A ONE HEALTH APPROACH TO ECHINOCOCCUS CANADENSIS AND OTHER PARASITIC ZOONOSES IN REMOTE, RURAL AND INDIGENOUS COMMUNITIES

In Canada, parasitism in people and well-managed animal populations is less common now than a century ago, likely due to accessible anthelmintics, heightened public awareness, and improved sanitation. Some zoonotic parasites, such as Echinococcus canadensis are now rarely diagnosed in people, but persist mainly in northern populations where diagnostic services are limited. Veterinary services are also limited in these areas, and as a result, human and animal incidence data does not exist, is outdated, or underestimates the true incidence. We closed this knowledge gap in certain areas of western Canada by determining the prevalence of E. canadensis and other zoonotic parasites in wildlife (wolves [Canis lupus] and ungulates; Chapters 2 and 3), domestic dogs (Canis familiaris; Chapters 4 and 5), and people (Chapters 6-8). Using a One Health framework, we also explored parasite control practices and potential policy solutions for rural and remote communities (Chapters 8 and 9). During post-mortem examination, we observed E. canadensis in approximately 11% (11/105) of elk [Cervus canadensis], and 21% (34/165) of wolves. Our examination of historical post-mortem reports of ungulates demonstrated that E. canadensis is distributed throughout Canada, except for the high Arctic islands, the Maritime provinces, and the island of Newfoundland. Our analysis of dog feces collected throughout Saskatchewan suggested that patent taeniid (Taenia or Echinococcus spp.) infection was rare (0-4%), and that rural and northern dogs had higher endoparasitism than urban dogs. Sero-surveillance for four zoonoses (E. canadensis, Toxoplasma gondii, Trichinella, and Toxocara canis) by enzyme-linked immunosorbent assay indicated similar results - that people in northern SK (65% of 201) had higher exposure to one or more parasites than those in southern SK (12% of 113). Using patient health records, we reported annual incidence rates for clinical illness for the following zoonotic parasites: echinococcosis – 1.4/1 000 000; toxoplasmosis- 1.7/1 000 000; and toxocariasis-0.06/1 000 000. In the final chapter we compared the cost of treating human echinococcosis cases with a prevention program based on dosing dogs with praziquantel at 6 week intervals in the Kelsey Trail region, where human incidence is highest. Based on direct healthcare costs, such a program is not currently cost saving, but could become so if echinococcosis incidence increased. Preventative programs should be considered for high risk communities, which are often economically marginalized and lack appropriate resources to effectively control zoonotic parasitism. Putting One Health into action may require integrated human-animal healthcare services, introduction of community-based animal health workers, and increased transdisciplinary research to improve access to and uptake of preventative healthcare services for parasitic zoonoses in northern and remote communities

Checklist for One Health Epidemiological Reporting of Evidence (COHERE).

One Health is defined as the intersection and integration of knowledge regarding humans, animals, and the environment, yet as the One Health scientific literature expands, there is considerable heterogeneity of approach and quality of reporting in One Health studies. In addition, many researchers who publish such studies do not include or integrate data from all three domains of human, animal, and environmental health. This points to a critical need to unify guidelines for One Health studies. This report details the Checklist for One Health Epidemiological Reporting of Evidence (COHERE) to guide the design and publication format of future One Health studies. COHERE was developed by a core writing team and international expert review group that represents multiple disciplines, including human medicine, veterinary medicine, public health, allied professionals, clinical laboratory science, epidemiology, the social sciences, ecohealth and environmental health. The twin aims of the COHERE standards are to 1) improve the quality of reporting of observational or interventional epidemiological studies that collect and integrate data from humans, animals and/or vectors, and their environments; and 2) promote the concept that One Health studies should integrate knowledge from these three domains. The 19 standards in the COHERE checklist address descriptions of human populations, animal populations, environmental assessment, spatial and temporal relationships of data from the three domains, integration of analyses and interpretation, and inclusion of expertise in the research team from disciplines related to human health, animal health, and environmental health

ECHINOCOCCUS GRANULOSUS GENOTYPE G8 IN MAINE MOOSE (ALCES ALCES)

During a 2012 survey of harvested moose (Alces alces) in Maine (USA), an incidental finding of hydatid cysts was found in 39% (21 of 54) of lung sets examined. Cytology of cyst contents was consistent with Echinococcus granulosus. The G8 genotype was identified based on PCR and DNA sequencing of a 470 base pair region of the NADH dehydrogenase subunit 1 (NAD1) mitochondrial gene. The hydatid cysts were the northern, or cervid genotype and this is the first confirmed report of E. granulosus in Maine moose. The Atlantic regions of the northern USA and Canada were not previously thought to be endemic regions for E. granulosus. It is presumed that either domestic dogs or eastern coyotes (Canis latrans) are the definitive host

Echinococcus across the north : Current knowledge, future challenges

Foodborne Parasites in Cold ClimatesAbstract Zoonotic Echinococcus spp. cestodes are present in almost all circumpolar nations, and have historically posed a risk to health of indigenous as well as other northern residents. However, surveillance data on both alveolar (AE) and cystic (CE) echinococcosis remains incomplete throughout the circumpolar region: Russia, Fennoscandia, Iceland, Greenland, Canada and Alaska (USA). Prevalence of Echinococcus spp. varies considerably in definitive canid hosts, animal intermediate hosts and accidental hosts like humans. Yet despite the high prevalence reported in canids in some geographic locations, human AE and CE are much less common than in endemic Asian and central European countries. This paper explores knowledge gaps and future challenges posed by Echinococcus spp. in eight circumpolar countries, a region where rapid environmental and social change are rewriting the boundaries, transmission, and impact of many pathogens, including zoonotic Echinococcus spp. Genotypes G6, G8 and G10 of Echinococcus canadensis are causative agents of human CE and have been identified in sylvatic (wild animal) and synanthropic (ecological association with humans) cervid-canine life cycles in the following northern regions: Alaska and northern Canada - G8 and G10; northern Russia - G6, G8, G10; and Fennoscandia - G10 in Finland - with no recent reports from Norway or Sweden. Echinococcus multilocularis, which causes AE, has been identified in a sylvatic arvicoline rodent-canine lifecycle in Alaska, Canada, Russia, Sweden and Svalbard (Norway). Asian, Mongolian, European and North American strains of E. multilocularis are found in Russia, with the North American N1 strain predominating in the north. The N1 strain is also found in Alaska, as well as Svalbard, whilst Asian strains have been identified in western Alaska. Central North American (N2) strain and European-type strains of E. multilocularis are present in Canada. Typing of the strain in Sweden is still pending. Individual human cases of AE with N2 and European-type strains are reported in North America, as well as multiple cases with Asian strains in Russia and historically on St Lawrence Island, Alaska (although genotyping of human cases was not available at the time). Echinococcus spp. have not been detected in Greenland and have been eliminated from Iceland. The predominance of E. multilocularis N1 strain and E. canadensis genotypes, in regions with high prevalence in definitive hosts yet low incidence of human AE and CE, suggests that these genotypes have lower zoonotic potential and pathogenicity than European and Asian strains of E. multilocularis and livestock genotypes of E granulosus sensu stricto. The continued monitoring of the emergence of Echinococcus genotypes within definitive and intermediate hosts, as well as people, is needed to assess the impact on public health risk, since the introduction of other genotypes could have serious repercussions. Lastly, determining risk factors and source attribution for human cases, including the possibility of food and waterborne transmission and the likelihood of autochthonous transmission, remain challenges.Peer reviewe

Barriers to livestock vaccine use among rural female smallholder farmers of Nyagatare district in Rwanda

This study examined the factors driving low adoption of vaccination against Newcastle disease (NCD) and Rift Valley fever (RFV) among smallholder women farmers of Nyagatare District in order to identify appropriate strategies that can lead to improved livestock production. Results reveal that women’s ability to use livestock vaccines is constrained by cultural norms that limit their decisions over productive assets and income for use in buying vaccines. Women are also hindered by unavailability of the livestock vaccines, lack of information and knowledge about livestock vaccination, and limited access to veterinary extension services.Bill & Melinda Gates FoundationGlobal Affairs Canad

Using outcome mapping to mobilize critical stakeholders for gender responsive Rift Valley fever and newcastle disease vaccine value chain in Rwanda

Women farmers find little support for the small livestock they manage due to official preference for cattle production. The study aimed to identify opportunities for women’s engagement in the livestock vaccine value chain (LVVC) and to reduce barriers to vaccines. Outcome Mapping, and the Gender Equality Continuum Tool were used to classify and engage critical partners. Enhanced positioning and visibility of women can occur through recognition of the roles that women play and systemic engagement of all stakeholders. Poverty among livestock keepers is particularly high in sub-Saharan Africa. It is estimated that more than 85 percent live in extreme poverty, where two-thirds of producers are women.Bill and Melinda Gates Foundation (BMGF)Global Affairs Canada (GAC

The African snakebite Alliance

The goal to reduce the burden of snakebite envenoming is challenged by the gaps in evidence for clinical care and public health. These evidence gaps and the absence of a strong network are illustrated by bibliometrics. The African Snakebite Alliance is a multidisciplinary group focusing on research themes which will generate evidence needed to shape policy and practice

Checklist for One Health epidemiological reporting of evidence (COHERE)

One Health is defined as the intersection and integration of knowledge regarding humans, animals, and the environment, yet as the One Health scientific literature expands, there is considerable heterogeneity of approach and quality of reporting in One Health studies. In addition, many researchers who publish such studies do not include or integrate data from all three domains of human, animal, and environmental health. This points to a critical need to unify guidelines for One Health studies. This report details the Checklist for One Health Epidemiological Reporting of Evidence (COHERE) to guide the design and publication format of future One Health studies. COHERE was developed by a core writing team and international expert review group that represents multiple disciplines, including human medicine, veterinary medicine, public health, allied professionals, clinical laboratory science, epidemiology, the social sciences, ecohealth and environmental health. The twin aims of the COHERE standards are to 1) improve the quality of reporting of observational or interventional epidemiological studies that collect and integrate data from humans, animals and/or vectors, and their environments; and 2) promote the concept that One Health studies should integrate knowledge from these three domains. The 19 standards in the COHERE checklist address descriptions of human populations, animal populations, environmental assessment, spatial and temporal relationships of data from the three domains, integration of analyses and interpretation, and inclusion of expertise in the research team from disciplines related to human health, animal health, and environmental health

Stakeholder perspectives from 15 countries in Africa on barriers in snakebite envenoming research and the potential role of research hubs

Snakebite envenoming is a debilitating neglected tropical disease disproportionately affecting the rural poor in low and middle-income countries in the tropics and sub-tropics. Critical questions and gaps in public health and policy need to be addressed if major progress is to be made towards reducing the negative impact of snakebite, particularly in the World Health Organisation (WHO) Africa region. We engaged key stakeholders to identify barriers to evidence-based snakebite decision making and to explore how development of research and policy hubs could help to overcome these barriers. We conducted an electronic survey among 73 stakeholders from ministries of health, health facilities, academia and non-governmental organizations from 15 countries in the WHO Africa region. The primary barriers to snakebite research and subsequent policy translation were limited funds, lack of relevant data, and lack of interest from policy makers. Adequate funding commitment, strong political will, building expert networks and a demand for scientific evidence were all considered potential factors that could facilitate snakebite research. Participants rated availability of antivenoms, research skills training and disease surveillance as key research priorities. All participants indicated interest in the development of research and policy hubs and 78% indicated their organization would be willing to actively participate. In conclusion, our survey affirms that relevant stakeholders in the field of snakebite perceive research and policy hubs as a promising development, which could help overcome the barriers to pursuing the WHO goals and targets for reducing the burden of snakebite