Presentation by Professor Sarah Cleaveland of the University of Glasgow at the One Health for the Real World: zoonoses, ecosystems and wellbeing symposium, London 17-18 March 2016

1. One Health for the Real World:
partnerships and pragmatism
Sarah Cleaveland
Institute of Biodiversity, Animal Health and Comparative Medicine
University of Glasgow
sarah.cleaveland@glasgow.ac.uk
One Health for the Real World, ZSL, March 18th 2016

2. Hampson et al. (2015) PLoS NTD,9(4): e0003709 ; Lembo et al. 2010. PLoS NTD 4: e626; Costa et al.
(2015) PLoS Negl Trop Dis 9(9): e0003898; http://www.who.int/csr/disease/ebola/en/
Emerging zoonosesEndemic zoonoses
Connecting health priorities
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Estimatedannualhumandeaths
affecting mainly
poor and neglected
communities
with potential to affect
high-income countries

3. “A global surveillance and
control system that is
established primarily for
emerging infectious
zoonotic diseases with
pandemic potential can be
readily improvised to
address the endemic
diseases that are a priority
in many developing
countries….”
Juergen Voegele, Director,
Agriculture and Rural Development,
The World Bank

4. “A global surveillance and
control system that is
established primarily for
emerging infectious
zoonotic diseases with
pandemic potential can be
readily improvised to
address the endemic
diseases that are a priority
in many developing
countries….”
Juergen Voegele, Director,
Agriculture and Rural Development,
The World Bank
A global surveillance and
control system that is
established primarily for
endemic diseases that are
a priority in many
developing countries can
be readily improvised to
address the emerging
infectious zoonotic
diseases with pandemic
potential ….
Halliday et al. (2012) Phil. Trans. R.
Soc. B 367: 2872-3880

5. Rabies surveillance: lessons learned
• Engaging frontline health
workers
– Incentivisation and
empowerment
– Effective response that provides
an immediate benefit
– Building trust and motivation…..
“which comes from a sense of
common good”
Mtema et al. (in press) Mobile phones as
surveillance tools: implementing and evaluating a
large-scale intersectoral surveillance system in
Tanzania. PLoS Medicine

6. Novel Lyssaviruses
• Surveillance of endemic rabies allowed detection of a novel lyssavirus
???
Marston et al. (2012) Emerg Infect Dis 18(4):664-7.
Horton et al. (2014) Gen Virol. 95: 1025–1032.
To date, no serological evidence of
infection in bats in Kenya or Tanzania
(n= 483 sera from 11 bat species)
?

7. Zoonotic Disease Unit, Kenya
Vision
A country with reduced burden of zoonotic diseases and better able to respond
to epidemics of emerging and re-emerging infectious diseases
Priority zoonoses: Anthrax,
trypanosomiasis, rabies,
brucellosis, Rift Valley Fever

8. Brucellosis (5.3%)
Leptospirosis (10.1%)
Q fever (7.9%)
Spotted fever group
rickettsiosis (8.7%)
Typhus group
rickettsiosis (1.0%)
Malaria – Overall
1.9%
ALL INFECTIONS
Causes of febrile illness in
adults and adolescents
Moshi, Tanzania
Biggs et al., 2011; Prabhu et al., 2011;
Crump et al., 2013
Malaria
(61.6%)
Other
(38.4%)
Clinical diagnosis No diagnosis (33.2%)
Fungal (18.8%)
Mycobacterial (12.5%)
Bacterial (61.6%)
Bloodstream
infections (27.8%)
Chikungunya (5.7 %)

9. Bacterial zoonoses
awareness among
healthcare providers in
Moshi, Tanzania, 2014–2015
Zhang HL et al. (2016) PLoS Negl Trop Dis
10(3): e0004476

10. MANYARA REGION
KCMC Hospital
Which populations to target:
Leptospirosis
Manyara region:
7.6% PCR positive
Arusha
Region:
14.2% PCR
positive
Kilimanjaro region:
0% PCR positive
Moshi abattoir
Jo Halliday Kath AllanDivine Ekwem
Rodents:
0% PCR positive
(n=393)

11. Large, mobile, dynamic, highly-connected livestock
populations

12. Changing livestock systems
– Shifts from traditional pastoralism with greater reliance on crops
– Increasing pressure on grazing lands
– Changing patterns of demand for meat and milk
– Increasing complexity of milk and meat value changes

13. Exploring cross-species
transmission: brucellosis
Viana et al. (2016) Parasitology
Sheep and goat contribute more to human infection than cattle
Rudovick Kazwala
and Jo HallidayMafalda Viana

14. How do perceptions of livestock status
influence policy and practice?
How do
understandings of
‘milk’ affect public
health messages?
“The poor man’s cow…”
Georgia Ladbury Jo Sharp

15. Photo: Felix Lankester

16. Investments in dog vaccination can provide a cost-effective and
equitable approach to human rabies prevention
$0.15
PEP
$0.34
PEP
$0.24
PEP
Data from Hampson et al. (2015) PLoS NTD,9(4): e0003709

18. Pragmatic Interventions
• Many tools already exist for effective control of
endemic and neglected zoonoses
– Design of interventions to mitigate on-going burden of
disease
– Strengthening institutions, leadership, building trust
through common good
– Interventions that prevent infection at source likely to
provide a broader ‘safety net’ than reliance on clinical
management of human cases alone

19. Acknowledgements
Supported by the Zoonoses and Emerging Livestock Systems Initiative:
-Social, Economic and Environmental Drivers of Zoonoses in Tanzania (SEEDZ)
-Molecular Epidemiology of Brucellosis in northern Tanzania
-Hazards Associated with Zoonotic enteric pathogens in Emerging Livestock meat
pathways (HAZEL)
http://livestocklivelihoodsandhealth.org
@Zoonoses_TZ