This success with RVF, demonstrated the need to expand and improve the approach for all potentially zoonotic outbreaks, but also to understand, prevent and control endemic zoonotic disease. In Particular a lack of a formal framework for systematic collaboration between government Ministries and among key stakeholders on management of zoonotic disease outbreaks was a critical gap.
These efforts led to the formation of a national One Health coordinating office referred to as Zoonotic Disease Unit ZDU in and the process to do this has been laid out previously [ 13 ] Fig. In , the governance system in Kenya changed from a centralized to a devolved government of 47 counties; where functions such as public health and animal were undertaken by county governments. This provided an opportunity and need to expand the One Health approach to the subnational county level. County One Health units focus on initiating or enhancing communication platforms between the health and livestock sectors to improve surveillance and reporting of zoonotic diseases, ensuring rapid joint investigation and response to zoonotic disease outbreaks to mitigate disease impact.
As of April , there were 31 of 47 Kenya counties with established county One Health units. Through collaborations with other international partners, there will be county One Health units in all 47 counties by Sharing of disease outbreak information across sectors and rapid joint outbreak response at county level should help reduce the burden of spillover to humans that acquire zoonotic disease infections as illustrated by an example of an anthrax outbreak in Nakuru County Table 1. In , a multidisciplinary team of human, animal and wildlife health experts in surveillance, research and laboratory science drawn from the national and county levels conducted prioritization of zoonotic diseases in Kenya [ 15 ].
From a list of 35 zoonotic diseases, the top five were anthrax, trypanosomiasis, rabies, brucellosis and Rift Valley Fever. Based on these findings, development and implementation of disease prevention and control plans for these priority zoonoses with greatest public health impact is being undertaken while promoting collaborative research and surveillance for all the diseases to generate national data and for evaluating control strategies.
Since , with increased recognition of the value of One Health, veterinarians have been admitted to the training [ 16 ]. Of these trained veterinarians, all initially returned to government positions, and the majority stayed at national or country level, strengthening collaboration between the human and animal health sector with fellow FELTP graduates participating in joint outbreak response and other activities during their training Fig.
Surveillance for animal diseases in most developing countries is designed to detect notifiable and trade sensitive diseases e. However, these systems are established to detect animal syndromes and generally without consideration of zoonotic aspects of clusters of animal diseases and the risk that infections may spill-over to humans locally and further afield.
This calls for establishment of surveillance platforms that can detect and report cases of these zoonotic diseases in a timely manner, coupled with enhanced collaboration and information sharing between human health and animal health sectors. The surveillance system collected environmental and livestock monitoring data from resident veterinary officers at county and sub-county level on weekly basis and provided for toll free telephone contact to headquarters in order to report any suspected RVF cases.
The veterinary surveillance officers contacted a network of farmers spread out through the sub counties. Although an outbreak had not occurred, the potential of one provided an opportunity to test a coordinated, rapid and enhanced surveillance response, highlighting possibility of a more robust and real-time reporting tool in place of a variety of manual and electronic tools that have been used with varied success.
In Kenya, the current surveillance effort is focusing on development and deployment of syndromic surveillance system in domestic and wild animals, using a mobile phone based application that will incorporate reporting and a feedback function to the surveillance officers and has capabilities for routine data analysis and visualization to detect animal disease events of public health concern.
The mobile application has adapted manual disease reporting forms currently in use for reporting. This surveillance is part of institutional capacity building funded by GHSA and targeted to reach up to 10 counties by The burden and transmission dynamics of many zoonotic infections are poorly understood in developing countries, including Kenya, which can challenge the progress of disease control programs to reduce burden and impact.
Additionally, in through collaborative partnerships with the Wellcome Trust, zoonotic disease research was started among farmers and animals within PBIDS. The zoonotic disease research in DGHP has catalyzed additional studies within the PBIDS platform with other partners such as Washington State University and developed further platforms in different sites in the country with the overall focus of generating disease data to inform public health actions Fig.
Some examples of these are outlined below. In , KEMRI and CDC Kenya carried out retrospective studies on archived human sera collected between and in the PBIDS platform and cross-sectional studies carried out in the same site in among cattle, sheep and goats and the vector ticks to determine the sero-prevalence of the disease [ 22 ].
These pivotal studies by CDC and KEMRI triggered a sustained interest among research groups who showed variable but high sero-prevalence in humans and the reservoir domestic animals in different eco-systems in Kenya and highlighted Coxiella burnetti as a key etiology for consideration for undifferentiated fever in communities keeping livestock [ 23 , 24 ]. In , data from these studies were used during a One Health Zoonotic Disease Prioritization workshop in Kenya, where Q-fever was identified as one of the diseases that would benefit from integrated prevention and control programs using the One Health approach [ 15 ].
This underscored the need for targeted public health messaging, effective diagnostic capacity in local hospitals and systematic control programs for brucellosis in animals [ 25 ]. The momentum built around the — RVF outbreak in Kenya progressed to robust research projects by multisectoral collaborative research groups. A key output from learning the lessons on preparedness from the — outbreak is the RVF decision support tool kit for Chief Veterinary officers in the Horn of Africa region to support evidence-based actions to mitigate the impact of RVF outbreaks when they occur [ 26 ].
This tool has been adapted into the RVF integrated preparedness and response plan for Kenya and was applied in late when RVF was predicted in Kenya and the Eastern Africa region as described previously. These data taken together with a historical review of RVF outbreaks since , were used to generate a risk map for RVF in Kenya [ 27 , 29 , 30 ].
A temporal spatial mapping of the RVF outbreaks in the Eastern Africa region followed by molecular analysis of viruses isolated from humans, animals and mosquitoes found foci-specific viral lineages suggesting de novo activation of viruses in specific outbreak sites rather than spatial spread from the initial outbreak site to another [ 31 ].
This knowledge was useful in defining the endemic nature of RVF in certain regions in Kenya and subsequent studies on factors associated with endemicity, outbreak flare-ups and factors associated with human morbidity and mortality [ 27 , 32 ]. To address safety concerns surrounding the locally available RVF vaccine, a field trial to evaluate the safety and efficacy of new RVF clone 13 vaccine was conducted in Kenya in collaboration with Kenya Ministry of Agriculture Livestock and Fisheries [ 33 , 34 , 35 ].
follow The results showed the vaccine as a promising tool, being safe and with high immunogenicity in sheep and goats and moderate immunogenicity in cattle under field conditions. This vaccine has been earmarked for registration locally. Rickettsia were detected by PCR in 7.
Further these studies identified, isolated and sequenced a novel to the world rickettsial pathogen, Rickettsia asemboensis in cat and dog fleas in western Kenya. Kenya has over three million camels reared in the arid northern part of the country.
None of the persons tested with well-characterized exposure to camels and camel products milk showed evidence of previous exposure MERS COV [ 41 ]. To test the hypothesis that perhaps a different strain of MERS COV that is less transmissible from camels to humans is circulating in camels in Kenya we have set up a study to detect and isolate MERS virus strain circulating in camels in Kenya for comparison with strains circulating elsewhere and addition expanded an enhanced surveillance of respiratory illness to Marsabit where camel pastoralists reside to detect any cases in humans.
In addition, from a variety of bats captured in multiple sites across Kenya, a high prevalence and diversity of Bartonella species were identified [ 44 ]. Detection of these pathogens in these animal reservoirs suggests potential for exposure and transmission to humans in different settings.
Future work is underway to understand the contribution of these pathogens as etiologies for undifferentiated fever in humans using multi-pathogen detection assay such as the AFI TaqMan array card in several sites including the PBIDs platform in Western Kenya. This integrated and unique study design allows for measuring of the impact of livestock diseases on human health and socio-economic status at household level.
Preliminary data analysis reported at household level, showed strong association between cumulative human and animal illness though the mechanism for this association was not clear [ 7 ]. There are on-going studies on impact of interventions to reduce diseases in animals on health and socio-economic status of households. In summary, the CDC, KEMRI and collaborators investments in research on zoonotic diseases has generated credible and useful data on occurrence, identified new pathogens and etiologies of common syndromes, clarified the ecology of disease occurrence and overall contributed in the formulation of science-based interventions in endemic zoonotic diseases.
In addition, the innovative and unique linked human-animal interface study designs have highlighted the benefits of adopting a One Health approach in research to study zoonoses and complex interlinked human and animal health relationships. Overall, 30 publications covering viral, bacterial and other mainly reviews and topics on disease ecology have been realized from this work Fig. While zoonotic diseases spill-over to human populations and the concept of controlling infections at source is well appreciated, the animal health sector continues to be under-resourced in critical elements of surveillance and reporting of animal diseases and laboratory diagnosis.
In addition, setting up surveillance programs is resource intensive with few partners providing support.
On a positive note, in DGHP Kenya funded the development of a rabies elimination plan for Kenya [ 14 ] that has since attracted funding from various MALF and MOH development partners for rabies elimination activities including mass dog vaccination, enhanced rabies surveillance in humans and animals, enhanced management of dog bite cases and operational research. Finally, the Kenya ZDU has not fully incorporated the environment health sector to be fully compliant with the scope of One Health approach.
This has in part been due to lack of clearly designated government ministry that represents the environment sector. Currently efforts have been made to include an ecologist as a core personnel to the ZDU to provide environmental health expertise. In addition, the strategic plan for the implementation of One Health is being reviewed to reflect the progress made and identify strategies for institutionalizing One Health at sub-national level.
The extent of adoption of the One Health approach has been remarkable at the national level. However, at the sub-national County and sub-county levels where most disease management decisions are made, more progress is needed. With GHSA support, the ZDU has made concerted efforts to establish functional One Health units at county levels to enhance coordination and communication of key ministries and stakeholders for surveillance and disease outbreak response; however the benefits of these efforts are currently being evaluated. Finally, sustainability of the current progress and efforts are not guaranteed due to the reliance on donor funding to implement these One Health activities.
This is a challenge that goes beyond One Health implementation and is largely appreciated for many donor-initiated efforts. Most governments have a host of competing interests including constant outbreaks of epidemic prone diseases such as cholera, other infectious diseases and non-communicable diseases within the health sector and focusing on promotion of international trade in animals and animal products that often make the importance of zoonotic diseases pale in comparison.
Commendably, ZDU has initiated advocacy plans to lobby for government support through the line ministries to maintain One Health activities beyond the current GHSA initiative. Since , CDC Kenya has successfully supported and collaborated with Kenyan government institutions to establish a sustainable One Health program at national and county levels; a process catalyzed by emerging zoonotic threats such as RVF and H5N1.
The results have been the establishment of an effective cross-sectoral coordinating government unit ZDU , an enhanced surveillance system in domestic and wild animals that meets the needs of animal and human health, a workforce trained in the One Health approach, improved outbreak investigations and a robust and productive public health scientific program including the discovery of zoonotic pathogens new to the world. The adoption of the One Health program and approach in Kenya has led to rapid detection and control of zoonotic disease outbreaks at their source and thereby enhanced global health security.
These achievements have allowed for advocacy and informed decisions to be made on the control and prevention of zoonotic pathogens and have identified gaps in diagnosis and surveillance. However, challenges remain in sustainability, veterinary laboratory diagnosis and resources to implement more comprehensive control and prevention measures.
Lessons learnt from Counties in Kenya are applicable to establish One Health programs throughout Kenya, the African region, and beyond. Global trends in emerging infectious diseases. American Veterinary Medical Association. One Health: a new professional imperative, one health initiative task force: final report July 15, World Bank.
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