One Health Surveillance: A Matrix to Evaluate Multisectoral Collaboration

The international community and governmental organizations are actively calling for the implementation of One Health (OH) surveillance systems to target health hazards that involve humans, animals, and their environment. In our view, the main characteristic of a OH surveillance system is the collaboration across institutions and disciplines operating within the different sectors to plan, coordinate, and implement the surveillance process. However, the multisectoral organizational models and possible collaborative modalities implemented throughout the surveillance process are multi-fold and depend on the objective and context of the surveillance. The purpose of this study is to define a matrix to evaluate the quality and appropriateness of multisectoral collaboration through an in-depth analysis of its organization, implementation, and functions. We developed a first list of evaluation attributes based on (i) the characteristics of the organization, implementation, and functionality of multisectoral surveillance systems; and (ii) the existing attributes for the evaluation of health surveillance systems and OH initiatives. These attributes were submitted to two rounds of expert-opinion elicitation for review and validation. The final list of attributes consisted of 23 organizational attributes and 9 functional attributes, to which 3 organizational indexes were added measuring the overall organization of collaboration. We then defined 75 criteria to evaluate the level of satisfaction for the attributes and indexes. The criteria were scored following a four-tiered scoring grid. Graphical representations allowed for an easy overview of the evaluation results for both attributes and indexes. This evaluation matrix is the first to allow an in-depth analysis of collaboration in a multisectoral surveillance system and is the preliminary step toward the creation of a fully standalone tool for the evaluation of collaboration. After its practical application and adaptability to different contexts are field-tested, this tool could be very useful in identifying the strengths and weaknesses of collaboration occurring in a multisectoral surveillance system

Approches participatives et estimation de l'acceptabilité des systèmes de surveillance : la méthode AccePT

peer reviewe

MERS-CoV at the animal–human interface: inputs on exposure pathways from an expert-opinion elicitation

Nearly 4 years after the first report of the emergence of Middle-East respiratory syndrome Coronavirus (MERS-CoV) and nearly 1800 human cases later, the ecology of MERS-CoV, its epidemiology, and more than risk factors of MERS-CoV transmission between camels are poorly understood. Knowledge about the pathways and mechanisms of transmission from animals to humans is limited; as of yet, transmission risks have not been quantified. Moreover the divergent sanitary situations and exposures to animals among populations in the Arabian Peninsula, where human primary cases appear to dominate, vs. other regions in the Middle East and Africa, with no reported human clinical cases and where the virus has been detected only in dromedaries, represents huge scientific and health challenges. Here, we have used expert-opinion elicitation in order to obtain ideas on relative importance of MERS-CoV risk factors and estimates of transmission risks from various types of contact between humans and dromedaries. Fourteen experts with diverse and extensive experience in MERS-CoV relevant fields were enrolled and completed an online questionnaire that examined pathways based on several scenarios, e.g., camels-camels, camels-human, bats/other species to camels/humans, and the role of diverse biological substances (milk, urine, etc.) and potential fomites. Experts believed that dromedary camels play the largest role in MERS-CoV infection of other dromedaries; however, they also indicated a significant influence of the season (i.e. calving or weaning periods) on transmission risk. All experts thought that MERS-CoV-infected dromedaries and asymptomatic humans play the most important role in infection of humans, with bats and other species presenting a possible, but yet undefined, risk. Direct and indirect contact of humans with dromedary camels were identified as the most risky types of contact, when compared to consumption of various camel products, with estimated 'most likely' incidence risks of at least 22 and 13% for direct and indirect contact, respectively. The results of our study are consistent with available, yet very limited, published data regarding the potential pathways of transmission of MERS-CoV at the animal-human interface. These results identify key knowledge gaps and highlight the need for more comprehensive, yet focused research to be conducted to better understand transmission between dromedaries and humans.published_or_final_versio

Comment améliorer l'efficacité de la surveillance passive des zoonoses en zones rurales : exemple de la grippe avaire H5N1 en Asie du Sud-Est

La propagation en Asie, Europe et Afrique du virus Influenza Aviaire hautement pathogène (IAHP) H5N1, l'épidémie de A/H1N1pdm en 2009, l'émergence de l'Influenza faiblement pathogène (IAFP), mais zoonotique, H7N9 en Chine en 2013 et la circulation récente de l'IAHP H5N8 en Europe, montrent que l'évolution permanente de ces virus chez les oiseaux, les humains et les porcs, pause un risque en santé humaine et animale au niveau mondial. Au cours des 10 dernières années, des efforts ont été fait pour renforcer les capacités en santé publique et vétérinaire. Malgré tout, le virus IAHP H5N1 reste endémique dans certains pays où il peut passer inaperçu dans les populations de volailles mais provoquent des cas humains. Ces pays sont caractérisés par une majorité de leur population vivant en zones rurales, une absence de systèmes de santé primaire et des secteurs de santé inefficaces.La surveillance passive (évènementielle) des maladies animales et humaines est souvent la seule méthode réalisable dans les milieux ruraux. Produisant une information incomplète, biaisée ou transmise avec des délais importants, elle a besoin d'être amélioré par des approches nouvelles mis en œuvre dans un cadre « One Health » prenant en compte les interfaces entre humains, animaux et environnement. Nous avons donc dans cette thèse conçu et/ou appliqué de nouvelles méthodes d'évaluation, de conception ou d'amélioration de la notification des cas d'IAHP H5N1 chez l'animal et chez l'homme en Asie du sud-est.Nous avons en premier examiné différentes alternatives d'évaluation. Nous avons appliqué des arbres de scénario (stochastique) pour modéliser et évaluer le système de surveillance de l'IAHP H5N1 en Thaïlande dans les systèmes traditionnels de productions avicoles. Nous avons estimé la sensibilité de la surveillance passive à 50 % (IC95 % 0,04-0,75) pour une détection maximale de 3 fermes infectées. Cela a montré l'utilité de cette méthode pour prouver l'absence de maladie dans les pays à ressources limitées. Par des méthodes participatives, nous avons impliqué les « agents communautaires de santé animale » dans leur propre évaluation et développé une nouvelle grille, qui comprend des indicateurs de succès utilisés par les agents eux-mêmes.Dans la seconde partie, nous avons examiné les méthodes pour améliorer la conception et l'efficacité de la surveillance passive. Nous avons appliqué la grille, pour évaluer 251 agents villageois dans trois provinces du Cambodge. La grille nous a permis de noter leur niveau d'activité et d'analyser, par régression logistique, les facteurs qui influencent l'obtention d'un score élevé. Puis, nous avons mis en place une étude pilote pour tester la déclaration par texto (SMS) auprès de 112 participants de 68 villages. L'objectif était de détecter des pics de mortalité et d'identifier plus rapidement les foyers de maladies infectieuses. Nous avons enfin utilisé l'analyse décisionnelle multicritère (MCDA) pour cartographier les risques de diffusion de l'IAHP H5N1 chez les volailles et les populations humaines en Thaïlande et au Cambodge, afin de renforcer la surveillance dans les zones à risque.En conclusion de ce travail, nous avons effectué une analyse comparative de deux environnements socio-économiques contraints : le Cambodge et Madagascar. Nous avons analysé les recherches mises en œuvre par le CIRAD (Centre Français de recherche pour le développement International) et ses partenaires dans ces 2 pays au cours de projets effectués ces 10 dernières années. L'objectif était de montrer comment de nouvelles approches pour les systèmes de surveillance peuvent être transférées entre différents pays aux contextes difficiles. A partir de cela, de nouvelles perspectives sont proposées.The latest events such as the spread over Asia, Europe and Africa of the Highly Pathogenic Avian Influenza (HPAI) virus H5N1, the epidemic of A/H1N1pdm in 2009, the emergence of the Low Pathogenic Avian Influenza (LPAI) but zoonotic virus H7N9 in China in 2013 and the recent circulation of HPAI H5N8 in Europe, show that the permanent evolution of influenza virus in birds, humans and pigs is exposing the world to the risk of new strains with unpredictable consequences in public and animal health. In the last 10 years, a lot of efforts have been put in the improvement of capacity of animal and public health systems. However the disease is now endemic in several countries where the virus goes often undetected within the poultry population resulting in sporadic human cases and mortality. These countries are characterized by a large proportion of their population living in rural areas with poor incomes, a lack of primary care system and inefficient public or veterinary health sectors.Passive surveillance is often the only type of method feasible in poor rural settings in human and animal surveillance. With often incomplete, biased or delayed information this method will benefit from new methods of evaluation or new design concepts that could be implemented within a “One Health” framework to take into account the interfaces between human, animals and environment. We have in this thesis conceived and/or applied new methodologies for the evaluation, the design or the improvement of volunteer case-reporting of human or animal HPAI H5N1 in South-east Asia.We have first looked at different options of evaluation. We have applied stochastic scenario tree to model and assess the surveillance system of HPAI H5N1 in Thailand in backyard and free-range poultry production systems. We have estimated the sensitivity of the passive surveillance at 50% (CI95% 0.04-0.75) for a maximum detection of 3 infected farms, and showing the usefulness of this method to demonstrate freedom of disease in countries with limited resources. Thanks to participatory methods, we have involved Village Animal Health Workers (VAHWs) in their own evaluation and developed a new criteria grid, which includes local indicators of success developed and used by the VAHWs themselves.In a second part, we have considered methods to improve the design and the efficiency of passive surveillance. We have applied the grid conceived previously, to evaluate 251 VAHWs in three provinces of Cambodia. The grid allowed us to give a score to their level of activity and to analyse through logistic regression the factors influencing the most “good score”. Then we have implemented a pilot-study to test the use of SMS reporting from 112 participants from 68 villages, the objective was to detect peaks of mortality, to identify more rapidly outbreaks of infectious diseases. In a final section we have used multiple criteria decision analysis (MCDA) to map the risk of diffusion of HPAI H5N1 in poultry and in human, in order to adjust and reinforce the surveillance in the zones with greater risk of occurrence of the disease in Thailand and Cambodia.To conclude this work about tools and methods to improve surveillance systems in remote areas, we have done a comparative analysis of two challenging environments, Cambodia and Madagascar. We have done a cross analysis of the researches implemented by CIRAD (French Research Centre for International Development) in these countries during research projects implemented over the past decade. The objective was to show how new approaches for surveillance systems could be transferred between different countries with difficult socioeconomic environments and to propose new perspectives

Comment améliorer l'efficacité de la surveillance passive des zoonoses en zones rurales : exemple de la grippe avaire H5N1 en Asie du Sud-Est

The latest events such as the spread over Asia, Europe and Africa of the Highly Pathogenic Avian Influenza (HPAI) virus H5N1, the epidemic of A/H1N1pdm in 2009, the emergence of the Low Pathogenic Avian Influenza (LPAI) but zoonotic virus H7N9 in China in 2013 and the recent circulation of HPAI H5N8 in Europe, show that the permanent evolution of influenza virus in birds, humans and pigs is exposing the world to the risk of new strains with unpredictable consequences in public and animal health. In the last 10 years, a lot of efforts have been put in the improvement of capacity of animal and public health systems. However the disease is now endemic in several countries where the virus goes often undetected within the poultry population resulting in sporadic human cases and mortality. These countries are characterized by a large proportion of their population living in rural areas with poor incomes, a lack of primary care system and inefficient public or veterinary health sectors.Passive surveillance is often the only type of method feasible in poor rural settings in human and animal surveillance. With often incomplete, biased or delayed information this method will benefit from new methods of evaluation or new design concepts that could be implemented within a “One Health” framework to take into account the interfaces between human, animals and environment. We have in this thesis conceived and/or applied new methodologies for the evaluation, the design or the improvement of volunteer case-reporting of human or animal HPAI H5N1 in South-east Asia.We have first looked at different options of evaluation. We have applied stochastic scenario tree to model and assess the surveillance system of HPAI H5N1 in Thailand in backyard and free-range poultry production systems. We have estimated the sensitivity of the passive surveillance at 50% (CI95% 0.04-0.75) for a maximum detection of 3 infected farms, and showing the usefulness of this method to demonstrate freedom of disease in countries with limited resources. Thanks to participatory methods, we have involved Village Animal Health Workers (VAHWs) in their own evaluation and developed a new criteria grid, which includes local indicators of success developed and used by the VAHWs themselves.In a second part, we have considered methods to improve the design and the efficiency of passive surveillance. We have applied the grid conceived previously, to evaluate 251 VAHWs in three provinces of Cambodia. The grid allowed us to give a score to their level of activity and to analyse through logistic regression the factors influencing the most “good score”. Then we have implemented a pilot-study to test the use of SMS reporting from 112 participants from 68 villages, the objective was to detect peaks of mortality, to identify more rapidly outbreaks of infectious diseases. In a final section we have used multiple criteria decision analysis (MCDA) to map the risk of diffusion of HPAI H5N1 in poultry and in human, in order to adjust and reinforce the surveillance in the zones with greater risk of occurrence of the disease in Thailand and Cambodia.To conclude this work about tools and methods to improve surveillance systems in remote areas, we have done a comparative analysis of two challenging environments, Cambodia and Madagascar. We have done a cross analysis of the researches implemented by CIRAD (French Research Centre for International Development) in these countries during research projects implemented over the past decade. The objective was to show how new approaches for surveillance systems could be transferred between different countries with difficult socioeconomic environments and to propose new perspectives.La propagation en Asie, Europe et Afrique du virus Influenza Aviaire hautement pathogène (IAHP) H5N1, l'épidémie de A/H1N1pdm en 2009, l'émergence de l'Influenza faiblement pathogène (IAFP), mais zoonotique, H7N9 en Chine en 2013 et la circulation récente de l'IAHP H5N8 en Europe, montrent que l'évolution permanente de ces virus chez les oiseaux, les humains et les porcs, pause un risque en santé humaine et animale au niveau mondial. Au cours des 10 dernières années, des efforts ont été fait pour renforcer les capacités en santé publique et vétérinaire. Malgré tout, le virus IAHP H5N1 reste endémique dans certains pays où il peut passer inaperçu dans les populations de volailles mais provoquent des cas humains. Ces pays sont caractérisés par une majorité de leur population vivant en zones rurales, une absence de systèmes de santé primaire et des secteurs de santé inefficaces.La surveillance passive (évènementielle) des maladies animales et humaines est souvent la seule méthode réalisable dans les milieux ruraux. Produisant une information incomplète, biaisée ou transmise avec des délais importants, elle a besoin d'être amélioré par des approches nouvelles mis en œuvre dans un cadre « One Health » prenant en compte les interfaces entre humains, animaux et environnement. Nous avons donc dans cette thèse conçu et/ou appliqué de nouvelles méthodes d'évaluation, de conception ou d'amélioration de la notification des cas d'IAHP H5N1 chez l'animal et chez l'homme en Asie du sud-est.Nous avons en premier examiné différentes alternatives d'évaluation. Nous avons appliqué des arbres de scénario (stochastique) pour modéliser et évaluer le système de surveillance de l'IAHP H5N1 en Thaïlande dans les systèmes traditionnels de productions avicoles. Nous avons estimé la sensibilité de la surveillance passive à 50 % (IC95 % 0,04-0,75) pour une détection maximale de 3 fermes infectées. Cela a montré l'utilité de cette méthode pour prouver l'absence de maladie dans les pays à ressources limitées. Par des méthodes participatives, nous avons impliqué les « agents communautaires de santé animale » dans leur propre évaluation et développé une nouvelle grille, qui comprend des indicateurs de succès utilisés par les agents eux-mêmes.Dans la seconde partie, nous avons examiné les méthodes pour améliorer la conception et l'efficacité de la surveillance passive. Nous avons appliqué la grille, pour évaluer 251 agents villageois dans trois provinces du Cambodge. La grille nous a permis de noter leur niveau d'activité et d'analyser, par régression logistique, les facteurs qui influencent l'obtention d'un score élevé. Puis, nous avons mis en place une étude pilote pour tester la déclaration par texto (SMS) auprès de 112 participants de 68 villages. L'objectif était de détecter des pics de mortalité et d'identifier plus rapidement les foyers de maladies infectieuses. Nous avons enfin utilisé l'analyse décisionnelle multicritère (MCDA) pour cartographier les risques de diffusion de l'IAHP H5N1 chez les volailles et les populations humaines en Thaïlande et au Cambodge, afin de renforcer la surveillance dans les zones à risque.En conclusion de ce travail, nous avons effectué une analyse comparative de deux environnements socio-économiques contraints : le Cambodge et Madagascar. Nous avons analysé les recherches mises en œuvre par le CIRAD (Centre Français de recherche pour le développement International) et ses partenaires dans ces 2 pays au cours de projets effectués ces 10 dernières années. L'objectif était de montrer comment de nouvelles approches pour les systèmes de surveillance peuvent être transférées entre différents pays aux contextes difficiles. A partir de cela, de nouvelles perspectives sont proposées

Mise en place d'un réseau de surveillance épidémiologiques dans les zones communales Nord de la Namibie

Avec l'appui de la Coopération française, les services vétérinaires namibiens ont mis en place dans le Nord de la Namibie un réseau de surveillance épidémiologique: le NNADIS (Northern Namibian Animal Diseases Information System). Ce réseau a pour but de réaliser une surveillance épidémiologique d'une qualité équivalente à celle des zones commerciales, alors que les conditions d'élevage communaux sont très différents : petits producteurs non organisés, frontières avec des pays aux infrastructures vétérinaires déficientes et une divagation de la faune sauvage induisant un fort risque d'occurrence de la fièvre aphteuse. Le réseau s'est appuyé sur une infrastructure vétérinaire solide, ayant traversé avec succès les difficultés liées à l'accession de la Namibie à l'indépendance. Ce travail présente étape après étape la naissance du NNADIS, son évaluation, faite en Juillet 2004, son devenir au niveau national et sa place au sein d'un réseau de surveillance épidémiologique supranational.TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE-EN Vétérinaire (315552301) / SudocSudocFranceF

Benefit–Cost Analysis of Foot-and-Mouth Disease Vaccination at the Farm-Level in South Vietnam

This study aimed to analyze the financial impact of foot-and-mouth disease (FMD) outbreaks in cattle at the farm-level and the benefit–cost ratio (BCR) of biannual vaccination strategy to prevent and eradicate FMD for cattle in South Vietnam. Production data were collected from 49 small-scale dairy farms, 15 large-scale dairy farms, and 249 beef farms of Long An and Tay Ninh province using a questionaire. Financial data of FMD impacts were collected using participatory tools in 37 villages of Long An province. The net present value, i.e., the difference between the benefits (additional revenue and saved costs) and costs (additional costs and revenue foregone), of FMD vaccination in large-scale dairy farms was 2.8 times higher than in small-scale dairy farms and 20 times higher than in beef farms. The BCR of FMD vaccination over 1 year in large-scale dairy farms, small-scale dairy farms, and beef farms were 11.6 [95% confidence interval (95% CI) 6.42–16.45], 9.93 (95% CI 3.45–16.47), and 3.02 (95% CI 0.76–7.19), respectively. The sensitivity analysis showed that varying the vaccination cost had more effect on the BCR of cattle vaccination than varying the market price. This benefit-cost analysis of biannual vaccination strategy showed that investment in FMD prevention can be financially profitable, and therefore sustainable, for dairy farmers. For beef cattle, it is less certain that vaccination is profitable. Additional benefit-cost analysis study of vaccination strategies at the national-level would be required to evaluate and adapt the national strategy to achieve eradication of this disease in Vietnam

Biosecurity measures for backyard poultry in developing countries: a systematic review

<p>Abstract</p> <p>Background</p> <p>Poultry represents an important sector in animal production, with backyard flocks representing a huge majority, especially in the developing countries. In these countries, villagers raise poultry to meet household food demands and as additional sources of incomes. Backyard production methods imply low biosecurity measures and high risk of infectious diseases, such as Newcastle disease or zoonosis such as Highly Pathogenic Avian Influenza (HPAI).</p> <p>We reviewed literature on biosecurity practices for prevention of infectious diseases, and published recommendations for backyard poultry and assessed evidence of their impact and feasibility, particularly in developing countries. Documents were sourced from the Food and Agriculture Organization (FAO) website, and from Pubmed and Google databases.</p> <p>Results</p> <p>A total of 62 peer-reviewed and non-referred documents were found, most of which were published recently (after 2004) and focused on HPAI/H5N1-related biosecurity measures (64%). Recommendations addressed measures for flock management, feed and water management, poultry trade and stock change, poultry health management and the risk to humans. Only one general guideline was found for backyard poultry-related biosecurity; the other documents were drawn up for specific developing settings and only engaged their authors (e.g. consultants). These national guidelines written by consultants generated recommendations regarding measures derived from the highest standards of commercial poultry production. Although biosecurity principles of isolation and containment are described in most documents, only a few documents were found on the impact of measures in family poultry settings and none gave any evidence of their feasibility and effectiveness for backyard poultry.</p> <p>Conclusions</p> <p>Given the persistent threat posed by HPAI/H5N1 to humans in developing countries, our findings highlight the importance of encouraging applied research toward identifying sustained and adapted biosecurity measures for smallholder poultry flocks in low-income countries.</p

One health surveillance: A matrix to evaluate multisectoral collaboration

The international community and governmental organizations are actively calling for the implementation of One Health (OH) surveillance systems to target health hazards that involve humans, animals, and their environment. In our view, the main characteristic of a OH surveillance system is the collaboration across institutions and disciplines operating within the different sectors to plan, coordinate, and implement the surveillance process. However, the multisectoral organizational models and possible collaborative modalities implemented throughout the surveillance process are multi-fold and depend on the objective and context of the surveillance. The purpose of this study is to define a matrix to evaluate the quality and appropriateness of multisectoral collaboration through an in-depth analysis of its organization, implementation, and functions. We developed a first list of evaluation attributes based on (i) the characteristics of the organization, implementation, and functionality of multisectoral surveillance systems; and (ii) the existing attributes for the evaluation of health surveillance systems and OH initiatives. These attributes were submitted to two rounds of expert-opinion elicitation for review and validation. The final list of attributes consisted of 23 organizational attributes and 9 functional attributes, to which 3 organizational indexes were added measuring the overall organization of collaboration. We then defined 75 criteria to evaluate the level of satisfaction for the attributes and indexes. The criteria were scored following a four-tiered scoring grid. Graphical representations allowed for an easy overview of the evaluation results for both attributes and indexes. This evaluation matrix is the first to allow an in-depth analysis of collaboration in a multisectoral surveillance system and is the preliminary step toward the creation of a fully standalone tool for the evaluation of collaboration. After its practical application and adaptability to different contexts are field-tested, this tool could be very useful in identifying the strengths and weaknesses of collaboration occurring in a multisectoral surveillance system

One health surveillance: A matrix to evaluate multisectoral collaboration

International audienceThe international community and governmental organizations are actively calling for the implementation of One Health (OH) surveillance systems to target health hazards that involve humans, animals, and their environment. In our view, the main characteristic of a OH surveillance system is the collaboration across institutions and disciplines operating within the different sectors to plan, coordinate, and implement the surveillance process. However, the multisectoral organizational models and possible collaborative modalities implemented throughout the surveillance process are multi-fold and depend on the objective and context of the surveillance. The purpose of this study is to define a matrix to evaluate the quality and appropriateness of multisectoral collaboration through an in-depth analysis of its organization, implementation, and functions. We developed a first list of evaluation attributes based on (i) the characteristics of the organization, implementation, and functionality of multisectoral surveillance systems; and (ii) the existing attributes for the evaluation of health surveillance systems and OH initiatives. These attributes were submitted to two rounds of expert-opinion elicitation for review and validation. The final list of attributes consisted of 23 organizational attributes and 9 functional attributes, to which 3 organizational indexes were added measuring the overall organization of collaboration. We then defined 75 criteria to evaluate the level of satisfaction for the attributes and indexes. The criteria were scored following a four-tiered scoring grid. Graphical representations allowed for an easy overview of the evaluation results for both attributes and indexes. This evaluation matrix is the first to allow an in-depth analysis of collaboration in a multisectoral surveillance system and is the preliminary step toward the creation of a fully standalone tool for the evaluation of collaboration. After its practical application and adaptability to different contexts are field-tested, this tool could be very useful in identifying the strengths and weaknesses of collaboration occurring in a multisectoral surveillance system