Impacts of Rift Valley Fever virus: a One Health approach to assess burden and inform prevention and control options

Background: Rift Valley Fever (RVF) is a climate-sensitive emerging zoonotic disease associated with large-scale livestock production losses and human disease burden in Sub-Saharan Africa and the Middle East. While recognized as a key One Health issue based on its transmission dynamics involving human, animal and environmental determinants, there has been poor coordination between sectors to reduce the risk and impact of RVF. Efforts to counter the disease remain largely reactive, presenting an ongoing threat to local and global health security. The intent of this dissertation was to improve understanding of the burden of RVF across society and to identify entry points for practical and cost-effective interventions at global, national, and local scales. Methods: For Aim 1, we quantified global impacts using official and unofficial reports of human and animal disease and deaths from RVF. We assessed univariate correlation between RVF reporting and broad country-level predictor variables for African nations and describe country development characteristics as well as review major capacity and implementation gaps. In Aim 2, we conducted the first national cost analysis for RVF in South Africa, utilizing a One Health approach to combine data from multiple sectors (agriculture, health, environment, tourism, and finance) and identify the type, magnitude, and distribution of expenditures and losses in outbreaks and inter-epidemic periods between 2003-2018. Aim 3 focuses on actionable policy recommendations, using a survey on RVF prevention and control practices and willingness to pay (WTP) measures to improve understanding of economic behaviors of farm owners, the primary decision-maker for RVF vaccine uptake, in South Africa’s Free State and Northern Cape provinces. Results: In Aim 1, we find that a total of 5,228 suspected human cases and 987 deaths, and 72,960 animal cases and 17,810 deaths, were officially reported in 32 countries between 2000-2019. Of the twelve country-level predictor variables assessed, a higher number of RVF publications was significantly associated with higher odds of official reporting of RVF 2000-2019 (OR=1.5), whereas higher level of political stability and absence of violence was protective against RVF reporting (OR=.39), as was higher percentage of population with access to electricity (OR=.97) (all p\u3c.05). On average, countries reporting RVF in Africa have high dependence on livestock, and face major economic, infrastructure, and capacity deficits, which can be expected to affect implementation and efficacy of RVF prevention, detection and response campaign. In Aim 2, we find that between 2003-2018, RVF was associated with at least US$120.6 million in expenditures and losses in South Africa. The majority of impacts were incurred during epidemic periods. The burden of disease from RVF was estimated at 680.913 Disability-Adjusted Life Years, with the majority from premature death. Productivity losses and medical and public health spending accounted for approximately 5$727.23 per year. Higher mean WTP to avoid animal losses from RVF was significantly associated with higher number of domestic animals and wool farming (p\u3c.05). There was also a significant difference in WTP to vaccinate herds against RVFbased on level of risk of RVF circulating in mosquitoes in their province or farm (p\u3c.000). Most farms indicated they would take measures other than or in addition to vaccination if they thought risk of RVF was high in their province, including insecticide/dip (90.65%) and antibiotics (28.04%). Several barriers and enablers were identified for uptake of livestock vaccination against RVF. Among the barriers, approximately half the farms thought vaccine supply was sufficient in general, whereas less than one-fourth thought it was sufficient during an outbreak. Discussion: Over the past two decades, RVF has affected multiple continents. The lack of a comprehensive reporting system for animal and human disease burden makes tracking official estimates challenging. A comparison to published estimates suggests wide under-reporting of RVF. In terms of prevention and control practices, affected countries face several major economic, capacity, and infrastructure barriers that may affect uptake and effectiveness of vaccination. Encouragingly, from our national- and farm-level analyses in South Africa, we find that there is some existing investment in RVF in interepidemic periods, and that there may be supply and demand-side practices that may be supported by low-cost or multi-disease interventions, such as enhanced risk communication and tracking of vaccine availability. Our findings can be paired with further willingness to pay studies of other payer groups to identify optimal resource allocation options. Future macro- and micro-costing studies can improve precision of data inputs. While the need for a One Health approach has been articulated for improved understanding of the risks of RVF, our findings demonstrate how a One Health lens also has utility in assessing impacts to identify a broader range of affected stakeholders and inform coordinated action to address both animal and human disease and wider societal impacts

One Health proof of concept: Bringing a transdisciplinary approach to surveillance for zoonotic viruses at the human-wild animal interface.

As the world continues to react and respond inefficiently to emerging infectious diseases, such as Middle Eastern Respiratory Syndrome and the Ebola and Zika viruses, a growing transdisciplinary community has called for a more proactive and holistic approach to prevention and preparedness - One Health. Such an approach presents important opportunities to reduce the impact of disease emergence events and also to mitigate future emergence through improved cross-sectoral coordination. In an attempt to provide proof of concept of the utility of the One Health approach, the US Agency for International Development's PREDICT project consortium designed and implemented a targeted, risk-based surveillance strategy based not on humans as sentinels of disease but on detecting viruses early, at their source, where intervention strategies can be implemented before there is opportunity for spillover and spread in people or food animals. Here, we share One Health approaches used by consortium members to illustrate the potential for successful One Health outcomes that can be achieved through collaborative, transdisciplinary partnerships. PREDICT's collaboration with partners around the world on strengthening local capacity to detect hundreds of viruses in wild animals, coupled with a series of cutting-edge virological and analytical activities, have significantly improved our baseline knowledge on the zoonotic pool of viruses and the risk of exposure to people. Further testament to the success of the project's One Health approach and the work of its team of dedicated One Health professionals are the resulting 90 peer-reviewed, scientific publications in under 5 years that improve our understanding of zoonoses and the factors influencing their emergence. The findings are assisting in global health improvements, including surveillance science, diagnostic technologies, understanding of viral evolution, and ecological driver identification. Through its One Health leadership and multi-disciplinary partnerships, PREDICT has forged new networks of professionals from the human, animal, and environmental health sectors to promote global health, improving our understanding of viral disease spillover from wildlife and implementing strategies for preventing and controlling emerging disease threats

Wild animal and zoonotic disease risk management and regulation in China : examining gaps and One Health opportunities in scope, mandates, and monitoring systems

Emerging diseases of zoonotic origin such as COVID-19 are a continuing public health threat in China that lead to a significant socioeconomic burden. This study reviewed the current laws and regulations, government reports and policy documents, and existing literature on zoonotic disease preparedness and prevention across the forestry, agriculture, and public health authorities in China, to articulate the current landscape of potential risks, existing mandates, and gaps. A total of 55 known zoonotic diseases (59 pathogens) are routinely monitored under a multi-sectoral system among humans and domestic and wild animals in China. These diseases have been detected in wild mammals, birds, reptiles, amphibians, and fish or other aquatic animals, the majority of which are transmitted between humans and animals via direct or indirect contact and vectors. However, this current monitoring system covers a limited scope of disease threats and animal host species, warranting expanded review for sources of disease and pathogen with zoonotic potential. In addition, the governance of wild animal protection and utilization and limited knowledge about wild animal trade value chains present challenges for zoonotic disease risk assessment and monitoring, and affect the completeness of mandates and enforcement. A coordinated and collaborative mechanism among different departments is required for the effective monitoring and management of disease emergence and transmission risks in the animal value chains. Moreover, pathogen surveillance among wild animal hosts and human populations outside of the routine monitoring system will fill the data gaps and improve our understanding of future emerging zoonotic threats to achieve disease prevention. The findings and recommendations will advance One Health collaboration across government and non-government stakeholders to optimize monitoring and surveillance, risk management, and emergency responses to known and novel zoonotic threats, and support COVID-19 recovery efforts

Global avian influenza surveillance in wild birds: A strategy to capture viral diversity

Wild birds play a major role in the evolution, maintenance, and spread of avian influenza viruses. However, surveillance for these viruses in wild birds is sporadic, geographically biased, and often limited to the last outbreak virus. To identify opportunities to optimize wild bird surveillance for understanding viral diversity, we reviewed responses to a World Organisation for Animal Health-administered survey, government reports to this organization, articles on Web of Knowledge, and the Influenza Research Database. At least 119 countries conducted avian influenza virus surveillance in wild birds during 2008-2013, but coordination and standardization was lacking among surveillance efforts, and most focused on limited subsets of influenza viruses. Given high financial and public health burdens of recent avian influenza outbreaks, we call for sustained, cost-effective investments in locations with high avian influenza diversity in wild birds and efforts to promote standardized sampling, testing, and reporting methods, including full-genome sequencing. (Résumé d'auteur

The Value Proposition of the Global Health Security Index

Infectious disease outbreaks pose major threats to human health and security. Countries with robust capacities for preventing, detecting and responding to outbreaks can avert many of the social, political, economic and health system costs of such crises. The Global Health Security Index (GHS Index)—the first comprehensive assessment and benchmarking of health security and related capabilities across 195 countries—recently found that no country is sufficiently prepared for epidemics or pandemics. The GHS Index can help health security stakeholders identify areas of weakness, as well as opportunities to collaborate across sectors, collectively strengthen health systems and achieve shared public health goals. Some scholars have recently offered constructive critiques of the GHS Index’s approach to scoring and ranking countries; its weighting of select indicators; its emphasis on transparency; its focus on biosecurity and biosafety capacities; and divergence between select country scores and corresponding COVID-19-associated caseloads, morbidity, and mortality. Here, we (1) describe the practical value of the GHS Index; (2) present potential use cases to help policymakers and practitioners maximise the utility of the tool; (3) discuss the importance of scoring and ranking; (4) describe the robust methodology underpinning country scores and ranks; (5) highlight the GHS Index’s emphasis on transparency and (6) articulate caveats for users wishing to use GHS Index data in health security research, policymaking and practice

Factors affecting the use of biosecurity measures for the protection of ruminant livestock and farm workers against infectious diseases in central South Africa

Biosecurity measures have been introduced to limit economic losses and zoonotic exposures to humans by preventing and controlling animal diseases. However, they are implemented on individual farms with varying frequency. The goal of this study was to evaluate which biosecurity measures were used by farmers to prevent infectious diseases in ruminant livestock and to identify factors that influenced these decisions. We conducted a survey in 264 ruminant livestock farmers in a 40,000 km2 area in the Free State and Northern Cape provinces of South Africa. We used descriptive statistics, to characterize biosecurity measures and farm attributes, then multivariable binomial regression to assess the strength of the association between the attributes and the implementation of biosecurity measures including property fencing, separate equipment use on different species, separate rearing of species, isolation of sick animals, isolation of pregnant animals, quarantine of new animals, animal transport cleaning, vaccination, tick control and insect control. Ninety-nine percent of farmers reported using at least one of the 10 biosecurity measures investigated (median [M]: 6; range: 0–10). The most frequently used biosecurity measures were tick control (81%, 214 out of 264), vaccination (80%, 211 out of 264) and isolation of sick animals (72%, 190 out of 264). More biosecurity measures were used on farms with 65–282 animals (M: 6; odds ratio [OR]: 1.52) or farms with 283–12,030 animals (M: 7; OR: 1.87) than on farms with fewer than 65 animals (M: 4). Furthermore, farmers who kept two animal species (M: 7; OR: 1.41) or three or more species (M: 7) used more biosecurity measures than single-species operations (M: 4). Farmers with privately owned land used more biosecurity measures (M: 6; OR: 1.51) than those grazing their animals on communal land (M: 3.5). Farms that reported previous Rift Valley fever (RVF) outbreaks used more biosecurity measures (M: 7; OR: 1.25) compared with farms without RVF reports (M: 6) and those that purchased animals in the 12 months prior to the survey (M: 7; OR: 1.19) compared with those that did not (M: 6). When introducing new animals into their herds (n = 122), most farmers used fewer biosecurity measures than they did for their existing herd: 34% (41 out of 122) used multiple biosecurity measures like those of vaccination, tick control, quarantine or antibiotic use, whereas 36% (44 out of 122) used only one and 30% (37 out of 122) used none. Certain farm features, primarily those related to size and commercialization, were associated with more frequent use of biosecurity measures. Given the variation in the application of biosecurity measures, more awareness and technical assistance are needed to support the implementation of a biosecurity management plan appropriate for the type of farm operation and available resources.DATA AVAILABILITY STATEMENT : The data that support the study's findings and that can be disclosed per IRB protocol are available upon request from EcoHealth Alliance, 520 Eighth Ave Ste 1200, New York, NY 10018, from Melinda K. Rostal ([email protected]).The project depicted is sponsored by the U.S. Department of Defense, Defense Threat Reduction Agency.http://wileyonlinelibrary.com/journal/tbedhj2022Production Animal Studie

Developing One Health surveillance systems

The health of humans, domestic and wild animals, plants, and the environment are inter-dependent. Global anthropogenic change is a key driver of disease emergence and spread and leads to biodiversity loss and ecosystem function degradation, which are themselves drivers of disease emergence. Pathogen spill-over events and subsequent disease outbreaks, including pandemics, in humans, animals and plants may arise when factors driving disease emergence and spread converge. One Health is an integrated approach that aims to sustainably balance and optimize human, animal and ecosystem health. Conventional disease surveillance has been siloed by sectors, with separate systems addressing the health of humans, domestic animals, cultivated plants, wildlife and the environment. One Health surveillance should include integrated surveillance for known and unknown pathogens, but combined with this more traditional disease-based surveillance, it also must include surveillance of drivers of disease emergence to improve prevention and mitigation of spill-over events. Here, we outline such an approach, including the characteristics and components required to overcome barriers and to optimize an integrated One Health surveillance system.</p

Developing One Health surveillance systems

The health of humans, domestic and wild animals, plants, and the environment are inter-dependent. Global anthropogenic change is a key driver of disease emergence and spread and leads to biodiversity loss and ecosystem function degradation, which are themselves drivers of disease emergence. Pathogen spill-over events and subsequent disease outbreaks, including pandemics, in humans, animals and plants may arise when factors driving disease emergence and spread converge. One Health is an integrated approach that aims to sustainably balance and optimize human, animal and ecosystem health. Conventional disease surveillance has been siloed by sectors, with separate systems addressing the health of humans, domestic animals, cultivated plants, wildlife and the environment. One Health surveillance should include integrated surveillance for known and unknown pathogens, but combined with this more traditional disease-based surveillance, it also must include surveillance of drivers of disease emergence to improve prevention and mitigation of spill-over events. Here, we outline such an approach, including the characteristics and components required to overcome barriers and to optimize an integrated One Health surveillance system