An appropriate response to emerging zoonoses requires close cooperation between medical, veterinary, food and wildlife professionals. Accordingly, a systematic One Health approach was developed and officially instituted for the purpose of sharing, assessing and responding to signals of new and re-emerging zoonotic infections in which medical, veterinary, food and wildlife professionals work together. In 2011, the Dutch Ministry of Health, Welfare and Sport and the Ministry of Agriculture, Nature and Food Quality formally adopted the integrated human-veterinary risk analysis structure as the Dutch national Zoonoses Structure.

The Zoonoses Structure consists of several steps (see Figure). Crucially, both medical and veterinary experts are involved in every step and other experts when needed. An important platform in this structure is the Signalling Forum for Zoonoses (SOZ), which conducts the initial assessment of signals. 

How the Signalling Forum for  Zoonoses works

The aim of the Signalling Forum for Zoonoses is to signal and assess zoonotic infections in humans and animals that may pose a public health threat. Representatives from the human, veterinary health and wildlife domains share and assess these signals in a monthly meeting. In the event that a threat is identified that may potentially be urgent, additional meetings are scheduled as needed on an ad hoc basis and the head of the RIVM Centre for Infectious Disease Control is notified. Subsequent steps within the Zoonoses Structure are considered, wherever possible based on a risk assessment. Veterinary and medical health professionals are updated monthly in an e-mail outlining relevant signals. 

Categories of signals

There are three categories of signals that meet the criteria for reporting a potential public health threat to the RIVM Centre for Infectious Disease Control. Once a threat has been reported, follow-up in the Zoonoses Structure may lead to various responses. 

1. An outbreak of an endemic zoonosis that exceeds the normal scope or severity

   Q fever was considered an endemic occupational zoonotic disease until a major outbreak occurred. The Signalling Forum for Zoonoses aims to identify outbreaks of such an endemic zoonosis at an early stage by combining veterinary and human health information. 

2. An outbreak of a zoonosis without sufficient options for treatment or prevention

   The first cases of Brucella canis were identified in dogs in 2016, all originating from countries in south-eastern Europe. Controlling brucellosis in dogs is also important to prevent human infection. The lack of previous cases in the Netherlands means that the legal framework for controlling the disease in dogs needs to be concretised. 

3. An emerging zoonotic agent with an unknown impact on public health

   Tick-borne encephalitis (TBE) is an inflammation of the brain caused by the TBE virus. Until recently, the virus only occurred abroad, but the virus was found in deer ticks in the Netherlands in the spring of 2016. There are several known cases of people having been infected by the virus in the Netherlands. Currently, the spread of the TBE virus and the risk of infection are being investigated. 

Members of the Dutch Signalling Forum Zoonoses (SOZ)

• GD Animal Health, Deventer
•Wageningen Bioveterinary Research (WBVR), Lelystad
• Faculty of Veterinary Medicine (FD), Utrecht University, Utrecht
•Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht
•Municipal Public Health Service (GGD)
• Dutch Wildlife Health Centre (DWHC), Utrecht
• National Institute for Public Health and the Environment (RIVM), Bilthoven