Prioritizing Zoonoses for Global Health Capacity Building-Themes from One Health Zoonotic Disease Workshops in 7 Countries, 2014-2016

A framework for supporting health capability-based planning: Identifying and structuring health capabilities

The COVID-19 pandemic has highlighted that health security systems must be redesigned, in a way that they are better prepared and ready to cope with multiple and diverse health threats, from predictable and well-known epidemics to unexpected and challenging pandemics. A powerful way of accomplishing this goal is to focus the planning on health capabilities. This focus may enhance the ability to respond to and recover from health threats and emergencies, while helping to identify the level of resources required to maintain and build up those capabilities that are critical in ensuring the preparedness of health security systems. However, current attempts for defining and organizing health capabilities have some important limitations. First, such attempts were not designed to consider diverse scenarios and multiple health threats. Second, they provide a limited representation of capabilities and lack a systemic perspective. Third, they struggle to identify capability and resource gaps. In this article, we thus propose a new framework for identifying and structuring health capabilities and support health capability planning. The suggested framework has three main potential benefits. First, the framework may help policymakers in planning under high levels of uncertainty, by considering multiple realistic and stressful scenarios. Second, it can provide risk analysts with a more comprehensive representation of health capabilities and their complex relationships. Third, it can support planners in identifying resource and capability gaps. We illustrate the use of the framework in practice considering an outbreak scenario caused by three different health threats (COVID-19, Ebola, and Influenza viruses).

Strengthening a One Health approach to emerging zoonoses

Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all.

New Insights into Bacterial Pathogenesis

Pathogenicity, or the ability of a microorganism to cause disease, depends on several factors, among which the immune status of the host and the microbial species involved in the exposure play a key role [...].

Application of a universal parasite diagnostic test to biological specimens collected from animals

A previously described universal parasite diagnostic (nUPDx) based on PCR amplification of the 18S rDNA and deep-amplicon sequencing, can detect human blood parasites with a sensitivity comparable to real-time PCR. To date, the efficacy of this assay has only been assessed on human blood. This study assessed the utility of nUPDx for the detection of parasitic infections in animals using blood, tissues, and other biological sample types from mammals, birds, and reptiles, known to be infected with helminth, apicomplexan, or pentastomid parasites (confirmed by microscopy or PCR), as well as negative samples. nUPDx confirmed apicomplexan and/or nematode infections in 24 of 32 parasite-positive mammals, while also identifying several undetected coinfections. nUPDx detected infections in 6 of 13 positive bird and 1 of 2 positive reptile samples. When applied to 10 whole parasite specimens (worms and arthropods), nUPDx identified all to the genus or family level, and detected one incorrect identification made by morphology. Babesia sp. infections were detected in 5 of the 13 samples that were negative by other diagnostic approaches. While nUPDx did not detect PCR/microscopy-confirmed trichomonads or amoebae in cloacal swabs/tissue from 8 birds and 2 reptiles due to primer template mismatches, 4 previously undetected apicomplexans were detected in these samples. Future efforts to improve the utility of the assay should focus on validation against a larger panel of tissue types and animal species. Overall, nUPDx shows promise for use in both veterinary diagnostics and wildlife surveillance, especially because species-specific PCRs can miss unknown or unexpected pathogens.

Human and animal botulism surveillance in France from 2008 to 2019

Botulism is a human and animal neurological disease caused by the action of bacterial neurotoxins (botulinum toxins) produced by bacteria from the genus Clostridium. This disease induces flaccid paralysis that can result in respiratory paralysis and heart failure. Due to its serious potential impact on public health, botulism is a closely monitored notifiable disease in France through a case-based passive surveillance system. In humans, this disease is rare, with an average of 10 outbreaks reported each year, mainly due to the consumption of contaminated foods. Type B and to a lesser extend type A are responsible for the majority of cases of foodborne botulism. Each year, an average of 30 outbreaks are recorded on poultry farms, about 20 cases in wild birds and about 10 outbreaks in cattle, involving a large number of animals. Mosaic forms C/D and D/C in birds and cattle, respectively, are the predominant types in animals in France. Types C and D have also been observed to a lesser extent in animals. With the exception of botulinum toxin E, which was exceptionally detected throughout the period in wild birds, the types of botulism found in animal outbreaks are different from those identified in human outbreaks over the last ten years in France and no human botulism outbreaks investigated have been linked to animal botulism. In line with the One Health concept, we present the first integrative approach to the routine surveillance of botulism in humans and animals in France.

A chromosomal-scale reference genome of the New World Screwworm, Cochliomyia hominivorax

The New World Screwworm, Cochliomyia hominivorax (Calliphoridae), is the most important myiasis-causing species in America. Screwworm myiasis is a zoonosis that can cause severe lesions in livestock, domesticated and wild animals, and occasionally in people. Beyond the sanitary problems associated with this species, these infestations negatively impact economic sectors, such as the cattle industry. Here, we present a chromosome-scale assembly of C. hominivorax's genome, organized in 6 chromosome-length and 515 unplaced scaffolds spanning 534 Mb. There was a clear correspondence between the D. melanogaster linkage groups A-E and the chromosomal-scale scaffolds. Chromosome quotient (CQ) analysis identified a single scaffold from the X chromosome that contains most of the orthologs of genes that are on the D. melanogaster fourth chromosome (linkage group F or dot chromosome). CQ analysis also identified potential X and Y unplaced scaffolds and genes. Y-linkage for selected regions was confirmed by PCR with male and female DNA. Some of the long chromosome-scale scaffolds include Y-linked sequences, suggesting misassembly of these regions. These resources will provide a basis for future studies aiming at understanding the biology and evolution of this devastating obligate parasite.

Integrating One Health topics to enhance health workers' leadership in health promotion activities

Moving into the next decade, the global health workforce can lead efforts to identify emerging health threats and develop immediate action plans to mitigate adverse effects on community health and well-being. To prepare health workers in their delivery of health education activities, the authors propose three didactic ('train the trainers') approaches: essential 'learning moments', critical analyses of One Health challenges, and the use of innovative real-time visualizations. Health workers' leadership is vital to achieve the targets of the 2030 Agenda for Sustainable Development, to safeguard population health, and ultimately to strengthen global health security.

Emerging and Re-Emerging Viral Infections: An Indian Perspective

Emerging and re-emerging viral infections pose a constant threat, especially in healthcare settings. Viral infections can be thought of as an ecological system, like a forest or a pond, with different species competing for resources. Pandemics tend to occur when there is a disruption to this ecosystem, such as introducing a strain of virus into humans or animals that they have no immunity against. Around 60% of human infectious diseases and 75% of emerging infections are zoonotic, with two-thirds originating in wildlife. There is an ongoing risk of viral diseases as the human population continues to grow and the rate of urbanization increases. The emergence and re-emergence of viral diseases are influenced by a variety of virologic and environmental factors. These factors can be roughly categorized as affecting humans, the environment and/or ecology, and viruses. The spread of zoonotic diseases among humans can be prevented by reducing the transmission risk associated with wildlife and exotic pets through education, legislation, and behavioral change programs that target individuals at risk for exposure.

Tick-Borne-Agents Detection in Patients with Acute Febrile Syndrome and Ticks from Magdalena Medio, Colombia

Acute febrile illness (AFI) is a morbid condition with a sudden onset of fever with at least seven days of evolution, where no signs or symptoms related to an apparent infection have been identified. In Latin America, a high proportion of disease is typically due to malaria and arboviruses. However, among the infectious etiologies, tick-borne diseases (TBDs) should also be considered, especially in areas where people come into direct contact with these arthropods. This study aims to describe the etiology and epidemiology related to tick-borne agents in patients with AFI and the tick’s natural infection by agents of TBD in the rural tropical Magdalena Medio region in Colombia, and explore the factors associated with the presence of Coxiella burnetii infection. We conduct a cohort study enrolling 271 patients with AFI to detect the bacteria of the genera Anaplasma, Ehrlichia, Coxiella, Rickettsia, Borrelia, and Francisella through molecular techniques, and additionally evaluate the presence of IgG antibodies with commercially available kits. We also conduct tick collection in the patient’s households or workplaces for the molecular screening of the same bacterial genera. Seropositivity to IgG antibodies was obtained for all the bacteria analyzed, with Francisella being the most common at 39.5% (107/271), followed by R. rickettsii at 31.4% (85/271), Ehrlichia at 26.9% (73/271), R. typhi at 15.5% (42/271), Anaplasma at 14.4% (39/271), and Borrelia at 6.6% (18/271). However, these bacteria were not detected by the molecular techniques used. Coxiella burnetii infection was detected in 39.5% of the patients: 49.5% only by phase I and II IgG antibodies, 33.6% only by real-time PCR, and 16.8% had a concordant positive result for both techniques. A total of 191 adult ticks, 111 females and 80 males, were collected and identified as Rhipicephalus sanguineus s.l. and Rhipicephalus microplus. In the 169 adult ticks in which natural infection was evaluated, Ehrlichia spp. was detected in 21.3% (36/169), Coxiella spp. in 11.8% (20/169), and Anaplasma spp. in 4.7% (8/169). In conclusion, we identified the prior exposition to Francisella, Anaplasma, Ehrlichia, Rickettsia, Borrelia, and Coxiella in patients through serological tests. We also detected the infection of C. burnetii using molecular techniques. In the ticks, we identified bacteria of the genera Coxiella, Anaplasma, and Ehrlichia. These results suggest the importance of these zoonotic agents as possible causes of AFI in this region.

Identification of vaccine candidate against Omicron variant of SARS-CoV-2 using immunoinformatic approaches

Despite the availability of COVID-19 vaccines, additional more potent vaccines are still required against the emerging variations of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the present investigation, we have identified a promising vaccine candidate against the Omicron (B.1.1.529) using immunoinformatics approaches. Various available tools like, the Immune Epitope Database server resource, and NetCTL-1.2, have been used for the identification of the promising T-cell and B-cell epitopes. The molecular docking was performed to check the interaction of TLR-3 receptors and validated 3D model of vaccine candidate. The codon optimization was done followed by cloning using SnapGene. Finally, In-silico immune simulation profile was also checked. The identified T-cell and B-cell epitopes have been selected based on their antigenicity (VaxiJen v2.0) and, allergenicity (AllerTOP v2.0). The identified epitopes with antigenic and non-allergenic properties were fused with the specific peptide linkers. In addition, the 3D model was constructed by the PHYRE2 server and validated using ProSA-web. The validated 3D model was further docked with the Toll-like receptor 3 (TLR3) and showed good interaction with the amino acids which indicate a promising vaccine candidate against the Omicron variant of SARS-CoV-2. Finally, the codon optimization, In-silico cloning and immune simulation profile was found to be satisfactory. Overall, the designed vaccine candidate has a potential against variant of SARS-Cov-2. However, further experimental studies are required to confirm.

Knowledge, attitudes, and practices associated with zoonotic disease transmission risk in North Sulawesi, Indonesia

BACKGROUND

Hunters, vendors, and consumers are key actors in the wildlife trade value chain in North Sulawesi, Indonesia, and potentially face an elevated risk of exposure to zoonotic diseases. Understanding the knowledge, attitudes, and practices (KAP) associated with the risk of zoonotic disease transmission in these communities is therefore critical for developing recommendations to prevent or mitigate zoonotic outbreaks in the future.

METHODS

Qualitative and quantitative methods were combined to understand KAP associated zoonotic diseases transmission risk in communities involved in the wildlife trade in North Sulawesi. Qualitative data were collected through semi-structured ethnographic interviews and focus group discussions (FGDs) while quantitative data were collected using questionnaires. We conducted 46 ethnographic interviews and 2 FGDs in 2016, and 477 questionnaire administrations in 2017-2018 in communities from five districts in North Sulawesi. We also collected biological specimens, including nasal swab, oropharyngeal swab, and blood, from 254 participants. The study sites were targeted based on known wildlife consumption and trade activities. The participants for qualitative data collection were purposively selected while participants for quantitative data collection were randomly selected. Biological samples were tested for five viral families including Coronaviridae, Filoviridae, Flaviviridae, Orthomyxoviridae and Paramyxoviridae.

RESULTS

Knowledge regarding disease transmission from animals to humans was similar across the participants in qualitative focus groups, including knowledge of rabies and bird flu as zoonotic diseases. However, only a small fraction of the participants from the quantitative group (1%) considered that contact with wild animals could cause sickness. Our biological specimen testing identified a single individual (1/254, 0.004%) who was sampled in 2018 with serological evidence of sarbecovirus exposure. Overall, participants were aware of some level of risk in working with open wounds while slaughtering or butchering an animal (71%) but most did not know what the specific risks were. However, significant differences in the attitudes or beliefs around zoonotic disease risk and health seeking behaviors were observed across our study sites in North Sulawesi.

CONCLUSIONS

Our study showed variable levels of knowledge, attitudes, and practices associated with the risk of zoonotic disease transmission among study participants. These findings can be used to develop locally responsive recommendations to mitigate zoonotic disease transmission.

Insights in the Development and Uses of Alternatives to Antibiotic Growth Promoters in Poultry and Swine Production

The overuse and misuse of antibiotics has contributed to the rise and spread of multidrug-resistant bacteria. To address this global public health threat, many countries have restricted the use of antibiotics as growth promoters and promoted the development of alternatives to antibiotics in human and veterinary medicine and animal farming. In food-animal production, acidifiers, bacteriophages, enzymes, phytochemicals, probiotics, prebiotics, and antimicrobial peptides have shown hallmarks as alternatives to antibiotics. This review reports the current state of these alternatives as growth-promoting factors for poultry and swine production and describes their mode of action. Recent findings on their usefulness and the factors that presently hinder their broader use in animal food production are identified by SWOT (strength, weakness, opportunity, and threat) analysis. The potential for resistance development as well as co- and cross-resistance with currently used antibiotics is also discussed. Using predetermined keywords, we searched specialized databases including Scopus, Web of Science, and Google Scholar. Antibiotic resistance cannot be stopped, but its spreading can certainly be hindered or delayed with the development of more alternatives with innovative modes of action and a wise and careful use of antimicrobials in a One Health approach.

A Spike Protein-Based Subunit SARS-CoV-2 Vaccine for Pets: Safety, Immunogenicity, and Protective Efficacy in Juvenile Cats

Whereas, multiple vaccine types have been developed to curb the spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) among humans, there are very few vaccines being developed for animals including pets. To combat the threat of human-to-animal, animal-to-animal, and animal-to-human transmission and the generation of new virus variants, we developed a subunit SARS-CoV-2 vaccine which is based on the recombinant spike protein extracellular domain expressed in insect cells and then formulated with appropriate adjuvants. Sixteen 8–12-week-old outbred female and male kittens (n = 4 per group) were randomly assigned into four treatment groups: spike protein alone; spike plus ESSAI oil-in-water (O/W) 1849102 adjuvant; spike plus aluminum hydroxide adjuvant; and a PBS control. All animals were vaccinated intramuscularly twice, 2 weeks apart, with 5 μg of spike protein in a volume of 0.5 ml. On days 0 and 28, serum samples were collected to evaluate anti-spike IgG, antibody inhibition of spike binding to angiotensin-converting enzyme 2 (ACE-2), neutralizing antibodies against wild-type and delta variant viruses, and hematology studies. At day 28, all groups were challenged with SARS-CoV-2 wild-type virus 10⁶ TCID₅₀ intranasally. On day 31, tissue samples (lung, heart, and nasal turbinates) were collected for viral RNA detection, and virus titration. After two immunizations, both vaccines induced high titers of serum anti-spike IgG that inhibited spike ACE-2 binding and neutralized both wild-type and delta variant virus. Both adjuvanted vaccine formulations protected juvenile cats against virus shedding from the upper respiratory tract and viral replication in the lower respiratory tract and hearts. These promising data warrant ongoing evaluation of the vaccine's ability to protect cats against SARS-CoV-2 infection and in particular to prevent transmission.

The urgency of wider adoption of one health approach for the prevention of a future pandemic

Recurring outbreaks of emerging and re-emerging zoonoses serve as a reminder that the health of humans, animals, and the environment are interconnected. Therefore, multisectoral, transdisciplinary, and collaborative approaches are required at local, regional, and global levels to tackle the ever-increasing zoonotic threat. The ongoing pandemic of COVID-19 zoonosis has been posing tremendous threats to global human health and economies. The devastation caused by the COVID-19 pandemic teaches us to adopt a "One Health Approach (OHA)" to tackle a possible future pandemic through a concerted effort of the global scientific community, human health professionals, public health experts, veterinarians and policymakers through open science and open data sharing practices. The OHA is an integrated, holistic, collaborative, multisectoral, and transdisciplinary approach to tackle potential pandemic zoonotic diseases. It includes expanding scientific inquiry into zoonotic infections; monitoring, and regulating traditional food markets, transforming existing food systems, and incentivizing animal husbandry and legal wildlife trade to adopt effective zoonotic control measures. To adopt an OHA globally, research and academic institutions, governments and non-government sectors at the local, regional, and international levels must work together. This review aimed to provide an overview of the major pandemics in human history including the COVID-19, anthropogenic drivers of zoonoses, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) reverse zoonoses, the concept of OHA and how an OHA could be utilized to prevent future pandemic threats to the human-animal-ecosystem interfaces. In addition, this review article discusses the strategic framework of OHA and possible challenges to implement OHA in practice to prevent any future pandemics. The practices of open data sharing, open science, and international collaboration should be included in the OHA to prevent and/or rapidly tackle any health emergencies in the future.

Current knowledge of vector-borne zoonotic pathogens in Zambia: A clarion call to scaling-up "One Health" research in the wake of emerging and re-emerging infectious diseases

Background

Although vector-borne zoonotic diseases are a major public health threat globally, they are usually neglected, especially among resource-constrained countries, including those in sub-Saharan Africa. This scoping review examined the current knowledge and identified research gaps of vector-borne zoonotic pathogens in Zambia.

Methods and findings

Major scientific databases (Web of Science, PubMed, Scopus, Google Scholar, CABI, Scientific Information Database (SID)) were searched for articles describing vector-borne (mosquitoes, ticks, fleas and tsetse flies) zoonotic pathogens in Zambia. Several mosquito-borne arboviruses have been reported including Yellow fever, Ntaya, Mayaro, Dengue, Zika, West Nile, Chikungunya, Sindbis, and Rift Valley fever viruses. Flea-borne zoonotic pathogens reported include Yersinia pestis and Rickettsia felis. Trypanosoma sp. was the only tsetse fly-borne pathogen identified. Further, tick-borne zoonotic pathogens reported included Crimean-Congo Haemorrhagic fever virus, Rickettsia sp., Anaplasma sp., Ehrlichia sp., Borrelia sp., and Coxiella burnetii.

Conclusions

This study revealed the presence of many vector-borne zoonotic pathogens circulating in vectors and animals in Zambia. Though reports of human clinical cases were limited, several serological studies provided considerable evidence of zoonotic transmission of vector-borne pathogens in humans. However, the disease burden in humans attributable to vector-borne zoonotic infections could not be ascertained from the available reports and this precludes the formulation of national policies that could help in the control and mitigation of the impact of these diseases in Zambia. Therefore, there is an urgent need to scale-up “One Health” research in emerging and re-emerging infectious diseases to enable the country to prepare for future epidemics, including pandemics.

Despite vector-borne zoonoses being a major public health threat globally, they are often overlooked, particularly among resource-constrained countries in sub-Saharan Africa, including Zambia. Therefore, we reviewed the current knowledge and identified research gaps of vector-borne zoonotic pathogens in Zambia. We focussed on mosquito-, tick-, flea- and tsetse fly-borne zoonotic pathogens reported in the country. Although we found evidence of circulation of several vector-borne zoonotic pathogens among vectors, animals and humans, clinical cases in humans were rarely reported. This suggests sparse capacity for diagnosis of vector-borne pathogens in healthcare facilities in the country and possibly limited awareness and knowledge of the local epidemiology of these infectious agents. Establishment of facility-based surveillance of vector-borne zoonoses in health facilities could provide valuable insights on morbidity, disease severity, and mortalities associated with infections as well as immune responses. In addition, there is also need for increased genomic surveillance of vector-borne pathogens in vectors and animals and humans for a better understanding of the molecular epidemiology of these diseases in Zambia. Furthermore, vector ecology studies aimed at understanding the drivers of vector abundance, pathogen host range (i.e., including the range of vectors and reservoirs), parasite-host interactions and factors influencing frequency of human-vector contacts should be prioritized. The study revealed the need for Zambia to scale-up One Health research in emerging and re-emerging infectious diseases to enable the country to be better prepared for future epidemics, including pandemics.

Scaling-up the delivery of dog vaccination campaigns against rabies in Tanzania

An increasing number of countries are committing to meet the global target to eliminate human deaths from dog-mediated rabies by 2030. Mass dog vaccination is central to this strategy. To interrupt rabies transmission from dogs to humans, the World Health Organization recommends that vaccination campaigns should be carried out every year in all dog-owning communities vaccinating 70% of their susceptible dogs. Monitoring and evaluation of dog vaccination campaigns are needed to measure progress towards elimination. In this study, we measured the delivery performance of large-scale vaccination campaigns implemented in 25 districts in south-east Tanzania from 2010 until 2017. We used regression modelling to infer the factors associated with, and potentially influencing the successful delivery of vaccination campaigns. During 2010-2017, five rounds of vaccination campaigns were carried out, vaccinating in total 349,513 dogs in 2,066 administrative vaccination units (rural villages or urban wards). Progressively more dogs were vaccinated over the successive campaigns. The campaigns did not reach all vaccination units each year, with only 16-28% of districts achieving 100% campaign completeness (where all units were vaccinated). During 2013-2017 when vaccination coverage was monitored, approximately 20% of vaccination units achieved the recommended 70% coverage, with average coverage around 50%. Campaigns were also not completed at annual intervals, with the longest interval between campaigns being 27 months. Our analysis revealed that districts with higher budgets generally achieved higher completeness, with a twofold difference in district budget increasing the odds of a vaccination unit being reached by a campaign by slightly more than twofold (OR: 2.29; 95% CI: 1.69-3.09). However, higher budgets did not necessarily result in higher coverage within vaccination units that were reached. We recommend national programs regularly monitor and evaluate the performance of their vaccination campaigns, so as to identify factors hindering their effective delivery and to guide remedial action.

The one health landscape in Sub-Saharan African countries

OBJECTIVES

One Health is transiting from multidisciplinary to transdisciplinary concepts and its viewpoints should move from 'proxy for zoonoses', to include other topics (climate change, nutrition and food safety, policy and planning, welfare and well-being, antimicrobial resistance (AMR), vector-borne diseases, toxicosis and pesticides issues) and thematic fields (social sciences, geography and economics). This work was conducted to map the One Health landscape in Africa.

METHODS

An assessment of existing One Health initiatives in Sub-Saharan African (SSA) countries was conducted among selected stakeholders using a multi-method approach. Strengths, weaknesses, opportunities and threats to One Health initiatives were identified, and their influence, interest and impacts were semi-quantitatively evaluated using literature reviews, questionnaire survey and statistical analysis.

RESULTS

One Health Networks and identified initiatives were spatiotemporally spread across SSA and identified stakeholders were classified into four quadrants. It was observed that imbalance in stakeholders' representations led to hesitation in buying-in into One Health approach by stakeholders who are outside the main networks like stakeholders from the policy, budgeting, geography and sometimes, the environment sectors.

CONCLUSION

Inclusion of theory of change, monitoring and evaluation frameworks, and tools for standardized evaluation of One Health policies are needed for a sustained future of One Health and future engagements should be outputs- and outcomes-driven and not activity-driven. National roadmaps for One Health implementation and institutionalization are necessary, and proofs of concepts in One Health should be validated and scaled-up. Dependence on external funding is unsustainable and must be addressed in the medium to long-term. Necessary policy and legal instruments to support One Health nationally and sub-nationally should be implemented taking cognizance of contemporary issues like urbanization, endemic poverty and other emerging issues. The utilization of current technologies and One Health approach in addressing the ongoing pandemic of COVID-19 and other emerging diseases are desirable. Finally, One Health implementation should be anticipatory and preemptive, and not reactive in containing disease outbreaks, especially those from the animal sources or the environment before the risk of spillover to human.

Dog rabies control in West and Central Africa: A review

Rabies is a neglected but preventable zoonotic disease that predominantly affects the most vulnerable populations living in remote rural areas of resource-limited countries. To date, every country on the African mainland is considered endemic for dog-mediated rabies with an estimated 21'500 human rabies deaths occurring each year. In 2018, the United Against Rabies collaboration launched the Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. The epidemiology of rabies from most Western and Central African countries remains poorly defined, making it difficult to assess the overall rabies situation and progress towards the 2030 goal. In this review, we attempt to provide an overview of the current rabies situation in 22 West and Central African countries based on published scientific literature and information obtained from rabies focal points. To this end, information was collected on i) established surveillance, ii) diagnostic capacity, iii) post-exposure prophylaxis (PEP) availability and coverage, iv) dog population estimates, v) dog vaccination campaigns, vi) animal and human health communication (One Health), vii) molecular studies, viii) Knowledge, Attitude and Practices (KAP), ix) cost estimates and x) national control strategies. Although rabies is a notifiable disease in the majority of the studied countries, national surveillance systems do not adequately capture the disease. A general lack of rabies diagnostic capacity has an additional negative impact on rabies surveillance and attempts to estimate rabies burden. Recurrent shortages of human rabies vaccine are reported by all of the countries, with vaccine availability usually limited to major urban centers but no country has yet adopted the new WHO-recommended 1-week intradermal vaccination regimen. Most countries carry out subsidized mass dog vaccination campaigns on World Rabies Day. Such activities are indispensable to keep rabies in the public consciousness but are not of the scale and intensity that is required to eliminate rabies from the dog population. Countries will need to scale up the intensity of their campaigns, if they are to progress towards the 2030 goal. But more than half of the countries do not yet have reliable figures on their dog populations. Only two countries reached stage 2 on the Stepwise Approach towards Rabies Elimination ladder - indicating that their national governments have truly prioritized rabies elimination and are thus providing the necessary support and political buy-in required to achieve success. In summary, the sub-region of West and Central Africa seems to be divided into countries which have accepted the challenge to eliminate rabies with governments committed to pushing forward rabies elimination, while other countries have achieved some progress, but elimination efforts remain stuck due to lacking government commitment and financial constraints. The possibility to meet the 2030 goal without international solidarity is low, because more than two-thirds of the countries rank in the low human development group (HDI ≤ 152). Leading countries should act as role models, sharing their experiences and capacities so that no country is left behind. Unified and with international support it is possible to reach the common goal of zero human rabies deaths by 2030.

AgSecure Africa ProgrammeTM: A Blended Training Approach for Africa

An innovative training program entitled "AgSecure Africa Programme^TM" was developed in partnership with the South African Agricultural Research Council-Onderstepoort Veterinary Research (ARC-OVR) to train veterinarians, animal health technicians, researchers and laboratory personnel. Three blended courses consisting of both virtual and in-person delivery were provided with the intent of contributing to the better prevention, detection and control of infectious diseases of livestock and poultry of significant importance for the region with a strong emphasis on transboundary animal diseases. A "train the trainer" model of instruction was employed to equip participants with the ability to train and share knowledge with colleagues and small-holder farmers in their various communities and regions. The design of this program was to increase the capacity of veterinarians and veterinary diagnosticians to safely and accurately diagnose infectious livestock diseases and to also empower small-holder farmers with the knowledge needed to safely and securely manage their livestock and be a first line defense in the prevention and control of infectious livestock diseases. Quantitative and qualitative evaluations were used to measure the impact of the trainings which revealed significant increases in knowledge gains. Course materials were submitted and approved for accreditation by the South African Veterinary Council (SAVC) becoming the first international training program to achieve this. Approval of these courses led to licensed veterinarians and animal health technicians being awarded continuing professional development credits upon their successful completion of courses. A larger goal was to build training capacity, not only for South Africa, but also for the region.

Using a One Health approach to prioritize zoonotic diseases in China, 2019

Background

China is vulnerable to zoonotic disease transmission due to a large agricultural work force, sizable domestic livestock population, and a highly biodiverse ecology. To better address this threat, representatives from the human, animal, and environmental health sectors in China held a One Health Zoonotic Disease Prioritization (OHZDP) workshop in May 2019 to develop a list of priority zoonotic diseases for multisectoral, One Health collaboration.

Methods

Representatives used the OHZDP Process, developed by the US Centers for Disease Control and Prevention (US CDC), to prioritize zoonotic diseases for China. Representatives defined the criteria used for prioritization and determined questions and weights for each individual criterion. A review of English and Chinese literature was conducted prior to the workshop to collect disease specific information on prevalence, morbidity, mortality, and Disability-Adjusted Life Years (DALYs) from China and the Western Pacific Region for zoonotic diseases considered for prioritization.

Results

Thirty zoonotic diseases were evaluated for prioritization. Criteria selected included: 1) disease hazard/severity (case fatality rate) in humans, 2) epidemic scale and intensity (in humans and animals) in China, 3) economic impact, 4) prevention and control, and 5) social impact. Disease specific information was obtained from 792 articles (637 in English and 155 in Chinese) and subject matter experts for the prioritization process. Following discussion of the OHZDP Tool output among disease experts, five priority zoonotic diseases were identified for China: avian influenza, echinococcosis, rabies, plague, and brucellosis.

Conclusion

Representatives agreed on a list of five priority zoonotic diseases that can serve as a foundation to strengthen One Health collaboration for disease prevention and control in China; this list was developed prior to the emergence of SARS-CoV-2 and the COVID-19 pandemic. Next steps focused on establishing a multisectoral, One Health coordination mechanism, improving multisectoral linkages in laboratory testing and surveillance platforms, creating multisectoral preparedness and response plans, and increasing workforce capacity.

COVID-19 pandemic: lessons learned from more than a century of pandemics and current vaccine development for pandemic control

Pandemic dynamics and health care responses are markedly different during the COVID-19 pandemic than in earlier outbreaks. Compared with established infectious disease such as influenza, we currently know relatively little about the origin, reservoir, cross-species transmission and evolution of SARS-CoV-2. Health care services, drug availability, laboratory testing, research capacity and global governance are more advanced than during 20th century pandemics, although COVID-19 has highlighted significant gaps. The risk of zoonotic transmission and an associated new pandemic is rising substantially. COVID-19 vaccine development has been done at unprecedented speed, with the usual sequential steps done in parallel. The pandemic has illustrated the feasibility of this approach and the benefits of a globally coordinated response and infrastructure. Some of the COVID-19 vaccines recently developed or currently in development might offer flexibility or sufficiently broad protection to swiftly respond to antigenic drift or emergence of new coronaviruses. Yet many challenges remain, including the large-scale production of sufficient quantity of vaccines, delivery of vaccines to all countries and ensuring vaccination of relevant age groups. This wide vaccine technology approach will be best employed in tandem with active surveillance for emerging variants or new pathogens using antigen mapping, metagenomics and next generation sequencing.

COVID-19, poverty and inclusive development

The COVID-19 epidemic provides yet another reason to prioritize inclusive development. Current response strategies of the global community and countries expose a low level of solidarity with poorer nations and poorer people in all nations. Against this background, this paper addresses the question: What are the development challenges that the COVID-19 pandemic lays bare and what lessons can be learnt for the way recovery processes are designed? Using an inclusive development and DPSIR lens to assess the literature, our study finds that, first, the current response prioritises the 'state' and 'impact' concerns of wealthier classes at the expense of the remainder of the world population. Second, responses have ignored underlying 'drivers' and 'pressures', instead aiming at a quick recovery of the economy. Third, a return to business-as-usual using government funding will lead to a vicious cycle of further ecological degradation, socio-economic inequality and domestic abuse that assist in exacerbating the drivers of the pandemic. We argue instead for an inclusive development approach that leads to a virtuous cycle by emphasizing human health, well-being and ecosystem regeneration. We conclude that the lost years for development did not commence in 2020 with the onset of COVID-19; the downward trend has actually been waxing over the past three decades. From this perspective, COVID-19 may be the shock needed to put the last first and transform vicious into virtuous cycles of inclusive development.

Critical Systematic Review of Zoonoses and Transboundary Animal Diseases' Prioritization in Africa

Background: Disease prioritization aims to enhance resource use efficiency concerning human and animal health systems’ preparedness and response to the most important problems for the optimization of beneficial outcomes. In sub-Sahara Africa (SSA), several prioritizations of zoonoses and transboundary animal diseases (TADs) have been implemented at different scales to characterize potential disease impacts. Method and principal findings: In this systematic review, we analyze the methodologies used, outcomes, and their relevance by discussing criteria required to align decision-makers’ perceptions of impacts to those of other stakeholders for different prioritization in SSA. In general, the sectorial representativeness of stakeholders for processes implemented with the support of international partners showed slight differences with the absence of local stakeholders. Whatever the tool prioritized, zoonoses were similar in general because of the structured nature of those tools in assessing decision-makers’ preferences through value trade-offs between criteria while ensuring transparency and reproducibility. However, by involving field practitioners and farmers, there were different outcomes with processes concerning only decision makers and experts who were more sensitive to infectious TADs, while the former raised parasitic disease constraints. In this context, multicriteria decision analysis-based zoonoses and TADs prioritizations involving a balanced participation of stakeholders might contribute to bridging these divergences, whatever the scale. Conclusion and significance: Prioritization processes were important steps toward building and harmonizing technical laboratory and surveillance networks to coordinate projects to address priority zoonoses and TADs at the country and/or sub-regional level. Those processes should be enhanced.

Deep learning model for distinguishing novel coronavirus from other chest related infections in X-ray images

Novel Coronavirus is deadly for humans and animals. The ease of its dispersion, coupled with its tremendous capability for ailment and death in infected people, makes it a risk to society. The chest X-ray is conventional but hard to interpret radiographic test for initial diagnosis of coronavirus from other related infections. It bears a considerable amount of information on physiological and anatomical features. To extract relevant information from it can occasionally become challenging even for a professional radiologist. In this regard, deep-learning models can help in swift, accurate and reliable outcomes. Existing datasets are small and suffer from the balance issue. In this paper, we prepare a relatively larger and well-balanced dataset as compared to the available datasets. Furthermore, we analyze deep learning models, namely, AlexNet, SqueezeNet, DenseNet201, MobileNetV2 and InceptionV3 with numerous variations such as training the models from scratch, fine-tuning without pre-trained weights, fine-tuning along with updating pre-trained weights of all layers, and fine-tuning with pre-trained weights along with applying augmentation. Our results show that fine-tuning with augmentation generates best results in pre-trained models. Finally, we have made architectural adjustments in MobileNetV2 and InceptionV3 models to learn more intricate features, which are then merged in our proposed ensemble model. The performance of our model is statistically analyzed against other models using four different performance metrics with paired two-sided t-test on 5 different splits of training and test sets of our dataset. We find that it is statistically better than its competing methods for the four metrics. Thus, the computer-aided classification based on the proposed model can assist radiologists in identifying coronavirus from other related infections in chest X-rays with higher accuracy. This can help in a reliable and speedy diagnosis, thereby saving valuable lives and mitigating the adverse impact on the socioeconomics of our community.

Development and validation of a cognitive, affective and behaviour questionnaire on pet-associated zoonotic diseases (CAB-ZDQ)

Background

Zoonoses among household pets are recognized as disease and infections transmitted between animals and humans. World Health Organization‐estimated zoonotic diseases have contributed about one billion cases of illness and millions of mortalities every year. Despite the emerging and re‐emerging zoonotic disease, most pet owners are unaware of the risks posed by their pets. As there are a lack of studies assessing infections at home, this study aimed to develop and validate a cognitive, affective and behaviour questionnaire (CAB‐ZDQ) to assess household pets’ zoonotic diseases.

Methods

This paper covers detailed explanation on the various developmental and validation process stages of the CAB zoonotic disease questionnaire development. The development phase comprised thorough literature search, focus group discussion, expert panel assessment and review. The validation process included pre‐test and pilot testing, data analysis of results, analysis of internal consistency and the development of the final version of the questionnaire. Participants selected represented main ethnicities, gender, levels of education and population type (urban/rural) in the Klang Valley area.

Results

The items in the questionnaire has undergone various changes in structurally and linguistically. The final refined CAB questionnaire consists of 14 items cognitive (no items removed at pilot phase), nine items affective (one item removed at pilot phase) and five items behaviour (no items removed from pre‐test phase), respectively. Reliability analysis revealed Cronbach's alpha values were 0.700 (cognitive) and 0.606 (affective) which indicated good internal consistency after item reduction.

Conclusions

The developed questionnaire has proved its feasibility in assessing the Malaysian general population cognitive, affective and behavior regarding the household pets’ zoonotic diseases.

This article detailed the process of development and validation of a questionnaire used to assess Cognitive, Affective and Behaviour for humans in relation to zoonotic diseases for pets at home.

Cross-Sectoral Zoonotic Disease Surveillance in Western Kenya: Identifying Drivers and Barriers Within a Resource Constrained Setting

Background: Collaboration between the human and animal health sectors, including the sharing of disease surveillance data, has the potential to improve public health outcomes through the rapid detection of zoonotic disease events prior to widespread transmission in humans. Kenya has been at the forefront of embracing a collaborative approach in Africa with the inception of the Zoonotic Disease Unit in 2011. Joint outbreak responses have been coordinated at the national level, yet little is currently documented on cross-sectoral collaboration at the sub-national level.

Methods: Key informant interviews were conducted with 28 disease surveillance officers from the human and animal health sectors in three counties in western Kenya. An inductive process of thematic analysis was used to identify themes relating to barriers and drivers for cross-sectoral collaboration.

Results: The study identified four interlinking themes related to drivers and barriers for cross-sectoral collaboration. To drive collaboration at the sub-national level there needs to be a clear identification of “common objectives,” as currently exemplified by the response to suspected rabies and anthrax cases and routine meat hygiene activities. The action of collaboration, be it integrated responses to outbreaks or communication and data sharing, require “operational structures” to facilitate them, including the formalisation of reporting lines, supporting legislation and the physical infrastructure, from lab equipment to mobile phones, to facilitate the activities. These structures in turn require “appropriate resources” to support them, which will be allocated based on the “political will” of those who control the resources.

Conclusions: Ongoing collaborations between human and animal disease surveillance officers at the sub-national level were identified, driven by common objectives such as routine meat hygiene and response to suspected rabies and anthrax cases. In these areas a suitable operational structure is present, including a supportive legislative framework and clearly designated roles for officers within both sectors. There was support from disease surveillance officers to increase their collaboration, communication and data sharing across sectors, yet this is currently hindered by the lack of these formal operational structures and poor allocation of resources to disease surveillance. It was acknowledged that improving this resource allocation will require political will at the sub-national, national and international levels.

Immunoinformatics based prediction of recombinant multi-epitope vaccine for the control and prevention of SARS-CoV-2

The emergence of SARS-CoV-2 has been reported during December 2019, in the city of Wuhan, China. The transmission of this virus via human to human interaction has already been described. The novel virus has become pandemic and declared as a comprehensive emergency worldwide by World Health Organization due to its exponential spread within and outside China. There is a need of time to create a therapeutic agent and a vaccine to cure and control this lethal SARS-CoV-2. Conventionally, the vaccine development process is time taking, tiresome and requires more economical inputs with manpower. However, bioinformatics offers a key solution to compute the possibilities. The present study focuses on the utilization of bioinformatics platforms to forecast B and T cell epitopes that belong to SARS-CoV-2 spike glycoprotein. The protein is thought to have an involvement in triggering of momentous immune response. NCBI database was explored to collect the surface glycoprotein sequence and was analyzed to determine the immunogenic epitopes. This prediction analysis was carried out using IEDB web based server and the prediction of protein structure was done by homology modeling approach. This study resulted in prediction of 5T cell and 13B cell epitopes. Moreover, GPGPG linker was used to make these predicted epitopes a single peptide prior to further analysis. Afterwards, a 3D model of the final vaccine peptide was constructed, and the structure quality of the final construct was checked by Ramachandran Plot analysis and ProSA-web. Moreover, docking analysis highlighted three interactions of epitope against HLA-B7 including Lys 178, Gol 303 and Thr 31 residues. In conclusion, the predicted multi epitope peptide can be suggested as therapeutic or prophylactic candidate vaccine against SARS-CoV-2 after further confirmation by immunological assays.

Deep Learning Model for Pathogen Classification Using Feature Fusion and Data Augmentation

Background:

Bacterial pathogens are deadly for animals and humans. The ease of their dissemination, coupled with their high capacity for ailment and death in infected individuals, makes them a threat to society.

Objective:

Due to high similarity among genera and species of pathogens, it is sometimes difficult for microbiologists to differentiate between them. Their automatic classification using deep-learning models can help in reliable, and accurate outcomes.

Method:

Deep-learning models, namely; AlexNet, GoogleNet, ResNet101, and InceptionV3 are used with numerous variations including training model from scratch, fine-tuning without pre-trained weights, fine-tuning along with freezing weights of initial layers, fine-tuning along with adjusting weights of all layers and augmenting the dataset by random translation and reflection. Moreover, as the dataset is small, fine-tuning and data augmentation strategies are applied to avoid overfitting and produce a generalized model. A merged feature vector is produced using two best-performing models and accuracy is calculated by xgboost algorithm on the feature vector by applying cross-validation.

Results:

Fine-tuned models where augmentation is applied produces the best results. Out of these, two-best-performing deep models i.e. (ResNet101, and InceptionV3) selected for feature fusion, produced a similar validation accuracy of 95.83 with a loss of 0.0213 and 0.1066, and a testing accuracy of 97.92 and 93.75, respectively. The proposed model used xgboost to attained a classification accuracy of 98.17% by using 35-folds cross-validation.

Conclusion:

The automatic classification using these models can help experts in the correct identification of pathogens. Consequently, they can help in controlling epidemics and thereby minimizing the socio-economic impact on the community.

Exotic pets in Ireland: 2. Provision of veterinary services and perspectives of veterinary professionals' on responsible ownership

BACKGROUND

There has been increasing concern expressed about the welfare of exotic pets worldwide. For the purposes of this article, an exotic pet is considered to be a non-domesticated species, where there are knowledge gaps on good practice (minimum standards of care), veterinary diagnostics and treatments. The categories of exotic pets included in this study were: small mammals (< 20 kg), large mammals (> 20 kg), birds, reptiles, amphibians, fish and invertebrates. Dogs, cats, rabbits, hamsters, gerbils, guinea pigs, mice, rats, and ferrets were excluded from the study. An online survey of veterinary professionals conducted between July and August 2020 provides the first empirical data for Ireland. In this pilot study (the second in this thematic series) we aim to characterise the provision of veterinary services to exotic pets from the veterinary professionals' perspective, explore the main concerns of veterinary professionals towards exotic pet ownership, and their recommendations to support responsible exotic pet ownership.

RESULTS

Using an online survey this pilot study gathered evidence from 63 veterinary professionals currently working in private practice in Ireland. The prevalence of veterinary services for exotic pets in Ireland was determined to be 82% of small and mixed animal clinics of respondents' practices ranging from 9.1 to 100% for different categories of exotic pets. The most common issues encountered in practice with exotic pets were related to nutrition, environment, and behaviour followed by clinical diseases such as respiratory, infectious, and gastrointestinal issues. The most common concerns veterinary professionals had with exotic pet ownership related to the lack of owner knowledge as well as the lack of veterinary knowledge and accessible resources. The most common strategic initiatives indicated by veterinary professionals included black or white lists (to prohibit and permit the keeping of exotic pet species respectively), licensing for owners and increased availability of CPD for veterinary professionals.

CONCLUSIONS

More than four in every five veterinary professionals in small or mixed animal practices surveyed were willing to treat exotic pets and in many cases they already were. A scaffold for best practice is required to support the health and welfare of exotic pets and responsible ownership. Keystones include veterinary education to support veterinary professionals with daily practice, establishing a white list of exotic species that are suitable as pets, registration at the point of purchase to enable traceability for biosecurity purposes and research to identify care standards to support the health and welfare of exotic pets.

Systemic factors for enhancing intersectoral collaboration for the operationalization of One Health: a case study in India

Background

One Health is a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional, national, and global levels—with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment. Operationalization of the One Health approach is still unclear for various local health systems with their respective targets. In this scenario, the empirical study of intersectoral collaboration between the human and animal health systems provides an opportunity to investigate the appropriate strategies and their enabling factors at the local health system level. Thus, this study documented and validated the innovative strategy for intersectoral collaboration, focusing on effectual prevention and control of zoonotic diseases with its enabling factors for a city in western India, Ahmedabad.

Methods

This case study was conducted in three phases: phase I (qualitative data collection, i.e., vignette interview), phase II (quantitative data collection through modified policy Delphi), and phase III (participatory workshop). The vignette data were handled for content analysis, and the Delphi data, like other quantitative data, for descriptive statistics. The participatory workshop adapts the computerized Sensitivity Model^® developed by Vester to analyse the health system dynamics.

Result

Out of the possible 36 strategies, this study validated the top 15 essential (must-have) and five preferred (should-have) strategies for the study area. For operationalization of the One Health approach, the enabling factors that were identified through the systems approach are micro-level factors at the individual level (trust, leadership, motivation, knowledge), meso-level factors at the organizational level (human resource, capacity-building, shared vision, decision-making capacity, laboratory capacity, surveillance), macro-level factors at the system level (coordinated roles, relationships, common platform), and external factors outside of the system (guidelines/policies, community participation, a specific budget, political will, smart technology).

Discussion

This study reveals that the micro-level factors at the individual level are potential levers of the health system. More attention to these factors could be beneficial for the operationalization of the One Health approach. This study recommends a systems approach through a bottom-up exploration to understand the local health system and its enabling factors, which should be accounted for in formulating future One Health policies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00727-9.

Prioritization of zoonotic diseases of public health significance in Nigeria using the one-health approach

Nigeria, with a population of over 190 million people, is rated among the 10 countries with the highest burden of infectious and zoonotic diseases globally. In Nigeria, there exist a sub-optimal surveillance system to monitor and track priority zoonoses. We therefore conducted a prioritization of zoonotic diseases for the first time in Nigeria to guide prevention and control efforts. Towards this, a two-day in-country consultative meeting involving experts from the human, animal, and environmental health backgrounds prioritized zoonotic diseases using a modified semi-quantitative One Health Zoonotic Disease Prioritization tool in July 2017. Overall, 36 of 52 previously selected zoonoses were identified for prioritization. Five selection criteria were used to arrive at the relative importance of prioritized diseases based on their weighted score. Overall, this zoonotic disease prioritization process marks the first major step of bringing together experts from the human-animal-environment health spectrum in Nigeria. Importantly, the country ranked rabies, avian influenza, Ebola Virus Disease, swine influenza and anthrax as the first five priority zoonoses in Nigeria. Finally, this One Health approach to prioritizing important zoonoses is a step that will help to guide future tracking and monitoring of diseases of grave public health importance in Nigeria.

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Nigeria is among the top ten countries with the highest burden of infectious and zoonotic diseases globally.

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One Health approach resulted in prioritization of important zoonoses and will guide their future tracking and monitoring.

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Rabies, avian influenza, Ebola Virus Disease, swine influenza and anthrax as the first five priority zoonoses in Nigeria.

Identification of Most Relevant Features for Classification of Francisella tularensis using Machine Learning

Background:

Francisella tularensis is a stealth pathogen fatal for animals and humans. Ease of its propagation, coupled with high capacity for ailment and death makes it a potential candidate for biological weapon.

Objective:

Work related to the pathogen’s classification and factors affecting its prolonged existence in soil is limited to statistical measures. Machine learning other than conventional analysis methods may be applied to better predict epidemiological modeling for this soil-borne pathogen.

Methods:

Feature-ranking algorithms namely; relief, correlation and oneR are used for soil attribute ranking. Moreover, classification algorithms; SVM, random forest, naive bayes, logistic regression and MLP are used for classification of the soil attribute dataset for Francisella tularensis positive and negative soils.

Results:

Feature-ranking methods concluded that clay, nitrogen, organic matter, soluble salts, zinc, silt and nickel are the most significant attributes while potassium, phosphorous, iron, calcium, copper, chromium and sand are the least contributing risk factors for the persistence of the pathogen. However, clay is the most significant and potassium is the least contributing attribute. Data analysis suggests that feature-ranking using relief produced classification accuracy of 84.35% for multilayer perceptron; 82.99% for linear regression; 80.27% for SVM and random forest; and 78.23% for naive bayes, which is better than other ranking methods. MLP outperforms other classifiers by generating an accuracy of 84.35%, 82.99% and 81.63% for feature-ranking using relief, correlation and oneR algorithms, respectively.

Conclusion:

These models can significantly improve accuracy and can minimize the risk of incorrect classification. They further help in controlling epidemics and thereby minimizing the socio-economic impact on the society.

Deep Ensemble Model for Classification of Novel Coronavirus in Chest X-Ray Images

The novel coronavirus, SARS-CoV-2, can be deadly to people, causing COVID-19. The ease of its propagation, coupled with its high capacity for illness and death in infected individuals, makes it a hazard to the community. Chest X-rays are one of the most common but most difficult to interpret radiographic examination for early diagnosis of coronavirus-related infections. They carry a considerable amount of anatomical and physiological information, but it is sometimes difficult even for the expert radiologist to derive the related information they contain. Automatic classification using deep learning models can help in better assessing these infections swiftly. Deep CNN models, namely, MobileNet, ResNet50, and InceptionV3, were applied with different variations, including training the model from the start, fine-tuning along with adjusting learned weights of all layers, and fine-tuning with learned weights along with augmentation. Fine-tuning with augmentation produced the best results in pretrained models. Out of these, two best-performing models (MobileNet and InceptionV3) selected for ensemble learning produced accuracy and FScore of 95.18% and 90.34%, and 95.75% and 91.47%, respectively. The proposed hybrid ensemble model generated with the merger of these deep models produced a classification accuracy and FScore of 96.49% and 92.97%. For test dataset, which was separately kept, the model generated accuracy and FScore of 94.19% and 88.64%. Automatic classification using deep ensemble learning can help radiologists in the correct identification of coronavirus-related infections in chest X-rays. Consequently, this swift and computer-aided diagnosis can help in saving precious human lives and minimizing the social and economic impact on society.

Adaptation of Animal and Human Health Surveillance Systems for Vector-Borne Diseases Accompanying Climate Change

Anthropogenic climate change is causing temperature rise in temperate zones resulting in climate conditions more similar to subtropical zones. As a result, rising temperatures increase the range of disease-carrying insects to new areas outside of subtropical zones, and increased precipitation causes flooding that is more hospitable for vector breeding. State governments, the federal government, and governmental agencies, like the Animal and Plant Health Inspection Service (APHIS) of USDA and the National Notifiable Disease Surveillance System (NNDSS) of the U.S. Centers for Disease Control and Prevention, lack a coordinated plan for vector-borne disease accompanying climate change. APHIS focuses its surveillance primarily on the effect of illness on agricultural production, while NNDSS focuses on the emergence of pathogens affecting human health. This article provides an analysis of the current framework of surveillance of, and response to, vector-borne infectious diseases, the impacts of climate change on the spread of vector-borne infectious diseases, and recommends changes to federal law to address these threats.

Vaccines for neglected, emerging and re-emerging diseases

Efforts to produce vaccines against SARS and MERS were prematurely halted since their scope was perceived to be geographically restricted and they were subsequently categorized as neglected diseases. However, when a similar virus spread globally triggering the COVID-19 pandemic, we were harshly reminded that several other neglected diseases might also be waiting for the perfect opportunity to become mainstream. As climate change drives urbanization, natural selection of pathogens and their intermediate vectors and reservoirs, the risk of neglected diseases emerging within a larger susceptible pool becomes an even greater threat. Availability of a vaccine for COVID-19 is widely considered the only way to end this pandemic. Similarly, vaccines are also seen as the best tools available to control the spread of neglected (sometimes referred to as emerging or re-emerging) diseases, until the water, hygiene and sanitation infrastructure is improved in areas of their prevalence. Vaccine production is usually cost and labour intensive and thus minimal funding is directed towards controlling and eliminating neglected diseases (NDs). A customised but sustainable approach is needed to develop and deploy vaccines against NDs. While safety, efficacy and public trust are the three main success pillars for most vaccines, affordability is vital when formulating vaccines for neglected diseases.

Feline-Human Zoonosis Transmission in North Africa: A Systematic Review

Throughout human history, domestic animal species have represented a unique zoonotic disease risk for the transmission of pathogens ranging from viral, bacterial, parasitic, and fungal. In North Africa, cats have a particularly long record and occupy a specialized niche within many communities. This systematic review was conducted to analyze the current and historical literature documenting the breadth and variety of zoonoses in North Africa, specifically relating to the domesticated feline. Multiple electronic databases were searched on January 16, 2019, for published reports on feline zoonoses in North Africa. A total of 76 studies met the inclusion criteria for a full assessment. Articles selected for the review ranged in publication dates from 1939 to 2019 and included a case study, cross-sectional surveys, genomic analyses, and a book chapter. The most commonly studied pathogen was Toxoplasma gondii (n = 17) followed by a variety of helminths (n = 10). Of the countries in the target region, most publications were of studies conducted in Egypt (n = 53) followed by Tunisia (n = 12), Algeria (n = 11), Morocco (n = 5), and Libya (n = 3). The results of this review identify a variety of viral, bacterial, fungal, and parasitic zoonotic diseases associated with cats in North Africa, ranging from historically endemic diseases in both human and animal populations in the region, to emerging infections with recent confirmatory diagnoses. This review describes reported feline zoonoses in North Africa and provides recommendations for their prevention and control. In addition to vaccination campaigns for domesticated felines and postexposure prophylaxis for humans, prompt veterinary and medical care of exposure risks and subsequent infections are essential in limiting the zoonotic disease burden in North African communities of humans and cats.

Zoonotic and Public Health Implications of Campylobacter Species and Squamates (Lizards, Snakes and Amphisbaenians)

Campylobacter spp. is one of the most widespread infectious diseases of veterinary and public health significance. Globally, the incidence of campylobacteriosis has increased over the last decade in both developing and developed countries. Squamates (lizards, snakes and amphisbaenians) are a potential reservoir and source of transmission of campylobacteriosis to humans. This systematic review examined studies from the last 20 years that have reported squamate-associated human campylobacteriosis. It was found that C. fetus subsp. testudinum and C. fetus subsp. fetus were the most common species responsible for human campylobacteriosis from a squamate host. The common squamate hosts identified included bearded dragons (Pogona vitticeps), green iguana (Iguana iguana), western beaked gecko (Rhynchoedura ornate) and blotched blue-tongued skink (Tiliqua nigrolutea). People with underlying chronic illnesses, the immunocompromised and the elderly were identified as the most vulnerable population. Exposure to pet squamates, wild animals, consumption of reptilian cuisines and cross contamination with untreated water were risk factors associated with Campylobacter infections. Proper hand hygiene practices, responsible pet ownership, ‘One Health’ education and awareness on zoonotic diseases will help reduce the public health risks arising from Campylobacter exposure through squamates. Continued surveillance using molecular diagnostic methods will also enhance detection and response to squamate-linked campylobacteriosis.

Host Diversity and Origin of Zoonoses: The Ancient and the New

Simple Summary

There is a wide variety of diseases caused by bacteria, viruses, and parasites that are transmitted to humans by different routes from other animals. These diseases, known as zoonoses, represent 75% of new or reemerging infectious diseases. There is a considerable impact of these diseases on the economy and health at local and global levels, including zoonotic diseases caused by the ingestion of food and products derived from animals. The wide range of animal species that host these disease-causing organisms include all groups of mammals. Birds are the second significant animal group to act as hosts for zoonoses. Much progress has been made in understanding disease evolution and animal origin, with important contributions from fields such as paleopathology and analysis of DNA, applied to ancient human bone remains. The study of ancient diseases such as brucellosis and tuberculosis benefits from these approaches. More research is needed as new diseases emerge causing pandemics and some previously eradicated reemerge in some regions. Global efforts are focused, based on evidence generated by research, on the prevention of new pandemics.

Abstract

Bacterial, viral, and parasitic zoonotic diseases are transmitted to humans from a wide variety of animal species that act as reservoir hosts for the causative organisms. Zoonoses contribute an estimated 75% of new or reemerging infectious diseases in humans. All groups of mammals have been shown to act as hosts for transmission of different organisms that cause zoonoses, followed in importance by birds; with both wild and domestic species identified as hosts in specific cases. There has been considerable research progress leading to a better understanding of the host range, animal origin, evolution, and transmission of important zoonoses, including those caused by the ingestion of food and products derived from animals. Paleopathology studies of ancient human bone lesions, in combination with ancient DNA analysis of the causative pathogen, have contributed to our understanding of the origin of zoonotic diseases, including brucellosis and mycobacterial zoonoses. However, there are still knowledge gaps and new confirmed and potential hosts are reported locally with some frequency. Both the economic cost and burden of disease of zoonoses are substantial at local and global levels, as reflected by recent coronavirus pandemics that spread rapidly around the world. Evidence-based prevention strategies are currently a global priority increasingly recognized, especially in zoonoses-affected regions.

Infectious Diseases and Meat Production

Most infectious diseases in humans originate from animals. In this paper, we explore the role of animal farming and meat consumption in the emergence and amplification of infectious diseases. First, we discuss how meat production increases epidemic risks, either directly through increased contact with wild and farmed animals or indirectly through its impact on the environment (e.g., biodiversity loss, water use, climate change). Traditional food systems such as bushmeat and backyard farming increase the risks of disease transmission from wild animals, while intensive farming amplifies the impact of the disease due to the high density, genetic proximity, increased immunodeficiency, and live transport of farmed animals. Second, we describe the various direct and indirect costs of animal-based infectious diseases, and in particular, how these diseases can negatively impact the economy and the environment. Last, we discuss policies to reduce the social costs of infectious diseases. While existing regulatory frameworks such as the "One Health" approach focus on increasing farms' biosecurity and emergency preparedness, we emphasize the need to better align stakeholders' incentives and to reduce meat consumption. We discuss in particular the implementation of a "zoonotic" Pigouvian tax, and innovations such as insect-based food or cultured meat.

Disease X: accelerating the development of medical countermeasures for the next pandemic

WHO has listed several priority diseases with epidemic potential for which there are no, or insufficient, medical countermeasures. In response, the Bill & Melinda Gates Foundation (with support from PricewaterhouseCoopers) coordinated subject matter experts to create a preparedness plan for Disease X. Disease X is caused by Pathogen X, an infectious agent that is not currently known to cause human disease, but an aetiologic agent of a future outbreak with epidemic or pandemic potential. We have identified crucial areas for acceleration in medical countermeasure product development and international coordination. We have also reviewed novel platforms and process improvements related to manufacturing, which could revolutionise the response to the next pandemic. Finally, we created several coordination and engagement guides. These guides range from the rational design of an intervention target product profile, to the key facets of vaccine and therapeutic development, to accelerated manufacturing and regulatory mechanisms. In this Personal View, we provide a high-level summary of the outcomes of the medical countermeasure development workstream, intended for a broad audience including academia, medical countermeasure developers, and multilateral coordinating bodies. We hope that they might find this piece useful in prioritising strategic investments and efforts to accelerate medical countermeasure development. We observed that in-depth analyses of clinical trial design, chemistry, manufacturing and control activities, and accelerated regulatory pathways are necessary for shortening the timelines for the product development of medical countermeasures. We intend to cover these topics in future publications.

The challenges of investigating antimicrobial resistance in Vietnam - what benefits does a One Health approach offer the animal and human health sectors?

BACKGROUND

The One Health concept promotes the enhancement of human, animal and ecosystem health through multi-sectorial governance support and policies to combat health security threats. In Vietnam, antimicrobial resistance (AMR) in animal and human health settings poses a significant threat, but one that could be minimised by adopting a One Health approach to AMR surveillance. To advance understanding of the willingness and abilities of the human and animal health sectors to undertake investigations of AMR with a One Health approach, we explored the perceptions and experiences of those tasked with investigating AMR in Vietnam, and the benefits a multi-sectorial approach offers.

METHODS

This study used qualitative methodology to provide key informants' perspectives from the animal and human health sectors. Two scenarios of food-borne AMR bacteria found within the pork value chain were used as case studies to investigate challenges and opportunities for improving collaboration across different stakeholders and to understand benefits offered by a One Health approach surveillance system. Fifteen semi-structured interviews with 11 participants from the animal and six from the human health sectors at the central level in Hanoi and the provincial level in Thai Nguyen were conducted.

RESULTS

Eight themes emerged from the transcripts of the interviews. From the participants perspectives on the benefits of a One Health approach: (1) Communication and multi-sectorial collaboration; (2) Building comprehensive knowledge; (3) Improving likelihood of success. Five themes emerged from participants views of the challenges to investigate AMR: (4) Diagnostic capacity; (5) Availability and access to antibiotics (6) Tracing ability within the Vietnamese food chain; (7) Personal benefits and (8) Managing the system.

CONCLUSION

The findings of this study suggest that there is potential to strengthen multi-sectorial collaboration between the animal and human health sectors by building upon existing informal networks. Based on these results, we recommend an inclusive approach to multi-sectorial communication supported by government network activities to facilitate partnerships and create cross-disciplinary awareness and participation. The themes relating to diagnostic capacity show that both sectors are facing challenges to undertake investigations in AMR. Our results indicate that the need to strengthen the animal health sector is more pronounced.

Synergising tools for capacity assessment and One Health operationalisation

Multisectoral, One Health collaboration is essential for addressing national and international health threats that arise at the human-animal-environment interface. Thanks to the efforts of multiple organisations, countries now have an array of One Health tools available to assess capacities within and between sectors, plan and prioritise activities, and strengthen multisectoral, One Health coordination, communication, and collaboration. By doing so, they are able to address health threats at the human-animal-environment interface, including emerging zoonotic and infectious diseases, more efficiently. However, to ensure optimal outcomes for the countries using these One Health tools, the partners responsible for implementation should regularly collaborate and share information such as implementation timelines, results and lessons learned, so that one process can inform the next. This paper presents a consensus framework on how commonly implemented One Health tools might align to best support countries in strengthening One Health systems. Twelve One Health tools were selected based on their high implementation rates, authors' experience with these tools and their focus on multisectoral, One Health coordination. Through a four-step process, the authors: a) jointly carried out a landscape analysis of One Health tools, using a Cloudbased spreadsheet to share the unique characteristics and applications of each tool; b) performed an implementation analysis to identify and share implementation dynamics and identify respective outcomes and synergies; c) jointly created a consensus conceptual model of how the authors suggest the tools might logically work together; and d) extrapolated from steps 1-3 an agreed-upon overarching conceptual framework for how current and future One Health tools could be categorised to best support One Health system strengthening at the national level. Highlighted One Health tools include the States Parties Annual Reporting Tool under the International Health Regulations (IHR), the World Organisation for Animal Health Performance of Veterinary Services (PVS) Pathway, the Joint External Evaluation process, IHR/PVS National Bridging Workshops, the Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization Tool, the Food and Agriculture Organization (FAO) Laboratory Mapping Tool, the FAO Assessment Tool for Laboratories and Antimicrobial Resistance Surveillance Systems, the FAO Surveillance Evaluation Tool, the One Health Systems Mapping and Analysis Resource Toolkit, the National Action Plan for Health Security, and IHR Monitoring and Evaluation Framework tools for After Action Reviews and Simulation Exercises. A new guidance document entitled, Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries was also included as a framework that provides guidance to support the implementation of the outputs of the tools described.

A Novel Integrated and Labile eHealth System for Monitoring Dog Rabies Vaccination Campaigns

The elimination of canine rabies through the implementation of high coverage mass dog vaccination campaigns is a complex task, particularly in the resource-limited countries of the rabies endemic world. Here we demonstrated the feasibility of applying targeted rabies vaccination campaigns to deliver more impactful intervention campaigns in resource-limited settings using evidence and lessons learnt from other diseases. With the use of strategic rabies intervention programs, we demonstrate the noteworthy reduction of rabies cases in two very different African settings. The strategic intervention was most significantly aided by the use of a custom-developed vaccination tracking device (the Global Alliance for Rabies Control (GARC) Data Logger) and an integrated rabies surveillance system (the Rabies Epidemiological Bulletin). Our first case study, an island-wide strategic dog vaccination on Tanzania's Unguja island, reduced the incidence of rabies by 71% in the first 16 months of implementation. In the second case study, a similar approach was applied in the metropolitan capital city of Zimbabwe and the incidence of rabies declined by 13% during the first 13 months of implementation. The methodologies and results presented here suggest that, in resource-limited settings, an optimal approach towards the elimination of dog rabies would revolve around strategic interventions, subject to the use of appropriate planning, surveillance, and vaccination tools.

Assessing health systems in Guinea for prevention and control of priority zoonotic diseases: A One Health approach

To guide One Health capacity building efforts in the Republic of Guinea in the wake of the 2014-2016 Ebola virus disease (EVD) outbreak, we sought to identify and assess the existing systems and structures for zoonotic disease detection and control. We partnered with the government ministries responsible for human, animal, and environmental health to identify a list of zoonotic diseases - rabies, anthrax, brucellosis, viral hemorrhagic fevers, trypanosomiasis and highly pathogenic avian influenza - as the country's top priorities. We used each priority disease as a case study to identify existing processes for prevention, surveillance, diagnosis, laboratory confirmation, reporting and response across the three ministries. Results were used to produce disease-specific systems "maps" emphasizing linkages across the systems, as well as opportunities for improvement. We identified brucellosis as a particularly neglected condition. Past efforts to build avian influenza capabilities, which had degraded substantially in less than a decade, highlighted the challenge of sustainability. We observed a keen interest across sectors to reinvigorate national rabies control, and given the regional and global support for One Health approaches to rabies elimination, rabies could serve as an ideal disease to test incipient One Health coordination mechanisms and procedures. Overall, we identified five major categories of gaps and challenges: (1) Coordination; (2) Training; (3) Infrastructure; (4) Public Awareness; and (5) Research. We developed and prioritized recommendations to address the gaps, estimated the level of resource investment needed, and estimated a timeline for implementation. These prioritized recommendations can be used by the Government of Guinea to plan strategically for future One Health efforts, ideally under the auspices of the national One Health Platform. This work demonstrates an effective methodology for mapping systems and structures for zoonotic diseases, and the benefit of conducting a baseline review of systemic capabilities prior to embarking on capacity building efforts.

Brucellosis awareness and knowledge in communities worldwide: A systematic review and meta-analysis of 79 observational studies

BACKGROUND

Brucellosis is regarded as a major zoonotic infection worldwide. Awareness and knowledge of brucellosis among occupational workers is considered an important aspect of brucellosis control in both humans and animals. The aim of this study was to explore the distributions of the pooled awareness level and the knowledge level of the disease worldwide.

METHODS

A meta-analysis was carried out to obtain pooled brucellosis awareness levels and knowledge levels of respondents regarding the zoonotic nature of brucellosis, mode of brucellosis transmission, and brucellosis symptoms in animals and humans. The analysis was conducted and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines.

RESULTS

A total of seventy-nine original articles reporting the brucellosis awareness levels of in populations from 22 countries were assessed. The total pooled awareness level of brucellosis was 55.5%, and the pooled awareness levels regarding the zoonotic nature of brucellosis, mode of brucellosis transmission, signs of human brucellosis and signs of animal brucellosis were 37.6%, 35.9%, 41.6%, and 28.4% respectively. The pooled awareness level was higher than the brucellosis-related knowledge level. Subgroup analyses showed that no obvious differences in brucellosis awareness levels between high-risk populations in Asia and Africa. Health workers (including human health workers and veterinarians) had the greatest overall awareness and knowledge of human brucellosis. The overall awareness levels and knowledge levels of livestock owners (farmers) and herders were higher than those of dairy farmers and abattoir workers. In addition, awareness and knowledge levels were higher among people who were involved in bovine, caprine and ovine animal production or in caprine and ovine animal production than among people who were involved in only bovine animal production.

CONCLUSIONS

Insufficient awareness and knowledge of brucellosis were observed in the original studies conducted mainly in Asia and Africa. Interventions to improve public knowledge about brucellosis are urgently needed.

Epidemiological Features of Human Cases After Bites/Scratches From Rabies-suspected Animals in Zenica-Doboj Canton, Bosnia and Herzegovina

OBJECTIVES

To determine the epidemiological features of patients and animals after bites/scratches from rabies-suspected animals in Zenica-Doboj Canton, Bosnia and Herzegovina.

METHODS

Data from all patients (and the causative animals) admitted to the Antirabies Service of the Institute for Health and Food Safety Zenica in the 2009-2017 period were analyzed, including age, sex, anatomical site of the bite/scratch, animal type (stray/owned/wildlife), veterinary observations of the animal, and whether antirabies post-exposure prophylaxis (PEP) was indicated and/or administered.

RESULTS

In total, 1716 patients were admitted. Bites/scratches were most frequently recorded during April and May (n=181, 10.5% and n=163, 9.5%, respectively). The persons admitted were mostly from the Zenica municipality (n=1278, 74.5%; incidence: 11.55/ 1000), which is 66.6% urbanized. Males were more frequently represented (n=1089, 63.6%). The patients were mostly 50-64 and 25-49 years of age (n=425, 24.7% and n=390, 22.7%, respectively). Dog bites were the most common cause (n=1634, 95.1%, of which n=1258, 77.0% were caused by stray dogs). PEP was indicated for 997 (58.1%) patients. Only 340 (19.9%) animals underwent veterinary observations (3.1% of stray and 76.1% of owned animals). The largest number of injuries were presented at lower extremities, 1044 (60.8%) cases.

CONCLUSIONS

Zenica-Doboj Canton is a rabies-free region. Due to the high rate of stray animals not undergoing veterinary observations, the non-existence of a unique dog registry, and the consequent lack of information about stray animals in terms of number, vaccination, neutering, and euthanasia, there is an urgent need for improving the prevention and control of rabies within the One Health framework.

Zoonoses under our noses

One Health is an effective approach for the management of zoonotic disease in humans, animals and environments. Examples of the management of bacterial zoonoses in Europe and across the globe demonstrate that One Health approaches of international surveillance, information-sharing and appropriate intervention methods are required to successfully prevent and control disease outbreaks in both endemic and non-endemic regions. Additionally, a One Health approach enables effective preparation and response to bioterrorism threats.

Convergence model for effectual prevention and control of zoonotic diseases: a health system study on 'One Health' approach in Ahmedabad, India

The complexity and increasing burden of zoonotic diseases create challenges for the health systems of developing nations. Public health systems must therefore be prepared to face existing and future disease threats at the human–animal interface. The key for this is coordinated action between the human and the animal health systems. Although some studies deal with the question of how these two systems interact during unforeseen circumstances such as outbreaks, a dearth of literature exists on how these systems interact on early detection, prevention and control of zoonotic diseases; assessing this problem from the health system perspective in a developing nation adds further complexity. Systems thinking is one of the promising approaches in understanding the factors that influence the system’s complexity and dynamics of health maintenance. Therefore, this study aims to understand the generic structure and complexity of interaction between these actors within the domain of One Health for the effectual prevention and control of zoonotic diseases in India.

The present study will be executed in Ahmedabad, located on the Western part of India, in Gujarat state, using a mixed methods approach. For the first step, zoonotic diseases will be prioritised for the local context through semi-quantitative tools. Secondly, utilising semi-structured interviews, stakeholders from the human and animal health systems will be identified and ranked. Thirdly, the identified stakeholders will be questioned regarding the current strength of interactions at various levels of the health system (i.e. managerial, provider and community level) through a quantitative network survey. Fourthly, utilising a vignette method, the ideal convergence strategies will be documented and validated through policy Delphi techniques. Finally, through a participatory workshop, the factors that influence convergence for the control and prevention of zoonotic diseases will be captured.

This study will provide a comprehensive picture of the current strength of collaboration and network depth at various levels of the health system. Further, it will assist different actors in identifying the relevance of possible One Health entry points for participation, i.e. it will not only contribute but will also develop a system convergence model for the effectual prevention and control of zoonotic diseases.