS: We use data on AMR in bacteria from randomly collected samples from broiler chickens, fattening pigs, veal calves and dairy cows. Escherichia coli was selected for resistance monitoring because they are intrinsically susceptible to the antibiotics included in the test panel (ciprofloxacin, cefotaxime, tetracycline and ampicillin) and they are present in all samples, which facilitates proper randomization and trend analysis. The AMR summary index was calculated for each animal species as a weighted average over the four antibiotics, taking into account their clinical relevance. Weights were obtained by conjoint analysis, a pairwise comparison study involving infectious diseases professionals with clinical and public health backgrounds, with data analysis by conditional logistic regression. The AMR summary index was then computed by Monte Carlo simulation, accounting for sampling and regression uncertainty. RESULTS: The highest weights (0.35) were given to ciprofloxacin and cefotaxime followed by ampicillin (0.23) and tetracycline (0.07). Throughout the years, the AMR index was highest in broiler chickens, followed by pigs and veal calves, while the lowest values were consistently recorded in dairy cows. In all animal species, the index in 2014 was significantly lower than in 2009. CONCLUSIONS: We demonstrate that high-dimensional data on surveillance of antimicrobial resistance can be summarized in an index for evaluating trends between and within food animal species by a process involving decision makers and scientists to select and weight the most relevant antibiotics.

Prioritizing of bacterial infections transmitted through substances of human origin in Europe.

BACKGROUND: Bacteria are the pathogens most frequently transmitted through substances of human origin (SoHO). The European Centre for Disease Prevention and Control (ECDC) organized an expert consultation, with the objective of developing a priority list of bacterial pathogens transmissible via SoHO. The list will be used to further assess risks and determine appropriate preventive measures. STUDY DESIGN AND METHODS: The 14 most frequently SoHO-transmitted bacteria identified through a scoping literature review were then prioritized during an expert workshop through a methodology based on multicriteria decision analysis. The selection of the prioritization method was based upon an ECDC framework for best practices in conducting risk-ranking exercises. Three transmission pathways, blood and blood components, tissues and cells, and organs, were considered in the ranking exercise. RESULTS: According to the ranking score (RS), bacteria were organized within each SoHO pathway into one of four risk tiers: Tier 1 (RS ≥ 0.70), Tier 2 (RS = 0.60-0.69), Tier 3 (RS = 0.40-0.59), or Tier 4 (RS < 0.40). The most consistently identified pathogens in the highest risk Tiers 1 and 2 of all three pathways were: Staphylococcus aureus, Klebsiella spp., Escherichia coli, ß-hemolytic streptococci, Pseudomonas spp., and Acinetobacter spp. CONCLUSION: Six bacteria were defined as being of the highest priority in respect of the threat to the safety of SoHO and will be the subject of subsequent in-depth risk assessments to be conducted by ECDC to identify measures to mitigate the risk posed by these bacteria.

The economic burden of a Salmonella Thompson outbreak caused by smoked salmon in the Netherlands, 2012-2013.

Background: In 2012, the Netherlands experienced the most extensive food-related outbreak of Salmonella ever recorded. It was caused by smoked salmon contaminated with Salmonella Thompson during processing. In total, 1149 cases of salmonellosis were laboratory confirmed and reported to RIVM. Twenty percent of cases was hospitalised and four cases were reported to be fatal. The purpose of this study was to estimate total costs of the Salmonella Thompson outbreak. Methods: Data from a case-control study were used to estimate the cost-of-illness of reported cases (i.e. healthcare costs, patient costs and production losses). Outbreak control costs were estimated based on interviews with staff from health authorities. Using the Dutch foodborne disease burden and cost-of-illness model, we estimated the number of underestimated cases and the associated cost-of-illness. Results: The estimated number of cases, including reported and underestimated cases was 21 123. Adjusted for underestimation, the total cost-of-illness would be €6.8 million (95% CI €2.5-€16.7 million) with productivity losses being the main cost driver. Adding outbreak control costs, the total outbreak costs are estimated at €7.5 million. Conclusion: In the Netherlands, measures are taken to reduce salmonella concentrations in food, but detection of contamination during food processing remains difficult. As shown, Salmonella outbreaks have the potential for a relatively high disease and economic burden for society. Early warning and close cooperation between the industry, health authorities and laboratories is essential for rapid detection, control of outbreaks, and to reduce disease and economic burden.

Risk ranking of foodborne parasites: State of the art.

In a time of increasing threats and decreasing financial resources, monitoring and controlling all possible foodborne hazards at the same time and to the same extent has become more challenging than ever. Therefore, attention is increasingly being paid to the so-called "risk ranking" methods that enable decision makers to focus on the most important foodborne hazards - even when time is limited and knowledge incomplete. In this review paper, we provide an overview of the most common quantitative methods and metrics used for ranking the risks associated with foodborne parasites and present the state of the art on risk ranking exercises for foodborne parasites. A number of risk ranking metrics and methods are available, ranging from simple approaches that can be used to assess the health or economic impact of a foodborne parasitic disease, to more complicated but more comprehensive multi-criteria assessments. For health impact assessment, measures of population health such as disease occurrence and number of deaths; Disability-Adjusted Life Years (DALYs) measuring the healthy life years lost; and Quality-Adjusted Life Years (QALYs) measuring the number of life years lived in optimal health, are described. For economic impact assessment, applied approaches that measure the cost-of-illness from a societal perspective and stated preference methods are outlined. Finally, Multi-Criteria Decision Analysis (MCDA), which can be used to integrate multiple metrics and criteria into a single ranking, is described. These risk ranking methods for foodborne parasites are increasingly performed to aid priority setting at global, regional, and national levels. As different stakeholders have their own prioritization objectives and beliefs, the outcome of such exercises is necessarily context-dependent. Therefore, when designing a risk ranking exercise for foodborne parasites, it is important to choose the metrics and methods, as well as what to rank, in the light of the predefined context of the question being addressed and the target audience.

Disease Burden of 32 Infectious Diseases in the Netherlands, 2007-2011.

BACKGROUND: Infectious disease burden estimates provided by a composite health measure give a balanced view of the true impact of a disease on a population, allowing the relative impact of diseases that differ in severity and mortality to be monitored over time. This article presents the first national disease burden estimates for a comprehensive set of 32 infectious diseases in the Netherlands. METHODS AND FINDINGS: The average annual disease burden was computed for the period 2007-2011 for selected infectious diseases in the Netherlands using the disability-adjusted life years (DALY) measure. The pathogen- and incidence-based approach was adopted to quantify the burden due to both morbidity and premature mortality associated with all short and long-term consequences of infection. Natural history models, disease progression probabilities, disability weights, and other parameters were adapted from previous research. Annual incidence was obtained from statutory notification and other surveillance systems, which was corrected for under-ascertainment and under-reporting. The highest average annual disease burden was estimated for invasive pneumococcal disease (9444 DALYs/year; 95% uncertainty interval [UI]: 8911-9961) and influenza (8670 DALYs/year; 95% UI: 8468-8874), which represents 16% and 15% of the total burden of all 32 diseases, respectively. The remaining 30 diseases ranked by number of DALYs/year from high to low were: HIV infection, legionellosis, toxoplasmosis, chlamydia, campylobacteriosis, pertussis, tuberculosis, hepatitis C infection, Q fever, norovirus infection, salmonellosis, gonorrhoea, invasive meningococcal disease, hepatitis B infection, invasive Haemophilus influenzae infection, shigellosis, listeriosis, giardiasis, hepatitis A infection, infection with STEC O157, measles, cryptosporidiosis, syphilis, rabies, variant Creutzfeldt-Jakob disease, tetanus, mumps, rubella, diphtheria, and poliomyelitis. The very low burden for the latter five diseases can be attributed to the National Immunisation Programme. The average disease burden per individual varied from 0.2 (95% UI: 0.1-0.4) DALYs per 100 infections for giardiasis, to 5081 and 3581 (95% UI: 3540-3611) DALYs per 100 infections for rabies and variant Creutzfeldt-Jakob disease, respectively. CONCLUSIONS: For guiding and supporting public health policy decisions regarding the prioritisation of interventions and preventive measures, estimates of disease burden and the comparison of burden between diseases can be informative. Although the collection of disease-specific parameters and estimation of incidence is a process subject to continuous improvement, the current study established a baseline for assessing the impact of future public health initiatives.