Open Access Highly Accessed Research article

Multi-criteria decision analysis as an innovative approach to managing zoonoses: results from a study on Lyme disease in Canada

Cécile Aenishaenslin1*, Valérie Hongoh1, Hassane Djibrilla Cissé2, Anne Gatewood Hoen3, Karim Samoura2, Pascal Michel14, Jean-Philippe Waaub2 and Denise Bélanger1

Author Affiliations

1 Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), Pavillon de la santé publique, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, CP 5000, Québec, Canada

2 Département de Géographie, Université du Québec à Montréal, Succursale Centre-ville, Montréal, CP 8888, Québec, Canada

3 Department of Community and Family Medicine, Geisel School of Medicine, One Medical Center Drive, Lebanon HB 7927, New Hampshire, USA

4 Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Saint-Hyacinthe CP 5000, Québec, Canada

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BMC Public Health 2013, 13:897  doi:10.1186/1471-2458-13-897

Published: 30 September 2013



Zoonoses are a growing international threat interacting at the human-animal-environment interface and call for transdisciplinary and multi-sectoral approaches in order to achieve effective disease management. The recent emergence of Lyme disease in Quebec, Canada is a good example of a complex health issue for which the public health sector must find protective interventions. Traditional preventive and control interventions can have important environmental, social and economic impacts and as a result, decision-making requires a systems approach capable of integrating these multiple aspects of interventions. This paper presents the results from a study of a multi-criteria decision analysis (MCDA) approach for the management of Lyme disease in Quebec, Canada. MCDA methods allow a comparison of interventions or alternatives based on multiple criteria.


MCDA models were developed to assess various prevention and control decision criteria pertinent to a comprehensive management of Lyme disease: a first model was developed for surveillance interventions and a second was developed for control interventions. Multi-criteria analyses were conducted under two epidemiological scenarios: a disease emergence scenario and an epidemic scenario.


In general, we observed a good level of agreement between stakeholders. For the surveillance model, the three preferred interventions were: active surveillance of vectors by flagging or dragging, active surveillance of vectors by trapping of small rodents and passive surveillance of vectors of human origin. For the control interventions model, basic preventive communications, human vaccination and small scale landscaping were the three preferred interventions. Scenarios were found to only have a small effect on the group ranking of interventions in the control model.


MCDA was used to structure key decision criteria and capture the complexity of Lyme disease management. This facilitated the identification of gaps in the scientific literature and enabled a clear identification of complementary interventions that could be used to improve the relevance and acceptability of proposed prevention and control strategy. Overall, MCDA presents itself as an interesting systematic approach for public health planning and zoonoses management with a “One Health” perspective.

Lyme disease; Lyme borreliosis; Multi-criteria decision analysis; Lyme disease prevention; Vector-borne diseases; Zoonoses; Public health decision-making