Efficacy of bacterial vaccines to prevent respiratory disease in swine: a systematic review and network meta-analysis

Susceptibility trends of swine respiratory pathogens from 2019 to 2022 to antimicrobials commonly used in Spain

BACKGROUND

Antimicrobial resistance is one of the most important health challenges in humans and animals. Antibiotic susceptibility determination is used to select the most suitable drug to treat animals according to its success probability following the European legislation in force for these drugs. We have studied the antibiotic susceptibility pattern (ASP) of Actinobacillus pleuropneumoniae (APP) and Pasteurella multocida (PM) isolates, collected during the period 2019-2022 in Spain. ASP was measured by determining minimum inhibitory concentration using standardized laboratory methods and its temporal trend was determined by logistic regression analysis of non-susceptible/susceptible isolates using clinical breakpoints.

RESULTS

It was not observed any significant temporal trends for susceptibility of Actinobacillus pleuropneumoniae to ceftiofur, florfenicol, sulfamethoxazole/trimethoprim, tulathromycin and tildipirosin during the study period (p > 0.05). Contrarily, a significant temporal trend (p < 0.05) was observed for quinolones (enrofloxacin and marbofloxacin), tetracyclines (doxycycline and oxyteracycline), amoxicillin, tiamulin and tilmicosin. On the other hand, it was not observed any significant temporal trends for susceptibility of Pasteurella multocida to quinolones (enrofloxacin and marbofloxacin), amoxicillin, ceftiofur, florfenicol and macrolides (tildipirosin, tulathromycin and tilmicosin) during the study period (p > 0.05). Contrarily, a significant temporal trend (p < 0.05) was observed for tetracyclines (oxyteracycline), tiamulin and sulfamethoxazole/trimethoprim.

CONCLUSIONS

In general terms, pig pathogens (APP and PM) involved in respiratory diseases analysed herein appeared to remain susceptible or tended to increase susceptibility to antimicrobials over the study period (2019-2022), but our data clearly showed a different pattern in the evolution of antimicrobial susceptibility for each combination of drug and microorganism. Our results highlight that the evolution of antimicrobial susceptibility must be studied in a case-by-case situation where generalization for drug families and bacteria is not possible even for bacteria located in the same ecological niche.

Does Vaccine-Induced Maternally-Derived Immunity Protect Swine Offspring against Influenza a Viruses? A Systematic Review and Meta-Analysis of Challenge Trials from 1990 to May 2021

It is unclear if piglets benefit from vaccination of sows against influenza. For the first time, methods of evidence-based medicine were applied to answer the question: "Does vaccine-induced maternally-derived immunity (MDI) protect swine offspring against influenza A viruses?". Challenge trials were reviewed that were published from 1990 to April 2021 and measured at least one of six outcomes in MDI-positive versus MDI-negative offspring (hemagglutination inhibition (HI) titers, virus titers, time to begin and time to stop shedding, risk of infection, average daily gain (ADG), and coughing) (n = 15). Screening and extraction of study characteristics was conducted in duplicate by two reviewers, with data extraction and assessment for risk of bias performed by one. Homology was defined by the antigenic match of vaccine and challenge virus hemagglutinin epitopes. Results: Homologous, but not heterologous MDI, reduced virus titers in piglets. There was no difference, calculated as relative risks (RR), in infection incidence risk over the entire study period; however, infection hazard (instantaneous risk) was decreased in pigs with MDI (log HR = -0.64, 95% CI: -1.13, -0.15). Overall, pigs with MDI took about a ½ day longer to begin shedding virus post-challenge (MD = 0.51, 95% CI: 0.03, 0.99) but the hazard of infected pigs ceasing to shed was not different (log HR = 0.32, 95% CI: -0.29, 0.93). HI titers were synthesized qualitatively and although data on ADG and coughing was extracted, details were insufficient for conducting meta-analyses. Conclusion: Homology of vaccine strains with challenge viruses is an important consideration when assessing vaccine effectiveness. Herd viral dynamics are complex and may include concurrent or sequential exposures in the field. The practical significance of reduced weaned pig virus titers is, therefore, not known and evidence from challenge trials is insufficient to make inferences on the effects of MDI on incidence risk, time to begin or to cease shedding virus, coughing, and ADG. The applicability of evidence from single-strain challenge trials to field practices is limited. Despite the synthesis of six outcomes, challenge trial evidence does not support or refute vaccination of sows against influenza to protect piglets. Additional research is needed; controlled trials with multi-strain concurrent or sequential heterologous challenges have not been conducted, and sequential homologous exposure trials were rare. Consensus is also warranted on (1) the selection of core outcomes, (2) the sizing of trial populations to be reflective of field populations, (3) the reporting of antigenic characterization of vaccines, challenge viruses, and sow exposure history, and (4) on the collection of non-aggregated individual pig data.

Maximizing value and minimizing waste in clinical trials in swine: Selecting outcomes to build an evidence base

Researchers planning clinical trials should identify the primary trial outcome and adequately power the trial to detect clinically meaningful differences in this outcome. All primary and secondary outcomes and their measurement should be comprehensively described, and their results reported. There is evidence that trials on the same subject use different outcomes or measure the same outcome in different ways, making it difficult to compare intervention effectiveness across clinical trials. Consensus development of core outcome sets could improve consistency in outcome measures used across trials and aid in development of an evidence-based body of literature on intervention effectiveness in swine populations.

Maximizing value and minimizing waste in clinical trial research in swine: Selecting interventions to build an evidence base

Researchers conduct a trial to compare an intervention of interest to a comparison group. Initially, researchers should determine whether a trial is evaluating superiority, equivalence, or noninferiority. This decision will guide the choice of a placebo versus active comparison group. Interventions, as well as baseline management, should be comprehensively reported to allow replication or clinical application. It is necessary to build a body of evidence across multiple trials to apply evidence-based decision-making. To achieve this, at least one intervention in every trial should be an intervention that has been used in at least one previously published trial.

Levels of Evidence, Quality Assessment, and Risk of Bias: Evaluating the Internal Validity of Primary Research

Clinical decisions in human and veterinary medicine should be based on the best available evidence. The results of primary research are an important component of that evidence base. Regardless of whether assessing studies for clinical case management, developing clinical practice guidelines, or performing systematic reviews, evidence from primary research should be evaluated for internal validity i.e., whether the results are free from bias (reflect the truth). Three broad approaches to evaluating internal validity are available: evaluating the potential for bias in a body of literature based on the study designs employed (levels of evidence), evaluating whether key study design features associated with the potential for bias were employed (quality assessment), and applying a judgement as to whether design elements of a study were likely to result in biased results given the specific context of the study (risk of bias assessment). The level of evidence framework for assessing internal validity assumes that internal validity can be determined based on the study design alone, and thus makes the strongest assumptions. Risk of bias assessments involve an evaluation of the potential for bias in the context of a specific study, and thus involve the least assumptions about internal validity. Quality assessment sits somewhere between the assumptions of these two. Because risk of bias assessment involves the least assumptions, this approach should be used to assess internal validity where possible. However, risk of bias instruments are not available for all study designs, some clinical questions may be addressed using multiple study designs, and some instruments that include an evaluation of internal validity also include additional components (e.g., evaluation of comprehensiveness of reporting, assessments of feasibility or an evaluation of external validity). Therefore, it may be necessary to embed questions related to risk of bias within existing quality assessment instruments. In this article, we overview the approaches to evaluating internal validity, highlight the current complexities, and propose ideas for approaching assessments of internal validity.

Beyond Antimicrobial Use: A Framework for Prioritizing Antimicrobial Resistance Interventions

Antimicrobial resistance (AMR) is a threat to animal and human health. Antimicrobial use has been identified as a major driver of AMR, and reductions in use are a focal point of interventions to reduce resistance. Accordingly, stakeholders in human health and livestock production have implemented antimicrobial stewardship programs aimed at reducing use. Thus far, these efforts have yielded variable impacts on AMR. Furthermore, scientific advances are prompting an expansion and more nuanced appreciation of the many nonantibiotic factors that drive AMR, as well as how these factors vary across systems, geographies, and contexts. Given these trends, we propose a framework to prioritize AMR interventions. We use this framework to evaluate the impact of interventions that focus on antimicrobial use. We conclude by suggesting that priorities be expanded to include greater consideration of host-microbial interactions that dictate AMR, as well as anthropogenic and environmental systems that promote dissemination of AMR.

Non-antibiotic Approaches for Disease Prevention and Control in Nursery Pigs: A Scoping Review

Swine producers are encouraged to practice antibiotic stewardship by reducing their use of antibiotics belonging to classes of medical importance to humans. We conducted a scoping review of non-antibiotic approaches in the form of products or management practices that might prevent or control disease and thus reduce the need for antibiotics in nursery pigs. Our objectives were to systematically describe the research on this broad topic for the North American context, identify specific topics that could feasibly support systematic reviews, and identify knowledge gaps. A search of multiple databases identified 11,316 articles and proceedings for relevance screening. From these, 441 eligible clinical trials and observational studies were charted. The majority were clinical trials (94%). Study results from EU countries were mostly communicated through journal articles, whereas study results from the USA were mostly communicated through conference proceedings. Interventions and health outcomes were diverse. The two most frequent intervention categories were feed additives and piglet vaccines. The three most frequent outcomes reported were diarrhea, mortality, and indices of vaccine immunity. There were 13 specific topics comprising various feed additives and vaccines that might feasibly support systematic reviews. There were relatively few studies in which interventions were compared with antibiotic comparison groups and relatively few studies evaluating management practices.

Predicting morbidity and mortality using automated milk feeders: A scoping review

Automated milk feeders (AMF) are computerized systems that provide producers with a tool that can be used to more efficiently raise dairy calves and allow for easier implementation of a high plane of nutrition during the milk feeding phase. Automated milk feeders also have the ability to track individualized behavioral data, such as milk consumption, drinking speed, and the number of rewarded and unrewarded visits to the feeder, that could potentially be used to predict disease development. The objective of this scoping review was to characterize the body of literature investigating the use of AMF data to predict morbidity and mortality in dairy calves during the preweaning stage. This review lists the parameters that have been examined for associations with disease in calves and identify discrepancies found in the literature. Five databases and relevant conference proceedings were searched. Eligible studies focused on the use of behavioral parameters measured by AMF to predict morbidity or mortality in preweaned dairy calves. Two reviewers independently screened titles and abstracts from 6,675 records identified during the literature search. After title and abstract screening, 382 studies were included and then assessed at the full-text level. Of these, 56 studies fed calves using an AMF and provided some measure of morbidity or mortality. Thirteen examined AMF parameters for associations with morbidity or mortality. The studies were completed in North America (n = 6), Europe (n = 6), and New Zealand (n = 1). The studies varied in sample size, ranging from 30 to 1,052 calves with a median of 100 calves. All 13 studies included enteric disease as an outcome and 11 studies evaluated respiratory disease. Of the studies measuring enteric disease, 8 provided disease definitions (n = 8/13, 61.2%); however, for respiratory disease, only 5 provided a disease definition (n = 5/11, 45.5%). Disease definitions and thresholds varied greatly between studies, with 10 using some form of health scoring. When evaluating feeding metrics as indicators of disease, all 13 studies investigated milk consumption and 6 and 7 studies investigated drinking speed and number of rewarded and unrewarded visits, respectively. Overall, this scoping review identified that daily milk consumption, drinking speed, and rewarded and unrewarded visits may provide insight into early disease detection in preweaned dairy calves. However, the disparity in reporting of study designs and results between included studies made comparisons challenging. In addition, to aid with the interpretation of studies, standardized disease outcomes should be used to improve the utility of this primary research.

Antimicrobial Susceptibility Pattern of Porcine Respiratory Bacteria in Spain

The monitoring of antimicrobial susceptibility of pig pathogens is critical to optimize antimicrobial treatments and prevent development of resistance with a one-health approach. The aim of this study was to investigate the antimicrobial susceptibility patterns of swine respiratory pathogens in Spain from 2017 to 2019. Bacterial isolation and identification were carried out following standardized methods from samples coming from sacrificed or recently deceased pigs with acute clinical signs compatible with respiratory tract infections. Minimum inhibitory concentration (MIC) values were determined using the broth microdilution method containing a total of 10 and 7–8 antimicrobials/concentrations respectively, in accordance with the recommendations presented by the Clinical and Laboratory Standards Institute (CLSI). The obtained antimicrobial susceptibility varies between pig respiratory pathogens. Actinobacillus pleuropneumoniae (APP) and Pasteurella multocida (PM) were highly susceptible (≥90%) to ceftiofur, florfenicol and macrolides (tilmicosin, tildipirosin and tulathromycin). However, the antimicrobial susceptibility was intermediate (>60% but <90%) for amoxicillin and enrofloxacin in the case of APP and sulfamethoxazole/trimethropim and tiamulin in the case of PM. Both bacteria showed low (<60%) antimicrobial susceptibility to doxycycline. Finally, Bordetella bronchiseptica was highly susceptible only to tildipirosin and tulathromycin (100%) and its susceptibility for florfenicol was close to 50% and <30% for the rest of the antimicrobial families tested. These results emphasize the need of determining antimicrobial susceptibility in pig respiratory cases in order to optimize the antimicrobial treatment in a case-by-case scenario.