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.

Evidence for current circulation of an ancient West Nile virus strain (NY99) in Brazil.

INTRODUCTION: In Brazil, West Nile virus (WNV) was first detected, in 2018, in horses with neurological disease. AIM: We report the first case of WNV infection in a horse from Ceará state and the complete genome sequence of an isolate from Espírito Santo state. Both infections occurred in 2019. METHODS: WNV was isolated from the tissues of a horse with neurological signs in Espírito Santo and sequenced by MiSeq. RESULTS: Phylogenetic analysis revealed that the isolate belongs to lineage 1a, clustering with the NY99 strain, a strain that has not circulated in the USA since 2005. CONCLUSIONS: Our findings reinforce the hypothesis that WNV has been silently circulating in Brazil for many years.

Evidence for current circulation of an ancient West Nile virus strain (NY99) in Brazil

Abstract INTRODUCTION: In Brazil, West Nile virus (WNV) was first detected, in 2018, in horses with neurological disease. AIM: We report the first case of WNV infection in a horse from Ceará state and the complete genome sequence of an isolate from Espírito Santo state. Both infections occurred in 2019. METHODS: WNV was isolated from the tissues of a horse with neurological signs in Espírito Santo and sequenced by MiSeq. RESULTS: Phylogenetic analysis revealed that the isolate belongs to lineage 1a, clustering with the NY99 strain, a strain that has not circulated in the USA since 2005. CONCLUSIONS: Our findings reinforce the hypothesis that WNV has been silently circulating in Brazil for many years.

HoBi-like pestivirus infection in an outbreak of bovine respiratory disease.

HoBi-like is an emerging pestivirus of the family Flaviviridae detected in cattle herds and biological products of bovine origin in many parts of the world, causing disease similar to that observed in bovine viral diarrhea virus (BVDV) infections. In this study we reported the detection of HoBi-like pestivirus in an outbreak of respiratory disease in calves from Brazil, seropositive for viruses of the bovine respiratory disease complex (BRDC). Thus, serum samples and nasal swabs were collected from calves up to one year old, presenting or not clinical signs of respiratory disease. Serum samples were submitted to virus neutralization test (VNT) for BVDV-1, BVDV-2, bovine herpesvirus-1 (BoHV-1), bovine respiratory syncytial virus (BRSV) and bovine parainfluenza-3 (BPIV-3). These samples were also tested for the presence of pestiviruses (BVDV-1, BVDV-2 and HoBi-like) and BoHV-1 by RT-PCR and PCR, respectively. Nasal swabs were analyzed by RT-PCR for pestiviruses, BRSV and BPIV-3. VNT results showed high serological prevalence and a wide range of antibodies titers, for all viruses studied, in calves of different age groups. The RT-PCR amplified the 5'UTR and E2 regions of pestiviruses of four calves, from both nasal swabs and serum samples, which sequencing identified the HoBi-like pestivirus. This is the first detection of HoBi-like in nasal secretions of calves in an outbreak of respiratory disease in Brazil, along with the serological detection of other respiratory viruses. We concluded that HoBi-like pestivirus should be considered as part of the BRDC, as a differential diagnosis, to take correct measures of control and prophylaxis.

The Importance of Coordinated Actions in Preventing the Spread of Yellow Fever to Human Populations: The Experience from the 2016-2017 Yellow Fever Outbreak in the Northeastern Region of São Paulo State.

Yellow fever (YF) is a zoonotic arthropod-borne disease that is caused by the yellow fever virus (YFV) and characterized by a sylvatic and urban cycle. Its most severe presentation is manifested as a hemorrhagic disease, and it has been responsible for thousands of deaths in the last decades. This study describes the public health approaches taken to control the 2016-2017 YF outbreak in nonhuman primates (NHPs) that took place in the northeastern region of São Paulo state, Brazil. NHPs recovered from the field were necropsied, and YF diagnoses were made at the Laboratory of Molecular Virology, Ribeirão Preto Medical School and the Center of Pathology, Adolfo Lutz Institute of São Paulo. NHP samples were inoculated into Vero cells for YFV isolation. RNA extraction was performed directly from NHP tissues and tested by RT-qPCR. YFV-positive samples were confirmed by sequencing. Based on the rapid RT-qPCR results, surveillance actions were implemented in the entire region. Confirmatory histopathology and immunohistochemistry for YFV were also performed. Among nine NHPs, gross hepatic involvement was observed in six animals, five of which were YFV-RT-qPCR-positive. One YFV was isolated from the serum of an infant NHP. YFV RNA sequences diverged from the virus responsible for the last epizootic that occurred in São Paulo state, but it was similar to the current Brazilian epizootic. Public health actions included dissemination of information on YF transmission, investigation of the probable location of NHP infection, characterization of the environment, and subsequent creation of the blueprint from which prevention and control measures were implemented. The YFV sylvatic cycle occurred in the periurban areas of the northeastern region of São Paulo state, but no human cases were reported during this period, showing that integrated actions between human, animal, and environmental health professionals were critical to restrain the virus to the sylvatic cycle.

Proposta de nova metodologia de apoio para indicação racional de profilaxia antirrábica humana pós-exposição / Proposal of new support methodology for rational indication of post-exposure human anti-rabies prophylaxis

A avaliação dos casos de agressão por animais, sem critérios bem definidos, pode levar à indicação equivocada de tratamento antirrábico humano pós-exposição. O número desses tratamentos, em muitos municípios em todo o Brasil, tem preocupado as autoridades sanitárias. Assim, o presente trabalho objetivou avaliar os registros e a conduta da profilaxia antirrábica humana no Município de Jaboticabal, no período de 2007 a 2010, e propor uma nova metodologia de ação. Foi elaborada uma nova ficha de atendimento antirrábico humano, a ficha referência de atendimento a agressão animal e a ficha de visita zoossanitária, todas com seus respectivos manuais de instrução para preenchimento. Além disso, realizou-se a capacitação dos responsáveis pela sua aplicação e as visitas zoossanitárias. Foram avaliadas as informações das fichas de atendimento e dos resultados de visitas domiciliares e observação dos animais agressores; os dados foram tabulados em Excel e analisados com softwares EpiInfo e Action. Também calculou-se o custo direto das vacinas antirrábicas humanas aplicadas. Em 1.366 fichas analisadas, computou-se um agravo para cada 212 habitantes; das pessoas agredidas, 74,3% receberam tratamento pós-exposição, num total de 1.251 doses de vacina. A análise detalhada dos dados, aliada ao fato de Jaboticabal ser considerada região controlada para a raiva, permite questionar que 894 pessoas podem ter recebido vacina sem necessidade, totalizando 1.094 doses a um custo aproximado de 20 mil reais. Nas visitas zoossanitárias constatou-se que, dentre os animais agressores, 78,1% eram domiciliados; 84,4% estavam sadios nos dias 0 e 10; 55% dos ataques foram provocados, e 73% das agressões ocorreram nas próprias residências. Assim, maior atenção deve ser dispensada ao atendimento a agravos por animais, com adequações na ficha de registro, aplicação das fichas referência de atendimento a agressão animal e de visita zoossanitária. É essencial a interação dos serviços médicos e médicos veterinários, além da intensificação de programas educativos sobre comportamento animal, cuidados e posse responsável. Isso dará subsídios e segurança ao médico responsável no momento de indicar ou não o tratamento antirrábico humano pós-exposição.

A poor assessment of cases of animal attacks on humans may lead to inadequate human anti-rabies prophylaxis. The high number of post-exposure prophylaxis (PEP) treatments in many Brazilian cities has become a concern for Public Health authorities. The present study aimed to assess the records and the conduct of human PEP in the municipality of Jaboticabal, in the period 2007-2010, and to propose a new methodology. Versions for the following forms, together with instructions for filling them out, are proposed: human rabies medical attention form, animal attack notification form, and an animal-sanitary visit form. The personnel in charge of the health sector were trained for filling out these forms and conducting visits. The analysis of patient's records and the results of home visitation and animal observation data were evaluated. Data were organized in Excel spreadsheet and analyzed using EpiInfo and Action software. The direct cost of human vaccination was also calculated. From the 1,366 analyzed records, there was one animal attack per 212 inhabitants. Among the affected people, 74.3% received PEP, resulting in a total of 1,251 vaccine shots. The fact that Jaboticabal is located in a region that has a controlled status for rabies, together with the data analysis, allowed hypothesizing that 894 persons may have received unnecessary rabies shots, which resulted in a total of 1,094 shots at a cost of approximately 20 thousand Brazilian reais. During the animal-sanitary visits, it could be observed that among the aggressors, 78.1% were domiciled animals; 84.4% remained healthy between observation days 0 to 10; 55% of the attacks were provoked and 73% of the events happened inside the domicile. It can be concluded that greater importance should be given to animal attack cases. The patient's records, animal attack notification form and animal-sanitary visit forms should be reviewed and duly amended. The integration of medical and veterinary services is essential, as well as the intensification of educational programs on animal behavior, care and responsible ownership. These actions will provide greater support and safety to the physician in charge upon deciding whether to provide PEP treatment or not.

Avaliação da conduta de profilaxia antirrábica indicada para pessoas envolvidas em agravos com cães e gatos no município de Jaboticabal, SP, no período de 2000 a 2006 / Evaluation of rabies post-exposure prophylaxis in humans injured by dogs and cats in the municipality of Jaboticabal, SP, from 2000 through 2006

Objetivando analisar as indicações de profilaxia antirrábica humana no Município de Jaboticabal-SP, foi realizado um estudo retrospectivo descritivo no período de 2000 a 2006, com levantamento de dados registrados nas fichas de investigação de atendimento e cálculo do custo com as vacinas destinadas à profilaxia pós-exposição. Constatou-se que 2.493 pessoas agredidas por animais foram submetidas à profilaxia com uso de vacina, num total de 7.108 doses e um custo de R$ 179.105,14. Da totalidade de casos notificados, 2.184 (71,5 por cento) foram causados por cães e gatos clinicamente sadios no momento da agressão e que assim se mantiveram durante o período de observação, a qual foi feita pela própria vítima ou pelo dono do animal. Considerando este fato e também a situação epidemiológica da raiva no Município, pode-se inferir que essas vítimas poderiam ter sido dispensadas da profilaxia; entretanto, apenas 464 o foram, ou seja, 1.720 pessoas podem ter recebido vacina sem necessidade, ou seja 4.590 doses a um custo de R$ 114.420,81. Em comparação com os números de outros municípios do Estado de São Paulo e com a média nacional, constata-se que o número de profilaxias pós-exposição contra raiva é muito alto em Jaboticabal, evidenciando que na conduta não se considerou o estado do agressor e a condição do Município de área controlada para raiva. Recomenda-se conscientização e capacitação permanentes das equipes de saúde pública quanto à epidemiologia da doença e à necessidade de observação adequada do animal agressor. É essencial a integração dos serviços médicos e veterinários no atendimento às vitimas, visando uma melhor avaliação do caso para que a decisão de se instituir ou não a profilaxia pós-exposição seja feita com critério e segurança.

The present study aimed to evaluate rabies post-exposure prophylaxis (PEP) in humans in the municipality of Jaboticabal, São Paulo from 2000 through 2006. A descriptive and retrospective study was conducted by collecting data available in patient records. Vaccination costs were also calculated; 2,493 patients injured by animals received PEP, totaling R$ 179,105.14 and 7,108 doses; 2,184 (71.5 percent) out of the total reports were caused by dogs and cats clinically healthy at the moment of the attack. These animals remained sound throughout the 10-day observation period. The observation was conducted by the victim or by the owner. Considering animal observation and the epidemiological status of rabies in the municipality, all of these patients could have been dismissed from PEP treatment. Instead, only 464 were dismissed, meaning that 1,720 patients were unnecessarily vaccinated. An estimated 4,590 doses and R$114,420.81 could have been saved. In comparison with rates of other municipalities of the State of São Paulo and with the national mean, the number of PEP in Jaboticabal is very high and it became evident that management evaluated neither the health status of the animal nor the epidemiological status of the area for rabies. Permanent awareness and education of public health professionals with respect to rabies epidemiology and the need to perform correct observation of the aggressors are recommended. It is essential that medical and veterinary services be integrated to provide better assessment of cases and safer decisions on the institution of PEP.

[Evaluation of rabies post-exposure prophylaxis in humans injured by dogs and cats in the municipality of Jaboticabal, SP, from 2000 through 2006]. / Avaliação da conduta de profilaxia antirrábica indicada para pessoas envolvidas em agravos com cães e gatos no município de Jaboticabal, SP, no período de 2000 a 2006.

The present study aimed to evaluate rabies post-exposure prophylaxis (PEP) in humans in the municipality of Jaboticabal, São Paulo from 2000 through 2006. A descriptive and retrospective study was conducted by collecting data available in patient records. Vaccination costs were also calculated; 2,493 patients injured by animals received PEP, totaling R$ 179,105.14 and 7,108 doses; 2,184 (71.5%) out of the total reports were caused by dogs and cats clinically healthy at the moment of the attack. These animals remained sound throughout the 10-day observation period. The observation was conducted by the victim or by the owner. Considering animal observation and the epidemiological status of rabies in the municipality, all of these patients could have been dismissed from PEP treatment. Instead, only 464 were dismissed, meaning that 1,720 patients were unnecessarily vaccinated. An estimated 4,590 doses and R$114,420.81 could have been saved. In comparison with rates of other municipalities of the State of São Paulo and with the national mean, the number of PEP in Jaboticabal is very high and it became evident that management evaluated neither the health status of the animal nor the epidemiological status of the area for rabies. Permanent awareness and education of public health professionals with respect to rabies epidemiology and the need to perform correct observation of the aggressors are recommended. It is essential that medical and veterinary services be integrated to provide better assessment of cases and safer decisions on the institution of PEP.

Implicações técnicas da vacinação na resposta imune contra o vírus da febre aftosa / Techinical implications of the vaccination in the immune response against the foot-and-mouth disease virus

Na bovinocultura brasileira, a vacinação contra o vírus da Febre Aftosa (FA) é fundamental para a fase inicial de erradicação da enfermidade. Mesmo a qualidade da vacina tendo controle rígido feito pelos órgãos oficiais, restam variáveis técnicas ainda não monitoradas como manipulação, transporte e conservação pelo consumidor, dose, local e forma de aplicação que interferem na resposta imune, preocupações essas, que direcionam o presente estudo. Assim, pela pesquisa de anticorpos neutralizantes do vírus da FA em placas de microtitulação com cultivo de células BHK-21, foram determinados os títulos, calculados em logaritmo decimal (SN), em soros sanguíneos de bovinos vacinados conforme o protocolo apresentado. No primeiro grupo com 25 animais, a média de SN foi igual a 2,37 e 2,19, respectivamente, 30 e 180 dias após a vacinação, cuja vacina foi manejada por especialista com todos os cuidados técnicos recomendados. Outro grupo com 140 bovinos, distribuídos em 5 fazendas distintas, apresentou média de SN igual a 1,66 e 1,5l depois de 30 e 180 dias após a vacinação, cuja vacina foi manejada sem acompanhamento técnico e por indivíduos não especializados. Finalmente um terceiro grupo com 10 animais, que ficaram sem vacinação, apresentou média de SN igual a 0,82 e 0,81, também 30 e 180 dias após a aplicação do placebo. Assim, só os cuidados com a qualidade da vacina são insuficientes para proporcionar títulos satisfatórios que determinam proteção dos rebanhos contra o vírus da FA, uma vez que a literatura pertinente considera rebanhos com 1,52 de média do SN como tendo 50% dos animais protegidos, e com 1,70 como tendo mais de 70% de proteção, no período de até 7 meses.