Fèvre, Eric M.

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A framework for understanding zoonoses at the livestock-human interface in western Kenya Dr Eric Fèvre www.zoonotic-diseases.org  Centre for Immunity, Infection and Evolution, University of Edinburgh and International Livestock Research Institute, Nairobi   In collaboration with: KEMRI, Centre for Microbiology Research   Department of Veterinary Services, Kenya Workshop: An Integrated Approach to Controlling Brucellosis in Africa, Addis Ababa, 29-31 January 2013 Acknowledgements Funded by: Wellcome Trust (UK) BBSRC (UK) MRC (UK)  Thanks to  Lian Thomas (University of Edinburgh) William de Glanville (University of Edinburgh) Annie Cook (University of Edinburgh)  The 15-strong PAZ team James Akoko, Omoto Lazarus, Lorren Alumasa, Daniel Cheriyot, Jenipher Ambaka, Fred Opinya, John Mwaniki, Hannah Kariuki, Gideon Mwali, George Omondi, Alice Kiyong’a, Lilian Abonyo, Maseno Cleophas, Fred Ambaka, Velma Kivali  Phil Toye (ILRI) Sam Kariuki (Kenya Medical Research Institute, KEMRI) Njeri Wamae (Kenya Medical Research Institute, KEMRI) Bernard “Risky” Agwanda (NMK) Mark Bronsvoort (Roslin Institute) Mark Woolhouse (University of Edinburgh) Claire Okell (Royal Veterinary College) The DVOs, Western Province What research is needed? - WHO Field epidemiological studies in humans and livestock the number of cases and number of deaths number of new infections age-and sex-specific disability weights for zoonoses   Estimates/models of under-reporting Much recent progress: rabies, sleeping sickness Case studies to gather an evidence-base  Multi-disease studies – what is the overall burden of zoonoses as a group on communities Public health Economics  Field-level diagnostics  Cost-effectiveness studies – dual medical/veterinary benefits  Pathogen and host ecology People, Animals and their Zoonoses (PAZ) Integrated project that addresses this lack of data and these scientific aims  Aims to address both (veterinary) public health and ‘biological’ questions  Epidemiology – population scale  Framework that can be repeated elsewhere in different communities and ecologies  Food chain Domestic animals Peri- domestic wildlife Humans Environment Aims of study  Acquire basic field epidemiological data on zoonotic diseases in both humans and animals  Enumerate co-infections/co-exposure with zoonoses amongst humans and livestock (with 1+ zoonosis; with all pathogens)   Quantify the human burden of zoonoses and other infections in the study area  Investigate links between zoonoses and non-zoonotic infections – co-factors (eg – are sick animals better reservoirs?)  Understand/model the extent to which co-factors predict exposure to zoonoses  What is the impact of zoonoses on production losses in livestock?  Understand the role of the wider ecosystem on disease transmission  Investigate the potential of simple livestock-targeted interventions as a means of improving human public health Study site Field site is the Western Province of Kenya  2000 km2 zone (500,000 cattle, 67,000 pigs, ~1 million people)  Small-holder crop-livestock production system in the Lake Victoria Crescent (highest human and livestock densities in East Africa)  Intensively and comprehensively sampled over 2.5 years  Cluster design (random household), organised by sub-location units  All sublocations in the study site to be sampled, proportionally by cattle population distribution The project is focused on… Cross sectional sample flow (field lab) Slaughter house sample flow (field lab)  Livestock cross sectional survey Infections with zoonotic diseases and other pathogens in cattle, pigs, goats  Sampling 1100 cattle in ~ 450 households  All cattle, pigs, goats in each home sampled  Comprehensive individual level questionnaire covering a diversity of socio-economic, spatial and biological risk factors (c.100 item questionnaire)  Process Field examination/full clinical exam, collection of blood, serum, faeces Parasitological screening, sample processing, some serologic diagnostic assays in field lab ELISA and PCR at central lab Biobanking + material for livestock genetics Pathogens and conditions considered (first pass) Organism/condition Test type Sample type Sample volume State of health Clinical examination Blood-borne parasites (Plasmodium, Rickettsia, Trypanosoma, microfilariae m, microfilariae, Theileria, Anaplasma, etc) Microscopy Thick and think blood smears; possibility of testing some rapid tests 100µl Various intestinal parasites (Ancylostoma, Trichuris, Strongologides, Ascaris, Necator, Hymenolepis, Taenia, Schistosoma, Coccidia, Crypto, Giardia, Fasiola, Entamoeba…) Kato-Katz concentration, formol-ether concentration, microscopy Fresh faeces 10g Haemoglobin PCV and direct measurement Whole blood 10µl Coxiella burnetii  (Q-fever) Serology Serum ** Brucella spp. (Brucellosis) Serology Whole blood in anticoagulant ** Mycobacterium bovis (Bovine TB) Serology (Gamma-interferon) Peripheral Blood Mononuclear Cells from whole blood 8mls Rift Valley Fever Serology Serum ** Trypanosoma brucei rhodesiense (sleeping sickness) Microscopy and PCR Whole blood in anticoagulant ** Taenia solium (pork tapeworm) Copro-PCR, serology and microscopy Stool, serum ** Faeces – 10g Taenia saginata (beef tapeworm) Microscopym serology and Copro-PCR Stool 10g HIV Serology Whole blood in anticoagulant ** Leptospirosis (?) Serology Serum and whole blood in anticoagulant **  Human cross sectional survey Same principle as livestock element, but in humans; 120 item questionnaire  Collaboration with Centre for Microbiology Research, KEMRI  Two strata - households that keep cattle and those that do not – target 2500 patients sampled  KEMRI ethical approval  Process Field examination and clinical exam, collection of blood, serum, faeces Sample processing, parasitology, some serologic diagnostic assays in field lab ELISA tests and PCR at central labs Biobanking of serum and blood for further analysis  Reporting back and free treatment of parasites Scientific data on epidemiological parameters in the study population and design of targeted interventions  Mapping disease distributions and risk  Modelling transmission and the role of co-factors in zoonotic disease spread  Co-investigation of all humans and livestock in the sampling unit gives a uniquely comprehensive understanding  Will provide data to address gaps in NZD knowledge identified by WHO  Country- and regional- scale policy outputs with a wider regional relevance Fin Thanks for your attention!  Eric Fèvre Email: Eric.Fevre@ed.ac.uk  Web: www.zoonotic-diseases.org  tel: +44 (0)131 208 32 35 tel: +254 (0) 722 545 345 Centre for Infection, Immunity and Evolution School of Biological Sciences University of Edinburgh Ashworth Labs West Mains Road Edinburgh EH9 3JT UK   International Livestock Research Institute   Old Naivasha Road   Po Box 30709-00100   Nairobi   Kenya Good Practice in Quantitative Veterinary Epidemiology http://www.qve-goodpracticeguide.org.uk/  Woolhouse, M.E.J., Fèvre, E.M., Handel, I., Heller, J., Tildesley, M.J., Parkin, T., & Reid, S.W.J. (2011). Guide to Good Practice for Quantitative Veterinary Epidemiology (http://www.qve-goodpracticeguide.org.uk/). VTRI0101, Universities of Edinburgh and Glasgow.  Data managament Facilities Full scale “district level” parasitology and microbiology diagnostic lab for human and animal samples  Post-mortem room for animals (pathology)  International Livestock Research Institute Health and Safety and equipment laboratory maintenance standards  International supply chain and cold chain  Water, electricity, broadband internet  Excellent relations with DVS, local leaders, government officials and the wider community  Access to field (incl 4x4 transport) among highest human and livestock population densities in Eastern Africa geographical gradation from the Lake Victoria in the south to the lower slopes of the Mt Elgon uplands in the north   List of current equipment 3x long wheelbase land cruisers for fieldwork Large refrigerated centrifuges x2 37C incubators x3 Water bath Incubator shaker Stomacher  Shakers Micro-Haematocrit centrifuges Autoclave Deionizer  Dissecting  microscopes Compound microscopes Balances  Automated haematology analyser Hemocue 2x Laminar air flow hoods 2x UV cabinets Fridges Biomedical freezers to -40 and -80 Computing facilities and wireless internet access Large generator Robust real-time PCR machine ELISA reader LAMP PCR equipment Various standard equipment for parasitology processing  Studies currently under way Large cross-sectional survey of 450 households investigating epidemiology of endemic zoonoses and co-infections  Zoonoses risk amongst slaughterhouse workers  MRSA in pigs and people  Food chain risk assessment of porcine cysticercosis and brucellosis  Molecular epidemiology of brucellosis  Development of pen-side diagnostics for cysticercosis  Pathogen discovery in peridomestic rodents and bats  

A framework for understanding zoonoses at the livestock-human interface in western Kenya

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A framework for understanding zoonoses at the livestock-human interface in western Kenya

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