Governance of the wildlife trade and the prevention of emerging zoonoses: a mixed methods network analysis of transnational organisations, silos, and power dynamics.

INTRODUCTION: The wildlife trade is an important arena for intervention in the prevention of emerging zoonoses, and leading organisations have advocated for more collaborative, multi-sectoral approaches to governance in this area. The aim of this study is to characterise the structure and function of the network of transnational organisations that interact around the governance of wildlife trade for the prevention of emerging zoonoses, and to assess these network characteristics in terms of how they might support or undermine progress on these issues. METHODS: This study used a mixed methods social network analysis of transnational organisations. Data were collected between May 2021 and September 2022. Participants were representatives of transnational organisations involved in the governance of wildlife trade and the prevention of emerging zoonoses. An initial seed sample of participants was purposively recruited through professional networks, and snowball sampling was used to identify additional participants. Quantitative data were collected through an online network survey. Measures of centrality (degree, closeness, and betweenness) were calculated and the network's largest clique was identified and characterised. To understand the extent to which organisations were connected across sectors, homophily by sector was assessed using exponential random graph modelling. Qualitative data were collected through semi-structured interviews. The findings from the quantitative analysis informed the focus of the qualitative analysis. Qualitative data were explored using thematic analysis. RESULTS: Thirty-seven participants completed the network survey and 17 key informants participated in semi-structured interviews. A total of 69 organisations were identified as belonging to this network. Organisations spanned the animal, human, and environmental health sectors, among others including trade, food and agriculture, and crime. Organisation types included inter-governmental organisations, non-governmental organisations, treaty secretariats, research institutions, and network organisations. Participants emphasised the highly inter-sectoral nature of this topic and the importance of inter-sectoral work, and connections were present across existing sectors. However, there were many barriers to effective interaction, particularly conflicting goals and agendas. Power dynamics also shaped relationships between actors, with the human health sector seen as better resourced and more influential, despite having historically lower engagement than the environmental and animal health sectors around the wildlife trade and its role in emerging zoonoses. CONCLUSION: The network of transnational organisations focused on the governance of wildlife trade and the prevention of emerging zoonoses is highly multi-sectoral, but despite progress catalysed by the COVID-19 pandemic, barriers still exist for inter-sectoral interaction and coordination. A One Health approach to governance at this level, which has gained traction throughout the COVID-19 pandemic, was shared as a promising mechanism to support a balancing of roles and agendas in this space. However, this must involve agreement around equity, priorities, and clear goal setting to support effective action.

Integrated surveillance systems for antibiotic resistance in a One Health context: a scoping review.

BACKGROUND: Antibiotic resistance (ABR) has emerged as a major threat to health. Properly informed decisions to mitigate this threat require surveillance systems that integrate information on resistant bacteria and antibiotic use in humans, animals, and the environment, in line with the One Health concept. Despite a strong call for the implementation of such integrated surveillance systems, we still lack a comprehensive overview of existing organizational models for integrated surveillance of ABR. To address this gap, we conducted a scoping review to characterize existing integrated surveillance systems for ABR. METHODS: The literature review was conducted using the PRISMA guidelines. The selected integrated surveillance systems were assessed according to 39 variables related to their organization and functioning, the socio-economic and political characteristics of their implementation context, and the levels of integration reached, together with their related outcomes. We conducted two distinct, complementary analyses on the data extracted: a descriptive analysis to summarize the characteristics of the integrated surveillance systems, and a multiple-correspondence analysis (MCA) followed by a hierarchical cluster analysis (HCA) to identify potential typology for surveillance systems. RESULTS: The literature search identified a total of 1330 records. After the screening phase, 59 references were kept from which 14 integrated surveillance systems were identified. They all operate in high-income countries and vary in terms of integration, both at informational and structural levels. The different systems combine information from a wide range of populations and commodities -in the human, animal and environmental domains, collection points, drug-bacterium pairs, and rely on various diagnostic and surveillance strategies. A variable level of collaboration was found for the governance and/or operation of the surveillance activities. The outcomes of integration are poorly described and evidenced. The 14 surveillance systems can be grouped into four distinct clusters, characterized by integration level in the two dimensions. The level of resources and regulatory framework in place appeared to play a major role in the establishment and organization of integrated surveillance. CONCLUSIONS: This study suggests that operationalization of integrated surveillance for ABR is still not well established at a global scale, especially in low and middle-income countries and that the surveillance scope is not broad enough to obtain a comprehensive understanding of the complex dynamics of ABR to appropriately inform mitigation measures. Further studies are needed to better characterize the various integration models for surveillance with regard to their implementation context and evaluate the outcome of these models.

Redefining On-Farm Practices: The Perceived Impact of a Responsible Antimicrobial Use Regulation on Dairy Farmers.

The global food animal industry faces a growing concern regarding antimicrobial resistance (AMR), primarily driven by the use of antimicrobials (AMs) for the treatment, control, and prevention of diseases. Addressing this challenge requires promoting responsible antimicrobial use (AMU) practices. In 2019, the province of Québec, Canada, took a significant step by implementing a regulation that limits the use of AMs of very high importance for human medicine (category I AMs as defined by Health Canada) in the food animal industry. However, the implementation of such regulation can significantly influence behavioral shifts among producers, contributing to the wider effort against AMR. Therefore, the objective of this observational study was to describe the perceived changes in knowledge of dairy producers and on-farm practices following the implementation of this regulation, using a cohort design. Data collection involved administering questionnaires to 87 dairy producers from 3 regions of the province of Québec (Estrie, Montérégie, Centre-Du-Québec) before (2017-2018) and after (2020-2021) the implementation of the regulation. The questionnaires explored the descriptive characteristics of farms, the knowledge of producers about the categorization of AMs, their on-farm treatment practices, and the perceived impacts of the regulation. Statistical analysis included t-tests and McNemar tests to compare the paired data obtained using the 2 questionnaires. The results indicated an increase in the knowledge score (the number of AMs correctly categorized by the producers by their importance for human medicine) after the implementation of the regulation, suggesting an improved understanding of the categorization of AMs based on their importance for human medicine. Trends in AMU practices for treating clinical mastitis and reproductive diseases suggested that category I AMs were less likely to be reported as the primary treatment after the regulation, while category II AMs were more often reported as primary treatment. Adoption of the selective dry cow therapy method significantly increased, while the use of teat sealants remained unchanged. Moreover, producers had divergent perceptions regarding the effect of the regulation on the cure rates and disease frequencies. This disparity emphasizes the need for comprehensive data collection to discern the risks associated with such regulatory shifts. The study acknowledges several limitations, including the potential for recall bias, confirmation bias, and desirability bias. Despite these limitations, this study shows that implementing regulations to encourage responsible AMU drives positive transformations in producers' knowledge and on-farm practices. This underscores the pivotal impact of proactive interventions in combating the escalating threat of AMR within the global food animal industry.

Professional characteristics, attitudes, and practices associated with stress and quality of life among Canadian animal health workers.

Objective: To describe the knowledge, attitudes, and practices (KAP) towards COVID-19 of Canadian companion animal health workers (AHW); to measure their perceived stress and quality of life (QoL); and to explore professional risk factors associated with stress and QoL. Sample: We sampled 436 companion animal veterinarians and technicians. Procedure: The study had cross-sectional and cohort components. It was conducted online in August to December 2020, and repeated in May to July 2021, using a questionnaire assessing the respondents' professional characteristics, COVID-19 KAP, perceived stress, and QoL. Results: Overall, AHW had sufficient knowledge of COVID-19 transmission, and reported having adopted good preventive practices. Since the beginning of the pandemic, participants reported increases in new clients (76%), in refusal of new clients (53%), and in pet euthanasia (24%). Increased client refusal and pet euthanasia were associated with greater stress and poorer professional QoL, whereas perceived susceptibility to and adoption of measures against COVID-19 were associated with lower stress and better QoL. Conclusion and clinical relevance: For AHW, professional characteristics were associated with stress and professional QoL. This information is important for developing strategies to cope with the ongoing shortage of AHW and with future public health crises.

Caractéristiques professionnelles, attitudes et pratiques associées au stress et à la qualité de vie des travailleurs en santé animale au Canada. Objectif: Décrire les connaissances, attitudes et pratiques (KAP) envers la COVID-19 des travailleurs canadiens en santé des animaux de compagnie (AHW); mesurer leur stress perçu et leur qualité de vie (QoL); et explorer les facteurs de risque professionnels associés au stress et à la QoL. Échantillonnage: Nous avons échantillonné 436 médecins vétérinaires et techniciens en pratique des animaux de compagnie. Procédure: L'étude avait des composantes transversale et de cohorte. Elle a été menée en ligne d'août à décembre 2020, et répétée de mai à juillet 2021, à l'aide d'un questionnaire évaluant les caractéristiques professionnelles des répondants, leurs KAP envers la COVID-19, leur stress perçu et leur QoL. Résultats: Dans l'ensemble, les AHW avaient une connaissance suffisante de la transmission de la COVID-19 et ont déclaré avoir adopté de bonnes pratiques de prévention. Depuis le début de la pandémie, les participants ont signalé une augmentation du nombre de nouveaux clients (76 %), du refus de nouveaux clients (53 %) et de l'euthanasie des animaux de compagnie (24 %). L'augmentation du refus des clients et de l'euthanasie des animaux de compagnie était associée à un plus grand stress et à une QoL professionnelle plus faible, tandis que la perception du risque et l'adoption de mesures contre le COVID-19 étaient associées à un stress plus faible et à une meilleure QoL. Conclusion et pertinence clinique: Pour les AHW, les caractéristiques professionnelles étaient associées au stress et à la QoL. Ces informations sont importantes pour développer des stratégies pour faire face à la pénurie continue d'AHW et aux futures crises de santé publique.(Traduit par Dr Serge Messier).

Behavioral risk factors associated with reported tick exposure in a Lyme disease high incidence region in Canada.

BACKGROUND: Tick-borne diseases, and especially Lyme Disease (LD), are on the rise in Canada and have been met with increasing public health concern. To face these emerging threats, education on the prevention of tick bites remains the mainstay of public health intervention. The objective of this study was to assess the adoption of preventive behaviors toward tick bites and LD and to investigate the association between behavioral risk factors and reported tick exposure in a Canadian, LD high incidence region (Estrie region, Quebec, Canada). METHODS: A cross-sectional study was conducted in 2018 which used a telephone questionnaire administered to a random sample of 10,790 adult residents of the study region. Questions investigated tick exposure, LD awareness, attitudes towards LD risk, outdoor and preventive behaviors, as well as antibiotic post-exposure prophylaxis (PEP) treatments in the case of a tick bite. Descriptive and multivariable analyses were carried out, considering the nine administrative subregions and the stratified survey design. RESULTS: The sub-regional prevalence of reported tick exposure in the previous year ranged from 3.4 to 21.9%. The proportion of respondents that adopted preventive behaviors varied from 27.0% (tick checks) to 30.1% (tick repellent) and 44.6% (shower after outdoor activities). A minority of respondents (15.9%) that sought healthcare after a tick bite received a PEP treatment. Performing tick checks (Odds ratio = 4.33), time spent outdoors (OR = 3.09) and living in a subregion with a higher public health LD risk level (OR = 2.14) were associated with reported tick exposure in multivariable models. CONCLUSIONS: This study highlights the low level of adoption of preventive behaviors against tick bites in a region where LD risk is amongst the highest in Canada. This suggests a concerning lack of improvement in LD prevention, as low levels of adoption were already reported in studies conducted in the last decade. Innovative and evidence-based approaches to improve education on ticks and tick-borne diseases and to promote behavior changes are urgently needed in Canada.

Telephone versus web panel National Survey for monitoring adoption of preventive behaviors to climate change in populations: a case study of Lyme disease in Québec, Canada.

BACKGROUND: To monitor the adoption of climate change adaptive behaviors in the population, public health authorities have to conduct national surveys, which can help them target vulnerable subpopulations. To ensure reliable estimates of the adoption of these preventive behaviors, many data collection methods are offered by polling firms. The aim of this study was to compare a telephone survey with a web survey on Lyme disease with regard to their representativeness. METHODS: The data comes from a cross-sectional study conducted in the Province of Québec (Canada). In total, 1003 people completed the questionnaire by telephone and 956 filled in a web questionnaire. We compared the data obtained from both survey modes with the census data in regard to various demographic characteristics. We then compared the data from both samples in terms of self-reported Lyme disease preventive behaviors and other theoretically associated constructs. We also assessed the measurement invariance (equivalence) of the index of Lyme disease preventive behaviors across the telephone and web samples. RESULTS: Findings showed that neither the telephone nor the web panel modes of data collection can be considered more representative of the target population. The results showed that the proportion of item non-responses was significantly higher with the web questionnaire (5.6%) than with the telephone survey (1.3%), and that the magnitude of the differences between the two survey modes was nil for 19 out of the 30 items related to Lyme disease, and small for 11 of them. Results from invariance analyses confirmed the measurement invariance of an index of adaptation to Lyme disease, as well as the mean invariance across both samples. CONCLUSIONS: Our results suggested that both samples provided similar estimates of the level of adaptation to Lyme disease preventive behaviors. In sum, the results of our study showed that neither survey mode was superior to the other. Thus, in studies where adaptation to climate change is monitored over time, using a web survey instead of a telephone survey could be more cost-effective, and researchers should consider doing so in future surveys on adaptation to climate. However, we recommend conducting a pretest study before deciding whether to use both survey modes or only one of them.

Development and validation of a behavioral index for adaptation to lyme disease.

BACKGROUND: Recent evidence suggests that climate change and other factors are leading to the emergence of Lyme disease in the province of Quebec, where it previously did not exist. As risk areas expand further north, the population can adopt specific preventive behaviors to limit chances of infection. The objectives of this study were to (1) create an index of Lyme disease prevention behaviors (LDPB), and (2) use the theory of planned behavior (TPB) to explain the decision-making process of people who choose to adopt LDPB. METHODS: A sample of 1959 adults living in a Lyme disease risk area completed a questionnaire by phone (n = 1003) or on the Web (n = 956). The questionnaire measured whether they did or did not adopt the LDPB proposed by public health officials. It also measured some TPB variables, including their attitude or perceived social norms regarding LDPB. RESULTS: Our findings led to the creation of a Lyme disease prevention index consisting of 10 behaviors, down from the 19 behaviors initially considered for inclusion in the index. Rates of adoption of each behavior varied tremendously, from 4.30 to 83.80%. All variables of the TPB model (attitude, social norms, and perceived control) were significantly associated with intention to adopt preventive behaviors. Intention itself was significantly associated with adoption of LDPB. Likewise, risk perception was positively correlated with the adoption of LDPB. CONCLUSIONS: This study led to the creation of a Lyme disease prevention index that can be used by public health agencies, researchers, and professionals to monitor the evolution over time of individuals' LDPB adoption rates. It also showed the usefulness of the TPB in understanding the adoption of LDPB and how intention to adopt such behaviors is formed.

Evidence needed for antimicrobial resistance surveillance systems.

One Health surveillance for antimicrobial resistance has been promoted by the scientific community and by international organizations for more than a decade. In this article, we highlight issues that need to be addressed to improve the understanding of the effectiveness of One Health surveillance for antimicrobial resistance. We also outline the evidence needed to support countries planning to increase the level of integration of their surveillance system. Based on experience in Canada and other countries, we argue that more effort is needed to understand and measure the added value of One Health for antimicrobial resistance surveillance and to identify the most effective integration strategies. To date, guidelines for the development of One Health surveillance have focused mainly on the types of data that should be integrated. However, it may be necessary to apply the concept of One Health to surveillance tasks beyond data integration to realize the full value of the approach. Integration can be enhanced across different surveillance activities (data collection, analysis, interpretation and dissemination), taking account of the different skills and perspectives of experts and stakeholders involved. More research is needed to investigate the mechanisms through which a One Health approach to surveillance can increase the performance of antimicrobial resistance surveillance and, ultimately, improve health outcomes.

Cela fait plus de dix ans que la communauté scientifique et les organisations internationales préconisent l'application de l'approche «Un monde, une santé¼ à la surveillance de la résistance aux antimicrobiens. Cet article souligne les éléments à considérer pour mieux comprendre l'efficacité d'une surveillance fondée sur cette approche. Nous y évoquons également les données requises pour éclairer les pays dans la définition de leurs plans nationaux afin d'améliorer le niveau d'intégration de leur système de surveillance. À partir de l'expérience du Canada et d'autres pays, nous estimons que des efforts doivent encore être faits pour comprendre et mesurer la véritable valeur ajoutée de l'approche «Un monde, une santé¼ dans le cadre de la surveillance de la résistance aux antimicrobiens et afin d'identifier les stratégies d'intégration les plus efficaces. À ce jour, les lignes directrices pour l'établissement d'une surveillance fondée sur cette approche se sont principalement axées sur les types de données qui devraient être intégrées. Néanmoins, pour exploiter toute la valeur de cette approche, il pourrait être utile d'appliquer le concept «Un monde, une santé¼ aux activités de surveillance au-delà de la simple intégration des données. Une meilleure intégration peut être obtenue au niveau des différentes activités de surveillance (collecte, analyse, interprétation et diffusion des données) en tenant compte des différentes compétences et des différents points de vue des experts et des parties prenantes. De nouvelles recherches sont nécessaires pour comprendre les mécanismes par lesquels l'approche «Un monde, une santé¼ appliquée à la surveillance peut améliorer les performances de la surveillance de la résistance aux antimicrobiens et, en fin de compte, améliorer les résultats de santé.

La comunidad científica y las organizaciones internacionales han promovido durante más de una década la vigilancia sanitaria de la resistencia a los antimicrobianos. En este artículo, destacamos las cuestiones que deben abordarse para mejorar la comprensión de la eficacia de la vigilancia de la resistencia a los antimicrobianos de One Health. También esbozamos las pruebas necesarias para apoyar a los países que planean aumentar el nivel de integración de su sistema de vigilancia. Basándonos en la experiencia de Canadá y de otros países, sostenemos que se necesitan más esfuerzos para comprender y medir el valor agregado de One Health para la vigilancia de la resistencia a los antimicrobianos y para identificar las estrategias de integración más eficaces. Hasta la fecha, las directrices para el desarrollo de vigilancia de One Health se han centrado principalmente en los tipos de datos que deben integrarse. Sin embargo, puede ser necesario aplicar el concepto de One Health a tareas de vigilancia que van más allá de la integración de datos para aprovechar todo el valor del enfoque. La integración puede mejorarse en las diferentes actividades de vigilancia (recopilación, análisis, interpretación y difusión de datos), teniendo en cuenta las diferentes competencias y perspectivas de los expertos y las partes interesadas. Se necesita más investigación para estudiar los mecanismos mediante los cuales un enfoque de vigilancia de One Health puede aumentar el rendimiento de la vigilancia de la resistencia a los antimicrobianos y, en última instancia, mejorar los resultados sanitarios.

Acceptability of tick control interventions to prevent Lyme disease in Switzerland and Canada: a mixed-method study.

BACKGROUND: Lyme disease control strategies may include tick control interventions in high risk areas. Public authorities may be interested to assess how these types of interventions are perceived by the public which may then impact their acceptability. The aims of this paper are to compare socio-cognitive factors associated with high acceptability of tick control interventions and to describe perceived issues that may explain their low acceptability in populations living in two different regions, one being an endemic region for LD since the last 30 years, the Neuchâtel canton, in Switzerland, and another where the disease is emerging, the Montérégie region, in Canada. METHODS: A mixed methods' design was chosen. Quantitative data were collected using web-surveys conducted in both regions (n = 814). Multivariable logistic regressions were used to compare socio-cognitive factors associated with high acceptability of selected interventions. Qualitative data were collected using focus group's discussions to describe perceived issues relative to these interventions. RESULTS: Levels of acceptability in the studied populations were the lowest for the use of acaricides and landscaping and were under 50 % in both regions for six out of eight interventions, but were higher overall in Montérégie. High perceived efficacy of the intervention was strongly associated with high acceptability of tick control interventions. A high perceived risk about LD was also associated with a high acceptability of intervention under some models. High level of knowledge about LD was negatively associated with high acceptability of the use of acaricides in Neuchâtel. Perceived issues explaining low acceptability included environmental impacts, high costs to the public system, danger of individual disempowerment and perceptions that tick control interventions were disproportionate options for the level of LD risk. CONCLUSION: This study suggests that the perceived efficacy and LD risk perception may be key factors to target to increase the acceptability of tick control interventions. Community-level issues seem to be important considerations driving low acceptability of public health interventions. Results of this study highlight the importance for decision-makers to account for socio-cognitive factors and perceived issues that may affect the acceptability of public health interventions in order to maximize the efficacy of actions to prevent and control LD.

Factors associated with preventive behaviors regarding Lyme disease in Canada and Switzerland: a comparative study.

BACKGROUND: Lyme disease (LD) is a vector-borne disease that is endemic in many temperate countries, including Switzerland, and is currently emerging in Canada. This study compares the importance of knowledge, exposure and risk perception for the adoption of individual preventive measures, within and between two different populations, one that has been living in a LD endemic region for several decades, the Neuchâtel canton in Switzerland, and another where the disease is currently emerging, the Montérégie region in the province of Québec, Canada. METHODS: A web-based survey was carried out in both study regions (814 respondents) in 2012. Comparative analysis of the levels of adoption of individual preventive measures was performed and multivariable logistic regression analyses were used to test and compare how knowledge, exposure and risk perception were associated with the adoption of selected measures in both regions and globally. RESULTS: In Montérégie, the proportion of reported adoption of five of the most commonly recommended preventive measures varied from 6% for 'applying acaricides on one's property' to 49% for 'wearing protective clothing', and in Neuchâtel, proportions ranged from 6% (acaricides) to 77% for 'checking for ticks (tick check)'. Differences were found within gender, age groups and exposure status in both regions. The perceived efficacy of a given measure was the strongest factor associated with the adoption of three specific preventive behaviors for both regions: tick check, protective clothing and tick repellent. Risk perception and a high level of knowledge about LD were also significantly associated with some of these specific behaviors, but varied by region. CONCLUSIONS: These results strongly suggest that social and contextual factors such as the epidemiological status of a region are important considerations to take into account when designing effective prevention campaigns for Lyme disease. It furthermore underlines the importance for public health authorities to better understand and monitor these factors in targeted populations in order to be able to implement preventive programs that are well adapted to a population and the epidemiological contexts therein.

From Lyme disease emergence to endemicity: a cross sectional comparative study of risk perceptions in different populations.

BACKGROUND: Lyme disease (LD) is a tick-borne emerging disease in Canada that has been endemic in many temperate countries for decades. Currently, one of the main approaches for LD prevention is the promotion of individual-level preventive behaviors against ticks. Health behaviors are influenced by individual and social factors, one important of which is risk perception. This study aims to describe and compare risk perception of LD, within and between general populations and experts living in two different regions: the Neuchâtel canton in Switzerland, where LD is endemic, and the Montérégie region in Québec (Canada), where LD is emerging. METHOD: A web-based survey was conducted in both study regions (814 respondents) in 2012, and a questionnaire was administered to 16 experts. Comparative analyses of knowledge, risk exposure and different components of LD risk perception were performed. Multivariate analyses were used to calculate a global risk perception score and to identify determinants of risk perception in both regions. RESULTS: In Montérégie, only 15% of the survey respondents had a good level of knowledge of LD compared to Neuchâtel where 51% of survey respondents had good levels of knowledge. In Montérégie, 24% of respondents perceived themselves as being at high or very high risk of contracting LD vs 54% in Neuchâtel; however, a higher percentage of respondents from this region believed that personal protection was simple to carry out (73% vs 58% in Montérégie). Based on the population surveys, almost all of the identified determinants of risk perception were different between both populations except for gender. A good level of knowledge, living in the risk zone and knowing someone who has had LD increased risk perception, while a high level of education and being 18-34 years of age decreased this perception. The majority of the studied components of risk perception were different between populations and their regional experts. CONCLUSION: This study suggests that risk perception of LD differs between populations and regional experts living in different epidemiological situations. Monitoring of knowledge and risk perception in local populations may help to better target LD communication efforts in accordance with population specific attributes thereby enhancing prevention efficacy.

Pharmacological studies and pharmacokinetic modelling to support the development of interventions targeting ecological reservoirs of Lyme disease.

The development of interventions targeting reservoirs of Borrelia burgdorferi sensu stricto with acaricide to reduce the density of infected ticks faces numerous challenges imposed by ecological and operational limits. In this study, the pharmacokinetics, efficacy and toxicology of fluralaner were investigated in Mus musculus and Peromyscus leucopus mice, the main reservoir of B. burgdorferi in North America. Fluralaner showed rapid distribution and elimination, leading to fast plasma concentration (Cp) depletion in the first hours after administration followed by a slow elimination rate for several weeks, resulting in a long terminal half-life. Efficacy fell below 100% while Cp (± standard deviation) decreased from 196 ± 54 to 119 ± 62 ng/mL. These experimental results were then used in simulations of fluralaner treatment for a duration equivalent to the active period of Ixodes scapularis larvae and nymphs. Simulations showed that doses as low as 10 mg/kg have the potential to protect P. leucopus against infestation for a full I. scapularis active season if administered at least once every 7 days. This study shows that investigating the pharmacology of candidate acaricides in combination with pharmacokinetic simulations can provide important information to support the development of effective interventions targeting ecological reservoirs of Lyme disease. It therefore represents a critical step that may help surpass limits inherent to the development of these interventions.

Lime for Lyme: Treatment of Leaf Litter with Dolomitic Lime Powder Impairs Activity of Immature Ixodes scapularis Ticks.

Background: Tick-borne diseases are an emerging threat to public health throughout the temperate world, leading to a growing field of research aimed at developing and testing intervention strategies for reducing human-tick encounters or prevalence of infection in ticks. Various wide-spectrum chemical acaricides have proven effective for controlling tick populations, but many of these have potential deleterious side-effects on health and the environment. In addition to chemical acaricides, certain compounds such as diatomaceous earth have been shown to have physical acaricidal properties. We hypothesized that dolomitic lime (CaMg(CO3)2, a corrosive, desiccant mineral that is already used extensively in agricultural and forestry contexts to balance the pH of soils, may affect ticks' locomotory activity, habitat position, or survival and that this should manifest as a reduction in the number of questing ticks collected by dragging. Objective: This study aimed to formally assess this hypothesis in a controlled laboratory setting. Methods: We carried out a microcosm experiment, with one control and three treated microcosm trays, each replicating the natural substrate characterizing I. scapularis habitat in northeastern North America. Each tray was infested with 200 living larvae and 50 nymphs, and then treated with 0 (control), 50, 100, or 500 g/m2 of lime powder. Ticks were collected by microdragging 24 and 72 h postliming. Results: Efficacy of liming at reducing the number of collected questing ticks ranged from 87% to 100% for larvae and 0% to 69% for nymphs 24 h postliming and from 91% to 93% for larvae and -47% to 65% for nymphs 72 postliming. Conclusion: This study provides the first experimental evidence of the potential efficacy of liming for impairing activity of questing immature ticks. Given that lime is a low-cost material, that methods for widespread application in deciduous woodlands already exist, and that it has been documented as having a limited negative impact on the environment, further assessment of lime application as a public health risk reduction intervention for tick-borne diseases is warranted.

Self-reported tick exposure as an indicator of Lyme disease risk in an endemic region of Quebec, Canada.

BACKGROUND: Lyme disease (LD) and other tick-borne diseases are emerging across Canada. Spatial and temporal LD risk is typically estimated using acarological surveillance and reported human cases, the former not considering human behavior leading to tick exposure and the latter occurring after infection. OBJECTIVES: The primary objective was to explore, at the census subdivision level (CSD), the associations of self-reported tick exposure, alternative risk indicators (predicted tick density, eTick submissions, public health risk level), and ecological variables (Ixodes scapularis habitat suitability index and cumulative degree days > 0 °C) with incidence proportion of LD. A secondary objective was to explore which of these predictor variables were associated with self-reported tick exposure at the CSD level. METHODS: Self-reported tick exposure was measured in a cross-sectional populational health survey conducted in 2018, among 10,790 respondents living in 116 CSDs of the Estrie region, Quebec, Canada. The number of reported LD cases per CSD in 2018 was obtained from the public health department. Generalized linear mixed-effets models accounting for spatial autocorrelation were built to fulfill the objectives. RESULTS: Self-reported tick exposure ranged from 0.0 % to 61.5 % (median 8.9 %) and reported LD incidence rates ranged from 0 to 324 cases per 100,000 person-years, per CSD. A positive association was found between self-reported tick exposure and LD incidence proportion (ß = 0.08, CI = 0.04,0.11, p < 0.0001). The best-fit model included public health risk level (AIC: 144.2), followed by predicted tick density, ecological variables, self-reported tick exposure and eTick submissions (AIC: 158.4, 158.4, 160.4 and 170.1 respectively). Predicted tick density was the only significant predictor of self-reported tick exposure (ß = 0.83, CI = 0.16,1.50, p = 0.02). DISCUSSION: This proof-of-concept study explores self-reported tick exposure as a potential indicator of LD risk using populational survey data. This approach may offer a low-cost and simple tool for evaluating LD risk and deserves further evaluation.

Towards an actionable One Health approach.

BACKGROUND: Despite the increasing focus on strengthening One Health capacity building on global level, challenges remain in devising and implementing real-world interventions particularly in the Asia-Pacific region. Recognizing these gaps, the One Health Action Commission (OHAC) was established as an academic community for One Health action with an emphasis on research agenda setting to identify actions for highest impact. MAIN TEXT: This viewpoint describes the agenda of, and motivation for, the recently formed OHAC. Recognizing the urgent need for evidence to support the formulation of necessary action plans, OHAC advocates the adoption of both bottom-up and top-down approaches to identify the current gaps in combating zoonoses, antimicrobial resistance, addressing food safety, and to enhance capacity building for context-sensitive One Health implementation. CONCLUSIONS: By promoting broader engagement and connection of multidisciplinary stakeholders, OHAC envisions a collaborative global platform for the generation of innovative One Health knowledge, distilled practical experience and actionable policy advice, guided by strong ethical principles of One Health.

Multi-criteria decision analysis as an innovative approach to managing zoonoses: results from a study on Lyme disease in Canada.

BACKGROUND: Zoonoses are a growing international threat interacting at the human-animal-environment interface and call for transdisciplinary and multi-sectoral approaches in order to achieve effective disease management. The recent emergence of Lyme disease in Quebec, Canada is a good example of a complex health issue for which the public health sector must find protective interventions. Traditional preventive and control interventions can have important environmental, social and economic impacts and as a result, decision-making requires a systems approach capable of integrating these multiple aspects of interventions. This paper presents the results from a study of a multi-criteria decision analysis (MCDA) approach for the management of Lyme disease in Quebec, Canada. MCDA methods allow a comparison of interventions or alternatives based on multiple criteria. METHODS: MCDA models were developed to assess various prevention and control decision criteria pertinent to a comprehensive management of Lyme disease: a first model was developed for surveillance interventions and a second was developed for control interventions. Multi-criteria analyses were conducted under two epidemiological scenarios: a disease emergence scenario and an epidemic scenario. RESULTS: In general, we observed a good level of agreement between stakeholders. For the surveillance model, the three preferred interventions were: active surveillance of vectors by flagging or dragging, active surveillance of vectors by trapping of small rodents and passive surveillance of vectors of human origin. For the control interventions model, basic preventive communications, human vaccination and small scale landscaping were the three preferred interventions. Scenarios were found to only have a small effect on the group ranking of interventions in the control model. CONCLUSIONS: MCDA was used to structure key decision criteria and capture the complexity of Lyme disease management. This facilitated the identification of gaps in the scientific literature and enabled a clear identification of complementary interventions that could be used to improve the relevance and acceptability of proposed prevention and control strategy. Overall, MCDA presents itself as an interesting systematic approach for public health planning and zoonoses management with a "One Health" perspective.

Knowledge, attitudes, and practices regarding dogs and dog bites in Indigenous northern communities: A mixed methods study.

Introduction: The singular relationship developed over the years between northern Indigenous peoples and dogs has been profoundly changed through historical trauma, settlements and increased use of snowmobiles. Issues related to dogs have become increasingly complex and worrisome with the endemic presence of the rabies virus among Arctic fox populations, and given the fact that northern Indigenous peoples may have a higher risk of dog bites than the general population. This study aimed to investigate factors related to the risk of dog bites in Naskapi and Innu communities located in northern Quebec (Canada) by (1) describing the knowledge, attitudes and practices (KAP) regarding dogs and dog bites in these communities, and (2) analyzing experiences of inhabitants and health professionals with regard to dog bites and their management. Methods: A mixed methods study design that combined an observational cross-sectional survey and individual interviews was used. The survey collected data on KAP regarding dogs and dog bites among 122 respondents. Individual interviews (n = 37) were then conducted with victims of dog bites, owners of dogs that have bitten a person before, and health professionals. Descriptive and inferential analysis (quantitative data) and thematic analysis (qualitative data) were performed. Results and discussion: Results highlighted that 21% of respondents have had a dog bite in their lifetime. Most respondents were not aware of the risk of contracting rabies following a dog bite, although rabies risk perception was associated with risk perception of dogs (linear regression: coefficient = 0.69, 95% CI = 0.36-1.02). The odds of being more knowledgeable on rabies were higher (logistic regression: OR = 2.92, 95% CI = 1.07-7.98) among young adults. Dogs were perceived as both threats and protectors by community members. When the fear of dogs was present, it affected the quality of life of some inhabitants. There was confusion about responsibilities in the management of biting dogs, although protocols to follow after a bite were clear for health care professionals. This study revealed a lack of awareness and knowledge about dog bites and rabies risks in both communities. Results provide important knowledge for the development of interventions adapted to northern Indigenous communities.

Barriers and opportunities for improving dog bite prevention and dog management practices in northern Indigenous communities.

Globally, people living in northern Indigenous communities are at higher risk of dog bites than the rest of the population living in North America, with annual incidence ranging from 0.61 to 59.6/10,000 inhabitants. Considering that rabies is endemic in wild canid populations in certain regions of the Arctic, the prevention of dog bites and the management of dog populations are of crucial importance for public health in these contexts. Most northern communities lack access to veterinary services, mainly due to their remote geographical location and to limited financial resources. Currently, northern Indigenous communities are using different approaches and strategies to prevent dog bites and manage dog populations, but the effectiveness of these approaches sometimes lacks evidence, and their low acceptability may affect their implementation. This study aims to describe (1) the current access and uses of veterinary services, and (2) the perceived barriers and opportunities related to dog population management practices currently implemented, or that could be implemented, in a Naskapi community and an Innu community located in northern Quebec (Canada). Quantitative data were collected through a survey to inhabitants on veterinary services (n = 122). Qualitative data were collected using individual interviews to inhabitants and health professionals to describe how dog population management measures were perceived, and to identify barriers and opportunities related to their implementation (n = 37). Descriptive and inferential analysis (quantitative data) and thematic analysis (qualitative data) were performed. Results show that the two main measures implemented at the time of the study - dog culling and short-duration veterinary clinics - were not perceived as fully acceptable and sustainable. Reinforcing access to veterinary services and other dog-related services, such as shelters and training programs on dogs, was identified as a need to improve dog bites prevention and dog population management in remote Indigenous communities. The implementation of animal health measures should be decided by concerned Indigenous communities to follow decolonial practices. It includes ensuring informed consent of dog owners, improving communication before, during and after interventions, separating veterinary services from rehoming and, most importantly giving back to Indigenous communities the complete leadership over animal health in their communities.

Integrated human behavior and tick risk maps to prioritize Lyme disease interventions using a 'One Health' approach.

Lyme disease (LD) risk is emerging rapidly in Canada due to range expansion of its tick vectors, accelerated by climate change. The risk of contracting LD varies geographically due to variability in ecological characteristics that determine the hazard (the densities of infected host-seeking ticks) and vulnerability of the human population determined by their knowledge and adoption of preventive behaviors. Risk maps are commonly used to support public health decision-making on Lyme disease, but the ability of the human public to adopt preventive behaviors is rarely taken into account in their development, which represents a critical gap. The objective of this work was to improve LD risk mapping using an integrated social-behavioral and ecological approach to: (i) compute enhanced integrated risk maps for prioritization of interventions and (ii) develop a spatially-explicit assessment tool to examine the relative contribution of different risk factors. The study was carried out in the Estrie region located in southern Québec. The blacklegged tick, Ixodes scapularis, infected with the agent of LD is widespread in Estrie and as a result, regional LD incidence is the highest in the province. LD knowledge and behaviors in the population were measured in a cross-sectional health survey conducted in 2018 reaching 10,790 respondents in Estrie. These data were used to create an index for the social-behavioral component of risk in 2018. Local Empirical Bayes estimator technique were used to better quantify the spatial variance in the levels of adoption of LD preventive activities. For the ecological risk analysis, a tick abundance model was developed by integrating data from ongoing long-term tick surveillance programs from 2007 up to 2018. Social-behavioral and ecological components of the risk measures were combined to create vulnerability index maps and, with the addition of human population densities, prioritization index maps. Map predictions were validated by testing the association of high-risk areas with the current spatial distribution of human cases of LD and reported tick exposure. Our results demonstrated that social-behavioral and ecological components of LD risk have markedly different distributions within Estrie. The occurrence of human LD cases or reported tick exposure in a municipality was positively associated with tick density and the prioritization risk index (p < 0.001). This research is a second step towards a more comprehensive integrated LD risk assessment approach, examining social-behavioral risk factors that interact with ecological risk factors to influence the management of emerging tick-borne diseases, an approach that could be applied more widely to vector-borne and zoonotic diseases.

The added value of One Health surveillance: data from questing ticks can provide an early signal for anaplasmosis outbreaks in animals and humans.

OBJECTIVE: In 2021, a first outbreak of anaplasmosis occurred in animals and humans in southern Québec, with 64% of confirmed human cases located in Bromont municipality. Ixodes scapularis ticks and Peromyscus mouse ear biopsies collected in Bromont from 2019 to 2021 were analyzed for Anaplasma phagocytophilum (Ap) with the objective of determining whether an early environmental signal could have been detected before the outbreak. METHODS: Samples were collected for a concurrent study aiming to reduce Lyme disease risk. Between 2019 and 2021, up to 14 experimental sites were sampled for ticks and capture of small mammals took place on three sites in 2021. Samples were screened for Ap using multiplex real-time PCR, and genetic strains were identified using a single-nucleotide polymorphism assay. RESULTS: Analyses showed an increase of 5.7% in Ap prevalence in ticks (CI95: 1.5-9.9) between 2019 and 2020, i.e., one year before the outbreak. A majority of Ap-positive ticks were infected with the zoonotic strain (68.8%; CI95: 50.0-83.9) during the study period. In 2021, 2 of 59 captured Peromycus mice were positive for Ap, for a prevalence of 3.4% (CI95: 0.4-11.7). CONCLUSION: We conclude that data collected in Bromont could have provided an early signal for an anaplasmosis risk increasing in the targeted region. This is a reminder that integrated surveillance of tick-borne diseases through structured One Health programs, i.e. systematically integrating data from humans, animals and the environment, can provide useful and timely information for better preparedness and response in public health.

RéSUMé: OBJECTIF: En 2021, suivant une éclosion d'anaplasmoses chez les animaux et les humains dans le sud du Québec, des tiques de l'espèce Ixodes scapularis et des biopsies de souris Peromyscus spp. échantillonées à Bromont, la municipalité où 64 % des cas humains confirmés était localisé, ont été testées pour Anaplasma phagocytophilum (Ap) avec pour objectif de déterminer si un signal environnemental précoce d'augmentation du risque aurait pu être détecté avant l'éclosion. MéTHODE: L'échantillonnage a été réalisé dans le cadre d'une étude visant à réduire le risque de maladie de Lyme. De 2019 à 2021, 14 sites expérimentaux ont été échantillonnés pour les tiques. En 2021, trois sites ont été sélectionnés pour la capture des micromammifères. Les échantillons ont été testés pour la présence d'Ap à l'aide d'un PCR multiplex en temps réelle et les lignées génétiques ont été identifiées grâce à un test de polymorphisme mononucléotidique. RéSULTATS: Les analyses ont montré une augmentation de 5,7 % (IC95% : 1,5­9,9) de la prévalence de Ap entre 2019 et 2020, c'est-à-dire un an avant l'éclosion. Cette augmentation est associée à la présence d'une majorité d'Ap de la lignée zoonotique (68,8 %; IC95% : 50,0­83,9) sur l'ensemble de la période étudiée. En 2021, deux Peromycus spp. capturées sur 59 étaient positives pour Ap pour une prévalence de 3,4 % (IC95% : 0,4­11,7). CONCLUSION: Les données environnementales échantillonnées à Bromont auraient pu fournir un signal précoce de l'augmentation du risque d'anaplasmose dans la région. C'est un rappel que la surveillance intégrée des maladies transmises par les tiques inspirée de l'approche Une seule santé, intégrant systématiquement des données humaines, animales et environnementales, peut fournir des informations utiles et opportunes aux autorités de santé publique.