IHR-PVS National Bridging Workshop in Cameroon: An interactive and participatory approach to engage stakeholders in the development of a One Health road map.

Introduction: Stakeholders involved in the implementation of the One Health (OH) welcome support for the operationalization of the approach and advice on how to address OH collaboration challenges. The IHR/PVS National Bridging Workshop (NBW) is an operational and outcome-oriented tool approach that allows animal health, human health and other relevant sectors to focus on their coordination. This paper describes how Cameroon leveraged on the NBW success factors to engage stakeholders in strengthening multisectoral collaboration. Methods: Stakeholder's engagement was implemented in two phases. Phase one consisted of engaging the multisectoral national task team for the preparation of the workshop. Phase two consisted of the bridging exercise itself during a three day workshop. The WOAH-WHO standardized IHR/PVS NBW toolkit was used throughout the workshop. Results: A total of 66 participants took part in the exercise. In total, 36% each came from human and animal health sectors with 23% and 5% from the environmental health and other sectors respectively. A total of 55% participants came from the national level and 39% from the regional level. The joint roadmap contained 55 activities and 13 objectives. Priority objectives were the establishment of a OH platform at all levels (62% of the vote) and building stakeholder's capacity on the OH approach (56% of the vote). A total of 67% of the activities required low or moderate cost and 87% would have a high impact on multisectoral collaboration. Conclusion: The NBW allowed consensus on operational activities to fill the gaps in coordination to build health security capacities. It enabled Cameroon to create a joint road map for enhanced multisectoral collaboration for health security. The output will be integrated in the National Action Plan for Health Security operational plan and support operational One Health activities. It would be crucial to develop global capacity assessment frameworks for environmental health, which could be included in the NBW, to incorporate interconnections with environmental sector. This should allow for a stronger multisectoral linkage of sectors all together for a more the robust OH approach in responding to emerging public health threats.

Health Security Planning: Developing the Cameroon National Action Plan for Health Security.

The health security planning process transforms recommendations from various evaluations into priority actions to strengthen countries' capacity for emergency preparedness using the One Health approach. Although the World Health Organization (WHO) has developed many tools to facilitate the planning process of a National Action Plan for Health Security (NAPHS) across the various components, a series of multisectoral workshops is still needed to complete the process. In this article, we report on the process of developing Cameroon's NAPHS and propose an innovative solution to improve the process. The NAPHS development process was conducted from May to December 2018. The WHO NAPHS framework, adapted to the local context, guided the process. The WHO planning matrix was used to plan activities and the WHO NAPHS costing tool was used to facilitate the costing exercise. A total of 84 Joint External Evaluation recommendations were translated into activities included in Cameroon's NAPHS. Among these activities, the majority (56%) were of medium priority. The total cost of a 5-year NAPHS was US$87,668,356, with almost half (49%) of the budget allocated to activities in the "Prevent" category and more than a third (35%) allocated to the "Detect" category. The top 3 cost drivers were immunization (22%), the national laboratory system (21%), and antimicrobial resistance (16%). The NAPHS informed policymakers of planned activities and funding needs to fast-track the development of health security capacities. Running gaps in funding will be addressed during a resource mapping exercise. To improve the overall planning process, a web-based support solution, where stakeholders select from a menu of recommendations from the Joint External Evaluation to develop a NAPHS, should be developed to improve the NAPHS development process.

Cross-Sectional Survey of Prophylactic and Metaphylactic Antimicrobial Use in Layer Poultry Farming in Cameroon: A Quantitative Pilot Study.

An evaluation of the patterns of antimicrobial use in livestock can help understand the increasing level of antimicrobial resistance worldwide. This study aimed at evaluating antimicrobial usage in modern layer poultry farms in the West Region of Cameroon. In this light, 70 layer poultry farms and 4 veterinary pharmacies were surveyed. Data on antimicrobial use were collected through interviews using a quantitative-frequency questionnaire and consultation of medical records. The four veterinary pharmacies sold a total of 2.8 tons of antimicrobials (active ingredients) during 2011. At the level of farms, 297 kg of antimicrobials (active ingredients) were used in the 50 layer poultry farms surveyed. Tetracycline, sulfonamides, quinolones, and ß-lactams (aminopenicillins) were the most sold and used drugs in layer farms. As for treatment indication, metaphylactic (58.1%) and prophylactic (41.9%) treatments were the most observed practices, and nearly all (99%) treatments were administered per os as remedies to respiratory (33.4%) and digestive (24.7%) tract symptoms. Overall, 78.2% of antimicrobials sold in pharmacies and 67.3% used in the farms belonged to the class of critically important antimicrobials of the WHO categorization of antimicrobials according to their importance to human medicine. Doxycycline, sulfonamide, ampicillin, and streptomycin, which have been banned for layer poultry in the production of eggs for human consumption, were still used in Cameroon. The treatment incidences based on the used daily dose (TIUDD) and animal daily dose (TIADD) were 11.59 and 10.45, respectively. In regard to dosage correctness based on the UDD/ADD ratio, aminoglycosides (100%), macrolides (90.6%), and tetracyclines (74.5%) were the most underdosed, while trimethoprim sulfonamides (45.8%) and ß-lactams (35.7%) were overdosed. This study highlights an irrational antimicrobial usage in layer poultry farms. Regulation of the use of antimicrobials and the education of farmers on adequate antimicrobial use are essential to preserve the effectiveness of drugs in both humans and animals.

Highly Pathogenic Avian Influenza A(H5N8) Virus, Cameroon, 2017.

Highly pathogenic avian influenza A(H5N8) viruses of clade 2.3.4.4 spread into West Africa in late 2016 during the autumn bird migration. Genetic characterization of the complete genome of these viruses detected in wild and domestic birds in Cameroon in January 2017 demonstrated the occurrence of multiple virus introductions.

Translating Predictions of Zoonotic Viruses for Policymakers.

Recent outbreaks of Ebola virus disease and Zika virus disease highlight the need for disseminating accurate predictions of emerging zoonotic viruses to national governments for disease surveillance and response. Although there are published maps for many emerging zoonotic viruses, it is unknown if there is agreement among different models or if they are concordant with national expert opinion. Therefore, we reviewed existing predictions for five high priority emerging zoonotic viruses with national experts in Cameroon to investigate these issues and determine how to make predictions more useful for national policymakers. Predictive maps relied primarily on environmental parameters and species distribution models. Rift Valley fever virus and Crimean-Congo hemorrhagic fever virus predictions differed from national expert opinion, potentially because of local livestock movements. Our findings reveal that involving national experts could elicit additional data to improve predictions of emerging pathogens as well as help repackage predictions for policymakers.