GRF 2nd One Health Summit 2013: Presentation by GIESSEN, Dr. Arjen van de, National Institute for Public Health and the Environment

1. Signaling and risk
assessment of
emerging zoonoses
in The Netherlands
Arjen van de Giessen,
Hendrik-Jan Roest,
Kitty Maassen
on behalf of the Dutch
Signaling Forum Zoonoses
Signaling and risk assessment of emerging zoonoses in
The Netherlands | 20 November 2013

2. Contents
1. Background:
zoonoses outbreaks in the NL
2. One Health approach to
signaling and RA of zoonoses
3. Further steps towards One Health
Signaling and risk assessment of emerging zoonoses in
the Netherlands | 20 November 2013

3. The Netherlands, a small and crowded country
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33.883 km2
16.6 million inhabitants
89 million chickens
12 million pigs
4.5 million cows
1.1 million sheep
0.3 million goats
Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

4. NL 2003: outbreak of Avian Influenza A virus subtype H7N7
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453 cases, 89 H7 pos
349 conjunctivitis, 22% H7
78 conjunctivitis + ILI, 10% H7
37 ILI, 5% H7
3 secondary cases
25
number of cases
20
10
15
10
Fatal case
5
13
9
5
1 May
27
23
19
15
11
7
3
30
26
22
18
14
10
6
2
28
24
20
16-feb
0
Koopmans et al, 2004
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

5. NL 2004: emergence of Livestock-associated MRSA
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

6. NL 2007-2010: Q-fever epidemic related to dairy goat farming
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

7. ● Recommendations to improve early warning and control
of emerging zoonoses by an One Health approach
● Implementation of an integrated humanveterinary, zoonoses risk analyses structure in 2011
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

8. Integrated human-veterinary
risk analysis structure for zoonoses
● Why: The last decades the Netherlands have encountered
outbreaks related to (emerging) zoonoses, such as HPAI, livestockassociated MRSA and Q-fever. These events emphasized the need
for a more systematic approach of sharing and assessing signals for
(emerging) zoonoses.
● Goal: To identify, assess and prevent/control (potential) emerging
zoonoses that may cause a threat to animal and/or human health in
an integrated human-veterinary approach.
● How: At each stage of the zoonoses risk analysis structure experts
from both human and veterinary health are involved.
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

10. Signaling Forum Zoonoses
Who:
• National Institute for Public Health
and the Environment (RIVM)
• Community Health Services (GGD)
• Netherlands Food and Consumer Product
Safety Authority (NVWA)
• Central Veterinary Institute
of Wageningen UR (CVI)
• Animal Health Service (GD)
• Faculty of Veterinary Medicine
of University of Utrecht (FD)
• Dutch Wildlife Health Centre (DWHC)
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

11. Sources of signals
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

12. Signaling Forum Zoonoses (SOZ)
Goal:
● Early detection of zoonotic signals in livestock, pets, vectors, wildlife, and humans
● Assessment of the (potential) risk of zoonoses to public health,
especially for those which are not covered by existing control protocols
How:
• Monthly face to face meeting
• Collected signals are discussed and, if relevant, assessed
• In case of a (possible) urgent threat, an ad-hoc (tele)meeting will be organized
Output:
• Identification of a possible threat: reporting to the next step in the zoonosis
structure (RT-Z/OMT-Z) including advice on follow-up actions
• Monthly report of the most important signals is send to professionals via email
• Signals can form a base for email-alerts for veterinary (vetinf@ct) and/or human
(inf@ct) professionals or other publications
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

13. Criteria for reporting to the Response Team Zoonoses
1. An outbreak of an endemic zoonosis which is larger (need for upscaling)
or more serious than normal
2. An outbreak in which control or prevention is complicated or far-reaching
• Example: Q-fever epidemic 2007-2010
• By implementation of the Signaling
Forum Zoonoses, outbreaks of endemic
zoonoses should be detected at an earlier
stage
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

14. Criteria for reporting to the Response Team Zoonoses
3. An outbreak with omissions in control and/or prevention guidelines
• Low pathogenic avian influenza can
cause human disease
• Signaling of omissions in the
guidelines for people in direct contact
with poultry in an outbreak of LPAI.
• As a result, monitoring of disease
signs has been included in guidelines
for human disease control.
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

15. Criteria for reporting to the Response Team Zoonoses
4. An emerging zoonotic agent of which the impact on public health is
still unknown
5. A zoonotic signal that potentially leads to social unrest
• Example: Schmallenberg virus
(SBV), introduced in Europe in
2011, causing serious
malformations in newborn lambs.
• The health consequences of this
new virus were unknown at that
time and therefore treated as a
potential threat to public health
• Fortunately, SBV appeared not to be
a zoonotic agent.
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Signaling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013

16. Further steps towards One Health
● Development of integrated human-veterinary research programmes
● Development of integrated human-veterinary surveillance
programmes in wildlife, vectors and livestock
● Cooperation between public health and veterinary authorities at the
regional level
● Integration of veterinary and public health prevention/control
guidelines
● Integrated risk communication on zoonoses
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Signaling and risk assessment of emerging zoonoses in The
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Signalling and risk assessment of emerging zoonoses in The
Netherlands | 20 November 2013