15 3. Interventions for dog-borne zoonoses. – Current initiatives to control The fourth international meeting on Neglected Zoonotic Diseases (NZD4) and Shona Lee, whose summing up underpinned a lively discussion at the end of the . FAO–OIE–WHO World Rabies Day joint in the training of thousands of health. Providing adequate in-person, hands-on training for zoonotic infections in either . at a 2-day workshop, Achieving Sustainable Global Capacity for Surveillance .. human deaths in 15 countries recorded through the end of June 2, , .. to meet the challenge of surveillance for zoonotic diseases (facilities, trained. All papers were circulated electronically to consultants prior to the meeting. The programmes must include training of the relevant professionals. .. Freeze pork in slices less than 15 cm thick for 20 days at °C to kill any worms. .. off an emergency FAO EMPRES mission to Guinea-Bissau at the end of May
Prioritization Criteria Six of the 7 countries selected 5 disease-ranking criteria; 1 country selected 6 criteria. All selected criteria were categorized into 7 overarching topic areas; 4 of those topics were further broken down into 2—3 more specific subtopics Table 2. All 7 countries ranked diseases on the basis of social, economic, or environmental impact.
Six of 7 countries ranked zoonotic diseases on the basis of availability of proven interventions, epidemic or pandemic potential, and severity of disease in humans; 5 ranked zoonoses on the basis of documented presence of disease in the country or region. Next were documented presence of disease in the country or region, and economic, environmental, or social impact. Last, availability of proven interventions and all other remaining criteria categories were assigned the lowest weight.
However, no single criterion stood out across all 7 workshops. Criteria Questions and Responses Six of the 7 countries created 1 single or compound question for each selected criterion. One country created 2 separate questions for 4 of their 5 criteria, for a total of 9 questions. Voting members chose ordinal variables for all responses assigned to each criteria question.
Regardless of the number of responses per question, all scores were normalized among criteria by using standard OHZDP tool methods A higher ordinal value or score was assigned to the responses for each question that correlated with a more severe, or negative, outcome. For questions that evaluated existing preventive measures, diagnostic capacity, and multisectoral collaboration, a higher ordinal score was given to responses indicating existing capacity or resources. For example, a zoonosis that could be diagnosed in the country would receive a higher score than one that could not.
Four of the 7 countries ranked a mix of endemic and emerging zoonoses; 2 ranked only endemic zoonoses 2728and 2 ranked only emerging zoonoses. Six countries ranked viral, bacterial, and fungal zoonoses, and 2 countries also ranked parasitic diseases; 1 country ranked only viral diseases. Two countries agreed to adjust their lists to incorporate other zoonoses that the voting members felt should be in the top 5, and 1 country chose to adjust the order of the rankings to better reflect importance but retained the same zoonoses.
Five countries chose a final list of 5 prioritized zoonoses, 1 country chose 6, and 1 country chose 3. The most common zoonoses seen on the final prioritized lists remained the same as the original ranked list with the exception that rabies was selected in an additional country and brucellosis was removed in 1 country Table 4. Two countries prioritized only endemic zoonoses 27 All of the emerging zoonoses prioritized by each country were viruses.
All voting members came to consensus on the final prioritized zoonoses list, modified or not. This final list was then endorsed and adopted by the participating ministries. Outcomes Six of 7 countries planned follow-up activities as part of the workshop. Twenty postworkshop action themes were identified Table 5.
All 6 countries sought to ensure that the final prioritized list and any after-action items were approved by all participating ministries. Developing or updating and approving some type of national One Health strategy, guiding principles, or workplan was also universally identified as a desired outcome of this prioritization process. Four of the 6 countries indicated plans to use this list to establish recurring meetings, a multisectoral One Health working group or coordinating mechanisms, or both; 1 country that did not list this as an outcome already has a One Health coordination mechanism in place.
The remaining action areas focused on various aspects of capacity building Table 5. Kenya, which did not plan postworkshop activities, had previously created a One Health strategic plan in Their plan included many of the same capacity-building activities stated by other countries, and prevention and control activities were already under way for 4 of the 5 prioritized zoonoses.
Several other tools and methods have been applied to prioritize zoonotic diseases 30 — 36but the OHZDP process is unique in that it enables country-led decisions using a multisectoral approach to prioritize both emerging and endemic zoonotic diseases while strengthening One Health collaborations and developing action plans to build capacity for the prioritized zoonoses.
In addition, the OHZDP tool can meet the needs of those working in areas where quantitative data on zoonoses are lacking. Last, the OHZDP process provides outcomes in a timely manner so that participants may give immediate feedback and capitalize on One Health collaborations built during the prioritization process. We have found key successes and lessons learned through the review of these workshops.
First, successful outcomes are dependent on trust, transparency, equal representation, and consensus from all relevant sectors participating in the prioritization process and approving the final prioritized list of zoonoses.
The CDC-trained OHZDP workshop facilitators not only conduct workshops but also train in-country facilitators to promote country ownership of the process and to build in-country capacity to conduct future workshops. Trained facilitators ensure that the prioritization process is standardized and conducted effectively. Our review found that most voting members were from the human To accommodate a larger number of voting participants, methods were modified in 2 workshops.
However, because these methods have not been rigorously tested, it is still advised that future workshops maintain the recommended number of participants 8 to 12 to enable more focused discussion during and timely results from the 2-day workshop. Funding partner advocacy and support of the process and future activities is a potential benefit of observer participation.
However, care is needed to ensure that the number of observers in their role as advisors and participants during discussions do not overwhelm or influence the process. Keeping to the recommended 10—15 total observers 26 is needed so that voting members can focus on the workshop process.
We recommend having an overview summary at the end of the workshop that is open to a larger group of higher level in-country representatives and other partners to share the workshop outcomes in a timely way. We found that most countries were interested in selecting criteria that targeted zoonoses known to be present in country with the following attributions: Most prioritized zoonoses were endemic diseases, illustrating that countries wanted to first focus their limited resources on diseases for which they could successfully implement enhanced diagnostic capacity, surveillance, and proven interventions.
Common priority action items identified in these workshops are highly relevant to advancing global health security, including improving data sharing between ministries, improving communication to the public, strengthening the One Health workforce, developing disease-specific subcommittees, and increasing general surveillance and outbreak response capacity.
Such activities will enhance the capacity of countries to rapidly detect, respond to, and contain public health emergencies, including outbreaks of zoonotic diseases, at their source and thereby ensure global health security. Most countries with identified priority action items planned to use this list to solicit or engage funding partners, which highlights countries taking ownership of the prioritization process, and recognizing and advocating for support around their country-specific priorities.
Six countries made sure that the prioritized list and any after-action items were approved by all participating ministries and that a national One Health strategy or multisectoral coordination mechanism was established if it had not been already. By forming or hosting these prioritization workshops with a ministerial One Health coordinating committee, these after-action plans are more readily taken up. Four of the 7 countries conducted this activity to meet Joint External Evaluation and GHSA zoonotic disease prioritization and collaboration goals.
CAPACITY BUILDINGFOR SURVEILLANCE AND CONTROLOF ZOONOTIC DISEASES
The next step is that these countries then build these plans into their existing activities. These countries are supported by global health partners to help meet these goals. As part of the continual improvement process for the OHZDP tool, we are employing postworkshop evaluations, in addition to continuing the postworkshop debriefs and facilitator interviews to ensure that these workshop continue to have successful outcomes.
Moving forward, lessons learned from OHZDP workshops conducted during — will be applied to standardize and enhance the prioritization process in the future. All 7 prioritizations were conducted during or in the wake of the West Africa Ebola outbreak This event likely influenced the outcome for 1 country that prioritized Ebola despite the disease not being endemic or a likely risk in the country or region.
Periodically repeating this prioritization process could help eliminate bias from current events, as well as aid in reevaluating if currently prioritized diseases still pose a public health threat, if sufficient capacity has been built, and if newly emerging diseases or other zoonoses need to be considered. In summary, the GHSA uses a One Health multisectoral approach to strengthen the capacity at the global and national levels to prevent, detect, and respond to human and animal infectious disease threats, whether naturally occurring or accidentally or deliberately spread, that threaten global health security.
Both endemic and emerging zoonotic diseases are recognized as being critical for global health security and related efforts. The OHZDP tool aids the GHSA mission by helping countries and regions prioritize their zoonotic diseases of greatest national concern and focusing GHSA capacity-building efforts on improving laboratory capacity, surveillance, outbreak response, and prevention activities on a few key zoonoses at first.
A multisectoral zoonotic disease prioritization with equal engagement from all sectors active in zoonotic disease work is one of the most cost-effective ways a country, especially one with limited resources, can begin using a One Health approach to prevent, detect, and respond to public health threats.
By building these capacities and strengthening One Health partnerships for prioritized diseases, a country will not only more effectively address existing diseases but also have the systems in place to be better prepared to detect and respond to new and emerging diseases that may occur and become a threat to global health security. Her interests include systems strengthening, global health, One Health, and emerging, zoonotic, and infectious diseases.
Host range and emerging and reemerging pathogens. These have often required dramatic responses from affected countries, either through their own resources or through support from international donors or non-governmental organizations.
Outbreaks of anthrax in wildlife are common features in southern and eastern Africa. Latin America and the Caribbean - The true situation of anthrax in Latin America requires definition. Under-reporting and failure to diagnose unexpected livestock deaths occurs, especially in small ruminants Turnbull, It is absent in Belize and throughout the Caribbean with the exception of the Republic of Haiti, where anthrax is endemic and which has recently experienced massive outbreaks of the disease.
However, implementation of this project has been severely affected by the political instability in that country causing insecurity for field operations. Weakness of veterinary services and lack of operational funds to control anthrax may be some of the causes for this epidemiological situation. Asia - Anthrax is enzootic in southern India but is less frequent or absent in the northern Indian states where the soil is more acidic Turnbull, In the Kingdom of Nepal the disease is endemic.
Malaysia and the Taiwan Province of China are free. The disease is limited to specific regions of the Republic of the Philippines and the Republic of Indonesia. Some countries may suppress anthrax reporting at the local or national levels for reasons of trade or for fear of a general perception of weak animal disease control infrastructure and therefore an affront to national dignity. They are therefore, the predominant phase in the environment and it is mostly through the uptake of spores that anthrax is contracted.
Within the infected host, the spores germinate to produce the vegetative forms, which multiply, elaborate potent exotoxins and eventually kill the host. Bacilli released by the dying or dead animal into the environment usually the soil under the carcass sporulate and are taken up by other animals, usually herbivores.
Within the context of economics and public health, the importance of anthrax lies in its ability to affect large numbers of livestock at one time Turnbull, Carcasses pose a hazard to humans and other animals in both in the vicinity and at a distance through their meat, hides, hair, wool or bones. The role of scavenging birds, such as vultures Gyps africanusmay be significant in the transport of anthrax-infected carcass parts over distances.
Hides, skins, hair, wool and bones may be transported long distances for use in industries, feedstuffs or handicrafts. It is a requirement that transport of drums and other handicrafts with animal hides from anthrax-endemic countries be certified free of anthrax organisms before export. Livestock may acquire the disease through contaminated feedstuffs or from spores that have reached fields in sewage sludge.
It is generally recognized that ingestion of the spores while grazing is a frequent mode of uptake. In view of associations between times of higher incidence and dry, hot conditions, theories have arisen that at such times, the animal is forced to graze dry, spiky grass close to the soil.Zoonotic Diseases/Zoonoses - Diseases You Can Get From your Pets
The spiky grass and grit produce gastrointestinal lesions and if the soil is contaminated with anthrax spores there is a high chance of infection occurring. Contaminated feedstuffs have been a significant source of infection, especially in developed countries. The source can either be improperly treated locally-produced meat-and-bone meal salvaged from moribund or fallen stock, or imported infected bones or contaminated meat-and-bone meals.
The ban on feeding meat-and-bone meal supplements to ruminants due to risk of infection with BSE may reduce this threat of anthrax spread. The examination of associations between climatic conditions and peak anthrax periods around the world has resulted in a number of theories Turnbull, The hypotheses are that: ANTHRAX IN MAN The principal sources of anthrax infection in man are direct or indirect contact with infected animals, or occupational exposure to infected or contaminated animal products such as hides, skins and wool.
Human case rates for anthrax are highest in Africa, the Middle East, and central and southern Asia. Where the disease is infrequent or rare in livestock, it is rarely seen in humans. Consumption of meat from, or skinning of, animals that have died suddenly have been the principal causes of anthrax outbreaks in humans.
The outbreaks of anthrax that occurred in humans in Zimbabwe in affected thousands of people, although in this case the fatality rate was low. Deliberate release of anthrax as part of a military offensive during the Zimbabwe war of liberation was suspected Nass, Three syndromes are recognized in man: During the biotic phase, animals die from the disease, the carcasses are opened by scavengers, and the anthrax spores that form contaminate the environment.
During the abiotic phase, spores are washed down drainage channels to low-lying poorly drained areas such as flood plains where they accumulate in the upper soil.
The spores could become suspended in drinking water and during droughts when water levels are low, animals become infected when they drink from the water-holes. In countries with warmer climates the occurrence of anthrax is closely integrated with the soil phase.
In countries with cold climates the temperature is unfavourable for growth and sporulation of anthrax bacilli and the disease is self-limiting.
Peak incidence may occur in winter when animals are stall-fed with feed prepared with contaminated fodder and feed supplements from anthrax-endemic areas. From August to Novemberthe Malilangwe Wildlife Reserve in Zimbabwe experienced massive outbreaks of anthrax that decimated the kudu population and severely affected other wildlife species Sarah Clegg, unpublished data.
Complex epizootics of anthrax were experienced in wildlife in Botswana, Namibia and Uganda involving hippos, kudu, elephants, buffaloes and other wildlife. Isolates of the bacterium, irrespective of source or geographical location, are almost identical phenotypically and genotypically.
Phenotypically, strain differences are only apparent in non-quantifiable or semi-quantifiable characteristics such as colonial morphology, physical properties in broth culture, cell size and LD50 in animal tests Nass, The biochemical, serological or phagetyping methods used in classifying other pathogens have proved of little value for identifying different strains of B. The degree of species monomorphism could be attributed to the fact that B.
One Health Zoonotic Disease Prioritization Workshop
The capsule and the toxin complex are the two known virulence factors of B. The poly-D-glutamic acid capsule protects the bacillus from phagocytosis Nass, A toxin complex consisting of three synergistically acting proteins - protective antigen PAlethal factor LF and edema factor EF - is produced during the log phase of growth of B.
LF in combination with PA [lethal toxin] and EF in combination with PA [edema toxin] are indeed regarded as being responsible for the characteristics signs and symptoms of anthrax. The endothelial cell linings of the capillary network are susceptible to lethal toxin and the resulting necrosis of lymphatic elements and blood vessel walls may be responsible for systemic release of the bacilli and for the characteristic terminal haemorrhage from the nose, mouth and anus of the victim.
During the incubation period of the infection, the bacteria are filtered by the spleen and other parts of the reticuloendothelial system. At the terminal stages, the bacteria build up rapidly in the blood. The action of exotoxins on the endothelial cell lining of blood vessels results in their breakdown and subsequent extravasation of blood.
The incubation period in herbivores ranges from about 36 to 72 hours and leads into the hyperacute systemic phase, usually without discernible clinical symptoms. The first signs of an anthrax outbreak are one or more sudden deaths in the affected herd or flock. Swellings in the submandibular fossa may be apparent; temperatures may remain normal for most of the period or may rise.
History is of major importance in the diagnosis of anthrax. Ruminants - sudden death, bleeding from orifices, subcutaneous haemorrhages. Equines and some wild herbivores - transient symptoms such as fever, restlessness, dyspnoea and agitation may be apparent. Pigs, carnivores, primates - local oedema and swelling of face and neck or of lymph nodes, particularly the mandibular and pharyngeal and the mesenteric.
The characteristic ground glass appearance on blood agar and absence of haemolysis makes this the medium of choice. In decomposed carcasses, confirmation of anthrax may depend on isolation from soil contaminated by the terminal discharges from the dead animal. Generally, there has been little need for serological or immunological tests as such methods are unreliable for the diagnosis of anthrax.
Distinguishing characteristics of other bacilli species such as B.
Disease control will not be cost effective or efficient if surveillance is not an integral part of a disease management programme.
In a number of countries, humans unknowingly serve as sentinels as a result of the differential quality and availability of medical and veterinary diagnostic laboratories. As a result, anthrax cases in animals are often missed thus diminishing the impact of the disease and the direction of control efforts.
A case in point is the current outbreak, in Mayof anthrax in Guinea-Bissau, where the disease was first detected in humans through isolation of the organism from a skin carbuncle, before the veterinary authorities were alerted to mortality in cattle caused by anthrax. Specific objectives of surveillance Objectives of an anthrax surveillance programme can be summarized as follows. Evaluate the health of animal populations at risk.
Estimate the extent and geographical distribution of the disease in the animal population. Identify high risk areas and animal populations. Evaluate the need for interventions, establishing priorities and allocating resources. Facilitate planning and communication in both human and animal health sectors. Develop a database for regular communications to people and institutions directly involved in anthrax control and prevention including the media.
Evaluate prevention and control activities by monitoring disease trends and measuring the impact of programmes programme evaluation and cost-effectiveness.
Monitor changes in the epidemiological patterns of the disease to be able to modify control activities appropriately, by monitoring: Case definition The unit of reference is usually the herd or flock rather than the individual animal. An identification system should ideally be in place for surveillance to be effective. Environmental surveillance of anthrax using soil samples is of importance in mapping out the potential areas of anthrax outbreaks for the implementation of strategic control of the disease.
Clinical surveillance and bio-surveillance based on characteristic features of anthrax are essential elements in the overall surveillance for the disease. Anthrax control measures are aimed principally at breaking the cycle of transmission. The following are the key elements of a control programme that could be implemented to control the disease.
Correct disposal of anthrax carcasses. Correct disinfection, decontamination and disposal of contaminated materials. Vaccination of exposed susceptible animals and humans in at-risk occupations. The Sterne vaccine strain 34F2 nonencapsulateddeveloped in the Republic of South Africa inremains the most potent vaccine for the protection of animals domestic and wildlife against the disease.
One Health Zoonotic Disease Prioritization Workshop | One Health | CDC
The 34F2 vaccine strain retains some level of virulence for goats. Adoption of quarantine and movement management controls. The debate in some countries as to whether anthrax vaccination is of public or private good has led to a drastic decline in the number of animals vaccinated against the disease because it has been left in private hands.
Past successes in the control of anthrax has led to complacency leading to reoccurrence of the disease in areas where it was thought to have been controlled. An important adjunct to the control of anthrax is public awareness creation and intersectoral collaboration between Ministries of Health and veterinary departments of Ministries of Agriculture. Farmer education and general public awareness on the dangers of consuming animals that die suddenly are very important in this regard.
In many herbivorous animal species, anthrax is so rapid that diagnosis can hardly be made before death. In special situations, prophylactic antibiotic treatment may be possible. International cooperation in anthrax control WHO has produced many publications on anthrax, with the active participation of FAO.
An authoritative publication Turnbull, has been put out by WHO to provide technical guidelines for the control of anthrax in both human and animals. Data on anthrax outbreaks worldwide provided by the OIE together with publication on standards for anthrax vaccine production and diagnostic tests http: Like the control of most animal diseases, an effective and functional veterinary service, with the correct channels for animal disease reporting and early reaction capabilities, is essential to the control of anthrax.
Most countries have laid down procedures and regulations for reporting animal disease outbreaks especially anthrax. Problems that exist with the control of the disease stem from failure to implement regulations due to several factors rather than from the non-existence of regulatory frameworks. Anthrax epizootic in Zimbabwe,