Public Health Risks from Illegally Imported African Bushmeat and Smoked Fish

Large-scale importation of bushmeat from West and Central Africa into Europe was reported in 2010. We sampled 18 illegal African bushmeat consignments seized at Charles de Gaulle airport, Paris, France and tested for the presence of bacteria. Additionally, five smuggled smoked fish were analysed for polycyclic aromatic hydrocarbons, which are known carcinogens. All bushmeat samples had viable counts of aerobic bacteria above levels considered safe for human consumption. We also identified zoonotic bacterial pathogens in bushmeat and unsafe levels of carcinogens in fish. The illegal importation of meat is a potential risk for the introduction of pathogens.     

Implications of BSE infection screening data for the scale of the British BSE epidemic and current European infection levels

The incidence of confirmed clinical cases of bovine spongiform encephalopathy (BSE) in Great Britain continues to decline, but the recent discovery of cases in previously unaffected countries (including Israel, Japan, Poland, Slovenia and Spain) has heightened concerns that BSE transmission was more intense and widespread than previously thought. We use back-calculation methods to undertake an integrated analysis of data on infection prevalence in apparently healthy cattle and the incidence of confirmed clinical disease. The results indicate substantial underascertainment of clinical cases over the course of the British epidemic, and consequently that two- to fourfold more animals were infected than previously estimated. Upper bounds on the predicted size of the new variant Creutzfeldt-Jakob Disease (vCJD) epidemic are unaffected, as the prediction methods employed fit to observed vCJD mortality data, and are not sensitive to estimates of the absolute magnitude of past human exposure to BSE-infected cattle, only to relative changes in exposure through time. We also estimate the per-head incidence of infection in cattle born between 1993 and 1997 in other European Union countries, using data on the testing of apparently healthy cattle slaughtered for consumption. Infection incidence for cattle born after mid-1996 was highest in Greece, Italy and Belgium, with Spain and The Netherlands having intermediate levels, and estimates for Great Britain, Germany and France being comparably low.     

Assessment of the risk of a bluetongue outbreak in Europe caused by Culicoides midges introduced through intracontinental transport and trade networks

The importation of infected hosts and the arrival of windborne infected Culicoides (Diptera: Ceratopogonidae) were considered unlikely mechanisms for bluetongue virus (BTV) incursion into a BTV‐free area during the recent BTV serotype 8 (BTV‐8) epidemic in northern Europe. Therefore, alternative mechanisms need to be considered. Air, sea and land transport networks continue to expand, and an important consequence of this is vector‐borne pathogen importation. One important aspect of bluetongue (BT) epidemiology not yet addressed is the potential movement of infected Culicoides via transport and trade networks. Therefore, a risk assessment model was constructed to assess the probability of a BTV outbreak as a consequence of the introduction of Culicoides via these networks. The model was applied to calculate the risk for a BTV‐8 epidemic in Spain in 2007 caused by the introduction of Culicoides from affected northern European countries. The mean weighted annual risk for an outbreak caused by transportation of a single vector from an affected northern European country varied from 1.8 × 10^?7 to 3.0 × 10^?13, with the highest risks associated with Culicoides imported from Belgium, the Netherlands, Germany and France. For this mechanism to pose a significant risk to BTV‐free countries, a large number of vectors would have to be transported.     

Risk of African swine fever introduction into the European Union through transport-associated routes: returning trucks and waste from international ships and planes

ABSTRACT: BACKGROUND: The uncontrolled presence of African swine fever (ASF) in Russian Federation (RF) poses a serious risk to the whole European Union (EU) pig industry. Although trade of pigs and their products is banned since the official notification in June 2007, the potential introduction of ASF virus (ASFV) may occur by other routes, which are very frequent in ASF, and more difficult to control, such as contaminated waste or infected vehicles. This study was intended to estimate the risk of ASFV introduction into the EU through three types of transport routes: returning trucks, waste from international ships and waste from international planes, which will be referred here as transport-associated routes (TAR). Since no detailed and official information was available for these routes, a semi-quantitative model based on the weighted combination of risk factors was developed to estimate the risk of ASFV introduction by TAR. Relative weights for combination of different risk factors as well as validation of the model results were obtained by an expert opinion elicitation. RESULTS: Model results indicate that the relative risk for ASFV introduction through TAR in most of the EU countries (16) is low, although some countries, specifically Poland and Lithuania, concentrate high levels of risk, the returning trucks route being the analyzed TAR that currently poses the highest risk for ASFV introduction into the EU. The spatial distribution of the risk of ASFV introduction varies importantly between the analyzed introduction routes. Results also highlight the need to increase the awareness and precautions for ASF prevention, particularly ensuring truck disinfection, to minimize the potential risk of entrance into the EU. CONCLUSIONS: This study presents the first assessment of ASF introduction into the EU through TAR. The innovative model developed here could be used in data scarce situations for estimating the relative risk associated to each EU country. This simple methodology provides a rapid and easy to interpret results on risk that may be used for a target and cost-effective allocation of resources to prevent disease introduction.     

Qualitative risk assessment of the role of the feral wild boar (Sus scrofa) in the likelihood of incursion and the impacts on effective disease control of selected exotic diseases in England

A qualitative risk assessment was undertaken to analyse the likelihood of the incursion of selected exotic infectious disease into England’s small populations of feral boar and the potential impacts these animals could have on effective disease control. In order to identify the exposure pathways, it was necessary to consider not only the epidemiology of the pathogens but also to understand how the ecology and behaviour of wild boar would affect disease transmission. It was concluded that the greatest risks of exotic disease incursion into the UK were associated with disease entering through the consumption of infected pork meat or meat products by either wild boar or domestic swine and thus the diseases of highest risk are classic swine fever, foot and mouth disease and Trichinella sp. It should be noted that much of the peer review publications used as the scientific evidence base for this assessment describes disease outbreaks in boar populations in countries which have the disease endemically or have been previously exposed to the disease. In the UK, disease may act differently as the UK population of boar will be naïve to the exotic notifiable diseases.

     

Health Gain by Salt Reduction in Europe: A Modelling Study

Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake exceeds the World Health Organization population nutrition goal of 5 grams per day in the European region. We assessed the health impact of salt reduction in nine European countries (Finland, France, Ireland, Italy, Netherlands, Poland, Spain, Sweden and United Kingdom). Through literature research we obtained current salt intake and systolic blood pressure levels of the nine countries. The population health modeling tool DYNAMO-HIA including country-specific disease data was used to predict the changes in prevalence of ischemic heart disease and stroke for each country estimating the effect of salt reduction through its effect on blood pressure levels. A 30% salt reduction would reduce the prevalence of stroke by 6.4% in Finland to 13.5% in Poland. Ischemic heart disease would be decreased by 4.1% in Finland to 8.9% in Poland. When salt intake is reduced to the WHO population nutrient goal, it would reduce the prevalence of stroke from 10.1% in Finland to 23.1% in Poland. Ischemic heart disease would decrease by 6.6% in Finland to 15.5% in Poland. The number of postponed deaths would be 102,100 (0.9%) in France, and 191,300 (2.3%) in Poland. A reduction of salt intake to 5 grams per day is expected to substantially reduce the burden of cardiovascular disease and mortality in several European countries.     

Human migratory flows

The presence of immigrants in the European states in the last twenty years has considerably increased. This increase is evidently due to the numerous waves of immigrants coming from East European countries. With regard to the present situation, 70% of the population increase of the European Union countries, in the course of the year 2000, was due to immigration. The destinations of about two-thirds of this migratory flow are Germany, Great Britain and Italy. These migratory movements originate in the more or less prevalent influence of demographic, economic and political forces. Historically Italy represented more a source of emigration than a destination for immigration; immigration came to exceed emigration for the first time in recent history only in 1973. It is interesting to note that a large proportion of the foreigners have been in Italy for a certain length of time. The immigration phenomenon, is however characterized by a considerable increase in the illegal flows. The impact with the new realities becomes extremely traumatic for the immigrants and in the end there is a significant possibility of psychological destabilization.     

A Standardized Vascular Disease Health Check in Europe: A Cost-Effectiveness Analysis

Background

No clinical trials have assessed the effects or cost-effectiveness of health check strategies to detect and manage vascular disease. We used a mathematical model to estimate the cost-effectiveness of several health check strategies in six European countries.

Methods

We used country-specific data from Denmark, France, Germany, Italy, Poland, and the United Kingdom to generate simulated populations of individuals aged 40–75 eligible for health checks in those countries (e.g. individuals without a previous diagnosis of diabetes, myocardial infarction, stroke, or serious chronic kidney disease). For each country, we used the Archimedes model to compare seven health check strategies consisting of assessments for diabetes, hypertension, lipids, and smoking. For patients diagnosed with vascular disease, treatment was simulated in a standard manner. We calculated the effects of each strategy on the incidence of type 2 diabetes, major adverse cardiovascular events (MACE), and microvascular complications in addition to quality of life, costs, and cost per quality-adjusted life-year (QALY).

Results

Compared with current care, health checks reduced the incidence of MACE (6–17 events prevented per 1000 people screened) and diabetes related microvasular complications (5–11 events prevented per 1000 people screened), and increased QALYs (31–59 discounted QALYs) over 30 years, in all countries. The cost per QALY of offering a health check to all individuals in the study cohort ranged from €14903 (France) to cost saving (Poland). Pre-screening the population and offering health checks only to higher risk individuals lowered the cost per QALY. Pre-screening on the basis of obesity had a cost per QALY of €10200 (France) or less, and pre-screening with a non-invasive risk score was similar.

Conclusions

A vascular disease health check would likely be cost effective at 30 years in Denmark, France, Germany, Italy, Poland, and the United Kingdom.     

First External Quality Assessment of Molecular and Serological Detection of Rift Valley Fever in the Western Mediterranean Region

Rift Valley fever (RVF) is a mosquito-borne viral zoonosis which affects humans and a wide range of domestic and wild ruminants. The large spread of RVF in Africa and its potential to emerge beyond its geographic range requires the development of surveillance strategies to promptly detect the disease outbreaks in order to implement efficient control measures, which could prevent the widespread of the virus to humans. The Animal Health Mediterranean Network (REMESA) linking some Northern African countries as Algeria, Egypt, Libya, Mauritania, Morocco, Tunisia with Southern European ones as France, Italy, Portugal and Spain aims at improving the animal health in the Western Mediterranean Region since 2009. In this context, a first assessment of the diagnostic capacities of the laboratories involved in the RVF surveillance was performed. The first proficiency testing (external quality assessment—EQA) for the detection of the viral genome and antibodies of RVF virus (RVFV) was carried out from October 2013 to February 2014. Ten laboratories participated from 6 different countries (4 from North Africa and 2 from Europe). Six laboratories participated in the ring trial for both viral RNA and antibodies detection methods, while four laboratories participated exclusively in the antibodies detection ring trial. For the EQA targeting the viral RNA detection methods 5 out of 6 laboratories reported 100% of correct results. One laboratory misidentified 2 positive samples as negative and 3 positive samples as doubtful indicating a need for corrective actions. For the EQA targeting IgG and IgM antibodies methods 9 out of the 10 laboratories reported 100% of correct results, whilst one laboratory reported all correct results except one false-positive. These two ring trials provide evidence that most of the participating laboratories are capable to detect RVF antibodies and viral RNA thus recognizing RVF infection in affected ruminants with the diagnostic methods currently available.     

Following spread of fire blight in Western, Central and Southern Europe by molecular differentiation of Erwinia amylovora strains with PFGE analysis

Fire blight has been detected recently in several areas of northern Spain and north-eastern Italy. To follow spread of the disease within Europe, more than 120 Erwinia amylovora strains isolated from 1957-1900 in England, France, Germany, The Netherlands, Belgium, Poland, Italy and Spain were assayed using pulsed-field gel electrophoresis (PFGE) analysis of genomic DNA after XbaI digestion. Pattern types Pt1 and Pt4 were found for strains from England. Pt1 was also found in central Europe and eastern France, Pt4 in western France. Pt2 appeared first in Egypt, from where strains with this pattern disseminated northwards as far as into the Balkans. Pt3 was typical for northern France and Belgium. Strains from Spain displayed the pattern types Pt3 and Pt4. In Italy, Pt2 was found in the south-eastern areas, Pt3 in the north-eastern areas, and Pt1 was found very recently in orchards adjacent to the Austrian border, together with Pt3. Despite barely controlled trade with fire blight host plants and associated plant products within Europe, the PFGE patterns of the E. amylovora isolates were ordered indicating sequential spread. On the other hand, the appearance of Pt3 in northern Italy and central Spain can be explained by the import of contaminated plants by nurseries.     

Origin and genetic diversity of mosquitofish (<Emphasis Type="Italic">Gambusia holbrooki</Emphasis>) introduced to Europe

We provide mitochondrial sequence variation of the invasive fish Gambusia holbrooki from 24 European populations, from Portugal to Greece. Phylogeographic structure in Europe was compared with genetic data from native samples (USA) and historical records were reviewed to identify introduction routes. Overall, data agree with records of historical introductions and translocations, and indicate that the most abundant haplotype throughout Europe originated from North Carolina and corresponded to the first introduction in 1921 to Spain, being transferred to Italy in 1922 and to many countries afterwards. Our results also show that at least another independent introduction occurred first in France and subsequently from France to Greece. Haplotypes of G. affinis were not detected in our European sampling effort but historical records and other data suggest that this species was introduced to Italy in 1927 and it might be present. At the continental scale, there is less diversity in Europe than in North America, in agreement with the low number of introduced fish. At the local scale, some European populations gained diversity from multiple introductions and from “de novo” mutations.     

野猪在非洲猪瘟流行中的重要作用

非洲猪瘟因其高死亡率、没有疫苗防疫、影响国际贸易而备受广泛关注。1921年首次确认非洲猪瘟疫情以来,先后在非洲、欧洲、美洲等多个国家和地区发病造成重大经济损失。野猪作为该病传播的重要生物媒介在俄罗斯等多个国家非洲猪瘟疫情散播中发挥了重要作用。充分了解全球非洲猪瘟疫情状况和野猪在俄罗斯非洲猪瘟疫情中的影响,分析我国野猪分布、疫病监测和管理现状,将为我国非洲猪瘟外来疫情防控策略制定提供参考。     

Revisiting GMOs: Are There Differences in European Consumers’ Acceptance and Valuation for Cisgenically vs Transgenically Bred Rice?

Both cisgenesis and transgenesis are plant breeding techniques that can be used to introduce new genes into plant genomes. However, transgenesis uses gene(s) from a non-plant organism or from a donor plant that is sexually incompatible with the recipient plant while cisgenesis involves the introduction of gene(s) from a crossable—sexually compatible—plant. Traditional breeding techniques could possibly achieve the same results as those from cisgenesis, but would require a much larger timeframe. Cisgenesis allows plant breeders to enhance an existing cultivar more quickly and with little to no genetic drag. The current regulation in the European Union (EU) on genetically modified organisms (GMOs) treats cisgenic plants the same as transgenic plants and both are mandatorily labeled as GMOs. This study estimates European consumers’ willingness-to-pay (WTP) for rice labeled as GM, cisgenic, with environmental benefits (which cisgenesis could provide), or any combination of these three attributes. Data were collected from 3,002 participants through an online survey administered in Belgium, France, the Netherlands, Spain and the United Kingdom in 2013. Censored regression models were used to model consumers’ WTP in each country. Model estimates highlight significant differences in WTP across countries. In all five countries, consumers are willing-to-pay a premium to avoid purchasing rice labeled as GM. In all countries except Spain, consumers have a significantly higher WTP to avoid consuming rice labeled as GM compared to rice labeled as cisgenic, suggesting that inserting genes from the plant’s own gene pool is more acceptable to consumers. Additionally, French consumers are willing-to-pay a premium for rice labeled as having environmental benefits compared to conventional rice. These findings suggest that not all GMOs are the same in consumers’ eyes and thus, from a consumer preference perspective, the differences between transgenic and cisgenic products are recommended to be reflected in GMO labeling and trade policies.     

On the state of the public ill health: premature mortality in the United Kingdom and Europe.

Recently published data on mortality in the European Economic Community and Scandinavia convincingly showed that mortality among men and women aged 45-64 was considerably higher in the United Kingdom than elsewhere. This applied to deaths due to circulatory and respiratory disease, cancer, and all causes. For example, in 1980 in Scotland twice as many, or more, women aged 55-64 per 100 000 died of heart disease than in Belgium, Denmark, France, Greece, West Germany, the Netherlands, Norway, and Sweden. Reductions in mortality from all causes during 1950-80 in the United Kingdom did not match those in other countries, such as Finland and France. Whether the public in the United Kingdom knows about its relatively poor mortality state is doubtful. To secure improved funding of appropriate preventive and treatment services directed at reducing premature mortality, public awareness should be raised urgently so that politicians and political parties will respond quickly in a way that the problem demands.     

Occupational exposure to immunologically active agents and risk for lymphoma: The European Epilymph case–control study

ObjectivesAllergies and asthma may be protective for the development of lymphoma. We evaluated whether occupational allergens that provoke immune reactivity and asthma through an IgE-mediated pathway are protective for lymphoma.MethodsThe Epilymph study includes histologically or cytologically confirmed Hodgkin, B-cell, and T-cell lymphoma cases from six European countries (Spain, France, Germany, Italy, Ireland, and Czech Republic) recruited in 1998–2004. Controls were frequency matched to cases by age, gender, and study centre. Lifetime occupational exposure to seven high molecular weight (HMW) agents was evaluated through an asthma-specific job-exposure matrix. 2205 lymphoma cases and 2296 controls with complete occupational history could be included in the analysis. Associations between HMW exposures and lymphoma were evaluated using pooled unconditional logistic regression analyses.ResultsIndividuals exposed to HMW agents had a non-statistically significant decreased risk of any lymphoma (OR, 0.88: 95% CI, 0.74–1.05) and of B-cell lymphoma (OR, 0.91; 95% CI, 0.76–1.09), and a significantly decreased risk for Hodgkin lymphoma (OR, 0.62; 95% CI, 0.40–0.98). A decrease in risk for lymphoma was found for exposure to latex (OR, 0.74; 95% CI, 0.55–0.99).ConclusionsFurther epidemiologic and mechanistic research is needed to confirm that occupational exposure to HMW agents predisposing to asthma can reduce the risk of lymphoma.     

A global assessment of the vulnerability of shellfish aquaculture to climate change and ocean acidification

Human‐induced climate change and ocean acidification (CC‐OA) is changing the physical and biological processes occurring within the marine environment, with poorly understood implications for marine life. Within the aquaculture sector, molluskan culture is a relatively benign method of producing a high‐quality, healthy, and sustainable protein source for the expanding human population. We modeled the vulnerability of global bivalve mariculture to impacts of CC‐OA over the period 2020–2100, under RCP8.5. Vulnerability, assessed at the national level, was dependent on CC‐OA‐related exposure, taxon‐specific sensitivity and adaptive capacity in the sector. Exposure risk increased over time from 2020 to 2100, with ten nations predicted to experience very high exposure to CC‐OA in at least one decade during the period 2020–2100. Predicted high sensitivity in developing countries resulted, primarily, from the cultivation of species that have a narrow habitat tolerance, while in some European nations (France, Ireland, Italy, Portugal, and Spain) high sensitivity was attributable to the relatively high economic value of the shellfish production sector. Predicted adaptive capacity was low in developing countries primarily due to governance issues, while in some developed countries (Denmark, Germany, Iceland, Netherlands, Sweden, and the United Kingdom) it was linked to limited species diversity in the sector. Developing and least developed nations (n = 15) were predicted to have the highest overall vulnerability. Across all nations, 2060 was identified as a tipping point where predicted CC‐OA will be associated with the greatest challenge to shellfish production. However, rapid declines in mollusk production are predicted to occur in the next decade for some nations, notably North Korea. Shellfish culture offers human society a low‐impact source of sustainable protein. This research highlights, on a global scale, the likely extent and nature of the CC‐OA‐related threat to shellfish culture and this sector enabling early‐stage adaption and mitigation.     

Cetacean By-Catch in the Korean Peninsula—by Chance or by Design?

Whaling remains one of the most contentious issues in global conservation. In South Korea, where commercial and subsistence whaling are both illegal, domestic sales of cetacean products such as skin, blubber and red meat are allowed if they are accidently caught. However, environmental groups have claimed that the high price of meat may be acting as an incentive for illegal hunting and ‘deliberate by-catch’ where whales are intentionally killed or left to die by fishermen when they become trapped in their nets. In this paper we investigate the issue of deliberate by-catch and illegal hunting of the protected Minke J-stock population in Korean waters using grounded theory, an approach that allows theories and understanding to emerge from the analysis of both qualitative and quantitative data. Our research suggests that deliberate by-catch is almost certainly taking place but that illegal hunting and/or illegal importation from Japan may be far more significant sources of Minke whale meat. We discuss possible measures to reduce incentives for deliberate by-catch and illegal hunting such as the introduction of mandatory reporting of quantities supplied and consumed in restaurants and a tax on meat sales at auction. More generally, our research illustrates how the analysis of price movements can shed light on the scale of illegal wildlife trade and how a combination of both qualitative and quantitative methodologies can provide understanding of a complex, multifaceted conservation issue.     

Trends in incidence of breast cancer among women under 40 in seven European countries: A GRELL cooperative study

Young women are not usually screened for breast cancer (BC). The trends in incidence in this population may better reflect changes in risk factors. However, studies on this subject are scarce and heterogeneous. The aim of this study was to describe the trends in incidence of BC in women under 40 from 1990 to 2008, using pooled European data. Thirty-seven European population-based cancer registries from Belgium, Bulgaria, France, Italy, Portugal, Spain and Switzerland participated in this study. World age-standardized incidence rates were first analyzed graphically and then using a Poisson regression model, in order to estimate average annual percent changes (AAPCs). The overall incidence rate of BC in the area covered increased linearly during the study period by 1.19% (0.93; 1.46) on average per year. This increase varied between countries from 0.20% (?0.53; 0.64) in Bulgaria to 2.68% (1.97; 3.40) in Portugal. In Italy, after a significant rise of 2.33% (1.14; 3.54) per year, BC incidence began decreasing in 2002 by ?2.30% (?4.07; ?0.50) yearly. The rise in incidence was greater for women under 35 and for ductal carcinomas. This increase can be due to a rise in risk factors and/or changes in diagnosis and surveillance practices, but we could not clearly distinguish between these two non-exclusive explanations.     

A snapshot of the Chinese SOL Project

In 2003, the International Solanaceae Project (SOL) was initiated by an international consortium of ten countries including Korea, China, the United Kingdom, India, the Netherlands, France, Japan, Spain, Italy and the United States. The first major effort of the SOL aimed to produce a DNA sequence map for euchromatin regions of 12 chromosomes of tomato (Solanum lycopersicum) before 2010. Here we present an update on Chinese effort for sequencing the euchromatin region of chromosome 3.     

An assessment of the hospital exemption landscape across European Member States: regulatory frameworks,use and impact

The hospital exemption (HE) (Article 28(2) of Regulation (EC) No 1394/2007; the “ATMP Regulation”) rule allows the invaluable opportunity to provide patients with access to innovative, potentially life-saving treatments in situations of unmet clinical need. Unlicensed, developmental advanced therapy medicinal products (ATMPs) - cell-, gene- or tissue-based therapies - can be used to treat patients under certain conditions. Such products should be produced on a non-routine basis, custom-made for an individual patient under the responsibility of the requesting physician, for use in a hospital setting within the same Member State in which they are manufactured. The HE rule, and the specific requirements permitting its use, is further regulated at the Member State level, which has led to divergence in the implementation of HE across the European Union (EU). As a result, HE use varies significantly across Member States depending on their respective national legal implementation, policy makers’ interpretation of HE, clarity of guidance at the national level, reimbursement opportunities and level of ATMP research and development activities carried out by academic and commercial organizations. With important variations in how quality, safety and efficacy standards are implemented and controlled across EU Member States for ATMPs provided via the HE rule and a lack of transparency around its use, the HE rule draws concern around its potential impact on public health. In this article, the authors report results of a legal analysis of the implementation of HE across the UK, France, Germany, Italy, Spain, Poland and the Netherlands and research findings on its current utilization, highlighting divergences across countries as well as gaps in legislation and control in these countries. The significance of these divergences and the differing levels of enforcement are discussed as well as their associated impact on patients, industry and health care professionals.