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Babarczy B, Hajdu Á, Benko R, Matuz M, Papp R, Antoniou P, Kandelaki K, Lo Fo Wong D, Warsi SK. Hungarian general practice paediatricians' antibiotic prescribing behaviour for suspected respiratory tract infections: a qualitative study. BMJ Open 2024; 14:e081574. [PMID: 38729758 DOI: 10.1136/bmjopen-2023-081574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Inappropriate antibiotic prescribing is a major cause of antimicrobial resistance (AMR). The aim of this study was to explore paediatric general practitioners' (GP Peds) antibiotic prescription practice in suspected respiratory tract infections (RTIs), using the capability-opportunity-motivation-behaviour framework. DESIGN The design is a qualitative study based on individual, semistructured telephone or virtual interviews. SETTING Paediatric general practice in Hungary. We applied stratified maximum variation sampling to cover the categories of age, sex and geographical location of participants. PARTICIPANTS We interviewed 22 GP Peds. Nine were male and 13 were female: 2 of them were less than 40 years old, 14 were between 40 and 60 years, and 6 were above 60 years. 10 worked in low-antibiotic prescription areas, 5 in areas with medium levels of antibiotic prescription, 3 in high-antibiotic prescription areas, and 4 in and around the capital city. RESULTS Study participants had varying antibiotic prescription preferences. Personal experience and physical examination play a central role in GP Peds' diagnostic and treatment practice. Participants emphasised the need to treat children in their entirety, taking their personal medical record, social background and sometimes parents' preferences into account, besides the acute clinical manifestation of RTI. Most respondents were confident they apply the most effective therapy even if, in some cases, this meant prescribing medicines with a higher chance of contributing to the development of AMR. Some participants felt antibiotic prescription frequency has decreased in recent years. CONCLUSIONS Our findings suggest that a more prudent attitude toward antibiotic prescribing may have become more common but also highlight relevant gaps in both physicians' and public knowledge of antibiotics and AMR. To reinforce awareness and close remaining gaps, Hungary should adopt its national AMR National Action Plan and further increase its efforts towards active professional communication and feedback for primary care physicians.
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Affiliation(s)
- Balázs Babarczy
- Syreon Research Institute, Budapest, Hungary
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Ágnes Hajdu
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Ria Benko
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Renáta Papp
- Centre of Science & Innovation Vice-rector and Business Development, Semmelweis University, Budapest, Hungary
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Sirota M, Habersaat KB, Betsch C, Bonga DL, Borek A, Buckel A, Butler R, Byrne-Davis L, Caudell M, Charani E, Geiger M, Gross M, Hart J, Kostopoulou O, Krockow EM, Likki T, Lo Fo Wong D, Santana AP, Sievert EDC, Theodoropoulou A, Thorpe A, Wanat M, Böhm R. We must harness the power of social and behavioural science against the growing pandemic of antimicrobial resistance. Nat Hum Behav 2024; 8:11-13. [PMID: 37985918 DOI: 10.1038/s41562-023-01762-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Miroslav Sirota
- Department of Psychology, University of Essex, Colchester, UK.
| | | | - Cornelia Betsch
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Daniela Lejla Bonga
- Behavioural and Experimental Economics Team, Ministry of Health, Bratislava, Slovakia
| | - Aleksandra Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anica Buckel
- Food and Agriculture Organisation of the United Nations, Nairobi, Kenya
| | - Robb Butler
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Lucie Byrne-Davis
- Division of Medical Education, University of Manchester, Manchester, UK
| | - Mark Caudell
- Food and Agriculture Organisation of the United Nations, Nairobi, Kenya
| | - Esmita Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mattis Geiger
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Marina Gross
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Jo Hart
- Division of Medical Education, University of Manchester, Manchester, UK
| | - Olga Kostopoulou
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Eva M Krockow
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Tiina Likki
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Danilo Lo Fo Wong
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Ana P Santana
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth D C Sievert
- Health Communication, Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Health Communication, Implementation Research, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | | | - Alistair Thorpe
- Department of Applied Health Research, University College London, London, UK
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marta Wanat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robert Böhm
- Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
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Singh-Phulgenda S, Antoniou P, Wong DLF, Iwamoto K, Kandelaki K. Knowledge, attitudes and behaviors on antimicrobial resistance among general public across 14 member states in the WHO European region: results from a cross-sectional survey. Front Public Health 2023; 11:1274818. [PMID: 38074764 PMCID: PMC10704021 DOI: 10.3389/fpubh.2023.1274818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023] Open
Abstract
Background Antimicrobial resistance (AMR) is a major global public health threat requiring urgent action. Pan-European data on knowledge, attitudes and behaviors among the general public regarding antibiotic use and AMR is limited. Methods A multicentric, cross-sectional survey of the general public was conducted in the capital cities of 14 Member States of the WHO European Region. A validated questionnaire from the AMR Eurobarometer survey was used to collect data on antibiotic use and knowledge, access to antibiotics, and understanding of policy responses through face-to-face exit interviews. Results Out of 8,221 respondents from 14 Member States, 50% took antibiotics in the past 12 months and the majority (53%) obtained their most recent course from a medical practitioner. The most reported reasons for taking antibiotics orally in the past 12 months were cold (24%), sore throat (21%), cough (18%), and flu (16%). Overall, 84% of participants showed a lack of knowledge about appropriate antibiotic use. However, only 37% of respondents reported receiving any information in the past year about the importance of avoiding unnecessary antibiotic use. Doctors were the most cited (50%) and most trusted (80%) source of information. Among respondents who experienced COVID-19, 28% took antibiotics with a prescription, while 8% took antibiotics without a prescription. Conclusion This study highlights the urgent need for targeted awareness campaigns and educational initiatives to address knowledge gaps and promote responsible antibiotic use. The findings emphasize the role of the general population in combating AMR. The data serve as baseline information for future evaluations and interventions in the Region.
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Affiliation(s)
- Sauman Singh-Phulgenda
- Infectious Diseases Data Observatory (IDDO), University of Oxford, Oxford, United Kingdom
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Verschuuren M, Berdzuli N, Kandelaki K, Gelormini M, Jorgensen TR, Lo Fo Wong D, Biesma Blanco R, Barnhoorn F, Verschuuren M. European Public Health News. Eur J Public Health 2023; 33:954-956. [PMID: 37821395 PMCID: PMC10567124 DOI: 10.1093/eurpub/ckad159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Affiliation(s)
| | - Nino Berdzuli
- Director Country Health Programmes WHO Regional Office for Europe
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Gasser M, Cassini A, Lo Fo Wong D, Gelormini M, Nahrgang SA, Zingg W, Kronenberg AO. Associated deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in Switzerland, 2010 to 2019. Euro Surveill 2023; 28:2200532. [PMID: 37199988 PMCID: PMC10197493 DOI: 10.2807/1560-7917.es.2023.28.20.2200532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/21/2022] [Indexed: 05/19/2023] Open
Abstract
BackgroundCassini et al. (2019) estimated that, in 2015, infections with 16 different antibiotic-resistant bacteria resulted in ca 170 disability-adjusted life-years (DALYs) per 100,000 population in the European Union and European Economic area (EU/EEA). The corresponding estimate for Switzerland was about half of this (87.8 DALYs per 100,000 population) but still higher than that of several EU/EEA countries (e.g. neighbouring Austria (77.2)).AimIn this study, the burden caused by the same infections due to antibiotic-resistant bacteria ('AMR burden') in Switzerland from 2010 to 2019 was estimated and the effect of the factors 'linguistic region' and 'hospital type' on this estimate was examined.MethodsNumber of infections, DALYs and deaths were estimated according to Cassini et al. (2019) whereas separate models were built for each linguistic region/hospital type combination.ResultsDALYs increased significantly from 3,995 (95% uncertainty interval (UI): 3;327-4,805) in 2010 to 6,805 (95% UI: 5,820-7,949) in 2019. Linguistic region and hospital type stratifications significantly affected the absolute values and the slope of the total AMR burden estimates. DALYs per population were higher in the Latin part of Switzerland (98 DALYs per 100,000 population; 95% UI: 83-115) compared with the German part (57 DALYs per 100,000 population; 95% UI: 49-66) and in university hospitals (165 DALYs per 100,000 hospitalisation days; 95% UI: 140-194) compared with non-university hospitals (62 DALYs per 100,000 hospitalisation days; 95% UI: 53-72).ConclusionsThe AMR burden estimate in Switzerland has increased significantly between 2010 and 2019. Considerable differences depending on the linguistic region and the hospital type were identified - a finding which affects the nationwide burden estimation.
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Affiliation(s)
- Michael Gasser
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Alessandro Cassini
- Infection Prevention and Control Unit, Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
- Deputy Cantonal Doctor, Public Health Department, Canton of Vaud, Lausanne, Switzerland
| | - Danilo Lo Fo Wong
- Control of Antimicrobial Resistance Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Marcello Gelormini
- Control of Antimicrobial Resistance Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Saskia Andrea Nahrgang
- Control of Antimicrobial Resistance Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Walter Zingg
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Oskar Kronenberg
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Gagliotti C, Högberg LD, Billström H, Eckmanns T, Giske CG, Heuer OE, Jarlier V, Kahlmeter G, Lo Fo Wong D, Monen J, Murchan S, Simonsen GS, Šubelj M, Andrašević AT, Żabicka D, Žemličková H, Monnet DL. Staphylococcus aureus bloodstream infections: diverging trends of meticillin-resistant and meticillin-susceptible isolates, EU/EEA, 2005 to 2018. Euro Surveill 2021; 26:2002094. [PMID: 34794536 PMCID: PMC8603406 DOI: 10.2807/1560-7917.es.2021.26.46.2002094] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
BackgroundInvasive infections caused by Staphylococcus aureus have high clinical and epidemiological relevance. It is therefore important to monitor the S. aureus trends using suitable methods.AimThe study aimed to describe the trends of bloodstream infections (BSI) caused by meticillin-resistant S. aureus (MRSA) and meticillin-susceptible S. aureus (MSSA) in the European Union (EU) and the European Economic Area (EEA).MethodsAnnual data on S. aureus BSI from 2005 to 2018 were obtained from the European Antimicrobial Resistance Surveillance Network (EARS-Net). Trends of BSI were assessed at the EU/EEA level by adjusting for blood culture set rate (number of blood culture sets per 1,000 days of hospitalisation) and stratification by patient characteristics.ResultsConsidering a fixed cohort of laboratories consistently reporting data over the entire study period, MRSA percentages among S. aureus BSI decreased from 30.2% in 2005 to 16.3% in 2018. Concurrently, the total number of BSI caused by S. aureus increased by 57%, MSSA BSI increased by 84% and MRSA BSI decreased by 31%. All these trends were statistically significant (p < 0.001).ConclusionsThe results indicate an increasing health burden of MSSA BSI in the EU/EEA despite a significant decrease in the MRSA percentage. These findings highlight the importance of monitoring antimicrobial resistance trends by assessing not only resistance percentages but also the incidence of infections. Further research is needed on the factors associated with the observed trends and on their attributable risk.
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Affiliation(s)
- Carlo Gagliotti
- Regional Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy
| | | | | | - Tim Eckmanns
- Healthcare-associated infections, surveillance of antimicrobial resistance and consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ole E Heuer
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Vincent Jarlier
- Sorbonne Universités (Paris 06) Inserm Centre d'Immunologie et des Maladies Infectieuses (CIMI), UMR 1135 & APHP, Pitié-Salpêtrière hospital, Laboratoire de Bactériologie-Hygiène, Paris, France
| | | | - Danilo Lo Fo Wong
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Jos Monen
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Research Group for Host Microbe Interaction, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Maja Šubelj
- National Institute of Public Health, University of Ljubljana, Slovenia
| | | | - Dorota Żabicka
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Helena Žemličková
- National reference laboratory for antibiotics, National Institute of Public Health, Prague, Czech Republic
- Department of Microbiology, 3rd Faculty of Medicine Charles University, University hospital Kralovske Vinohrady, and National Institute of Public Health, Prague, Czech Republic
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Newitt S, Anthierens S, Coenen S, Lo Fo Wong D, Salvi C, Puleston R, Ashiru-Oredope D. Expansion of the 'Antibiotic Guardian' one health behavioural campaign across Europe to tackle antibiotic resistance: pilot phase and analysis of AMR knowledge. Eur J Public Health 2019; 28:437-439. [PMID: 29401283 DOI: 10.1093/eurpub/ckx239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major public health threat. The UK Antibiotic Guardian (AG) behavioural change campaign developed to tackle AMR was expanded across Europe through translation into Russian, Dutch and French. Demographics and knowledge of AGs were analyzed between 01 November 2016 and 31 December 2016. A total of 367 pledges were received with the majority from the public and health care professionals. The pilot has significantly increased the proportion of pledges from Europe (excluding UK) (χ2 = 108.7, P < 0.001). AMR knowledge was greater in AGs (including the public) compared to the EU Eurobarometer survey. Further promotion across Europe is required to measure an impact on tackling AMR.
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Affiliation(s)
| | - Sibyl Anthierens
- Belgian Antibiotic Policy Coordination Committee (BAPCOC), Brussels, Belgium.,Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Samuel Coenen
- Belgian Antibiotic Policy Coordination Committee (BAPCOC), Brussels, Belgium.,Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
| | - Danilo Lo Fo Wong
- World Health Organization Regional Office for Europe (WHO/Europe), Denmark
| | - Cristiana Salvi
- World Health Organization Regional Office for Europe (WHO/Europe), Denmark
| | - Richard Puleston
- Public Health England, UK.,Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Iwamoto K, Pedersen HB, Tello JE, Lo Fo Wong D, Robertson J. Cross-programmatic consultation on the role of primary care in the responsible use of medicines and the reduction of antimicrobial resistance. Expert Rev Anti Infect Ther 2019; 17:75-78. [PMID: 30626232 DOI: 10.1080/14787210.2018.1563482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This meeting was held from the 30 October to the 1 November 2018 in Almaty, Kazakhstan. The meeting brought together participants from 16 countries of central Asia, Caucasus, eastern Europe and expert speakers from western Europe and India. Participants discussed the analysis and use of data on antimicrobial medicines consumption, country experiences in enforcing legislation for prescription-only access to antibiotics, the role of primary health care (PHC) in tackling antimicrobial resistance (AMR), strategies to improving competencies of practitioners using evidence-based clinical protocols and public engagement in the responsible use of medicines. Moving toward prescription-only access to antibiotics requires that government involve, from the onset, different stakeholders, e.g. public, patients, practitioners, pharmacists and pharmaceutical industry in designing and applying policies that ensure access to antibiotics accompanied by measures that promote responsible use and limit excessive use.
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Affiliation(s)
| | | | - Juan E Tello
- a WHO Regional Office for Europe , Copenhagen , Denmark
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Aarestrup FM, Brown EW, Detter C, Gerner-Smidt P, Gilmour MW, Harmsen D, Hendriksen RS, Hewson R, Heymann DL, Johansson K, Ijaz K, Keim PS, Koopmans M, Kroneman A, Lo Fo Wong D, Lund O, Palm D, Sawanpanyalert P, Sobel J, Schlundt J. Integrating genome-based informatics to modernize global disease monitoring, information sharing, and response. Emerg Infect Dis 2013; 18:e1. [PMID: 23092707 PMCID: PMC3559169 DOI: 10.3201/eid/1811.120453] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The rapid advancement of genome technologies holds great promise for improving the quality and speed of clinical and public health laboratory investigations and for decreasing their cost. The latest generation of genome DNA sequencers can provide highly detailed and robust information on disease-causing microbes, and in the near future these technologies will be suitable for routine use in national, regional, and global public health laboratories. With additional improvements in instrumentation, these next- or third-generation sequencers are likely to replace conventional culture-based and molecular typing methods to provide point-of-care clinical diagnosis and other essential information for quicker and better treatment of patients. Provided there is free-sharing of information by all clinical and public health laboratories, these genomic tools could spawn a global system of linked databases of pathogen genomes that would ensure more efficient detection, prevention, and control of endemic, emerging, and other infectious disease outbreaks worldwide.
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Aarestrup FM, Brown EW, Detter C, Gerner-Smidt P, Gilmour MW, Harmsen D, Hendriksen RS, Hewson R, Heymann DL, Johansson K, Ijaz K, Keim PS, Koopmans M, Kroneman A, Wong DLF, Lund O, Palm D, Sawanpanyalert P, Sobel J, Schlundt J. Integrating Genome-based Informatics to Modernize Global Disease Monitoring, Information Sharing, and Response. Emerg Infect Dis 2012. [DOI: 10.3201/eid1811.120453] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Pires SM, Vieira AR, Perez E, Lo Fo Wong D, Hald T. Attributing human foodborne illness to food sources and water in Latin America and the Caribbean using data from outbreak investigations. Int J Food Microbiol 2011; 152:129-38. [PMID: 21570732 DOI: 10.1016/j.ijfoodmicro.2011.04.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
Abstract
Foodborne pathogens are responsible for an increasing burden of disease worldwide. Knowledge on the contribution of different food sources and water for disease is essential to prioritize food safety interventions and implement appropriate control measures. Source attribution using outbreak data utilizes readily available data from outbreak surveillance to estimate the contribution of different sources to human disease. We developed a probabilistic model based on outbreak data that attributes human foodborne disease by various bacterial pathogens to sources in Latin America and the Caribbean (LA&C). Foods implicated in outbreaks were classified by their ingredients as simple foods (i.e. belonging to one single food category), or complex foods (i.e. belonging to multiple food categories). For each agent, the data from simple-food outbreaks were summarized, and the proportion of outbreaks caused by each category was used to define the probability that an outbreak was caused by a source. For the calculation of the number of outbreaks attributed to each source, simple-food outbreaks were attributed to the single food category in question, and complex-food outbreaks were partitioned to each category proportionally to the estimated probability. We analysed all bacterial pathogens together, focused on important bacterial pathogens separately, and, when data were sufficient, performed analyses by country, decade and location. Between 1993 and 2010, 6313 bacterial outbreaks were reported by 20 countries. In general, the most important sources of bacterial disease were meat, dairy products, water and vegetables in the 1990s, and eggs, vegetables, and grains and beans in the 2000s. We observed fluctuations of the most important sources of disease for each pathogen between decades and countries, which may be a consequence of changes in the control of zoonotic disease over the years, of changes in food consumption habits, or of changes in public health focus and availability of data of different pathogens. This study identified data gaps in the region and highlighted the importance of effective surveillance systems to identify sources of disease. Still, the application of this method for source attribution in the LA&C region was successful, and we concluded that this approach can be used to attribute disease to food sources and water in other regions, including developing regions with limited data on the public health impact of foodborne diseases.
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Affiliation(s)
- Sara M Pires
- National Food Institute, Technical University of Denmark, Lyngby, Denmark.
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Abstract
We describe Salmonella control programs of broiler chickens, layer hens, and pigs in Denmark. Major reductions in the incidence of foodborne human salmonellosis have occurred by integrated control of farms and food processing plants. Disease control has been achieved by monitoring the herds and flocks, eliminating infected animals, and diversifying animals (animals and products are processed differently depending on Salmonella status) and animal food products according to the determined risk. In 2001, the Danish society saved U.S.$25.5 million by controlling Salmonella. The total annual Salmonella control costs in year 2001 were U.S.$14.1 million (U.S.$0.075/kg of pork and U.S.$0.02/kg of broiler or egg). These costs are paid almost exclusively by the industry. The control principles described are applicable to most industrialized countries with modern intensive farming systems.
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