Magazine

Magazine
Issue 6
Summer 2013
A is for Advisory Council p3
The neglected of the neglected p4
Brucellosis in Morocco and Tanzania.
Back to databasics p6
Gathering the evidence we need to mobilise intervention.
A new way of looking at disease p7
Geospatial data gives a fresh view.
ICONZ has twenty-one partners across the world
who have joined together to combat a group of
diseases that move between animals and humans.
These diseases are debilitating, ultimately deadly
but often overlooked. Each partner will contribute
a part of the solution that will save lives and secure
livelihoods, by controlling zoonotic disease across
the human and animal populations.
Dear Readers,
Welcome to the sixth edition of the
ICONZ Magazine.
As an EC project, we are currently reflecting
upon our progress in the last eighteen months
and compiling our third periodic report. As we
plan for our fourth and final period, we do so
with great anticipation at seeing the outcomes
of our hard work.
In this issue, we first turn our attention towards
our Advisory Council, and welcome our newest
member Prof Richard Kock, a veterinarian
specialising in One Health and the ecology
of wildlife disease in Africa.
Next we speak to Prof Ignacio Moriyón (Work
Package Leader 5) and his team about their
work on neglected bacterial zoonoses.
Prof Jim Scudamore (Work Package Leader 2)
then tells us about his neglected zoonoses
research projects database.
Finally, Ward Bryssinckx of Avia-GIS
demonstrates how mapping can help us
visualise and draw conclusions from our data.
Experts working together with affected
communities is what makes ICONZ unique.
Thank you for being part of the team; and
together we’ll be part of the solution.
Kind regards,
Sue Welburn
ICONZ Co-ordinator,
University of Edinburgh
iconz@ed.ac.uk
www.iconzafrica.org
A is for Advisory Council
The Advisory Council is at the core of ICONZ, advising the Management Board on technical, financial,
administrative and dissemination issues. They provide links to institutions and organisations, and help
improve information sharing and coordination with stakeholders.
Advisory Council Chair
Professor Paul Gibbs, BVSc, PhD, FRCVS
(Veterinarian)
Emeritus Professor, Department of Infectious Diseases
and Pathology, College of Veterinary Medicine,
University of Florida, Gainesville, Florida.
Professional Focus: One World – One Health by focusing on the control
and prevention of emerging and foreign animal diseases including
those of zoonotic importance through research, education, and
policy development.
Advisory Council Members
Dr Chioma (Chichi) Amajoh
(Medical Parasitologist)
Executive Director, Community Vision Initiative (CVI).
Former National Coordinator for the National Malaria
and Vector Control Programme, Federal Ministry of
Health, Nigeria. She remains active in the Roll Back
Malaria Vector Control Working Group and consults
for the World Health Organization (WHO). A member of the Technical
Expert Group of the Malaria Policy and Advisory Committee constituted
by WHO/Global Malaria Program (GMP).
Professional Focus: Vector control with a specific interest in malaria.
Managing and providing technical leadership for the design and
implementation of malaria control, particularly Integrated Vector
Management (IVM), with specific focus on Indoor Residual Spraying
(IRS) and Larval Source Management (LSM).
Dr Katinka de Balogh
(Veterinarian)
Senior Officer – Veterinary Public Health
Animal Health Service, Food and Agriculture
Organization (FAO).
Professional Focus: Veterinary Public Health with a specific interest in
neglected zoonoses and One Health. In her current position at FAO she
is responsible for the setting up of international networks for veterinary
public health and the development of zoonotic disease control strategies
at global level.
Dr Speciosa Wandira Kazibwe
(Medical Doctor)
Former Vice President, Republic of Uganda (1994-2003)
Vice President Emeritus – Republic of Uganda Senior
Presidential Advisor – Population and Health.
Professional Focus: Affirmative action for women and other marginalised
groups. Her mission is “to see the emancipation of rural women through
functional skills development and access to micro-financing to ensure
internally generated improvement.” In her current capacity, she is
coordinating health financing reforms in Uganda’s health sector.
Prof Richard Kock
(Wildlife Veterinarian and Conservationist)
Chair Wildlife Health and Emerging Diseases,
Pathology and Infectious Diseases Department,
Royal Veterinary College, London, UK (Wildlife
Veterinarian and Conservationist).
Professional Focus: One Health and the ecology of wildlife disease
in Africa and South and Central Asia. He has a specific interest in the
relationship between wildlife and pastoral communities. He has engaged
closely with the evolving global One Health movement where he highlights
biodiversity issues in the disease and health context, in relation to
environment and ecosystem health.
Dr François-Xavier Meslin
(Veterinarian)
Team leader, Neglected Zoonotic Diseases (NZD),
HIV/AIDS, Tuberculosis, Malaria and Neglected
Tropical Diseases (HTM), World Health Organization
(WHO), Geneva.
Professional Focus: Neglected Zoonotic Diseases with a specific interest
in rabies. Dr Meslin has occupied various positions in WHO, including
supervision of WHO activities dealing with antimicrobial resistance in
human pathogens, public health response to biological weapons, the
control of human African trypanosomiasis and leishmaniasis, as well
as veterinary public health and the prevention and control of zoonoses.
Dr Vincent Tanya
(Veterinarian)
Director of Research, Technical Adviser
No 1, Ministry of Scientific Research and
Innovation, Cameroon.
Professional Focus: Tropical animal health, with a special interest in
viral diseases. He has worked on bluetongue, rinderpest (cattle plague),
foot-and-mouth disease, African swine fever, PPR (peste des petits
ruminants), and the parasitic disease, river blindness (onchocerciasis).
ICONZ Magazine | Issue 6 3
The neglected of the neglected
Ignacio Moriyón, leader of Work Package 5, has recently conducted a first stakeholder meeting with
a view to taking action on brucellosis in Morocco. It was a highly successful, small-scale intervention
that included local officials, students, vets and also farmers’ representatives.
The war on brucellosis formally
began in 1887 when Scottish
pathologist Dr David Bruce
established the causal relationship
between the organism and the
disease, then known as Malta
fever. Shortly afterwards, the
Mediterranean Fever Commission
traced the origin of the disease
to infected ruminants. Since then
many battles have been won and
numerous countries in the world
are able to declare themselves
brucellosis free, thanks to animal
vaccination, test and slaughter
programmes and pasteurization
techniques.
However we are nowhere near winning the war
and, for many countries in Africa, brucellosis is
still taking a heavy toll. Despite being a chronic
disease with the risk of disabling consequences,
brucellosis is rarely fatal in affected humans
(about 2%). With no specific clinical picture,
aside from recurrent fever, it is often
It’s hard but we
have to get the
message across
to people that no
matter what they
think, raw milk
is full of bacteria.”
misdiagnosed as drug-resistant malaria. It is
likely that tens of thousands of people across
Africa are affected by this debilitating disease
despite the existence of animal vaccines and
other means of control. It has become the most
neglected of the neglected.
“The meeting in Sidi Kacem was very well
organised. I travelled to Africa with a colleague
from Spain, Dr Jose Maria Blasco, who is a world
expert in brucellosis vaccination. We gave two
talks. I spoke about the basis of brucellosis
vaccination and Dr Blasco talked about how to
get the most from the vaccines that we currently
have,” explained Ignacio.
“Then on the second day we went into the field
to see a farm with cattle and sheep. We used
a placebo to demonstrate the conjunctival
vaccination technique to students and vets from
the Moroccan Food Safety Agency (ONSSA).”
The conjunctival technique involves putting a few
drops of the vaccine into the eye of the animal.
(A video showing injectable and conjunctival
techniques can be found on the ICONZ
website: www.iconzafrica.org/category/videos)
“It went very well. On the third day we went for
a meeting with the local authorities and it was
clear that they were listening carefully.”
The first task Ignacio has to address is to
convince people that their sheep and cattle
actually have brucellosis, such is the strong
bond between farmers and their animals in
the communities involved.
“It’s hard but we have to get the message across
to people that no matter what they think, raw
milk is full of bacteria. Sometimes you tell people
and they say: ‘Our sheep and cattle are not like
that!’ But these are smart people. I think we
should show them the milk under the microscope.”
Having convinced all those concerned of the
existence of the disease, it then falls to the
ICONZ team to put the case for conjunctival
rather than subcutaneous vaccination of
livestock – a more effective method.
“Most vets here in Spain were reluctant to move
from subcutaneous to conjunctival but when
they did, they said: ‘Wow, forget needles,
forget syringes’. Students in Morocco, who had
never vaccinated conjunctivally before, were
able to do it first time,” Ignacio reports.
However, despite his enthusiasm, the WP5
interventions are not without difficulties.
“At this time the conjunctival formulation is not
commercially available. The subcutaneous form
can be adapted but it would be great to get it
in a ready-made dropper. Then we also have the
problem that, because of the political and security
situation, we can no longer work in Mali and there
are problems working in central Nigeria. So
our next steps will be in Morocco and also we
are organising a course in Tanzania in May.”
The course in Tanzania will focus on the impact
of community-based interventions, for example
educating and promoting best practice for
health to farmers, pastoralists, women and
families. Moroccan colleagues are also
planning an education campaign.
The outlook, of course, needs to be long term
with goals beyond the ICONZ timeframe.
But people are talking more about brucellosis,
and awareness has been raised. The most
neglected of the neglected is getting a little
attention at last.
Taming brucellosis in Tanzania
– Lawrencia Wankyo Mbahi
is making sure brucellosis
is a little less neglected than
it once was.
As an ICONZ-funded MSc student at
Sokoine University of Agriculture in Tanzania,
Wankyo has taken on the task of working on
the socio-economics of brucellosis in humans.
She conducted a two year study in the
Morogoro region involving 1807 out-patients
complaining of fever, as well as local officials,
doctors, lab technicians and village leaders
amongst others.
“I had different groups of people from all age
categories and with different occupations
such as pastoralists, farmers, employed
people and students. After screening, we
found a substantial number of those tested
had brucellosis. Many of them were surprised
by the diagnosis and were not aware they
might have brucellosis; even the laboratory
technicians testing the samples were
surprised.
Brucellosis is not routinely diagnosed
in Morogoro; only two private health
centres offer the test. So obviously there’s
misdiagnosis as malaria, typhoid and
venereal diseases such as syphilis. Some
people have brucellosis for a long time
leading to a range of health problems
causing permanent disabilities in any
organ of their bodies.
In socio-economic terms, misdiagnosis is
expensive and time-consuming. People incur
great expense treating the wrong disease
and also fail to conduct their daily activities
because they are weak most of the time.
Some relate the disease to supernatural
causes.
It’s important to control the disease in livestock
but raising public awareness about how the
disease is transmitted is key, because it is
a genuine threat to public health.”
ICONZ Magazine | Issue 6 5
Back to
databasics
Veteran vet Jim Scudamore tells ICONZ Magazine
why statistics are so vital.
For many people, beginning
retirement is likely to involve some
slippers, a newspaper and perhaps
a spot of golf. For Jim Scudamore,
retiring in 2004 meant taking
on (amongst other things) an
appointment as Professor of
Livestock Veterinary and Public
Health at the University of Liverpool
and the leadership of ICONZ
Work Package 2 “Mapping Global
Research on Neglected Zoonoses.”
As a former Chief Veterinary Officer for the UK
with a background in research, fieldwork and
policymaking he was the ideal candidate for
this vitally important work package.
“What we are trying to do is create a database
to give us a clear picture of what’s going on
in terms of research into the eight diseases.
We then want to analyse results for each
disease to see where the gaps are in the
understanding of the diseases and the
availability of tools for their control. This
information can then be used to identify the
research that is needed to ensure that tools,
such as diagnostic tests, vaccines and cost/
benefit analyses, are developed to help control
the neglected zoonoses. That’s going to be
very useful to many organisations.”
Jim and colleagues began by asking researchers
to fill out questionnaires, letting them know what
work was currently being undertaken, but the
response was poor. Thankfully another EU
Project called EMIDA, set up to look at emerging
infectious diseases, was able to assist and
provide a great deal of information on the eight
zoonoses, helping support the first database.
The next step was to analyse the published
work relating to the ICONZ diseases and build
a second, publications database.
“We looked at PubMed because it’s an open
source of data. We downloaded all the papers
produced since 1950. The numbers of
publications certainly reflected the neglected
nature of the diseases. We did a comparison with
E. coli and a few other diseases and contrast
was clear. The exception was anthrax because
of its potential for bio-terrorism,” he explains.
A considerable amount of information was
generated, but the analysis had to go beyond
simple numbers of papers. They developed a
semi-automated system that could look at all
the papers and place them in a category like
basic science, costs and burdens, control and
management, diagnostics and vaccines and
lastly epidemiology and risk. This methodology
is still being evaluated for its accuracy.
The third database that Jim and his team have
recently been working on is a funder’s database.
The team have searched the websites and
databases of the main funders, to pull out
currently funded projects and categorize them
for the database.
The last step will be to produce a report,
compiling the three data sets and defining the
research gaps for each disease.
“One thing that’s come out of the work we have
done is how few papers have been published
on costs and burdens. But unless you can
demonstrate that it costs a lot, policy makers
will take no notice,” he warns. “Neglected
zoonoses are neglected because there’s
not enough evidence to show that they’re a
problem. The whole point of this is to attract
policy makers’ attention and persuade them
of what needs to be done.”
The whole point
of this is to attract
policy makers’
attention and
persuade them
of what needs
to be done.”
A new way of
looking at disease
Work Package 3, Knowledge and Information on Neglected Zoonoses,
has been using everything from Google Earth to GPS receivers
to assemble a raft of geospatial data and find a new way of looking
at neglected zoonoses.
Says Ward Bryssinckx of Belgian
partner Avia-GIS: “Within ICONZ,
geographical information systems
(GIS) have been used to process
data from a variety of sources.
The maps below show how
bovine tuberculosis (bTB) is
clustered in the Morogoro study
area in Tanzania. It enables us
to see at a glance the area with
a high rate of bTB in the context
of major rivers and roads and the
boundaries of nature reserves.
By visualising this information
we can begin to try and draw
Descriptive maps
like these have
been produced
for all the ICONZ
case study areas.
conclusions about the effect
the livestock-wildlife interface
is having on bTB. We can also
include information that changes
continuously like land surface
temperature or vegetation.”
Descriptive maps like these have been
produced for all the ICONZ case study areas
showing the baseline data that has been
collected. A Livestock Mapping Tool has been
developed to assist researchers in selecting
appropriate sample sites for livestock studies.
Finally, custom maps will be created in order
to visualize the outcomes of the ICONZ case
study interventions.
Morogoro: spatial cluster analysis
Morogoro: bovine tuberculosis prevalence in cattle
N
-6°
-7°
-7°
latitude
-8°
-8°
-9°
-9°
-10°
-10°
37°
38°
39°
35°
36°
0
110 km
32
Major Rivers
h:
Major Roads
ig
Low rate Clusters
39°
Mikumi and Selous Reserves
H
High rate Clusters
38°
Prevalence of bovine tuberculosis (%)
+ Sample locations
+ Sample locations
37°
longitude
longitude
:0
36°
w
35°
Lo
latitude
N
-6°
0
110 km
Maps: Adapted from: Mwakapuja, R.S. et al. (2013, in press) Prevalence and significant geospatial clusters
of bovine tuberculosis infection at livestock–wildlife interface ecosystem in Eastern Tanzania. Tropical
Animal Health and Production (left-hand map) and ICONZ Tanzania maps (right-hand map), both created
by Ward Bryssinckx.
ICONZ Magazine | Issue 6 7
ICONZ Meetings
Recent Publications (continued)
Past Meetings
Borgström E, Andersen P, Atterfelt F, Julander I, Källenius G, Maeurer
M, Rosenkrands I, Widfeldt M, Bruchfeld J, Gaines H (2012) Immune
responses to ESAT-6 and CFP-10 by FASCIA and multiplex technology
for diagnosis of M. tuberculosis infection; IP-10 Is a promising marker.
PLoS One 7(11): e43438
ICONZ WP5 Meeting
Edinburgh, United Kingdom
11th January 2013
Other Meetings
Upcoming Events for 2013
2nd International Congress on Pathogens at the Human-Animal
Interface (ICOPHAI)
One Health for Sustainable Development
14th-17th August 2013
Porto De Galinhas, Brazil
Past Events
One Health Symposium: Breaking Barriers and Crossing Scales
21st-23rd March 2013
Athens, Georgia, USA
2nd International One Health Conference
29th January-2nd February 2013
Bangkok, Thailand
4th International Symposium on Emerging Infectious Diseases
6th-7th September 2012
Ulaanbaatar, Mongolia
Ecohealth 2012
15th-18th October 2012
Kunming City, China
Emerging Infectious Diseases Symposium
22nd-23rd October 2012
Victoria, Australia
Recent Reports
High-Level Technical Meeting to Address Health Risks at the
Human-Animal-Ecosystems Interfaces
15th-17th November 2011, Mexico City, Mexico
http://www.onehealthglobal.net/wp-content/uploads/2012/02/12-11FAO-OIE-WHO-HLTM-final-report.pdf
Recent Publications
Berg S, Garcia-Pelayo MC, Müller B, Hailu E, Asiimwe B, Kremer K,
Dale J, Boniotti MB, Rodriguez S, Hilty M, Rigouts L, Firdessa R,
Machado A, Mucavele C, Ngandolo BNR, Bruchfeld J, Boschiroli L,
Müller A, Sahraoui N, Pacciarini M, Cadmus S, Joloba M,
van Soolingen D, Michel AL, Djønne B, Aranaz A, Zinsstag J,
van Helden P, Portaels F, Kazwala R, Källenius G, Hewinson RG,
Aseffa A, Gordon SV, Smith NH (2011) African 2, a clonal complex
of Mycobacterium bovis epidemiologically important in East Africa.
J Bacteriol.193(3): 670–678
Would you like to receive ICONZ Magazine by email or in printed form? Email your
details to iconz@ed.ac.uk, ICONZ Secretariat, Division of Pathway Medicine, College
of Medicine and Veterinary Medicine, The University of Edinburgh, Chancellors Building,
49 Little France Crescent, Edinburgh EH16 4SB, Scotland, United Kingdom.
For a full list of partners and other information, see our website www.iconzafrica.org
Editor in chief: Iona Beange, Editorial Services: Stephanie Brickman, Writer: Stephanie
Brickman, Translation: Joëlle Glore, Design: Tayburn, Photography: P1 Sue Welburn,
P2 Marie Ducrotoy, P4 Ignacio Moriyón,P5 (inset) Kevin Bardosh, P6 Richard Mwakapuja
and Christine Amongi Acup. Thanks also to Alexandra Shaw and Marie Ducrotoy for their
assistance in proof-reading these magazines.
The University of Edinburgh co-ordinates the ICONZ project. No part of this publication
may be reproduced without permission.
Dean AS, Crump L, Greter H, Schelling E, Zinsstag J (2012) Global
burden of human brucellosis: a systematic review of disease frequency.
PLoS Negl Trop Dis. 6(10):e1865
Dean AS, Crump L, Greter H, Hattendorf J, Schelling E, et al. (2012)
Clinical manifestations of human brucellosis: a systematic review and
meta-analysis. PLoS Negl Trop Dis 6(12): e1929
Durnez L, Katakweba A, Sadiki H, Katholi CR, Kazwala RR,
Machang’u RR, Portaels F, Leirs H. (2011) Mycobacteria in terrestrial
small mammals on cattle farms in Tanzania. Vet Med Int. 2011:495074
Hill V, Zozio T, Sadikalay S, Viegas S, Streit E, Källenius G, Rastogi N
(2012) MLVA based classification of Mycobacterium tuberculosis
complex lineages for a robust phylogeographic snapshot of its
worldwide molecular diversity. PLoS One 7(9): e41991
Mahoney A, Weetjens BJ, Cox C, Beyene N, Reither K, Makingi G,
Jubitana M, Kazwala R, Mfinanga GS, Kahwa A, Durgin A, Poling A
(2012) Pouched rats’ detection of tuberculosis in human sputum:
comparison to culturing and polymerase chain reaction. Tuberc Res
Treat. 2012:716989
Makita, K, Fèvre EM, Waiswa C, Eisler MC, Thrusfield M, Welburn SC
(2011) Herd prevalence of bovine brucellosis and analysis of risk factors
in cattle in urban and peri-urban areas of the Kampala economic zone,
Uganda. BMC Vet Res. 7: 60
Makita K, Fèvre EM, Waiswa C, Kaboyo W, Eisler MC, Welburn SC
(2011) Spatial epidemiology of hospital-diagnosed brucellosis in
Kampala, Uganda. Int J Health Geogr 10: 52
Pawlowski A, Jansson M, Sköld M, Rottenberg ME, Källenius G
(2012) Tuberculosis and HIV Co-Infection. PLoS Pathog. 8(2):
e1002464
Smith NH, Berg S, Dale J, Allen A, Rodriguez S, Romero B, Matos F,
Ghebremichael S, Karoui C, Donati C, Machado Ada C, Mucavele C,
Kazwala RR, Hilty M, Cadmus S, Ngandolo BN, Habtamu M, Oloya J,
Muller A, Milian-Suazo F, Andrievskaia O, Projahn M, Barandiarán S,
Macías A, Müller B, Zanini MS, Ikuta CY, Rodriguez CA, Pinheiro SR,
Figueroa A, Cho SN, Mosavari N, Chuang PC, Jou R, Zinsstag J,
van Soolingen D, Costello E, Aseffa A, Proaño-Perez F, Portaels F,
Rigouts L, Cataldi AA, Collins DM, Boschiroli ML, Hewinson RG,
Ferreira Neto JS, Surujballi O, Tadyon K, Botelho A, Zárraga AM,
Buller N, Skuce R, Michel A, Aranaz A, Gordon SV, Jeon BY, Källenius G,
Niemann S, Boniotti MB, van Helden PD, Harris B, Zumárraga MJ,
Kremer K (2011) European 1: a globally important clonal complex
of Mycobacterium bovis. Infect Genet Evol 11(6):1340-51
Zinsstag J, Mackenzie JS, Jeggo M, Heymann DL, Patz JA, Daszak P
(2012) Mainstreaming one health. Ecohealth 9(2):107-10