Bats, People and a complex web of disease transmission

Bats, People and a complex web of disease transmission

Bats, People and a complex web of disease transmission

It might seem strange that after millennia of human history, outbreaks of new, ’emerging’ diseases that we’ve never seen before still regularly occur around the world, some of which go on to become pandemic. However, this may not be so surprising considering how quickly and how intensively the world is changing – expansion of populations, industries, and travel and trade networks are all thought to play a role.

BatsMany current strategies to deal with emerging diseases are reactive, rather than proactive, i.e. the response is focused on dealing with outbreaks after they happen. But what if we could improve our response by projecting where the next outbreak will be and how it will occur? Or better yet, prevent it altogether?

This is the aim of the PREDICT programme, a consortium of worldwide disease biologists. Working with several PREDICT members from the EcoHealth Alliance, our team at University College London, in collaboration too with the STEPS-led Dynamic Drivers of Disease in Africa Consortium, aimed to quantify how these global changes affect the risk of emerging bat-borne viruses.

Bats and disease

The majority of human diseases are zoonoses, that is, they originate via transmission from animals, and bats are no exception. Many devastating viral outbreaks of the last 15 years are suspected to have their origins in bats, from Nipah virus disease in 1999 and SARS in 2002 to the recent outbreaks of Ebola disease and Middle East respiratory syndrome (MERS) in the last several years.

We started by mapping out the potential distribution of each of the 33 viruses shared between bats and humans, collaborating with the Vonhof group at Western Michigan University who have been collecting together data on all viruses known in bats, and which species they infect.

Next, we collected together spatial data on global changes and the wider environment, as well as human density and agriculture. This also included data on domestic animals as bat viruses can sometimes reach people through our livestock, and bushmeat hunting, as bats are hunted and consumed in many parts of the world. It’s critical to understand not just whether these factors affect disease emergence, but also through what means.

Virus risk hotspots

We grouped factors together depending on whether they were likely to increase risk through either increasing richness of viruses (the total number of viruses present) or increasing transmission potential from contact between bats and humans.

Using spatial statistical modelling, we then combined all of this into a single risk map. What we see from this is that, overall, there is a large hotspot of risk in sub-Saharan Africa, including West Africa, where the most recent Ebola virus outbreaks have occurred.

Global map of risk of bat-human shared viruses from statistical model based on ecological and human drivers.

However, when we break down the model into whether the risks occur through richness of viruses or bat-human contact, the resulting maps look very different. Central and South America seem to be a risk hotspot because a naturally high diversity of viruses occurs there, and associations in our model suggest this is a result of a high diversity of bat hosts. Contrastingly, South and East Asia seem to a be a risk hotspot because of high bat-human contact potential, a reflection of high densities of humans and domestic animals, as well as bushmeat practices in some areas.

This tells us something critical – that those places where wild bat populations host many viruses do not seem to be the same as those places where people frequently come into contact with bats, and that both contribute to risk in a different way.  Our risk maps take that first step in untangling the complex, multi-step process behind the emergence of a new bat-borne virus in humans.

One Health

In the last decade, there has been a real shift in the way public health is viewed to a much more modern, holistic – or ‘One Health‘ – approach. This acknowledges that animal health and human health are fundamentally connected through our wider ecology, and has guided much of our thinking in the Dynamic Drivers of Disease in Africa Consortium.

Future work will be able to delve deeper into the specific connections between bats and people that could help prevent future disease outbreaks. Although there is much we have yet to understand, what is clear is that bats should not be vilified for their association with emerging diseases. They can be key contributors to environmental stability and ecosystem services, and – admittedly, more sentimentally – they’re fascinating animals, whose world we’ve only just ventured into.

Kate Jones is Professor of Ecology and Biodiversity at University College London and a partner in the STEPS-led Dynamic Drivers of Disease in Africa Consortium. She will be speaking at the One Health for the Real World: zoonoses, ecosystems and wellbeing symposium, being held at the Zoological Society of London, 17-18 March 2016.

Quantifying Global Drivers of Zoonotic Bat Viruses: A Process-Based Perspective’, authored by Liam Brierley, Maarten J. Vonhof , Kevin J. Olival, Peter Daszak and Kate E. Jones, is published in The American Naturalist.

Article originally appeared on the Steps Centre website at: http://steps-centre.org/2016/blog/bats-people/ authored by Kate Jones and Liam Brierley on 5th January 2016

Kate Jones and Liam Brierley
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Scientists Study Slums for Signs of Spreading Superbugs

Scientists Study Slums for Signs of Spreading Superbugs

Scientists Study Slums for Signs of Spreading Superbugs

The next superbug could emerge from the slums of the developing world, researchers warn.

Rapid, unplanned growth in many urban areas has people, livestock and wildlife living in close proximity and with inadequate sanitation. These are ideal conditions for microbes to evolve and spread.

So a major project is underway, designed to shed light on how microbes move through the slums of Nairobi and beyond.

It’s known as the Urban Zoo project. “Zoo” is short for zoonosis, the spread of diseases from animals to humans. From salmonella to swine flu, that’s how we get most of our diseases.

Slum farm

But “zoo” also suggests the menagerie of creatures found in Nairobi’s slums that could carry those diseases.

At the garbage dump in Nairobi’s Viwandani neighborhood, people, goats and Marabou storks pick through the trash side by side. (Credit: S. Baragona/VOA)

At the garbage dump in Nairobi’s Viwandani neighborhood, people, goats and Marabou storks pick through the trash side by side. (Credit: S. Baragona/VOA)

Fenced in by sheets of rusting corrugated metal in Nairobi’s Viwandani neighborhood, Joseph Mwai and his family share a couple thousand square feet with three cows, a handful of chickens, about a dozen goats and a small herd of pigs.

These are far from optimal conditions for raising livestock. But Mwai says he doesn’t have much of a choice.

“It’s important to me because I don’t have any job to do,” he said. “I make a living from them.”

A garbage dump smolders behind Mwai’s tiny homestead, across a stream polluted with raw sewage. People, goats and Marabou storks pick through the trash side by side, looking for anything useful or edible. Plastic bags are pulled from the heaps, rinsed in the contaminated river and resold.

It’s a rich environment for the spread of bacteria and other microbes.

Gene swappers

The Urban Zoo project is watching one microbe in particular: E. coli.

Mostly harmless, E. coli usually leads a quiet life in the digestive tract of warmblooded animals, from humans to birds to mice.

But some strains cause disease. And it’s of special interest to researchers for two other reasons.

Molecular biologist John Kiiru studies drug-resistant bacteria spreading in Nairobi’s slums at the Kenya Medical Research Institute. (Credit: S. Baragona/VOA)

Molecular biologist John Kiiru studies drug-resistant bacteria spreading in Nairobi’s slums at the Kenya Medical Research Institute. (Credit: S. Baragona/VOA)

First, it can spread easily and widely, according to molecular biologist John Kiiru with the Kenya Medical Research Institute. He explained, “E. coli is able to survive in the environment and it can also be shared between humans and animals.”

And E. coli are exceptionally good at swapping genes with other microbes, including genes that transform harmless bacteria into dangerous germs, or that render them immune to antibiotics.

These genes “can actually be transferred to other organisms which could be pathogenic,” Kiiru said.

That’s not a hypothetical. Kiiru says his team has identified E. coli that are resistant to four antibiotics, then found that same resistance pattern spreading to another germ, salmonella.

“And when we sequenced and analyzed these resistances,” he said, “we found that the same block of resistance genes that we had found in E. coli were actually now in salmonella.”

Even more concerning: Cholera germs may have picked up those resistance genes as well. “What you end up creating is a superbug” that’s highly virulent and highly resistant, Kiiru said.

Germ movement

But scientists know very little about how any bacteria move through this complex environment.

So the Urban Zoo project is visiting 99 households across Nairobi, rich and poor, with livestock and without. They’re taking samples from people, their animals, and whatever wildlife they can find nearby (and catch): storks, mice, bats, et cetera. They’re sampling the ground around homes, yards and livestock pens with white paper booties.

The aim, says University of Liverpool veterinarian Judy Bettridge, is “to try and understand on a small scale how those bacteria are shared” among each household’s people, livestock and environment. “And then when we scale it up, are the bacteria here being shared with the household that’s 50 meters over there? Or 100 meters over there? So, how far can they actually spread?”

Once they find out, Kiiru says, the researchers need to be sensitive about how they present their results. Livestock are technically illegal in the city, but they are important sources of food and income.

And they don’t want to make pariahs of people who are already marginalized.

“We are not necessarily investigating who is spreading the resistant or the virulent organisms,” he said. “But actually we are trying to solve a problem.”

Food networks

Another question is the role that food plays in spreading those bacteria. Mwai’s city livestock are one small part of the vast network that delivers meat, milk and eggs throughout Nairobi.

The Urban Zoo project is mapping those routes. In this modernizing East African capital, that includes everything from shiny, modern supermarkets to grimy street-food stalls.

Street food and other informal vendors are especially important in communities like Viwandani, where many people don’t have time — or kitchens — to prepare their own meals.

WATCH: Small Shops in Nairobi Get Food Safety Training

0:00:00

“You can find [residents] depending entirely on the [informal] food vendors,” says Nicholas Ngomi with the African Population and Health Research Center. That makes street-food hawkers and cooks in tiny corner shops key to protecting the health of Viwandani’s residents, he adds.

But food poisoning is rampant here. As Urban Zoo researchers mapped Viwandani’s food networks, they talked with these informal cooks about foodborne disease. One request kept coming up, Ngomi said: “ ‘Teach us about how these diseases come about.’ ”

The project didn’t have much money to spare. But they set up a half-day training session for 25 neighborhood food handlers.

Lessons in food safety

They covered the basics: how to wash hands, produce and cutting surfaces, plus basic microbiology and food spoilage.

James Kuria, owner of the 11th Hour Butchery, learned that the meat that hangs in bright red slabs in his shop window goes bad quickly without refrigeration.

After learning how quickly meat spoils without refrigeration, butcher James Kuria buys less and keeps it for less time. (Credit: S. Baragona/VOA)
After learning how quickly meat spoils without refrigeration, butcher James Kuria buys less and keeps it for less time. (Credit: S. Baragona/VOA)

“If it will last here for long, it will maybe bring some diseases to my customers,” he said. Now he only buys enough to last a couple of days. That also means he throws away less, he added, which cuts his losses.

For Charity Nyambura, who sells rice, beans and vegetables at a nearby street stall, the big discovery was that her cutting boards can harbor bacteria.

“When you cut the kale there are particles that come off the board, and you unknowingly give them to the customers along with the kale,” she said. “So, they eat the particles in the food and in the long run it affects their health.”

Now she washes her cutting boards, knives and vegetables before she starts chopping.

Only a few hawkers got training. But success breeds imitation, Nyambura said.

“In this business there’s a lot of competition,” she said. “They’re always trying to copy what I’m doing so they can also try and get customers.”

Charity Nyambura was one of 25 food vendors in Viwandani who received basic food safety training. (Credit: S. Baragona/VOA)

Charity Nyambura was one of 25 food vendors in Viwandani who received basic food safety training. (Credit: S. Baragona/VOA)

The hope is that other vendors will copy Nyambura, Kuria and the other trainees, so food safety practices will spread through the neighborhood, slowing the spread of illness.

Ultimately, the Urban Zoo project aims to provide evidence that will help policymakers improve conditions in Nairobi’s slums.

They are already making worrying discoveries.

“We have started seeing resistance among organisms that are easily recovered from animals or animal food products,” Kiiru said. “This evidence is going to give us a chance to … confidently tell the government, ‘We think there’s a challenge. Let’s improve the sanitation, the hygiene.’ ”

Originally appeared at the Voice of America website: http://www.voanews.com/content/scientists-study-slums-signs-spreading-superbugs/3116155.html

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Current drivers and future directions of global livestock disease dynamics

Current drivers and future directions of global livestock disease dynamics

Current drivers and future directions of global livestock disease dynamics

The article: Perry, B.D., Grace, D. and Sones, K. 2013. Current drivers and future directions of global livestock disease dynamics. PNAS 110(52): 20871-20877

The authors review the global dynamics of livestock disease over the last two decades. They state, “Our imperfect ability to detect and report disease hinders assessment of trends” but they suggest that, although endemic diseases continue their historic decline in wealthy countries, poor countries experience static or deteriorating animal health and epidemic diseases show both regression and expansion.

They further state that at a mesolevel, disease is changing in terms of space and host, which is illustrated by bluetongue, Lyme disease, and West Nile virus, and it is also emerging, as illustrated by highly pathogenic avian influenza and others. Major proximate drivers of change in disease dynamics include ecosystem change, ecosystem incursion, and movements of people and animals; underlying these are demographic change and an increasing demand for livestock products.

The authors identify three trajectories of global disease dynamics:

  1. the worried well in developed countries (demanding less risk while broadening the circle of moral concern),
  2. the intensifying and market-orientated systems of many developing countries, where highly complex disease patterns create hot spots for disease shifts, and
  3. the neglected cold spots in poor countries, where rapid change in disease dynamics is less likely but smallholders and pastoralists continue to struggle with largely preventable and curable livestock diseases.

Originally appeared at: https://cgspace.cgiar.org/handle/10568/3673

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Fifteen Years After To Err is Human: A Success Story to Learn From

Fifteen Years After To Err is Human: A Success Story to Learn From

Fifteen Years After To Err is Human: A Success Story to Learn From

In late 1999, the Institute of Medicine released To Err is Human, a report that grabbed the world’s attention. It stated that up to 98,000 patients die each year in the United States from medical errors.  But little was done to reduce infections and other harms at that time.

In the article, Fifteen Years After To Err is Human, Dr. Peter J. Pronovost, Sr. Vice President for Patient Safety and Quality, Director of the Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine joined co-authors from HHS, CDC and ARHQ to highlight a key success story in protecting patients. Combined and coordinated efforts to reduce central line associated bloodstream infections (CLABSI) infections turned the tide in thinking that healthcare-associated infections were inevitable, instead showing clinicians and policymakers that these infections can be prevented by great numbers and patient mortality can be decreased.

The authors detail how a change in attitude, driven by five essential elements has led to national success in reducing CLABSI rates. These essential elements include:

  • Reliable and valid measurement systems
  • Evidence-based care practices
  • Investment in implementation science
  • Local ownership and peer learning communities
  • Align and synergize efforts around common goals and measures

In 2009, a national five year CLABSI prevention goal was set at 50% following this approach. By 2013, infections were reduced by 46% in intensive care units.

For more on this success story and insights into the components which led to the dramatic reductions in CLABSI, please visit: BMJ Quality & Safety website.

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Global Disease Detection Stories: Tracking and Taming Zoonotic Diseases in South Africa

Global Disease Detection Stories: Tracking and Taming Zoonotic Diseases in South Africa

Global Disease Detection Stories: Tracking and Taming Zoonotic Diseases in South Africa

A One Health program in South Africa connects physicians and veterinarians to better understand causes of human disease by looking at animals in a new light.

How do you tonsil swab a wild African buffalo? More importantly, why? The answer is that buffaloes are reservoirs for certain “zoonotic” diseases, or diseases that can be passed from animals to humans. Many infectious diseases (such as rabies and Rift Valley Fever) are transmitted through animals, which is why tracking animal diseases that could potentially jump to humans is a crucial aspect of public health. Early detection means spotting these diseases in animals before they make people sick.

Tracking disease in a national park

Dr. Marietjie Venter of the Global Disease Detection program in South Africa, visited Kruger National Park along with Jumari Steyn, a PhD student from the University of Pretoria. As part of a wildlife surveillance program, a skilled group of veterinarians sampled 30 buffalo in three hours. They swabbed tonsils and collected blood, fecal, and stomach content to investigate foot and mouth disease (FMD), which can cause major outbreaks in cattle if they come into contact with infected buffalo.

“Early detection means spotting diseases in animals before they make people sick.”

While buffalo are natural reservoirs for FMD, they are also thought to carry Rift Valley Fever, bovine tuberculosis, and other bacteria and viruses that could potentially spread to humans. The University’s research unit will use the collected samples to investigate for these zoonotic diseases which have been detected in wildlife, farm animals and humans.

An expanded partnership between the Centers for Disease Control and Prevention (CDC) South Africa and the University’s research unit improves surveillance capacity to include priority zoonotic diseases in the region: anthrax, brucellosis, rodent- and bat-borne pathogens, and many others. It also adds additional data collection sites and enhances reporting.

Bridging animal health and human health

Tracking diseases in domestic animals and wildlife has been happening for a long time, but linking that information to humans who are sick or could become sick has not. South Africa has strong surveillance systems; CDC’s role has been to support and expand them through its One Health program.

Buffalo are natural reservoirs for foot and mouth disease.

Buffalo are natural reservoirs for foot and mouth disease.

While it makes sense to get human and animal experts together, this is not an easy task. The One Health initiative has programs all over the world and builds bridges between people who may not otherwise work together. The success of the program lies in the regularity of the exchanges. One Health programs explores connections between human health, animal health, and the environment, bringing together experts in fields as diverse as climate change, farming practices, and wildlife management. According to Dr. Wanda Markotter, the Principal Investigator for CDC’s original agreement with the University of Pretoria, “This new project will significantly enhance the collaboration between the Health and Veterinary faculties to develop joint surveillance and diagnostic programs on zoonotic disease in South Africa and provide feedback to the Ministries of Health and Agriculture in South Africa.”

So back to that buffalo. Are you curious about how those specimens are collected?

       Step 1: Tranquilizer dart.
Step 2: Apply blindfold.
Step 3: Drag with tractor to recovery area.
Step 4: Collect sample.
Step 5: Provide tranquilizer antidote.
Step 6: Run! Doctors treating humans may want to count their blessings.

Originally posted at the CDC website under the Global Health Protection and Security at: http://www.cdc.gov/globalhealth/healthprotection/gdd/stories/south_africa_zoonotic_diseases.html

 

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