Can we learn more about human cancer from dogs?

Can we learn more about human cancer from dogs?

Can we learn more about human cancer from dogs?

The study of cancer through comparative oncology (the study of cancers in both humans and animals), in recent times, has provided invaluable insights on how the pet-dog is not only man’s companion but also plays an integral role in improving human health and well-being. More importantly, reiterating the added value of One Health (which is a collaborative and multidisciplinary approach to solving societal challenges) by acting or having the potential to act as sentinels (early warning systems) and models for studying, early diagnosis and treatment of human cancer.

Cancer is a devastating diagnosis and may have touched us at some point in our lives, either directly as a patient, or as a relative, friend, workmate or owner to a pet (Figure-1) that develops cancer. Worldwide, it continues to torment man and dog alike, with the global burden increasing in both species.

Figure 1: Lung cancer in a dog

Figure 1: Lung cancer in a dog

 In Kenya, cancer ranks as the number three cause of mortality in humans, after infectious diseases and cardiovascular diseases, with the number of cancer cases projected to nearly double by 2030. This has and will continue to escalate the ‘double burden’ of disease, with an accompanying dual effect of not only straining existing health-care systems but also causing loss of income to already poor families and posing cumulative economic losses. The challenge of addressing cancer in Kenya has been attributed to several technical, economic, infrastructural and social factors.

 The dog is of special interest compared to other laboratory and domestic animals in studying human cancer, because: it naturally and increasingly develops spontaneous cancer similar to humans, which could be as a result of the increasing ‘human-dog bond’ which increases their exposure to similar risk factors and environmental carcinogens (things that cause/initiate cancer). Moreover, the dog is phylogenetically closely related to man this is supported by the fact that, approximately all the 19000 genes identified in the dog match to a similar gene in the human genome. Astonishingly the clinical signs of cancer in dogs also have a close resemblance to those of humans (see Figure-2).

Figure 2: Clinical signs of cancer

Figure 2: Clinical signs of cancer

 Several studies have documented that pet-dogs respond to a number of environmental carcinogens, similar to the way humans do. For instance, the association between industrial activity and consequent bladder cancer has been established, with the dog having a shorter latent period of bladder cancer (10 years), as compared to man (20 years). Thus, humans and dogs do develop similar cancers when exposed to similar risk factors or carcinogens, and by inference, monitoring the health of pet-dogs will aid early identification and correlation between exposure to environmental contaminants and cancer in humans.

Published work in Nairobi (http://dx.doi.org/10.14202/IJOH.2016.42-57) shows that the common cancers in both male humans and dogs are those of the Prostate, the Respiratory tract, Lymphoma and Liver, while in females they are those of the Breast, Mouth, Liver and Lymphoma (see Figure-3 elaborating on lymphosarcoma). With the breeds commonly affected with cancer being those of the German Shepherd, cross breeds and Rottweilers, this could also be attributed to the high population ownership of those breeds as well.

Figure 3: Brief description of lymphosarcoma

Figure 3: Brief description of lymphosarcoma

 

 The high cases of prostate cancer in both male humans and dogs could probably be related to testosterone levels, with a lower occurrence in male dogs compared to humans probably due to dog castration/neutering. The high cases of mammary gland cancers in both dogs and humans, could be explained by the fact that a high proportion of females in both groups are entire (not spayed). Both humans and dogs have high cases of liver cancers which can be explained by the fact that both feed on common diets, specifically maize meal which is prone to aflatoxin contamination.

Clinically most cancers would appear as masses (see figure 4) and clinicians are inclined to surgically remove the mass and this is why the surgical method of treatment is a common therapeutic intervention in both humans and dogs to control or eliminate local cancer in an attempt to improve the quality of the patient’s life; while the medical approach is mainly used on palliative basis. Chemotherapy is also used in some cases (or in combination with surgery) mainly to ease pain and provide the highest quality of life in both humans and pet dogs.

Figure 4: Tumour of the mouth in dog


Figure 4: Tumour of the mouth in dog

 The co-sharing of some of the cancers by both humans and dogs fortifies that it may be possible to use dogs as models and sentinels in studying human cancers. This, therefore, reiterates the fact that developing joint animal-human cancer registries and integrated cancer surveillance systems may possibly lead to accelerated detection of the risks of cancer, especially in developing countries where cancer incidences have recently been shown to be spiking. This calls for more comparative research in this area in order to empower with information for giving collaborative policy guidelines in cancer prevention and control in both humans as well as animals. Since cancer prevention is one of the primary objectives in the government of Kenya, we (physicians and veterinarians-and their sub-groupings) have a responsibility to advise people and pet owners on the benefit of simple lifestyle changes as a means of reducing the risk of cancer in Kenya and other developing countries as well.

If you work in Veterinary Cancer Registry field, join the Global Initiative for Veterinary Cancer Surveillance https://www.givcs.org/

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Online disease reporting systems: rhetoric or reality?

Online disease reporting systems: rhetoric or reality?

Online disease reporting systems: rhetoric or reality?

Introductory remark

Generally, under the emblem of a One Health approach towards disease surveillance, the media and health professionals (Fig.1) have a critical role when it comes to disease surveillance and reporting.

Fig1. A clinical officer collecting field data from a respondent for surveillance purposes. Photo credit: ZED Group

The media are many times, alluded as “unofficial sources” when it comes to disease reporting while the Director of Veterinary/Medical Services and/or the County Directors of Veterinary/Medical Services are alluded as “official sources.” It is important to argue from a point of evidence and weigh the pros and cons of both and especially reiterating their complementation. I will try to convince you how these three systems complement each other and especially support the importance of having the open access online reporting systems (of which the media plays a huge role).

Categorizing the online disease reporting systems

 The term online disease reporting systems bring to mind initially three groups of disease reporting systems:
  • Open access systems such as ProMED-mail founded in 1994 (ProMED-mail, 1994), HealthMap founded in 2006 (Healthmap, 2006), which capture a wide range of disease outbreaks and others targeting a single disease/pathogen e.g. Global Ranavirus reporting system (GRRS, 2015) (it is important to note that both ProMED-mail and Healthmap, borrow alot of their information from the media as well as the official reporting systems such as WAHIS as well as WHO-DONs)
  • Closed access systems such as those at the level of government ministries using the DHIS2 web application (such as the Health Information System in Kenya (Fig.2) and Lebanon initiated by World Health Organisation (WHO, 2014) and also the Visual Confidentiality Mobility Report system in Los Angeles (Dibya, 2002).
  • Semi-closed systems such as the more recently launched EPICORE system which is trying to provide a platform of “verifying” or discarding the rumours from the media through the use of speciliasts to verify outbreak related information.

Fig2. The user interface of the Kenya Health Information System

Systems like ProMED-mail disseminates its information via email lists, websites and social media. Which is a free subscription service with over 75,000 subscribers in 180 countries. The accuracy and quality of all reports on ProMED-mail may be assured because all reports are screened by experts before posting (Woodall, 2015).

Benefits of online disease reporting systems

Several benefits or “added value” of online disease reporting systems are:

  • Provide early warning of outbreaks of infectious diseases, toxins and environmental contamination affecting humans, animals and food and feed worldwide e.g. Avian Influenza-H7N9 in China (ProMED-mail, 2016)
  • Ability to access the reports by mobile devices e.g. cell phones from locations without health services and therefore connection cost is not borne by the ministry of health e.g. HealthMap android App
  • Ability of the public to monitor and easy to understand visualizations of disease epidemiology such as the HealthMap e.g. Chronic wasting disease in deer in Oneida county-Wisconsin, click to view image-HealthMap-CWD-Wiscosin.png  (HealthMap, 2016)
  • Enhancing accuracy and accelerating the collection of reported information to a central point as compared to the old decentralized systems of using phoned/faxed reports that would result to lateness and full of errors (see SARS outbreak in Beijing (Healthxchange, 2013) which resulted to adoption of online systems) and the Visual CMR system in Los Angeles (Sarkar, 2002).
  • A more recent system (The EPICORE system Fig.3) is trying to provide a pathway of “verifying or discarding the rumours from the media.”

The EPICORE system interface. Visit the website to apply to be a member (https://epicore.org/#/home)

A case study from Kenya: The Emergency Operation Centre

I would like to reiterate the importance of all the three groups of systems working together in kind of an integration, that is more important than relying on one system. Let me try and clarify using a Kenya context based example as below: The Emergency Operation Centre (EOC) anchored within the Ministry of Health, specifically under the Disease Surveillance and Response Unit is part of Kenya’s Emergency Preparedness and Response programme. The EOC collects data from social media, websites of mainstream media, direct calls and other numerous sources regarding outbreaks and public events of health importance which they use to generate daily reports. Based on these reports they send out alerts to key people for actioning. This is a very good example of a system that has adapted to the technological growth of information for efficient and effective detection and response to outbreaks in Kenya. Of course, in the long run, verified information is important but the question is should we only respond to outbreaks based on the verified information or also on the preliminary information. In my opinion, both have a part to play in an outbreak/emergency scenario using different intervention mechanisms.

Conclusions

In conclusion, the online disease reporting systems have revolutionized surveillance systems and in future social media e.g. Twitter may become an invaluable source of disease outbreaks and it will be imperative to think of a way of advising the public on how to interpret and act on this information. In future, it may also be important for governments to integrate these ‘open access’ systems into their surveillance systems.

Online disease reporting systems provide an early/preliminary working strategy for public safety pending confirmation; for instance, the anthrax outbreak in wildlife in Kenya, if you check on ProMED-mail, the first alert was on 22nd July 2015 sourced from DailyNation (ProMED-mail, 2015a), while the second official report came from OIE on 27 August 2015 (ProMED-mail, 2015b). If the legal action could have been taken on August, 27 you can imagine what would have happened. This certainly informs us that the media and online open access reporting systems do have a role to play in disease surveillance and reporting but above and beyond that, they act as a quick and first line of “defence” termed as “early warning systems” (Madoff, 2004).

Remember to drop your questions, comments and feedback as well.

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A day working in the Zoonoses in Livestock in Kenya project: a case of One Health surveillance

A day working in the Zoonoses in Livestock in Kenya project: a case of One Health surveillance

A day working in the Zoonoses in Livestock in Kenya project: a case of One Health surveillance

What’s ZooLink?

The Zoonoses in Livestock in Kenya project abbreviated as “ZooLink”, seeks to develop an integrated surveillance system for fifteen (15) pathogens transmissible between humans and animals (zoonoses) piloted in three counties (Busia, Bungoma and Kakamega) geographically positioned in Western Kenya. In subsequent components, the project will: (1) validate, deploy and develop high-throughput laboratory assays for the targeted zoonotic diseases; (2) model their risk; (3) determine their socio-economic implications and (4) forecast how demographics, husbandry and genetics of livestock will change over time. An in-depth description of the project work packages is available on the project website avaulable at: http://www.zoonotic-diseases.org/project/zoolink-project/). My name is Dr Kelvin Momanyi and I work as a Research Assistant under this exciting project and in subsequent paragraphs, I will share with you “what a day working in “ZooLink” feels like in the context of our field activities from the animal team.

The tri-team structure

The ZooLink multi and trans-disciplinary operational field activities are implemented by three functionally interlinked teams: (1) the animal team (Fig.1) that collects, stores, delivers samples and electronically relays data related to livestock and their owners from the livestock markets and slaughterhouses; (2) the human team that collects stores, delivers samples and electronically relays data related to the human patients visiting county, sub-county and mission hospitals and; (3) the laboratory team that receives, processes and stores (long-term) the samples as recieved from both the animal and human teams.

Fig-1: A section of the field team examining, sampling and capturing metadata of a cow at the Koyonzo slaughterhouse

The sampling sites

A day in the ZooLink animal team normally starts at 5 am when visiting field sites far away i.e. Webuye, Chwele, Kimilili, Lubao, Webuye, Shinyalu, Malaba, and Angurai or at 5:30 am when visiting close-by sites i.e. Myanga, Butula, Funyula, and Koyonzo. There are 3 sampling days per week, where each selected livestock market, slaughterhouse and hospital is visited once every month.

The animal team is disaggregated into two intradisciplinary teams (the livestock market team and the slaughterhouse team). A day prior to the field activity the consumables for the two teams are prepared in two separate field carriers, one with a pink lid designated for the slaughterhouse as well as packing their coveralls in a red disposable bag and consumables for the livestock market team are packed in a yellow-lidded carrier with coveralls in a black disposal bag (Fig.2). The separation aims in seemless identification.

Fig-2: Field car fully packed and ready for dispatch to the field

Whom we work with 

The goal is to arrive at the field site at or before 7 am when abattoirs are designated to open. At the field site, the first stage is to gown-up with Personal Protective Equipment (coveralls and gloves) followed by role allocation which would fall into two categories i.e. data entry and animal sampling). At the livestock animal market, the first step is to inform the livestock market chairperson and/or the livestock market master of our presence and activities for the day (the chairperson is contacted a day prior to the visit). The livestock market chairperson/master would then help in identifying a local person to aid in animal restraint (a crucial step to ensure and assure the safety of the staff, the handler, the animal and other market participants). At the slaughterhouse, the meat inspector and slaughterhouse workers are informed of the day’s activities (the meat inspector is also contacted a day prior to the visit). Animal restraint, at the slaughterhouse, is normally undertaken by the field staff and with the occasional recruitment of an animal restrainer. Working in both the livestock markets and slaughterhouses is facilitated by closely working together with the County and sub-county Directors of Veterinary Services of the study sites.

In-training mentorship programme of the AHITI interns

Our multidisciplinary teams (human, animal and laboratory) also offer hands-on practical mentorship and training (Fig.3) to recent graduates from the AHITI (an animal health training institute in Kenya) who are attached to the project through a memorandum of understanding between the project and the training institute.

Fig-3: One of the AHITI intern under cohort 5 being trained on how to collect blood from a cow

Animal identification and consent

At both the livestock market and slaughterhouse the goal is to sample 10 animals (6 cattle, 2 sheep and 2 goats) as may be possible. At the livestock market, the animals are recruited randomly from each corner of the livestock market ring. Although in some markets there is no clear-cut demarcation of the market, hence a “virtual ring” is maintained. After the animal is recruited the owner is identified. The project is described to the owner using one of the two national languages (either English or Kiswahili) conversant to the respondent. The owner is informed of how the animal was recruited, the purpose of the project (Fig.3), the procedures to be undertaken, confidentiality of the information and on how feedback will be provided as pooled results at a later stage. If the animal owner accepts to participate in the study, animal sampling and data collection commences and if he/she declines he/she is thanked and the next animal is identified and recruited.

Animal sampling and human metadata collection

During animal sampling, two staff members examine and collect samples from the animal while the other takes notes, labels the samples and collects further metadata from the animal owner, (Fig.3) detailing the source of the animal, reasons for buying/selling, and the destination of the animal among others. When the owner is a farmer further information regarding other animals kept, history of treatment, vaccination and episodes of sudden death are recorded. If the animal is from a different county then a movement permit is requested and photo-captured.

Fig-3: Obtaining consent, explaining the project to a participant and sampling of a goat in one of the livestock market

Animal sampling involves the collection of baseline information about the animal, examining the animal for possible pointers (signs) to illness and collection of samples. Baseline information includes the breed, age, and gender of the animal; the pointers to illness (signs) include visually determining the demeanour, body condition score (prominence of the ribs and hip bones), haircoat, weight (extrapolated from measuring the heart girth), nature of the ocular mucous membranes (whether pale/anaemic, congested, jaundice, or cyanotic), presence of vesicles, sores or lesions in the mouth or feet; collection of samples: (1) Blood from the jugular vein (Fig.5) into a red-topped vacutainer for serum to investigate exposure to pathogens such as Brucella, Rift Valley Fever, purple-topped vacutainer for whole blood to investigate extracellular parasites such as Trypanosomes and intracellular parasites such as Coxiella burnetti, Anthrax and a green-topped vacutainer for heparinised blood to investigate the zoonotic Mycobaterium bovis;

Figure 5: Blood collection from the jugular vein of a pig at the Shinyalu pig slaughter slab

(2) Nasal swab (Fig.6) to investigate the methicillin-resistant Staphylococcus aureus;

Fig-6: Collection of a nasal swab at the Myanga livestock market

(3) Per-rectal fecal sample collection to investigate pathogens causing gastrointestinal infections such as Salmonella, E. coli, and Campylobacter; at the slaughterhouse level further samples collected include; (4) parasites such as the Fasciola spp from an infested liver; (5) tissue sample collection of affected organs such as a cyst from the liver/lung to investigate Echinococcus spp and other hydatid-causing pathogens or tongue to investigate Cysticercosis; (6) ear tissue sample collection (Fig.7) for genetic and breed-purity investigation (subsequent blog entries will describe in detail the pathogens and their role human disease burden, so stay tuned);

Fig-7: Ear tissue collection from a cow at the Amukura livestock market

(7) Tick samples (Fig-8) from infested animals are collected to further detect disease-causing pathogens.

Fig-8: Tick samples are collected and stored for further investigation

Data entry and relay

The first stage of the data entry process, at the field, is to barcode all the samples (blood, faecal, nasal swabs, tissues). The barcodes help to uniquely identify the samples and help in sample tracking. The data is entered with the aid of the Gather® application installed in the project’s mobile devices (Fig-9).

Fig-9: Data entry using a mobile device installed with the Gather® application

The first stage is to scan a barcode that serves as an animal ID, followed by the entry of the metadata i.e. baseline information, pointers to illness, owner responses and scanning in all the sample-barcodes belonging to each individual animal. All the information entered is transmitted in real-time to a secure project server managed by the Kestrel Technologies Group.

Afterwards a field feedback form is filed detailing on the number of project staff involved in the sampling process, the number of local staff involved, number of animals sampled and if few than 10 animals were sampled reasons for not attaining the maximum number, number of declines to consent and reasons, number of animals with incomplete data and lastly rating the difficulty in sampling from that site.

Sample storage and transport to the laboratory

Sampling normally ends at around mid-day. All the samples are always kept in cool boxes (after collection, when barcoding and during transport back to the lab). The consumables that were used are disinfected as well as the gumboots and car contact points (Fig-10).

Fig-10: Disinfection of the car

On our way to the office, a WhatsApp message is sent to the laboratory team informing them of the number of animals sampled and tentative time of arrival. On arrival at the laboratory, the cool boxes with samples are received by the laboratory team and processing of the samples initiated. Afterwards, both the livestock market and slaughterhouse consumable boxes are checked and refilled as appropriate, the coveralls are replaced with clean ones and the gumboots are further thoroughly washed and sanitized with Virkon in preparation for the subsequent field visits.

Feedback and significance of the study

The fifteen diseases being investigated by ZooLink affect both humans and animals. The study seeks to determine if indeed such diseases are circulating in the human and animal population. If these diseases are detected, feedback is provided at the hospital, livestock market (Fig-11) and slaughterhouse level. So far the feedback has been provided to medical officers, public health officers, nursing officers, clinical officers and laboratory staff at Bumula sub-county hospital in Busia County (28/02/2018) Mukumu mission hospital in Kakamega county (07/02/2018) and Lukolis health centre in Bungoma County (14/12/2017). Public engagement with livestock traders, butchers, meat inspectors and animal health officers at Myanga slaughterhouse and livestock market in Bungoma County (28/02/2018) and in Shinyalu slaughterhouse and livestock market in Kakamega County (07/02/2018).

Fig-11: A public engagement session in one of the livestock market to provide feedback

The objective of the public engagements at the health facilities, livestock markets and slaughterhouses are to share preliminary research sampling results so far based on study screening tests, to inform every one of the work we do, zoonoses covered by the study and offer recommendations on control and prevention of the zoonoses detected. The public engagements are done through talks and info-booklets highlighting ZooLink’s objectives, study areas, detected zoonoses through info-stories, including their control & prevention options and the project’s next steps.

All the previous study info-booklets are available on the study website available at: http://www.zoonotic-diseases.org/project/zoolink-project/

 

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One Health Anthem

One Health Anthem

One Health Anthem

The One Health Club of the University of the University of Nairobi have developed a One Health Anthem as below:

“We are one health,
A multidisciplinary society,
Bound together by a love for Africa,

A free Africa, free from disease, hunger and war,

Ooh Africa my home my love my peace my joy,

Eee one health ,
we aspire for quality products ,quality animals and a healthy people free from diseases free from hunger and free from war.

So let’s hold hands fight for each other not against each other we can do this if only we believe.

Coz Africa our home our love our peace and our joy,
Together let’s work for Africa.
Yeah .
One health one people one universe.”

The audio version is also available here:

Credits to Isaac Karuri, Dorothy Gaunye, Topirian Kerempe, Susan Mutuku, Simel Silau, Emonje Henry & Alice Kiarie for creating the audio version.

 

Potential of Social Media and Internet-Based Data in Preventing and Fighting Infectious Diseases

Potential of Social Media and Internet-Based Data in Preventing and Fighting Infectious Diseases

Potential of Social Media and Internet-Based Data in Preventing and Fighting Infectious Diseases

This article reports on the importance of using social media and the Internet in the fight against infectious diseases. Disadvantages and advantages of data gathered from social media and the Internet for public health use are also discussed. Examples and exploration of tools like GT is also given with its own opportunities and challenges. Future challenges and current gaps are also highlighted in this chapter so that future strategies can be formulated in order to improve contemporary surveillance system.

Abstract

This article can be accessed online at: http://dx.doi.org/10.1007/5584_2016_132

Urbanization and Disease Emergence: Dynamics at the Wildlife–Livestock–Human Interface

Urbanization and Disease Emergence: Dynamics at the Wildlife–Livestock–Human Interface

Urbanization and Disease Emergence: Dynamics at the Wildlife–Livestock–Human Interface

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

landscapes

How different interfaces interact and drivers propagate disease emergence; Image source: http://dx.doi.org/10.1016/j.tree.2016.09.012

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