Interventions to Reduce Risk for Pathogen Spillover and Early Disease Spread to Prevent Outbreaks, Epidemics, and Pandemics

Behavioral risk assessment of exposure to wild and domestic animals in response to a Marburg virus disease outbreak, Ghana 2022

In July 2022, Ghana reported its first outbreak of Marburg virus disease (MVD). The source of the outbreak was unknown. In August 2022 we conducted a behavioral risk assessment, surveying 715 participants in three rural communities associated with the presumptive index case: Site 1 in Ashanti Region and Sites 2 and 3 in the Western Region of Ghana. Our primary aim was to characterize exposure to wild and domestic animals, specifically Egyptian rousette bats (ERBs), the natural reservoir for Marburg virus. We focused on two primary routes of potential exposure to ERBs: 1) eating fruit bearing bite marks and 2) entering caves or mines where bats were present. Eating fruit bearing bite marks was common across all sites, but highest at Site 2 in the Western Region. Higher levels of education were negatively correlated with eating fruit bearing bite marks, while having fruit trees present on the participant's home compound increased the odds of this exposure. Residents in Site 3 were significantly more likely to be exposed to bats in caves and mines. Participants across all sites also reported high levels of exposure to bats inside buildings; while ERBs do not typically roost in buildings, this presents a potential risk of exposure to other bat-associated pathogens. One participant at Site 3 reported symptoms consistent with MVD in the previous four months, suggesting the possibility of unrecognized cases that may have been associated with the outbreak. This study identified behaviors within the outbreak regions that could increase the risk of exposure to Marburg virus and other bat-borne pathogens. Serological surveys in these communities would provide important information about the extent of the Marburg outbreak by identifying unreported cases, as well as exposure to other filoviruses.

Community Engagement Within the Evaluation of Public Policies for Zoonotic Spillover Prevention: A Secondary Matrix Analysis

Despite the overall health, economic, and social costs of zoonotic spillover, its impacts are not felt equally around the globe. Engaging local communities in primary spillover prevention may help to better ensure equity is considered in research and policy-making activities. Our study aimed to gain an understanding of how and at what level community engagement (CE) has been incorporated into the evaluation of public policies for zoonotic spillover prevention. We conducted a secondary analysis on an existing dataset from a systematic review, beginning with a structured deductive content analysis. A secondary matrix of analysis was engaged using an adapted CE tool for screening the included articles based on their level of CE. We then characterized relevant themes based on the CE elements within the included articles. Of the 95 articles included, 55 had no level of CE reported. Among the included articles that had some level of CE, elements included the platforming of community consultation, community training for involvement in spillover prevention research, cultural and language considerations being engaged, community protection and awareness programmes for public health and biosecurity, and community-centered data collection processes being engaged. Our findings highlight the persistent equity gaps in appropriately engaging affected communities within the evaluation of public policies for spillover prevention.

Emergency Department Utilization for Postpartum Behavioral Health Problems and Assault Injury During the COVID-19 Pandemic

Objective: Distinctive stressors facing pregnant and postpartum individuals during the COVID-19 pandemic may have affected their emergency department (ED) care-seeking for behavioral health concerns and violence victimization. We tested whether the incidence of postpartum behavioral health and assault injury ED visits differed for individuals according to their months of postpartum pandemic exposure. Methods: We used statewide, longitudinally linked hospital and ED administrative claims data from California to classify all individuals with hospital deliveries between January 1, 2016, and December 31, 2020, according to their months of postpartum pandemic exposure. Outcomes comprised 12-month incidence of any ED visit for a psychiatric disorder, drug use disorder/overdose, alcohol use disorder/intoxication, or assault injury, defined using International Classification of Diseases-Clinical Modification, version 10 codes. Risk ratios compared the incidence of each outcome among people with 1-12 months of postpartum pandemic exposure to those with 0 months of exposure. Results: Compared to people with 0 months of postpartum pandemic exposure (n = 1,163,215), delivering people with 1-12 month' exposure (range: n = 26,836 to n = 273,561) were approximately equally likely to have a postpartum ED visit for a psychiatric disorder, drug use disorder, or alcohol use disorder, after adjusting for demographic differences (most p > 0.10). The incidence of assault injury was significantly lower among delivering individuals with 11 or 12 months of pandemic exposure (RRadj = 0.70 and 0.91, respectively; both p < 0.01) compared to those with 0 months. Conclusions: Contrary to expectations, the pandemic did not appear to have affected ED utilization for most behavioral health conditions among postpartum individuals, but assault injury ED visits declined.

Novel Rodent Coronavirus-like Virus Detected Among Beef Cattle with Respiratory Disease in Mexico

In February 2024, while conducting surveillance for novel respiratory viruses, we studied four beef cattle farms near Monterrey, Mexico. Nasal swabs were collected from sick and healthy beef cattle along with 3 h aerosol samples. None of the samples had molecular evidence of influenza A viruses. Three (8%) of thirty-six nasal swabs collected from the four farms and four (33.3%) of the twelve bioaerosol specimens had molecular evidence of influenza D virus. Five sick cow nasal swabs and one bioaerosol sample on a single farm had molecular evidence of rodent coronavirus-like (RCoV), an alphacoronavirus. Three (60%) of the five RCoV-positive cattle nasal swabs also had molecular evidence of influenza D. Attempts to isolate the RCoV in Vero-E6, LLC-MK2, MDBK, and L-2 cells were unsuccessful. However, we were able to assemble ~60% of the RCoV genome using next-generation sequencing. The six RCoV-positive samples clustered with RCoV strains identified in China in 2021. During the last 12 months, we have studied an estimated 478 dairy and beef cattle nasal swabs on 11 farms in the US and Mexico, and these RCoV detections are the first we have encountered. While feed contamination cannot be ruled out, given the propensity of CoVs to jump species and that we detected RCoV only in the noses of sick cows on this one farm, we are concerned that these findings could represent an isolated RCoV spillover event. With this report, we are alerting veterinarians and cattle farm owners of our observations that RCoV may be a new cause of bovine respiratory disease.

Visualization of Critical Limits and Critical Values Facilitates Interpretation

Background/Objectives: This study aimed to analyze critical limit and critical value test lists from major US medical centers, identify changes in quantitative critical limit thresholds since 1990, document notification priorities for qualitative and new listings, and visualize information alongside clinical thresholds and pathophysiological trends. Methods: A systematic search was conducted, acquiring 50 lists of critical limits and critical values from university hospitals, Level 1 trauma centers, centers of excellence, and high-performing hospitals across the US. Lists were obtained through direct contact or web-accessible postings. Statistical analysis used the Kruskal-Wallis non-parametric test and Student's t-test to determine significant differences between 1990 and 2024 critical limits. Results: Statistically significant differences were identified in various clinical tests between 1990 and 2024, comprising glucose, calcium, magnesium, CO2 content, blood gas parameters, hematology, and coagulation tests. Ranges for critical limits narrowed for several tests, and new measurands were added. Cardiac biomarkers were infrequently listed. Point-of-care testing (POCT) listings were sparse and showed significant differences from main lab values in the high median critical limit for glucose Conclusions: Visualizing this information has potential benefits, including ease of interpretation, which can improve patient care, reduce inconsistencies, and enhance the efficiency and quality of healthcare delivery.

Cooling perspectives on the risk of pathogenic viruses from thawing permafrost

Climate change is inducing wide-scale permafrost thaw in the Arctic and subarctic, triggering concerns that long-dormant pathogens could reemerge from the thawing ground and initiate epidemics or pandemics. Viruses, as opposed to bacterial pathogens, garner particular interest because outbreaks cannot be controlled with antibiotics, though the effects can be mitigated by vaccines and newer antiviral drugs. To evaluate the potential hazards posed by viral pathogens emerging from thawing permafrost, we review information from a diverse range of disciplines. This includes efforts to recover infectious virus from human remains, studies on disease occurrence in polar animal populations, investigations into viral persistence and infectivity in permafrost, and assessments of human exposure to the enormous viral diversity present in the environment. Based on currently available knowledge, we conclude that the risk posed by viruses from thawing permafrost is no greater than viruses in other environments such as temperate soils and aquatic systems.

Influences of individual interaction validity on coupling propagation of information and disease in a two-layer higher-order network

All complex phenomena in complex systems arise from individual interactions, which include pairs and higher-order forms. Research indicates that various physical and mental factors can impact the validity of these interactions, potentially preventing diffusion phenomena. This paper explores the influences of the interaction validity on coupling propagation of information and disease in a two-layer higher-order network. Interaction validity is defined using a threshold function based on the individual activity level. The dynamic evolution equations of the nodes are derived by using the microscopic Markov chain approach, and the transmission threshold of the disease is determined. Extensive numerical simulations on both artificial and real-world networks reveal that higher-order interactions significantly enhance the diffusion of disease and related information. Reducing individual activity levels diminishes interaction validity, thereby restricting disease transmission. Moreover, optimizing disease control can be achieved by increasing public activity in virtual social networks while reducing it in physical contact networks. Strengthening interlayer coupling enhances self-protective measures, thus amplifying the suppression of disease by information.

Risk assessment of emerging infectious diseases in China under the One Health framework

Background

Emerging infectious diseases (EIDs) pose significant public health challenges due to increasing interactions between humans, animals, and the environment. The One Health framework, an interdisciplinary and collaborative approach, plays a critical role in the risk assessment of EIDs. The study aims to systematically review the risk assessment of EIDs in China under the One Health framework, covering policy support, monitoring and assessment systems, and implementation methods.

Methods

Relevant literature and official documents between 1997 and 2024 were retrieved from Web of Science, PubMed, Scopus, China National Knowledge Infrastructure, Wan Fang, China Science and Technology Journal Database, and government websites. Data were synthesized to analyze progress, challenges, and gaps.

Results

There were 43 academic studies and 31 official documents included in this review. The study found that risk assessment systems existed across human, animal, and environmental health sectors in China, and the government was advancing intelligent monitoring and fostering inter-departmental cooperation. However, several challenges remain in risk assessment of EIDs, including inadequate monitoring systems for unknown EIDs, limited capacity building for risk assessment in ecosystems and environmental systems, insufficiently detailed risk assessment guidance at the county level, and barriers to cross-sectoral information sharing at the international and county levels.

Conclusion

The findings highlighted the need to enhance risk assessment of EIDs at the local level, expand the scope of disease surveillance including aquatic and wild animals, and strengthen inter-departmental data sharing to improve early warning capabilities under the One Health framework.

Utilising a livestock model for wildlife health planning

Health planning provides a structure for the application of epidemiological data to managed populations with the intention of maximising health and identifying targets for intervention. Whilst this is established practice in livestock health, such schemes are rarely applied to free-living wild animal populations. The health of wildlife is important for a variety of reasons including conservation, human health, and ecosystem health, and so it is recommended that a formalised health planning approach be adopted for wildlife, based upon advantages of livestock health schemes identified here. Six key strengths of livestock herd health plans are identified in that these plans are: (1) Outcome driven, (2) Structured and repeatable, (3) They can incorporate both health and welfare considerations and in doing so, establish multidisciplinary management teams, (4) Evidence-based allowing for the prioritisation of key risk factors, (5) Encompassing of both population and individual metrics, and (6) Offer the opportunity for accreditation schemes. The benefits highlighted have implications for both wildlife management and research agendas where the structured format of the health plans will highlight knowledge gaps. Challenges are acknowledged, and it is recognised that livestock health planning cannot simply be copied across to a wildlife context. However, the strengths identified are great enough that it is recommended that wildlife population health planning is developed for active management of individual populations, learning lessons from existing plans.

Integrating animal welfare into the WHO pandemic treaty: a thematic analysis of civil society perspectives and comparison with treaty drafting

The COVID-19 pandemic has exposed critical weaknesses in the global health system, highlighting the urgent need for a coordinated international approach to pandemic prevention and management. As negotiations for a new WHO pandemic treaty progress, the effective integration of animal welfare is crucial. This paper aims to investigate the perspectives of key civil society organizations on the integration of animal welfare provisions into the pandemic treaty. Through a thematic analysis of documents prepared by FOUR PAWS, Wildlife Conservation Society, and Action for Animal Health between 2020-2023, five major themes are identified: prevention of zoonotic spillover, One Health approach, animal health systems and infrastructure, sustainable and ethical animal management practices, and policy coherence and governance. A comparative analysis of these themes against the April 2024 draft of the pandemic treaty reveals areas of alignment and divergence. Due to the ongoing controversies and the need for further improvements, the WHO's intergovernmental negotiating body was unable to finalize the treaty text for the 77th World Health Assembly in May 2024, leading to an extended mandate until 2025. Based on the findings, the paper proposes recommendations to strengthen the integration of animal welfare into the treaty, arguing that incorporating these recommendations is critical for developing a transformative, equitable, and effective treaty that addresses the systemic drivers of pandemic risk.

Anthrax in Humans, Animals, and the Environment and the One Health Strategies for Anthrax Control

Anthrax is a notorious disease of public health importance caused by Bacillus anthracis. The causative agent can also be used as a biological weapon. Spores of these bacteria can sustain extreme environmental conditions and remain viable in soil for decades. Domestic and wild ruminants are highly susceptible to this pathogen, which usually presents as a peracute to acute disease. In humans, cutaneous anthrax is frequent but pulmonary and enteric anthrax are more serious. Humans, animals, and the environment are all involved, making anthrax a perfect target for a One Health approach. The environment plays a key role in disease transmission. At a time when the One Health concept is not mere slogans, collaborative efforts of medical professionals, veterinarians, and environmental scientists will be valuable for the prevention and control of this disease. In this review, we discussed the transmission dynamics of anthrax in the environment, animals, and humans, as well as One Health strategies to control and prevent anthrax.

Evaluating climate-dependent distribution of orthohantaviruses with monitoring wild rodents: One Health Perspective†

Orthohantaviruses, cause hemorrhagic fever with renal syndrome, nephropathia epidemica, and hantavirus pulmonary syndrome, are major public health problems all over the world. Wild rodent surveillance for orthohantaviruses is of great importance for the preparedness against these human infections and the prediction of possible outbreak regions. Thus, we aimed to screen orthohantaviruses in wild rodents in Southern Anatolia, where the area has some of the glacial period refugia in the Mediterranean Basin, and interpret their current epidemiology with climatic biovariables in comparison with previously positive regions.We trapped muroid rodents between 2015 and 2017, and screened for orthohantaviruses. Then, we evaluated the relationship between orthohantavirus infections and bioclimatic variables. In spite of the long-term and seasonal sampling, we found no evidence for Orthohantavirus infections. The probable absence of orthohantaviruses in the sampling area was further evaluated from the climatic perspective, and results led us suggest that Orthohantavirus epidemiology might be relatively dependent on precipitation levels in driest and warmest quarters, and temperature fluctuations.These initial data might provide necessary perspective on wild rodent surveillance for orthohantaviruses in other regions, and help to collect lacking data for a such habitat suitability study in a bigger scale in the future.

One Health Ethics and the Ethics of Zoonoses: A Silent Call for Global Action

This paper presents a critical review of key issues related to the emergence of new networks for the spread of zoonotic diseases amid the mass extinction of species. Zoonotic and infectious diseases account for approximately 70% of new and existing diseases affecting humans and animals. The initial section argues that the term "zoonoses" should not be confined to single-cause events within veterinary medicine. Instead, zoonoses should be viewed as complex, systemic phenomena shaped by interrelated factors, including environmental, sociocultural, and economic elements, influenced by anthropogenic climate change. The second section presents bioethical principles and potential strategies for those engaged in zoonotic disease prevention. The third section uses the slaughter of animals in disaster settings as a case study to illustrate the need for further clarification of normative and interspecies justice conflicts in One Health ethics. This section concludes with an outlook on "zoonoethics". Section four develops the analysis of the interlinked elements that trigger zoonoses and examines antimicrobial resistance (AMR) from an ethical and political standpoint, concluding with policy recommendations for addressing AMR. Section five offers a critical reflection, integrating contributions from zoonoethics, human ecology, and the ecotheological turn. Finally, section six concludes with a call to action and policy recommendations for an inclusive, intercultural, and gender-sensitive One Health approach.

Mapping Bovine Tuberculosis in Colombia, 2001-2019

INTRODUCTION

Bovine tuberculosis is a zoonotic disease of significant impact, particularly in countries where a pastoral economy is predominant. Despite its importance, few studies have analysed the disease's behaviour in Colombia, and none have developed maps using geographic information systems (GIS) to characterise it; as such, we developed this study to describe the temporal-spatial distribution of bovine tuberculosis in Colombia over a period of 19 years.

METHODS

A retrospective cross-sectional descriptive study, based on reports by the Colombian Agricultural Institute (ICA), surveillance of tuberculosis on cattle farms in Colombia from 2001 to 2019 was carried out. The data were converted into databases using Microsoft Access 365®, and multiple epidemiological maps were generated with the QGIS® version 3.36 software coupled to shape files of all the country's departments.

RESULTS

During the study period, 5273 bovine tuberculosis cases were identified in multiple different departments of Colombia (with a mean of 278 cases/year). Regarding its temporal distribution, the number of cases varied from a maximum of 903 cases (17.12% of the total) in 2015 to a minimum of 0 between 2001 and 2004 and between 2017 and 2019 (between 2005 and 2016, the minimum was 46 cases, 0.87%).

CONCLUSIONS

GIS are essential for understanding the temporospatial behaviour of zoonotic diseases in Colombia, as is the case for bovine tuberculosis, with its potential implications for the Human and One Health approaches.

A review of emerging health threats from zoonotic New World mammarenaviruses

Despite repeated spillover transmission and their potential to cause significant morbidity and mortality in human hosts, the New World mammarenaviruses remain largely understudied. These viruses are endemic to South America, with animal reservoir hosts covering large geographic areas and whose transmission ecology and spillover potential are driven in part by land use change and agriculture that put humans in regular contact with zoonotic hosts.We compiled published studies about Guanarito virus, Junin virus, Machupo virus, Chapare virus, Sabia virus, and Lymphocytic Choriomeningitis virus to review the state of knowledge about the viral hemorrhagic fevers caused by New World mammarenaviruses. We summarize what is known about rodent reservoirs, the conditions of spillover transmission for each of these pathogens, and the characteristics of human populations at greatest risk for hemorrhagic fever diseases. We also review the implications of repeated outbreaks and biosecurity concerns where these diseases are endemic, and steps that countries can take to strengthen surveillance and increase capacity of local healthcare systems. While there are unique risks posed by each of these six viruses, their ecological and epidemiological similarities suggest common steps to mitigate spillover transmission and better contain future outbreaks.

Co-Circulating Monkeypox and Swinepox Viruses, Democratic Republic of the Congo, 2022

In September 2022, deaths of pigs manifesting pox-like lesions caused by swinepox virus were reported in Tshuapa Province, Democratic Republic of the Congo. Two human mpox cases were found concurrently in the surrounding community. Specific diagnostics and robust sequencing are needed to characterize multiple poxviruses and prevent potential poxvirus transmission.

Infectious Diseases Training in the 21st Century: A Glass Half Full or Half Empty?

The percentage of infectious diseases (ID) fellowship positions filled has declined in the last years despite a relatively stable number of applicants. The data are concerning since this could impact an already strained workforce. A recent survey of ID fellowship program directors provides insight into the perceptions of program directors about factors that might have affected the match rate in 2023 and could also be applicable to the recent 2024 match. Here, we discuss the results of this survey and discuss the complex factors that might influence the choice of ID as an specialty. Although concerning, recent fellowship match results provide new opportunities to reassess current models of ID training and design innovative strategies for ID fellowship and education.

Emerging and re-emerging pediatric viral diseases: a continuing global challenge

The twenty-first century has been marked by a surge in viral epidemics and pandemics, highlighting the global health challenge posed by emerging and re-emerging pediatric viral diseases. This review article explores the complex dynamics contributing to this challenge, including climate change, globalization, socio-economic interconnectedness, geopolitical tensions, vaccine hesitancy, misinformation, and disparities in access to healthcare resources. Understanding the interactions between the environment, socioeconomics, and health is crucial for effectively addressing current and future outbreaks. This scoping review focuses on emerging and re-emerging viral infectious diseases, with an emphasis on pediatric vulnerability. It highlights the urgent need for prevention, preparedness, and response efforts, particularly in resource-limited communities disproportionately affected by climate change and spillover events. Adopting a One Health/Planetary Health approach, which integrates human, animal, and ecosystem health, can enhance equity and resilience in global communities. IMPACT: We provide a scoping review of emerging and re-emerging viral threats to global pediatric populations This review provides an update on current pediatric viral threats in the context of the COVID-19 pandemic This review aims to sensitize clinicians, epidemiologists, public health practitioners, and policy stakeholders/decision-makers to the role these viral diseases have in persistent pediatric morbidity and mortality.

Financial influence on global risks of zoonotic emerging and re-emerging diseases: an integrative analysis

BACKGROUND

Emerging and re-emerging infectious diseases (EIDs), such as Ebola virus disease and highly pathogenic influenza, are serious threats to human health and wellbeing worldwide. The financial sector has an important, yet often ignored, influence as owners and investors in industries that are associated with anthropogenic land-use changes in ecosystems linked to increased EIDs risks. We aimed to analyse financial influence associated with EIDs risks that are affected by anthropogenic land-use changes. We also aimed to provide empirical assessments of such influence to help guide engagements by governments, private organisations, and non-governmental organisations with the financial sector to advance a planetary health agenda.

METHODS

For this integrative analysis, we identified regions in the world where there was evidence of a connection between EIDs and anthropogenic land-use changes between Nov 9, 1999, and Oct 25, 2021, through a targeted literature review of academic literature and grey literature to identify evidence of drivers of anthropogenic land-use change and their association with commodity production in these regions. We only included publications in English that showed a connection between deforestation and the production of one or more commodities. Publications merely describing spatial or temporal land-use change dynamics (eg, a reduction of forest or an increase of palm-oil plantations) were excluded. As we were assessing financial influence on corporate activities through ownership specifically, we focused our analysis on publicly listed companies. Equity data and data about ownership structure were extracted from Orbis, a company information database. We assessed financial influence by identifying financial entities with the largest equity ownership, descriptively mapping transboundary connections between investors and publicly listed companies.

FINDINGS

227 public and private companies operating in five economic sectors (ie, production of palm oil, pulp and wood products, cocoa, soybeans, and beef) between Dec 15, 2020, and March 8, 2021, were identified. Of these 227, 99 (44%) were publicly listed companies, with 2310 unique shareholders. These publicly listed companies operated in six geographical regions, resulting in nine case-study regions. 54 (55%) companies with complete geographical information were included in the countries network. Four financial entities (ie, Dimensional, Vanguard, BlackRock, and Norway's sovereign wealth fund) each had ownership in 39 companies or more in three of the case-study regions (ie, north America, east Asia, and Europe). Four large US-based asset managers (ie, Vanguard, BlackRock, T Rowe Price, and State Street) were the largest owners of publicly listed companies in terms of total equity size, with ownership amounts for these four entities ranging from US$8 billion to $21 billion. The specific patterns of cross-national ownership depended on the region of interest; for example, financial influence on EIDs risks that was associated with commodity production in southeast and east Asia came from not only global asset managers but also Malaysian, Chinese, Japanese, and Korean financial entities. India, Brazil, the USA, Mexico, and Argentina were the countries towards which investments were most directed.

INTERPRETATION

Although commodity supply chains and financial markets are highly globalised, a small number of investors and countries could be viewed as disproportionally influential in sectors that increase EIDs risks. Such financial influence could be used to develop and implement effective policies to reduce ecological degradation and mitigate EIDs risks and their effects on population health.

FUNDING

Formas and Networks of Financial Rupture-how cascading changes in the climate and ecosystems could impact on the financial sector.

Evaluating event-based surveillance capacity in Africa: Use of the Africa CDC scorecard, 2022-2023

Introduction

Event-based surveillance (EBS) is a critical component of Early Warning, Alert and Response (EWAR) capacity needed for outbreak prevention and control. To better understand existing EBS and monitor the progress of capacity-building efforts over time, Africa CDC developed an EBS scorecard as part of a revision to the EBS Framework.

Methods

We distributed the scorecard to African Union (AU) Member States (MSs). Survey responses from the MSs' human health sector were aggregated, cleaned, and analysed. MS, regional, and continental EBS capacity was assessed.

Results

Between 21 July 2022 and 4 April 2023, a total of 63 respondents representing 49 (89%) of 55 MSs completed the survey. Given Africa CDC's public health mandate, we acknowledged the importance of One Health collaboration in MSs but focused on and analysed only the human health sector responses. Thirty-four (71%) MSs stated having EBS in place; hotline was the most common type of EBS implemented (76%). Seventeen (50%) MSs reported multisectoral, One Health collaboration as part of EBS implementation. Scorecard outcomes showed a minimal (score of <60%) to average (score between 60-80%) level of EBS capacity in 29 and five (5) MSs respectively.

Discussion

Current EBS capacity levels need to be strengthened in Africa to ensure the continent remains prepared for future public health threats. The Africa CDC EBS scorecard provides a useful way to measure and track this capacity over time. Results can be used to advocate for and target resources for capacity building to foster public health emergency preparedness efforts.

Pandemic Preparedness and Response: Lessons From COVID-19

The global experience with COVID-19 holds important lessons for preparing for, and responding to, future emergences of pathogens with pandemic potential.

Unbiased Virus Detection in a Danish Zoo Using a Portable Metagenomic Sequencing System

Metagenomic next-generation sequencing (mNGS) is receiving increased attention for the detection of new viruses and infections occurring at the human-animal interface. The ability to actively transport and relocate this technology enables in situ virus identification, which could reduce response time and enhance disease management. In a previous study, we developed a straightforward mNGS procedure that greatly enhances the detection of RNA and DNA viruses in human clinical samples. In this study, we improved the mNGS protocol with transportable battery-driven equipment for the portable, non-targeted detection of RNA and DNA viruses in animals from a large zoological facility, to simulate a field setting for point-of-incidence virus detection. From the resulting metagenomic data, we detected 13 vertebrate viruses from four major virus groups: (+)ssRNA, (+)ssRNA-RT, dsDNA and (+)ssDNA, including avian leukosis virus in domestic chickens (Gallus gallus), enzootic nasal tumour virus in goats (Capra hircus) and several small, circular, Rep-encoding, ssDNA (CRESS DNA) viruses in several mammal species. More significantly, we demonstrate that the mNGS method is able to detect potentially lethal animal viruses, such as elephant endotheliotropic herpesvirus in Asian elephants (Elephas maximus) and the newly described human-associated gemykibivirus 2, a human-to-animal cross-species virus, in a Linnaeus two-toed sloth (Choloepus didactylus) and its enclosure, for the first time.