The potential Public Health Impact of Mycobacterium avium ssp. paratuberculosis: Global Opinion Survey of Topic Specialists.
Global research knowledge has accumulated over the past few decades, and there is reasonable evidence for a positive association between Mycobacterium avium spp. paratuberculosis and Crohn's disease in humans, although its role as a human pathogen has not been entirely accepted. For this reason, management of public health risk due to M. paratuberculosis remains an important policy issue in agri-food public health arenas in many countries. Responsible authorities must decide whether existing mitigation strategies are sufficient to prevent or reduce human exposure to M. paratuberculosis. A Web-based questionnaire was administered to topic specialists to elicit empirical knowledge and opinion on the overall public health impact of M. paratuberculosis, the importance of various routes of human exposure to the pathogen, existing mitigation strategies and the need for future strategies. The questionnaire had four sections and consisted of 20 closed and five open questions. Topic specialists believed that M. paratuberculosis is likely a risk to human health (44.8%) and, given the paucity of available evidence, most frequently ranked it as a moderate public health issue (40.1%). A significant correlation was detected between topic specialists' commitment to M. paratuberculosis in terms of the number of years or proportion of work dedicated to this topic, and the likelihood of an extreme answer (high or low) to the above questions. Topic specialists identified contact with ruminants and dairy products as the most likely routes of exposure for humans. There was consensus on exposure routes for ruminants and what commodities to target in mitigation efforts. Described mandatory programmes mainly focused on culling diseased animals and voluntary on-farm prevention programmes. Despite ongoing difficulties in the identification of subclinical infections in animals, the topic specialists largely agreed that further enhancement of on-farm programmes in affected commodities by the agri-food industry (68.4%) and allocation of resources by governments to monitor the issue (92%) are most appropriate given the current state of evidence.
Department of Population Medicine, University of Guelph, Guelph, ON, Canada.|Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, ON, Canada.
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Waddell
Food Safety and Quality, Agriculture and Consumer Protection Department, Food and Agriculture Organization, Rome, Italy.
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Rajić
Royal Veterinary College, North Mymms, UK.
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Stärk
Department of Population Medicine, University of Guelph, Guelph, ON, Canada.
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McEwen
D000818:Animals; D003424:Crohn Disease / Q000453:epidemiology* / Q000382:microbiology; D003611:Dairy Products / Q000382:microbiology; D006801:Humans; D016927:Mycobacterium avium subsp. paratuberculosis / Q000302:isolation & purification*; D010283:Paratuberculosis / Q000453:epidemiology* / Q000382:microbiology; D011634:Public Health; D012307:Risk Factors; D012418:Ruminants / Q000382:microbiology; D011795:Surveys and Questionnaires
Crohn's disease; Johne's disease; Paratuberculosis; expert opinion; questionnaire; survey