European data sources for computing burden of (potential) vaccine-preventable diseases in ageing adults.

BACKGROUND: To guide decision-making on immunisation programmes for ageing adults in Europe, one of the aims of the Vaccines and InfecTious diseases in the Ageing popuLation (IMI2-VITAL) project is to assess the burden of disease (BoD) of (potentially) vaccine-preventable diseases ((P)VPD). We aimed to identify the available data sources to calculate the BoD of (P)VPD in participating VITAL countries and to pinpoint data gaps. Based on epidemiological criteria and vaccine availability, we prioritized (P) VPD caused by Extra-intestinal pathogenic Escherichia coli (ExPEC), norovirus, respiratory syncytial virus, Staphylococcus aureus, and pneumococcal pneumonia. METHODS: We conducted a survey on available data (e.g. incidence, mortality, disability-adjusted life years (DALY), quality-adjusted life years (QALY), sequelae, antimicrobial resistance (AMR), etc.) among national experts from European countries, and carried out five pathogen-specific literature reviews by searching MEDLINE for peer-reviewed publications published between 2009 and 2019. RESULTS: Morbidity and mortality data were generally available for all five diseases, while summary BoD estimates were mostly lacking. Available data were not always stratified by age and risk group, which is especially important when calculating BoD for ageing adults. AMR data were available in several countries for S. aureus and ExPEC. CONCLUSION: This study provides an exhaustive overview of the available data sources and data gaps for the estimation of BoD of five (P) VPD in ageing adults in the EU/EAA, which is useful to guide pathogen-specific BoD studies and contribute to calculation of (P)VPDs BoD.

Economic burden of varicella in Europe in the absence of universal varicella vaccination.

BACKGROUND: Though the disease burden of varicella in Europe has been reported previously, the economic burden is still unknown. This study estimated the economic burden of varicella in Europe in the absence of Universal Varicella Vaccination (UVV) in 2018 Euros from both payer (direct costs) and societal (direct and indirect costs) perspectives. METHODS: We estimated the country specific and overall annual costs of varicella in absence of UVV in 31 European countries (27 EU countries, plus Iceland, Norway, Switzerland and the United Kingdom). To obtain country specific unit costs and associated healthcare utilization, we conducted a systematic literature review, searching in PubMed, EMBASE, NEED, DARE, REPEC, Open Grey, and public heath websites (1/1/1999-10/15/2019). The number of annual varicella cases, deaths, outpatient visits and hospitalizations were calculated (without UVV) based on age-specific incidence rates (Riera-Montes et al. 2017) and 2018 population data by country. Unit cost per varicella case and disease burden data were combined using stochastic modeling to estimate 2018 costs stratified by country, age and healthcare resource. RESULTS: Overall annual total costs associated with varicella were estimated to be €662,592,061 (Range: €309,552,363 to €1,015,631,760) in Europe in absence of UVV. Direct and indirect costs were estimated at €229,076,206 (Range €144,809,557 to €313,342,856) and €433,515,855 (Range €164,742,806 to €702,288,904), respectively. Total cost per case was €121.45 (direct: €41.99; indirect: €79.46). Almost half of the costs were attributed to cases in children under 5 years, owing mainly to caregiver work loss. The distribution of costs by healthcare resource was similar across countries. France and Germany accounted for 49.28% of total annual costs, most likely due to a combination of high numbers of cases and unit costs in these countries. CONCLUSIONS: The economic burden of varicella across Europe in the absence of UVV is substantial (over 600 M€), primarily driven by caregiver burden including work productivity losses.

Perceived social support from teachers and classmates does not moderate the inverse association between body mass index and health-related quality of life in adolescents.

PURPOSE: The current study investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among a large and non-clinical sample of adolescents, and tested the possible moderating effect of perceived teacher and classmate support on this association. METHODS: French-speaking Belgian adolescents (n = 11,342) self-reported height and weight, HRQoL (KIDSCREEN-10), as well as their perception of teacher and classmate relationships. Adjusting for sociodemographics, linear regression analyses with HRQoL as the outcome variable were performed for boys and girls separately. Interactions between BMI and teacher support, and between BMI and classmate support were included to examine the effect of this support on the association between BMI and HRQoL. RESULTS: Obesity was associated with lower HRQoL for boys (ß = - 2.14, p = 0.002) and for girls (ß = - 2.96, p = 0.001), while only overweight girls showed a significant impaired HRQoL compared with normal-weight ones (ß = - 0.94, p = 0.01). In both sexes, lower perceived teacher and classmate support was associated with lower HRQoL. Interactions between BMI and perceived teacher relationships, and between BMI and perceived classmate relationships, were not significant for boys as for girls. CONCLUSIONS: Perceived school-related social support constitutes an important dimension of adolescent well-being, suggesting the relevance of considering it for promoting greater HRQoL in overweight and obese youth. Future studies are needed to confirm the absence of moderating effect of this support and explore its effect on other weight-related factors, like body image, weight misperception and bullying, associated with decreased HRQoL in adolescents.

Environmental correlates of physical activity among children 10 to 13 years old in Wallonia (Belgium).

BACKGROUND: In Belgium, as in many other countries, the juvenile practice of physical activity is insufficient. A growing attention has been paid to environmental factors that may influence physical activity but with inconsistent findings. This study aims to estimate the association between daily life environment characteristics and physical activity among children 10 to 13 years old in Wallonia (Belgium). METHODS: Data were collected using a self-administered questionnaire among 1940 children (HBSC survey). Associations between factors related to the children's living environment and physical activity (vigorous physical activity (VPA) ≥ twice a week; global physical activity (GPA) defined as VPA ≥ twice a week and moderate-to-vigorous physical activity ≥1 h/day) were estimated using logistic regressions adjusted for potential confounders. RESULTS: Nearly three-quarters of the children practiced VPA ≥ twice a week, but only one in five practiced GPA consistent with recommendations. After adjustment, children living in a neighborhood with playgrounds or parks were more likely to achieve a recommended level of GPA (OR: 1.34 [1.04-1.73]), as were children who reported that other youngsters were present in their neighborhood with whom they could play outside (OR: 1.50 [1.12-1.99]). The presence of neighborhood children was also positively associated with VPA (OR: 1.80 [1.42-2.29]); in stratified analyses, the association was significant only among boys (OR: 1.95 [1.34-2.82]). Moreover, and only in girls (OR: 1.66 [1.10-2.49]), a feeling of safety in one's neighborhood was positively associated with VPA. No association was found between VPA and the existence of a yard or a garden at home to go playing outside. CONCLUSION: Our results argue for developing actions aimed at creating living environments more favorable to children's daily physical activity. More specifically, they help better understand the environment of Belgian children and thus contribute to better identify their needs.

Feelings about the timing of first sexual intercourse and health-related quality of life among adolescents.

BACKGROUND: Early sexual intercourse (SI) may have long-lasting negative impacts on health-related quality of life (HRQoL). So far, these impacts have been studied using age for defining early SI instead of feelings about its timing. The present study examined the association between feelings about the timing of first SI and current HRQoL. METHODS: Data came from the 2014 cross-sectional Health Behaviour in School-aged Children (HBSC) study in French-speaking Belgium. Among participants aged 16-20 years who already had SI, 1778 were included in analyses. Univariate and multivariate logistic regressions were performed, including potential confounders. RESULTS: One quarter of adolescents (26.4%) had poor HRQoL, 19.8% expressed a negative feeling about the timing of first SI and 19.6% did not think about it. Compared with adolescents who thought first SI happened at the right time or wished it had happened sooner, adolescents who had a negative feeling about the timing and those who did not think about it were more likely to have a poor HRQoL (cOR = 1.67 (1.28-2.17) and cOR = 1.37 (1.05-1.80), respectively). After adjustment, associations were no more significant (aOR = 1.22 (0.91-1.63) and aOR = 1.22 (0.91-1.64)). Sex disparity in expressing a negative feeling mostly explained the difference between crude and adjusted analyses. CONCLUSION: Further research is needed to better understand such a complex relationship. The high proportion of adolescents having poor HRQoL and negative feeling about the timing of first SI shows how important it is to find out effective prevention for both domains.

Confirmation of spatial patterns and temperature effects in Bluetongue virus serotype-8 transmission in NW-Europe from the 2007 reported case data.

Two separate analyses were carried out to understand the epidemiology of Bluetongue virus serotype 8 (BTV-8) in 2007 in North West Europe: First, the temporal change in transmission rates was compared to the evolution of temperature during that season. Second, we evaluated the spatio-temporal dynamics of newly reported outbreaks, to estimate a spatial transmission kernel. For both analyses, the approach as used before in analysing the 2006 BTV-8 epidemic had to be adapted in order to take into account the fact that the 2007 epidemic was not a newly arising epidemic, but one advancing from whereto it had already spread in 2006. We found that within the area already affected by the 2006 outbreak, the pattern of newly infected farms in 2007 cannot be explained by between-farm transmission, but rather by local re-emergence of the virus throughout that region. This indicates that persistence through winter was ubiquitous for BTV-8. Just like in 2006, we also found that the temperature at which the infection starts to spread lies close to 15 °C. Finally, we found that the shape of the transmission kernel is in line with the one from the 2006 epidemic. In conclusion, despite the substantial differences between 2006 and 2007 in temperature patterns (2006 featured a heat wave in July, whereas 2007 was more regular) and spatial epidemic extent, both the minimum temperature required for transmission and the transmission kernel were similar to those estimated for the 2006 outbreak, indicating that they are robust properties, suitable for extrapolation to other years and similar regions.

A Model-Based Estimation of RSV-Attributable Incidence of Hospitalizations and Deaths in Italy Between 2015 and 2019.

INTRODUCTION: Respiratory syncytial virus (RSV) incidence is known to be underestimated in adults due to its infrequent diagnostic testing and lower sensitivity of single nasal/nasopharyngeal swab PCR testing outside of the early childhood period. RSV can trigger acute cardiac events as well as cause respiratory disease. Consequently, we used a model-based study to estimate RSV-attributable hospitalization and mortality incidence among adults in Italy between 2015 and 2019. METHODS: Through a database predisposed by CREA Sanità, by extracting monthly data from the Italian hospitalization collection data of the Ministry of Health and the Italian National Institute of Statistics (ISTAT) data (mortality), we estimated yearly RSV-attributable incidence of events for different cardiorespiratory outcomes. We used a quasi-Poisson regression model, which accounted for periodic and aperiodic time trends and viral activity proxies. RESULTS: The yearly RSV-attributable cardiorespiratory hospitalization incidence increased with age and was highest among adults aged ≥ 75 years (1064-1527 cases per 100,000 person-years). Similarly, the RSV-attributable cardiorespiratory mortality rate was highest among persons aged ≥ 75 years (59-85 deaths per 100,000 person-years). Incidence rates for RSV-attributable hospitalizations and RSV-attributable mortality were on average 2-3 times higher for cardiorespiratory than respiratory disease alone. Incidence rate based on RSV-specific ICD codes only were 405-1729 times lower than modeled estimates accounting for untested events. CONCLUSION: RSV causes a substantial disease burden among adults in Italy and contributes to both respiratory and cardiovascular conditions. Our results emphasize the need for effective RSV prevention strategies, particularly among older adults.

Effect of a DIVA vaccine with and without in-feed use of coated calcium-butyrate on transmission of Salmonella Typhimurium in pigs.

BACKGROUND: For satisfactory Salmonella control, good biosecurity along the pork production chain is crucial, although additional control measures on-farm need to be considered. This study evaluated the effect of two potential control measures against the spread of Salmonella Typhimurium via a transmission experiment with 56 piglets (3-15 weeks of age): two groups were orally vaccinated with 107 - 108 Colony Forming Units (CFU)/2 mL of a new attenuated Salmonella Typhimurium vaccine 'Salmoporc-∆rfaJ' with DIVA capacities (Differentiation between Infected and Vaccinated Animals) (n = 2x16); the feed of one group was additionally supplemented with coated calcium-butyrate salt. Two weeks post vaccination, four pigs per group were orally challenged with 107 CFU/2 mL of a Salmonella Typhimurium strain 112910a. Both groups were compared with a positive (challenged/untreated; n = 16) and negative (unchallenged/untreated; n = 8) control group. Until six weeks post challenge, blood, individual faecal and finally tissue samples were examined. Adjusted transmission ratios 'Ra' were estimated, based on the challenge strain isolation from faecal and/or tissue samples. RESULTS: In both intervention groups, Ra values were lower compared to the positive control group, although these differences were not significant. In the combination group DIVA vaccine + coated butyrate, less non-challenged contact animals excreted Salmonella and less tissue samples were found Salmonella-positive in all pigs, when compared to the positive control group (P < 0.01). Seroconversion was detected in none of the vaccinated animals before challenge, when using a commercial lipopolysaccharide (LPS) ELISA targeting only Salmonella O-antigens, deleted in this vaccine. This was in contrast with an in-house whole-cell ELISA testing for various Salmonella antigens, in which Salmonella-specific antibodies were found pre-challenge in the serum of the vaccinated pigs. CONCLUSIONS: Both interventions showed a limited, non-significant reduction of Salmonella transmission between piglets. They may have applications towards Salmonella control and surveillance. Firstly, the number of Salmonella excreting contact pigs was significantly lower in the group where vaccination was combined with coated calcium-butyrate salt in the feed; secondly, the new vaccine confirmed its DIVA capacity. Therefore, these interventions merit further research with larger sample sizes, to optimize their use for Salmonella programmes.

Systematic Literature Review of the Epidemiological Characteristics of Pneumococcal Disease Caused by the Additional Serotypes Covered by the 20-Valent Pneumococcal Conjugate Vaccine.

Higher valency pneumococcal conjugate vaccines (PCV15 and PCV20) have been developed to address the disease burden of current non-vaccine serotypes. This review describes the epidemiological characteristics of serotypes beyond PCV13 (serotypes 8, 10A, 11A, 12F, 15B/C, 22F, and 33F; PCV20nonPCV13 serotypes). Peer-reviewed studies published between 1 January 2010 (the year PCV13 became available) and 18 August 2020 were systematically reviewed (PROSPERO number: CRD42021212875). Data describing serotype-specific outcomes on disease proportions, incidence, severity, and antimicrobial non-susceptibility were summarized for individual and aggregate PCV20nonPCV13 serotypes by age group and by type and duration of pediatric PCV immunization program. Of 1168 studies, 127 (11%) were included in the analysis. PCV20nonPCV13 serotypes accounted for 28% of invasive pneumococcal disease (IPD), although the most frequent serotypes differed between children (10A, 15B/C) and adults (8, 12F, 22F). In children, serotype 15B/C tended to be more frequently associated with pneumococcal meningitis and acute otitis media; in adults, serotype 8 was more frequently associated with pneumonia and serotype 12F with meningitis. Serotypes 10A and 15B/C in children and 11A and 15B/C in adults were often associated with severe IPD. Serotype 15B/C was also among the most frequently identified penicillin/macrolide non-susceptible PCV20nonPCV13 serotypes. These results could inform decision making about higher valency PCV choice and use.

Economic Evaluation of Universal Varicella Vaccination in Mexico.

BACKGROUND: Universal varicella vaccination has proven to be cost-effective (CE) in countries where implemented. However, this has not been evaluated for Mexico. METHODS: The yearly disease burden (varicella cases/deaths, outpatient visits, and hospitalizations) was derived from Mexican seroprevalence data adjusted to the 2020 population. The yearly economic burden was calculated by combining disease with Mexican unit cost data from both health care and societal perspectives. Four different vaccination strategies were evaluated: (1) 1 dose of varicella vaccine at 1 year old; (2) 2 doses at 1 and 6 years; (3) 1 dose of varicella vaccine at 1 year, and quadrivalent measles-mumps-rubella-varicella vaccine at 6 years; (4) 2 doses of measles-mumps-rubella-varicella vaccine at 1 and 6 years. We developed an economic model for each vaccination strategy where 20 consecutive birth cohorts were simulated. Vaccination impact (number of avoided cases/deaths) was evaluated for a 20-year follow-up period based on vaccine effectiveness (87% and 97.4% for 1 and 2 doses), and assuming a 95% coverage. We estimated annual costs saved, incremental cost-effectiveness ratio, and costs per life year gained. RESULTS: Avoided cases during the 20-year follow-up with 1, and 2 doses were 20,570,722 and 23,029,751, respectively. Strategies 1 and 2 were found to be cost saving, and strategy 3 to be CE. Strategy 4 was not CE. Strategies 1 and 2 would allow saving annually $53.16 and $34.41 million USD, respectively, to the Mexican society. CONCLUSIONS: Universal varicella vaccination, using 1 dose or 2 doses, would result in a cost-beneficial and CE public health intervention in Mexico.

Quantitative analysis of transmission parameters for bluetongue virus serotype 8 in Western Europe in 2006.

The recent bluetongue virus serotype 8 (BTV-8) epidemic in Western Europe struck hard. Controlling the infection was difficult and a good and safe vaccine was not available until the spring of 2008. Little was known regarding BTV transmission in Western Europe or the efficacy of control measures. Quantitative details on transmission are essential to assess the potential and efficacy of such measures.To quantify virus transmission between herds, a temporal and a spatio-temporal analysis were applied to data on reported infected herds in 2006. We calculated the basic reproduction number between herds (Rh: expected number of new infections, generated by one initial infected herd in a susceptible environment). It was found to be of the same order of magnitude as that of an infection with Foot and Mouth Disease (FMD) in The Netherlands, e.g. around 4. We concluded that an average day temperature of at least 15 °C is required for BTV-8 transmission between herds in Western Europe. A few degrees increase in temperature is found to lead to a major increase in BTV-8 transmission.We also found that the applied disease control (spatial zones based on 20 km radius restricting animal transport to outside regions) led to a spatial transmission pattern of BTV-8, with 85% of transmission restricted to a 20 km range. This 20 km equals the scale of the protection zones. We concluded that free animal movement led to substantial faster spread of the BTV-8 epidemic over space as compared to a situation with animal movement restrictions.

Effectiveness and cost-benefit study to encourage herd owners in a cost sharing vaccination programme against bluetongue serotype-8 in Belgium.

Bluetongue (BT) is a ruminant viral infectious disease transmitted by Culicoides spp. midges. In 2006, when bluetongue virus serotype 8 (BTV-8) appeared for the first time in Northern Europe, it rapidly spread and infected a large proportion of animals. BThas a significant economic impact due to a direct effect on animal health and to an indirect effect in disrupting international trade of animals and animal products. In spring 2008, a compulsory subsidized vaccination programme in Europe resulted in a drastic decrease in the number of reported cases. However, due to the turn-over of the population, without a continuous vaccination programme, the animal population was becoming progressively susceptible. Vaccination would enable Belgium to maintain its status of freedom from infection of BTV-8 that could possibly be re-introduced. Subsidizing it could be an incentive to convince more farmers to vaccinate. To finance this programme, both decision-makers and stakeholders need to be persuaded by the effectiveness and the cost-benefit of vaccination. The study evaluated the effectiveness of vaccination against BTV-8 in Belgium. The change in serology which has shown the effectiveness of the vaccine to induce antibody production has been significantly associated with the time between the first injection and the sampling date and the number of injections of the primo-vaccination. This study also clearly confirms the benefit of vaccination by reducing economic impact of treatment and production losses, especially in dairy cattle. Based on a participating epidemiological approach, a national voluntary and subsidized vaccination was accepted, and permitted Belgium to vaccinate more than 9,000 herds in 1 month. Because this mass vaccination occurred before the vector season, it probably helped Belgium remain free from BTV-8.

Salmonella in Belgian laying hens: an identification of risk factors.

Since the 1980s, the prevalence of Salmonella in Belgian poultry layers and broilers has greatly fluctuated with a rise observed in 2003 and a significant decrease in 2005. In order to alleviate the risk at egg consumer level, it is crucial to understand the factors which influence the contamination and the spread of Salmonella in laying hens. To study such determinants we explored the Belgian data from the 2005 baseline study on the prevalence of Salmonella in laying flocks of Gallus gallus in the European Union. The response variables corresponded to presence or absence of Salmonella from dust and faecal samples taken from the environment of a Belgian layer flock. The explanatory variables included: region of Belgium, sampling time (month the flock was sampled), production type (cage or barn and free range), Salmonella vaccination status, flock age and flock size. Analyses of these data were performed using a bivariate logistic regression model assuming independence between the two responses and bivariate generalized estimating equations model, which incorporates the correlation between the two responses on the same flock. The main risk factor that was identified was rearing flocks in cages compared to barns and free-range systems. The results also showed a significant higher risk for Salmonella for a 1 week increase in flocks' age as well as with a unit increase in the size of the flock.

Field observations during the bluetongue serotype 8 epidemic in 2006. I. Detection of first outbreaks and clinical signs in sheep and cattle in Belgium, France and the Netherlands.

Starting August 2006, a major epidemic of bluetongue (BT) was identified in North-West Europe, affecting The Netherlands, Belgium, Germany, Luxembourg and the North of France. It was caused by BT virus serotype 8 (BTV-8), a serotype previously unknown to the European Union (EU). In this outbreak, the virus caused clinical disease in a few individual animals within cattle herds, whereas overt clinical disease was usually restricted to sheep. Investigations in Belgium suggested that the first clinical signs of BTV-8 appeared mid July 2006 in a cattle herd, while the first suspicion of a BT-outbreak in Belgium was reported on 17 August 2006. In the first 10 BTV-8 outbreaks in the Netherlands, the owners indicated that the first clinical signs started approximately 12-17 days before a suspicion was reported to the veterinary authorities via a veterinary practitioner. In BTV-8 affected sheep flocks, erosions of the oral mucosa, fever, salivation, facial and mandibular oedema, apathy and tiredness, mortality, oedema of the lips, lameness, and dysphagia were among the most frequent clinical signs recorded. The most prominent clinical signs in BTV-8 affected cattle herds were: crusts/lesions of the nasal mucosa, erosions of lips/crusts in or around the nostrils, erosions of the oral mucosa, salivation, fever, conjunctivitis, coronitis, muscle necrosis, and stiffness of the limbs. Crusts/lesions of nasal mucosa, conjunctivitis, hyperaemic/purple coloration and lesions of the teats, and redness/hypersensitivity of the skin were relatively more seen on outbreak farms with cattle compared to sheep. Mortality, oedema of the head and ears, coronitis, redness of the oral mucosa, erosions/ulceration of tongue mucosa, purple coloration of the tongue and tongue protrusion and dyspneu were relatively more seen on outbreak farms with sheep compared to cattle.

A trend analysis of antimicrobial resistance in commensal Escherichia coli from several livestock species in Belgium (2011-2014).

A temporal trend analysis was performed on antimicrobial resistance data collected over 4 consecutive years (2011-2014) in the official Belgian antimicrobial resistance monitoring programme. Commensal Escherichia coli strains were isolated from faecal samples of four livestock categories (veal calves, young beef cattle, broiler chickens and slaughter pigs) and the trends of resistance profiles were analysed. The resistance prevalence remained high (>50%) during the study period for ampicillin in veal calves and chickens, for ciprofloxacin and nalidixic acid in chickens, for sulfamethoxazole in veal calves, chickens and pigs and for tetracycline in veal calves. Using logistic regression and Generalized Estimating Equation and after p value adjustment for multiple testing (Linear step-up method), statistically significant decreasing temporal trends were observed for several of the 11 tested antimicrobials in several livestock categories: in veal calves (10/11), in chickens (6/11) and in pigs (5/11). A significant increasing trend was observed for the prevalence of resistance to ciprofloxacin in chickens. Multi-resistance, considered as the resistance to at least three antimicrobials of different antibiotic classes, was observed in the four livestock categories but was significantly decreasing in veal calves, chickens and pigs. Overall, the prevalence of resistance and of multi-resistance was lowest in the beef cattle livestock category and highest in broiler chickens. These decreasing temporal trends of antimicrobial resistance might be due to a decrease of the total antimicrobial consumption for veterinary use in Belgium which was reported for the period between 2010 and 2013. The methodology and statistical tools developed in this study provide outputs which can detect shifts in resistance levels or resistance trends associated with particular antimicrobial classes and livestock categories. Such outputs can be used as objective evidence to evaluate the possible efficacy of measures taken by animal health authorities and stakeholders in the livestock sector to limit antimicrobial resistance occurrence.

Evaluation of a hierarchical ascendant clustering process implemented in a veterinary syndromic surveillance system.

Syndromic surveillance is considered as one of the surveillance components for early warning of health-related events, as it allows detection of aberrations in health indicators before laboratory confirmation. "MoSS-Emergences 2" (MoSS-E2), a tool for veterinary syndromic surveillance, aggregates groups of similar clinical observations by hierarchical ascendant classification (HAC). In the present study, this HAC clustering process was evaluated using a reference set of data that, for the purpose of this evaluation, was a priori divided and defined as Bluetongue (BTV) positive cases (PC) on the one hand and BTV negative cases (NC) on the other hand. By comparing the clustering result of MoSS-E2 with the expected outcome, the sensitivity (the ability to cluster PC together) and specificity (the ability to exclude NC from PC) of the clustering process were determined for this set of data. The stability of the classes obtained with the clustering algorithm was evaluated by comparing the MoSS-E2 generated dendrogram (applying complete linkage) with dendrograms of STATA® software applying average and single linkage methods. To assess the systems' robustness, the parameters of the distance measure were adjusted according to different scenarios and obtained outcomes were compared to the expected outcome based on the a priori known labels. Rand indexes were calculated to measure similarity between clustering outcomes. The clustering algorithm in its default settings successfully segregated the reference BTV cases from the non-BTV cases, resulting in a sensitivity of 100.0% (95% CI: 89.0-100.0) and a specificity of 100.0% (95% CI: 80.0-100.0) for this set of data. The different linkage methods showed similar clustering results indicating stability of the classes (Rand indexes of respectively 0.77 for average and 0.75 for single linkage). The system proved to be robust when changing the parameters as the BTV cases remained together in meaningful clusters (Rand indexes between 0.72 and 1). The configurable MoSS-E2 system demonstrated its suitability to identify meaningful clusters of clinical syndromes.

The Schmallenberg virus epidemic in Europe-2011-2013.

During the Schmallenberg virus (SBV) epidemic, the European Food Safety Authority (EFSA) collected data on SBV occurrence across Europe in order to provide an assessment of spread and impact. By May 2013, twenty-nine countries were reporting to EFSA and twenty-two countries had reported cases of SBV. The total number of SBV herds reported was 13,846 and the number of SBV laboratory confirmed herds was 8730. The surveillance activities were based on the detection of SBV clinical cases (either adults or newborns). Malformation in newborns was the most commonly reported clinical sign of SBV-infection. All countries were able to provide the date when the first suspicion of SBV in the herd was reported and nineteen could report the location of the herd at a regional level. This allowed the spread of SBV in Europe to be measured both temporally and spatially. The number of SBV confirmed herds started to increase in December 2011 and two peaks were observed in 2012 (February and May). Confirmed herds continued to be reported in 2012 and into 2013. An increase during winter 2012 and spring 2013 was again observed, but the number of confirmed herds was lower than in the previous year. SBV spread rapidly throughout Europe from the initial area of detection. SBV was detected above the latitude of 60° North, which exceeds the northern expansion observed during the bluetongue virus serotype 8 epidemic in 2006-2009. The impact of SBV was calculated as ratio of the number of herds with at least one malformed SBV positive foetus and the total number of herds in this region. The 75th percentile of the malformations ratio in the various affected countries for the whole reporting period was below 1% and 3% for cattle and sheep herds, respectively. International data collection on emerging diseases represents a challenge as the nature of available data, data quality and the proportion of reported cases may vary widely between affected countries. Surveillance activities on emerging animal diseases are often structured only for case detection making the estimation of infection/diseases prevalence and the investigation of risk factors difficult. The impact of the disease must be determined to allow risk managers to take appropriate decisions. Simple within-herd impact indicators suitable for emerging disease outbreaks should be defined that could be measured as part of routine animal health surveillance programmes and allow for rapid and reliable impact assessment of emerging animal health diseases.

Bluetongue surveillance system in Belgium: a stochastic evaluation of its risk-based approach effectiveness.

BACKGROUND: The aim of this study was to assess the sensitivity of the four major bluetongue surveillance components implemented in Belgium in 2007 for farmed animals and prescribed by the European Union regulation; winter serological screening, sentinel system, passive clinical surveillance, export testing. Scenario tree methodology was used to evaluate the relative sensitivity of detection and targeted approach of each component in terms of early detection and freedom of infection substantiation. Field data collected from the previous year's outbreaks in Belgium were used to determine the risk groups to be considered. RESULTS: The best sensitivities at herd level, taking into account the diagnostic test sensitivity, design prevalence and the number of animals tested within a herd were obtained with the winter screening and sentinel component. The sensitivities at risk group level, taking into account the obtained herd sensitivity, effective probabilities of infection and number of herds tested were high in all components, except for the export component. Component sensitivities ranged between 0.77 and 1 for all components except for the export component with a mean value of 0.22 (0.17-0.26). In terms of early detection, the probability of detection was best using the passive clinical component or the sentinel component. Sensitivity analysis showed that the passive clinical component sensitivity was mostly affected by the diagnostic process and the number of herds sampled. The sentinel and export components sensitivity were mainly affected by the relative risk estimates whereas the winter screening component was mainly affected by the assumptions about the design prevalence. CONCLUSIONS: This study revealed interesting features regarding the sensitivity of detection and early detection of infection in the different surveillance components and their risk based approach as requested by the international standards.

Serological and virological BVDV prevalence and risk factor analysis for herds to be BVDV seropositive in Belgian cattle herds.

Bovine viral diarrhoea virus (BVDV) is a worldwide spread virus that most commonly infects cattle and can cause considerable economic losses. To determine the prevalence of BVDV in Belgium, a cross-sectional study was performed between November 2009 and March 2010. Young stock aged between 6 and 12 months from 773 randomly selected Belgian cattle herds were tested for BVDV-specific antibodies and antigen. With a target and maximum of 10 animals per sampled herd, a total of 5246 animals were selected. Additionally a questionnaire including different herd management topics and questions about participation in animal health programmes, including BVDV, was sent to 1100 Belgian cattle herds, including the 773 herds for BVDV testing. This paper focuses on results regarding these 773 herds. The true prevalence of BVDV-specific antibodies and antigen at herd level was respectively 47.4% and 4.4%, while at animal level this was respectively 32.9% and 0.3%. In 44.4% of the herds where BVDV-specific antibodies were detected at least 60% of the sampled young stock was BVDV seropositive. Interestingly, 83.4% of these farmers stated not to have suffered from problems related to BVDV. Moreover, only 8.4% of all farmers who completed the questionnaire (n=895) reported problems possibly related to BVDV the past 3 years. This demonstrates that farmers are often unaware of the presence of BVDV in their herd. Risk factors for a herd to be BVDV seropositive were identified by means of a multivariable logistic regression model. Large herds were significantly more likely to be BVDV seropositive (OR=1.004, p<0.01). The interaction between "Antigen positive animal detected in this study" and "BVDV vaccination in 2009" was significant (p<0.01). In non-vaccinating herds, the detection of antigen positive animals was significantly associated with BVDV seropositive herds (OR=13.8, p<0.01). In herds with no antigen positive animals detected, vaccination resulted in a significant risk factor to be BVDV seropositive compared to non-vaccinating herds (OR=3.4, p<0.01). Herds reporting BVDV-related problems the past 3 years were more likely to be BVDV seropositive (OR=1.9, p<0.05). This relation became non-significant (OR=1.8, p=0.08) when only a subset of herds with no vaccination of animals <12 months was taken into account. The results of the current study suggest an active circulation of BVDV in a considerable number of Belgian cattle herds.

Evaluation of the Salmonella surveillance program in Belgian pig farms.

Since July 2007, Belgium has implemented a national surveillance and control program for Salmonella in pigs. Pig farms are designated as Salmonella high risk farms based on serological profiles and are obliged to subsequently take part in a Salmonella specific action plan (SSAP). The SSAP was evaluated and potential risk factors for the persistence of Salmonella on the farm were investigated. First, the Kaplan-Meier method was used in order to study the period during which a farm maintains a Salmonella high risk status. Farms recovered more slowly from their high risk status before the SSAP was implemented compared to after the program was implemented (p<0.001). However, results showed that 29% of the farms were withdrawn from the program possibly only because of sampling error. The program should thus be adapted to accommodate for this. Secondly, the influence of several risk factors (type of farm, season of entrance into the SSAP, size of farm and farm density of the municipality) on the time to withdrawal from the high risk status was evaluated using univariable methods and a Cox multiple regression model for survival data. A statistically significant association was identified between the type of farm and the time to withdrawal from the high risk status. At any point in time after the onset of the SSAP, withdrawals from the high risk status occurred at a 39% and 28% higher rate in mixed (p=0.01) and fattening farms (p=0.05), respectively, compared to closed farms. The risk attributed to closed pig farms is related to the presence of sows in this particular type of structure, which underlines the importance of implementing control measures in this category of animals.