preventive medicine II
Terms
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- What is the differnce bt surveillance and monitoring?
-
Surveillance is a system of collecting, processing
and summarizing data about disease where some directed
action will be taken if the data indicate a certain disease
threshold has been breached.
Monitoring is:
The intermittent performance and analysis of
routine measurements, aimed at detecting
changes in the environment or health status of
populations. Not to be confused with
surveillance which is a continuous process. - ⬢ Active v. Passive Surveillance
-
– active surveillance: systematic or regular
recording of cases of a designated disease
or group of diseases for the specific goal
of surveillance (e.g. bovine brucellosis
slaughter surveillance)
– passive surveillance: reporting of clinical
or subclinical suspect cases to health
authorities by health care professionals at
their discretion (e.g. practitioner reported
foreign animal disease surveillance) - ⬢ Scanning v. Targeted surveillance
-
– scanning surveillance: also called
screening surveillance is the consistent
and standardized collection of samples and
associated data for disease detection from
generalized populations of animals (e.g.
brucellosis surveillance conducted at
bovine slaughter plants)
– targeted surveillance: collection of
samples and associated data from
specifically identified at risk populations
(e.g. BSE surveillance in cattle over 30
months of age) - Hierarchical Surveillance
-
– application of differing
intensities of testing or sample
collection depending on the
perceived risk or threat
• geospatial risk
• temporal risk
• socio-political risk -
Key point
in the process of Probability Based Surveillance -
Risk Analysis/Pathways Analysis
Threat Analysis/Modeling -
US BSE surveillance program:
1. which animals are sampled?
2.What is the purpose of the surveillance progarm?
3.What is the prevalence of disease this system is designed to detect? -
1.include all high-risk adults
2.Goal of surveillance was detection
• The surveillance program was not
designed to estimate prevalence of BSE
– Sampling was not random. Rather, it targeted
the high-risk population
3.Desire to detect BSE (detectable) if occurs at
1/10 million in adult population - Tests Used in USA BSE sureillance program
-
• All tests detect PrPsc
• Tests:
– Screening test:
• ELISA
– Designed to identify suspicious (inconclusive) samples for
further confirmatory tests.
– False positives possible/probable from time to time.
• Screening casts a wide net to detect any possible case
– Confirmatory tests:
• Immunohistochemistry
• Western blot (proprietary and OIE SAF immunoblot) - describe the role of the pracitioner in FAD surveillance.
-
Practitioner makes
farm call with
tentative DX
suspicion of FAD
Practitioner contacts
animal health official
(3 options):
1. Local FADD
2. State Veterinarian
3. Veterinary Services,
Area Veterinarian in
Charge (AVIC)
AVIC assigns investigation
to FADD
FADD contacts
owner/practitioner for
history, tentative DX,
and to schedule visit -
Antimicrobial Drug Use in
Veterinary Medicine General recommendations -
Recommendation A
􀂄􀂄 Sale of antimicrobial drugs restricted:
such drugs can only be used by a
veterinarian or with a veterinarian’s
explicit order
Recommendation B
􀂄􀂄 Antimicrobial drugs should be used in
accordance with recommendations
from veterinarian
Recommendation C
􀂄􀂄 All veterinarians should understand
the problem of antimicrobial
resistance and understand the
principles of judicious use of
antimicrobials
Recommendation D
􀂄􀂄 Veterinarians should assist in
development of formal infection
control plans for all facilities where
animals are reared or managed,
including veterinary clinics
􀂄􀂄 Decreased risk of bacterial infection
􀂄􀂄 Increased awareness
􀂄􀂄 Decreased spread of resistant bacteria
Recommendation E
􀂄􀂄 Veterinarians should identify common case
scenarios in which antimicrobial drugs are
used and develop standardized
antimicrobial drug use recommendations
specific for the practice
􀂄􀂄 Examples: septicemia, infectious respiratory
disease, infectious GI disease, cystitis, otitis…
􀂄􀂄 Guidelines NOT substitution for clinical
discretion and judgment
Recommendation F
􀂄􀂄 Veterinarians should categorize all
antimicrobials used in the practice
into use categories
􀂄􀂄 This should be voluntary effort rather
than a formal requirement made by
licensing agency or pharmaceutical
company 􀂄􀂄 Primary: older drugs with narrow spectrum of
action
􀂄􀂄 simple penicillins, tetracyclines, sulfonamides
􀂄􀂄 Secondary: newer drugs with extended spectrum
of action, drugs to which resistance devellops
rapidly
􀂄􀂄 Culture and sensitivity exclude Primary drug use
􀂄􀂄 Tertiary: new drugs important in human medicine
􀂄􀂄 Culture and sensitivity exclude Primary and Secondary
drugs
􀂄􀂄 Used together with other precautions: local use over
systemic use, infection control practices…etc
􀂄􀂄 Carefully considered e.g. not used in animals unlikely to
survive
Recommendation G
􀂄􀂄 Diagnostic specimens should be
submitted for bacterial culture,
pathogen identification and AST
whenever possible to allow evidencebased
approach for drug selection
Recommendation H
􀂄􀂄 Selection of resistant bacteria through
use of antimicrobial drugs should
always be considered as an important
potential risk
􀂄􀂄 Possibility of transfer to humans
􀂄􀂄 Empirical therapy with primary drugs
􀂄􀂄 Switch to higher classes based on
culture and AST results
Recommendation I
􀂄􀂄 Treatment in the absence of clinical
disease should be conservative
􀂄􀂄 Primary use drugs
􀂄􀂄 Research based evidence of
effectiveness
􀂄􀂄 Consider other means of controlling
infectious disease
􀂄􀂄 Vaccination, separation, cleaning and
disinfection, nutrition, quarantine…etc
Recommendation J
􀂄􀂄 Veterinary diagnostic laboratories play
an active role in affecting
antimicrobial use practices
􀂄􀂄 Standardized reporting focused on
pathogenic bacteria
􀂄􀂄 “Normal flora†rather than
“Numerous E. coliâ€
􀂄􀂄 Appropriate panel of antibiotics for AST
Recommendation K
􀂄􀂄 Monitoring of antimicrobial drug use
and surveillance for trends in the
prevalence of resistant bacteria
should be promoted
􀂄􀂄 Federal funds
􀂄􀂄 Uniformity of methods between
diagnostic laboratories
􀂄􀂄 Active vs. passive surveillance
􀂄􀂄 Local surveillance
Recommendation L
􀂄􀂄 Increased educational effort
regarding resistance and antimicrobial
drug use among veterinarians,
student, technicians, owners,
breeders…etc
􀂄􀂄 Veterinary curriculum
􀂄􀂄 In-depth CE seminars
􀂄􀂄 Example: Veterinary Antimicrobial
Decision Support System
Recommendation M
􀂄􀂄 Pharmaceutical companies should
market drugs on a basis of scientific
information about efficacy and
adverse treatment outcomes and
promote conservative antimicrobial
treatment
Recommendation N
􀂄􀂄 Funding agencies should prioritize
research regarding antimicrobial use,
resistance, and alternative strategies
to control of infectious diseases -
Directed Actions for
Disease Management -
􀂄 Diagnosis
􀂄 Mass Treatment
􀂄 Quarantine
􀂄 Sacrifice of diseased or exposed animals
􀂄 Environmental hygiene
􀂄 Mass immunization
􀂄 Applied ecology
􀂄 Education
􀂄 Genetic resistance