Abstract

BackgroundZoonoses are a growing international threat interacting at the human-animal-environment interface and call for transdisciplinary and multi-sectoral approaches in order to achieve effective disease management. The recent emergence of Lyme disease in Quebec, Canada is a good example of a complex health issue for which the public health sector must find protective interventions. Traditional preventive and control interventions can have important environmental, social and economic impacts and as a result, decision-making requires a systems approach capable of integrating these multiple aspects of interventions. This paper presents the results from a study of a multi-criteria decision analysis (MCDA) approach for the management of Lyme disease in Quebec, Canada. MCDA methods allow a comparison of interventions or alternatives based on multiple criteria.MethodsMCDA models were developed to assess various prevention and control decision criteria pertinent to a comprehensive management of Lyme disease: a first model was developed for surveillance interventions and a second was developed for control interventions. Multi-criteria analyses were conducted under two epidemiological scenarios: a disease emergence scenario and an epidemic scenario.ResultsIn general, we observed a good level of agreement between stakeholders. For the surveillance model, the three preferred interventions were: active surveillance of vectors by flagging or dragging, active surveillance of vectors by trapping of small rodents and passive surveillance of vectors of human origin. For the control interventions model, basic preventive communications, human vaccination and small scale landscaping were the three preferred interventions. Scenarios were found to only have a small effect on the group ranking of interventions in the control model.ConclusionsMCDA was used to structure key decision criteria and capture the complexity of Lyme disease management. This facilitated the identification of gaps in the scientific literature and enabled a clear identification of complementary interventions that could be used to improve the relevance and acceptability of proposed prevention and control strategy. Overall, MCDA presents itself as an interesting systematic approach for public health planning and zoonoses management with a “One Health” perspective.

Highlights

  • Zoonoses are a growing international threat interacting at the human-animal-environment interface and call for transdisciplinary and multi-sectoral approaches in order to achieve effective disease management

  • Preventive communication strategies refers to all modes of communication implemented by public health authorities to prevent Lyme disease in humans; surveillance strategies refers to vector, animal and human related surveillance activities designed to monitor the disease and the state of the infection in the reservoir and the vector; and control strategies refers to field interventions which can be implemented to reduce the risk of transmission of the infectious agent to humans

  • For the examination of surveillance and control strategies, two models were developed to address two specific research questions identified by the stakeholders: 1) what strategies are most effective for Lyme disease surveillance? (SURV model); and 2) what interventions are most effective for the prevention and control of Lyme disease? (CONT model)

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Summary

Introduction

Zoonoses are a growing international threat interacting at the human-animal-environment interface and call for transdisciplinary and multi-sectoral approaches in order to achieve effective disease management. Zoonoses pose important prevention and control challenges because multiple organisations and stakeholders share responsibilities with regards to public health actions; the implementation and anticipated effects of cross-sectoral interventions can be more difficult to predict for strategic planners and decision-makers. This complexity calls for transdisciplinary and multi-sectoral approaches in order to achieve effective disease management, a call which can no longer be ignored [7]

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