Epidemic intelligence in Europe: a user needs perspective to foster innovation in digital health surveillance.

BACKGROUND: European epidemic intelligence (EI) systems receive vast amounts of information and data on disease outbreaks and potential health threats. The quantity and variety of available data sources for EI, as well as the available methods to manage and analyse these data sources, are constantly increasing. Our aim was to identify the difficulties encountered in this context and which innovations, according to EI practitioners, could improve the detection, monitoring and analysis of disease outbreaks and the emergence of new pathogens. METHODS: We conducted a qualitative study to identify the need for innovation expressed by 33 EI practitioners of national public health and animal health agencies in five European countries and at the European Centre for Disease Prevention and Control (ECDC). We adopted a stepwise approach to identify the EI stakeholders, to understand the problems they faced concerning their EI activities, and to validate and further define with practitioners the problems to address and the most adapted solutions to their work conditions. We characterized their EI activities, professional logics, and desired changes in their activities using NvivoⓇ software. RESULTS: Our analysis highlights that EI practitioners wished to collectively review their EI strategy to enhance their preparedness for emerging infectious diseases, adapt their routines to manage an increasing amount of data and have methodological support for cross-sectoral analysis. Practitioners were in demand of timely, validated and standardized data acquisition processes by text mining of various sources; better validated dataflows respecting the data protection rules; and more interoperable data with homogeneous quality levels and standardized covariate sets for epidemiological assessments of national EI. The set of solutions identified to facilitate risk detection and risk assessment included visualization, text mining, and predefined analytical tools combined with methodological guidance. Practitioners also highlighted their preference for partial rather than full automation of analyses to maintain control over the data and inputs and to adapt parameters to versatile objectives and characteristics. CONCLUSIONS: The study showed that the set of solutions needed by practitioners had to be based on holistic and integrated approaches for monitoring zoonosis and antimicrobial resistance and on harmonization between agencies and sectors while maintaining flexibility in the choice of tools and methods. The technical requirements should be defined in detail by iterative exchanges with EI practitioners and decision-makers.

A questionnaire survey for the assessment of wild-domestic pig interactions in a context oedema disease outbreaks among wild boars (Sus scrofa) in South-Eastern France.

Pig outdoor farming is gaining popularity and commercial success in the European Union, and its expansion, together with an increasing wild boar population, facilitates interactions between domestic and wild suids. In the Southern French Department of Ardèche, several episodes of mass mortalities due to infection with an enteropathogenic strain of Escherichia coli causing oedema disease (OD) were reported in wild boar populations between 2013 and 2016. In order to investigate a potential link between those events and the frequency of interactions between wild boar and domestic pig, we analyzed regional vegetation and hunting bag data and implemented a semi-structured questionnaire survey among a total of 30 outdoor pig farmers and 30 hunters distributed inside and outside the identified area of OD emergence. One third of interviewed farmers (11/30) had experienced intrusions of wild boars in domestic pig premises during the previous year. Similarly, 23% of interviewed hunters reported interactions between wild boar and feral free-ranging pigs in recent years, and 60% reported the observation of free-ranging pigs with a phenotypic feature of Vietnamese pot-bellied pigs (55%). Our analysis identified that in the OD emergence area, several factors could facilitate the transmission of pathogens between wild and domestic suids including a predominance of forested vegetation, a higher estimated wild boar density, weaker levels of farm biosecurity, a higher level of reported wild boar intrusions in pig farms and several reports of feral pot-bellied pig presence. Although our sample was limited, our study suggested a widespread occurrence of situations facilitating the transmission of pathogens between wild and domestic suids. Similar studies in other rural regions in the European Union are recommended, in order to promote preparedness for the emergence and circulation of shared swine pathogens.

An expert opinion assessment of blood-feeding arthropods based on their capacity to transmit African swine fever virus in Metropolitan France.

To deal with the limited literature data on the vectorial capacity of blood-feeding arthropods (BFAs) and their role in the transmission of African swine fever virus (ASFV) in Metropolitan France, a dedicated working group of the French Agency for Food, Environmental and Occupational Health & Safety performed an expert knowledge elicitation. In total, 15 different BFAs were selected as potential vectors by the ad hoc working group involved. Ten criteria were considered to define the vectorial capacity: vectorial competence, current abundance, expected temporal abundance, spatial distribution, longevity, biting rate, active dispersal capacity, trophic preferences for Suidae, probability of contact with domestic pigs and probability of contact with wild boar. Fourteen experts participated to the elicitation. For each BFA, experts proposed a score (between 0 and 3) for each of the above criteria with an index of uncertainty (between 1 and 4). Overall, all experts gave a weight for all criteria (by distributing 100 marbles). A global weighted sum of score per BFA was calculated permitting to rank the different BFAs in decreasing order. Finally, a regression tree analysis was used to group those BFAs with comparable likelihood to play a role in ASF transmission. Out of the ten considered criteria, the experts indicated vectorial competence, abundance and biting rate as the most important criteria. In the context of Metropolitan France, the stable fly (Stomoxys calcitrans) was ranked as the most probable BFA to be a vector of ASFV, followed by lice (Haematopinus suis), mosquitoes (Aedes, Culex and Anopheles), Culicoides and Tabanidea. Since scientific knowledge on their vectorial competence for ASF is scarce and associated uncertainty on expert elicitation moderate to high, more studies are however requested to investigate the potential vector role of these BFAs could have in ASFV spread, starting with Stomoxys calcitrans.

Questionnaire-Based Assessment of Wild Boar/Domestic Pig Interactions and Implications for Disease Risk Management in Corsica.

Wild boars and domestic pigs belong to the same species (Sus scrofa). When sympatric populations of wild boars, feral pigs, and domestic pigs share the same environment, interactions between domestic and wild suids (IDWS) are suspected to facilitate the spread and maintenance of several pig pathogens which can impact on public health and pig production. However, information on the nature and factors facilitating those IDWS are rarely described in the literature. In order to understand the occurrence, nature, and the factors facilitating IDWS, a total of 85 semi-structured interviews were implemented face to face among 25 strict farmers, 20 strict hunters, and 40 hunting farmers in the main traditional pig-farming regions of Corsica, where IDWS are suspected to be common and widespread. Different forms of IDWS were described: those linked with sexual attraction of wild boars by domestic sows (including sexual interactions and fights between wild and domestic boars) were most frequently reported (by 61 and 44% of the respondents, respectively) in the autumn months and early winter. Foraging around common food or water was equally frequent (reported by 60% of the respondents) but spread all along the year except in winter. Spatially, IDWS were more frequent in higher altitude pastures were pig herds remain unattended during summer and autumn months with limited human presence. Abandonment of carcasses and carcass offal in the forest were equally frequent and efficient form of IDWS reported by 70% of the respondents. Certain traditional practices already implemented by hunters and farmers had the potential to mitigate IDWS in the local context. This study provided quantitative evidence of the nature of different IDWS in the context of extensive commercial outdoor pig farming in Corsica and identified their spatial and temporal trends. The identification of those trends is useful to target suitable times and locations to develop further ecological investigations of IDWS at a finer scale in order to better understand diseases transmission patterns between populations and promote adapted management strategies.

Assessment of Domestic Pigs, Wild Boars and Feral Hybrid Pigs as Reservoirs of Hepatitis E Virus in Corsica, France.

In Corsica, extensive pig breeding systems allow frequent interactions between wild boars and domestic pigs, which are suspected to act as reservoirs of several zoonotic diseases including hepatitis E virus (HEV). In this context, 370 sera and 166 liver samples were collected from phenotypically characterized as pure or hybrid wild boars, between 2009 and 2012. In addition, serum and liver from 208 domestic pigs belonging to 30 farms were collected at the abattoir during the end of 2013. Anti-HEV antibodies were detected in 26% (21%-31.6%) of the pure wild boar, 43.5% (31%-56.7%) of hybrid wild boar and 88% (82.6%-91.9%) of the domestic pig sera. In addition, HEV RNA was detected in five wild boars, three hybrid wild boars and two domestic pig livers tested. Our findings provide evidence that both domestic pig and wild boar (pure and hybrid) act as reservoirs of HEV in Corsica, representing an important zoonotic risk for Corsican hunters and farmers but also for the large population of consumers of raw pig liver specialties produced in Corsica. In addition, hybrid wild boars seem to play an important ecological role in the dissemination of HEV between domestic pig and wild boar populations, unnoticed to date, that deserves further investigation.