The importance of a One Health approach for prioritising zoonotic diseases to focus on capacity-building efforts in Uganda.

Zoonotic diseases constitute a significant threat to the health of humans, livestock and wildlife, as well as to livestock production, and can also have a negative impact on our shared environment and on livelihoods. Uganda is a hotspot for emerging and re-emerging zoonotic disease threats, with the main drivers of this phenomenon being identified as agricultural intensification, proximity to wildlife reservoirs and climate change. The threat of zoonotic disease outbreaks affects not only human healthcare systems but also livestock production, food security, human capital development, wildlife health, environmental health and privatesector growth. Firstly, to prevent, control and mitigate the threat from zoonotic diseases, in March 2017, Uganda prioritised zoonotic diseases using a One Health approach that focuses the limited resources available on those diseases that have the greatest impact at the national level. The prioritised zoonotic diseases in question are anthrax, zoonotic influenza viruses, viral haemorrhagic fevers, brucellosis, trypanosomiosis (African sleeping sickness), plague and rabies. Secondly, in January 2018, Uganda published a National One Health Strategic Plan, which was developed after these zoonotic diseases had been prioritised. In addition, the Ugandan Government and its partners are currently collaboratively addressing several of these previously neglected, endemic zoonotic diseases, such as anthrax, brucellosis and rabies. As a result of these One Health efforts, capacity has increased for early detection of, reporting on and response to zoonotic diseases at all levels. To consolidate the achievements of the One Health approach, the Ugandan Government and its partners should continue to support capacity building for the prevention and control of zoonotic diseases.

Les maladies zoonotiques représentent une menace importante pour la santé publique, pour la santé du bétail et de la faune sauvage et pour la productivité du secteur de l'élevage ; en outre, elles ont un impact négatif sur notre environnement commun et sur les moyens de subsistance des populations. L'Ouganda est particulièrement exposé au risque d'émergence et de réémergence des menaces zoonotiques, les principaux facteurs de ce phénomène étant l'intensification agricole, la proximité des espèces sauvages faisant office de réservoirs et le changement climatique. Les menaces de foyers de maladie zoonotique n'affectent pas seulement les systèmes de santé publique mais aussi la production animale, la sécurité alimentaire, le développement du capital humain, la santé de la faune sauvage, la santé environnementale et la croissance du secteur privé. Afin de maîtriser et d'atténuer les menaces liées aux zoonoses, l'Ouganda a d'abord entrepris en mars 2017 de prioriser ces maladies au moyen d'une méthode Une seule santé destinée à recentrer les ressources disponibles, qui sont limitées, sur les zoonoses présentant le plus fort impact au niveau national. Les maladies ainsi définies comme prioritaires sont la fièvre charbonneuse, les virus influenza zoonotiques, les fièvres hémorragiques virales, la brucellose, la trypanosomose humaine africaine (maladie du sommeil), la peste et la rage. Dans un deuxième temps, l'Ouganda a publié en janvier 2018 son Plan stratégique national Une seule santé, en tenant compte des maladies zoonotiques définies comme prioritaires. En outre, le gouvernement ougandais et ses partenaires ont mis en place un cadre de collaboration en vue de traiter un certain nombre de maladies zoonotiques endémiques précédemment négligées telles que la fièvre charbonneuse, la brucellose et la rage. Grâce à ces efforts Une seule santé, l'Ouganda à pu renforcer ses capacités en matière de détection précoce des maladies zoonotiques, de notification et de réponse, et ce à tous les niveaux. Afin de consolider les résultats obtenus par l'approche Une seule santé, le gouvernement ougandais et ses partenaires devraient continuer à soutenir les efforts de renforcement des capacités destinées à la prévention et au contrôle des zoonoses.

Las enfermedades zoonóticas constituyen una importante amenaza no solo para la salud de personas, animales domésticos y fauna silvestre, sino también para la producción pecuaria, sin olvidar que pueden repercutir negativamente en el entorno natural que todos compartimos y en nuestros medios de sustento. Por lo que respecta al peligro que representan las enfermedades zoonóticas emergentes y reemergentes, cabe decir que Uganda es un «avispero¼, en el que convergen varios de los principales factores que alimentan el fenómeno: la intensificación de la agricultura, la cercanía de animales salvajes que ejercen de reservorio y el cambio climático. La amenaza de brotes de enfermedades zoonóticas afecta no solo a los sistemas de atención sanitaria sino también a la producción pecuaria, la seguridad alimentaria, el desarrollo del capital humano, la sanidad de los animales silvestres, la salud ambiental y el crecimiento del sector privado. En primer lugar, con el fin de prevenir, controlar y reducir la amenaza derivada de enfermedades zoonóticas, en marzo de 2017 Uganda definió un orden de prioridades entre esta clase de enfermedades, aplicando para ello la lógica de Una sola salud para concentrar los escasos recursos en aquellas enfermedades que tienen la mayor repercusión a escala nacional. Las enfermedades zoonóticas consideradas así prioritarias son: el carbunco bacteridiano, los virus gripales zoonóticos, las fiebres hemorrágicas víricas, la brucelosis, la tripanosomosis (enfermedad del sueño africana), la peste y la rabia. En segundo lugar, en enero de 2018 Uganda hizo público un Plan Estratégico Nacional de Una sola salud, que se elaboró tras haber definido como prioritarias las mencionadas enfermedades zoonóticas. Además, el Gobierno ugandés y sus asociados colaboran ahora en la lucha contra varias de estas enfermedades zoonóticas endémicas, hasta ahora desatendidas, como el carbunco, la brucelosis o la rabia. Gracias a estas actividades en clave de Una sola salud, el país se ha dotado de mayor capacidad para detectar rápidamente enfermedades zoonóticas, notificarlas y afrontarlas a todos los niveles. Ahora, para afianzar los resultados obtenidos, es preciso que el Gobierno del país y sus asociados sigan respaldando la labor de creación de capacidad para la prevención y el control de enfermedades zoonóticas.

Cholera outbreak caused by drinking lake water contaminated with human faeces in Kaiso Village, Hoima District, Western Uganda, October 2015.

BACKGROUND: On 12 October 2015, a cholera outbreak involving 65 cases and two deaths was reported in a fishing village in Hoima District, Western Uganda. Despite initial response by the local health department, the outbreak persisted. We conducted an investigation to identify the source and mode of transmission, and recommend evidence-led interventions to control and prevent cholera outbreaks in this area. METHODS: We defined a suspected case as the onset of acute watery diarrhoea from 1 October to 2 November 2015 in a resident of Kaiso Village. A confirmed case was a suspected case who had Vibrio cholerae isolated from stool. We found cases by record review and active community case finding. We performed descriptive epidemiologic analysis for hypothesis generation. In an unmatched case-control study, we compared exposure histories of 61 cases and 126 controls randomly selected among asymptomatic village residents. We also conducted an environmental assessment and obtained meteorological data from a weather station. RESULTS: We identified 122 suspected cases, of which six were culture-confirmed, 47 were confirmed positive with a rapid diagnostic test and two died. The two deceased cases had onset of the disease on 2 October and 10 October, respectively. Heavy rainfall occurred on 7-11 October; a point-source outbreak occurred on 12-15 October, followed by continuous community transmission for two weeks. Village residents usually collected drinking water from three lakeshore points - A, B and C: 9.8% (6/61) of case-persons and 31% (39/126) of control-persons were found to usually use point A, 21% (13/61) of case-persons and 37% (46/126) of control-persons were found to usually use point B (OR = 1.8, 95% CI: 0.64-5.3), and 69% (42/61) of case-persons and 33% (41/126) of control-persons were found to usually use point C (OR = 6.7; 95% CI: 2.5-17) for water collection. All case-persons (61/61) and 93% (117/126) of control-persons reportedly never treated/boiled drinking water (OR = ∞, 95% CI Fisher: 1.0 - ∞). The village's piped water system had been vandalised and open defecation was common due to a lack of latrines. The lake water was found to be contiminated due to a gully channel that washed the faeces into the lake at point C. CONCLUSIONS: This outbreak was likely caused by drinking lake water contaminated by faeces from a gully channel. We recommend treatment of drinking water, fixing the vandalised piped-water system and constructing latrines.