Antimicrobials are drugs that help cure people and animals of infections with bacteria. The slogan: ‘the more you use, the faster you lose,’ applies to antimicrobials. When you use antimicrobials, more bacteria become resistant, meaning infection can no longer be treated. This is a worldwide challenge for treating diseases in animals and humans.

Like many other organizations, the World Health Organization (WHO) are advocating for reducing the use of antimicrobials when they are not needed. The COINCIDE project explores what will happen when the use of colistin in animals is banned in Indonesia. Colistin is a specific antimicrobial that is used as a last resort in humans if nothing else works, resistance against this antimicrobial means that resistant disease-causing bacteria will have free reign.

In animals, colistin was banned in 2020, and a group of human doctors, veterinarians, anthropologists, and DNA researchers will look if fewer bacteria become resistant. We also want to reduce the colistin use in humans, as it is suspected to be used in humans without good reason. We will work with farmers and their veterinarians, but also with people in the community, doctors, and pharmacies, to find out why they are still using colistin and if they can do without. The project's outcome will help governments, farmers, veterinarians, human doctors, and everybody who needs colistin to safeguard this antimicrobial for use only when we cannot do without.

Project partners
Anis Karuniawati, Universitas Indonesia, Indonesia 
Juliëtte Severin, Erasmus MC University Medical Center Rotterdam, Netherlands
Jaap Wagenaar, Utrecht University, Faculty of Veterinary Medicine, Netherlands
Sunandar Sunandar, Center for Indonesian Veterinary Analytical Studies, Indonesia
Herman Barkema, University of Calgary, Canada
Koen Peeters, Institute of Tropical Medicine, Belgium
Imron Suandy, Directorate of Veterinary Public Health, DG of Livestock and Animal Health Services, MoA-Indonesia, Indonesia

Ph.D. Candidate

Soe Yu Naing, Utrecht University

• dr. A.L. (Aldert) Zomer
• Soe Yu Naing

https://www.uu.nl/organisatie/faculteit-diergeneeskunde/ons-onderzoek/samenwerkingsverbanden/netherlands-centre-for-one-health-ncoh/fighting-covid-19-in-animals-and-humans

• prof. dr. H.S. (Hans) Kooistra
• drs. W.J.R. (Ruth) van der Leij
• drs. M.M. (Marleen) Kannekens-Jager
• dr. H.F. (Herman) Egberink
• dr. E.M. (Els) Broens
• prof. dr. J.A. (Arjan) Stegeman
• prof. dr. Merel Langelaar

• NCOH
• WUR
• Erasmus MC
• WBVR

Antimicrobial resistance (AMR) is a major threat for public health and is caused by use of antimicrobials in humans and animals. In Indonesia, high amounts of antimicrobials are used in the poultry sector. As antimicrobials are widely used by farmers without prescription, and they are called to reduce antimicrobial use (AMU), there is a need to know why antimicrobials are used and what alternatives can be offered to prevent production losses and keep animals healthy while reducing AMU. In the NWO-CORNERSTONE project (started April 1st 2019) this will be studied. However, more in-depth knowledge of the infectious diseases (viral and bacterial) that are present on the farms is needed to better understand why specific antimicrobials are used and what alternatives can be offered to prevent these diseases and use antimicrobials responsibly when diseases occur. By using diagnostic tests, this Hestia project investigates the presence of viruses and bacteria on farms included in the CORNERSTONE-study, and when they occur. This knowledge can be used to develop tailored interventions consisting of specific biosecurity (hygiene) measures and vaccination programs. Prevention of these diseases has a huge potential to reduce AMU. The knowledge of this project is not only of value for the participating farmers (n=25), but gives more insight in the bacteria and viruses that typically threaten animal health on Indonesian poultry farms. It can also be used to support other poultry farmers in the poultry-dense areas in Indonesia and countries in the region with comparable poultry production systems, in their sustainable farming.

https://www.nwo.nl/projecten/vidw115419017-0

• dr. D.C. (David) Speksnijder

Since 2015, under the auspices of WHO, a basic protocol for One Health Surveillance of AMR has been established. This “Tricycle” protocol integrates human, animal and environmental surveillance and focuses on a single indicator for AMR: ESBL-producing E. coli. To our knowledge, this is the first One Health AMR surveillance protocol that has consistently been piloted across six different countries across the world.

The TRIuMPH project builds on the Tricycle project and on the JPI network “NETESE” by adding new research elements and protocols, thereby extending the application of the Tricycle surveillance. This will be achieved in a collaborative approach with current Tricycle and NETESE partners (PK, MY and MG) and partners that contributed to the Tricycle protocol development (Utrecht University, INSERM and RIVM National Institute for Public Health and the Environment ). New One Health protocols will be developed and applied in a one-year surveillance campaign for the detection of carbapenemase-producing Enterobacteriaceae (CPE, WP2), and for whole-genome sequencing analysis of ESBL / CPE isolates (WP3).

Within one single country, the extension of surveillance to a broader scale is needed, as analyses are currently limited to single cities. This will be brought about by two activities: Inclusion of additional sites within participating countries through in-country training (WP4), and integration with existing monitoring campaigns, such as for water samples taken within the Polio Eradication campaign (WP5). These also offer the opportunity to validate the applicability of wastewater sampling as a proxy of community prevalence of ESBL and CPE.

RIVM coordinates TRIuMPH. Partner countries involved are France, Madagascar, Malaysia, Pakistan and the Netherlands. RIVM's Heike Schmitt is the project coordinator.

Funding
The project has been awarded funding within the JPIAMR 9th transnational call: “Call on Diagnostics and Surveillance 2019.

• dr. L. (Linda) van der Graaf-van Bloois
• dr. A.L. (Aldert) Zomer

• Coordinator: Heike Schmitt - National Institute for Public Health and the Environment (RIVM) The Netherlands
• Laurence Armand-Lefevre - University Paris-Diderot Medical School INSERM IAME UMR1137 France
• Luc Samison - University of Antananarivo Centre d’Infectiologie Charles Mérieux Faculty of Medicine Madagascar
• Rohaidah Hashim - Institute for Medical Research Infectious Disease Research Centre MOH Kuala Lumpur Malaysia
• Muhammad Salman - National Institute of Health Public Health Laboratories Division Islamabad Pakistan

Het VASAP-project is een vervolg op het onlangs afgeronde Antimicrobial Stewardship and Pets (ASAP)-project, waarin een Antimicrobial Stewardship Programma (ASP) is ontwikkeld en geïmplementeerd in 44 Nederlandse gezelschapsdierenartsenpraktijken.

Het doel van het VASAP-project is om de meest succesvolle onderdelen uit het ASAP-project op een praktisch haalbare, laagdrempelige en efficiënte wijze uit te rollen onder meer gezelschapsdierenartsenpraktijken. Om dit te bewerkstellingen zal een interactieve online training opgezet worden die in kleine groepen aangeboden zal worden. De training beoogt inzicht te geven in de achtergronden van antibioticaresistentie en verantwoord antibioticumgebruik en biedt dierenartsen handvaten voor de dagelijkse praktijk. De training zal eveneens als (keuze)module in de Master Gezelschapsdieren aangeboden worden aan studenten diergeneeskunde. Deelnemers uit het ASAP-project en verschillende stakeholders zullen betrokken zijn bij het VASAP-project.

• dr. E.M. (Els) Broens
• dr. I.M. (Inge) van Geijlswijk
• dr. N.E.M. (Nonke) Hopman

Antimicrobial resistance (AMR) is a major threat for animal and public health and recognized by Heads of State in the General Assembly of the United Nations as a major issue on global scale. To contain AMR, antimicrobial usage (AMU) should be reduced as this is considered to be the main driver of selection for resistant bacteria. Furthermore, the veterinary use of (highly prioritized) critically important antimicrobials for human medicine should be reduced as much as possible and replaced by less important antimicrobials for human medicine. Preliminary data collected by consortium partners, showed considerable overuse of antimicrobials in the Indonesian poultry production. Scientific research is needed to support an evidence-based transition towards a sustainable poultry production chain with responsible use of antimicrobials. The research questions are i) why, what and how much antimicrobials are used in broiler production in Indonesia, ii) what alternatives for AMU are available iii) is it possible to reduce AMU by introducing tailor made on-farm intervention strategies. The parameters to be measured are reduction in AMU and the change in AMR levels on farms. One of the results of this project will be the development of a ‘best practice’ document to be used (inter)nationally by stakeholders and scientific publications to share the results with the scientific community. The consortium consists of research organisations, a commercial partner and 4 supporting organisations with strong links with the broiler sector in Indonesia. Two stakeholder meetings will be part of this project to ensure close involvement in the development of the intervention and in the end phase to communicate results and best practices to end-users. Several elements of capacity building are one of the pillars of the project. This project contributes to a safe and sustainable poultry food chain in Indonesia and reduces the risks of resistant bacteria for humans.

https://www.nwo.nl/projecten/w-07501827-0

• dr. D.C. (David) Speksnijder

Pig farms act as reservoir of Livestock-Associated Methicillin-resistant Staphylococcus aureus (LA-MRSA). Through occupational exposure to farm dust and contact with pigs, farm workers are at risk for acquiring LA-MRSA. Although health care institutions can cope with the current situation, it is a burden for patients, health care staff, and finances. In addition, the recent observed adaptation of LA-MRSA originating from pigs to humans in Denmark further highlights the need to reduce LA-MRSA colonization in pigs and subsequent transmission to humans. In a pilot study of the nasal microbiome we observed that piglets become LA-MRSA positive after a few days of birth. The presence of several other bacterial species, including coagulase-negative staphylococci was negatively associated with the presence of LA-MRSA. More evidence is needed regarding which bacterial species and/or strains compete with LAMRSA. The project aims to establish the effect of colonization resistance (bacterial competition) on the transmission of LA-MRSA from pigs to humans by i) identifying bacterial species that compete with LA-MRSA (S. aureus in general) in a systematic way using state of the art bioinformatics and metagenomics methods at strain level, ii) studying the efficacy of applying a nasal microflora for piglets which will be produced under GMP conditions by the industrial partner in the project and tested under field conditions at conventional farms, and iii) to estimate the risk reduction as a result from limiting MRSA transmission to humans by reducing shedding and consequently a more limited environmental contamination. Communication with farmers, veterinarians, public health workers and other stakeholders, with the help of our supporting organizations, will prepare the stakeholders for the outcome of the project, bringing it close to immediate use in practice. ExcludeMRSA will deliver a reduction of MRSA colonization or will lead to complete prevention of MRSA colonization by precolonization of piglets with microflora. The efficacy will be assessed in two countries by using proven environmental risk models for human exposure and evaluating changes in the exposure risk association. Because of the earlier performed successful pilot studies, the experience of the partners and the inclusion of an industrial partner experienced in production of live strains, this project is feasible in three years’ time

• prof. dr. ir. D.J.J. (Dick) Heederik
• A.A. (Abel) Vlasblom
• dr. B. (Birgitta) Duim
• dr. A.L. (Aldert) Zomer

• Marcus Claesson (UCC)
• Peadar Lawlor (Teagasc)
• Fellipe Freitas Barbosa (EW-nutrition)

MRSA-PREVENT richt zich op het verminderen van de overdracht van de methicilline-resistente Staphylococcus aureus (MRSA) bacterie van varkens naar mensen. Mensen op varkensbedrijven lopen het risico om besmet te worden met deze resistentie bacterie. In ziekenhuizen wordt door het actieve ‘search en destroy’ beleid de insleep van MRSA voorkomen maar de kosten hiervan zijn hoog.

In dit project wordt gezocht, met hightech moleculaire technieken, of bacteriën die van nature bij varkens in de neus voorkomen de groei van MRSA kunnen remmen. Modelmatig wordt onderzocht of deze bacteriën ‘kolonisatie resistentie’ geven zodat MRSA zich niet meer kan vestigen in de varkens neus. Bij een aantal varkens bedrijven wordt onderzocht hoeveel deze toediening het risico voor overdracht van MRSA naar mensen beperkt. Dit project is een interdisciplinaire aanpak, waarin artsen, onderzoekers, dierenartsen en veehouders gezamenlijk werken aan het beperken van de overdracht van MRSA van varkens naar mensen.

• prof. dr. ir. L.A. (Lidwien) Smit
• prof. dr. ir. D.J.J. (Dick) Heederik
• dr. A. (Arie) van Nes
• dr. A Fluit
• A.A. (Abel) Vlasblom
• dr. B. (Birgitta) Duim
• dr. A.L. (Aldert) Zomer

• Marjolein Kluytmans-van den Bergh
• Gerard van Eijden

Vroege detectie in de veehouderij is essentieel wanneer het gaat om resistentie (ABR) tegen antimicrobiële middelen die essentieel zijn voor de behandeling van bacteriële infecties bij mensen.

Als ten tijde van de eerste detectie een nieuw type ABR maar op een klein aantal bedrijven voorkomt, dan is het goed mogelijk om het risico op blootstelling van mensen te minimaliseren. Echter, wanneer een groot aantal bedrijven positief zijn bevonden is dat niet meer haalbaar. Het doel van BEWARE is de ontwikkeling van een blauwdruk voor detectie van nieuwe typen ABR in de veehouderij als het aantal positieve bedrijven nog laag is. Hoewel de methode toepasbaar is voor alle typen ABR en alle diersoorten, zal BEWARE zich richten op carbapenemase-producerende Enterobacteriaceae (CPE) in vleeskalveren, varkens en vleeskuikens. Dit zijn de meest relevante diersectoren voor ABR en CPE is een zeer belangrijk middel voor behandeling van humane Intensive Care patiënten.

• N. (Natcha) Dankittipong
• prof. dr. J.A. (Arjan) Stegeman
• dr. A.L. (Aldert) Zomer

• Jantien Backer (RIVM)
• Alex Bossers (WUR)
• Clazien de Vos (WUR)
• Manon Swanenburg (WUR)

De afgelopen jaren is in Nederland succesvol beleid gevoerd om het antibioticagebruik in de veehouderij terug te dringen en de verwachting is dat er een verdere daling mogelijk is. Om het antibioticagebruik verantwoord terug te kunnen brengen zijn de afgelopen jaren diverse veterinaire richtlijnen ontwikkeld maar er zijn aanwijzingen dat de implementatie van deze richtlijnen geoptimaliseerd kan worden. In het project VET-ENHANCE zal worden onderzocht in hoeverre deze richtlijnen in de praktijk door dierenartsen worden geïmplementeerd en hoe de implementatie kan worden verbeterd. In een interventiestudie zal worden getoetst of de implementatie van de richtlijnen te verbeteren is waardoor het antibioticagebruik op een verantwoorde manier verder gereduceerd kan worden.

https://www.uu.nl/organisatie/faculteit-diergeneeskunde/over-de-faculteit/departement-biomolecular-health-sciences/infectieziekten-en-immunologie/onderzoek/vet-enhance 

• ing. Isaura Wayop MSc
• dr. D.C. (David) Speksnijder

In dit project identificeren we de kritische succesfactoren voor antibioticagebruik door voor een groot aantal varkensbedrijven informatie te verzamelen en de relatie daarvan met antibioticumgebruik te bepalen. Tevens maken we gebruik van informatie die is verzameld in een recent door de overheid gefinancierd project. Op basis van de geïdentificeerde factoren ontwikkelen we maatregelen die veehouders kunnen doorvoeren om het antibioticumgebruik terug te dringen. Het effect van deze maatregelen meten we aan de hand van antibioticumgebruik en antibioticumresistentie.

https://www.infectionandimmunity.nl/projects/details/reduction-of-antimicrobial-use-on-farms-by-targeting-critical-success-factors-in-farm-management

• dr. D.C. (David) Speksnijder

Since the 1950s, antimicrobials have been increasingly used in modern intensive livestock production systems. Besides preventive and therapeutic use, antimicrobials were used as growth promoters in the European Union (EU) until their ban in 2006. This was preceded by decades of growing evidence and concerns about the public health impact of widespread veterinary antimicrobial use (AMU) and associated increasing antimicrobial resistance (AMR). As AMU in livestock favors AMR development in bacterial populations as it does in humans, the public health risks of veterinary AMU are threefold: 1) resistant bacteria can pass onto humans via direct contact with animals; 2) these bacteria can pass on via food of either animal origin or cross-contaminated during production; 3) these bacteria can spread into the environment via farm runoff or unprocessed manure used as fertilizer. Moreover, large volumes of antimicrobial residues in manure cause further environmental exposure and potential selective pressure. In 2007, the Netherlands was the largest veterinary antimicrobial consumer per biomass unit of animal production among 10 EU countries. Together with the discovery of large reservoirs of methicillin-resistant S. aureus (MRSA) and Extended-Spectrum Beta-Lactamase (ESBL)-producing bacteria in Dutch livestock, this led to considerable socio-political pressure, with the government imposing 20%, 50% and 70% AMU reductions in livestock in 2011, 2013 and 2015, respectively. After an initial rapid AMU reduction (56% in 2013), mostly attributable to replacing group treatments, adopting herd health and treatment plans, guidelines, benchmarking systems and transparency in prescriptions, a 58% AMU reduction was reported in 2015, indicating that a 70% of higher AMU reduction would require more fundamental changes in the livestock production systems rather than in prescribing procedures alone. Indeed some structural differences in AMU still exist between Dutch livestock farms and overall AMU remains high in a subset of them, mainly because of the highly intensive nature of the Dutch farming industry. Moreover, in recent years AMU reduction has levelled off despite further reduction is sought after, particularly in broilers, weaned piglets and veal calves, whose groups now account for most AMU in Dutch livestock. An important counter argument is the increased economic burden placed on the farmers and eventually on the consumers through further restriction to veterinary AMU when this is needed for therapeutic purposes. A rise in livestock production costs would be unbearable in the highly competitive international agricultural market wherein the Dutch livestock industry relies heavily on exports. Providing the right conditions for incentivizing further AMU reduction in Dutch livestock requires an assessment of the potential impact on AMU and associated (negative or positive) financial effects of the available interventions aiming at keeping livestock healthy, on the principle that every infection prevented is an opportunity for no treatment. Policy makers and livestock producers would then be able to consider supporting the implementation of a specific intervention instead of another based their cost-effectiveness. These interventions include: (i) infection control (i.e. enhanced farm biosecurity and hygiene standards), (ii) animal husbandry practices (i.e. enhanced farm management, e.g. low-stock density farming, all-in/all-out production systems, rearing of slow-growing breeds, etc.), (iii) vaccination (for bacterial diseases, but also viral diseases often complicated by secondary bacterial infections). Indeed, there is still no quantitative evidence for the impact of these interventions on AMU, and even less evidence for their sustainability. Consequently, comprehensive recommendations to farmers about which interventions are most cost-effective and would best suit their specific situations in relation to the public health needs remain rather vague (e.g. as general statements like ‘increased vaccination’ or ‘improved biosecurity’) or are based on individual veterinarians’ personal experience and opinion. As a collaboration of two leading institutions in animal and public health in the Netherlands (Veterinary Medicine Faculty of Utrecht University and the RIVM) and using both existing and newly collected data, we will quantify in a scenario-based modelling framework the impact of different biosecurity/hygiene standards, vaccination schemes and husbandry practices on AMU reduction (overall and for specific antimicrobials) in broilers, weaned piglets and veal calves, including their cost-effectiveness. Determining the impact and feasibility of these interventions will provide livestock producers and policy makers with a management tool to set targets and draw plans for the implementation of those interventions with the highest potential for AMU reduction, and so decreasing AMR in a rational and sustainable way.

• prof. dr. J.A. (Arjan) Stegeman
• prof. dr. ir. D.J.J. (Dick) Heederik
• P. (Panagiotis) Mallioris
• dr. L. (Lapo) Mughini Gras

Campylobacteriosis is the primary zoonosis in Europe, causing over 1.6 M cases and €76 M costs annually in the Netherlands alone (~17 M people). Most cases are caused by Campylobacter jejuni and C. coli, which are widespread in livestock and wildlife, providing many ways for human exposure beyond just food. Despite all the research and control efforts in the food chain, there is no significant decrease in human campylobacteriosis. Up to 80% of human campylobacteriosis cases can be attributed to the poultry reservoir, but only ~40% of poultry-borne cases are attributable to poultry consumption; thus, many poultry-borne Campylobacter strains infect humans via other routes. Campylobacter is often found in environmental sources like surface water, indicating recent contamination with (animal) fecal material, but its environmental routes are still largely unexplored. While Campylobacter survives poorly outside the host, there are some environmentally adapted strains that play a key role in the transmission between animals and humans via the environment. Surface water is a ‘sink’ that collects Campylobacter strains from different hosts whose relative contributions are largely unknown, though wild birds are thought to play a major role. However, the devastating H7N7 bird flu epidemic hitting the Netherlands in 2003 showed that even without a huge drop in poultry consumption, the massive poultry culling and closure of poultry abattoirs to contain the epidemic was associated with a 44-50% drop in human campylobacteriosis where these measures were enforced, suggesting a major role of the environment in human exposure to poultry-borne strains. Moreover, while studies show that poultry and wild birds are the most important contributors to Campylobacter surface water pollution, their contributions vary with the size of the poultry production. The environment may also act as a source of Campylobacter (re)colonization in livestock. As the environment seems to be a key player in Campylobacter epidemiology and the non-foodborne side of campylobacteriosis receives little attention despite its potential to provide new targets for Campylobacter control and research, this project will discern the origins and spread of Campylobacter strains contaminating the environment and will determine their contribution to human campylobacteriosis morbidity, as well as the underlying (non-foodborne) transmission routes. As a collaboration of 4 leading institutes in public, animal and environmental health in the Netherlands (RIVM, CVI, UU and Alterra WUR), we will collect and type with a gene-by-gene approach (whole-genome multilocus sequence typing, wg-MLST) over 1200 C. jejuni/coli isolates representative of the Dutch eco-epidemiological situation from human cases, surface water (agricultural ditches, recreational waters, wastewater outlets), animals (broilers, layers, beef/dairy cattle, sheep/goats, pigs, pets), and wild birds (Anseriformers, Charadriformes, Columbiformes, Suliformes) using both well-established surveillance systems and ad hoc sampling schemes. We will: (i) characterize genotypically the strains circulating in surface water, animals and humans; (ii) quantify the contribution of different wild bird, farm and companion animals to Campylobacter pollution in different surface water types, seasons and areas with varying human, livestock and wild bird densities; (iii) quantify the contribution of different animal reservoirs and surface water to human campylobacteriosis in different seasons and areas with varying human, livestock and wild bird densities to estimate both the fraction of human cases attributable to the environment and the relation between human cases and reservoir density; (iv) determine the evolutionary history and relations of Campylobacter strains in the environment, humans and animals to understand their diversity and ecology, identify source-specific genetic markers, examine the role of the environment in the emergence of pathogenic strains, and perform source attribution at a high resolution; (v) conduct combined source attribution and case-control analyses to identify risk exposures for human campylobacteriosis of environmental origin and its underlying transmission routes. By depicting the epidemiology of non-foodborne campylobacteriosis, this project will allow for the delineation of more holistic control strategies, including those preventing Campylobacter dissemination into the environment. Besides standard scientific outputs, the results of this project will be translated into practical action points and advices for regulatory authorities on how to tackle environmental campylobacteriosis. The project members host national/international Campylobacter reference labs and participate since many years in advisory groups for the Dutch Ministries of Health and Economic Affairs, as well as the poultry industry, so through these forums knowledge gained in this project will be translated into interventions.

• dr. B. (Birgitta) Duim
• dr. A.L. (Aldert) Zomer
• dr. L. (Lapo) Mughini Gras
• dr. A.C. (Annemieke) Mulder MSc

• Eelco Franz (RIVM)
• Wilfrid van Pelt (RIVM)
• Hetty Blaak (RIVM)
• Ciska Schets (RIVM)
• Ralf Buij (WUR Alterra)
• Miriam Koene (WBVR)

• dr. B. (Birgitta) Duim
• ing. M.J. (Marian) Broekhuizen-Stins
• dr. E.M. (Els) Broens
• H. (Heleen) Zweerus
• A.J. (Arjen) Timmerman

• dr. N.E.M. (Nonke) Hopman
• prof. dr. ir. D.J.J. (Dick) Heederik
• prof. dr. Theo Verheij
• prof. dr. L.J. (Ludo) Hellebrekers
• dr. I.M. (Inge) van Geijlswijk
• dr. E.M. (Els) Broens

• Jan Prins
• Tjerk Bosje
• Marlies Hulscher
• Merel Langelaar

De doelstellingen van het Project Monitoring Zoönosen Gezelschapsdieren zijn het volgen van trends en het oppikken van ongebruikelijke signalen betreffende zoönosen en antimicrobiële resistentie bij gezelschapsdieren. Hiervoor worden twee bronnen gebruikt: de meldingen die binnenkomen via de telefonische help- en melddesk, en de informatie uit de routinediagnostiek van het Veterinair Microbiologisch Diagnostisch Centrum (VMDC). Onder andere door het analyseren van de trends in voorkomen van zoönotische agentia uit het lab informatie systeem. Voor bijzondere gevallen kan aanvullende diagnostiek ingezet worden. Tot slot maakt deelname aan het Signaleringsoverleg en het (mede) opstellen van VetInfect berichten deel uit van het project.

• drs. M.A.M. (Marloes) van Dijk
• dr. E.M. (Els) Broens