Operationalizing the One Health Approach in Uganda: Challenges and Opportunities.

Uganda is considered as a 'hot spot' for emerging and re-emerging infectious disease epidemics. The country has experienced several epidemics including; Ebola, Marburg, plague, Rift Valley fever, yellow fever and Crimean Congo haemorrhagic fever. Epidemics overwhelm health systems, devastate economies and cause global health insecurity. These public health challenges arising from the interaction of humans-animals-environment link require a holistic approach referred to as One Health (OH). OH is the collaborative effort of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals, and the environment. Given its situation, Uganda has embraced the OH approach in order to be able to predict, prepare and respond to these public health challenges effectively, though still in infancy stages. In this paper, we present major achievements and challenges of OH implementation, and make recommendations for systematic and sustainable OH implementation. Achievements include: formation of the National One Health (NOH) platform with a Memorandum of Understanding between sectors; a national priority list of zoonotic diseases, the NOH Strategic Plan and a One Health communication strategy to strengthen engagement across sectors and stakeholders. There have also been efforts to integrate OH in academia. The challenges are related to inadequate; coordination across sectors, government commitment, advocacy and awareness creation and research. For systematic and sustainable OH engagements, urgent efforts should be made through government support to address current and related future challenges.

Summit proceedings: Biomedical countermeasure development for emerging vector-borne viral diseases.

Emerging and re-emerging infectious diseases are an expanding global threat to public health, security, and economies. Increasing populations, urbanization, deforestation, climate change, anti-vaccination movements, war, and international travel are some of the contributing factors to this trend. The recent Ebola, MERS-CoV, and Zika outbreaks demonstrated we are insufficiently prepared to respond with proven safe and effective countermeasures (i.e., vaccines and therapeutics). The State University of New York Upstate Medical University and the Trudeau Institute convened a summit of key opinion and thought leaders in the life sciences and biomedical research and development enterprises to explore global biopreparedness challenges, take an inventory of existing capabilities and capacities related to preparation and response, assess current "gaps," and prospect what could be done to improve our position. Herein we describe the summit proceedings, "Translational Immunology Supporting Biomedical Countermeasure Development for Emerging Vector-borne Viral Diseases," held October 2-3, 2018, at the Trudeau Institute in Saranac Lake, NY.

The 2017 Oslo conference report on neglected tropical diseases and emerging/re-emerging infectious diseases - focus on populations underserved.

BACKGROUND: In 2017, the Centre for Global Health (CGH) at the University of Oslo in collaboration with the Coalition for Epidemic Preparedness Innovations (CEPI) and the Norwegian Agency for Development Cooperation (Norad) held a meeting to discuss together with leading figures in disease control, research and development the issue of neglected tropical diseases and emerging/re-emerging infectious diseases. This commentary has taken up this discussion and the conclusions drawn at this meeting to make a case for the opportunity the Sustainable Development Goals (SDGs) provide in highlighting the interconnectedness of factors that are relevant in the successful fight against neglected tropical diseases (NTDs) and emerging infectious diseases (EIDS). MAIN BODY: Despite NTDs being endemic and EIDS being epidemic, in order to prevent both disease groups effectively, it is important to appreciate that they share essential health determining factors, namely: neglect, poverty, a lack of access to clean water and sanitation facilities and an absence of or severely limited provision of healthcare as well as in many cases a zoonotic nature. Instead of looking to "simple disease management" for the answer, the SDGs help to understand the interplay of multiple priority areas and thereby help to promote a more holistic approach to addressing these two disease groups. CONCLUSIONS: Their commonalities mean that the Global Health community should leverage opportunities and efforts in the prevention and elimination of both NTDs and EIDs. Doing so using a One Health approach is considered to offer a "public health best-buy". Concrete solutions are proposed.

Avoiding bites and scratches? Understanding the public health implication of human-bat interactions in Ghana.

Zoonotic pathogens cause an estimated 70% of emerging and re-emerging infectious diseases in humans, affecting various aspects of human development on a global scale. The significance of bats as a source of emerging infectious diseases is being progressively appreciated. This study was undertaken post-Ebola virus disease in West Africa and assessed the public health implications of human-bat interactions by exploring the reasons for contact between humans and bats, as well as reported actions taken upon experiencing bat bites or scratches. The paper highlights the nuances of human-bat interactions, stressing zoonotic disease risk awareness as well as the sources of information. The study used questionnaires to solicit information from 788 respondents in five communities with significant bat populations. We show that bat consumption was one of the main reasons for human-bat interactions. More men across the various communities ate bat meat. Only a small number of respondents (4.4%) reported being bitten by a bat, and 6.1% had been scratched by a bat. More than 21% had come into direct contact with bat blood. An even lower number went to the hospital after been bitten or scratched by bats. There was little knowledge on post-exposure management. The most common places human-bat interactions occurred were at home and on farms. Seventy-three per cent of the respondents believed that bats carried diseases, with Ebola virus disease being the most mentioned. Respondents indicated that the way they interacted with bats had not changed, even though they believed bats carried diseases and 46% stated that they had not changed the way they interacted with bats over the last two years. Apart from providing information on avoiding bites and scratches, a more holistic framework is needed to reduce human-bat interactions. The paper recommends a comprehensive and coordinated approach to optimizing an effective response to a potential bat-borne zoonotic disease spillover.

Risk Prevention of Spreading Emerging Infectious Diseases Using a HybridCrowdsensing Paradigm, Optical Sensors, and Smartphone.

The risk of spreading diseases within (ad-hoc)crowds and the need to pervasively screen asymptomatic individuals to protect the population against emerging infectious diseases, request permanentcrowd surveillance., particularly in high-risk regions. Thecase of Ebola epidemic in West Africa in recent years has shown the need for pervasive screening. The trend today in diseases surveillance is consisting of epidemiological data collection about emerging infectious diseases using social media, wearable sensors systems, or mobile applications and data analysis. This approach presents various limitations. This paper proposes a novel approach for diseases monitoring and risk prevention of spreading infectious diseases. The proposed approach, aiming at overcoming the limitation of existing disease surveillance approaches, combines the hybrid crowdsensing paradigm with sensing individuals' bio-signals using optical sensors for monitoring any risks of spreading emerging infectious diseases in any (ad-hoc) crowds. A proof-of-concept has been performed using a drone armed with a cat s60 smartphone featuring a Forward Looking Infra-Red (FLIR) camera. According to the results of the conducted experiment, the concept has the potential to improve the conventional epidemiological data collection. The measurement is reliable, and the recorded data are valid. The measurement error rates are about 8%.

Optimization of human, animal, and environmental health by using the One Health approach.

Emerging diseases are increasing burdens on public health, negatively affecting the world economy, causing extinction of species, and disrupting ecological integrity. One Health recognizes that human, domestic animal, and wildlife health are interconnected within ecosystem health and provides a framework for the development of multidisciplinary solutions to global health challenges. To date, most health-promoting interventions have focused largely on single-sector outcomes. For example, risk for transmission of zoonotic pathogens from bush-meat hunting is primarily focused on human hygiene and personal protection. However, bush-meat hunting is a complex issue promoting the need for holistic strategies to reduce transmission of zoonotic disease while addressing food security and wildlife conservation issues. Temporal and spatial separation of humans and wildlife, risk communication, and other preventative strategies should allow wildlife and humans to co-exist. Upstream surveillance, vaccination, and other tools to prevent pathogen spillover are also needed. Clear multi-sector outcomes should be defined, and a systems-based approach is needed to develop interventions that reduce risks and balance the needs of humans, wildlife, and the environment. The ultimate goal is long-term action to reduce forces driving emerging diseases and provide interdisciplinary scientific approaches to management of risks, thereby achieving optimal outcomes for human, animal, and environmental health.

Toward a collaborative model of pandemic preparedness and response: Taiwan's changing approach to pandemics.

BACKGROUND: Over time, as newly emerging infectious diseases have become increasingly common and more easily spread, it has become clear that traditional response mechanisms have proven inadequate to the task of prevention and control. PURPOSE: To explore whether enhanced cooperation with local government and community institutions can effectively supplement traditional state-centric public health epidemic responses. METHODS: Drawing on Taiwan as a case study, we assess the role of the whole-of-society approach to epidemic response as arises from the collaborative governance literature. The approach calls for enhanced cooperation, trust building, resource sharing and consensus-oriented decision making among multiple levels of government, business, non-profits, and the public in general. RESULTS: The Taiwan case illustrates the benefits of the whole-of-society approach. Enhanced cooperation between state, local government and non-state institutions, particularly neighborhood committees, has resulted in a strengthened, holistic epidemic preparedness and response infrastructure. CONCLUSION: The Taiwan case provides evidence that by implementing the whole-of-society approach to pandemic preparedness and response governments can enhance their ability to manage future outbreaks. We recommend that governments beyond Taiwan's borders seriously consider adopting this approach.

[One Health--mutual health of humans, animals and the environment]. / One Health--ihmisten, eläinten ja ympäristön yhteinen terveys.

The detection in the early 2000's of new, pandemically spreading viral diseases and threats led to "One Health", a holistic concept of the inevitability of collaboration between human and animal health and the protection of the ecosystem. The movement initiated by physicians and veterinarians emerges form the idea that the health of humans and animals is interconnected and connected with the environment and that changes occurring in the environment will have a significant impact on health. Problems associated with health, such as antimicrobial resistance or zoonoses, require global solutions.

Infectious diseases in oyster aquaculture require a new integrated approach.

Emerging diseases pose a recurrent threat to bivalve aquaculture. Recently, massive mortality events in the Pacific oyster Crassostrea gigas associated with the detection of a microvariant of the ostreid herpesvirus 1 (OsHV-1µVar) have been reported in Europe, Australia and New Zealand. Although the spread of disease is often viewed as a governance failure, we suggest that the development of protective measures for bivalve farming is presently held back by the lack of key scientific knowledge. In this paper, we explore the case for an integrated approach to study the management of bivalve disease, using OsHV-1 as a case study. Reconsidering the key issues by incorporating multidisciplinary science could provide a holistic understanding of OsHV-1 and increase the benefit of research to policymakers.

Rabies in Greece; historical perspectives in view of the current re-emergence in wild and domestic animals.

Greece has been rabies free since 1987 while no human cases have been seen since 1970. The re-emergence of rabies in Northern Greece during 2012-2013 in wild and domestic animals prompted a systematic review of historical evidence of the presence of the disease in the country from ancient years till the present. Historical data is presented along with efforts to prevent disease in animals and humans especially during the high prevalent periods in the country in the mid-20th century. These efforts serve as a guide to current extensive efforts to prevent spread especially in the wild and domestic animal populations.

Deconstructing "malaria": West Africa as the next front for dengue fever surveillance and control.

Presumptive treatment of febrile illness patients for malaria remains the norm in endemic areas of West Africa, and "malaria" remains the top source of health facility outpatient visits in many West African nations. Many other febrile illnesses, including bacterial, viral, and fungal infections, share a similar symptomatology as malaria and are routinely misdiagnosed as such; yet growing evidence suggests that much of the burden of febrile illness is often not attributable to malaria. Dengue fever is one of several viral diseases with symptoms similar to malaria, and the combination of rapid globalization, the long-standing presence of Aedes mosquitoes, case reports from travelers, and recent seroprevalence surveys all implicate West Africa as an emerging front for dengue surveillance and control. This paper integrates recent vector ecology, public health, and clinical medicine literature about dengue in West Africa across community, regional, and global geographic scales. We present a holistic argument for greater attention to dengue fever surveillance in West Africa and renew the call for improving differential diagnosis of febrile illness patients in the region.

Establishing a One Health office in Kenya.

A One Health (OH) approach that integrates human,animal and environmental approaches to management of zoonotic diseases has gained momentum in the last decadeas part of a strategy to prevent and control emerging infectious diseases. However, there are few examples of howan OH approach can be established in a country. Kenya establishment of an OH office, referred to asthe Zoonotic Disease Unit (ZDU) in 2011. The ZDU bridges theanimal and human health sectors with a senior epidemiologist deployed from each ministry; and agoal of maintaining collaboration at the animal and human health interface towards better prevention and control of zoonoses. The country is adding an ecologist to the ZDU to ensure that environmental risks are adequately addressed in emerging disease control.

Emergence of novel Leptospira serovars: a need for adjusting vaccination policies for dogs?

A total of 855 sera from dogs in Greece were tested for antibodies to strains belonging to the Pomona, Grippotyphosa and Australis serogroups of Leptospira to assess exposure levels to these serogroups, possible associations with clinical disease and to evaluate whether these findings support the inclusion of additional serovars in dog vaccines. Antibodies were detected in 110 (12·9%) dogs. The highest seroprevalence (4·9%) was to the proposed novel serovar Altodouro belonging to the Pomona serogroup. This serovar also showed a statistically significant association with clinical disease. Serovar Bratislava antibodies were found in 3·4% of sera. Consideration should be given to the inclusion of serovars belonging to the Pomona serogroup and serovar Bratislava in future dog vaccines for the Greek market.

One Health approach in the South East Asia region: opportunities and challenges.

The outbreaks of SARS, avian influenza, and Nipah virus in Asian countries clearly demonstrated that new highly infectious agents periodically emerge at the human-animal interface. The experiences of regional countries with prevention and control of avian influenza, SARS have reinforced the need for sustained, well-coordinated, multi-sector, multi-disciplinary, community-based actions to address emerging disease threats. 'One Health' is a cost-effective, sustainable, and practical approach to find solutions for problems which need holistic, multidisciplinary approaches, particularly in resource-constrained countries. While there is a growing recognition of One Health, it has to be translated from concept into actions through country level activities that are relevant for specific situations.

A framework for the study of zoonotic disease emergence and its drivers: spillover of bat pathogens as a case study.

Many serious emerging zoonotic infections have recently arisen from bats, including Ebola, Marburg, SARS-coronavirus, Hendra, Nipah, and a number of rabies and rabies-related viruses, consistent with the overall observation that wildlife are an important source of emerging zoonoses for the human population. Mechanisms underlying the recognized association between ecosystem health and human health remain poorly understood and responding appropriately to the ecological, social and economic conditions that facilitate disease emergence and transmission represents a substantial societal challenge. In the context of disease emergence from wildlife, wildlife and habitat should be conserved, which in turn will preserve vital ecosystem structure and function, which has broader implications for human wellbeing and environmental sustainability, while simultaneously minimizing the spillover of pathogens from wild animals into human beings. In this review, we propose a novel framework for the holistic and interdisciplinary investigation of zoonotic disease emergence and its drivers, using the spillover of bat pathogens as a case study. This study has been developed to gain a detailed interdisciplinary understanding, and it combines cutting-edge perspectives from both natural and social sciences, linked to policy impacts on public health, land use and conservation.

Laboratory systems and services are critical in global health: time to end the neglect?

The $63 billion comprehensive global health initiative (GHI) emphasizes health systems strengthening (HSS) to tackle challenges, including child and maternal health, HIV/AIDS, family planning, and neglected tropical diseases. GHI and other initiatives are critical to fighting emerging and reemerging diseases in resource-poor countries. HSS is also an increasing focus of the $49 billion program of the US President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Laboratory systems and services are often neglected in resource-poor settings, but the funding offers an opportunity to end the neglect. To sustainably strengthen national laboratory systems in resource-poor countries, the following approaches are needed: (1) developing integrative national laboratory strategic plans and policies and building systems to address multiple diseases; (2) establishing public-private partnerships; (3) ensuring effective leadership, commitment, and coordination by host governments of efforts of donors and partners; (4) establishing and/or strengthening centers of excellence and field epidemiology and laboratory training programs to meet short- and medium-term training and retention goals; and (5) establishing affordable, scalable, and effective laboratory accreditation schemes to ensure quality of laboratory tests and bridge the gap between clinicians and laboratory experts on the use of test results.

Major trends in human parasitic diseases in China.

Tremendous progress has been made in the control and prevention of human parasitic diseases in mainland China in the past 30 years because of China's Reform and Opening to the Outside Policies initiated in 1978. However, parasitic diseases remain a major human health problem, with significant morbidity and mortality as well as adverse socioeconomic consequences. Although soil-transmitted parasitic diseases are in the process of being gradually controlled, food-borne parasitic diseases and emerging parasitic diseases are becoming the focus of new campaigns for control and prevention. This article reviews major trends in human parasitic diseases in mainland China, with perspectives for control.