Zoonoses under our noses

Abstract

One Health is an effective approach for the management of zoonotic disease in humans, animals and environments. Examples of the management of bacterial zoonoses in Europe and across the globe demonstrate that One Health approaches of international surveillance, information-sharing and appropriate intervention methods are required to successfully prevent and control disease outbreaks in both endemic and non-endemic regions. Additionally, a One Health approach enables effective preparation and response to bioterrorism threats.

Keywords: Anthrax; Brucella; Brucellosis; Coxiella; Q fever; Tularaemia.

Fig. 1

Reported cases of anthrax, brucellosis, tularaemia and Q fever in the EU/EEA between 2008–2016. A) Maps of the EU/EEA colour-coded by the total number of cases of each zoonosis reported where data is available. Data on Q fever occurrence in Italy is not available for 2008–2015, therefore it is omitted here. B) Reported annual cases of brucellosis, Q fever and tularaemia; Anthrax is omitted here due to the much smaller number of cases (on average fewer than 10 per year). Dataset provided by ECDC based on data provided by WHO and Ministries of Health from the affected countries . Figure generated using mapchart.net (https://mapchart.net/europe.html), GraphPad Prism v.6.0.1 and gravit. io (https://gravit.io/).

Fig. 2

Number of cases of anthrax reported each year in the EU/EEA. Data is shown for every country with at least one case reported between 2007 and 2016. Peaks in cases reported to the ECDC have been attributed to injectional anthrax, caused by the use of contaminated heroin. 14 cases were reported to the ECDC in 2009 and 32 in 2010. It should be noted that there is a discrepancy between the ECDC data and original literature reported in December 2011 for the injectional anthrax outbreak, reflecting under-reporting by approximately 20% in the data shown here . 2012 then saw a second episode of injectional anthrax cases in the UK and Germany again, with an additional report in France and two in Denmark. Dataset provided by ECDC based on data provided by WHO and Ministries of Health from the affected countries . Figure generated using GraphPad Prism v.6.0.1.

Fig. 3

Number of cases of brucellosis reported each year in the EU/EEA. Data is shown for every country with >50 total cases reported between 2007 and 2016. In most European Member States, the notification of brucellosis in humans is mandatory. The exceptions are the UK (where only animal infection is notifiable), Belgium, and Denmark. Voluntary surveillance systems have full national coverage in the former two, but in Denmark brucellosis remains non-notifiable, with no surveillance system in place . Brucellosis prevalence is highest in Italy and Greece; Italy consistently reports the highest average cases per year, but Greece has the highest incidence in its population, with on average 12 in 100,000 Greeks reporting a case of brucellosis each year, four times more than Italians. Despite high incidence of brucellosis in Spain at the start of Atlas data records, this has generally fallen from over 200 reported cases in 2007 to only 37 cases reported in 2016. Bulgaria had an outbreak in 2015 with 36 cases, compared to the yearly average of just six. 2008 had the highest number of cases of brucellosis across the EU/EEA between 2007 and 2016, with a total of 735 cases. This is 37% higher than the average total number of cases per year over that period. Dataset provided by ECDC based on data provided by WHO and Ministries of Health from the affected countries . Figure generated using GraphPad Prism v.6.0.1.

Fig. 4

Number of cases of tularaemia reported each year in the EU/EEA. Data is shown for every country with >100 total cases reported between 2008 and 2016. Human tularaemia is not a notifiable disease in Denmark, Portugal and Liechtenstein, however, notification is mandatory in most EU/EEA member states (Fig. 4). A voluntary surveillance system is in place for Belgium and the United Kingdom . Sweden reported the highest total number of cases, 3164, followed by Finland, Czech Republic, Norway and Hungary. France, Germany, Spain and Slovakia experienced much lower incidences, fewer than 1 in 100,000 cases reported each year on average. 2015 saw the highest number of reported cases of tularaemia over 2008–2016, with 64% of these occurring in Sweden. Sweden generally reported more cases each year than any other country, except in 2009 when Finland saw twice its average yearly cases, and in 2016 when Finnish cases reached a peak of 699, 3.6 times its yearly average. In 2011 Norway also saw three times its average number of cases, affecting almost 4 in every 100,000 people. In both 2010 and 2014 Hungary experienced outbreaks, reporting 126 and 140 cases respectively, compared to the yearly average of 56. Dataset provided by ECDC based on data provided by WHO and Ministries of Health from the affected countries . Figure generated using GraphPad Prism v.6.0.1.

Fig. 5

Number of cases of Q fever reported each year in the EU/EEA. Data is shown for every country with >125 total cases reported between 2008 and 2016. The 2007–2010 Q fever epidemic was contained within southern areas of the Netherlands, affecting small ruminant farms in the direction of the prevailing wind from the affected goat farms. This accounted for 37% of the total cases of Q fever in the EU/EEA between 2008 and 2016, with on average 1300 cases reported per year. After this was resolved, the country with the highest prevalence of Q fever was Germany, with on average 240 cases/year between 2011 and 2016 (incidence of 2 in 100,000), followed by France, Spain and Hungary, with 180, 110 and 60 cases/year, respectively. In the six years following the epidemic resolution, the Netherlands experienced a much-reduced average of 37 cases reported per year. Additionally, in 2013 Hungary experienced an epidemic of 135 cases, this was resolved within two years. Dataset provided by ECDC based on data provided by WHO and Ministries of Health from the affected countries . Figure generated using GraphPad Prism v.6.0.1.