Using a participatory qualitative risk assessment to estimate the risk of introduction and spread of transboundary animal diseases in scarce-data environments: A Spatial Qualitative Risk Analysis applied to foot-and-mouth disease in Tunisia 2014-2019

This article presents a participative and iterative qualitative risk assessment framework that can be used to evaluate the spatial variation of the risk of infectious animal disease introduction and spread on a national scale. The framework was developed through regional training action workshops and field activities. The active involvement of national animal health services enabled the identification, collection and hierarchization of risk factors. Quantitative data were collected in the field, and expert knowledge was integrated to adjust the available data at regional level. Experts categorized and combined the risk factors into ordinal levels of risk per epidemiological unit to ease implementation of risk-based surveillance in the field. The framework was used to perform a qualitative assessment of the risk of introduction and spread of foot-and-mouth disease (FMD) in Tunisia as part of a series of workshops held between 2015 and 2018. The experts in attendance combined risk factors such as epidemiological status, transboundary movements, proximity to the borders and accessibility to assess the risk of FMD outbreaks in Tunisia. Out of the 2,075 Tunisian imadas, 23 were at a very high risk of FMD introduction, mainly at the borders; and 59 were at a very high risk of FMD spread. To validate the model, the results were compared to the FMD outbreaks notified by Tunisia during the 2014 FMD epizootic. Using a spatial Poisson model, a significant alignment between the very high and high-risk categories of spread and the occurrence of FMD outbreaks was shown. The relative risk of FMD occurrence was thus 3.2 higher for imadas in the very high and high spread risk categories than for imadas in the low and negligible spread risk categories. Our results show that the qualitative risk assessment framework can be a useful decision support tool for risk-based disease surveillance and control, in particular in scarce-data environments.

Evolutionary history and dynamics of dog rabies virus in western and central Africa

The burden of rabies in Africa is estimated at 24,000 human deaths year(-1), almost all of which result from infection with dog rabies viruses (RABV). To investigate the evolutionary dynamics of RABV in western and central Africa, 92 isolates sampled from 27 African countries over 29 years were collected and sequenced. This revealed that RABV currently circulating in dogs in this region fell into a single lineage designated 'Africa 2'. A detailed analysis of the phylogeographical structure of this Africa 2 lineage revealed strong population subdivision at the country level, with only limited movement of virus among localities, including a possible east-to-west spread across Africa. In addition, Bayesian coalescent analysis suggested that the Africa 2 lineage was introduced into this region of Africa only recently (probably <200 years ago), in accordance with the timescale of expanding European colonial influence and urbanization, and then spread relatively slowly, perhaps occupying the entire region in a 100 year period.