Costs and Benefits of Alternative Strategies to Control the Spread of Livestock-Acquired Methicillin-Resistant Staphylococcus Aureus From Pig Production.

BACKGROUND: Livestock-acquired methicillin-resistant Staphylococcus aureus (LA-MRSA) is a concern in healthcare and a political priority in some countries. OBJECTIVE: This study investigates the net societal costs of 2 alternative strategies for controlling LA-MRSA in Denmark: (1) eradicating LA-MRSA in all pig housing units, and (2) containing LA-MRSA within the units. METHODS: Benefits and costs are considered for affected economic sectors: healthcare, pig production, pig-related industries, and public administration. RESULTS: The cost to society of eradication is estimated at €2.3 to €2.5 billion (present value). Containment will cost €55 to €93 million. For both strategies, the main cost lies in primary pig production-for containment this is mainly due to establishing and operating anterooms and shower rooms, and for eradication it is due to production losses, loss of genetic resources, and costs of cleaning and disinfection. CONCLUSION: Compared with these costs, health economic benefits are moderate for both strategies. Containment is superior to eradication when measured by a benefit-cost ratio.

Southeast Asia Strategic Multilateral Dialogue on Biosecurity.

A strategic multilateral dialogue related to biosecurity risks in Southeast Asia, established in 2014, now includes participants from Singapore, Malaysia, Indonesia, Thailand, Philippines, and the United States. This dialogue is conducted at the nonministerial level, enabling participants to engage without the constraints of operating in their official capacities. Participants reflect on mechanisms to detect, mitigate, and respond to biosecurity risks and highlight biosecurity issues for national leadership. Participants have also identified factors to improve regional and global biosecurity, including improved engagement and collaboration across relevant ministries and agencies, sustainable funding for biosecurity programs, enhanced information sharing for communicable diseases, and increased engagement in international biosecurity forums.

[Cost analysis comparing single-use (Ambu® aScope™) and conventional reusable fiberoptic flexible scopes for difficult tracheal intubation]. / Analyse de coût comparant les fibroscopes à usage unique (Ambu®aScope™) et les fibroscopes réutilisables pour l'intubation difficile.

OBJECTIVE: Recommendations on difficult tracheal intubation constrain each surgical block to have a fiberscope available. Reusable fiberscope presents the problem of availability, the risk of non-conventional infections transmission and the cost. Single-use fiberscopes are presently available (Ambu® aScope™). This medico-economic study aims to assess the cost of using a reusable fiberscope as compared to the single use fiberscope. STUDY DESIGN: Cost minimization analysis. MATERIAL: Reusable fiberscope Pentax® FB 15P (Pentax France, Argenteuil) and single-use fiberscope Ambu® aScope™ (Ambu A/S, Ballerup, Denmark). METHOD: Minimization-cost analysis conducted between 2006 and 2012. The amortization cost per utilization for two reusable fiberscopes took into account the acquisition and maintenance costs, as well as the costs related to disinfection. The cost of the single use fiberscope was calculated according to its acquisition cost. RESULTS: The total cost of the reusable material was 55,874€ over 6years, corresponding to a unitary cost of 206€ per fiberscopy. During this period, 780 sterilizations were carried out for a total cost of 32,611€. Acquisition and maintenance costs were respectively 18,382€ and 4880€. The cost of the single use fiberscope is of 200€ per fiberscopy. CONCLUSION: This medico-economic evaluation shows that the utilization cost of single use and reusable fiberscopes are very close. This should be analyzed at the light of some benefits of using single use devices for the difficult tracheal intubation.

Assessment of biosecurity practices of small-scale broiler producers in central Egypt.

In the current situation of endemicity of highly pathogenic avian influenza (HPAI) in Egypt, improving the biosecurity of poultry production has become essential to the progressive reduction the incidence of the disease. A significant proportion of the Egyptian commercial poultry system consists of small-scale poultry producers operating with low to minimal biosecurity measures. An investigation was conducted into the level of adoption of standard biosecurity measures of the small-scale commercial chicken growers, including both farm- and home-based commercial production, input suppliers and other actors along the meat chicken value chain in Fayoum, Egypt. The study which used direct observations and group discussions of nearly 160 participants and structured interviews with 463 respondents, assessed biosecurity implementation to improve management practices and ultimately to control and prevent highly pathogenic avian influenza (HPAI). The survey found that overall, biosecurity measures are rarely implemented in small-scale commercial poultry production units. Compliance with recommended biosecurity practices did not greatly vary from home-based to farm-based commercial production. Furthermore, serious risk practices were identified, such as unsafe disposal of poultry carcasses and potential disease spread posed by poor biosecurity measures implemented during vaccination. HPAI control measures have been ineffective due to limited cooperation between public and private sector, aggravated by the unpopular measures taken in the event of outbreaks and no compensation paid for incurred losses. Outreach and biosecurity awareness raising initiatives should be specifically developed for small-scale producers with the objective of improving general poultry management and thus preventing HPAI and other poultry diseases.

Assessment of farm-level biosecurity measures after an outbreak of avian influenza in the United Kingdom.

During Avian Influenza outbreaks in England, the 'AI Order' states that a poultry keeper may be required to keep domestic birds separate from wild birds. This study aimed to assess a) how effectively this was done and b) the negative impact this had for bird owners and animal welfare during the November 2007 Highly Pathogenic Avian Influenza (HPAI) outbreak in Suffolk, UK. A voluntary questionnaire was posted to holdings (n=296) that were within 10 km of an infected premises; these holdings were required to separate domestic and wild birds where possible. Holdings were identified during outbreak investigations conducted by the authorities. Holdings of all sizes were included. A sample of holdings received a follow-up visit or telephone call to validate the questionnaire (n=29). From the 38% of eligible holdings that responded, 13% (95% CI 7-22%) left their birds outdoors throughout the outbreak. If game birds were excluded, 9% (CI 4-17%) of holdings did not house their birds. Major cost and welfare problems were rare; however, there were exceptions. Enforced housing was often relaxed before a minor welfare problem deteriorated. Contact between wild and domestic birds was greatly reduced during the outbreak, resulting in a reduced probability of HPAI transmission via wild birds for most, but not all, holdings.

A catalytically and genetically optimized beta-lactamase-matrix based assay for sensitive, specific, and higher throughput analysis of native henipavirus entry characteristics.

Nipah virus (NiV) and Hendra virus (HeV) are the only paramyxoviruses requiring Biosafety Level 4 (BSL-4) containment. Thus, study of henipavirus entry at less than BSL-4 conditions necessitates the use of cell-cell fusion or pseudotyped reporter virus assays. Yet, these surrogate assays may not fully emulate the biological properties unique to the virus being studied. Thus, we developed a henipaviral entry assay based on a beta-lactamase-Nipah Matrix (betala-M) fusion protein. We first codon-optimized the bacterial betala and the NiV-M genes to ensure efficient expression in mammalian cells. The betala-M construct was able to bud and form virus-like particles (VLPs) that morphologically resembled paramyxoviruses. betala-M efficiently incorporated both NiV and HeV fusion and attachment glycoproteins. Entry of these VLPs was detected by cytosolic delivery of betala-M, resulting in enzymatic and fluorescent conversion of the pre-loaded CCF2-AM substrate. Soluble henipavirus receptors (ephrinB2) or antibodies against the F and/or G proteins blocked VLP entry. Additionally, a Y105W mutation engineered into the catalytic site of betala increased the sensitivity of our betala-M based infection assays by 2-fold. In toto, these methods will provide a more biologically relevant assay for studying henipavirus entry at less than BSL-4 conditions.

An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers.

OBJECTIVES: To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees. SETTING: A 700-bed university hospital. DESIGN: Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis. METHODS: Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes. RESULTS: During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P < .001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P < .001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste. CONCLUSION: A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.

Disposal of outdated anti-infective products.

After an unsuccessful search for guidelines to destroy outdated anti-infective products, a procedure was developed for pharmacy that uses currently available biohazardous materials. By using a blood/body-fluid absorbent, an inexpensive waste system was developed to avoid the negative public sentiment caused by use of public landfills and avoid the risk of disposing waste in hospital drainage systems.

When siting works, Canada-style.

Hazardous waste management poses increasing problems for Canadian provinces and American states, given the vast quantities and types of wastes generated and the virtual inability to open new storage, treatment, or disposal facilities. The Canadian experience is very similar to the American one in many respects, except for the fact that three provinces (Alberta, Manitoba, and Quebec) have devised alternative approaches to siting that appear successful in moving beyond the political gridlock so common on this issue. In each of these cases, traditional, top-down approaches to siting have been eschewed in favor of a more comprehensive approach that includes extensive public participation, economic and social compensation packages, formal partnerships between public and private organizations, and direct links between siting proposals and other aspects of waste management, including waste reduction, recycling, and export/import control.