Measurement and sampling error in mixed-methods research for the control of Peste des Petits Ruminants in the Karamoja subregion of Northeastern Uganda: A cautionary tale.

A team of interdisciplinary researchers undertook a mixed methods, participatory epidemiology (PE) based study as part of a pilot project for localized control of Peste des petits ruminants (PPR), a small ruminant disease of high socio-economic impact. Mixed methods research combines qualitative and quantitative methods, allowing iterative comparison of results to arrive at a more comprehensive and informed outcome. In this study, the use of PE and a household survey (HHS) resulted in contradictory results. However, the mixed methods approach also facilitated the detection and the explanation of bias in the HHS, which may have gone undetected and unexplored had only one method been used. Results show that logistical constraints leading to a failure to apply key aspects of the sampling strategy led to problematic gender/ethnic composition of the HHS sample population. Additionally, while PE findings on local disease and terminology were integrated during HHS development and training, there is apparent measurement error related to enumerator bias in HHS results, possibly due to insufficient respondent understanding or a lack of analytic clarity. The extensive nature of the PE, surveillance methodologies used in the initial site assessment, and formative research for the HHS allowed for a critical analysis and interpretation of HHS results as well as reflection on the research process. The findings of this paper underscore the (1) flexibility and utility of participatory methods, (2) the importance of mixed methods research in designing health interventions, and (3) the necessity of tight integration of study design with team planning for implementation of research in environments such as Karamoja, Uganda. If all three are to be achieved not only researchers but funders must provide these space and structure beginning in the study design phase. These findings are relevant in many places, but have particular importance for international, interdisciplinary teams working from various on-and-off-site locations with traditional or indigenous knowledge systems.

Eradication of Peste des Petits Ruminants Virus and the Wildlife-Livestock Interface.

Growing evidence suggests that multiple wildlife species can be infected with peste des petits ruminants virus (PPRV), with important consequences for the potential maintenance of PPRV in communities of susceptible hosts, and the threat that PPRV may pose to the conservation of wildlife populations and resilience of ecosystems. Significant knowledge gaps in the epidemiology of PPRV across the ruminant community (wildlife and domestic), and the understanding of infection in wildlife and other atypical host species groups (e.g., camelidae, suidae, and bovinae) hinder our ability to apply necessary integrated disease control and management interventions at the wildlife-livestock interface. Similarly, knowledge gaps limit the inclusion of wildlife in the FAO/OIE Global Strategy for the Control and Eradication of PPR, and the framework of activities in the PPR Global Eradication Programme that lays the foundation for eradicating PPR through national and regional efforts. This article reports on the first international meeting on, "Controlling PPR at the livestock-wildlife interface," held in Rome, Italy, March 27-29, 2019. A large group representing national and international institutions discussed recent advances in our understanding of PPRV in wildlife, identified knowledge gaps and research priorities, and formulated recommendations. The need for a better understanding of PPRV epidemiology at the wildlife-livestock interface to support the integration of wildlife into PPR eradication efforts was highlighted by meeting participants along with the reminder that PPR eradication and wildlife conservation need not be viewed as competing priorities, but instead constitute two requisites of healthy socio-ecological systems.

Identification of Peste des Petits Ruminants Transmission Hotspots in the Karamoja Subregion of Uganda for Targeting of Eradication Interventions.

This paper describes an assessment of the patterns of peste des petits ruminants virus circulation in the Karamoja subregion of Uganda conducted to identify the communities that maintain the virus and inform the development of a targeted vaccination strategy. Participatory epidemiological methods were used to develop an operational hypothesis for the patterns of PPR in Karamoja that was subsequently validated through outbreak investigation and genomics. The participatory epidemiological assessment included risk mapping with livestock owners, community animal health workers and veterinarians and indicated there were two critical foci of virus transmission on the Uganda-Kenya border. One was located in two adjacent subcounties of Kotido and Kaabong Districts in northern Karamoja and the other in Loroo subcounty of Amudat District in southern Karamoja. Participants reported that these were locations where outbreaks were usually first observed in Karamoja and subsequently spread to other areas. Following the participatory assessment, surveillance activities were implemented across the Karamoja subregion in 2018. Three outbreak were detected, investigated and sampled. Two outbreaks were located in the northern and one on the southern focus of transmission. No Outbreaks were diagnosed in Karamoja outside of these foci during 2018. Genomics indicated different clusters of viruses were associated with the northern and southern foci that were more closely related to other East African isolates than to each other. This indicates these are two separate systems of virus circulation which should be explicitly addressed in eradication as separate cross-border systems that require integrated cross-border interventions.

A thermostable presentation of the live, attenuated peste des petits ruminants vaccine in use in Africa and Asia.

The research objective was to develop a thermostable vaccine against peste des petits ruminants (PPR), a morbilliviral disease of small ruminants targeted for eradication that is a major constraint on the livelihoods of the rural poor throughout much of Africa and Asia. Although existing PPR vaccines provide life-long immunity, they require continuous refrigeration. This limits their utility in developing countries. Methods for the lyophilization of a related morbillivirus, rinderpest (RP), resulted in vaccine that could be used in the field for up to 30days without refrigeration which was a major contribution to the global eradication of RP completed in 2011. The present research applied the rinderpest lyophilization method to the attenuated Nigeria 75/1 PPR vaccine strain, and measured thermostability in accelerated stability tests (AST) at 37°C. The shelf-life of the vaccine was determined as the time a vial retained the minimum dose required as a 25-dose presentation at the specified temperature. A lactalbumin hydrolysate and sucrose (LS) stabilizer was compared to stabilizers based on trehalose. PPR vaccine produced using the Xerovac drying method was compared to vaccine produced using the rinderpest lyophilization method in AST. LS vaccine was evaluated in AST at 37, 45 and 56°C and an Arrhenius plot was constructed for estimation of stability at temperatures not tested. Vaccines produced using LS and the rinderpest method of lyophilization were the most stable. The shelf-life of the Xerovac preparation was 22.2days at 37°C. The three LS vaccine batches had shelf-lives at 37°C of 177.6, 105.0 and 148.9days, respectively, at 37°C. At 56°C, the shelf-life was 13.7days. The projected half-life at 25°C was 1.3years. This is sufficient thermostability for use without a cold chain for up to 30days which will greatly facilitate the delivery of vaccination in the global eradication of PPR.

The Opportunity To Eradicate Peste des Petits Ruminants.

Peste des petits ruminants (PPR) is a highly infectious disease of sheep and goats that is caused by PPR virus, a member of the genus Morbillivirus that includes the viruses that cause rinderpest (RP) in cattle. RP was the first animal disease to be globally eradicated in 2011 and is only the second disease, after smallpox, to have ever been eradicated. PPR is one of the principal constraints to small ruminant production in Africa, Asia, and the Middle East. The epidemiology of PPR and RP as well as the technologies available for their diagnosis and control are similar. The conditions that favored the eradication of RP are also largely present for PPR. In this work, we outline the evolving strategy for eradication in light of current opportunities and challenges, as well as the lessons from other eradication programs in animal and human health. The global PPR situation and technology for its control are summarized. A strategy based on the lessons from previous eradication efforts that integrate epidemiology, social science, and economics as tools to target and motivate vaccination is summarized. Major aspects of the cost and benefit-cost analysis of the indicated program are presented. The overall undiscounted cost of eradication was estimated as $3.1 billion, and the benefit-cost ratio for the most likely scenario was estimated at 33.8. We close with a discussion of the possible next steps.

The Economic Impact of Eradicating Peste des Petits Ruminants: A Benefit-Cost Analysis.

Peste des petits ruminants (PPR) is an important cause of mortality and production loss among sheep and goats in the developing world. Despite control efforts in a number of countries, it has continued to spread across Africa and Asia, placing an increasing burden on the livelihoods of livestock keepers and on veterinary resources in affected countries. Given the similarities between PPR and rinderpest, and the lessons learned from the successful global eradication of rinderpest, the eradication of PPR seems appealing, both eliminating an important disease and improving the livelihoods of the poor in developing countries. We conducted a benefit-cost analysis to examine the economic returns from a proposed programme for the global eradication of PPR. Based on our knowledge and experience, we developed the eradication strategy and estimated its costs. The benefits of the programme were determined from (i) the averted mortality costs, based on an analysis of the literature, (ii) the downstream impact of reduced mortality using a social accounting matrix, and (iii) the avoided control costs based on current levels of vaccination. The results of the benefit-cost analysis suggest strong economic returns from PPR eradication. Based on a 15-year programme with total discounted costs of US$2.26 billion, we estimate discounted benefits of US$76.5 billion, yielding a net benefit of US$74.2 billion. This suggests a benefit cost ratio of 33.8, and an internal rate of return (IRR) of 199%. As PPR mortality rates are highly variable in different populations, we conducted a sensitivity analysis based on lower and higher mortality scenarios. All the scenarios examined indicate that investment in PPR eradication would be highly beneficial economically. Furthermore, removing one of the major constraints to small ruminant production would be of considerable benefit to many of the most vulnerable communities in Africa and Asia.

Mathematical modelling of the transmission dynamics of contagious bovine pleuropneumonia reveals minimal target profiles for improved vaccines and diagnostic assays.

Contagious bovine pleuropneumonia (CBPP) is a cattle disease that has hampered the development of the livestock sector in sub-Saharan Africa. Currently, vaccination with a live vaccine strain is its recommended control measure although unofficial antimicrobial use is widely practiced. Here, modelling techniques are used to assess the potential impact of early elimination of infected cattle via accurate diagnosis on CBPP dynamics. A herd-level stochastic epidemiological model explicitly incorporating test sensitivity and specificity is developed. Interventions by annual vaccination, annual testing and elimination and a combination of both are implemented in a stepwise manner and their effectiveness compared by running 1000 simulations per intervention over ten years. The model predicts that among the simulated interventions, the ones likely to eliminate the disease from an isolated herd all involved annual vaccination of more than 75% of the animals with a vaccine that protects for at least 18 months combined with annual testing (and elimination of positive reactors) of 75% of the animals every six months after vaccination. The highest probability of disease elimination was 97.5% and this could occur within a median of 2.3 years. Generally, our model predicts that regular testing and elimination of positive reactors using improved tests will play a significant role in minimizing CBPP burden especially in the current situation where improved vaccines are yet to be developed.

Experiences in participatory surveillance and community-based reporting systems for H5N1 highly pathogenic avian influenza: a case study approach.

Participatory surveillance (PS) is the application of participatory rural appraisal methods to the collection of epidemiological information to inform decision-making and action. It was applied in Africa and Asia as part of emergency programs to address the H5N1 highly pathogenic avian influenza (HPAI) pandemic. The approach resulted in markedly increased case detection in countries experiencing HPAI, and a better understanding of the epidemiological situation. Where HPAI was absent and PS was implemented, the method did not result in false positives and contributed to the overall epidemiological assessment that the country was free of disease. It was noted that clarity of surveillance objectives and resulting data needs at the outset was essential to optimize the balance of surveillance methods, size of the program and costs. The quality of training programs and adherence to international guidelines on good PS training practice were important for assuring the competence of PS practitioners. Orientation of senior decision-makers was an important step in assuring effective program management and appropriate use of results. As a problem-solving methodology, PS is best used to rapidly assess situations and inform strategy. Several countries continued PS after the end of projects and went on to apply PS to other health challenges.

Development of an improved vaccine for contagious bovine pleuropneumonia: an African perspective on challenges and proposed actions.

Contagious bovine pleuropneumonia (CBPP) caused by Mycoplasma mycoides subsp. mycoides (Mmm) is an economically very important cattle disease in sub-Saharan Africa. CBPP impacts animal health and poverty of livestock-dependent people through decreased animal productivity, reduced food supply, and the cost of control measures. CBPP is a barrier to trade in many African countries and this reduces the value of livestock and the income of many value chain stakeholders. The presence of CBPP also poses a constant threat to CBPP-free countries and creates costs in terms of the measures necessary to ensure the exclusion of disease. This opinion focuses on the biomedical research needed to foster the development of better control measures for CBPP. We suggest that different vaccine development approaches are followed in parallel. Basic immunology studies and systematic OMICs studies will be necessary in order to identify the protective arms of immunity and to shed more light on the pathogenicity mechanisms in CBPP. Moreover a robust challenge model and a close collaboration with African research units will be crucial to foster and implement a new vaccine for the progressive control of this cattle plague.

Rinderpest eradication: appropriate technology and social innovations.

Rinderpest is only the second infectious disease to have been globally eradicated. In the final stages of eradication, the virus was entrenched in pastoral areas of the Greater Horn of Africa, a region with weak governance, poor security, and little infrastructure that presented profound challenges to conventional control methods. Although the eradication process was a development activity rather than scientific research, its success owed much to several seminal research efforts in vaccine development and epidemiology and showed what scientific decision-making and management could accomplish with limited resources. The keys to success were the development of a thermostable vaccine and the application of participatory epidemiological techniques that allowed veterinary personnel to interact at a grassroots level with cattle herders to more effectively target control measures.

Epidemiological assessment of the Rift Valley fever outbreak in Kenya and Tanzania in 2006 and 2007.

To capture lessons from the 2007 Rift Valley fever (RVF) outbreak, epidemiological studies were carried out in Kenya and Tanzania. Somali pastoralists proved to be adept at recognizing symptoms of RVF and risk factors such as heavy rainfall and mosquito swarms. Sandik, which means "bloody nose," was used by Somalis to denote disease consistent with RVF. Somalis reported that sandik was previously seen in 1997/98, the period of the last RVF epidemic. Pastoralists communicated valuable epidemiological information for surveillance and early warning systems that was observed before international warnings. The results indicate that an all or none approach to decision making contributed to the delay in response. In the future, a phased approach balancing actions against increasing risk of an outbreak would be more effective. Given the time required to mobilize large vaccine stocks, emergency vaccination did not contribute to the mitigation of explosive outbreaks of RVF.