Abstract
Disease or pathogen risk prioritisations aid understanding of infectious agent impact within surveillance or mitigation and biosecurity work, but take significant development. Previous work has shown the H-(Hirsch-)index as an alternative proxy. We present a weighted risk analysis describing infectious pathogen impact for human health (human pathogens) and well-being (domestic animal pathogens) using an objective, evidence-based, repeatable approach; the H-index. This study established the highest H-index European pathogens. Commonalities amongst pathogens not included in previous surveillance or risk analyses were examined. Differences between host types (humans/animals/zoonotic) in pathogen H-indices were explored as a One Health impact indicator. Finally, the acceptability of the H-index proxy for animal pathogen impact was examined by comparison with other measures. 57 pathogens appeared solely in the top 100 highest H-indices (1) human or (2) animal pathogens list, and 43 occurred in both. Of human pathogens, 66 were zoonotic and 67 were emerging, compared to 67 and 57 for animals. There were statistically significant differences between H-indices for host types (humans, animal, zoonotic), and there was limited evidence that H-indices are a reasonable proxy for animal pathogen impact. This work addresses measures outlined by the European Commission to strengthen climate change resilience and biosecurity for infectious diseases. The results include a quantitative evaluation of infectious pathogen impact, and suggest greater impacts of human-only compared to zoonotic pathogens or scientific under-representation of zoonoses. The outputs separate high and low impact pathogens, and should be combined with other risk assessment methods relying on expert opinion or qualitative data for priority setting, or could be used to prioritise diseases for which formal risk assessments are not possible because of data gaps.
Highlights
Disease or pathogen risk prioritisation exercises are used by organisations charged with providing surveillance and mitigation measures including disease management and control, and biosecurity measures
Some pathogens may generally be commensals or natural biota (Aggregatibacter actinomycetemcomitans, Candida species, Enterobacter, Enterococcus, Staphylococcus species, Candida tropicalis, Helicobacter pylori, and Porphyromonas gingivalis) or species existing in the environment (Acinetobacter baumannii, Burkholderia cepacia, Candida glabrata, Entamoeba histolytica, Fusarium oxysporum, Gibberella moniliformis, Proteus mirabilis, Pseudomonas species, Rhizopus oryzae, Serratia marcescens, Staphylococcus aureus, and Stenotrophomonas maltophilia) causing opportunistic infections in immunecompromised individuals; their impact upon the general population may not be quantified
The European Commission has outlined measures to strengthen coordinated approaches to health security at EU level, including monitoring, early warning and combating specific threats of a cross-border nature. These measures could be for climate change resilience [23] or for biosecurity, for infectious diseases including communicable diseases, antimicrobial resistant and healthcare-associated infections related to communicable diseases, and biotoxins or other biological agents [24]
Summary
Disease or pathogen risk prioritisation exercises are used by organisations charged with providing surveillance and mitigation measures including disease management and control, and biosecurity measures. Quantitative measures for risk prioritisation include the calculation of epidemiological parameters such as disease incidence, prevalence, mortality and morbidity rates, costs of prevention, treatment or control, and for human disease, years lived with disability (YLD) and disability-adjusted-life-year estimates (DALY). Semi-quantitative and qualitative risk assessments are less demanding of data than quantitative approaches. They require significant time and physical resources (for example, to obtain parameters and effect sizes from the scientific literature), need updating regularly, and they usually require expert-opinion, adding subjectivity [1,2,3,4,5]
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