Parallel multi-criteria decision analysis for sub-national prioritization of zoonoses and animal diseases in Africa: The case of Cameroon.

The use of multi-criteria decision analysis (MCDA) for disease prioritization at the sub-national level in sub-Sahara Africa (SSA) is rare. In this research, we contextualized MCDA for parallel prioritization of endemic zoonoses and animal diseases in The Adamawa and North regions of Cameroon. MCDA was associated to categorical principal component analysis (CATPCA), and two-step cluster analysis. Six and seven domains made of 17 and 19 criteria (out of 70) respectively were selected by CATPCA for the prioritization of zoonoses and animal diseases, respectively. The most influencing domains were "public health" for zoonoses and "control and prevention" for animal diseases. Twenty-seven zoonoses and 40 animal diseases were ranked and grouped in three clusters. Sensitivity analysis resulted in high correlation between complete models and reduced models showing the robustness of the simplification processes. The tool used in this study can be applied to prioritize endemic zoonoses and transboundary animal diseases in SSA at the sub-national level and upscaled at the national and regional levels. The relevance of MCDA is high because of its contextualization process and participatory nature enabling better operationalization of disease prioritization outcomes in the context of African countries or other low and middle-income countries.

Zoo-Sanitary Situation Assessment, an Initial Step in Country Disease Prioritization Process: Systematic Review and Meta-Analysis from 2000 to 2020 in Cameroon.

To prevent and/or control infectious diseases in animal and human health, an appropriate surveillance system based on suitable up-to-date epidemiological data is required. The systematic review protocol was designed according to the PRISMA statement to look at the available data on infectious diseases of livestock in Cameroon from 2000-2020. Data were searched through online databases. Grey literature was comprised of dissertations and theses from veterinary higher education institutions in Cameroon. A random-effects model was used to calculate pooled prevalence using Comprehensive Meta-Analysis Software. Based on disease prevalence, major infectious diseases of livestock in Cameroon were gastrointestinal parasitosis (57.4% in cattle, 67.2% in poultry, 88% in pigs), hemoparasites (21.6% in small ruminants, 19.7% in cattle), bovine pasteurellosis (55.5%), fowl salmonellosis (48.2%), small ruminant plague (39.7%), foot-and-mouth disease (34.5% in cattle), and African swine fever (18.9%). Furthermore, other important endemic zoonoses in the country included: Rift Valley fever (10.9% in cattle, 3.7% in small ruminants), brucellosis (7% in cattle, 8% in pigs), bovine tuberculosis (4.7% in cattle), hepatitis E virus (8.4% in pigs) and bovine leptospirosis (2.5%). Most of the retrieved research were carried out in the Adamawa, Northwest, and West regions of Cameroon. The evaluation of existing data as evidence, albeit publication-specific, is an important step towards the process of prioritizing animal diseases, including zoonoses.

An economic evaluation of cattle tick acaricide-resistances and the financial losses in subtropical dairy farms of Ecuador: A farm system approach.

Estimates of economic losses in cattle due to tick infestations in subtropical areas are limited, such as in Ecuador. Ticks affect animal production and health, but those direct effects are difficult to estimate since financial exercises carried out in farms consider both costs of the inputs and revenues. This study aims to quantify the costs of inputs involved in milk production and to know the role of acaricide treatment in the production costs on dairy farms in subtropical zones using a farming system approach. Regression and classification trees were used to study the relationship between tick control, acaricide resistance and the presence of high level of tick infestation in the farm system. Even though there was no significant direct association between high levels of tick infestation and the presence of acaricide resistance in ticks, a more complex structure for resistances operates in the manifestation of high tick infestation involving levels of farm technology and no acaricide resistance. Farms with higher levels of technology allocate a lower percentage of sanitary expenses to control ticks (13.41%) in comparison to semi-technified (23.97%) and non-technified farms (32.49%). Likewise, more technified and bigger herds have a lower annual expenditure on acaricide treatment (1.30% of the production budget equivalent to 8.46 USD per animal) compared to non-technified farms where it can represent more than 2.74% of the production budget and where the absence of cypermethrin resistance increases the treatment cost to 19.50 USS per animal annually. These results can motivate the development of information campaigns and control programmes targeted to the reality of small and medium farms that are the most affected in terms of the money they invest in controlling ticks.

Assessing the use of animal health platforms: User's needs, preferences and constraints.

Animal health information systems or risk analysis tools are indispensable not only for animal health surveillance, but also to observe the evolution and risk of disease incursion into a disease-free area. Given the various information that can be derived from these both animal information systems and risk analysis tools, different international and national organizations have customized or created their own systems/tools to provide specific information for use by the respective countries. Moreover, with the increase of technology and data storage, they have become more accessible and widely used by professionals in animal and human health sciences. This study aimed to establish user's preferences, needs and constraints in respect of these animal information systems and risk analysis tools. An online survey was conducted and answered by 213 respondents from 132 countries. The respondents were animal health or public health professionals in different employment sectors (mostly in government, research and university institutions) and various fields of competency (highest for animal and public health). The majority of respondents used the animal health information systems frequently and on a weekly basis, with prevention measures of diseases being regarded as the most useful information. Descriptive epidemiology was more used/needed than analytical epidemiology. Risk analysis was performed by the majority of the respondents (70%), using a qualitative approach more than a quantitative or semi-qualitative. The primary objectives were to produce risk assessment and preparedness in areas involving origin and spread of animal diseases. The features most sought after in risk analysis tools were pathways of introduction and spread assessment. The level of satisfaction was higher for the platform which is most used by the respondents. Overall, these results could be taken into consideration when improving an already available platform, or when creating a new efficient tool.

Quantitative Assessment of the Entry through Mechanical Transport in Aircraft of Rift Valley Fever Virus-Infected Mosquitoes into Previously Unaffected Areas.

(1): Rift Valley Fever (RVF) is a zoonotic disease of significant international health concern and considered as an emerging risk to Europe, where no RVF outbreaks in humans or animals have been reported so far. (2): Using a stochastic approach, we estimated the risk of RVF virus (RVFV) introduction during the period of May to October (the period when mosquito populations, including RVFV potential vectors, are present in European countries), into previously unaffected areas (e.g., United Kingdom, UK) via virus-carrying vectors traveling in commercial aircraft from RVF-affected countries (e.g., East Africa); (3): On average N = 68 (95% CI: 0-337), RVF-virus-infected mosquitoes are estimated to be mechanically transported by planes (with N = 0 as most likely), in direct flights from RVF-affected East African countries to the UK, between May and October. This estimate is considered as low but not negligible. The model developed should be easily scaled up to other European countries by amending appropriately country-specific variables (e.g., number of flights between countries) in order to map the areas/airports of higher risk and inform risk management per country accordingly and to adopt risk-mitigation measures.

Semi-quantitative risk assessment by expert elicitation of potential introduction routes of African swine fever from wild reservoir to domestic pig industry and subsequent spread during the Belgian outbreak (2018-2019).

Since the introduction in Georgia in 2007 of an African swine fever (ASF) genotype 2 virus strain, the virus has rapidly spread to both Western European and Asian countries. It now constitutes a major threat for the global swine industry. The ongoing European transmission cycle has been related to the 'wild boar habitat' with closed transmission events between wild boar populations and incidental spillovers to commercial and non-commercial (backyard) pig holdings. During the epidemic in Belgium, only wild boar were infected and although the introduction route has not yet been elucidated, the 'human factor' is highly suspected. While ASF was successfully contained in a small region in the Southern part of Belgium without affecting domestic pigs, the risk of spillover at the wild/domestic interface remains poorly assessed. In this study, we used a semi-quantitative method, involving national and international experts, to assess the risk associated with different transmission routes for ASF introduction from wild boar to domestic pig holdings and subsequent dissemination between holdings in the Belgian epidemiological context. Qualitative responses obtained by our questionnaire were numerically transformed and statistically processed to provide a semi-quantitative assessment of the occurrence of the hazard and a ranking of all transmission routes. 'Farmer', 'bedding material', 'veterinarian' and 'professionals from the pig sector' were considered as the most important transmission routes for ASF introduction from the wild reservoir to pig holdings. 'Animal movements', 'farmer', 'veterinarian', 'iatrogenic', 'animal transport truck' and 'animal care equipment' were considered as the most important transmission routes posing a risk of ASF spread between pig holdings. Combined with specific biosecurity checks in the holdings, this assessment helps in prioritizing risk mitigation measures against ASF introduction and further spread in the domestic pig industry, particularly while the ASF situation in Western Europe is worsening.

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.

Polycyclic aromatic hydrocarbons contamination of traditionally grilled pork marketed in South Benin and health risk assessment for the Beninese consumer.

Polycyclic aromatic hydrocarbons (PAHs) contamination was monitored in grilled pork sold in Beninese street restaurants, as well as in grilled pork from a well-controlled experiment replicating traditional grilling using Acacia auriculiformis wood as fuel. Fifteen PAHs were analysed using a high-performance liquid chromatography method coupled with fluorescence detection. To assess the risk for the consumer, the margins of exposure (MOEs) were calculated, as the ratio between benchmark PAHs levels and consumer intakes. A MOE below 10,000 indicates a concern for human health for carcinogenic compounds such as PAHs. Benzo(a)pyrene (BaP) levels up to 17.9 and 53.6 µg/kg were found in grilled pork sampled in restaurants and from the controlled experiment, respectively. When considering both median estimated daily intake and median PAHs contamination levels, MOEs calculated for Benzo(a)pyrene (BaP) alone, or for the sum of 2, 4 or 8 PAHs were above 10,000, meaning no risk in these cases. However, for the same PAHs contamination level, MOE for consumers having large amounts of grilled pork (97.5th percentile and maximum level of pork consumption) were well below 10,000. When considering the maximum level of PAHs contamination, MOEs ranged between 257 and 2,757 for the high and median levels of consumption, indicating a safety concern for these consumers. This study reveals that Beninese grilled pork consumers from South Benin can be exposed to high levels of PAHs, which might result in public health issues.

Prioritization of livestock transboundary diseases in Belgium using a multicriteria decision analysis tool based on drivers of emergence.

During the past decade, livestock diseases have (re-)emerged in areas where they had been previously eradicated or never been recorded before. Drivers (i.e. factors of (re-)emergence) have been identified. Livestock diseases spread irrespective of borders, and therefore, reliable methods are required to help decision-makers to identify potential threats and try stopping their (re-)emergence. Ranking methods and multicriteria approaches are cost-effective tools for such purpose and were applied to prioritize a list of selected diseases (N = 29 including 6 zoonoses) based on the opinion of 62 experts in accordance with 50 drivers-related criteria. Diseases appearing in the upper ranking were porcine epidemic diarrhoea, foot-and-mouth disease, low pathogenic avian influenza, African horse sickness and highly pathogenic avian influenza. The tool proposed uses a multicriteria decision analysis approach to prioritize pathogens according to drivers and can be applied to other countries or diseases.

Assessment of the impact of forestry and leisure activities on wild boar spatial disturbance with a potential application to ASF risk of spread.

In Europe, African swine fever virus (ASFV) is one of the most threatening infectious transboundary diseases of domestic pigs and wild boar. In September 2018, ASF was detected in wild boar in the South of Belgium. France, as a bordering country, is extremely concerned about the ASF situation in Belgium, and an active preparedness is ongoing in the country. One of the questions raised by this situation relates to disturbing activities that may affect wild boar movements and their possible impact on the spread of ASFV. Despite evidence of disturbance related to hunting practices, there is a paucity of information on the impact of forestry and human leisure activities. To assess this impact on wild boar movements, a systematic review was first conducted but very few useful data were obtained. For this reason, an expert elicitation was carried out by the French Agency for Food, Environmental and Occupational Health & Safety in order to deal with this knowledge gap. A total of 30 experts originating from France and adjacent neighbouring countries (Spain, Belgium and Switzerland) were elicited about the relative importance of six factors of spatial disturbance of wild boar (noise, smell, invasion of space, modification of the environment, duration and frequency of the activity). Then, for each factor of disturbance, they were asked about the impact of 16 different commercial forestry and human leisure activities. A global weighted score was estimated in order to capture the variability of a wide range of territorial conditions and the uncertainty of expert elicitation. This estimate permitted ranking all 16 activities and aggregating them in three groups according to their potential for disturbance of wild boar, using a regression tree analysis. The results of this expert elicitation provide a methodological approach that may be useful for French and other European decision makers and stakeholders involved in the crisis management of ASF.

Economic impact of contagious caprine pleuropneumonia and cost-benefit analysis of the vaccination programmes based on a one-year continuous monitoring of flocks in the arid and semi-arid lands of Kenya.

In Kenya and East Africa, contagious caprine pleuropneumonia (CCPP) is one of the most prevalent infectious diseases affecting small ruminants in pastoral areas with adverse consequences on livelihoods. This is so despite the implementation of bi-annual vaccination campaigns. Unfortunately, the impact of the disease and the cost-effectiveness of its prevention and control in a pastoral context have been difficult to assess due to a lack of reliable data. The dynamic of flock population, high illiteracy and limited outreach are the main challenges for proper data collection. Nevertheless, such analysis is important to justify the implementation of national vaccination campaign for livestock disease control and to contribute to pastoral households' economy support programme. A continuous flock monitoring was performed for a year in Turkana County to collect data on flock dynamics and the different causes of mortalities. A stochastic model was developed to evaluate the annual economic losses due to CCPP in a standard flock of 100 heads and evaluate the cost-benefit ratio of the vaccination programmes based on different scenarios of 95%, 50% and 20% vaccination effectiveness. The annual economic losses due to CCPP for a standard flock of 100 heads were estimated at Euros 1,712.66 in average. The benefits-costs ratio of the vaccination supports the current bi-annual vaccination campaigns, even with a vaccine effectiveness limited to 20% (average benefits-costs ratio of 5.715 with SD of 3.914). This justifies the campaigns as part of a food security or livelihood support programme. However, from an overall health perspective and for long-term effects on livestock asset protection and disease control, a higher vaccination effectiveness is required.

Assessment of cross-protection induced by a bluetongue virus (BTV) serotype 8 vaccine towards other BTV serotypes in experimental conditions.

Bluetongue disease is caused by bluetongue virus (BTV) and BTV serotype 8 (BTV8) caused great economic damage in Europe during the last decade. From 1998 to 2007, in addition to BTV8, Europe had to face the emergence of BTV1, 2, 4, 9, and 16, spreading in countries where the virus has never been detected before. These unprecedented outbreaks trigger the need to evaluate and compare the clinical, virological and serological features of the European BTV serotypes in the local epidemiological context. In this study groups of calves were infected with one of the following European BTV serotypes, namely BTV1, 2, 4, 9 and 16. For each tested serotype, two groups of three male Holstein calves were used: one group vaccinated against BTV8, the other non-vaccinated. Clinical signs were quantified, viral RNA was detected in blood and organs and serological relationship was assessed. Calves were euthanized 35 days post-infection and necropsied. Most of the infected animals showed mild clinical signs. A partial serological cross reactivity has been reported between BTV8 and BTV4, and between BTV1 and BTV8. BTV2 and BTV4 viral RNA only reached low levels in blood, when compared to other serotypes, whereas in vitro growth assays could not highlight significant differences. Altogether the results of this study support the hypothesis of higher adaptation of some BTV strains to specific hosts, in this case calves. Furthermore, cross-protection resulting from a prior vaccination with BTV8 was highlighted based on cross-neutralization. However, the development of neutralizing antibodies is probably not totally explaining the mild protection induced by the heterologous vaccination.

Moku Virus in Invasive Asian Hornets, Belgium, 2016.

We report the detection of Moku virus in invasive Asian hornets (Vespa velutina nigrithorax) in Belgium. This constitutes an unexpected report of this iflavirus outside Hawaii, USA, where it was recently described in social wasps. Although virulence of Moku virus is unknown, its potential spread raises concern for European honeybee populations.

Retrospective evaluation of 155 adult equids and 21 foals with tetanus from Western, Northern, and Central Europe (2000-2014). Part 2: Prognostic assessment.

OBJECTIVE: To identify prognostic variables for adult equids and foals with tetanus. DESIGN: Multicenter retrospective study (2000-2014). SETTING: Twenty Western, Northern, and Central European university teaching hospitals and private referral centers. ANIMALS: One hundred fifty-five adult equids and 21 foals with tetanus. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Variables from history and clinical examination were statistically compared between survivors and nonsurvivors (adults: 49 survivors, 85 nonsurvivors; foals: 7 survivors, 10 nonsurvivors). Cases euthanized for financial reasons were excluded. Mortality rates in adults and foals were 68.4% and 66.7%, respectively. Variables associated with survival in adults included: standing, normal intestinal sounds and defecation, voluntarily drinking, eating soft or normal food, lower heart and respiratory rates, high base excess on admission, longer diagnosis time, treatment and hospitalization delay, and mild severity grade. Variables associated with death included: anorexia, dysphagia, dyspnea, low blood potassium concentration on admission, moderate and severe disease grading, development of dysphagia, dyspnea, recumbency and seizures during hospitalization, treatment with glycerol guaiacolate, intravenous fluids, and intravenous glucose solutions. Variables associated with survival in foals included standing on admission, voluntarily eating soft food and drinking, older age, and longer hospitalization delay. Outcome was not different between different tetanus antitoxin (TAT) dosages, although there was a trend of increasing survival rate with increasing TAT dosages. Cases with appropriate vaccination prior to development of tetanus were rare, but had improved outcome and shorter hospitalization. CONCLUSIONS: Prognosis for equine tetanus is poor with similar outcome and prognostic factors in foals and adults. The prognostic assessment of cases with tetanus provides clinicians with new evidence-based information related to patient management. Several prognostic indicators relate to the ability to eat or drink, and more severe clinical signs relate to poor outcome. Increasing intravenous dosages of TAT has no significant effect on outcome, but the positive trend identified may support a recommendation for high intravenous TAT dosages. Further evaluation is warranted.

Molecular epidemiology of Mycobacterium tuberculosis complex in Brussels, 2010-2013.

The tuberculosis (TB) incidence rate in Brussels-Capital Region is 3-fold higher than in Belgium as a whole. Eight years after the realization of initial prospective population-based molecular epidemiology investigations in this Region, a similar study over the period 2010-2013 was conducted. TB strains isolated from 945 patients were submitted to genotyping by standardized 24-locus-MIRU-VNTR typing and spoligotyping. The phylogenetic analysis showed that the LAM (16.7%) and Haarlem (15.7%) branches are the two most prevalent TB lineages circulating in Brussels. Analysis of the MDR subgroup showed an association with Beijing strains (39.9%) and patients native of Eastern Europe (40.7%). Genotyping detected 113 clusters involving 321 patients, giving a recent transmission index of 22.9%. Molecular-guided epidemiological investigations and routine surveillance activities revealed family transmission or social contact for patients distributed over 34 clusters. Most of the patients were foreign-born (75.7%). However, cluster analysis revealed only limited trans-national transmission. Comparison with the previous study shows a stable epidemiological situation except for the mean age difference between Belgian-born and foreign-born patients which has disappeared. This study confirms that molecular epidemiology has become an important determinant for TB control programs. However, sufficient financial means need to be available to perform all required epidemiological investigations.

Genetic Assessment of African Swine Fever Isolates Involved in Outbreaks in the Democratic Republic of Congo between 2005 and 2012 Reveals Co-Circulation of p72 Genotypes I, IX and XIV, Including 19 Variants.

African swine fever (ASF) is a devastating disease of domestic pigs. It is a socioeconomically important disease, initially described from Kenya, but subsequently reported in most Sub-Saharan countries. ASF spread to Europe, South America and the Caribbean through multiple introductions which were initially eradicated-except for Sardinia-followed by re­introduction into Europe in 2007. In this study of ASF within the Democratic Republic of the Congo, 62 domestic pig samples, collected between 2005-2012, were examined for viral DNA and sequencing at multiple loci: C-terminus of the B646L gene (p72 protein), central hypervariable region (CVR) of the B602L gene, and the E183L gene (p54 protein). Phylogenetic analyses identified three circulating genotypes: I (64.5% of samples), IX (32.3%), and XIV (3.2%). This is the first evidence of genotypes IX and XIV within this country. Examination of the CVR revealed high levels of intra-genotypic variation, with 19 identified variants.

Estimating the economic impact of a possible equine and human epidemic of West Nile virus infection in Belgium.

This study aimed at estimating, in a prospective scenario, the potential economic impact of a possible epidemic of WNV infection in Belgium, based on 2012 values for the equine and human health sectors, in order to increase preparedness and help decision-makers. Modelling of risk areas, based on the habitat suitable for Culex pipiens, the main vector of the virus, allowed us to determine equine and human populations at risk. Characteristics of the different clinical forms of the disease based on past epidemics in Europe allowed morbidity among horses and humans to be estimated. The main costs for the equine sector were vaccination and replacement value of dead or euthanised horses. The choice of the vaccination strategy would have important consequences in terms of cost. Vaccination of the country's whole population of horses, based on a worst-case scenario, would cost more than EUR 30 million; for areas at risk, the cost would be around EUR 16-17 million. Regarding the impact on human health, short-term costs and socio-economic losses were estimated for patients who developed the neuroinvasive form of the disease, as no vaccine is available yet for humans. Hospital charges of around EUR 3,600 for a case of West Nile neuroinvasive disease and EUR 4,500 for a case of acute flaccid paralysis would be the major financial consequence of an epidemic of West Nile virus infection in humans in Belgium.

Distribution and Potential Indicators of Hospitalized Cases of Neurocysticercosis and Epilepsy in Ecuador from 1996 to 2008.

BACKGROUND: Epilepsy is one of the most common signs of Neurocysticercosis (NCC). In this study, spatial and temporal variations in the incidence of hospitalized cases (IHC) of epilepsy and NCC in Ecuadorian municipalities were analyzed. Additionally, potential socio-economic and landscape indicators were evaluated in order to understand in part the macro-epidemiology of the Taenia solium taeniasis/cysticercosis complex. METHODOLOGY: Data on the number of hospitalized epilepsy and NCC cases by municipality of residence were obtained from morbidity-hospital systems in Ecuador. SatScan software was used to determine whether variations in the IHC of epilepsy and NCC in space and time. In addition, several socio-economic and landscape variables at municipality level were used to study factors intervening in the macro-epidemiology of these diseases. Negative Binomial regression models through stepwise selection and Bayesian Model Averaging (BMA) were used to explain the variations in the IHC of epilepsy and NCC. PRINCIPAL FINDINGS: Different clusters were identified through space and time. Traditional endemic zones for NCC and epilepsy, recognized in other studies were confirmed in our study. However, for both disorders more recent clusters were identified. Among municipalities, an increasing tendency for IHC of epilepsy, and a decreasing tendency for the IHC of NCC were observed over time. In contrast, within municipalities a positive linear relationship between both disorders was found. An increase in the implementation of systems for eliminating excrements would help to reduce the IHC of epilepsy by 1.00% (IC95%; 0.2%-1.8%) and by 5.12% (IC95%; 3.63%-6.59%) for the IHC of NCC. The presence of pig production was related to IHC of NCC. CONCLUSION/SIGNIFICANCE: Both disorders were related to the lack of an efficient system for eliminating excrements. Given the appearance of recent epilepsy clusters, these locations should be studied in depth to discriminate epilepsies due to NCC from epilepsies due to other causes. Field studies are needed to evaluate the true prevalence of cysticercosis in humans and pigs in different zones of the country in order to better implement and manage prevention and/or control campaigns.

Applying participatory approaches in the evaluation of surveillance systems: A pilot study on African swine fever surveillance in Corsica.

The implementation of regular and relevant evaluations of surveillance systems is critical in improving their effectiveness and their relevance whilst limiting their cost. The complex nature of these systems and the variable contexts in which they are implemented call for the development of flexible evaluation tools. Within this scope, participatory tools have been developed and implemented for the African swine fever (ASF) surveillance system in Corsica (France). The objectives of this pilot study were, firstly, to assess the applicability of participatory approaches within a developed environment involving various stakeholders and, secondly, to define and test methods developed to assess evaluation attributes. Two evaluation attributes were targeted: the acceptability of the surveillance system and its the non-monetary benefits. Individual semi-structured interviews and focus groups were implemented with representatives from every level of the system. Diagramming and scoring tools were used to assess the different elements that compose the definition of acceptability. A contingent valuation method, associated with proportional piling, was used to assess the non-monetary benefits, i.e., the value of sanitary information. Sixteen stakeholders were involved in the process, through 3 focus groups and 8 individual semi-structured interviews. Stakeholders were selected according to their role in the system and to their availability. Results highlighted a moderate acceptability of the system for farmers and hunters and a high acceptability for other representatives (e.g., private veterinarians, local laboratories). Out of the 5 farmers involved in assessing the non-monetary benefits, 3 were interested in sanitary information on ASF. The data collected via participatory approaches enable relevant recommendations to be made, based on the Corsican context, to improve the current surveillance system.

Surveillance systems evaluation: a systematic review of the existing approaches.

BACKGROUND: Regular and relevant evaluations of surveillance systems are essential to improve their performance and cost-effectiveness. With this in mind several organizations have developed evaluation approaches to facilitate the design and implementation of these evaluations. METHODS: In order to identify and to compare the advantages and limitations of these approaches, we implemented a systematic review using the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). RESULTS: After applying exclusion criteria and identifying other additional documents via citations, 15 documents were retained. These were analysed to assess the field (public or animal health) and the type of surveillance systems targeted; the development process; the objectives; the evaluation process and its outputs; and the attributes covered. Most of the approaches identified were general and provided broad recommendations for evaluation. Several common steps in the evaluation process were identified: (i) defining the surveillance system under evaluation, (ii) designing the evaluation process, (iii) implementing the evaluation, and (iv) drawing conclusions and recommendations. CONCLUSIONS: A lack of information regarding the identification and selection of methods and tools to assess the evaluation attributes was highlighted; as well as a lack of consideration of economic attributes and sociological aspects.