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One Health units and brucellosis in Kenya

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Presented by Stella Kiambi at a workshop on an integrated approach to controlling brucellosis in Africa, Addis Ababa, Ethiopia, 29-31 January 2013.

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One Health units and brucellosis in Kenya

  1. 1. One Health Units and Brucellosis inKenyaDr. Stella Kiambi, BVM, MscZoonotic Disease UnitKenyaWorkshop: An Integrated Approach to Controlling Brucellosis in Africa, AddisAbaba, 29-31 January 2013
  2. 2.  Introduction One Health Concept Drive for OH in Kenya Brucellosis in Kenya Brucellosis projectPresentation Outline
  3. 3. IntroductionKenya- Geographic Attributes Total landmass 582,650 km2 . 80% of the landmass is ASALthat supports domestic animalsand game. 30% of Kenyan population livein ASALs and derive virtuallyall their livelihood from animalresource.
  4. 4. Human Livestock Demographics Human population 39 Million ( Kenya Bureau of Standards, 2009) Average annual population growth rate 2.6% Population density 71 people per sq km Livestock populations Cattle 18 million Sheep 18 million Goats 28 million Camels 3 million Poultry 30 million Swine 0.3 million Wildlife Biodiverse
  5. 5. One Health ConceptConvergence of the Human-Animal-Environment InterfaceHumanHealthAnimalHealthEnvironmental health
  6. 6. Definition of One Health “the collaborative efforts of multiple disciplines workinglocally, nationally and globally to attain optimal healthfor people, animals and our environment” (AVMA,2007) Other names for One Health: One Medicine, One World OneHealth (OWOH), Conservation Medicine, Eco-health & VPHetc6
  7. 7. Majority (60%) of infectious problems of humans are sharedwith animalsEmergence and re-emergence of diseases and pathogens such asHIV virus, SARS, HPAI virus, H1N1 Virus, RVF, Ebola, Lassa,MarburgGrowing concern owing to the continued neglected diseases likebrucellosis, cysticercosis, trypanosomosis, coxiellosis, anthrax,rabiesWhy One Health approach
  8. 8.  The global pandemic threat by H5N1; 1st coordinated One Health activity- CP developed Saw the establishment of the National Avian Influenza Task forcein 2005. Multisectoral/ Multidisciplinary body comprising over 24 agenciesand bodies. Rift Valley Fever outbreak in 2006/07; Multi-sectoral collaboration derived from the National TaskForce Ad hoc response to zoonoses outbreaks due to lack of integratedgovernment structureDrive for One Health in Kenya
  9. 9. Meat Control Act administered by veterinary services forcontrol of meat & meat products for human consumptionPublic Health Act administered by Ministry of Public Healthanalogous to Meat Control ActRabies Act requires Veterinary Officers to notify the MedicalOfficer of Health of any cases of rabies in domestic animals.Confirmatory rabies diagnosis in humans has historically beendone in the Central Veterinary LaboratoriesLegal Framework for One Healthin Kenya
  10. 10. MOU: Signed by MoPHS and MoLD in Aug 2011Housing: Office constructed on government land and officiallyopened by the Minister for MoLD and Minister for MoPHS – Oct2012Staff: Epidemiologists deployed by governmentSupport staff: Admin Assistant and Data personnelInstitutionalization of One Healthin Kenya: Zoonotic Disease Unit (ZDU)
  11. 11. Mission: To establish and maintain activecollaboration at the animal, human and ecosysteminterface towards better prevention and control ofzoonotic diseasesVision: A country with reduced burden of zoonoticdiseases and better able to respond to the epidemics ofemerging infectious diseasesZoonotic Disease Unit (ZDU)
  12. 12. Launch of the ZDUHon. Minister, MOLD and Hon.Minister MoPHS officially openZDU office
  13. 13. Strategic Plan for ImplementingOH in Kenya (2012-17)Objectives: Strengthen surveillance,prevention and control ofzoonoses Establish structuresand partnerships topromote OH Conduct andPromoteApplied ResearchTo download visitWWW.ZDUKenya.org
  14. 14. Brucellosis in KenyaAlthough endemic in Africa, brucellosis data in Kenya is scarceHuge Public health problem owing to:Weak laboratory diagnosis (human diagnosis)Non standardized control in animalsVaccination not widely done; if any??Test and slaughter/ culling not practical
  15. 15. Brucellosis in Kenya… Brucellosis included in IDSR for monthly reporting in march2011 Sentinel surveillance; yet to be established Enlisted as a notifiable disease in livestock (April 2011) Control strategy, yet to be developed
  16. 16. FebrileDiagnostic kit®Polymerase chain reaction (PCR)Positive Negative TotalPositive 22 100 122Negative 37 225 262Total 59 325 384Sensitivity=37% Specificity=69% Concordance=0.03Predictive valuepositive =18%Predictive valuenegative =86%Yields from evaluation of rapid kit used at Ijara District Hospital,2011 (Thesis work: Stella Kiambi)
  17. 17. Brucellosis Study
  18. 18.  Zoonotic Diseases Unit (Coordinating) Ministry of Livestock Development Ministry of Public Health and Sanitation CDC/KEMRI Training institutions (FELTP) Funding: Unites States Department of Defense, DefenseThreat Reduction Agency (DTRA)Collaborating institutions
  19. 19. Multi-Sectoral, Multi-DisciplinaryBrucellosis Planning Team
  20. 20. Phase 1Sero-prevalence survey with following objectives:To determine the baseline sero-prevalence of brucellosis inhumans and animalsIdentify the factors of infections with Brucella spp inanimals and humansTo evaluate the community knowledge attitude andpractices with regard to BrucellosisStudy Set Up: Two phases
  21. 21. Phase 2Incidence study with the objectives:To determine the incidence of human and animalbrucellosisDetermine the socio-economic impact of brucellosis inboth human and livestock populationsTo determine the circulating brucella serotypesValidate the appropriate human diagnostic kits
  22. 22. Research output (sero-prevalenceand incidence studies)•Establish burden of brucellosis in humans and livestock•Determine the incidence and factors associated of brucellosis•Determine the socio-economic impacts of brucellosis infection•Determine the brucella spp contributing to infections and possibletransmission pathways•Establish the appropriate diagnostic test for brucellosis
  23. 23.  Weekly planning meetings (multi-sectoral) Standard Operating Procedures developed Survey manual developed Series of trainings and workshops Good clinical practice training carried out Field work (Nov-Dec 2012)Phase 1: Pre-study Planning
  24. 24. Study design: Cross-sectional surveyStudy sites:Kiambu CountyConsidered low risk; Peri-urban small holder systemAnimals mainly on zero grazingKajiado CountyConsidered high risk countyLand tenure, mainly communal with little crop farmingPastoralism is the main livestock keeping systemNo animal vaccination for brucellosis in these countiesMaterials and Methods
  25. 25. Kiambu County
  26. 26. Kajiado county
  27. 27. Two stage cluster sampling by sub-locationand householdRandom selection of sub-locations afterstratification by livestock production systemGPS handsets used to locate the pre-determined geo-codesRandom selection of householdsInterviewing -Household/compound head and additionally toeach consenting/assenting human before samplingSamplingHH= Household
  28. 28. Human specimen collection on all enrolledHHsThree humans ≥ 5 yrs of age per HHAnimal specimen collection in enrolled HHsoUp to 15 animals of each eligible species (cattle,sheep, goats, camels)Data collection using a standardizedquestionnaire on PDAsMethods….
  29. 29. Study Coordination structureZDUBrucellosis NationalcoordinatorKiambu CountyCoordinators(DVO & DMoH)Kajiado County Coordinators(DVO & DMOH)Kiambu County Supervisors(Vet & Medic)Kajiado County Supervisors(Vet & Medic)Team leaders (Most senior inthe team Vet or Medic)Team leaders (Most senior inthe team Vet or Medic)Brucellosiscoordinating team
  30. 30.  There were 10 teams in total, with 5 teams per county Each team consisted of seven staff: A Health worker (nurse/ clinical officer) Two veterinarians/paravets A Lab technologist A guide Two animal handlers Roles for every team member were elaboratedTeams composition
  31. 31. Explaining the studyI wonderwhatthesepeoplewant!
  32. 32. Field session: Data collection
  33. 33. Questionnaire administration (PDA)Thisphone istoo big!
  34. 34. Human sampling
  35. 35. Cattle sampling
  36. 36. County HumansamplesLivestocksamplesTotalsamplesNo. ofHouseholdsKiambu 1210 2005 3304 494Kajiado 813 3513 4331 310Total 2023 5518 7635 804Samples collected and shipped toappropriate labs
  37. 37. Laboratory•All samples logged into a database within CVL•Human sera - ELISA (IBL America ELISA•CDC Kisumu lab Kisumu•Animal sera -by cELISA (Svanovir ELISA)•Central Veterinary lab in KabeteNB: Testing to commence soon
  38. 38.  To commence in 2013Phase 2: Incidence study
  39. 39. Acknowledgement•Principal Investigator-Dr. Kariuki Njenga•CDC/KEMRI•Department of Veterinary Services•Department of Public Health and Sanitation•Local administration•Local guides•Hospitals•Study team•Communities and study participants of Kiambu & KajiadoCounties•Transport Company•Any other person that may have assisted in the study in anyway
  40. 40. “There is no dividing line between the medicine ofdifferent species, nor should there be.”Virchow

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