Outbreak of Anthrax Associated with Handling and Eating Meat from a Cow, Uganda, 2018

Anthrax outbreak linked to consumption and handling of meat from unexpectedly deceased cattle, Kyotera district, Uganda, June-December 2023

BACKGROUND

Anthrax is an infectious zoonotic disease caused by gram-positive, rod-shaped, and spore-forming bacteria known as Bacillus anthracis. It continues to be a disease of public health importance in Uganda, with sporadic outbreaks reported annually in many parts of the country. In November 2023, Kyotera District reported a strange illness, characterized by itching, rash, swelling, and skin lesions which was later confirmed as anthrax. We investigated to assess its magnitude, identify potential exposures, and propose evidence-based control measures.

METHODS

A suspected cutaneous anthrax case was an acute onset of skin itching/swelling plus ≥ 2 of: skin reddening, lymphadenopathy, headache, fever or general body weakness. A suspected gastrointestinal anthrax case was an acute onset of ≥ 2 of: abdominal pain, vomiting, diarrhea, mouth lesions or neck swelling. A confirmed anthrax case was a suspected case with Bacillus anthracis PCR-positive results. To identify cases, we reviewed medical records and conducted community active case-finding. We conducted an unmatched case-control study and used logistic regression to identify risk factors of anthrax transmission. Controls were selected at a 1:4 ratio from the same villages as the case-patients.

RESULTS

We identified 63 cases (46 suspected and 17 confirmed); 48 (76%) were male. Of the 63, 55 cases (87%) were cutaneous and 8 (13%) were gastrointestinal, with a mean age of 42 years. Overall attack rate (AR) was 3.1/1,000; males were more affected (AR = 4.5/1,000) than females (AR = 1.5/1,000). Case-fatality rate was 19% (n = 12). Among the 63 cases, 18 (29%) sought care from health facilities; 33 (52%) were managed by traditional healers. The odds of anthrax infection were highest in individuals who both consumed and handled infected meat (OR = 20.9, 95% CI: 8.8-49.8), followed by those who only consumed the meat (OR = 5.81, 95% CI: 2.12-15.9).

CONCLUSION

The anthrax outbreak in Kyotera District was primarily attributed to the consumption and handling of meat from cattle that had suddenly died. Poor health-seeking behavior and seeking care from traditional healers likely contributed to the high case fatality rate. To prevent future outbreaks, authorities should enforce cattle inspection protocols, expand anthrax vaccination campaigns, and enhance community education on safe meat handling and medical care-seeking practices.

Time to control of anthrax outbreaks in Africa, 2014-2023: A systematic review and meta-analysis

Anthrax is a notifiable zoonotic disease targeted for control in Africa, however, outbreaks due to anthrax are still frequent and large. Surveillance systems should monitor and detect anthrax outbreaks early for prompt response. This systematic review and meta-analysis aimed to determine anthrax outbreaks epidemiological investigations gaps and time to control in Africa, Jan 2014-Dec 2023. We searched MEDLINE, PubMed, Scopus, Embase, Google Scholar, and Web of Science databases using PICO framework for studies on anthrax investigations. Using Covidence, we screened and extracted studies, analysed descriptive data using Microsoft Excel and quantitative data using RStudio version 4.3.1. We calculated heterogeneity and confidence intervals around pooled effect and performed risk of bias assessment. Ten of 1,639 studies met eligibility criteria and were included. Pooled median duration to control was 40.5 (IQR 80.8) days and estimated duration of outbreak end was 59.2 days (95% CI: 7.4-111.0), far beyond two incubation periods of anthrax (14 days). Median time to alert was 5 days (95% CI:0-490). A third (30%) didn't investigate animal anthrax. No study reported use of all levels of case definitions, and no study translated case investigation forms into local languages. A third (30%) of studies omitted time component of descriptive epidemiology and 22% of studies used cross-sectional study design. All studies used epidemiologists for case investigations, with 90% employing field epidemiologists, only one study used a social worker. Only 20% of studies used government funds; majority (80%) instituted public health actions. Risk of bias was at 0-20%. Median duration to control was greater than two anthrax incubation periods indicating delayed response. Several epidemiological gaps including delayed outbreak verification, focus on human anthrax and neglect of zoonotic aspects, and inappropriate working case definitions were highlighted. Timely and comprehensive epidemiological investigations, with a One Health approach to anthrax outbreak control is recommended. Systematic Review Registration: The protocol that guided this review was registered on PROSPERO: CRD42024498034.

Identification of Anthrax as the Cause of a Cluster of Unexplained Deaths, Uganda, 2023: The Role of Metagenomic Next-Generation Sequencing and Postmortem Specimens

Between April and November 2023, 27 unexplained human deaths that presented with swelling of the arms, skin sores with black centers, difficulty in breathing, obstructed swallowing, headaches, and other body aches were reported in Kyotera District, Uganda by the Public Health Emergency Operations Center. Subsequently, the death of cattle on farms and the consumption of carcass meat by some residents were also reported. Field response teams collected clinical/epidemiological data and autopsy samples to determine the cause of deaths. Metagenomic next-generation sequencing (mNGS) and target enrichment sequencing conducted on postmortem samples confirmed Bacillus anthracis, the etiological agent of anthrax disease, as the cause of the deaths. Applying mNGS to autopsy specimens is useful as a retrospective tool for identifying high-consequence pathogens during suspected outbreaks of unknown etiology.

Anthrax Outbreaks in Kyotera District, Uganda: Implications for Public Health Emergency Preparedness

Introduction

In late 2023, Uganda's Ministry of Health declared an anthrax outbreak in the Kyotera district, Masaka region, following reported animal and human fatalities. This article outlines the initial outbreak characteristics and the multi-sectoral response initiated by national and international stakeholders.

Methodology

This article presents a descriptive account of the anthrax outbreak in Kyotera district based on preliminary investigations, surveillance data provided by the Ministry of Health and collaborating partners (WHO, Infectious Disease Institute, Public Health Fellowship Program, Masaka Regional PHEOC), and a review of the unfolding events up to October 31, 2023.

Results

The anthrax outbreak in Kyotera district significantly impacted both human and livestock populations, leading to confirmed human cases, fatalities, and the death of 24 animals by October 31, 2023. The outbreak disrupted community livelihoods and strained the healthcare system, particularly as Uganda continues its recovery from the COVID-19 pandemic. Preliminary observations suggest a potential link between the outbreak and the rainy season, consistent with previous anthrax occurrences in East Africa. Economic consequences included potential job losses in the local meat industry and increased demands on healthcare resources.

Conclusion

The recent anthrax outbreak in Kyotera district underscores the ongoing threat of zoonotic diseases and the importance of a swift, coordinated, and multi-sectoral response. The findings highlight the need for strengthened interministerial cooperation, proactive health education campaigns targeting at-risk communities, consideration of prophylactic interventions, and the adoption of a comprehensive One Health approach for effective prevention and control of future outbreaks in Uganda.

Application of the Modified Grunow-Finke Risk Assessment Tool to the Sverdlovsk Anthrax Outbreak of 1979

INTRODUCTION

The modified Grunow-Finke tool (mGFT) is an improved scoring system for distinguishing unnatural outbreaks from natural ones. The 1979 Sverdlovsk anthrax outbreak was due to the inhalation of anthrax spores from a military laboratory, confirmed by Russian President Boris Yeltsin in 1992. At the time the Soviet Union insisted that the outbreak was caused by meat contaminated by diseased animals. At the time there was no available risk assessment tool capable of thoroughly examine the origin of the outbreak.

METHODS

This study aimed to retrospectively apply the mGFT to test its ability to correctly identify the origin of the Sverdlovsk anthrax outbreak of 1979 as unnatural, using data available up to 1992, before the disclosure of a laboratory leak. Data spanning from 1979 to 1992 were collected through literature reviews. Evidence related to each mGFT criterion was scored on a scale of 0 to 3 and independently reviewed by 3 assessors. These scores were then multiplied with a weighting factor and summed to obtain a maximum score. A final score exceeding 30 was indicative of an unnatural origin.

RESULTS

The mGFT results assigned a total of 47 points to the Sverdlovsk anthrax outbreak, suggesting an unnatural origin with a 78% likelihood.

CONCLUSIONS

These findings align with the confirmed unnatural origin of the outbreak, highlighting the value of tools such as the mGFT in identifying unnatural outbreaks. Such tools integrate both intelligence evidence and biological evidence in the identification of unnatural outbreaks. The use of such tools for identifying unnatural outbreaks is limited. Outbreak investigation can be improved if risk assessment tools become integral to routine public health practice and outbreak investigations.

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.

Doxycycline, levofloxacin, and moxifloxacin are superior to ciprofloxacin in treating anthrax meningitis in rabbits and NHP

Efficient treatment of anthrax-related meningitis in patients poses a significant therapeutic challenge. Previously, we demonstrated in our anthrax meningitis rabbit model that ciprofloxacin treatment is ineffective with most of the treated animals succumbing to the infection. Herein we tested the efficacy of doxycycline in our rabbit model and found it highly effective. Since all of our findings are based on a rabbit model, we test the efficacy of ciprofloxacin or doxycycline in a specific central nervous system (CNS) model developed in non-human primates (NHPs). Similar to rabbits, ciprofloxacin treatment was ineffective, while doxycycline protected the infected rhesus macaques (n = 2) from the lethal CNS Bacillus anthracis infection. To test whether the low efficacy of Ciprofloxacin is an example of low efficacy of all fluoroquinolones or only this substance, we treated rabbits that were inoculated intracisterna magna (ICM) with levofloxacin or moxifloxacin. We found that in contrast to ciprofloxacin, levofloxacin and moxifloxacin were highly efficacious in treating lethal anthrax-related meningitis in rabbits and NHP (levofloxacin). We demonstrated (in naïve rabbits) that this difference probably results from variances in blood-brain-barrier penetration of the different fluoroquinolones. The combined treatment of doxycycline and any one of the tested fluoroquinolones was highly effective in the rabbit CNS infection model. The combined treatment of doxycycline and levofloxacin was effective in an inhalation rabbit model, as good as the doxycycline mono-therapy. These findings imply that while ciprofloxacin is highly effective as a post-exposure prophylactic drug, using this drug to treat symptomatic patients should be reconsidered.

Spatial clusters of human and livestock anthrax define high-risk areas requiring intervention in Lao Cai Province, Vietnam 1991-2022

Anthrax, a widespread zoonosis in low and middle-income countries with low disease awareness and insufficient livestock vaccination coverage, has been known in Lao Cai Province in northern Vietnam for years before its apparent absence in 2009, which requires investigation as this infection is frequently reported from neighbouring provinces and countries. We aimed to describe the seasonal patterns of anthrax (1991-2008), compare livestock anthrax vaccine coverage to disease occurrence (1991- 2022), and delineate the high-risk areas to inform local disease surveillance in the province. We illustrated the seasonal pattern of anthrax and provided a comparison between livestock vaccine coverage and disease occurrence by purely spatial SaTScan (Poisson model, 25% population at risk) to detect spatial clusters of human and livestock anthrax using population derived from zonal statistics routines. The number of cases, crude cumulative incidence, and spatial clusters of human and livestock anthrax were mapped in QGIS. Results indicate peak anthrax incidence from May to October. Buffalo, domestic cattle, and horses accounted for 75% of total animal cases. Horse anthrax was more common in Lao Cai than in its neighbours and often occurred in years with human mortality. Vaccination covered less than 30% of the livestock population. We found an apparent pattern where anthrax was controlled from 1998-2003 with higher vaccine coverage (>20%) and identified spatial clusters of human and livestock anthrax in Muong Khuong, Bao Thang, and Bac Ha districts of Lao Cai. The local public health and veterinary agencies are recommended to revisit the high-risk areas and communicate with neighbouring provinces for a regional approach to anthrax surveillance and control.

Investigation of human anthrax outbreak in Koraput district of Odisha, India

BACKGROUND

Anthrax is a zoonotic infection resulting from the bacteria Bacillus anthracis. Humans contract cutaneous anthrax by coming into contact, and gastrointestinal (GI) anthrax by consumption of infected animals or animal products. An outbreak investigation was conducted to confirm the occurrence of the anthrax outbreak, comprehend its extent, understand the epidemiological characteristics, identify the outbreak's cause, and propose control measures.

METHODS

A descriptive epidemiology was carried out for this outbreak investigation. We defined a suspected human cutaneous anthrax case as appearance of skin lesions and symptoms (itching/redness/swelling) and a suspected case of GI anthrax as appearance of diarrhoea/abdominal pain/vomiting in a resident of Koraput district after being associated with slaughtering and/or consumption of carcass during 5th April to 15th May 2023. The etiological hypothesis was formulated using descriptive epidemiological methods. Laboratory confirmation was performed by real-time polymerase chain reaction (RT-PCR). Statistical analyses were conducted using SPSS 25.

RESULTS

A total of 47 clinically suspected anthrax cases were identified during the outbreak in five villages of Koraput district in Odisha. The epidemic curve indicated multiple point-source exposures starting from 13th April 2023. About 10 cases were identified by RT-PCR testing as confirmed cases of anthrax. No death was recorded in this outbreak investigation.

CONCLUSIONS

Based on a thorough examination of epidemiological survey results and laboratory findings, we conclude that the outbreak was of human cutaneous and GI anthrax. Exposures from handling dead animals were associated with cutaneous anthrax, whereas eating uncooked meat of dead sheep was associated with gastrointestinal anthrax.

Incidence and Spatial distribution of Human and Livestock Anthrax in Cao Bang Province, Vietnam (2004-2020)

Specific knowledge on the distribution of anthrax, a zoonosis caused by Bacillus anthracis, in Southeast Asia, including Vietnam, remains limited. In this study, we describe disease incidence and spatial distribution of human and livestock anthrax using spatially smoothed cumulative incidence from 2004 to 2020 in Cao Bang province, Vietnam. We employed the zonal statistics routine a geographic information system (GIS) using QGIS, and spatial rate smoothing using spatial Bayes smoothing in GeoDa. Results showed higher incidence of livestock anthrax compared with human anthrax. We also identified co-occurrence of anthrax in humans and livestock in northwestern districts and the province center. Livestock anthrax vaccine coverage was <6% and not equally distributed among the districts of Cao Bang province. We provide implications for future studies and recommend improving disease surveillance and response through data sharing between human and animal health sectors.

Building National Health Security Through a Rapid Self-Assessment and Annual Operational Plan in Uganda, May to September 2021

Uganda established a National Action Plan for Health Security in 2019, following a Joint External Evaluation (JEE) of International Health Regulations (2005) capacities in 2017. The action plan enhanced national health security awareness, but implementation efforts were affected by limited funding, excess of activities, and challenges related to monitoring and evaluation. To improve implementation, Uganda conducted a multisectoral health security self-assessment in 2021 using the second edition of the JEE tool and developed a 1-year operational plan. From 2017 to 2021, Uganda's composite ReadyScore improved by 20%, with improvement in 13 of the 19 technical areas. Indicator scores showing limited capacity declined from 30% to 20%, and indicators with no capacity declined from 10% to 2%. More indicators had developed (47% vs 40%), demonstrated (29% vs 20%), and sustained (2% vs 0%) capacities in 2021 compared with 2017. Using the self-assessment JEE scores, 72 specific activities from the International Health Regulations (2005) benchmarks tool were selected for inclusion in a 1-year operational plan (2021-2022). In contrast to the 264 broad activities in the 5-year national action plan, the operational plan prioritized a small number of activities to enable sectors to focus limited resources on implementation. While certain capacities improved before and during implementation of the action plan, countries may benefit from using short-term operational planning to develop realistic and actionable health security plans to improve health security capacities.

Improving the effectiveness of Field Epidemiology Training Programs: characteristics that facilitated effective response to the COVID-19 pandemic in Uganda

BACKGROUND

The global need for well-trained field epidemiologists has been underscored in the last decade in multiple pandemics, the most recent being COVID-19. Field Epidemiology Training Programs (FETPs) are in-service training programs that improve country capacities to respond to public health emergencies across different levels of the health system. Best practices for FETP implementation have been described previously. The Uganda Public Health Fellowship Program (PHFP), or Advanced-FETP in Uganda, is a two-year fellowship in field epidemiology funded by the U.S. Centers for Disease Control and situated in the Uganda National Institute of Public Health (UNIPH). We describe how specific attributes of the Uganda PHFP that are aligned with best practices enabled substantial contributions to the COVID-19 response in Uganda.

METHODS

We describe the PHFP in Uganda and review examples of how specific program characteristics facilitate integration with Ministry of Health needs and foster a strong response, using COVID-19 pandemic response activities as examples. We describe PHFP activities and outputs before and during the COVID-19 response and offer expert opinions about the impact of the program set-up on these outputs.

RESULTS

Unlike nearly all other Advanced FETPs in Africa, PHFP is delinked from an academic degree-granting program and enrolls only post-Master's-degree fellows. This enables full-time, uninterrupted commitment of academically-trained fellows to public health response. Uganda's PHFP has strong partner support in country, sufficient technical support from program staff, Ministry of Health (MoH), CDC, and partners, and full-time dedicated directorship from a well-respected MoH staff member. The PHFP is physically co-located inside the UNIPH with the emergency operations center (EOC), which provides a direct path for health alerts to be investigated by fellows. It has recognized value within the MoH, which integrates graduates into key MoH and partner positions. During February 2020-September 2021, PHFP fellows and graduates completed 67 major COVID-related projects. PHFP activities during the COVID-19 response were specifically requested by the MoH or by partners, or generated de novo by the program, and were supervised by all partners.

CONCLUSION

Specific attributes of the PHFP enable effective service to the Ministry of Health in Uganda. Among the most important is the enrollment of post-graduate fellows, which leads to a high level of utilization of the program fellows by the Ministry of Health to fulfill real-time needs. Strong leadership and sufficient technical support permitted meaningful program outputs during COVID-19 pandemic response. Ensuring the inclusion of similar characteristics when implementing FETPs elsewhere may allow them to achieve a high level of impact.

Anthrax outbreak amidst the COVID-19 pandemic in Africa: Challenges and possible solutions

Anthrax and coronavirus disease 2019 (COVID-19) are both notable zoonoses that have high morbidity and mortality, not to mention adverse socio-economic and health consequences on the communities they ravage. Anthrax wreaks disease amongst mammalian species worldwide and has an endemic distribution in Africa and Asia. Kenya, for example, records an average of 10 outbreaks annually. In 2014 and 2017, it held anthrax attack rates of 15% and 29%, respectively, and case fatality rates of 1–5%. As with COVID-19, effective surveillance, containment, and vaccination programs are crucial in the fight against anthrax. While there is no evidence of direct, human-to-human transmission of anthrax currently, Bacillus anthracis remains a disease of public health concern that serves to fuel the devastating effects of SARS-CoV-2 in African communities. In this commentary, we examine anthrax spread in Africa amidst COVID-19, the challenges faced by these simultaneous zoonoses, and the efforts put to combat both equally.

Establishing a Public Health Emergency Operations Center in an Outbreak-Prone Country: Lessons Learned in Uganda, January 2014 to December 2021

Uganda is highly vulnerable to public health emergencies (PHEs) due to its geographic location next to the Congo Basin epidemic hot spot, placement within multiple epidemic belts, high population growth rates, and refugee influx. In view of this, Uganda's Ministry of Health established the Public Health Emergency Operations Center (PHEOC) in September 2013, as a central coordination unit for all PHEs in the country. Uganda followed the World Health Organization's framework to establish the PHEOC, including establishing a steering committee, acquiring legal authority, developing emergency response plans, and developing a concept of operations. The same framework governs the PHEOC's daily activities. Between January 2014 and December 2021, Uganda's PHEOC coordinated response to 271 PHEs, hosted 207 emergency coordination meetings, trained all core staff in public health emergency management principles, participated in 21 simulation exercises, coordinated Uganda's Global Health Security Agenda activities, established 6 subnational PHEOCs, and strengthened the capacity of 7 countries in public health emergency management. In this article, we discuss the following lessons learned: PHEOCs are key in PHE coordination and thus mitigate the associated adverse impacts; although the functions of a PHEOC may be legalized by the existence of a National Institute of Public Health, their establishment may precede formally securing the legal framework; staff may learn public health emergency management principles on the job; involvement of leaders and health partners is crucial to the success of a public health emergency management program; subnational PHEOCs are resourceful in mounting regional responses to PHEs; and service on the PHE Strategic Committee may be voluntary.

Outbreak of cutaneous anthrax associated with handling meat of dead cows in Southwestern Uganda, May 2018

Background

Anthrax is a zoonotic infection caused by the bacteria Bacillus anthracis. Humans acquire cutaneous infection through contact with infected animals or animal products. On May 6, 2018, three cows suddenly died on a farm in Kiruhura District. Shortly afterwards, a sub-county chief in Kiruhura District received reports of humans with suspected cutaneous anthrax in the same district. The patients had reportedly participated in the butchery and consumption of meat from the dead cows. We investigated to determine the magnitude of the outbreak, identify exposures associated with illness, and suggest evidence-based control measures.

Methods

We conducted a retrospective cohort study among persons whose households received any of the cow meat. We defined a suspected human cutaneous anthrax case as new skin lesions (e.g., papule, vesicle, or eschar) in a resident of Kiruhura District from 1 to 26 May 2018. A confirmed case was a suspected case with a lesion testing positive for B. anthracis by polymerase chain reaction (PCR). We identified cases through medical record review at Engari Health Centre and active case finding in the community.

Results

Of the 95 persons in the cohort, 22 were case-patients (2 confirmed and 20 suspected, 0 fatal cases) and 73 were non-case household members. The epidemic curve indicated multiple point-source exposures starting on May 6, when the dead cows were butchered. Among households receiving cow meat, participating in slaughtering (RR = 5.3, 95% CI 3.2–8.3), skinning (RR = 4.7, 95% CI = 3.1–7.0), cleaning waste (RR = 4.5, 95% CI = 3.1–6.6), and carrying meat (RR = 3.9, 95% CI = 2.2–7.1) increased the risk of infection.

Conclusions

This cutaneous anthrax outbreak was caused by handling infected animal carcasses. We suggested to the Ministry of Agriculture, Animal Industry and Fisheries to strengthen surveillance for possible veterinary anthrax and ensure that communities do not consume carcasses of livestock that died suddenly. We also suggested that the Ministry of Health equip health facilities with first-line antibiotics for community members during outbreaks.

Point of care diagnostics and non-invasive sampling strategy: a review on major advances in veterinary diagnostics

The use of point of care diagnostics (POCD) in animal diseases has steadily increased over the years since its introduction. Its potential application to diagnose infectious diseases in remote and resource limited settings have made it an ideal diagnostic in animal disease diagnosis and surveillance. The rapid increase in incidence of emerging infectious diseases requires urgent attention where POCD could be indispensable tools for immediate detection and early warning of a potential pathogen. The advantages of being rapid, easily affordable and the ability to diagnose an infectious disease on spot has driven an intense effort to refine and build on the existing technologies to generate advanced POCD with incremental improvements in analytical performance to diagnose a broad spectrum of animal diseases. The rural communities in developing countries are invariably affected by the burden of infectious animal diseases due to limited access to diagnostics and animal health personnel. Besides, the alarming trend of emerging and transboundary diseases with pathogen spill-overs at livestock-wildlife interfaces has been identified as a threat to the domestic population and wildlife conservation. Under such circumstances, POCD coupled with non-invasive sampling techniques could be successfully deployed at field level without the use of sophisticated laboratory infrastructures. This review illustrates the current and prospective POCD for existing and emerging animal diseases, the status of non-invasive sampling strategies for animal diseases, and the tremendous potential of POCD to uplift the status of global animal health care.

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.

Uganda Mountain Community Health System-Perspectives and Capacities towards Emerging Infectious Disease Surveillance

In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs' perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts.