Human-Wildlife Interactions Predict Febrile Illness in Park Landscapes of Western Uganda

Interventions to Reduce Risk for Pathogen Spillover and Early Disease Spread to Prevent Outbreaks, Epidemics, and Pandemics

The pathogens that cause most emerging infectious diseases in humans originate in animals, particularly wildlife, and then spill over into humans. The accelerating frequency with which humans and domestic animals encounter wildlife because of activities such as land-use change, animal husbandry, and markets and trade in live wildlife has created growing opportunities for pathogen spillover. The risk of pathogen spillover and early disease spread among domestic animals and humans, however, can be reduced by stopping the clearing and degradation of tropical and subtropical forests, improving health and economic security of communities living in emerging infectious disease hotspots, enhancing biosecurity in animal husbandry, shutting down or strictly regulating wildlife markets and trade, and expanding pathogen surveillance. We summarize expert opinions on how to implement these goals to prevent outbreaks, epidemics, and pandemics.

"There are many fevers": Communities' perception and management of Febrile illness and its relationship with human animal interactions in South-Western Uganda

Diagnosing the causative agent of febrile illness in resource-limited countries is a challenge in part due to lack of adequate diagnostic infrastructure to confirm cause of infection. Most febrile illnesses (>60%) are non-malarial, with a significant proportion being zoonotic and likely from animal origins. To better characterize the pathways for zoonotic disease transmission and control in vulnerable communities, adequate information on the communities' experiences and lexicon describing fever, and their understanding and perceptions of risk pathways is required. We undertook an ethnographic study to understand behaviors, exposures, and attitudes toward fever at the community level. Our hope is to better elucidate areas of priority surveillance and diagnostic investment. A focused ethnography consisting of participant observation, informal conversations, 4 barazas (community meetings), and formal ethnographic interviews (13 Focus group discussions and 17 Key informant interviews) was conducted between April and November 2015 in Kasese and Hoima Districts in Uganda. Perception of illness and associated risk factors was heavily influenced by the predominant livelihood activity of the community. The term "fever" referred to multiple temperature elevating disease processes, recognized as distinct pathological occurrences. However, malaria was the illness often cited, treated, or diagnosed both at the health facilities and through self-diagnosis and treatment. As expected, fever is as an important health challenge affecting all ages. Recognition of malarial fever was consistent with a biomedical model of disease while non-malarial fevers were interpreted mainly through ethno etiological models of explanation. These models are currently being used to inform education and prevention strategies and treatment regimens toward the goal of improving patients' outcomes and confidence in the health system. Development of treatment algorithms that consider social, cultural, and economic contexts, especially where human-animal interaction is prevalent, should factor animal exposure and zoonotic illnesses as important differentials.

Community health and human-animal contacts on the edges of Bwindi Impenetrable National Park, Uganda

Cross-species transmission of pathogens is intimately linked to human and environmental health. With limited healthcare and challenging living conditions, people living in poverty may be particularly susceptible to endemic and emerging diseases. Similarly, wildlife is impacted by human influences, including pathogen sharing, especially for species in close contact with people and domesticated animals. Here we investigate human and animal contacts and human health in a community living around the Bwindi Impenetrable National Park (BINP), Uganda. We used contact and health survey data to identify opportunities for cross-species pathogen transmission, focusing mostly on people and the endangered mountain gorilla. We conducted a survey with background questions and self-reported diaries to investigate 100 participants' health, such as symptoms and behaviours, and contact patterns, including direct contacts and sightings over a week. Contacts were revealed through networks, including humans, domestic, peri-domestic, and wild animal groups for 1) contacts seen in the week of background questionnaire completion, and 2) contacts seen during the diary week. Participants frequently felt unwell during the study, reporting from one to 10 disease symptoms at different intensity levels, with severe symptoms comprising 6.4% of the diary records and tiredness and headaches the most common symptoms. After human-human contacts, direct contact with livestock and peri-domestic animals were the most common. The contact networks were moderately connected and revealed a preference in contacts within the same taxon and within their taxa groups. Sightings of wildlife were much more common than touching. However, despite contact with wildlife being the rarest of all contact types, one direct contact with a gorilla with a timeline including concerning participant health symptoms was reported. When considering all interaction types, gorillas mostly exhibited intra-species contact, but were found to interact with five other species, including people and domestic animals. Our findings reveal a local human population with recurrent symptoms of illness in a location with intense exposure to factors that can increase pathogen transmission, such as direct contact with domestic and wild animals and proximity among animal species. Despite significant biases and study limitations, the information generated here can guide future studies, such as models for disease spread and One Health interventions.

Comparison of Three Methods to Assess the Potential for Bushpig-Domestic Pig Interactions at the Wildlife-Livestock Interface in Uganda

Bushpigs (Potamochoerus larvatus) are considered a nuisance to farmers because of their crop raiding habits. Through their incursions into farmlands, they may interact with free-ranging domestic pigs and potentially cause transmission of infectious diseases such as African Swine Fever (ASF). The role of the bushpig in the epidemiology of ASF is poorly known and one of the gaps of knowledge is precisely the nature of interaction between bushpigs and domestic pigs. Thus, in this study, we investigated the frequency of bushpig visits to crop fields in rural communities where ASF is endemic, at the edge of a wildlife protected area in northwestern Uganda, to better understand the potential for interaction and disease transmission. We used three methods (questionnaires, camera traps, and observations for tracks) to assess bushpig visits to farmland. These methods were implemented concurrently in 28 farms during rainy and dry seasons. The results obtained by each of the three methods were analyzed by generalized linear mixed models. Potential risk factors including crop type, season, and landscape characteristics related to bushpig ecology were tested as explanatory variables. A generalized linear model and the Kendall test were used to compare the results and consistency of the frequency values obtained by the three methods. A high percentage (75%) of interviewed farmers reported visits from bushpigs in 29.6% of assessed crops (n = 145), and a frequency of 0.014 +/-0.05 visits per night was obtained through camera-trapping. Bushpig tracks were detected in 36% of sessions of observation. Cassava (Manihot esculenta) and groundnut (Arachis hypogaea L.) crop fields were the most visited, and these visits were more common during the rainy than the dry season. Distances from crop sites to the boundary of the protected area and to the river also influenced visit frequency. Camera-trapping was the least sensitive method while questionnaires and track observations presented consistent and complementary results to characterize spatial and temporal visits of bushpig into the crop fields. Evidence from our study shows that when used in combination, these methods can provide useful data to improve our understanding of the interactions between bushpigs and domestic pigs at the wildlife-domestic interface.