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Poultry and human infections

  • F. Allerberger
    Correspondence
    Corresponding author: F. Allerberger, Austrian Agency for Health and Food Safety (AGES), Spargelfeldstr. 191, 1220 Vienna, Austria.
    Affiliations
    Österreichische Agentur für Gesundheit und Ernährungssicherheit, MED Ltg, Austria
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Open ArchivePublished:October 19, 2015DOI:https://doi.org/10.1016/j.cmi.2015.10.016
      The role of poultry in the spread of pathogens and resistant organisms is probably unappreciated considering the extensive movement of poultry meat under the world trade agreements. As a consequence of this globalized food production and consumption system, food safety is being increasingly scrutinized and questioned by the public. In addition, foodborne illnesses are becoming an increasingly significant and costly global problem [
      • Vétérinaires Sans Frontières
      One health, one world? Policies and perspectives.
      ]. After pork, poultry meat is the second most important meat species produced in the EU. In 2013, 12.5 million tons (slaughter weight) of poultry meat were produced in the EU, mainly broilers (75%), turkeys (16%) and ducks (4%) [

      Association of Poultry Processors and Poultry Trade in the EU Countries (AVEC). 2014 annual report. Available at: http://www.avec-poultry.eu/system/files/archive/new-structure/avec/Annual_Report/2014/Version%20Finale.pdf.

      ].
      Chicken and turkey meat are well recognized sources of human salmonellosis and campylobacteriosis, the latter being the main bacterial cause of community-acquired gastroenteritis in Europe [
      • Spina A.
      • Kerr K.G.
      • Cormican M.
      • et al.
      Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis.
      ]. However, as stated in this issue in the article from Skarp et al. [
      • Skarp C.P.A.
      • Hänninen M.L.
      • Rautelin H.I.K.
      Campylobacteriosis: the role of poultry meat.
      ], only 28% of people surveyed in 2014 had heard of Campylobacter, as opposed to 90% who had heard of Salmonella. Campylobacteriosis has been increasing in the past decade and poultry identified as the major contributor. However, Skarp et al. postulate that other sources, as yet unknown, could transmit Campylobacter to both humans and poultry. Despite an 80% decrease in the incidence of salmonellosis during the last decade, one out of every 80 EU inhabitants is still affected by salmonellosis each year [
      • European Food Safety Authority Panel on Biological Hazards
      Scientific opinion on a quantitative estimation of the public health impact of setting a new target for the reduction of Salmonella in broilers.
      ]. In this CMI issue, Antunes et al. [
      • Antunes P.
      • Mourão J.
      • Campos J.
      • Peixe L.
      Salmonellosis: the role of poultry meat.
      ] point out that a shift in Salmonella serotypes related to poultry and poultry production has been reported in different geographical regions in recent years, particularly associated with the spread of certain well-adapted clones. Increasing antimicrobial resistance (AMR) of nontyphoidal Salmonella is an additional concern in the management of salmonellosis.
      Although the incidence of these two community-acquired gastrointestinal infections is amazingly high, it is even outranked by the incidence of infection caused by extraintestinal pathogenic Escherichia coli (ExPEC): In the United States ExPEC infections exceed 7 million office visits, 1 million emergency room visits and 100 000 hospitalizations every year [
      • Foxman B.
      Epidemiology of urinary tract infections: incidence, morbidity, and economic costs.
      ]. The multiple lines of evidence indicating poultry as a major food animal reservoir for urinary tract infection and for possible dissemination of ExPEC via retail meat are described by Manges [
      • Manges A.R.
      Escherichia coli and urinary tract infections: the role of poultry-meat.
      ], also in this CMI issue. The problem of potential foodborne transmission of ExPEC is closely interlinked with antimicrobial-resistant ExPEC, specifically with fluoroquinolone-resistant and extended spectrum β-lactamase (ESBL)-producing E. coli. If the increase in antimicrobial resistant extraintestinal infections caused by E. coli were attributable to the introduction of new multidrug-resistant ExPEC lineages via contaminated food products, the relevance to public health, food animal production and food safety would be enormous [
      • Manges A.R.
      Escherichia coli and urinary tract infections: the role of poultry-meat.
      ]. Lord Soulsby postulated that both injecting third-generation cephalosporins, such as ceftiofur, into eggs before chickens hatch and dipping eggs in β-lactams explain why there has been a marked increase in ESBL E. coli isolates causing community-onset infections in people around the world [
      • Soulsby Lord
      Antimicrobial resistance: animal use of antibiotics.
      ].
      Much antibiotic use is linked to animal production. In Germany a broiler is treated for 10 days with antibiotics within its 39-day production period [
      • van Rennings L.
      • von Münchhausen C.
      • Hartmann M.
      • et al.
      [Antibiotic usage and antibiotic sales in Germany in 2011—the situation of drug usage in veterinary medicine].
      ]. This massive use of antibiotics amplifies and accelerates the emergence and spread of drug-resistant bacteria and ultimately leads to transmission of resistant bacteria from animals to humans through the food chain. The direct consequences of infection with resistant Campylobacter, Salmonella or ExPEC can be severe, including increased mortality, longer illnesses and prolonged hospital stays.
      The role of poultry meat as a source for enterococci and staphylococci is less clear. In this CMI issue, Bortolaia et al. [
      • Bortolaia V.
      • Espingosa-Gongora C.
      • Guardabassi L.
      Human health risks associated with antimicrobial-resistant enterococci and Staphylococcus aureus on poultry meat.
      ] provide an overview of the health risks associated with the occurrence of these opportunistic human pathogens, with particular focus on the risk of foodborne transmission of AMR. The movement of antibiotic resistance genes, as opposed to movement of resistant bacterial strains, has become an issue in connection with clinical and agricultural antibiotics. The problem of increasing AMR is so dire that some experts are predicting that the era of antibiotics may be coming to an end, ushering in a postantibiotic era: according to the World Health Organization, ‘The problem is so serious that it threatens the achievements of modern medicine. A post-antibiotic era—in which common infections and minor injuries can kill—is a very real possibility for the 21st century’ [
      • World Health Organization
      Antimicrobial resistance: global report on surveillance, 2014.
      ]. AMR is not, however, merely a future threat. The present human and economic costs of AMR already amount to thousands of casualties each year, increase the infectious disease burden around the world and lead to billions of euros’ worth of direct health costs and lost productivity. Therefore, a comprehensive policy response is urgently needed. A part of this response will require coping with the challenges of industrialized meat production, including poultry meat. With the increasing globalization of foodstuffs like poultry meat, new problems and challenges will arise, requiring new integrated intervention strategies along the food chain. Continuous monitoring to detect the emergence of new clones along the food chain is of critical importance for public health, as are measures for warning about the emergence of new food safety risks involving foodstuffs like poultry meat, one of the most consumed and increasing globally traded meat products.
      Unexpected pathogens may become prominent and constitute a zoonotic risk due to breaches in slaughter hygiene or improper handling, cooking or cooling of meat [
      • European Food Safety Authority Panel on Biological Hazards
      Scientific opinion on a quantitative estimation of the public health impact of setting a new target for the reduction of Salmonella in broilers.
      ]. In addition, international trade of broiler meat may expose new susceptible populations to strains that they do not regularly encounter in domestic products. In this CMI theme issue, Harder et al. [
      • Harder T.C.
      • Buda S.
      • Hengel H.
      • Beer M.
      • Mettenleiter T.C.
      Poultry food products—a source of avian influenza virus transmission to humans?.
      ] review the role of avian influenza virus and ask for concerted efforts to ensure that no poultry products potentially contaminated with zoonotic avian influenza virus can reach the food chain.
      Our focus on poultry as a major potential source for pathogens and for AMR is the result of significant public health concerns. In 2012 the European Food Safety Authority (EFSA) suggested that traditional poultry meat inspection may no longer suffice to fully address the most relevant biological hazards to public health [
      • EFSA Panels on Biological Hazards (BIOHAZ), on Contaminants in the Food Chain (CONTAM), and on Animal Health and Welfare (AHAW)
      Scientific opinion on the public health hazards to be covered by inspection of meat (poultry).
      ]. Classical visual inspection of postmortem poultry carcasses is no longer a targeted approach and will be replaced by setting targets for the main microbiologic hazards. Foodborne diseases are largely preventable; however, there is no simple one-step prevention measure. Future legislation and codes of practice are likely to require that detailed monitoring to evaluate the welfare of poultry on farms and during transport becomes mandatory. This implies that numerous measures are needed to prevent the spread of microorganisms among animals and to limit contamination of foods.

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      The author reports no conflicts of interest relevant to this editorial.

      References

        • Vétérinaires Sans Frontières
        One health, one world? Policies and perspectives.
        VSF Policy Brief. 2015; 3: 1-5
      1. Association of Poultry Processors and Poultry Trade in the EU Countries (AVEC). 2014 annual report. Available at: http://www.avec-poultry.eu/system/files/archive/new-structure/avec/Annual_Report/2014/Version%20Finale.pdf.

        • Spina A.
        • Kerr K.G.
        • Cormican M.
        • et al.
        Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis.
        Clin Microbiol Infect. 2015; 21: 719-728
        • Skarp C.P.A.
        • Hänninen M.L.
        • Rautelin H.I.K.
        Campylobacteriosis: the role of poultry meat.
        Clin Microbiol Infect. 2016; 22: 103-109
        • European Food Safety Authority Panel on Biological Hazards
        Scientific opinion on a quantitative estimation of the public health impact of setting a new target for the reduction of Salmonella in broilers.
        EFSA J. 2011; 9: 1-94
        • Antunes P.
        • Mourão J.
        • Campos J.
        • Peixe L.
        Salmonellosis: the role of poultry meat.
        Clin Microbiol Infect. 2016; 22: 110-121
        • Foxman B.
        Epidemiology of urinary tract infections: incidence, morbidity, and economic costs.
        Am J Med. 2002; 113: 5S-13S
        • Manges A.R.
        Escherichia coli and urinary tract infections: the role of poultry-meat.
        Clin Microbiol Infect. 2016; 22: 122-129
        • Soulsby Lord
        Antimicrobial resistance: animal use of antibiotics.
        in: Palmer S.R. Soulsby Lord Torgeson P.R. Brown D.W.G. Oxford textbook of zoonoses. 2nd ed. Oxford University Press, Oxford2011: 38-42
        • van Rennings L.
        • von Münchhausen C.
        • Hartmann M.
        • et al.
        [Antibiotic usage and antibiotic sales in Germany in 2011—the situation of drug usage in veterinary medicine].
        Berl Munch Tierarztl Wochenschr. 2014; 127: 366-374
        • Bortolaia V.
        • Espingosa-Gongora C.
        • Guardabassi L.
        Human health risks associated with antimicrobial-resistant enterococci and Staphylococcus aureus on poultry meat.
        Clin Microbiol Infect. 2016; 22: 130-140
        • World Health Organization
        Antimicrobial resistance: global report on surveillance, 2014.
        World Health Organization, Geneva2014
        • Harder T.C.
        • Buda S.
        • Hengel H.
        • Beer M.
        • Mettenleiter T.C.
        Poultry food products—a source of avian influenza virus transmission to humans?.
        Clin Microbiol Infect. 2016; 22: 141-146
        • EFSA Panels on Biological Hazards (BIOHAZ), on Contaminants in the Food Chain (CONTAM), and on Animal Health and Welfare (AHAW)
        Scientific opinion on the public health hazards to be covered by inspection of meat (poultry).
        EFSA J. 2012; 10: 2741

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