Multisectoral prioritization of zoonotic diseases in Uganda, 2017: A One Health perspective

Gender and exposure pathways to zoonotic infections in communities at the interface of wildlife conservation areas of Uganda: A qualitative study

The changing climate and increasingly frequent environmental shocks are creating new pressures on land use and intensifying inter-species contact that might foster zoonotic disease transmission. In areas where there are complex interactions between wild/domestic animals and humans, preventing and managing zoonotic infections requires an integrated One Health approach based on interdisciplinary and multisectoral collaboration. We used a One Health approach to investigate how potential zoonotic disease exposures might be gendered based on sociocultural norms. In six conservation areas in Uganda, we focused on three zoonoses: Rift Valley Fever, Brucellosis and Crimean-Congo Haemorrhagic Fever. We conducted in-depth interviews and focus group discussions with 379 purposively selected participants. Interviews/discussions were audio recorded, transcribed, coded and analysed thematically. In all areas, women and girls were responsible for household-related work while men and boys cared for larger livestock outside of the home, with some regional variations in roles. Location-specific cultural norms differentially impacted women's and men's exposures, including male initiation rituals involving consuming raw meat and animal blood reported in one study area. The different activities performed by women and men lead to differential risks of infection, suggesting that gender-sensitive interventions are required to address the risks faced by people living in these settings.

Meeting report: CEPI workshop on Rift Valley fever epidemiology and modeling to inform human vaccine development, Nairobi, 4-5 June 2024

Rift Valley fever (RVF) is a zoonotic viral disease that causes epidemics and epizootics among humans and livestock, resulting in substantial health and socioeconomic consequences. Currently, there are no RVF vaccines licensed for humans, but several candidates show promise in early-stage development. Existing gaps in RVF epidemiological data and challenges associated with predicting RVF outbreak risk complicate the planning of efficacy studies, making the pathway to licensure for promising candidates unclear. In June 2024, the Coalition for Epidemic Preparedness Innovations (CEPI) convened a two-day workshop in Nairobi, Kenya, to discuss RVF epidemiology, modeling priorities, and specific gaps relevant to human RVF vaccine development. The workshop included representatives from multiple RVF-endemic countries, key global collaborators, and international health organizations. Workshop participants identified five key priorities: (1) Looking beyond outbreaks: There is a need to better characterize the complex One Health epidemiology of RVF and understand interepidemic persistence of the virus; (2) Better data for better models: Epidemiological modeling is crucial for research, prediction, and planning, but it requires accurate and representative data; (3) New, improved and accessible diagnostics and serological assays: These are needed to inform epidemiology and case definitions, without which RVF research will continue to suffer due to paucity of data and challenges in determining infection and exposure; (4) Defining use cases, regulatory pathways, and implementation strategies for human vaccines: Clarity on these topics will facilitate licensure and effective use of RVF vaccines; and (5) People-centered approaches: Community engagement and involvement of social and behavioral scientists are key to the success of human vaccine research and development and implementation, particularly as the virus impacts livestock and livelihoods. Workshop participants welcomed a renewed focus for RVF epidemiology and modeling, and expressed enthusiasm for continued multidisciplinary collaborations to support enabling sciences for human RVF vaccine research and development.

Gender and cultural aspects of brucellosis transmission and management in Nakasongola cattle corridor in Uganda

BACKGROUND

Brucellosis is a zoonotic disease with significant public health and economic effects on societies. In Uganda, brucellosis is endemic and a primary contributor in livestock productivity losses. This is more worrisome for populations in the cattle corridor with high reliance on cattle and milk for nutritional value and symbol in social relations and identity. The community's social construction may affect comprehension of brucellosis hence leading to exposure and increased vulnerability to transmission. Despite brucellosis' high prevalence in the cattle corridor, little attention has been paid to its social construction. Hence, this study explored the interplay between gender dynamics, vulnerability and social construction of brucellosis transmission, in consideration of the unique socio-cultural context that characterizes cattle corridor populations.

METHODS

Using an exploratory qualitative approach, the study was conducted in Nakasongola cattle corridor within three sub counties; Nabiswera, Nakitoma and Wabinyonyi using key informant interviews (KIIs) and focus group discussions (FGDs). Purposive sampling was used to identify participants for the four FGD [8-12] each from a subcounty though one was combined and 15 KIIs. Data were collected using face -to -face interviews with an interview guide that was structured using the Socio Ecological Model of Human Behaviour framework (SEMHB) constructs. Thematic analysis was conducted in NVivo 12 Pro incorporating both deductive (guided by the SEMHB) and inductive approaches (guided by the data).

FINDINGS

The study identified important themes under each SEMHB influence level (Individual, Interpersonal, Community and Societal level). The study indicates that social composition and role distribution are driven by social and cultural expectations and significantly contribute to exposure and vulnerability to infection in the cattle corridor. For instance, it is paramount that women undergoing marriage preparations to be fed on raw milk for a certain period prior to their ceremony to enhance beauty. Also, important to note that use of personal protection to assist births is viewed by the community as opposing cultural norms, creating a perception of detachment from the highly valued cattle. Another noteworthy finding is the level of knowledge on brucellosis in terms of symptoms, transmission route, prevention and treatment at the interpersonal level. Furthermore, findings show practices such as the consumption of raw milk and assisted births, as being rooted in the social cultural norms, hence critical for transmission of brucellosis. At the community and organizational levels, the findings indicate an inadequate level of knowledge sharing and reluctance towards preventive measures as structural factors for the transmission of brucellosis and are ingrained in family and power relations.

CONCLUSION

The findings highlight that the social construction of brucellosis transmission is rooted in gender roles, social- cultural and power structures highlighting the influence of living process and spaces, at the different societal levels. Such complex dynamics play a critical role in determining individuals' susceptibility to infection as well as transmission potential of the disease-causing agent in cattle keeping communities. The gendered induced vulnerabilities related to the socio-cultural norms and familial roles, also play an important role in the exposure and spill over at the individual, interpersonal and community levels. The insufficient knowledge-sharing and reluctance to adopt preventive measures emerge as structural contributors to the persistence of brucellosis and other emerging zoonoses. These factors, intertwined with family dynamics and power relations, call for targeted interventions that address both individual behaviors and broader socio-cultural and institutional barriers to effective disease management and prevention. Conversely, policies that align with the community's social construction, gender and context are more likely to be feasible, adopted and sustained by the affected population.

Effective community engagement in one health research in Sub-Saharan Africa: a systematic review

BACKGROUND

The one health (OH) approach, linking human, animal, and environmental health, relies on effective community engagement (CE), education, stewardship, and effective regional and global partnerships. For real impact, communities should be at the centre of research agenda setting and program implementation. This review aimed at synthesizing empirical evidence on how communities are involved in one health research. Specifically, the review aimed at documenting the extent of community involvement in one health research, as well as to identify the barriers and facilitators to effective community engagement in one health research in sub Saharan Africa.

METHODS

The study was a systematic review conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Empirical peer-reviewed research articles on community engagement in one health research published from January 2000 to September 2023 in English or French were retrieved from seven databases: MEDLINE, EMBASE, CINAHL, Cochrane Library, WHO Afro Library, the National Institute for Health Research, and African Journals Online databases. The extracted data from the included studies were analysed using a thematic synthesis approach.

RESULTS

The final review and synthesis included eight studies. The extent of CE in the one health research approach is quite limited. Two main best practices of CE in OH research were: 1) Awareness raising on OH research through social mobilization, rural outreach sensitization, and wide community assembly and 2) Building local capacity through community-based OH Training and Leadership workshops. The barriers to effective CE included: inadequate community research literacy levels, contextual disparities in CE, inadequate dissemination of research findings, language barriers and ineffective and uncoordinated stakeholder involvement.

CONCLUSION

The review underscores the importance of effective CE in one health research. The best practices for CE in one health research are raising awareness and co-creation which should guide future initiatives. There are cultural, geographical, linguistic, and educational constraints that pose barriers to CE, requiring a more integrated and community-centric approach to one health research in SSA. An effective CE in one health research through this approach will ultimately lead to more effective responses and control of zoonotic disease outbreaks.

Seroprevalence of Brucella spp. and Rift Valley fever virus infections in communal pastoral cattle at the wildlife-livestock interface, Zambezi region, Namibia

Introduction

Brucellosis and Rift Valley fever (RVF) are neglected zoonotic diseases (NZD) that threaten public health, animal health, and production in resource-limited countries including Namibia.

Methods

The objective of this cross-sectional study was to determine Brucella spp. and RVFV seroprevalence in cattle at the wildlife-livestock interface in the Kabbe South constituency (Zambezi region) of Namibia. Cattle sera (n = 371) were randomly collected from 18 cattle herds in six constituency areas and tested for antibodies against Brucella [complement fixation test (CFT) and indirect enzyme-linked immunosorbent (ELISA) assay in parallel] and Rift Valley fever virus (competitive ELISA).

Results

Apparent individual animal prevalence for Brucella spp. was 5.9% (95% CI: 3.95%-8.81%, 22/371) and 20.8% (95% CI: 16.9%-25.2%, 77/371) based on the CFT and I-ELISA, respectively. For RVFV, apparent and true animal prevalence were 41.0% (95% CI: 36.1%-46.0%, 152/371) and 47.6% (95% CI: 41.8%-53.6%), respectively. Animal and true prevalence of Brucella spp. based on the CFT and ELISA in parallel were 22.6% (95% CI: 18.7%-27.2%, 84/371) and 19.7% (95% CI: 15.6%-24.4%), respectively. About 10.8% (40/371) of cattle tested positive for both Brucella spp. and RVFV antibodies. Prevalence of Brucella-positive cattle herds was 83.3% (15/18). Within herd Brucella spp. seroprevalence was 0%-70%. All cattle herds tested positive for RVFV, with prevalence of 1.7% to 70%. Binomial logistic regression revealed that sex was a significant predictor (p < 0.05) for RVFV seropositivity, but not for Brucella spp. seropositivity (p > 0.05). Test agreement between CFT and I-ELISA when used for the detection of anti-Brucella antibodies was poor (k = 0.2322).

Discussion

Brucella spp. and RVFV infections were prevalent in communal pastoral cattle at the human-wildlife-livestock interface in the Zambezi region suggesting a higher likelihood of occurrence of reproduction losses in cattle and zoonotic disease in humans. We recommend the enforcement of the requirements for the vaccination of heifers against brucellosis in the affected communal areas to reduce the risk of human infection. The use of One Health principles for the surveillance, prevention and control of Brucella spp. and RVFV infections can promote the effective control of these zoonotic infections at the interface.

Are we ready for the next anthrax outbreak? Lessons from a simulation exercise in a rural-based district in Uganda

Anthrax is a bacterial zoonotic disease caused by Bacillus anthracis. We qualitatively examined facilitators and barriers to responding to a potential anthrax outbreak using the capability, opportunity, motivation behaviour model (COM-B model) in the high-risk rural district of Namisindwa, in Eastern Uganda. We chose the COM-B model because it provides a systematic approach for selecting evidence-based techniques and approaches for promoting the behavioural prompt response to anthrax outbreaks. Unpacking these facilitators and barriers enables the leaders and community members to understand existing resources and gaps so that they can leverage them for future anthrax outbreaks.This was a qualitative cross-sectional study that was part of a bigger anthrax outbreak simulation study conducted in September 2023. We conducted 10 Key Informant interviews among key stakeholders. The interviews were audio recorded on Android-enabled phones and later transcribed verbatim. The transcripts were analyzed using a deductive thematic content approach through Nvivo 12.The facilitators were; knowledge of respondents about anthrax disease and anthrax outbreak response, experience and presence of surveillance guidelines, availability of resources, and presence of communication channels. The identified barriers were; porous boarders that facilitate unregulated animal trade across, lack of essential personal protective equipment, and lack of funds for surveillance and response activities.Generally, the district was partially ready for the next anthrax outbreak. The district was resourced in terms of human resources but lacked adequate funds for animal, environmental and human surveillance activities for anthrax and related response. The district technical staff had the knowledge required to respond to the anthrax outbreak but lacked adequate funds for animal, environmental and human surveillance for anthrax and related response. We think that our study findings are generalizable in similar settings and therefore call for the implementation of such periodic evaluations to help leverage the strong areas and improve other aspects. Anthrax is a growing threat in the region, and there should be proactive efforts in prevention, specifically, we recommend vaccination of livestock and further research for human vaccines.

Strengthening anthrax outbreak response and preparedness: simulation and stakeholder education in Namisindwa district, Uganda

BACKGROUND

Anthrax is a zoonotic disease caused by Bacillus anthracis that poses a significant threat to both human health and livestock. Effective preparedness and response to anthrax outbreak at the district level is essential to mitigate the devastating impact of the disease to humans and animals. The current diseaae surveillance in animals and humans uses two different infrastructure systems with online platform supported by established diagnostic facilities. The differences in surveillance systems affect timely outbreak response especially for zoonotic diseases like anthrax. We therefore aimed to assess the feasibility of implementing a simulation exercise for a potential anthrax outbreak in a local government setting and to raise the suspicion index of different district stakeholders for a potential anthrax outbreak in Namisindwa District, Uganda.

METHODS

We conducted a field-based simulation exercise and a health education intervention using quantitative data collection methods. The study participants mainly members of the District Taskforce (DTF) were purposively selected given their role(s) in disease surveillance and response at the sub-national level. We combined 26 variables (all dichotomized) assessing knowledge on anthrax and knowledge on appropriate outbreak response measures into an additive composite index. We then dichotomized overall score based on the 80% blooms cutoff i.e. we considered those scoring at least 80% to have high knowledge, otherwise low. We then assessed the factors associated with knowledge using binary logistic regression with time as a proxy for the intervention effect. Odds ratios (ORs) and 95% Confidence intervals (95%CI) have been reported.

RESULTS

The overall district readiness score was 35.0% (24/69) and was deficient in the following domains: coordination and resource mobilization (5/16), surveillance (5/11), laboratory capacity (3/10), case management (4/7), risk communications (4/12), and control measures (4/13). The overall community readiness score was 7 out of 32 (22.0%). We noted poor scores of readiness in all domains except for case management (2/2). The knowledge training did not have an effect on the overall readiness score, but improved specific domains such as control measures. Instead tertiary education was the only independent predictor of higher knowledge on anthrax and how to respond to it (OR = 1.57, 95% CI = 1.07-2.31). Training did not have a significant association with overall knowledge improvement but had an effect on several individual knowledge aspects.

CONCLUSION

We found that the district's preparedness to respond to a potential anthrax outbreak was inadequate, especially in coordination and mobilisation, surveillance, case management, risk communication and control measures. The health education training intervention showed increased knowledge levels compared to the pre-test and post-test an indicator that the health education sessions could increase the index of suspicion. The low preparedness underscores the urgency to strengthen anthrax preparedness in the district and could have implications for other districts. We deduce that trainings of a similar nature conducted regularly and extensively would have better effects. This study's insights are valuable for improving anthrax readiness and safeguarding public and animal health in similar settings.

A Generalizable Prioritization Protocol for Climate-Sensitive Zoonotic Diseases

Emerging and re-emerging zoonotic diseases pose a significant threat to global health and economic security. This threat is further aggravated by amplifying drivers of change, including climate hazards and landscape alterations induced by climate change. Given the complex relationships between climate change and zoonotic disease health outcomes, a structured decision-making process is required to effectively identify pathogens of greatest concern to prioritize prevention and surveillance efforts. Here, we describe a workshop-based expert elicitation process in six steps to prioritize climate-sensitive zoonoses based on a structured approach to defining criteria for climate sensitivity. Fuzzy analytical hierarchy process methodology is used to analyze data provided by experts across human, animal, and environmental health sectors accounting for uncertainties at different stages of the prioritization process. We also present a new interactive expert elicitation interface that facilitates data collection and real-time visualization of prioritization results. The novel approach presented in this paper offers a generalized platform for prioritizing climate-sensitive zoonoses at a national or regional level. This allows for a structured decision-making support process when allocating limited financial and personnel resources to enhance preparedness and response to zoonotic diseases amplified by climate change.

How feasible or useful are timeliness metrics as a tool to optimise One Health outbreak responses?

INTRODUCTION

As timeliness metrics gain traction to assess and optimise outbreak detection and response performance, implementation and scale-up require insight into the perspectives of stakeholders adopting these tools. This study sought to characterise the feasibility and utility of tracking One Health outbreak milestones across relevant human, animal, plant, and environmental sectors to systematically quantify timeliness metrics in Uganda, a country prone to outbreaks of WHO priority diseases.

METHODS

A database of outbreak events occurring in Uganda between 2018 and 2022 was compiled. Outbreak reports meeting our inclusion criteria were reviewed to quantify the frequency of milestone reporting. Key informant interviews were conducted with expert stakeholders to explore the feasibility and utility of tracking metrics using a framework analysis. Quantitative and qualitative data were collected and analysed concurrently.

RESULTS

Of the 282 public health emergencies occurring between 2018 and 2022, 129 events met our inclusion criteria, and complete data were available for 82 outbreaks. For our qualitative portion, 10 informants were interviewed from 7 institutions, representing the human, animal and environmental sectors. Informants agreed most One Health milestones are feasible to track, which was supported by the frequency of milestone reporting; however, there was a demonstrated need for increased reporting of after-action reviews, as well as outbreak start and end dates. Predictive alerts signalling potential outbreaks and preventive responses to alerts are seen as challenging to routinely capture, reflecting the lack of public health action for these domains.

CONCLUSION

Despite consensus among stakeholders that timeliness metrics are a beneficial tool to assess outbreak performance, not all One Health metrics are being tracked consistently, thereby missing opportunities to optimise epidemic intelligence, preparedness and prevention. The feasibility of tracking these metrics depends on the integration of reporting channels, enhanced documentation of milestones and development of guidance for early adopters, recognising country-specific on-the-ground realities and challenges to national scaling efforts.

Bridging Food Systems and One Health: A key to preventing future pandemics?

Food Systems and One Health are two approaches increasingly known for the holistic perspective they bring when addressing the issues that concern them: food and health. This systematic literature review aims to explore the evidence for using these approaches in a concerted manner to better manage zoonoses. By zoonoses management, we refer to improving the ability to address current zoonoses as well as preventing future ones. A total of 98 scientific articles were screened, of which 29 were considered eligible due to their focus on operationalizing each approach to help address zoonoses, as well as a combination of the two. Most articles implement One Health to prevent zoonoses by guiding stakeholders in concerted and participatory decision-making processes. However, the One Health approach can also be adopted via data modelling. Several articles refer to the monitoring and evaluation process of One Health initiatives to prevent zoonoses and discuss best practices to successfully implement the approach. Contrastingly, only three studies adopt a Food System approach to manage zoonoses, despite the profound connections existing between our food systems and the emergence of zoonotic risks. We conclude that there is a lack of integration between the One Health and Food System approaches to manage zoonoses. We also show that experts call for integration, so that not only human, animal, plant, and environmental health are considered, but also the socio-economic trade-offs when monitoring and developing strategies to manage zoonoses. This can be reversed, enabling zoonotic risks to be addressed when planning for our food systems of tomorrow.

The application of the One Health approach in the management of five major zoonotic diseases using the World Bank domains: A scoping review

The international authorities, such as the Food and Agriculture Organization of the United Nations, World Health Organization, World Organization for Animal Health, United Nations Environment Programme, and World Bank, have endorsed the One Health concept as an effective approach to optimize the health of people, animals, and the environment. The One Health concept is considered as an integrated and unifying approach with the objective of sustainably balancing and optimizing the health of people, animals, and ecosystems. Despite variations in its definitions, the underlying principle remains consistent - recognizing the interconnected and interdependent health of humans, animals, and the environment, necessitating interdisciplinary collaboration to optimize health outcomes. The One Health approach has been applied in numerous countries for detecting, managing, and controlling diseases. Moreover, the concept has found application in various areas, including antimicrobial resistance, food safety, and ecotoxicology, with a growing demand. There is a growing consensus that the One Health concept and the United Nations Sustainable Development Goals mutually reinforce each other. The World Bank has recommended five domains as foundational building blocks for operationalising the One Health approach, which includes: i) One Health stakeholders, roles, and responsibilities; ii) financial and personal resources; iii) communication and information; iv) technical infrastructure; and v) governance. The domains provide a generalised overview of the One Health concept and guide to its application. We conducted a scoping review following the five-staged Arksey and O'Malley's framework. The objective of the review was to map and synthesise available evidence of application of the One Health approach to five major zoonotic diseases using the World Bank domains. Publications from the year 2004, marking the inception of the term 'One Health,' to 2022 were included. Information was charted and categorised against the World Bank domains identified as a priori. We included 1132 records obtained from three databases: Embase, Medline, and Global Health; as well as other sources. After excluding duplicates, screening for titles and abstracts, and full text screening, 20 articles that contained descriptions of 29 studies that implemented the One Health approach were selected for the review. We found that included studies varied in the extent to which the five domains were utilised. Less than half the total studies (45%) used all the five domains and none of the studies used all the sub-domains. The environmental sector showed an underrepresentation in the application of the One Health approach to zoonotic diseases as 14 (48%) studies in 10 articles did not mention it as a stakeholder. Sixty two percent of the studies mentioned receiving support from international partners in implementing the One Health approach and 76% of the studies were supported by international donors to conduct the studies. The review identified disparate funding mechanisms employed in the implementation of the One Health approach. However, there were limited discussions on plans for continuity and viability of these funding mechanisms in the future.

Current and potential use of animal disease data by stakeholders in the global south and north

What cannot be measured will not be managed. The Global Burden of Animal Diseases (GBADs) will generate information on animal disease burdens by species, production system, type and gender of farmer and consumer, geographical region, and time period. To understand the demand for burden of animal disease (BAD) data and how end-users might benefit from this, we reviewed the literature on animal diseases prioritisation processes (ADPP) and conducted a survey of BAD information users. The survey covered their current use of data and prioritizations as well as their needs for different, more, and better information. We identified representative (geography, sector, species) BAD experts from the authors' networks and publicly available documents and e-mailed 1485 experts. Of 791 experts successfully contacted, 271 responded (34% response rate), and 185 complete and valid responses were obtained. Most respondents came from the public sector followed by academia/research, and most were affiliated to institutions in low- and middle-income countries (LMICs). Of the six ADPPs commonly featured in literature, only three were recognised by more than 40% of experts. An additional 23 ADPPs were used. Awareness of ADDPs varied significantly by respondents. Respondents ranked animal disease priorities. We used exploded logit to combine first, second and third disease priorities to better understand prioritzation and their determinants. Expert priorities differed significantly from priorities identified by the ADDPs, and also from the priorities stated veterinary services as reported in a survey for a World Organisation of Animal Health (WOAH) technical item. Respondents identified 15 different uses of BAD data. The most common use was presenting evidence (publications, official reports, followed by disease management, policy development and proposal writing). Few used disease data for prioritzation or resource allocation, fewer routinely used economic data for decision making, and less than half were aware of the use of decision support tools (DSTs). Nearly all respondents considered current BAD metrics inadequate, most considered animal health information insufficiently available and not evidence-based, and most expressed concerns that decision-making processes related to animal health lacked transparency and fairness. Cluster analysis suggested three clusters of BAD users and will inform DSTs to help them better meet their specific objectives. We conclude that there is a lack of satisfaction with current BAD information, and with existing ADDPs, contributing to sub-optimal decision making. Improved BAD data would have multiple uses by different stakeholders leading to better evidenced decisions and policies; moreover, clients will need support (including DSTs) to optimally use BAD information.

The study on setting priorities of zoonotic agents for medical preparedness and allocation of research resources

The aim of this study is to develop a scoring platform to be used as a reference for both medical preparedness and research resource allocation in the prioritization of zoonoses. Using a case-control design, a comprehensive analysis of 46 zoonoses was conducted to identify factors influencing disease prioritization. This analysis provides a basis for constructing models and calculating prioritization scores for different diseases. The case group (n = 23) includes diseases that require immediate notification to health authorities within 24 hours of diagnosis. The control group (n = 23) includes diseases that do not require such immediate notification. Two different models were developed for primary disease prioritization: one model incorporated the four most commonly used prioritization criteria identified through an extensive literature review. The second model used the results of multiple logistic regression analysis to identify significant factors (with p-value less than 0.1) associated with 24-hour reporting, allowing for objective determination of disease prioritization criteria. These different modeling approaches may result in different weights and positive or negative effects of relevant factors within each model. Our study results highlight the variability of zoonotic disease information across time and geographic regions. It provides an objective platform to rank zoonoses and highlights the critical need for regular updates in the prioritization process to ensure timely preparedness. This study successfully established an objective framework for assessing the importance of zoonotic diseases. From a government perspective, it advocates applying principles that consider disease characteristics and medical resource preparedness in prioritization. The results of this study also emphasize the need for dynamic prioritization to effectively improve preparedness to prevent and control disease.

Sero-prevalence and risk factors associated with occurrence of anti-Brucella antibodies among slaughterhouse workers in Uganda

INTRODUCTION

Brucellosis is a febrile zoonosis occurring among high-risk groups such as livestock keepers and abattoir workers and is a public health priority in Uganda. The technical complexities of bacteriological and molecular methods make serological approaches the cornerstone of diagnosis of human brucellosis in resource limited settings. Therefore, proper application and interpretation of serological tests is central to achieve a correct diagnosis.

MATERIALS AND METHODS

We conducted a cross-sectional study to estimate the seroprevalence and factors associated with anti-Brucella antibodies among slaughterhouse workers processing ruminants and pigs in three regions of the country with serial testing using a combination of the Rose Bengal Test (RBT) and the BrucellaCapt test. An authorized clinician collected 543 blood samples from consenting abattoir workers as well as attribute medical and social demographic data. Univariable and multivariable logistic regression were used to determine factors associated with anti-Brucella sero-positivity.

RESULTS AND DISCUSSION

The sero-prevalence among ruminant slaughterhouse workers ranged from 7.3% (95% CI: 4.8-10.7) using BrucellaCapt to 9.0% (95% CI: 6.3-12.7) using RBT. Slaughterhouse workers from the Eastern regions (AOR = 9.84, 95%CI 2.27-69.2, p = 0.006) and those who graze animals for alternative income (AOR = 2.36, 95% CI: 1.91-6.63, p = 0.040) were at a higher risk of exposure to Brucella. Similarly, those who wore Personal Protective Equipment (AOR = 4.83, 95%CI:1.63-18.0, p = 0.009) and those who slaughter cattle (AOR = 2.12, 95%CI: 1.25-6.0, p = 0.006) were at a higher risk of exposure to Brucella. Those who slaughter small ruminants (AOR = 1.54, 95%CI: 1.32-4.01, p = 0.048) were also at a higher risk of exposure to Brucella.

CONCLUSIONS AND RECOMMENDATIONS

Our study demonstrates the combined practical application of the RBT and BrucellaCapt in the diagnosis of human brucellosis in endemic settings. Both pharmaceutical (e.g., routine testing and timely therapeutic intervention), and non-pharmaceutical (e.g., higher index of suspicion of brucellosis when investigating fevers of unknown origin and observation of strict abattoir hygiene) countermeasures should be considered for control of the disease in high-risk groups.

Demands for Intersectoral Actions to Meet Health Challenges in East and Southern Africa and Methods for Their Evaluation

OBJECTIVES

Focusing on the East, Central, and Southern African region, this study examines both regional and country-level initiatives aimed at promoting multisectoral collaboration to improve population health and the methods for their economic evaluation.

METHODS

We explored the interventions that necessitate cooperation among policymakers from diverse sectors and the mechanisms that facilitate effective collaboration and coordination across these sectors. To gain insights into the demand for multisectoral collaboration in the East, Central, and Southern African region, we presented 3 country briefs, highlighting policy areas and initiatives that have successfully incorporated health-promoting actions from outside the health sector in Zimbabwe, Uganda, and Malawi. Additionally, we showcased initiatives undertaken by the Ministry of Health in each country to foster coordination with national and international stakeholders, along with existing coordination mechanisms established for intersectoral collaboration. Drawing on these examples, we identified the primary challenges in the economic evaluation of multisectoral programs aimed at improving health in the region.

RESULTS

We illustrated how decision making in reality differs from the traditional single-sector and single-decision-maker perspective commonly used in cost-effectiveness analyses. To ensure economic evaluations can inform decision making in diverse settings and facilitate regional collaboration, we highlighted 3 fundamental principles: identifying policy objectives, defining the perspective of the analysis, and considering opportunity costs. We emphasized the importance of adopting a flexible and context-specific approach to economic evaluation.

CONCLUSIONS

Through this work, we contribute to bridging the gap between theory and practice in the context of intersectoral activities aimed at improving health outcomes.

One Health approach for prioritization of potential foodborne pathogens: Risk-ranking, Delphi survey, and criteria evaluation pre- and post-COVID-19 pandemic

Frequent foodborne illnesses with unknown causative agents highlight the need to explore zoonotic potential foodborne pathogens (PFPs). An effective PFP prioritization tool is indispensable, especially after experiencing the recent pandemic caused by zoonotic SARS-CoV-2. Risk information on pathogens (excluding 30 known foodborne pathogens) provided by governmental and international organizations was reviewed to generate a list of PFPs. Risk-ranking of PFPs was conducted based on a literature review of food poisoning or detection cases, and the ranks were determined with a decision tree. PFPs were prioritized by infectious disease (ID), veterinary medicine (VET), and food safety (FS) experts through a pre- and postpandemic Delphi survey, and key criteria in their decisions were illuminated. Among 339 PFPs, 32 rank-1 PFPs were involved in the foodborne outbreak(s). Discrepancies in opinions on prioritization between experts in different fields deepened after the pandemic. Only VET and FS experts valued the plausibility of foodborne transmission in evaluating bacteria and viruses, and a significant correlation between their selection of PFPs was found (p < .05). The impact of the pandemic induced all fields to focus more on human transmission and severity/fatality in prioritizing viruses, and only FS experts emphasized the plausibility of foodborne transmission after the pandemic. In contrast to prioritizing bacteria or viruses, ID and VET experts are unusually focused on foodborne transmission when prioritizing parasites. Criteria of consensus deduced by interdisciplinary experts with different interests and the criteria directly related to foodborne transmission should be acknowledged for adequate PFP prioritization.

Prioritization of zoonoses for multisectoral, One Health collaboration in Somalia, 2023

Background

The human population of Somalia is vulnerable to zoonoses due to a high reliance on animal husbandry. This disease risk is exacerbated by relatively low income (poverty) and weak state capacity for health service delivery in the country as well as climate extremes and geopolitical instability in the region. To address this threat to public health efficiently and effectively, it is essential that all sectors have a common understanding of the priority zoonotic diseases of greatest concern to the country.

Methods

Representatives from human, animal (domestic and wildlife), agriculture, and environmental health sectors undertook a multisectoral prioritization exercise using the One Health Zoonotic Disease Prioritization (OHZDP) tool developed by the United States CDC. The process involved: reviewing available literature and creating a longlist of zoonotic diseases for potential inclusion; developing and weighting criteria for establishing the importance of each zoonoses; formulating categorical questions (indicators) for each criteria; scoring each disease according to the criteria; and finally ranking the diseases based on the final score. Participants then brainstormed and suggested strategic action plans to prevent, and control prioritized zoonotic diseases.

Results

Thirty-three zoonoses were initially considered for prioritization. Final criteria for ranking included: 1) socioeconomic impact (including sensitivity) in Somalia; 2) burden of disease in humans in Somalia); 3) availability of intervention in Somalia; 4) environmental factors/determinants; and 5) burden of disease in animals in Somalia. Following scoring of each zoonotic disease against these criteria, and further discussion of the OHZDP tool outputs, seven priority zoonoses were identified for Somalia: Rift Valley fever, Middle East respiratory syndrome, anthrax, trypanosomiasis, brucellosis, zoonotic enteric parasites (including Giardia and Cryptosporidium), and zoonotic influenza viruses.

Conclusions

The final list of seven priority zoonotic diseases will serve as a foundation for strengthening One Health approaches for disease prevention and control in Somalia. It will be used to: shape improved multisectoral linkages for integrated surveillance systems and laboratory networks for improved human, animal, and environmental health; establish multisectoral public health emergency preparedness and response plans using One Health approaches; and enhance workforce capacity to prevent, control and respond to priority zoonotic diseases.

Zoonoses research in Somalia: A scoping review using a One Health approach

Zoonoses are likely to cause a substantial burden on both human and animal health systems in Somalia, given the close proximity between the pastoralist majority and their livestock. However, decades of instability leading to weak disease surveillance have meant that data on the burden of zoonoses is lacking. The aim of this scoping review was to assess and synthesize the available literature on the presence and burden of zoonoses in Somalia. We used keywords to search Web of Science for relevant publications. Studies were included if they contained relevant data on a zoonosis and were undertaken in Somalia or were undertaken in another country where exposure could reasonably be assumed to have occurred in Somalia (e.g., migrants/refugees, returning soldiers, exported animals). Studies were not included if they focused on Somali ethnic communities permanently living elsewhere or if zoonotic aspects were not considered. We extracted data on disease(s) reported, geographic focus, data reported (human, animal, environment), study design and author affiliation. A total of 22 zoonotic infections were documented in 76 publications. The most frequently studied diseases were Rift Valley Fever (n = 15, 17%), brucellosis (n = 13, 14%) and hepatitis E (n = 10, 11%). Around 30% of papers reported data from relevant populations outside Somalia. Only 18 papers undertook laboratory analysis within Somalia. Most papers reported data on humans (45%) and animals (36%) with limited research on the environmental domain. Descriptive studies (47%) dominated and most were led by non-Somali researchers (89% in first authors and 95% of last authors). This study highlights the need for well-designed zoonoses research in Somalia supported by capacity building of local researchers and investments in diagnostic laboratories.

Mapping brucellosis risk in Kenya and its implications for control strategies in sub-Saharan Africa

In Sub-Saharan Africa (SSA), effective brucellosis control is limited, in part, by the lack of long-term commitments by governments to control the disease and the absence of reliable national human and livestock population-based data to inform policies. Therefore, we conducted a study to establish the national prevalence and develop a risk map for Brucella spp. in cattle to contribute to plans to eliminate the disease in Kenya by the year 2040. We randomly generated 268 geolocations and distributed them across Kenya, proportionate to the area of each of the five agroecological zones and the associated cattle population. Cattle herds closest to each selected geolocation were identified for sampling. Up to 25 cattle were sampled per geolocation and a semi-structured questionnaire was administered to their owners. We tested 6,593 cattle samples for Brucella immunoglobulin G (IgG) antibodies using an Enzyme-linked immunosorbent assay (ELISA). We assessed potential risk factors and performed spatial analyses and prevalence mapping using approximate Bayesian inference implemented via the integrated nested Laplace approximation (INLA) method. The national Brucella spp. prevalence was 6.8% (95% CI: 6.2-7.4%). Exposure levels varied significantly between agro-ecological zones, with a high of 8.5% in the very arid zone with the lowest agricultural potential relative to a low of 0.0% in the agro-alpine zone with the highest agricultural potential. Additionally, seroprevalence increased with herd size, and the odds of seropositivity were significantly higher for females and adult animals than for males or calves. Similarly, animals with a history of abortion, or with multiple reproductive syndromes had higher seropositivity than those without. At the herd level, the risk of Brucella spp. transmission was higher in larger herds, and herds with a history of reproductive problems such as abortion, giving birth to weak calves, or having swollen testes. Geographic localities with high Brucella seroprevalence occurred in northern, eastern, and southern regions of Kenya all primarily characterized by semi-arid or arid agro-ecological zones dominated by livestock pastoralism interspersed with vast areas with mixed livestock-wildlife systems. The large spatial extent of our survey provides compelling evidence for the widespread geographical distribution of brucellosis risk across Kenya in a manner easily understandable for policymakers. Our findings can provide a basis for risk-stratified pilot studies aiming to investigate the cost-effectiveness and efficacy of singular and combined preventive intervention strategies that seek to inform Kenya's Brucellosis Control Policy.

Data analysis of zoonoses notifications in Aboriginal and Torres Strait Islander populations in Australia 1996-2021: implications for One Health

Introduction

Zoonoses are a health concern for Aboriginal and Torres Strait Islander peoples in Australia that face elevated risk of disease related to the environment and animals. Internationally, One Health is encouraged to effectively manage zoonoses by taking integrated approaches involving animal, human, and environmental health sectors to improve health outcomes. However, Australia's health systems manage zoonotic diseases in animals and people separately which does not support a One Health approach. For the effective management of zoonoses, a strong evidence base and database regarding the epidemiology of zoonotic pathogens is needed. However, we currently lack this evidence limiting our understanding of the impact of zoonoses on Aboriginal and Torres Strait Islander populations.

Methods

As a first step towards building the evidence base, we undertook a descriptive analysis of Aboriginal and Torres Strait Islander zoonotic notifications in Australia from 1996 to 2021. We presented notifications as annual notification rates per 100,000 population, and percentages of notifications by state, remoteness, sex, and age group.

Results

Salmonellosis and campylobacteriosis were the most notified zoonoses with the highest annual notification rates of 99.75 and 87.46 per 100,000 population, respectively. The north of Australia (Queensland, Northern Territory and Western Australia), remote and outer regional areas, and young children (0-4 years of age) had the highest percentages of notifications.

Discussion

To our knowledge, these findings are the first national presentation of the epidemiology of zoonoses within Aboriginal and Torres Strait Islander populations. A greater understanding of transmission, prevalence and impact of zoonoses on Aboriginal and Torres Strait Islander peoples (including animal and environmental health factors) is required to inform their effective management through a One Health approach.

Approaches for disease prioritization and decision-making in animal health, 2000-2021: a structured scoping review

This scoping review identifies and describes the methods used to prioritize diseases for resource allocation across disease control, surveillance, and research and the methods used generally in decision-making on animal health policy. Three electronic databases (Medline/PubMed, Embase, and CAB Abstracts) were searched for articles from 2000 to 2021. Searches identified 6, 395 articles after de-duplication, with an additional 64 articles added manually. A total of 6, 460 articles were imported to online document review management software (sysrev.com) for screening. Based on inclusion and exclusion criteria, 532 articles passed the first screening, and after a second round of screening, 336 articles were recommended for full review. A total of 40 articles were removed after data extraction. Another 11 articles were added, having been obtained from cross-citations of already identified articles, providing a total of 307 articles to be considered in the scoping review. The results show that the main methods used for disease prioritization were based on economic analysis, multi-criteria evaluation, risk assessment, simple ranking, spatial risk mapping, and simulation modeling. Disease prioritization was performed to aid in decision-making related to various categories: (1) disease control, prevention, or eradication strategies, (2) general organizational strategy, (3) identification of high-risk areas or populations, (4) assessment of risk of disease introduction or occurrence, (5) disease surveillance, and (6) research priority setting. Of the articles included in data extraction, 50.5% had a national focus, 12.3% were local, 11.9% were regional, 6.5% were sub-national, and 3.9% were global. In 15.2% of the articles, the geographic focus was not specified. The scoping review revealed the lack of comprehensive, integrated, and mutually compatible approaches to disease prioritization and decision support tools for animal health. We recommend that future studies should focus on creating comprehensive and harmonized frameworks describing methods for disease prioritization and decision-making tools in animal health.

Prevalence of Brucella species in stray cattle, dogs and cats: A systematic review

Stray animals are unowned free roaming, homeless, abandoned, street or sheltered animals, particularly dogs, cats and cattle. They could act as carrier of several zoonotic pathogens such as rabies virus, Mycobacterium and Brucella species. However, comprehensive information on the prevalence of zoonotic pathogens in stray animals is very limited. We conducted a systematic review as per Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines to estimate the prevalence of brucellosis in stray dogs, cats and cattle. Eligibility criteria for the study were determined using the PECOS classification (population, exposure, comparison, outcome, study design) as a tool to guide the research and adjust the search strategy. Major bibliographic databases [Web of Science, Medline, Scopus, ScienceDirect, Google Scholar and PubMed] were searched using predefined keywords for published epidemiological studies on brucellosis in stray animals (dogs, cats and cattle). Systematic assessments of all the studies since 1990-2022 were conducted and those reporting the prevalence of brucellosis in stray dogs, cats and cattle using appropriate diagnostic tests (culture, molecular, serological) were included. Studies reporting prevalence of brucellosis (Brucella infection or exposure) in kennel dogs, dairy herds, livestock farms, humans or marine species were excluded. The apparent individual test- wise prevalence along with 95% confidence intervals (CI) was estimated using Epitools. Out of 2689 studies, 37 met the inclusion criteria and were included in the systematic review. Of 37 studies, 28 (75.7%) were conducted in stray dogs, 7 (18.9%) in cattle and 2 (5.4%) in cats. Furthermore, only 21.62% studies (8/37) used probabilistic random sampling approaches and 13.51% studies (5/37) explained and justified the study sample size using appropriate methods for estimation of disease prevalence in the study populations. Higher sero-prevalence in stray dogs has been reported in studies conducted in Jordan (38.0% (95% CI: 24.0-54.0) and Pakistan (38.0% (95% CI: 31.0-45.0) whereas no sero-positivity was recorded in the studies conducted in Brazil, North Colombia, Cyprus, South Korea and USA. All studies on brucellosis (n = 7) in stray cattle were from India; conducted in stray cattle reared in cow-shelters. Sero-prevalence in the range of 4.3%- 64.3% was reported in stray cattle. Differences in diagnostic tests and host species, as well as limited number and non-randomized studies and high statistical heterogeneity did not allow us to determine combined meta-analysed prevalence estimates. Stray animals are likely to pose a zoonotic and disease spillover risk to human and livestock populations.

Assessing and Prioritizing Zoonotic Diseases in Punjab, India: A One Health Approach

Zoonotic diseases have a significant impact on both human and animal health globally. The present study was planned to prioritize the zoonoses in Punjab state of India. To develop a zoonotic disease prioritization scoring system, a comprehensive approach has been taken, including literature review, key person interviews with animal health experts (n = 12) and medical professionals (n = 7), and nine focus group discussions (FGDs) with veterinary academicians, medical professionals, and field veterinary doctors. The scoring system comprises of seven major criteria, each assigned a weightage score (ws): prevalence/incidence of the disease (ws = 0.20), severity of illnesses in humans (ws = 0.18), epidemic potential (ws = 0.16), socio-economic burden (ws = 0.16), availability of effective control and prevention measures (ws = 0.15), inter-sectoral collaborations (ws = 0.1), and bioterrorism potential (ws = 0.05). The finalized scoring system, accompanied by a list of 15 selected zoonotic diseases, was implemented among a group of 23 professionals engaged in zoonoses research (n = 7), animal health (n = 10), and medical health (n = 6) to determine their prioritization. The zoonotic diseases prioritized for the Punjab (India) included, Brucellosis (0.70) > Rabies (0.69) > Anthrax (0.64) > Leptospirosis (0.62) = Toxoplasmosis (0.62) = Highly Pathogenic Avian Influenza (HPAI) (0.62) > Bovine tuberculosis (0.61) > Q fever (0.60) > Cysticercosis (0.59) > Listeriosis (0.58) > Crimean-Congo haemorrhagic fever (CCHF) (0.57) > Japanese encephalitis (0.56) = Echinococcosis (0.56) > Dermatophytosis (0.53) > and Scrub typhus (0.48), respectively. Higher priority is suggested for endemic zoonoses (e.g., brucellosis and rabies) as compared to those with epidemic potential (e.g., CCHF, HPAI etc.) in Punjab. Results of the current study will help in the development of targeted control and prevention strategies for zoonotic diseases in Punjab and other geographical regions facing similar challenges.

Prioritization of livestock diseases by pastoralists in Oloitoktok Sub County, Kajiado County, Kenya

INTRODUCTION

Livestock diseases are a big challenge for the livelihood of pastoralists in sub-Saharan Africa because they reduce livestock productivity and increase mortality. Based on the literature available there is limited understanding on how pastoralists prioritize these diseases in the context of their culture, ecosystems and livelihoods. A study was conducted to provide insights on lay prioritization of animal diseases by pastoralists in Kenya.

METHODOLOGY

A qualitative study was undertaken between March and July 2021. Thirty in-depth interviews and six focus group discussions (FGDs) were conducted with community members to explore community attitudes on livestock diseases prioritization. Male and female livestock keepers were purposively selected and interviewed and they were all long-term residents of the area. Fourteen key informant interviews (KIIs) were conducted with professionals from different key sectors to provide detailed stakeholder perspectives on livestock diseases. The interviews were analyzed thematically using the QSR Nvivo software to identify the emerging themes related to the study objectives.

RESULTS

The pastoralists prioritized livestock diseases based on effect on their economic wellbeing, cultural values and utilization of ecosystem services. There were gender variabilities in how diseases were prioritized among the pastoralists. Men cited high priority diseases as foot and mouth disease and contagious bovine pleuropneumonia due to their regular occurrence and effect on livelihood. Notably, women regarded coenuruses as very important because it affected sheep and goats with a high mortality rate and lumpy skin disease because it rendered the meat from the carcasses inedible. Malignant catarrhal fever and trypanosomiasis were noted as some of the common diseases in the livestock-wildlife interface but not cited as priority diseases. Challenges related to disease control in pastoralist contexts exist including limited access to livestock treatment services, inadequate information on disease impact and complex environmental factors.

CONCLUSION

This study sheds light on the body of knowledge in Kenya regarding livestock diseases and their prioritization by livestock keepers. This could aid in the development of a common disease control framework and prioritization at the local level which would take into consideration the dynamic socio-cultural, ecological, livelihood and economic contexts of the communities.

Investigating the etiology of acute febrile illness: a prospective clinic-based study in Uganda

BACKGROUND

Historically, malaria has been the predominant cause of acute febrile illness (AFI) in sub-Saharan Africa. However, during the last two decades, malaria incidence has declined due to concerted public health control efforts, including the widespread use of rapid diagnostic tests leading to increased recognition of non-malarial AFI etiologies. Our understanding of non-malarial AFI is limited due to lack of laboratory diagnostic capacity. We aimed to determine the etiology of AFI in three distinct regions of Uganda.

METHODS

A prospective clinic-based study that enrolled participants from April 2011 to January 2013 using standard diagnostic tests. Participant recruitment was from St. Paul's Health Centre (HC) IV, Ndejje HC IV, and Adumi HC IV in the western, central and northern regions, which differ by climate, environment, and population density. A Pearson's chi-square test was used to evaluate categorical variables, while a two-sample t-test and Krukalis-Wallis test were used for continuous variables.

RESULTS

Of the 1281 participants, 450 (35.1%), 382 (29.8%), and 449 (35.1%) were recruited from the western, central, and northern regions, respectively. The median age (range) was 18 (2-93) years; 717 (56%) of the participants were female. At least one AFI pathogen was identified in 1054 (82.3%) participants; one or more non-malarial AFI pathogens were identified in 894 (69.8%) participants. The non-malarial AFI pathogens identified were chikungunya virus, 716 (55.9%); Spotted Fever Group rickettsia (SFGR), 336 (26.2%) and Typhus Group rickettsia (TGR), 97 (7.6%); typhoid fever (TF), 74 (5.8%); West Nile virus, 7 (0.5%); dengue virus, 10 (0.8%) and leptospirosis, 2 (0.2%) cases. No cases of brucellosis were identified. Malaria was diagnosed either concurrently or alone in 404 (31.5%) and 160 (12.5%) participants, respectively. In 227 (17.7%) participants, no cause of infection was identified. There were statistically significant differences in the occurrence and distribution of TF, TGR and SFGR, with TF and TGR observed more frequently in the western region (p = 0.001; p < 0.001) while SFGR in the northern region (p < 0.001).

CONCLUSION

Malaria, arboviral infections, and rickettsioses are major causes of AFI in Uganda. Development of a Multiplexed Point-of-Care test would help identify the etiology of non-malarial AFI in regions with high AFI rates.

Structure of the pork value chain in Northern Uganda: implications for Taenia solium control interventions

Introduction

This study characterizes the pork value chain in Agago, Kitgum, Lamwo, and Pader districts of Northern Uganda and analyzes its implications on the transmission and control of Taenia solium infections.

Methodology

Data were collected through focus group discussions (FGDs) with farmers and pig and pork traders, key informant interviews (KIIs) with local government officials and consumers, and district-level multi-stakeholder mini workshops organized in the study area. The value chain actors identified include input and services providers, pig farmers, live pig traders, pork traders, and consumers.

Results

Most of the pig production, marketing and consumption was found to occur through informal channels. Pig production in this area is dominated by smallholder extensive systems, with most producers keeping less than 10 pigs. The production segment of the pig value chain is characterized by low use of inputs and services such as veterinary extension, drugs and improved feeds. Pigs scavenge for food under free-range systems and are at risk of parasitic infections such as the zoonotic helminth Taenia solium. This risk is exacerbated by the inherent contextual aspects of the study sites including low latrine coverage, open defecation, and high poverty. In addition, some respondents viewed pigs as "sanitation policemen" where they leave them to roam around and eat dirt including feaces thereby cleaning the environment. T. solium was recognized as an important pig health constraint in this value chain alongside African swine fever (ASF). Unlike ASF that was associated with the pig mortalities, the cysts were associated with rejection of pigs by traders at purchase, condemnation of pig carcasses by meat inspectors and rejection of raw pork by consumers at points of sale.

Discussion

Poor organization of the value chain and lack veterinary extension and meat inspection services results in some pigs infected with T. solium entering the food chain, exposing consumers to infection with the parasite. To reduce the pig production losses and public health impact from T. solium infections, there is need for control and prevention interventions targeting specific nodes of the value chain where the risk of transmission is highest.

Multisectoral prioritization of zoonotic diseases in Haryana (India) using one health approach

Zoonotic diseases have huge livestock and public health burden worldwide, including India. Prioritizing zoonotic diseases is one of the important tasks under 'One Health' as it facilitates effective policy making, proper allocation of resources and promotion of multisectoral collaboration. Although some efforts have been made to prioritizing zoonotic diseases at national level in India, it is important to identify priority diseases in regional settings due to wide variation in climate and demography of different states. Therefore, the present study aims to prioritize zoonotic diseases for the state of Haryana (India). One Health Zoonotic Disease Prioritization (OHZDP) tool was used in this study to prioritize zoonotic diseases. Based on literature review of the past 23 years (2000-2022) on prevalence, morbidity, and mortality of zoonotic diseases, twenty-three high-scoring zoonotic diseases in Haryana and neighboring states of India were initially shortlisted for prioritization. A three-day participatory workshop was conducted involving 17 experts representing the Health, Animal Husbandry and Wildlife departments of Haryana. The Analytical Hierarchy Process (AHP) was used to rank the criteria, which were used to score the selected diseases using the decision tree analysis. The participants selected the following 7 criteria along with their relative weights to score the diseases: (1) Severity of disease in humans, (2) Severity of disease in animals, (3) Presence of disease in the region, (4) Transmission and outbreak potential, (5) Socio-economic impact, (6) Availability of interventions, and (7) Existing inter-sectoral collaboration for surveillance and reporting. The top scoring eight diseases selected as priority zoonotic diseases for Haryana were rabies, Japanese encephalitis, bovine tuberculosis, leptospirosis, avian influenza (H5N1), brucellosis, glanders and Influenza A (H1N1). Sensitivity analysis did not reveal any significant variation in prioritization results by varying criteria weights. This is the first systemic attempt to prioritize zoonotic diseases in the state and this will help in formulating effective monitoring, prevention, and control strategies for zoonotic diseases in the regional settings.

Anthrax hotspot mapping in Kenya support establishing a sustainable two-phase elimination program targeting less than 6% of the country landmass

Using data collected from previous (n = 86) and prospective (n = 132) anthrax outbreaks, we enhanced prior ecological niche models (ENM) and added kernel density estimation (KDE) approaches to identify anthrax hotspots in Kenya. Local indicators of spatial autocorrelation (LISA) identified clusters of administrative wards with a relatively high or low anthrax reporting rate to determine areas of greatest outbreak intensity. Subsequently, we modeled the impact of vaccinating livestock in the identified hotspots as a national control measure. Anthrax suitable areas included high agriculture zones concentrated in the western, southwestern and central highland regions, consisting of 1043 of 1450 administrative wards, covering 18.5% country landmass, and hosting 30% of the approximately 13 million cattle population in the country. Of these, 79 wards covering 5.5% landmass and hosting 9% of the cattle population fell in identified anthrax hotspots. The rest of the 407 administrative wards covering 81.5% of the country landmass, were classified as low anthrax risk areas and consisted of the expansive low agricultural arid and semi-arid regions of the country that hosted 70% of the cattle population, reared under the nomadic pastoralism. Modelling targeted annual vaccination of 90% cattle population in hotspot administrative wards reduced > 23,000 human exposures. These findings support an economically viable first phase of anthrax control program in low-income countries where the disease is endemic, that is focused on enhanced animal and human surveillance in burden hotspots, followed by rapid response to outbreaks anchored on public education, detection and treatment of infected humans, and ring vaccination of livestock. Subsequently, the global anthrax elimination program focused on sustained vaccination and surveillance in livestock in the remaining few hotspots for a prolonged period (> 10 years) may be implemented.

Seromonitoring of brucellosis in goats and sheep slaughtered at an abattoir in Kampala, Uganda

We conducted a cross-sectional serologic study at Kampala City abattoir in Uganda on 287 small ruminants (221 goats and 66 sheep) to determine the seroprevalence of brucellosis. The samples were tested using a modified rose bengal test (mRBT) and an indirect ELISA (iELISA). Small ruminant Brucella spp. seropositivity was 18 of 287 (6.3%) by mRBT and 19 of 287 (6.6%) by iELISA. The prevalence of brucellosis by mRBT was non-significantly higher in goats (17 of 221; 7.7%) than in sheep (1 of 66, 1.5%; p = 0.069), and also non-significantly higher by the iELISA in goats (18 of 221; 8.1%) than in sheep (1 of 66, 1.5%; p = 0.057). Brucellosis in slaughtered goats and sheep is a public health hazard to abattoir workers and consumers that calls for control and eradication measures at the farm level, given that testing is not carried out routinely at slaughter points.

Zoonotic pathogens and diseases detected in Vietnam, 2020-2021

Vietnam has been identified as a country at high-risk for emergence and re-emergence of zoonotic diseases. The government of Vietnam recognized five priority zoonoses, including highly pathogenic avian influenza, rabies, leptospirosis, anthrax, and Streptococcus suis, and established a framework for One Health investigation and response to these diseases. From July 2020 to February 2021, quantitative data of zoonoses were collected from an online survey in 61 of 63 provinces based on either clinical diagnosis or laboratory confirmation. The responses were followed up by using in-depth interviews, and scientific literatures on zoonoses in Vietnam during 2010 to 2020 were reviewed. A total of 234 human health professionals and 95 animal health professionals responded to the survey. The proportion of clinical-based respondents was higher than laboratory-based respondents in both human health (130/234, 55.6%) and animal health (65/95, 68.4%) sectors. There were differences in the reported frequency of zoonoses between human and animal health professionals, and between clinical-based and laboratory-based respondents. Rabies was the most serious zoonotic disease based on the number of human cases and the geographic distribution. No human cases of avian influenza infection have been reported since 2015, although the H5 subtype viruses have been found in poultry. Besides, some bacterial, fungal, and parasitic zoonoses were detected in both humans and animals. Out of the 75 zoonoses identified, we recommend that the original five prioritized zoonoses, plus 24 additional zoonoses, should be targeted for future prevention, detection, and control under One Health approach in Vietnam.

Brucellosis testing patterns at health facilities in Arusha region, northern Tanzania

BACKGROUND

Brucellosis is listed as one of six priority zoonoses in Tanzania's One Health strategic plan which highlights gaps in data needed for the surveillance and estimation of human brucellosis burdens. This study collected data on current testing practices and test results for human brucellosis in Arusha region, northern Tanzania.

METHODS

Retrospective data were extracted from records at 24 health facilities in Arusha region for the period January 2012 to May 2018. Data were captured on: the test reagents used for brucellosis, procurement and testing protocols, the monthly number of patients tested for brucellosis and the monthly number testing positive. Generalised linear mixed models were used to evaluate relationships between health facility characteristics and the probability that brucellosis testing was conducted in a given month, and the proportion of individuals testing positive.

RESULTS

Four febrile Brucella agglutination tests were used widely. The probability of testing for brucellosis in a given month was significantly associated with an interaction between year of testing and facility ownership. Test probability increased over time with more pronounced increases in privately owned as compared to government facilities. The proportion of individuals testing positive for brucellosis was significantly associated with facility type and district, with individuals tested in hospitals in Meru, Monduli and Ngorongoro districts more likely to test positive.

CONCLUSIONS

Febrile Brucella agglutination tests, known for their poor performance, were the mainstay of brucellosis testing at health facilities in northern Tanzania. The study indicates that historical data on human brucellosis in Arusha and other regions are likely to provide an inaccurate measure of true disease burden due to poor performance of the tests used and variation in testing practices. Measures to address these identified shortcomings could greatly improve quality of testing and surveillance data on brucellosis and ultimately inform prevention and control of this priority disease.

"There are many fevers": Communities' perception and management of Febrile illness and its relationship with human animal interactions in South-Western Uganda

Diagnosing the causative agent of febrile illness in resource-limited countries is a challenge in part due to lack of adequate diagnostic infrastructure to confirm cause of infection. Most febrile illnesses (>60%) are non-malarial, with a significant proportion being zoonotic and likely from animal origins. To better characterize the pathways for zoonotic disease transmission and control in vulnerable communities, adequate information on the communities' experiences and lexicon describing fever, and their understanding and perceptions of risk pathways is required. We undertook an ethnographic study to understand behaviors, exposures, and attitudes toward fever at the community level. Our hope is to better elucidate areas of priority surveillance and diagnostic investment. A focused ethnography consisting of participant observation, informal conversations, 4 barazas (community meetings), and formal ethnographic interviews (13 Focus group discussions and 17 Key informant interviews) was conducted between April and November 2015 in Kasese and Hoima Districts in Uganda. Perception of illness and associated risk factors was heavily influenced by the predominant livelihood activity of the community. The term "fever" referred to multiple temperature elevating disease processes, recognized as distinct pathological occurrences. However, malaria was the illness often cited, treated, or diagnosed both at the health facilities and through self-diagnosis and treatment. As expected, fever is as an important health challenge affecting all ages. Recognition of malarial fever was consistent with a biomedical model of disease while non-malarial fevers were interpreted mainly through ethno etiological models of explanation. These models are currently being used to inform education and prevention strategies and treatment regimens toward the goal of improving patients' outcomes and confidence in the health system. Development of treatment algorithms that consider social, cultural, and economic contexts, especially where human-animal interaction is prevalent, should factor animal exposure and zoonotic illnesses as important differentials.

Exploring and Mitigating Plague for One Health Purposes

Purpose of Review

In 2020, the Appropriations Committee for the U.S. House of Representatives directed the CDC to develop a national One Health framework to combat zoonotic diseases, including sylvatic plague, which is caused by the flea-borne bacterium Yersinia pestis. This review builds upon that multisectoral objective. We aim to increase awareness of Y. pestis and to highlight examples of plague mitigation for One Health purposes (i.e., to achieve optimal health outcomes for people, animals, plants, and their shared environment). We draw primarily upon examples from the USA, but also discuss research from Madagascar and Uganda where relevant, as Y. pestis has emerged as a zoonotic threat in those foci.

Recent Findings

Historically, the bulk of plague research has been directed at the disease in humans. This is not surprising, given that Y. pestis is a scourge of human history. Nevertheless, the ecology of Y. pestis is inextricably linked to other mammals and fleas under natural conditions. Accumulating evidence demonstrates Y. pestis is an unrelenting threat to multiple ecosystems, where the bacterium is capable of significantly reducing native species abundance and diversity while altering competitive and trophic relationships, food web connections, and nutrient cycles. In doing so, Y. pestis transforms ecosystems, causing "shifting baselines syndrome" in humans, where there is a gradual shift in the accepted norms for the condition of the natural environment. Eradication of Y. pestis in nature is difficult to impossible, but effective mitigation is achievable; we discuss flea vector control and One Health implications in this context.

Summary

There is an acute need to rapidly expand research on Y. pestis, across multiple host and flea species and varied ecosystems of the Western US and abroad, for human and environmental health purposes. The fate of many wildlife species hangs in the balance, and the implications for humans are profound in some regions. Collaborative multisectoral research is needed to define the scope of the problem in each epidemiological context and to identify, refine, and implement appropriate and effective mitigation practices.

Zoonoses and the Aboriginal and Torres Strait Islander population: A One Health scoping review

With limited access to animal health services, and high disease burdens among domesticated animals, Aboriginal and Torres Strait Islander communities in Australia face higher risk of disease including zoonoses. However, we lack understanding of the contribution of often preventable zoonoses to the health of these communities, which would enable us to enhance public health strategies and improve health outcomes. We conducted a scoping review to identify the current state of evidence on zoonoses in the Aboriginal and Torres Strait Islander population. We examined the size, scope and characteristics of the evidence base and analysed the zoonoses detected in the studies within a One Health framework. We identified 18 studies that detected 22 zoonotic pathogens in animals, people, and the environment, with most studies detecting pathogens in a single One Health sector and no studies investigating pathogens in all three sectors. Findings indicate that despite the strong conceptual foundations of One Health throughout the evidence base, evidence is lacking in application of this concept. There is a need to undertake further research that prioritises Aboriginal and Torres Strait Islander leadership, considers the contribution of human, animal and environmental health factors, and investigates the prevalence and impact of zoonoses in communities through a One Health approach.

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.

Twenty years of integrated disease surveillance and response in Sub-Saharan Africa: challenges and opportunities for effective management of infectious disease epidemics

INTRODUCTION

This systematic review aimed to analyse the performance of the Integrated Disease Surveillance and Response (IDSR) strategy in Sub-Saharan Africa (SSA) and how its implementation has embraced advancement in information technology, big data analytics techniques and wealth of data sources.

METHODS

HINARI, PubMed, and advanced Google Scholar databases were searched for eligible articles. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols.

RESULTS

A total of 1,809 articles were identified and screened at two stages. Forty-five studies met the inclusion criteria, of which 35 were country-specific, seven covered the SSA region, and three covered 3-4 countries. Twenty-six studies assessed the IDSR core functions, 43 the support functions, while 24 addressed both functions. Most of the studies involved Tanzania (9), Ghana (6) and Uganda (5). The routine Health Management Information System (HMIS), which collects data from health care facilities, has remained the primary source of IDSR data. However, the system is characterised by inadequate data completeness, timeliness, quality, analysis and utilisation, and lack of integration of data from other sources. Under-use of advanced and big data analytical technologies in performing disease surveillance and relating multiple indicators minimises the optimisation of clinical and practice evidence-based decision-making.

CONCLUSIONS

This review indicates that most countries in SSA rely mainly on traditional indicator-based disease surveillance utilising data from healthcare facilities with limited use of data from other sources. It is high time that SSA countries consider and adopt multi-sectoral, multi-disease and multi-indicator platforms that integrate other sources of health information to provide support to effective detection and prompt response to public health threats.

Preventing the cross-border spread of zoonotic diseases: Multisectoral community engagement to characterize animal mobility-Uganda, 2020

In Uganda, the borders are highly porous to animal movement, which may contribute to zoonotic disease spread. We piloted an animal adaptation of an existing human-focused toolkit to collect data on animal movement patterns and interactions to inform One Health programs. During January 2020, we conducted focus group discussions and key informant interviews with participatory mapping of 2 national-level One Health stakeholders and 2 local-level abattoir representatives from Kampala. Zoonotic disease hotspots changed in 2020 compared with reports from 2017-2019. In contrast to local-level participants, national-level participants highlighted districts rather than specific locations. Everyone discussed livestock species; only national-level participants mentioned wildlife. Participants described seasonality differently. Stakeholders used the results to identify locations for zoonotic disease interventions and sites for future data collection. This implementation of an animal-adapted population mobility mapping exercise highlights the importance of multisectoral initiatives to promote One Health border health approaches.

One planet, one health, one future: The environmental perspective

The final goal of the "One Health" is the control of the global health of our planet with a multidisciplinary approach that involves knowledge for different disciplines. In the near future, we could see in the same team veterinarians, doctors, and environmental experts work together to guarantee the health of our planet and one sustainable future for all.

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.

Cutaneous anthrax associated with handling carcasses of animals that died suddenly of unknown cause: Arua District, Uganda, January 2015-August 2017

BACKGROUND

Anthrax is a zoonotic disease that can be transmitted to humans from infected animals. During May-June 2017, three persons with probable cutaneous anthrax were reported in Arua District, Uganda; one died. All had recently handled carcasses of livestock that died suddenly and a skin lesion from a deceased person tested positive by PCR for Bacillus anthracis. During July, a bull in the same community died suddenly and the blood sample tested positive by PCR for Bacillus anthracis. The aim of this investigation was to establish the scope of the problem, identify exposures associated with illness, and recommend evidence-based control measures.

METHODS

A probable case was defined as acute onset of a papulo-vesicular skin lesion subsequently forming an eschar in a resident of Arua District during January 2015-August 2017. A confirmed case was a probable case with a skin sample testing positive by polymerase chain reaction (PCR) for B. anthracis. Cases were identified by medical record review and active community search. In a case-control study, exposures between case-patients and frequency- and village-matched asymptomatic controls were compared. Key animal health staff were interviewed to learn about livestock deaths.

RESULTS

There were 68 case-patients (67 probable, 1 confirmed), and 2 deaths identified. Cases occurred throughout the three-year period, peaking during dry seasons. All cases occurred following sudden livestock deaths in the villages. Case-patients came from two neighboring sub-counties: Rigbo (attack rate (AR) = 21.9/10,000 population) and Rhino Camp (AR = 1.9/10,000). Males (AR = 24.9/10,000) were more affected than females (AR = 0.7/10,000). Persons aged 30-39 years (AR = 40.1/10,000 population) were most affected. Among all cases and 136 controls, skinning (ORM-H = 5.0, 95%CI: 2.3-11), butchering (ORM-H = 22, 95%CI: 5.5-89), and carrying the carcass of livestock that died suddenly (ORM-H = 6.9, 95%CI: 3.0-16) were associated with illness.

CONCLUSIONS

Exposure to carcasses of animals that died suddenly was a likely risk factor for cutaneous anthrax in Arua District during 2015-2017. The recommendations are investigation of anthrax burden in livestock, prevention of animal infections through vaccinations, safe disposal of the carcasses, public education on risk factors for infection and prompt treatment of illness following exposure to animals that died suddenly.

Prioritization of neglected tropical zoonotic diseases: A one health perspective from Tigray region, Northern Ethiopia

Neglected tropical zoonotic diseases (NTZDs) continue to have a major effect on the health of humans and animals. In this study, a one health approach was used to prioritize and rank neglected tropical zoonotic diseases at the regional and zonal levels in Tigray National Regional State, Ethiopia. For prioritization of NTZDs a cross-sectional study through a structured questionnaire was administered to 313 health experts from human and animal health sectors. In addition, focus group discussions (FGD) were held with purposively selected key informants. Descriptive, and Multivariable analysis was applied to report the results and a ranked list of diseases was developed at the zonal and regional level. In the region, 8 of the 12 World Health Organization listed NTZDs were considered major diseases including anthrax, brucellosis, bovine tuberculosis, taeniasis, leishmaniasis, rabies, schistosomiasis, and soil-transmitted helminths. Considering the zoonotic and socioeconomic importance of the diseases at the regional level, rabies ranked 1^stwhereas anthrax, bovine tuberculosis, leishmaniasis, and brucellosis were ranked from 2^nd to 5^th, respectively. The FGD result also supported the prioritization result. The Multivariable analysis showed a statistically significant difference in the zonal distribution of anthrax (р = 0.009, OR = 1.16), taeniasis (p<0.001, OR = 0.82), leishmaniasis (p<0.001, OR = 1.91), rabies (p = 0.020, OR = 0.79) and soil-transmitted helminths (p = 0.007, OR = 0.87) but not for brucellosis (p = 0.585), bovine tuberculosis (p = 0.505), and schistosomiasis (p = 0.421). Anthrax (p<0.001, OR = 26.68), brucellosis (p<0.001, OR = 13.18), and taeniasis (p<0.001, OR = 6.17) were considered as the major zoonotic diseases by veterinary practitioners than human health practitioners whereas, leishmaniasis was recognized as a major health challenge by human health professionals. Understanding the priority diseases in the region is supportive for informed decision-making and prioritizes the limited resources to use. Furthermore, strengthening the collaboration between human and animal health professions is important to control the diseases.

One hundred years of zoonoses research in the Horn of Africa: A scoping review

BACKGROUND

One Health is particularly relevant to the Horn of Africa where many people's livelihoods are highly dependent on livestock and their shared environment. In this context, zoonoses may have a dramatic impact on both human and animal health, but also on country economies. This scoping review aimed to characterise and evaluate the nature of zoonotic disease research in the Horn region. Specifically, it addressed the following questions: (i) what specific zoonotic diseases have been prioritised for research, (ii) what data have been reported (human, animal or environment), (iii) what methods have been applied, and (iv) who has been doing the research?

METHODOLOGY/PRINCIPAL FINDINGS

We used keyword combinations to search online databases for peer-reviewed papers and theses. Screening and data extraction (disease, country, domain and method) was performed using DistillerSR. A total of 2055 studies focusing on seven countries and over 60 zoonoses were included. Brucellosis attracted the highest attention in terms of research while anthrax, Q fever and leptospirosis have been comparatively under-studied. Research efforts did not always align with zoonoses priorities identified at national levels. Despite zoonoses being a clear target for 'One Health' research, a very limited proportion of studies report data on the three domains of human, animal and environment. Descriptive and observational epidemiological studies were dominant and only a low proportion of publications were multidisciplinary. Finally, we found that a minority of international collaborations were between Global South countries with a high proportion of authors having affiliations from outside the Horn of Africa.

CONCLUSIONS/SIGNIFICANCE

There is a growing interest in zoonoses research in the Horn of Africa. Recommendations arising from this scoping review include: (i) ensuring zoonoses research aligns with national and global research agendas; (ii) encouraging researchers to adopt a holistic, transdisciplinary One Health approach following high quality reporting standards (COHERE, PRISMA, etc.); and (iii) empowering local researchers supported by regional and international partnerships to engage in zoonoses research.

Research priorities for control of zoonoses in South Africa

BACKGROUND

Zoonoses pose major threats to the health of humans, domestic animals and wildlife, as seen in the COVID-19 pandemic. Zoonoses are the commonest source of emerging human infections and inter-species transmission is facilitated by anthropogenic factors such as encroachment and destruction of wilderness areas, wildlife trafficking and climate change. South Africa was selected for a 'One Health' study to identify research priorities for control of zoonoses due to its complex disease burden and an overstretched health system.

METHODS

A multidisciplinary group of 18 experts identified priority zoonotic diseases, knowledge gaps and proposed research priorities for the next 5 y. Each priority was scored using predefined criteria by another group of five experts and then weighted by a reference group (n=28) and the 18 experts.

RESULTS

Seventeen diseases were mentioned with the top five being rabies (14/18), TB (13/18), brucellosis (11/18), Rift Valley fever (9/11) and cysticercosis (6/18). In total, 97 specific research priorities were listed, with the majority on basic epidemiological research (n=57), such as measuring the burden of various zoonoses (n=24), followed by 20 on development of new interventions. The highest research priority score was for improving existing interventions (0.77/1.0), followed by health policy and systems research (0.72/1.0).

CONCLUSION

Future zoonotic research should improve understanding of zoonotic burden and risk factors and new interventions in public health. People with limited rural services, immunocompromised, in informal settlements and high-risk occupations, should be the highest research priority.

Prioritizing zoonotic diseases utilizing the One Health approach: Jordan's experience

Background

Zoonotic diseases constitute a threat to humans and animals. The Middle East Region is a hotspot for such a threat; given its geographic location under migratory birds' flight paths, mass gatherings, political conflicts, and refugee crises. Thus, prioritizing zoonotic diseases of national significance is critical for preventing and controlling such threats and optimizing limited resources. Using a multi-sectoral One Health (OH) approach, this study aimed at prioritizing zoonotic diseases of national significance to Jordan and identifying future recommendations and action plans.

Methods

Zoonotic diseases of national significance to Jordan were initially identified (n = 27 diseases). In December 2019, national staff from governmental and non-state sectors were invited to develop ranking criteria, including questions and answers choices, and to weigh each criterion. Then, the national staff were asked to assess zoonotic diseases' priority using the developed criteria and provide recommendations and action plans to strengthen multi-sectoral collaboration.

Results

Seven zoonotic diseases were identified as being of great significance. Rabies was ranked as the number one priority disease, followed by middle east respiratory syndrome, avian influenza, brucellosis, leishmaniasis, rickettsiosis, and salmonellosis. The highest weighted criteria used to rank diseases were disease severity, outbreaks profile, and potential human-to-human transmission. Establishing a one-health platform, surveillance, laboratory, preparedness planning, outbreak response, and workforce were suggested as recommendations for approaching the priority diseases. Respondents identified data sharing, coordination, event-based surveillance, and effective communication channels as vital areas to enhance prevention and control strategies, conduct joint outbreak investigations, and improve multi-sectoral collaboration.

Conclusions

This study represents the first attempt to prioritize zoonotic diseases of national significance in Jordan using the OH approach and a semi-qualitative, transparent, and comparative method. Study results can be used as a decision-making guide for policymakers and stakeholders and a cornerstone for combating zoonotic disease threats.

•

This is the first regional report to prioritize zoonotic diseases using the One Health (OH) approach.

•

A list of country relevant zoonotic diseases was identified, prioritized, and approved using the OH Zoonotic Disease Prioritization (OHZDP) tool.

•

Relevant surveillance systems in Jordan should adopt a standardized data sharing mechanism and an event-based method for zoonotic events.

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.

•

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

•

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

•

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

Species misidentification in local markets: Discrepancies between reporting and molecular identification of bushmeat species in northern Uganda

Bushmeat hunting and consumption, although widely utilized as necessary supplement to household income and nutrition in many regions, presents threats to public health and wildlife conservation efforts. In northern Uganda, consumption of bats and primates, two wildlife groups often implicated in zoonotic disease emergence, is not widely culturally accepted; however, these species are reported by hunters to often be hunted and sold as culturally desirable species, like antelope and warthog. To investigate the prevalence of market bushmeat misidentifiction, we collected 229 bushmeat samples from 23 communities adjacent to Murchison Falls National Park. Reported species was recorded on acquisition for each sample. PCR targeting mammalian cyt b and 12 s rRNA genes and sequencing were performed to identify samples to the lowest taxonomic unit using NCBI BLAST. Overall, 27.9% (61/219) of samples had disparate results between species reported and BLAST analysis. Thirty-four species were identified, with the most frequent wildlife being waterbuck (31.5%), warthog (13.7%), and black rat (5.9%). These data reveal a public health risk for bushmeat consumers in northern Uganda as they cannot assess species-related risk when purchasing bushmeat and take appropriate precautions against zoonotic pathogen exposure. These data also provide insight into regional hunter prey preference and market preference of local community members which may inform conservation strategy in the region.

•

The most frequently identified wildlife species were antelopes.

•

Nearly a 30% discrepancy between species reported at point of sale and PCR confirmation.

•

Samples from hunters had statistically lower discrepancy than cooks and dealers.

Zoonotic disease preparedness in sub-Saharan African countries

BACKGROUND

The emergence of high consequence pathogens such as Ebola and SARS-CoV-2, along with the continued burden of neglected diseases such as rabies, has highlighted the need for preparedness for emerging and endemic infectious diseases of zoonotic origin in sub-Saharan Africa (SSA) using a One Health approach. To identify trends in SSA preparedness, the World Health Organization (WHO) Joint External Evaluation (JEE) reports were analysed. JEEs are voluntary, collaborative processes to assess country's capacities to prevent, detect and rapidly respond to public health risks. This report aimed to analyse the JEE zoonotic disease preparedness data as a whole and identify strengths and weaknesses.

METHODS

JEE zoonotic disease preparedness scores for 44 SSA countries who had completed JEEs were analysed. An overall zoonotic disease preparedness score was calculated as an average of the sum of all the SSA country zoonotic disease preparedness scores and compared to the overall mean JEE score. Zoonotic disease preparedness indicators were analysed and data were collated into regions to identify key areas of strength.

RESULTS

The mean 'Zoonotic disease' preparedness score (2.35, range 1.00-4.00) was 7% higher compared to the mean overall JEE preparedness score (2.19, range 1.55-3.30), putting 'Zoonotic Diseases' 5th out of 19 JEE sub-areas for preparedness. The average scores for each 'Zoonotic Disease' category were 2.45 for 'Surveillance Systems', 2.76 for 'Veterinary Workforce' and 1.84 for 'Response Mechanisms'. The Southern African region scored highest across the 'Zoonotic disease' categories (2.87).A multisectoral priority zoonotic pathogens list is in place for 43% of SSA countries and 70% reported undertaking national surveillance on 1-5 zoonotic diseases. 70% of SSA countries reported having public health training courses in place for veterinarians and 30% had veterinarians in all districts (reported as sufficient staffing). A multisectoral action plan for zoonotic outbreaks was in place for 14% countries and 32% reported having an established inter-agency response team for zoonotic outbreaks. The zoonotic diseases that appeared most in reported country priority lists were rabies and Highly Pathogenic Avian Influenza (HPAI) (both 89%), anthrax (83%), and brucellosis (78%).

CONCLUSIONS

With 'Zoonotic Diseases' ranking 5th in the JEE sub-areas and a mean SSA score 7% greater than the overall mean JEE score, zoonotic disease preparedness appears to have the attention of most SSA countries. However, the considerable range suggests that some countries have more measures in place than others, which may perhaps reflect the geography and types of pathogens that commonly occur. The category 'Response Mechanisms' had the lowest mean score across SSA, suggesting that implementing a multisectoral action plan and response team could provide the greatest gains.

A serological survey of brucellosis in wildlife in four major National Parks of Uganda

Background

Brucellosis is a contagious zoonotic disease of great public health and economic significance especially in developing countries. The disease affects humans and several species of livestock and wildlife. Studies on Brucellosis in wildlife in Uganda have been limited to single populations particularly in Queen Elizabeth National Park. This study aimed at estimating the percentage of positive samples of Brucella spp. in wildlife in four major national parks of Uganda. This was a retrospective survey which utilized archived samples collected from wildlife during the annual disease surveillance activities between 2013 and 2017.

Results

A total of 241 samples from seven species namely African buffalo (Syncerus caffer, n = 109), African elephant (Loxodonta africana, n = 22), giraffe (Giraffa camelopardalis rothschildi, n = 41), Uganda kob (Kobus kob thomasi, n = 36), lion (Panthera leo, n = 6), plain zebra (Equus quagga, n = 25), and bushbuck (Tragelaphus scriptus, n = 2), were tested for antibodies using the Rose Bengal Plate Test. The overall percentage of positive samples in the four national parks was 31.1% (75/241; 95% CI: 25.6–37.2). Kidepo Valley National Park had a significantly higher percentage of positive samples of 55.9% (19/34; 95% CI: 39.5–71.1) compared to other sampled national parks (p < 0.05). Lions had significantly higher percentage of positive samples at 66.7% (4/6) than African buffalo at 48.6% (53/109, p < 0.0001). There were no antibodies for Brucella spp. detected in African elephant and bushbuck.

Conclusion

This study shows variations in percentage of positive samples with Brucella spp. between species and across national parks and notably a high percentage with Brucella spp. in wildlife in Uganda than that recorded elsewhere in sub-Saharan region of Africa. Potential for transmission to other wildlife and spill over to livestock is high especially in national parks with high livestock-wildlife interaction.