Prioritizing Emerging Zoonoses in The Netherlands: "The EMZOO Project"

Abstract

Abstract Introduction: Zoonotic disease prioritization is a complex challenge with inherent methodological limitations and subjectivity. This thesis addresses the prioritization of zoonotic pathogens based on their impact in the Netherlands. It aims to provide an overview of the severity of pathogenesis of endemic and non-endemic zoonoses in humans. Methods: First, a comprehensive literature review was conducted to gather epidemiological data on mortality, morbidity, and endemicity for 80 previously selected zoonotic diseases. Data sources included peer-reviewed publications, reports from international organizations (e.g., WHO, OIE), and national surveillance databases. Where data were incomplete or unavailable, information from sources such as the EMZOO-RIVM report was considered, with careful attention to potential inconsistencies. Expert elicitation was used to supplement the literature review, gathering qualitative insights on factors influencing disease emergence and transmission. We also explored the use of ASreview, an AI-assisted tool, to streamline the systematic review process, potentially reducing the workload associated with literature screening and data extraction. Results: Our findings reveal that mortality is a key driver in prioritizing zoonotic diseases, but also emphasize that low morbidity values should not be overlooked due to the potential for severe outbreaks. We observed distinct patterns in the risk distribution of viruses and bacteria, with viruses being more evenly distributed and bacteria tending to cluster in high-risk areas. Comparison with the Havelaar et al. study revealed both agreement and notable differences in pathogen risk categorization, highlighting the influence of assessment methodologies and data availability. Discussion: Inherent subjectivity in criteria selection and data limitations necessitate interdisciplinary approaches and continuous database updating. A One Health approach is essential for effective surveillance and epidemic preparedness. Conclusion: Based on our methods, we found that European bat lyssa virus 1 and 2, SARS-CoV-2, Capnocytophaga canimorsus, Crimean-Congo hemorrhagic fever virus, and Cryptosporidium spp. Zoonotic, are the most impactful pathogens in the Netherlands.