Implementation of One Health surveillance systems: Opportunities and challenges - lessons learned from the OH-EpiCap application.

As the complexity of health systems has increased over time, there is an urgent need for developing multi-sectoral and multi-disciplinary collaborations within the domain of One Health (OH). Despite the efforts to promote collaboration in health surveillance and overcome professional silos, implementing OH surveillance systems in practice remains challenging for multiple reasons. In this study, we describe the lessons learned from the evaluation of OH surveillance using OH-EpiCap (an online evaluation tool for One Health epidemiological surveillance capacities and capabilities), the challenges identified with the implementation of OH surveillance, and the main barriers that contribute to its sub-optimal functioning, as well as possible solutions to address them. We conducted eleven case studies targeting the multi-sectoral surveillance systems for antimicrobial resistance in Portugal and France, Salmonella in France, Germany, and the Netherlands, Listeria in The Netherlands, Finland and Norway, Campylobacter in Norway and Sweden, and psittacosis in Denmark. These evaluations facilitated the identification of common strengths and weaknesses, focusing on the organization and functioning of existing collaborations and their impacts on the surveillance system. Lack of operational and shared leadership, adherence to FAIR data principles, sharing of techniques, and harmonized indicators led to poor organization and sub-optimal functioning of OH surveillance systems. In the majority of studied systems, the effectiveness, operational costs, behavioral changes, and population health outcomes brought by the OH surveillance over traditional surveillance (i.e. compartmentalized into sectors) have not been evaluated. To this end, the establishment of a formal governance body with representatives from each sector could assist in overcoming long-standing barriers. Moreover, demonstrating the impacts of OH-ness of surveillance may facilitate the implementation of OH surveillance systems.

OH-EpiCap: a semi-quantitative tool for the evaluation of One Health epidemiological surveillance capacities and capabilities.

Although international health agencies encourage the development of One Health (OH) surveillance, many systems remain mostly compartmentalized, with limited collaborations among sectors and disciplines. In the framework of the OH European Joint Programme "MATRIX" project, a generic evaluation tool called OH-EpiCap has been developed to enable individual institutes/governments to characterize, assess and monitor their own OH epidemiological surveillance capacities and capabilities. The tool is organized around three dimensions: organization, operational activities, and impact of the OH surveillance system; each dimension is then divided into four targets, each including four indicators. A semi-quantitative questionnaire enables the scoring of each indicator, with four levels according to the degree of satisfaction in the studied OH surveillance system. The evaluation is conducted by a panel of surveillance representatives (during a half-day workshop or with a back-and-forth process to reach a consensus). An R Shiny-based web application facilitates implementation of the evaluation and visualization of the results, and includes a benchmarking option. The tool was piloted on several foodborne hazards (i.e., Salmonella, Campylobacter, Listeria), emerging threats (e.g., antimicrobial resistance) and other zoonotic hazards (psittacosis) in multiple European countries in 2022. These case studies showed that the OH-EpiCap tool supports the tracing of strengths and weaknesses in epidemiological capacities and the identification of concrete and direct actions to improve collaborative activities at all steps of surveillance. It appears complementary to the existing EU-LabCap tool, designed to assess the capacity and capability of European microbiology laboratories. In addition, it provides opportunity to reinforce trust between surveillance stakeholders from across the system and to build a good foundation for a professional network for further collaboration.

Is methicillin-susceptible Staphylococcus aureus (MSSA) CC398 a true animal-independent pathogen?

OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) belonging to ST398 has been widely described in animals. In parallel, methicillin-susceptible (MSSA) ST398 isolates causing severe infections in humans have recently emerged as animal-independent pathogens. This study aimed at characterising MSSA CC398 from different animal species in France in comparison with MSSA CC398 genomes, mostly of human origin. METHODS: CC398 were detected by clone-specific PCR. Antimicrobial susceptibility testing was performed using the disk diffusion method. Whole genome sequencing (WGS) was performed on 47 MRSA and MSSA isolates, of which spa-types as well as resistance and virulence genes were extracted. A maximum likelihood phylogenetic tree based on SNPs was performed on all sequenced isolates and 51 additional MRSA and MSSA data found on publicly available databases. RESULTS: From 275 MSSA isolates studied, 28 (10.18%) belonged to the CC398 lineage (26 ST398 and two single-locus variants) and mainly originated from cats (n=12/44, 27.3%) and dogs (n=8/55, 14.6%). Five different spa-types were identified, t571 (n=18, 64.3%) and t1451 (n=5, 17.9%) being the most frequent ones. Out of the 28 MSSA isolates, 26 carried the scn gene, whereas 24 carried the erm(T) gene, and all were genetically similar to human isolates. CONCLUSION: This study challenges the current scientific opinion that human infections due to MSSA CC398 should only be considered an animal-independent issue.

Detection and molecular characterisation of methicillin-resistant Staphylococcus aureus isolated from raw meat in the retail market.

OBJECTIVES: This study aimed to detect and characterise methicillin-resistant Staphylococcus aureus (MRSA) from retail meat in the Czech Republic. METHODS: Isolates were identified by PCR detection of the S. aureus-specific fragment Sa442 and mecA gene. spa typing, MLST, detection of genes encoding staphylococcal enterotoxins, Panton-Valentine leukocidin (pvl), exfoliative toxins A and B (eta and etb), toxic shock syndrome toxin (tst) and staphylokinase (sak), detection of φSa3 prophage and antimicrobial susceptibility testing were performed. RESULTS: Of 65 raw meat samples examined (poultry, beef, pork and rabbit), 23 (35.4%) were positive for MRSA. Twelve positive samples originated from poultry (12/33; 36.4%), while the remaining eleven came from pork (9/9; 100%) and pork/beef mixed minced meat (2/5; 40.0%). Eight spa types belonging to five different sequence types (STs) were identified. ST398 was the most frequent (28/36; 77.8%), presenting spa types t011, t034, t2576, t4132, t588 and t899. Other livestock-associated MRSA STs (ST9-t899, ST5-t002, ST692-t8646 or the newly described ST4034-t899) were also sporadically identified. In seven isolates (19.4%), one or more staphylococcal enterotoxin genes were detected, with sea, seg and sei prevailing. Three isolates from turkey [ST398-t899 (n = 2) and ST398-t011] harboured the sak gene, and the latter also harboured the sea gene. Seven isolates from poultry harboured the φSa3 prophage and were resistant to tetracycline. CONCLUSION: Specific kinds of meat appear to be a possible source of MRSA, although the risk to humans is hard to define. Therefore, surveillance of MRSA in meat as well as hygienic practices should be improved.

Genomic Insights into Methicillin-Resistant Staphylococcus aureus spa Type t899 Isolates Belonging to Different Sequence Types.

Methicillin-resistant Staphylococcus aureus (MRSA) presenting spa type t899 is commonly associated with sequence type 9 (ST9) but is also increasingly linked to ST398. This study provides genomic insight into the diversity of t899 isolates using core genome multilocus sequence typing (cgMLST), single nucleotide polymorphism (SNP)-based phylogeny, and the description of selected antimicrobial resistance and virulence markers. The SNP-based phylogenic tree showed that isolates sharing the same spa type (t899) but different STs highly diverged in their core and accessory genomes, revealing discriminant antimicrobial resistance (AMR) and virulence markers. Our results highlighted the idea that in a surveillance context where only spa typing is used, an additional multiplex PCR for the detection of the tet(M), sak, and seg genes would be valuable in helping distinguish ST9 from ST398 isolates on a routine basis.IMPORTANCE This study showed the genetic diversity and population structure of S. aureus presenting the same spa type, t899, but belonging to different STs. Our findings revealed that these isolates vary deeply in their core and accessory genomes, contrary to what is regularly inferred from studies using spa typing only. Given that identical spa types can be associated with different STs and that spa typing only is not appropriate for S. aureus isolates that have undergone major recombination events which include the passage of the spa gene (such as in t899-positive MRSA), the combination of both MLST and spa typing methods is recommended. However, spa typing alone is still largely used in surveillance studies and basic characterization. Our data suggest that additional markers, such as tet(M), sak, and seg genes, could be implemented in an easy and inexpensive manner in order to identify S. aureus lineages with a higher accuracy.

Genome Sequences of Livestock-Associated Methicillin-Resistant Staphylococcus aureusspa Type t899 Strains Belonging to Three Different Sequence Types (ST398, ST9, and ST4034).

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) is an emerging MRSA lineage rapidly evolving in the community. In this report, we present the draft genome sequences of nine LA-MRSA strains. These strains were isolated from meat and a human nasal swab sample and belong to one unique spa type (t899), but to three different sequence types, ST398, ST9, and ST4034.

Assessing informed consent practices during normal vaginal delivery and immediate postpartum care in tertiary-level hospitals of Bangladesh.

INTRODUCTION: This study was conducted to assess the informed consent practices during normal vaginal delivery (NVD) process and immediate postpartum care in the tertiary-level hospitals of Bangladesh. METHODS: A cross-sectional study was conducted at Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in November 2015. The study population and respondents were mothers who gave normal vaginal childbirth within the past 24 hours and received postpartum care in the study sites (N=190). The interview of every alternate mother from the patient register was conducted by researchers using a structured questionnaire. Descriptive analysis of findings was carried out using MS Excel 2013. RESULTS: The study findings revealed the complete absence of informed consent practices during NVD and postpartum care in the tertiary-level hospitals in Bangladesh. Consent (not informed consent) was taken from 95% of the mothers before proceeding with the NVD process, 50-72% of examinations (except breast examination, 0%) and 8-72% of procedures during postpartum care. Choice and preferences of mothers for taking an alternative process/examination/procedure were absent in all cases. CONCLUSIONS: The Respectful Maternity Care (RMC) Charter endorsed informed consent as one of the basic rights of child-bearing women. Absence of informed consent practices in the study sites indicates disrespect to maternity care and violation of this right. The Standard Clinical Management Protocols of Bangladesh also lacks clarification of this right. Improvement of the existing protocol, increased awareness and practices are essential to address protection of this right.

Microbiological safety and hygienic quality of camel meat at abattoir and retail houses in Jigjiga city, Ethiopia.

INTRODUCTION: Camel meat is a relatively new, emerging meat type that may serve as sources of foodborne pathogens to the consumer. METHODOLOGY: A cross-sectional study was conducted to determine the microbiological safety and quality of camel meat from an abattoir and retail houses in Jigjiga city, Ethiopia. A total of 140 camel carcass and retail meat samples (70 each) were examined for the presence and load of Staphylococcus aureus, Escherichia coli O157: H7, Listeria monocytogenes, Campylobacter spp., aerobic bacteria, fecal coliforms (FCs), and yeast and molds (Y and Ms). Presumptive isolates were confirmed using biochemical tests. RESULTS: S. aureus and E. coli O157: H7 populations varied widely between carcasses at the abattoir and retail meat samples. S. aureus and E. coli O157:H7 were detected in 12.1 and 4.3% of the samples, respectively. E. coli O157:H7 counts were significantly higher in retail meat (4.21 ± 0.02) compared to the carcasses (3.99 ± 0.00) at the abattoir (P < 0.05). Out of 140 samples analyzed, 5% were positive for Campylobacter spp. The mean fecal coliforms, and yeast and molds counts were significantly higher in retail meat samples (6.17 ± 0.067 and 4.95 ± 0.067 log10 cfug-1, respectively). L. monocytogenes (11 cfug-1) were detected below the permissible limit (100 cfug-1). CONCLUSIONS: This study indicated that the further the process progress, the greater the risk of contamination to the product. Therefore, good hygienic practices at the abattoir and retail houses and strict slaughtering process should be prompted to enhance the overall safety and quality of camel meat.

Detection and Molecular Characterization of Methicillin-Resistant Staphylococcus aureus Isolated from Bulk Tank Milk of Cows, Sheep, and Goats.

This study is aimed at detecting and characterizing methicillin-resistant Staphylococcus aureus (MRSA) from bulk tank milk samples of cows, sheep, and goats collected from dairy farms in the Czech Republic. All MRSA isolates were identified using PCR detection of the Staphylococcus aureus-specific fragment SA442 and mecA gene. The staphylococcal chromosomal cassettes mec (SCCmec), spa, and multilocus sequence types (MLST) were determined. The presence of genes encoding enterotoxins (ses), Panton-Valentine leukocidin (pvl), exfoliative toxins A, B (eta, etb), and toxic shock syndrome toxin (tst) were assessed. To differentiate human and animal origin, the presence of staphylokinase (sak) gene, ϕSa3 prophage, and susceptibility to tetracycline was tested. Out of 49 bulk tank milk samples examined, 14 (28.6%) were MRSA-positive. Eleven positive samples came from cow's milk (38%) and the remaining three from goat's milk (33%). All samples of ewe's milk were negative. In MRSA isolates three sequence types containing seven spa types were identified. Twelve isolates (85.7%) belonged to ST398 spa types t011/SCCmec IVa, t011/SCCmec V, t034/SCCmec V, t1456/SCCmec IVa, t1255/SCCmec V, and t2346/SCCmec V. Another two isolates belonged to ST5/t3598/SCCmec IVa and ST8/t064/SCCmec IVNT. In six isolates, one or more ses genes (seb, sed, seg, sei, and sej) were confirmed. One isolate from cow's milk harbored the tst gene. Another two isolates (ST398/t1456/SCCmec IVa and ST5/t3598/SCCmec IVa) harbored the sak gene and ϕSa3 prophage, and the latter was the only tetracycline-susceptible isolate in this study. However, none of the isolates was positive for pvl or eta, etb. These results suggest that there is the wide geographical spread of ST398 across different regions of the Czech Republic with no host preference among dairy cattle and goats. Therefore, when evaluating the occupational and foodborne risks, MRSA carriage and infection should be taken into account.