“This report of EFSA and the European Centre for Disease Prevention and Control presents the results of the zoonoses monitoring activities carried out in 2015 in 32 European countries (28 Member States (MS) and four non-MS). Campylobacteriosis was the most commonly reported zoonosis and the increasing European Union (EU) trend for confirmed human cases since 2008 continued. In food, the occurrence of Campylobacter remained high in broiler meat. The decreasing EU trend for confirmed human salmonellosis cases since 2008 continued, but the proportion of human Salmonella Enteritidis cases increased. Most MS met their Salmonella reduction targets for poultry. More S. Enteritidis isolates were reported and S. Infantis was confirmed as the most frequent serovar isolated from domestic fowl. In foodstuffs, the EU level Salmonella non-compliance for minced meat and meat preparations from poultry was low. Despite the significant increasing trend since 2008, the number of human listeriosis cases stabilised in 2015. In ready-to-eat foods, Listeria monocytogenes seldom exceeded the EU food safety limit. The decreasing EU trend for confirmed yersiniosis cases since 2008 continued. Positive findings for Yersinia were mainly reported in pig meat and products thereof. The number of confirmed shiga toxin-producing Escherichia coli (STEC) infections in humans was similar to 2014. In food, STEC was most frequently reported in meat from ruminants. A total of 4,362 food-borne outbreaks, including waterborne outbreaks, were reported. Bacteria were the most commonly detected causative agents, followed by bacterial toxins, viruses, other causative agents and parasites. The causative agent remained unknown in 33.5% of all outbreaks. As in previous years, Salmonella in eggs continued to represent the highest risk agent/food combination. The report further summarises trends and sources for tuberculosis due to Mycobacterium bovis, Brucella, Trichinella, Echinococcus, Toxoplasma, rabies, Coxiella burnetii (Q fever), West Nile virus and tularaemia.”
Eric Fèvre, University of Liverpool
There are fears that Africa’s next major modern disease crisis will emerge from its cities. Like Ebola, it may well originate from animals. Understanding where it would come from and how this could happen is critical to monitoring and control.
Growth and migration are driving huge increases in the number of people living in Africa’s urban zones. More than half of Africa’s people are expected to live in cities by 2030, up from about a third in 2007.
The impact of this high rate of urbanisation on issues like planning, economics, food production and human welfare has received considerable attention. But there hasn’t been a substantive effort to address the effects on the transmission of the organisms – pathogens – that cause disease. This is despite several influential reports linking urbanisation to the risk of emerging infectious diseases.
Africa’s cities are melting pots of activity and interaction. Formal and informal trading take place side by side. The wealthy live alongside the poor, livestock alongside people and waste is poorly disposed of near food production areas.
This degree of mixing and contact creates an opportune ecological setting for pathogen transmission for a variety of bugs. Already approximately 60% of human pathogens are zoonotic. This means that three out of five human diseases are transmitted from animals. Scientists predict that this is set to increase and that about 80% of new pathogens will have zoonotic origins.
Emerging infectious diseases are a major concern to the global public health community, both in terms of disease burden and economic burden. Understanding the processes that lead to their emergence is therefore a scientific research priority.
Over the last five years I have been working with a group of researchers to understand what leads to the introduction of pathogens in urban environments and how those then emerge in the human population.
Investigating the pathogens we already know about can help us understand the mechanisms and processes that underlie the emergence of new pathogens.
The questions that need to be addressed are:
What’s been lacking from a public health perspective are studies linking wider ecological systems – such as intensive farming systems – to disease emergence and human social organisation. Also missing are studies that investigate the diversity of micro-organisms at a genetic level in these settings – a field called microbial genetics. This kind of research is not often undertaken on a meaningful scale.
The work that we’ve been doing in Kenya’s capital Nairobi aims to go some way towards plugging this gap.
Our Urban Zoo project, funded by the UK Medical Research Council and other UK research councils, has focused on livestock as a major source of emerging zoonotic diseases. This is a critical interface as 40% of known livestock pathogens (200 species) can infect humans.
We’ve been taking a landscape genetics approach to understand how urban populations connect to livestock. This means we study the pathogens and their hosts from an ecological perspective. It’s a fascinating way to do science on a big scale. We investigate humans in different socio-economic groups, the peri-domestic wildlife that live around them, the livestock they keep and the livestock that feed them.
Our method of choice is to explore the diversity of the bacterium Escherichia coli as an exemplar. E. coli is an excellent microbe to study for this purpose. It is zoonotic, exists in many hosts and in the environment, and can be found in food products of animal origin.
We have also been:
As a global scientific community, and as providers of evidence to those who make policy, we need to be able to explain the mechanisms behind issues such as this. Only when we have achieved this will the risk of disease emergence in these settings be relevant to those responsible for mitigating its occurrence. The risks must be balanced against the benefits of allowing city environments to provide a livelihood for their residents.
Eric Fèvre, Professor of Veterinary Infectious Diseases, University of Liverpool
This article was originally published on The Conversation. Read the original article.
An excellent recent review by Hasselle et al., (2016) argues that understanding the form and function of the wildlife-livestock-human interfaces could provide clues on how to mitigate risks of disease emergence.
That shifting focus from the pathogen to the processes underlying emergence and also from single pathogen studies to multi-pathogen studies might facilitate rapid detection of pathogen emergence.
They further point out that anthropogenic influence on ecological systems dictate the level of risk of zoonotic disease emergence as compared to wildlife and domestic animal reservoirs.
From these findings we could certainly conclude that urbanization, especially in developing countries, could be propagating disease emergence especially where we have such intimate wildlife-livestock-human interfaces. Further probing for establishment of “One Health” surveillance systems.
Access the full paper here:
Hassell, J. M., Begon, M., Ward, M. J., & Fèvre, E. M. (2016). Urbanization and Disease Emergence: Dynamics at the Wildlife–Livestock–Human Interface. Trends in Ecology & Evolution. doi:10.1016/j.tree.2016.09.012
How different interfaces interact and drivers propagate disease emergence; Image source: http://dx.doi.org/10.1016/j.tree.2016.09.012
Following the inception of IDSR strategy, the reporting system has been evolving. Before then, there was no surveillance reporting system for priority diseases. At the inception, the existing reporting challenges resulted in district reporting rates of 30% and below, with even lower health facility reporting rates. The system was largely paper-based. Health facilities reviewed records and summarized data of priority diseases on a form that was relayed to the district (currently called sub-county) offices by fax, hand delivery, courier or email by end of business every Monday. Districts likewise collated the health facility reports manually onto a summarized form and relayed it to the province and national level using fax, hand delivery, courier or email by end of business every Wednesday. The national focal offices received the data forms from districts and submitted them to data management officers for manual entry into computers for analysis.
In 2007, then Disease Outbreak Management Unit (DOMU) at MOH resolved to develop an electronic database that would meet the evolving information needs. With the support from partners, an Epi Info electronic database was established at Afya House. Facilities sent their data to districts for aggregation and onward transmission to the National. Penetration and availability of mobile phones services among health workers also offered opportunities to improve reporting. Health workers at periphery begun to use unstructured Short Message Services (SMS) messages to report to the next level in order to beat timelines and other challenges related to hard to reach areas.
A study on IDSR reporting showed that for districts that had achieved >80% reporting rate (RR), about 62% of the health facilities (HFs) used SMS based reporting while 31% had used hand delivery method. For districts that achieved <80% RR, about 63% of HFs used hand delivery method whole 28% used SMS based reporting. The study concluded the use of SMS based reporting had a positive association with surveillance RR [4] Justification to embrace an innovative mobile phone-based reporting platform was strongly building up.
In 2011 the Ministry of Health with support from partners (WHO, CLinton Health Access Initiative, Hewlette-Packard, and Strathmore University), innovated eIDSR, a web based system to overcome challenges of sending data from sub-county to the county and national level. The desired goal was to have data relayed from the facility top a central server, but due to challenges of inadequate resources this was not realized.
Currently, data from health facility is transmitted to the sub-county transmission on paper-based standardized tools. The system transits at sub-county level into web-based eIDSR platform where the hard copy data from the facility is keyed in for onward transmission to the county and national.
While significant leaps on IDSR have been realized, bottlenecks exist that form potential areas for improvement. The web-based system (eIDSR) that rests at the sub-county, does not allow facilities on suspected outbreak cases and public health events are not availed on time as required to allow timely execution of necessary public health action. In addition, several officers manually handle data before it reaches destination, thus data is prone to high chances of errors.
To address the observed gaps in the existing eIDSR system for immediate reporting, the MOH in collaboration with the JICA_AMED SATREPS project piloted and established a mobile SMS-based disease outbreak alert system (mSOS). The pilot was conducted in Busia and Kajiado counties for six months [5,6]. A stakeholders meeting was held in June 2015 and findings and recommendations were shared. (In the meeting, salient issues were raised and recommendations were shared to improve and roll-out the system to other regions in the country [7-9]. In order to foster sustainability of the system, it was necessary to integrate the immediate and weekly reporting reporting of IDSR data and immediate disease reporting system (mSOS) into the National District health Information System (DHIS) platform [10].
mSOS/IDSR Weekly Mobile Reporting System
Mobile SMS-based disease Outbreak alert System (mSOS)/Integrated Disease Surveillance and Response (IDSR) Weekly Mobile Reporting System is designed for real-time information sharing and prompt response disease outbreaks and public health events.
The system is intended for health facility in-charges to report the following:
The system was developed by the Ministry of Health in Kenya (Disease Surveillance and Response, Health Information System, ICT, eHealth, Zoonotic Disease Unit, Disaster Response) within the DHIS2 system, through collaborations with World Health Organization (WHO), Centres for Disease Control (CDC), Japan International Cooperation Agency (JICA) and United STates Agency for International Development (USAID).
Figure 2: mSOS/IDSR Weekly Mobile Reporting System
IDSR Weekly Reporting (MOH 505)
There are 36 disease and conditions that require weekly reporting in the MOH 505 form. Existing IDSR reporting system is incapable of real time reporting from facility to higher levels for public health action. In the new mSOS/IDSR Weekly Mobile platform, health workers at facility level will be able to submit disease surveillance data using mobile phones. The mSOS/IDSR Weekly Mobile application is hosted in the DHIS2 platform for affordability and sustainability amidst competing healthcare priorities.
Disease surveilance focal person of the in-charge of the health facility have rights in the mobile pltform and is expected to report every Monday as stipulated in the IDSR national technical guidelines.
The SUb-county Disease Surveillance Coordinator (SCDSC) oversees surveillance activities within the sub-county. He/she validates, responds and submits the data into the server and gives feedback. In the event that the SCDSC does not verify data in the system by Wdnesday of every week, the system wil assume that the sub-county has not reported. County Disease Surveillance Coordinators (CDSC) have rights to view, comment and provide feedback in support for the sub-counties within their counties.
Health Records and Information Officers (HRIO) at County and Sub-county levels provide administrative and technical support for the system hosted in the DHIS platform. This includes, troubleshooting and continued training in DHIS2.
Table 1: IDSR Weekly Reporting
Immediate Reportable Diseases
The mSOS/IDST Weekly Mobile system enables health workers to report immediately reportable disease on real time basis as required in the IDSR national technical guidelines. There are a number of disease and conditions requiring immediate reporting within 24 hours.
![Table 2: Disease, conditions or events requiring immediate reporting (within 24 hours) [3]](https://i0.wp.com/www.momanyink.com/wp-content/uploads/2016/10/mSOS_Table-2-1.jpg?resize=1080%2C994&ssl=1)
Table 2: Disease, conditions or events requiring immediate reporting (within 24 hours) [3]
Once data is reported, the server synchronizes and raises alerts via SMS and emails of designated managers to trigger response action. Responsible disease surveillance officers are expected t respond and record the initial response measure via the web portal.
Alerts generated through the DHIS2 platform will be relayed to the Emergency Operation Centre (EOC) for analyses and further public health action. Analyses of the occurrence of events, response actions taken, time between reporting and response are availed for evaluation.
Public Health events
The mSOS/IDSR Weekly Mobile sytej enables health workers to report public health events on real-time basis as required in IHR 2005. There are a number of conditions and events requiring immediate reporting within 24 hours.
Disease outbreak rumours, the location of the occurrence of the event, the number affected and deaths are reported in mSOS/IDSR Weekly Mobile Reporting System. Once data is reported, the server synchronizes and raises alerts via SMS and emails of designated managers to trigger response action. Responsible disease surveillance officers are expected to respond and record the initial response measure via the web portal.
Alerts generated through the DHIS2 platform will be relayed to the Emergency Operation Centre (EOC) for analyses and further public health action. Analyses of the occurrence of events, response actions taken, time between reporting and response are availed for evaluation.
Surveillance Indicators
Surveillance Data Flow
Weekly Data (MOH 505)
The surveillance focal person at health facility level submits surveillance data into DHIS2 via mobile phone or computer
Sub-county Disease Surveillance Coordinator does verification and validation before the data is submitted to the server. In the event that the verification is not completed by Wednesday, the system assumes that the sub-county did not report. County and National levels access the ddata after the data is submitted to the server.
Immediately Reportable Diseases
Surveillance focal person of health facility in-charge submits data for immediately reportable diseases real-time (or within 24 hours) of detection into the system. The disease and conditions are specified in Table 2.
Alert messages, surpassing thresholds, are automatically raised via SMS and email to Sub county, County, and National focal person real-time.
Public Health Events
Surveillance focal person or health facility in-charge submits data for public health events, including rumours from community real-time (or within 24 hours). The events are specified in Table 3.
Alert messages, surpassing thresholds, are automatically raised via SMS and email to Sub county, County, and National focal person real-time.
Primary source of information
Rachel Wanjiru, Ian Njeru, mSOS/DST Weekly Mobile Reporing Stakeholders, John Gichangi, David Kareko, Annastacia Muange, Sophia Karanja, Ngina Kisangau, Boniface Waweru, Raphael Pundo, Oliver Munyao, Steve Waweru, Daniel Langat, Lyndah Makayotto, Mitsuru Toda (2016) mSOS/IDSR Weekely Mobile Reporting: Training Manual, Ministry of Health Kenya, Nairobi
References
[1] Division of Disease Surveillance an Response (DDSR). IDSR STrategy. Available from: http://www.ddsr.or.ke/idsr/strategy.php
[2] World Health Organisation, International Health Regulations (2005), 2008.
[3] Ministry of Public Health and Sanitation, Integrated Disease Surveillance and Response in Kenya: Technical Guidelines 2012, 2012
[4] Njuguna, C., Integrated Disease Surveillance & Response (IDSR) Strategy in Kenya, 2010, WHO KEnya: Nairobi
[5] Mendoza, G., et al., mSOS: Using mHealth to strengthen real-time disease surveillance and response in Kenya, in mHealth Compedium, M.S.f.H. African Strategies for Health, Editor 2014, USAID: Arlington, VA.
[6] Minstry of Health Disease Surveillance and Response Unit. Mobile SMS Based Disease outbreak Alert System. 2015 Available from: http://ddsr.or.ke/mSOS/about
[7] Njeru, I., et al., mSOS (mobile SMS-based disease outbreak alert system) Preliminary Report, 2015, Disease Surveillance and Response Unit (DSRU) at the Ministry of Health: Nairobi, Kenya.
[8] Japan International Cooperation Agency. mSOS: A versatile Tool for Disease outbreak Alert. 2015 June 5, 2015. Available from: http://www.jica.go.jp/kenya/english/office/topics/150605.html
[9] Japan International Cooperation Agency. Meeting with Mr. James Macharia, cabinet Secretary, Ministry of Health. 2015. Available from: http://www.jica.go.jp/project/english/kenya/006/news/general/150708.html
[10] Ministry of Medical Services. Ministries of Health Launch District Health Information System. 21 Feb 2012 5 July 2012. Available from: http://www.medical.go.ke/index.php?option=com_content&view=article&id=136:ministry-of-health-launch-dhis-software&catid=34:news-and-events&itemid=62