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

Is there an association between plastic consumption (by animals), quality of meat and public health?

We would like to bring to your attention a documentary that appeared in the NTV (Kenya) on 21st August 2017 as part of a short baseline study between UNEP and the ILRI-ZED Group and which can be accessed at the video at end of this post:

Cases: It is noted that out of 100 animals that are slaughtered 10-15 have plastic materials in their rumen with cases prevalent among animals reared in the urban and peri-urban areas.

Seasonality: Mainly an issue during dry periods due to scarce food

Impact to animals: Plastics lodge in the rumen of the ruminants and thus affecting the normal motility of the rumen. The impaired motility of the rumen results to poor nutrient absorption and altered normal feeding with consequent poor weight gain and diminished health status.

Impact to humans: The public health implications is an area that is further being explored.

Your feedback on this subject is welcome (send us your feedback through our Contact Page )

The video clip originally appeared on the Kenya NTV YouTube channel available at this: https://www.youtube.com/watch?v=1eHcZ2mPvbs

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.

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”

womanandlivestockatdandoragarbagedump_cropped
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

Dr. John Kiiru: My experience as a Post Doc

I joined the Urban Zoo Project in June 2014 as a laboratory coordinator. The Urban Zoo study is a collaborative project bringing together experts from various institutions in the UK (University of Liverpool, The Royal Veterinary College, University of Edinburgh etc.),  and at least three institutions in Kenya (The University of Nairobi (UoN), International Livestock Research Institute (ILRI) and the Kenya Medical Research Institute (KEMRI). The Team in ILRI handles the fieldwork while the teams at KEMRI and UoN handle the lab work. My main responsibility has been to develop standard protocols for use in the two labs and to ensure that the data generated is not only robust, but accurate. The two labs have approximately 10 technicians, numerous students on attachments and a number of interns from Kenya and the UK.

esei-meeting

With Lord Alexander Trees in London during an ESEI meeting

In order to appreciate the uniqueness of zoonoses, it is important to realize that there are approximately 600 pathogens which are known to infect humans and 61% of these cause zoonotic diseases. Zoonotic bacteria originating from food animals can reach people through direct faecal oral route, contaminated animal food products, improper food handling, and inadequate cooking.  These diseases have a negative im-pact on travel, commerce, and economies worldwide. It has been my view that the unique dynamic interaction between the humans, animals, and pathogens, sharing the same environment should be considered within the “One Health” approach, which dates back to ancient times of Hippocrates. The Urban Zoo project combines mapping, sampling from humans, animals and their environment, determination of antimicrobial resistance profiles and whole genome sequencing of isolates obtained from human and environmental sources. Joining this study therefore gave me that unique opportunity to gain a lot of insights in this subject.

The very fact that this study brings so many experts with unique expertise together makes Urban Zoo project unique. Work-ing with different labs requires substantial managerial skills and the need to consult and reach consensus on all major issues that impact on the quality of the data generated. Through my engagement in the study, I have not only gained considerable organization/leadership skills, but also better communication skills. My participation in this study has also impacted positively on my career and I have been invited as an expert in antimicrobial resistance as a trainer in international workshops by the WHO, the Welcome Trust Advanced Courses and for the drafting on a situation paper by the FAO on application of whole genome sequencing of foodborne pathogens in developing countries.

This article has been written by  John Kiiru (Post Doc under the 99HH Study, based jointly between the KEMRI and International Livestock Research Institute (ILRI) in Kenya). 

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