Prioritization of livestock transboundary diseases in Belgium using a multicriteria decision analysis tool based on drivers of emergence

Prioritization of vegetable-borne biological hazards in Argentina using a multicriteria decision analysis tool

Vegetables, especially those eaten raw, have been implicated in several foodborne disease outbreaks. Since multiple vegetable matrices and hazards are involved, risk managers have to prioritize those with the greatest impact on public health to design control strategies. In this study, a scientific-based risk ranking of foodborne pathogens transmitted by leafy green vegetables in Argentina was performed. The prioritization process included hazard identification, evaluation criteria identification and definition, criteria weighting, expert survey design and selection and call for experts, hazard score calculation, hazard ranking and variation coefficient, and result analysis. Regression tree analysis determined four risk clusters: high (Cryptosporidum spp., Toxoplasma gondii, Norovirus), moderate (Giardia spp., Listeria spp., Shigella sonnei), low (Shiga toxin-producing Escherichia coli, Ascaris spp., Entamoeba histolytica, Salmonella spp., Rotavirus, Enterovirus) and very low (Campylobacter jejuni, hepatitis A virus and Yersinia pseudotuberculosis). Diseases caused by Norovirus, Cryptosporidium spp. and T. gondii do not require mandatory notification. Neither viruses nor parasites are included as microbiological criteria for foodstuff. The lack of outbreak studies did not allow to accurately identify vegetables as a source of Norovirus disease. Information on listeriosis cases or outbreaks due to vegetable consumption was not available. Shigella spp. was the main responsible for bacterial diarrhea, but it has not been epidemiologically associated with vegetable consumption. The quality of the available information for all hazards studied was very low and low. The implementation of good practice guidelines throughout the entire vegetable production chain could prevent the presence of the identified hazards. The current study allowed the identification of vacancy areas and could help reinforce the need for performing epidemiological studies on foodborne diseases potentially associated with vegetable consumption in Argentina.

Scanning European Needs and Expectations Related to Livestock Biosecurity Training by Using the World Café Method

The European Union Animal Health Law (2016/429) emphasizes disease prevention, underpinned by livestock biosecurity, surveillance, and traceability, as key aspects to minimize the risk of animal diseases. An important element of biosecurity is the training of key actors involved in implementing it. However, their needs and expectations regarding this training are poorly known. Under the COST action BETTER (CA20103), a World Café was organized to identify the needs and expectations of biosecurity training for farmers, veterinary practitioners, veterinary students, and other actors. A total of 78 participants distributed in four groups participated in the World Café. Needs and expectations were identified and ranked in decreasing order of importance. For farmers, the most important aspects were training focusing on practical aspects, the planning of training sessions in the day to accommodate workload, the need to prepare multiple reminders of upcoming training, and the short duration of events. For veterinary practitioners, it was considered that a mixed approach, including a theoretical and a practical part where people are invited to create a biosecurity plan and a follow-up report, were the most important features of training. For veterinary students, creating a good knowledge of the main principles of biosecurity was found as an essential element of training. Regarding other actors, gaining an understanding in the spread of pathogens and the repercussions on the cost of animal products that diseases might have (consumers), training on good/best practices of cleaning and disinfection and the development of clear protocols (transporters), and a mixture of formal and informal training and training on communication skills (other actors) were considered important. The World Café was a useful method to have a first identification, discussion, and differentiation on livestock biosecurity training needs and expectations of the key actors, although additional follow-up research involving more participants from more diverse countries with different coverage of cultures and education would be beneficial. These needs and expectations are relevant and should be considered when designing new training courses.

One Health approach for prioritization of potential foodborne pathogens: Risk-ranking, Delphi survey, and criteria evaluation pre- and post-COVID-19 pandemic

Frequent foodborne illnesses with unknown causative agents highlight the need to explore zoonotic potential foodborne pathogens (PFPs). An effective PFP prioritization tool is indispensable, especially after experiencing the recent pandemic caused by zoonotic SARS-CoV-2. Risk information on pathogens (excluding 30 known foodborne pathogens) provided by governmental and international organizations was reviewed to generate a list of PFPs. Risk-ranking of PFPs was conducted based on a literature review of food poisoning or detection cases, and the ranks were determined with a decision tree. PFPs were prioritized by infectious disease (ID), veterinary medicine (VET), and food safety (FS) experts through a pre- and postpandemic Delphi survey, and key criteria in their decisions were illuminated. Among 339 PFPs, 32 rank-1 PFPs were involved in the foodborne outbreak(s). Discrepancies in opinions on prioritization between experts in different fields deepened after the pandemic. Only VET and FS experts valued the plausibility of foodborne transmission in evaluating bacteria and viruses, and a significant correlation between their selection of PFPs was found (p < .05). The impact of the pandemic induced all fields to focus more on human transmission and severity/fatality in prioritizing viruses, and only FS experts emphasized the plausibility of foodborne transmission after the pandemic. In contrast to prioritizing bacteria or viruses, ID and VET experts are unusually focused on foodborne transmission when prioritizing parasites. Criteria of consensus deduced by interdisciplinary experts with different interests and the criteria directly related to foodborne transmission should be acknowledged for adequate PFP prioritization.

Approaches for disease prioritization and decision-making in animal health, 2000-2021: a structured scoping review

This scoping review identifies and describes the methods used to prioritize diseases for resource allocation across disease control, surveillance, and research and the methods used generally in decision-making on animal health policy. Three electronic databases (Medline/PubMed, Embase, and CAB Abstracts) were searched for articles from 2000 to 2021. Searches identified 6, 395 articles after de-duplication, with an additional 64 articles added manually. A total of 6, 460 articles were imported to online document review management software (sysrev.com) for screening. Based on inclusion and exclusion criteria, 532 articles passed the first screening, and after a second round of screening, 336 articles were recommended for full review. A total of 40 articles were removed after data extraction. Another 11 articles were added, having been obtained from cross-citations of already identified articles, providing a total of 307 articles to be considered in the scoping review. The results show that the main methods used for disease prioritization were based on economic analysis, multi-criteria evaluation, risk assessment, simple ranking, spatial risk mapping, and simulation modeling. Disease prioritization was performed to aid in decision-making related to various categories: (1) disease control, prevention, or eradication strategies, (2) general organizational strategy, (3) identification of high-risk areas or populations, (4) assessment of risk of disease introduction or occurrence, (5) disease surveillance, and (6) research priority setting. Of the articles included in data extraction, 50.5% had a national focus, 12.3% were local, 11.9% were regional, 6.5% were sub-national, and 3.9% were global. In 15.2% of the articles, the geographic focus was not specified. The scoping review revealed the lack of comprehensive, integrated, and mutually compatible approaches to disease prioritization and decision support tools for animal health. We recommend that future studies should focus on creating comprehensive and harmonized frameworks describing methods for disease prioritization and decision-making tools in animal health.

First Expert Elicitation of Knowledge on Possible Drivers of Observed Increasing Human Cases of Tick-Borne Encephalitis in Europe

Tick-borne encephalitis (TBE) is a viral disease endemic in Eurasia. The virus is mainly transmitted to humans via ticks and occasionally via the consumption of unpasteurized milk products. The European Centre for Disease Prevention and Control reported an increase in TBE incidence over the past years in Europe as well as the emergence of the disease in new areas. To better understand this phenomenon, we investigated the drivers of TBE emergence and increase in incidence in humans through an expert knowledge elicitation. We listed 59 possible drivers grouped in eight domains and elicited forty European experts to: (i) allocate a score per driver, (ii) weight this score within each domain, and (iii) weight the different domains and attribute an uncertainty level per domain. An overall weighted score per driver was calculated, and drivers with comparable scores were grouped into three terminal nodes using a regression tree analysis. The drivers with the highest scores were: (i) changes in human behavior/activities; (ii) changes in eating habits or consumer demand; (iii) changes in the landscape; (iv) influence of humidity on the survival and transmission of the pathogen; (v) difficulty to control reservoir(s) and/or vector(s); (vi) influence of temperature on virus survival and transmission; (vii) number of wildlife compartments/groups acting as reservoirs or amplifying hosts; (viii) increase of autochthonous wild mammals; and (ix) number of tick species vectors and their distribution. Our results support researchers in prioritizing studies targeting the most relevant drivers of emergence and increasing TBE incidence.

An update on epidemiology and clinical aspects of besnoitiosis in livestock and wildlife in sub-Saharan Africa: A systematic review

Besnoitiosis is a parasitic disease of economic importance caused by cyst-forming protozoa from the genus Besnoitia. The disease affects the skin, subcutis, blood vessels, and mucous membranes of the animals. It is traditionally endemic in the tropical and sub-tropical regions of the world, and causes enormous economic loss associated with impaired productivity and reproduction, as well as skin lesions. Therefore, knowledge of the epidemiology of the disease, including the current Besnoitia species occurring in sub-Saharan Africa, the wide range of mammalian species hosts they use as intermediate hosts, and the clinical signs manifested by infected animals is crucial in developing effective prevention and control measures. This review collected information from peer-reviewed publications involving the epidemiology and clinical signs of besnoitiosis in sub-Saharan Africa using four electronic databases. Results showed that B. besnoiti, B. bennetti, B. caprae, B. darlingi-like and unidentified Besnoitia spp. were found naturally infecting livestock and wildlife across nine reviewed sub-Saharan African countries. Besnoitia besnoiti was the most common species, occurring in all nine reviewed countries, and utilised a wide range of mammalian species as intermediate hosts. Prevalence of B. besnoiti ranged from 2.0 to 80.3%, and B. caprae 5.45-46.53%. Infection rate was high with serology compared to other techniques. Some of the typical signs of besnoitiosis included sand-like cysts on the sclera conjunctiva, nodules in the skin, thickening and wrinkling of the skin and alopecia. Inflammation, thickening and wrinkling of the scrotum were observed in bulls, and lesions on the scrotum deteriorated progressively and became generalized in some cases in spite of treatment. There is still a need for surveys focusing on detecting and identifying Besnoitia spp. using molecular techniques in combination with serological, histology and visual observation, and scoping their natural intermediate and definitive hosts, as well as assessing the burden of the disease animals reared on different husbandry systems in sub-Saharan Africa.

First Expert Elicitation of Knowledge on Drivers of Emergence of Bovine Besnoitiosis in Europe

Bovine besnoitiosis (BB) is a chronic and debilitating parasitic disease in cattle caused by the protozoan parasite Besnoitia besnoiti. South European countries are affected and have reported clinical cases of BB. However, BB is considered as emerging in other countries/regions of central, eastern and northern Europe. Yet, data on drivers of emergence of BB in Europe are scarce. In this study, fifty possible drivers of emergence of BB in cattle were identified. A scoring system was developed per driver. Then, the scoring was elicited from eleven recognized European experts to: (i) allocate a score to each driver, (ii) weight the score of drivers within each domain and (iii) weight the different domains among themselves. An overall weighted score was calculated per driver, and drivers were ranked in decreasing order of importance. Regression tree analysis was used to group drivers with comparable likelihoods to play a role in the emergence of BB in cattle in Europe. Finally, robustness testing of expert elicitation was performed for the seven drivers having the highest probability to play a key role in the emergence of BB: i.e., (i) legal/illegal movements of live animals from neighbouring/European Union member states or (ii) from third countries, (iii) risk of showing no clinical sign and silent spread during infection and post infection, (iv) as a consequence, difficulty to detect the emergence, (v) existence of vectors and their potential spread, (vi) European geographical proximity of the pathogen/disease to the country, and (vii) animal density of farms. Provided the limited scientific knowledge on the topic, expert elicitation of knowledge, multi-criteria decision analysis, cluster and sensitivity analyses are very important to prioritize future studies, e.g., the need for quantitative import risk assessment and estimation of the burden of BB to evidence and influence policymaking towards changing (or not) its status as a reportable disease, with prevention and control activities targeting, firstly, the top seven drivers. The present methodology could be applied to other emerging animal diseases.

Different variants of pandemic and prevention strategies: A prioritizing framework in fuzzy environment

In this trying time for the world battling different variants of the COVID'19 pandemic, different intervention strategies are being taken by government, to limit the spread of infection. Closing educational institutes, stay at home orders, campaigns for emphasis on vaccination, usage of medical mask and frequently sanitizing hands, etc. are the endeavors made by the authorities to decrease the number of cases in the country. In this regard, the contribution aims to help the decision-makers to identify a potential prevention strategy, based on public acceptance and intervention effectiveness. To achieve this objective, feasible judgments of professionals from three different sectors are brought together through meetings. Opinions, based on ten criteria, are recorded in linguistic form for prioritizing six alternatives. The linguistic terms are then evaluated and manipulated by entailing triangular fuzzy numbers and a group multi-criteria decision making (GMCDM) approach. After using the fuzzy analytical hierarchy process (F-AHP) for the complex decisions, the fuzzy VIšekriterijumsko KOmpromisno Rangiranje method (F-VIKOR) is utilized to attain the closest ideal stratagem. Consequently, through the ranking orders of defuzzified scores, intuitive preference of compromise solutions is suggested. The tactic gaining more priority with respect to the group utility to the majority and F-VIKOR index is complete lockdown for the short term. Furthermore, a comparison analysis is also added in the discussion to verify the attained prioritized outcomes. This comparative study is carried out through the technique for order of preference by similarity to ideal solution (TOPSIS), which evidently produces the same preference of alternatives. In addition, this strategy can be apparently discovered to be an effective strategy adopted by different countries in successfully decreasing the number of cases.

Critical Systematic Review of Zoonoses and Transboundary Animal Diseases' Prioritization in Africa

Background: Disease prioritization aims to enhance resource use efficiency concerning human and animal health systems’ preparedness and response to the most important problems for the optimization of beneficial outcomes. In sub-Sahara Africa (SSA), several prioritizations of zoonoses and transboundary animal diseases (TADs) have been implemented at different scales to characterize potential disease impacts. Method and principal findings: In this systematic review, we analyze the methodologies used, outcomes, and their relevance by discussing criteria required to align decision-makers’ perceptions of impacts to those of other stakeholders for different prioritization in SSA. In general, the sectorial representativeness of stakeholders for processes implemented with the support of international partners showed slight differences with the absence of local stakeholders. Whatever the tool prioritized, zoonoses were similar in general because of the structured nature of those tools in assessing decision-makers’ preferences through value trade-offs between criteria while ensuring transparency and reproducibility. However, by involving field practitioners and farmers, there were different outcomes with processes concerning only decision makers and experts who were more sensitive to infectious TADs, while the former raised parasitic disease constraints. In this context, multicriteria decision analysis-based zoonoses and TADs prioritizations involving a balanced participation of stakeholders might contribute to bridging these divergences, whatever the scale. Conclusion and significance: Prioritization processes were important steps toward building and harmonizing technical laboratory and surveillance networks to coordinate projects to address priority zoonoses and TADs at the country and/or sub-regional level. Those processes should be enhanced.

Assessing the use of animal health platforms: User's needs, preferences and constraints

Animal health information systems or risk analysis tools are indispensable not only for animal health surveillance, but also to observe the evolution and risk of disease incursion into a disease-free area. Given the various information that can be derived from these both animal information systems and risk analysis tools, different international and national organizations have customized or created their own systems/tools to provide specific information for use by the respective countries. Moreover, with the increase of technology and data storage, they have become more accessible and widely used by professionals in animal and human health sciences. This study aimed to establish user's preferences, needs and constraints in respect of these animal information systems and risk analysis tools. An online survey was conducted and answered by 213 respondents from 132 countries. The respondents were animal health or public health professionals in different employment sectors (mostly in government, research and university institutions) and various fields of competency (highest for animal and public health). The majority of respondents used the animal health information systems frequently and on a weekly basis, with prevention measures of diseases being regarded as the most useful information. Descriptive epidemiology was more used/needed than analytical epidemiology. Risk analysis was performed by the majority of the respondents (70%), using a qualitative approach more than a quantitative or semi-qualitative. The primary objectives were to produce risk assessment and preparedness in areas involving origin and spread of animal diseases. The features most sought after in risk analysis tools were pathways of introduction and spread assessment. The level of satisfaction was higher for the platform which is most used by the respondents. Overall, these results could be taken into consideration when improving an already available platform, or when creating a new efficient tool.

Control and prevention of infectious diseases from a One Health perspective

The ongoing COVID-19 pandemic has caught the attention of the global community and rekindled the debate about our ability to prevent and manage outbreaks, epidemics, and pandemics. Many alternatives are suggested to address these urgent issues. Some of them are quite interesting, but with little practical application in the short or medium term. To realistically control infectious diseases, human, animal, and environmental factors need to be considered together, based on the One Health perspective. In this article, we highlight the most effective initiatives for the control and prevention of infectious diseases: vaccination; environmental sanitation; vector control; social programs that encourage a reduction in the population growth; control of urbanization; safe sex stimulation; testing; treatment of sexually and vertically transmitted infections; promotion of personal hygiene practices; food safety and proper nutrition; reduction of the human contact with wildlife and livestock; reduction of social inequalities; infectious disease surveillance; and biodiversity preservation. Subsequently, this article highlights the impacts of human genetics on susceptibility to infections and disease progression, using the SARS-CoV-2 infection as a study model. Finally, actions focused on mitigation of outbreaks and epidemics and the importance of conservation of ecosystems and translational ecology as public health strategies are also discussed.

Prioritisation for future surveillance, prevention and control of 98 communicable diseases in Belgium: a 2018 multi-criteria decision analysis study

Background

National public health agencies are required to prioritise infectious diseases for prevention and control. We applied the prioritisation method recommended by the European Centre for Disease Prevention and Control to rank infectious diseases, according to their relative importance for surveillance and public health, to inform future public health action in Belgium.

Methods

We applied the multi-criteria-decision-analysis approach. A working group of epidemiologists and statisticians from Belgium (n = 6) designed a balanced set of prioritisation criteria. A panel of Belgian experts (n = 80) allocated in an online survey each criteria a weight, according to perceived relative importance. Next, experts (n = 37) scored each disease against each criteria in an online survey, guided by disease-specific factsheets referring the period 2010–2016 in Belgium. The weighted sum of the criteria’s scores composed the final weighted score per disease, on which the ranking was based. Sensitivity analyses quantified the impact of eight alternative analysis scenarios on the top-20 ranked diseases. We identified criteria and diseases associated with data-gaps as those with the highest number of blank answers in the scoring survey. Principle components of the final weighted score were identified.

Results

Working groups selected 98 diseases and 18 criteria, structured in five criteria groups. The diseases ranked highest were (in order) pertussis, human immunodeficiency virus infection, hepatitis C and hepatitis B. Among the five criteria groups, overall the highest weights were assigned to ‘impact on the patient’, followed by ‘impact on public health’, while different perceptions were identified between clinicians, microbiologists and epidemiologists. Among the 18 individual criteria, ‘spreading potential’ and ‘events requiring public health action’ were assigned the highest weights. Principle components clustered with thematic disease groups. Notable data gaps were found among hospital-related diseases.

Conclusions

We ranked infectious diseases using a standardised reproducible approach. The diseases ranked highest are included in current public health programs, but additional reflection for example about needs among risk groups is recommended. Cross-reference of the obtained ranking with current programs is needed to verify whether resources and activities map priority areas. We recommend to implement this method in a recurrent evaluation cycle of national public health priorities.

First expert elicitation of knowledge on drivers of emergence of influenza D in Europe

The influenza D virus (IDV) was first identified and characterized in 2011. Considering the virus' zoonotic potential, its genome nature (segmented RNA virus), its worldwide circulation in livestock and its role in bovine respiratory disease, an increased interest is given to IDV. However, few data are available on drivers of emergence of IDV. We first listed fifty possible drivers of emergence of IDV in ruminants and swine. As recently carried out for COVID-19 in pets (Transboundary and Emerging Diseases, 2020), a scoring system was developed per driver and scientific experts (N = 28) were elicited to (a) allocate a score to each driver, (b) weight the drivers' scores within each domain and (c) weight the different domains among themselves. An overall weighted score was calculated per driver, and drivers were ranked in decreasing order. Drivers with comparable likelihoods to play a role in the emergence of IDV in ruminants and swine in Europe were grouped using a regression tree analysis. Finally, the robustness of the expert elicitation was verified. Eight drivers were ranked with the highest probability to play a key role in the emergence of IDV: current species specificity of the causing agent of the disease; influence of (il)legal movements of live animals (ruminants, swine) from neighbouring/European Union member states and from third countries for the disease to (re-)emerge in a given country; detection of emergence; current knowledge of the pathogen; vaccine availability; animal density; and transport vehicles of live animals. As there is still limited scientific knowledge on the topic, expert elicitation of knowledge and multi-criteria decision analysis, in addition to clustering and sensitivity analyses, are very important to prioritize future studies, starting from the top eight drivers. The present methodology could be applied to other emerging animal diseases.

Improving laboratory diagnostic capacities of emerging diseases using knowledge mapping

Over the last decade, European countries faced several emerging and re-emerging animal diseases as well as zoonotic diseases. During these episodes, the laboratory diagnostic capabilities were a key factor to rapidly control and/or eradicate them. Because of the associated socio-economic and health consequences, it is crucial to react rapidly and efficiently, not only during crisis but also in peacetime (i.e. preparedness). However, to date, there is no published method to identify diseases with diagnostic gaps and to prioritize assays to be implemented. This study was conducted based on the outcome of a prioritization exercise in which 29 epizootic and exotic diseases with high risk of emergence or re-emergence in Belgium (Bianchini et al., [2020] Transboundary and Emerging Diseases, 67(1), 344-376) were listed. Knowledge mapping was used to visualize and identify gaps in the diagnostic procedures for different epidemiological scenarios at national level. To fill these gaps, an overview of diagnostic capabilities at national and international level (laboratories and kits providers or manufacturers) as well as the published assays in the scientific literature and the prescribed assays by international institutions and kits providers was carried out. The outcome of this study revealed the usefulness of knowledge mapping as a tool to identify gaps and ultimately gain insight on alternatives for better preparedness and responsiveness. While this exercise was limited to Belgium, we believe this exercise can benefit other countries and thereby enhancing knowledge sharing and collaboration to increase diagnostic capabilities for a common list of (re-) emerging diseases in crisis situation.

First expert elicitation of knowledge on drivers of emergence of the COVID-19 in pets

Infection with the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) induces the coronavirus infectious disease 19 (COVID‐19). Its pandemic form in human population and its probable animal origin, along with recent case reports in pets, make drivers of emergence crucial in domestic carnivore pets, especially cats, dogs and ferrets. Few data are available in these species; we first listed forty‐six possible drivers of emergence of COVID‐19 in pets, regrouped in eight domains (i.e. pathogen/disease characteristics, spatial‐temporal distance of outbreaks, ability to monitor, disease treatment and control, characteristics of pets, changes in climate conditions, wildlife interface, human activity, and economic and trade activities). Secondly, we developed a scoring system per driver, then elicited scientific experts (N = 33) to: (a) allocate a score to each driver, (b) weight the drivers scores within each domain and (c) weight the different domains between them. Thirdly, an overall weighted score per driver was calculated; drivers were ranked in decreasing order. Fourthly, a regression tree analysis was used to group drivers with comparable likelihood to play a role in the emergence of COVID‐19 in pets. Finally, the robustness of the expert elicitation was verified. Five drivers were ranked with the highest probability to play a key role in the emergence of COVID‐19 in pets: availability and quality of diagnostic tools, human density close to pets, ability of preventive/control measures to avoid the disease introduction or spread in a country (except treatment, vaccination and reservoir(s) control), current species specificity of the disease‐causing agent and current knowledge on the pathogen. As scientific knowledge on the topic is scarce and still uncertain, expert elicitation of knowledge, in addition with clustering and sensitivity analyses, is of prime importance to prioritize future studies, starting from the top five drivers. The present methodology is applicable to other emerging pet diseases.

Prioritization of livestock transboundary diseases in Belgium using a multicriteria decision analysis tool based on drivers of emergence

During the past decade, livestock diseases have (re-)emerged in areas where they had been previously eradicated or never been recorded before. Drivers (i.e. factors of (re-)emergence) have been identified. Livestock diseases spread irrespective of borders, and therefore, reliable methods are required to help decision-makers to identify potential threats and try stopping their (re-)emergence. Ranking methods and multicriteria approaches are cost-effective tools for such purpose and were applied to prioritize a list of selected diseases (N = 29 including 6 zoonoses) based on the opinion of 62 experts in accordance with 50 drivers-related criteria. Diseases appearing in the upper ranking were porcine epidemic diarrhoea, foot-and-mouth disease, low pathogenic avian influenza, African horse sickness and highly pathogenic avian influenza. The tool proposed uses a multicriteria decision analysis approach to prioritize pathogens according to drivers and can be applied to other countries or diseases.