A simplified method of performance indicators development for epidemiological surveillance networks--application to the RESAPATH surveillance network

Resumeq: A Novel Way of Monitoring Equine Diseases Through the Centralization of Necropsy Data

The French surveillance network for causes of equine mortality (Resumeq) was created in 2015 for the qualitative surveillance of equine mortality through the centralization in a national database of necropsy data and their subsequent epidemiological analysis. It was designed to identify the causes of equine mortality, monitor their evolution over time and space, and detect emerging diseases as early as possible. Resumeq is an event-based surveillance system involving various players and structures. It is organized around a steering body, a scientific and technical support committee and a coordination unit. Different tools have been developed specifically for Resumeq. These include standardized necropsy protocols, a thesaurus for the anatomopathological terms and the causes of equine death, and an interactive web application so that network contributors can display data analysis results. The four French veterinary schools, seventeen veterinary laboratories, and ten veterinary clinics already contribute to the production and centralization of standardized data. To date, the data from around 1,000 equine necropsies have been centralized. While most deaths were located in western France, the geographic coverage is gradually improving. Data analysis allows the main causes of death to be ranked and major threats identified on a local, regional or national level. Initial results demonstrate the feasibility and benefits of this national surveillance tool. Moreover, in the future, this surveillance could take an international dimension if several countries decided to jointly capitalize on their necropsy data.

Are animals a source of Stenotrophomonas maltophilia in human infections? Contributions of a nationwide molecular study

Stenotrophomonas maltophilia (Sm) is an archetypal environmental opportunistic bacterium responsible for health care-associated infections. The role of animals in human Sm infections is unknown. This study aims to reveal the genetic and phylogenetic relationships between pathogenic strains of Sm, both animal and human, and identify a putative role for animals as a reservoir in human infection. We phenotypically and genotypically characterized 61 Sm strains responsible for animal infections (mainly respiratory tract infections in horses) from a French nationwide veterinary laboratory network. We tested antimicrobial susceptibility and performed MLST and genogrouping using the concatenation of the seven housekeeping genes from the original MLST scheme. Excluding the eight untypeable strains owing to the lack of gene amplification, only 10 out of the 53 strains yielded a known ST (ST5, ST39, ST162, ST8, ST27, ST126, ST131). The genogroup distribution highlighted not only genogroups (genogroups 5 and 9) comprised exclusively of animal strains but also genogroups shared by human and animal strains. Interestingly, these shared genogroups were primarily groups 2 and 6, which have previously been identified as the two most frequent genogroups among human-pathogenic Sm strains, especially among respiratory pathogens. The antimicrobial susceptibility testing underlined the presence of acquired resistance: 18.8 and 7.5% of the tested isolates were resistant to the sulfonamide-trimethoprim combination and ciprofloxacin, respectively. Animal strains of Sm shared phylogenetic traits with some of the most successful human strains. The exact relationships between the human and animal strains, and the genetic support of these common traits, need to be determined.

Selection of key recommendations for quality indicators describing good quality outbreak response

BACKGROUND

The performance of recommended control measures is necessary for quick and uniform infectious disease outbreak control. To assess whether these procedures are performed, a valid set of quality indicators (QIs) is required. The goal of this study was to select a set of key recommendations that can be systematically translated into QIs to measure the quality of infectious disease outbreak response from the perspective of disaster emergency responders and infectious disease control professionals.

METHODS

Applying the Rand modified Delphi procedure, the following steps were taken to systematically select a set of key recommendations: extraction of recommendations from relevant literature; appraisal of the recommendations in terms of relevance through questionnaires to experts; expert meeting to discuss recommendations; prioritization of recommendations through a second questionnaire; and final expert meeting to approve the selected set. Infectious disease physicians and nurses, policymakers and communication experts participated in the expert group (n=48).

RESULTS

In total, 54 national and international publications were systematically searched for recommendations, yielding over 200 recommendations. The Rand modified Delphi procedure resulted in a set of 65 key recommendations. The key recommendations were categorized into 10 domains describing the whole response pathway from outbreak recognition to aftercare.

CONCLUSION

This study provides a set of key recommendations that represents 'good quality of response to an infectious disease outbreak'. These key recommendations can be systematically translated into QIs. Organizations and professionals involved in outbreak control can use these QIs to monitor the quality of response to infectious disease outbreaks and to assess in which domains improvement is needed.