Uppsala Health Summit: Behaviour change and biosciences necessary to tackle infectious diseases threats

This blog entry has been reblogged from the CGIAR research programme on livestock website featuring the Uppsala Health Summit, themed “Tackling Infectious Disease Threats” that was held as from 10th to 11th October, 2017 of which the team lead of our ZED Group, Prof Eric Fèvre, presented work from our Urban Zoo project on how pathogens from livestock are introduced and spread in urban environments .

Photo credit: Fernanda Dórea

Research shows that six out of 10 emerging human infectious diseases are zoonoses. Thirteen zoonotic diseases sicken over 2 billion people and they kill 2.2 million each year, mostly in developing countries. Poor people are more exposed to zoonoses because of their greater contact with animals, less hygienic environments, lack of knowledge on hazards, and lack of access to healthcare. 80% of the burden of these zoonotic diseases thus falls on people in low and middle income countries.

A workshop at last week’s Uppsala Health Summit zoomed in on zoonotic diseases in livestock and ways to mitigate risk behaviour associated with their emergence and spread. Critical roles and behaviours of people and institutions in preventing, detecting and responding to zoonotic livestock diseases were identified – as well as necessary changes and incentives so we are well-prepared for infections long before they reach people.

These zoonotic infections often originate from livestock which can serve as a bridge for disease transmission between animals and humans. Thus, controlling zoonotic diseases in livestock is an important means to reduce infectious disease threats to humans. Zoonotic diseases are a threat not only to public health, but also to food production, food safety, animal welfare, and rural livelihood.

Within their own sectors, researchers and practitioners from different fields have a considerable understanding of outbreaks of disease and how to handle them. They also know they must bear in mind how local factors, traditions and politics can determine the outcome. But a disease outbreak causing deaths and disruption is always a complex picture. It requires all actors to gather knowledge from beyond their own field of expertise to be fully able to address disease outbreaks efficiently.

The 50 or so workshop participants, comprising vets and medics in a one health context, tackled two objectives. First, they identified who is involved in preventing, detecting and responding to zoonotic livestock diseases and the associated behaviours that need to change. Second, they set out some initial recommendations and incentives to mitigate risky behaviours.

Biosciences and behaviour

Co-organizer Ulf Magnusson from the Swedish University of Agricultural Sciences explained in his opening remarks that the challenge for the group lies at the intersection between biosciences and behaviour. We know a lot about the biosciences; but for the biosciences to be effective, we need to change and strengthen the behaviours of different actors involved in infectious diseases.  He particularly emphasized the ‘one health’ element, that we need to look beyond animals to develop productive collaboration across the veterinary and medical professions.

Three people were charged to set the scene: Barbara Wieland from the International Livestock Research Institute (ILRI) introduced mainly Ethiopian experiences from rural settings; Eric Fèvre from the University of Liverpool and ILRI gave some urban perspectives from Kenya; and Elisabeth Lindahl-Rajala from the Swedish University of Agricultural Sciences shared a case on controlling Brucella in Tajikistan.

Wieland argued that effective prevention, detection and response requires good understanding of the specific ‘local’ situations in which livestock are kept and especially the roles of different people in this. Her research pointed to major gender differences with women closer to the animals, their care and feeding, and the farmstead and men more involved in marketing, slaughter and dealing with externals like vets. She also pointed to local cultural practices and their effect on handling and consumption of some animal-source products like milk or cheese. Taking account of these role differences and cultural aspects is very critical when designing interventions to tackle zoonotic infectious diseases. Focusing on the farmer actor, she identified especially the need for smaller more manageable changes, the transformative opportunities offered by information and communication technologies and the potential of one health to help overcome capacity and infrastructure problems in remote rural areas.

Fèvre reported on research in Nairobi to understand how pathogens from livestock are introduced and spread in urban environments. He introduced the notion of ‘interfaces’ – physical and social – as useful to help understand disease transmission between livestock and food systems, arguing that the behaviours of people, institutions and policies in and across these interfaces are critical in zoonotic disease spread. Looking at the food systems in a city like Nairobi, value chains connect the many different actors, moving animals and products, moving payments, moving animal health information, and ultimately also accelerating or hindering the spread of diseases. While Wieland focused on rural farmers as a primary actor, the urban systems and chains that Fèvre isolated comprise many different public and private actors, each with specialized roles and sets of desirable behaviours. Mapping and measuring these from a zoonotic perspective will allow current and future disease risks to be understood, leading to improved prevention, detection, and response.

Photo credit: Tanja Strand

Lindahl-Rajala reported on research on the prevalence of Brucella, the cause of brucellosis, in the city of Dushanbe in Tajikistan. Globally, some 500,000 cases of brucellosis occur each year, making it one of the most common bacterial infection spread from animals to humans worldwide. In Tajikistan, increasing urbanization of people is leading to increasing urbanization of animals and increased threats from brucellosis though consumption of raw dairy products or direct contact with infected animals. Research showed Brucella to be widespread in the city’s animals. It also showed low levels of awareness of the diseases among producer and consumers as well as several risky behaviours.  Lindahl-Rajala identified three priority actor groups who need to be targeted to tackle the spread of this disease:  farmers who need to adopt safer behaviours, consumers who need to avoid raw milk from street vendors and policy makers who need to give greater attention and devise a long-lasting control program.

Mapping actors and behaviours

Starting from the three presentations and using their own expertise, the initial task of participants was to take each of the three priorities – prevent, detect and respond – and map the main actors and the desirable behaviours/roles necessary to tackle the spread of zoonotic infectious diseases.

Actors identified across the different priorities included livestock owners and keepers, household members, vets, researchers and academics, diagnostic labs, local government, ministries, traders, transporters, medics and physicians, the media, private companies and consumers. One group, tackling ‘responding’ identified the animals themselves as key actors, in this case to ‘stay put’ and avoid people.

After this broad mapping of the actors, participants were asked to dive deeper, to prioritize the most important actors and behaviour changes for different rural and urban scenarios and likely incentives to achieve these changes. This led to more focus on specific actors and behaviours and to a wide range of useful materials and lessons to build out recommendations in this area (see photos below).

Emerging messages

Sofia Boqvist from the Swedish University of Agricultural Sciences reported some key insights to the summit plenary (see picture top of this post).

Under ‘prevention’, the three key messages identified were: effective biosecurity measures, good communication all round, and long term investment. She emphasized a point from within the group that detecting, and treating, a zoonotic infection in a sick person is an indicator of failure. Investing in up-front prevention of disease in animals will keep people healthy.

Under ‘detection’, the three key messages identified were: good infrastructure in rural areas – to overcome geography, distance and poor connectivity, joint medical/veterinary surveillance so all the key actors look out for all the risks, and proper compensation to protect livelihoods when animals need to be culled to protect lives.

Under ‘response’, the three key messages identified were: the importance of strong and effective institutions that do their assigned tasks and roles well, effective communications and especially media engagement to provide proper information and avoid scares, and sufficient resources and expertise to actually tackle the situations. In an informal unscientific poll of participant perceptions in the workshop, this was the area highlighted as the weakest link among the prevent, detect and respond priorities.

Participants discuss zoonotic disease mitigation priorities. Photo credit: Erik Bongcam-Rudloff

More information

The workshop was organized by Sofia Boqvist and Ulf Magnusson from the Swedish University of Agricultural Sciences. Magnusson leads the Livestock Health Flagship of the CGIAR Research Program on Livestock.

A summary report from the workshop will be produced as part of the overall summit report.

See the presentation by Barbara Wieland; more on this work

See the presentation by Eric Fèvre; more on this work

See more on Elisabeth Lindahl-Rajala’s work in Tajikistan

Zoonoses in Livestock in Kenya – The Beginnings of Surveillance

By Steven Kemp, PhD student, University of Liverpool

After a period of intense lab work at both KEMRI and the UK, investigating the patterns of antimicrobial resistance in faecal bacteria isolated from slaughterhouse workers in Busia County and the surrounding areas, I have returned to Kenya to begin the next phase of my PhD project.

ZooLinK is a cyclical programme which aims to set up surveillance systems of both human and animal health sectors over a long period of time. Surveillance of disease is particularly important, as the more information we have, the better we can treat diseases in both human and animal sectors. Recent research by colleagues indicates that the incidence of several zoonotic diseases, including E. coli, Salmonella sp. and others are vastly underestimated.

In recent times, we often hear about how we should now look to conform to the ‘One Health’ approach; this is where, in order to combat issues surrounding antimicrobial resistance and associated issues effectively, intersectoral approaches which share the cost and responsibility evenly between environmental, human & veterinary health professionals is required. In theory, this would be a perfect way to help educate and better promote antimicrobial stewardship.

Currently, I have large amounts of data on access to, use of, and perceptions of antimicrobials from a variety of parties, including animal healthcare workers, district veterinary offices, farmers and agrovet shops. Over the last three months, I have added to this repository by investigating the amounts of antibiotic resistance found in E. coli, which have been isolated from the faeces of workers in 142 slaughterhouses which were selected in western Kenya. These included slaughterhouses in Busia County and the surrounding Kakamega and Bungoma counties.

For the next portion of this study, I am attempting to collect four different sets of samples – to complete the ‘picture’. I will attempt to collect both human and animal faecal samples, from farmers and farm animals, water samples (to determine if there are patterns of resistance in animals which share common grazing grounds) and environmental samples (from the inside of homesteads, where animals are allowed to roam). By covering all of these bases, we will be able to eventually determine not only if there is transfer of antimicrobial resistance between animals and humans and the environment, but also which direction it is going in.

Typical small-holder farm in Funyula, Busia. Most farmers manage between 5-25 cattle.

Example of environment which may also be a good idea to sample in the future. If antimicrobial resistance can be found in the envi-ronment, then why not in wild animals such as these Zebra?

Challenges associated with tracking the movements of people and their livestock

Phase two of this study (detailed in the previous ZooLink newsletter) began in November. Over the last two months, we revisited 27 households that we collected GPS data from in phase one in order to track the movements of the same people and livestock as we did in July and August of this year. Briefly, this involves visiting randomly selected households in Busia County and asking the participant to wear a small GPS tracker on a lanyard around their neck or alternatively, to keep it in a pocket on their person for one week. During the same visits, we also attach an identical GPS unit on a collar to one of the livestock belonging to the household. After the week is over we return to the household to collect the trackers and to ask a few questions about the experience.

Cattle with trackers around their necks

Although most people have been keen to participate in the study for a second time, we often hear of challenges they encountered while wearing the trackers. These are nearly always due to other people’s perceptions of the purpose of the trackers and the research. For example, many participants reported that they were questioned by people from other households, which led to participants having to convince other people of the purpose and worth of the study. In the worst cases, participants reported that other people were convinced that the tracker was listening to their conversations, was a bomb or was doing “the work of the devil”. However, it was heartening to hear that in all cases the participant attempted to explain the study to other people, with varying results. Interestingly, the intensity of the questioning by outsiders seemed to be related to the participant’s age and gender: We tended to find that young women wearing the trackers were more likely to be subjected to questioning and (attempted) persuasion to discontinue their participation in the study than others. Nonetheless, participants invariably reported that while others might be doubtful, they themselves remained convinced of the purpose of the study and continued to wear the trackers.

Cattle outside a “boma” with trackers around their necks

Sometimes it was difficult to find our participants and collect the trackers when the week was up – we would drive to a sub-location up to two hours away from Busia town, only to find that the people we wanted to visit were out and we would have to track them down, mainly by asking the villagers where our participants might be. On the bright side, this also meant that our trackers were out collecting interesting data, and has led to us stumbling upon various events within the villages, including a funeral, a circumcision ceremony and a fishing trip.

Overall, this second phase of fieldwork has been largely successful!

This blog article was authored by Jessica Floyd, PhD student, University of Southampton and also appears in our Zoolink Newsletter Volume1 Issue 2

Do livestock have a role in the emergence of disease in urban cities?

One of the primary objectives of the Urban Zoo project is to quantify and understand microbial diversity in an urban setting and to try and link that to urban livestock keeping. In so doing we aim to elucidate the possible role of livestock as a risk factor in the emergence of disease in cities.

To give us a handle on microbial diversity we have chosen commensal Escherichia coli as an indicator species, which we have isolated from samples taken from a diversity of sources across the city of Nairobi. These comprise people and their living spaces, including the food they eat; their immediate environments, including water sources, waste and wildlife; and the livestock that they keep either for their own consumption or for sale. From these samples we isolate and culture E. coli, extract their DNA, and perform whole genome sequencing, enabling us to compare isolates from different compartments and to determine how closely related they are, and thus how microorganisms might pass from one to another.

The collection of these samples has been guided by a highly structured sampling frame, which I described in Urban Zoo newsletter number 7. Essentially, we have selected 33 sub-locations in Nairobi representing a range of social strata and, within each, have chosen 3 households to sample: one with no livestock; one with only monogastric species (pigs or chickens); and one with ruminant livestock (sheep, goats or cattle); You can view the spatial maps at our earlier post by clicking here .

The collection of such comprehensive data from these 99 households was an enormous undertaking and has been a considerable logistical feat of coordination between the field and the laboratory. The good news is that the sampling is now complete, thanks to the heroic efforts of the field team, led by Judy Bettridge and James Akoko, and of our colleagues in the laboratories.

Overall, 2,351 samples have been collected and we managed to culture E. coli from 80% of these (1,850). Once the last few have been done this will give us 1,809 whole genome sequences to analyse. 327 of these are from people; 58 from the places where they prepare food; 64 from animal source foods (milk meat and eggs); 644 from 12 different species of livestock; 239 from the environment around the home-stead including water sources; and 477 from a wide diversity of wildlife in the vicinity of the household.

But it is not over yet. We will very soon have finalised the sequencing and now comes the equally challenging task of deciphering all of this genetic data to unveil the pattern of microbial diversity across Nairobi. Over to you Melissa!

On that note, I would like once again to congratulate the field and laboratory teams, and to wish everyone a great year ahead, 2017.

This article was authored by Dr. Timothy Robinson who is a co-principal investigator in the Urban Zoo project and also a principal scientist with ILRI’s Livestock Systems and Environment research group.

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!

1.2.2.1.28 Floyd Jess

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

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