From the Approach to the Concept: One Health in Latin America-Experiences and Perspectives in Brazil, Chile, and Colombia

Professionals throughout the world have been working to assess the interdisciplinary interaction and interdependence between health and wellbeing in a constantly changing environment. The One Health concept was developed to encourage sustainable collaborative partnerships and to promote optimal health for people, animals, plants, the environment, and the whole planet. The dissemination of scientific discoveries and policies, by working directly with diverse communities, has been one of the main goals for Global One Health. The One Health concept has also been referred or related to as "One Medicine, One Medicine-One Health, One World-One Health, EcoHealth," and Planetary Health," depending on each fundamental view and approach. In Latin America, despite the concept still being discussed among health professionals and educators, several One Health initiatives have been used daily for more than decades. One Health action has been applied especially in rural and underserved urban areas where low socioeconomic status, lack of health professionals, and scarcity of medical resources may require professionals to work together. Local communities from diverse social and economic statuses, including indigenous populations have been working with institutions and social organizations for many years, accomplishing results through grassroots movements. These "bottom-up" socio-community approaches have also been tools for the prevention and control of diseases, such practice has preceded the One Health concepts in Latin American countries. It is strongly believed that collaborative, multidisciplinary, political, and economic initiatives with prosocial focus may become investments toward obtaining significant results in the face of global, economic and health challenges; working for a healthier world with inclusivity, equity, and equality. In this study, it is briefly presented how the One Health approach has been initiated and developed in Latin America, highlighting the events and actions taken in Brazil, Chile, and Colombia.

Setting priorities for surveillance, prevention, and control of zoonoses in Bogotá, Colombia

OBJECTIVE

To establish priorities for zoonoses surveillance, prevention, and control in Bogotá, Colombia.

METHODS

A Delphi panel of experts in veterinary and human medicine was conducted using a validated prioritization method to assess the importance of 32 selected zoonoses. This exercise was complemented by a questionnaire survey, using the knowledge, attitudes, and practices (KAP) methodology, administered in 19 districts of Bogotá from September 2009 to April 2010 to an at-risk population (workers at veterinary clinics; pet shops; butcher shops; and traditional food markets that sell poultry, meat, cheese, and eggs). A risk indicator based on level of knowledge about zoonoses was constructed using categorical principal component and logistic regression analyses.

RESULTS

Twelve experts participated in the Delphi panel. The diseases scored as highest priority were: influenza A(H1N1), salmonellosis, Escherichia coli infection, leptospirosis, and rabies. The diseases scored as lowest priority were: ancylostomiasis, scabies, ringworm, and trichinellosis. A total of 535 questionnaires were collected and analyzed. Respondents claimed to have had scabies (21%), fungi (8%), brucellosis (8%), and pulicosis (8%). Workers with the most limited knowledge on zoonoses and therefore the highest health risk were those who 1) did not have a professional education, 2) had limited or no zoonoses prevention training, and 3) worked in Usme, Bosa, or Ciudad Bolívar districts.

CONCLUSIONS

According to the experts, influenza A(H1N1) was the most important zoonoses. Rabies, leptospirosis, brucellosis, and toxoplasmosis were identified as priority diseases by both the experts and the exposed workers. This is the first prioritization exercise focused on zoonoses surveillance, prevention, and control in Colombia. These results could be used to guide decision-making for resource allocation in public health.

[Impact assessment of the rotavirus vaccine in Colombia using rapid evaluation methods]

OBJECTIVE

Estimate the effectiveness of the monovalent rotavirus vaccine in preventing the need to hospitalize children under 2 years old for acute diarrheal disease in five Colombian cities.

METHODS

A population survey was conducted based on a probability sample of children over 2 months and under 24 months of age in five Colombian cities (Barranquilla, Bogotá, Cali, Cartagena, and Riohacha) over the period from August through October 2010. The vaccine had been introduced in the Expanded Program on Immunization in January 2009. Rotavirus vaccination coverage was estimated by age group; the cumulative incidence of hospitalization for severe diarrhea was determined; and the magnitude of correlation between vaccination with one or two doses of rotavirus vaccine and hospitalization for diarrhea was calculated using the age-adjusted probability ratio (PR) and other epidemiologically significant factors. Effectiveness of the vaccine was estimated using the expression 1-PR.

RESULTS

Coverage with a single dose of the rotavirus vaccine was 87.3%. During the 12 months prior to the survey, 1 453 of the children under 24 months old in the study areas (43.2%) had presented with diarrhea, and of these, 174 (5.2%) had been hospitalized for this cause. The effectiveness of two doses of the vaccine in preventing hospitalization for severe diarrhea was 68% (CI 95% = 55%-77%).

CONCLUSIONS

In Colombia, rotavirus vaccination protects against hospitalization for diarrhea due to any cause. The use of cross-sectional surveys appeared to be adequate for rapid evaluation of an immunization program's effectiveness with a new vaccine.

Risk perception about zoonoses in immigrants and Italian workers in Northwestern Italy

OBJECTIVE

To assess factors associated with a low risk perception of zoonoses and to identify the gaps in knowledge about transmission and prevention of zoonoses in immigrant and Italian workers.

METHODS

A cross-sectional study with 175 workers in the agro-livestock and agro-food industry in Piemonte, Italy, was carried out. Data were collected with a semi-structured questionnaire based on knowledge, attitudes and practices (KAP) survey. We calculated proportions and used chi-square tests and odds ratios to assess associations. Eight individual interviews with key informants on immigration and public health in Piemonte were carried out.

RESULTS

Participants were 82 (47%) Italians and 93 (53%) immigrants. Immigrants were from Romania, Morocco, Albania, India, China, Argentina, Peru, Macedonia, Ivory Coast, Ukraine and Colombia. The study revealed significant differences in risk perception at work (p = 0.001). We found associations between "not having correct knowledge about zoonoses" and the following variables: i. "being immigrant" OR = 4.1 (95%CI 1.7;9.8 p ≤ 0.01); ii. "working in the livestock industry" OR = 2.9 (95%CI 1.2;15.4 p = 0.01); and iii. "being an unqualified worker" OR = 4.4 (95%CI 2.9;15.4 p ≤ 0.01). Another strong association was found between being immigrant and having a low job qualification OR = 6.7 (IC95% 2.9 - 15.4 p ≤ 0.01). Asian immigrants were the group with the highest frequency of risky behaviours and the lowest level of knowledge about zoonoses.

CONCLUSIONS

Our results indicate that there were differences in risk perception of zoonoses between the groups participating in our study. These results suggest that immigrant status can be considered a risk factor for having lower risk perception and lower level of knowledge of zoonoses at work. There is a relationship between this specific knowledge of zoonoses and lack of training and instruction among migrant populations. Our results stress the need for developing education programs on zoonoses prevention among the immigrant population in Piemonte, Italy.

[Epidemiological and economic impact of tetanus vaccination in Colombian adults]

OBJECTIVE

Assess the potential epidemiological and economic impact of vaccinating the over-15 Colombian population against tetanus with a booster dose every 10 years.

METHODS

A cost-effectiveness analysis of tetanus vaccination with a booster dose every 10 years was conducted in Colombia and compared with the current strategy (2, 4, 6, 18, and 60 months). Estimates of the burden of disease were based on three official data sources. A Markov model from the perspective of the third party payer was developed. The time horizon was the lifetime of a person. Deterministic and probabilistic sensitivity analyses were conducted.

RESULTS

In Colombia, 30 to 48 cases of tetanus resulting in 9.6 to 10.1 deaths are reported each year. Although booster vaccination for the entire population was cost-effective (the cost per disability-adjusted life year [DALY] avoided was US$ 11,314 in the entire population), gender-based differentiation of the results showed that it would not be cost-effective in women (cost per DALY avoided was US$ 4,903 in men and US$ 22,332 in women).

CONCLUSIONS

This is the first study that evaluates the cost-effectiveness of a tetanus vaccine booster dose every 10 years in a developing country. Use of this measure would be cost-effective in Colombia, especially for men. As a result of the gender-based differences in the results, any decision about its use in women of childbearing age should take current vaccination into account.

[The epidemiology of canine rabies in Colombia]

OBJECTIVE

An epidemiological-ecological study was carried out on canine rabies in Colombia to describe its tendency and explore the factors associated with its incidence.

METHODS

Socio-economic variable data was collected by questionnaire applied to the rabies control programme's regional epidemiology coordinators in each Colombian department. Statistical association analysis was carried out on the 2001-2006 historical epidemiologic data on canine rabies incidence and sources of official national survey figures. Incidence rate ratios and Spearman correlation tests were calculated.

RESULTS

Canine rabies incidence rate was 0.4 cases x 100,000 dogs/year (without adjustment for 2001-2006). Average immunisation coverage from 1994 to 2005 was 45 % to 63 %; only 25 % of Colombian departments had higher than 60 % immunisation coverage. The following variables were associated with the presence of canine rabies: an urban population, immunisation coverage, a lack of a cold chain for vaccines, a lack of participation in surveillance committees, the lack of an epidemiological map, the unavailability of a rabies' diagnosis laboratory, the absence of trained human resources, the absence of a zoonosis centre for observing dogs, comparative analysis between monthly and semester basis data and the percentage of people displaced by internal violence.

CONCLUSIONS

The analysis suggested the need for active surveillance and rapid response. Canine rabies is associated with the weaknesses of regional control programmes. Internal human migration could influence human-dog-selvatic reservoir ratios and rabies frequency.

New approaches for education and training in veterinary public health: the SAPUVET projects

Continued contact between humans and animals, in combination with the ever-increasing movement of human and animal populations that is one effect of globalization, contributes to the spread of diseases, often with detrimental effects on public health. This has led professionals involved in both animal health and public health to recognize veterinary public health (VPH) as a key area for their activities to address the human-animal interface. Veterinarians, a profession with major involvement in this field, are in need of specific knowledge and skills to prevent and control public-health problems. As a result, VPH must be directly integrated into veterinary educational programs. At present, only few veterinary schools have specific VPH programs; in most institutions, VPH does not feature as a specific subject in either undergraduate or post-graduate curricula. SAPUVET and SAPUVETNET II are network projects supported by the ALFA program of the European Union (EU). Their main objectives are to reach a common understanding between European and Latin American universities in the definition of the areas in which VPH is important in their respective countries, and to design a harmonized training program for veterinarians in VPH, by making use of new technological applications and innovative teaching methodologies. The elaboration of educational material in combination with case studies presenting real-life problems provides a basis to apply the knowledge acquired on VPH. It is envisaged that the material and modules developed during the two projects will be integrated into the veterinary curricula of the participating universities, as well as in other partner organizations.