Prioritization of Zoonotic Diseases in Kenya, 2015

Prioritization of Zoonotic Diseases in Kenya, 2015

Prioritization of Zoonotic Diseases in Kenya, 2015

A recent publication (24 August 2016) by Munyua et al., shows that the ranked priority disease list for Kenya having emphasis towards Neglected Tropical Diseases, with the top five being (Anthrax, Trypanosomiasis, Rabies, Brucellosis, and Rift Valley Fever). Find out more at the  link below:

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161576

journal.pone.0161576.t003

Source of image: http://dx.doi.org/10.1371/journal.pone.0161576.t003

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Chinese medical workers will survey Tibet to prepare a treatment plan for controlling echinococcosis

Chinese medical workers will survey Tibet to prepare a treatment plan for controlling echinococcosis

Chinese medical workers will survey Tibet to prepare a treatment plan for controlling echinococcosis

Picture of echinococcus egg Source: http://www.dpd.cdc.gov/dpdx/HTML/ImageLibrary/Echinococcosis_il.htm

Picture of echinococcus egg (Ssource)

Beijing, Aug 23 (PTI) Chinese medical workers will survey Tibet to prepare a treatment plan for controlling echinococcosis, a fatal parasitic tapeworm disease affecting herding communities.

A total of 920 doctors and medical workers, including 624 from Tibet and 296 from the rest of the country, will be sent to 364 villages in 70 counties and districts of Tibet by the end of this month, Li Bin, deputy director of the regional disease control and prevention centre, said.

Some 72,800 people will be covered under the scheme.

The field investigation will be finished within a month, and the investigators will create an investigation report and treatment plan.

“Hopefully the treatment can begin by the end of this year,” Li said.

Echinococcosis also known as Hydatid disease is a potentially lethal zoonotic disease caused by tapeworms. It mainly affects herding areas in Chinas Gansu, Inner Mongolia, Ningxia, Qinghai, Sichuan, Tibet and Xinjiang.

As of 2012, about 50 million people lived in areas where the disease is prevalent.

The government aims to control the disease by 2020. Tibet started fighting the disease in 2007. From 2011 to 2015, more than 700 people in the region received surgery, state-run Xinhua news agency reported. PTI KJV UZM

This post originally appeared on the IndiaToday website on 23rd August 2016. available at: http://indiatoday.intoday.in/story/china-to-survey-tibet-for-fighting-deadly-parasite/1/746988.html

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Accelerating Progress beyond the MDG-era through addressing endemic zoonoses in the East African Community Member States

Accelerating Progress beyond the MDG-era through addressing endemic zoonoses in the East African Community Member States

Accelerating Progress beyond the MDG-era through addressing endemic zoonoses in the East African Community Member States

1.1 Introductory statement

This blog post will initially provide an overview of the achievements and “pending issues” of the Millennium Development Goals (MDGs) and the opportunities that the Sustainable Development Goals (SDGs) present to the East African Community (EAC) Member States so as to accelerate progress beyond the MDGs. Secondly, it will propose priority zoonotic diseases to be targeted (that will act as a model of controlling the other zoonotic diseases) and lastly, provide recommendations on adequate measures to improve their surveillance, prevention and control.

1.2 Overview

1.2.1 Transition from Millennium Development Goals to Sustainable Development Goals

The eight MDGs[4] adopted on 18th September 2000 have guided development efforts for fifteen years (2000 to 2015), with a clear focus on poverty and on developing nations. The EAC Member States comprise of Kenya, Uganda, Tanzania, Burundi and Rwanda[1] (Figure 1), all of which are classified as developing countries and lower income economies, except Kenya which was recently re-classified as a lower-middle income economy[5]. Three of the 8 MDGs focused directly on health (MDG-4, MDG-5 and MDG-6), with the goal of reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases, respectively. The MDG Report 2015: “Assessing Progress in Africa toward the Millennium Development Goals”[6] highlights important success stories from the MDGs in Africa.

Figure 1: EAC Member States

Figure 1: EAC Member States

Contrary to the success stories, there are “pending issues” that cannot be overlooked especially with respect to the EAC Member States. The MDGs were compartmentalized to specific health goals which drove resources to specific types of programmes. This is very evident from the MDG country progress reports from the EAC Member States i.e. Kenya[7], Uganda[8], Tanzania[9], Burundi[10], and Rwanda[11], all of which provide elaborate documentation on the progress made and statistics on TB, Malaria and HIV/AIDS forgetting the “other neglected and endemic diseases”. Therefore a  key lesson from the MDGs for the EAC Member States is that endemic zoonotic diseases are a great burden to human and animal health[12] characterized by lack of reliable data which undermines the ability to set goals, optimize investments, decisions, and measure progress[13].

The 17 Sustainable Development Goals (SDGs)[14], originally conceptualized as “The Future We Want” on September 2012[15] were adopted on September 2015[14] after a series of inclusive and consultative meetings (Figure 2).

Figure 2: The origin and evolution of SDGs [2]

Figure 2: The origin and evolution of SDGs [2]

In contrast to the 3 MDGs focused on health, only 1 out of the 17 proposed SDGs focus on health framed broadly as: to ensure healthy lives and promote well-being for all at all ages. Based on the ‘Alma Ata Declaration’[16] defining health as, “A state of complete physical, mental and social well-being”, it therefore means that health priorities may also be sustained through several of the other SDGs, namely: Goal 8, Goal 11, Goal 16 and Goal 10. The SDGs therefore spur transformative change towards sustainable development, addressing systemic barriers to social, economic and environmental progress[17] at the global, regional and national level and between different sectors. They thus form the basis of a more comprehensive and integrated development agenda and requiring far-reaching change in domestic policy and action [2, 18].

1.1 Zoonoses as a platform of addressing the SDG goal 3, target 3.3 & 3.d

1.1.1 Burden of zoonotic diseases in the EAC Member States

Outbreaks of endemic zoonotic diseases in the EAC Member States, such as anthrax and rabies have considerable impact on the health care systems at the local level and adversely affect livelihoods. The burden of zoonotic diseases in this region remains poorly defined[13], in part, because of weak surveillance and health information systems and also because endemic zoonoses are not considered of high priority within both the human and animal health sectors[3].

The increasing burden of zoonotic diseases in the EAC Member States can be attributed to several factors[3, 12]. The intensification of farming, for example, leads to closer relationships between individual animals, generating opportunities for more rapid mutations as organisms move from host to host, while also providing a structured way for those pathogens to enter highly ordered food chains that branch out and reach very large numbers of people[19]. At the same time development of antimicrobial resistance poses an increasing burden in the treatment of some of the zoonotic diseases in the region[20].

1.1.2 Suggested priority diseases to target

In the EAC Member States, several zoonotic diseases of neglected populations conspire to hinder the health of people and the animals they depend on for their livelihoods which are transmitted in many ways.  For the scope of this report let us focus on four:

  • Brucellosis is an important source of morbidity in all EAC Member States. It causes a chronic debilitating disease in humans and often misdiagnosed thus wrongly treated[21]. Misdiagnosis is expensive; individuals incur significant expenses in failing to acquire diagnosis and treatment, and fail to conduct their daily activities by being unwell. Across the EAC Member States, brucellosis is still a very common but often neglected disease, and constitutes a major under-reported problem[22]. Geographical distribution depends upon local food habits, milk processing methods, animal husbandry types and standards of personal and environmental hygiene. Cattle, sheep and goats harbour this bacterium, which they transmit to each other and humans through milk or through contaminated aborted materials[19].
  • Rabies is a well-known, but nonetheless, neglected zoonotic infection, caused by the rabies virus and a public health problem in the region. For example in Kenya it is estimated that 2000 human deaths occur annually due to rabies[23]. It is transmitted and maintained mostly in domestic dog populations (though in areas with a wildlife interface, the epidemiology may get more complex), which transmit the infection to humans through bites. It is best controlled by vaccinating the dog reservoir to prevent disease from developing if infection occurs, but a human vaccine is available both as a pre- and post-exposure course, and effective and timely delivery of the vaccine will minimize mortality (but the human vaccine is very costly). Lack of cooperation between the health and veterinary sectors often impedes progress in the control of rabies. Limited accessibility to modern rabies vaccine, lack of public awareness and insufficient political commitment are the major problems in EAC Members States[23].
  • Cysticercosis is a disease caused by the tapeworm Taenia solium. It has a relatively complex lifecycle, involving pigs eating Taenia egg-carrying human faeces that contaminates the environment, humans eating undercooked pork meat, and environmental contamination with eggs that can encyst in humans. The greatest problem with solium is that it may cause a neurological disease called neurocysticercosis in people who are infected with tapeworm eggs; in the EAC Member States, it is the single largest cause of acquired epilepsy in humans[24, 25].
  • Anthrax is a disease caused by the spore-forming bacteria Bacillus anthracis, that is classified as a category ‘A’ agent by the CDC [26]. Anthrax is a very serious zoonotic disease of livestock and wild animals because it can potentially cause the rapid loss of a large number of animals in a very short time. It is estimated that 1 livestock case equals 10 human cutaneous and enteric cases [27]. A recent (July 2015) outbreak of the disease in Nakuru County in Kenya killed over one hundred buffaloes and 2 rhinos.

1.2 Conclusion and recommendations

Many factors involved in prevention and control of zoonotic infections in the EAC Member States cannot be addressed by the livestock or health sector alone.  To effectively address the proposed priority zoonoses (to act as a model to control other zoonoses and infections) it will entail focusing transmission control, prevention and burden reduction in animals so as to accrue the benefits of control and prevention  in humans as documented by other studies in Chad[28] and Mongolia[29]. This, in turn, requires a One Health approach, involving joint surveillance, control and policy management by veterinary, medical and other sectors[30]. The outstanding opportunity that is at hand is there is already a working model of a One Health office in Kenya[3], this model offers a “success story” that can be adopted to suit the needs of the other EAC Member States in addressing the priority zoonotic diseases and others as well. The good thing is that, the model will utilize the existing medical and veterinary workforce within the respective countries (Figure 3).

Figure 3: Potential One Health Coordination model among EAC Member States (modified from ZDU[3])

Figure 3: Potential One Health Coordination model among EAC Member States (modified from ZDU[3])

For these suggested priority diseases many aspects of their basic biology are well understood, and the transmission of the pathogens has been controlled in many countries. The outstanding issues that the EAC Member States need to address to effectively deploy intervention efforts, are:

  • High-level commitment and the ability of national programmes to mobilize the necessary resources and to strengthen collaboration with the pre-existing funding agencies and organisations from the MDG era e.g. the World Health Organization[31] among others to scale up intervention strategies in order to cope with the common challenges in the control of zoonoses.
  • Create multisectoral committees responsible for surveillance and control of zoonoses. These committees should be empowered to coordinate zoonosis control activities at national level and be provided with adequate budget. The committees should comprise members from all sectors and the community involved in zoonoses surveillance and control, particularly public health and veterinary services.
  • Develop national integrated surveillance systems with an open policy of cross sharing information among the EAC Member States on occurrence, distribution and disease burden. These integrated surveillance systems to be linked to the National statistics system to complement monitoring the SDGs[32].
  • Update veterinary and health professions educational curricula according to current knowledge and practical needs for control of zoonotic diseases, with emphasis on multisectoral and community led approaches
  • Diagnostic facility strengthening by deploying, and in some cases developing, new and better tools to diagnose the infections in humans and animals esp. for brucellosis, and cysticercosis (because accurate and efficient detection is key to both delivering cure and also to gathering good surveillance data)
  • Finally and most importantly, develop key indicators (reflecting each country socio-economic context and political priorities[18]) so as to measure progress in the work of controlling the four priority zoonotic diseases.

References

  1. EAC. The East African Community. 2015; Available from: http://www.eac.int/.
  2. Weitz, N., et al., Sustainable Development Goals for Sweden: Insights on Setting a national Agenda in Working Paper 2015-10. 2015, Stockholm Environmental Institute: Sweden.
  3. ZDU, Zoonotic Disease Unit: National One Health Strategic Plan 2012-2017, Ministry of Health and L.a.F. Ministry of Agriculture, Editors. 2012, The Zoonotic Diseases Unit Nairobi. p. 1-46.
  4. UN, Resolution adopted by the General Assembly-United Nations Millennium Declaration, G. Assembly, Editor. 2000, United Nations: Geneva.
  5. Bank, W., Country and Lending Groups. 2015.
  6. UNDP, MDG Report 2015: Lessons learned in implementing the MDGS, in Assessing progress in Africa toward the Millennium Development Goals. 2015, United Nations Economic Commission for Africa, African Union, African Development Bank and United Nations Development Programme.
  7. UNDP, Millennium Development Goals: Status Report for Kenya 2013, in Country MDG Progress Reports. 2014, Ministry of Devolution and Planning: Nairobi. p. 1-56.
  8. UNDP, Millennium Development Goals: Report for Uganda 2013, in Country MDG Progress Reports. 2014.
  9. UNDP, Millennium Development Goals 2014-Tanzania, in Country MDG Progress Reports. 2014.
  10. UNDP, Système des Nations Unies au Burundi et Gouvernement du Burundi 2012, in Country MDG Progress Reports. 2012, United Nations Development Programme: Burindi. p. 1-131.
  11. UNDP, Millennium Development Goals: Final Progress Report, Rwanda 2013, in Country MDG Progress Reports. 2014: Rwanda p. 1-117.
  12. Delia, G., Mapping of poverty and likely zoonoses hotspots. 2012, Department for International Development, UK: Nairobi, Kenya. p. 1-119.
  13. Hotez, P.J. and A. Kamath, Neglected tropical diseases in sub-saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis, 2009. 3(8): p. e412.
  14. UN, Resolutions adopted by General Assembly on 25 September 2015, G. Assembly, Editor. 2015, United Nations. p. 1-35.
  15. UN General Assembly, The Future We Want, G. Assembly, Editor. 2012, United Nations: Rio de Janeiro.
  16. ICPHC, Declaration of Alma-Ata, A.-A. International Conference on Primary Health Care, USSR, 6-12 September 1978, Editor. 1978.
  17. Kumar, G., et al., A Transformative Post-2015 Development Agenda. 2014, Independent Research Forum (IRF2015): London.
  18. Porsch, L., T. Kafyeke, and J. Yuan, How to measure the Sustainable Development Goals in central Europe?, NETGREEN, Editor. 2015. p. 1-25.
  19. Microbiology Society, Comment: Zoonoses in Africa. Microbiology Society’s online magazine-Microbiology Today, 2015(November 2015).
  20. Kimang’a Andrew, N., A situational analysis of antimicrobial drug resistance in Africa: Are we losing the battle. Ethiop J Health Sci, 2012. 22(2): p. 1-9.
  21. McDermott, J.J. and S.M. Arimi, Brucellosis in sub-Saharan Africa: epidemiology, control and impact. Vet Microbiol 2002. 90: p. 111–34.
  22. Welburn, S.C., et al., The Neglected Zoonoses – The Case for Integrated Control and Advocacy. Clinical Microbiology And Infection: The Official Publication Of The European Society Of Clinical Microbiology And Infectious Diseases, 2015.
  23. ZDU, Kenya Strategic Plan for the Elimination of Human Rabies in kenya 2014-2030, Ministry of Health and L.a.F. Ministry of Agriculture, Editors. 2014, Zoonotic Diseases unit.
  24. Phiri, I.K., et al., The emergence of Taenia solium cysticercosis in Eastern and Southern Africa as a serious agricultural problem and public health risk. Acta Tropica, 2003. 87(1): p. 13-23.
  25. Ngowi, H.A., et al., Taenia Solium Cyticercosis in eastern and Southern Africa: An Emerging Problem in Agriculture and Public Health. 2004. 35(1): p. 266-270.
  26. CDC. Bioterrorism Agents/Diseases. Emergency Preparedness and Response 2015 [cited 2015 23 Nov 2015]; Available from: http://emergence\y.cdc.gov/agent/agentlist.asp.
  27. ZDU. Anthrax Outbreak Response, Nakuru COunty-February 2014. Outbreaks 2015 [cited 2015 23 Nov 2015]; Available from: http://zdukenya.org/outbreaks/.
  28. Zinsstag, J., et al., Potential of cooperation between human and animal health to strengthen health systems. The Lancet, 2005. 366(9503): p. 2142-2145.
  29. Batsukh, Z., et al., One Health in Mongolia. Current Topics In Microbiology And Immunology, 2013. 366: p. 123-37.
  30. Zinsstag, J., et al., One Health: The Theory and Practice of Integrated Health Approaches. 2015: CAB International.
  31. WHO, Neglected tropical diseases, in Closer intersectoral collaboration using existing tools can defeat zoonoses affecting humans. 2015, World Health Organisation Online.
  32. SDSN, Data for development: An Action Plan to Finance the Data Revolution for Sustainable Development. 2015, Sustainable Development Solutions Network, Open Data Watch.

 

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Wildlife markets are hotbeds of disease

Wildlife markets are hotbeds of disease

Wildlife markets are hotbeds of disease

Wildlife market

Wildlife market

In 2003, the world met SARS. The coronavirus wreaks havoc on a patient’s immune system, and even after treatment patients have gone on to suffer from long-term diseases like osteoporosis or lung disease. It’s thought that the virus jumped from animals to humans, facilitated by markets in southern China known for trading in wildlife and wildlife parts. The infection eventually spread to 29 countries on five continents. In all there were 8,098 human cases and 774 deaths. The outbreak cost China some $16.8 billion in lost tourism revenue.

The illegal trade in wildlife is not only devastating ecologically; it also has a real and measurable impact on human health and economics. And the problem is not just in China.

Laos, more properly known as the Lao People’s Democratic Republic or Lao PDR, is home to a stunning diversity of mammal, reptile, bird, and amphibian species. Many of them are endemic—animals found there and no place else—like the Phou Khao Khouay leaf-nosed bat, the Truong Son muntjac, and the critically endangered Saola. Like in China, there’s a tremendous amount of illegal trade in wildlife and wildlife parts in Laos. The extent of that trade, and its possible consequences for human health, were recently revealed in a study led by Zoe F. Greatorex and Sarah H. Olson of the Wildlife Conservation Society.

First, 375 basic surveys of 93 markets scattered across 15 of the 17 Laotian provinces were carried out over the course of three years. These surveys were simply to identify markets in which wildlife was sold, and they were carried out discretely by two Laotians who could blend in to the crowd.

Then, the researchers conducted detailed surveys in the winter and spring of 2012 at 44 markets. These surveys documented which species were being sold and how many individual animals per species were offered to buyers. In addition, researchers recorded the prices at which wildlife was sold, the origins of market visitors (information gleaned from license plates visible in the parking areas), and the hygiene of merchants and butchers. (For example: Did the butcher clean his or her equipment after every animal? Did the vendors wash their hands often enough?)

Finally, to assess the potential for the spread of zoonotic pathogens from wild animals to humans, the researchers focused on seven markets with a particularly high level of wildlife trade, using the data collected during the first two phases of the study. Each of these markets was observed selling more than 100 animals per day on at least four different days.

Nearly 7,000 animals were for sale for sale at these markets, weighing more than 2,000 kilograms combined. Across all 93 markets, they recorded 33,752 animals for sale, with nearly 7,000 of them belonging to species of conservation concern, including turtles, tortoises, deer, and lorises. This volume in wildlife trade is on par with some of the most prolific wildlife markets elsewhere, like in Equatorial Guinea, Myanmar, and China.

The mammals alone represented 12 taxonomic families ranging from rodents to primates, species previously documented to be capable of transmitting at least 36 pathogens, like Ebola, Lassa fever, Marburg virus, monkeypox, dengue, yellow fever, West Nile, and others. (Because their ability to transmit pathogens isn’t clear, carcasses that were smoked, dried, fermented, or frozen were omitted. The researchers concentrated instead on living animals or ones freshly slaughtered for this analysis.)

Though proper hygiene can limit the transmission of many of these pathogens, the researchers documented remarkable disregard for biosecurity. “In half-hour observations of 11 wildlife vendors in these seven markets, hand washing was only observed to be performed by one individual,” write the researchers. Only four of the markets even had running water available. And while five of the six markets that also sold domestic meat products had zoning regulations to keep livestock products and wildlife products separate, that didn’t seem to apply to poultry, fish, or produce—only to mammals. The possibility—likelihood, even—for cross-contamination in that sort of environment is mind-boggling.

To find out just who was purchasing all these wildlife products, the researchers compared the price of wild animals to that of fresh domestic pork. In most cases, wildlife generated a lot more revenue. In early 2012, one kilogram of pork could be sold for around 34,000 Kip, which is about $4. A kilogram of brush-tailed porcupine sold for four times as much. This suggests that urban consumers eat wildlife as a luxury, rather than for nutrition or subsistence. And since the average Laotian makes around $4 per day, there’s a high economic incentive to sell wildlife meat rather than livestock. A kilogram of pork represents around one day of income, while a kilogram of bat equates to three days’ worth of income.

The impacts of the Laotian wildlife trade are far-reaching. Not only does the study demonstrate the enormous potential for zoonotic spillover and the serious damage that the wildlife trade does to Laotian ecosystems, but it also reveals a challenge to food security to the poorest Laotians, who have historically relied on subsistence hunting for protein.

If wildlife is to be harvested, conclude the researchers, it needs to be done with serious oversight and enforcement, as per the Lao PDR Wildlife and Aquatic Law. Because it poses risks both to public health and to biodiversity, they say this form of wildlife trade provides a unique opportunity for public health officials, conservationists, law enforcement, and other groups to collaborate on addressing the underlying economic realities that drive the sale of wild animals. – Jason G. Goldman | 06 April 2016

Source: Greatorex ZF, Olson SH, Singhalath S, Silithammavong S, Khammavong K, Fine AE, et al. (2016) Wildlife Trade and Human Health in Lao PDR: An Assessment of the Zoonotic Disease Risk in Markets. PLoS ONE 11(3): e0150666. DOI: 10.1371/ journal.pone.0150666.

This article originally appeared on teh university of Washington, Conservation page on 6th April , 2016. Available at: http://conservationmagazine.org/2016/04/wildlife-markets-spread-disease/

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Presentations available from the One Health for the Real World symposium

Presentations available from the One Health for the Real World symposium

Presentations available from the One Health for the Real World symposium

STO05286KEN

The presentations from the international symposium, ‘One Health for the Real World: zoonoses, ecosystems and wellbeing’ which took place at the Zoological Society of London, 17-18 March 2016 are now available on the STEPS website: http://steps-centre.org/2016/blog/onehealth2016/

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