The Added-Value of Using Participatory Approaches to Assess the Acceptability of Surveillance Systems: The Case of Bovine Tuberculosis in Belgium

Evaluation of 17 years of MERIN (Meningitis and Encephalitis register in Lower Saxony, Germany) surveillance system: participants acceptability survey, completeness and timeliness of data

BACKGROUND

A Meningitis and Encephalitis Surveillance (MERIN) was implemented in 2003 in Lower Saxony, Germany as an alternative to acute flaccid paralyses surveillance, as the latter did not reach WHO sensitivity criteria. The system provides information on circulating enterovirus (EV) serotypes by focussing on patients with suspected aseptic meningitis, encephalitis or acute flaccid paralysis and contributes to the national surveillance in documenting polio free status. MERIN is based on voluntary participation of hospitals. Therefore, our evaluation focusses on acceptability of the system's objectives and performance, and identifying areas for improvement.

METHODS

To assess acceptability, 32 contributing hospitals were invited to an online-based survey (11/2021 to 01/2022) to rate the MERIN objectives, laboratory's performance, their workload, modes of processes and communication. Ideas for improvement were collected in open fields. In addition, data completeness and timeliness of laboratory diagnostics were assessed.

RESULTS

Of 32 hospitals, 21 responded (66% response rate), sending 30 questionnaires, 25 from pediatric and 5 from neurological departments. High levels of satisfaction with the communication (≥ 96%), timeliness (≥ 81%), and distribution of the results (≥ 85%) were reported, 97% of participants judged the required workload as adequate. The median proportion of eligible patients included in MERIN was 75%. Participants gave rapid and reliable diagnostic testing the highest priority (96%), while monitoring of Germany's polio-free status was rated the lowest (61%). Providing medical reports digitally as well as regular updates about circulating EV serotypes were identified as areas for improvement. Data completeness of selected variables ranged from 78.3 to 99.9%. Median time between sample collection and arrival at laboratory was 2 days [IQR 1-3], EV diagnostics via PCR took one day [IQR 0-6] and EV isolation on cell culture 11 days [IQR 10-13].

CONCLUSION

MERIN is a highly accepted surveillance system. Its quality was enhanced further by addressing the suggested improvements such as regular reports on circulating EV serotypes and facilitating digital access to laboratory results. Our results emphasise the importance of recognizing and considering participants' motivations and expectations, and addressing their priorities, even if this is not the surveillance system's main focus. This approach can be applied to surveillance systems of other non-mandatory notifiable diseases.

Improving the communication between farmers and veterinarians to enhance the acceptability of bovine tuberculosis eradication programmes

France and Spain have been fighting against bovine tuberculosis (bTB) for years, even though new outbreaks continue to appear on both sides of the border, generating misconceptions about the disease and social distrust in the eradication programme and competent authorities. The perceived disease risk and the commitment of all interested parties are key factors for the successful implementation of control programmes, as they might influence the acceptability of recommended measures. Effective communication can contribute to increasing knowledge, trust and stakeholders' engagement, thus ensuring the acceptability of the eradication programme. This study was conducted in Catalonia (Spain) and Pyrenees-Atlantiques (France) in the frame of the INNOTUB project (https://innotub.eu/) to characterise the communication on bTB in the trans-Pyrenees region and provide recommendations to improve it. The communication on bTB was characterised by analysing 153 (Spain) and 66 (France) online freely available texts, published between 2018 and 2020, through Content Analysis and Critical Metaphor Analysis. Moreover, six farmers and four veterinarians were in-depth interviewed in each area to gather information about the communication on bTB. Interviews were made in original languages and analysed using a qualitative thematic approach. A pilot participatory intervention inspired by the Systematic Tool for Behavioural Assumption Validation and Exploration (STAVE) method was used to develop a list of proposals to improve communication and to promote the creation of territorial networks/committees on bTB prevention and control. It included three focus groups with farmers and veterinarians, a meeting with representatives of the regional veterinary services, and a final deliberative workshop. Results highlight the existence of a controversial debate on bTB and a heterogeneous understanding between stakeholders. Institutional and scientific communication mainly focus on bTB detection and control while other aspects are left in the background. On the contrary, farmers extend their communication to a greater variety of topics. The metaphorical framing strongly differed among actors, while veterinary services and researchers "fight" against bTB and "progress" toward the eradication, farmers place themselves in a framework of "sacrifice" and, particularly in Spain, they play a passive role. The proposals developed by the participants to improve the current communication on bTB included: (i) create participatory meeting spaces to share opinions and information; (ii) improve data accessibility (on epidemiological situations); (iii) develop clearer and written protocols and informative visual material; (iv) redesign the training courses (v) increase the stakeholders' participation in the design of protocols.

Evaluation of the collaborative integrated surveillance system (ViCo) in Guatemala: a qualitative study on lessons learned and future perspectives

Background

The collaborative integrated surveillance system known as Vigilancia Integrada Comunitaria (ViCo) was implemented in 2007 to better understand and characterize the burden of diarrheal, respiratory and febrile illnesses in Guatemala.

Methods

To evaluate the usefulness of ViCo and inform a redesign of the system and new surveillance activities in the Central American region, personnel from the United States Centers for Disease Control and Prevention (CDC) conducted thirty-nine in-depth interviews from June—December 2018 with key stakeholders responsible for the design and implementation of ViCo in Guatemala. A semi-structured questionnaire adapted from the Updated CDC Guidelines for Evaluating Public Health Surveillance Systems was used for data collection. We used a grounded theory approach to explore stakeholder perceptions of ViCo and generate recommendations for improvement. Primary qualitative findings were organized based on thematic areas using ATLAS.ti version 8 software.

Results

Emergent themes relevant to the usefulness of ViCo were organized across strengths, weaknesses, and recommendations pertaining to the: (1) Size and Complexity of ViCo, (2) Stakeholder Expectations About the Objectives of ViCo, (3) Data Management and Structure of the Information System, (4) Local Control of Data, (5) Integration of ViCo within the Ministry of Health, and, (6) Improvement of the Operational and Design Aspects of ViCo across System, Process, and Output levels.

Conclusions

Stakeholders perceived ViCo to be useful. They recommended measures to improve system performance and quality, including simplifying the surveillance system, routine data analysis and feedback, and channeling efforts towards integrating surveillance data into the national health information system. To create a well-performing surveillance system and achieve the intended objective of surveillance for public health action, ongoing evaluation and assessment of surveillance activities are necessary.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12719-7.

Progressive Area Elimination of Bovine Brucellosis, 2013-2018, in Gauteng Province, South Africa: Evaluation Using Laboratory Test Reports

Bovine brucellosis is a zoonotic disease of global public health and economic importance. South Africa has had a national bovine brucellosis eradication scheme since 1979; however, no published report on elimination progress from any province exists. We analysed laboratory test results of all cattle herds participating in the Gauteng Provincial Veterinary Services’ eradication scheme between 2013 and 2018. Herd reactor status and within-herd seroprevalence, modelled using mixed-effects logistic and negative binomial regression models, respectively, showed no significant change over the period. However, provincial State Vet Areas, Randfontein (OR = 1.6; 95% CI: 1.2–2.1; p < 0.001) and Germiston (OR = 1.9; 95% CI: 1.5–2.5, p = 0.008) had higher odds of reactor herds than the Pretoria Area and within-herd prevalence count ratios for these areas were 1.5-fold greater than the Pretoria State Vet Area (p < 0.001). Reactor herds were associated with increased herd size (p < 0.001) and larger herd sizes were associated with lower within-herd prevalence (p < 0.001). Despite no evidence of significant progress toward bovine brucellosis elimination in Gauteng province, variability in bovine brucellosis prevalence between State Vet Areas exists. A public health and farmer-supported strategy of ongoing district-based surveillance and cattle vaccination targeting small- to medium-sized herds combined with compulsory test and slaughter of reactors in larger herds is recommended for the province.

Quantitative decision making in animal health surveillance: Bovine Tuberculosis Surveillance in Belgium as case study

Despite eradication and control measures applied across Europe, bovine tuberculosis (bTB) remains a constant threat. In Belgium, after several years of official bTB-free status, routine movement testing, as currently practiced, revealed itself inadequate to detect some herds affected by sporadic breakdowns. The aim of this study was to assess different surveillance system components that strike a balance between cost and effectiveness and to identify sustainable alternatives, which substantiate a bTB-free claim while ensuring early detection and acceptance by various animal health stakeholders. For this pupose, a stochastic iteration model was used to simulate the current surveillance system's expected performance in terms of detection sensitivity and specificity. These results were then descriptively compared with observed field results. Second, the cost and effectiveness of simulated alternative surveillance components were quantified. Sensitivity analyses were performed to measure key assumptions' impacts (i.e. regarding diagnostic tests and true prevalence). The results confirmed discrepancies between the observed and simulated expected performance of bTB surveillance in Belgium. Second, simulated alternatives showed that interferon gamma (IFN-γ) and serological testing with antibody-enzyme linked immunosorbent assay (Ab-ELISA) targeting at-risk herds would enable an increase in the overall cost effectiveness (sensitivity and specificity) of the Belgian bTB surveillance system. Sensitivity analyses showed that results remained constant despite the modification of some key assumptions. While the performance of the ongoing bTB surveillance system in Belgium was questionable at the time of the study, this exercise highlighted that not only sensitivity but specificity also are key drivers of surveillance performance. The quantitative approach, taking into consideration various stakeholders' needs and priorities, revealed itself to be a useful tool in allowing evidence-based decision making for future tuberculosis surveillance in Belgium, in line with the international standards.

An evaluation tool to strengthen the collaborative process of the public-private partnership in the veterinary domain

Public-private partnerships (PPPs) in the veterinary domain are widely implemented worldwide and can help to strengthen the capacities of Veterinary Services. Few analyses have been made of these initiatives. This study is aimed at developing an evaluation tool based on participatory approaches and focusing on the quality of PPP processes in the veterinary domain. The tool was divided into ten sections relevant to PPP process organisation and activities. The 44 evaluation criteria and six quality attributes (operationality, relevance, acceptability, inclusiveness, adaptability, and stability) were identified based on literature review and case-study application. The tool was adjusted during four regional PPP training workshops bringing together stakeholders from both public and private sectors. Finally, the tool was validated through an experts' elicitation process and applied in the field in Paraguay. The tool was developed in a non-normative perspective to help the partners adapt the PPP to their specific context, to maximize the opportunities and minimize the risks of such collaborations, and to formulate adapted recommendations to strengthen and improve the PPP collaborative process and thus the outcomes. In an ex-ante perspective, this tool would also help public and private actors to engage and develop a PPP process following the best possible practices. The aim of this tool is to help decision making in terms of PPP development and implementation in the veterinary domain to ensure the added value and relevance of such a collaborative approach in different countries worldwide.

A Comparison of Perceptions of Estonian and Latvian Hunters With Regard to the Control of African Swine Fever

Since the first detected African swine fever (ASF) cases in Lithuanian wild boar in 2014, the virus has occurred in many other member states of the European Union (EU), most recently in Belgium in 2018 and in Germany in 2020. Passive surveillance and various control measures are implemented as part of the strategy to stop disease spread in the wild boar population. Within this framework, hunters perform important activities, such as the removal of carcasses, fencing or hunting. Therefore, the successful implementation of these measures largely depends on their acceptability by hunters. Methods of participatory epidemiology can be used to determine the acceptance of control measures. The use of participatory methods allows the involvement of key stakeholders in the design, the implementation and the analysis of control and surveillance activities. In the present study, two studies that had been conducted using participatory epidemiology with hunters in Estonia and Latvia were compared on the topics recruitment, participants, facilitators, focus group discussion (FGDs) and their contents. The aim was to evaluate similarities and differences in the two studies and to identify a broader spectrum of possibilities to increase the willingness of hunters supporting the fight against ASF. Evaluating all conducted FGDs in both countries showed primarily similarities in the perceptions and opinions of the hunters in Estonia and Latvia. One notable difference was that passive surveillance in Latvia was perceived mostly as topic of duty and ethics rather than an issue driven by incentives. Participatory methods have proven to be an effective tool in the evaluation of the acceptance of established ASF control systems. The results of this study point out further chances for improving the cooperation with hunters in the future. Nevertheless, the importance of gathering and analyzing the opinions of hunters in all ASF affected countries individually is highlighted.

Profiles of opinions among farmers and veterinarians towards the Tuberculosis Eradication Programme in cattle in Spain

The level of commitment among farmers and veterinarians may have a significant influence on the effectiveness of control efforts against tuberculosis in cattle (bTB), facilitating or hindering the achievement of its eradication. In this study, we investigated the opinions and attitudes of farmers and veterinarians towards the bTB eradication programme in Spain. Our aim was to assess the existence of groups of people that share the same arguments and outline their characteristic features. Data was collected through a structured questionnaire using a telephone survey in a random sample of 706 farmers and 180 veterinarians. The relationships between the variables and individuals were explored by using Multiple Correspondence Analysis. Afterwards, we applied Hierarchical Clustering on Principal Components in order to identify and characterise the opinion profiles. We identified three different groups of opinions characterised by the attitude towards bTB diagnostic tests, the perception on the importance and the zoonotic impact of bTB, and the perceived importance of other domestic reservoirs. There were people with positive and people with negative attitudes towards the programme, and a third group with a tendency to not respond. The presence of opposite profiles was observed among farmers. Veterinarians, on the other hand, were more homogeneous, especially the group of veterinarians working in the official veterinary services, as the vast majority of them expressed a positive attitude towards the programme. Nevertheless, there were also a few veterinarians who showed the same negative attitude as farmers. Education and communication are of paramount importance to ensure the adequate commitment of all people involved in the eradication programme, and our results highlight that, in Spain, both should be improved. However, this alone may not be enough to change people's behaviours, and more complex change interventions might be necessary for people with a negative attitude. Such strategies should target the perception on the role of wildlife reservoirs, the uncertainty of ante-mortem tests results, as well as the beliefs on the importance of bTB.

Participatory assessment of paid vaccination campaigns for village chickens against Newcastle disease in Kongo Central province

In the Democratic Republic of Congo (DRC), where state-driven animal vaccination campaigns are organized only in response to epidemics, the organization of a permanent animal vaccination service is urgently needed. A non-governmental organization has set up an experimental paid vaccination service for village chickens against Newcastle Disease (ND) in the Kongo Central province. This mixed-method study presents a participatory assessment of this experiment, identifying socio-economic factors that influence the decision of chicken keepers to adopt vaccination. The study was conducted in four territories of the province. Qualitative and quantitative data were collected through 12 focus group discussions (FGDs) with professionals of animal health and chicken keepers and 160 semi-structured interviews with chicken keepers, sampled by snowball technique. This participatory process has resulted in the design of a grid for assessing animal vaccination service's performance. Here translating the narratives into a preliminary structured assessment, this grid is an output of the study, to be mobilized for future rapid assessments of the vaccination service in a quantitative prospect. The grid consisted of nine criteria, further composed by 16 items, translated into questions to be asked to chicken keepers and vaccinators. In our study area, fieldworkers enumerated four animal vaccination campaigns during a period of 21 years (except those subject to the present assessment). Around 13% of chicken keepers of our sample had participated in ND vaccination programs. Almost 96% of interviewed chicken keepers expressed their willingness to pay for ND vaccination, and 87% of chicken keepers that vaccinated their chickens perceived the vaccine as effective. Vaccinators estimated that 56% of the chicken keepers who were contacted had actually paid for the vaccination of their chickens. The assessment grid highlighted four points in favor of the sustainability of this service, i.e. the general interest of chickens keepers, vaccine efficacy, vaccine availability and ease of use of the vaccine. Two weak points were identified, viz. the poor access of chicken keepers to information and the weak motivation of vaccinators. The vaccine coverage was calculated within the sample at 13.1%. Paid vaccination campaign for village chicken in Kongo Central obtained a performance score of 62.8%, with the highest score in Kwilu-Ngongo (73.1%) and the lowest in Kasangulu (52.4%). Two factors of adoption of vaccination were identified as statistically significant, i.e. chicken housing and territory. Significant differences appeared between territories in access to information for chicken keepers and in vaccinators motivation. The priorities for the improvement of this service appear to be awareness raising among chicken keepers and increasing vaccinators' motivation.

Valuing Health Surveillance as an Information System: Interdisciplinary Insights

The economic evaluation of health surveillance systems and of health information is a methodological challenge, as for information systems in general. Main present threads are considering cost-effectiveness solutions, minimizing costs for a given technically required output, or cost-benefit analysis, balancing costs with economic benefits of duly informed public interventions. The latter option, following a linear command-and-control perspective, implies considering a main causal link between information, decision, action, and health benefits. Yet, valuing information, taking into account its nature and multiple sources, the modalities of its processing cycle, from production to diffusion, decentralized use and gradual building of a shared information capital, constitutes a promising challenge. This work proposes an interdisciplinary insight on the value of health surveillance to get a renewed theoretical framework integrating information and informatics theory and information economics. The reflection is based on a typological approach of value, basically distinguishing between use and non-use values. Through this structured discussion, the main idea is to expand the boundaries of surveillance evaluation, to focus on changes and trends, on the dynamic and networked structure of information systems, on the contribution of diverse data, and on the added value of combining qualitative and quantitative information. Distancing itself from the command-and-control model, this reflection considers the behavioral fundaments of many health risks, as well as the decentralized, progressive and deliberative dimension of decision-making in risk management. The framework also draws on lessons learnt from recent applications within and outside of health sector, as in surveillance of antimicrobial resistance, inter-laboratory networks, the use of big data or web sources, the diffusion of technological products and large-scale financial risks. Finally, the paper poses the bases to think the challenge of a workable approach to economic evaluation of health surveillance through a better understanding of health information value. It aims to avoid over-simplifying the range of health information benefits across society while keeping evaluation within the boundaries of what may be ascribed to the assessed information system.

Investigation of field intradermal tuberculosis test practices performed by veterinarians in France and factors that influence testing

Bovine tuberculosis infection remains at a low but persistent level in French cattle herds and requires for its surveillance the use of tests with limited sensitivity and specificity. It thus appears essential to understand the reality of the field situation, to identify parameters which could affect how veterinarians perform these tests and how it can affect the sensitivity of the bovine tuberculosis surveillance system. We surveyed rural veterinarians (n = 1084), major stakeholders of the bovine tuberculosis surveillance system, after judgement (non-random) sampling to investigate their skin-test practices and their perception of the surveillance and control programs for this disease. The response rate was 19.4% (210/1084). The responses highlighted that veterinarians were aware of the importance of the fight against bovine tuberculosis and were resilient to the challenges and issues faced during fieldwork. However, we identified several areas of noncompliance with regulatory recommendations, particularly regarding the choice of injection site, verifying the quality of the injection, the method of test reading, and the reporting of non-negative test results. Multivariate analysis showed that veterinarians who had worked for fewer years in large-animal practice had better skin-test procedures. A higher proportion of performed comparative tests and a more positive perception of surveillance and control programs by veterinarians were associated with better skin-test practices. The areas of noncompliance identified in this study could be detrimental to the sensitivity of bovine tuberculosis surveillance but our results suggest that improving the information provided to veterinarians and increasing their awareness are feasible solutions to improve the surveillance efficacy.

Responding to Climate and Environmental Change Impacts on Human Health via Integrated Surveillance in the Circumpolar North: A Systematic Realist Review

Environments are shifting rapidly in the Circumpolar Arctic and Subarctic regions as a result of climate change and other external stressors, and this has a substantial impact on the health of northern populations. Thus, there is a need for integrated surveillance systems designed to monitor the impacts of climate change on human health outcomes as part of broader adaptation strategies in these regions. This review aimed to identify, describe, and synthesize literature on integrated surveillance systems in Circumpolar Arctic and Subarctic regions, that are used for research or practice. Following a systematic realist review approach, relevant articles were identified using search strings developed for MEDLINE® and Web of Science™ databases, and screened by two independent reviewers. Articles that met the inclusion criteria were retained for descriptive quantitative analysis, as well as thematic qualitative analysis, using a realist lens. Of the 3431 articles retrieved in the database searches, 85 met the inclusion criteria and were analyzed. Thematic analysis identified components of integrated surveillance systems that were categorized into three main groups: structural, processual, and relational components. These components were linked to surveillance attributes and activities that supported the operations and management of integrated surveillance. This review advances understandings of the distinct contributions of integrated surveillance systems and data to discerning the nature of changes in climate and environmental conditions that affect population health outcomes and determinants in the Circumpolar North. Findings from this review can be used to inform the planning, design, and evaluation of integrated surveillance systems that support evidence-based public health research and practice in the context of increasing climate change and the need for adaptation.

Perceptions and acceptability of some stakeholders about the bovine tuberculosis surveillance system for wildlife (Sylvatub) in France

Bovine tuberculosis (bTB) is a common disease of cattle and wildlife, with economic repercussions and implications for animal and human health. The surveillance of bTB in wildlife is particularly important, to shed light on the epidemiological role of wild species and for the adaptation of control measures. In France, a bTB surveillance system for free-ranging wildlife, the Sylvatub system, was launched in 2011 on wild boars, red deer, roe deer and badgers. It relies on active and passive surveillance activities, constrained by practical difficulties, such as the accessibility of wild animals, and regulatory rules for the trapping of badgers, for example. We report here the first assessment of stakeholders’ perceptions of the Sylvatub system and its acceptability, based on 20 individual semi-structured interviews with three types of stakeholder (collectors, coordinators, officers) in areas with different rates of bTB infection. With the caveat that these findings cannot be assumed to be representative of the national situation, we found that the Sylvatub system was considered useful by all the stakeholders interviewed. Those from the world of hunting participate in surveillance mostly to help livestock farmers, who are not systematically involved in bTB surveillance in wildlife. Many practical and regulatory constraints were raised, which could be offset by recognition of the work done by the “hunting community”, to maintain the willingness of these individuals to participate. We also identified a need for improvements in communication and information. Qualitative information, such as that collected here, is essential to improve our understanding of the reasons favoring and disfavoring participation in surveillance, and should be taken into account in the evaluation process. These results are relevant to hunters and to veterinary authorities wishing to identify the determinants of participation in the Sylvatub system. They could provide support for decision-making processes to improve surveillance strategies.

Successful Application of the Gamma-Interferon Assay in a Bovine Tuberculosis Eradication Program: The French Bullfighting Herd Experience

In the French Camargue region, where bovine tuberculosis had been enzootic for several years in bullfighting cattle herds, the gamma-interferon (IFN) assay was used since 2003 in parallel with the intradermal test in order to increase overall disease detection sensitivity in infected herds. This study presents the results of a field-evaluation of the assay during a 10-year period (2004–2014) of disease control and surveillance program and explores the particular pattern of IFN assay results in bullfight herds in comparison to cattle from other regions of France. The low sensitivity [59.2% (50.6; 67.3)] of IFN assay using the tuberculin stimulation could be related to the poor gamma-IFN production from bullfight cattle blood cells which is significantly lower than in animals of conventional breeds. The characteristics of the assay were progressively adapted to the epidemiological situation and the desired strategic applications. Data analysis with a receiver operating characteristic curve based on a simple S/P value algorithm allowed for the determination of a new cutoff adapted for a global screening, giving a high specificity of 99.9% results and a high accuracy of the assay. Having regularly risen to above 5% since 2005, with a peak around 10% in 2010, the annual incidence dropped to under 1% in 2014. The positive predictive value relative to the bacteriological confirmation evolved during the years, from 33% in 2009 to 12% during the last screening period, a normal trend in a context of decreasing prevalence. The estimated rate of false-positive reactions during screening campaigns was 0.67%, confirming the high specificity of the test, measured in bTB negative herds, in this epidemiological context. The proportion of false-positive reactions decreased with the age and was higher in males than in females. Although these results indicate that the IFN assay is accurate in the field, it also emphasizes great differences between interferon quantities produced by bullfight cattle blood samples compared to those of classical bovine breeds, which underlines the necessity to adapt the algorithms and combinations of the assay according to local epidemiological contexts.

Farmer and Veterinarian Attitudes towards the Bovine Tuberculosis Eradication Programme in Spain: What Is Going on in the Field?

The effectiveness of health interventions against bovine tuberculosis (bTB) is influenced by several "non-biological" factors that may hamper bTB detection and control. Although the engagement of stakeholders is a key factor for the eradication programme's success, social factors have been often ignored in the control programmes of animal diseases, especially in developed countries. In this study, we used a qualitative approach to investigate perceptions, opinions, attitudes, and beliefs of farmers, and veterinarians who may influence the effectiveness of the Spanish bTB eradication programme. The study was carried out in two phases. First, 13 key representatives of different groups involved in the programme were interviewed through exploratory interviews to identify most relevant themes circulating in the population. Interviews focused on strong and weak points of the programme; reasons for failure to achieve eradication; benefits of being disease free; future perspectives, and proposed changes to the programme. Based on these results, a thematic guide was developed and detailed information was gained through face-to-face in-depth interviews conducted on a purposive sample of 39 farmers and veterinarians. Data were analysed following an ethnographic methodology. Main results suggested that the bTB programme is perceived as a law enforcement duty without an adequate motivation of some stakeholders and a general feeling of distrust arose. The complexity of bTB epidemiology combined with gaps in knowledge and weak communication throughout stakeholders contributed to causing disbeliefs, which in turn generated different kinds of guesses and interpretations. Low reliability in the routine skin test for bTB screening was expressed and the level of confidence on test results interpretation was linked with skills and experience of public and private veterinarians in the field. Lack of training for farmers and pressure faced by veterinarians during field activities also emerged. Few benefits of being bTB free were perceived and comparative grievances referred to wildlife and other domestic reservoirs, sector-specific legislation for bullfighting farms, and the absence of specific health legislation for game hunting farms were reported. Understanding reasons for demotivation and scepticism may help institutions to ensure stakeholders' collaboration and increase the acceptability of control measures leading to an earlier achievement of eradication.

Qualitative Research to Design Sustainable Community-Based Surveillance for Rabies in Northern Australia and Papua New Guinea

Given the proximity and recent spread of rabies in Indonesia, effective rabies surveillance in dogs is a priority in Northern Australia and Papua New Guinea (PNG). Reporting of potential cases requires community engagement; therefore, the value and acceptability of such a system is critical to ensure sustainable surveillance. We used qualitative research methods to identify factors that influence the acceptability and value of community-based rabies surveillance. Thirty-two semi-structured interviews were conducted with informants in 16 communities in East Arnhem, the Northern Peninsula Area, the Torres Strait in Australia, and in Western Province, PNG. Thematic analysis identified common themes including the importance of verbal communication, particularly via radio, community meetings, and direct conversation. We also found that dogs have high value to community members through connection to culture, economic (especially hunting), and companionship. The greatest barrier to the reporting of sick dogs was insufficient veterinary services and the subsequent lack of treatment response. In some regions, acceptance that sick dogs are a normal daily occurrence and lack of trust of authorities were also barriers to reporting. The findings from this study will be used to design sustainable rabies surveillance in Northern Australia and PNG by utilizing traditional communication channels and building on existing and valued animal-management services. The methods and findings of this study complement previous quantitative research, so as to target surveillance to high-risk areas within these regions.

Active animal health surveillance in European Union Member States: gaps and opportunities

Animal health surveillance enables the detection and control of animal diseases including zoonoses. Under the EU-FP7 project RISKSUR, a survey was conducted in 11 EU Member States and Switzerland to describe active surveillance components in 2011 managed by the public or private sector and identify gaps and opportunities. Information was collected about hazard, target population, geographical focus, legal obligation, management, surveillance design, risk-based sampling, and multi-hazard surveillance. Two countries were excluded due to incompleteness of data. Most of the 664 components targeted cattle (26·7%), pigs (17·5%) or poultry (16·0%). The most common surveillance objectives were demonstrating freedom from disease (43·8%) and case detection (26·8%). Over half of components applied risk-based sampling (57·1%), but mainly focused on a single population stratum (targeted risk-based) rather than differentiating between risk levels of different strata (stratified risk-based). About a third of components were multi-hazard (37·3%). Both risk-based sampling and multi-hazard surveillance were used more frequently in privately funded components. The study identified several gaps (e.g. lack of systematic documentation, inconsistent application of terminology) and opportunities (e.g. stratified risk-based sampling). The greater flexibility provided by the new EU Animal Health Law means that systematic evaluation of surveillance alternatives will be required to optimize cost-effectiveness.