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In Denmark, between 3,740 and 5,389 human Campylobacter cases have been registered yearly in the past five years (See Table A1). In 2022, the number of registered Campylobacter cases was 5,142, 28% of which were travel-related. Since 2019, a subset of human samples (around 10-15%) have been sent routinely to Statens Serum Institut for subtyping by whole genome sequencing in order to detect clusters and outbreaks. Figure 5.1 shows the number of domestic cases from 2018 to 2022, the proportion of cases in clusters, and clusters with a food match. In 2022, the threshold for investigation of clusters was changed to examine genetic clusters of human cases down to five cases. This was done to gain further knowledge of their aetiology. Since this surveillance setup only captures the tip of the iceberg, it is estimated that whenever a cluster of five cases is detected, this covers an outbreak of a least 40-50 cases. From 2018 to 2022, 62 genetic clusters were detected with five C. jejuni cases or more constituting 32% (849 / 2,683) of the sequenced human isolates. Twenty-six clusters comprised ten or more cases constituting 23% (618 / 2,683) of the sequenced human isolates. The largest cluster contained 124 cases (spanning 2018-2022) and was described in Anonymous 2020 [1]. In 2022, nineteen genetic clusters with five or more cases were detected (Figure 5.2) comprising 26% (192 / 737) of the sequenced cases. For nine of these clusters a food match was detected within the same or the previous year. Food matches were linked to Danish produced chicken meat, except from one that was linked to imported chicken meat. In total, 25% (184 / 737) of the sequenced human isolates in 2022, was matched to a source. Since chicken meat is consumed by the majority of the Danish population, and it is hard to remember brand or type of meat, the interviews of cases in the genetic clusters do not add much to the aetiology. The exception is point source outbr

The health of humans, animals and our shared environment are interconnected. Protection of animal health and public health from zoonotic threats requires a One Health approach and collaborations across sectors and country borders. Cross-sectoral One Health collaboration is increasingly emphasised and applied in Denmark, in Europe and globally and societal, political and environmental changes call for continuous evolution of the One Health approach.

Listeriosis is a foodborne infection caused by Listeria monocytogenes. The clinical spectrum of listeriosis ranges from mild to invasive disease including bacteraemia or meningitis. Listeria monocytogenes can also be transmitted from mother to fetus in utero or to the neonate during birth. Risk factors for invasive disease include immunosuppression, advanced age, and pregnancy. The incubation is longer than for most foodborne pathogens, usually a few weeks. In Denmark, invasive forms of listerioses in humans are monitored in the Danish surveillance system. The 30-day mortality of registered cases of listeriosis is about 25% [1].

Q fever, a disease caused by Coxiella burnetii (CB), is an emerging zoonotic health problem. The prevalence data from potential sources are valuable for assessing the risk to human and animal health. To estimate the prevalence of CB antibodies in Estonian ruminants, pooled milk and serum samples from cattle (Bos taurus) and pooled serum samples from sheep (Ovis aries) and goats (Capra hircus) were analyzed. Additionally, bulk tank milk samples (BTM; n = 72) were analyzed for the presence of CB DNA. Questionnaires and herd-level datasets were used to identify the risk factors for exposure using binary logistic regression analysis. The prevalence of CB-positive dairy cattle herds (27.16%) was significantly higher than that in beef cattle herds (6.67%) and sheep flocks (2.35%). No CB antibodies were detected in the goat flocks. CB DNA was found in 11.36% of the BTM samples. The odds of seropositivity were higher in dairy cattle herds, with an increasing number of cattle in the herd, and with location in southwestern, northeastern and northwestern Estonia. Dairy cattle herds had higher odds of testing positive for CB in BTM if the dairy cows were kept loose and lower odds if the herd was located in northwestern Estonia.

Background: Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. Methods: We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. Results: We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables. Conclusions: Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability

Campylobacter er den hyppigst rapporterede årsag til infektiøse mave-tarm sygdomme i Europa, hvilket gør den til en af de vigtigste fødevarebårne bakterielle zoonoser (ECDC 2019). En af målene for ”Handlingsplan for campylobacter i slagtekyllinger, fødevarer og det omgivende miljø. 2018-2021” er at fastholde forekomsten af bakterien Campylobacter i kloaksvaberprøver fra danske slagtekyllinger på niveauet fra 2017 (Fødevarestyrelsen 2019). Fritgående og økologiske kyllinger udgør en særlig udfordring i at nå handleplanens mål, da en højere andel disse slagtekyllinger er positive for Campylobacter end hvad der findes i konventionelle slagtekyllinger (Fødevarestyrelsen 2019, Helwigh et al. 2020). Der mangler viden og redskaber, der kan anvendes til at reducere forekomsten af Campylobacter for udegående kyllinger. Nødvendigheden af denne viden forøges samtidigt med den stigende markedsefterspørgsel på kød fra fritgående og økologiske kyllinger. Dette illustreres ved at en firdobling af solgt økologisk kyllingekød det sidste årti (Danmarks Statistik 2020). Forholdene for udegående slagtekyllinger adskiller sig fra det konventionelle opdræt ved, at dyrene har adgang til et udendørsarealer. Denne kontakt med omgivelserne gør, at kyllingerne også i højere grad eksponeres til Campylobacter fra naturligt forekomne smittekilder i miljøet (Hansson et al. 2010). Mulighederne for at kontrollere smitten ved brug af biosikkerhed er derfor begrænset, da denne tilgang hovedsageligt handler om at isolere kyllingerne i et indendørs miljø, der kan kontrolleres. Det vil ikke være muligt at udrydde Campylobacter fra udegående flokke, men det kan måske være muligt at reducere mængden af Campylobacter, som de bringer til slagteriet. Da biosikkerhed ikke er en mulighed, skal der kigges mod andre former for kontrolmetoder f.eks. tilsætningsstoffer til foder, vacciner eller biologiske løsninger. Mange af disse produkte

Denne rapport beskriver produktionen og campylobacterstatus for økologiske slagtekyllinger i Danmark baseret på nationale overvågningsdata med de usikkerheder det giver. Den vil være hypotesedrivende og danne grundlag de efterfølgende epidemiologiske undersøgelser i OutCampy-projektet, der har til formål at afdække epidemiologien af og smittekilder for Campylobacter i økologiske og fritgående slagtekyllinger. Rapporten indeholder mange beskrivende figurer og tabeller og kan bruges som opslagsværk og evidensgrundlag for Campylobacter i udegående slagtekyllinger. Besætninger med økologiske og fritgående slagtekyllinger er gået fra at være spredt i hele Danmark til at være koncentreret i dele af Jylland. Flest flokke produceres nu i den sydligste del af Jylland og midten af Nordjylland. Mellem 2017-2019 var der været en større udskiftning af besætninger, specielt ved årsskiftet mellem 2018 og 2019. Der er reelt tale om forskellige situationer hvad angår populationssammensætning før og efter 2019. Dette formodes at hænge sammen med de to store ændringer på de slagterier, der slagtede økologiske kyllinger. I 2018 ophørte slagteri C med at modtage økologiske og fritgående slagtekyllinger, og de fleste af de tilknyttede besætninger sendte så deres kyllinger til slagteri A. I 2019 ophørte slagteri B med at modtage økologiske og fritgående slagtekyllinger, og en større antal besætninger lukkede i 2019. Slagteri A var i resten af 2019, det eneste slagteri, der modtog økologiske slagtekyllinger. Disse begivenheder falder også sammen med ændringer i forekomsten og fordelingen af campylobacterpositive flokke både nationalt og regionalt. Prævalenserne af både campylobacterpositive flokke og kontaminerede lårskindsprøver fra slagteriet var høje sammenlignet med den konventionelle produktion. Dog var koncentrationen af Campylobacter på lårskindsprøverne (LS) økologiske slagtekyllinger sammenlignelig med den på konventionelle slagtekyllinger. Campylo

In this study, we summarize Trichinella findings from four wild, free-ranging host species from Estonia during 2007–2014. Trichinella spp. larvae were detected in 281 (0.9%, 95% confidence interval (CI) 0.8–1.0) of 30,566 wild boars (Sus scrofa), 63 (14.7%, 95% CI 11.6–18.3) of 429 brown bears (Ursus arctos), 59 (65.56%, 95% CI 55.3–74.8) of 90 Eurasian lynxes (Lynx lynx), and three (60.0%, 95% CI 18.2–92.7) of five badgers (Meles meles). All four European Trichinella species were detected: T. britovi in 0.7% of the wild boars, 7.2% of the brown bears, 45.6% of the lynxes, and 40.0% of the badgers; T. nativa in 0.1% of the wild boars, 5.8% of the brown bears, and 20.0% of the lynxes; T. pseudospiralis in 0.02% the wild boars; and T. spiralis in 0.03% of the wild boars and 4.4% of the lynxes. The results include the first description from Estonia of T. britovi in brown bear and badgers, T. pseudospiralis in wild boars, and T. spiralis in wild boars and lynxes. The results indicate high infection pressure in the sylvatic cycles across the years—illustrating continuous risk of spillover to domestic cycles and of transmission to humans.

Herbivores can be accidental hosts for the zoonotic nematode parasites Trichinella spp., which are endemic at high prevalence in wildlife in northeastern Europe. Using direct and indirect detection methods for Trichinella spp., we investigated samples from 463 wild moose (Alces alces) harvested by hunters in Estonia in 2015. A total of 460 moose were tested directly by artificial digestion of diaphragm muscle, 463 moose were tested indirectly by enzyme-linked immunosorbent assay (ELISA), and 34 moose also by western blot. Positive-control reference sera were from other host species. Nematode larvae were found in six muscle samples; five of which were pooled samples. None of the larvae were identified as Trichinella spp., based on their morphology and molecular analyses. Twelve moose (2.6%) were positive by ELISA, but none were positive by the western blot test. Trichinella spp. infection was not detected, but ELISA results may suggest Trichinella spp. exposure in a small proportion of moose in Estonia.

The zoonotic parasite Dirofilaria repens has spread toward north in Europe, and cases of autochthonous dirofilariosis caused by D. repens have emerged in the Baltic countries Estonia, Latvia, and Lithuania. We conducted a review on the emergence of dirofilariosis in humans and domestic dogs in these three countries in northeastern Europe. Based on the available literature and reports, the first finding in the Baltic countries was made in Latvia in 2008, followed by the first in Lithuania in 2010, and the first in Estonia in 2012. In all three countries, further findings were reported soon after the first reports. By the end of 2019, autochthonous human D. repens infections had been described from Latvia and Lithuania, and autochthonous canine D. repens infections had been described from all three Baltic countries. While no epidemiological studies estimating prevalence or incidence of the human infections have been published from the three countries, a substantial proportion of investigated dogs have tested positive for microfilariae in studies performed in Latvia and Lithuania. Dirofilariosis is an emerging zoonosis in northern Europe, and the summarized data confirm that D. repens has become established and endemic in the Baltic countries. The available data do not provide a good overview of the situation, and further epidemiological studies are needed. Awareness about the recently emerged zoonotic parasite should be increased among medical doctors, veterinarians, and the general public. Managing this zoonotic infection is a public health challenge that needs to be addressed using a One Health approach. Investigating the spread of D. repens in the Baltic countries could be useful for better preparedness for the anticipated further spread to the Nordic countries.

Leptospirosis is a zoonotic bacterial disease that affects humans and animals worldwide. Recently, more attention has been paid to Leptospira spp. infections in domestic cats. In this seroepidemiological study, we estimated the prevalence of anti-Leptospira spp. antibodies in domestic cats in Estonia and evaluated risk factors for the seropositivity. A total of 546 surplus feline plasma and serum samples, collected in collaboration with small animal clinics and an animal shelter in 2013 and 2015, were included in this study. The samples were tested for antibodies against Leptospira spp. using a microscopic agglutination test. The panel included Leptospira interrogans serovars Pomona, Icterohaemorrhagiae, Bratislava, Canicola, and Hardjo, and Leptospira kirschneri serovar Grippotyphosa. Titers ≥100 (positive reactions at dilutions ≥1/100) were considered positive. Anti-Leptospira spp. antibodies were detected in 12.8% of the cats. The percentage of cats that tested positive for antibodies against L. interrogans serovars Pomona, Icterohaemorrhagiae, Bratislava, Canicola, and Hardjo were 9.3%, 3.5%, 2.4%, 0.4%, and 0.2%, respectively, and the percentage of cats that tested positive for antibodies against L. kirschneri serovar Grippotyphosa was 7.3%. Of the seropositive cats, 46.5%, 35.2%, 12.7%, 4.2%, and 1.4% tested positive for 1, 2, 3, 4, and 5 serovars, respectively. The prevalence of anti-Leptospira spp. antibodies was 11.2% in pet cats and 16.3% in shelter cats. Among pet cats, the seroprevalence was over four times higher in cats that had access to the outdoors (17.2%) than in indoor cats (3.9%). Multivariable models, one based on data on pet cats only and another including also data on shelter cats, identified having access to the outdoors, being a shelter cat, and being from Western Estonia as the risk factors for seropositivity. Cats could be better protected from exposure to Leptospira spp. by not allowing them to roam freely outdoors.

Background: Many parasites (protozoa and helminths) can be transmitted through food and lead to infections with high morbidity, as well as disease outbreaks. Although the importance of foodborne parasites (FBP) is recognised by many sectors of the food industry, standardized analytical methods and validation procedures for testing food for FBP are lacking. Scope and approach:Current methods for detection of FBP, and their validation, are critically reviewed, focusing on priority FBP in Europe: the helminths Echinococcus multilocularis, Echinococcus granulosus, Taenia saginata, Trichinella spp., and Anisakidae, and the protozoa Toxoplasma gondii, Cryptosporidium spp., and Giardia duodenalis. Key findings and conclusions:Standard methods exist for detection of T. saginata in beef, and Trichinella spp. in meat (and are mandatory at meat inspection in Europe), Anisakidae in fish, and Cryptosporidium spp. and G. duodenalis in leafy green vegetables and berry fruits. For other FBP or foods, methods used in sample surveys have been described, but validation data are generally absent; limits of detection are not provided, ring trials have rarely been performed, and for most FBP quality control materials, proficiency schemes, and reference standards are lacking. The use of surrogate particles or organisms for method development or validation purposes needs to be carefully considered. Documented procedures for validation, such as ISO17468 and ISO16140-2:2016 that were established for bacteria, are mostly inappropriate for FBP. The development and application of standardized and validated detection methods would enhance understanding of the foodborne route of transmission, improve risk assessments, and help identify and verify critical control points.