Volume 18, Number 4—April 2012
Peer Reviewed Report Available Online Only
Multidisciplinary and Evidence-based Method for Prioritizing Diseases of Food-producing Animals and Zoonoses
Marie-France Humblet1, Sébastien Vandeputte1, Adelin Albert, Christiane Gosset, Nathalie Kirschvink, Eric Haubruge, Fabienne Fecher-Bourgeois, Paul-Pierre Pastoret, and Claude Saegerman
Table 2
Fifty-seven criteria used for ranking diseases of food-producing animals and zoonoses classified by category, Europe*
| Epidemiology |
Score |
||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ranking | Criteria | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | ||||||||||||||
| 1 | Illness rate, % | <1 | 1–10 | 11–30 | 31–50 | 51–70 | 71–90 | >90 | |||||||||||||||
| 2 | Case-fatality rate, % | <1 | 1–10 | 11–30 | 31–50 | 51–70 | 71–90 | >90 | |||||||||||||||
| 3 | Agent specificity | 1 host species | 2 host species | 3 host species | 4 host species | >4 host species | |||||||||||||||||
| 4 | Mode of transmission | No vector-borne transmission (not contagious) | Contamination by direct contact | Contamination by indirect contact | Vector-borne transmission | Airborne contamination | |||||||||||||||||
| 5 | Incubation period | Not applicable: clinical disease never reported in species considered in the study | <1 d | 1–7 d | 8–14 d | 15–30 d | 1–6 mo | >6–12 mo | >12 mo | ||||||||||||||
| 6 | Clinical course | Not applicable: clinical disease never reported in species considered in the study | <1 d | 1–7 d | 8–14 d | 15–30 d | 1–6 mo | >6–12 mo | >12 mo | ||||||||||||||
| 7 | Environmental persistence | None: no persistence in the environment, no vector(s) or wildlife reservoir(s) identified | Rare: anecdotal isolation in a potential vector(s) or the environment | No data available on presence/survival of pathogenic agent in reservoir(s), vector(s) or the environment | Wildlife reservoir(s)/vector(s): pathogen agent persistent in wildlife reservoir(s) and/or vector(s) | Environment: agent naturally surviving in the environment (soil, water) | |||||||||||||||||
| 8 | Epizootic potential | Never: only sporadic cases, epizootics never reported | Rare: most cases are sporadic; possibility of localized epizootic if conditions are ideal: e.g., abnormal multiplication of reservoir(s) and/or vector(s) | Localized: pathogen characterized by localized epizootic potential essentially related to the transmission mode: e.g., food-borne diseases | (Inter)national: epizootic characteristics well known after introduction, possibility of wide spatiotemporal expansion | ||||||||||||||||||
| 9 | Evolutive characteristics of pathogen | Null: stability of pathogen, stable pathogen–vector(s)/pathogen–reservoir(s) relationships (no impact on pathogenicity) | Rare: some mutations/reassortments observed but without any impact on pathogenicity, stable pathogen–vector(s)/pathogen–reservoir(s) relationships | Moderate/not determined: pathogen not characterized for evolutive characteristics yet (recently discovered, limited means of study), mutations with limited consequences on its virulence; stable pathogen–vector(s)/pathogen–-reservoir(s) relationships | Frequent: genetic variability during replication cycles more or less defined; variability of pathogenicity, species affected, reservoir(s), and vector(s) | High: pathogen has a high mutation rate/frequent genetic reassortments and creation of new pathogenic variants at each cycle: variable pathogenicity, host(s), reservoir(s), and vector(s) | |||||||||||||||||
| 10 | Cattle | Pathogen never reported as etiologic agent of clinical disease in that species | Accidental: few clinical cases reported, only if conditions are favorable (wound, traumatism, favorable environmental conditions) | Rare: clinical disease reported in few cases and no need for favorable conditions | Occasional: clinical disease occasionally reported and no need for favorable conditions | Frequent: clinical disease frequently reported in that species, but not specifically (multispecies pathogen) | Specific: clinical disease only reported in that species | Reservoir species | |||||||||||||||
| 11 | Small ruminants | Pathogen never reported as etiologic agent of clinical disease in that species | Accidental: few clinical cases reported, only if conditions are favorable (wound, traumatism, favorable environmental conditions) | Rare: clinical disease reported in few cases and no need for favorable conditions | Occasional: clinical disease occasionally reported and no need for favorable conditions | Frequent: clinical disease frequently reported in that species, but not specifically (multispecies pathogen) | Specific: clinical disease only reported in that species | Reservoir species | |||||||||||||||
| 12 | Swine | Pathogen never reported as etiologic agent of clinical disease in that species | Accidental: few clinical cases reported, only if conditions are favorable (wound, favorable environmental conditions) | Rare: clinical disease reported in few cases and no need for favorable conditions | Occasional: clinical disease occasionally reported and no need for favorable conditions | Frequent: clinical disease frequently reported in that species, but not specifically (multispecies pathogen) | Specific: clinical disease only reported in that species | Reservoir species | |||||||||||||||
| 13 | Equine | Pathogen never reported as etiologic agent of clinical disease in that species | Accidental: few clinical cases reported, only if conditions are favorable (wound, traumatism, favorable environmental conditions) | Rare: clinical disease reported in few cases and no need for favorable conditions | Occasional: clinical disease occasionally reported and no need for favorable conditions | Frequent: clinical disease frequently reported in that species, but not specifically (multispecies pathogen) | Specific: clinical disease only reported in that species | Reservoir species | |||||||||||||||
| 14 | Poultry | Pathogen never reported as etiologic agent of clinical disease in that species | Accidental: few clinical cases reported, only if conditions are favorable (wound, traumatism, favorable environmental conditions) | Rare: clinical disease reported in few cases and no need for favorable conditions | Occasional: clinical disease occasionally reported and no need for favorable conditions | Frequent: clinical disease frequently reported in that species, but not specifically (multispecies pathogen) | Specific: clinical disease only reported in that species | Reservoir species | |||||||||||||||
| 15 | Lagomorphs | Pathogen never reported as etiologic agent of clinical disease in that species | Accidental: few clinical cases reported, only if conditions are favorable (wound, traumatism, favorable environmental conditions) | Rare: clinical disease reported in few cases and no need for favorable conditions | Occasional: clinical disease occasionally reported and no need for favorable conditions | Frequent: clinical disease frequently reported in that species, but not specifically (multispecies pathogen) | Specific: clinical disease only reported in that species | Reservoir species | |||||||||||||||
| 16 | Wildlife | Pathogen never reported as etiologic agent of clinical disease in that species | Accidental: few clinical cases reported, only if conditions are favorable (wound, traumatism, favorable environmental conditions) | Rare: clinical disease reported in few cases and no need for favorable conditions | Occasional: clinical disease occasionally reported and no need for favorable conditions | Frequent: clinical disease frequently reported in that species, but not specifically (multispecies pathogen) | Specific: clinical disease only reported in that species | Reservoir species | |||||||||||||||
| 17 | Presence/absence of vector(s) and/or reservoir(s) in EU | Not vector-borne disease and/or no known reservoir | Absence of vector(s)/reservoir(s) in EU | Localized presence: reservoir(s) and/or vector(s) in a limited area of >1 member states | Mediterranean region/northern Europe/central Europe: vector(s) and/or reservoir(s) in 1 of these 3 regions, each one covering several member states, presence linked to bioclimatic preferences | Mediterranean region, northern Europe/northern Europe, central Europe: vector(s) and/or reservoir(s) in 1 of both regions according to bioclimatic preferences | Generalized repartition: repartition of vector(s) and/or reservoir(s) in the entire EU (few bioclimatic specificities) | ||||||||||||||||
| Prevention–control | Score | ||||||||||||||||||||||
| Ranking | Criteria | 0 | 1 | 2 | 3 | 4 | |||||||||||||||||
| 1 | Control of reservoir(s) and/or vector(s) | Not applicable: no vector-borne transmission and/or no reservoir(s) known to date | Effective: limited reservoir(s), easy to identify; effective control measures and trapping; reservoir(s)/vector(s) with limited demographic and geographic repartition; extensive scientific knowledge of vector(s)/reservoir(s); possibility of integrated control method | Limited: limited reservoir(s), easy to identify; effective control measures and trapping but not applicable at a large scale; reservoir(s)/vector(s) with a limited demographic and geographic repartition; extensive scientific knowledge of vector(s)/reservoir(s); no integrated control method | Possible but poorly/not effective: reservoirs easy to identify but numerous; control measures and trapping poorly effective (poorly active molecule(s); resistances and/or negative impact on environment); reservoir(s)/vector(s) with a limited demographic and geographic repartition; no scientific knowledge of vector(s)/reservoir(s); no integrated control method | Absent/impossible: vector(s)/reservoir(s) not identified; no effective control measure against vector(s) (no active molecule, ineffective trapping); strong demography and/or wide repartition of vector(s) and/or reservoir(s); no scientific knowledge of vector(s)/reservoir(s); no integrated control method | |||||||||||||||||
| 2 | Vaccination | Not applicable: clinical disease never reported in species considered in the study | Commercialized: commercial vaccine available on a global scale | Local/monospecies: vaccine available at a regional/national scale and/or for a targeted species (not systematically available for a global control plan) | Experimental: experimental vaccine, not commercialized; severe adverse reaction when applied; limited protector effect | Absence: no vaccine available for use in species considered in the study, no experimental vaccine | |||||||||||||||||
| 3 | Treatment | Not applicable: clinical disease never reported in species considered in the study | Available/effective: effective treatment available; recommended in cases of infection; economical and rational from a zootechnical point of view | Available but not recommended: masks clinical course of disease; contrary to the control plan; not justified economically or from a zootechnical point of view | Available but poorly/not effective: treatment with a limited effectiveness; severe adverse reactions; experimental or empirical treatment | Absence: no effective treatment available, no experimental treatment available | |||||||||||||||||
| 4 | Availability and quality of diagnostic tools | High: field test(s) available and easy to use, and highly discriminating sensitivity and specificity | Moderate: tests only used in local/regional laboratories | Low: tests only used in specialized laboratories/national reference laboratory | Absence: no diagnostic tools available | ||||||||||||||||||
| 5 | Knowledge of pathogen | Very high: extensive scientific knowledge of pathogen, extensive scientific literature available on its biology: transmission mode, knowledge of vector(s), infectivity | High: detailed scientific knowledge of pathogen but conflicting scientific results; some elements of pathogen biology are still not elucidated | Moderate: limited scientific knowledge of pathogen because it is still being characterized; pathogen recently discovered/isolated but belonging to a well known and studied family of pathogens; pathogen characterized by multiple variants not characterized | Low: no scientific knowledge of pathogen (multiplication, infectivity, incubation period, transmission mode); pathogen recently discovered or emerging | ||||||||||||||||||
| 6 | Effectiveness of control measures other than treatment, vaccination, and vector(s)/ reservoir(s) control | High: effectiveness of implemented control measures (quarantine, slaughter, and restriction area); effective epidemiologic investigation (origin of the infection rapidly identified and quick implementation of control measures) | Moderate: effectiveness of implemented control measures (quarantine, slaughter, and restriction area); epidemiologic investigation poorly conclusive (incomplete traceability of animals and by-products) | Low: limitation of control measures implemented (quarantine, slaughter, and restriction area), limiting dissemination of pathogen; epidemiologic investigation inconclusive | Null: ineffectiveness of implemented control measures (quarantine, slaughter, and restriction area) and/or control measures not indicated because of characteristics of pathogen; epidemiologic investigation inconclusive | ||||||||||||||||||
| 7 | Effectiveness of prevention other than vaccination and control of vector(s)/ reservoir(s) | High: sanitary certificate; effective traceability of animals and by-products; effective disinfection measures; no contact between domestic and wild animals; effective biosecurity measures | Moderate: no sanitary certificate; effective traceability of animals and by-products; effective disinfection measures; limited or incomplete possibilities to restrict contacts between domestic and wild animals; effective biosecurity measures | Low: no sanitary certificate; incomplete traceability of animals and by-products; ineffective disinfection measures; incomplete restriction of contacts between domestic and wild animals; ineffective biosecurity measures | Null: no sanitary certificate; no traceability of animals and by-products; ineffective disinfection measures; no restriction of contact between domestic and wild animals; ineffective biosecurity measures | ||||||||||||||||||
| 8 | Surveillance of pathogen | Generalized: surveillance implemented by all EU member states (even worldwide surveillance) | Member states at risk: surveillance of pathogen in >1 neighboring member states and in those where epizootics were recently reported | Outside EU: pathogen surveyed in non-EU regions | Absent: no surveillance of pathogen | ||||||||||||||||||
| Economy/trade | Score | ||||||||||||||||||||||
| Ranking | Criteria | 0 | 1 | 2 | 3 | ||||||||||||||||||
| Individual data (herd/farmer) | |||||||||||||||||||||||
| 1 | Losses of productivity (milk, eggs, growth) | Null: no impact on animal productivity | Low: losses of productivity <20% | Moderate: losses of productivity of 20%–50% | Severe: losses of productivity >50% | ||||||||||||||||||
| 2 | Additional costs: mandatory slaughtering | Not required | Outbreaks only | Outbreaks and restriction areas | |||||||||||||||||||
| Additional costs: treatment, disinfection | Low: treatment not required (e.g., slaughtering justified from an economic point of view) or absent (virus), application of basic sanitary measures (disinfection, footbath) | Moderate: spontaneous resolution of cases, only the animals with serious clinical signs require treatment, application of basic sanitary measures (disinfection, footbath) | High: systematic treatment of animals with clinical signs; application of stricter sanitary measures | ||||||||||||||||||||
| 3 | Additional costs: vaccination | Low: no vaccination advocated or no vaccination available | Moderate: vaccination not mandatory but possible in particular cases, e.g., avian sector | High: mandatory vaccination | |||||||||||||||||||
| Global (sector/market) | |||||||||||||||||||||||
| 4 | Limitation of importation–exportation | Absent: no impact on the importation/exportation of animal and/or by-products | Local: restrictions of animal and/or by-products movements limited to surveillance areas implemented when an outbreak is confirmed | Regional: animal and/or by-products movements limited in an area greater than the surveillance zone but only in 1 member state | International: perturbation/limitation of importations/exportations of animal and by-products between several member states and/or between member states and countries outside the EU | ||||||||||||||||||
| 5 | Disturbance of supply and demand (decrease in prices) | Absent: no impact on supply and demand | Low: temporary disturbance of supply and demand in a limited area and low impact on prices | Moderate: temporary disturbance of supply and demand and decrease in prices <30% in >1 member states | High: major disturbance of supply and demand and decrease in prices >30% affecting several member states | ||||||||||||||||||
| 6 | Impact on related sectors (tourism, animal feeds) | Absent: no impact on related sectors | Low: turnover reduction <20% in >1 related sectors | Moderate: turnover reduction 20%–50% in >1 related sectors | High: turnover reduction >50% in >1 related sectors | ||||||||||||||||||
| 7 | Impact on cattle industry | Absent: no impact on cattle industry | Low: increased spends and/or decreased benefits <20% compared with situation before beginning of epizootics | Moderate: increased spends and/or decreased benefits between 20% and 50% compared with situation before beginning of epizootics | High: increased spends and/or decreased benefits >50% compared with situation before beginning of epizootics | ||||||||||||||||||
| 7 | Impact on small ruminants industry | Absent: no impact on small ruminants industry | Low: increased spends and/or decreased benefits <20% compared with situation before beginning of epizootics | Moderate: increased spends and/or decreased benefits between 20% and 50% compared with situation before beginning of epizootics | High: increased spends and/or decreased benefits >50% compared with situation before beginning of epizootics | ||||||||||||||||||
| 7 | Impact on swine industry | Absent: no impact on swine industry | Low: increased spends and/or decreased benefits <20% compared with situation before beginning of epizootics | Moderate: increased spends and/or decreased benefits between 20% and 50% compared with situation before beginning of epizootics | High: increased spends and/or decreased benefits >50% compared with situation before beginning of epizootics | ||||||||||||||||||
| 7 | Impact on equine industry | Absent: no impact on equine industry | Low: increased spends and/or decreased benefits <20% compared with situation before beginning of epizootics | Moderate: increased spends and/or decreased benefits between 20% and 50% compared with situation before beginning of epizootics | High: increased spends and/or decreased benefits >50% compared with situation before beginning of epizootics | ||||||||||||||||||
| 7 | Impact on poultry industry | Absent: no impact on poultry industry | Low: increased spends and/or decreased benefits <20% compared with situation before beginning of epizootics | Moderate: increased spends and/or decreased benefits between 20% and 50% compared with situation before beginning of epizootics | High: increased spends and/or decreased benefits >50% compared with situation before beginning of epizootics | ||||||||||||||||||
| Impact on lagomorph industry | Absent: no impact on poultry industry | Low: increased spends and/or decreased benefits <20% compared with situation before beginning of epizootics | Moderate: increased spends and/or decreased benefits between 20% and 50% compared with situation before beginning of epizootics | High: increased spends and/or decreased benefits >50% compared with situation before beginning of epizootics | |||||||||||||||||||
| 7 | Impact on wildlife industry | Absent: no impact on wildlife industry | Low: increased spends and/or decreased benefits <20% compared with situation before beginning of epizootics | Moderate: increased spends and/or decreased benefits between 20% and 50% compared with situation before beginning of epizootics | High: increased spends and/or decreased benefits >50% compared with situation before beginning of epizootics | ||||||||||||||||||
| Cost of disease in humans | |||||||||||||||||||||||
| 8 | Zoonotic impact (cost of illness) | Absent: nonzoonotic or common† disease | Low: medical consultation facultative, hospitalization not required, treatment for most severe clinical cases with conventional drugs, maximum incapacity 7 d | Moderate: medical consultation necessary, hospitalization of most severe clinical cases, systematic and adapted treatment with conventional drugs, incapacity 8–4 d | High: medical consultation necessary, systematic hospitalization but of variable duration, required and adapted treatment with second line drugs, incapacity >14 d, quarantine may be required | ||||||||||||||||||
| 9 | Zoonotic impact (costs of prevention per person) | Absent: nonzoonotic or common disease | Low: vaccination not advocated, simple and low-cost preventive measures (handwashing, mask carrying, insect repellents) | Moderate: vaccination of populations at risk (YOPI), simple and low-cost preventive measures (handwashing, mask carrying, insect repellents) | High: generalized vaccination recommended, restricting and expensive preventive measures (thermograph, quarantine, home containment) | ||||||||||||||||||
| Public health | Score | ||||||||||||||||||||||
| Ranking | Criteria | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | ||||||||||||||
| 1 | Zoonotic/ common agent† | Not zoonotic or common | Accidental: human clinical disease only when favorable conditions are set (YOPI, high infection pressure, practices at risk, unusual transmission route) | Rare: human clinical disease reported in a minority of cases, without necessity of favorable conditions | Frequent: clinical disease often reported in man (multi-species pathogen) without need for favorable conditions | Systematic: clinical disease systematically reported in humans | |||||||||||||||||
| 2 | Classification of zoonoses | Not zoonotic or common | 1: transmission from wild animals to humans | 1+: transmission from wild animals to humans with further human-to-human transmission(s) | 2: transmission from wild animals to domestic animals to humans | 2+: transmission from wild animals to domestic animals to humans, and further human-to-human transmission(s) | |||||||||||||||||
| 3 | Disease knowledge in humans | Not zoonotic or common | Very high: deep scientific knowledge of pathogen, extensive scientific literature available on its biology: transmission mode, knowledge on vector(s), infectivity | High: detailed scientific knowledge of pathogen but conflicting scientific results; some elements of pathogen biology are still not elucidated | Moderate: limited scientific knowledge of pathogen because it is still being characterized; pathogen recently discovered/isolated but belonging to a well-known and studied family of pathogens; pathogen has multiple variants not characterized | Low: no scientific knowledge of pathogen (multiplication, infectivity, incubation period, transmission mode); pathogen agent recently discovered or emerging | |||||||||||||||||
| 4 | Illness rate, % | Not zoonotic or common | <1 | 1–10 | 11–30 | 31–50 | 51–70 | 71–90 | >90 | ||||||||||||||
| 5 | Case-fatality rate, % | Not zoonotic or common | <1 | 1–10 | 11–30 | 31–50 | 51–70 | 71–90 | >90 | ||||||||||||||
| 6 | Mode of contamination | Not zoonotic or common | No vector-borne transmission (not contagious) | Contamination by direct contact | Contamination by indirect contact | Vector-borne transmission | Airborne contamination | ||||||||||||||||
| 7 | Aftereffects or negative impact on the patients' quality of life | Not zoonotic or common | Null: no after effects | Moderate: % disability <30% but no loss of autonomy | Severe: after effects not enabling a professional activity but no loss of autonomy | Very severe: unable to perform professional activities, loss of autonomy, and personal assistance necessary | |||||||||||||||||
| 8 | Control plan (vaccination, determination of populations at risk, surveillance of the disease, definition of areas at risk) | Not zoonotic or common | Worldwide (EU and other countries): international and coordinated control plan (member states and third-world countries) | Generalized (EU): coordinated control plan implemented in all member states | Targeted: coordinated control plan implemented in >1 member state(s) at risk | Extracommunautary: absence of a control plan in EU but implemented in third-world countries | Absent: no control plan elaborated and implemented | ||||||||||||||||
| 9 | Epidemic potential | Not zoonotic or common | Never: only sporadic cases, epidemics never reported | Rare: most cases are sporadic but when favorable conditions are set, possibility of localized epidemics, e.g., abnormal multiplication of reservoir(s) and/or vector(s) | Localized: pathogen characterized by localized epidemic; potential pathogenicity essentially related to transmission mode (e.g., food-borne diseases) | (Inter)national: epidemic characteristics well known after introduction, possible a wide spatiotemporal expansion | |||||||||||||||||
| 10 | Vaccination | Not zoonotic or common | Commercialized: commercial vaccine available on a global scale | Local/monospecies: vaccine available at a regional/national scale (not systematically available for a global control plan) | Experimental: experimental vaccine, not commercially available; severe adverse reaction when applied; limited protector effect | Absence: no commercially available or experimental vaccine | |||||||||||||||||
| 11 | Treatment | Not zoonotic or common | Existing/effective: effective treatment commercially available | Available but not recommended: major side effects | Available but poorly effective: treatment with limited effectiveness, partial resistance of pathogen or experimental treatment | Absent: no commercially available or experimental treatment | |||||||||||||||||
| 12 | Availability and quality of diagnostic tools | Not zoonotic or common | High: field test(s) available and easy to use with highly discriminating sensitivity and specificity | Moderate: tests only used in local/regional laboratory | Low: tests only used in specialized laboratories/national reference laboratory | Absence: no diagnostic tools available | |||||||||||||||||
| Society | Score | ||||||||||||||||||||||
| Ranking | Criteria | 0 | 1 | 2 | 3 | 4 | |||||||||||||||||
| 1 | Lower human consumption of animals | No: no impact on consumption | Low: impact on consumption and a decrease <20% compared with previous consumption | Moderate: impact on consumption and a decrease of 20%–50% compared with previous consumption | High: impact on consumption and a decrease >50% compared with previous consumption | ||||||||||||||||||
| 2 | Perception of problem by the consumer (problem poorly known or unknown, problem poorly controllable or uncontrollable, affects a sensitive public) | Not zoonotic or common | Null: clear perception by the consumer; problem well known, controllable, and no impact on the family; short-term effect; does not affect a sensitive public (children, pregnant women) | Low: clear perception by the consumer; problem well known, controllable, and no impact on the family; long-term effect; does not affect a sensitive public (children, pregnant women) | Moderate: clear perception by the consumer; problem poorly known, controllable, with an impact on the family; long-term effect; affects a sensitive public (children, pregnant women) | High: bad perception by the consumer; problem poorly known, difficult to control, with an impact on the family; long-term effect; affects a sensitive public (children, pregnant women) | |||||||||||||||||
| 3 | Potential impact of media | Null: no impact of media on consuming habits | Low: short-term and minor impact on consuming habits | Moderate: long-term but minor impact on consuming habits | High: major and long-lasting impact on consuming habits (rejection of a particular by-product) | ||||||||||||||||||
| 4 | Impact on animal welfare and biodiversity | Null: no impact on animal welfare and biodiversity: no slaughtering, no specific control measures applied to wildlife, no quarantine or containment of animals | Low: no slaughtering but limited control measures and limited containment of species at risk (domestic and wild animals) | Moderate: selective slaughtering of animals showing clinical signs in outbreaks, control and containment of species at risk (domestic and wild animals) | High: systematic slaughtering of domestic and wild animals (outbreaks and surveillance zones), mandatory quarantine, containment of domestic animals at risk | ||||||||||||||||||
*EU, European Union; YOPI, young, old, pregnant, immunosuppressed.
†Common, pathogen able to cause a clinical disease in humans and animals but without a zoonotic characteristic (common source of contamination).
1These authors contributed equally to this article.
Page created: February 17, 2012
Page updated: February 17, 2012
Page reviewed: February 17, 2012
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