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Kimani T, Kiambi S, Eckford S, Njuguna J, Makonnen Y, Rugalema G, Morzaria SP, Lubroth J, Fasina FO. Expanding beyond zoonoses: the benefits of a national One Health coordination mechanism to address antimicrobial resistance and other shared health threats at the human-animal-environment interface in Kenya. REV SCI TECH OIE 2019; 38:155-171. [PMID: 31564733 DOI: 10.20506/rst.38.1.2950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In order to manage global and transnational health threats at the human- animal-environment interface, a multisectoral One Health approach is required. Threats of this nature that require a One Health approach include, but are not limited to, emerging, endemic and re-emerging zoonotic diseases, food safety, antimicrobial resistance (AMR), vector-borne and neglected infectious diseases, toxicosis and pesticides. Relevant Kenyan authorities formally institutionalised One Health in 2011 through the establishment of the Zoonotic Disease Unit (ZDU) and its advisory group, the Zoonoses Technical Group. At that time, the One Health agenda focused on zoonotic diseases. As the issue of AMR began to gain traction globally, a One Health approach to its management was advocated in Kenya in 2015. This paper summarises a series of interviews (with respondents and key informants) that describe how AMR institutionalisation evolved in Kenya. It also examines how responses to other health threats at the human-animal- environment interface were coordinated and used to identify gaps and make recommendations to improve One Health coordination at the national level in Kenya. Results showed that the road to the institutionalisation of AMR through the National Action Plan on Prevention and Containment of Antimicrobial Resistance, 2017-2022 and a formally launched One Health coordination mechanism, the National Antimicrobial Stewardship Interagency Committee (NASIC), took ten years. Moreover, supplementary actions are still needed to further strengthen AMR coordination. In addition to the ZDU and NASIC, Kenya has established two other formal multisectoral and multidisciplinary coordination structures, one for aflatoxicosis and the other for health threats associated with pesticide use. The country has four distinct and separate One Health coordination mechanisms: for zoonoses, for AMR, for aflatoxicosis and for the health threats associated with pesticide use. The main gap lies in the lack of overall coordination between these topic-specific structures. An overall coordination mechanism for all One Health issues is therefore needed to improve synergy and complementarity. None of the topic-specific mechanisms plays a critical role in the policy development process, institutionalisation or implementation of activities related to the other topic areas. The authors recommend renaming the ZDU as the One Health Office, and expanding it to include AMR and food safety teams, and their associated technical working groups. Through this restructuring, the One Health Office would become an umbrella organisation dealing with all four issues mentioned above. Based on Kenya's experience, the authors recommend that other countries also consider expanding the scope of multisectoral One Health coordination mechanisms to include other shared health threats.
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Kiambi S, Corman VM, Sitawa R, Githinji J, Ngoci J, Ozomata AS, Gardner E, von Dobschuetz S, Morzaria S, Kimutai J, Schroeder S, Njagi O, Simpkin P, Rugalema G, Tadesse Z, Lubroth J, Makonnen Y, Drosten C, Müller MA, Fasina FO. Detection of distinct MERS-Coronavirus strains in dromedary camels from Kenya, 2017. Emerg Microbes Infect 2018; 7:195. [PMID: 30482895 PMCID: PMC6258726 DOI: 10.1038/s41426-018-0193-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/28/2018] [Accepted: 10/21/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Stella Kiambi
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Victor M Corman
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany
- German Centre for Infection Research, associated partner Charité, Berlin, Germany
| | - Rina Sitawa
- Directorate of Veterinary Services, Nairobi, Kenya
| | | | - James Ngoci
- Directorate of Veterinary Services, Nairobi, Kenya
| | | | - Emma Gardner
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | | | - Subhash Morzaria
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Joshua Kimutai
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Simon Schroeder
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany
| | | | - Piers Simpkin
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Gabriel Rugalema
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Zelalem Tadesse
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Juan Lubroth
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Yilma Makonnen
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Christian Drosten
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany
- German Centre for Infection Research, associated partner Charité, Berlin, Germany
| | - Marcel A Müller
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany.
- German Centre for Infection Research, associated partner Charité, Berlin, Germany.
| | - Folorunso O Fasina
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
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Gikonyo S, Kimani T, Matere J, Kimutai J, Kiambi SG, Bitek AO, Juma Ngeiywa KJZ, Makonnen YJ, Tripodi A, Morzaria S, Lubroth J, Rugalema G, Fasina FO. Mapping Potential Amplification and Transmission Hotspots for MERS-CoV, Kenya. Ecohealth 2018; 15:372-387. [PMID: 29549589 PMCID: PMC7088189 DOI: 10.1007/s10393-018-1317-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 10/21/2017] [Accepted: 01/24/2018] [Indexed: 02/05/2023]
Abstract
Dromedary camels have been implicated consistently as the source of Middle East respiratory syndrome coronavirus (MERS-CoV) human infections and attention to prevent and control it has focused on camels. To understanding the epidemiological role of camels in the transmission of MERS-CoV, we utilized an iterative empirical process in Geographic Information System (GIS) to identify and qualify potential hotspots for maintenance and circulation of MERS-CoV, and produced risk-based surveillance sites in Kenya. Data on camel population and distribution were used to develop camel density map, while camel farming system was defined using multi-factorial criteria including the agro-ecological zones (AEZs), production and marketing practices. Primary and secondary MERS-CoV seroprevalence data from specific sites were analyzed, and location-based prevalence matching with camel densities was conducted. High-risk convergence points (migration zones, trade routes, camel markets, slaughter slabs) were profiled and frequent cross-border camel movement mapped. Results showed that high camel-dense areas and interaction (markets and migration zones) were potential hotspot for transmission and spread. Cross-border contacts occurred with in-migrated herds at hotspot locations. AEZ differential did not influence risk distribution and plausible risk factors for spatial MERS-CoV hotspots were camel densities, previous cases of MERS-CoV, high seroprevalence and points of camel convergences. Although Kenyan camels are predisposed to MERS-CoV, no shedding is documented to date. These potential hotspots, determined using anthropogenic, system and trade characterizations should guide selection of sampling/surveillance sites, high-risk locations, critical areas for interventions and policy development in Kenya, as well as instigate further virological examination of camels.
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Affiliation(s)
- Stephen Gikonyo
- Emergency Centre for Transboundary Animal Diseases - (ECTAD) Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya
| | - Tabitha Kimani
- Emergency Centre for Transboundary Animal Diseases - (ECTAD), Regional Office for East Africa Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya
| | - Joseph Matere
- Emergency Centre for Transboundary Animal Diseases - (ECTAD) Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya
| | - Joshua Kimutai
- Emergency Centre for Transboundary Animal Diseases - (ECTAD) Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya
| | - Stella G Kiambi
- Emergency Centre for Transboundary Animal Diseases - (ECTAD) Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya
| | - Austine O Bitek
- Emergency Centre for Transboundary Animal Diseases - (ECTAD) Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya
| | - K J Z Juma Ngeiywa
- Directorate of Veterinary Services, State Department of Livestock, Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Yilma J Makonnen
- Emergency Centre for Transboundary Animal Diseases - (ECTAD), Regional Office for East Africa Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya
| | - Astrid Tripodi
- Animal Health Service, Animal Production and Health Division, Food and Agriculture Organization of the UN (FAO), Rome, Italy
| | - Subhash Morzaria
- Animal Health Service, Animal Production and Health Division, Food and Agriculture Organization of the UN (FAO), Rome, Italy
| | - Juan Lubroth
- Animal Health Service, Animal Production and Health Division, Food and Agriculture Organization of the UN (FAO), Rome, Italy
| | - Gabriel Rugalema
- Emergency Centre for Transboundary Animal Diseases - (ECTAD) Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya
| | - Folorunso Oludayo Fasina
- Emergency Centre for Transboundary Animal Diseases - (ECTAD) Kenya, Food and Agriculture Organization of the United Nations (FAO), UN Office in Nairobi, Gigiri, Kenya.
- Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa.
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