A Quantitative Approach to the Prioritization of Zoonotic Diseases in North America: A Health Professionals’ Perspective

Background

Currently, zoonoses account for 58% to 61% of all communicable diseases causing illness in humans globally and up to 75% of emerging human pathogens. Although the impact of zoonoses on animal health and public health in North America is significant, there has been no published research involving health professionals on the prioritization of zoonoses in this region.

Methodology/Principal Findings

We used conjoint analysis (CA), a well-established quantitative method in market research, to identify the relative importance of 21 key characteristics of zoonotic diseases for their prioritization in Canada and the US. Relative importance weights from the CA were used to develop a point-scoring system to derive a recommended list of zoonoses for prioritization in Canada and the US. Study participants with a background in epidemiology, public health, medical sciences, veterinary sciences and infectious disease research were recruited to complete the online survey (707 from Canada and 764 from the US). Hierarchical Bayes models were fitted to the survey data to derive CA-weighted scores for disease criteria. Scores were applied to 62 zoonotic diseases to rank diseases in order of priority.

Conclusions/Significance

We present the first zoonoses prioritization exercise involving health professionals in North America. Our previous study indicated individuals with no prior knowledge in infectious diseases were capable of producing meaningful results with acceptable model fits (79.4%). This study suggests health professionals with some knowledge in infectious diseases were capable of producing meaningful results with better-fitted models than the general public (83.7% and 84.2%). Despite more similarities in demographics and model fit between the combined public and combined professional groups, there was more uniformity across priority lists between the Canadian public and Canadian professionals and between the US public and US professionals. Our study suggests that CA can be used as a potential tool for the prioritization of zoonoses.     

A Quantitative and Novel Approach to the Prioritization of Zoonotic Diseases in North America: A Public Perspective

Background

Zoonoses account for over half of all communicable diseases causing illness in humans. As there are limited resources available for the control and prevention of zoonotic diseases, a framework for their prioritization is necessary to ensure resources are directed into those of highest importance. Although zoonotic outbreaks are a significant burden of disease in North America, the systematic prioritization of zoonoses in this region has not been previously evaluated.

Methodology/Principal Findings

This study describes the novel use of a well-established quantitative method, conjoint analysis (CA), to identify the relative importance of 21 key characteristics of zoonotic diseases that can be used for their prioritization in Canada and the US. Relative importance weights from the CA were used to develop a point-scoring system to derive a recommended list of zoonoses for prioritization in Canada and the US. Over 1,500 participants from the general public were recruited to complete the online survey (761 from Canada and 778 from the US). Hierarchical Bayes models were fitted to the survey data to derive CA-weighted scores. Scores were applied to 62 zoonotic diseases of public health importance in Canada and the US to rank diseases in order of priority.

Conclusions/Significance

This was the first study to describe a systematic and quantitative approach to the prioritization of zoonoses in North America involving public participants. We found individuals with no prior knowledge or experience in prioritizing zoonoses were capable of producing meaningful results using CA as a novel quantitative approach to prioritization. More similarities than differences were observed between countries suggesting general agreement in disease prioritization between Canadians and Americans. We demonstrate CA as a potential tool for the prioritization of zoonoses; other prioritization exercises may also consider this approach.     

The relationship between lay and technical views of Escherichia coli O157 risk

Here, we bring together and contrast lay (accessible primarily through social science methodologies) and technical (via risk assessment and epidemiological techniques) views of the risk associated with the Escherichia coli O157 pathogen using two case study areas in the Grampian region of Scotland, and North Wales. Epidemiological risk factors of contact with farm animals, visiting farms or farm fields and having a private water supply were associated with postcode districts of higher than average disease incidence in the human population. However, this was not the case for the epidemiological risk factor of consumption of beef burgers, which was independent of disease incidence in the postcode district of residence. The proportion of the population expressing a high knowledge of E. coli O157 was greatest in high-incidence disease districts compared with low-incidence areas (17% cf. 7%). This supports the hypothesis that in high-disease-incidence areas, residents are regularly exposed to information about the disease through local cases, the media, local social networks, etc. or perhaps that individuals are more likely to be motivated to find out about it. However, no statistically significant difference was found between high- and low-incidence postcode districts in terms of the proportion of the population expressing a high likelihood of personal risk of infection (10% cf. 14%), giving a counterintuitive difference between the technical (epidemiological and quantitative microbiological risk assessment (QMRA)) and the lay assessment of E. coli O157 risk. This suggests that lay evaluations of E. coli O157 risk reflect intuitive and experience-based estimates of the risk rather than probabilistic estimates. A generally strong correspondence was found in terms of the rank order given to potential infection pathways, with environment and foodborne infection routes dominating when comparing public understanding with technical modelling results. Two general conclusions follow from the work. First, that integrative research incorporating both lay and technical views of risk is required in order that informed decisions can be made to handle or treat the risk by the groups concerned (e.g. the public, policy makers/risk managers, etc.). Second, when communicating risk, for example, through education programmes, it is important that this process is two-way with risk managers (e.g. including Food Standards Agency officials and communications team, public health infection control and environmental health officers) both sharing information with the public and stakeholder groups, as well as incorporating public knowledge, values and context (e.g. geographical location) into risk-management decisions.     

Understanding risk perceptions to enhance communication about human-wildlife interactions and the impacts of zoonotic disease

Inclusion of wildlife in the concept of One Health is important for two primary reasons: (1) the physical health of humans, domesticated animals, and wildlife is linked inextricably through shared diseases, and (2) humans' emotional well-being can be affected by their perceptions of animal health. Although an explicit premise of the One Health Initiative is that healthy wildlife contribute to human health, and vice versa, the initiative also suggests implicitly that wildlife may pose threats to human health through zoonotic disease transmission. As people learn more about One Health, an important question surfaces: How will they react to communications carrying the message that human health and wildlife health are linked? In the absence of adequate relevant research data, we recommend caution in the production and dissemination of One Health messages because of possible unintended or collateral effects. Understanding how and why individuals perceive risks related to wildlife diseases is essential for determining message content that promotes public support for healthy wildlife populations, on the one hand, and, on the other, for identifying messages that might inadvertently increase concern about human health effects of diseased wildlife. To that end, we review risk perception research and summarize the few empirical studies that exist on perceived risk associated with zoonoses. We conclude with some research questions that need answering to help One Health practitioners better understand how the public will interpret their messages and thus how to communicate positively and without negative collateral consequences for wildlife conservation.     

The Public and Professionals Reason Similarly about the Management of Non-Native Invasive Species: A Quantitative Investigation of the Relationship between Beliefs and Attitudes

Despite continued critique of the idea of clear boundaries between scientific and lay knowledge, the ‘deficit-model’ of public understanding of ecological issues still seems prevalent in discourses of biodiversity management. Prominent invasion biologists, for example, still argue that citizens need to be educated so that they accept scientists’ views on the management of non-native invasive species. We conducted a questionnaire-based survey with members of the public and professionals in invasive species management (n = 732) in Canada and the UK to investigate commonalities and differences in their perceptions of species and, more importantly, how these perceptions were connected to attitudes towards species management. Both native and non-native mammal and tree species were included. Professionals tended to have more extreme views than the public, especially in relation to nativeness and abundance of a species. In both groups, species that were perceived to be more abundant, non-native, unattractive or harmful to nature and the economy were more likely to be regarded as in need of management. While perceptions of species and attitudes towards management thus often differed between public and professionals, these perceptions were linked to attitudes in very similar ways across the two groups. This suggests that ways of reasoning about invasive species employed by professionals and the public might be more compatible with each other than commonly thought. We recommend that managers and local people engage in open discussion about each other’s beliefs and attitudes prior to an invasive species control programme. This could ultimately reduce conflict over invasive species control.     

Research options for controlling zoonotic disease in India, 2010-2015

Background

Zoonotic infections pose a significant public health challenge for low- and middle-income countries and have traditionally been a neglected area of research. The Roadmap to Combat Zoonoses in India (RCZI) initiative conducted an exercise to systematically identify and prioritize research options needed to control zoonoses in India.

Methods and Findings

Priority setting methods developed by the Child Health and Nutrition Research Initiative were adapted for the diversity of sectors, disciplines, diseases and populations relevant for zoonoses in India. A multidisciplinary group of experts identified priority zoonotic diseases and knowledge gaps and proposed research options to address key knowledge gaps within the next five years. Each option was scored using predefined criteria by another group of experts. The scores were weighted using relative ranks among the criteria based upon the feedback of a larger reference group. We categorized each research option by type of research, disease targeted, factorials, and level of collaboration required. We analysed the research options by tabulating them along these categories. Seventeen experts generated four universal research themes and 103 specific research options, the majority of which required a high to medium level of collaboration across sectors. Research options designated as pertaining to ‘social, political and economic’ factorials predominated and scored higher than options focussing on ecological, genetic and biological, or environmental factors. Research options related to ‘health policy and systems’ scored highest while those related to ‘research for development of new interventions’ scored the lowest.

Conclusions

We methodically identified research themes and specific research options incorporating perspectives of a diverse group of stakeholders. These outputs reflect the diverse nature of challenges posed by zoonoses and should be acceptable across diseases, disciplines, and sectors. The identified research options capture the need for ‘actionable research’ for advancing the prevention and control of zoonoses in India.     

Communicating about ocean health: theoretical and practical considerations

As anthropogenic stressors threaten the health of marine ecosystems, there is a need to better understand how the public processes and responds to information about ocean health. Recent studies of public perceptions about ocean issues report high concern but limited knowledge, prompting calls for information campaigns to mobilize public support for ocean restoration policy. Drawing on the literature from communication, psychology and related social science disciplines, we consider a set of social-cognitive challenges that researchers and advocates are likely to encounter when communicating with the public about ocean health and emerging marine diseases—namely, the psychological distance at which ocean issues are construed, the unfamiliarity of aquatic systems to many members of the public and the potential for marine health issues to be interpreted through politicized schemas that encourage motivated reasoning over the dispassionate consideration of scientific evidence. We offer theory-based strategies to help public outreach efforts address these challenges and present data from a recent experiment exploring the role of message framing (emphasizing the public health or environmental consequences of marine disease) in shaping public support for environmental policy.     

Fish-borne parasitic zoonoses: status and issues

The fish-borne parasitic zoonoses have been limited for the most part to populations living in low- and middle-income countries, but the geographical limits and populations at risk are expanding because of growing international markets, improved transportation systems, and demographic changes such as population movements. While many in developed countries will recognize meat-borne zoonoses such as trichinellosis and cysticercosis, far fewer are acquainted with the fish-borne parasitic zoonoses which are mostly helminthic diseases caused by trematodes, cestodes and nematodes. Yet these zoonoses are responsible for large numbers of human infections around the world. The list of potential fish-borne parasitic zoonoses is quite large. However, in this review, emphasis has been placed on liver fluke diseases such as clonorchiasis, opisthorchiasis and metorchiasis, as well as on intestinal trematodiasis (the heterophyids and echinostomes), anisakiasis (due to Anisakis simplex larvae), and diphyllobothriasis. The life cycles, distributions, epidemiology, clinical aspects, and, importantly, the research needed for improved risk assessments, clinical management and prevention and control of these important parasitic diseases are reviewed.     

The Economic Impact of Pig-Associated Parasitic Zoonosis in Northern Lao PDR

The parasitic zoonoses human cysticercosis (Taenia solium), taeniasis (other Taenia species) and trichinellosis (Trichinella species) are endemic in the Lao People’s Democratic Republic (Lao PDR). This study was designed to quantify the economic burden pig-associated zoonotic disease pose in Lao PDR. In particular, the analysis included estimation of the losses in the pork industry as well as losses due to human illness and lost productivity. A Markov-probability based decision-tree model was chosen to form the basis of the calculations to estimate the economic and public health impacts of taeniasis, trichinellosis and cysticercosis. Two different decision trees were run simultaneously on the model’s human cohort. A third decision tree simulated the potential impacts on pig production. The human capital method was used to estimate productivity loss. The results found varied significantly depending on the rate of hospitalisation due to neurocysticerosis. This study is the first systematic estimate of the economic impact of pig-associated zoonotic diseases in Lao PDR that demonstrates the significance of the diseases in that country.     

Predicting the lay preventive strategies in response to avian influenza from perceptions of the threat

Background

The identification of patterns of behaviors that lay people would engage in to protect themselves from the risk of infection in the case of avian influenza outbreak, as well as the lay perceptions of the threat that underlie these risk reduction strategies.

Methodology/Principal Findings

A population-based survey (N = 1003) was conducted in 2008 to understand and describe how the French public might respond to a possible outbreak. Factor analyses highlighted three main categories of risk reduction strategies consisting of food quality assurance, food avoidance, and animal avoidance. In combination with the fear of contracting avian influenza, mental representations associated with the manifestation and/or transmission of the disease were found to significantly and systematically shape the behavioral responses to the perceived threat.

Conclusions/Significance

This survey provides insight into the nature and predictors of the protective patterns that might be expected from the general public during a novel domestic outbreak of avian influenza.     

Comparative Host Feeding Patterns of the Asian Tiger Mosquito,Aedes albopictus,in Urban and Suburban Northeastern USA and Implications for Disease Transmission

Background

Aedes albopictus is an invasive species which continues expanding its geographic range and involvement in mosquito-borne diseases such as chikungunya and dengue. Host selection patterns by invasive mosquitoes are critically important because they increase endemic disease transmission and drive outbreaks of exotic pathogens. Traditionally, Ae. albopictus has been characterized as an opportunistic feeder, primarily feeding on mammalian hosts but occasionally acquiring blood from avian sources as well. However, limited information is available on their feeding patterns in temperate regions of their expanded range. Because of the increasing expansion and abundance of Ae. albopictus and the escalating diagnoses of exotic pathogens in travelers returning from endemic areas, we investigated the host feeding patterns of this species in newly invaded areas to further shed light on its role in disease ecology and assess the public health threat of an exotic arbovirus outbreak.

Methodology/Principal Findings

We identified the vertebrate source of 165 blood meals in Ae. albopictus collected between 2008 and 2011 from urban and suburban areas in northeastern USA. We used a network of Biogents Sentinel traps, which enhance Ae. albopictus capture counts, to conduct our collections of blooded mosquitoes. We also analyzed blooded Culex mosquitoes collected alongside Ae. albopictus in order to examine the composition of the community of blood sources. We found no evidence of bias since as expected Culex blood meals were predominantly from birds (n = 149, 93.7%) with only a small proportion feeding on mammals (n = 10, 6.3%). In contrast, Aedes albopictus fed exclusively on mammalian hosts with over 90% of their blood meals derived from humans (n = 96, 58.2%) and domesticated pets (n = 38, 23.0% cats; and n = 24, 14.6% dogs). Aedes albopictus fed from humans significantly more often in suburban than in urban areas (χ², p = 0.004) and cat-derived blood meals were greater in urban habitats (χ², p = 0.022). Avian-derived blood meals were not detected in any of the Ae. albopictus tested.

Conclusions/Significance

The high mammalian affinity of Ae. albopictus suggests that this species will be an efficient vector of mammal- and human-driven zoonoses such as La Crosse, dengue, and chikungunya viruses. The lack of blood meals obtained from birds by Ae. albopictus suggest that this species may have limited exposure to endemic avian zoonoses such as St. Louis encephalitis and West Nile virus, which already circulate in the USA. However, growing populations of Ae. albopictus in major metropolitan urban and suburban centers, make a large autochthonous outbreak of an arbovirus such as chikungunya or dengue viruses a clear and present danger. Given the difficulties of Ae. albopictus suppression, we recommend that public health practitioners and policy makers install proactive measures for the imminent mitigation of an exotic pathogen outbreak.     

Food-borne parasitic zoonoses in China: perspective for control

Food-borne parasitic zoonoses (FBPZs) cause death and serious diseases in humans and animals worldwide, and are of both public health significance and socioeconomic importance. The FBPZ problem is severe in mainland China, where approximately 150 million people are suffering from FBPZs and more people are at risk. Here, the current status of the FBPZ problem in mainland China is reviewed and strategies and measures for effective control of FBPZs are proposed. Major parasitic zoonoses transmitted through consumption of infected or contaminated meat, fish, plants and/or water will be discussed.     

Improved Perceptions and Practices Related to Schistosomiasis and Intestinal Worm Infections Following PHAST Intervention on Kome Island,North-Western Tanzania

Schistosomiasis and intestinal worm infections are widespread diseases of public health importance in Tanzania. A study on perceptions and practices related to schistosomiasis and intestinal worm infections was undertaken among a community population of Kome Island in Sengerema District, north-western Tanzania, where intestinal schistosomiasis and intestinal worm infections are endemic. Schistosomiasis and intestinal worm-related perceptions and practices were assessed before and 3 years after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention as a control measure. Data were obtained from baseline and post-intervention knowledge, attitudes, and practices (KAP) questionnaire surveys conducted twice in 2009 and 2012 among 82 individuals aged ≥15 years. We found significant increases in respondents’ knowledge of the cause, transmission, symptoms, health consequences, and prevention of schistosomiasis and intestinal worm infections after PHAST intervention. The increase in respondents’ knowledge on almost all aspects of the said infections was translated into actions to control schistosomiasis and intestinal worm infections. This has not been achieved by chance, but due to well-designed and locally-adapted PHAST intervention. We conclude that despite criticisms, PHAST approach is still useful in empowering communities to control water, sanitation, and hygiene related infectious diseases such as schistosomiasis and intestinal worm infections.     

Association between environmental and climatic risk factors and the spatial distribution of cystic and alveolar echinococcosis in Kyrgyzstan

BackgroundCystic and alveolar echinococcosis (CE and AE) are neglected tropical diseases caused by Echinococcus granulosus sensu lato and E. multilocularis, and are emerging zoonoses in Kyrgyzstan. In this country, the spatial distribution of CE and AE surgical incidence in 2014-2016 showed marked heterogeneity across communities, suggesting the presence of ecological determinants underlying CE and AE distributions.Methodology/Principal findingsFor this reason, in this study we assessed potential associations between community-level confirmed primary CE (no.=2359) or AE (no.=546) cases in 2014-2016 in Kyrgyzstan and environmental and climatic variables derived from satellite-remote sensing datasets using conditional autoregressive models. We also mapped CE and AE relative risk. The number of AE cases was negatively associated with 10-year lag mean annual temperature. Although this time lag should not be considered as an exact measurement but with associated uncertainty, it is consistent with the estimated 10–15-year latency following AE infection. No associations were detected for CE. We also identified several communities at risk for CE or AE where no disease cases were reported in the study period.Conclusions/SignificanceOur findings support the hypothesis that CE is linked to an anthropogenic cycle and is less affected by environmental risk factors compared to AE, which is believed to result from spillover from a wild life cycle. As CE was not affected by factors we investigated, hence control should not have a geographical focus. In contrast, AE risk areas identified in this study without reported AE cases should be targeted for active disease surveillance in humans. This active surveillance would confirm or exclude AE transmission which might not be reported with the present passive surveillance system. These areas should also be targeted for ecological investigations in the animal hosts.     

Birds and zoonoses

Birds may harbour many organisms, some of which can be transmitted to humans (zoonoses) and domestic livestock. Certain zoonoses are of considerable importance and their control may necessitate changes in management of bird populations. If problems relating to zoonoses are to be effectively tackled there is a need for closer collaboration between ornithologists and those concerned with public health, more research on avian diseases and the collation of relevant data.     

Environmental Factors Related to Enterobiasis in a Southeast Region of Korea

Pinworm infection can occur through contact with contaminated surfaces followed by ingestion or even through inhalation of infective eggs. We have limited information regarding environmental contamination by eggs of Enterobius vermicularis. In order to determine environmental risk factors associated with the rate of E. vermicularis infection, we investigated possible environmental risk factors using a questionnaire from 46 kindergartens in 3 different cities of the southeast area of Korea. In total, using the cellotape anal swab technique, 3,422 children were examined for E. vermicularis infection. We evaluated E. vermicularis egg of books, educational materials, toys, room door handles, dusts of window edges, desks, chairs, tables, and dusts of classrooms. The overall egg-positive rate for E. vermicularis was 6.0%, and the prevalence of enterobiasis in each kindergarten ranged between 0% and 16.9%. We found that 78.9% of egg positive kindergartens were managed by private foundations, which was significantly higher, compared with kindergartens managed by public foundations or the nation. Compared with public or national kindergartens, most private kindergartens were located in residential areas and the number of children in these areas was significantly higher. In conclusion, numbers of children in kindergartens was found to be an environmental risk factor associated with transmission of enterobiasis in Korea.     

Genetic trade‐offs between complex diseases and longevity

Longevity was influenced by many complex diseases and traits. However, the relationships between human longevity and genetic risks of complex diseases were not broadly studied. Here, we constructed polygenic risk scores (PRSs) for 225 complex diseases/traits and evaluated their relationships with human longevity in a cohort with 2178 centenarians and 2299 middle‐aged individuals. Lower genetic risks of stroke and hypotension were observed in centenarians, while higher genetic risks of schizophrenia (SCZ) and type 2 diabetes (T2D) were detected in long‐lived individuals. We further stratified PRSs into cell‐type groups and significance‐level groups. The results showed that the immune component of SCZ genetic risk was positively linked to longevity, and the renal component of T2D genetic risk was the most deleterious. Additionally, SNPs with very small p‐values (p ≤ 1x10^‐5) for SCZ and T2D were negatively correlated with longevity. While for the less significant SNPs (1x10^‐5 < p ≤ 0.05), their effects on disease and longevity were positively correlated. Overall, we identified genetically informed positive and negative factors for human longevity, gained more insights on the accumulation of disease risk alleles during evolution, and provided evidence for the theory of genetic trade‐offs between complex diseases and longevity.     

From Chemistry to Behavior. Molecular Structure and Bioactivity of Repellents against Ixodes ricinus Ticks

Tick-borne zoonoses are considered as emerging diseases. Tick repellents represent an effective tool for reducing the risk of tick bite and pathogens transmission. Previous work demonstrated the repellent activity of the phenylpropanoid eugenol against Ixodes ricinus; here we investigate the relationship between molecular structure and repellency in a group of substances related to that compound. We report the biological activity of 18 compounds varying for the presence/number of several moieties, including hydroxyl and methoxy groups and carbon side-chain. Each compound was tested at different doses with a bioassay designed to measure repellency against individual tick nymphs. Both vapor pressure and chemical features of the tested compounds appeared to be related to repellency. In particular, the hydroxyl and methoxy groups as well as the side-chain on the benzene ring seem to play a role. These results are discussed in light of available data on chemical perception in ticks. In the course of the study new repellent compounds were identified; the biological activity of some of them (at least as effective as the “gold standard” repellent DEET) appears to be very promising from a practical point of view.     

Control and prevention of emerging parasitic zoonoses

Emerging zoonoses have been defined as zoonoses that are newly recognised or newly evolved, or that have occurred previously but show an increase in incidence or expansion in geographical, host or vector range. Among parasitic zoonoses, protozoa are particularly likely to emerge. Control and prevention of emerging parasitic zoonoses are complex tasks that require an integrative and multidisciplinary approach. Reduction of parasite burden is certainly a major objective but cannot be set alone. Therefore, environmental and ecological modifications need to be implemented to reduce not only the parasitic load, but also the risk of parasite transmission. Finally, education and behavioral changes are critical for the success of both control and prevention of these diseases. However, without appropriate financial resources specifically allocated at the local and national levels as well as through international cooperation, control and prevention of these emerging parasitic diseases will not be possible.     

Focus: Zoonotic Disease: Biology,Epidemiology, Clinical Features,Diagnosis, and Treatment of Selected Fish-borne Parasitic Zoonoses

Fish-borne parasites have been part of the global landscape of food-borne zoonotic diseases for many decades and are often endemic in certain regions of the world. The past 20 years or so have seen the expansion of the range of fish-borne parasitic zoonoses to new geographic regions leading to a substantial public health burden. In this article, we summarize current knowledge about the biology, epidemiology, clinical characteristics, diagnosis, treatment and control of selected fish-borne helminthic diseases caused by parasitic roundworm (Anisakis), tapeworm (Dibothriocephalus), and fluke (Metagonimus). Humans acquire infection via consumption of raw or improperly cooked fish or fish products. The burden from these diseases is caused by morbidity rather than mortality. Infected patients may present with mild to severe gastrointestinal (eg, abdominal pain, diarrhea, and indigestion) or allergic manifestations. Patients are often admitted to the hospital or clinic with acute symptoms and no prior health problems and no travel history. Diagnosis is often established based on the detection of the diagnostic parasite stages (eg, eggs or tapeworm segments) in the patient’s feces. Sometimes imaging is required to exclude other causes and avoid unnecessary surgery. Dibothriocephalus and Metagonimus are mainly treated with praziquantel. Extraction of adult Dibothriocephalus or Anisakis larvae from the bowel ensures complete elimination of the parasites and prevents a relapse of infection. The development and implementation of more efficient food safety and public health strategies to reduce the burden of zoonotic diseases attributable to fish-borne parasites is highly desirable.