Animal Health Sectors Research Articles

Role of regulatory capacity in the animal and human health systems in driving response to zoonotic disease outbreaks in the Mekong region

We conducted a policy situation analysis in three Mekong region countries, focused on how the animal and human health systems interact to control avian influenza (AI). The study used scoping literature reviews aimed at establishing existing knowledge concerning the regulatory context. We then conducted a series of key informant interviews with national and sub-national government officials and representatives of producers and poultry farmers to understand their realities in managing the complex interface of the two sectors to control AI.We found signs of formal progress in establishing the policy and legislative frameworks needed to enable cooperation of the two sectors but a series of constraints that impede their effective operation. These included the competitive relationships involved, especially with budgetary allocations and mandates that can conflict with each other. Many local actors also view development partners (e.g., bilateral and multilateral donors) as having a dominant role in establishing these collaborations, limiting the extent to which there is local ownership of the agenda.The animal and human health sectors are not equally resourced, with the animal health sector disadvantaged in terms of surveillance and laboratory systems, human resources and financial allocations. Contrasting strategies for achieving objectives have also characterised the two sectors in recent decades, seeing a major shift towards the use of incentive-based approaches in the human health sector but very little parallel development in the animal health sector, largely dependent on command and control approaches.Successful future collaborations between the two sectors are likely to depend on better resourcing in the animal health sector, increasing local ownership of the agenda, and ensuring that both sectors can use the full range of regulatory strategies available to achieve objectives.

Electronic information systems for One Health surveillance of antimicrobial resistance: a systematic scoping review

IntroductionElectronic information systems (EIS) that implement a ‘One Health’ approach by integrating antimicrobial resistance (AMR) data across the human, animal and environmental health sectors, have been identified as a global...

Complexo teníase-cisticercose em assentamentos da reforma agrária, Brasil

ABSTRACT: Thousands of families live in agrarian reform rural settlements, these existing in Brazil since the 1980s. Factors such as agglomerations of families living in the same environment and the production of domestic animals can promote the transmission and maintenance of zoonosis in these areas. The epidemiology and geographic distribution of zoonotic diseases in settlement communities need to be highlighted. The present study aimed to investigate the prevalence, risk factors and spatial distribution of the teniasis-cysticercosis complex in the agrarian reform rural settlements in the state of Minas Gerais. A total of 497 family farming properties, distributed in 52 settlements, were randomly selected and sampled. Biological samples of humans, cattle and pigs were collected and processed. Survey questionnaires were applied in each family farming property to collect data on animal production as well as sanitary, hygienic and social conditions of each family. Human fecal samples were analyzed for detection of teniasis infection, while animal blood samples were collected and subjected to serological testing to detect the cysticercosis infection. A total of three (0.35%) positive cases of human teniasis were identified, 64 (4.2%) of bovine cysticercosis and 17 (3.3%) of swine cysticercosis. Prevalence per family farming unit was 0.6% (3/497) of taeniasis through fecal test, 5.8% (17/294) for swine cysticercosis and 11.1% (52/469) for bovine cysticercosis. The spatial profile for human teniasis and swine cysticercosis were clustered in two different regions, while bovine cysticercosis showed a dispersed geographical distribution. Two risk factors were associated with the occurrence of bovine cysticercosis: stream as source of water (p=0.009) and the environment as destination of sewage (p=0.031), while burning of garbage was shown to be a significant protective factor (p<0.001). Risk factor for swine cysticercosis was associated with the presence of free range pigs (p=0.008) and the environment as the destination of sewage (p≤0.024). The low number of positive human taeniasis did not allow statistical analysis. These zoonotic diseases represent a significant risk to public health because of their occurrence in livestock which are produced for both beef consumption and for commercialization. Significant endemic areas in the state of Minas Gerais have been determined in this study, and these discoverments suggest the importance of further investment in public health education about teniasis-cysticercosis transmission, the improvement of sanitary facilities for the settlements such as source and treatment of water and adequate destination of sewage. Integrated actions between the human, animal and environmental health sectors, at local and regional levels are needed, aiming at the adoption of effective public policies for the control and eradication of the teniasis-cysticercosis complex where the disease occurs.

Using a One Health approach to prioritize zoonotic diseases in China, 2019.

China is vulnerable to zoonotic disease transmission due to a large agricultural work force, sizable domestic livestock population, and a highly biodiverse ecology. To better address this threat, representatives from the human, animal, and environmental health sectors in China held a One Health Zoonotic Disease Prioritization (OHZDP) workshop in May 2019 to develop a list of priority zoonotic diseases for multisectoral, One Health collaboration. Representatives used the OHZDP Process, developed by the US Centers for Disease Control and Prevention (US CDC), to prioritize zoonotic diseases for China. Representatives defined the criteria used for prioritization and determined questions and weights for each individual criterion. A review of English and Chinese literature was conducted prior to the workshop to collect disease specific information on prevalence, morbidity, mortality, and Disability-Adjusted Life Years (DALYs) from China and the Western Pacific Region for zoonotic diseases considered for prioritization. Thirty zoonotic diseases were evaluated for prioritization. Criteria selected included: 1) disease hazard/severity (case fatality rate) in humans, 2) epidemic scale and intensity (in humans and animals) in China, 3) economic impact, 4) prevention and control, and 5) social impact. Disease specific information was obtained from 792 articles (637 in English and 155 in Chinese) and subject matter experts for the prioritization process. Following discussion of the OHZDP Tool output among disease experts, five priority zoonotic diseases were identified for China: avian influenza, echinococcosis, rabies, plague, and brucellosis. Representatives agreed on a list of five priority zoonotic diseases that can serve as a foundation to strengthen One Health collaboration for disease prevention and control in China; this list was developed prior to the emergence of SARS-CoV-2 and the COVID-19 pandemic. Next steps focused on establishing a multisectoral, One Health coordination mechanism, improving multisectoral linkages in laboratory testing and surveillance platforms, creating multisectoral preparedness and response plans, and increasing workforce capacity.

The burden of zoonoses in Paraguay: A systematic review.

Underestimation of zoonoses is exacerbated in low and middle-income countries due mainly to inequalities with serious consequences in healthcare. This is difficult to gauge and reduce the impact of those diseases. Our study focuses on Paraguay, where the livestock industry is one of the major components of the country's economy. Therefore, the rationale of this study was to develop a case study in Paraguay to estimate the dual impact of zoonotic diseases on both the human health and animal health sector and thus determine the societal burden of such diseases. We conducted a systemic review (including a meta-analysis) to assess the burden of zoonoses in Paraguay, including official reports and grey literature of disease incidence and prevalence. We estimated the Disability Adjusted Life Years (DALYs) and Zoonosis Disability Adjusted Life Years (zDALYs) to measure the difference between the current health status and the desired health situation of animals and the Paraguayan population based on 50 zoonotic diseases suggested by the WHO (World Health Organization), OIE (World Organization for Animal Health) and the National Health in Paraguay. The total DALYs represent 19,384 (95% CI: from 15,805 to 29,733), and zDALYs, 62,178 (95% CI: from 48,696 to 77,188). According to the results, the priority pathogens for DALYs are E. coli, Trypanosoma cruzi, Leishmania spp, and Toxoplasma gondii. When we include the additional animal health burden, the most important pathogens are Brucella spp, E. coli, Trypanosoma cruzi, and Fasciola hepatica for zDALYs. This is the first study to integrate DALYs and zDALYs with important clues related to the health status of Paraguay. Through DALYs and zDALYs, our perspective becomes more complete because we consider not only human health but also animal health. This is important for setting priorities in disease control, especially in a society where livestock contribute significantly to the economy and to human well-being.

South-to-south mentoring as a vehicle for implementing sustainable health security in Africa

BackgroundWhile sustainability has become a universal precept in the development of global health security systems, supporting policies often lack mechanisms to drive policies into regular practice. ‘On-paper’ norms and regulations are to a great extent upheld by frontline workers who often lack the opportunity to communicate their first-hand experiences to decisionmakers; their role is an often overlooked, yet crucial, aspect of a sustainable global health security landscape. Initiatives and programs developing transdisciplinary professional skills support the increased bidirectional dialogue between these frontline workers and key policy- and decisionmakers which may sustainably narrow the gap between global health security policy design and implementation.MethodsThe International Federation of Biosafety Associations’ (IFBA) Global Mentorship Program recruits biosafety and biosecurity champions across Africa to provide local peer mentorship to developing professionals in their geographic region. Mentors and mentees complete structured one year program cycles, where they are provided with written overviews of monthly discussion topics, and attend optional virtual interactive activities. Feedback from African participants of the 2019–2020 program cycle was collected using a virtual Exit Survey, where aspects of program impact and structure were assessed.ResultsFollowing its initial call for applications, the IFBA Global Mentorship Program received considerable interest from professionals across the African continent, particularly in East and North Africa. The pilot program cycle matched a total of 62 individuals from an array of professional disciplines across several regions, 40 of which were located on the African continent. The resulting mentorship pairs shared knowledge, skills, and experiences towards translating policy objectives to action on the front lines. Mentorship pairs embraced multidisciplinary approaches to harmonize health security strategies across the human and animal health sectors. South-to-South mentorship therefore provided mentees with locally relevant support critical to translation of best technical practices to local capacity and work.ConclusionThe IFBA’s South-to-South Global Mentorship Program has demonstrated its ability to form crucial links between frontline biosafety professionals, laboratory workers, and policy- and decision-makers across several implicated sectors. By supporting regionally relevant peer mentorship programs, the gap between health security policy development and implementation may be narrowed.

Is One Health a Viable Strategy in Animal Health Litigation: Evidence from Civil Lawsuits in China.

Simple SummaryStrategic litigation launched to protect animal welfare worldwide branches out with several tactical themes: environmental protection, child abuse, veterinarian malpractice, product liability and quasi-family member. Currently, the litigation strategy themed in One Health has been observed in legal practice in Chinese mainland. Using 1520 zoonosis related civil lawsuit judgments, this study aimed to assess the effectiveness of this litigation strategy in animal health cases from Chinese mainland. It has been confirmed that using the litigation strategy themed in One Health results in more successful outcomes and larger damage awards, so there might be a practical value in using this strategy in animal welfare lawsuits.Several litigation strategies are used to gain support from courts in order to protect animals. While the emerging litigation strategy themed in One Health stimulates judicial protection in the animal health sector, little is known about whether and how such strategies are supported by courts. In this article, we investigate how animal welfare litigation strategies influence judge’s choices within their discretion. We argue that litigators equipped with the litigation strategy themed in One Health are placed in an advantageous position in animal health cases, but that this tendency varies markedly across zoonoses. Specifically, we suggest that litigators utilizing One Health’s litigation strategy are associated with higher probabilities to win, whereas normal litigators are not. Further, we propose that litigators equipped with the One Health litigation strategy are awarded more damages from judges. We test and find support for our predictions using a cross sectional dataset of civil lawsuit cases centering on the animal health industry in Chinese mainland. Our findings indicate that courts indeed were persuaded by the One Health litigation strategy, even when bound by the discretion rules. At the same time, we suggest that for advocates who would like to litigate for animal welfare in the animal health sector, the litigation strategy themed in One Health might have potentially positive implications.

Rabies in Animal Bite Victims: How to Handle in North Kolaka Regency

Rabies is one of the most important zoonoses in the world with a high impact on public health. Rabies disease in Indonesia is one of the public health problems with a high level of endemicity that has spread in 24 out of 34 provinces in Indonesia. In Indonesia, there are an average of 80,861 cases and 103 deaths per year from rabies transmitting animal bites (GHPR). From January to May 2019, there were 41 GHPR cases and 1 death case or 2.4% CFR in North Kolaka Regency. This research is descriptive with a qualitative approach. The population in this study is 42 cases of GHPR, all of which act as samples. The results showed that most cases of rabies were experienced by women (52.4%), the age of most people with rabies was the occupations of most of the sufferers (23.8%) were students and housewives, the ownership status of the animals was mostly wild animals (66.67%), and the bite history was mostly unprovoked (92.8%). This study recommends that joint efforts are needed to control rabies from the animal and human health sectors with a synergistic approach.

Rabies and the pandemic: lessons for One Health.

This article examines the impact of coronavirus disease 2019 (COVID-19) on dog-mediated rabies, a neglected tropical disease that remains endemic in >65 countries. A globally agreed strategy for rabies elimination is underpinned by a One Health approach, coordinating human and animal health sectors and engaging communities. We present data on the scale and nature of COVID-19 disruption to rabies control programmes and the wider learning for One Health implementation. We argue that the global shift in health priorities caused by the pandemic, and consequent side-lining of animal health, will have broader ramifications for One Health implementation and preparedness for future emergent zoonoses.

Operationalising the \u201cOne Health\u201d approach in India: facilitators of and barriers to effective cross-sector convergence for zoonoses prevention and control

BackgroundThere is a strong policy impetus for the One Health cross-sectoral approach to address the complex challenge of zoonotic diseases, particularly in low/lower middle income countries (LMICs). Yet the implementation of this approach in LMIC contexts such as India has proven challenging, due partly to the relatively limited practical guidance and understanding on how to foster and sustain cross-sector collaborations. This study addresses this gap by exploring the facilitators of and barriers to successful convergence between the human, animal and environmental health sectors in India.MethodsA mixed methods study was conducted using a detailed content review of national policy documents and in-depth semi-structured interview data on zoonotic disease management in India. In total, 29 policy documents were reviewed and 15 key informant interviews were undertaken with national and state level policymakers, disease managers and experts operating within the human-animal-environment interface of zoonotic disease control.ResultsOur findings suggest that there is limited policy visibility of zoonotic diseases, although global zoonoses, especially those identified to be of pandemic potential by international organisations (e.g. CDC, WHO and OIE) rather than local, high burden endemic diseases, have high recognition in the existing policy agenda setting. Despite the widespread acknowledgement of the importance of cross-sectoral collaboration, a myriad of factors operated to either constrain or facilitate the success of cross-sectoral convergence at different stages (i.e. information-sharing, undertaking common activities and merging resources and infrastructure) of cross-sectoral action. Importantly, participants identified the lack of supportive policies, conflicting departmental priorities and limited institutional capacities as major barriers that hamper effective cross-sectoral collaboration on zoonotic disease control. Building on existing informal inter-personal relationships and collaboration platforms were suggested by participants as the way forward.ConclusionOur findings point to the importance of strengthening existing national policy frameworks as a first step for leveraging cross-sectoral capacity for improved disease surveillance and interventions. This requires the contextual adaptation of the One Health approach in a manner that is sensitive to the underlying socio-political, institutional and cultural context that determines and shapes outcomes of cross-sector collaborative arrangements.

Digital technologies and implications for Veterinary Services.

The pace of digital disruption over the past few years has been spectacular, transforming every sector of the economy, including animal production, health and welfare. This paper reviews some advanced digital technologies that may shape the future of Veterinary Services. These technologies are all data driven and are illustrated by three examples that fall under the following categories: a) wireless and mobile technologies for animal health monitoring, disease surveillance, reporting and information sharing; b) advanced data-processing technologies, such as big data and data analytics used to detect patterns, make predictions, find correlations and other information; and c) promising technologies such as blockchain applications, used for effective and efficient management of various input supply chains. The authors briefly discuss current challenges to increasing the use of these technologies in the animal health sector, along with some implications for Veterinary Services. Digital technologies will have a profound effect on how animal health services are delivered and how animal health systems are managed. It is therefore crucial for Veterinary Services to be proactive and adapt to the ongoing digital transformation. Investment in new technologies and preparing the current and future veterinary workforce with the necessary digital skills and knowledge to stay up to date and at the centre of digital innovation in animal health should be a priority for the years to come.

Lessons Learned From a Large Cross-Border Field Simulation Exercise to Strengthen Emergency Preparedness in East Africa, 2019.

Field simulation exercises (FSXs) require substantial time, resources, and organizational experience to plan and implement and are less commonly undertaken than drills or tabletop exercises. Despite this, FSXs provide an opportunity to test the full scope of operational capacities, including coordination across sectors. From June 11 to 14, 2019, the East African Community Secretariat conducted a cross-border FSX at the Namanga One Stop Border Post between the Republic of Kenya and the United Republic of Tanzania. The World Health Organization Department of Health Security Preparedness was the technical lead responsible for developing and coordinating the exercise. The purpose of the FSX was to assess and further enhance multisectoral outbreak preparedness and response in the East Africa Region, using a One Health approach. Participants included staff from the transport, police and customs, public health, animal health, and food inspection sectors. This was the first FSX of this scale, magnitude, and complexity to be conducted in East Africa for the purpose of strengthening emergency preparedness capacities. The FSX provided an opportunity for individual learning and national capacity strengthening in emergency management and response coordination. In this article, we describe lessons learned and propose recommendations relevant to FSX design, management, and organization to inform future field exercises.

Complete mitochondrial genome of Asian longhorned tick, Haemaphysalis longicornis, Neumann, 1901 (Acari: Ixodida: Ixodidae) identified in the United States

Haemaphysalis longicornis (Ixodida: Ixodidae), the Asian longhorned tick, which is native to temperate East Asia, has been recently detected in the northeastern region of the United States, drawing concerns about its potential impact on the US animal and public health sectors. Knowledge about the genetic features of H. longicornis found in the US is limited. Therefore, we sequenced the complete mitochondrial genome (mt-genome) from two H. longicornis ticks recently collected in the State of New York, USA, in 2020. These ticks were morphologically identified and tested for tick-borne pathogens at the Connecticut Veterinary Medical Diagnostic Laboratory (Storrs, CT). The mt-genome was 14,694 bp in length and encoded 37 genes, including 13 protein-coding genes, 22 transfer RNAs, and two ribosomal RNAs. Phylogenetic analysis showed that the mt-genome clustered with those of other H. longicornis identified in China. The mt-genome sequence was 99.7% identical to a H. longicornis mt-genome (GenBank: MK439888) collected in China. The cox1 gene haplotype in these ticks belonged to the H1 type, which is the dominant haplotype present in central NJ and Staten Island, NY. The complete mt-genome data are needed to provide insights into genetic changes and phylogenetic studies of H. longicornis ticks.

Zoonotic enteric parasites in Mongolian people, animals, and the environment: Using One Health to address shared pathogens.

BackgroundCryptosporidium spp. and Giardia duodenalis are important zoonotic enteric pathogens of One Health concern for humans, animals, and the environment. For this study, we investigated parasite prevalence and risk factors among rural, peri-urban, and urban households and environments of Mongolia.MethodsThis cross-sectional study implemented a household risk factor survey at 250 home sites along with sample collection from humans, animals, flies, and drinking water. Multiplex real-time PCR analysis was conducted to look for Cryptosporidium spp. and/or Giardia duodenalis within household samples.ResultsLab analysis found one or both zoonotic parasites at 20% of the participating households (51/250). Human samples had a parasite prevalence of 6.4% (27/419), domestic animals at 3.3% (19/570), pooled filth flies at 14.8% (17/115), and drinking water samples at 2% (5/250). Parasite presence at the household was significantly associated with a household’s use of an improved drinking water source (OR 0.27; CI 0.12–0.61; p = < 0.01), having an indoor handwashing site (OR 0.41; CI 0.19–0.92; p = 0.03), domestic animal ownership (OR 2.40; CI 1.02–5.65; p = 0.05), and rural location (OR 0.50; CI 0.25–0.98; p = 0.04). Household use of an improved drinking water source remained significant in the multivariate model (OR 0.16; CI 0.04–0.68; p = 0.01).ConclusionIn Mongolia, public and veterinary health are intertwined, particularly for rural herding households. Increased access to safe water, sanitation and hygiene infrastructure could help prevent further transmission of zoonotic enteric parasites. Public health interventions, policy and messaging should utilize a One Health framework employing joint leadership from local human and animal health sectors.

Cross-Sectoral Zoonotic Disease Surveillance in Western Kenya: Identifying Drivers and Barriers Within a Resource Constrained Setting.

Background: Collaboration between the human and animal health sectors, including the sharing of disease surveillance data, has the potential to improve public health outcomes through the rapid detection of zoonotic disease events prior to widespread transmission in humans. Kenya has been at the forefront of embracing a collaborative approach in Africa with the inception of the Zoonotic Disease Unit in 2011. Joint outbreak responses have been coordinated at the national level, yet little is currently documented on cross-sectoral collaboration at the sub-national level.Methods: Key informant interviews were conducted with 28 disease surveillance officers from the human and animal health sectors in three counties in western Kenya. An inductive process of thematic analysis was used to identify themes relating to barriers and drivers for cross-sectoral collaboration.Results: The study identified four interlinking themes related to drivers and barriers for cross-sectoral collaboration. To drive collaboration at the sub-national level there needs to be a clear identification of “common objectives,” as currently exemplified by the response to suspected rabies and anthrax cases and routine meat hygiene activities. The action of collaboration, be it integrated responses to outbreaks or communication and data sharing, require “operational structures” to facilitate them, including the formalisation of reporting lines, supporting legislation and the physical infrastructure, from lab equipment to mobile phones, to facilitate the activities. These structures in turn require “appropriate resources” to support them, which will be allocated based on the “political will” of those who control the resources.Conclusions: Ongoing collaborations between human and animal disease surveillance officers at the sub-national level were identified, driven by common objectives such as routine meat hygiene and response to suspected rabies and anthrax cases. In these areas a suitable operational structure is present, including a supportive legislative framework and clearly designated roles for officers within both sectors. There was support from disease surveillance officers to increase their collaboration, communication and data sharing across sectors, yet this is currently hindered by the lack of these formal operational structures and poor allocation of resources to disease surveillance. It was acknowledged that improving this resource allocation will require political will at the sub-national, national and international levels.

IHR-PVS National Bridging Workshops, a tool to operationalize the collaboration between human and animal health while advancing sector-specific goals in countries.

Collaborative, One Health approaches support governments to effectively prevent, detect and respond to emerging health challenges, such as zoonotic diseases, that arise at the human-animal-environmental interfaces. To overcome these challenges, operational and outcome-oriented tools that enable animal health and human health services to work specifically on their collaboration are required. While international capacity and assessment frameworks such as the IHR-MEF (International Health Regulations-Monitoring and Evaluation Framework) and the OIE PVS (Performance of Veterinary Services) Pathway exist, a tool and process that could assess and strengthen the interactions between human and animal health sectors was needed. Through a series of six phased pilots, the IHR-PVS National Bridging Workshop (NBW) method was developed and refined. The NBW process gathers human and animal health stakeholders and follows seven sessions, scheduled across three days. The outputs from each session build towards the next one, following a structured process that goes from gap identification to joint planning of corrective measures. The NBW process allows human and animal health sector representatives to jointly identify actions that support collaboration while advancing evaluation goals identified through the IHR-MEF and the OIE PVS Pathway. By integrating sector-specific and collaborative goals, the NBWs help countries in creating a realistic, concrete and practical joint road map for enhanced compliance to international standards as well as strengthened preparedness and response for health security at the human-animal interface.

A one health glossary to support communication and information exchange between the human health, animal health and food safety sectors

Collaboration across sectors, disciplines and countries is a key concept to achieve the overarching One Health (OH) objective for better human, animal and environmental health. Differences in terminology and interpretation of terms are still a significant hurdle for cross-sectoral information exchange and collaboration within the area of OH including One Health Surveillance (OHS). The development of the here described glossary is a collaborative effort of three projects funded within the One Health European Joint Programme (OHEJP). We describe the infrastructure of the OHEJP Glossary, as well as the methodology to create such a cross-sectoral web resource in a collaborative manner. The new OHEJP Glossary allows OH actors to identify terms with different or shared interpretation across sectors. Being aware of such differences in terminology will help overcome communication hurdles in the future and consequently support collaboration and a more inclusive development of OHS. The OHEJP Glossary was implemented as a web-based, user-friendly and searchable infrastructure that complies with the Findable, Accessible, Interoperable, Reusable (FAIR) data principles. Maintenance, enrichment and quality control of the OHEJP Glossary is supported through a flexible and updatable curation infrastructure. This increases the uptake potential and exploitation of the OHEJP Glossary by other OH initiatives or tools and services.

One Health information management: health system reforms to support social well-being in Thailand

Background and Aim: The information about the health problems interaction between animal health, ecosystems, and human health that the "One Health (OH)" concept is becoming more complex. This study focused on OH information in Thailand to develop guidelines for establishing a "One Health Information Management (OHIM)" system by drafting the structure of an OH information strategic plan. Materials and Methods: A mixed methods approach was used and included questionnaires, interviews, focus groups, and observations in agencies across the country to gather evidence about actions relating to the OH concept, such as the Memorandum of Agreements between the Ministry of Public Health and eight main agencies. Results: The study concentrated on the key issue that understanding the OH concept is difficult, as the environment and human health sectors include less knowledge of this concept than the animal health sector. Further, there are concerns about the comprehension of OH concepts, and high-level information management and data storage relating to OH, including medicine, cattle, wild animal, environment, and environmental resource management. Data from OH researchers and publicly accessible government data are less integrated and inconsistently managed across agencies. Conclusion: The study of OHIM strategic development should consist of four important points: (1) Clarity in the OH concept, (2) OH staff development, (3) development of an OHIM data network and innovation, and (4) research and academic development, and global OHIM academic exchange. All of these points will lead to health system reforms to support social well-being.

Multisectoral cost analysis of a human and livestock anthrax outbreak in Songwe Region, Tanzania (December 2018–January 2019), using a novel Outbreak Costing Tool

ObjectivesWe applied a novel Outbreak Costing Tool (OCT), developed by the US Centers for Disease Control and Prevention (CDC), to estimate the costs of investigating and responding to an anthrax outbreak in Tanzania. We also evaluated the OCT's overall utility in its application to a multisectoral outbreak response. MethodsWe collected data on direct costs associated with a human and animal anthrax outbreak in Songwe Region (December 2018 to January 2019) using structured questionnaires from key-informants. We performed a cost analysis by entering direct costs data into the OCT, grouped into seven cost categories: labor, office, travel and transport, communication, laboratory support, medical countermeasures, and consultancies. ResultsThe total cost for investigating and responding to this outbreak was estimated at 102,232 United States dollars (USD), with travel and transport identified as the highest cost category (62,536 USD) and communication and consultancies as the lowest, with no expenditure, for the combined human and animal health sectors. ConclusionsMultisectoral investigation and response may become complex due to coordination challenges, thus allowing escalation of public health impacts. A standardized framework for collecting and analysing cost data is vital to understanding the nature of outbreaks, in anticipatory planning, in outbreak investigation and in reducing time to intervention. Pre-emptive use of the OCT will also reduce overall and specific (response period) intervention costs for the disease. Additional aggregation of the costs by government ministries, departments and tiers will improve the use of the tool to enhance sectoral budget planning for disease outbreaks in a multisectoral response.

Findings from the initial Stepwise Approach to Rabies Elimination (SARE) Assessment in China, 2019.

In 2015, China and other member states of the United Nations adopted the goal of eliminating dog-mediated rabies by 2030. China has made substantial progress in reducing dog-mediated human rabies since peaking with more than 3,300 reported cases in 2007. To further improve coordination and planning, the Chinese Center for Disease Control and Prevention, in collaboration with the United States Centers for Disease Control and Prevention, conducted a Stepwise Approach towards Rabies Elimination (SARE) assessment in March 2019. Assessment goals included outlining progress and identifying activities critical for eliminating dog-mediated rabies. Participants representing national, provincial and local human and animal health sectors in China used the SARE assessment tool to answer 115 questions about the current dog-mediated rabies control and prevention programs in China. The established surveillance system for human rabies cases and availability of post-exposure prophylaxis were identified as strengths. Low dog vaccination coverage and limited laboratory confirmation of rabid dogs were identified gaps, resulting in an overall score of 1.5 on a scale of 0 to 5. Participants outlined steps to increase cross-sectoral information sharing, improve surveillance for dog rabies, increase dog vaccination coverage, and increase laboratory capacity to diagnose rabies at the provincial level. All assessment participants committed to strengthening cross-sector collaboration using a One Health approach to achieve dog-mediated human rabies elimination by 2030.