It is time to rethink the way we handle pets and wildlife

It is time to rethink the way we handle pets and wildlife

It is time to rethink the way we handle pets and wildlife

In Summary

  • During the Kenya Medical Research Institute’s fifth scientific conference, which also took place in February, scientists raised the alarm over the transmission of diseases from animal to humans.
  • The World Health Organisation says that 60 per cent of the pathogens that cause infectious diseases in human beings come from animals.
  • According to the US’s Centre for Disease Control and prevention, zoonoses include a wide range of diseases, ranging from mass killers such as anthrax, Ebola, swine flu, West Nile Virus, bird flu, Crimean-Congo haemorrhagic fever and the Hendra Virus to subtle and slow killers like rabies, Rift Valley Fever and Brucellosis

During the funeral of a 39-year old woman who died of Aids in Homa Bay in February this year, a clinical officer who had attended to her engaged DN2 in a discussion about the Zika Virus in South America, and how it had triggered yet another debate on how man’s unguided relationship with nature is hurting him.

Sadly, neither the potential victims, nor the government, are adequately conversant of this to take the necessary precautions.

It is worth noting that at the time the Homa Bay funeral was taking place, across the Atlantic Ocean in Boston, US, the annual Conference on Retroviruses and Opportunistic Infections (CROI) was also taking place. The discussion focused on yet another deadly infection that came to human beings from animals: Ebola.

In Kenya, the Ministry of Health allayed fears of possible disease outbreaks from the Ebola and Zika viruses.

Only a few scientists, like Lancet Laboratory’s executive officer, Dr Ahmed Kalebi, took note of the public health issues raised at CROI.

Meanwhile, during the Kenya Medical Research Institute’s (KEMRI) fifth scientific conference, which also took place in February, scientists raised the alarm over the transmission of diseases from animal to humans. They expressed concern about humans’ continued intrusion into wildlife territory.

Whether it is the burgeoning population or the desire to live in quiet, exclusive environments, human intrusion into animal habitats has grown considerably in the country in recent times.

The area around the Lewa Conservancy which straddles Meru and Laikipia counties, is a case in point. Apart from the herds of elephants and buffalos that roam the plains, one can also spot residential houses tucked away in between the trees.

A great deal has been documented about the booming real estate business in Laikipia County, which for decades was dominated by large territorial mammals such as rhinos, elephants and buffaloes.

Not surprisingly, this intrusion has seen elephants destroy crops in the areas neighbouring their habitat.

Now, experts are warning of a threat greater than the destruction of crops of trampling to death of humans: zoonoses.
Zoonoses are diseases transmitted from animals to humans.

The World Health Organisation, (WHO) says that 60 per cent of the pathogens that cause infectious diseases in human beings come from animals.

And researchers warn that the close interaction between humans and animals, whether wild or domesticated, is increasingly making Kenyans ill.

According to the US’s Centre for Disease Control and prevention, zoonoses include a wide range of diseases, ranging from mass killers such as anthrax, Ebola, swine flu, West Nile Virus, bird flu, Crimean-Congo haemorrhagic fever and the Hendra Virus to subtle and slow killers like rabies, Rift Valley Fever and Brucellosis.

Although these diseases are a global health problem, their impact is felt more in Africa than in other parts of the world because they tend to be neglected. African governments dedicate few or no resources to detect and respond to them at the local or national levels. Only 0.7 per cent of these diseases affect people in developed countries as poor nations bear the brunt.

It was only after the Ebola outbreak in West Africa in 2013, which wreaked havoc in West Africa, that people started paying attention to the usually muted voice of researchers on the link between diseases, animals and the environment.

PUTTING UP SKYCRAPPERS

Given the rate at which construction is going on in the country, it is time we sat up and took notice.

Not too long ago, the ambience in Nairobi’s upmarket Kilimani allowed residents and colobus monkeys to live in harmony. Today, the gibbering of monkeys has been replaced by the roar of construction machines putting up skyscrapers.

The same trend can be observed in other parts of the country such as Lower and Upper Kabete, Gathiga, slightly past Kitisuru in Nairobi, Mang’u (Kiambu County), Kabarak and Sobea (Nakuru County) Nyahera (Kisumu County and Kapchorua in Nandi Hills (Nandi County).

Unknown to many, as this trend continues, disease-causing pathogens are mutating, becoming more lethal and embedding themselves in the complex yet delicate human food chain and way of life.

A study in 2012 titled “Zoonoses: A potential Obstacle to the Growing Wildlife Industry of Namibia published in the journal, Infection Ecology and Epidemiology, drew a chilling pattern in Kenya, similar to Namibia’s cases of zoonoses: the serum of buffaloes in Ijara, Nakuru, Laikipia, Nairobi and parts of the North Rift tested positive for antibodies of Rift Valley Fever.

Dr Eric Osoro, a medical epidemiologist at the Zoonotic Diseases Unit (ZDU) in the Ministry of Health, says that at least 2,000 Kenyans die of rabies every year, which is unfortunate, given that it costs less than Sh100 to vaccinate a dog, compared with the thousands of shillings required to treat the viral disease.

“The number of rabies deaths reported is a gross underestimation of the actual number of deaths that occur in Kenya annually from this terrifying fatal disease,” he says.

Many more Kenyans could be dying of rabies, which can be caused even by a scratch by an unvaccinated dog, because the incubation period for the virus is estimated to be about two months.

“Sometimes the wound might have even healed, so none one would suspect it is rabies,” Dr Osoro says.

While rabies can be prevented by vaccinating dogs, WHO says it is 100 per cent fatal once the clinical signs appear.

Apart from rabies, Dr Osoro also cautioned about Brucellosis — a disease one gets from taking milk that has not been boiled properly — and anthrax.

“Anthrax kills cattle in less than 12 hours, but many will consume the flesh because the animal looked healthy,” he says.

Prof Thumbi Mwangi, a clinical assistant professor at Washington State University in the US and a researcher on zoonoses at the Kenya Medical Research Institute (KEMRI), told DN2 that while the interaction between humans and animals is not necessarily a bad thing, failure to keep healthy animals increases the chances of ill health for humans.

PATHOGENS FIND NEW HOSTS

In March last year, Prof Mwangi carried out a study in which he tracked 1,500 households and their livestock in 10 villages in Western Kenya. He and his team obtained data on 6,400 adults and children, 8,000 cattle, 2,400 goats, 1,300 sheep and 18,000 chicken.

The results, published in the open journal, Plos One, revealed that for every 10 cases of animal illnesses or deaths that occurred, the probability of human sickness in the same household increased by about 31 per cent.

Prof Eric Fèvre, a professor of veterinary infectious diseases at the Institute of Infection and Global Health at the University of Liverpool and the International Livestock Research Institute (ILRI), wrote a blog post, “Zoonoses in Africa” on the websitemicrobiologysociety.org, in which he said that urbanisation is presenting opportunities for pathogens to find new hosts to survive.

The post, published on November 11, 2015 read: “The intensification of farming, for example, leads to closer relationships between individuals and 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”.

Other studies paint an increasingly disturbing pattern of diseases either emerging, or the incidence of existing ones increasing.

A study in Dagoretti, Nairobi, by the International Livestock Research Institute (ILRI), found that women were more exposed to cryptosporidiosis, a diarrhoeal disease transmitted from cattle to humans, because of their involvement in milking, feeding and watering the animals.

And a study by the Kenya Medical and Research Foundation (KEMRI) Kisumu and the US’ CDC linked a strain of tuberculosis to an area in Western Kenya where homes had a higher cattle:human ratio.

In wildlife settings, the situation is more complex. A 2014 study found cases of suspected rabies in Laikipia County where humans had encroached on animal habitat.

When landscapes and bio diversities are altered by activities relating to construction such as roads and farms, diseases are “created”: as trees are felled, the species that protect humans from the ones that act as disease-reservoirs are destroyed.

The harmful pathogens are usually multi-host, meaning they can live in many different animals, which gives them a competitive edge to survive as the protective trees are wiped out by human activity.

In 2012, ILRI reported that 2 million people are killed by zoonoses every year, thanks to the disruption of the ecosystem.

Malaria is a good example: as people in tropical countries like Kenya encroached on the habitat, the incidence of the disease quadrupled.

ECOLOGICAL BALANCE

When DN2 asked nine developers from Nakuru, Nairobi and Kisumu whether they consider the ecological balance of a location important when they are building, six responded with the question, “What is that?” After it was explained to them, all except one said they were “satisfied with the National Environmental Management Authority (NEMA) clearance”.

It is notable that NEMA officials and environmental inspectors have said at scientific forua that many of the constructions approved by the counties do not heed their counsel.

Only 1 per cent solution to wildlife viruses are known, according to WHO, and the ecology of diseases and wildlife immunology is in its infancy in Kenya.

Meanwhile, Kenya’s Zoonotic Disease Unit, has been lauded at various fora for its holistic approach, with its national rabies control strategy highly regarded.

It has conducted a large-scale study on the epidemiology of brucellosis, responded to many zoonotic disease outbreaks, and developed preparedness strategies for epidemic zoonoses such as Rift Valley fever.

But for now, one can only hope that ecological safety will be factored in amid the real estate industry boom.

SOURCE

This article originally appeared in the Kenya Daily Nation website on 9th March, 2016 authored by Verah Okeyo, available athttp://www.nation.co.ke/lifestyle/DN2/Take-care-how-you-interact-with-animals/-/957860/3108294/-/15fadaoz/-/index.html

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Why is it that in the past there were very few diseases than today?

Why is it that in the past there were very few diseases than today?

Why is it that in the past there were very few diseases than today?

The ever increasing human population and greater global connectivity today, provides rapid dissemination of infectious diseases from the initial focus. Whereas in previous centuries a disease focus might have died out through failing to establish a chain of transmission, now it has the opportunity to rapidly recruit susceptible hosts on a global stage. To draw an analogy, there is now so much available tinder on the forest floor that the flickering early flame can rapidly be fanned into a forest fire. In support of this thesis, consider the following:

  • The human population of Earth took until 1800 to reach one billion; by 2000 it had
    exceeded six billion; and it reached the seven billion mark in 2011;
  • In 1800, the time taken to circumnavigate the globe by sailing ship was approximately one year. Today, no two cities served by commercial aircraft are more than 24 hours apart;
  • Annually, the world’s airlines carry a total approaching two billion passengers. At any one moment, about half a million people worldwide are flying in commercial aircraft ;
  • In 2011, there were 219 million passenger departures/arrivals at British airports;
  • In lieu of precise trade data, Billy Karesh of the Wildlife Conservation Organization in New York conservatively estimates that in east and southeast Asia, tens of millions of wild animals are shipped each year regionally and from around the world, for food or use in traditional medicine (Karesh and others 2005).

Wildlife often acts as a reservoir for diseases of domestic animal and humans see figure Figure 1.2 published in an article in Science in 2000 (Daszak et al. 2000).

Daszak et al 2000.jpg

Most emerging diseases exist within a host and parasite continuum between wildlife, domestic animal, and human populations. Few diseases affect exclusively any one group, and the complex relations between host populations set the scene for disease emergence. Examples of emerging infectious diseases that overlap these categories are canine distemper (domestic animals to wildlife), Lyme disease (wildlife to humans), cat scratch fever (domestic animals to humans) and rabies (all three categories). Arrows denote some of the key factors driving disease emergence (Daszak et al. 2000).

References

Daszak P, Cunningham AA, Hyatt AD. (2000) Emerging infectious diseases of wildlife-threats to biodiversity and human health. Science, 287: 443-449. Available at: http://science.sciencemag.org/content/287/5452/443.full

Gibbs EPJ. (2016): Week One Lecture notes for the course: An Introduction to trans-boundary diseases and their impact on trade and wildlife populations. University of Edinburgh-MSc One Health. Available at: https://www.learn.ed.ac.uk/bbcswebdav/pid-1677759-dt-content-rid-3167481_1/courses/ls_transboundary_diseases_2015/2015%202016/Week%201/Week%201%20Lecture%20Gibbs%20EM%20FINAL%202016copy.pdf

 

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MRSA in humans and animals in Kenya (an overview)

MRSA in humans and animals in Kenya (an overview)

MRSA in humans and animals in Kenya (an overview)

Introduction

Staphylococcus aureus is an important bacteria because of its ability to cause a wide range of diseases and adapt to diverse environments. The bacteria causes infection to both humans and animals by colonizing their skin, skin glands and mucous membranes, resulting to septicemia, meningitis, and arthritis in man and mastitis in the bovine, as well as poultry limb infections [1]. Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staphyloccocal bacteria that is resistant to beta-lactams. It is a common cause of healthcare-associated infections in both developed and developing countries, though limited information is available from the latter [2] [3].

MRSA Resistance mechanisms

The resistance of S. aureus against methicillin is caused by expression of Penicillin binding protein 2A (PBP2A) encoded by the mecA gene [4]. PBP2A has low affinity for beta-lactam antibiotics such as amoxicillin, methicillin and oxacillin, rendering these antibiotics ineffective in treating infections caused by Staphylococcus aureus. Lately, a new methicillin resistance mechanism gene, mecC has been reported in isolates from humans and animals [5]. This therefore means that MRSA is not only associated with prior exposure to a health care facility but also raises concerns for infections originating from the community and veterinary species, and there is a possibility of a cross-infection with animals being potential sources of MRSA infection to humans [6].

MRSA the Kenyan perspective

In 1997, documented rates of MRSA in Kenya were 28 percent of all S. aureus tested in city hospitals. A separate hospital-based study during the same year found the prevalence of MRSA to be 40 percent of all S. aureus infections. In 2006, MRSA was found in 33 percent of S. aureus isolates at another hospital based study [2]. Resistance, therefore, may indicate illegal use of drugs by the public. A survey of farmers in Kenya found that the majority conflated treatment with prevention, effectively replacing hygiene and feeding practices as standard disease prevention with disease treatment [2]. Patterns of resistant Staphylococcus aureus in cattle imply a significant difference in resistance profiles of large and small scale farms, with smaller producers using nearly twice the amount of antibiotics per animal compared with larger producers [7]. The prevalence of multidrug resistance, at 34 percent on small farms, was likewise almost double the rate found at large farms [2].

The dillemma

There is evidence that MRSA infection increases the risk of mortality, morbidity, medical care costs and loss of productivity. The increased medical care costs accrued directly as expenses caused by extension of hospital stay, additional diagnostic or therapeutic procedures, and additional antibiotic use while loss of productivity is due to absence from work during hospitalization. At the same time, published data  concerning  the  antibiotic  susceptibility  patterns  of  MRSA  in  sub-Saharan  Africa  are extremely limited, and few studies on it have been conducted in Kenya [2] [3]. Many studies on MRSA in Kenya are mainly cross-sectional with a focus to determine the prevalence, identifying the antibiotic resistance but they have not focused on the zoonotic significance of MRSA. There is need to understand on how the resistance to MRSA is changing over time so as to be able to clearly visualize the mechanism and transfer of resistance genes in the population [3].

Zoonotic directionality of resistance

It is therefore important not only to determine the antibiotic resistance, but also determine what and who is causing this resistance in humans and animals belonging to the same household and also determine the temporal and spatial change of this resistance over time. This is because, by understanding the dynamics and the epidemiology of MRSA infection over time it will be possible to develop more informed prevention and control strategies, develop more sound policies including education on the rational use of antibiotics to the public.  At the same time it is important to  fill the knowledge gap [3] (especially from a developing country setting) in the zoonotic directionality of MRSA.

References 

Waldvogel, F.A., Staphylococcus aureus, in Principles and practices of infectious disease, G.L. Mandell, D. R.G., and B. J.E., Editors. 2000, Pennsylvania, USA.: Churchill Livingstone, Philadelphia, . p. 1754-1777.

Global Antibiotic Resistance Partnership-Kenya Working Group, Situation Analysis and Recommendations: Antibiotic Use and Resistance in Kenya, S. Kariuki, Editor. 2011, Center for Disease Dynamics, Economics & Policy: Washington, DC and New Delhi.

WHO, Antimicrobial resistance global report on surveillance. 2014. p. 1-256.

Wielders, C.L.C., et al., mecA Gene Is Widely Disseminated in Staphylococcus aureus Population. J. Clin. Microbiol., 2002. 40(11): p. 3970-3975.

Paterson, G.K., et al., The newly described mecA homologue, mecALGA251, is present in methicillin-resistant Staphylococcus aureus isolates from a diverse range of host species. J. Antimicrob. Chemother., 2012. 67(12): p. 2809-2813.

Ferreira, J.P., et al., Transmission of MRSA between Companion Animals and Infected Human Patients Presenting to Outpatient Medical Care Facilities. PLoS ONE, 2011. 6(11): p. e26978.

Shitandi, A. and A. Sternesjö, Prevalence of Multidrug Resistant Staphylococcus aureus in Milk from Large and Small Scale Producers in Kenya. Journal of Dairy Science, 2004. 87: p. 4145-4149.

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Role of mapping in preventing epidemics like Ebola

Role of mapping in preventing epidemics like Ebola

Role of mapping in preventing epidemics like Ebola


A review in The International Journal of Epidemiology has offered some practical suggestions for preventing a future epidemic like the recent Ebola crisis.
stop-ebola

In a future epidemic, more effective strategies must be put in place to stop the spread.

Prof. Tom Koch, of the University of British Columbia, asks how it could be that many of the best minds in infectious disease, epidemiology and disaster medicine missed the early spread of the Eboladisease so that it became a regional epidemic.

While insisting that all parties involved “labored heroically, often at great personal risk, to restrict the original outbreak and treat those affected by it,” Prof. Koch believes there are lessons to learn about containing future disease outbreaks in rural areas with minimal resources.

In his review, he focuses on the potential of mapping as a tool to help deal with future disasters.

Prof. Koch points out that limits on data relating to patient location and travel mapping made it harder to contain the Ebola crisis.

At the same time, regional disease protocols were not implemented soon enough, as nobody anticipated such an expansive epidemic.

Records now show that the 2014 epidemic probably began in 2013, when a 2-year-old boy in the village of Meliandou in Guinea’s Gue ́ckédo Prefecture first became infected.

Infections need to be appropriately mapped

However, local, national and international health officials assumed that, as in previous cases, this outbreak would be a static, and thus controllable, localized disease event.

Prof. Kock explains that infectious diseases have a spatial structure and that their spread depends on individual features that either promote or hinder their progress. Based on this, he argues that various forms of mapping could help to contain such diseases.

In the case of the Ebola epidemic, having no maps or census data for the region where the outbreak occurred made it difficult to apply aggressive quarantine programs, which could have isolated the villages where Ebola was active and protected those at risk from villagers who did not display symptoms.

Prof. Koch discusses the need to involve the community in mapping and education.

He says:

“Employing community members in the mapping also serves anthropologically, involving community members in the disease response, teaching them about an expanding viral event and its local effects. In areas where there is distrust of foreign or official health workers, this can be critical.”

Prof. Koch gives the example of the Nepal earthquake in 2015, where resources of Humanitarian Open Street Map and Digital Globe satellite data enabled 39 volunteers to create Quakemap.org, a crowd-sourced mapping program that enabled correlation of reports of earthquakes in individual villages to help ensure that supplies were directed where they were needed.

In connection with the Ebola crisis, he focuses on a strategy called diffusion mapping. In this approach, smaller scale maps are used in patient interviews to identify travel patterns of patients before they become symptomatic. This could be helpful in anticipating the number of patients likely to present with symptoms in time.

He describes the approach as “a potentially invaluable, if so far untested, approach that would rapidly characterize local travel patterns and thus the potential for regional disease expansion.”

Prof. Koch hopes that the review will help shape ideas about how mapping could help significantly in future outbreaks by contributing toward a prompt response.

Medical News Today recently reported on trials into the effectiveness and safety ofusing convalescent plasma to treat Ebola patients.

Source
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Pregnant women advised to avoid animals that are giving birth

Pregnant women advised to avoid animals that are giving birth

Pregnant women advised to avoid animals that are giving birth

Public Health Wales is reminding pregnant women to avoid close contact with animals that are giving birth.
Pregnant women who come into close contact with sheep during lambing or other farm animals that are giving birth may risk their own health, and that of their unborn child, from infections that such animals can carry.
Therefore Public Health England, the Department of Health, the Department for Environment, Food and Rural Affairs, the Animal and Plant Health Agency and the Health and Safety Executive, in association with the Welsh Government and Public Health Wales, the Scottish Government and Health Protection Scotland and the Departments of Agriculture and Rural Development (DARD) and of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland have issued annual advice for a number of years that women who are or may be pregnant should avoid animals that are giving, or have recently given, birth.
Although the number of human pregnancies affected by contact with an infected animal is extremely small, it is important that pregnant women are aware of the potential risks and take appropriate precautions.
These risks are not only associated with sheep, nor confined only to the spring (when the majority of lambs are born). Cattle and goats that have recently given birth can also carry similar infections.
To avoid the possible risk of infection, pregnant women should:
  • not help ewes to lamb, or provide assistance to a cow that is calving or a nanny goat that is kidding;
  • avoid contact with aborted or new-born lambs, calves or kids or with the afterbirth, birthing fluids or materials (e.g. bedding) contaminated by such birth products;
  • avoid handling (including washing) clothing, boots or any materials  that may have come into contact with animals that have recently given birth, their young or afterbirths. Potentially contaminated clothing will be safe to handle after being washed on a hot cycle;
  • ensure contacts or partners who have attended lambing ewes or other animals giving birth take appropriate health and hygiene precautions, including the wearing of personal protective equipment and clothing and adequate washing to remove any potential contamination.
Pregnant women should seek medical advice if they experience fever or influenza-like symptoms, or if concerned that they could have acquired infection from a farm environment.
Farmers and livestock keepers have a responsibility to minimise the risks to pregnant women, including members of their family, the public and professional staff visiting farms.
Further advice is available to download from the document: More information on the following document... Q&A for pregnant women during lambing season

Source

Article originally appeared on the Public Health Wales Health Protection Division website on 11th January available at: http://www.wales.nhs.uk/sites3/news.cfm?orgid=457&contentid=39978

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