How can gender considerations be better integrated into animal health emergency preparedness and response?

Global and national authorities have not historically approached animal health emergencies through a gendered lens. Yet these events almost certainly have gendered dimensions, such as differential engagement of women or men depending on their culturally accepted or assigned roles for animal care; risk of exposure to zoonoses; and access to emergency resources during response and recovery. Despite the role that gender seems to play with respect to animal health emergencies, little research has been conducted to better understand such dynamics, and little policy has been promulgated to address it in a way that optimizes response while ensuring equitable outcomes. This piece summarizes 3 key themes that emerged from a panel discussion on gender and animal health emergencies at the World Organisation for Animal Health Global Conference on Emergency Management in April 2023. These themes were differential gendered exposure to pathogens; a lack of equitable gender representation in animal health decision-making; and enhancement of pathways for recognizing gender in national and international actions in preparing for, detecting, and responding to animal health emergencies. Beyond increasing opportunities for women to engage in leadership, the animal health and veterinary communities will benefit from connecting practitioners with gender experts to develop more integrative approaches to emergency preparedness and management. Animal health professionals should also advocate for further research to elucidate gender-specific dynamics in human populations in the context of animal emergencies and the promulgation of evidence-based policies. Such transformative efforts will lead to better outcomes for all people who depend on and provide care for animals.

Seroprevalence of Mycoplasma hyopneumoniae in sows fifteen years after implementation of a control programme for enzootic pneumonia in Switzerland.

Mycoplasma hyopneumoniae is the etiological agent of enzootic pneumonia (EP), an economically important chronic respiratory disease in pigs. M. hyopneumoniae impacts the mucociliary clearance system by disrupting the cilia and modulates the immune response, resulting in intermittent dry non-productive cough. For progressive control of EP in Switzerland, a corresponding programme was fully implemented in 2004. It is based on total depopulation strategies of affected fattening farms as well as partial depopulation in breeding farms. Surveillance of EP status in Switzerland is mainly based on real-time PCR of nasal swabs from coughing animals or suspicious lungs and thereby sporadic cases are still observed every year. In order to obtain information on the seroprevalence, serum samples of 5021 sows from 968 farms collected in 2018 at eight different slaughterhouses were analyzed for the presence of M. hyopneumoniae-specific antibodies using a commercial ELISA kit. The overall seroprevalence was low with 0.98% of sows testing positive and these seropositive animals could be allocated to 3.92% of farms tested. Most seropositive farms presented weakly positive singleton reactors and only one farm showed several strongly seropositive animals. In conclusion, the serological status mirrors the successful progressive control of M. hyopneumoniae in the Swiss domestic pig population over the years. The current study underlines the added value of serological testing in the surveillance of EP in a country with low prevalence and confirms the sustained benefit of strategic control programmes.

Does having a cat in your house increase your risk of catching COVID-19?

Due to the zoonotic origin of SARS-Coronavirus 2 (SARS-CoV-2), the potential for its transmission from humans back to animals and the possibility that it might establish ongoing infection pathways in other animal species has been discussed. Cats are highly susceptible to SARS-CoV-2 and were shown experimentally to transmit the virus to other cats. Infection of cats has been widely reported. Domestic cats in COVID-19-positive households could therefore be a part of a human to animal to human transmission pathway. Here, we report the results of a qualitative risk assessment focusing on the potential of cat to human transmission in such settings. The assessment was based on evidence available by October 2021. After the introduction of SARS-CoV-2 to a household by a human, cats may become infected and infected cats may pose an additional infection risk for other members of the household. In order to assess this additional risk qualitatively, expert opinion was elicited within the framework of a modified Delphi procedure. The conclusion was that the additional risk of infection of an additional person in a household associated with keeping a domestic cat is very low to negligible, depending on the intensity of cat-to-human interactions. The separation of cats from humans suffering from SARS-CoV-2 infection should contribute to preventing further transmission.

Evaluating Integrated Surveillance for Antimicrobial Use and Resistance in England: A Qualitative Study.

Integrated surveillance systems for antimicrobial use (AMU) and antimicrobial resistance (AMR) require regular evaluation to ensure the effectiveness and efficiency of the system. An important step in the evaluation is to choose an appropriate tool for the purpose of the evaluation. The "Integrated Surveillance System Evaluation" (ISSE) framework is a conceptual framework that was developed to evaluate One Health (OH) integration in surveillance system for AMU/AMR. This study aimed to evaluate the performance and value of integrated surveillance system for AMU/AMR in England by applying the ISSE framework, which was used to develop data collection protocols and define the study design. A qualitative study using semi-structured interviews was conducted to collect the data and analyse it thematically. Eighteen stakeholders from human, animal, food and environment sectors that are involved in AMU/AMR surveillance were interviewed. Four main themes emerged from the analysis: (1) Cross-sectoral integration in the surveillance system for AMU/AMR; (2) Production of OH outputs and outcomes; (3) Drivers and barriers to cross-sectoral collaboration; and 4) Need for more cross-sectoral collaboration. The findings showed that there were links between integrated surveillance information, decision making and interventions. However, there were only few OH examples, such as the UK AMR contingency plan, where the potential of cross-sectoral collaboration was fully exploited. A lot of the benefits described were related to the generation of information and increase in knowledge and understanding without links to how the information generated was used. While these intangible benefits have a value on their own, being able to link surveillance information and mitigation measures would help to enhance the value of integrated surveillance. In terms of improvement, the main areas identified were the development of more harmonised methods for data collection and analysis, provision of resources dedicated to cross-sectoral collaboration, improved coordination, and collection of surveillance data from the environment and from companion animals. By identifying links between OH surveillance information produced and various outputs and outcomes; this study helped to understand the wider benefits of integrated surveillance for AMU/AMR in England and provided insights on how the system could be improved and efficiency increased.

Income compensation options and partial budget analysis following a reduction of antimicrobial sales at the veterinary practice level.

Over the years, the excessive consumption of antimicrobials (AM) by animals and humans has become a major concern at the global level, and several studies have highlighted the link between antimicrobial use (AMU) and antimicrobial resistance. Previous studies showed that, in Switzerland, every calf in the fattening process received in average seven days of AM treatment, and mainly oral group treatments. Therefore, policies to reduce the consumption of AM among veal calves should be implemented and promoted to decrease AM pressure on the microbiome. This study aimed to assess how a potential loss of income due to a reduction of AM prescriptions and sales in the Swiss veal calves sector could potentially be compensated. Partial budget models at the veterinary practice level were built to evaluate the effect on the net profit of veterinary practices, following four different national policy interventions that aim to reduce AM prescriptions for veal calves. The best-case scenarios resulted in a positive net profit. The scenarios assuming complete loss of profit from AM sales resulted in very low or negative net profit. Therefore, without financial support (e.g. through the government or other entities), veterinarians are likely to find it difficult to fully compensate the economic losses. At the practice level, income compensation mechanisms require a fundamental change of the business model. New model should be largely independent of pharmaceutical sales and should promote paid counselling on herd health management.

Evaluating the Integration of One Health in Surveillance Systems for Antimicrobial Use and Resistance: A Conceptual Framework.

It is now widely acknowledged that surveillance of antimicrobial resistance (AMR) must adopt a "One Health" (OH) approach to successfully address the significant threats this global public health issue poses to humans, animals, and the environment. While many protocols exist for the evaluation of surveillance, the specific aspect of the integration of a OH approach into surveillance systems for AMR and antimicrobial Use (AMU), suffers from a lack of common and accepted guidelines and metrics for its monitoring and evaluation functions. This article presents a conceptual framework to evaluate the integration of OH in surveillance systems for AMR and AMU, named the Integrated Surveillance System Evaluation framework (ISSE framework). The ISSE framework aims to assist stakeholders and researchers who design an overall evaluation plan to select the relevant evaluation questions and tools. The framework was developed in partnership with the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). It consists of five evaluation components, which consider the capacity of the system to: [1] integrate a OH approach, [2] produce OH information and expertise, [3] generate actionable knowledge, [4] influence decision-making, and [5] positively impact outcomes. For each component, a set of evaluation questions is defined, and links to other available evaluation tools are shown. The ISSE framework helps evaluators to systematically assess the different OH aspects of a surveillance system, to gain comprehensive information on the performance and value of these integrated efforts, and to use the evaluation results to refine and improve the surveillance of AMR and AMU globally.

Characterisation and mapping of the surveillance system for antimicrobial resistance and antimicrobial use in the United Kingdom.

BACKGROUND: Surveillance of antimicrobial resistance (AMR) is an essential component of any strategy to mitigate AMR and needs regular evaluation to ensure its effectiveness. A first step for any evaluation is to describe the system and context. In this study, we aimed to characterise and map the surveillance system for AMR and antimicrobial use (AMU) in the United Kingdom (UK) using a One Health (OH) approach and to identify integration points in the system. METHODS: To describe the surveillance system for AMR/AMU, international guidelines for establishing surveillance systems for AMR and AMU were used. A review of the literature was conducted to collect information on the different parameters identified. RESULTS: Multiple data collection systems exist for AMU and AMR in humans, animals and food. Each sector is responsible for the planning, implementation, analysis and reporting of its own surveillance for AMR and AMU. Some cross-sectoral collaborative activities exist such as the UK AMR contingency plan and the publication of UK OH reports; there are opportunities for further integration such as the harmonisation of data analyses methods and interpretation across sectors and the publication of joint surveillance reports. CONCLUSION: This overview of key stakeholders, data collection streams, reporting, linkages within and across sectors and international monitoring forms an important basis for future evaluation of the UK AMR/AMU surveillance system from a OH perspective.

Monitoring of Farm-Level Antimicrobial Use to Guide Stewardship: Overview of Existing Systems and Analysis of Key Components and Processes.

The acknowledgment of antimicrobial resistance (AMR) as a major health challenge in humans, animals and plants, has led to increased efforts to reduce antimicrobial use (AMU). To better understand factors influencing AMR and implement and evaluate stewardship measures for reducing AMU, it is important to have sufficiently detailed information on the quantity of AMU, preferably at the level of the user (farmer, veterinarian) and/or prescriber or provider (veterinarian, feed mill). Recently, several countries have established or are developing systems for monitoring AMU in animals. The aim of this publication is to provide an overview of known systems for monitoring AMU at farm-level, with a descriptive analysis of their key components and processes. As of March 2020, 38 active farm-level AMU monitoring systems from 16 countries were identified. These systems differ in many ways, including which data are collected, the type of analyses conducted and their respective output. At the same time, they share key components (data collection, analysis, benchmarking, and reporting), resulting in similar challenges to be faced with similar decisions to be made. Suggestions are provided with respect to the different components and important aspects of various data types and methods are discussed. This overview should provide support for establishing or working with such a system and could lead to a better implementation of stewardship actions and a more uniform communication about and understanding of AMU data at farm-level. Harmonization of methods and processes could lead to an improved comparability of outcomes and less confusion when interpreting results across systems. However, it is important to note that the development of systems also depends on specific local needs, resources and aims.

Exposure Pathways to Antimicrobial Resistance at the Human-Animal Interface-A Qualitative Comparison of Swiss Expert and Consumer Opinions.

Antimicrobial resistance (AMR) is an emerging global health concern, affecting both the animal and the human population. Transmission pathways of AMR are therefore abundant and complex, and ways to prevent or reduce transmission to consumers must be identified. The overall goal of this study was to define the content of an intervention study aimed at reducing the transmission of AMR from animal sources to humans. To identify the most relevant pathways, Swiss experts and consumers were interviewed about their opinions on the risks of transmission of AMR. Opinions of experts and consumers were then qualitatively compared and the main gaps identified. The results revealed that Swiss consumers had several misconceptions regarding the sources and transmission of AMR, and that they in particular underestimated the importance of poultry meat and pets as a potential source of AMR. Furthermore, high uncertainty was noted in experts regarding the prevalence of AMR in pets and the potential of transmission to their owners. Consequently, awareness of AMR transmission pathways should be increased among consumers to overcome common misconceptions, which will help reduce the risk of transmission. Further research is needed to better understand the pets' potential to harbor and transmit AMR to their owners, and to identify most effective methods to increase risk awareness in consumers as well as intervention strategies promoting consumer behaviors to mitigate AMR transmissions at the human-animal interface.

To Sample or Not to Sample? An Analysis of the Need for Salmonella Sampling of Smaller Poultry Processors.

Within the European Union (EU), microbiological criteria (MC) sampling for Salmonella in poultry was introduced in 2005. In particular, processors had to meet a target of fewer than seven positive samples out of 50. However, processors producing small amounts of poultry meat did not have to sample if national authorities determined this was an acceptable risk. The U.K. Food Standards Agency (FSA) thus has a sampling regime based on throughput that allows smaller processors not to sample. In 2011, the limit of 7/50 was reduced to 5/50. Given the current uncertainty regarding U.K. trade relations with the EU, the U.K. FSA decided to conduct a new risk assessment of the risks of Salmonella produced by smaller processors, to determine whether sampling was now necessary. Current evidence suggests that an MC sampling regime in smaller slaughterhouses is not warranted from a national public health perspective. Because of the insensitivities of the MC sampling scheme, the introduction of MC sampling into smaller slaughterhouses would only be necessary if the suspected carcass prevalence was 15% or more. While our analysis is prone to uncertainty, we estimated that the carcass prevalence in smaller processors is below this. Thus, we recommended that the current sampling framework, allowing smaller processors not to sample, was still applicable.

Addressing Learning Needs on the Use of Metagenomics in Antimicrobial Resistance Surveillance.

One Health surveillance of antimicrobial resistance (AMR) depends on a harmonized method for detection of AMR. Metagenomics-based surveillance offers the possibility to compare resistomes within and between different target populations. Its potential to be embedded into policy in the future calls for a timely and integrated knowledge dissemination strategy. We developed a blended training (e-learning and a workshop) on the use of metagenomics in surveillance of pathogens and AMR. The objectives were to highlight the potential of metagenomics in the context of integrated surveillance, to demonstrate its applicability through hands-on training and to raise awareness to bias factors. The target participants included staff of competent authorities responsible for AMR monitoring and academic staff. The training was organized in modules covering the workflow, requirements, benefits and challenges of surveillance by metagenomics. The training had 41 participants. The face-to-face workshop was essential to understand the expectations of the participants about the transition to metagenomics-based surveillance. After revision of the e-learning, we released it as a Massive Open Online Course (MOOC), now available at https://www.coursera.org/learn/metagenomics. This course has run in more than 20 sessions, with more than 3,000 learners enrolled, from more than 120 countries. Blended learning and MOOCs are useful tools to deliver knowledge globally and across disciplines. The released MOOC can be a reference knowledge source for international players in the application of metagenomics in surveillance.

Overview of Evidence of Antimicrobial Use and Antimicrobial Resistance in the Food Chain.

Antimicrobial resistance (AMR) is a global health problem. Bacteria carrying resistance genes can be transmitted between humans, animals and the environment. There are concerns that the widespread use of antimicrobials in the food chain constitutes an important source of AMR in humans, but the extent of this transmission is not well understood. The aim of this review is to examine published evidence on the links between antimicrobial use (AMU) in the food chain and AMR in people and animals. The evidence showed a link between AMU in animals and the occurrence of resistance in these animals. However, evidence of the benefits of a reduction in AMU in animals on the prevalence of resistant bacteria in humans is scarce. The presence of resistant bacteria is documented in the human food supply chain, which presents a potential exposure route and risk to public health. Microbial genome sequencing has enabled the establishment of some links between the presence of resistant bacteria in humans and animals but, for some antimicrobials, no link could be established. Research and monitoring of AMU and AMR in an integrated manner is essential for a better understanding of the biology and the dynamics of antimicrobial resistance.

Assessing the Adoption of Recommended Standards, Novel Approaches, and Best Practices for Animal Health Surveillance by Decision Makers in Europe.

Animal health surveillance is an important tool for disease mitigation and helps to promote animal health and welfare, protect human health, support efficient animal production, and enable trade. This study aimed to assess adoption of recommended standards and best practice for surveillance (including risk-based approaches) in Europe. It included scoping interviews with surveillance experts in Denmark, the Netherlands, Norway, and Switzerland to gather information on knowledge acquisition, decisions and implementation of surveillance, and perceptions. This was followed by an online survey among animal health and food safety surveillance users in EU, EEA, and Schengen countries. A total of 166 responses were collected from 27 countries; 111 were eligible for analysis. A strong preference for legislation and established standards was observed, with peer-reviewed publications, conferences, symposia, and workshops to be major sources of information. The majority of respondents indicated a need for international evaluation for surveillance and implied that considerations of cost-effectiveness were essential when making a decision to adopt new surveillance standards. However, most of the respondents did not use a formal evaluation to inform the adoption of new standards or only conducted a descriptive assessment before their implementation or adaptation. Only a few respondents reported a quantitative economic evaluation despite economic efficiency being considered as a highly relevant criterion for surveillance implementation. Constraints mentioned in the adoption of new surveillance standards included insufficient time, financial and human resources, and lack of competency. Researchers aiming to achieve impact by their surveillance work are advised to consider ways of influencing binding standards and to disseminate their work pro-actively using varied channels of engagement tailored to relevant target audiences and their needs. Generally, a more formal linkage between surveillance information and disease mitigation decisions-for example, by using systematic evaluation-could help increase the economic value of surveillance efforts. Finally, a collaborative, international platform for exchange and learning on surveillance as well as co-design and dissemination of surveillance standards is recommended.

Comparison of international legislation and standards on veterinary drug residues in food of animal origin.

Current legislation governing monitoring of drug residues in foodstuff of animal origin is being revised at the European level. This study provides a qualitative comparison of the legislation, public and private standards in the European Union, the United States of America (USA) and the Eurasian Customs Union/Russia. We made a quantitative comparison of Maximum Residue Levels (MRLs) applied in each region for pork kidneys for tetracycline (with a focus on doxycycline), penicillin and chloramphenicol. The Customs Union generally applied lower levels than the other regions, with MRLs for tetracyclines in pig kidneys being 1200 times lower than those applied in the USA. Growing consumer interest and concern about chemicals in their food could be leveraged to support and enhance the implementation of new initiatives to improve veterinary public health. Farmers and veterinarians could help reduce findings of drug residues in meat through the judicious use of preventive actions when using veterinary medicine.

Use of molecular and genomic data for disease surveillance in aquaculture: Towards improved evidence for decision making.

Diagnostic tools for the identification and confirmation of animal diseases have been evolving rapidly over the last decade, with diseases of aquatic animals being no exception. Hence, case definitions used in surveillance may now include molecular and genomic components and ultimately be based on the entire genome of a pathogen. While the opportunities brought on by this change in our ability to define and differentiate organisms are manifold, there are also challenges. These include the need to consider typing tool characteristics during sampling design, but also the re-thinking of diagnostic protocols and standards for the meaningful interpretation of the increasingly complex data presented to surveillance managers. These issues are illustrated for aquaculture using the example of multi-country surveillance of antimicrobial resistance of Aeromonas spp. strains isolated from rainbow trouts (Oncorhynchus mykiss) in Europe. In order to fully exploit the opportunities of molecular and genomic information, a multi-disciplinary approach is needed to develop harmonised diagnostic procedures and modified surveillance designs for aquaculture as well as for terrestrial animal production. This will require adjustments in the relevant standards applicable to assess food safety and trade risks.

A One Health Evaluation of the University of Copenhagen Research Centre for Control of Antibiotic Resistance.

We applied the evaluation framework developed by the EU COST Action "Network of Evaluation of One Health" (NEOH) to assess the operations, supporting infrastructures and outcomes of a research consortium "University of Copenhagen Research Centre for Control of Antibiotic Resistance" (UC-CARE). This 4-year research project was a One Health (OH) initiative with participants from 14 departments over four faculties as well as stakeholders from industry and health authorities aiming to produce new knowledge to reduce the development of antimicrobial resistance (AMR). This was a case study focusing on assessing beneficial and counter-productive characteristics that could affect the OH outcomes. The study was also used to provide feedback to NEOH about the evaluation framework. The framework and evaluation tools are described in the introduction paper of this special journal issue. Data for the evaluation were extracted from the funding research proposal, the mid-term UC-CARE project evaluation report and supplemented with opinions elicited from project participants and stakeholders. Here, we describe the underlying system, theory of change behind the initiative and adapted questions from the NEOH tools that we used for semi-open interviews with consortium members throughout the evaluation process. An online survey was used to obtain information from stakeholders. The NEOH evaluation tools were then used for the qualitative and quantitative evaluation of the OH characteristics of UC-CARE. Senior UC-CARE researchers were interested and willing to be interviewed. Young scientists were more difficult to engage in interviews, and only 25% of stakeholders answered the online survey. Interviewees mentioned that the main benefit of UC-CARE was an increased awareness and general understanding of AMR issues. All interviewees stated that the adopted OH approach was relevant given the complexity of AMR. However, some questioned the applicability, and identified potentially counter-productive issues mainly related to the information sharing, collaboration and working methods across the consortium. A more integrated project organization, more stakeholder involvement and time for the project, flexibility in planning and a dedicated OH coordinator were suggested to allow for more knowledge exchange, potentially leading to a higher societal impact.

Consumer Exposure to Antimicrobial Resistant Bacteria From Food at Swiss Retail Level.

Background: Antimicrobial resistance (AMR) in bacteria is an increasing health concern. The spread of AMR bacteria (AMRB) between animals and humans via the food chain and the exchange of AMR genes requires holistic approaches for risk mitigation. The AMRB exposure of humans via food is currently only poorly understood leaving an important gap for intervention design. Method: This study aimed to assess AMRB prevalence in retail food and subsequent exposure of Swiss consumers in a systematic literature review of data published between 1996 and 2016 covering the Swiss agriculture sector and relevant imported food. Results: Data from 313 out of 9,473 collected studies were extracted yielding 122,438 food samples and 38,362 bacteria isolates of which 30,092 samples and 8,799 isolates were AMR positive. A median AMRB prevalence of >50% was observed for meat and seafood harboring Campylobacter, Enterococcus, Salmonella, Escherichia coli, Listeria, and Vibrio spp. and to a lesser prevalence for milk products harboring starter culture bacteria. Gram-negative AMRB featured predominantly AMR against aminoglycosides, cephalosporins, fluoroquinolones, penicillins, sulfonamides, and tetracyclines observed at AMR exposures scores of levels 1 (medium) and 2 (high) for Campylobacter, Salmonella, E. coli in meat as well as Vibrio and E. coli in seafood. Gram-positive AMRB featured AMR against glycoproteins, lincosamides, macrolides and nitrofurans for Staphylococcus and Enterococcus in meat sources, Staphylococcus in seafood as well as Enterococcus and technologically important bacteria (incl. starters) in fermented or processed dairy products. Knowledge gaps were identified for AMR prevalence in dairy, plant, fermented meat and novel food products and for the role of specific indicator bacteria (Staphylococcus, Enterococcus), starter culture bacteria and their mobile genetic elements in AMR gene transfer. Conclusion: Raw meat, milk, seafood, and certain fermented dairy products featured a medium to high potential of AMR exposure for Gram-negative and Gram-positive foodborne pathogens and indicator bacteria. Food at retail, additional food categories including fermented and novel foods as well as technologically important bacteria and AMR genetics are recommended to be better integrated into systematic One Health AMR surveillance and mitigation strategies to close observed knowledge gaps and enable a comprehensive AMR risk assessment for consumers.

Optimising cost-effectiveness of freedom from disease surveillance-Bluetongue Virus Serotype 8 as an example.

The aim of this study was to propose a procedure for optimising the cost-effectiveness of vector borne disease surveillance using a scenario tree model and cost-effectiveness analysis. The surveillance systems for Bluetongue Virus serotype 8 (BTV-8) implemented in Switzerland and Belgium were used as examples. In twenty four different, simulated population structures, passive surveillance and five designs of active surveillance were investigated. The influence of surveillance system design and parameters such as farmer disease awareness, veterinary disease awareness, herd and within-herd design prevalence on the overall surveillance system sensitivity were assessed. Furthermore, the cost-effectiveness of mandatory and voluntary vaccination regimes in relation to disease surveillance was investigated. Under the assumption that BTV-8 manifests clinically, freedom from disease in a population can be established with almost certainty over the period of one year using clinical surveillance alone. Additional investment in active surveillance would therefore economically only be justified, if no clinical manifestation is suspected or other surveillance objectives are to be provided such as early detection. The best cost-effectiveness is obtained by sampling more herds rather than more animals within a herd. Mandatory vaccination reduces the cost of surveillance by 0.26 € per vaccine and voluntary vaccination only marginally reduces the cost of risk-based surveillance, by reducing the population at risk. Finally, in populations with predominantly dairy cattle, bulk-tank milk testing is the method of choice to actively demonstrate freedom from disease.