Letter from the PI: Emergence of pathogens in the human and animal population

Letter from the PI: Emergence of pathogens in the human and animal population

It’s a real pleasure to have the opportunity to write for the UrbanZoo newsletter in this first quarter of 2016.  This is a job of the co-PIs on this large project do in turn, and as I wrote for the first newsletter, this must make this issue the 10th so far.

The Urban Zoo project is certainly an exciting and challenging ‘beast.’  Funded by the UK Research Council Environmental and Social Ecology of Human Infectious Diseases (ESEI) initiative, we’ve certainly been deeply engaged in building an evidence base that is allowing us to understand the human, natural, wildlife and social environment of the complex and fascinating city of Nairobi.  Our teams, each led by specific expertise in different leading academic institutions in Kenya and the UK, have lifted the lid on the complex worlds of livestock production, food supply, human nutrition, diarrhoeal disease, wildlife-human-livestock interfaces, microbial genetics, low income settlement patterns and urban planning.  The efforts and energy of the field teams and lab teams in delivering the samples and the data on this project are quite astounding.

The last 18 months have been pivotal for this project.  We’ve been working extremely hard on the “99 household study,” which is described in this newsletter and in other newsletters in this series, and which focuses on mapping bacterial genetic relationships in isolates in a diversity of ecological niches at the household level.  The sample frame is stratified both by type of livestock kept and by socio-economic status.  Material gets selected in the field, at the point of collection, for forwarding for whole genome sequencing (WGS) with our partners in the UK.  It won’t be long now before we have our first WGS-derived phylogenetic tree of E. coli isolated from this part of the project, a major milestone.

The productivity in data gathering in the early years of the project is starting to pay off.  At the last count, there are 15 manuscripts in preparation, with a long string of others awaiting data to come back from collaborators so we can get down to analysis and paper writing.  We’re in negotiations with journals to have special issues bringing some of our key papers together, and have our eye on some very high impact journals to report our key results.  We have been, and continue to be, grateful not only to the ESEI programme for funding this far reaching work, but also to the other funders who have contributed to specific elements, including the CGIAR Research Programme on Agriculture, Nutrition and Health, the Leverhulme Centre for Integrative Research on Agriculture and Health and the funders of several of our PhD students.

With now just over a year to go on this project, we are working hard to understand the mechanisms that may lead to the introduction of pathogens into urban environments, and the emergence of those pathogens in the human population.

Eric Fèvre is a Professor of Veterinary Infectious Diseases, Institute of Infection and Global Health, University of Liverpool with expertise in epidemiology of zoonoses at the livestock human interface. View his profile

It is time to rethink the way we handle pets and wildlife

It is time to rethink the way we handle pets and wildlife

In Summary

  • During the Kenya Medical Research Institute’s fifth scientific conference, which also took place in February, scientists raised the alarm over the transmission of diseases from animal to humans.
  • The World Health Organisation says that 60 per cent of the pathogens that cause infectious diseases in human beings come from animals.
  • According to the US’s Centre for Disease Control and prevention, zoonoses include a wide range of diseases, ranging from mass killers such as anthrax, Ebola, swine flu, West Nile Virus, bird flu, Crimean-Congo haemorrhagic fever and the Hendra Virus to subtle and slow killers like rabies, Rift Valley Fever and Brucellosis

During the funeral of a 39-year old woman who died of Aids in Homa Bay in February this year, a clinical officer who had attended to her engaged DN2 in a discussion about the Zika Virus in South America, and how it had triggered yet another debate on how man’s unguided relationship with nature is hurting him.

Sadly, neither the potential victims, nor the government, are adequately conversant of this to take the necessary precautions.

It is worth noting that at the time the Homa Bay funeral was taking place, across the Atlantic Ocean in Boston, US, the annual Conference on Retroviruses and Opportunistic Infections (CROI) was also taking place. The discussion focused on yet another deadly infection that came to human beings from animals: Ebola.

In Kenya, the Ministry of Health allayed fears of possible disease outbreaks from the Ebola and Zika viruses.

Only a few scientists, like Lancet Laboratory’s executive officer, Dr Ahmed Kalebi, took note of the public health issues raised at CROI.

Meanwhile, during the Kenya Medical Research Institute’s (KEMRI) fifth scientific conference, which also took place in February, scientists raised the alarm over the transmission of diseases from animal to humans. They expressed concern about humans’ continued intrusion into wildlife territory.

Whether it is the burgeoning population or the desire to live in quiet, exclusive environments, human intrusion into animal habitats has grown considerably in the country in recent times.

The area around the Lewa Conservancy which straddles Meru and Laikipia counties, is a case in point. Apart from the herds of elephants and buffalos that roam the plains, one can also spot residential houses tucked away in between the trees.

A great deal has been documented about the booming real estate business in Laikipia County, which for decades was dominated by large territorial mammals such as rhinos, elephants and buffaloes.

Not surprisingly, this intrusion has seen elephants destroy crops in the areas neighbouring their habitat.

Now, experts are warning of a threat greater than the destruction of crops of trampling to death of humans: zoonoses.
Zoonoses are diseases transmitted from animals to humans.

The World Health Organisation, (WHO) says that 60 per cent of the pathogens that cause infectious diseases in human beings come from animals.

And researchers warn that the close interaction between humans and animals, whether wild or domesticated, is increasingly making Kenyans ill.

According to the US’s Centre for Disease Control and prevention, zoonoses include a wide range of diseases, ranging from mass killers such as anthrax, Ebola, swine flu, West Nile Virus, bird flu, Crimean-Congo haemorrhagic fever and the Hendra Virus to subtle and slow killers like rabies, Rift Valley Fever and Brucellosis.

Although these diseases are a global health problem, their impact is felt more in Africa than in other parts of the world because they tend to be neglected. African governments dedicate few or no resources to detect and respond to them at the local or national levels. Only 0.7 per cent of these diseases affect people in developed countries as poor nations bear the brunt.

It was only after the Ebola outbreak in West Africa in 2013, which wreaked havoc in West Africa, that people started paying attention to the usually muted voice of researchers on the link between diseases, animals and the environment.

PUTTING UP SKYCRAPPERS

Given the rate at which construction is going on in the country, it is time we sat up and took notice.

Not too long ago, the ambience in Nairobi’s upmarket Kilimani allowed residents and colobus monkeys to live in harmony. Today, the gibbering of monkeys has been replaced by the roar of construction machines putting up skyscrapers.

The same trend can be observed in other parts of the country such as Lower and Upper Kabete, Gathiga, slightly past Kitisuru in Nairobi, Mang’u (Kiambu County), Kabarak and Sobea (Nakuru County) Nyahera (Kisumu County and Kapchorua in Nandi Hills (Nandi County).

Unknown to many, as this trend continues, disease-causing pathogens are mutating, becoming more lethal and embedding themselves in the complex yet delicate human food chain and way of life.

A study in 2012 titled “Zoonoses: A potential Obstacle to the Growing Wildlife Industry of Namibia published in the journal, Infection Ecology and Epidemiology, drew a chilling pattern in Kenya, similar to Namibia’s cases of zoonoses: the serum of buffaloes in Ijara, Nakuru, Laikipia, Nairobi and parts of the North Rift tested positive for antibodies of Rift Valley Fever.

Dr Eric Osoro, a medical epidemiologist at the Zoonotic Diseases Unit (ZDU) in the Ministry of Health, says that at least 2,000 Kenyans die of rabies every year, which is unfortunate, given that it costs less than Sh100 to vaccinate a dog, compared with the thousands of shillings required to treat the viral disease.

“The number of rabies deaths reported is a gross underestimation of the actual number of deaths that occur in Kenya annually from this terrifying fatal disease,” he says.

Many more Kenyans could be dying of rabies, which can be caused even by a scratch by an unvaccinated dog, because the incubation period for the virus is estimated to be about two months.

“Sometimes the wound might have even healed, so none one would suspect it is rabies,” Dr Osoro says.

While rabies can be prevented by vaccinating dogs, WHO says it is 100 per cent fatal once the clinical signs appear.

Apart from rabies, Dr Osoro also cautioned about Brucellosis — a disease one gets from taking milk that has not been boiled properly — and anthrax.

“Anthrax kills cattle in less than 12 hours, but many will consume the flesh because the animal looked healthy,” he says.

Prof Thumbi Mwangi, a clinical assistant professor at Washington State University in the US and a researcher on zoonoses at the Kenya Medical Research Institute (KEMRI), told DN2 that while the interaction between humans and animals is not necessarily a bad thing, failure to keep healthy animals increases the chances of ill health for humans.

PATHOGENS FIND NEW HOSTS

In March last year, Prof Mwangi carried out a study in which he tracked 1,500 households and their livestock in 10 villages in Western Kenya. He and his team obtained data on 6,400 adults and children, 8,000 cattle, 2,400 goats, 1,300 sheep and 18,000 chicken.

The results, published in the open journal, Plos One, revealed that for every 10 cases of animal illnesses or deaths that occurred, the probability of human sickness in the same household increased by about 31 per cent.

Prof Eric Fèvre, a professor of veterinary infectious diseases at the Institute of Infection and Global Health at the University of Liverpool and the International Livestock Research Institute (ILRI), wrote a blog post, “Zoonoses in Africa” on the websitemicrobiologysociety.org, in which he said that urbanisation is presenting opportunities for pathogens to find new hosts to survive.

The post, published on November 11, 2015 read: “The intensification of farming, for example, leads to closer relationships between individuals and animals, generating opportunities for more rapid mutations as organisms move from host to host, while also providing a structured way for those pathogens to enter highly ordered food chains that branch out and reach very large numbers of people”.

Other studies paint an increasingly disturbing pattern of diseases either emerging, or the incidence of existing ones increasing.

A study in Dagoretti, Nairobi, by the International Livestock Research Institute (ILRI), found that women were more exposed to cryptosporidiosis, a diarrhoeal disease transmitted from cattle to humans, because of their involvement in milking, feeding and watering the animals.

And a study by the Kenya Medical and Research Foundation (KEMRI) Kisumu and the US’ CDC linked a strain of tuberculosis to an area in Western Kenya where homes had a higher cattle:human ratio.

In wildlife settings, the situation is more complex. A 2014 study found cases of suspected rabies in Laikipia County where humans had encroached on animal habitat.

When landscapes and bio diversities are altered by activities relating to construction such as roads and farms, diseases are “created”: as trees are felled, the species that protect humans from the ones that act as disease-reservoirs are destroyed.

The harmful pathogens are usually multi-host, meaning they can live in many different animals, which gives them a competitive edge to survive as the protective trees are wiped out by human activity.

In 2012, ILRI reported that 2 million people are killed by zoonoses every year, thanks to the disruption of the ecosystem.

Malaria is a good example: as people in tropical countries like Kenya encroached on the habitat, the incidence of the disease quadrupled.

ECOLOGICAL BALANCE

When DN2 asked nine developers from Nakuru, Nairobi and Kisumu whether they consider the ecological balance of a location important when they are building, six responded with the question, “What is that?” After it was explained to them, all except one said they were “satisfied with the National Environmental Management Authority (NEMA) clearance”.

It is notable that NEMA officials and environmental inspectors have said at scientific forua that many of the constructions approved by the counties do not heed their counsel.

Only 1 per cent solution to wildlife viruses are known, according to WHO, and the ecology of diseases and wildlife immunology is in its infancy in Kenya.

Meanwhile, Kenya’s Zoonotic Disease Unit, has been lauded at various fora for its holistic approach, with its national rabies control strategy highly regarded.

It has conducted a large-scale study on the epidemiology of brucellosis, responded to many zoonotic disease outbreaks, and developed preparedness strategies for epidemic zoonoses such as Rift Valley fever.

But for now, one can only hope that ecological safety will be factored in amid the real estate industry boom.

SOURCE

This article originally appeared in the Kenya Daily Nation website on 9th March, 2016 authored by Verah Okeyo, available athttp://www.nation.co.ke/lifestyle/DN2/Take-care-how-you-interact-with-animals/-/957860/3108294/-/15fadaoz/-/index.html

View the Newspaper pages

Informal food vendors training

The food vendors training was held at Mlango Kubwa on 25th February, 2016 involving 30 plus food vendors carefully selected from thirteen villages in Mathare Valley in Kenya. The food vendors ranged from the ones who sell: meat products, vegetables, fruits, eggs, fish and the ones selling ready made food products.

The aim of the training was to enlighten and empower the participants with practical skills and knowledge on proper food, premise and attire hygiene, sanitation and safety issues.

Muungano wa Wanavijiji food security programme coordinators mobilized the participants while ILRI and APHRC facilitated the training. The activity was in response to vendors’ own requests for capacity-building and offered a crucial opportunity to support livelihoods and bolster community health across eight villages in Mathare.

The training was organised into five sessions:

  • Session 1: Introduced the participants to the Urban Zoo projects which seeks to understand how disease emerge in urban and peri-urban areas of Nairobi 
  • Session 2: Highlighted the relationship between germs and food safety. Participants were introduced to the adverse effects of germs to health, their portals of entry and that proper hand washing, food preparation and hygiene can prevent most food-borne diseases. This session concluded by demystifying the various myths and truths about food.
  • Session 3: Participants were introduced to common food-borne symptoms and how proper PPE, hygiene and sanitation of food, body, containers, clothes and towels prevents most of the food-borne infections. A practical session on how germs spread was also demonstrated using drinking chocolate powder and proper hand washing demonstrated using the Glo-germ.
  • Session 4: This session equipped participants with skills on proper premise hygiene, water treatment, storage of perishable food to avoid spoilage. Various modes of contamination and precautions to take when handling meat, eggs, vegetables, and fruits were also illustrated.
  • Session 5: The last session equipped and empowered participants on: ways and why they need to improve their product quality; why and how they need to deal with customers and suppliers; advised on promotional activities that they can engage in to improve their product sells; participants were also advised on the importance of innovation, diversification, standardization of recipes and processes.
  • Practical sessions: The training came to an end with further practical demonstrations on how to wash equipment, sukuma wiki (kales), and meat.
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Click to view report

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Training action photos [Click photo to enlarged image]

Hand hygiene demo

Meat hygiene demo

Hygiene of equipment demo

Hand hygiene demo using Glow-germ

Why Nairobi must spread the right food message in an unhealthy environment

Why Nairobi must spread the right food message in an unhealthy environment

Untitled2

Scientific evidence shows that consuming at least five portions of fruit and vegetables a day can prolong your life and reduce your risk of developing non-communicable diseases such as diabetes and cancer.

Yet not enough people across the world are consuming adequate amounts of fruit and vegetables. In low and middle income countries, over 75% of adults consume less than the minimum recommendation. In Tanzania more than 95% of people consume less than the minimum requirement.

In the slums of Nairobi, our research shows that less than half of the adult population are meeting their daily fruit or vegetable requirements. Instead, as global fast food outlets flood the Kenyan market, they prefer junk food which they see as a status symbol.

This could be why there are high levels of hypertension and diabetes in these slums where one in every five people has one of the two conditions. In addition, we found that less than a quarter of those who had diabetes were aware of their condition. And fewer than 5% of all people with diabetes had their blood sugar under control.

Africa’s fat map

The increase in non-communicable diseases such as diabetes in low and middle income countries is largely driven by rapid urbanisation and preferences for high-calorie diets with decreasing levels of physical activity.

In sub-Saharan Africa alone diabetes sufferers are projected to double from 12 million to 24 million in the next two decades. Evidence from the World Health Organisation shows type 2 diabetes will be the key contributor to this rise.

Several studies from the continent show excessive body weight and obesity as risk factors for diabetes.

A review of the Demographic and Health Survey data from seven African countries over 10 years shows that there are rising trends in overweight and obese urban women. Even more worrying is that the increase is seven times higher among the poorest urban women compared with the richest urban women.

Price is not the problem

Nairobi’s slums are known for their thriving vegetable markets. So, why are slum residents not consuming adequate amounts of fruit and vegetables?

Initially we thought that the price of the fruit and vegetables was prohibitive for slum residents given that the majority of them live on less than $2 a day.

But the price is not the main deterrent. While imported fruit such as pomegranates may, understandably, be expensive, local produce such as bananas or the trendy superfood kale – a Kenyan staple for generations known as sukuma wiki – are affordable.

When we dug a bit deeper through focus group discussions, we found there was a social desirability issue: slum residents wanted junk food because it reflected a higher socioeconomic status.

Their aspirations are linked to a combination of clever marketing, celebrity culture and the social media frenzy around global fast food outlets opening in Kenya.

Several fast food outlets have opened in Nairobi in recent years, encouraging people to eat highly processed food. Noor Khamis/Reuters

And who could blame them? In the past few years, several major global fast food brandshave set up shop in Kenya including KFC chicken and Pizza Hut. And more are said to be eyeing an entrance into East Africa’s largest economy.

Why it’s hard to change eating habits

Trying to find ways to promote fruit and vegetable consumption among slum residents isn’t easy. To add to the problem one of Kenya’s major dailies recently published a bombshell article slamming fruit and vegetables.

According to the article, laboratory tests conducted by scientists on samples of fruit and vegetables from across Nairobi found toxic levels of various substances.

It argued that samples of sukuma wiki had shown high levels of lead, most likely from contaminated riverbeds where the vegetable is typically grown. And samples of bananas and oranges had high levels of calcium carbide, which is used illegally to hasten the ripening of fruit.

The article sparked widespread negative reaction and has exacerbated the challenge of those living in urban slums not eating vegetables.

The World Health Organistion’s recommendations for improving fruit and vegetable intake are pitched at a high policy level. For example, one recommendation is that marketing of food and beverages to children should be restricted.

But for health practitioners on the ground suggestions such as these do not necessarily translate into practical steps to change eating habits.

The challenge health practitioners have is what message do we pass to the residents of Nairobi’s slums? Do we ask them to eat more fruit and vegetables given the revelations in the news article? Or do we ask them to stick with junk food until the relevant authorities get their act together and halt illicit practices affecting the fruit and vegetable industry?

What needs to be done

Clearly this is a catch-22 situation. The newspaper article highlights the need for developing countries like Kenya to review their food and agricultural policies.

There is an urgent need for policies that protect the lives of people by:

  • promoting access to healthy food
  • regulating the production, sale and marketing of junk food (and drinks)
  • ensuring that the food supply chain is free of toxic chemicals, drugs and other contaminants, and
  • minimising the effects of food production on climate change and vice versa.

The policy environment for these interventions is currently weak. And unless the government takes urgent steps to put these policies in place, there is no way to stop people from lining up at the next fast food outlet.

 

Article originally posted by Samuel Oti on the Conversation-Africa website, available at: https://theconversation.com/why-nairobi-must-spread-the-right-food-message-in-an-unhealthy-environment-53513

WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations

WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations

WHO statement: 1 February 2016

Source: http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/

The first meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding clusters of microcephaly cases and other neurologic disorders in some areas affected by Zika virus was held by teleconference on 1 February 2016, from 13:10 to 16:55 Central European Time.

The WHO Secretariat briefed the Committee on the clusters of microcephaly and Guillain-Barré Syndrome (GBS) that have been temporally associated with Zika virus transmission in some settings. The Committee was provided with additional data on the current understanding of the history of Zika virus, its spread, clinical presentation and epidemiology.

The following States Parties provided information on a potential association between microcephaly and/or neurological disorders and Zika virus disease: Brazil, France, United States of America, and El Salvador.

The Committee advised that the recent cluster of microcephaly cases and other neurologic disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern (PHEIC).

The Committee provided the following advice to the Director-General for her consideration to address the PHEIC (clusters of microcephaly and neurologic disorders) and their possible association with Zika virus, in accordance with IHR (2005).

Microcephaly and neurologic disorders

  • Surveillance for microcephaly and GBS should be standardized and enhanced, particularly in areas of known Zika virus transmission and areas at risk of such transmission.
  • Research into the etiology of new clusters of microcephaly and neurologic disorders should be intensified to determine whether there is a causative link to Zika virus and/or other factors or co-factors.

As these clusters have occurred in areas newly infected with Zika virus, and in keeping with good public health practice and the absence of another explanation for these clusters, the Committee highlights the importance of aggressive measures to reduce infection with Zika virus, particularly among pregnant women and women of childbearing age.

As a precautionary measure, the Committee made the following additional recommendations:

Zika virus transmission
  • Surveillance for Zika virus infection should be enhanced, with the dissemination of standard case definitions and diagnostics to at-risk areas.
  • The development of new diagnostics for Zika virus infection should be prioritized to facilitate surveillance and control measures.
  • Risk communications should be enhanced in countries with Zika virus transmission to address population concerns, enhance community engagement, improve reporting, and ensure application of vector control and personal protective measures.
  • Vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to Zika virus.
  • Attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure.
  • Pregnant women who have been exposed to Zika virus should be counselled and followed for birth outcomes based on the best available information and national practice and policies.
Longer-term measures
  • Appropriate research and development efforts should be intensified for Zika virus vaccines, therapeutics and diagnostics.
  • In areas of known Zika virus transmission health services should be prepared for potential increases in neurological syndromes and/or congenital malformations.
Travel measures
  • There should be no restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission.
  • Travellers to areas with Zika virus transmission should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites.
  • Standard WHO recommendations regarding disinsection of aircraft and airports should be implemented.
Data sharing
  • National authorities should ensure the rapid and timely reporting and sharing of information of public health importance relevant to this PHEIC.
  • Clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared with WHO to facilitate international understanding of the these events, to guide international support for control efforts, and to prioritize further research and product development.

Based on this advice the Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.


For further information please contact:

Gregory Hartl
Telephone: +41 22 791 4458
Mobile: +41 79 203 6715
E-mail: hartlg@who.int

Christian Lindmeier
Telephone: +41 22 791 1948
Mobile: +41 79 5006552
E-mail: lindmeierch@who.int

Tarik Jasarevic
Telephone: +41 22 791 5099
Mobile: +41 79 367 6214
E-mail: jasarevict@who.int

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