Opinion of the Scientific Panel on Biological Hazards (BIOHAZ) and of the Scientific Panel on Animal Health and Welfare (AHAW) on “Review of the Community Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Antimicrobial Resistance in the European Union in 2004

No abstract available

The Community system for monitoring and collection of information on zoonoses was established by Council Directive 92/117/EEC setting rules for the Member States (MS) of European Union (EU) to collect, evaluate and report to the Commission, each year, data on specific zoonoses and zoonotic agents in animals, foodstuffs and feedingstuffs. The Directive 92/117/EEC was replaced by a new Zoonoses Directive 2003/99/EC, adopted by the Council and the European Parliament on 17 November 2003, and instated as of 12 June 2004.

The European Food Safety Authority (EFSA) was assigned the tasks of collecting the data and preparing the Community Summary Report for the year 2004 and onwards. Data from the 25 MS (EU-25), including the 10 new MS (EU-10), and Norway was collected according to the former Directive 92/117/EEC. The Zoonoses Collaboration Centre (the Danish Institute for Food and Veterinary Research) was commissioned to prepare the Community Summary report 2004 under the supervision of EFSA and it was published on the EFSA website on 21 December 2005.

The AHAW and BIOHAZ panels were asked, in the light of the results presented in the Community Summary Report 2004 to review the situation. The review done by both Panels included:

• conclusions on the situation in the Community and identification of public and animal health priorities,
• the risk factors related to zoonoses, antimicrobial resistance and food-borne outbreaks covered by the report,
• recommendations, when appropriate, for actions to be taken to improve the protection of public and animal health in the Community, and
• suggestions for the improvement of the monitoring and reporting of zoonoses, zoonotic agents, antimicrobial resistance and food-borne outbreaks and the analyses of the information.

It should be recognised that the first summary report demonstrates its considerable potential as a basis for community and stakeholder actions aimed at preventing infections transmitted from animals to humans. This first Community Summary Report on zoonoses and antibiotic resistance has substantial potential to develop into a most valuable tool that will enable preventive actions to be taken to control foodborne and other zoonotic infections in all the member states as was suggested in the White Paper on food safety.

It is important to note that the data and information included in the Community Summary Report must be carefully interpreted since they derive from monitoring, surveillance or, more generally, sampling schemes that are not harmonised between different MS.

For the purposes of this Opinion, the same definitions of ‘zoonosis’, ‘zoonotic agent’, ‘antimicrobial resistance’, ‘food-borne outbreak’ and ‘monitoring’, as stated in Directive 2003/99/EC, shall apply.

For the purposes of this Opinion, all factors able to potentially increase or significantly associated with a human health impact (incidence and/or severity) of zoonoses or antimicrobial resistance were considered as risk factors. Thus, factors impacting on the occurrence of hazards in the production chain are also included.

The following were identified as the key conclusions and recommendations to be drawn from the 2004 Annual Community Zoonoses Report. They are not presented in any order of priority.

Overview of the situation in the Community

• The most commonly reported zoonotic infections in humans in the EU are, by far, those caused by bacterial zoonotic agents that can be shed by asymptomatic farm animals: salmonellosis (192 703 reported cases in total) and campylobacterosis (183 961)[1]; followed by yersiniosis (10 381) and HP-VTEC infections (4 143). Comparably, there are significantly fewer reported cases of human listeriosis (1 267). Total number of reported cases of parasitic zoonoses is 2 349 (trichinellosis, toxoplasmosis and echinococcosis put together). Compared to the main bacterial foodborne infections mentioned above (395 455; put together), reported human cases of “classic” zoonoses are relatively low: brucellosis (1 337), tuberculosis due to M. bovis (86) and rabies (2 imported).
• However, it is important to keep in mind that the Community Summary Report gives only an indication of the situation in the Community due to assumed under-detection and under-reporting which vary by countries. Furthermore, the prevalence of sequelae is not reported. Thus, it is not possible to determine the total disease burden in EU from the Community Summary Report and to compare the public health impact in the MS.
• Most of the cases of salmonellosis seem to be linked to the consumption of contaminated eggs and egg products.
• Listeria monocytogenes was the agent responsible for most reported deaths associated with foodborne diseases.
• Contaminated water (recreational water, drinking water, irrigation water) has been identified as an important transmission route for zoonotic agents, and has been implicated in both sporadic cases and outbreaks.
• Emerging fluoroquinolone resistance in Salmonella spp. and Campylobacter spp. isolated from food animals and meat is a public health concern.
• Parasites (Toxoplasma gondii, Echinococcus spp., Trichinella spp. and Taenia spp. / Cysticercus spp.) have been reported less frequently in humans, and have caused fewer outbreaks, than bacteria and viruses in the EU in 2004. However, in many instances their impact (severe illness, disability, death, and costs related to diagnostic procedures, hospitalization and treatment) on vulnerable groups of the population, and often in immunocompetent persons, has probably been considerable.
  • Toxoplasmosis, despite having the highest reported human incidence amongst the parasitic zoonoses recorded in the Community Summary Report, is particularly considered to be an under-detected and under-reported disease.
  • Echinococcus multilocularis is considered to be an emerging zoonotic risk in the Community.
  • Echinococcus granulosus still causes the majority of human cases of echinococcosis in the Community, and the number of cases has not decreased in 2004, as is suggested by the numbers recorded by WHO and OIE.
  • There has been an increase of reported human cases of trichinellosis in the EU, due in part, to the inclusion of reports from new MS.
• The data presented in the report indicate that the situation regarding human brucellosis in Europe has improved during the reporting period. Brucellosis in humans appears to be mainly due to B. melitensis and is therefore most probably linked to infection in small ruminants. There is no general decline in the occurrence of bovine brucellosis, although brucellosis in small ruminants has declined in several of MS.
• Due to insufficient data it is currently not possible to draw definitive conclusions on the Community situation for tuberculosis due to Mycobacterium bovis in humans. The epidemiological evidence in relation to the tuberculosis situation generated by the existing surveillance reporting systems is of varying quality.
• Rabies continues to pose a serious (fatal) human health risk in areas with rabies in wildlife. The widespread occurrence of wildlife rabies in some Eastern European countries both inside and outside EU can lead to an occasional spill-over into domestic animals. Compulsory vaccination of dogs against rabies is implemented in some countries but an insufficient level of vaccination coverage may explain the continued incidence in these species.

Additional conclusion specifically related to animal health:

• Salmonella contaminated feed is an important route for introducing Salmonella into animal production*.

Recommended actions

• As Salmonella Enteritidis is the cause of the majority of reported cases of salmonellosis, and as contaminated eggs are identified as a major source of Salmonella Enteritidis, the setting of targets for Salmonella in laying hen flocks is supported.
• As contaminated poultry meat is identified as a major source of Salmonella Enteritidis and Salmonella Typhimurium, the setting of targets for Salmonella spp. in poultry flocks is supported.
• As contaminated poultry meat is identified as a major source of Campylobacter spp., measures to reduce Campylobacter spp. at different stages along the poultry food chain are recommended.
• The apparently higher incidence of infection with the zoonotic agents Salmonella spp., Yersinia spp., and VTEC in young children merits further investigation.
• It is recommended that GMP, GHP and HACCP be applied effectively and monitored closely to decrease the proportion of foods with high prevalences and/or concentrations of Listeria monocytogenes.
• GMP, GHP, HACCP and official controls should be applied effectively and closely monitored to decrease the risk of contamination by Salmonella, and other relevant zoonotic agents in food and feed.
• The importance and the role of contaminated water in the epidemiology of zoonoses and foodborne outbreaks require further clarification.
• It is recommended that risk communication measures be implemented stressing the importance of prudent use of antimicrobials in animals, targeted at farmers and veterinary practitioners. In particular, strategies to prevent development of fluoroquinolone resistance are needed.
• Risk communication initiatives aiming at the improvement of food hygiene procedures and hygienic food handling are recommended. These educational campaigns should be targeted at food operators, vulnerable groups in the population as well as the general public.
• The capacity for laboratory testing, epidemiological investigations and reporting for human brucellosis could be strengthened. Non-Officially Brucellosis Free (non-OBF) MS should allocate sufficient resources to eradication/ control programmes adapted to the epidemiological situation with the overall goal of OBF status
• In relation to brucellosis and tuberculosis, increasing the percentage of herds covered by the programme that are effectively tested, will improve the reliability of the eradication/ control programme already in place. Tuberculosis in cattle, might be regarded as a re-emerging disease in some MS.
• In Europe, the key to control of rabies is through infection control in the major reservoir species (fox, racoon dog) by oral immunisation. Since endemic areas may span several MS and third countries, successful control relies heavily on cross-border cooperation and implementation of vaccination plans. It is therefore highly recommended that vaccination plans should be coordinated at Community level in terms of strategic planning, regulatory and financial support. It is also recommended that systematic prophylactic vaccination and identification of pets be implemented in all endemic areas.

Additional recommendations specifically related to animal health

• Efforts should be made to decrease the risk of Salmonella contamination of the food chain through feed.
• Data allowing an evaluation of the possible influence that different husbandry systems might have on the risk of intestinal colonisation by zoonotic agents, such as Salmonella should be collected.

Recommended improvements for the monitoring and reporting

• There is a need for a common strategy on data collection, monitoring and reporting as well as improvement of harmonisation of definitions, in order to improve the usefulness of the data presented in the Community Summary Report.
• To improve the comparability of reported data and to assess the incidence and underreporting of (foodborne) zoonoses in the Community, studies to analyse the reported rates at different levels of the surveillance pyramid (general population, general practitioner, hospitals) in different MS are encouraged.
• More extensive use of molecular methods for microbiological typing should be made, as this will allow the comparison of isolates, improve the traceability of infections and contamination along the food chain and the identifying of epidemiological links e.g. between human outbreaks and infection in animals.
• Mandatory monitoring of antimicrobial usage in animals, preferably according to animal species and antimicrobial categories, is recommended as this would enable better epidemiological analyses of occurrences and trends of antimicrobial resistance and would provide a basis for conducting risk assessment as well as for implementing and evaluating interventions.
• A clear definition of human pathogenic VTEC, in particular the serotypes and virulence factors that are of public health importance, would aid in the interpretation of the results of the Community Summary Report.
• The introduction of an improved surveillance and reporting system for toxoplasmosis is considered to be crucial for assessing its true disease burden.
• Mandatory notification should be considered for cysticercoses to improve the efficiency of control measures.
• When reporting cases and outbreaks, there is a need to distinguish between human cases where the infection was acquired domestically and those acquired abroad to enable a better analysis of the data.
• Data on the origin of implicated food should be included when reporting on the identification of food sources for outbreaks.
• The priorities for microbiological monitoring should be reassessed periodically.
• It is difficult to assess disease burden from the data presented. In future, other approaches, for example the use of DALYs (Disability-Adjusted Life Years) rather than reporting solely the numbers of cases, might lead to more comprehensive analyses and interpretation at the EU level and aid in risk-based priority setting.
• Discrepancies need to be resolved between data collected by other international organizations (e.g. OIE, WHO) along with data presented in scientific publications and data presented in the Community Summary Report such as identified for parasitic diseases.
• The reporting of Brucella in food products in countries where Brucella is still endemic should be improved. Brucellosis in wildlife should be monitored and reported in areas where the role of wildlife as a reservoir has been established.
• The reporting of brucellosis and tuberculosis in animals should account for the percentage of the herds tested which are covered by eradication/ control programmes.
• Data supplied to EFSA by some MS on Mycobacterium bovis infections in humans do not accord with that available in the public domain in these MS. There is a need to ensure that communication and linkage with existing databases in MS is harmonised. The geographical resolution of the data and the analyses related with Mycobacterium bovis should be at the very least at regional (or an analogous geographical unit) level to allow meaningful descriptive analyses of spatial and as well as temporal patterns.

Opinion of the Scientific Panel on Biological Hazards (BIOHAZ) and of the Scientific Panel on Animal Health and Welfare (AHAW) on “Review of the Community Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Antimicrobial Resistance in the European Union in 2004