PhD Scholarship Opportunity at the University of Nairobi, in association with the ZELS ZooLinK project

PhD Scholarship Opportunity at the University of Nairobi, in association with the ZELS ZooLinK project

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The Zoonoses in Livestock in Kenya (ZooLinK) project is funded by the UK Zoonosis and Emerging Livestock Systems (ZELS) Programme of the BBSRC, ESRC, NERC, MRC, DFID and DSTL. ZooLinK is a collaborative project between the Universities of Liverpool, Edinburgh, Nottingham, The Royal Veterinary College, Nairobi and Kenya Medical Research Institute and International Livestock Research Institute. The parties are conducting a five year study on integrated zoonosis surveillance on 14 zoonotic diseases in western Kenya.

ZooLinK seeks to recruit a PhD student to be registered at the University of Nairobi to join its interdisciplinary research team to address the various objectives of the project.

The normal rules of admission and academic selection of the University of Nairobi will be applied in the recruitment for this position.  Interested candidates must have an MSc degree in basic sciences or medicine/veterinary medicine with a strong bias towards epidemiology and quantitative biostatistics. He/She must submit his/her detailed CV, an application cover letter, and a concept note not exceeding 3 pages in the form of a research proposal detailing a proposed project he/she wishes to pursue.  To be considered, the proposed project must fall within the scope of the ZooLinK programme.  It may focus on an aspect of one of the zoonotic diseases under study or integrate approaches across several diseases. Candidates falling under the University of Nairobi staff development programme will have an added advantage.

The deadline for submission is 5pm on 15th August 2016.  All applications, as well as any informal enquiries, are to be sent to Professor Erastus Kang’ethe, at the email address mburiajudith@gmail.com.

More details on the project, the focus diseases and other details can be obtained at the ZooLinK website [hyperlink http://www.zoonotic-diseases.org/project/zoolink-project/].

Collaborators

Zoonotic Disease Unit, Government of Kenya (www.zdukenya.org), Animal Health & Industry Training Institute (AHITI) – Kabete (http://www.ahitikabetecpd.org/), Kestel Technologies (http://ktg-tech.com/) and Diagnostics for All (http://www.dfa.org/)

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Update: 99 Households study: wildlife component

Update: 99 Households study: wildlife component

Wildlife 2As we approach the final quarter of the 99 household study, it is a pleasure to be asked to reflect on the wildlife sampling component of this study. The wildlife sampling team has come a long way since its inception in September 2015, when we were all relative novices in trapping Nairobi’s diverse array of wildlife species. We have had some long days and sleepless nights, but to their credit, the enthusiasm of those involved has never waivered.

A typical day for the wildlife team starts at 5am, when we embark on bird sampling. To ensure we follow best practice for all of our trapping we collaborate with experts at the National Museums of Kenya, and in the mornings Titus Imboma (an ornithologist from the museums) helps us set up an array of mist nets, aimed at trapping birds as they fly in proximity to the household and livestock-keeping areas of each compound. Once caught, each bird is placed in a paper bag to collect a faecal sample, before a number of other body measurements and biological samples are collected. Such opportunistic sampling is a common philosophy among wildlife Table 1-Taxadisease ecologists, and additional samples provide an important resource for future epidemiological work. We next check the rodent traps – we use live-capture Sherman traps which are set throughout the house, livestock-keeping facilities and the household compound. Any rodents that we catch are transported back to the lab at ILRI, where they are humanely euthanized and subjected to a post-mortem examination (PME). This procedure is used to permit the collection of fresh faeces and organ samples which are stored frozen and in formalin. The latter ensures that tissues from these animals are preserved for histopathological interpretation, should the need arise in the future. As dusk settles over Nairobi, the sampling team heads back to the house to trap bats.

The techniques used to trap bats are vey similar to those for birds; very fine mist nets are suspended between fly-ways where bats seek their food (either insects or fruit depending on the species of bat). Due to their propensity to bite, bats present a challenge to remove from the nets and restrain during sampling, but with the appropriate techniques and equipment (i.e. tough gloves!) they can be safely held to collect measurements and samples. We sacrifice a maximum of two bats each night, which are taken back to the lab at ILRI for PME. The rest are sampled live, and released Wildlife 4unharmed. When we encounter a bird or bat roost, we use tarpaulins spread underneath the roost in order to collect pooled faecal samples representative of the individual animals using the roost.

Something that has become evident as we move from house-to-house, navigating Nairobi’s  maze of leafy suburbs, high-rise apartments and river-side slums, is the shear diversity of wildlife habitat present in this city. This is reflected in the number of species (birds, rodents, bats, primates and carnivores) we have sampled to date (see table 1). All of these species inhabit different ecological niches which likely govern their levels of interaction with humans and livestock; as an example one would expect very different levels of interaction between house rats that scavenge on animal feed and sunbirds that rely on nectar. How this translates to the risk of disease transmission is something we hope to shed light on by studying the genetic diversity of E. coli in these wildlife, and comparing it to those from humans, livestock and the
environment.

James Hassell

Article By James Hassell

 

This blog entry is an article on our quarterly Urban Zoo Newsletter Volume 3 Issue 3 which can be accessed by clicking here.

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

URBAN ZOO PROJECT: The 99 Household Study

URBAN ZOO PROJECT: The 99 Household Study

The 99 households study is now well under way, with sampling being carried out across a range of neighbourhoods in Nairobi. Each week the team targets a different sub-location, where three house-holds are recruited; two with different types of livestock and a third which does not keep any livestock species. Our team of clinical officers and vets collect samples from all human members of the house-hold, along with samples from livestock present, from the general household environment and from any animal source foods in the home. In addition, the wildlife team trap and sample rodents, wild birds, bats, primates and small carnivores in the vicinity.

Sampling a household is intensive, and participants not only consent to donate their faeces to the study, but also give up a good portion of their time, answering questionnaires, aiding the sampling by handling their livestock, and providing access to their property at all hours to allow checking of rodent traps. As such, only three households are sampled in a week, but after 8 weeks more than 400 samples have already been collected.

All samples are sent to our two collaborating laboratories at KEMRI and the University of Nairobi, where they are cultured to grow E.coli bacteria, the primary focus of the study. Multiple individual bacterial colonies are selected from the first culture to go forward for purification and further testing. This means that each animal, human or environmental sample taken in the field can generate up to five subsequent bacterial isolates, and so the number of colonies in the collection is increasing rapidly.

Genetic data from the bacterial samples will allow us to study similarities and differences between these normal bacteria carried by individuals, and how they can be shared between humans, animals and the environment. The questionnaire data collected, among other things, builds on the project’s previous work on value chains, and will allow us to assess how these consumers from a range of social strata are connected to the various value chains that exist in Nairobi for meat and animal products.

A great deal of work has led up to the start of this study, including developing strate-gies for finding participants to represent a diverse section of the city, developing sampling and laboratory protocols, and designing the electronic data capture sys-tems used in the field and laboratories. Everyone involved is delighted that things are now up and running and our colleagues in the UK are eagerly waiting for the first shipment of bacterial DNA to arrive. Watch our blog space!

The 99 Households Study is part of the Urban Zoo Project http://www.zoonotic-diseases.org/project/urban-zoo-project/ which is a joint project between scientists from Kenya and the UK. We are interested in how diseases can be transmitted between animals and people living in close contact in a city environment. The 99 Household study aims to collect in-depth information from 99 families from 33 different neighbourhoods stratified by socio-economic status across the whole of Nairobi. We are testing humans, animals and the home environment for bacteria that can be shared and spread between them.

This article has been written by Judy Bettridge (Post Doc under the 99HH Study, based jointly between the University of Liverpool, UK and International Livestock Research Institute (ILRI) in Kenya).

Using tablet to collect data

Sampling a rabbit in Makongeni

Field team in one of the sampling sites

Sampling the environment

Microbiology plates in readiness for culturing samples

WHO’s first ever global estimates of foodborne diseases find children under 5 account for almost one third of deaths

WHO’s first ever global estimates of foodborne diseases find children under 5 account for almost one third of deaths

Overview

  • First ever estimates of the global burden of foodborne diseases show almost 1 in 10 people fall ill every year from eating contaminated food and 420 000 die as a result
  • Children under 5 years of age are at particularly high risk, with 125 000 children dying from foodborne diseases every year
  • WHO African and South-East Asia Regions have the highest burden of foodborne diseases

News release

Almost one third (30%) of all deaths from foodborne diseases are in children under the age of 5 years, despite the fact that they make up only 9% of the global population. This is among the findings of WHO’s Estimates of the global burden of foodborne diseases – the most comprehensive report to date on the impact of contaminated food on health and wellbeing.

The report, which estimates the burden of foodborne diseases caused by 31 agents – bacteria, viruses, parasites, toxins and chemicals – states that each year as many as 600 million, or almost 1 in 10 people in the world, fall ill after consuming contaminated food. Of these, 420 000 people die, including 125 000 children under the age of 5 years.

“Until now, estimates of foodborne diseases were vague and imprecise. This concealed the true human costs of contaminated food. This report sets the record straight,” says Dr Margaret Chan, Director-General of WHO. “Knowing which foodborne pathogens are causing the biggest problems in which parts of the world can generate targeted action by the public, governments, and the food industry.”

While the burden of foodborne diseases is a public health concern globally, the WHO African and South-East Asia Regions have the highest incidence and highest death rates, including among children under the age of 5 years.

“These estimates are the result of a decade of work, including input from more than 100 experts from around the world. They are conservative, and more needs to be done to improve the availability of data on the burden of foodborne diseases. But based on what we know now, it is apparent that the global burden of foodborne diseases is considerable, affecting people all over the world – particularly children under 5 years of age and people in low-income areas,” says Dr Kazuaki Miyagishima, Director of WHO’s Department of Food Safety and Zoonoses.

Diarrhoeal diseases are responsible for more than half of the global burden of foodborne diseases, causing 550 million people to fall ill and 230 000 deaths every year. Children are at particular risk of foodborne diarrhoeal diseases, with 220 million falling ill and 96 000 dying every year. Diarrhoea is often caused by eating raw or undercooked meat, eggs, fresh produce and dairy products contaminated by norovirus, Campylobacter, non-typhoidal Salmonella and pathogenic E. coli.

Other major contributors to the global burden of foodborne diseases are typhoid fever, hepatitis A, Taenia solium (a tapeworm), and aflatoxin (produced by mould on grain that is stored inappropriately).

Certain diseases, such as those caused by non-typhoidal Salmonella, are a public health concern across all regions of the world, in high- and low-income countries alike. Other diseases, such as typhoid fever, foodborne cholera, and those caused by pathogenic E. coli, are much more common to low-income countries, while Campylobacter is an important pathogen in high-income countries.

The risk of foodborne diseases is most severe in low- and middle-income countries, linked to preparing food with unsafe water; poor hygiene and inadequate conditions in food production and storage; lower levels of literacy and education; and insufficient food safety legislation or implementation of such legislation.

Foodborne diseases can cause short-term symptoms, such as nausea, vomiting and diarrhoea (commonly referred to as food poisoning), but can also cause longer-term illnesses, such as cancer, kidney or liver failure, brain and neural disorders. These diseases may be more serious in children, pregnant women, and those who are older or have a weakened immune system. Children who survive some of the more serious foodborne diseases may suffer from delayed physical and mental development, impacting their quality of life permanently.

Food safety is a shared responsibility, says WHO. The report’s findings underscore the global threat posed by foodborne diseases and reinforce the need for governments, the food industry and individuals to do more to make food safe and prevent foodborne diseases. There remains a significant need for education and training on the prevention of foodborne diseases among food producers, suppliers, handlers and the general public. WHO is working closely with national governments to help set and implement food safety strategies and policies that will in turn have a positive impact on the safety of food in the global marketplace.

Note to the editor:

In addition to disease incidence and deaths, the WHO report and PLOS papers also quantify the disease burden in terms of Disability-Adjusted Life Years (DALYs)—the number of healthy years of life lost due to illness and death—to facilitate ranking between causes of disease and across regions. The global burden of foodborne diseases caused by the 31 hazards in 2010 was 33 million DALYs; children under five years old bore 40% of this burden.

The policy and social impact of this report will be discussed in detail at a symposium organised by WHO and the Dutch National Institute for Public Health and the Environment (RIVM), 15-16 December in Amsterdam.

Contact information

Fadéla Chaib, WHO
Telephone: +41 22 791 32 28
Mobile: +41 79 475 55 56
E-mail: chaibf@who.int

Olivia Lawe-Davies, WHO
Telephone: +41-22-7911209
Mobile: +41-794755545
Email: lawedavieso@who.int

 

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FERG symposium

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Factsheet (click image)

WHO African Region

The WHO African Region was estimated to have the highest burden of foodborne diseases per population. More than 91 million people are estimated to fall ill and 137 000 die each year.

Diarrhoeal diseases are responsible for 70% of foodborne diseases in the African Region. Non-typhoidal Salmonella, which can be caused by contaminated eggs and poultry, causes the most deaths, killing 32 000 a year in the Region—more than half of the global deaths from the disease. 10% of the overall foodborne disease burden in this Region is caused byTaenia solium (the pork tapeworm).

Chemical hazards, specifically cyanide and aflatoxin, cause one quarter of deaths from foodborne diseases in the Region. Konzo, a particular form of paralysis caused by cyanide in cassava, is unique to the African Region, resulting in death in 1 in 5 people affected.

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WHO Region of the Americas

The WHO Region of the Americas is estimated to have the second lowest burden of foodborne diseases globally. Nevertheless 77 million people still fall ill every year from contaminated food, with an estimated 9000 deaths annually in the Region. Of those who fall ill, 31 million are under the age of 5 years, resulting in more than 2000 of these children dying a year.

While the overall burden of diarrhoeal diseases is lower than in other Regions, it is still the most common foodborne disease in the Region of the Americas with Norovirus, Campylobacter, E. coli and non-typhoidal Salmonella causing 95% of cases.

Toxoplasmosis and the pork tapeworm (Taenia solium) are very important food safety concerns in the Central and South America. Toxoplasmosis is spread through undercooked or raw meat and fresh produce, and can result in impaired vision and neurological conditions.

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WHO Eastern Mediterranean Region

The Eastern Mediterranean Region has the third highest estimated burden of foodborne diseases per population, after the African and South-East Asia Regions. More than 100 million people living in the Eastern Mediterranean Region are estimated to become ill with a foodborne disease every year and 32 million of those affected are children under 5 years.

Diarrhoeal diseases (caused by E. coli, Norovirus, Campylobacter and non-typhoidal Salmonella) account for 70% of the burden of foodborne disease.

An estimated 37 000 people in the Eastern Mediterranean Region die each year from unsafe food, caused primarily by diarrhoeal diseases, typohoid fever, hepatitis A, and brucellosis. Both typhoid fever and hepatitis A are contracted from food contaminated by the faeces of an infected person and brucellosis is commonly caused by unpasteurized milk or cheese of infected goats or sheep. Half of the global cases of brucellosis are in people living in this Region, with more than 195 000 people infected every year, causing fever, muscle pain or more severe arthritis, chronic fatigue, neurologic symptoms and depression.

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WHO European Region

The report highlights that although the WHO European Region has the lowest estimated burden of foodborne diseases globally, more than 23 million people in the Region fall ill from unsafe food every year, resulting in 5000 deaths.

Diarrhoeal diseases account for the majority of foodborne illnesses in the WHO European Region with the most common being Norovirus infections, causing an estimated 15 million cases, followed by campylobacteriosis, causing close to 5 million cases. Non-typhoid salmonellosis causes the highest number of deaths—almost 2000 annually.

Foodborne toxoplasmosis, a severe parasitic disease spread through undercooked or raw meat and fresh produce, may cause up to 20% of the total foodborne disease burden and affects more than 1 million people in the Region each year. Listeria infection also has a severe impact on the health of people who contract it and causes an estimated 400 deaths in the European Region annually. Listeria can result in septicaemia and meningitis, and is usually spread by consuming contaminated raw vegetables, ready-to-eat meals, processed meats, smoked fish or soft cheeses.

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WHO South-East Asia Region

The WHO South-East Asia Region has the second highest burden of foodborne diseases per population, after the African Region. However, in terms of absolute numbers, more people living in the WHO South-East Asia Region fall ill and die from foodborne diseases every year than in any other WHO Region, with more than 150 million cases and 175 000 deaths a year. Some 60 million children under the age of 5 fall ill and 50 000 die from foodborne diseases in the South-East Asia Region every year.

Diarrhoeal disease causing agents, Norovirus, non-typhoidal Salmonellaand pathogenic E. coli cause the majority of foodborne disease deaths in the Region. Additionally, the pork tapeworm (Taenia solium) has a major impact on health. It can cause cysts to develop in the brain, which is the most frequent preventable cause of epilepsy worldwide.

Globally, half of the people who are infected and die from either Typhoid fever or hepatitis A reside in the South-East Asia Region.

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WHO Western Pacific Region

Every year, 125 million people in the WHO Western Pacific Region become ill from contaminated food, causing more than 50 000 deaths. As in other Regions, the burden is highest in children under 5 years of age with 40 million falling ill and 7000 dying every year.

Unlike other Regions of the world, where diarrhoeal diseases cause the highest proportion of deaths, aflatoxin is estimated to be the leading cause of foodborne disease deaths in the Western Pacific Region. Aflatoxin is a toxin produced by mould that grows on grain that has been stored inappropriately, and can cause liver cancer, one of the most deadly forms of cancer. More than 10 000 people in the Western Pacific are estimated to develop liver cancer due to aflatoxin every year, with the disease proving fatal in 9 out of 10 people. An estimated 70% of people who become ill from aflatoxin worldwide live in the WHO Western Pacific Region.

The Western Pacific Region also has the highest death rate from foodborne parasites, particularly the Chinese liver fluke (Clonorchis sinensis), Echinococcus multilocularis and Taenia solium (the pork tapeworm). The Chinese liver fluke, which is commonly contracted through raw and incorrectly processed or cooked fish, infects more than 30 000 people in the Region a year, causing death in 1 in 5 cases. Almost all of those who are infected with Chinese liver fluke in the world live in the Western Pacific. The highest disease burden results from the disabling impact ofParagonimus spp. infections of the lungs and central nervous system.

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