ZOONOTIC DISEASE UNIT IN
KENYA: BLUE PRINT FOR A
NATIONAL ONE HEALTH OFFICE
Dr Murithi R. Mbabu
Department of Veterinary S...
Presentation Outline
 Key steps in OH in Kenya
 Outline of milestones in OH
 Application: One Health in Action
Kenya: Key OH Steps
(2005-2012)
 Formation of National Influenza Task

force(NIT) - 2005
 NIT responded to RVF outbreak ...
Kenya: Key OH Steps
(2005-2012) …
 Revision of IDSR technical guidelines to

incorporate zoonotic diseases -2011
 Creati...
OH Milestones in Kenya
(2006-2012)
1. Formation of Zoonotic Technical
Working Group (ZTWG)
Formed in 2008
 Multi-sectoral, including MoH, MoLD, WHO,
FAO, AU...
2. Creation of One Health
office: Zoonotic Disease Unit (ZDU)
MOU: Signed by MoPHS and MoLD in Aug 2011

Housing: Office c...
ZDU Formation
Zoonotic Disease Forum: Sept 22-24, 2010
Launch of the ZDU

Minister, MOLD and PS MoPHS
officially open ZDU office
ZDU Organogram
3. Development of Kenya Priority
Zoonotic Diseases List –2011*
1.

Viral Hemorrhagic Fevers
i.
ii.
iii.
iv.
v.
vi.

2.
3.
...
4. Kenya Revised IDSR
Technical Guidelines
Key changes
 Addition of zoonotic diseases in the priority
disease list
 Incl...
5.1.2 IDENTIFY MEMBERS OF THE PHEMC
Organize the district PHEMC to include a mix of representatives from the public, non
g...
Table 1: Kenya’s Priority Diseases, Conditions and Events for
Integrated Dis ease Surveillance and Response – 2011
Epidemi...
5. Strategic Plan for Implementing
OH in Kenya (2012-17) :Highlights
Strategic Plan for Implementing
OH in Kenya (2012-17)
Objectives:
 Strengthen surveillance,

prevention and control of zo...
Goal 1:Strengthen surveillance,
prevention and control of zoonoses
• Conducted risk mapping for 4 priority

zoonotic disea...
Goal 1: Strengthen Zoonoses
Surveillance, Prevention and Control
 Identified subject matter experts for priority

zoonoti...
Goal 2 : Establish structures
and partnerships to promote OH

 Decentralize OH to the county and district levels




S...
Goal 2: Establish structures and
partnerships to promote One Health





ZDU operational
Quarterly Zoonotic
Technical W...
Goal 3:Conduct and Promote
Applied Research
 Promote applied research at the human-animal-

ecosystem interface
 Brucell...
Strategic Plan Outcomes
 Greater compliance with WHO/IHR and OIE

guidelines on public health threats
 Risk maps and ide...
Strategic Plan Outcomes…
 Established plan and capacity for early

epidemic detection, diagnosis, and rapid
response
 Be...
6. Revision of National Policies
to Incorporate OH
 The veterinary policy – on going
 The National Health policy framewo...
One Health in Action
Outline
 HAT investigation
 Brucellosis sero-prevalence study
 Development of disease control strategies
HAT Investigation: Introduction
 In March 2012, two case reports of Human

African Trypanosomiasis (HAT) reported from
to...
Human Investigation
Active surveillance

Setting up
surveillance sites.
Animal Investigation
Entomological Investigation

Ngu trap
Biconical trap
Findings/Actions
 No human infective forms of T. brucei

detected in human, animals or tsetse flies
 Five Sentinel surve...
Brucellosis Sero-prevalence Study
 Objectives
1. Establish representative prevalence estimates in

humans and animals in ...
Brucellosis Sero-prevalence Study
 Sites

Marsabit – High prevalence
• Kajiado- High prevalence
• Kiambu- Low prevalence
...
Brucellosis Sero-prevalence Study
Proportion of households with at least 1 positive human case
32%

14%
6%

Kajiado

Kiamb...
Brucellosis Sero-prevalence Study
Proportion of herds with at least one positive animal case
31%

12%

11%

11%

6%
2%
Ove...
Disease Control strategies
 RVF

 Rabies
 Brucellosis
 Anthrax
Rabies Control Strategy
 Multiple agencies/institutions involved –

including WSPA
 WSPA Commitment
 Facilitate a

best...
“Medicine is a social science, and
politics is nothing else but medicine on a
large scale”
Rudolf
Virchow

Thank you
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Zoonotic Disease Unit Of Kenya: Blueprint For A National One Health Office

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GRF 2nd One Health Summit 2013: Presentation by Mbabu Murithi, Government of Kenya

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  • Conduct risk mapping for 4 priority zoonotic diseases (Anthrax, Rabies, Brucellosis, RVF) Implement OH plans for jointly responding to zoonotic disease outbreaksStrengthen laboratory diagnosis for zoonosisDevelop and implement prevention and control strategies for 4 priority zoonotic diseases
  • Zoonotic Disease Unit Of Kenya: Blueprint For A National One Health Office

    1. 1. ZOONOTIC DISEASE UNIT IN KENYA: BLUE PRINT FOR A NATIONAL ONE HEALTH OFFICE Dr Murithi R. Mbabu Department of Veterinary Services Ministry of Agriculture, Livestock and Fisheries
    2. 2. Presentation Outline  Key steps in OH in Kenya  Outline of milestones in OH  Application: One Health in Action
    3. 3. Kenya: Key OH Steps (2005-2012)  Formation of National Influenza Task force(NIT) - 2005  NIT responded to RVF outbreak as Rift Valley Fever Task force - 2006/7  Formation of Zoonotic Technical Working Group (ZTWG)- 2008  Development of Kenya’s priority zoonotic diseases list – 2011
    4. 4. Kenya: Key OH Steps (2005-2012) …  Revision of IDSR technical guidelines to incorporate zoonotic diseases -2011  Creation of One Health office: Zoonotic Disease Unit (ZDU) - 2011  Development of Strategic Plan for Implementing One Health in Kenya (2012 2017) – 2012  Revision of national policies to incorporate One Health- ongoing
    5. 5. OH Milestones in Kenya (2006-2012)
    6. 6. 1. Formation of Zoonotic Technical Working Group (ZTWG) Formed in 2008  Multi-sectoral, including MoH, MoLD, WHO, FAO, AU-IBAR KEMRI, CDC, KWS among others  Meets quarterly  Chaired alternately by Director of Veterinary Services or Director of Public Health and Sanitation 
    7. 7. 2. Creation of One Health office: Zoonotic Disease Unit (ZDU) MOU: Signed by MoPHS and MoLD in Aug 2011 Housing: Office constructed on government land and officially opened by the Minister for MoLD and Minister for MoPHS – Oct 2012 Staff: Two Epidemiologists deployed by government Support staff: Admin Assistant and Data Manager (supported by donor)
    8. 8. ZDU Formation Zoonotic Disease Forum: Sept 22-24, 2010
    9. 9. Launch of the ZDU Minister, MOLD and PS MoPHS officially open ZDU office
    10. 10. ZDU Organogram
    11. 11. 3. Development of Kenya Priority Zoonotic Diseases List –2011* 1. Viral Hemorrhagic Fevers i. ii. iii. iv. v. vi. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Crimean Congo Hemorrhagic Fever Dengue Fever Rift Valley Fever Yellow fever Ebola Marburg Virus Fever Avian influenza & influenza A H1N1 Brucellosis Leishmaniasis Leptospirosis Anthrax Rabies Bovine TB Plague Tularemia (Rabbit Fever) Protozoa Infections i. ii. 12. 13. Salmonellosis Helminths i. ii. iii. iv. v. 14. Cryptosporidiosis Toxoplasmosis Trichinosis Cysticercosis Hydatidosis Sarcoptic mange Diphyllobothrium Fungal Diseases i. ii. iii. iv. Dermatophilosis Histoplasmosis Cryptococcosis Aspergillosis 15. Schistosomiasis 16. West Nile Virus Trypanosomiasis 17. *Not ranked
    12. 12. 4. Kenya Revised IDSR Technical Guidelines Key changes  Addition of zoonotic diseases in the priority disease list  Inclusion of Veterinary Officer in the District and County Public Health Emergency Management Committees (PHEMC)
    13. 13. 5.1.2 IDENTIFY MEMBERS OF THE PHEMC Organize the district PHEMC to include a mix of representatives from the public, non governmental organizations (NGO) and private sectors. The following should be members of the PHEMC teams at provincial and district levels - Core group District level District Medical Officer of Health Disease surveillance officer Health Records Information Officer Public Health Officer Public Health Nurse Medical Laboratory technologist Clinical Officer Health Education officer Wildlife experts Veterinary Officer Nutritionist Provincial /county level PDPHS/Provincial/county Medical Officer Disease surveillance officer Health Records Information Officer Public Health Officer Public health Nurse Medical Laboratory technologist Clinical Officer Health Education Officer Wildlife experts Veterinary Officer Nutritionist
    14. 14. Table 1: Kenya’s Priority Diseases, Conditions and Events for Integrated Dis ease Surveillance and Response – 2011 Epidemic prone diseases 1. Acute haemorrhagic fever syndrome* 2. Anthrax 3. Cholera 4. Diarrhea with blood (Shigella ) 5. Measles 6. Meningococcal meningitis 7. Plague 8. SARI** 9. Typhoid fever 10. Yellow fever 11. Brucellosis *Ebola, Marburg, Rift Valley, Lassa, Crimean Congo, West Nile Fever Diseases targeted for eradication or elimination 1. 2. 3. 4. 5. 1 Dracunculiasis Leprosy Leishmaniasis Neonatal tetanus 1 Poliomyelitis Disease specified by IHR (2005) for immediate notification Other major diseases, events or conditions of public health importance 1. Acute Jaundice 2. Adverse events following immunization (AEFI) 3. Diabetes mellitus 4. Diarrhea with dehydration less than 5 years of age 5. HIV/AIDS (new cases) 6. Hypertension 7. Road traffic Injuries 8. Malaria 9. Malnutrition in children under 5 years of age 10. Maternal deaths 11. Rabies (animal bites) 12. Severe pneumonia less than 5 years of age 13. STIs 14. Trachoma 15. a. Tuberculosis b. MDR/XDR -TB 16. Substance abuse 17. Cancers 18. Neonatal deaths 19. Schistosomiasis
    15. 15. 5. Strategic Plan for Implementing OH in Kenya (2012-17) :Highlights
    16. 16. Strategic Plan for Implementing OH in Kenya (2012-17) Objectives:  Strengthen surveillance, prevention and control of zoonoses  Establish structures and partnerships to promote OH  Conduct and Promote Applied Research To download visit WWW.ZDUKenya.org
    17. 17. Goal 1:Strengthen surveillance, prevention and control of zoonoses • Conducted risk mapping for 4 priority zoonotic diseases • Outbreak response - jointly responding to zoonotic disease outbreaks • • • • Rabies Trypanosomosis Dengue Salmonellosis
    18. 18. Goal 1: Strengthen Zoonoses Surveillance, Prevention and Control  Identified subject matter experts for priority zoonotic diseases  Developed national guidelines on Rabies   Elimination strategy, based on PCP approach Rabies Management guidelines  Developed Rift Valley Fever national guidelines   Contingency plan for Rift Valley fever Risk mapping for Rift Valley fever
    19. 19. Goal 2 : Establish structures and partnerships to promote OH  Decentralize OH to the county and district levels    Sensitize the county heads Train focal persons at the county levels Establish mini-ZDU in Laikipia or Isiolo  Develop OH communication strategy  Decentralize OH to the county and district levels
    20. 20. Goal 2: Establish structures and partnerships to promote One Health    ZDU operational Quarterly Zoonotic Technical Working Group (ZTWG) meetings Linkages with OHCEA, FAO, AU-IBAR, OIE, WHO
    21. 21. Goal 3:Conduct and Promote Applied Research  Promote applied research at the human-animal- ecosystem interface  Brucellosis sero-prevalence study in Kajiado & Kiambu counties  Transmission of influenza virus from animals (pig) to humans among pig farmers  Plan to hold conference for universities, research institutions and individual scientists on zoonotic diseases  Provide training and mentoring to veterinary, medical and public health trainees
    22. 22. Strategic Plan Outcomes  Greater compliance with WHO/IHR and OIE guidelines on public health threats  Risk maps and identification of hotspots for zoonotic diseases  Development and implementation of disease prevention and control strategies for zoonoses
    23. 23. Strategic Plan Outcomes…  Established plan and capacity for early epidemic detection, diagnosis, and rapid response  Better understanding of socio-economic impacts of zoonotic diseases and their interventions to households and the government
    24. 24. 6. Revision of National Policies to Incorporate OH  The veterinary policy – on going  The National Health policy framework, 2011 to 2030 – ongoing  Memorandum of understanding between MoALF and MoH – Aug 2011
    25. 25. One Health in Action
    26. 26. Outline  HAT investigation  Brucellosis sero-prevalence study  Development of disease control strategies
    27. 27. HAT Investigation: Introduction  In March 2012, two case reports of Human African Trypanosomiasis (HAT) reported from tourists who had visited a national reserve  Travel advisory from CDC given based on the reports  Joint Outbreak Investigation in 3 teams    Human health Animal health Entomological team
    28. 28. Human Investigation Active surveillance Setting up surveillance sites.
    29. 29. Animal Investigation
    30. 30. Entomological Investigation Ngu trap Biconical trap
    31. 31. Findings/Actions  No human infective forms of T. brucei detected in human, animals or tsetse flies  Five Sentinel surveillance sites established
    32. 32. Brucellosis Sero-prevalence Study  Objectives 1. Establish representative prevalence estimates in humans and animals in high and low prevalence areas 2. Identify risk factors associated with brucellosis in humans and animals in Kenya 3. To assess livestock owners knowledge, attitude and practices regarding brucellosis
    33. 33. Brucellosis Sero-prevalence Study  Sites Marsabit – High prevalence • Kajiado- High prevalence • Kiambu- Low prevalence  Study population • Humans – ages > 5years • livestock ( cattle, sheep, goats and camels)  Specimens • Serum samples •
    34. 34. Brucellosis Sero-prevalence Study Proportion of households with at least 1 positive human case 32% 14% 6% Kajiado Kiambu Combined
    35. 35. Brucellosis Sero-prevalence Study Proportion of herds with at least one positive animal case 31% 12% 11% 11% 6% 2% Overall Cows Kajiado 1% Goats Kiambu 3% Sheep
    36. 36. Disease Control strategies  RVF  Rabies  Brucellosis  Anthrax
    37. 37. Rabies Control Strategy  Multiple agencies/institutions involved – including WSPA  WSPA Commitment  Facilitate a best practice learning trip to Kwazul Natal, SA;  Support in completion of elimination strategy;  Support in acquisition of Rabies diagnostic kits – dRIT;  Assist in rabies outbreak response
    38. 38. “Medicine is a social science, and politics is nothing else but medicine on a large scale” Rudolf Virchow Thank you

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