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Airikkala-Otter I, Fröchlich J, Porkodi S, Gibson A, Gamble L, Rayner E. Sharing the Load by One Health: Integrating Canine Rabies Vaccination With Bovine Foot-and-Mouth Vaccination Program and Community Public Health Services in Rural Nilgiris District, Tamil Nadu, India. Indian J Community Med 2022; 47:600-603. [PMID: 36742947 PMCID: PMC9891052 DOI: 10.4103/ijcm.ijcm_1438_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/16/2022] [Indexed: 02/07/2023] Open
Abstract
Background India carries the largest national burden for rabies globally. Coordinating large-scale canine rabies elimination programs is challenging, particularly in rural areas, where the majority of human rabies deaths occur. This study evaluated the feasibility of combining canine rabies vaccination with pre-existing animal-health interventions or public health programs in a rural area of India. Materials and Methods Canine rabies vaccination teams collaborated with a bi-annual bovine foot-and-mouth vaccination program coordinated by the Animal Husbandry Department (AH-collaboration) and with a village health program by the Public Health Department (PH-collaboration) in Nilgiris, Tamil Nadu, to vaccinate dogs during the implementation of these government-led health initiatives. Results A total of 251 dogs were vaccinated over 7 days during the AH-collaboration, and 1083 dogs were vaccinated over 15 days during the PH-collaboration. The AH-collaboration achieved a vaccination coverage of 76% based on same-time sighting survey, and 58% based on post-vaccination survey. The PH-collaboration achieved vaccination coverage of 79% based on the same-time survey and 83% based on the post-vaccination survey. Conclusions The integration of mass dog vaccination into existing government sector initiatives may facilitate the scaling up of canine rabies vaccination campaigns.
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Affiliation(s)
- Ilona Airikkala-Otter
- Worldwide Veterinary Service India, International Training Center, Gramya Bhavan, RDO Trust Building, Aruvankadu The Nilgiris, Tamil Nadu, India
| | - Julia Fröchlich
- MSD Sharp and Dohme GmbH, Levelingstr. 4a, 81673 Munich, Germany
| | - S. Porkodi
- Department of Health Services, Villupuram District, Tamil Nadu, India
| | - Andrew Gibson
- Worldwide Veterinary Service (WVS), 4 Castle Street, Cranborne, Dorset BH21 5PZ, United Kingdom
| | - Luke Gamble
- Worldwide Veterinary Service (WVS), 4 Castle Street, Cranborne, Dorset BH21 5PZ, United Kingdom
| | - Emma Rayner
- Worldwide Veterinary Service (WVS), 4 Castle Street, Cranborne, Dorset BH21 5PZ, United Kingdom
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Davis A, Virhia J, Bunga C, Alkara S, Cleaveland S, Yoder J, Kinung’hi S, Lankester F. “Using the same hand”: The complex local perceptions of integrated one health based interventions in East Africa. PLoS Negl Trop Dis 2022; 16:e0010298. [PMID: 35377878 PMCID: PMC9009769 DOI: 10.1371/journal.pntd.0010298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/14/2022] [Accepted: 03/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Neglected Tropical Diseases (NTDs) such as soil transmitted helminths (STH) and human rabies represent a significant burden to health in East Africa. Control and elimination remains extremely challenging, particularly in remote communities. Novel approaches, such as One Health based integrated interventions, are gaining prominence, yet there is more to be learned about the ways in which social determinants affect such programmes.
Methodology
In 2015 a mixed method qualitative study was conducted in northern Tanzania to determine community perceptions towards integrated delivery of two distinct healthcare interventions: treatment of children for STH and dog vaccination for rabies. In order to assess the effectiveness of the integrated approach, villages were randomly allocated to one of three intervention arms: i) Arm A received integrated mass drug administration (MDA) for STH and mass dog rabies vaccination (MDRV); ii) Arm B received MDA only; iii) Arm C received MDRV only.
Principle findings
Integrated interventions were looked upon favourably by communities with respondents in all arms stating that they were more likely to either get their dogs vaccinated if child deworming was delivered at the same time and vice versa. Participants appreciated integrated interventions, due to time and cost savings and increased access to essential health care. Analysis of qualitative data allowed deeper exploration of responses, revealing why people appreciated these benefits as well as constraints and barriers to participation in integrated programmes.
Conclusions/significance
An interdisciplinary One Health approach that incorporates qualitative social science can provide key insights into complex local perceptions for integrated health service delivery for STH and human rabies. This includes providing insights into how interventions can be improved while acknowledging and addressing critical issues around awareness, participation and underlying health disparities in remote pastoralist communities.
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Affiliation(s)
- Alicia Davis
- Institute of Health and Wellbeing, School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Jennika Virhia
- Institute of Health and Wellbeing, School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Catherine Bunga
- National Institute for Medical Research (NIMR), Mwanza Centre, Mwanza, Tanzania
| | | | - Sarah Cleaveland
- Institute of Biodiversity Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Jonathan Yoder
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
| | - Safari Kinung’hi
- National Institute for Medical Research (NIMR), Mwanza Centre, Mwanza, Tanzania
| | - Felix Lankester
- Global Animal Health Tanzania, Arusha, Tanzania
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, United States of America
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Delesalle L, Sadoine ML, Mediouni S, Denis-Robichaud J, Zinszer K, Zarowsky C, Aenishaenslin C, Carabin H. How are large-scale One Health initiatives targeting infectious diseases and antimicrobial resistance evaluated? A scoping review. One Health 2022; 14:100380. [PMID: 35386427 PMCID: PMC8978269 DOI: 10.1016/j.onehlt.2022.100380] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
While One Health initiatives are gaining in popularity, it is unclear if and how they are evaluated when implementation at scale is intended. The main purpose of this scoping review was to describe how One Health initiatives targeting infectious diseases and antimicrobial resistance at a large scale are evaluated. Secondary objectives included identifying the main facilitators and barriers to the implementation and success of these initiatives, and how their impacts were assessed. Twenty-three studies evaluating One Health initiatives were eligible. Most studies included the human (n = 22) and animal (n = 15) sectors; only four included the environment sector. The types of evaluated initiative (non-exclusive) included governance (n = 5), knowledge (n = 6), protection (n = 17), promotion (n = 16), prevention (n = 9), care (n = 8), advocacy (n = 10) and capacity (n = 10). Studies used normative (n = 4) and evaluative (n = 20) approaches to assess the One Health initiatives, the latter including impact (n = 19), implementation (n = 8), and performance (n = 7) analyses. Structural and economic, social, political, communication and coordination-related factors, as well as ontological factors, were identified as both facilitators and barriers for successful One Health initiatives. These results identified a wide range of evaluation methods and indicators used to demonstrate One Health's added values, strengths, and limitations: the inherent complexity of the One Health approach leads to the use of multiple types of evaluation. The strengths and remaining gaps in the evaluation of such initiative highlight the relevance of comprehensive, mixed-method, context-sensitive evaluation frameworks to inform and support the implementation of One Health initiatives by stakeholders in different governance settings. Studies evaluating One Health initiatives were scarce. Only One Health initiatives related to infectious diseases were evaluated. Evaluations were mainly conducted using quantitative approaches. Involvement of the community was identified as a major facilitator.
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Affiliation(s)
- Léa Delesalle
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | - Margaux L. Sadoine
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Sarah Mediouni
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | | | - Kate Zinszer
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Christina Zarowsky
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Cécile Aenishaenslin
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | - Hélène Carabin
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
- Corresponding author at: Faculté de Médecine Vétérinaire, 3200 rue Sicotte, Saint-Hyacinthe J2S 2M2, Québec, Canada.
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Nyasulu PS, Weyer J, Tschopp R, Mihret A, Aseffa A, Nuvor SV, Tamuzi JL, Nyakarahuka L, Helegbe GK, Ntinginya NE, Gebreyesus MT, Doumbia S, Busse R, Drosten C. Rabies mortality and morbidity associated with animal bites in Africa: a case for integrated rabies disease surveillance, prevention and control: a scoping review. BMJ Open 2021; 11:e048551. [PMID: 34857556 PMCID: PMC8640643 DOI: 10.1136/bmjopen-2020-048551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 09/08/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The objective of this scoping review was to map the current situation and available evidence and gaps on rabies morbidity, mortality, integrated rabies surveillance programmes, and existing prevention and control strategies in Africa. METHODS We conducted a systematic scoping review following the Joanna Briggs methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist. Medline, Embase, CINAHL (EBSCOHost), Scopus, Web of Science and rabies web conferences were used to search for peer-reviewed publications between January 1946 and May 2020. Two researchers reviewed the studies and extracted data based on author (year) and region, study design and data collection duration, participants/comparators, interventions, control conditions/exposures and outcomes (rabies mortality and morbidity) and key findings/gaps/challenges. The results were reported narratively using Arksey and O'Malley's methodological framework. RESULTS Electronic search yielded 2775 records, of which 43 studies were included. A total of 543 714 bite victims were censored through the included studies. Most of the victims were less than 15 years of age. The studies included rabies morbidity (21) and mortality (15) fluctuating in space and time across Africa depending on countries' rabies prevention and control practices (16). Others were surveillance (nine studies); surveillance and prevention (five studies); management and control (seven studies); and surveillance, prevention and control (six studies). We found challenges in rabies reporting, existing dog vaccination programmes and post-exposure prophylaxis availability or compliance. CONCLUSION This study found challenges for dog rabies control and elimination in Africa and the need for a policy to drive the goal of zero dog-transmitted rabies to humans by 2030.This is an open-access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build on this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated and the use is non-commercial (see http://creativecommons.org/licenses/by-nc/4.0/).
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Affiliation(s)
- Peter Suwirakwenda Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacqueline Weyer
- Centre for Emerging Zoonosis and Parasitic Diseases, National Institute of Communicable Diseases, Johannesburg, South Africa
- Department of Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Rea Tschopp
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Samuel Victor Nuvor
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Jacques Lukenze Tamuzi
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luke Nyakarahuka
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Gideon Kofi Helegbe
- Department of Biochemistry and Molecular Medicine, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Nyanda Elias Ntinginya
- Mbeya Medical Research Centre, National Institute of Medical Research, Mbeya, Tanzania, United Republic of
| | | | - Seydou Doumbia
- Faculty of Medicine and Odontostomatology & University Clinical Research Center, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
| | - Reinhard Busse
- Department of Health Care Management, Technical University Berlin, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité-University Medicine Berlin, Berlin, Germany
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Banda GT, Deribe K, Davey G. How can we better integrate the prevention, treatment, control and elimination of neglected tropical diseases with other health interventions? A systematic review. BMJ Glob Health 2021; 6:bmjgh-2021-006968. [PMID: 34663634 PMCID: PMC8524265 DOI: 10.1136/bmjgh-2021-006968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Globally, about 1.7 billion people living in poverty are affected by one or more of a group of disabling, disfiguring and poverty-promoting conditions known as neglected tropical diseases (NTDs). Major global health actors, like the WHO, have endorsed a shift from vertical to integrated NTD management. Objective This systematic review aimed to evaluate how integration is being conducted and how we can improve it. Methods PubMed, Medline, Cochrane library, Web of Science, Trip, Embase, Global Health and Google Scholar were searched from 1 April to 22 July 2020. We included peer-reviewed articles published between 1 January 2000 and 22 July 2020 in English. Results Database searches produced 24 565 studies, of which 35 articles met the inclusion criteria. Twenty of these articles were conducted in sub-Saharan Africa. Twenty articles were also published between 2015 and 2020. Literature revealed that NTDs have been integrated—among themselves; with water, sanitation and hygiene programmes; with vector control; with primary healthcare; with immunisation programmes; and with malaria management. Integrated mass drug administration for multiple NTDs was the most common method of integration. The three complex, yet common characteristics of successful integration were good governance, adequate financing and total community engagement. Conclusion The dataset identified integrated management of NTDs to be cost effective and potentially to increase treatment coverage. However, the identified modes of integration are not exclusive and are limited by the available literature. Nonetheless, integration should urgently be implemented, while considering the programmatic and sociopolitical context. PROSPERO registration number The study protocol was registered with PROSPERO number, CRD42020167358.
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Affiliation(s)
- Gift Treighcy Banda
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK .,Mzimba District Hospital, Malawi Ministry of Health, Mzimba, Malawi
| | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Changalucha J, Hampson K, Jaswant G, Lankester F, Yoder J. Human rabies: prospects for elimination. CAB REVIEWS : PERSPECTIVES IN AGRICULTURE, VETERINARY SCIENCE, NUTRITION AND NATURAL RESOURCES 2021; 16:039. [PMID: 34765015 PMCID: PMC8580373 DOI: 10.1079/pavsnnr202116039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Almost half of all countries in the world are effectively free of human deaths from dog-mediated rabies. But the disease still affects people in low- and middle-income countries, especially the rural poor, and children. Successful regional elimination of human rabies is attributable to advances in significant and sustained investment in dog vaccination, post-exposure vaccination and surveillance, illustrated by productive efforts to reduce human rabies in Latin America over the last 35 years. Nonetheless, countries still facing endemic rabies face significant barriers to elimination. Using the 2017 Global Strategic Plan to end human rabies deaths from dog-mediated rabies by 2030 as a reference point and an organizing framework, we assess progress toward global rabies elimination by examining the characteristics of successful regional control efforts and barriers to elimination. Although substantive barriers exist for countries where rabies remains endemic, advances in knowledge, technology, institutions, and economics provide a basis for optimism.
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Affiliation(s)
- Joel Changalucha
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 78373, Dar es salaam, 14112, Tanzania
- Boyd Orr Centre for Population and ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12, 8QQ, UK
- College of Veterinary Medicine and Biomedical Science, Sokoine University of Agriculture, P.O. Box 3021, Morogoro, 23, Tanzania
| | - Katie Hampson
- Boyd Orr Centre for Population and ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12, 8QQ, UK
| | - Gurdeep Jaswant
- Boyd Orr Centre for Population and ecosystem Health, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12, 8QQ, UK
- University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), P.O. Box 30197, Nairobi, 00202, Kenya
- Tanzania Industrial Research Development Organisation (TIRDO), P.O. Box 23235, Dar es salaam, Tanzania
| | - Felix Lankester
- Global Animal Health Tanzania, Ngorongoro Conservation Area Authority Building, P.O. Box 1642, Arusha, Tanzania
- Paul G. Allen School for Global Animal Health, Washington state University, P.O. Box 647090, Pullman, Washington, WA 99164 United States of America
| | - Jonathan Yoder
- Paul G. Allen School for Global Animal Health, Washington state University, P.O. Box 647090, Pullman, Washington, WA 99164 United States of America
- School of Economic Sciences, Washington State University, P.O. Box 646210, Pullman, Washington, WA 99164-6210, United States of America
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Laing G, Vigilato MAN, Cleaveland S, Thumbi SM, Blumberg L, Salahuddin N, Abdela-Ridder B, Harrison W. One Health for neglected tropical diseases. Trans R Soc Trop Med Hyg 2021; 115:182-184. [PMID: 33169163 PMCID: PMC7842102 DOI: 10.1093/trstmh/traa117] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/23/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022] Open
Abstract
The forthcoming World Health Organization road map for neglected tropical
diseases (NTDs) 2021–2030 recognises the complexity surrounding control
and elimination of these 20 diseases of poverty. It emphasises the need for a
paradigm shift from disease-specific interventions to holistic cross-cutting
approaches coordinating with adjacent disciplines. The One Health approach
exemplifies this shift, extending beyond a conventional model of zoonotic
disease control to consider the interactions of human and animal health systems
within their shared environment and the wider social and economic context. This
approach can also promote sustainability and resilience within these systems. To
achieve the global ambition on NTD elimination and control, political will,
along with contextualised innovative scientific strategies, is required.
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Affiliation(s)
| | - Marco Antonio Natal Vigilato
- Pan American Center for Foot and Mouth Disease and Veterinary Public Health, Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organisation, Brazil
| | - Sarah Cleaveland
- Institute of Biodiversity Animal Health & Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - S M Thumbi
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.,Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh EH9 3FL, UK.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh EH9 3FL, UK.,Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA 99164, USA
| | - Lucille Blumberg
- Centre for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2192, South Africa.,Faculty of Veterinary Science, University of Pretoria, Pretoria 0110, South Africa
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Zendejas-Heredia PA, Colella V, Hii SF, Traub RJ. Comparison of the egg recovery rates and limit of detection for soil-transmitted helminths using the Kato-Katz thick smear, faecal flotation and quantitative real-time PCR in human stool. PLoS Negl Trop Dis 2021; 15:e0009395. [PMID: 34038411 PMCID: PMC8153506 DOI: 10.1371/journal.pntd.0009395] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/17/2021] [Indexed: 01/02/2023] Open
Abstract
Background Monitoring the success of soil-transmitted helminth (STH) control programs relies on accurate diagnosis and quantitative assessment of infection prevalence and intensity. As preventative chemotherapeutic program coverage for STH expands, the necessity of gaining insights into the relative or comparative sensitivities, in terms of limits of detection (LOD) and egg-recovery-rates (ERR) for microscopy and quantitative polymerase chain reaction qPCR-based diagnostic techniques becomes imperative to inform suitability for their intended use for large scale STH monitoring and treatment efficacy studies. Methodology/Principal findings The diagnostic performance in terms of ERR and LOD of the Kato-Katz (KK) thick smear technique, sodium nitrate (NaNO3) faecal floatation (FF) and qPCR for the accurate detection and enumeration of STH eggs were calculated and expressed in eggs per gram (EPG), by experimentally seeding parasite-free human faeces with Ascaris spp., Trichuris spp. and Necator americanus eggs representing low, medium and high intensity infections. The efficiency of NaNO3 flotation was also calculated over a range of specific gravities (SpGr) for the optimum recovery of STH eggs. FF of SpGr 1.30 recovered 62.7%, 11% and 8.7% more Trichuris spp., Necator americanus and Ascaris spp. eggs respectively, than the recommended SpGr of 1.20. All diagnostic methods demonstrated strong direct correlation to the intensity of seeded EPG. KK and FF (SpGr 1.30) resulted in significant lower ERRs compared to qPCR (p <0.05). qPCR demonstrated significantly (p <0.05) greater sensitivity with an ability to detect as little as 5 EPG for all three STH, compared to 50 EPG by KK and FF (SpGr 1.30). Conclusions/Significance This study compares the diagnostic parameters in terms of LOD and ERRs of STHs for the KK, FF and qPCR. These results indicate that the diagnostic performance of qPCR assays should be considered by control programs in the phase that aims to seek confirmation of transmission break and cessation of preventive chemotherapy in low-transmission settings, in line with the control targets of the WHO neglected tropical diseases 2030 Roadmap. STH infections predominately affect resource-poor communities and negatively impact on child and maternal health. Diagnostics play a critical role in guiding and informing existing STH control programs and the implementation and evaluation of intervention strategies. The KK technique is most commonly used as per WHO guidelines and is the basis for determining quantitative thresholds for low, moderate and heavy infections. More recently, FF and laboratory-based quantitative PCR techniques have provided alternative options of diagnosing STH infections. A number of studies correlating the relative sensitivity, diagnostic agreement, and egg enumeration of these techniques by comparing field-generated diagnostic data have attempted to correlate quantitative outputs to those defined by the WHO, with little resolution. Moreover, as large-scale deworming programs levels scale up, the necessity to apply techniques that can precisely detect light infections is of outmost importance to establish preventive chemotherapy end-points using more accurate means. In this study we compared the LOD and ERR of seeded non-infected human faecal samples with Ascaris, Trichuris and Necator spp. eggs using KK, FF and qPCR. When compared to copro-microscopy methods, qPCR showed the highest sensitivity for the detection of light-intensity infections and was more accurate in enumerating the original number of eggs per gram of seeded faeces. In addition to this, the results indicated that the diagnostic performance of both KK and FF (using solution at a SpGr of 1.30) were equally efficient and should be considered with their diagnostic limitations in mind, when aiming to monitor STH infections in low-transmission settings.
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Affiliation(s)
- Patsy A. Zendejas-Heredia
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
| | - Vito Colella
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Sze Fui Hii
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
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Suijkerbuijk AWM, Mangen MJJ, Haverkate MR, Luppino FS, Bantjes SE, Visser LG, Swaan CM, Ruijs WLM, Over EAB. Rabies vaccination strategies in the Netherlands in 2018: a cost evaluation. Euro Surveill 2020; 25:1900716. [PMID: 32975187 PMCID: PMC7533619 DOI: 10.2807/1560-7917.es.2020.25.38.1900716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundThe risk of contracting rabies is low for travellers. However, the number of Dutch travellers potentially exposed abroad following an animal-associated injury and needing post-exposure prophylaxis (PEP) has increased, resulting in increased costs.AimHere, we evaluated the costs and the cost-effectiveness of different pre- and post-exposure interventions in the Netherlands, taking into account the 2018 World Health Organization (WHO) recommendations for the prevention of rabies.MethodsA decision tree-based economic model was constructed. We calculated and compared the cost of different WHO pre-exposure prophylaxis (PrEP) recommendations, intramuscular vs intradermal vaccination and PEP subsequent to increased vaccination coverage in risk groups. We estimated cost-effectiveness, expressed as incremental costs per rabies immunoglobulin (RIG) administration averted, using a societal perspective. Statistical uncertainty regarding number of travellers and vaccination coverage was assessed.ResultsTotal costs at the national level were highest using previous WHO recommendations from 2012, estimated at EUR 15.4 million annually. Intradermal vaccinations in combination with the current recommendations led to the lowest costs, estimated at EUR 10.3 million. Higher vaccination uptake resulted in higher overall costs. The incremental costs per RIG administration averted varied from EUR 21,300-46,800.ConclusionsThe change in rabies PrEP and PEP recommendations in 2018 reduced total costs. Strategies with increased pre-travel vaccination uptake led to fewer RIG administrations and fewer vaccinations after exposure but also to higher total costs. Although larger scale intradermal administration of rabies vaccine can reduce total costs of PrEP and can positively influence vaccination uptake, it remains a costly intervention.
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Affiliation(s)
- Anita WM Suijkerbuijk
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
| | - Marie-Josee J Mangen
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands,These authors contributed equally to this manuscript
| | - Manon R Haverkate
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands,These authors contributed equally to this manuscript
| | | | - Sabine E Bantjes
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
| | - Leo G Visser
- Leiden University Medical Center, Leiden, the Netherlands,Department of Infectious Diseases, Leiden University, Leiden, the Netherlands
| | - Corien M Swaan
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
| | - Wilhelmina LM Ruijs
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
| | - Eelco AB Over
- National Institute for Public Health and the Environment, RIVM, Bilthoven, the Netherlands
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Griffith EF, Pius L, Manzano P, Jost CC. COVID-19 in pastoral contexts in the greater Horn of Africa: Implications and recommendations. PASTORALISM : RESEARCH, POLICY AND PRACTICE 2020; 10:22. [PMID: 33072249 PMCID: PMC7550841 DOI: 10.1186/s13570-020-00178-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/11/2020] [Indexed: 05/08/2023]
Abstract
COVID-19 is a global pandemic that continues to spread around the world, including to Africa where cases are steadily increasing. The African Centres for Disease Control and Prevention is leading the pandemic response in Africa, with direction from the World Health Organization guidelines for critical preparedness, readiness, and response actions. These are written for national governments, lacking nuance for population and local differences. In the greater Horn of Africa, conditions unique to pastoralists such as inherent mobility and limited health and service infrastructure will influence the dynamics of COVID-19. In this paper, we present a One Health approach to the pandemic, consisting of interdisciplinary and intersectoral collaboration focused on the determinants of health and health outcomes amongst pastoralists. Our contextualized public health strategy includes community One Health teams and suggestions for where to implement targeted public health measures. We also analyse the interaction of COVID-19 impacts, including those caused directly by the disease and those that result from control efforts, with ongoing shocks and vulnerabilities in the region (e.g. desert locusts, livestock disease outbreaks, floods, conflict, and development displacement). We give recommendations on how to prepare for and respond to the COVID-19 pandemic and its secondary impacts on pastoral areas. Given that the full impact of COVID-19 on pastoral areas is unknown currently, our health recommendations focus on disease prevention and understanding disease epidemiology. We emphasize targeting pastoral toponymies with public health measures to secure market access and mobility while combating the direct health impacts of COVID-19. A contextualized approach for the COVID-19 public health response in pastoral areas in the Greater Horn of Africa, including how the pandemic will interact with existing shocks and vulnerabilities, is required for an effective response, while protecting pastoral livelihoods and food, income, and nutrition security.
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Affiliation(s)
- Evan F. Griffith
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, USA
| | - Loupa Pius
- Dynamic Agro-Pastoralist Development Organization (DADO), Kaabong, Uganda
- Arid Landscape Initiative (ALIN Africa), Moroto, Uganda
- Coalition for European Lobbies on Eastern Africa Pastoralism (CELEP), Brussels, Belgium
| | - Pablo Manzano
- Global Change and Conservation Lab, Organismal and Evolutionary Biology Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
- Helsinki Institute of Sustainability Science (HELSUS), Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Christine C. Jost
- Global Health Support Initiative III, Social Solutions International, United States Agency for International Development Bureau for Humanitarian Assistance, Washington, D.C., USA
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