GRF 2nd One Health Summit 2013: Presentation by REID, Dr. Simon Andrew, The University of Queensland

1. A MULTISECTORAL NATIONAL
STRATEGY FOR THE CONTROL OF
LEPTOSPIROSIS IN FIJI
Associate Professor Simon Reid
School of Population Health
University of Queensland
Brisbane, Australia
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2. The process
• MoH initiated a planning process to develop a national
strategy for leptospirosis in 2011
• 2 one-day workshops were held in 2011 to facilitate a
discussion between different sectors/disciplines
• ~46 participants from 6 ministries, NGO’s, industry
• 4 subgroups were formed:
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Clinical Management
Laboratories
Agriculture
Environmental Health and Health Promotion
• Final step was an experts meeting with a multidisciplinary
panel supported by WHO
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3. Fiji national strategy
PURPOSE:
• Reduce the incidence (morbidity and mortality) due to
leptospirosis in Fijian communities
COMPONENT OBJECTIVES:
1. Reduce the mortality rate in the human population
2. Strengthen laboratory capacity
3. Implement a structured program to reduce leptospirosis
in livestock
4. Strengthen community-based programs to control
reservoir species and exposure to leptospires

4. Agriculture
• Determine the impact of leptospirosis on livestock
enterprise in Fiji
• Strengthen stray dog control in urban and rural
communities
• Develop and implement a structured strategic
communication program for livestock farmers and animal
owners in high risk areas
• Develop and implement strategies to enhance crosssectoral communication
• Develop and implement strategies to ensure joint
surveillance and outbreak investigation is undertaken

5. Clinical management
• Early detection and presentation of cases (rapid tests
/ case definition)
• Determine evidence base for enhanced clinical
management protocols
• Standardise treatment protocols
• Training to improve case detection and management
using standardised protocols
• Strengthen communication with clinical departments
• Determine major risk factors for infection and severe
disease
• Strengthen communication campaigns to improve early
presentation

6. Env. Health/Health communication
• Develop and implement a program to monitor rodent
populations
• Develop strategies to review and strengthen
enforcement of legislation with regards rodent control
• Enhance collaboration and communication with other
stakeholders (MPI, MoH)
• Develop a climate based Early Warning System

7. Laboratories
• Develop capacity for testing clinical and surveillance
specimens from humans and domestic animals
(ELISA and PCR)
• Develop framework for collaborative strengthening of AH
and PH laboratory capacity
• Develop protocols for multiple disease testing of samples
(panel of disease approach)
• Improve report dissemination

8. Governance framework
GOVERNANCE
NTCOPD
Clinical
Management
Surveillance
Capacity building/training
Monitoring and evaluation
Control

9. MAJOR OBJECTIVES
REDUCE
FATALITY RATE
OF
LEPTOSPIROSIS
• IMPROVE CLINICAL
Mgmt OF AFI
REDUCE
INCIDENCE AND
BURDEN OF
LEPTOSPIROSIS
• REDUCE
LEPTOSPIROSIS
TRANSMISSION
STRATEGIES
• SHORT
TERM
• LONG
TERM

10. Improve clinical
management of febrile illness
Reduce leptospirosis
transmission
Develop/Implement new clinical
guidelines for aggressive initial
management and referral of cases
Identify reservoir hosts and other risk
factors
Improve management of severe cases
Develop appropriate strategies to
reduce the size of the reservoir (i.e.
livestock/dog vaccination, rodent
management as appropriate)
Improve health seeking behaviours
(i.e. early presentation)
Improve outreach/communication
messages to reduce frequency of risky
behaviours

11. Reduce transmission
Short term 6-9 months
Retrospective analysis of surveillance data and linked
information from clinical records and environmental
health officer reports from case investigation
Initial surveys of rodents/livestock and humans in
hotspot areas
Sero-survey or a separate activity that requires work on
rodents/mongoose reservoirs

12. Medium/long Term 6-18 Months
• Development of longer term research program to
characterize risk factors/reservoir hosts
• Ongoing development of health promotion activities based
on findings from research and feedback from evaluations
• Improve surveillance and health information systems

13. Lessons learnt
• Lack of formal and informal structures for inter-sectoral
communication/collaboration
• Poor understanding of cross-sectoral issues (i.e. public
health staff do not understand the agricultural sectors
needs)
• Need for increased capacity in environmental health
• Animal health capacity is a limiting factor
• Importance of the strategy document for institutional
advocacy
• One health in this context is the leadership and
coordination of the whole program

14. ONE HEALTH SHORT COURSE
Brisbane, Australia
14-18 July, 2014
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