GRF 2nd One Health Summit 2013: Presentation by Mbabu Murithi, Government of Kenya

1. ZOONOTIC DISEASE UNIT IN
KENYA: BLUE PRINT FOR A
NATIONAL ONE HEALTH OFFICE
Dr Murithi R. Mbabu
Department of Veterinary Services
Ministry of Agriculture, Livestock and Fisheries

2. Presentation Outline
 Key steps in OH in Kenya
 Outline of milestones in OH
 Application: One Health in Action

3. Kenya: Key OH Steps
(2005-2012)
 Formation of National Influenza Task
force(NIT) - 2005
 NIT responded to RVF outbreak as Rift Valley
Fever Task force - 2006/7
 Formation of Zoonotic Technical Working
Group (ZTWG)- 2008
 Development of Kenya’s priority zoonotic
diseases list – 2011

4. Kenya: Key OH Steps
(2005-2012) …
 Revision of IDSR technical guidelines to
incorporate zoonotic diseases -2011
 Creation of One Health office: Zoonotic
Disease Unit (ZDU) - 2011
 Development of Strategic Plan for
Implementing One Health in Kenya (2012 2017) – 2012
 Revision of national policies to incorporate
One Health- ongoing

5. OH Milestones in Kenya
(2006-2012)

6. 1. Formation of Zoonotic Technical
Working Group (ZTWG)
Formed in 2008
 Multi-sectoral, including MoH, MoLD, WHO,
FAO, AU-IBAR KEMRI, CDC, KWS among
others
 Meets quarterly
 Chaired alternately by Director of Veterinary
Services or Director of Public Health and
Sanitation


7. 2. Creation of One Health
office: Zoonotic Disease Unit (ZDU)
MOU: Signed by MoPHS and MoLD in Aug 2011
Housing: Office constructed on government land and
officially opened by the Minister for MoLD and
Minister for MoPHS – Oct 2012
Staff: Two Epidemiologists deployed by government
Support staff: Admin Assistant and Data Manager
(supported by donor)

8. ZDU Formation
Zoonotic Disease Forum: Sept 22-24, 2010

9. Launch of the ZDU
Minister, MOLD and PS MoPHS
officially open ZDU office

10. ZDU Organogram

11. 3. Development of Kenya Priority
Zoonotic Diseases List –2011*
1.
Viral Hemorrhagic Fevers
i.
ii.
iii.
iv.
v.
vi.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Crimean Congo Hemorrhagic
Fever
Dengue Fever
Rift Valley Fever
Yellow fever
Ebola
Marburg Virus Fever
Avian influenza & influenza A
H1N1
Brucellosis
Leishmaniasis
Leptospirosis
Anthrax
Rabies
Bovine TB
Plague
Tularemia (Rabbit Fever)
Protozoa Infections
i.
ii.
12.
13.
Salmonellosis
Helminths
i.
ii.
iii.
iv.
v.
14.
Cryptosporidiosis
Toxoplasmosis
Trichinosis
Cysticercosis
Hydatidosis
Sarcoptic mange
Diphyllobothrium
Fungal Diseases
i.
ii.
iii.
iv.
Dermatophilosis
Histoplasmosis
Cryptococcosis
Aspergillosis
15.
Schistosomiasis
16.
West Nile Virus
Trypanosomiasis
17.
*Not ranked

12. 4. Kenya Revised IDSR
Technical Guidelines
Key changes
 Addition of zoonotic diseases in the priority
disease list
 Inclusion of Veterinary Officer in the District
and County Public Health Emergency
Management Committees (PHEMC)

13. 5.1.2 IDENTIFY MEMBERS OF THE PHEMC
Organize the district PHEMC to include a mix of representatives from the public, non
governmental organizations (NGO) and private sectors.
The following should be members of the PHEMC teams at provincial and district levels
-
Core group
District level
District Medical Officer of Health
Disease surveillance officer
Health Records Information Officer
Public Health Officer
Public Health Nurse
Medical Laboratory technologist
Clinical Officer
Health Education officer
Wildlife experts
Veterinary Officer
Nutritionist
Provincial /county level
PDPHS/Provincial/county Medical Officer
Disease surveillance officer
Health Records Information Officer
Public Health Officer
Public health Nurse
Medical Laboratory technologist
Clinical Officer
Health Education Officer
Wildlife experts
Veterinary Officer
Nutritionist

14. Table 1: Kenya’s Priority Diseases, Conditions and Events for
Integrated Dis ease Surveillance and Response – 2011
Epidemic prone diseases
1. Acute haemorrhagic
fever syndrome*
2. Anthrax
3. Cholera
4. Diarrhea with blood
(Shigella )
5. Measles
6. Meningococcal
meningitis
7. Plague
8. SARI**
9. Typhoid fever
10. Yellow fever
11. Brucellosis
*Ebola, Marburg, Rift
Valley, Lassa, Crimean
Congo, West Nile Fever
Diseases targeted for
eradication or elimination
1.
2.
3.
4.
5.
1
Dracunculiasis
Leprosy
Leishmaniasis
Neonatal tetanus
1
Poliomyelitis
Disease specified by IHR
(2005) for immediate
notification
Other major diseases,
events or conditions of
public health importance
1. Acute Jaundice
2. Adverse events
following
immunization (AEFI)
3. Diabetes mellitus
4. Diarrhea with
dehydration less than
5 years of age
5. HIV/AIDS (new
cases)
6. Hypertension
7. Road traffic Injuries
8. Malaria
9. Malnutrition in
children under 5
years of age
10. Maternal deaths
11. Rabies (animal
bites)
12. Severe pneumonia
less than 5 years of
age
13. STIs
14. Trachoma
15. a. Tuberculosis
b. MDR/XDR -TB
16. Substance abuse
17. Cancers
18. Neonatal deaths
19. Schistosomiasis

15. 5. Strategic Plan for Implementing
OH in Kenya (2012-17) :Highlights

16. Strategic Plan for Implementing
OH in Kenya (2012-17)
Objectives:
 Strengthen surveillance,
prevention and control of zoonoses
 Establish structures
and partnerships to promote OH
 Conduct and Promote Applied
Research
To download visit WWW.ZDUKenya.org

17. Goal 1:Strengthen surveillance,
prevention and control of zoonoses
• Conducted risk mapping for 4 priority
zoonotic diseases
• Outbreak response - jointly responding to
zoonotic disease outbreaks
•
•
•
•
Rabies
Trypanosomosis
Dengue
Salmonellosis

18. Goal 1: Strengthen Zoonoses
Surveillance, Prevention and Control
 Identified subject matter experts for priority
zoonotic diseases
 Developed national guidelines on Rabies


Elimination strategy, based on PCP approach
Rabies Management guidelines
 Developed Rift Valley Fever national
guidelines


Contingency plan for Rift Valley fever
Risk mapping for Rift Valley fever

19. Goal 2 : Establish structures
and partnerships to promote OH
 Decentralize OH to the county and district levels



Sensitize the county heads
Train focal persons at the county levels
Establish mini-ZDU in Laikipia or Isiolo
 Develop OH communication strategy
 Decentralize OH to the county and district levels

20. Goal 2: Establish structures and
partnerships to promote One Health



ZDU operational
Quarterly Zoonotic
Technical Working
Group (ZTWG)
meetings
Linkages with OHCEA,
FAO, AU-IBAR, OIE,
WHO

21. Goal 3:Conduct and Promote
Applied Research
 Promote applied research at the human-animal-
ecosystem interface
 Brucellosis sero-prevalence study in Kajiado &
Kiambu counties
 Transmission of influenza virus from animals (pig) to
humans among pig farmers
 Plan to hold conference for universities, research
institutions and individual scientists on zoonotic
diseases
 Provide training and mentoring to veterinary, medical
and public health trainees

22. Strategic Plan Outcomes
 Greater compliance with WHO/IHR and OIE
guidelines on public health threats
 Risk maps and identification of hotspots for
zoonotic diseases
 Development and implementation of disease
prevention and control strategies for
zoonoses

23. Strategic Plan Outcomes…
 Established plan and capacity for early
epidemic detection, diagnosis, and rapid
response
 Better understanding of socio-economic
impacts of zoonotic diseases and their
interventions to households and the
government

24. 6. Revision of National Policies
to Incorporate OH
 The veterinary policy – on going
 The National Health policy framework, 2011
to 2030 – ongoing
 Memorandum of understanding between
MoALF and MoH – Aug 2011

25. One Health in Action

26. Outline
 HAT investigation
 Brucellosis sero-prevalence study
 Development of disease control strategies

27. HAT Investigation: Introduction
 In March 2012, two case reports of Human
African Trypanosomiasis (HAT) reported from
tourists who had visited a national reserve
 Travel advisory from CDC given based on the
reports
 Joint Outbreak Investigation in 3 teams



Human health
Animal health
Entomological team

28. Human Investigation
Active surveillance
Setting up
surveillance sites.

29. Animal Investigation

30. Entomological Investigation
Ngu trap
Biconical trap

31. Findings/Actions
 No human infective forms of T. brucei
detected in human, animals or tsetse flies
 Five Sentinel surveillance sites established

32. Brucellosis Sero-prevalence Study
 Objectives
1. Establish representative prevalence estimates in
humans and animals in high and low prevalence
areas
2. Identify risk factors associated with brucellosis in
humans and animals in Kenya
3. To assess livestock owners knowledge, attitude and
practices regarding brucellosis

33. Brucellosis Sero-prevalence Study
 Sites
Marsabit – High prevalence
• Kajiado- High prevalence
• Kiambu- Low prevalence
 Study population
• Humans – ages > 5years
• livestock ( cattle, sheep, goats and camels)
 Specimens
• Serum samples
•

34. Brucellosis Sero-prevalence Study
Proportion of households with at least 1 positive human case
32%
14%
6%
Kajiado
Kiambu
Combined

35. Brucellosis Sero-prevalence Study
Proportion of herds with at least one positive animal case
31%
12%
11%
11%
6%
2%
Overall
Cows
Kajiado
1%
Goats
Kiambu
3%
Sheep

36. Disease Control strategies
 RVF
 Rabies
 Brucellosis
 Anthrax

37. Rabies Control Strategy
 Multiple agencies/institutions involved –
including WSPA
 WSPA Commitment
 Facilitate a
best practice learning trip to Kwazul
Natal, SA;
 Support in completion of elimination strategy;
 Support in acquisition of Rabies diagnostic kits –
dRIT;
 Assist in rabies outbreak response

38. “Medicine is a social science, and
politics is nothing else but medicine on a
large scale”
Rudolf
Virchow
Thank you