Lessons for rabies control and elimination programmes: a decade of One Health experience from Bali, Indonesia.

Since the emergence of rabies on Bali, Indonesia, in 2008, the Indonesian Government and other stakeholders have implemented disease control and prevention activities with the aim of re-securing Bali's freedom from dog-mediated rabies. The authors report on the lessons learned during these efforts, and their applicability to other regions where canine rabies is endemic, as well as to rabies-free populations that are at risk from incursions. To eliminate rabies from Bali will require time and commitment, as well as a combination of approaches employing the principle of One Health. Efforts should be directed towards well-coordinated, highcoverage, annual dog vaccination campaigns using high-quality vaccines, and enhanced surveillance focused on investigations of biting animals. Bali, an island, is an ideal target for achieving freedom from rabies, but the logistics of vaccinating its very large, free-roaming dog population are challenging. Lessons can be drawn from Bali for other large and dense dog populations, where dog management and rabies control appear difficult. Well-trained teams with nets can rapidly catch and vaccinate large numbers of dogs where central-point vaccination is insufficient, and post vaccination surveys of collared dogs can be used to evaluate coverage and target supplementary vaccination. However, careful planning is required to ensure that all communities are reached during such campaigns and that sufficient vaccine is available over the following years. Effective communication strategies are needed to coordinate intersectoral activities, and to keep communities engaged, particularly during the 'end game', when the risk of rabies appears only minimal. An effective One Health approach to eliminate rabies requires long-term planning, multisectoral communication and coordination, and sustained effort, using tried and tested methods.

Suite à l'émergence de la rage à Bali (Indonésie) en 2008, le gouvernement indonésien et d'autre parties prenantes ont introduit des mesures de contrôle et de prévention de la maladie afin de sécuriser le statut précédemment indemne de Bali au regard de la rage transmise par les chiens. Les auteurs font le point sur les enseignements tirés de cette expérience et évaluent sa pertinence pour d'autres régions, par exemple celles où la rage canine est endémique ou qui possèdent des populations indemnes de rage mais exposées au risque d'une incursion du virus. L'élimination de la rage à Bali est une entreprise qui prendra du temps et exigera une grande détermination ainsi que le recours combiné à diverses méthodes suivant les principes Une seule santé. Les efforts devront s'orienter vers des campagnes annuelles de vaccination des chiens, qu'il faudra coordonner avec soin en assurant une couverture élevée et en faisant appel à des vaccins de haute qualité, et vers une surveillance accrue avec notamment l'investigation de tout chien responsable de morsure. De par son insularité, Bali constitue un territoire idéal pour réussir l'élimination totale de la rage, mais la logistique requise pour la vaccination est lourde, en plus du défi majeur que posent les effectifs importants de chiens errants. Les leçons tirées de l'expérience de Bali peuvent se révéler fructueuses dans d'autres régions dotées de populations canines denses et nombreuses et où les opérations de gestion de ces populations et de lutte contre la rage se présentent sous un jour peu favorable. Dans les contextes où il n'y a pas suffisamment de centres de vaccination, les chiens peuvent être capturés et vaccinés en grand nombre par des équipes bien entraînées et disposant de filets, tandis que le suivi post-vaccinal des chiens enregistrés offre un bon moyen d'évaluer la couverture vaccinale et de cibler les besoins supplémentaires. Il est essentiel de bien planifier ces campagnes afin de s'assurer qu'elles ont touché toutes les communautés et que les stocks de vaccins sont suffisants pour les années à venir. Des stratégies efficaces de communication sont nécessaires pour coordonner les activités intersectorielles et pour maintenir le niveau de motivation des communautés, en particulier en fin de campagne car les risques de rage sont alors perçus comme étant minimes. Pour être efficace, une approche Une seule santé d'élimination de la rage requiert une planification sur le long terme, une communication multisectorielle et des efforts de longue haleine recourant à des méthodes éprouvées.

Desde que en 2008 la rabia hizo su aparición en Bali (Indonesia), el Gobierno del país y otras partes interesadas han llevado a cabo una serie de actividades de control y prevención de la enfermedad con el objetivo de devolver a la isla la condición de «libre de la rabia transmitida por perros¼. Los autores dan cuenta de las enseñanzas extraídas de esta labor y examinan la viabilidad de aplicarlas a otras regiones donde la rabia canina es endémica, así como a poblaciones libres de rabia que corren peligro de sufrir incursiones de la enfermedad. Para eliminar la rabia de Bali hará falta tiempo y dedicación, así como una combinación de métodos regida por los principios de Una sola salud. Convendría centrar el trabajo en campañas anuales de vacunación de perros bien coordinadas, de amplia cobertura y realizadas con vacunas de gran calidad, que se acompañen de una vigilancia más intensa centrada en la investigación de los casos de animales mordedores. Por su condición insular, Bali ofrece condiciones idóneas para lograr la eliminación de la rabia, pero la logística de las vacunaciones es muy aparatosa y las poblaciones de perros vagabundos plantean grandes problemas. De la experiencia balinesa cabe extraer enseñanzas útiles para otras zonas que albergan poblaciones de perros amplias y densas, donde la gestión de estas poblaciones y la lucha antirrábica parecen resultar dificultosas. Allí donde la vacunación centralizada no baste, cabe desplegar equipos bien formados y provistos de redes que puedan capturar y vacunar rápidamente a un gran número de perros, empleando después, eventualmente, estudios posvacunales de los perros con collar identificativo para evaluar la cobertura y seleccionar objetivos de vacunación complementaria. Sin embargo, para llegar a todas las comunidades en el curso de tales campañas y tener la seguridad de disponer de un suministro suficiente de vacunas en los años subsiguientes hace falta una minuciosa planificación. Se necesitan asimismo dispositivos eficaces de comunicación para coordinar las actividades intersectoriales, y también hay que mantener movilizadas a las comunidades, especialmente en la fase final, cuando el riesgo de rabia parece ser mínimo. Todo método eficaz de eliminación de la rabia que parta de los postulados de Una sola salud exige planificación a largo plazo, comunicación y coordinación multisectoriales y una labor sostenida, con empleo de métodos de probada y contrastada eficacia.

The Middle East and Eastern Europe rabies Expert Bureau (MEEREB) third meeting: Lyon-France (7-8 April, 2015).

MEEREB is an inter-regional network of countries from North Africa, Europe, the Middle East and Central Asia that work together with the aim of improving rabies control and prevention at local, regional and global level. MEEREB members met for the third time in 2015 in France (Lyon) to review the current rabies situation within the network and to discuss the way forward the prospect of a One Health approach against rabies. Dogs were the main vector of transmission in all MEEREB countries except for Croatia and Serbia where foxes represented the primary source. The number of rabies animal cases reported in 2014 varied substantially between countries with Ukraine reporting the highest number of animal cases. Human cases still occur in North Africa and all Middle East and Eurasian countries while no cases of human rabies were reported in Croatia, Serbia and Romania, although cases of rabies were identified in both dogs and foxes in 2014. Participants concluded that MEEREB can act as a think-tank where countries can share data, information, experiences and best practices to jointly address challenges in rabies control and prevention. They called for elimination of dog-transmitted rabies through vaccine and rabies immunoglobulin stockpiles and implementation of a One Health approach to achieve rabies's eradication.

The Pan-African Rabies Control Network (PARACON): A unified approach to eliminating canine rabies in Africa.

Even though Africa has the highest per capita death rate from rabies of any continent, and the disease is almost entirely transmitted by the bites of rabid dogs, there has been no coordinated pan-African approach to controlling canine rabies. In order to attain an inclusive and unified network, the Pan-African Rabies Control Network (PARACON) was established in 2014. By following the 'One Health' concept, which involves close coordination between animal and human health sectors across national, regional and continental levels, PARACON will provide a platform to facilitate and promote coordinated and sustainable control strategies and programmes. Meetings will take place at regular intervals and will be centred on the involvement by key focal persons from the medical and veterinary sectors. The inaugural meeting was held in South Africa in June, 2015 and was focused around interactive discussions and workshops, whilst updating country representatives on the tools available to aid them in developing and implementing sustainable rabies intervention strategies. Experts from various global organizations, institutions and industry participated in the discussions and shared their experience and expertise. The workshops focused on the latest format of the Rabies Blueprint platform (www.rabiesblueprint.com), which in the broadest sense assists with control and elimination campaigns, including educational and advocacy drives, improvement of surveillance and diagnosis and the systematic monitoring of progress. Together with the Stepwise Approach towards Rabies Elimination, the Blueprint is a planning tool to help countries free themselves from canine-transmitted rabies.

Bovine rabies in Turkey: patterns of infection and implications for costs and control.

The incidence of rabies in livestock is an important factor for estimating the economic impact of the disease, but obtaining reliable data is hindered by inadequate surveillance. In order to understand the contribution of livestock rabies to the overall burden of disease, the rabies incidence in cattle was investigated in detail for Turkey between 2008 and 2011. Data were compiled on cattle numbers, samples submitted for rabies diagnosis, vaccinated animals and positive rabies cases in animals for seven regions in Turkey. Rabies incidence in cattle fluctuated annually and differed between regions from 0·10 to 3·87 cases/100 000 animals. The positive influence of compensation schemes was observed. Livestock losses were conservatively estimated at around $250 000 international dollars per annum, although in areas where compensation schemes are not operating this could be an underestimate of the economic burden. Vaccination of cattle remains an option for disease prevention, although oral rabies vaccination through aerially distributed baits should be implemented to prevent the further spread of fox-mediated rabies, which could result in much greater economic costs.

Innocuity and immune response to Brucella melitensis Rev.1 vaccine in camels (Camelus dromedarius).

A field trial was conducted in a camel brucellosis-free herd to evaluate antibody response to the Brucella melitensis Rev.1 vaccine in camels and assess shedding of the vaccine strain in milk. Twenty eight camels were divided into four groups according to their age and vaccination route. Groups A (n=3) and B (n=3) consisted of non-pregnant lactating female camels, vaccinated through subcutaneous and conjunctival routes, respectively. Groups C (n=10) consisted of 8-11 months old calves vaccinated through conjunctival route. The rest of the herd (n=12) composed of female and young camels were not vaccinated and were considered as the control group. Each animal from groups A, B and C was given the recommended dose of 2 × 10(9) colony forming units of Rev.1 vaccine irrespective of age or route of vaccination. Blood samples were collected from all the animals at the time of vaccination and at weekly, bi-weekly and monthly interval until 32 weeks post vaccination and from controls at weeks 8 and 24. The serological tests used were modified Rose Bengal Test, sero-agglutination test, and an indirect Enzyme Linked Immunosorbent Assay. Milk samples were collected from all vaccinated female camels and tested for the presence of Rev.1 vaccine strain. Most vaccinated animals started to show an antibody response at week 2 and remained positive until week 16. By week 20 post-vaccination all animals in the three groups were tested negative for Brucella antibodies. Bacteriological analysis of milk samples did not allow any isolation of Brucella melitensis. All samples were found Brucella negative in PCR analysis. The results of this study indicate that the Rev.1 vaccine induces seroconversion in camels. Rev.1 vaccine strain is not excreted in the milk of camels. These findings are promising as to the safe use of the Rev.1 vaccine in camels.

Integrating the surveillance of animal health, foodborne pathogens and foodborne diseases in developing and in-transition countries.

Animal diseases, foodborne pathogens and foodborne diseases have enormous impacts upon the health and livelihoods of producers and consumers in developing and in-transition countries. Unfortunately, the capacity for effective surveillance of infectious disease threats is often limited in these countries, leading to chronic under-reporting. This further contributes towards underestimating the effects of these diseases and an inability to implement effective control measures. However, innovative communications and diagnostic tools, as well as new analytical approaches and close cooperation within and between the animal and human health sectors, can be used to improve the coverage, quality and speed of reporting, as well as to generate more comprehensive estimates of the disease burden. These approaches can help to tackle endemic diseases and build essential surveillance capacities to address changing disease threats in the future.

Assessing the burden of Taenia solium cysticercosis and echinococcosis.

This collection of articles provides an account of the papers delivered at the 19th International Conference of the World Association for the Advancement of Veterinary Parasitology (WAAVP)(held in New Orleans, LA, USA, from 10 to 14 August 2003) in a symposium session on assessing the burden of Taenia solium cysticercosis and echinococcosis organised and chaired by A. Lee Willingham III from the WHO/FAO Collaborating Center for Research and Training on Emerging and other Parasitic Zoonoses in Denmark and Peter M. Schantz from the Parasitic Diseases Division of the US Centers for Disease Control and Prevention, USA. The focus was on the persistence of the zoonotic parasitic diseases cysticercosis, caused by the pork tapeworm T. solium, and echinococcosis,caused by species of the tapeworm Echinococcus, and why these diseases are given very little attention on the national and international agendas in spite of the availability of tools to detect, treat,control and prevent them when it is quite clear in most instances that they are clearly associated with and help perpetuate poverty. A major reason for this is that in many endemic areas the presence and impact of these diseases are not known due to the lack of investigation and information thus policymakers are not aware of their burden and benefits of their control. Documentation is also needed to help increase awareness of the international community and hopefully result in financial and technical support being made available. Thus, burden assessments of cysticercosis and echinococcosis provide an essential evidence base for securing political will and financial and technical support as well as providing a basis for cost-benefit analysis of prevention and control efforts. In order to make an appropriate and full burden assessment one must consider the health, agricultural, social and other impacts of these parasitic zoonoses comprehensively. During the symposium presentations were given concerning current ongoing initiatives to assess the burden of cysticercosis and echinococcosis and examples of the impact of these diseases in both developing and developed countries were provided. In addition, cost factors related to vaccines for these cestode diseases were discussed and the possibilities for technical and financial support from multilateral agencies for assessments and interventions presented.

Veterinary public health activities at FAO: echinococcosis/hydatid disease.

Cystic hydatidosis is a zoonotic disease that remain as a significant cause of human morbidity and mortality in many parts of the world. The disease has veterinary public health implications. FAO is involved with some activities in the control of echinococcosis/hydatid disease: within the Animal Production and Health Division the Veterinary Public Health (VHP) Programme is constituted by members of the different Services (Animal Health, Animal Production, and Livestock Policy) within the Division. FAO regular programme has also established a global network of professionals directly involved in VPH. Furthermore FAO's Technical Cooperation Projects (TCP) is a tool to assist member countries in responding to urgent and unforeseen demands.

[The current importance of veterinary public health: the SAPUVET project]. / Importancia de la salud pública veterinaria en ia actualidad: el proyecto SAPUVET.

The authors propose reviewing the current needs for implementing veterinary public health programmes, from both the teaching and professional standpoints. This is warranted by the fact that veterinary public health has become extremely important in various fields of work, beyond conventional food inspection. The article discusses the public health role which veterinarians must play and the interactions between their activities and those of other groups such as doctors, epidemiologists, ecologists, chemists, or even sociologists and anthropologists. The authors also study and assess the basic working tool in veterinary public health--epidemiological surveillance--and how it operates on the basis of diagnosis and risk analysis. The second part of the article discusses the need to unify criteria for veterinary public health training and the role which the SAPUVET network is playing in doing so (SAPUVET is a European Union-supported project within the ALFA programme that is designed to establish links between Latin American and European veterinary faculties).

Ecological sources of zoonotic diseases.

Although of zoonotic origin, pathogens or infections posing a global threat to human health such as human immunodeficiency virus, severe acute respiratory syndrome or emerging influenza type A viruses may actually have little in common with known, established zoonotic agents, as these new agents merely underwent a transient zoonotic stage before adapting to humans. Evolution towards person-to-person transmission depends on the biological features of the pathogen, but may well be triggered or facilitated by external factors such as changes in human exposure. Disease emergence may thus be depicted as an evolutionary response to changes in the environment, including anthropogenic factors such as new agricultural practices, urbanisation, or globalisation, as well as climate change. Here the authors argue that in the case of zoonotic diseases emerging in livestock, change in agricultural practices has become the dominant factor determining the conditions in which zoonotic pathogens evolve, spread, and eventually enter the human population. Livestock pathogens are subjected to pressures resulting from the production, processing and retail environment which together alter host contact rate, population size and/or microbial traffic flows in the food chain. This process is illustrated by two study cases: a) livestock development in the 'Eurasian ruminant street' (the area extending from central Asia to the eastern Mediterranean basin) and the adjacent Arabian peninsula b) poultry production in Southeast Asia. In both scenarios, environmental factors relating to demography, land pressure and imbalances in production intensification have led to an unstable epidemiological situation, as evidenced by the highly pathogenic avian influenza upsurge early in 2004, when the main outbreaks were located in areas which had both large scale, peri-urban commercial holdings and a high density of smallholder poultry units.

[Bioterrorism: the role of veterinarians in detection and prevention]. / Bioterrorisme. Rol van de dierenarts in detectie en bestrijding.

The fear of terrorist attacks has increased since the events of 11 September 2001 in New York. In the weeks following the terrorist attack, letters containing anthrax spores were received at various locations in the USA. This shows that bioterrorism is possible and that is necessary to be prepared for the potential release of biological agents. Such agents can be distributed not only via the air and drinking water but also via household pets. The aim of terrorist attacks, namely, the disruption of society and daily life, can be achieved in three ways, ways which are of importance to practising veterinarians, namely, via pets, via contamination of pet foods of animal origin, and by the spread of infectious animal diseases that have far-reaching economic consequences. These ways are discussed in this article, together with possible ways in which veterinarians can act to diminish the consequences of such an event.

A lysosomal storage disease induced by Ipomoea carnea in goats in Mozambique.

A novel plant-induced lysosomal storage disease was observed in goats from a village in Mozambique. Affected animals were ataxic, with head tremors and nystagmus. Because of a lack of suitable feed, the animals consumed an exotic hedge plant growing in the village that was identified as Ipomoea carnea (shrubby morning glory, Convolvulaceae). The toxicosis was reproduced by feeding I. carnea plant material to goats. In acute cases, histologic changes in the brain and spinal cord comprised widespread cytoplasmic vacuolation of neurons and glial cells in association with axonal spheroid formation. Ultrastructurally, cytoplasmic storage vacuoles in neurons were membrane bound and consistent with lysosomes. Cytoplasmic vacuolation was also found in neurons in the submucosal and mesenteric plexuses in the small intestine, in renal tubular epithelial cells, and in macrophage-phagocytic cells in the spleen and lymph nodes in acute cases. Residual alterations in the brain in chronic cases revealed predominantly cerebellar lesions characterized by loss of Purkinje neurons and gliosis of the Purkinje cell layer. Analysis of I. carnea plant material by gas chromatography-mass spectrometry established the presence of the mannosidase inhibitor swainsonine and 2 glycosidase inhibitors, calystegine B2 and calystegine C1, consistent with a plant-induced alpha-mannosidosis in the goats. The described storage disorder is analogous to the lysosomal storage diseases induced by ingestion of locoweeds (Astragalus and Oxytropis) and poison peas (Swainsona).

A dog ecology study in an urban and a semi-rural area of Zambia.

Characteristics of dog populations and their accessibility for rabies vaccination were compared in an urban and a semi-rural area in Zambia. A total of 1,190 households were interviewed. In the urban study area (Mutendere, a low income suburb of Lusaka) only 11% of the households kept dogs with a dog:human ratio of 1:45. In the semi-rural area (Palabana) dogs were kept by 42% of households with a dog:human ratio of 1:6,7. In conjuction with the study of the dog populations in these two areas, immunization of dogs against rabies was provided by door-to-door visits in both study areas and also through central point vaccination in the urban area. The attitude of the public towards free rabies vaccinations was positive, although some misconceptions regarding indications and modalities of treatment following exposure to suspect dogs were found. Approximately 50% of the dog removals were as a result of disease and the demand for dogs was higher than the supply. Although only information on the owned segment of the dog population was obtained during the study, the proportion of ownerless dogs appeared to be very low. Generally, there is a need for better co-ordination between the different services involved in rabies control in Zambia to enhance the sustainability of vaccination programmes and improve the treatment of persons bitten by dogs.