Prioritisation of zoonotic diseases for coordinated surveillance systems under the One Health approach for cross-border pathogens that threaten the Union

Raw Equid Milk: A Potential Risk for Q Fever?

Equid milk (donkey or mare) has traditionally been consumed raw or fermented due to its distinctive chemical composition, which closely resembles human milk, and its nutritional benefits. Nowadays, interest in it is increasing, despite limited research on its microbiological risk. Coxiella burnetii (C. burnetii), a globally re-emerging zoonotic agent, has rarely been investigated in equid milk. The objective of this study was to demonstrate the applicability of selected analytical methods for detecting C. burnetii in raw equid milk. A commercial molecular assay was tested on three serial dilutions of one donkey milk sample contaminated with a C. burnetii plasmid, which showed no interference of donkey milk with real-time PCR detection. The commercial molecular assay and a serological assay routinely used in the laboratory were also applied to screen a total of 106 equid milks from 16 farms to assess their applicability to diagnostic samples. No C. burnetii DNA or anti-C. burnetii antibodies were detected in these screenings. In our study, the implemented methods appeared to be suitable for C. burnetii investigation in equid milk. While the overall low prevalence recorded in Italy among domestic species is reassuring, strategic surveillance and risk assessment remain essential considering the low infectious dose of C. burnetii and its zoonotic potential.

Detection of Rocahepevirus ratti in Bivalve Mollusks from São Luís Island, Maranhão, Brazil: A Potential Transmission Route of an Emerging Zoonotic Pathogen?

The attempt to investigate hepatitis E virus (HEV) contamination in naturally growing mangrove bivalve mollusks captured for local sale in a touristic area of Maranhão state in Brazil revealed the detection of rat hepatitis E virus (ratHEV). Using international standard protocols for processing and nucleic acid extraction, we analyzed 89 bivalve samples (Mytella falcata and Crassostrea rhizophorae) with two broadly reactive assays: heminested pan-Hepeviridae (ORF-1) and probe-based HEV-1 to HEV-4 (ORF-2/ORF-3). Heminested reactions presented 2 (2.2%) amplifications of the expected size. Nucleotide identities ranged from 86.6 to 89.0% with ratHEV isolates from wild rats, pigs, one human case and sewage reported in different countries. Regarding the phylogenetic tree, the sequences grouped with genotype HEV-C1. This first report of ratHEV detection in bivalve mollusks may be a starting point for further research on virus variability, distribution, host range and especially the possible role of contaminated shellfish as a vehicle for ratHEV transmission.

Molecular and Serological Screening Support the Lack of Coxiella burnetii Circulation in Wild Birds of Portugal

Coxiella burnetii is a highly infectious zoonotic pathogenic bacterium that has a major economic impact in the livestock industry throughout the world and causes unpredictable outbreaks in humans worldwide. Although it is known that birds are potential reservoirs of C. burnetii, their role in the epidemiological cycle of the pathogen has not been fully verified. Due to its non-specific symptoms and clinical signs, it is certainly an underdiagnosed disease. The objective of this study was to obtain more information on C. burnetii prevalence in wild birds in Portugal. Blood, plasma, and other tissue samples were obtained from wild birds admitted at wildlife rehabilitation centres in Portugal in the scope of passive surveillance. Antibodies specific to C. burnetii were screened using a commercial enzyme-linked immunosorbent assay according to the manufacturer’s instructions. Evidence of C. burnetii infection was sought based on the detection of bacterial DNA. No positive results were found, either in terms of antibodies to C. burnetii or molecular biology. These serological findings do not indicate the endemic circulation of C. burnetii in wild birds, which can be considered relevant information. However, a more complete and serialized approach over time is necessary to be able to make real inferences about the endemicity of the pathogen in the country and its dispersion among wild avian populations. qPCR results were also negative, a finding suggesting that this host population may not play a significant role in the transmission dynamics of C. burnetii. Given the importance of wild bird species as natural reservoirs of this zoonotic bacterium, we consider these data useful for multidisciplinary work in the prevention and control of Q fever, following a One Health approach.

Intersecting realities: Exploring the nexus between armed conflicts in eastern Democratic Republic of the Congo and Global Health

The eastern Democratic Republic of the Congo (DRC) grapples with entrenched armed conflicts, creating a complex humanitarian crisis with far-reaching implications for global health. This paper explores the intersection between armed conflict in the region and the risks of zoonotic disease transmission, shedding light on interconnected challenges and proposing integrated strategies for mitigation. Armed conflict disrupts healthcare systems, affecting healthcare facilities (HCF) and healthcare workers (HCW), destroying millions of lives, impoverishing communities, and weakening surveillance systems. This deleterious situation is a bottleneck to achieving the Sustainable Development Goals (SDGs), especially Universal Health Coverage (UHC), as it prevents millions of Congolese from accessing healthcare services. The direct impact of armed insecurity undermines Global Health Security (GHS) by fostering natural habitat degradation and biodiversity loss, exacerbating vulnerabilities to zoonotic disease outbreaks. Forced population displacement and encroachment on natural habitats amplify human-wildlife interaction, facilitating zoonotic disease spillover and increasing the risk of regional and global spread. Biodiversity loss and poaching further compound these challenges, underscoring the need for holistic approaches that address both conservation and public health concerns. Mitigating zoonotic disease risks requires strengthening surveillance systems, promoting community engagement, and integrating conservation efforts with conflict resolution initiatives. By adopting a comprehensive approach, including the incorporation of One Health considerations in all peace-seeking and humanitarian efforts, stakeholders can enhance Global Health Security, scale up UHC, and promote sustainable development in conflict-affected regions. Creativity and strategic foresight are essential to safeguarding the well-being of human, livestock, plant, and wildlife populations in the Eastern DRC.

Integrating animal welfare into the WHO pandemic treaty: a thematic analysis of civil society perspectives and comparison with treaty drafting

The COVID-19 pandemic has exposed critical weaknesses in the global health system, highlighting the urgent need for a coordinated international approach to pandemic prevention and management. As negotiations for a new WHO pandemic treaty progress, the effective integration of animal welfare is crucial. This paper aims to investigate the perspectives of key civil society organizations on the integration of animal welfare provisions into the pandemic treaty. Through a thematic analysis of documents prepared by FOUR PAWS, Wildlife Conservation Society, and Action for Animal Health between 2020-2023, five major themes are identified: prevention of zoonotic spillover, One Health approach, animal health systems and infrastructure, sustainable and ethical animal management practices, and policy coherence and governance. A comparative analysis of these themes against the April 2024 draft of the pandemic treaty reveals areas of alignment and divergence. Due to the ongoing controversies and the need for further improvements, the WHO's intergovernmental negotiating body was unable to finalize the treaty text for the 77th World Health Assembly in May 2024, leading to an extended mandate until 2025. Based on the findings, the paper proposes recommendations to strengthen the integration of animal welfare into the treaty, arguing that incorporating these recommendations is critical for developing a transformative, equitable, and effective treaty that addresses the systemic drivers of pandemic risk.

Seroepidemiology of Coxiella burnetii in Domestic and Wild Ruminant Species in Southern Spain

The European Food Safety Authority has recently listed Q fever as a priority for setting up a coordinated surveillance system. Although Spain is the country with the highest human incidence of the disease in the European Union, updated data on Coxiella burnetii in ruminants are still limited. A total of 780 serum samples from small ruminants and 605 sera from wild ruminants were collected in the Mediterranean ecosystems of southern Spain during the period 2015-2023. Anti-C. burnetii antibodies were detected using a commercial indirect ELISA. The overall individual seroprevalence in the small ruminants was 49.1% (383/780; 95% CI: 45.6-52.6). Antibodies against C. burnetii were identified in 40.0% (156/390) of sheep and in 58.2% (227/390) of goats. At least one seropositive animal was observed in all sheep (100%) and in 92.3% of goat flocks. The species (goat) and the existence of reproductive disorders in primiparous females were potential risk factors for C. burnetii exposure in small ruminant farms. In the wild ruminants, the overall seroprevalence against C. burnetii was 1.5% (9/605; 95% CI: 0.8-2.8). Anti-C. burnetii antibodies were found in 1.8% (2/110) of mouflon, 1.5% (6/390) of red deer, and 1.0% (1/105) of Iberian ibex. The high exposure of the small ruminants to C. burnetii, particularly in goats, detected in the present study is of animal and public health concern. Our results denote that wild ruminants only play a minor role in the epidemiology of this bacterium in southern Spain and suggest an independent epidemiological cycle of C. burnetii in domestic and wild ruminant species in the study area.

Occurrence of Coxiella burnetii in wild lagomorphs and their ticks in Spanish Mediterranean ecosystems

BACKGROUND

Coxiella burnetii, the causative agent of Q fever, is a zoonotic multi-host vector-borne pathogen of major public health importance. Although the European Food Safety Authority has recently made the monitoring of this bacterium in wildlife a priority, the role of wild lagomorphs in the transmission and maintenance of C. burnetii is poorly understood.

AIMS

The aims of this study were to determine the prevalence and risk factors associated with C. burnetii circulation in European wild rabbits (Oryctolagus cuniculus) and Iberian hares (Lepus granatensis) and to assess the presence of this pathogen in ticks that feed on them in Mediterranean ecosystems in Spain, the country with the highest number of reported cases of Q fever in Europe.

METHODS

A total of 574 spleen samples were collected from 453 wild rabbits and 121 Iberian hares, and 513 ticks (processed in 120 pools) between the 2017/2018 and 2021/2022 hunting seasons.

RESULTS

C. burnetii DNA was detected in 103 (17.9%; 95% CI: 14.8-21.1) of the 574 wild lagomorphs tested. By species, prevalence was 16.3% (74/453; 95% CI: 12.9-19.7) in the European wild rabbit and 24.0% (29/121; 95% CI: 16.4-31.6) in the Iberian hare. At least one positive lagomorph was found on 47.9% of the 96 hunting estates sampled and in every hunting season since 2018/2019. Two risk factors associated with C. burnetii infection were as follows: outbreak of myxomatosis on the hunting estate in the month prior to sampling and high tick abundance observed by gamekeepers on the hunting estate. C. burnetii DNA was also found in 33 of the 120 (27.5%; 95% CI: 19.5-35.5) tick pools tested. The pathogen was detected in 66.7% (4/6), 29.2% (26/89) and 21.4% (3/14) of Haemaphysalis hispanica, Rhipicephalus pusillus and Hyalomma lusitanicum pools respectively.

CONCLUSIONS

This study provides new epidemiological data on C. burnetii in European wild rabbits and is the first survey on this zoonotic pathogen performed in Iberian hares. Our results indicate widespread endemic circulation of C. burnetii and highlight the importance of both wild lagomorph species as natural reservoirs of this zoonotic bacterium in Mediterranean ecosystems in southern Spain, which may be of public and animal health concern. The high prevalence and wide diversity of positive tick species suggest the possible role of ticks in the epidemiological cycle of C. burnetii, with the potential risk of transmission to sympatric species, including humans.

Hepatitis E Virus in Domestic Ruminants and Virus Excretion in Milk-A Potential Source of Zoonotic HEV Infection

The hepatitis E virus is a serious health concern worldwide, with 20 million cases each year. Growing numbers of autochthonous HEV infections in industrialized nations are brought on via the zoonotic transmission of HEV genotypes 3 and 4. Pigs and wild boars are the main animal reservoirs of HEV and play the primary role in HEV transmission. Consumption of raw or undercooked pork meat and close contact with infected animals are the most common causes of hepatitis E infection in industrialized countries. However, during the past few years, mounting data describing HEV distribution has led experts to believe that additional animals, particularly domestic ruminant species (cow, goat, sheep, deer, buffalo, and yak), may also play a role in the spreading of HEV. Up to now, there have not been enough studies focused on HEV infections associated with animal milk and the impact that they could have on the epidemiology of HEV. This critical analysis discusses the role of domestic ruminants in zoonotic HEV transmissions. More specifically, we focus on concerns related to milk safety, the role of mixed farming in cross-species HEV infections, and what potential consequences these may have on public health.

Assessing One Health capacities for transboundary zoonotic diseases at the Libya-Tunisia border

BACKGROUND

The dynamic nature of zoonotic emergence, spillover and spread necessitates multisectoral coordination beyond national borders to encompass cross-boundary and regional cooperation. Designated points of entry (POEs), specifically ground crossings, serve as critical locales for establishing and maintaining robust prevention, detection, notification, coordination, and response mechanisms to transboundary emerging and re-emerging disease threats. In order to better assess One Health capacities for transboundary zoonotic diseases (TZD) prevention, detection and response we adapted an existing tool, One Health Systems Assessment for Priority Zoonoses (OHSAPZ), for a cross-border, POE setting in North Africa.

METHODS

The One Health Transboundary Assessment for Priority Zoonoses (OHTAPZ) tool was used to support prioritization of transboundary zoonoses and analyze operational capacities between national and subnational-level human and animal health stakeholders from Libya and Tunisia. Country partners jointly identified and prioritized five TZDs of concern. Case study scenarios for each priority pathogen were used to elicit current disease operations, as well as multisectoral and bilateral engagement networks. Finally, a gap analysis was performed to determine bilateral strengths and weaknesses to TZDs.

RESULTS

The five priority TZDs jointly confirmed to undergo One Health assessment were avian influenza (low and high pathogenic strains); brucellosis; Rift Valley fever; Crimean-Congo hemorrhagic fever; and rabies. Using the qualitative information collected, a transboundary systems map schematic was developed outlining the movement of human patients, animals, diagnostic samples, and routes of communication and coordination both within and between countries for zoonotic diseases.

CONCLUSIONS

Analysis of current operations (prevention, detection, surveillance, laboratory capacity, quarantine/isolation, and response) and the resulting transboundary systems map schematic helped identify existing capacity strengths for certain priority pathogens, as well as challenges to timely information-sharing and coordination. We developed targeted recommendations to address these limitations for joint action planning between Libya and Tunisia.

Exposure to Coxiella burnetii in Wild Lagomorphs in Spanish Mediterranean Ecosystems

Coxiella burnetii is an important zoonotic pathogen of worldwide distribution that can infect a wide range of wild and domestic species. The European wild rabbit (Oryctolagus cuniculus) can play a role as a reservoir for this bacterium in certain epidemiological scenarios, but, to date, a very limited numbers of large-scale serosurveys have been conducted for this species worldwide. Although exposure in hare species has also been described, C. burnetii in Iberian hare (Lepus granatensis) has never been assessed. Here, we aimed to determine the seroprevalence and risk factors associated with C. burnetii exposure in wild lagomorphs in the Mediterranean ecosystems of southern Spain. Between the 2018/2019 and 2021/2022 hunting seasons, blood samples from 638 wild lagomorphs, including 471 wild rabbits and 167 Iberian hares, were collected from 112 hunting grounds distributed across all eight provinces of Andalusia (southern Spain). The overall apparent individual seroprevalence was 8.9% (57/638; 95% CI: 6.8-11.4). Antibodies against C. burnetii were found in 11.3% (53/471; 95% CI: 8.4-14.1) of the wild rabbits and 2.4% (4/167; 95% CI: 0.1-4.7) of the Iberian hares. Seropositive animals were detected for 16 (14.3%; 95% CI: 7.8-20.8) of the 112 hunting grounds tested and in all the hunting seasons sampled. A generalized estimating equations model showed that the geographical area (western Andalusia) and presence of sheep were risk factors potentially associated with C. burnetii exposure in wild lagomorphs. A statistically significant spatial cluster (p < 0.001) was identified in the south-west of Andalusia. Our results provide evidence of moderate, endemic and heterogeneous circulation of C. burnetii in wild lagomorph populations in Spanish Mediterranean ecosystems. Risk-based strategies for integrative surveillance programs should be implemented in these species to reduce the risk of transmission of the bacterium to sympatric species, including humans.

First report of an outbreak of "Q" fever IN an abattoir from Argentina

In late October 2021, one of the veterinarians and the occupational physician of a bovine and swine abattoir from Entre Ríos Province, Argentina were alerted about workers with atypical pneumonia symptoms, raising suspicious of a possible Q fever outbreak. An outbreak epidemiological investigation was carried out. Analysis was based on the description of the study population, according to gender, age, symptoms, and position within the abattoir, as well as on outbreak epidemic curve and its probable origin. Cases of Q fever in the workers were confirmed by serology. Measurements of the association between the evaluated variables and the risk of exposure were investigated and calculated as attack rates. The outbreak occurred between October and November 2021, symptomatically affecting 11 workers, out of a total exposed population of 49 individuals. The index case was a 33-year-old male who started with symptoms on 27 October 2021, and the outbreak extended for at least 17 days. Workers in the clean zone of the slaughter floor had a 4.68 times higher risk of contracting Q fever than people located in other areas. Importantly, two pregnant cows were slaughtered a few days before the outbreak began, which could have been the origin of the outbreak. The present study demonstrates the urgent need to consider Q fever when diagnosing abortive diseases of ruminants in Argentina, as well as in zoonotic disease epidemiological surveillance to inform all actors of the health system.

European Food Safety Authority (EFSA), Berezowski J, De Balogh K, Dórea FC, Ruegg S, Broglia A, Zancanaro G, Gervelmeyer A. Coordinated surveillance system under the One Health approach for cross-border pathogens that threaten the Union - options for sustainable surveillance strategies for priority pathogens

This report provides guidance for Member states who plan to submit applications under the work programme 'CP-g-22-04.01 Direct grants to Member States' authorities'. The priority pathogens on which the coordinated surveillance under the grant initiative shall focus have been identified in a prioritisation exercise with Member States and ECDC. These are Crimean Congo haemorrhagic fever, echinococcosis, hepatitis E, highly pathogenic avian influenza (HPAI), influenza in swine, Lyme disease, Q-fever, Rift Valley fever, tick-borne encephalitis, West Nile fever and Disease X (Disease Y of animals). Surveillance activities (surveillance cards) have been proposed for these agents in this report. Member States should select one or more diseases from the list of priority diseases and then choose surveillance activities from the surveillance cards and modify them where needed, to reflect their national needs and situation. Member States can also design alternative surveillance activities for the priority infectious agents that may better fit the epidemiological situation in their country. Further, this report provides a section on surveillance perspectives that links infectious agents to different hosts, allowing Member States to consider the testing for multiple infectious agents in samples from a single host population, as well as sections providing guidance on surveillance in vectors and wildlife and for Disease X (Disease Y in animals). Member States are encouraged to develop cross-sectoral collaborations and the report provides guidance on cross-sectoral collaboration to help them. Finally, there is a roadmap providing an overall description of the steps in the process of developing a surveillance system in order to apply for the grant.