Companion Animals multisectoriaL interprofessionaL and Interdisciplinary Strategic Think tank On zoonoses

Final Report Summary - CALLISTO (Companion Animals multisectoriaL interprofessionaL and Interdisciplinary Strategic Think tank On zoonoses)

Executive Summary:
CALLISTO has investigated the role of companion animals in the transmission of pathogens to people and to food producing animals.
The work of the CALLISTO consortium was structured into seven Expert Advisory Groups (EAGs) and five work packages over three cycles of one year each (2012 – 2014).
The objectives of the CALLISTO Project, and the cycles during which they were addressed, were:
• To develop a detailed overview of the role of companion animals as a source of infectious diseases for man and food animals, including available information on disease incidence and geographical distribution in these host categories (cycle 1).
• To identify knowledge and technology gaps in the management of the most important zoonoses transmitted by companion animals (cycle 2).
• To propose targeted actions that contribute to reducing the risk for infectious disease outbreaks in man and food animals associated with keeping companion animals (cycle 3).
• To disseminate the results of CALLISTO to relevant stakeholders to contribute to the uptake of the CALLISTO-proposed actions and to promote risk-awareness in healthy and balanced human/animal relationships (cycles 1 – 3).
CALLISTO found that throughout Europe there are very large numbers of companion animals which live in close interaction with their owners. These animals, of varied species, play an integral role in human society, providing very real human health and welfare benefits. However, at the same time there is the risk that these contacts with companion animals may lead to the transmission of infectious diseases. Companion animals also play a role in the transmission of pathogens to livestock. Moreover companion animals can be a vector in the spread of bacteria that are resistant to treatment with antibiotics.
CALLISTO has established an inter-professional multi-disciplinary and inter-sectorial network of experts that has looked into these risks. The network came up with a number of recommendations for the prevention and mitigation of the risks.
The recommendations are divided into 5 different groups: Demographics and tracing/movement of companion animals; Education and communication; Surveillance and infection control; Risk assessment; New tools for diagnosis, prevention, and therapy.
Much emphasis was given to the importance of responsible pet ownership (RPO). Further policy and research actions that could be implemented by the EU and/or national governments to further reduce the risks include the development of systems for identifying and registering individuals from the most common companion animal species and establishing surveillance programmes that capture data on zoonoses that occur in these animals. Closer attention should be paid to the health status of animals entering or re-entering the EU from third countries and the welfare surrounding companion animal cross-border movement. Data collection and pathogen assessment in the less studied exotic companion animals being kept is also needed to better understand risks. Disease and disease vector spread within Europe should be monitored and solutions found to limit such spread. The emergence of antimicrobial resistance in companion animals should be monitored.

Project Context and Objectives:
An increasing number and range of companion animals are being kept in close interaction with human beings. Keeping companion animals has become widespread in industrialized societies with participation by many individuals and households. The vast majority of these keep classical pets such as dogs, cats, rabbits, small rodents, birds and fish. However, an increasing number of animals kept as companion animals are exotic and wild animals, posing a poorly understood risk for both human and farm animal health.
Zoonotic infectious diseases are diseases that can be passed between animals and humans. These diseases are very common. Scientists estimate that more than 6 out of every 10 infectious diseases in humans are spread from animals.
Zoonotic diseases can be caused by viruses, bacteria, fungi or parasites.
Zoonotic viruses
An important and probably best known example of a zoonotic viral disease from companion animals is rabies, which should be considered in the differential diagnosis of any patient presented with encephalitis in endemic areas. In recent years, a number of other zoonotic viruses from companion animals have emerged. Highly pathogenic avian influenza virus H5N1, which causes severe respiratory disease in humans, has been diagnosed in dogs and cats.
Zoonotic bacteria and fungi
Traditionally, the most common bacterial zoonoses include bite wound infections (Pasteurella multocida and Capnocytophaga canimorsus), cat scratch disease (Bartonella henselae) and campylobacteriosis (Campylobacter jejuni, C. coli and C. upsaliensis) in household pets; salmonellosis (S. enterica) in cold-blooded animals as well as in various mammalian and avian species; and psittacosis (Chlamydophila psittaci) in birds. In addition to traditional zoonoses, opportunistic pathogens such as Escherichia coli and staphylococci are exchanged between pets and humans sharing the same household.
Zoonotic parasites
Parasitic zoonoses associated with companion animals are among the most widely spread infections of humans in a European context. These include toxoplasmosis, leishmaniosis, and helminth infections of canines or felines (e.g. echinococcosis, toxocarosis, ancylostomiosis and dirofilariosis). Companion animals may also carry strains of Giardia. In addition to that, arthropod parasites of companion animals, such as ticks, fleas, mosquitoes, flies and sand flies may transmit a variety of infectious agents to humans. Increased mobility of companion animals especially from and to the Mediterranean basin area, has resulted in transmission of zoonotic parasitic pathogens, such as Leishmania infantum

There are serious concerns about the role of companion animals in the transmission of zoonotic infections from animals to people. Companion animals can transmit a wide range of zoonotic infectious diseases to humans through physical injuries, direct contact, and environmental contamination, ingestion of contaminated food or water, or arthropod vectors.
The available information on the risks associated with companion animal zoonoses is insufficient or scattered. These knowledge gaps results in a lack of adequate prevention and intervention options. The role of companion animals in the emergence of infectious diseases in man and food animals remains a relatively underrepresented area of attention, both in research and in surveillance. Consequently, although we have some knowledge about the general principles, crucial details such as on the pathogenesis and epidemiology of many zoonotic infections are missing. This hampers the further development of rapid and reliable methods for diagnosis and more effective and/or approved antimicrobial agents and vaccines and other antimicrobial strategies. Moreover, the available knowledge and understanding of the zoonotic risks associated with companion animals is scattered across various sectors in different areas, each having a different and relatively limited perspective on the whole subject. Also, there is insufficient exchange of information with initiatives elsewhere in the world that deal with emerging zoonoses from companion animals. Consequently we lack a complete overview of the situation in terms of for example:
− The incidence of zoonotic pathogens in companion animals and main (geographic) risk areas;
− The main risk species of companion animals;
− The main risk factors for companion animal infection with or carriage of known zoonotic agents;
− The potential of companion animals as vectors for community spread of new emerging infectious agents;
− The risks of zoonotic infections for veterinary staff, pet care takers and owners;
− Assessment of the possible role of these people as vectors for secondary transmission in the community.
This lack of knowledge has hampered the further development of appropriate evidence-based, targeted public health and animal health policies and actions to prevent, reduce and in due course eliminate the health risks for man and food animals associated with the infectious agents carried by companion animals.
This has led to the current situation where we lack for example adequate monitoring of pet animals for infections transmissible to humans and food animals and lack effective guidelines for prevention and control of zoonoses in veterinary hospitals and the community. The relative lack of disease surveillance of companion animals contrasts with that in both humans and food animals.
It should be noted that, in addition to the risks of companion animals transmitting infectious diseases to humans, certain pets (e.g. cats and hunting dogs) are free to roam outdoors and therefore more prone to acquire new pathogens from wildlife compared with food animals, which are generally reared within closed systems in modern intensive farming. Furthermore, those people directly involved such as pet owners, care-takers and veterinarians lack the necessary awareness of the risks of acquiring infections with these zoonotic pathogens and their subsequent role as potential vectors for further spread of these infectious diseases. Moreover, even if aware of any health risks associated with keeping companion animals, pet-owners are not always willing to take the necessary precautions if these would lead to sacrificing the beneficial relationship they have with their pets. For instance some studies show that many people allergic to their own companion animals refuse to give up their pets and decide to live with the symptoms. Any proposed actions to reduce the risk of zoonotic infections transmitted by companion animals should therefore find a proper balance with allowing beneficial contact with companion animals in order to be effective.
The aims set for CALLISTO are to:
1. develop a detailed overview of the role of companion animals as a source of infectious diseases for man and food animals, including available information on disease incidence and geographical distribution in these host categories;
2. identify knowledge and technology gaps in the management of the most important zoonoses transmitted by companion animals.
3. propose targeted actions that contribute to reducing the risk for infectious disease outbreaks in man and food animals associated with keeping companion animals.
4. disseminate the results of CALLISTO to relevant stakeholders to contribute to the uptake of the CALLISTO-proposed actions and to promote risk-awareness in healthy and balanced human/animal relationships.
The CALLISTO consortium is composed of the following 9 partners;
• Federation of Veterinarians of Europe (FVE)
• University of Copenhagen (UCPH)
• International Association of Human-Animal Interaction Organisations (IAHAIO)
• Erasmus Medical Center (EMC)
• World Small Animal Veterinary Associations (WSAVA)
• Federation of European Companion Animal Veterinary Associations (FECAVA)
• Instituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “G.Caporale” (ICT)
• The Hebrew University of Jerusalem (HUJI)
• University of Bristol (UoB)
Partners, together with scientists and stakeholders from many other organisations and institutes worked together in 3 annual project cycles.

• 2012 – 1st cycle – Objective: to develop an overview of the role of companion animals as a source of infectious diseases for man and food animals;

• 2013 – 2nd cycle – Objective: to identify knowledge and technology gaps in the management of the most important zoonoses transmitted by companion animals;

• 2014 – 3rd cycle – Objective: to propose targeted actions that contribute to reducing the risk for infectious disease outbreaks and to disseminate the results of CALLISTO to relevant stakeholders with the aim to promote risk-awareness in healthy and balanced human/animal relationships.

The experts involved in CALLISTO were grouped in 7 Expert Advisory Groups (EAG):
− EAG I: User Community;
− EAG II: Policy Actions;
− EAG III: Zoonotic Viral Infections;
− EAG IV: Zoonotic Bacterial Infections;
− EAG V: Zoonotic Parasitic Infections;
− EAG VI: Epidemiology and underlying factors;
− EAG VII: Sociology and Welfare.
However to stimulate interaction between the different disciplines the EAGs came together in the the cross EAG meetings. These meetings were a gateway between the meetings of the EAGs and the large CALLISTO conferences. Whereas the EAG meetings provided the in-depth knowledge at the basis of CALLISTO, the Cross-EAG meetings have provide for the synthesis across these expert level inputs in preparation of the large CALLISTO conferences at the end of each cycle.
The CALLISTO Synthesis Conferences have been the center stage of the project, where experts from all EAGs came together to engage in discussions with each other and with other representatives from outside the network. Results from the Conferences have been widely disseminated in electronic format and by organizing an open seminar as well as through brochures and presentations held by CALLISTO partners.

Project Results:
CALLISTO is a coordination and support action and as such the main results of this project are the recommendations for targeted actions that contribute to reducing the risk for infectious disease outbreaks in man and food animals associated with keeping companion animals.
CALLISTO final recommendations, arising from the three years of activities (current situation analysis, risk assessment and targeted actions) are grouped into five areas:
• Demographics and tracing/movement of companion animals;
• Education and communication;
• Surveillance and infection control;
• Risk assessment;
• New tools for diagnosis, prevention, and therapy.
CALLISTO recommendations inspire further activities in the field of human-companion animal health and wellbeing.
Veterinary and human healthcare professionals, the pet industry, associations and governments play a crucial role in communicating to pet owners benefits and risks of keeping a companion animal. Owners of companion animals have to be aware of basic hygiene norms and healthy behaviors and follow the principles of responsible pet ownership, to mitigate the risks of diseases potentially transmittable by companion animals. Priority recommendations and target end users are also hereby detailed.

Demographics and tracing/movement of companion animals
• More robust data be gathered on the numbers and distribution of owned and free roaming (including stray) companion animals in the EU.
Such data are essential in order to be able to quantify the actual risks of zoonotic diseases attributable to companion animals and to develop sustainable interventions to prevent transmission to humans and livestock.
• The development of systems for microchip identification of companion animals and registration of these animals in a cross-border accessible database.
Identification and registration in a cross-border accessible database are of relevant value for zoonotic disease prevention and control, epidemiological studies and surveys.
• To consider the control of companion animal movement between areas of the EU endemic for particular zoonoses and areas that are not currently endemic for that disease.
Considering the zoonotic potential of infections such as echinococcosis, leishmaniosis and dirofilariosis, specific legislative rules should regulate animal movements within the EU.
• A specific scientific study of the reasons underlying the re-emergence of rabies in foxes in Eastern Europe.
Understanding the origin of rabid foxes would help to take directed measures (e.g. vaccination barriers) in appropriate geographical areas for this re-emerging disease.
• The introduction of more robust monitoring of companion animals imported into the EU and implementation of schemes to assess mortality during transportation of such animals.
Knowledge of trends of imported companion animals can provide an early warning signal of which species should be paid more attention for the presence of pathogens important for human and food animal health; knowledge of trends and monitoring of unexplained death during transport of imported companion animals can provide an early warning signal for the presence of pathogens important for human and food animal health.

Education and communication
• Any message delivered about companion animal zoonoses achieves a balance between maintaining, or possibly increasing, the benefits of keeping companion animals and mitigating or eradicating potential infectious disease risks.
The final goal is to achieve a balanced communication on benefits of keeping companion animals and mitigating or eradicating potential risks.
• The promotion of, and education in, the concept of Responsible Pet Ownership (*).

Responsible pet ownership aims to maintain a good level of animal health and welfare, to maximise physical and psychological benefits to people and to minimise the potential risks that companion animals may pose to the public, other animals, or the environment

• To create opportunities for the education of physicians, veterinarians, owners and other relevant professional categories in companion animal zoonoses. Specifically, from a “One Health” perspective, increasing the knowledge of human physicians in this area is crucial.
Several zoonotic diseases are likely under-diagnosed by physicians due to lack of knowledge of these diseases and their clinical presentations, often characterized by mild and non-specific symptoms. Potential risks of infections are of special concern for people who are very young, old, pregnant or immune-compromised, who are particularly susceptible to infections.
Owners should be aware of the importance of proper socialisation of pets in reducing unwanted behavior (e.g. dog bites) and why it is important to teach children to interact safely with animals (proper hygiene when they are in contact with companion animal).

Surveillance and infection control
• The implementation of a European network,linked to EFSA and ECDC, for monitoring the prevalence of known zoonotic agents in the relevant companion animal species and for early detection of new zoonotic infectious diseases using companion animals as sentinels.
Being able to follow dissemination of new pathogens across borders is critical to establish rapid and effective measures to prevent and control disease spread.
• Companion animals (particularly dogs, cats, and horses) are to be included in national surveillance programmes on antibiotic resistanceimplementation of methods for improved reporting of companion animal zoonotic infectious diseases.

• Targeted scientific research to address the significance of specific pathogens for which there is currently little information about whether companion animals are sources of these infections, and how transmission of these pathogens might occur between man and companion animals

• The introduction of systems for monitoring companion animals travelling outside of the EU for the potential introduction of exotic pathogens as these animals return to the EU.
Companion animals may acquire several zoonotic pathogens (including resistant bacteria) when travelling to exotic destinations.
• Implementation of methods for improved reporting of companion animal zoonotic infectious diseases.
Many zoonoses are reportable or notifiable in humans or in humans and farmed animals, but not in companion animals. It is therefore impossible to identify possible common geographical distributions or common patterns of temporal trends.

Risk assessment
• The initiation of multicentre case–control studies to evaluate the role of companion animals as a source of infection for people by determining the population attributable fraction of disease due to companion animals.
Quantitative knowledge is essential to estimate the risks associated with animal contact and ultimately to justify and weigh recommendations to omit such risks.
• The performance of studies to identify risk factors for companion animal infection or colonisation with pathogens known to have a relevant role in human disease.
A better understanding of risk factors for disease and pathogen shedding in companion animals is important to ensure proper and targeted infection control practices. Such knowledge may be acquired through case-control studies, i.e. investigations of the types of exposure observed in pet-owning patients and in matched, unaffected pet owners.
• Specific targeted investigations to assess the potential human pathogenicity of a group of pathogens associated with companion animals for which there are currently few data on zoonotic risk.
Pathogenity and burden to human diseases have to be assessed for less studied companion animal pathogens (e.g. less studied species within the genera Bartonella, Campylobacter, Chlamydophila, Giardia and Cryptosporidium).
• The performance of studies to characterise the transmission dynamics of infections moving between companion animal, human and production animal populations in a farm setting.
Food and companion animals share several pathogens of zoonotic relevance; a better understanding of transmission dynamics may enforce new guidelines to optimize infection barriers/biosecurity within and between farms.

New tools for diagnosis, prevention, and therapy
• Introduction of some form of regulation of the use of critically important antibiotics (CIAs) used in human medicine for companion animals, and the development of new alternative veterinary antimicrobials and alternative treatment strategies to manage multidrug-resistant infections in companion animals.
The increasing usage in companion animals of critically important antimicrobials (CIAs) in human hospitals poses serious concerns regarding the possible risk that veterinary usage may create a reservoir of resistance to CIAs in companion animals and contribute to loss of efficacy of CIAs for treatment of life-threatening human infections.
• The development of rapid field diagnostic test kits for the veterinary practice.
Rapid diagnostic tools with high sensitivity and specificity are important, since they facilitate implementation of proper infection control practices and early treatment.
• The development of new vaccines that protect against diseases transmitted by companion animals.
Vaccination is an attractive option to prevent infections that are difficult or expensive to control and treat in other ways. Toxoplasma gondii, Leishmania infantum, rabies are pathogens for which either new vaccines or optimised versions of existing vaccines would be attractive.
• Introduction of schemes for the regulation and certification of diagnostic laboratories and definition of minimum requirements to ensure quality control of diagnostics and susceptibility testing within veterinary hospitals.
The quality of diagnostics and consequently treatment of animals should be optimised to ensure best animal health practice and to facilitate infection control locally; common standards are necessary to enable comparison of prevalence of pathogens and antibiotic resistance from different laboratories and countries

Potential Impact:
One of the main impacts the project has had is the creation of the interdisciplinary, multi-sectorial and inter-professional network itself. Thanks to intensive collaboration between the different experts a unique think tank has been formed. CALLISTO will form the basis for further cooperation between these people from all these different backgrounds.
CALLISTO is also expected to lead to further private and public sector initiatives with a goal to reduce the risks associated with the close integration of companion animals into human society and to increase the benefits of healthy human-animal relationships.
Further potential impact from CALLISTO is to be found in the implementation of the CALLISTO recommendations. This would provide a much better insight in the real situation, for example in numbers and species of animals kept. The recommended microchip identification of animals would also contribute to a more detailed overview. It would also support the tracking and tracing of infectious diseases.
Recommendations in the field of education and communication are considered key elements for the prevention of infectious diseases spread by companion animals. The promotion of Responsible Pet Ownership (RPO) is considered a major element for sustainable changes in pet owner behavior and risk management. A better understanding and increased awareness of risks associated with keeping companion animals are crucial to motivate pet owners to choose animals they are able keep under the right conditions, and to seek timely expert advice when needed.
The recommended development of new tools for the diagnosis, prevention and treatment of specific diseases will help to the prevention, early diagnosis and prevention of targeted infections and diseases. Disease monitoring and surveillance will also be facilitated by the availability of the right tools.
CALLISTO has produced two definitions useful to understand the work. These are:
• COMPANION ANIMALS are any domesticated, domestic-bred or wild-caught animals, permanently living in a community and kept by people for company, enjoyment, work (e.g. support for blind or deaf people, police or military dogs) or psychological support – including, but not limited to dogs, cats, horses, rabbits, ferrets, guinea pigs, reptiles, birds and ornamental fish.
• RESPONSIBLE PET OWNERSHIP (RPO) is a duty of care based on the principle that animals are sentient beings having intrinsic value, are dependent on humans for their health and welfare and are part of the ecosystem. RPO aims to maintain a good level of animal health and welfare, to maximize physical and psychological benefits to humans and to minimize the potential risk that pets may pose to the public, other animals, or the environment. This duty starts with responsible acquisition and continues with providing appropriate care and protection for pets and their offspring.

List of Websites:

www.callistoproject.eu

Final Report Summary - CALLISTO (Companion Animals multisectoriaL interprofessionaL and Interdisciplinary Strategic Think tank On zoonoses)

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