A One Health, participatory epidemiology assessment of anthrax (Bacillus anthracis) management in Western Uganda

Approaches for disease prioritization and decision-making in animal health, 2000-2021: a structured scoping review

This scoping review identifies and describes the methods used to prioritize diseases for resource allocation across disease control, surveillance, and research and the methods used generally in decision-making on animal health policy. Three electronic databases (Medline/PubMed, Embase, and CAB Abstracts) were searched for articles from 2000 to 2021. Searches identified 6, 395 articles after de-duplication, with an additional 64 articles added manually. A total of 6, 460 articles were imported to online document review management software (sysrev.com) for screening. Based on inclusion and exclusion criteria, 532 articles passed the first screening, and after a second round of screening, 336 articles were recommended for full review. A total of 40 articles were removed after data extraction. Another 11 articles were added, having been obtained from cross-citations of already identified articles, providing a total of 307 articles to be considered in the scoping review. The results show that the main methods used for disease prioritization were based on economic analysis, multi-criteria evaluation, risk assessment, simple ranking, spatial risk mapping, and simulation modeling. Disease prioritization was performed to aid in decision-making related to various categories: (1) disease control, prevention, or eradication strategies, (2) general organizational strategy, (3) identification of high-risk areas or populations, (4) assessment of risk of disease introduction or occurrence, (5) disease surveillance, and (6) research priority setting. Of the articles included in data extraction, 50.5% had a national focus, 12.3% were local, 11.9% were regional, 6.5% were sub-national, and 3.9% were global. In 15.2% of the articles, the geographic focus was not specified. The scoping review revealed the lack of comprehensive, integrated, and mutually compatible approaches to disease prioritization and decision support tools for animal health. We recommend that future studies should focus on creating comprehensive and harmonized frameworks describing methods for disease prioritization and decision-making tools in animal health.

Anthrax bio-surveillance of livestock in Arua District, Uganda, 2017-2018

Anthrax, caused by Bacillus anthracis, is a widespread zoonotic disease with many human cases, especially in developing countries. Even with its global distribution, anthrax is a neglected disease with scarce information about its actual impact on the community level. Due to the ecological dynamics of anthrax transmission at the wildlife-livestock interface, the Sub-Saharan Africa region becomes a high-risk zone for maintaining and acquiring the disease. In this regard, some subregions of Uganda are endemic to anthrax with regular seasonal trends. However, there is scarce data about anthrax outbreaks in Uganda. Here, we confirmed the presence of B. anthracis in several livestock samples after a suspected anthrax outbreak among livestock and humans in Arua District. Additionally, we explored the potential risk factors of anthrax through a survey within the community kraals. We provide evidence that the most affected livestock species during the Arua outbreak were cattle (86%) compared to the rest of the livestock species present in the area. Moreover, the farmers' education level and the presence of people's anthrax cases were the most critical factors determining the disease's knowledge and awareness. Consequently, the lack of understanding of the ecology of anthrax may contribute to the spread of the infection between livestock and humans, and it is critical to reducing the presence and persistence of the B. anthracis spores in the environment. Finally, we discuss the increasingly recognized necessity to strengthen global capacity using a One Health approach to prevent, detect, control, and respond to public threats in Uganda.

Co-created community contracts support biosecurity changes in a region where African swine fever is endemic – Part II: Implementation of biosecurity measures

Smallholder subsistence pig production is common in Uganda and African swine fever (ASF) is endemic in the country, with its spread driven by human activities along the smallholder value chain. Previous research in the study area has revealed that many stakeholders are aware of how ASF is spread, its prevention and control, and have a generally positive attitude towards biosecurity. Despite this, even basic biosecurity is largely lacking. Costs, as well as a lack of adaptation to the local context, culture and traditions have been identified as factors hindering biosecurity implementation. Community engagement and local ownership of disease problems are increasingly recognised as important for improving disease prevention and control. The objective of this study was to investigate the capacity of participatory action at community level with broad inclusion of stakeholders to improve biosecurity in the smallholder pig value chain. Specific attention was paid to participants' perceptions and experiences of implementing the biosecurity measures included in their co-created community contracts. The study was conducted in Northern Uganda in villages purposively selected on the basis of previous occurrences of ASF. In each village, farmers and traders were also purposively selected. At a first meeting, basic information about ASF was shared and participants presented with a list of biosecurity measures adapted for farmers and traders respectively. Participants discussed each measure in farmer and trader subgroups, decided on the measures to implement for one year, and signed a community contract to this effect. The following year, interviews were again undertaken and implementation support given. Interview data were coded and thematically analysed. Each subgroup chose a minimum of three and a maximum of nine measures, with wide variations between villages in their selection of measures. At the follow-ups, none of the subgroups had fully implemented what had been agreed in their contract, but all had changed some of their biosecurity routines. Some frequently recommended biosecurity measures, such as not borrowing breeding boars, were not considered feasible. Relatively simple and cheap biosecurity measures were rejected for reasons of cost, highlighting the participants' general level of poverty and the relevance of poverty as a specific factor governing disease control results. The participatory methodology allowing for discussions, co-creation and the option to refuse measures seemed to facilitate the implementation of measures that had initially been thought to be controversial. The broad community approach was deemed to be positive for strengthening community identity, cooperation and implementation.

Establishing a Public Health Emergency Operations Center in an Outbreak-Prone Country: Lessons Learned in Uganda, January 2014 to December 2021

Uganda is highly vulnerable to public health emergencies (PHEs) due to its geographic location next to the Congo Basin epidemic hot spot, placement within multiple epidemic belts, high population growth rates, and refugee influx. In view of this, Uganda's Ministry of Health established the Public Health Emergency Operations Center (PHEOC) in September 2013, as a central coordination unit for all PHEs in the country. Uganda followed the World Health Organization's framework to establish the PHEOC, including establishing a steering committee, acquiring legal authority, developing emergency response plans, and developing a concept of operations. The same framework governs the PHEOC's daily activities. Between January 2014 and December 2021, Uganda's PHEOC coordinated response to 271 PHEs, hosted 207 emergency coordination meetings, trained all core staff in public health emergency management principles, participated in 21 simulation exercises, coordinated Uganda's Global Health Security Agenda activities, established 6 subnational PHEOCs, and strengthened the capacity of 7 countries in public health emergency management. In this article, we discuss the following lessons learned: PHEOCs are key in PHE coordination and thus mitigate the associated adverse impacts; although the functions of a PHEOC may be legalized by the existence of a National Institute of Public Health, their establishment may precede formally securing the legal framework; staff may learn public health emergency management principles on the job; involvement of leaders and health partners is crucial to the success of a public health emergency management program; subnational PHEOCs are resourceful in mounting regional responses to PHEs; and service on the PHE Strategic Committee may be voluntary.

Social insights on the implementation of One Health in zoonosis prevention and control: a scoping review

Background

The One Health (OH) concept has been promoted widely around the globe. OH framework is expected to be applied as an integrated approach to support addressing zoonotic diseases as a significant global health issue and to improve the efficiency and effectiveness of zoonosis prevention and control. This review is intended to overview the social impact of the implementation of OH on zoonosis prevention and control.

Methods

A scoping review of studies in the past 10 years was performed to overview the integration feature of OH in zoonosis prevention and control and the social impacts of OH. PubMed and Web of Science were searched for studies published in English between January 2011 and June 2021. The included studies were selected based on predefined criteria.

Results

Thirty-two studies were included in this review, and most of them adopted qualitative and semi-qualitative methods. More than 50% of the studies focused on zoonosis prevention and control. Most studies were conducted in low- and middle-income countries in Africa and Asia. Applying OH approach in diseases control integrates policymakers, stakeholders, and academics from various backgrounds. The impact of OH on economic is estimated that it may alleviate the burden of diseases and poverty in the long term, even though more financial support might be needed at the initial stage of OH implementation. OH implementation considers social and ecological factors related to zoonosis transmission and provides comprehensive strategies to assess and address related risks in different communities according to regions and customs.

Conclusions

Based on reviewed literature, although there seems to be a lack of guidelines for assessing and visualizing the outcomes of OH implementation, which may limit the large-scale adoption of it, evidence on the contributions of implementing OH concepts on zoonosis prevention and control indicates long-term benefits to society, including a better integration of politics, stakeholders and academics to improve their cooperation, a potential to address economic issues caused by zoonosis, and a comprehensive consideration on social determinants of health during zoonosis prevention and control.

Zootherapy as a potential pathway for zoonotic spillover: a mixed-methods study of the use of animal products in medicinal and cultural practices in Nigeria

BACKGROUND

Understanding how and why people interact with animals is important for the prevention and control of zoonoses. To date, studies have primarily focused on the most visible forms of human-animal contact (e.g., hunting and consumption), thereby blinding One Health researchers and practitioners to the broader range of human-animal interactions that can serve as cryptic sources of zoonotic diseases. Zootherapy, the use of animal products for traditional medicine and cultural practices, is widespread and can generate opportunities for human exposure to zoonoses. Existing research examining zootherapies omits details necessary to adequately assess potential zoonotic risks.

METHODS

We used a mixed-methods approach, combining quantitative and qualitative data from questionnaires, key informant interviews, and field notes to examine the use of zootherapy in nine villages engaged in wildlife hunting, consumption, and trade in Cross River State, Nigeria. We analyzed medicinal and cultural practices involving animals from a zoonotic disease perspective, by including details of animal use that may generate pathways for zoonotic transmission. We also examined the sociodemographic, cultural, and environmental contexts of zootherapeutic practices that can further shape the nature and frequency of human-animal interactions.

RESULTS

Within our study population, people reported using 44 different animal species for zootherapeutic practices, including taxonomic groups considered to be "high risk" for zoonoses and threatened with extinction. Variation in use of animal parts, preparation norms, and administration practices generated a highly diverse set of zootherapeutic practices (n = 292) and potential zoonotic exposure risks. Use of zootherapy was patterned by demographic and environmental contexts, with zootherapy more commonly practiced by hunting households (OR = 2.47, p < 0.01), and prescriptions that were gender and age specific (e.g., maternal and pediatric care) or highly seasonal (e.g., associated with annual festivals and seasonal illnesses). Specific practices were informed by species availability and theories of healing (i.e., "like cures like" and sympathetic healing and magic) that further shaped the nature of human-animal interactions via zootherapy.

CONCLUSIONS

Epidemiological investigations of zoonoses and public health interventions that aim to reduce zoonotic exposures should explicitly consider zootherapy as a potential pathway for disease transmission and consider the sociocultural and environmental contexts of their use in health messaging and interventions.

Isolation and identification of avirulent strains of Bacillus anthracis from environmental samples in Central Java, Indonesia

Background and Aim: Anthrax is a non-contagious infectious disease caused by Bacillus anthracis. The bacteria form spores that are resistant to extreme conditions and can contaminate the environment for decades. This study aimed to detect and characterize B. anthracis found in endemic areas of anthrax in Yogyakarta and Central Java province, Indonesia. Materials and Methods: Soil samples were collected from Gunungkidul regency, Yogyakarta province (n=315) and Boyolali regency, Central Java province (n=100). Additional soil samples (n=10) and straw samples (n=5) were obtained from Pati regency, Central Java province. The isolation and identification of B. anthracis were performed using conventional methods: Morphology of bacteria colony in solid media, Gram staining, capsule staining, spores staining, and motility test. Isolates were further identified using polymerase chain reaction (PCR) against Ba813, lef (pXO1), and capC (pXO2) gene. An avirulent vaccine strain of B. anthracis (strain 34F2) was used as a control. Results: Only four samples grew on blood agar with a ground-glass appearance, white-gray colony (Gunungkidul and avirulent strain) or yellowish (Boyolali and Pati). All were Gram-positive, presented chains, square-ended rods, spores, and were then identified as B. anthracis. Boyolali, Pati, and avirulent strain isolates had slightly different characteristics, including the growth of non-mucoid in the bicarbonate agar medium, and their uncapsulated form. The PCR showed two Gunungkidul isolates which amplified three genes, including Ba813, lef, and capC. Contrarily, the other isolates did not amplify the capC gene. Conclusion: Gunungkidul isolates were identified as virulent strains of B. anthracis while Boyolali and Pati isolates were proposed as avirulent strains. This is the first report of isolation and identification of avirulent strains of B. anthracis in Central Java, Indonesia.

Cutaneous anthrax associated with handling carcasses of animals that died suddenly of unknown cause: Arua District, Uganda, January 2015-August 2017

BACKGROUND

Anthrax is a zoonotic disease that can be transmitted to humans from infected animals. During May-June 2017, three persons with probable cutaneous anthrax were reported in Arua District, Uganda; one died. All had recently handled carcasses of livestock that died suddenly and a skin lesion from a deceased person tested positive by PCR for Bacillus anthracis. During July, a bull in the same community died suddenly and the blood sample tested positive by PCR for Bacillus anthracis. The aim of this investigation was to establish the scope of the problem, identify exposures associated with illness, and recommend evidence-based control measures.

METHODS

A probable case was defined as acute onset of a papulo-vesicular skin lesion subsequently forming an eschar in a resident of Arua District during January 2015-August 2017. A confirmed case was a probable case with a skin sample testing positive by polymerase chain reaction (PCR) for B. anthracis. Cases were identified by medical record review and active community search. In a case-control study, exposures between case-patients and frequency- and village-matched asymptomatic controls were compared. Key animal health staff were interviewed to learn about livestock deaths.

RESULTS

There were 68 case-patients (67 probable, 1 confirmed), and 2 deaths identified. Cases occurred throughout the three-year period, peaking during dry seasons. All cases occurred following sudden livestock deaths in the villages. Case-patients came from two neighboring sub-counties: Rigbo (attack rate (AR) = 21.9/10,000 population) and Rhino Camp (AR = 1.9/10,000). Males (AR = 24.9/10,000) were more affected than females (AR = 0.7/10,000). Persons aged 30-39 years (AR = 40.1/10,000 population) were most affected. Among all cases and 136 controls, skinning (ORM-H = 5.0, 95%CI: 2.3-11), butchering (ORM-H = 22, 95%CI: 5.5-89), and carrying the carcass of livestock that died suddenly (ORM-H = 6.9, 95%CI: 3.0-16) were associated with illness.

CONCLUSIONS

Exposure to carcasses of animals that died suddenly was a likely risk factor for cutaneous anthrax in Arua District during 2015-2017. The recommendations are investigation of anthrax burden in livestock, prevention of animal infections through vaccinations, safe disposal of the carcasses, public education on risk factors for infection and prompt treatment of illness following exposure to animals that died suddenly.

Cutaneous anthrax outbreak associated with handling dead animals, Rhino Camp sub-county: Arua District, Uganda, January-May 2018

BACKGROUND

On 18 January 2018 a 40 year old man presented with skin lesions at Rhino Camp Health Centre. A skin lesion swab was collected on 20 January 2018 and was confirmed by PCR at Uganda Virus Research Institute on 21 January 2018. Subsequently, about 9 persons were reported to have fallen ill after reporting contact with livestock that died suddenly. On 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. We investigated to determine the scope and mode of transmission and exposures associated with identified anthrax to guide control and prevention measures.

METHODS

We defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December 2017 to 31 May 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test.

RESULTS

We identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (affected proportion: 12/10,000). Mean age of case-persons was 33 years (SD: 22). The outbreak lasted for 5 months, from January 2018-May 2018, peaking in February. Skinning (risk ratio = 2.7, 95% CI = 1.1-6.7), dissecting (RR = 3.0, 95% CI = 1.2-7.6), and carrying dead animals (RR = 2.7, 95% CI = 1.1-6.7) were associated with increased risk of illness, as were carrying dissected parts of animals (RR = 2.9, 95% CI 1.3-6.5) and preparing and cooking the meat (RR = 2.3, 95% CI 0.9-5.9). We found evidence of animal remains on pastureland.

CONCLUSION

Multiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

Prioritizing smallholder animal health needs in East Africa, West Africa, and South Asia using three approaches: Literature review, expert workshops, and practitioner surveys

Managing the health needs of livestock contributes to reducing poverty and improving the livelihoods of smallholder and pastoralist livestock keepers globally. Animal health practitioners, producers, policymakers, and researchers all must prioritize how to mobilize limited resources. This study employed three approaches to prioritize animal health needs in East and West Africa and South Asia to identify diseases and syndromes that impact livestock keepers. The approaches were a) systematic literature review, b) a series of expert workshops, and c) a practitioner survey of veterinarians and para-veterinary professionals. The top constraints that emerged from all three approaches include endo/ ectoparasites, foot and mouth disease, brucellosis, peste des petits ruminants, Newcastle disease, and avian influenza. Expert workshops additionally identified contagious caprine pleuropneumonia, contagious bovine pleuropneumonia, mastitis, and reproductive disorders as constraints not emphasized in the literature review. Practitioner survey results additionally identified nutrition as a constraint for smallholder dairy and pastoralist small ruminant production. Experts attending the workshops agreed most constraints can be managed using existing veterinary technologies and best husbandry practices, which supports a shift away from focusing on individual diseases and new technologies towards addressing systemic challenges that limit access to veterinary services and inputs. Few research studies focused on incidence/ prevalence of disease and impact, suggesting better incorporation of socio-economic impact measures in future research would better represent the interests of livestock keepers.

With or without a Vaccine-A Review of Complementary and Alternative Approaches to Managing African Swine Fever in Resource-Constrained Smallholder Settings

The spectacular recent spread of African swine fever (ASF) in Eastern Europe and Asia has been strongly associated, as it is in the endemic areas in Africa, with free-ranging pig populations and low-biosecurity backyard pig farming. Managing the disease in wild boar populations and in circumstances where the disease in domestic pigs is largely driven by poverty is particularly challenging and may remain so even in the presence of effective vaccines. The only option currently available to prevent ASF is strict biosecurity. Among small-scale pig farmers biosecurity measures are often considered unaffordable or impossible to implement. However, as outbreaks of ASF are also unaffordable, the adoption of basic biosecurity measures is imperative to achieve control and prevent losses. Biosecurity measures can be adapted to fit smallholder contexts, culture and costs. A longer-term approach that could prove valuable particularly for free-ranging pig populations would be exploitation of innate resistance to the virus, which is fully effective in wild African suids and has been observed in some domestic pig populations in areas of prolonged endemicity. We explore available options for preventing ASF in terms of feasibility, practicality and affordability among domestic pig populations that are at greatest risk of exposure to ASF.

Accounting for One Health: Insights from the social sciences

This paper discusses the relationship between One Health (OH) and the social sciences. Using a comparison between three narratives of the history of OH, it is argued that OH can be studied as a social phenomenon. The narrative of OH by its promoters (folk narratives) emphasizes two dimensions: OH as a renewal of veterinary medicine and OH as an institutional response to global health crises. Narratives from empirical social science work explore similar dimensions, but make them more complex. For political sociology, OH is the result of negotiations between the three international organisations (WHO, OIE and FAO), in a context of a global health crisis, which led to the reconfiguration of their respective mandates and scope of action: OH is a response to an institutional crisis. For the sociology of science, OH testifies to the evolution of the profession and veterinary science, enabling it to position itself as a promoter of interdisciplinarity, in a context of convergence between research and policy. In the Discussion section, I propose an approach to OH as an “epistemic watchword”: a concept whose objective is to make several actors work together (watchword), in a particular direction, that of the production of knowledge (epistemic).

The pattern of anthrax at the wildlife-livestock-human interface in Zimbabwe

Anthrax is an important but neglected zoonosis in southern Africa and elsewhere which occurs naturally in herbivorous wildlife and livestock. Fatal outbreaks in animals are spaced by potentially extended periods of non-activity during which the bacterium is maintained in soil. The ecology of the pathogen in the multi-host system and the environment is still not fully understood. This study investigated the patterns of anthrax in Zimbabwe in order to better understand the occurrence of disease in susceptible wildlife and livestock and hence its control. The study used available data in governmental reports between 1995 and 2018 and structured interviewer-administered questionnaires of local communities in three porous wildlife-livestock-human interface sites where livestock/wildlife interactions were documented from previous researches. Two non-interface sites were also included for comparison based on known previous anthrax outbreaks. Respondents from non-interface sites had significantly higher odds (χ² = 23.2, OR = 3.5, 2.1<OR<5.8, p<0.001) of reporting anthrax outbreaks than their counterparts at the interface. Overall 20.0% (74/372) of the respondents reported that some anthrax carcasses were left to dissipate into the environment indicating a risk of environmental contamination. In livestock a total of 214 outbreaks with 2911 losses (mainly cattle) were recorded between 2000 and 2018, while 10 outbreaks with 3171 deaths were noted in wildlife. In humans 99 outbreaks were recorded involving 903 individual cases with 16 fatalities due to enteric infections following the consumption of infected meat between 2010 and 2018. Since its first incidence in wildlife in 2004–2005 in the south-eastern Lowveld of Zimbabwe, anthrax appears to be establishing endemic status along the Zambezi River basin. The disease has expanded spatially affecting 45 (72.6%) of the country’s 62 rural districts in a single decade. Thus, robust multi-disciplinary efforts are encouraged for surveillance and disease containment measures to minimize its impact on livestock, wildlife and humans.

Anthrax is an expanding zoonotic and tropical disease which negatively impacts livestock, wildlife and human health ultimately impacting livelihoods and biodiversity conservation. In this work we have shown it to be a serious disease in Zimbabwe where its surveillance and control are sub-optimum even though it is causing serious losses in animals and human health. Observed practices such as the non-burial of infected carcasses subsequently contaminating the environment following anthrax outbreaks in animals, have most likely contributed to its expansion in geographic range and the increase in frequency of outbreaks. Since the late 1970s, the disease status has changed from that causing a low-level mortality in livestock, probably due to underreporting, to a common disease in livestock, wildlife and humans. It is hoped that by quantifying the impact of the disease across livestock, wildlife and human health and livelihoods, and establishing factors responsible for its continued expansion, adequate resources for surveillance and containment of anthrax will be allocated in order to improve rural livelihoods and also enhance wildlife conservation.

"Can we agree on that"? Plurality, power and language in participatory research

Participatory epidemiology (PE) is a method that gathers data from groups through focus group interviews and participatory visual and scoring exercises. The method is often used in poor communities in low-income countries where it is hard to obtain conventional epidemiological data. This paper draws on research on the public sphere and democratic deliberation, along with research on language and interpretation, to suggest how PE research could be better equipped to account for diversity in local knowledge, include minority views and acknowledge power dynamics. These aspects are discussed under the three themes of 'plurality', 'power' and 'language'. A review of highly-cited PE literature suggests that PE research engages with plurality and power to a very limited extent, and only marginally more so with language and translation. Examples are taken from the authors' own PE research on African swine fever in -Uganda, classical swine fever in Germany, peste des petits ruminants (PPR) in Eastern Europe, and Ugandan pastoralists' understanding of cattle disease to provide more detail as to why conventional PE studies might fail to record issues of plurality, power and language, and also to suggest how this can be addressed. With reference to the literature on the public sphere and democratic deliberation, and on language and interpretation, this paper concludes with some suggestions as to how to take plurality, power and language into greater consideration in PE studies in future, thus improving the validity and reliability of PE data.

Power, participation and their problems: A consideration of power dynamics in the use of participatory epidemiology for one health and zoonoses research

The use of Participatory Epidemiology in veterinary research intends to include livestock keepers and other local stakeholders in research processes and the development of solutions to animal health problems, including potentially zoonotic diseases. It can also be an attempt to bring some of the methods and insights of social science into a discipline largely shaped by natural science methods and ways of seeing the world. The introduction of participatory methodologies to veterinary epidemiology and disease surveillance follows a wider movement in development thinking, questioning the top-down nature of much post-second world war development efforts directed from the Global North towards the Global South. In the best cases, participatory methods can help to empower the poor and marginalised to participate in and have some control over research and interventions which affect them. Compiled from experience in multi-disciplinary One Health projects, this paper briefly traces the rise of participatory epidemiology before examining some of the limitations observed in its implementation and steps that might be taken to alleviate the problems observed. The three areas in which the operationalisation of Participatory Epidemiology in veterinary and One Health research could be improved are identified as: broadening the focus of engagement with communities beyond quantitative data extraction; taking note of the wider power structures in which research takes place, and questioning who speaks for a community when participatory methods are used. In particular, the focus falls on how researchers from different disciplines, including veterinary medicine and the social sciences, can work together to ensure that participatory epidemiology is employed in such a way that it improves the quality of life of both people and animals around the world.

Outbreak of gastrointestinal anthrax following eating beef of suspicious origin: Isingiro District, Uganda, 2017

INTRODUCTION

Gastrointestinal anthrax is a rare but serious disease. In August 2017, Isingiro District, Uganda reported a cluster of >40 persons with acute-onset gastroenteritis. Symptoms included bloody diarrhoea. We investigated to identify the etiology and exposures, and to inform control measures.

METHODS

We defined a suspected case as acute-onset of diarrhoea or vomiting during 15-31 August 2017 in a resident (aged≥2 years) of Kabingo sub-county, Isingiro District; a confirmed case was a suspected case with a clinical sample positive for Bacillus anthracis by culture or PCR. We conducted descriptive epidemiology to generate hypotheses. In a case-control study, we compared exposures between case-patients and neighbourhood-matched controls. We used conditional logistic regression to compute matched odds ratios (MOR) for associations of illness with exposures.

RESULTS

We identified 61 cases (58 suspected and 3 confirmed; no deaths). In the case-control study, 82% of 50 case-patients and 12% of 100 controls ate beef purchased exclusively from butchery X during the week before illness onset (MOR = 46, 95%CI = 4.7-446); 8.0% of case-patients and 3.0% of controls ate beef purchased from butchery X and elsewhere (MOR = 19, 95%CI = 1.0-328), compared with 6.0% of case-patients and 30% of controls who did not eat beef. B. anthracis was identified in two vomitus and one stool sample. Butchery X slaughtered a sick cow and sold the beef during case-patients' incubation period.

CONCLUSION

This gastrointestinal anthrax outbreak occurred due to eating beef from butchery X. We recommended health education, safe disposal of the carcasses of livestock or game animals, and anthrax vaccination for livestock.

Smallholders' perceptions on biosecurity and disease control in relation to African swine fever in an endemically infected area in Northern Uganda

BACKGROUND

In Africa, intensified pig production is frequently accompanied by increased occurrence of African swine fever (ASF) outbreaks, leading to high case fatality rates and socio-economic impact for the farmers. ASF control relies on prevention of disease transmission and control of outbreaks. The aim of this study was to increase the understanding on how the knowledge of ASF epidemiology and control can be transferred into successfully implemented biosecurity interventions on farm and community level. Structured interviews with 200 randomly selected, pig-keeping households in northern Uganda were undertaken three times. Perceptions related to general biosecurity and hypothetical control interventions and attitudes towards pig farming were investigated by measuring the agreement to statements using a Likert scale.

RESULTS

Respondents generally conveyed positivism towards pig farming, biosecurity, and the potential of biosecurity for preventing ASF outbreaks. These positive attitudes, as well as the will to invest in biosecurity, were reduced in households that had experienced ASF outbreaks. Among the control interventions change of boots before entering the pig stable was highly accepted and seasonal adaptation of pig rearing times accepted on medium level. Statements on preventive sales of healthy pigs in connection with outbreaks and on buying pork products from slaughter operations receiving ASF-contact pigs received low acceptance, increasing, however, for households that had experienced ASF outbreaks. Consumption of pork from ASF infected pigs was generally not accepted, medium level of agreement was expressed for statements on the zoonotic potential of ASF and for neutralizing ASF by cooking.

CONCLUSIONS

To gain in-depth understanding of the complexity of people's behaviour, reasoning and decision-making processes, deeper involvement of the social sciences and a qualitative research approach might be used for further studies. Communicating information regarding the ASF not being zoonotic, and how the virus is neutralized will be important for increasing acceptance and enhancing implementation for the hypothetical control interventions preventive sales, safe slaughter, and consumption of processed and safe pork. Likewise, participatory development to adopt any control interventions to the local context on community level will be necessary for successful implementation.

Smallholders' perceptions on biosecurity and disease control in relation to African swine fever in an endemically infected area in Northern Uganda

BACKGROUND

In Africa, intensified pig production is frequently accompanied by increased occurrence of African swine fever (ASF) outbreaks, leading to high case fatality rates and socio-economic impact for the farmers. ASF control relies on prevention of disease transmission and control of outbreaks. The aim of this study was to increase the understanding on how the knowledge of ASF epidemiology and control can be transferred into successfully implemented biosecurity interventions on farm and community level. Structured interviews with 200 randomly selected, pig-keeping households in northern Uganda were undertaken three times. Perceptions related to general biosecurity and hypothetical control interventions and attitudes towards pig farming were investigated by measuring the agreement to statements using a Likert scale.

RESULTS

Respondents generally conveyed positivism towards pig farming, biosecurity, and the potential of biosecurity for preventing ASF outbreaks. These positive attitudes, as well as the will to invest in biosecurity, were reduced in households that had experienced ASF outbreaks. Among the control interventions change of boots before entering the pig stable was highly accepted and seasonal adaptation of pig rearing times accepted on medium level. Statements on preventive sales of healthy pigs in connection with outbreaks and on buying pork products from slaughter operations receiving ASF-contact pigs received low acceptance, increasing, however, for households that had experienced ASF outbreaks. Consumption of pork from ASF infected pigs was generally not accepted, medium level of agreement was expressed for statements on the zoonotic potential of ASF and for neutralizing ASF by cooking.

CONCLUSIONS

To gain in-depth understanding of the complexity of people's behaviour, reasoning and decision-making processes, deeper involvement of the social sciences and a qualitative research approach might be used for further studies. Communicating information regarding the ASF not being zoonotic, and how the virus is neutralized will be important for increasing acceptance and enhancing implementation for the hypothetical control interventions preventive sales, safe slaughter, and consumption of processed and safe pork. Likewise, participatory development to adopt any control interventions to the local context on community level will be necessary for successful implementation.

Ugandan cattle farmers' perceived needs of disease prevention and strategies to improve biosecurity

Background

Infectious diseases are an important role obstacle to high productivity in Ugandan cattle production. General disease prevention is particularly important in low-income countries, where veterinary services and adequate treatment regimens for many infectious diseases are insufficient. Improved biosecurity could lead to improved animal health and production with lower mortality and better reproductive rates. Any sustainable biosecurity interventions must be feasible for the farmers, from a practical as well as social and cultural aspect. An understanding of the farmers’ view of biosecurity and the diseases it is intended to prevent is also needed. The aim of the study was to explore the perceived needs of Ugandan cattle farmers as regards disease prevention, tools and strategies for improved biosecurity, and to assess the feasibility of basic biosecurity practices, in order to contribute to long-term strategies for improved livestock management. We conducted two rounds of focus group (FG) discussions about infectious diseases and biosecurity with cattle farmers in the districts Kabarole, Kamwenge and Kasese in western Uganda.

Results

A thematic analysis revealed four organising themes: Disease prevention and biosecurity practices, Knowledge among farmers and other actors, Community and peer pressure and Services and infrastructure. From these four organising themes, a global theme of “Biosecurity is a common effort based on collective knowledge” could be derived. Diseases represent a loss of income and wealth for farmers. Lack of knowledge, training and education among farmers were seen as a challenge. While there were claims during the first round of FGs that many biosecurity measures would be impossible to practise, in all follow-up FGs at least someone had tried. Perceived barriers for implementing biosecurity were financial and cultural. Experiences that were shared were that practising biosecurity measures had made their cattle healthier, but it also incurred extra costs.

Conclusion

The perceived needs of farmers that emerged include knowledge, access to veterinary services, resources and community involvement for a broader implementation of basic biosecurity. There is potential for improved cattle production by educating farmers about infectious diseases and disease prevention measures. Such training should be participatory, involve communities and encourage participants to overcome practical and cultural obstacles.

Electronic supplementary material

The online version of this article (10.1186/s12917-019-1961-2) contains supplementary material, which is available to authorized users.

Epidemiological considerations on African swine fever in Europe 2014-2018

In 2007 African swine fever (ASF) arrived at a Black Sea harbour in Georgia and in 2014 the infection reached the European Union (EU), where it still expands its territory. ASF is a fatal viral disease affecting domestic pigs and wild boar of all ages with clinical presentations ranging from per-acute to chronic disease, including apparently asymptomatic courses. Until the detection of the first case inside the EU, infections in the current epidemic were mainly seen among pig farms with generally low biosecurity, and with incidental spill over to the wild boar population. In the EU, however, the infection survived locally in the wild boar population independently from outbreaks in domestic pigs, with a steady and low prevalence. Apart from the wild boar population and the habitat, the current epidemic recognizes humans as the main responsible for both long distance transmission and virus introduction in the domestic pig farms. This underlines the importance to include social science when planning ASF-prevention, -control, or -eradication measures. Based on experiences, knowledge and data gained from the current epidemic this review highlights some recent developments in the epidemiological understanding of ASF, especially concerning the role of wild boar and their habitats in ASF epidemiology. In this regard, the qualities of three epidemiological traits: contagiousity, tenacity, and case fatality rate, and their impact on ASF persistence and transmission are especially discussed.

Health workers' knowledge of zoonotic diseases in an endemic region of Western Uganda

Many factors, including lack of knowledge, influence diagnosis and reporting of disease in Sub-Saharan Africa. Health Care workers (HCWs) are in constant interaction with communities and play an important role in the prevention, diagnosis and treatment of infectious diseases, including zoonoses. We determined knowledge of HCWs regarding cause, vector, transmission, diagnosis and clinical symptoms of five zoonotic diseases: anthrax, brucellosis, rabies as well as Ebola and marburg haemorrhagic fevers in endemic western Uganda. This was a descriptive cross-sectional study among HCWs based at health centres in and around Queen Elizabeth Conservation Area, Western Uganda. A self-administered questionnaire was used to measure knowledge of these five most common zoonoses recently recorded in the area. Data were captured as true if the responses were correct or false if incorrect. Analyses were in STATA and inferential statistics by cross-tabulation, and a chi-square P-value of less than 0.05 was considered significant. A majority (114/140; 81.4%) of the respondents had heard about zoonoses. The most accurately identified zoonoses were anthrax (128/140; 91.4%) closely followed by rabies (126/140; 90%), while only 21 (15%) respondents knew that cryptosporidiosis was zoonotic. Up to 20% (28/140) and 12.8% (18/140) thought that malaria and HIV, respectively, were zoonotic. There was poor overall knowledge of the endemic diseases brucellosis among all the participants, where only 1.4% (2/140) knew its causative agent, clinical symptoms and transmission. There was a total lack of knowledge (0%) about anthrax and Ebola whereby none of the 140 HCWs knew all the three above aspects required to be knowledgeable for each of the two diseases. Generally, there was poor knowledge of the five zoonoses. We recommend that medical curricula incorporate training on zoonotic and other emerging diseases, and continuing medical education regarding zoonoses should be designed for the HCWs practicing in hotspot zones.

A serological survey of anthrax in domestic dogs in Zimbabwe: a potential tool for anthrax surveillance

Anthrax is an important disease caused by the bacteriumBacillus anthracisaffecting both domestic and wild animals at the wildlife/livestock interface, defined here as a physical space in which wild and domestic species overlap in range and potentially interact. In endemic regions, sporadic anthrax outbreaks occur, causing significant deaths of both wildlife and livestock and sporadically, humans. However, it may also occur as isolated outbreaks with a few animals affected. Such isolated anthrax outbreaks maybe missed. High seroprevalence among carnivores suggests either regular non-fatal exposure to the pathogen circulating in a given environment, or contact with missed cases through consumption of anthrax carcases. To investigate the relevance of this potential indicator, a cross-sectional study was conducted to determine anthrax seroprevalence in domestic dogs (Canis lupus familiaris)from selected interface and non-interface areas of Zimbabwe with known history of anthrax outbreaks. Based on past anthrax outbreaks in the respective areas, the sites were further classified as high or low risk areas for anthrax outbreaks. Sera were collected from domestic dogs (n= 186) and tested for antibodies againstB. anthracisprotective antigens (PA) using an ELISA test. The overall seroprevalence was 51.6% (96/186; 95% CI 44.2–59.0). Sites from the non-interface areas recorded a significantly (P< 0.001) higher (72.1%) anthrax seroprevalence compared with those from the wildlife –livestock interface (41.5%). The results demonstrated a strong association (χ2= 14.3; OR = 3.2, 1.6 < OR < 6.2,P< 0.001) between anthrax seropositivity and interface type. Low-risk sites (42.5%) had a significantly (P= 0.044) lower seroprevalence compared with high-risk sites (58.5%) but still demonstrated high seroprevalence for areas where anthrax was last reported more than 20 years back. Dogs from Tsholotsho South were more than 90-times (OR = 96.5, 13.5 < OR < 690.8) more likely to be seropositive compared with those from Hwange. The study demonstrated the potential to use domestic dogs as indicators of anthrax in the study areas to survey anthrax circulation in supposed low-risk areas and calls for a redefinition of both low and high risk areas for anthrax in Zimbabwe based on an improved surveillance.

Increasing the Local Relevance of Epidemiological Research: Situated Knowledge of Cattle Disease Among Basongora Pastoralists in Uganda

Cattle disease can have severe negative impacts on the livelihoods of the poor, but still, animal disease management and outreach often remain suboptimal in low-income settings. In a study on Basongora pastoralists in Uganda, we examined local priorities, perceptions and practices regarding cattle disease, in order to improve outreach and disease control advisory work in such contexts. We also investigated how participatory epidemiology can be better equipped for gathering situated knowledge. Empirical material obtained in focus group discussions, interviews, participatory mapping, and wealth-ranking was used to perform a thematic, bottom-up analysis. The concepts of situated knowledge and embodied objectivity and insights from participatory research and interdisciplinary dialogue were applied to better embrace local perspectives. Cowdriosis, trypanosomosis, contagious bovine pleuropneumonia, East Coast fever and anthrax were high-priority diseases for participants. Lack of control over the animal health situation and money invested in treatments that did not guarantee recovery were of general importance for disease prioritization. Participants' descriptions of diseases sometimes diverged from textbook definitions. Co-infections, chronic and recurring infections and lack of access to formal knowledge were identified as important factors for differences between formal and situated knowledge. Paying attention to situated knowledge and particular context-specific issues such as proximity to a national park proved to be of special relevance for local understanding and experiences with disease. Another factor was the local importance ascribed to number of cattle, rather than production levels. These factors need to be taken into consideration when formulating disease control advice, as does the complex disease landscape. The results reveal the importance of moving research and advice beyond curing “knowledge-gaps” and creating different ways of understanding disease so that situated knowledge can be considered, and disease control improved.

One Health Integration: A Proposed Framework for a Study on Veterinarians and Zoonotic Disease Management in Ghana

In parallel with the recent world-wide promotion of One Health (OH) as a policy concept, a growing body of social science studies has raised questions about how successful OH policies and programs have been in managing some global health issues, such as zoonotic diseases. This paper briefly reviews this literature to clarify its critical perspective. Much of the literature on OH also is focused on health management at an international level and has paid less attention to implementation programs and policies for OH at the national and local levels, especially in low-and-middle-income countries (LMICs). Programs to implement OH often are linked to the concept of “integration”, a notion that lacks a universal definition, but is nonetheless a central tenet and goal in many OH programs. At the local and national levels, strong differences in perspectives about OH among different professions can be major barriers to integration of those professions into OH implementation. Policies based on integration among professions in sectors like animal, human and environmental health can threaten professions’ identities and thus may meet with resistance. Taking into account these criticisms of OH research and implementation, this paper proposes a research framework to probe the dominant social dimensions and power dynamics among professional participants that affect OH implementation programs at the local and national levels in a low-income country. The proposed research focus is the veterinary profession and one aspect of OH in which veterinarians are necessary actors: zoonotic disease management. Results from research framed in this way can have immediate application to the programs under study and can inform more expansive research on the social determinants of successful implementation of OH programs and policies.

Anthrax outbreaks in the humans - livestock and wildlife interface areas of Northern Tanzania: a retrospective record review 2006-2016

Background

Anthrax outbreaks in Tanzania have been reported from the human, livestock and wildlife sectors over several years, and is among the notifiable diseases. Despite frequent anthrax outbreaks, there is no comprehensive dataset indicating the magnitude and distribution of the disease in susceptible species. This study is a retrospective review of anthrax outbreaks from the human, livestock, and wildlife surveillance systems from 2006 to 2016. The objectives were to identify hotspot districts, describe anthrax epidemiology in the hotspot areas, evaluate the efficiency of the anthrax response systems and identify potential areas for further observational studies.

Methods

We prepared a spreadsheet template for a retrospective comprehensive record review at different surveillance levels in Tanzania. We captured data elements including demographic characteristics of different species, the name of health facility, and date of anthrax diagnosis. Also, we collected data on the date of specimen collection, species screened, type of laboratory test, laboratory results and the outcome recorded at the end of treatment in humans. After establishing the database, we produced maps in Quantum GIS software and transferred cleaned data to Stata software for supportive statistical analysis.

Results

Anthrax reported incidences over 4 years in humans were much higher in the Arusha region (7.88/100,000) followed by Kilimanjaro region (6.64/100,000) than other regions of Tanzania Mainland. The health facility based review from hotspot districts in parts of Arusha and Kilimanjaro regions from 2006 to 2016, identified 330 human anthrax cases from the selected health facilities in the two regions. Out of 161 livestock and 57 wildlife specimen tested, 103 and 18 respectively, were positive for anthrax.

Conclusion

This study revealed that there is gross under-reporting in the existing surveillance systems which is an obstacle for estimating a true burden of anthrax in the hotspot districts. Repeated occurrences of anthrax in livestock, wildlife and humans in the same locations at the same time calls for the need to strengthen links and promote inter–disciplinary and multi-sectoral collaboration to enhance prevention and control measures under a One Health approach.

Producing Interdisciplinary Competent Professionals: Integrating One Health Core Competencies into the Veterinary Curriculum at the University of Rwanda

Infectious diseases of grave concern to human health are emerging from wildlife and livestock populations in multiple regions of the world. Responding effectively to these emerging pandemics requires engagement of multidisciplinary groups of professionals. Using a One Health approach, One Health Central and Eastern Africa (OHCEA), a network of seven schools of public health and seven veterinary schools, with the support of the United States Agency for International Development (USAID), has engaged in curriculum review with the aim of building the skills of multidisciplinary groups of professionals to improve their capacity to respond to emerging infectious diseases. Through stakeholder analysis and curriculum development workshops, the University of Rwanda's School of Veterinary Medicine, in association with Tufts University, revised its curriculum to incorporate One Health competencies to be better prepared to respond to any infectious disease outbreak in Africa. The revised curriculum aimed to build cross-sectoral skills and knowledge; transform students' ways of thinking about infectious disease outbreak response; link human, veterinary, and wildlife health training opportunities; and strengthen community frontline responder training. Eight different disciplines engaged in the curriculum review process: Veterinary Medicine, Livestock Production, Wildlife and Aquatic Resources, Environmental Health and Epidemiology, Communication Technology, Engineering, Agriculture, and Public Health. One Health competencies such as communication, collaboration, leadership, and advocacy were added to the new curriculum, helping ensure that each professional be appropriately equipped with skills to recognize and respond effectively to any emerging infections.

African swine fever outbreak on a medium-sized farm in Uganda: biosecurity breaches and within-farm virus contamination

In Uganda, a low-income country in east Africa, African swine fever (ASF) is endemic with yearly outbreaks. In the prevailing smallholder subsistence farming systems, farm biosecurity is largely non-existent. Outbreaks of ASF, particularly in smallholder farms, often go unreported, creating significant epidemiological knowledge gaps. The continuous circulation of ASF in smallholder settings also creates biosecurity challenges for larger farms. In this study, an on-going outbreak of ASF in an endemic area was investigated on farm level, including analyses of on-farm environmental virus contamination. The study was carried out on a medium-sized pig farm with 35 adult pigs and 103 piglets or growers at the onset of the outbreak. Within 3 months, all pigs had died or were slaughtered. The study included interviews with farm representatives as well as biological and environmental sampling. ASF was confirmed by the presence of ASF virus (ASFV) genomic material in biological (blood, serum) and environmental (soil, water, feed, manure) samples by real-time PCR. The ASFV-positive biological samples confirmed the clinical assessment and were consistent with known virus characteristics. Most environmental samples were found to be positive. Assessment of farm biosecurity, interviews, and the results from the biological and environmental samples revealed that breaches and non-compliance with biosecurity protocols most likely led to the introduction and within-farm spread of the virus. The information derived from this study provides valuable insight regarding the implementation of biosecurity measures, particularly in endemic areas.

Mapping the Distribution of Anthrax in Mainland China, 2005-2013

Background

Anthrax, a global re-emerging zoonotic disease in recent years is enzootic in mainland China. Despite its significance to the public health, spatiotemporal distributions of the disease in human and livestock and its potential driving factors remain poorly understood.

Methodology/Principal Findings

Using the national surveillance data of human and livestock anthrax from 2005 to 2013, we conducted a retrospective epidemiological study and risk assessment of anthrax in mainland China. The potential determinants for the temporal and spatial distributions of human anthrax were also explored. We found that the majority of human anthrax cases were located in six provinces in western and northeastern China, and five clustering areas with higher incidences were identified. The disease mostly peaked in July or August, and males aged 30–49 years had higher incidence than other subgroups. Monthly incidence of human anthrax was positively correlated with monthly average temperature, relative humidity and monthly accumulative rainfall with lags of 0–2 months. A boosted regression trees (BRT) model at the county level reveals that densities of cattle, sheep and human, coverage of meadow, coverage of typical grassland, elevation, coverage of topsoil with pH > 6.1, concentration of organic carbon in topsoil, and the meteorological factors have contributed substantially to the spatial distribution of the disease. The model-predicted probability of occurrence of human cases in mainland China was mapped at the county level.

Conclusions/Significance

Anthrax in China was characterized by significant seasonality and spatial clustering. The spatial distribution of human anthrax was largely driven by livestock husbandry, human density, land cover, elevation, topsoil features and climate. Enhanced surveillance and intervention for livestock and human anthrax in the high-risk regions, particularly on the Qinghai-Tibetan Plateau, is the key to the prevention of human infections.

Anthrax is a worldwide zoonosis affecting mostly grazing herbivores, with occasional spillover to humans who have contact with infected animals or contaminated animal products. We characterized the distributional patterns of both human and livestock anthrax in China from 2005 to 2013, and identified agro-ecological, environmental and meteorological factors contributing to the temporal and spatial distributions of the disease. We found that the spatial distribution of human anthrax in China was mainly driven by densities of cattle, sheep and humans, coverage of meadow, coverage of typical grassland, elevation, pH level of topsoil, concentration of organic carbon in topsoil, and meteorological factors. We also identified the regions with higher probabilities for the occurrence of human cases. Our findings provided a clear qualitative and quantitative understanding of the epidemiological characteristics and risk recognition of anthrax in China, and can be helpful for prioritizing surveillance and control programs in the future.

One Health: competing perspectives in an emerging field

Over the last decade, One Health has attracted considerable attention from researchers and policymakers. The concept argues that the fields of human, animal and environmental health ought to be more closely integrated. Amid a flurry of conferences, projects and publications, there has been substantial debate over what exactly One Health is and should be. This review summarizes the main trends in this emerging discussion, highlighting the fault lines between different perspectives on One Health. Some have shown that One Health's call to synthesize knowledge from different disciplines can lead to better interventions. Others, however, argue that One Health's challenge to existing practice must go further, and set out a vision that foregrounds the social and economic drivers of disease. Meanwhile, recent examples of One Health in practice highlight the potential but also the challenges of institutionalizing cooperation. We also discuss the promise and pitfalls of using complexity theory to tackle multifaceted problems, and consider how the One Health concept has been brought to bear on other issues, such as emerging new technologies. Ultimately, One Health is an important and worthwhile goal, and requires a debate that clarifies both the competing uses and the political nature of the project.