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Tick-borne encephalitis (TBE) is a viral disease endemic in Eurasia. The virus is mainly transmitted to humans via ticks and occasionally via the consumption of unpasteurized milk products. The European Centre for Disease Prevention and Control reported an increase in TBE incidence over the past years in Europe as well as the emergence of the disease in new areas. To better understand this phenomenon, we investigated the drivers of TBE emergence and increase in incidence in humans through an expert knowledge elicitation. We listed 59 possible drivers grouped in eight domains and elicited forty European experts to: (i) allocate a score per driver, (ii) weight this score within each domain, and (iii) weight the different domains and attribute an uncertainty level per domain. An overall weighted score per driver was calculated, and drivers with comparable scores were grouped into three terminal nodes using a regression tree analysis. The drivers with the highest scores were: (i) changes in human behavior/activities; (ii) changes in eating habits or consumer demand; (iii) changes in the landscape; (iv) influence of humidity on the survival and transmission of the pathogen; (v) difficulty to control reservoir(s) and/or vector(s); (vi) influence of temperature on virus survival and transmission; (vii) number of wildlife compartments/groups acting as reservoirs or amplifying hosts; (viii) increase of autochthonous wild mammals; and (ix) number of tick species vectors and their distribution. Our results support researchers in prioritizing studies targeting the most relevant drivers of emergence and increasing TBE incidence.

BACKGROUND: The Dutch government has set targets for reduction of antimicrobial usage in food animals, stipulating a 50% reduction in usage (on a weight basis) in 2013 as compared to 2009 and a 70% decrease in 2015. A monitoring program has been instituted to evaluate the impact on antimicrobial resistance (AMR). The Dutch Ministry of Public Health Welfare and Sports has expressed the need for a summary index to present the results of the monitoring data concisely to policy makers.METHODS: We use data on AMR in bacteria from randomly collected samples from broiler chickens, fattening pigs, veal calves and dairy cows. Escherichia coli was selected for resistance monitoring because they are intrinsically susceptible to the antibiotics included in the test panel (ciprofloxacin, cefotaxime, tetracycline and ampicillin) and they are present in all samples, which facilitates proper randomization and trend analysis. The AMR summary index was calculated for each animal species as a weighted average over the four antibiotics, taking into account their clinical relevance. Weights were obtained by conjoint analysis, a pairwise comparison study involving infectious diseases professionals with clinical and public health backgrounds, with data analysis by conditional logistic regression. The AMR summary index was then computed by Monte Carlo simulation, accounting for sampling and regression uncertainty.RESULTS: The highest weights (0.35) were given to ciprofloxacin and cefotaxime followed by ampicillin (0.23) and tetracycline (0.07). Throughout the years, the AMR index was highest in broiler chickens, followed by pigs and veal calves, while the lowest values were consistently recorded in dairy cows. In all animal species, the index in 2014 was significantly lower than in 2009.CONCLUSIONS: We demonstrate that high-dimensional data on surveillance of antimicrobial resistance can be summarized in an index for evaluating trends between and within food animal

OBJECTIVES: MRSA emerged in livestock and persons in contact with livestock is referred to as livestock-associated MRSA (LA-MRSA). We assessed the prevalence and risk factors for MRSA carriage in persons not living or working on a farm.METHODS: A cross-sectional study was performed among 2492 adults living in close proximity of livestock farms. Persons working and/or living on farms were excluded. Nasal swabs were cultured using selective media. Participants completed questionnaires and the distance from the residential address to the nearest farm was calculated. The Mann-Whitney U-test was used to compare median distances. Risk factors were explored with logistic regression.RESULTS: Fourteen persons carried MRSA (0.56%; 95% CI 0.32%-0.92%), 10 of which carried LA-MRSA of multiple-locus variable-number tandem repeat analysis complex (MC) 398 (0.40%; 95% CI 0.20%-0.71%). MRSA MC 398 carriers lived significantly closer to the nearest farm than non-carriers (median: 184 versus 402 m; P < 0.01). In bivariate analyses correcting for contact with livestock, this difference remained significant.CONCLUSIONS: Although the prevalence was low, living near farms increased the risk of MRSA MC 398 carriage for persons not living or working on a farm. Further research is necessary to identify the transmission routes.

BACKGROUND: The Dutch government has set targets for reduction of antimicrobial usage in food animals, stipulating a 50% reduction in usage (on a weight basis) in 2013 as compared to 2009 and a 70% decrease in 2015. A monitoring program has been instituted to evaluate the impact on antimicrobial resistance (AMR). The Dutch Ministry of Public Health Welfare and Sports has expressed the need for a summary index to present the results of the monitoring data concisely to policy makers.METHODS: We use data on AMR in bacteria from randomly collected samples from broiler chickens, fattening pigs, veal calves and dairy cows. Escherichia coli was selected for resistance monitoring because they are intrinsically susceptible to the antibiotics included in the test panel (ciprofloxacin, cefotaxime, tetracycline and ampicillin) and they are present in all samples, which facilitates proper randomization and trend analysis. The AMR summary index was calculated for each animal species as a weighted average over the four antibiotics, taking into account their clinical relevance. Weights were obtained by conjoint analysis, a pairwise comparison study involving infectious diseases professionals with clinical and public health backgrounds, with data analysis by conditional logistic regression. The AMR summary index was then computed by Monte Carlo simulation, accounting for sampling and regression uncertainty.RESULTS: The highest weights (0.35) were given to ciprofloxacin and cefotaxime followed by ampicillin (0.23) and tetracycline (0.07). Throughout the years, the AMR index was highest in broiler chickens, followed by pigs and veal calves, while the lowest values were consistently recorded in dairy cows. In all animal species, the index in 2014 was significantly lower than in 2009.CONCLUSIONS: We demonstrate that high-dimensional data on surveillance of antimicrobial resistance can be summarized in an index for evaluating trends between and within food animal species by a process inv