Cross-sectional study on patient-physician aggression in Belgium: physician characteristics and aggression types.

OBJECTIVES: The aim of this Belgian research study was to describe the characteristics of physicians who are at increased risk for patient-physician aggression. Second, aggression subtypes were described and data were provided on the prevalence of patient-physician aggression in Belgium. DESIGN: Cross-sectional survey. SETTING: Primary and secondary care inside and outside hospitals. PARTICIPANTS: Any physician who had worked in Belgium for the preceding 12 months was eligible to participate (n=34 648). MAIN OUTCOME MEASURES: An online, original questionnaire was used to obtain physician characteristics (eg, age, sex, native language), department, working conditions and contact with aggressive patients during their career and during the preceding 12 months. RESULTS: The questionnaire was completed by 4930 participants and 3726 (76%) were valid to take into account for statistics. During the preceding 12 months, 37% had been victims of aggression: 33% experienced verbal aggression, 30% psychological, 14% physical and 10% sexual. Multiple answers were allowed. Women and younger physicians were more likely to experience aggression. Psychiatric departments and emergency departments were the settings most commonly associated with aggression. Physicians who provided primarily outpatient care were more subject to aggression. CONCLUSION: Belgian physicians experience several forms of aggression. Those most at-risk of aggression are young and female physicians who work in outpatient, emergency or psychiatric settings.

Serological monitoring on milk and serum samples in a BVD eradication program: A field study in Belgium showing antibody ELISA performances and epidemiological aspects.

In a cross-sectional field study involving 51 cattle herds in Belgium, 3159 serum samples and 557 individual milk samples were collected and tested by four different commercial antibody (Ab) ELISAs on serum and two Ab ELISAs on milk. A virus neutralization test (VNT) was performed on serum samples with discording ELISA results and on all samples from non-vaccinating herds. An epidemiological survey was carried out in the same herds to collect information about herd characteristics, management practices, BVD vaccination and BVD infection status. The objective of the study was to evaluate the performances of the Ab ELISAs relatively to the VNT, to assess the possibility of using pooled samples and to give recommendations regarding serological monitoring of BVD-free herds in the context of the Belgian national BVD eradication program which started early 2015. Depending on the assays, for ELISAs on serum, the diagnostic sensitivity (DSe) was estimated to be between 93.0 and 98.7% and the diagnostic specificity (DSp) between 94.3% and 99.1%. For the two ELISAs on milk, the DSe were 91.3% and 96.7% and the DSp 94.0% and 100% respectively and the Cohen's agreement coefficients between serum and milk samples were 0.75 and 0.85. Positive serum and milk samples diluted in negative samples to mimic different pool sizes were not detected by all ELISAs at dilutions above 1:5 or 1:10, leading to the conclusion that the testing of pooled samples should be used cautiously for serological monitoring and only with ELISAs with high sensitivity. The epidemiological analysis and the seroprevalence study, based on a general estimating equation model, showed that several factors had a significant influence on overall animal seroprevalence and within-herd seroprevalence such as age class, herd size, BVD herd infection status, BVD vaccination of young and/or adult cattle and the number of stables in the farm. This study showed that the best performances obtained with commercial Ab ELISAs are observed on individual serum samples, which should therefore be the preferred matrix to monitor BVD-free herds in the context of the Belgian eradication program. By regularly testing a limited number of samples from young (6-18 months) unvaccinated cattle it is possible to confirm the BVD-free herd status or to detect a recent infection.

Evaluation of 16 commercial antibody ELISAs for the detection of bovine viral diarrhea virus-specific antibodies in serum and milk using well-characterized sample panels.

We performed a thorough fit-for-purpose evaluation of commercial ELISAs for the detection of bovine viral diarrhea virus (BVDV)-specific antibodies in serum and in milk by testing 2 panels of well-characterized serum and milk samples. Sixteen ELISAs from 9 different manufacturers, available on the Belgian market at the time of our study, were assessed for their diagnostic and analytical sensitivity (DSe and ASe, respectively), diagnostic specificity (DSp), and repeatability relative to the virus neutralization (VN) test considered to be the gold standard assay. Using serum as a matrix, DSe was much lower for competitive (c)ELISAs (min. 45%, max. 65%) than for indirect (i)ELISAs (min. 85%, max. 100%), partly because of the lower detection of positive samples from vaccinated animals included in the panel. ASe was also better for iELISAs; DSp was >95% for all but 2 ELISAs. Repeatability, expressed as coefficients of variation (CV) of optical densities, was generally good, although 3 ELISAs had a mean CV >10%. With milk samples, as observed for serum, DSe was lower for cELISAs (min. 57%, max. 75%) than for iELISAs (min. 61%, max. 89%), and DSp was high for all ELISAs (min. 94%, max. 100%). Both DSe and ASe were lower when testing milk samples compared to serum samples. These results confirm that serologic monitoring of BVDV-free herds should be performed using serum samples of unvaccinated animals to avoid interference of vaccination and to maximize the chance of detecting seroconversion linked to BVDV infection. Further investigations using a larger collection of field samples are recommended.

Field performance of six Mycobacterium avium subsp. paratuberculosis antigens in a 20h interferon gamma release assay in Belgium.

Paratuberculosis, caused by Mycobacterium avium subsp. paratuberculosis (Map), is a chronic granulomatous enteritis which primarily affects domestic and wild ruminants, resulting in serious economic losses for dairy and beef industry around the world. There is no satisfactory cure or vaccine, and actual diagnostic tests need improvement, particularly for the initial stages of the disease. Map specific cell-mediated immune responses may allow early detection of the infection at subclinical stages. In this study, over a period of 39 months, we collected 548 blood samples in two culture-confirmed Map-infected herds, 95 blood samples in five dairy herds that scored negative during 3 consecutive years of Map serology testing and 79 samples in three culture-confirmed M. bovis infected herds. Based on criteria of bacteriology, serology and ratio of IFN-γ induced with bovine and avian purified protein derivative of tuberculin (PPD-B/PPD-A), we classified the samples in four groups: 415 samples as Map-exposed/infected (MAP), 58 samples as aspecific reactors (AR), 179 samples as non-responders (NI) and 70 samples as M. bovis infected (TB). Age of the animals influenced the IFN-γ response in the MAP group, with PPD specific IFN-γ levels (but not PPD-B/PPD-A IFN-γ ratio) being significantly higher in animals <18 months of age. Map specific antibodies were detected by IDEXX ELISA in 13/415 (3%) sera of the MAP group, whereas fecal culture was positive for only 7/405 (1.7%) samples. Animals in the MAP group could therefore be considered being at the very early stage of Map infection. Six purified, recombinant Map antigens (Ag5, Ag6, MAP1637c, MAP0388, MAP3547c and MAP0586c), previously identified using combined advanced proteomic or reverse genomic approaches, were tested for their diagnostic potential in a 20h IFN-γ release assay. In the age group >18 months old, Ag5 and MAP0388 were recognized by only 10.1% and 7.7% of the animals in the MAP group, whereas a total of 38.6.%, 29.4%, 25.6% and 39.0% of the animals in the MAP group reacted to Ag6, MAP1637c, MAP3547c and MAP0586c respectively. None of the animals in the TB group reacted to Ag6, MAP1637c or MAP586c. Except for MAP0388, the % of reactors in the MAP group was significantly higher in animals <18 months old: 28.0%, 24.0%, 45.5%, 47.1%, 49.8% and 47.4% respectively. Further studies of these candidates and their combination are needed to confirm their diagnostic potential for the detection of early Map infection.

First TBEV serological screening in Flemish wild boar.

In the frame of a Flemish wildlife surveillance in 2013, a serological screening was performed on sera from wild boar (Sus scrofa; n=238) in order to detect tick-borne encephalitis virus (TBEV)-specific antibodies. Neutralising antibodies were titrated with a seroneutralisation test (SNT), using two cut-off titres (1/10-1/15). Seven wild boars were found TBEV-seropositive and showed moderate (>1/15) to high (>1/125) SNT-titres; three individuals had borderline results (1/10-1/15). This study demonstrated the presence of TBEV-specific antibodies in wild boar and highlighted potential TBEV-foci in Flanders. Additional surveillance including direct virus testing is now recommended.

Serologic screening for 13 infectious agents in roe deer (Capreolus capreolus) in Flanders.

INTRODUCTION: In order to investigate the role of roe deer in the maintenance and transmission of infectious animal and human diseases in Flanders, we conducted a serologic screening in 12 hunting areas. MATERIALS AND METHODS: Roe deer sera collected between 2008 and 2013 (n=190) were examined for antibodies against 13 infectious agents, using indirect enzyme-linked immunosorbent assay, virus neutralisation, immunofluorescence, or microagglutination test, depending on the agent. RESULTS AND DISCUSSION: High numbers of seropositives were found for Anaplasma phagocytophilum (45.8%), Toxoplasma gondii (43.2%) and Schmallenberg virus (27.9%), the latter with a distinct temporal distribution pattern following the outbreak in domestic ruminants. Lower antibody prevalence was found for Chlamydia abortus (6.7%), tick-borne encephalitis virus (5.1%), Neospora caninum (4.8%), and Mycobacterium avium subsp paratuberculosis (4.1%). The lowest prevalences were found for Leptospira (1.7%), bovine viral diarrhoea virus 1 (1.3%), and Coxiella burnetii (1.2%). No antibodies were found against Brucella sp., bovine herpesvirus 1, and bluetongue virus. A significant difference in seroprevalence between ages (higher in adults >1 year) was found for N. caninum. Four doubtful reacting sera accounted for a significant difference in seroprevalence between sexes for C. abortus (higher in females). CONCLUSIONS: Despite the more intensive landscape use in Flanders, the results are consistent with other European studies. Apart from maintaining C. abortus and MAP, roe deer do not seem to play an important role in the epidemiology of the examined zoonotic and domestic animal pathogens. Nevertheless, their meaning as sentinels should not be neglected in the absence of other wild cervid species.

Veal Calves Produce Less Antibodies against C. Perfringens Alpha Toxin Compared to Beef Calves.

Enterotoxaemia is a disease with a high associated mortality rate, affecting beef and veal calves worldwide, caused by C. perfringens alpha toxin and perfringolysin. A longitudinal study was conducted to determine the dynamics of antibodies against these toxins in 528 calves on 4 beef and 15 veal farms. The second study aimed to determine the effect of solid feed intake on the production of antibodies against alpha toxin and perfringolysin. The control group only received milk replacer, whereas in the test group solid feed was provided. Maternal antibodies for alpha toxin were present in 45% of the veal calves and 66% of the beef calves. In beef calves a fluent transition from maternal to active immunity was observed for alpha toxin, whereas almost no veal calves developed active immunity. Perfringolysin antibodies significantly declined both in veal and beef calves. In the second study all calves were seropositive for alpha toxin throughout the experiment and solid feed intake did not alter the dynamics of alpha and perfringolysin antibodies. In conclusion, the present study showed that veal calves on a traditional milk replacer diet had significantly lower alpha toxin antibodies compared to beef calves in the risk period for enterotoxaemia, whereas no differences were noticed for perfringolysin.

Prediction of respiratory disease and diarrhea in veal calves based on immunoglobulin levels and the serostatus for respiratory pathogens measured at arrival.

Failure of passive transfer is a common problem in calves destined for veal production. At present it is unknown whether the risk for respiratory disease (BRD) or neonatal calf diarrhea (NCD) in the veal herd is associated with total immunoglobulin (Ig) and/or on the serostatus for respiratory pathogens measured at arrival. Therefore, the first objective of this prospective longitudinal cohort study was to determine associations between serum protein fractions as determined by routine electrophoresis (total protein, albumin, alpha-1 and -2 globulins, beta-globulins and Ig's) at arrival and BRD and NCD in the first 3 weeks of the production cycle. The second objective was to determine whether the serostatus (seropositive/seronegative) of seven respiratory pathogens (bovine respiratory syncytial virus (BRSV), parainfluenzavirus-3, bovine coronavirus (BCV), bovine herpesvirus-1, bovine viral diarrhea virus, Mannheimia haemolytica and Mycoplasma bovis) of these arrival serum samples could be associated with the risk of having BRD. The third objective was to determine which of the electrophoresis proteins and respiratory serostatuses were associated with average daily gain (ADG) in the study period. The study population consisted of 150 rosé veal calves housed in a single air-space. The study period ended at day 18 post arrival, when BRD incidence was judged to be too high to further postpone a group treatment. A Cox regression model was used to determine the effect of the studied protein fractions and antibodies on the time to BRD and NCD occurrence. The effect of the studied predictors on ADG was determined by linear regression. Calves with Ig levels under 7.5g/L had an increased BRD hazard (hazard ratio (HR)=1.9 (95% confidence interval (CI)=1.2-3.0)). NCD was only positively associated with the alpha-2 globulin concentration. Calves with a negative serostatus for BCV (HR=1.7 (95% CI=1.0-2.8)) or BRSV (HR=2.0 (95% CI=1.0-3.9)) had an increased BRD hazard. Average daily gain (ADG) was 0.242kg/day (SD=0.142) and was not related to the occurrence of BRD or NCD. Calves with Ig's below 7.5g/L and with increased levels of alpha-2 globulins showed a decrease in ADG. This study showed the importance of providing sufficient colostrum to veal calves and the potential benefit of the presence of BCV and BRSV antibodies at arrival to reduce the BRD hazard in the first 3 weeks.

Autochthonous tick-borne encephalitis virus-seropositive cattle in Belgium: a risk-based targeted serological survey.

The risk of tick-borne encephalitis virus (TBEV) introduction into Belgium remains high, and the presence of infected wildlife in Belgium is suspected. Domestic animals can serve as excellent sentinels for TBEV surveillance to install an early warning surveillance component for this emerging zoonotic disease of public health importance. In a targeted, risk-based and cross-sectional sampling design, serological screening was performed on Belgian cattle (n=650), selected from the 2010 Belgian national cattle surveillance serum bank. All samples were subjected to a gold standard TBEV seroneutralization test (SNT), based on the rapid fluorescent focus inhibition test (RFFIT) protocol. Seventeen bovines were seropositive (titer >1/15) and six had borderline results (1/10 < titer < 1/15). The accuracy of the RFFIT-SNT was confirmed in a mouse inoculation test. The overall bovine TBEV seroprevalence in the targeted area was estimated between 2.61% and 4.29%. This confirms for the first time the presence of infected foci in Belgium. Further surveillance in cattle, other sentinels, ticks, and humans at risk is recommended to further determine the location and size of endemic foci and the risk for public health.

Characterization of methicillin-resistant Staphylococcus aureus from healthy carrier chickens.

Methicillin-resistant Staphylococcus aureus (MRSA) has long been recognized as an important pathogen in human medicine leading to hospital and community-acquired infections. However, it is now also considered a growing problem in veterinary medicine, although causing little or no disease. Although MRSA has already been detected in livestock including poultry, little is known about the epidemiology of MRSA in broiler and layer chickens. We therefore investigated 372 poultry farms in Belgium. We also compared the isolation method recommended by the European Food Safety Authority using two enrichment steps with an isolation method using only one enrichment step. Isolated MRSA was characterized by means of antimicrobial resistance profiling, spa typing, multi-locus sequence typing, and SCCmec typing. MRSA prevalence was 0.8% using the double broth enrichment method, while using the single broth enrichment method it was 1.8%. Five MRSA strains belonged to the livestock-associated (LA) MRSA ST398 (four with spa type t011 and one with t899), and three to the hospital-acquired MRSA ST239 spa type t037. The ST239 strains carried SCCmec type III while those belonging to ST398 carried SCCmec type IV or V. All isolates showed additional resistance to erythromycin and tetracycline apart from the expected resistance to cefoxitin and penicillin. All strains were susceptible to linezolid, mupirocin and vancomycin. In conclusion, a higher sensitivity for the isolation of LA-MRSA was obtained using only one enrichment step. While the typical LA-MRSA ST398 was present at low prevalence in poultry, human-associated strains have also been found.

Evaluation of two different swab transport systems in the detection of avian influenza virus excretion from infected Pekin ducks (Anas platyrhynchos).

The role of wild birds in the epidemiology and ecology of influenza A viruses has long been recognised (Alexander, 2007a). As a result of the emergence of a H5N1 highly pathogenic avian influenza (HPAI) virus and the apparent role of wild birds in its spread across Asia, Europe and Africa, avian influenza (AI) wild bird surveillance has been implemented in many countries including, since February 2006, a mandatory programme in the European Union (CEC, 2006a). In the present study the detection of virus excreted from Pekin ducks (Anas platyrhynchos) infected experimentally with A/mallard/England/2126/07 (H3N6) was investigated over a fourteen day period post-infection using cloacal and oropharyngeal swabs, with (wet) and without (dry) viral transport medium which were collected from each duck in alternating order. For influenza A virus matrix gene RNA detection, wet oropharyngeal swabs were significantly more sensitive than dry oropharyngeal on days 4-5 after infection. For cloacal samples, dry swabs were equivalent or superior to wet swabs throughout the study. Although differences in detection between dry and wet swabs were observed, the qualitative bird-level results were unaffected, meaning that the infection status of individual birds was correctly determined.

Tick-borne encephalitis virus seropositive dog detected in Belgium: screening of the canine population as sentinels for public health.

Tick-borne encephalitis virus (TBEV) is an important emerging tick-borne viral infection of humans and dogs in Europe. Currently, TBEV surveillance is virtually nonexistent in Belgium, which is considered nonendemic. A commercial enzyme-linked immunosorbent assay (ELISA) was adapted for the detection of TBEV-specific IgG-antibodies in canine sera. Serum samples of Belgian dogs were obtained from three diagnostic laboratories from Northern (n=688) and Southern Belgium (n=192). ELISA-positive and borderline samples were subjected to a TBEV rapid fluorescent focus inhibition confirmation test. One dog was confirmed TBEV seropositive. Several ELISA-positive and borderline sera underwent seroneutralization and hemagglutinin inhibition tests to rule out West Nile and Louping Ill viruses, but tested negative. The clinical history of the seropositive dog could not explain beyond doubt where and when TBEV infection was acquired. Further surveillance is necessary to determine whether this dog remains a single travel-related case or whether it represents an early warning of a possible future emergence of TBEV.