One Health research at ILRI to address neglected tropical diseases,
zoonoses and emerging infectious diseases in Southeast Asia
Hung Nguyen1, Fred Unger1, Hu Suk Lee1, Johanna Lindahl1, Thang Nguyen1, Bernard Bett1, Eric Fevre1,
Sothyra Tum2, Dang Xuan Sinh1, Arshnee Moodley1, Delia Randolph1
1International Livestock Research Institute (ILRI), Vietnam and Kenya
2National Animal Health and Production Research Institute, Cambodia
One Health Collaborating Centre, Universitas Gadjah Mada – International Series, World Zoonoses Day 2020: Lessons Learned and Future Directions
7 July 2020

Content
1. ILRI and partnership in Asia
2. Research portfolio on health (neglected tropical
diseases-NTDs, zoonoses, emerging infectious diseases-
EIDs, foodborne diseases, wet markets), decision support
tools linked to agriculture and One Health
3. Covid-19 in Vietnam: success in disease control
4. Conclusions

Reduce
poverty
Improve
food and
nutrition
security
Improve
natural
resources
and
ecosystem
services
ILRI’s mission is
to improve food and nutritional security
and to reduce poverty in developing
countries through research for
efficient, safe and sustainable
use of livestock —
ensuring better lives through livestock.
CGIAR and ILRI mandates
ILRI strategic objectives
• …develop, test, adapt and promote science-based
practices….
• …provide compelling scientific evidence…
• …increase capacity amongst ILRI’s key stakeholders
and the institute itself

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250
E.AsiaPacific
China
SouthAsia
SSA
Highincome
% growth in demand for livestock products to 2030
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100
150
200
250
E.AsiaPacific
China
SouthAsia
SSA
Highincome
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150
200
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350
400
E.AsiaPacific
China
SouthAsia
SSA
Highincome
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50
100
150
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E.AsiaPacific
China
SouthAsia
SSA
Highincome
Estimates of the % growth in demand for animal source foods in different World regions, comparing 2005 and 2030.
Estimates were developed using the IMPACT model, courtesy Dolapo Enahoro, ILRI.
Beef Pork
Poultry Milk
Increases not because of overconsumption!
OECD average 2018 = 69 kg/capita meat
SSA average 2018 = 10 kg/capita meat

ILRI’s livestock research: solutions for food and nutritional security,
poverty, environmental and human health
Mitigating climate change, enhancing
resilience and increasing livestock
productivity
Sustainable Livestock Systems
Taking livestock solutions to scale for
inclusive development
Impact at Scale
Delivering solutions for livestock, zoonotic
and foodborne diseases
Animal and Human Health
Efficient livestock production driving
inclusive growth and employment
Policies, Institutions & Livelihoods
(including gender)
Improving genetics for better productivity
and profitability
Livestock Genetics
Accelerating Africa’s agricultural
development through biosciences
BecA-ILRI hub
Better nutrition for improved animal
productivity
Feed and Forage Development
Capacity development; communications; knowledge management

Main campuses: Nairobi,
Kenya and Addis Ababa,
Ethiopia
Offices in 14 other
countries
ILRI offices

Challenges in Asia
• Population and economic growth, environmental
issues, intensive agriculture and livestock, food
security, nutrition, politics…
• Complex health issues and transition (EID, AMR,
NCD…) need innovative, integrated approaches.
• Strengthening the capacity of professionals working
in the human, animal and environmental health
sectors to respond to, control and prevent
outbreaks of EID is vital.
• Cultural, development – environment consideration

GHGI
Regional Expertise
EcoEID BECA FBLI APEIR & former
EcoZD teams
Ecosystem Approaches to the Better Management of Zoonotic Emerging Infectious
Diseases in Southeast Asia (EcoZD)

Metropolitan mosquitoes: Understanding urban
livestock keeping and vector-borne disease in growing
tropical cities – the potential of sustainable control
methods and the risks for emergence to Sweden.

• Urban livestock keeping is an important and integral part of cities in many tropical and developing
countries
 Ensure highly nutritious food on urban markets
 Provide urban inhabitants with livelihood options
• Urban agriculture involves approximately 800 million people and produces 15-20 % of the food in
the world
• Whereas livestock is increasing in the growing cities, mosquitoes also are adapting and finding urban
breeding habitats
Urban livestock is important

Study site: Hanoi city
• Hanoi city is populous and in rapid progress of
urbanization.
• The livestock is diverse and numerous
 160.000 cattle
 1.6 million pigs
 23 million poultry
• Situation of mosquitos-borne diseases in human
 Dengue fever is emerging as an endemic disease: The
largest dengue outbreak ever in both urban and rural
districts with nearly 38.000 cases and 7 deaths was
observed in 2017
 Japanese Encephalitis Virus (JEV) is still circulating: 9
cases in 2017
 No Zika virus observed until now
Source: General Statistics Office of Vietnam & Hanoi Preventive Medicine Center’s report, 2017

Urban livestock-keeping and dengue in urban and peri-
urban Hanoi, Vietnam, 2018
Frida Jakobsen et al.
• 140 households were interviewed, of which 69 kept livestock.
• Respondents living in the Dan Phuong district, a peri-urban district, had better
knowledge and practice regarding dengue as compared to the urban Ha Dong district.
• 3,899 mosquitoes were collected and identified, of which 52 (1.3%) were Aedes
species. A significant difference between the two districts was observed, with
households in Ha Dong having more frequent Aedes spp. mosquitoes (p=0.02) and a
higher incidence of dengue fever (p=0.001). There was no significant association
between livestock-rearing and the presence of Aedes spp. mosquitoes (p=0.955), or
between livestock-rearing and the incidence of dengue fever (p=0.08).
• In conclusion: could not find any indication that households keeping livestock were at
higher risk of dengue virus infections in Hanoi during the season of lowest occurrence
of dengue, but indicate the need for more information provided to urban inhabitants,
particularly on personal protection.

Urban livestock keeping in Hanoi city, Vietnam: Systems and the
risks for flaviviral vector-borne diseases in humans
PhD student - Nguyen Tien Thang (2018-2021)
1. KAP among urban inhabitants in
regard to risks and benefits of urban
agriculture, and the current knowledge
on mosquito-borne disease transmission
2. The distribution of mosquitoes and Flaviviruses
(dengue, Japanese encephalitis, and Zika virus)
present in urban mosquitoes and its relationship to
livestock keeping.
4. Intervention package
• On-site training
• Given fans with simple key messages
• Weekly reminders through text messages
 3. Risk factors of mosquito-borne
flavivirus by investigating febrile
patients in a national hospital

Data collection activities
Face-to-face interview
Mosquito trapping
• Backpack aspirator
• CDC light trap, BG, GATS
Searching for larvae
in water containers…
Taking blood of
dogs and pigs

Progress and partnership with health institution
• 502 blood samples of dog and 704 blood samples of pigs were taken
• WNV ELISA test was done for pig and dog sera at Vietnam National Institute
of Veterinary Research (NIVR).
 The overall seroprevalence of pigs and dogs was 86% and 70.7%,
respectively
• All pig samples was were tested for Pan-flavivirus detection by qPCR at
IMBIM - Uppsala and NIVR.
 No positive sample.

Surveillance and early warning systems for
climate sensitive diseases in Vietnam
(2015-2018)

Decision
support tools
Notification
to farmers
Climate Data
Zoonotic/livestock diseases
- Surveillance Data
- Field surveys
Responses
- Vaccination
- Movement control
- Quarantine
-…
Main objectives
• To develop early warning systems of climate sensitive diseases (CSDs) (prediction/disease models and risk maps)
• To conduct epidemiological investigations of CSDs
• To support capacity building for public health
Early Warning and Forecasting System concept

Sampling areas
• Swine urine/sera samples from 5
provinces
- Total sample size
sera: 1,959; urine: 1,920
- 385 samples / province
- Slaughter houses
- JE, Lepto (sera) and AFM1(urine)
- KAP survey (252 people)
• Maize samples from 6 provinces
- Total sample size: 2,370
- 385 samples / province
- AFB1
- KAP survey (551 people)
• MOH/MARD/FAO surveillance data
*Sample size (each province): 50% prevalence,
95% CI and precision 5%
Japanese encephalitis
- A vector-borne virus disease
- 3 billion people live in endemic areas
- Fatality rate reached 60% in humans
- Pigs are the main amplifying hosts
Leptospirosis
- A bacterial disease, outbreak is associated
with heavy rainfall
- Fatality rate from 5% to 30% in humans
- Rodents, pigs, horses, dogs and sheep/goats
are the common reservoirs.
Aflatoxin-associated diseases
- Toxin produced by Aspergillus spp.
- Fungi infect crops and animals via feed
- Responsible for around 1 in 4 human cases
of live cancer

Seasonality of Viral Encephalitis (VE) in humans between 2004 and 2013
4-5 times
higher than
Feb
*Previous study showed 17~71% of VE were caused by JE

• Rabies cases were
limited to specific
areas
• Seasonal patterns
were observed in the
MRD region
Rabies research in Vietnam

Spatiotemporal analysis of historical records (2001 –
2012) on dengue fever in Vietnam and development
of a statistical model for forecasting risk
Bernard Bett et al.
The distribution of crude number of
dengue cases (1A), estimated human
population (1B) and crude incidence (1C) by
province in Vietnam in 2001 – 2009. The
lower panel gives crude number of cases
(2A), estimated human population (2B) and
crude incidence (2C) by province in 2010 –
2012. The observed dengue incidence given
in 2C was used to validate the forecasting
model developed in this study

Seasonal trends in R, T and dengue incidence in Vietnam
observed in 2001 – 2009
Inter-annual trends in dengue incidence in Vietnam. Months that had higher
than expected peaks in the disease incidence are indicated in text within the
graph. The horizontal line shows the dengue incidence threshold of 10.31 is
used to identify changes in the peak incidence before and after mid-2005

Predicted dengue mean incidence for 2010-2012,
with 2.5% and 95% quantiles
Maps prepared from re-analyzed data on altitude (from FAO’s soil data portal)
and land cover (downloaded from NASA’s Moderate Resolution Imaging
Spectroradiometer [MODIS]) in Vietnam. All these data were used for
multivariable modelling but the area under Urban settlement/built-up areas
was the only significant variable.

Surveillance of Influenza virus in LBMs in Hanoi and three
highland border provinces in northern Vietnam from 2019-2020

Bioaerosol samplers using NIOSH 2-stage
sampler (BC 251 sampler)
Small, portable device used to collect non-
viable particles
It is assembled on a tripod and positioned 0.5m
from the ground
Run for 3 hours, flow rate of 5L/min
Bioaerosol samples will be processed with PBS
HOBO data logger
• A HOBO U12 Data Logger was used to collect
air temperature and relative humidity.

Sample collection activities
- Monthly collect 6 swabs, 9 feces, 3 bioaerosol, 6 poultry worker nasal wash samples in the
LBMs in 3 border provinces.
- Weekly collect samples in the biggest LBMs in Hanoi.

Quang
Ninh
Province
Lao Cai
Province
Lang Son
Province
Hanoi
Sampling sites for H7N, EIDs, Pigs and Poultry
- Bioaerosol sampling can be
applied for AIV surveillance in
the live bird market and in the
poultry farm.
- Bioaerosol sampling could be
used for early warning screening
of poultry markets for novel
influenza virus detection such as
H7N9 and other EIDs
- Continued surveillance of
Influenza virus in the border
provinces is critical issue for
early warning of the cross virus
transmission.

FBD- a new priority – most probably from ASF
Millions DALYs lost per year (global)
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
18,000,000
20,000,000
Asia Africa Other
developing
Developed
Other toxins
Aflatoxins
Helminths
Microbial
Havelaar et al., 2015
31 hazards
• 600 mio illnesses
• 420,000 deaths
• 33 million DALYszoonoses
non zoonoses
Burden LMIC
Cost estimates for 2016 (US$ billion)
Productivity loss 95
Illness treatment 15
Trade loss or cost 5 to 7
Domestic costs may be 20
times trade costs

Research approach: what do we do to understand and
improve food safety?
• Situational analyses of food safety
• Capacity building on risk-based approaches
• Proof of concept: participatory risk assessment
• Pilot testing interventions

Policy impact: translational research for
interventions in modernizing food system
• CGIAR/ILRI niche - risk assessment and
policy / regulatory analysis for fresh foods
in domestic markets
• World Bank convenes overall support to
government: ILRI led technical works
• Upcoming projects based on WB report
we led will improve food safety for 20
million people in 3 major cities of Vietnam

1. Risk profiling
1. Scoping visits
2. Systematic literature
review
3. Risk profiles
4. Training in risk ranking
5. Stakeholder prioritisation
2. Generate
evidence on FBD
Five Urban Survey
Study
QMRA
Markets
Cost of
Illness
Household
Nutrition
3. Develop & test solutions for wet
markets
RCT intervention
Taskforce
Gender TOC
NutritionImpact
QMRA
Markets
Cost of
Illness
• Reducing the burden of
foodborne disease in
informal, emerging formal,
and niche markets and
targeting small and
medium scale producers.
• Better evidence on food
borne disease in
Cambodia
• Approach for improving
food safety in wet
markets
Safe Food, Fair Food
for Cambodia

Cost of per episode of hospitalization of FBD by group of
health facilities
Cost National Hospital
(n=44)
Referral Hospital
(n=60)
Regional
Hosp.
(n=100)
Community
Clinic
(n=62)
Overall
(n=266)
Direct medical cost
 Amount [usd] 125.77 9.42 27.85 4.19 34.38
Direct non-medical cost
 Amount [usd] 40.64 8.36 26.33 0.30 18.58
Indirect cost
 Amount [usd] 21.43 6.38 10.89 3.08 9.80
Total cost [usd] 185.88 24.16 65.07 7.57 62.76
COST OF ILLNESS

FBD- a new priority – most from livestock
Millions DALYs lost per year (global)
Trichinellosis:
7th ranked parasitic FBD worldwide
Cysticercosis:
1st ranked parasitic FBD worldwide
Cysticercosis & Trichinellosis: Importance & life cycle

Studies in Vietnam, Lao PDR and Cambodia
Aim:
To assess and reduce both parasitic pig-borne diseases (PPBD) in rural and/or ethnic minorities
Specific objectives:
To assess the prevalence for both PPBD (pigs and humans) due to serology and hospital records
To determine the perception and awareness of value chain actors including consumers on both PPBD
To improve diagnostic capacity to detect both PPBD e.g. through hands-on meat inspection and laboratory testing.
To develop and test promising interventions to reduce both PPBD and promote a brand aligned with the Safe pork
project e.g. Safer pork for healthier consumers”
To build capacity and engage with policymakers to support application of interventions

Capacity building
Training on improved lab diagnostic, Sep & Oct 2018
Hands- on training on field diagnostic and meat inspection, Nov 2018
1 NIVR researcher at BfR
5 Trainees, NIVR
34 Trainees, Hoa Binh (FUB trainers)

Vietnam:
• Pigs: 13.6% Trichinella (ELISA) & 1.7 % Cysticercosis (Western blot) out of
352 local pigs
• Humans: 0.6% Trichinella (ELISA) & 0.7 % Cysticercosis (ELISA) out of 300
Laos:
• Pigs: 28.5 Trichinella (ELISA) & Cysticercosis not done (out of 270 pigs)
• Humans: 16.7% Trichinella (ELISA) & 3.5 % Cysticercosis (ELISA) out of 254

Savannakhet, Lao PDR
Foodborne parasitic disease research 10. 2017
Decision makers
Public
health
(MD,
army
health)
Scientists
Vets

ILRI highlights of zoonoses and EIDs work in Africa
• Studies on Rift Valley fever –a
mosquito-borne viral zoonosis
mainly affecting cattle, sheep,
goats and camels
• Outputs
- Risk maps
- Improved understanding on drivers
e.g. climate change/variability
- Livestock vaccination strategies

Covid-19 responses at ILRI
• Continue to produce evidence-based
scientific assessments (e.g. active
surveillance)
• Policy options (e.g. raise awareness and
improve health governance)
• A One Health approach is the optional
method for preventing and responding

FOOD
SAFETY
ZOONOTIC DISEASES
ANTIMICROBIAL
RESISTANCE
ILRI Health program: biomedical science, epidemiology
ILRI Integrated sciences: socio-economics, gender, behavior change, environment
Management unit
CAPACITY BUILDING
Research:
Fellowship program;
Science communication
Field practitioners:
community-based disease reporters;
value chain actors;
lab technicians
Policy makers and
government staff:
simulation exercises (link to
international health regulations;
setup and use of surveillance
systems (outbreak investigation))
EMERGING INFECTIOUS
DISEASES
One Health Research, Education, Outreach and
Awareness Centre (OHRECA)
2020-2024
Zoonoses, EIDs
Herd Health
AMR Hub
Food Safety

Covid-19 responses at ILRI and CGIAR
• One Health COVID-19 testing at ILRI for Kenya MOH
funded by BMZ/OHRECA
• Covid-19 survey in India, Kenya, Vietnam at various stages
• CGIAR Covid-19 Hub (IFPRI, ILRI, LSHTM, CIFOR…)
• provides a coordinated research response to the
global pandemic threatening health systems
worldwide, along with posing serious risks to food
security; local businesses and national economies;
and hard-fought progress by stakeholders at all
levels towards the Sustainable Development

Minh HV et al. (2020)

Covid-19 in Vietnam: success story in disease control
(1) The commitment from the government with a
multisectoral approach;
(2) A timely, accurate, and transparent risk
communication;
(3) Active surveillance and intensive
isolation/quarantine operation, case
management with tracing all new arrivals and
close contact up to 3 clusters
(4) Suspension of flights, shutting schools, and all
nonessential services.
Duong Minh Duc et al. (2020). Asia Pacific Journal of Public Health 1– 2. 2020
Maurizio Trevisan et al. (2020)
(1) FAST LEARNING;
(2) SWIFT AND DECISIVE ACTION
(3) A STRONG SYSTEM RESPONSE
(4) CONSISTENT, TRUTHFUL MESSAGES
(5) SOCIAL SOLIDARITY

• Research with partners on TND, zoonoses, EIDs, food safety: advancing
science and capacity building for partners
• Research translation in this areas: evidence available, but translation
into action is limited
• More decision support tools needed, and importantly engage policy
makers and stakeholders.
• Maintaining networks of One Health / Ecohealth in the region and
broaden the health perspective to link with the environmental issues
and development.
Conclusions

This presentation is licensed for use under the Creative Commons Attribution 4.0 International Licence.
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ILRI thanks all donors and organizations which globally support its work through their contributions
to the CGIAR Trust Fund