statusactions future considerations present status, actions taken and future considerations due to...
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Present status, actions taken and future considerations due to the findings of Echinococcus multilocularis in two Scandinavian countriesHelene Wahlström (SE), Heidi L Enemark (DK) Rebecca K Davidson (NO), Antti Oksanen (FI)
Vet Parasitol, in press
Background
www.scantours.com
1999 Svalbard
2000
2011
Considered free from E. multilocularis*
Considered free from E. multilocularis*
Kapel & Saeed, 2000Henttonen et al., 2001
Osterman Lind et al., 2011Enemark et al., 2013*Prevalence <1% in final host
2013
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
First finding in DK First finding in SE
Finding of high endemic focus in Southern DK
Surveillance - timeline
Pos. cat detected by German lab
DKSENO/FI
MC-PCR
Detection of Em in DK Detection of Em in SE
Surveillance of Em in foxes
2000
2002
2004
2006
2008
2010
2012
0
500
1000
1500
2000
2500
3000
3500
4000
DenmarkSwedenNorwayFinland
MethodsSur DK SE NO FI
2000 - CoA ELISA (SSCT)
- CoA ELISA (SCT)
2001 - CoA ELISA (SSCT)
- CoA ELISA (SCT)
2002 SCT CoA ELISA (SSCT)
CoA ELISA (egg PCR)
CoA ELISA (SCT)
2003 - CoA ELISA (SSCT)
CoA ELISA (egg PCR)
CoA ELISA (SCT)
2004 - CoA ELISA (SSCT)
CoA ELISA (egg PCR)
CoA ELISA (SCT)
2005 - CoA ELISA (SSCT)
CoA ELISA (egg PCR)
CoA ELISA (SCT)
2006 - CoA ELISA (SSCT)
Egg PCR CoA ELISA (SCT)
2007 - CoA ELISA (SSCT)
Egg PCR CoA ELISA (SCT)
2008 - CoA ELISA (SSCT)
Egg PCR CoA ELISA (SCT)
2009 - CoA ELISA (SSCT)
Egg PCR CoA ELISA (SCT)
2010 - CoA ELISA (SSCT)MC-PCR
- CoA ELISA (SCT)
2011 SCT MC-PCR Egg PCR CoA ELISA (SCT)
2012 SCT MC-PCR Egg PCR CoA ELISA (SCT)
2013 SCT MC-PCR MC-PCR CoA ELISA (SCT)
MC-PCR
Required to document fredomSurveillance of
geographical
spread &
prevalence
(0.1%)
Surveillance of prevalence (low),
detection of hot spots
Total no of foxes Dec. 2014: 1169
DK: surveillance 2011-2014
Total no of racoon dogs Dec. 2014: 265
Other wild carnivores Dec. 2014: 66In total: 1500
National:SE: very low 0.1%DK: low 1.2% RegionalSE: Certain regions 1% DK: Southern Denmark >30%
Prevalence
25%
Positive findings in foxes/fox scatsFindings in foxes and raccoon dogs
Location of positive findings
20002012-14
2014
2011
2011
2011
2014
2014 (intermediate host)
2004 & 2012 (PCR pos. cats)
Costs of E. multilocularis surveillance
Costs (Euro)
DK SE NO FI
Annually 50,000 400,000 150,000 60,000
Per animal /sample
170 96(174/317)
Intensified surveillance
659,000
1.2% 0.1% 0 0 >30% 1%
Obligation of notification
DK SE NO FI
Em in animals
Yes Yes Yes Yes
AE in humans
No Yes (since 2004;
voluntary basis since 1994)
Yes (since 2003)
Yes (since 1995)
Spp.info Available upon
request
Not required Not required Not required
Risk assessment
DK: No risk assessment for human AE Export of Danish dogs to SE – negligible risk vs. import of dogs
from high endemic European areas (Bødker et al., 2007)
SE: Very low risk for humans 1 per 9 mio every 5th year (Wahlstrom et al., 2012)
Need for more knowledge concerning Em prevalence in urban fox populations
NO: Likely that Em is detected during the next decade (VKM, 2012)
Unlikely that Em is detected upon first introduction Moderate probability of import via rehomed stray dogs FI: Considerable risk of introduction via wildlife Difficult to assess due to lacking info of the situation in
northwestern Russia AH treatment of improted pets and increased surveillance
recommended (Maijala et al., 2001)
Surveillance in humans
DK* SE NO FI
Reported cases
1 (+ 1)
2 (2012) 19 (2006-2013) 16 (1975-2002)**
No AE22 E. granulosus (2000-2014)
No tested annually
86 (2009-13)
3 (<2011)37-79 (>2011)
? ?
Annual No ELISA positive
1-3 (<2012)6 (2012 & 2013)
8 (totally) ? ?
Autochthonous cases
No No 2 arctic fox researchers (Svalbard) seroconverted
No
* Number of cases unknown as AE is not notifiable** Not notifiable < 2003
First human AE cases in SE (n=2)(infected abroad)
2004
First human AE case in DK (infected abroad)
First finding of Em in foxes in SE
First finding of Em in foxes in DK
2000
No. of tested patients/analysis per million inhabitants in Denmark and Sweden,
2008(SE)/2009(DK) to 2013
DKSE
Actions due to findings of Em in DK Before 2013: No import requirements to prevent introduction 2000 (first detection in the Copenhagen area) & 2012 (first
detection in Højer): No actions February 2013 (high endemic area in Højer/southern DK):
● prophylactic treatment* (praziquantel) of dogs (free roaming/hunting) recommended each 4 weeks
● praziquantel treatment of dogs entering from Central Europe February 2014 (detection of Em in Central Jutland):
● Treatment recommendations extended to the whole countryIn addition:● Prevent dogs from eating rodents● Wash free roaming dogs regularly● Rinse raw fruits and vegetables before consumption
Tønder municipality
* Prophylactic treatment generally not allowed in DK
Actions due to findings of Em in SE
Before 1994: all imported dogs dewormed in quarantine After 2011 (first detection):
● General advice on food hygiene – but no specific recommendations
● Worried consumers recommended to boil their food● Worried dog owners recommended to treat prophylactically
each month – however not a general recommendation!● Deworming after travel to high endemic areas
Further considerations
Aim of surveillance?freedom of infectiongeographical spreadsudden changes in prevalence
Role of foodborne transmission?
Conclusions
Repeated monitoring needed to describe geographical distribution evaluated fluctuations in prevalence (identification of hot spots).
Reliable statistics on AE required – including spp. level! (DK: notifiability).
Call for better/repeated risk assessment to allow for effective risk management in different prevalence situations.
Increased awareness among clinicians needed.
Microsatellite (EmsB) subtyping
Introduction and spread???
D
S
V
G
H
Juremalm et al., in prep.
Acknowledgments
Mohammad Nafi Al-Sabi, DTU-VETMariann Chriel, DTU-VETHenrik Vedel Nielsen, SSITorben Grubbe, DVFADanish Veterinary & Food Admin.
Virva ValleAntti LavikainenEviraFinnish Forest Research Institute
Maria Cedersmyg, SBAAnders Wallensten, PHASRoland Lindqvist, NFASilvia Botero, Karolinska inst.Maria Dahlen, SVAGiampaolo Cocca, SVANational board of Agriculture
Knut Madslien, NVIØivind Øines, NVIInger Sofie Hamnes, NVINorwegian Food Safety Authority