New approaches to pharmacosurveillance for monitoring prescription frequency, diversity, and co-prescription in a large sentinel network of companion animal veterinary practices in the United Kingdom, 2014-2016.

Pharmaceutical agents (PAs) are commonly prescribed in companion animal practice in the United Kingdom. However, little is known about PA prescription on a population-level, particularly with respect to PAs authorised for human use alone prescribed via the veterinary cascade; this raises important questions regarding the efficacy and safety of PAs prescribed to companion animals. This study explored new approaches for describing PA prescription, diversity and co-prescription in dogs, cats and rabbits utilising electronic health records (EHRs) from a sentinel network of 457 companion animal-treating veterinary sites throughout the UK over a 2-year period (2014-2016). A novel text mining-based identification and classification methodology was utilised to semi-automatically map practitioner-defined product descriptions recorded in 918,333 EHRs from 413,870 dogs encompassing 1,242,270 prescriptions; 352,730 EHRs from 200,541 cats encompassing 491,554 prescriptions, and 22,526 EHRS from 13,398 rabbits encompassing 18,490 prescriptions respectively. PA prescription as a percentage of booked consultations was 65.4% (95% confidence interval, CI, 64.6-66.3) in dogs; in cats it was 69.1% (95% CI, 67.9-70.2) and in rabbits, 56.3% (95% CI, 54.7-57.8). Vaccines were the most commonly prescribed PAs in all three species, with antibiotics, antimycotics, and parasiticides also commonly prescribed. PA prescription utilising products authorised for human use only (hence, 'human-authorised') comprised 5.1% (95% CI, 4.7-5.5) of total canine prescription events; in cats it was 2.8% (95% CI, 2.6-3.0), and in rabbits, 7.8% (95% CI, 6.5-9.0). The most commonly prescribed human-authorised PA in dogs was metronidazole (antibiotic); in cats and rabbits it was ranitidine (H2 histamine receptor antagonist). Using a new approach utilising the Simpson's Diversity Index (an ecological measure of relative animal, plant etc. species abundance), we identified differences in prescription based on presenting complaint and species, with rabbits generally exposed to a less diverse range of PAs than dogs or cats, potentially reflecting the paucity of authorised PAs for use in rabbits. Finally, through a novel application of network analysis, we demonstrated the existence of three major co-prescription groups (preventive health; treatment of disease, and euthanasia); a trend commonly observed in practice. This study represents the first time PA prescription has been described across all pharmaceutical families in a large population of companion animals, encompassing PAs authorised for both veterinary and human-only use. These data form a baseline against which future studies could be compared, and provides some useful tools for understanding PA comparative efficacy and risks when prescribed in the varied setting of clinical practice.

Spread rate of lumpy skin disease in the Balkans, 2015-2016.

After its introduction in Turkey in November 2013 and subsequent spread in this country, lumpy skin disease (LSD) was first reported in the western Turkey in May 2015. It was observed in cattle in Greece and reported to the World Organization for Animal Health (OIE) in August 2015. From May 2015 to August 2016, 1,092 outbreaks of lumpy skin disease were reported in cattle from western Turkey and eight Balkan countries: Greece, Bulgaria, The Former Yugoslav Republic of Macedonia, Serbia, Kosovo, and Albania. During this period, the median LSD spread rate was 7.3 km/week. The frequency of outbreaks was highly seasonal, with little or no transmission reported during the winter. Also, the skewed distribution of spread rates suggested two distinct underlying epidemiological processes, associating local and distant spread possibly related to vectors and cattle trade movements, respectively.

Identifying Areas Suitable for the Occurrence of Rift Valley Fever in North Africa: Implications for Surveillance.

Rift Valley fever (RVF) is a vector-borne zoonotic disease that has caused widespread outbreaks throughout Africa and the Arabian Peninsula, with serious consequences for livestock-based economies and public health. Although there have never been any reports of RVF in Morocco, Algeria, Tunisia and Libya, it is a priority disease in the Maghreb, due to the threat of introduction of the virus through transboundary livestock movements or infected mosquito vectors. However, the implementation of surveillance activities and early warning contingency plans requires better knowledge of the epidemiological situation. We conducted a multicriteria decision analysis, integrating host distribution with a combination of important ecological factors that drive mosquito abundance, to identify hotspots and suitable time periods for RVF enzootic circulation (i.e. stable transmission at a low to moderate level for an extended period of time) and an RVF epizootic event (i.e. a sudden occurrence of a large number of infected animals over a large geographic area) in the Maghreb. We also modelled vector species distribution using available information on vector presence and habitat preference. We found that the northern regions of the Maghreb were moderately suitable for RVF enzootics, but highly suitable for RVF epizootics. The vector species distribution model identified these regions as the most favourable mosquito habitats. Due to the low density of animal hosts and arid conditions, the desert region showed low RVF suitability, except in oases. However, the presence of competent vectors in putative unsuitable areas underlines the need for further assessments of mosquito habitat preference. This study produced monthly RVF suitability maps useful for animal health managers and veterinary services involved in designing risk-based surveillance programmes. The suitability maps can be further enhanced using existing country-specific sources of information and by incorporating knowledge - as it becomes available - on the epidemiology of the disease and distribution of vectors in the Maghreb.

Cut-off value of mantoux induration in tuberculous children in R. Macedonia and their nutritional status.

INTRODUCTION: The interpretation of the Mantoux test, as well as knowledge of factors that affect the test's induration size, is significant for the early diagnosis of tuberculosis in children. AIMS: To determine the Mantoux test induration cut-off size which distinguishes between positive and negative results in Macedonian children suffering from tuberculosis. To find whether there is any correlation between the nutritional status (malnutrition) and the Mantoux induration size. MATERIALS AND METHODS: A retrospective and descriptive study was carried out in 270 patients up to 14 years old with diagnosed tuberculosis, treated during the period of 2003-2007 in the Pediatric Tuberculosis Department at the Kozle Institute for Respiratory Diseases in Children, Skopje, Macedonia. The cut-off value of the Mantoux test induration size was determined by analysis of the test results distribution. The nutritional status was calculated as the weight for age standard (z-score). Correlation between the TST results and the nutritional status was calculated with Pearson's coefficient of correlation. RESULTS: Two hundred and seventy (270) children with tuberculosis were included in the study. The lung form of tuberculosis was present in 87.8% of the children. 53.7% of the patients were male, and 46.3% were female. The age group of 1-2 years was the most numerous (15.2%), followed by the group aged 7-8 years (10.4%). 33 children (12.2%) were undernourished (z-score<-2). The Mantoux test induration size was in the range of 0 to 32 mm, with an average of 13.4 mm. The distribution of the frequencies of the indurations had a bimodal form, with the primary mode at 0 mm, the secondary mode at 15-19 mm, and antimode at 5-9 mm. The Mantoux test had a sensitivity of 82.5%, specificity of 62%, positive predictive value of 68.46% and negative predictive value of 78.61%. Pearson's coefficient of correlation (r) of 0.175 showed a weak positive correlation between the results of TST (induration size) and the nutriational status. CONCLUSIONS: The cut-off value of the induration which distinguishes negative from positive Mantoux reaction was 5 mm. The interpretation of the test is recommended to be carried out depending on the risk factors for TB development, which surround the children. The Mantoux test in malnourished children should be interpreted with caution.