FAO Initiatives and Protocols on Brucellosis and Tuberculosis Prevention and Control in Animals Sean V. Shadomy, DVM, MPH, DACVPM FAO Animal Health Service CDC One Health Office Liaison to FAO
Outline Epidemiology and distribution Challenges to disease control FAO programs and activities addressing brucellosis and tuberculosis
Brucellosis - common zoonosis Brucellosis remains one of the most important and widespread zoonoses in the world Global threat to human and animal health Under reported Pappas et al.,2006. Lancet Infect. Dis. 6, 91 99. Brucellosis should be controlled at the national and regional levels in the interest of the livestock industry, public health and human livelihoods
Bovine brucellosis (Brucella abortus) reporting status, 2012-2017 Map credit: E. Palamara, FAO-AGAH
Ovine and Caprine brucellosis (Brucella melitensis) reporting status, 2012-2017 Map credit: E. Palamara, FAO-AGAH
B. melitensis: epidemiological trends Most virulent Brucella spp. in humans and affects multiple livestock species Endemic in the Mediterranean, Near and Middle East and Central Asia Re-emergence of infection in other regions (Eastern Europe, the Balkans) Emergence of B. melitensis infection in cattle and camel populations
Brucellosis control challenges Weak veterinary capacity (laboratory, epidemiology) hinder control efforts Lack of accurate and reliable information on disease both in human and animals prevalence and distribution are under reported Level of control can differ between livestock systems (intensive versus smallholder, large versus small ruminants) Increasing demand for milk, increased peri-urban dairy production, and lack of adequate food safety are risk factors for human brucellosis
Brucellosis control challenges Existing control programs not always based on sound epidemiologic strategy and not planned for sustainability Control strategies require long term commitment and monitoring Impact of uncontrolled cross border movement of animals Lack of intersectoral collaboration One Health collaboration between public health and veterinary services is essential for control
Bovine tuberculosis (Mycobacterium bovis) reporting status, 2012-2017 Map credit: E. Palamara, FAO-AGAH
Bovine tuberculosis challenges Complex epidemiologic patterns and wildlife reservoirs constrain control and eradication programs for livestock Weak veterinary capacity (laboratory, epidemiology) hinder control Prevalence data are minimal, and disease is under reported (under recognized and underdiagnosed/misdiagnosed in animals and humans) Test and slaughter control methods may not be feasible in many countries / settings Lack of animal identification and slaughterhouse surveillance and uncontrolled cross-border movement of animals
Bovine tuberculosis challenges One Health integrated approach and regional collaboration are needed for successful control Political and producer support and strong veterinary and abattoir inspection services are needed M. bovis contribution to AMR in tuberculosis Naturally resistant to pyrazinamide human cases may receive inadequate antimicrobial therapy Resistance developing to other TB drugs FAO has recognized zoonotic bovine tuberculosis as a priority disease to control at the human-animal-ecosystem interface
FAO FAO Brucellosis programme Program for brucellosis control RADISCON (1996-2003) TCP Morocco Syria Kyrgyzstan Oman Bosnia and Herzegovina Georgia Yemen Swaziland Donor funded projects Kosovo Tajikistan Iraq Armenia KSA
FAO program for brucellosis control Key elements include: A baseline seroprevalence survey representative of both the susceptible livestock and regions of the country; High-coverage, risk-based vaccination control strategy, based on survey findings; Surveillance system to ensure early warning against spread of disease/infection to new areas; Monitoring progress and changes in infection/disease incidence; and reviewing and updating control strategies; Public awareness and targeted education; Development of regional cooperation
Vaccination the most successful tool High coverage and long term programs (10-15 years) are needed Both adults and young stock vaccinated initially Following years vaccination of young replacement only
Brucellosis Control Program in Tajikistan Model program (2004-2014) combined FAO technical support and financial support from donor countries Developed brucellosis control program with Ministries of Agriculture and Health Partnership with private veterinarians and farmers Mass vaccination of small ruminants followed by biannual vaccination of young animals and new additions Supported community awareness and professional education and capacity building (animal and human health) Established and implemented cost-sharing system where livestock owners share vaccination costs
Prevalence (%) Brucellosis Control Program in Tajikistan 16 14 12 10 8 6 4 2 0 Districts Prevelence 2003 Prevelence 2009 8.9% 1.8% Vaccination Program Whole flock vaccination in y1 and y4 Biannual vaccination of young animals Conjunctival Rev 1 vaccine at full dose l Ear notching 83% reduction in prevalence over six years in eight best-vaccinated districts 40% reduction in districts with lower coverage Veterinary Record, 2012;170(4):100 106
Uganda Community One Health Project FAO teams in 2013 worked with local One Health teams in the pastoralist Karimojong community in northeast Uganda Goal - find ways to address brucellosis and other zoonotic diseases and improve delivery of health services for the pastoralists and their livestock
Uganda Community One Health Project Community-based, participatory approach working with villagers, the community health clinic, district health and agriculture and wildlife officials, and national decision-makers Villagers identified key concerns, and the best methods for communication and community education https://www.youtube.com/watch?v=rftiluyjpz0
Camel brucellosis - due to B. melitensis and B. abortus Country Number of samples Tests used Prevalence Strain Reference Egypt 360 SAT 11.6 Ahmed & Nada (1993) Iran 1123 RBT 10.5 B. melitensis biovar 1 Rafieipour & Ziaei (2007) Zowghi & Ebadi (1988) Jordan 412 RBT, FC, ELISA Kuwait 698 SAT, CFT, RBPT 12.1 B. melitensis biovar 3 14.8 B. melitensis biovar 3 Al-Majali et al. (2008) Al Khalaf & El Khaladi (1989) Libya 967 RBT,SAT, CFT 4.1 B. abortus biovar 1 Gameel et al. (1993) Saudi Arabia 2536 RBT 8.0 B. melitensis biovars 1, 2, 3 Radwan et al. (1995) Sudan 3274 RBT 7.8 B. abortus biovar 3 Musa & Shigidi (2001) Agab et al. (1996) Oman 1502 RBT 7.0 Yagoub et al. (1990)
B. melitensis Rev. 1 vaccine evaluation in camels 2014 FAO collaborative study Mean SAT in camels following B. melitensis Rev. 1 vaccine Test immune response to B. melitensis Rev.1 vaccine in naïve camels A: Adult camels (n=3) Conjunctival; B: Adult camels (n=3) Subcutaneous; C: Young camels (n=10) conjuctival Open Vet J. 2014;42(6):96
Rev. 1 vaccine evaluation in camels All milk samples for 8 weeks after vaccination were culture negative and negative on PCR for B. melitensis and Rev. 1 Findings of pilot suggestive but limited by sample size Larger studies are needed to demonstrate protective efficacy and safety
Framework for progressive control of brucellosis (Stepwise approach) Stage 1 Stage 2 Stage 3 Stage 4 Situation Situation Situation Situation Unknown situation of the disease No structured control activities Known situation of the disease with a control programme under way Brucellosis at low levels within susceptible livestock population No evidence of brucellosis in livestock No human cases Outcome Outcome Outcome Outcome Better understanding of the disease situation Brucellosis infection rates falling in livestock Reduced impact of brucellosis in livestock and humans Self-declared freedom from brucellosis with or without vaccination Activities Implement a baseline survey and epidemiological investigations Develop an appropriate control strategy and action plan Inform stakeholders Activities Implement the agreed control plan Monitor the plan for quality and progress Facilitate public health and animal health collaboration Activities Undertake Rrisk analysis to revise control strategy as appropriate Implement revised control plan Enhance surveillance and monitoring Activities Provide data to support brucellosis-free status according to OIE standards Investigate and clear all suspected brucellosis cases Monitor and maintain disease free status Level of brucellosis declining in livestock and humans Capacity of national veterinary services improving
One Health Zoonotic Disease Prioritization FAO is collaborating with US CDC to conduct One Health Zoonotic Disease Prioritization (OHZDP) Workshops CDC piloted the OHZDP tool and workshop in 2014 - conducted in 15 countries to date Since 2015 FAO has supported and participated in OHZDP country workshops FAO staff will be trained as workshop facilitators under cooperative agreement with CDC FAO will facilitate OHZDP workshops with CDC technical support Increases ability to conduct OHZDP workshops in GHSA phase-1 and phase-2 countries and beyond
OHZDP Process Multi-sectoral, One Health approach to prioritize endemic and emerging zoonotic diseases of major public health concern to be jointly addressed by participating human, animal, and environmental health ministries Participants representing human, animal, and environmental ministries commit to develop strategies for newly prioritized ZDs. Prioritization promotes joint efforts to reduce illness and death in people and animals: Building lab capacity Conduct and enhance disease surveillance Plan outbreak response and preparedness Develop prevention and control strategies Original publication for OHZDP tool http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109986
OHZDP Process Country specific: Workshop goal is specified by the country Can help country meet IHR, GHSA, and JEE capacity building goals/activities Locally appropriate criteria are selected in order to rank diseases Examples: pandemic potential, economic impact, high morbidity/ mortality to animals and/or people
Europe/Asia OHZDP Workshops (n=4) 2014 30 August 2017 Azerbaijan c Pakistan Thailand Bangladesh
Africa OHZDP Workshops (n=11) 2014 30 August 2017 Uganda Burkina Faso Rwanda Ethiopia Senegal Kenya Côte d Ivoire Cameroon Tanzania Democratic Republic of Congo South Africa
Zoonotic Diseases Most Frequently Prioritized in OHZDP Workshops Disease Number of Countries that Prioritized (n = 15) % Rabies 14 93.3 Zoonotic Influenza (including Avian Influenza) 13 86.7 Anthrax 11 73.3 Brucellosis 11 73.3 Viral Hemorrhagic Fevers (incl. Ebola/ Marburg, CCHF, RVF) 10 66.7 Zoonotic Tuberculosis 6 40
Conclusions and further study Brucellosis and bovine tuberculosis remain global threats for humans and animals Epidemiology and distribution remain largely unknown Diagnostic and surveillance capabilities in many countries are sporadic A number of areas exist in which specific actions and clear guidance are needed for better control Prioritization of brucellosis and bovine tuberculosis may increase commitments to address these diseases