Opportunities for Improved Disease Surveillance and Control by Use of Integrated Data on Animal and Human Health

Toward One Health: a spatial indicator system to model the facilitation of the spread of zoonotic diseases

Recurrent outbreaks of zoonotic infectious diseases highlight the importance of considering the interconnections between human, animal, and environmental health in disease prevention and control. This has given rise to the concept of One Health, which recognizes the interconnectedness of between human and animal health within their ecosystems. As a contribution to the One Health approach, this study aims to develop an indicator system to model the facilitation of the spread of zoonotic diseases. Initially, a literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify relevant indicators related to One Health. The selected indicators focused on demographics, socioeconomic aspects, interactions between animal and human populations and water bodies, as well as environmental conditions related to air quality and climate. These indicators were characterized using values obtained from the literature or calculated through distance analysis, geoprocessing tasks, and other methods. Subsequently, Multi-Criteria Decision-Making (MCDM) techniques, specifically the Entropy and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods, were utilized to combine the indicators and create a composite metric for assessing the spread of zoonotic diseases. The final indicators selected were then tested against recorded zoonoses in the Valencian Community (Spain) for 2021, and a strong positive correlation was identified. Therefore, the proposed indicator system can be valuable in guiding the development of planning strategies that align with the One Health principles. Based on the results achieved, such strategies may prioritize the preservation of natural landscape features to mitigate habitat encroachment, protect land and water resources, and attenuate extreme atmospheric conditions.

Comparative assessment of the human and animal health surveillance systems in Tanzania: Opportunities for an integrated one health surveillance platform

Globally, there have been calls for an integrated zoonotic disease surveillance system. This study aimed to assess human and animal health surveillance systems to identify opportunities for One Health surveillance platform in Tanzania. A desk review of policies, acts and strategies addressing disease surveillance that support inter-sectoral collaboration was conducted. A semi-structured questionnaire was administered to key informants from the two sectors. Databases with potential relevance for surveillance were assessed. One Health-focused policies, acts, strategic plans and guidelines emphasising inter-sectoral collaboration strengthening were in place. Stable systems for collecting surveillance data with trained staff to implement surveillance activities at all levels in both sectors were available. While the human surveillance system was a mix of paper-based and web-based, the animal health system was mainly paper-based. The laboratory information system existed in both sectors, though not integrated with the epidemiological surveillance systems. Both the animal and human surveillance systems had low sensitivity to alert outbreaks. The findings indicate that individual, organisational, and infrastructure opportunities that support the integration of surveillance systems from multiple sectors exist. Challenges related to data sharing and quality need to be addressed for the effective implementation of the platform.

Mapping food surveillance chains through different sectors

European countries are investing in strengthening disease surveillance from a One Health (OH) perspective. During the MATRIX project, in the context of the One Health European Joint Programme, existing surveillance chains across the sectors of animal health, food safety, and public health have been investigated through questionnaires. Provided information has then been selected to be displayed in a single slide using an implemented mapping template. Two real-life scenarios are presented as case studies: the surveillance activities in place in France for Salmonella in the pork meat food chain, and in Norway for Listeria monocytogenes in the dairy food chain. The results collected through the questionnaires and the lessons learnt during the mapping process are reported, to share the advantages and drawbacks of the methodology. Moreover, the presented template could be adjusted and applied to different contexts. Mapping the components of existing disease surveillance systems is a fundamental step in understanding the relationships between its components, and subsequently facilitating their collaboration and integration under a OH approach.

SARS-CoV-2 at the Human-Animal Interface: Implication for Global Public Health from an African Perspective

The coronavirus disease 2019 (COVID-19) pandemic has become the most far-reaching public health crisis of modern times. Several efforts are underway to unravel its root cause as well as to proffer adequate preventive or inhibitive measures. Zoonotic spillover of the causative virus from an animal reservoir to the human population is being studied as the most likely event leading to the pandemic. Consequently, it is important to consider viral evolution and the process of spread within zoonotic anthropogenic transmission cycles as a global public health impact. The diverse routes of interspecies transmission of SARS-CoV-2 offer great potential for a future reservoir of pandemic viruses evolving from the current SARS-CoV-2 pandemic circulation. To mitigate possible future infectious disease outbreaks in Africa and elsewhere, there is an urgent need for adequate global surveillance, prevention, and control measures that must include a focus on known and novel emerging zoonotic pathogens through a one health approach. Human immunization efforts should be approached equally through the transfer of cutting-edge technology for vaccine manufacturing throughout the world to ensure global public health and one health.

Search term “One Health” remains of limited use to identify relevant scientific publications: Denmark as a case study

One Health has become a popular approach, and scientific advancements in the field should be easily findable and accessible to a wide range of relevant audiences, from researchers to policymakers, and across sectors. We conducted a systematic narrative review of available scientific publications concerning One Health in the setting of Denmark that were retrievable using “One Health” as the key search term. Three searches in two databases yielded 30 retrieved publications, 13 of which were included in the review. The included publications had been published between 2015 and 2021. Twelve of the included publications were co-authored in collaboration across institutes from different sectors. Three of the included publications had focus on antimicrobial resistance, three on disease surveillance and/or control, and five were assessments or evaluations. The overall number of publications identified by a search using “One Health” as the key search term was small, and the search identified some publications that were not relevant to One Health. Our work thus highlights a missed scientific and communication opportunity of signposting articles as relevant to One Health. Using the expression “One Health” as keyword could help making One Health research more easily findable and thereby obtaining an overview of research in the field.

Evaluating Integrated Surveillance for Antimicrobial Use and Resistance in England: A Qualitative Study

Integrated surveillance systems for antimicrobial use (AMU) and antimicrobial resistance (AMR) require regular evaluation to ensure the effectiveness and efficiency of the system. An important step in the evaluation is to choose an appropriate tool for the purpose of the evaluation. The “Integrated Surveillance System Evaluation” (ISSE) framework is a conceptual framework that was developed to evaluate One Health (OH) integration in surveillance system for AMU/AMR. This study aimed to evaluate the performance and value of integrated surveillance system for AMU/AMR in England by applying the ISSE framework, which was used to develop data collection protocols and define the study design. A qualitative study using semi-structured interviews was conducted to collect the data and analyse it thematically. Eighteen stakeholders from human, animal, food and environment sectors that are involved in AMU/AMR surveillance were interviewed. Four main themes emerged from the analysis: (1) Cross-sectoral integration in the surveillance system for AMU/AMR; (2) Production of OH outputs and outcomes; (3) Drivers and barriers to cross-sectoral collaboration; and 4) Need for more cross-sectoral collaboration. The findings showed that there were links between integrated surveillance information, decision making and interventions. However, there were only few OH examples, such as the UK AMR contingency plan, where the potential of cross-sectoral collaboration was fully exploited. A lot of the benefits described were related to the generation of information and increase in knowledge and understanding without links to how the information generated was used. While these intangible benefits have a value on their own, being able to link surveillance information and mitigation measures would help to enhance the value of integrated surveillance. In terms of improvement, the main areas identified were the development of more harmonised methods for data collection and analysis, provision of resources dedicated to cross-sectoral collaboration, improved coordination, and collection of surveillance data from the environment and from companion animals. By identifying links between OH surveillance information produced and various outputs and outcomes; this study helped to understand the wider benefits of integrated surveillance for AMU/AMR in England and provided insights on how the system could be improved and efficiency increased.

Assessment of Evaluation Tools for Integrated Surveillance of Antimicrobial Use and Resistance Based on Selected Case Studies

Regular evaluation of integrated surveillance for antimicrobial use (AMU) and resistance (AMR) in animals, humans, and the environment is needed to ensure system effectiveness, but the question is how. In this study, six different evaluation tools were assessed after being applied to AMU and AMR surveillance in eight countries: (1) ATLASS: the Assessment Tool for Laboratories and AMR Surveillance Systems developed by the Food and Agriculture Organization (FAO) of the United Nations, (2) ECoSur: Evaluation of Collaboration for Surveillance tool, (3) ISSEP: Integrated Surveillance System Evaluation Project, (4) NEOH: developed by the EU COST Action "Network for Evaluation of One Health," (5) PMP-AMR: The Progressive Management Pathway tool on AMR developed by the FAO, and (6) SURVTOOLS: developed in the FP7-EU project "RISKSUR." Each tool was scored using (i) 11 pre-defined functional aspects (e.g., workability concerning the need for data, time, and people); (ii) a strengths, weaknesses, opportunities, and threats (SWOT)-like approach of user experiences (e.g., things that I liked or that the tool covered well); and (iii) eight predefined content themes related to scope (e.g., development purpose and collaboration). PMP-AMR, ATLASS, ECoSur, and NEOH are evaluation tools that provide a scoring system to obtain semi-quantitative results, whereas ISSEP and SURVTOOLS will result in a plan for how to conduct evaluation(s). ISSEP, ECoSur, NEOH, and SURVTOOLS allow for in-depth analyses and therefore require more complex data, information, and specific training of evaluator(s). PMP-AMR, ATLASS, and ISSEP were developed specifically for AMR-related activities-only ISSEP included production of a direct measure for "integration" and "impact on decision making." NEOH and ISSEP were perceived as the best tools for evaluation of One Health (OH) aspects, and ECoSur as best for evaluation of the quality of collaboration. PMP-AMR and ATLASS seemed to be the most user-friendly tools, particularly designed for risk managers. ATLASS was the only tool focusing specifically on laboratory activities. Our experience is that adequate resources are needed to perform evaluation(s). In most cases, evaluation would require involvement of several assessors and/or stakeholders, taking from weeks to months to complete. This study can help direct future evaluators of integrated AMU and AMR surveillance toward the most adequate tool for their specific evaluation purpose.

A Survey on One Health Perception and Experiences in Europe and Neighboring Areas

A questionnaire survey was promoted under the COST Actions “Network for Evaluation of One Health-NEOH” and “European Network for Neglected Vectors and Vector-Borne Infections-EURNEGVEC”, from June 2016 to April 2017, to collect information on the existence of One Health (OH) collaboration and implementation of OH initiatives in 37 EU COST Countries. The questionnaire was to be answered by key respondents representing the three major OH components: (i). Animal Health; (ii). Human Health/Public Health; (iii). Environmental Health. A target respondent rate of nine respondents/country was aimed for, representing the following categories: (i). ministries; (ii). academia-research; (iii). private sector and NGOs, associations and scientific societies. The questionnaire, composed of 27 questions organized in six sections, was circulated to target respondents by Committee Members of the two COST actions. A total of 171 respondents from 34 countries completed the questionnaire, mainly belonging to academic and research institutions (55.5%), and to Animal Health/Animal Science fields (53.8%). Although the majority (57.9%) declared they had heard about OH, few respondents (10.7%) provided a complete definition. The “human” and “animal” elements prevailed over other key elements of OH definition (ecosystem, intersectoral, transdisciplinary, holistic, collaboration). Overall, 62.6% respondents declared to take part in OH initiatives. Antimicrobial resistance, avian influenza and environmental pollution were cited as the top three OH issues over the past 5 years. Limitations and gaps in intersectoral collaboration included communication and organizational problems resulting in poor networking, differing priorities and a lack of understanding between sectors. Regarding control and monitoring of zoonotic diseases, respondents from different sectors preferentially selected their own directorates/ministries while actually in most countries both Ministry of Health and Ministry of Agriculture are engaged. According to respondents, the level of awareness of OH amongst the general public is limited. Similarly, a dearth of opportunities of collaborations at different institutional and/or professional levels was described. Our survey provided an overview of how respondents in COST countries perceived and experienced OH and current limits to OH implementation. Identifying how initiatives are currently working and knowing the promoting and hindering factors allowed suggesting strategies to promote efficiency and effectiveness of OH implementation in the future.