[One Health: a perspective of the informal ministerial network : "What if the One Health approach became the guiding theme of cooperation at the national, European and global level?"] / One Health: Eine Sichtweise des informellen ministeriellen Netzwerkes : "Was wäre, wenn der One-Health-Ansatz zum Leitmotiv von Kooperation auf nationaler, europäischer und globaler Ebene würde?".

In the view of the German government, the One Health approach is a pioneering compass for inter- and transdisciplinary thinking, networking, and action. To protect the health of humans, animals, plants, and ecosystems, it should always receive attention at all its interfaces and activities. The One Health approach has gained political importance in recent years and is being taken into account in several strategies.This article reports on the current strategies using a One Health approach. These include the German Antibiotic Resistance Strategy, the German Strategy for Adaptation to Climate Change, the global initiative Nature for Health, and the international pandemic agreement, which is currently being drafted and in which prevention also plays an important role. The issues of biodiversity loss and climate protection must be placed in a common context that takes into account the interdependencies of the health status of humans, animals, plants, and ecosystems. By involving relevant disciplines at different levels as a matter of course, we can succeed in making a joint contribution to sustainable development, as required by the United Nations' Agenda 2030. This perspective guides Germany's global engagement in global health policy toward greater stability, freedom, diversity, solidarity, and respect for human rights. Thus, a holistic approach such as One Health can contribute to achieving sustainability and strengthening democratic principles.

[Strategies for the rational use of antibiotics in the outpatient sector-results of a workshop with key stakeholders in the healthcare system]. / Strategien zum rationalen Antibiotikaeinsatz im ambulanten Sektor ­ Ergebnisse eines Workshops mit wichtigen Akteuren des Gesundheitswesens.

In November 2021, the Federal Ministry of Health (BMG) organized the one-day virtual workshop "Rational antibiotic use in the outpatient sector - potential and opportunities for change" with scientific support from the Robert Koch Institute (RKI). The aim was to collect strategies for promoting the appropriate use of antibiotics in the outpatient sector. With 114 participants, important stakeholders of the healthcare system were represented. In the run-up to the event, the invited participants had already been asked to take part in an online survey on perspectives, experiences, and ideas for the rational use of antibiotics in the outpatient sector. The answers were analyzed and presented at the workshop.The workshop was introduced with plenary lectures on the German Antibiotic Resistance Strategy (DART) and the antibiotic resistance situation in Germany. All experts participated in 10 working group discussions; the resulting findings were presented in the concluding plenary session. In this conference report, selected aspects of these discussions are presented. The insights gained are to be incorporated into the "DART 2030" strategy.

The zoonotic potential of Clostridium difficile from small companion animals and their owners.

BACKGROUND: Clostridium difficile infections (CDI) in humans range from asymptomatic carriage to life-threatening intestinal disease. Findings on C. difficile in various animal species and an overlap in ribotypes (RTs) suggest potential zoonotic transmission. However, the impact of animals for human CDI remains unclear. METHODS: In a large-scale survey we collected 1,447 fecal samples to determine the occurrence of C. difficile in small companion animals (dogs and cats) and their owners and to assess potential epidemiological links within the community. The Germany-wide survey was conducted from July 2012-August 2013. PCR ribotyping, Multilocus VNTR Analysis (MLVA) and PCR detection of toxin genes were used to characterize isolated C. difficile strains. A database was defined and logistic regression used to identify putative factors associated with fecal shedding of C. difficile. RESULTS: In total, 1,418 samples met the inclusion criteria. The isolation rates for small companion animals and their owners within the community were similarly low with 3.0% (25/840) and 2.9% (17/578), respectively. PCR ribotyping revealed eight and twelve different RTs in animals and humans, respectively, whereas three RTs were isolated in both, humans and animals. RT 014/0, a well-known human hospital-associated lineage, was predominantly detected in animal samples. Moreover, the potentially highly pathogenic RTs 027 and 078 were isolated from dogs. Even though, C. difficile did not occur simultaneously in animals and humans sharing the same household. The results of the epidemiological analysis of factors associated with fecal shedding of C. difficile support the hypothesis of a zoonotic potential. CONCLUSIONS: Molecular characterization and epidemiological analysis revealed that the zoonotic risk for C. difficile associated with dogs and cats within the community is low but cannot be excluded.

DNA microarray-based PCR ribotyping of Clostridium difficile.

This study presents a DNA microarray-based assay for fast and simple PCR ribotyping of Clostridium difficile strains. Hybridization probes were designed to query the modularly structured intergenic spacer region (ISR), which is also the template for conventional and PCR ribotyping with subsequent capillary gel electrophoresis (seq-PCR) ribotyping. The probes were derived from sequences available in GenBank as well as from theoretical ISR module combinations. A database of reference hybridization patterns was set up from a collection of 142 well-characterized C. difficile isolates representing 48 seq-PCR ribotypes. The reference hybridization patterns calculated by the arithmetic mean were compared using a similarity matrix analysis. The 48 investigated seq-PCR ribotypes revealed 27 array profiles that were clearly distinguishable. The most frequent human-pathogenic ribotypes 001, 014/020, 027, and 078/126 were discriminated by the microarray. C. difficile strains related to 078/126 (033, 045/FLI01, 078, 126, 126/FLI01, 413, 413/FLI01, 598, 620, 652, and 660) and 014/020 (014, 020, and 449) showed similar hybridization patterns, confirming their genetic relatedness, which was previously reported. A panel of 50 C. difficile field isolates was tested by seq-PCR ribotyping and the DNA microarray-based assay in parallel. Taking into account that the current version of the microarray does not discriminate some closely related seq-PCR ribotypes, all isolates were typed correctly. Moreover, seq-PCR ribotypes without reference profiles available in the database (ribotype 009 and 5 new types) were correctly recognized as new ribotypes, confirming the performance and expansion potential of the microarray.

Zoonoses research in the German National Cohort : feasibility of parallel sampling of pets and owners.

Cats and dogs live in more than 20 % of German households and the contact between these pets and their owners can be very close. Therefore, a transmission of zoonotic pathogens may occur. To investigate whether zoonotic research questions can be examined in the context of population-based studies like the German National Cohort (GNC), two studies on different study populations were conducted as part of the feasibility tests of the GNC. The aim of the first study was to quantify the actual exposure of participants of the GNC to cats and dogs. In the second study summarised here the feasibility of the sampling of cats and dogs by their owners was tested. To quantify the exposure of participants of the GNC to cats and dogs 744 study participants of the Pretests of the GNC were asked whether they had contact with animals. Currently 10 % have a dog and 14 % have a cat in their household. These figures confirm that a large proportion of the German population has contact with pets and that there is a need for further zoonoses research. To establish the collection of biological samples from cats and dogs in the context of large-scale population-based studies feasible methods are needed. Therefore, a study was conducted to test whether pet owners can take samples from their cats and dogs and whether the quality of these samples is comparable to samples taken by a qualified veterinarian. A total of 82 dog and 18 cat owners were recruited in two veterinary practices in Hannover and the Clinic for Small Animals at the University of Veterinary Medicine in Hannover. Sampling instructions and sample material for nasal and buccal swabs, faecal samples and, in the case of cat owners, a brush for fur samples, were given to the pet owners. The pet owners were asked to take the samples from their pets at home and to send the samples by surface mail. Swab samples were cultured and bacterial growth was quantified independent of bacterial species. The growth of Gram-positive and Gram-negative bacteria from samples taken by the veterinarian and the pet owners were compared. For Gram-positive bacteria the agreement of laboratory results was 71 % for nasal swabs and 78 % for oral swabs while for Gram-negative bacteria the agreement of laboratory results was 55 % for nasal swabs and 87 % for oral swabs. In conclusion it has been shown that participants of the GNC are exposed to cats and dogs and that the sampling of cats and dogs by their owners is a feasible method which can be a useful tool for zoonoses research in population-based studies.