One World-One Health at the RSTMH Biennial Meeting, autumn 2016

There are fears that Africa’s next major modern disease crisis will emerge from its cities. Like Ebola, it may well originate from animals”. So writes Eric Fèvre from Nairobi in his conversation “Urban Zoo”

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This intimate association between human and animal health underpins what is known as the One Health agenda, recognised by both the WHO (World Health Organisation) and the OIE (World Animal Health Organisation). And it’s not only in Africa that urgency applies but throughout the world, particularly in developing regions where surveillance systems are at their weakest and pandemic spread is highly likely.

Against this backdrop, the RSTMH is showing great insight in focussing attention on the need to bring together medical and veterinary health delivery systems and expertise under the headline of “One World-One Health” (OW-OH). Lord Soulsby, the veterinary parasitologist and long-time proponent of OW-OH, celebrated his 90th birthday last year. Hence it was entirely fitting for the RSTMH, as part of its Biennial Meeting in autumn last year, to kick off an afternoon programme dedicated to OW-OH by hosting the inaugural Soulsby Lecture followed by a series of presentations by world authorities in their field.

Of great importance was the decision to focus the programme on the challenges and opportunities for human and animal health delivery systems to collaborate and take a more holistic systems-based approach. The message that “the collaborative whole is greater than the sum of the parts” was obvious throughout, from David Heymann’s opening message early in the conference (new challenges in the ‘last mile’ of disease elimination caused by animal reservoirs) to Sandy Trees’ illumination of how veterinary research into onchocerciasis in cattle has given new insight into river blindness in humans; from Sarah Cleaveland’s demonstration of how mass rabies vaccination of dogs is both feasible and cost-effective in eliminating the disease in people, to Eric Fèvre’s plea for disease surveillance systems to consider the human-animal interface in relation to the “Urban Zoo”.

I was particularly drawn to the case made by Bernadette Abela-Ridder that many rural communities in the least developed countries live in close proximity to their animals. This means that eliminating zoonotic diseases is critically important to their own health as well as the health of their animals. Furthermore the financial well-being of these communities is also dependent on the health and well-being of their animals. And Esther Schelling illustrated the importance of generating community engagement and trust to deliver such integrated programmes.

Many health delivery programmes reside in silos directed only towards human populations – either intentionally (“this funding is only for human health benefit”) or through lack of information (“we didn’t realise the relationship with animal health”). By pooling resources, significant cost savings can be made. And the benefits to each sector will be clearly demonstrable by attributing costs carefully.

So for me, there are two massively important take-home messages to be drawn from all this wisdom.

Firstly that eradication of human disease will often be frustrated by failing to appreciate the parallel situation in animal health.  This may be due to lack of awareness of animal reservoirs of infection or to failure to incorporate essential veterinary experience and resources. The  sooner veterinary and medical scientists and practitioners work more effectively together to  contribute to the challenges they all face, the better the world will be.

And secondly, and equally importantly, resources available to achieve disease elimination are necessarily limited and, to be effective, require local involvement. The sustainability of such local involvement may weaken just at the time when it is most needed – the ‘last mile’ when the big gains have already been achieved and the final small but essential gains require relentless and absolute commitment. At such a time, that same local involvement could be sustained by broadening their remit to include animal health matters; same skills – different patient. However the silos of project funding seem often to not support this happening.

By acting on these take-home messages, both human and animal welfare will benefit and opportunities for disease elimination in both populations will become more realistic.

This article originally appeared on the Royal Society of Tropical Medicine and Hygiene website available at (here). Authored by Judy MacArthur Clark

Rapid tool for the surveillance of cysticercosis

Rapid tool for the surveillance of cysticercosis

A blog entry by Kimetrica discusses promising progress in the development of a rapid tool for the surveillance of cysticercosis which will contribute to the global efforts by the World Health Organization in controlling cysticercosis by 2020. The proposed control method is rapid, cheap and requires little resources but which could yield important epidemiological information on community risk.
Read more about these developments on the Kimetrica blog by clicking here.

Dengue and Chikungunya infections among febrile children in Busia County Referral Hospital

Dengue and Chikungunya infections among febrile children in Busia County Referral Hospital

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Recruitment and venous blood sampling of children in the study

Infections leading to fever are the largest causes of child morbidity and mortality in Africa. Dengue and Chikungunya infections are among viral diseases that cause fever even in traditionally malaria endemic areas. We set out to determine the prevalence and risk factors of Dengue and Chikungunya infections and estimate coinfection with malaria among children aged between 1 and 12 years presenting with fever at Busia County Referral Hospital in Western Kenya.

We sampled a cross section of children presenting with fever. We interviewed the parents/guardians of these children and collected blood samples and tested by microscopy for malaria and by conventional PCR for dengue and chikungunya. We found that chikungunya was prevalent among febrile children and infection was more likely among children presenting with vomiting and children with positive blood slide for malaria. None of the children screened was found to have dengue.

Our results suggest that mainly chikungunya virus appears to be actively circulating in western Kenya even in the absence of a declared outbreak. We recommend the establishment of prevention measures and routine laboratory testing of febrile cases for chikungunya in western Kenya.

Article by Isaac Ngere– Resident, Kenya FELTP

Tracking the movements of people and their livestock

Tracking the movements of people and their livestock

cattle-with-trackersAs zoonotic diseases can be transported across landscapes by hosts, understanding the complexities of host-mediated pathogen movement is a priority for zoonotic disease research.  For my research, I   have been using surveys and GPS trackers to gather data on the movement patterns of people and their livestock. We will be looking at the differences in movement patterns between the wet and dry seasons: the first part of the study took place in July and we anticipate completion in November 2016.

At each selected household, we interview the adults present and ask them questions about places they regularly go to, how they get there and how long they stay. We also ask questions about places they go to less regularly and their activities involving livestock kept by the household. At the end of the interview, we ask the adult who spends the most time looking after the livestock (if they have any) to wear a GPS tracker on a lanyard around their neck for one week which stores their location once a minute. At the same time, if they keep cattle, goats or sheep then one of these animals (usually a cow) is fitted with an identical device attached to a collar. If the household does not keep any livestock, one person is still asked to wear a tracker, so that we can detect differences in movement patterns between people who do keep livestock and those who don’t. Once the week is up, we return to the household to collect the devices and download the data. The devices are set to record their location once a minute, and the batteries can last up to 10 days.

Nearly all of the people we interviewed have been willing to wear a tracker and all of the trackers given out have been returned without problems. We look forward to sharing some results from this study in the next newsletter!

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Article authored by Jessica Floyd, PhD student, University of Southampton, UK.

Freshwater Vector Snails and their Infection with Trematode cercariae in Busia County

Freshwater Vector Snails and their Infection with Trematode cercariae in Busia County

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Capturing snails

In this study, we  sought to identify snail species infected with Trematode cercariae and environmental factors that correlate with their presence.  This was undertaken to better understand the underlying biology of these species to better understand the risk of transmission of livestock- and human-infectious trematodes.

We found that lymnaeid snails were widely distributed in all the agro-ecological zones (AEZs) we studied, and were the majority snail

at low altitudes. Biomphalariae, Bulinus, Oncomelaniae and Melanoides were present in some but not all of the zones. The study found that snails were more abundant in streams originating from springs and swamps near the shores of Lake Victoria. Biomphalariae and Lymnaeid species were found to be infected with trematode cercariae. The B. sudanica species found in the swamps near the lakeshore were infected with both Fasciola gigantica and Schistosoma mansoni pointing to a co-existence of Schistosoma and Fasciola infection at the site. The relative abundance of vector snails was found to be influenced by water pH, water temperature, ambient temperature and vegetation cover.

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Identification/Isolation of cercariae

The presence of vector snails and cercariae in all of the zones points to the presence of possible transmission foci for Schistosomiasis, Fascioliasis and other foodborne trematodiases. People and animals using water and pasture from these sites in western Kenya are at a risk of contracting these parasitic infections.

Control of foodborne trematode infection should be targeted in all the AEZ’s with emphasis placed on the areas that border the lake and those with streams flowing from springs.

Article by Maurice Omondi Owiny, Resident, Kenya FELTP. Resident, Kenya Field Epidemiology and Laboratory Training Programme based at the International Livestock Research Institute

 

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