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IntroductionThe singular relationship developed over the years between northern Indigenous peoples and dogs has been profoundly changed through historical trauma, settlements and increased use of snowmobiles. Issues related to dogs have become increasingly complex and worrisome with the endemic presence of the rabies virus among Arctic fox populations, and given the fact that northern Indigenous peoples may have a higher risk of dog bites than the general population. This study aimed to investigate factors related to the risk of dog bites in Naskapi and Innu communities located in northern Quebec (Canada) by (1) describing the knowledge, attitudes and practices (KAP) regarding dogs and dog bites in these communities, and (2) analyzing experiences of inhabitants and health professionals with regard to dog bites and their management.MethodsA mixed methods study design that combined an observational cross-sectional survey and individual interviews was used. The survey collected data on KAP regarding dogs and dog bites among 122 respondents. Individual interviews (n = 37) were then conducted with victims of dog bites, owners of dogs that have bitten a person before, and health professionals. Descriptive and inferential analysis (quantitative data) and thematic analysis (qualitative data) were performed.Results and discussionResults highlighted that 21% of respondents have had a dog bite in their lifetime. Most respondents were not aware of the risk of contracting rabies following a dog bite, although rabies risk perception was associated with risk perception of dogs (linear regression: coefficient = 0.69, 95% CI = 0.36–1.02). The odds of being more knowledgeable on rabies were higher (logistic regression: OR = 2.92, 95% CI = 1.07–7.98) among young adults. Dogs were perceived as both threats and protectors by community members. When the fear of dogs was present, it affected the quality of life of some inhabitants. There was confusion about responsibilities in the management of biting dogs, although protocols to follow after a bite were clear for health care professionals. This study revealed a lack of awareness and knowledge about dog bites and rabies risks in both communities. Results provide important knowledge for the development of interventions adapted to northern Indigenous communities.

While dogs can have a positive impact on physical and mental health, they also represent a public health risk in terms of bites and zoonotic diseases. In the specific context of Inuit villages, the...

The relationship between northern Indigenous people and dogs has evolved over the past years alongside events such as colonization, settlement, proliferation of snowmobiling and other socio-cultural and environmental changes. These changes have had negative impacts on this relationship, and with the endemic presence of arctic fox rabies, dog bites have become an important public health burden. The objective of this study was to synthesize the state of knowledge regarding the occurrence of dog bites and associated risk factors in the specific context of northern Indigenous communities. A scoping review was conducted in seven bibliographic databases, from June 2018 to May 2020. From this search, 257 original studies were identified and eight papers were included for final analysis. Annual occurrence of dog bites in northern Indigenous communities ranged from 0.61 to 59.6/10,000 inhabitants. Dog bites affected 27–62.9% of the population in those regions during their lifetime. Very few studies compared the occurrence of dog bites between people living in northern communities with other populations or settings, but available evidence suggests that Indigenous people living in northern communities are at higher risk of dog bites than the rest of the population. Several individual and environmental risk factors were identified in the selected studies, although the strength of evidence varied significantly. Age (children) and gender (male) were well documented individual risk factors. Other factors, such as organizational barriers to dog management and lack of access to veterinary services, were identified and discussed by several authors. The results of this study support concerns about the higher risk of bites in northern Indigenous communities, and underscore the urgent need for more research into the contextual and environmental factors that impact the mitigation of these risks.

Climate change has been linked with the establishment and geographical expansion of zoonotic diseases, an example of which is the well-documented increase in human cases of Lyme disease in Quebec, Canada. As temperatures continue to increase in Quebec, it is anticipated that several zoonotic diseases will be affected. In response to the growing zoonotic issues facing public health authorities, Quebec’s Multi-Party Observatory on Zoonoses and Adaptation to Climate Change (Observatoire multipartite québécois sur les zoonoses et l’adaptation aux changements climatiques) (the Observatory) was founded in 2015 as part of the Quebec government’s Climate Change Action Plan (Plan d’action 2013–2020 sur les changements climatiques). The Observatory was designed to bring together agencies involved in formulating public policy and experts from the disciplines of human health, animal health and environmental sciences, in a manner similar to the innovative “One World, One Health” approach. The Observatory provides a platform for knowledge sharing and consensus building among representatives of public policy decision makers and scientists. Its main objectives are to anticipate and prioritize potential issues associated with zoonotic diseases in Quebec, in order to support applicable risk management and climate change adaptation. This article describes what the Observatory is, what it does and outlines its plans for the future.

Background In Nunavik, arctic rabies is still endemic with spillover from wildlife to dogs. The prevention of human exposure and the management of potential exposure is a high public health concern there.Methods The study retrospectively described cases of potential exposure to rabies in human reported to the Nunavik Public Health Board using the registry of declared cases. Multi-correspondence analysis as well as univariable and multivariable regression models were used to appraise the difference between children and adults and the importance of dogs.Results From 2008 to 2017, 320 cases of potential exposures to rabies were reported, 92% linked to dogs. The annual incidence rate was 2.5 per 1,000 population. The incidence increased significantly during the study period without clear explanation for that. Fifteen exposures actually were with rabid animals, mostly dogs (9 out of the 15). No human cases of rabies occurred thank to adequate medical case management. Two specific profiles for potential exposure to rabies were identified based on age and gender. Children (< 15 y/o), male or female, were more likely to be exposed through playing with dogs and more often injured in the head and/or the neck. Young male adult cases (aged 15 to 34 y/o) were more involved with wildlife than other age groups and mostly injured in the upper limbs and as a reaction from the animal.Conclusions Rabies being a serious and genuine public health threat in Nunavik, potential exposure to rabies needs to be prevented and prevention measures should be tailored to the two risk profiles identified based on age, gender and the animal involved.

Background In Nunavik, Arctic rabies is still endemic due to a spillover from wildlife to dogs. The prevention of human exposure and the management of potential exposure is a significant public health concern in this region. Methods This study retrospectively describes cases of potential exposure to rabies in humans as reported to the Nunavik Public Health Board through their registry of reported cases. We used multi-correspondence analysis as well as univariable and multivariable regression models to test for differences between children and adults in reported cases, and to examine the contexts of exposure to dogs and dog attacks. Results From 2008 to 2017, 320 cases of potential exposure to rabies were reported, 92% of which were linked to dogs. The annual incidence rate was 2.5 per 1000 people. The incidence increased significantly during the study period, although the reasons for this are unclear. Fifteen cases of exposure were with rabid animals, mostly dogs (9 of 15). No human cases of rabies occurred thanks to adequate medical case management. Two specific profiles for potential exposure to rabies were identified based on age and gender. The first was children ( Conclusion Rabies is a real public health threat in Nunavik. Potential human exposure needs to be prevented, and prevention measures should be tailored to the two risk profiles identified based on age, gender and animal species involved.

Background Toxoplasma gondii, a zoonotic protozoan parasite, infects mammals and birds worldwide. Infection in humans is often asymptomatic, though illnesses can occur in immunocompromised hosts and the fetuses of susceptible women infected during pregnancy. In Nunavik, Canada, 60% of the Inuit population has measurable antibodies against T. gondii. Handling and consumption of wildlife have been identified as risk factors for exposure. Serological evidence of exposure has been reported for wildlife in Nunavik; however, T. gondii has not been detected in wildlife tissues commonly consumed by Inuit. Methods We used a magnetic capture DNA extraction and real-time PCR protocol to extract and amplify T. gondii DNA from large quantities of tissues (up to 100 g) of 441 individual animals in Nunavik: 166 ptarmigan (Lagopus lagopus), 156 geese (Branta canadensis and Chen caerulescens), 61 ringed seals (Pusa hispida), 31 caribou (Rangifer tarandus) and 27 walruses (Odobenus rosmarus). Results DNA from T. gondii was detected in 9% (95% CI: 3–15%) of geese from four communities in western and southern Nunavik, but DNA was not detected in other wildlife species including 20% (95% CI: 12–31%) of ringed seals and 26% (95% CI: 14–43%) of caribou positive on a commercial modified agglutination test (MAT) using thawed heart muscle juice. In geese, tissue parasite burden was highest in heart, followed by brain, breast muscle, liver and gizzard. Serological results did not correlate well with tissue infection status for any wildlife species. Conclusions To our knowledge, this is the first report on the detection, quantification, and characterization of DNA of T. gondii (clonal lineage II in one goose) from wildlife harvested for food in Nunavik, which supports the hypothesis that migratory geese can carry T. gondii into Nunavik where feline definitive hosts are rare. This study suggests that direct detection methods may be useful for detection of T. gondii in wildlife harvested for human consumption and provides data needed for a quantitative exposure assessment that will determine the risk of T. gondii exposure for Inuit who harvest and consume geese in Nunavik.

To inform source attribution efforts, a comparative exposure assessment was developed to estimate the relative exposure to Campylobacter, the leading bacterial gastrointestinal disease in Canada, for 13 different transmission routes within Ontario, Canada, during the summer. Exposure was quantified with stochastic models at the population level, which incorporated measures of frequency, quantity ingested, prevalence, and concentration, using data from FoodNet Canada surveillance, the peer-reviewed and gray literature, other Ontario data, and data that were specifically collected for this study. Models were run with @Risk software using Monte Carlo simulations. The mean number of cells of Campylobacter ingested per Ontarian per day during the summer, ranked from highest to lowest is as follows: household pets, chicken, living on a farm, raw milk, visiting a farm, recreational water, beef, drinking water, pork, vegetables, seafood, petting zoos, and fruits. The study results identify knowledge gaps for some transmission routes, and indicate that some transmission routes for Campylobacter are underestimated in the current literature, such as household pets and raw milk. Many data gaps were identified for future data collection consideration, especially for the concentration of Campylobacter in all transmission routes.

In Central Africa, bushmeat is commonly consumed, although its importance relative to other meats is incompletely understood. The urban demand for bushmeat is thought to be fueling the unsustainabl...

In 2016 and 2017 the first three MOOCs (Massive Online Open Course) addressing One Health were released, two of them by University of Geneva and University of Basel (Switzerland). With the support of Swiss School of Public Health and using these two highly interdisciplinary MOOCs, the first 'Global Flipped Classroom in One Health' was organized in Geneva and Basel in July 2017. This innovative event gathered 12 Swiss and international MOOC learners to work on specific public/global health challenges at the human-animal-ecosystem interface in interdisciplinary teams supported by experts from academia and international organisations (e.g. World Health Organization) based in Geneva, Basel and internationally. According to the final survey, the level of satisfaction by learners was high and they benefited from the experience in different ways: reinforcement of their knowledge and capacity to perform innovative research in One Health (e.g. using digital epidemiology), visits and meetings with experts in Global Health (e.g. World Health Organization and Institute of Global Health in Geneva, Swiss Tropical and Public Health Institute in Basel) and emerging research collaborations etc. A novel project-based learning and research model arising from MOOCs was successfully created, which offers opportunities for global education and research addressing real world challenges utilising a One Health approach. Keywords: One Health, Global Health, MOOC, E-learning, Flipped-classroom, Project-based learning

As the range of the blacklegged tick (Ixodes scapularis) expands into southern Quebec, cases of Lyme disease – caused by Borrelia burgdorferi and transmitted by blacklegged ticks – are also expected to rise. The authors of this article aimed to compare the experience, knowledge and practices regarding Lyme disease of physicians in Montérégie, a region affected by Lyme disease, with phyisicians in other regions not yet affected by the disease., BACKGROUND: Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management. OBJECTIVES: To describe FPs’ clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie). METHODS: In the present descriptive cross-sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans). RESULTS: A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%). CONCLUSION: The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.

In 2016 and 2017 the first three MOOCs (Massive Online Open Course) addressing One Health were released, two of them by University of Geneva and University of Basel (Switzerland). With the support of Swiss School of Public Health and using these two highly interdisciplinary MOOCs, the first 'Global Flipped Classroom in One Health' was organized in Geneva and Basel in July 2017. This innovative event gathered 12 Swiss and international MOOC learners to work on specific public/global health challenges at the human-animal-ecosystem interface in interdisciplinary teams supported by experts from academia and international organisations (e.g. World Health Organization) based in Geneva, Basel and internationally. According to the final survey, the level of satisfaction by learners was high and they benefited from the experience in different ways: reinforcement of their knowledge and capacity to perform innovative research in One Health (e.g. using digital epidemiology), visits and meetings with experts in Global Health (e.g. World Health Organization and Institute of Global Health in Geneva, Swiss Tropical and Public Health Institute in Basel) and emerging research collaborations etc. A novel project-based learning and research model arising from MOOCs was successfully created, which offers opportunities for global education and research addressing real world challenges utilising a One Health approach.

SUMMARYInformation is lacking in Canada on the frequency of exposures of healthy people to enteric pathogen sources (i.e. water, food, animal contact) at the community level. This information is critical to develop more robust risk assessments and prioritize control measures. A 12-month-long cross-sectional telephone survey of 1200 healthy individuals in a sentinel community was performed. Survey respondents were divided into three recall period groups (3, 7, 14 days). The occurrence of 46 exposures (including water, animal contact, environmental contact and high-risk foods) was assessed per recall period. Effect of age, gender, and season on exposures was modelled and frequencies of exposure were extrapolated. Thirty-five exposures had similar occurrences across recall periods. Age was significant for 23 exposures, season for 18, and gender for three. Exposures that vary by age and season (i.e. bottled water, swimming, etc.) warrant consideration when investigating and analysing cases of enteric illness.

Wild animal meat represents an important source of protein for many people in central Africa. Also known as bushmeat, this meat commodity is derived from wild animals hunted under uncontrolled conditions, transported to distant markets under rudimentary or no hygienic methods, and often eviscerated >24 hr after death. Considering the plausible role of wildlife as a reservoir for bacterial zoonotic pathogens, bushmeat may be an important public health risk in Central Africa. This cross-sectional survey served to evaluate the presence of Campylobacter, Salmonella, and Shigella in the muscle tissue of 128 wild animal carcasses from several hunted wildlife species (guenons [Cercopithecus spp.], collared mangabeys [Cercocebus torquatus], gray-cheeked mangabeys [Lophocebus albigena], African crested porcupines [Atherurus africanus], duikers [Cephalophus spp.], and red river hogs [Potamocherus porcus]) sold in two markets of Port-Gentil, Gabon, in July and August 2010. Salmonella was detected from one carcass; no Campylobacter or Shigella was detected. If Campylobacter and Shigella were present, the maximum expected prevalence was estimated at 6% and 1%, respectively. In light of such very low apparent muscle contamination levels, bushmeat likely does not represent a health risk per se with respect to Campylobacter, Salmonella, or Shigella. However, because carcass evisceration and skinning can take place within households prior to consumption, consumers should follow strict hygiene and food safety practices to avoid potential health hazards associated with the handling, preparation, or consumption of bushmeat.

SUMMARYSalmonella Enteritidis has emerged as the most prevalent cause of human salmonellosis in Canada. Recent trends of S. Enteritidis subtypes and their potential sources were described by integrating Salmonella data from several Canadian surveillance and monitoring programmes. A threefold increase in S. Enteritidis cases from 2003 to 2009 was identified to be primarily associated with phage types 13, 8 and 13a. Other common phage types (4, 1, 6a) showed winter seasonality and were more likely to be associated with cases linked to international travel. Conversely, phage types 13, 8 and 13a had summer seasonal peaks and were associated with cases of domestically acquired infections. During agri-food surveillance, S. Enteritidis was detected in various commodities, most frequently in chicken (with PT13, PT8 and PT13a predominating). Antimicrobial resistance was low in human and non-human isolates. Continued integrated surveillance and collaborative prevention and control efforts are required to mitigate future illness.

Fecal contamination of recreational waters is a complex public health and environmental issue involving multiple possible sources and contributing factors. Agricultural and animal production activities represent one such source of contamination from which various microorganisms transmissible to humans can be found. This study used regression models to ascertain and describe various time-independent agroenvironmental determinants associated with fecal contamination of recreational lake waters. From a logistic regression model analysis, two determinants were statistically associated with the level of fecal coliforms, namely: the presence of ruminant production in the area of influence (OR=2.78) and urban area (OR=3.69). Moreover, our data suggest that sources of fecal contamination located within the area of the lake water catchment and from within a distance of two kilometers of the beach have the most influence on the water quality.

The study used a structured expert elicitation survey to derive estimates of food-specific attribution for nine illnesses caused by enteric pathogens in Canada. It was based on a similar survey conducted in the United States and focused on Campylobacter spp., Escherichia coli O157:H7, Listeria monocytogenes, nontyphoidal Salmonella enterica, Shigella spp., Vibrio spp., Yersinia enterocolitica, Cryptosporidium parvum, and Norwalk-like virus. A snowball approach was used to identify food safety experts within Canada. Survey respondents provided background information as well as self-assessments of their expertise for each pathogen and the 12 food categories. Depending on the pathogen, food source attribution estimates were based on responses from between 10 and 35 experts. For each pathogen, experts divided their estimates of total foodborne illness across 12 food categories and they provided a best estimate for each category as well as 5th and 95th percentile limits for foods considered to be vehicles. Their responses were treated as triangular probability distributions, and linear aggregation was used to combine the opinions of each group of experts for each pathogen-food source group. Across the 108 pathogen-food groups, a majority of experts agreed on 30 sources and 48 nonsources for illness. The number of food groups considered to be pathogen sources by a majority of experts varied by pathogen from a low of one food source for Vibrio spp. (seafood) and C. parvum (produce) to a high of seven food sources for Salmonella spp. Beta distributions were fitted to the aggregated opinions and were reasonable representations for most of the pathogen-food group attributions. These results will be used to quantitatively assess the burden of foodborne illness in Canada as well as to analyze the uncertainty in our estimates.

SUMMARYCampylobacteriosis is a leading cause of acute bacterial gastroenteritis. An ecological study was undertaken to explore the association between environmental characteristics and incidence of campylobacteriosis in relation to four age groups and two seasonal periods. A multi-level Poisson regression model was used for modelling at the municipal level. High ruminant density was positively associated with incidence of campylobacteriosis, with a reduced effect as people become older. High poultry density and presence of a large poultry slaughterhouse were also associated with higher incidence, but only for people aged 16–34 years. The effect of ruminant density, poultry density, and slaughterhouses were constant across seasonal periods. Other associations were detected with population density and average daily precipitation. Close contacts with farm animals are probably involved in the associations observed. The specificity of age and season on this important disease must be considered in further studies and in the design of preventive measures.

Background Risk of infections by enteropathogens among individuals traveling outside their country of residence is considered important. Such travel‐related cases (TRC) have been poorly estimated and described in Canada. Methods Data from an enhanced, passive surveillance system of diseases caused by enteropathogens within a Canadian community from June 2005 to May 2009 were used to describe TRC in terms of disease (pathogen, symptoms, hospitalization, duration, and timing of sickness relative to return); demographics (age and gender); and travel (destination, length, and accommodation); and to compare them with non‐TRC. Results Among 1,773 reported cases, 446 (25%) were classified as TRC with 9% of them being new immigrants. The main TRC diseases were campylobacteriosis, salmonellosis, and giardiasis. Disease onset occurred before return in 42% of TRC. Main destinations were Latin America/Caribbean and Asia. No differences by month and year were observed for onset, departure, and return dates. In addition to new immigrants, three subgroups of TRC based on travel destination, length of travel, type of accommodation, and age were identified and some diseases were more frequently observed in these subgroups. Generally, TRC did not differ from domestic cases in terms of age, gender, symptoms, hospitalization, and disease duration. Campylobacter coli and Salmonella enteritidis were significantly more frequent among TRC. Conclusions TRC of diseases caused by enteropathogens that are reportable in Canada represent a significant proportion of the burden of the total diseases. Subgroups of TRC exist and are associated with certain diseases. These results help inform the assessment of the actual risk related to travel for each subgroup of travelers and quantify the attribution of traveling abroad to the overall burden of these gastrointestinal diseases.

The study used a structured expert elicitation survey to derive estimates of the foodborne attributable proportion for nine illnesses caused by enteric pathogens in Canada. It was based on a similar study conducted in the United States and focused on Campylobacter, Escherichia coli O157:H7, Listeria monocytogenes, nontyphoidal Salmonella enterica, Shigella spp., Vibrio spp., Yersinia enterocolitica, Cryptosporidium parvum, and Norwalk-like virus. For each pathogen, experts were asked to provide their best estimate and low and high limits for the proportion of foodborne illness relative to total cases. In addition, they provided background information with regard to food safety experience, including self-evaluated expertise for each pathogen on a 5-point scale. A snowball approach was used to identify 152 experts within Canada. The experts' background details were summarized using descriptive statistics. Factor analysis was used to determine whether the variability in best estimates was related to self-assessed level of expertise or other background information. Cluster analysis followed by beta function fitting was undertaken on best estimates from experts who self-evaluated their expertise 3 or higher. In parallel, Monte Carlo resampling was run using triangular distributions based on each expert's best estimate and its limits. Sixty-six experts encompassing various academic backgrounds, fields of expertise, and experiences relevant to food safety provided usable data. Considerable variation between experts in their estimated foodborne attributable proportions was observed over all diseases, without any relationship to the expert's background. Uncertainty about their estimate (measured by the low and high limits) varied between experts and between pathogens as well. Both cluster analysis and Monte Carlo resampling clearly indicated disagreement between experts for Campylobacter, E. coli O157, L. monocytogenes, Salmonella, Vibrio, and Y. enterocolitica. In the absence of more reliable estimates, the observed discrepancy between experts must be explored and understood before one can judge which opinion is the best.

Two Agroenvironmental hygienic pressure indicators (AHPIs) were developed to evaluate the effects of livestock production on water contamination and the risk for human health by expressing a complex public health risk via simple quantifiable figures. The first of the two AHPIs is addressing the aspect of surface water contamination while the second one is dealing with groundwater contamination. Each of the two AHPIs is built from a multiplicative model based on 25 parameters related to the transmission of bacteria through excretion by animals, survival in manure, and by run-off or infiltration water produced by rainfall. A global sensitivity approach was used to identify the most significant parameters in regard to the AHPIs output results. This analysis found that bacterial survival on the soil after manure spreading or grazing of animals (Ks), the proportion of bacteria able to reach surface water with run-off from manure on the soil (Brun-off), bacteria concentration in faeces Bconc, within-herd proportion of animals shedding the pathogenic bacteria targeted (Bprev) and the area used for pasture (A) – on bovine farms – are the most influential parameters with respect to the estimation of the AHPIs. With the exception of the latter element, these factors are all directly related to bacterial characteristics and parameters for which obtaining high quality data is most challenging. The identification of these most influential parameters will guide further research to enhance both the precision application of the AHPIs, and their use in managing public health risks.

Two Agroenvironmental Hygienic Pressure Indicators (AHPIs) have been proposed as model-based indicators for the public health risk of surface and ground water contamination by enteropathogens from agroenvironmental sources. Each of these indicators summarises twenty five parameters. The scientific goal of this work was to assess in an ex-ante way the usefulness of these indicators. One of the major reasons why many models and indicators fail to be used is the lack of the necessary data. Hence, the first step of the study assessed the availability of the data necessary for computing the AHPIs for the province of Quebec. Another reason for lack of usage is if the indicators do not meet the needs of the targeted audience. Consequently, this article also demonstrates key aspects of the AHPIs that make them a tool that is likely to be useful for the end-user. The evaluation of the availability and quality of available data for use in the AHPI led to minor modifications to the AHPI original parameters and equations. These modifications are presented. Once modified, adequate data were acquired to compute the indicator for Escherichia coli for surface and groundwater for all livestock farms in the province of Quebec, Canada. Data related to the microbial aspect of the AHPIs such as pathogen presence in livestock, its survival time in storage or on the soil, and its movement with water were the most difficult to obtain. For example, E. coli was used as a general indicator of faecal contamination in the absence of province-wide data on intra-herd contamination by specific human enteropathogens. Maps were generated and interpreted for their biophysical meaning to illustrate how the indicator values could be interpreted by various stakeholders involved in the public health management of water contamination from animal agriculture production and how this could be useful.

Human illness attribution has been recently recognized as an important tool to better inform food safety decisions. Analysis of outbreak data sets has been used for that purpose. This study was conducted to explore the usefulness of three comprehensive Canadian foodborne outbreak data sets covering 30 years for estimating food attribution in cases of gastrointestinal illness, providing Canadian food attribution estimates from a historical perspective. Information concerning the microbiological etiology and food vehicles recorded for each outbreak was standardized between the data sets. The agent-food vehicle combinations were described and analyzed for changes over time by using multiple correspondence analysis. Overall, 6,908 foodborne outbreaks were available for three decades (1976 through 2005), but the agent and the food vehicle were identified in only 2,107 of these outbreaks. Differences between the data sets were found in the distribution of the cause, the vehicle, and the location or size of the outbreaks. Multiple correspondence analysis revealed an association between Clostridium botulinum and wild meat and between C. botulinum and seafood. This analysis also highlighted changes in food attribution over time and generated the most up-to-date food attribution values for salmonellosis (29% of cases associated with produce, 15% with poultry, and 15% with meat other than poultry, pork, and beef), campylobacteriosis (56% of cases associated with poultry and 22% with dairy products other than fluid milk), and Escherichia coli infection (37% of cases associated with beef, 23% with cooked multi-ingredient dishes, and 11% with meat other than beef, poultry, and pork). Because of the inherent limitations of this approach, only the main findings should be considered for policy making. The use of other human illness attribution approaches may provide further clarification.

Active monitoring of pathogens on retail foods has been recommended and implemented in a number of developed countries. Because only a portion of retail food is contaminated with pathogens, a cost-effective and informative surveillance program at the retail level often involves a two-stage approach of initial presence-absence analysis and subsequent pathogen enumeration in any positive samples. Most-probable-number (MPN) methods are more resource intensive and therefore used only for samples considered positive by presence-absence methods. Interpretation of the results assumes that the initial bacterial count remains relatively stable between the initiation of the presence-absence analysis and the enumeration analysis. The objective of this study was to quantify the influence of 4 degrees C storage for 5 and 8 days on pathogen counts on raw chicken. The three pathogens examined were Salmonella Typhimurium, Campylobacter jejuni, and Listeria monocytogenes. No significant differences were found between treatments for Salmonella and Campylobacter. However, significant differences were observed for Listeria; counts at day 0 were lower than counts after 5 or 8 days of refrigerated storage (the maximum mean difference was less than 0.6 log units). These findings suggest that a two-stage approach could overestimate the number of Listeria cells on chicken at the time of purchase. By using an MPN analysis on the presumptive positive samples after 5 days of refrigerated storage, this difference will be reduced. These findings support the decision to reduce surveillance costs by performing a two-stage analysis for Salmonella and Campylobacter on retail chicken. This study provides direction for future sampling or surveillance programs that include enumeration of Listeria on retail food.

Background Lyme disease control strategies may include tick control interventions in high risk areas. Public authorities may be interested to assess how these types of interventions are perceived by the public which may then impact their acceptability. The aims of this paper are to compare socio-cognitive factors associated with high acceptability of tick control interventions and to describe perceived issues that may explain their low acceptability in populations living in two different regions, one being an endemic region for LD since the last 30 years, the Neuchâtel canton, in Switzerland, and another where the disease is emerging, the Montérégie region, in Canada. Methods A mixed methods’ design was chosen. Quantitative data were collected using web-surveys conducted in both regions (n = 814). Multivariable logistic regressions were used to compare socio-cognitive factors associated with high acceptability of selected interventions. Qualitative data were collected using focus group’s discussions to describe perceived issues relative to these interventions. Results Levels of acceptability in the studied populations were the lowest for the use of acaricides and landscaping and were under 50 % in both regions for six out of eight interventions, but were higher overall in Montérégie. High perceived efficacy of the intervention was strongly associated with high acceptability of tick control interventions. A high perceived risk about LD was also associated with a high acceptability of intervention under some models. High level of knowledge about LD was negatively associated with high acceptability of the use of acaricides in Neuchâtel. Perceived issues explaining low acceptability included environmental impacts, high costs to the public system, danger of individual disempowerment and perceptions that tick control interventions were disproportionate options for the level of LD risk. Conclusion This study suggests that the perceived efficacy and LD risk perception may be key factors to target to increase the acceptability of tick control interventions. Community-level issues seem to be important considerations driving low acceptability of public health interventions. Results of this study highlight the importance for decision-makers to account for socio-cognitive factors and perceived issues that may affect the acceptability of public health interventions in order to maximize the efficacy of actions to prevent and control LD.

A cross-sectional study was implemented to determine which factors related to management, housing and stockperson in the farrowing quarters were associated with preweaning mortality and piglets weaned per litter in swine breeding herds. The associations were sought separately for the two most common types of swine production in Quebec. Forty-eight randomly-selected independent farms and 38 others belonging to integrated organizations specialized in swine production conveniently chosen among the largest organizations in Quebec participated in the study. Preweaning performances were computed from the sow records. Information on housing features was gathered during the visit to the farrowing quarters. Management practices were obtained through a questionnaire from the stockperson working in the farrowing quarters and his or her personality traits were evaluated through a personality test. Backward elimination procedure was used to build multiple linear regression models for each measure of performance for each type of farm. The procedures started from the management, housing and stockperson groups of variables taken separately and altogether, leading to the building of different regression models. Piglets weaned per litter averaged 8.9 and 8.6 on the independent and integrated farms, respectively and preweaning mortality, 14.4 and 15.4%, respectively. On the independent farms, high preweaning performances (high number of piglets weaned per litter and low preweaning mortality) were associated with routinely washing the farrowing crates, vaccination of the sows against neonatal diarrhea, farrowing crates equipped with high bottom bars, partially-slotted floors in the farrowing pens and high self-discipline from the stockperson. Poor performances were associated with the use of oxytocin around farrowing, mixed nursery-farrowing quarters and a stockperson being exaggeratedly self-assured and sensitive. On the integrated farms, the use of oxytocin at farrowing was also associated with poor performances, as well as several rooms or all-in/all-out farrowing quarters, farrowing crates equipped with high or medium bottom bars, totally-slotted floors and a stockperson being rather bold, suspecting and tense. High performances were positively associated with warmth, emotional stability and self-discipline from the stockperson. These findings provided evidences of the influence of the stockperson's personality on performances in particular, on the integrated farms on which the management in the farrowing quarters was more proactive (implying a stronger relationship between the stockperson and the pigs). In contrast, the importance to preweaning performances of general hygiene and health control was emphasized on the independent farms.

The recent emergence of West Nile virus (WNV) in North America highlights vulnerability to climate sensitive diseases and stresses the importance of preventive efforts to reduce their public health impact. Effective prevention involves reducing environmental risk of exposure and increasing adoption of preventive behaviours, both of which depend on knowledge and acceptance of such measures. When making operational decisions about disease prevention and control, public health must take into account a wide range of operational, environmental, social and economic considerations in addition to intervention effectiveness. The current study aimed to identify, assess and rank possible risk reduction measures taking into account a broad set of criteria and perspectives applicable to the management of WNV in Quebec under increasing transmission risk scenarios, some of which may be related to ongoing warming in higher-latitude regions. A participatory approach was used to collect information on categories of concern to relevant stakeholders with respect to WNV prevention and control. Multi-criteria decision analysis was applied to examine stakeholder perspectives and their effect on strategy rankings under increasing transmission risk scenarios. Twenty-three preventive interventions were retained for evaluation using eighteen criteria identified by stakeholders. Combined evaluations revealed that, at an individual-level, inspecting window screen integrity, wearing light colored, long clothing, eliminating peridomestic larval sites and reducing outdoor activities at peak times were top interventions under six WNV transmission scenarios. At a regional-level, the use of larvicides was a preferred strategy in five out of six scenarios, while use of adulticides and dissemination of sterile male mosquitoes were found to be among the least favoured interventions in almost all scenarios. Our findings suggest that continued public health efforts aimed at reinforcing individual-level preventive behaviours combined with the application of larvicides to manage the risk of WNV infection are the interventions most acceptable and effective at reaching current management objectives now and under future theoretical transmission risk.

OBJECTIVES: Despite its extensive use, the termSurveillanceoften takes on various meanings in the scien- tific literature pertinent to public health and animal health. A critical appraisal of this literature also reveals ambiguities relating to the scope and necessary structural components underpinning the surveillance process. The authors hypothesized that these inconsistencies translate to real or perceived deficiencies in the conceptu - al framework of population health surveillance. This paper presents a population health surveillance theory framed upon an explicit conceptual system relative to health surveillance performed in human and animal populations. METHODS: The population health surveillance theory reflects the authors' system of thinking and was based on a creative process. RESULTS: Population health surveillance includes two broad components: one relating to the human organi- zation (which includes expertise and the administrative program), and one relating to the system per se (which includes elements of design and method) and which can be viewed as a process. The population health surveil- lance process is made of five sequential interrelated steps: 1) a trigger or need, 2) problem formulation, 3) sur - veillance planning, 4) surveillance implementation, and 5) information communication and audit. CONCLUSIONS: The population health surveillance theory provides a systematic way of understanding, or- ganizing and evaluating the population health surveillance process.

Veterinary and public health surveillance programs can be evaluated to assess and improve the planning, implementation and effectiveness of these programs. Guidelines, protocols and methods have been developed for such evaluation. In general, they focus on a limited set of attributes (e.g., sensitivity and simplicity), that are assessed quantitatively whenever possible, otherwise qualitatively. Despite efforts at standardization, replication by different evaluators is difficult, making evaluation outcomes open to interpretation. This ultimately limits the usefulness of surveillance evaluations. At the same time, the growing demand to prove freedom from disease or pathogen, and the Sanitary and Phytosanitary Agreement and the International Health Regulations require stronger surveillance programs. We developed a method for evaluating veterinary and public health surveillance programs that is detailed, structured, transparent and based on surveillance concepts that are part of all types of surveillance programs. The proposed conceptual evaluation method comprises four steps: (1) text analysis, (2) extraction of the surveillance conceptual model, (3) comparison of the extracted surveillance conceptual model to a theoretical standard, and (4) validation interview with a surveillance program designer. This conceptual evaluation method was applied in 2005 to C-EnterNet, a new Canadian zoonotic disease surveillance program that encompasses laboratory based surveillance of enteric diseases in humans and active surveillance of the pathogens in food, water, and livestock. The theoretical standard used for evaluating C-EnterNet was a relevant existing structure called the “Population Health Surveillance Theory”. Five out of 152 surveillance concepts were absent in the design of C-EnterNet. However, all of the surveillance concept relationships found in C-EnterNet were valid. The proposed method can be used to improve the design and documentation of surveillance programs. It complements existing surveillance evaluation methods. Conceptual evaluation is not a performance-oriented evaluation method and so it is particularly useful for surveillance programs with a valid conceptual framework but limited technical capacity and resources. Such programs would be penalized using existing performance-based evaluation methods. Applying conjointly the conceptual evaluation along with existing performance-oriented evaluation methods will better judge the worth of surveillance programs. We recommend developing a comprehensive surveillance evaluation framework for veterinary and public health surveillance programs that integrates all existing surveillance evaluation tools and provides an appropriate way to evaluate various types of surveillance programs.

SUMMARYThis study provides a comprehensive epidemio-clinical picture of sporadic, domestically acquired cases of amoebiasis, cryptosporidiosis and giardiasis in one Canadian community based on patient symptom, outcome and exposure data from an enhanced surveillance system. It yields valuable data for estimating the burden of those diseases including the proportion of bloody diarrhoea, hospitalization, and disease duration. Age differences were observed by incidence rate and for some clinical information and exposures to risk factors. For each of the three diseases, the animal/environment-to-person route was the most common possible main transmission route according to the exposure reported, whereas the person-to-person route was the least common. Exposure was higher for the 10–24 years age group of giardiasis cases for swimming in recreational waters (79%) and attending a barbeque (50%). Therefore, comparisons between groups of cases or extrapolation of results when estimating the burden of illness should be adjusted for age.

This study used integrated surveillance data to assess the seasonality in retail chicken contamination and of human activities and their role on the seasonality of human endemic salmonellosis. From June 2005 to May 2008, reported cases of salmonellosis were followed-up comprehensively using a standardized questionnaire, and 616 retail chicken breasts were systematically tested for Salmonella, in one Canadian community. Poisson regression was used to model seasonality of human cases, Salmonella in retail chicken, and to assess the relationship between these and selected meteorological variables. The case-case approach was used to compare the activities of salmonellosis cases that occurred during the summer peak to the other cases. There were 216 human endemic salmonellosis cases (incidence rate: 14.7 cases/100,000 person-years), predominantly of Typhimurium and Enteritidis serotypes (28.4% and 20.8%, respectively). The monthly distribution of cases was associated with ambient temperature (p0.001) with a significant seasonal peak in June (p = 0.03) and July (p = 0.0005), but it was not associated with precipitation (p = 0.38). Several activities reported by cases tended to be more frequent during summer. Particularly, attending a barbeque and gardening within the 3 days before the disease onset were two significant risk factors for salmonellosis in June or July compared with the salmonellosis cases that occurred in the other months. Out of all chicken samples, 185 (30%) tested positive for Salmonella spp., Kentucky being the dominant serotype (44.3% of positive samples). The monthly proportion of positive chicken samples showed no seasonal variations (p = 0.30) and was not associated with the monthly count of human cases (p = 0.99). In conclusion, even though evidence generally supports chicken as a primary vehicle of Salmonella to humans, the contamination of retail chicken was not driving the seasonality in human salmonellosis. Attending a barbeque or gardening during the hotter months of the year should be further assessed for their risk.

Analysis of foodborne outbreak data is one approach to estimate the proportion of human cases of specific enteric diseases attributable to a specific food item (food attribution). Although we recognize that for a variety of reasons reported outbreaks represent only a small portion of all actual outbreaks, using outbreak data for food attribution is the only methodological approach where, theoretically, there is an actual direct link between the pathogen, its source and each infected person. The purpose of this study was to explore the usefulness of foodborne outbreak data extracted from publicly available international electronic reports and publications to provide estimates of food attribution, to derive and compare these estimates between regions, while improving the understanding of the pathogen/food vehicle combination. Electronic reports and publications of foodborne outbreaks that occurred globally since the 1980s were systematically scanned and their data were extracted and compiled in a database. A system of food categorization was developed and food vehicles assigned accordingly. The association between the aetiology and the food source was statistically described for outbreaks with both reported aetiology and incriminated food vehicle. Differences in associations between Australia and New Zealand, Canada, the European Union (EU) and the United States (US) were explored using multiple correspondence analysis and were formally tested between the EU and the US for selected pathogens and food sources. As a result, the food and aetiology cross tabulation of 4093 foodborne outbreaks that occurred globally between 1988 and 2007 is presented and discussed. For a few aetiologies and some foods the association is very specific. The lack of a specific association between the other foods and aetiologies highlights the potential roles of cross-contamination, environmental contamination and the role of the infected foodhandler along the food chain from farm to fork. Detailed analysis of the four regions highlighted some specific associations: Salmonella Enteritidis outbreaks occurred relatively often in the EU states with eggs as the most common source; Campylobacter associated outbreaks were mainly related to poultry products in the EU and to dairy products in the US; there was an association between Escherichia coli outbreaks and beef in Canada; and while Salmonella Typhiumurium outbreaks were relatively common in Australia and New Zealand, across all regions, Salmonella was associated with a variety of food groups. The value and limitations of the study are discussed, as well as the extrapolation of the food attribution estimates beyond their outbreak context.

Porcine proliferative enteropathy caused by Lawsonia intracellularis is an important enteric disease in swine throughout the world. Information regarding the distribution of this pathogen in Canadian swine herds would be beneficial for the creation of control protocols. Pigs from Ontario, Quebec, and Alberta were tested by using an indirect immunofluorescence assay for antibodies to L. intracellularis. Pig seroprevalence was calculated as the proportion of pigs positive from total pigs tested in the targeted population. Seroprevalence (+/- standard error [s(x)]) in market hogs in Ontario from farrow-finish (FF) farms and finishing (FIN) farms were significantly different at 77% (s(x) = 7%) and 29% (s(x) = 15%), respectively. Seroprevalence for sows and gilts in FF and farrowing and nursery (FAR + NUR) farms in Ontario were 90% (s(x) = 3%) and 93% (s(x) = 6%), respectively. Seroprevalence in breeding females in Quebec from FF and FAR farms was 82% (s(x) = 5%) and 87% (s(x) = 3%), respectively. Seroprevalence (57%, s(x) = 8%) in finishing pigs in Alberta from FF farms was significantly different from that of multisite (MS) farms and FIN farms, 6% (s(x) = 6%) and 9% (s(x) = 5%), respectively. Lawsonia intracellularis appears to be widespread in Canada and the seroprevalence on FF farms is higher than that on FIN and MS farms, possibly due to the presence of breeding females or management differences.

In the context of meat inspection modernization, the current mandatory incision and visual inspection of all hog mandibular lymph nodes (MLNs) to detect signs of infection by Mycobacterium bovis, a zoonotic infection is examined. Canadian data of MLN pathology and microbial contamination are scarce and the performance of the current regulatory inspection of MLNs in actually detecting lesions and contamination by Mycobacterium bovis has not been documented. A survey of MLN condition in market hogs according to various inspection schemes was undertaken to fill the data gap. One MLN of a representative sample of 149 483 hogs were submitted to standard pathological and bacteriological analyses. Actual abnormal MLNs actually were rare (below 8%). They are often under detected by the current inspection because of limited sensitivity (18%). Such abnormalities, even undetected, have very limited, if any, impact on human health since the pathological and microbiological analyses failed to provide evidence of Mycobacterium bovis infection. On the other hand, MLNs can be contaminated with several bacteria potentially pathogenic to humans, raising the risk of cross-contamination during the inspection with incision. Finally, the current incision and visual inspection of all hog MLNs and the proposed visual-only inspection perform similarly in identifying abnormal MLNs.

In the context of a risk-based meat inspection modernization, the change towards a visual only inspection of all hog mandibular lymph nodes (MLN) has been made in some countries and is considered in Canada. In fact, the current mandatory incision and visual inspection of all MLNs put in force a century ago to detect signs of infection by Mycobacterium bovis may no longer be relevant and may even generate cross-contamination by bacteria potentially pathogenic to humans. To support a science-based decision, a qualitative risk-benefit assessment following the European Food Safety Authority framework was undertaken for each inspection approach (with or without systematic incision). Both risk-benefit assessments led to similar results in concluding that the benefit of any MLN inspection for the detection of M. bovis infection in hogs is no longer existent. For the risk associated with this incision, data is lacking to differentiate the risk between both inspections on the qualitative scale chosen. In conclusion, the scientific opinion is that the replacement of the current systematic incision and visual inspection of all hog MLNs by a systematic visual-only inspection of all MLNs will not affect the food safety risks and in fact may reduce some of them.

Five protocols were compared to determine the combined effects of different sample weights and culture methods for the recovery of Salmonella from 310 pig cecal samples taken in abattoirs as part of the Canadian Integrated Program for Anti-microbial Resistance Surveillance. Sample weights evaluated were 1 and 10 g. Culture methods used with each sample weight were modified semisolid Rappaport-Vassiliadis agar (MSRV) and brilliant green agar with sulfa and novobiocin (BGSN) and xylose-lysine-tergitol-4 agar (XLT4). A preliminary sample preparation step in saline was also evaluated using a 10-g sample and MSRV. The Salmonella recovery rate varied from 20% for the saline MSRV 10-g protocol to 32% for the MSRV 10-g and the BGSN-XLT4 10-g protocols. A good agreement (K > 0.8) was observed between pairs of protocols except whenever the saline MSRV 10-g and the MSRV 1-g protocols were compared. Larger samples (10 g) yielded higher detection of Salmonella than 1-g samples for the MSRV protocol (32 versus 25%), whereas the differences were not statistically significant for the BGSN-XLT4 protocols. Protocols using the BGSN-XLT4 agar yielded higher detection rates of Salmonella compared with MSRV with 1-g samples (30 versus 25%), whereas it was equivalent with 10-g samples. Considering a greater recovery rate, the ease of use, and a better time and resource efficiency, the MSRV 10-g protocol was therefore adopted by the Canadian Integrated Program for Antimicrobial Resistance Surveillance.

Infections by enteropathogenic microorganisms linked to agroenvironmental contamination represent a significant threat to urban and rural communities. To better characterize and manage this risk, it is necessary, not only to accurately describe enteric illnesses occurring over time or across regions, but also to correctly assess exposure attributable to this environmental pollution. New agroenvironmental hygienic pressure indicators (AHPIs) were developed to synthesise relevant data expressing this exposure. They were derived from a conceptual framework for developing sustainable agriculture indicators and specifically adapted for describing the microbial risk of water contamination by livestock operations. The proposed indicators include two components, and five attributes whose values are calculated at the livestock operation level from a set of available data related to the fields of microbiology, animal production, agronomy, hydrology, and meteorology. They are then aggregated at a higher geographical level to better express exposure of human populations to potential of water contamination by zoonotic enteropathogens. The indicators are calculated separately by zoonotic enteropathogens, and by water source (surface or groundwater). They take into account the various animal species within each livestock operation. When validated, the proposed indicators will allow decision-makers and public health officials to better manage crucial issues in the area of water safety and agriculture.

Twenty-four sows (six littermate groups of four sows each) from 29 to 106 kg liveweight were fed either 0 or 8% solvent-extracted rapeseed meal, substituted on an isonitrogenous basis for soybean meal and wheat. The two groups were then subdivided to receive either 0 or 8% rapeseed meal in their diets through two complete reproductive cycles.Average daily gain of gilts fed rapeseed meal was lower throughout the growing period but was significantly depressed only from 90 to 106 kg liveweight. Number of services to conception, gestation weight gains, gestation length and lactation weight losses were not significantly influenced by dietary treatment. In the first reproductive cycle, sows fed rapeseed meal during the growing period farrowed only 0.2 pigs less per litter than those fed the diet containing soybean meal, but weaned 2.5 pigs less which resulted in a reduced litter weaning weight.During the second reproductive cycle, treatment during growth had no significant influence on performance of the sows or litters. Sows fed rapeseed meal during gestation and lactation performed as well during both reproductive cycles as those fed the soybean meal diet. The results indicate that levels of 8% rapeseed meal should not be fed to growing gilts that are to be saved for reproduction.