Speaker 3 slides

1. Hongying Li
EcoHealth Alliance, New York, USA
www.ecohealthalliance.org
Understand and prevent the emergence of
zoonotic diseases

2. Outline
q Key concepts and knowledge
q Case study 1 – Understanding the bat coronavirus spillover risk in
southern China
q Case study 2 – Wildlife trade in Sulawesi, Indonesia
q Question and discussion

3. Zoonotic Diseases and the Transmission
Direct Contact
Indirect Contact
Vector-borne
Foodborne
Waterborne

4. Emerging Infectious Diseases (EIDs) & Zoonotic Diseases & Wildlife
60.3% of the known EIDs are
zoonotic
71.8% of zoonotic diseases are
originated from wildlife
Jones et al. 2008 Nature
335 EIDs, 1940-2004

5. Underlying Drivers of Emerging Infectious Disease Events
Loh, Elizabeth H., et al. 2015 Vector-Borne and Zoonotic Diseases

6. Human-Animal-Environment Interactions and Disease Emergence
National Research Council. 2010 National Academies Press.

7. Karesh et al. 2012 The Lancet
Pathogen
Spillover and
Disease
Emergence
Morse et al. 2012 The Lancet

8. Latinne et al. 2020 Nature Communications

9. Has any of these viruses spillovered into humans?
What are the risks in human-animal interactions that drive the spillover?
Question:

10. Surveillance in bats and rural communities, 2015 - 2017
• Eight (8) field surveillance
sites around bat roosts
• Human questionnaire
among 1,596 residents
• Sero-surveillance of 1,497
participants
• Bat coronavirus sero-
positivity was detected in
people in four (4) sites in
this study

11. Variable Total
N Valid %
Gender Female 968 61.5
(n= 1,574) Male 605 38.4
Other 1 0.1
Age Under 18 years 71 4.5
(n=1,582) 18 to 44 years 420 26.5
45 to 64 years 780 49.3
Age 65 or older 311 19.7
Province Guang Dong 420 26.5
(n=1,585) Guang Xi 412 26.0
Yun Nan 753 47.5
Residence time < 1 month 4 0.3
(n=1,568) 1 month – 1 year 12 0.8
1 year – 5 years 26 1.7
> 5 years 1,526 97.3
Family annual <1000 yuan 271 17.3
PCI (n=1,565) 1001-10000yuan 1067 68.2
>10000 yuan 227 14.5
Livelihood Extraction of minerals, gas, oil, timber (n=1,566) 5 0.3
since last year Crop production (n=1,569) 1,196 76.2
Wildlife restaurant business (n=1,564) 5 0.3
Wild/exotic animal trade/market business (n=1,566) 8 0.5
Rancher/farmer animal production business (n=1,566) 27 1.7
Meat processing, slaughterhouse, abattoir (n=1,567) 8 0.5
Zoo/sanctuary animal health care (n=1,565) 1 0.1
Protected area worker (n=1,567) 7 0.4
Hunter/trapper/fisher (n=1,565) 3 0.2
Forager/gatherer/non-timber forest product collector (n=1,566) 4 0.3
Migrant laborer (n=1,567) 144 9.2
Nurse, doctor, healer, community health worker (n=1567) 7 0.4
Construction (n=1,564) 41 2.6
Other (n=1,568) 293 18.7
Education None 428 27.3
(n=1,570) Primary School 632 40.3
Secondary school/Polytechnic school 479 30.5
College/university/professional 31 2.0
Live with No 73 4.7
family
(n=1,564)
Yes 1491 95.3
Demographics of study participants

12. Animal contact and exposure to bat coronaviruses
Low rate of sero-positivity (9/1,497, 0.6%) -- bat coronavirus spillover seems a rare event
Animal contact rates in the previous 12 months among the survey population and seropositive individuals

13. Self-report SARI/ILI symptoms and animal contact
• Severe Acute Respiratory
Infection (SARI) symptoms:
fever with cough and shortness
of breath or difficulty breathing
• Influenza-Like Illness (ILI)
symptoms: fever with muscle
aches, cough, or sore throat
• 265 (17%) reported
experiencing SARI (n = 73)
and/or ILI (n = 227) symptoms in
the last year
Li et al. (2019) Biosafety and Health

14. • Serological evidence for bat-borne coronavirus transmission to people.
• Direct contact with bats was not identified as a risk factor.
• Self-reported severe acute respiratory infection (SARI) and/or influenza-like illness (ILI) was
linked to human interaction with other wildlife and livestock, suggesting that there may be
other zoonotic exposures leading to clinical illness in these populations.
More questions…
What we know now
• Other risk factors in human behaviors, community environment and policies for zoonotic
disease emergence? (if not just bats, not just bat coronaviruses…)
• Opportunities to developing local risk-mitigation strategies?

15. Ethnographic interviews in rural communities
Five core themes related to zoonotic
disease emergence:
1. Human movement
2. Socioeconomics
3. Biosecurity in human environments
4. Human-animal contact and illness
5. Medical care/treatment and death
55 field observations and 88 individuals enrolled from nine study sites
Li et al. (2020) International Health

16. Practice
Attitude
Protective Factors
Knowledge
Individual
Community
Policy or Regulation
Practice
Attitude
Cats
Civets
Insecta
Lagomorphs
Snakes
Chelonians
Others
Illness, treatment and death
Unusual illness and symptoms
Illness from animal
Treatment seeking
Healthcare protocol
Funeral/burial rites
Code
segments
analysis
Animal taxa
Rodent/shrews
Bats
Non-Human primates
Birds
Carnivores
Ungulates
Pangolins
Poultry
Goats/sheep
Camels
Swine
Wild boar
Cattle/buffalo
Dogs
Human animal contact
Animal raising
Wild animal hunting/trade/consumption
Meat preparation
Animal bite/scratch
Animal health
Risk Factors
Knowledge
Individual
Coding Themes and Subthemes
Community
Biosecurity in human environment
Hygiene and sanitation
Water and food
Live animal/wet markets
Animals in/around human dwellings/croplands
New construction
Demographic
Gender
Age
Livelihood/occupation
Policy or Regulation
Coding themes, subthemes, and analysis framework
Li et al. (2020) International Health

17. I am on the way to interview a potential participant, currently going through a small local market, here they sell
fresh vegetables, fruits, pork, and live poultry on both sides of the street. Live chickens, ducks, and geese are
mixed and kept in cages, I can smell the feces. A vendor (female) is slaughtering a chicken for her customer
who just selected one from the cage, she seems very proficient, only wears an apron but no gloves, the ground
is covered by blood and feather. Not far away, there is a woman wearing orange uniform who is cleaning the
street. After 5 minutes, I turn my way into a cropland, surrounded by Karst mountains, there are mostly rice
and some vegetables planted, small birds are flying, two cattle are eating grass. I see a house across the
cropland, where is the home of our potential participant, I hear a dog barking when I approach the house.
-- Xiaolou County, Guangzhou, Guangdong province (Sept. 25, 2015)
Examples of field observation notes
Li et al. (2020) International Health

18. Demographic characteristics of the study participants
Characteristics
Participants (N =88)
Frequency n Percent %
Gender
Male 58 66%
Female 30 34%
Age (years)
18-30 8 9%
31-50 55 63%
>50 25 28%
Province
Yunnan 36 41%
Guangxi 25 28%
Guangdong 27 31%
Source of Livelihood
Government employee 10 11%
Private company employee 7 8%
School teacher 5 6%
Cash crop production (e.g. fruit tree, bamboo) 23 26%
Grain crop production (e.g. corn, rice) 32 36%
Household animal raising for sale 13 15%
Domestic animal farmer 1 1%
Wild animal farmer 2 2%
Health worker 2 2%
Construction worker 10 11%
Nature reserve worker 8 9%
Small business (e.g. restaurant, grocery store owner) 16 18%
Student 1 1%
Mineworker 1 1%
Other casual or out-migrating work (non-specific) 30 34%
Has worked or work on multiple jobs to make a living 35 40%
Without sharing detailed income or
education information, participants who
discussed socioeconomic status generally
indicated:
• low levels of education (e.g., “I didn’t go
to school that much”), or a
• low economic status (e.g., “we’re poor”).
Li et al. (2020) International Health

19. Potential risks from human-animal interactions
“Two bats flew into our room, so we caught them to eat.”
Female peasant farmer, age 60, Guangxi
“I found the chickens died, then I washed them to feed my
dog.” Female janitor at a local college, age 50, Guangxi
(INT: Do you wear gloves when killing chicken?) “No, that
would be inconvenient.” Female worker at a local
restaurant, age 50, Guangxi
(INT: Why do people like eating bats?) “Nourishment for
vitality.” Male peasant farmer, age 65, Guangdong
(INT: Will people get shot once bats bite them?) “No. People
only get injections for snake or dog bites.” Male peasant
farmer, age 60, Guangdong
Li et al. (2020) International Health

20. Environmental biosecurity concerns in local community
(INT: Do they wash hands with soap?) “No. The places to
kill chickens and ducks are usually dirty and smelly,
especially during the summer.” Male chef at a local
restaurant, age 24, Guangdong
“Once a person died, his or her children will clean the body,
put on the cloth, and put the body into a coffin to stay at
home. Then they inform relatives and friends to have a
meeting to select a date for the burial, when there will be
cemetery ritual activities and dinner. When my father-in law
and mother-in law died, their bodies stay at home for 3
days.” Female peasant farmer, age 43, Yunnan
“There is a cave behind our house, there are always some
people going inside the cave and catching bats for food.”
Female peasant farmer, age 60, Guangxi
Li et al. (2020) International Health

21. Existing opportunities for mitigating the risks
National
Immunization
Program
(INT: Does your child get vaccine regularly?) “Yes, some people will inform us.” (INT:
Free charge of vaccine?) “Almost free, only pay very small amount of injection fee.”
Male peasant farmer, age 36, Yunnan
Animal Health
“Vaccine for foot and mouth disease cost 1RMB per shot, vaccine of sheep pox cost
2 RMB per shot.” Female peasant farmer, age 27, Yunnan
Disease
Prevention
(INT: How to control mouse at home?) “The village committee give out rat poison
each year and I also buy sticky rat board.” Female peasant farmer, age 43, Yunnan
Rabies
Prevention
(INT: Are there many people who got sick after being bitten by dogs?) “Not so many,
since 2011, our state has monitored and treated more than 100 people. Treating
regularly, they are never sick. But some people refused injection, as a result, they
were dead.” (INT: Are there some policies that domestic dogs must be vaccinated?)
“Yes, but it’s hard to implement.” Male staff of local CDC, age 42, Yunnan
Li et al. (2020) International Health

22. v Con-current surveillance among human, wildlife, and livestock is critical to discover, predict,
and prevent potential zoonotic diseases.
v Integrated biological, behavioral, and environmental study in healthy community settings
can help identify potential zoonotic disease spillover events or target surveillance to at-risk
populations.
v This one health approach represents a potential early-warning system that could be used
under non-outbreak conditions to identify potential zoonotic emerging diseases prior to
largescale outbreaks.
v More targeted viral surveillance and in-depth research in the future
Conclusions

23. Latinne et al. 2020 Global Ecology and Conservation
Wildlife Market and Trade Chain Surveys

24. Latinne et al. 2020 Global Ecology and Conservation
Wildlife Market and Trade Chain Surveys

25. Latinne et al. 2020 Global Ecology and Conservation
The Impacts of Wildlife Trade on Local Bat Populations

26. How to prevent the next emerging infectious disease from wildlife trade?
Different perspectives of wildlife trade
What is the role of wildlife trade in disease emergence?
What is driving the wildlife trade?
How you are going to address the issues in wildlife trade?
What expertise and resources you need to achieve your goal?

27. • Wuhan Institute of Virology, Chinese Academy of Sciences
• School of Health Sciences, Wuhan University
• Guangdong Institute of Applied Biological Resources,
Guangdong Academy of Sciences
• Chinese Centers of Diseases Control and Prevention
• Duke-NUS Medical School, Singapore
• Institute of Microbiology, Chinese Academy of Sciences
• Mailman School of Public Health, Columbia University
Collaborators

29. Thank You
Questions?