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1.
Prev Vet Med ; 174: 104823, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31734519

RESUMO

As part of the development of a quantitative microbial risk assessment (QMRA) model of third-generation cephalosporins (3GC)-resistant Salmonella Heidelberg, a compartmental (SEIR) model for S. Heidelberg transmission within a typical Canadian commercial broiler chicken flock was developed. The model was constructed to estimate the within-flock prevalence and the bacterial concentration in the barn environment at pre-harvest, and to assess the effect of selected control measures. The baseline scenario predicted an average within-flock prevalence of 23.5 % (95 % tolerance interval: 15.7-31.4) and an average bacterial concentration of 3.579 (0-4.294) log CFU/g of feces in the barn environment at pre-harvest (on the day the flock is sent to slaughter). Because vertical introduction of S. Heidelberg into the barn was already uncommon in the baseline scenario, vaccination of broiler parent flocks appeared to have a negligible effect, while vaccination of broiler chicken flocks substantially reduced the bacterial concentration at pre-harvest. Cleaning and disinfection between batches markedly reduced the within-flock prevalence at pre-harvest, but the effect on bacterial concentration was limited outside of the beginning of the production period. Extending downtime between batches by 7 days had little effect on within-flock prevalence or bacterial concentration of S. Heidelberg when compared to the baseline scenario. This study provides a basis to describe S. Heidelberg dynamics within a broiler chicken flock and to predict the within-flock prevalence and bacterial concentration at pre-harvest, and includes a description of the limitations and data gaps. The results of these analyses and associated uncertainties are critical information for populating QMRA models of the downstream impacts on public health from on-farm and other food-chain practices. Specifically, the study findings will be integrated into a broader farm-to-fork QMRA model to support the risk-based control of S. Heidelberg resistant to 3GC in broiler chicken in Canada.

2.
Front Vet Sci ; 6: 220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380397

RESUMO

Antimicrobial use surveillance data need to be analyzed and reported in a standardized and harmonized way. In veterinary medicine, one approach is to use defined daily doses (DDD) for animals. DDD for animals are technical standards used in various measures or metrics that quantify antimicrobial use. The European Medicines Agency published principles for assigning DDDvet values based on information on dosing obtained from nine European countries. For measuring antimicrobial use in livestock within Canada, DDDs for animals reflective of Canadian veterinary antimicrobial use (DDDvetCAs) were needed. Our objectives were (1) to describe the development of DDDvetCA standards for pigs and poultry (broiler chickens and turkeys) for authorized and compounded antimicrobial active ingredients used in Canada, including those used extra-label; and (2) to compare the DDDvetCAs with EMA's DDDvets, where possible. Species-specific DDDvetCAs were assigned based on the average of unique antimicrobial daily doses obtained from product information, stratified by route of administration and age indication (where applicable). The feed, water and bolus DDDvetCAs were compared to oral DDDvets, and injectable DDDvetCAs to parenteral DDDvets, that matched by antimicrobial active ingredient. Seventy-five DDDvetCAs were assigned for pigs; 51 for poultry. Seventeen injectable DDDvetCAs could be compared to 14 EMA's parenteral DDDvets and 53 feed, water, and bolus DDDvetCAs could be compared to 40 oral DDDvets. Feed and water DDDvetCAs were generally lower than EMA's oral DDDvets, although differences in methodology between Canada and Europe make comparisons challenging. The assignment of DDDvetCAs was a resource intensive and iterative process. EMA's published principles for assigning DDDvets were an invaluable source of information. The use of DDDvetCAs will reflect exposure of Canadian animals to antimicrobials, be useful for evaluating associations between use and resistance within Canada and provide information for risk assessment and stewardship policies. However, when reporting antimicrobial use data internationally, using the same DDD standards as other reporting countries will facilitate between country comparisons, although differences in which antimicrobial active ingredients are licensed between countries may create challenges. Future steps include assigning DDDvetCAs for other food animal species, such as cattle, veal, and farmed fish.

3.
Front Microbiol ; 10: 1107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231317

RESUMO

Whole-genome sequencing (WGS) will soon replace traditional phenotypic methods for routine testing of foodborne antimicrobial resistance (AMR). WGS is expected to improve AMR surveillance by providing a greater understanding of the transmission of resistant bacteria and AMR genes throughout the food chain, and therefore support risk assessment activities. At this stage, it is unclear how WGS data can be integrated into quantitative microbial risk assessment (QMRA) models and whether their integration will impact final risk estimates or the assessment of risk mitigation measures. This review explores opportunities and challenges of integrating WGS data into QMRA models that follow the Codex Alimentarius Guidelines for Risk Analysis of Foodborne AMR. We describe how WGS offers an opportunity to enhance the next-generation of foodborne AMR QMRA modeling. Instead of considering all hazard strains as equally likely to cause disease, WGS data can improve hazard identification by focusing on those strains of highest public health relevance. WGS results can be used to stratify hazards into strains with similar genetic profiles that are expected to behave similarly, e.g., in terms of growth, survival, virulence or response to antimicrobial treatment. The QMRA input distributions can be tailored to each strain accordingly, making it possible to capture the variability in the strains of interest while decreasing the uncertainty in the model. WGS also allows for a more meaningful approach to explore genetic similarity among bacterial populations found at successive stages of the food chain, improving the estimation of the probability and magnitude of exposure to AMR hazards at point of consumption. WGS therefore has the potential to substantially improve the utility of foodborne AMR QMRA models. However, some degree of uncertainty remains in relation to the thresholds of genetic similarity to be used, as well as the degree of correlation between genotypic and phenotypic profiles. The latter could be improved using a functional approach based on prediction of microbial behavior from a combination of 'omics' techniques (e.g., transcriptomics, proteomics and metabolomics). We strongly recommend that methodologies to incorporate WGS data in risk assessment be included in any future revision of the Codex Alimentarius Guidelines for Risk Analysis of Foodborne AMR.

4.
Front Microbiol ; 9: 362, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29559960

RESUMO

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.

5.
Ecohealth ; 15(1): 209-227, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29330676

RESUMO

Having gained momentum in the last decade, the One Health initiative promotes a holistic approach to address complex global health issues. Before recommending its adoption to stakeholders, however, it is paramount to first compile quantitative evidence of the benefit of such an approach. The aim of this scoping review was to identify and summarize primary research that describes monetary and non-monetary outcomes following adoption of a One Health approach. An extensive literature search yielded a total of 42,167 references, of which 85 were included in the final analysis. The top two biotic health issues addressed in these studies were rabies and malaria; the top abiotic health issue was air pollution. Most studies described collaborations between human and animal (n = 42), or human and environmental disciplines (n = 41); commonly reported interventions included vector control and animal vaccination. Monetary outcomes were commonly expressed as cost-benefit or cost-utility ratios; non-monetary outcomes were described using disease frequency or disease burden measurements. The majority of the studies reported positive or partially positive outcomes. This paper illustrates the variety of health challenges that can be addressed using a One Health approach, and provides tangible quantitative measures that can be used to evaluate future implementations of the One Health approach.


Assuntos
Saúde Ambiental/organização & administração , Saúde Única , Pesquisa/organização & administração , Saúde Ambiental/economia , Saúde Ambiental/normas , Prática Clínica Baseada em Evidências , Relações Interprofissionais , Pesquisa/normas
6.
Risk Anal ; 38(5): 1070-1084, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28973821

RESUMO

Human exposure to bacteria resistant to antimicrobials and transfer of related genes is a complex issue and occurs, among other pathways, via meat consumption. In a context of limited resources, the prioritization of risk management activities is essential. Since the antimicrobial resistance (AMR) situation differs substantially between countries, prioritization should be country specific. The objective of this study was to develop a systematic and transparent framework to rank combinations of bacteria species resistant to selected antimicrobial classes found in meat, based on the risk they represent for public health in Switzerland. A risk assessment model from slaughter to consumption was developed following the Codex Alimentarius guidelines for risk analysis of foodborne AMR. Using data from the Swiss AMR monitoring program, 208 combinations of animal species/bacteria/antimicrobial classes were identified as relevant hazards. Exposure assessment and hazard characterization scores were developed and combined using multicriteria decision analysis. The effect of changing weights of scores was explored with sensitivity analysis. Attributing equal weights to each score, poultry-associated combinations represented the highest risk. In particular, contamination with extended-spectrum ß-lactamase/plasmidic AmpC-producing Escherichia coli in poultry meat ranked high for both exposure and hazard characterization. Tetracycline- or macrolide-resistant Enterococcus spp., as well as fluoroquinolone- or macrolide-resistant Campylobacter jejuni, ranked among combinations with the highest risk. This study provides a basis for prioritizing future activities to mitigate the risk associated with foodborne AMR in Switzerland. A user-friendly version of the model was provided to risk managers; it can easily be adjusted to the constantly evolving knowledge on AMR.


Assuntos
Anti-Infecciosos/análise , Contaminação de Alimentos , Microbiologia de Alimentos , Carne/microbiologia , Algoritmos , Animais , Campylobacter jejuni , Bovinos , Galinhas/microbiologia , Tomada de Decisões , Farmacorresistência Bacteriana , Enterococcus , Escherichia coli , Fluoroquinolonas/farmacologia , Gado , Carne/análise , Modelos Estatísticos , Aves Domésticas/microbiologia , Modelos de Riscos Proporcionais , Medição de Risco , Gestão de Riscos , Suínos/microbiologia , Suíça , Medicina Veterinária
7.
Vet Rec ; 181(24): 657, 2017 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-29051316

RESUMO

Pig farmers are strongly encouraged to reduce their antimicrobial usage because of the rising threat from antimicrobial resistance. However, such efforts should not compromise the herd health status and performance. This study aimed to describe the profile of so-called 'top-farms' that managed to combine both high technical performance and low antimicrobial usage. A cross-sectional study was conducted among 227 farrow-to-finish farms in Belgium, France, Germany and Sweden. Among them, 44 farms were allocated to the top-farms group and were compared with the 'regular' farms group in terms of farm characteristics, biosecurity and health status. Top-farms had fewer gastrointestinal symptoms in suckling pigs and fewer respiratory symptoms in fatteners, which could partly explain their reduced need for antimicrobials and higher performance. They also had higher biosecurity and were located in sparsely populated pig areas. However, 14 farms of the top-farms group were located in densely populated pig areas, but still managed to have low usage and high technical performance; they had higher internal biosecurity and more extensive vaccination against respiratory pathogens. These results illustrate that it is possible to control infectious diseases using other approaches than high antimicrobial usage, even in farms with challenging environmental and health conditions.


Assuntos
Criação de Animais Domésticos/métodos , Anti-Infecciosos/uso terapêutico , Fazendas/organização & administração , Doenças dos Suínos/prevenção & controle , Animais , Estudos Transversais , Europa (Continente) , Humanos , Suínos , Vacinação/veterinária
8.
Int J Food Microbiol ; 242: 107-115, 2017 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-27919006

RESUMO

The objective of this study was i) to quantify the risk of hepatitis E for Swiss consumers by specified pork products and ii) to estimate the total burden of human food-borne hepatitis E in Switzerland. A quantitative risk assessment from slaughter to consumption was carried out according to the Codex Alimentarius framework. In the hazard characterization, assumptions were made due to the lack of a dose-response relationship for oral exposure to hepatitis E virus (HEV). The prevalence of HEV in 160 pig livers of 40 different Swiss fattening farms was examined and determined to be 1.3% (CI 0.3%; 4.4%). This result was used as input in the risk assessment model, together with data from other published studies. The annual burden of hepatitis E was estimated in terms of Disability Adjusted Life Years (DALY), using data about hepatitis E cases diagnosed between 2010 and 2015 at two major hospitals located in the canton Ticino. Only the risk of foodborne hepatitis E from products containing pork liver was evaluated, as those containing only pork meat could not be evaluated because of lack of data on HEV load in pork. Assuming that successful oral infection occurs in 1% of servings contaminated with high HEV loads (>105 genome copies), and that acute illness develops in 5% of susceptible consumers, the most likely annual number of foodborne hepatitis E cases in Switzerland was estimated to be 1481 (95% CI 552; 4488) if all products containing pork liver were considered. If only high-risk products, such as plain pork liver and liver sausages (e.g. Saucisse au Foie), were considered, the annual number of cases was estimated to be 176 (95% CI 64; 498). We were unable to calculate the total burden of hepatitis E in Switzerland due to lack of data. Yet, for the canton Ticino, it was shown that a significant increase had occurred from <5 DALY per 100,000 inhabitants before 2012 to >50 DALY per 100,000 inhabitants in 2015. This change could partly be due to an increased reporting and higher awareness among medical practitioners. Extrapolation to other regions could be accomplished if detailed information on food consumption patterns were available. Notification of HEV cases and attempts of cases source attribution would improve the basis for risk assessments.


Assuntos
Doenças Transmitidas por Alimentos/virologia , Vírus da Hepatite E/isolamento & purificação , Hepatite E/transmissão , Hepatite E/virologia , Produtos da Carne/virologia , Animais , Contaminação de Alimentos/análise , Doenças Transmitidas por Alimentos/epidemiologia , Hepatite E/epidemiologia , Vírus da Hepatite E/genética , Vírus da Hepatite E/fisiologia , Humanos , Fígado/virologia , Masculino , Medição de Risco , Suínos , Suíça/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-28405435

RESUMO

BACKGROUND: High antimicrobial usage and the threat of antimicrobial resistance highlighted the need for reduced antimicrobial usage in pig production. Prevention of disease however, is necessary to obtain a reduced need for antimicrobial treatment. This study aimed at assessing possible associations between the biosecurity level, antimicrobial usage and farm and production characteristics in order to advice on best practices for a low antimicrobial usage and maximum animal health and production. A cross-sectional study was conducted in 227 farrow-to-finish pig herds in Belgium, France, Germany and Sweden between December 2012 and December 2013. Associations between biosecurity status, antimicrobial usage, and production parameters were evaluated with multivariable general linear models, according to an assumed causal pathway. RESULTS: The results showed that higher antimicrobial usage in sows tended to be associated with higher antimicrobial usage from birth until slaughter (p = 0.06). The antimicrobial usage from birth until slaughter was positively associated with the number of pathogens vaccinated against (p < 0.01). A shorter farrowing rhythm (p < 0.01) and a younger weaning age (p = 0.06) tended to be also associated with a higher antimicrobial usage from birth until slaughter whereas a better external biosecurity (p < 0.01) was related with a lower antimicrobial usage from birth until slaughter. CONCLUSION: Management practices such as weaning age and biosecurity measures may be important factors indirectly impacting on antimicrobial usage. We therefore promote a holistic approach when assessing the potential to reduce the need for antimicrobial treatments.

10.
Prev Vet Med ; 118(4): 457-66, 2015 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-25650306

RESUMO

Nineteen alternatives to antimicrobial agents were ranked on perceived effectiveness, feasibility and return on investment (ROI) from 0 (not effective, not feasible, no ROI) to 10 (fully effective, completely feasible, maximum ROI) by 111 pig health experts from Belgium, Denmark, France, Germany, Sweden and Switzerland. The top 5 measures in terms of perceived effectiveness were (1) improved internal biosecurity, (2) improved external biosecurity, (3) improved climate/environmental conditions, (4) high health/Specific Pathogen Free/disease eradication and (5) increased vaccination. The top 5 measures in terms of perceived feasibility were (1) increased vaccination, (2) increased use of anti-inflammatory products, (3) improved water quality, (4) feed quality/optimization and (5) use of zinc/metals. The top 5 measures in terms of perceived ROI were (1) improved internal biosecurity, (2) zinc/metals, (3) diagnostics/action plan, (4) feed quality/optimization and (5) climate/environmental improvements. Univariate linear regression showed that veterinary practitioners rank internal biosecurity, vaccination, use of zinc/metals, feed quality optimization and climate/environmental on average highest, while researchers and professors focused more on increased use of diagnostics and action plans. Financial incentives/penalties ranked low in all countries. Belgian respondents ranked feed quality significantly lower compared to the German respondents while reduction of stocking density was ranked higher in Belgium compared to Denmark. Categorical Principal Component Analysis applied to the average ranking supported the finding that veterinary practitioners had a preference for more practical, common and already known alternatives. The results showed that improvements in biosecurity, increased use of vaccination, use of zinc/metals, feed quality improvement and regular diagnostic testing combined with a clear action plan were perceived to be the most promising alternatives to antimicrobials in industrial pig production based on combined effectiveness, feasibility and ROI.


Assuntos
Criação de Animais Domésticos/métodos , Anti-Infecciosos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Ração Animal , Criação de Animais Domésticos/economia , Animais , Anti-Infecciosos/economia , Análise Custo-Benefício , Europa (Continente) , Estudos de Viabilidade , Humanos , Modelos Lineares , Suínos , Vacinação/veterinária , Zinco/uso terapêutico
11.
J Antimicrob Chemother ; 70(1): 294-302, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25223972

RESUMO

OBJECTIVES: To establish a consensus defined daily dose animal (DDDA) for each active substance (AS) and administration route for porcine veterinary antimicrobial products authorized in four European countries, thus allowing cross-country quantification and comparison of antimicrobial usage data. METHODS: All veterinary antimicrobial products authorized for porcine use in Belgium, France, Germany and Sweden were listed for each administration route. First, separate DDDAs for each product were defined based on the recommended dosing for the main indication. Second, a consensus DDDA was established by taking the mean of the DDDAs for each product within a certain category of AS plus administration route. RESULTS: One-hundred-and-fifty-nine, 240, 281 and 50 antimicrobial products were licensed in Belgium, France, Germany and Sweden, respectively, in February 2013. Large variations were observed for dosage and treatment duration recommendations between products and between countries for the same ASs. Only 6.8% of feed/water and 29.4% of parenteral AS groups had the same recommended dosage in the four countries. CONCLUSIONS: This study presents a consensus DDDA list for use in the quantification and comparison of antimicrobial consumption. Four major recommendations have been formulated: (i) urgent need for harmonization of authorization and recommended summary of product characteristics (SPC) dosages; (ii) expand the developed preliminary DDDA list to include all authorized veterinary medicinal products in all EU member states and for all (food-producing) animal species; (iii) improved accessibility of country-specific SPC data would be preferable; and (iv) statement of the 'long-acting' duration of a product in the SPC.


Assuntos
Criação de Animais Domésticos/métodos , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/normas , Suínos/crescimento & desenvolvimento , Medicina Veterinária/métodos , Criação de Animais Domésticos/normas , Animais , Europa (Continente) , Drogas Veterinárias/administração & dosagem , Drogas Veterinárias/uso terapêutico , Medicina Veterinária/normas
12.
Acta Trop ; 134: 17-28, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24583141

RESUMO

In countries with a lack of primary care systems, health workers are of crucial importance to improving the delivery of health and animal health services at community level. But somehow they are rarely evaluated and usually with a top-down approach. This is the case in Cambodia, where thousands of Village Animal Health Workers (VAHWs) have been trained by the government, and where no standardized evaluation tool is available to accurately assess the situation. Based on methodology developed by the French NGO Agronomes et Vétérinaires Sans Frontières (AVSF) in Madagascar for farmers' association evaluation, we developed our own participatory methods to collect information about the VAHW context and build a criteria grid for their evaluation. In this framework, several participatory approaches were used such as problem trees, semi-structured interviews, pair-wise ranking and focus groups. The grid was built with the help of relevant stakeholders involved in the animal health system in Cambodia in order to (i) identify VAHW functions; (ii) set up criteria and associated questionnaires, and (iii) score the grid with all the stakeholders. The tool was divided into five categories of evaluation criteria: sustainability, treatment, production, vaccination and disease reporting. Our approach looked at local indicators of success developed and used by VAHWs themselves, which should lead to better acceptability of evaluation. This method gave priority to dialog aiming to engage decision makers and other stakeholders in a mutual learning process and could be applied in other countries to develop trust between health workers and official service representatives as well as to foster corrective action after evaluation.


Assuntos
Assistência à Saúde/organização & administração , Mão de Obra em Saúde , Medicina Veterinária , Animais , Camboja , Humanos
13.
Emerg Themes Epidemiol ; 10(1): 7, 2013 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-23941327

RESUMO

BACKGROUND: Systems for animal disease mitigation involve both surveillance activities and interventions to control the disease. They are complex organizations that are described by partial or imprecise data, making it difficult to evaluate them or make decisions to improve them. A mathematical method, called loop analysis, can be used to model qualitatively the structure and the behavior of dynamic systems; it relies on the study of the sign of the interactions between the components of the system. This method, currently widely used by ecologists, has to our knowledge never been applied in the context of animal disease mitigation systems. The objective of the study was to assess whether loop analysis could be applied to this new context. We first developed a generic model that restricted the applicability of the method to event-based surveillance systems of endemic diseases, excluding the emergence and eradication phases. Then we chose the mitigation system of highly pathogenic avian influenza (HPAI) H5N1 in Cambodia as an example of such system to study the application of loop analysis to a real disease mitigation system. RESULTS: Breaking down the generic model, we constructed a 6-variables model to represent the HPAI H5N1 mitigation system in Cambodia. This construction work improved our understanding of this system, highlighting the link between surveillance and control which is unclear in traditional representations of this system. Then we analyzed the effect of the perturbations to this HPAI H5N1 mitigation system that we interpreted in terms of investment in a given compartment. This study suggested that increasing intervention at a local level can optimize the system's efficiency. Indeed, this perturbation both decreases surveillance and intervention costs and reduces the disease's occurrence. CONCLUSION: Loop analysis can be applied to disease mitigation systems. Its main strength is that it is easy to design, focusing on the signs of the interactions. It is a simple and flexible tool that could be used as a precursor to large-scale quantitative studies, to support reflection about disease mitigation systems structure and functioning.

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