“This report of EFSA and the European Centre for Disease Prevention and Control presents the results of the zoonoses monitoring activities carried out in 2015 in 32 European countries (28 Member States (MS) and four non-MS). Campylobacteriosis was the most commonly reported zoonosis and the increasing European Union (EU) trend for confirmed human cases since 2008 continued. In food, the occurrence of Campylobacter remained high in broiler meat. The decreasing EU trend for confirmed human salmonellosis cases since 2008 continued, but the proportion of human Salmonella Enteritidis cases increased. Most MS met their Salmonella reduction targets for poultry. More S. Enteritidis isolates were reported and S. Infantis was confirmed as the most frequent serovar isolated from domestic fowl. In foodstuffs, the EU level Salmonella non-compliance for minced meat and meat preparations from poultry was low. Despite the significant increasing trend since 2008, the number of human listeriosis cases stabilised in 2015. In ready-to-eat foods, Listeria monocytogenes seldom exceeded the EU food safety limit. The decreasing EU trend for confirmed yersiniosis cases since 2008 continued. Positive findings for Yersinia were mainly reported in pig meat and products thereof. The number of confirmed shiga toxin-producing Escherichia coli (STEC) infections in humans was similar to 2014. In food, STEC was most frequently reported in meat from ruminants. A total of 4,362 food-borne outbreaks, including waterborne outbreaks, were reported. Bacteria were the most commonly detected causative agents, followed by bacterial toxins, viruses, other causative agents and parasites. The causative agent remained unknown in 33.5% of all outbreaks. As in previous years, Salmonella in eggs continued to represent the highest risk agent/food combination. The report further summarises trends and sources for tuberculosis due to Mycobacterium bovis, Brucella, Trichinella, Echinococcus, Toxoplasma, rabies, Coxiella burnetii (Q fever), West Nile virus and tularaemia.”
There are fears that Africa’s next major modern disease crisis will emerge from its cities. Like Ebola, it may well originate from animals. Understanding where it would come from and how this could happen is critical to monitoring and control.
Growth and migration are driving huge increases in the number of people living in Africa’s urban zones. More than half of Africa’s people are expected to live in cities by 2030, up from about a third in 2007.
The impact of this high rate of urbanisation on issues like planning, economics, food production and human welfare has received considerable attention. But there hasn’t been a substantive effort to address the effects on the transmission of the organisms – pathogens – that cause disease. This is despite several influential reports linking urbanisation to the risk of emerging infectious diseases.
Africa’s cities are melting pots of activity and interaction. Formal and informal trading take place side by side. The wealthy live alongside the poor, livestock alongside people and waste is poorly disposed of near food production areas.
This degree of mixing and contact creates an opportune ecological setting for pathogen transmission for a variety of bugs. Already approximately 60% of human pathogens are zoonotic. This means that three out of five human diseases are transmitted from animals. Scientists predict that this is set to increase and that about 80% of new pathogens will have zoonotic origins.
Emerging infectious diseases are a major concern to the global public health community, both in terms of disease burden and economic burden. Understanding the processes that lead to their emergence is therefore a scientific research priority.
Over the last five years I have been working with a group of researchers to understand what leads to the introduction of pathogens in urban environments and how those then emerge in the human population.
Tracking the next disease
Investigating the pathogens we already know about can help us understand the mechanisms and processes that underlie the emergence of new pathogens.
The questions that need to be addressed are:
- what is it about urban environments that might predispose to an emergence event, and
- what is the relevance of livestock as reservoirs of potentially emerging pathogens in these environments?
What’s been lacking from a public health perspective are studies linking wider ecological systems – such as intensive farming systems – to disease emergence and human social organisation. Also missing are studies that investigate the diversity of micro-organisms at a genetic level in these settings – a field called microbial genetics. This kind of research is not often undertaken on a meaningful scale.
The work that we’ve been doing in Kenya’s capital Nairobi aims to go some way towards plugging this gap.
Urban zoo project
Our Urban Zoo project, funded by the UK Medical Research Council and other UK research councils, has focused on livestock as a major source of emerging zoonotic diseases. This is a critical interface as 40% of known livestock pathogens (200 species) can infect humans.
We’ve been taking a landscape genetics approach to understand how urban populations connect to livestock. This means we study the pathogens and their hosts from an ecological perspective. It’s a fascinating way to do science on a big scale. We investigate humans in different socio-economic groups, the peri-domestic wildlife that live around them, the livestock they keep and the livestock that feed them.
Our method of choice is to explore the diversity of the bacterium Escherichia coli as an exemplar. E. coli is an excellent microbe to study for this purpose. It is zoonotic, exists in many hosts and in the environment, and can be found in food products of animal origin.
We have also been:
- Mapping animal source food systems – in both the formal and informal sectors – that bring food to city residents
- Trying to understand human relationships with livestock in the city itself. This is a social science and economic approach that explores why people keep animals and how they contribute to their livelihoods
- Factoring in public health, environmental, social and ecological characterisation of the city. For example, we’ve mapped low income neighbourhoods using cameras on hot air balloons to see how food sellers are distributed in a bacteria-rich environment
As a global scientific community, and as providers of evidence to those who make policy, we need to be able to explain the mechanisms behind issues such as this. Only when we have achieved this will the risk of disease emergence in these settings be relevant to those responsible for mitigating its occurrence. The risks must be balanced against the benefits of allowing city environments to provide a livelihood for their residents.
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
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:
Chinese medical workers will survey Tibet to prepare a treatment plan for controlling echinococcosis
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
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.
1.2.1 Transition from Millennium Development Goals to Sustainable Development Goals
The eight MDGs 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 (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. 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” highlights important success stories from the MDGs in Africa.
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, Uganda, Tanzania, Burundi, and Rwanda, 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 characterized by lack of reliable data which undermines the ability to set goals, optimize investments, decisions, and measure progress.
The 17 Sustainable Development Goals (SDGs), originally conceptualized as “The Future We Want” on September 2012 were adopted on September 2015 after a series of inclusive and consultative meetings (Figure 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’ 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 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, 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.
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. At the same time development of antimicrobial resistance poses an increasing burden in the treatment of some of the zoonotic diseases in the region.
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. 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. 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.
- 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. 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.
- 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 . 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 . 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 and Mongolia. This, in turn, requires a One Health approach, involving joint surveillance, control and policy management by veterinary, medical and other sectors. The outstanding opportunity that is at hand is there is already a working model of a One Health office in Kenya, 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).
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 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.
- 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) so as to measure progress in the work of controlling the four priority zoonotic diseases.
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