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

New global migration mapping to help fight against infectious diseases

New global migration mapping to help fight against infectious diseases

newglobalmigGeographers at the University of Southampton have completed a large scale data and mapping project to track the flow of internal human migration in low and middle income countries.

Researchers from the WorldPop project at the University have, for the first time, mapped estimated in across three continents; Africa, Asia and Latin America and the Caribbean.

Professor Andy Tatem, Director of WorldPop, comments: “Understanding how people are moving around within countries is vital in combating infectious diseases like malaria. The parasite which causes the disease can be quickly reintroduced to a malaria free area by highly mobile populations.

“Having an accurate overview of how different regions of countries are connected by human movement aids effective disease control planning and helps target resources, such as treated bed nets or community health workers, in the right places. Having data for all low and across three continents will greatly aid disease control and elimination planning on global and regional scales.”

Working with colleagues at the Flowminder Foundation and supported by the Bill and Melinda Gates Foundation, the researchers have used census micro-data (anonymised census information at the individual level) to model estimates of flows within countries and then produced a series of maps to visually represent the data. The research paper ‘Mapping internal connectivity through human migration in malaria endemic countries’ published in Scientific Data details the methods they employed, and presents the freely available data.

Lead author Dr Alessandro Sorichetta from the University of Southampton says: “We sourced the census data from around 40 different countries and have produced detailed population migration maps on a scale not seen before. They show webs of connectivity within countries – indicating high and low flows of people moving between different locations.”

Figures from the International Organization for Migration and The World Bank show that, without accounting for seasonal and temporary migrants, more than one billion people live outside their place of origin – 740 million as ‘internal migrants’. Human mobility is expected to continue to rise, creating a range of impacts, such as invasive species, drug resistance spread and disease pandemics.

Dr Sorichetta comments: “It’s crucial we understand human mobility, so we can quantify the effect it has on our societies and the environment and provide strong evidence to support the development of policies to address issues, such as public health problems.”

The researchers are now integrating the migration estimates with data on malaria prevalence – helping to inform regional elimination and global eradication plans for the disease. Equally, they believe the data could be used to support regional control and elimination strategies for other , for example, Schistosomiasis, River Blindness, HIV, dengue and Yellow Fever. Furthermore, the datasets could help inform decisions in the fields of trade, demography, transportation and economics.

More information: Alessandro Sorichetta et al. Mapping internal connectivity through human migration in malaria endemic countries, Scientific Data (2016). DOI: 10.1038/sdata.2016.66

This post originally appeared at: http://medicalxpress.com/news/2016-08-global-migration-infectious-diseases.html

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The role of wildlife in transboundary animal diseases in Kenya

The role of wildlife in transboundary animal diseases in Kenya

SUMMARY OF RECENT HISTORY (SINCE 2000) OF SELECTED TRANSBOUNDARY DISEASES IN KENYA

Avian influenza A (H7N9 & H1N1)

The 2009 Pandemic influenza A (H1N1) was first characterized in Kenya on 29th June, 2009 (Matheka et al., 2013). Thereafter sentinel data from ten sites in Kenya have identified both influenza type A and B circulating in Kenya (Muthoka, 2012). The distribution of these influenza types between 2006 to 2011 was as follows: Type A pandemic (H1N1) 2009 (28%), Type A (H1N1) seasonal (10%), Type A (H3N3) seasonal (24%), Type B (31%) and uncharacterized (7%) (Muthoka, 2012). In 2012 the predominant strain in Kenya was H3N2 with a seasonal occurrence (Achilla et al., 2009, Muthoka, 2012).

Foot and Mouth Disease

The Foot and Mouth disease outbreaks (see Figure 1 and 4) that have occurred in Kenya during the period 2004-2006 have involved serotypes: O, A, C, SAT1 and SAT2 (Sangula, 2006, CDC, 2007). The outbreak serotype distribution over the years has been as follows: 1 outbreak of SAT 1 and 19 of SAT2 reported in 2004; 3 of SAT1 and 10 of SAT2 reported in 2005; and 7 of SAT 1 and 4 of SAT 2 reported in 2006 (Sangula, 2006).

Figure 1: Map of Kenya showing reported FMD Outbreaks per province: 2004-2006 (Sangula, 2006)

Rift Valley Fever

The most recent outbreak of Rift Valley Fever in Kenya occurred between November 2006 to January 2007 (see Figure 4) that affected 6 provinces and 29 administrative districts (see Figure 2 & 3) out of the total 8 provinces and 69 administrative districts, respectively (Munyua et al., 2010) as a result of extraordinarily heavy rainfall during October-December 2006 (CDC, 2007). Following the El-nino development advisory that was issued by Kenya Meteorological Department on 22nd September, 2015 (Kenya, 2015a), as of 19th February, 2016 (time of writing this assignment) there has not been any confirmed RVF case in Kenya preceding the late-2015 El-Nino rains.

Figure 2: Districts in Kenya with confirmed RVF cases in humans and animals during 2006/07 outbreak (Munyua et al., 2010)

 

Figure 3: Number and percentage of reported RVF cases by district in Kenya Nov 2006-January 25th 2007 (CDC, 2007)

Figure 3: Number and percentage of reported RVF cases by district in Kenya Nov 2006-January 25th 2007 (CDC, 2007)

 The last known outbreak of Rinderpest in Kenya was of cattle reported in Meru National Park in 2001 (Omiti and Irungu, 2010) and a buffalo (AVMA, 2011). Since then Kenya has been free of Rinderpest (see Figure 4)

Figure 4: OIE-WAHIS Disease timelines for FMD, RVF and Rinderpest in Kenya between 2005-2015 (OIE, 2016b)

RISK OF WILDLIFE IN THE EPIDEMIOLOGY OF FMD IN KENYA

Records at the Kenya national Foot-and-Mouth Disease Laboratory show that previous studies on FMD in Kenya have mainly focused on cattle and rarely on other susceptible domestic species (Wekesa et al., 2014) and only to a minor extent on wildlife. However, in 1979, a field survey isolated SAT1 and SAT2 FMDVs from buffalo populations in the southern part of Kenya (Anderson et al., 1979).

(Bronsvoort et al., 2008) demonstrated a high and increasing seroprevalence of Foot and Mouth Disease Virus (FMDV) between the years 1994-2002 among the African buffalo (Syncerus caffer) in Eastern Africa (Kenya inclusive) with a high sero-conversation early in life (1-2 years). The study also found that the dominant serotypes were SAT2, SAT1 and then SAT3 in that order, although the buffalo seemed to be more associated to maintain the SAT2 as compared to the other serotypes.

FMDV has also been shown to infect several wild species that are found in Laikipia, with the African elephant proposed to play a potential transmission role (Aftosa, 2014). This potential transmission is further purported by (Benka, 2012) where 92.2% of the respondents in Laikipia-Kenya noted an increased contact time and population of wildlife in the recent past, especially the elephants and the buffaloes. The OIE WAHIS database also shows existence of FMD outbreaks in Kenya among wildlife (refer to Figure 4), with suspected cases in 2009 and confirmed cases between 2010-2011 that were limited to one or more zones (OIE, 2016b).

A study by (Wekesa et al., 2015) found that the Buffalo harbored SAT1 and SAT2 serotypes (see Figure 5). Wildlife have been implicated, through molecular epidemiology, as a possible culprit for the upsurge of the SAT1 and SAT2 epidemics in Kenya because of the intimate interaction of livestock and wildlife in the pastoral ecosystem (Sangula, 2006, CDC, 2007). This makes it imperative to undertake antigenic comparison to determine if the current vaccines confer protection against these co-shared serotypes at the livestock-wildlife interface.

The cross-border movement of wildlife from Kenya to Tanzania (see Figure 6) could be facilitating the complex and trans-boundary nature of this disease and further complicating its epidemiology. This could mean that control measures need to be collaborative between the governments of Kenya and Tanzania, employing a One Health concept.

Figure 5: Cross-border movement of wildlife between Kenya and Tanzania (Rovi film, 2013)

Figure 6: Circles with numbers indicate geographic origins of the 15 SAT 1 and SAT 2 foot-and-mouth disease viruses (FMDVs) isolated from buffalo and cattle (Wekesa et al., 2015)

Figure 6: Circles with numbers indicate geographic origins of the 15 SAT 1 and SAT 2 foot-and-mouth disease viruses (FMDVs) isolated from buffalo and cattle (Wekesa et al., 2015)

BIOLOGIC, SOCIOLOGIC, AND ECONOMIC FACTORS IMPORTANT IN THE CONTROL AND/OR ELIMINATION OF FMD IN KENYA

BIOLOGIC FACTORS

Wide array of serotypes: There are several serotypes for the FMDV with antigenic variations within each serotype making it impossible for one serotype to confer immunity against another serotype (OIE, 2012), and therefore in practice vaccine matching becomes necessary with the field strains  (Chepkwony, 2011).

FMDV is highly contagious: Transmission can be facilitated through contact with infected animals, their excretions, secretions, or contaminated fomites and products (OIE, 2012, USDA, 2013). It has also been shown that humans can possibly transmit the FMDV to susceptible animals during FMD outbreaks (USDA, 2013) and therefore responders should uphold biosecurity measures.

Wide range of susceptible hosts: Many of the cloven-hoofed wildlife and domestic species at the wildlife-livestock interface in Kenya, including: cattle, goats, sheep, and pigs are susceptible to FMDV, and this presents a possible spillover of infection into livestock or sympatric cloven-hoofed wildlife (OIE, 2012 1512).

Carrier state: Cattle, sheep, and goats can become carriers or persistently infected even after successful vaccination (Chhetri et al., 2010). The carrier state is a complication which should be considered during outbreak situations (Grubman and Baxt, 2004).

FMDV is moderately stable in the environment: Under certain conditions the FMDV can maintain infectivity in the environment for extended periods of time (USDA, 2013). It is essential for livestock owners and producers to maintain sound biosecurity practices as outlined by (OIE, 2016a) to prevent introduction/spread of the virus during outbreaks.

Illegal movement routes: Illegal stock routes for trade as a result of drought, forced cattle movement due to cattle rustling and across the borders are some of the main causes of FMDV spread in Kenya (Chepkwony, 2011). Therefore there should be coordinated livestock movement control at borders and stop cattle rustling.

Pastoralism: Pastoral long distance movement of animals, and high stocking densities facilitates the widespread of viral particles (OIE and FAO, 2012) within and across borders.

Several differential diagnosis: FMD cannot be differentiated clinically from other similar diseases and therefore an suspected case is best confirmed through laboratory diagnosis (OIE, 2012).

SOCIAL FACTORS

The social factors to be considered are:

  • Effective, timely and accurate communications with the affected premises, stakeholders, farmers and animal keepers, the public and the media so as to reduce the impact and spread of disease and to provide accurate and timely updates on latest situation
  • Timely risk communication to the public, region and international community during an outbreak or incident to ensure effective representation of Kenya disease control activities.
  • Background knowledge on the structure of livestock production systems to understand epidemiology and control options suitable at the local setting
  • Public health implications since FMD can cause mild disease in humans and accompanied by floods during the rains
  • Assurance to the public and international community of safe commodities for trade
  • Public acceptance especially when it comes to: culling of animals and animal welfare perspectives
  • Provision of support services e.g. psychological support during mass death
  • How to counter misinformation and misconceptions especially through media
  • Supporting legal framework in Kenya: The animal diseases Act Chapter 364; Public Health act cap 242; Meat Control Act cap 356; Procurement and audit act

ECONOMIC FACTORS

Some of the economic factors to consider are (OIE, 2014):

  • Costs and benefits of intervention
  • Availability of resources
  • Logistics and ease of implementation
  • Stakeholder engagement especially the public-private partnerships
  • Environmental impact
  • Political will
  • Incentives and compensation
  • Budget and financial resources planning

IMPORTANT STAKEHOLDERS TO BE INVOLVED IN THE CONTROL

Ministry of Agriculture, Livestock and Fisheries: Kenya’s economy is dominated by the agricultural sector and FMD poses a great threat to it both as production losses and indirect losses.

Ministry of Health: FMD has public health implications e.g. flooding & zoonotic.

Ministry of Tourism and other local & international travel organisations: The African wildlife are a major tourist attraction and if there is a risk of infection from wildlife this may impact negatively on the tourism industry

Devolved local government administration: have the responsibility to enforce disease control measures, offer administrative and information technology resources such as administered movement licensing, provide advice and support to affected sectors.

Central Veterinary Laboratory: has the capacity to provide and interpret diagnostic and surveillance data and provide disease-specific expert knowledge in terms of the epidemiology and control measures of FMD.

Regional or Local NGOs, CBOs, FBOs, youth groups, churches etc.:  These groups will help inform local decision making as appropriate and will assist with ensuring that developments in local operations are communicated to all relevant parties, including those who are not engaged with industry groups and sector councils, and can be a challenge to reach.

Ministry of Defence and Police:  They will play the role of organization and logistical arrangements especially when it comes to intensifying biosecurity patrols and protecting the public order with individual roles such as: enforcement of movement controls with local authorities, policing of control zones, coordination of legal entry to premises etc.

Global facilitation/technical assistance bodies: such as GARC (Global Alliance for Rabies Control) who can act as a liaison body between national governments, community stakeholders and the international FAO-OIE-WHO tripartite.

Regional banks and stakeholders: they have contributed and still contribute significantly to FMD control efforts in Africa.

Ministry of Environment and Natural Resources: Will contributed to development of carcass transport arrangements and advice on planning, air and environment quality issues relating to disposal of carcasses and cleanup.

Foot and Mouth Disease champion: Having an FMD champion from a country that has successfully eradicated FMD so as to provide ‘good practices’ that can locally be adopted in the prevention and control of FMD

Kenya Veterinary Vaccines Production Institute (KEVEVAPI): Since they produce the FMD vaccine they will play a valuable contribution in its control through vaccine provision

Local community: They have and are already suffering because of the production losses as a result of FMD and therefore will be a direct beneficiary and implementer of prevention/control strategies proposed.

The media:  They will disseminate key messages on the prevention and control of FMD to the public

CONCLUSIONS AND RECOMMENDATIONS

It is clear that wildlife have a potential role in the epidemiology of Foot and Mouth Disease in Kenya and the neighboring regions, although the existing information is still limited. Hence, Foot and Mouth Disease control in Kenya should principally target on reducing the high burden of disease among livestock and consequently limit the livestock-wildlife interaction through collaborative efforts with stakeholders and between countries that share a border with Kenya that facilitate cross-border movement of livestock and wildlife. This can be achieved through a number of ways:

  • Strengthen surveillance systems: Build the capacity of local laboratories and promote regional integrated surveillance systems so as to facilitate early detection and rapid response to any FMD outbreak. At the same time develop multivalent vaccines targeting the shared serotypes between livestock and wildlife.
  • Disease prevention and infection control: with the aim of slowing the spread of FMD and end the outbreak so as to prevent new cases from arising. This can be at the:
    • Human level through: public health education; behavior change communication especially targeting the pastoralists to avoid risky practices that propagate transmission between communities and across borders
    • Animal level through: strategic livestock vaccination in specific hot spots; imposition of quarantines in affected areas and slaughter bans.
  • Cross-border mitigation: The cross-border movement of livestock and wildlife necessitates that control measures need to be collaborative between the governments employing a One Health concept.
  • Support services: Contingency plans to be in place to provide support in regard to floods that can result to partial/full harm to humans which may require provision of temporary support facilities and relief aid to both humans and animals
  • Targeted and coordinated communication: The aim is to provide accurate, timely and easy to understand information through coordinated communication among all relevant stakeholders to ensure consistent messages to the general public and at the same time address the circulating rumours, misinformation and conflicting information.
  • Standard Operating Procedures and protocols: Should be available before the outbreak and address: simulation and training, quarantine measures, handling of samples, vaccination of livestock, surveillance, rapid response teams, biosecurity and biosafety, communication protocol, and allocation of responsibilities.

 REFERENCES

ACHILLA, R. A., BULIMO, W. D., MAJANJA, J. M. & WADEGU, M. O. 2009. Decline of Pandemic (2009) H1N1 Influenza Cases in Sentinel Surveillance Sites in Kenya January 2012-May 2012. ISIRV Conference.  Available at: http://creativestage.nucleusclient.com/isirv/Incidence/Poster_Presentations.pdf [Accessed 15 February, 2016].

AFTOSA, F. 2014. Foot and Mouth Disease. The Centre for Food Secueity and Public Health Institute for International Cooperation in Animal Biologics Available at: http://www.cfsph.iastate.edu/Factsheets/pdfs/foot_and_mouth_disease.pdf [Accessed 15 February, 2016].

ANDERSON, E. C., DOUGHTY, W. J., ANDERSON, J. & PALING, R. 1979. The pathogenesis of foot-and-mouth disease in the African buffalo (Syncerus caffer) and the role of this species in the epidemiology of the disease in Kenya. Journal of Comparative Pathology, 89, 541-549 Available at: http://www.sciencedirect.com/science/article/pii/0021997579900458 [Accessed 15 February, 2016].

AVMA. 2011. Rinderpest eradicated [Online]. American Veterinary and Medical Association. Available at: https://www.avma.org/News/JAVMANews/Pages/110701a.aspx.

BENKA, V. A. W. 2012. Human-wildlife conflict, interspecies disease, and justice in a wildlife-rich region of Kenya. Master of Science Msc, University of Michigan.  Available at: http://deepblue.lib.umich.edu/bitstream/handle/2027.42/96190/benka%20thesis%20final.pdf?sequence=1.

BRONSVOORT, B. M., PARIDA, S., HANDEL, I., MCFARLAND, S., FLEMING, L., HAMBLIN, P. & KOCK, R. 2008. Serological survey for foot-and-mouth disease virus in wildlife in eastern Africa and estimation of test parameters of a nonstructural protein enzyme-linked immunosorbent assay for buffalo. Clin Vaccine Immunol, 15, 1003-11.http://dx.doi.org/10.1128/CVI.00409-07:

CDC 2007. Rift Valley Fever Outbreak  Kenya, November 2006 January 2007. Morbidity and Mortality Weekly Report.  Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5604a3.htm [Accessed 11 February, 2016].

CHEPKWONY, E. C. 2011. An Epidemiological Survey Of The Serotypes Of Foot and Mouth Disease Virus In Circulation In The Somali-ecosystem In Kenya. Applied Veterinary Microbiology Msc, University of Nairobi.  Available at: http://erepository.uonbi.ac.ke/bitstream/handle/11295/13995/An%20Epidemiological%20Survey%20Of%20The%20Serotypes%20Of%20Footand-mouth%20Disease%20Virus%20In%20Circulation%20In%20The%20Somali-ecosystem%20In%20Kenya.pdf?sequence=4.

CHHETRI, B. K., PEREZ, A. M. & THURMOND, M. C. 2010. Factors associated with spatial clustering of foot-and-mouth disease in Nepal. Trop Anim Health Prod, 42, 1441-9.http://dx.doi.org/10.1007/s11250-010-9573-7:

GRUBMAN, M. J. & BAXT, B. 2004. Foot-and-Mouth Disease. Clinical Microbiology Reviews, 17, 465-493.http://dx.doi.org/10.1128/cmr.17.2.465-493.2004:

KENYA, G. O. 2015a. Advisory on development of El-Nino. In: RESOURCES, M. O. E. A. N. (ed.). Nairobi-Kenya: Kenya Meteorological Department Available at: http://www.meteo.go.ke/pdf/elnino_2.pdf [Accessed 16 February, 2016].

KENYA, G. O. 2015b. Kenya Veterinary Policy (draft). In: MINISTRY OF AGRICULTURE, L. A. F. (ed.). Nairobi:  Available at: http://www.kilimo.go.ke/wp-content/uploads/2015/06/Draft-Veterinary-Policy.pdf [Accessed].

MATHEKA, D. M., MOKAYA, J. & MARITIM, M. 2013. Overview of influenza virus infections in Kenya: past, present and future. Pan Afr Med J, 14, 138.http://dx.doi.org/10.11604/pamj.2013.14.138.2612:

MUNYUA, P., MURITHI, R. M., WAINWRIGHT, S., GITHINJI, J., HIGHTOWER, A., MUTONGA, D., MACHARIA, J., ITHONDEKA, P. M., MUSAA, J., BREIMAN, R. F., BLOLAND, P. & NJENGA, M. K. 2010. Rift Valley fever outbreak in livestock in Kenya, 2006-2007. Am J Trop Med Hyg, 83, 58-64.http://dx.doi.org/10.4269/ajtmh.2010.09-0292:

MUTHOKA, P. 2012. Influenza Epidemiology in Kenya. 3rd Annual African Network for Influenza Surveillance and Epidemiology(ANISE) Nairobi-Kenya:  Available at: https://www.team-psa.com/anise/2012/pres/WEDFEB1/InfluenzaSurvUpdates/Muthoka_Influenza%20Epidemiolgy%20in%20Kenya.pdf [Accessed 16 February, 2016].

OIE 2012. Foot and Mouth Disease. Terrestrial Manual 2012. 7 ed.: World Organisation for Animal Health Available at: http://www.oie.int/international-standard-setting/terrestrial-manual/access-online/ [Accessed].

OIE 2014. Guidelines for Animal Disease Control. World Organisation For Animal Health,  Available at: http://www.oie.int/fileadmin/Home/eng/Our_scientific_expertise/docs/pdf/A_Guidelines_for_Animal_Disease_Control_final.pdf [Accessed 16 February, 2016]. 1-10

OIE 2016a. Foot and Mouth Disease Portal: Prevention and control. World Organisation for Animal Health Available at: http://www.oie.int/animal-health-in-the-world/fmd-portal/prevention-and-control/ [Accessed].

OIE 2016b. WAHIS-Disease Information-disease timelines for FMD, RVF and Rinderpest. World Organisation for Animal Health Available at: http://www.oie.int/wahis_2/public/wahid.php/Diseaseinformation/Diseasetimelines [Accessed].

OIE & FAO 2012. The Global Foot and Mouth Disease Control Strategy: Strengthening animal health systems through improved control of major diseases, World Organisation for Animal Health

Food and Agriculture Organisation of  the United Nations.

OMITI, J. & IRUNGU, P. 2010. Socio-economic Benefits of Rinderpest Eradication from Ethiopia and Kenya. In: OMITI, J. & IRUNGU, P. (eds.) Consultancy Report. African Union InterAfrican Bureau for Animal Resources Available at: file:///C:/Users/MomanyiNK/Desktop/doc_20100301_serecu_socioecobenefits_en.pdf [Accessed 11 February, 2016].

ROVI FILM 2013. The Serengeti gnu migration route.  Available at: http://www.rovifilm.tv/index.php/press-articles/item/between-tanzania-and-kenya-the-serengeti [Accessed 16 February, 2016].

SANGULA, A. K. 2006. Foot-and-Mouth disease serotypes SAT1 and SAT2 Epidemiology in East Africa. Food and Agriculture Organisation of the United Nations: Foot and Mouth Disease Laboratory, Embakasi-Kenya Available at: http://www.fao.org/AG/AGAInfo/commissions/en/documents/reports/paphos/App18.pdf [Accessed 11 February, 2016].

USDA 2013. Foreign Animal Disease Preparedness & Response Plan: Foot and Mouth Disease Standard Operating Procedures-Overview of Etiology and Ecology. In: SERVICE, A. A. P. H. I. (ed.). United States Department of Agriculture Available at:  [Accessed 16 February, 2016].

WEKESA, S. N., NAMATOVU, A., SANGULA, A. K., DHIKUSOOKA, M. T., MUWANIKA, V. B. & TJORNEHOJ, K. 2014. A serological survey for antibodies against foot-and-mouth disease virus (FMDV) in domestic pigs during outbreaks in Kenya. Trop Anim Health Prod, 46, 575-81.http://dx.doi.org/10.1007/s11250-013-0530-0:

WEKESA, S. N., SANGULA, A. K., BELSHAM, G. J., TJORNEHOJ, K., MUWANIKA, V. B., GAKUYA, F., MIJELE, D. & SIEGISMUND, H. R. 2015. Characterisation of recent foot-and-mouth disease viruses from African buffalo (Syncerus caffer) and cattle in Kenya is consistent with independent virus populations. BMC Vet Res, 11.http://dx.doi.org/10.1186/s12917-015-0333-9:

 

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Researchers confirm link between schistosomiasis and HIV acquisition

Researchers confirm link between schistosomiasis and HIV acquisition

WWF

Photo by John Bett, WWF

A comprehensive review of secondary data sources has confirmed a long-suspected link between female genital schistosomiasis (FGS) and HIV infection for women in southern Africa. Researchers confirmed the link in Mozambique, finding that exposure to schistosomiasis, combined with HIV prevalence, increases the odds of HIV infection by three times. Researchers also conclude that treating young girls for schistosomiasis could avert millions of new cases of HIV infection at far less cost than treating HIV infection once it has occurred.

Schistosomiasis is a fresh water-borne parasitic infection, usually contracted in childhood through activities such as swimming, bathing, fishing, and fetching water. It affects 261 million people worldwide and is known to be highly endemic in sub-Saharan Africa. Domestic chores can place girls and women at greater risk of contracting FGS, which, the researchers say, may help explain the fact that only in sub-Saharan Africa are HIV infections higher among females than among males.

The authors, Paul Henry Brodish and Kavita Singh, conducted the study for MEASURE Evaluation, funded by the U.S. Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR), a project of the Carolina Population Center of the University of North Carolina at Chapel Hill (UNC).

Researchers confirmed the link in Mozambique by investigating two high-quality secondary data sources on HIV prevalence and FGS: the 2009 National Survey on Prevalence, Behavioral Risks, and Information about HIV and AIDS in Mozambique (INSIDA) and the Global Neglected Tropical Diseases (GNTD) open source database. Their results can reasonably be applied generally to sub-Saharan Africa and perhaps especially to South Africa, Tanzania, and Zimbabwe, where field studies showed woman whose vaginal mucosal barrier tissue was compromised due to FGS were three times as likely as their neighbors to be infected with HIV.

School children in Niger with gross hematuria (blood in urine) caused by schistosomiasis (photo by Jurg Utzinger)

School children in Niger with gross hematuria (blood in urine) caused by schistosomiasis (photo by Jurg Utzinger)

In fact, two decades of studies have indicated that HIV/AIDS can be exacerbated by co-infection with neglected tropical diseases (including schistosomiasis), which weaken immune systems, increase susceptibility to other infections, and lower the effectiveness of antiretroviral therapy (ART).

The study’s findings also offer a significant potential cost savings for governments and global donors, as treatment for FGS would cost significantly less than treating HIV infection. The authors cite estimates that de-worming 70 million African children twice a year for a decade would cost about $112 million, versus an estimated $38 billion PEPFAR would expend in the same period.

These results are additional evidence supporting the link between neglected tropical diseases (NTD) and HIV and the need to scale up treatment for NTD and for increased access to improved water sources. The authors suggest further studies are necessary in other locales where there is high HIV prevalence and endemic NTDs.

The researchers say the study is limited by its indirect assessment of exposure to FGS (S. haematobium) and that the availability of mass drug administration in various survey regions is not known. However, both of these limitations would tend to make it more difficult to draw an association between FGS and HIV infections.

The study is also significant on a global scale as the Sustainability Development Goals (SDG), USAID’s goal of an AIDS-free generation (AFG), and prevention of mother-to-child transmission of HIV (PMTCT), will be that much more attainable if HIV infection can be curtailed in sub-Saharan Africa—where 60 percent of new cases are female and mostly young.

This article originally appeared on the Measure Evaluation website, authored by WWF CHAPEL HILL, NC. Available at: http://www.cpc.unc.edu/measure/news/schistosomiasis-and-hiv-acquisition

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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.

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Dr. Kelvin Momanyi

Dr. Kelvin Momanyi

I am a Veterinarian & a part time web designer. My current research is focused on the evidence-based added value & evaluation of One Health.

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