Veterinary public health (VPH) was originally defined in a 1975 Joint FAO/WHO Expert Committee Report as "the component of public health activities devoted to the application of professional veterinary skills, knowledge, and resources to the protection and improvement of human health." A more recent WHO study group report in 1999 expanded this definition to include "the sum of all contributions to the physical, mental, and social well-being of humans through an understanding and application of veterinary science". This latter report emphasized that VPH would have to develop against a rapidly changing background of population growth, increasing urbanization, an increasing poverty and technology gap between developed and developing countries as well as changes in land use, the environment, and climate.
Capacity building is a process whereby individuals, groups, institutions, organizations and societies enhance their abilities to identify and meet development challenges in a sustainable manner. FAO proactively supports global capacity building activities and the Animal Health Service works closely with stakeholders in Member Nations and the international community in the area of surveillance, prevention and control of zoonotic diseases in support of agricultural development, food safety and food security.
The majority of developed countries have surveillance systems in place to detect and control major zoonotic diseases at national and subnational levels. In developing countries and those countries in transition whose infrastructures require rebuilding, general VPH services and surveillance systems and control programmes are likely to be deficient at all levels.
Many publications, surveys, and conclusions from a recent 2001 FAO/WHO/OIE-sponsored electronic conference on VPH and the control of zoonoses in developing countries have identified numerous difficulties relating to the effective delivery of prevention and control programmes.
lack of any organized surveillance programme;
focus on task-oriented VPH programmes unrelated to risk-based priorities;
poorly defined epidemiological knowledge of local VPH problems;
minimal communication and cooperation between providers of human and veterinary health services;
lack of VPH educational materials and programmes for extension;
difficulties in electronic access to science-based current VPH information sources;
lack of suitably trained individuals at all levels; and
lack of VPH infrastructures.
The VPH priorities of developed countries in recent years have tended to focus on emerging infections albeit often of low incidence, chemical residues in foods of animal origin, antibiotic-resistant microorganisms and prevention of acts of biological terrorism. These issues are not necessarily the same priorities for developing countries. The latter are faced with long-standing and persistent zoonoses, such as rabies, anthrax, brucellosis, tuberculosis, cysticercosis, and echinococcosis. Surveillance, control and eradication procedures as used in developed countries may not be technically or economically feasible.
Poverty is now being recognized as a major risk factor for zoonoses and food-borne illness in both rural and urban consumers. Livestock offer both a major contribution to the livelihood of the poor and a pathway out of poverty, but also are a risk to their own health, well-being and performance.
The objectives of the consultation were to consider and make specific recommendations regarding the implementation of surveillance methodologies for zoonotic diseases, with special emphasis on developing countries in the following major areas:
training programmes in surveillance methodologies at veterinary and paraveterinary levels;
implementation of a surveillance programme in taeniasis/cysticercosis;
training programmes for the surveillance, prevention and control of BSE;
capacity building for surveillance and control of zoonotic disease under emergency conditions;
surveillance and control programmes in brucellosis, tuberculosis, anthrax, salmonellosis and other food-borne pathogens;
surveillance, early warning and early reaction to zoonoses outbreaks; and
surveillance approaches in antimicrobial resistance.
Background papers were presented on each of the above topics by invited participants. Each expert was asked to have a minimum of two coauthors or peer-reviewers of their paper. All papers were circulated electronically to consultants prior to the meeting. A one-page summary of each paper is included in the following section and the full papers in the appendices.
Following a summary presentation of each paper by the primary author, discussions were held with both other experts and FAO invited participants and staff. Finally, the experts deliberated and presented their conclusions and recommendations to a plenary session.
A summary of each of the papers presented during the plenary sessions is given below. The full text of each paper presented appears in the Appendices.
Capacity building for veterinarians and veterinary paraprofessionals
The emergence and re-emergence of zoonoses and their potentially disastrous impact on human health have made food safety (including threats regarding the deliberate misuse of pathogenic biological agents) a priority issue for veterinary services (which includes all professional service providers and institutions) around the world. To be able to effectively and efficiently address the needed surveillance, monitoring, prevention, control and eradication of animal and zoonotic diseases, the professional capacities of all role players (including training institutions, laboratories etc.) must meet the levels of the international standards prescribed or required (e.g. by OIE, CODEX) to be able to benefit from the sanitary and phytosanitary (SPS) provisions and access regional and/or international markets for animals and animal products. Special attention should be paid to capacity building relating to:
the professional performance and capability of veterinary services in relation to the required quality of service provision;
pre- and postgraduate training in food safety and, specifically, zoonoses control;
establishment, maintenance and performance of veterinary statutory bodies; and
harmonization of registration/licensing requirements for veterinarians and veterinary paraprofessionals on a regional level;
Dr Herbert Schneider said that this was the fiftieth anniversary of collaboration between the World Veterinary Association and FAO. He noted that zoonotic diseases have been issues on the agenda of the World Veterinary Association for many years. Despite this, there had been a shift in emphasis from concern with infectious diseases and transboundary animal diseases (TADs) to emphasis on companion animals. He questioned what had happened to epidemiologists, veterinary researchers, veterinary services and their associated infrastructure. He noted particularly that the new European Union (EU) hygiene package (which would come into force in January 2006) would have a tremendous bearing on all countries wishing to export to the EU. He also noted the importance of bioterrorism. The important role players in VPH are the official veterinarian, veterinarian (licensed by the veterinary statutory body), paraveterinarians (authorised through licence by the veterinary statutory body), and the veterinary statutory bodies. Also important was the quality of veterinary services and evaluation (according to the OIE code). The principles were: professional judgement, independence, impartiality, integrity and objectivity. Financial resources were also vital. The priorities were: training, harmonization of registration/licensing, and maintenance/establishment of veterinary statutory bodies. The involvement of private veterinarians was also increasingly important given the reduction in public services.
Dr Murrell asked about the lines of authority relating to legislation and statutory bodies (Codex, OIE). How does FAO affect that aspect in a country? Dr Schneider responded that FAO should give guidance and assistance on legal and statutory matters through workshops, etc. FAO could facilitate the implementation of regulations and guidelines. Dr Eddi noted that WHO/FAO was working closely with OIE. The Technical Cooperation Programme (TCP) is a good tool that is being used in this context all over the world. Dr Schneider added that a TCP was being used in Namibia to update legislation.
Dr Meslin said that, except in the case of avian influenza, support for action against other zoonotic diseases was limited. No resources were trickling down. He observed however that there was a lot going on and this expert consultation should make a list of key activities of VPH concerns. He noted that in this area of capacity building for VPH we were not starting from scratch.
Capacity building for surveillance and control of taenia solium/cysticercosis
K.D. Murrell and Z. Pawlowski
Control of neurocysticercosis from Taenia solium infections will require a multidisciplinary and multilevel approach because of the complex nature of their epidemiology. A control programme will necessitate establishing a national organization that helps and guides local efforts. The control programme will also demand cooperation and participation by the veterinary, medical and public health sectors. In addition to resources, this complex organization of experts and stakeholders must be provided with a solid understanding of the epidemiology and biology of the zoonosis and the rationale for control strategies that are to be pursued. In addition to basic parasitology of T. solium, a good understanding of the risks associated with animal husbandry and human behavioural practices, and the economics of pig production and marketing is essential. Important to the success of a programme is attention to management and coordination of the various components of the control organization. Therefore, a good deal of effort and investment in training and indoctrination of all participants in the overall control programme will be required up front. Even pilot or demonstration control projects will require substantial capacity building. Without this level of preparation, controlling this zoonosis, which is so dependent upon long-established risky animal rearing and cultural traits, will remain nearly intractable. Dr Murrell showed the incidence of taeniasis in developing and developed countries (USA). The disease was potentially eradicable, given that the human is the only definitive host for the parasite. Therefore, the human is the target for mass treatment with drugs. However, this was not to preclude improved meat inspection, improved pig rearing and sanitation practices. Education and training were required. Clandestine marketing was also a problem. There was a need to strengthen the laboratory diagnostic base. He also stressed the importance of management, supervisory and organizational skills. He highlighted the need for intersectoral cooperation (medical, veterinary and non-medical). There was a need to revise legislation, to create awareness, to train the trainers, and for community-level education.
Professor Mantovani stated that there was a need for professional training for all zoonoses. He considered that the group should not limit itself to communicable diseases only but include chemical contaminants, etc. Dr Nari noted that in developing countries there was no real connection between veterinary services and veterinary faculties of universities. Dr Eddi commented that cysticercosis has been eradicated in Europe without sophisticated scientific techniques such as DNA probes, GIS mapping and molecular vaccines, but with improvement in livestock production techniques, awareness creation and mainly with improvement in lifestyles. Continuing education was needed to improve on capacity for zoonotic disease surveillance and control. At this point, Dr Jutzi (Director of AGA) welcomed participants to the consultations and noted the concurrence of this event with the steering committee meeting of the Pro Poor Livestock Policy Initiative, with whom the experts would meet at a social event at 17.00 hours the same day.
Capacity building for surveillance and control of bovine spongiform encephalopathy and other zoonotic diseases
U. Kihm, E. Mumford, A. Speedy
The project utilizes Swiss expertise and FAO infrastructure to assist the governments of selected partner countries in building capacity, establishing preventive measures, and analysing risks for bovine spongiform encephalopathy (BSE). The project aims to improve or build technical capacity along the entire food production chain (including governmental and private veterinary services, diagnostic laboratories, livestock, animal-feed, and meat industries) in partner countries so that all components required for an effective and sustainable BSE control programme are available. The ultimate goal of the project is that the partner countries either are able to prove themselves to be BSE-free, or are able to decrease their BSE risks to acceptable levels. Although the focus of this project is to lessen the negative impacts of BSE on public health, animal health, and trade in partner countries, the capacity developed will promote implementation of similar control programmes for other emerging zoonotic food-borne pathogens. This project is concerned with public health, animal health and trade and with the whole food chain, and not only veterinary services. Economics and trade are the driving forces and BSE is the model. The process involved risk assessment, risk-based (targeted) surveillance, disease awareness, and control measures. He outlined the project organization and explained the four courses in diagnostics, surveillance, feed industry and meat industry and subsequent in-country activities.
Dr Aidara-Kane thought that, in the context of risk assessment, the chain should extend to the hospital and epidemiological data from the public health domain. Projects should include participants from the public health domain. The integrated approach should not end at the table. She referred to Salmonella as an example where risk assessment included quantitative (numbers) and qualitative aspects (serotypes).
Capacity building for surveillance and control of tuberculosis
Dr J. Berrada
Through a well-designed project, a developing country, the Kingdom of Morocco, built and strengthened organizational and technical capacities for surveillance and control of bovine tuberculosis. In this regard TCP/MOR/2904 (Stratégie nationale de lutte contre la tuberculose bovine) could serve as a model for other capacity building programmes in developing countries with similar levels of development.
At the regional level, it was recommended to establish collaborating and reference centres for training, surveillance, diagnosis and research on bovine tuberculosis. At the international level, it was recommended to assist developing countries in developing and financing participatory approaches to define country needs and priorities and in so doing, strengthen human resource and institutional capabilities. Dr Berrada provided a definition of surveillance: surveillance is defined as the "systematic" collection, analysis, interpretation, and timely dissemination of health data for the planning, implementation, and evaluation of health programmes. Surveillance could be active, passive or a combination of both. Bovine tuberculosis was the model. It was a serious public health (hygienic) as well as an economic problem. The only successful control method was the test and slaughter method. It depended on the capacity of professionals and paraprofessionals.
He reported on the TCP project in the Kingdom of Morocco. The project included a survey, capacity building, surveillance and testing, training of meat inspectors and stakeholder workshops. There was also provision of laboratory equipment and reagent supplies for bovine tuberculosis diagnosis. The final stage was building farmer awareness, trust and advocacy: this was a key element of project objectives. It involved extension, video shows and radio presentations on laboratory diagnosis and field recognition of the disease in cattle. He noted the trend of increase in problems with tuberculosis prevalence from population pressure, trade and intensification of cattle production as well as HIV/AIDS in Africa. Regional and international assistance was therefore needed to control bovine tuberculosis. He noted that before the project started the expected incidence (infected herds) was 2 percent; the actual incidence was found to be 32 percent during the implementation of the project.
Dr Pasquali noted that brucellosis has been eradicated or controlled by developed and rich countries and that the same situation was also true of bovine tuberculosis. What was needed was basic financial support. Dr Berrada further contributed that developing countries need to prioritize their problems, because there were several zoonotic diseases with different impacts. In the Kingdom of Morocco, rabies has a low cost to the livestock sector but has a disastrous impact on public health and the authorities are prepared to act to control the disease. In the case of brucellosis, tuberculosis and hydatid cysts, the political will is not so strong. These diseases have a common background and similarities therefore capacity built for one will support the control of the other. Dr Amanfu questioned the sustainability of these activities? It was good to provide training but could we sustain this capacity?
Capacity building for surveillance and control of bovine and caprine brucellosis
L.E. Sammartino, A.Gil and P. Elzer
Brucellosis is still a major disease of worldwide distribution. There are many factors involved in both human and animal brucellosis that are important challenges in the control and eradication of this disease. Today, we have very powerful tools available: excellent serological methods, very effective immunogens and an overall knowledge of the pathogenesis of the disease. Efforts should be made by authorities responsible to devise feasible control plans. The development of these plans should involve all participants working together. Support for control programmes will require strong economic structure. One of the most important aspects to be considered is education, which must be targeted to all susceptible populations and be adjustable for each region and its cultural peculiarities.
Dr Sammartino noted that the disease was still important. He described the aetiology and epidemiology, both as an occupational disease and as a food-borne disease. In animals, the disease is often asymptomatic. Many serological tests are currently available. Vaccines are likewise available. All materials for control of brucellosis have been available for many years. New diagnostic tests are also available. He outlined the guidelines, strategies and control methods that need resources and laboratory facilities. Agglutination tests can be used anywhere for screening. It was recommended to adopt ELISA and FPA technology. PCR should be considered where technically feasible. He also recommended surveillance methods including the milk ring test and market cattle testing. Education is linked with all phases of the control programme. Collaboration between veterinary services and public health services is essential.
William Amanfu asked if Dr Sammartino could give his perception of the distribution of different species of Brucella. Dr Sammartino replied that B. abortus is worldwide in distribution but is mainly found in Latin America; B. melitensis is the most pathogenic Brucella to humans and is found in Mediterranean countries, north Africa and central Asia and central Europe. In the Argentine Republic, B. suis is important because there is a large population of pigs. B. abortus and B. melitensis both occur in Africa; B. abortus type 3 is the main serotype. B. abortus type 1 occurs in Asia.
Capacity building for surveillance and control of zoonotic disease under emergency conditions
P. Pasquali, U. Agrimi, R. Borroni, L. Busani, C. Graziani, M. Leonardi, G. Poglayen, A. Macrì and A. Mantovani
Veterinary public health is a fundamental part of public health systems in general but it assumes a pivotal role in disaster emergencies, especially in, but not limited to, the prevention of the spread of communicable or zoonotic diseases. In recent years, increasing demands have arisen for veterinary action in calamities, whether natural in origin or artificial (man-made). In emergency conditions following a disaster, the operational systems to monitor and control communicable diseases suddenly stop and the best conditions to spread infectious diseases arise. Even if culling is the most common and successful approach used to control and eradicate epidemic outbreaks in developed countries, it requires considerable technologies for animal carcass disposal. Moreover, the growing tendency in managing the waste of animal products and the negative environmental impact of technologies utilized for animal carcasses disposal must be considered. Before deciding on measures to avoid spread of epidemics and on methods of carcass disposal, a well-balanced risk analysis must be done. This is especially important in developing countries where food supplies and disposal plants are both very limited. Management plans for carcass disposal are essential tools both in epidemic and in non-epidemic veterinary emergencies. Plans must be established well in advance taking into consideration all possible risks, the epidemiological situation, the geographical and geological characteristic of the area, the social situation and all the available human and technological resources. Efficient management plans need interprofessional cooperation and extensive consultation among concerned people. Dr Pasquali considered different kinds of disasters, natural and man-made. Following an incident, he listed the recognition phase; emergency phase; secondary action; and restoration phase. He also covered risk management and communication in zoonotic emergency, surveillance and control of zoonoses in non-epidemic emergencies, and capacity building for surveillance and control of zoonotic diseases in urban areas. He suggested the establishment of an emergency task force.
Dr Murrell said that if he were to propose an emergency task force he would be told that agencies already existed. He was not sure what such a task force would do. Were there examples? Dr Pasquali responded that it was difficult to achieve this and that it was a very broad area. It is an important issue to develop a training system for people interested in these issues and this should focus on priorities such as VPH.
Professor Mantovani said that all activities in non-epidemic emergencies are typically horizontal (cross-disciplinary). There have been two stages; in the 1980s, the Italian earthquake involved improvised task forces, whereas later the civil defence system was developed. The aim was to give general guidelines and to have local services able to respond. Emergencies involving animals may also be small-scale in extent and must be dealt with by local veterinary services. Dr Schneider thought that Dr Pasquali had summarized the current situation well. In emergencies, there was a lack of practical advice. A database of people and resources is needed. Carlos Eddi said that FAO is prepared to assist but needed specific information of veterinary services that are capable of providing such support in emergencies. Andrew Speedy said that all facilities and expertise exist in FAO but departments are vertically structured and we need horizontal (cross-disciplinary) organization in emergencies. A recommendation by the experts in this regard, would be welcome.
Professor Mantovani referred to the European Centre for Disaster Medicine in San Marino. This institute gives training courses but they are still fairly general. Dr Meslin said that WHO had a task force for the tsunami and this had been well coordinated. He noted however that following the tsunami in the Democratic Socialist Republic of Sri Lanka, it was found that there had been little destruction of animals. He called for further examples. Dr Pasquali said there were few good examples but disease outbreaks can occur at any time. In any change of environment, relationship between humans, animals and pathogens could change. Dr Meslin was not sure if we should put funds into hypothetical situations. Dr Pasquali said that this was a risk analysis situation. In planning for emergencies, we should take account of the risk of zoonoses. Dr Eddi thought that a minimum database was needed. This would include guidelines on how to handle food safety, water quality, etc. He said there was a need to evaluate economic costs and benefits. This was needed to convince stakeholders.
Dr Kihm noted that, in public health incidents (fact or perception), people are scared and there is often a ban on trade. The question is, "What is an acceptable risk?" BSE has had a major effect because now everyone is talking of food safety. A small risk is a big hurdle. There are much bigger numerical risks, e.g. brucellosis, salmonellosis, etc. Dr Murrell cited the prevalence of E. coli in the USA. Dr Kihm suggested further that non-epidemic emergencies are a low priority. Dead bodies do not spread zoonotic diseases. But water supplies are a problem. Dr Murrell recalled that, in the former Yugoslavia, trichinellosis had been largely eradicated but there was a reservoir in wild pigs. During the war, animals were turned loose, and some of highest rates of trichinellosis occurred in that area. Dr Kihm agreed that war is another problem because infrastructure is destroyed. However, he reiterated that VPH emergencies were often not a priority. Dr Pasquali agreed.
The global framework for the progressive control of transboundary animal diseases (TADs)
The Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs) is a joint FAO/OIE initiative, which combines the strength of both organizations to achieve agreed common objectives. It is a facilitating mechanism that endeavours to empower regional alliances in the fight against transboundary animal diseases (TADs), to provide for capacity building and to assist in establishing programmes for the specific control of TADs based on regional priorities. Outbreaks of foot-and-mouth disease (FMD) from 1997 to 2003, classical swine fever in Europe and the Caribbean, rinderpest within the Somali ecosystem, peste des petits ruminants outbreaks in the Republic of India and in the People's Republic of Bangladesh, contagious bovine pleuropneumonia (CBPP) in Angola, Zambia and Namibia, and Rift Valley fever outbreaks in 2000, provided the main stimulus for the creation of the GF-TADs initiative. The spread of TADs will increase unless international concerted efforts are put in place for effective prevention and progressive control, as currently shown by the avian influenza epidemic in parts of Asia, in which FAO, WHO and OIE have collaborated at various levels in order to bring the outbreaks under control. Prior to the avian influenza crisis, FAO and OIE had examined the problem of TADs from the standpoint of complexity of the environment, market access, food chain and international public good goals of social equity. Thus, the GF-TADs proposes control of major TADs as an effective contribution to the achievement of the Millennium Development Goals (MDGs) by providing assistance and guidance to member countries through the existing regional specialized organizations such as the African Union-Interafrican Bureau for Animal Resources (AU-IBAR) in Africa, the Pan-American Health Organization (PAHO) in South America, the South Asian Association for Regional Cooperation (SAARC) in Asia, and others. A major component of TADs is the Global Early Warning System (GLEWS), which will be a joint FAO/OIE/WHO initiative. GLEWS is a joint system that builds on the added value of combining and coordinating the alert and response mechanisms of the three organizations for the international community and stakeholders and so assists in prediction, prevention and control of animal disease threats, including zoonoses. The GF-TADs programme will be developed along four main thrusts namely:
1. regionally led mechanisms to implement action against priority animal diseases as agreed by relevant stakeholders;
2. development of regional and Global Early Warning Systems for major animal diseases;
3. application of research on TADs-causing agents at the molecular and ecological levels for more effective strategic disease management and control; and
4. the completion of the Global Rinderpest Eradication Programme (GREP) set for achieving global declaration of freedom from the disease by year 2010.
Lessons learnt from GREP, the control of FMD in Africa, South America, Asia and Europe and the current FAO/WHO/OIE joint control actions in managing the avian influenza outbreaks in parts of Asia, offered critical ideas and focus for implementing the GF-TADs concept. Specifically, conclusions from the avian influenza epidemic management, including capacity building for improved surveillance, will be analysed and developed within the context of GF-TADs. The successful implementation of GF-TADS requires that FAO and OIE work in synergy, and not in competition, to achieve set goals and objectives. Budgetary support is expected from the donor community and roughly 100 million dollars expected through parallel initiatives. Seventy per cent of funds are expected to be committed at the regional level. Dr Murrell wanted to know what potential difficulties were to be foreseen in the implementation of the programme. Dr Domenech responded by stating weak epidemiological analysis, lack of disease reporting, lack of political will in animal disease control, and poor recognition of the role of livestock in improving peoples' livelihoods, have been identified as challenges facing the GF-TADs concept.
WHO systems for surveillance, alert and response to zoonoses
Communicable disease outbreaks threaten the health of the world's population and as such require regional/global alert and response mechanisms to ensure rapid access to technical advice and resources to support national public health capacity. No single institution or country has all the necessary capacities to respond to international public health emergencies caused by epidemics and by new and emerging infectious diseases. WHO collects both official and unofficial information on outbreaks of communicable diseases including zoonoses and other events of potential international public health significance. The organization uses different networks and news/rumours scanning systems including the Global Public Health Information System (GPHIN). When an event requires international assistance WHO ensures that countries have rapid access to the most appropriate experts and resources through the Global Outbreak Alert and Response Network (GOARN). GOARN was created in April 2000 to improve the coordination of international outbreak responses and to provide an operational framework to focus the delivery of support to countries. Since 2000, WHO and GOARN have responded to over 50 events worldwide with over 400 experts providing field support and capacity building in disease management to some 40 countries.
GOARN acts in the following ways:
1. It assists countries with disease control efforts by ensuring appropriate technical support to affected populations rapidly.
2. It investigates and characterizes events and assesses risks of rapidly emerging epidemic disease threats.
3. It sustains national outbreak preparedness by ensuring that responses contribute to sustained containment of epidemic threats. Major constraints have been local beliefs, security and accessibility in outbreak investigations, and verification of rumours of disease.
Many of the most recent outbreaks of international public health concern have been of animal origin with, for example, severe acute respiratory syndrome (SARS) in 2003 and avian influenza in 2004 and 2005. In addition to these new emerging infections which have mobilized worldwide attention, a number of epidemic-prone and endemic zoonotic agents have emerged or re-emerged in various parts of the world such as Nipah and West Nile viruses, anthrax, leptospirosis and rabies. For zoonoses detection, verification and response, sharing of official and unofficial information with other organizations specializing in animal diseases, such as FAO and OIE, is particularly important. To this goal, OIE, FAO and WHO have developed a common platform named Global Early Warning System (GLEWS). GLEWS covers a number of animal diseases such as FMD, Rinderpest, CBPP and a number of zoonotic diseases as well as any emerging or re-emerging infections that represent or could become animal and human health emergencies. Essential elements of GLEWS are forecasting, epidemic intelligence, disease tracking, alert, verification, assessment, response and dissemination of information.
This presentation generated a lot of discussions. A question was asked by Dr Nari on the apparent lesser degree of involvement of WHO in South America. Dr Meslin responded that the probable reason could be fewer requests from member countries of WHO in South America, or that countries in that continent may have the capacity for dealing with outbreaks. The presence of PAHO is essential and it may have the capacity to respond to outbreaks and other disease emergencies. However, there were more WHO interventions in Central America than in South America. The response of WHO to a suspect Rift Valley fever outbreak in the Federal Democratic Republic of Ethiopia due to climatic changes characterized by floods was questioned. Dr Meslin responded by stating that in some instances WHO was not made aware of the potential outbreak of Rift Valley fever or other potential zoonotic diseases and it was essential that veterinary authorities flagged zoonotic disease suspicions for the attention of WHO so that it could play the necessary role in supporting control efforts.
Dr Kihm raised the issue that that there was the impression that WHO was interested only in stopping outbreaks once they occurred, but there were not enough guidelines to prevent the outbreaks in the first place. In the control of the avian influenza outbreak there was no provision of safer food, chickens were destroyed, compensation was delayed and no alternative safe food was provided. Problems with difficulties in access to WHO data were raised and the need for more transparency of data for risk analysis was emphasized.
On intersectoral collaboration, Dr Seimenis pointed out that there could be positive changes in attitude if the highest political leadership are involved. Dr Meslin supported this view and informed the group that in the Kingdom of Thailand the Prime Minister became involved and WHO, with a lot of pressure, managed to get Agriculture and Health to cooperate. The Ministry of Health of Thailand acknowledged the first case of avian influenza in humans. An official statement made by the Minister of Health was posted on the OIE website. Sometimes there are conflicts within public health departments in the name of protection of "turf" and these are always detrimental. Sometimes responsibilities are not carried out. In the Rift Valley fever outbreak in the Arab Republic of Egypt, the Ministry of Health confirmed the disease, but the Ministry of Agriculture denied the outbreak. Difficulties accessing RABNET were pointed out and it was suggested that the same software available for other zoonoses could be used. Dr Berrada further elaborated on intersectoral collaboration - there should be more emphasis on communication between the two ministries. For example a case of infectious bronchitis was referred to as avian influenza and this nearly collapsed the poultry industry in the Kingdom of Morocco. Also BSE was reported by the Ministry of Health without proof in the Kingdom of Morocco but denied by the Ministry of Agriculture. Information accuracy was deemed very important for the avoidance of confusion between the two ministries. It was also felt that intrasectoral collaboration and information sharing could help avoid some of the confusion mentioned above. In PAHO, the Ministries of Agriculture and Health have regular meetings for information sharing.
Activities of the Ad Hoc Group on antimicrobial resistance
Following a request of the OIE Regional Commission for Europe in 1997, OIE considered the use of veterinary antimicrobial substances as a key issue in animal and human health. A debate on this issue followed at the General Assembly in 1998 and an International Ad Hoc Group on Antimicrobial Resistance was created in 1999. The objectives of the Ad Hoc Group were to address the human and animal health risks associated with antimicrobial resistance and to address the contribution of antimicrobial use in veterinary medicine.
The Ad Hoc Group for Antimicrobial Resistance adopted the following terms of reference:
1. To develop an appropriate risk assessment methodology for the potential impact on public health of antimicrobial resistant bacteria of animal origin.
2. To develop technical guidelines on prudent use of antimicrobials in animal husbandry.
3. To develop technical guidelines on monitoring the quantities of antibiotics used in animal husbandry.
4. To harmonize national antimicrobial resistance monitoring programmes in animals and food of animal origin. To elaborate a priority list of relevant bacteria and antimicrobial substances to be included in resistance monitoring programmes.
5. To standardize and harmonize laboratory methodologies used for the detection and quantification of antimicrobial resistance.
6. To collect information on the procedures used in veterinary laboratories and in clinical biological laboratories in different countries for quantitative and qualitative analysis of bacterial resistance to antibiotics.
7. To propose standardized protocols for analysing the antibiotic resistance of bacteria isolated from animals or products of animal origin, and notably specific procedures for different bacterial groups.
8. To propose to the OIE Standards Commission on harmonization of assays on antibiotics in the veterinary laboratories of OIE member countries.
9. To formulate recommendations to the OIE Standards Commission on the preparation and distribution of resistant bacterial strains taking account of international reference strains and the requirement for biosecurity.
Guidelines were developed following OIE procedures and during the General Assembly of 2003, four guidelines concerning antimicrobial resistance were accepted. Three guidelines are now part of the Terrestrial Animal Health Code (Section 3.9) and the fourth guideline is part of the OIE Manual of Diagnostic Tests and Vaccines for Terrestrial Animals.
1. Surveillance of bacterial resistance (Appendix 3.9.1)
2. Monitoring the quantities of antimicrobials used in animal husbandry (Appendix 3.9.2)
3. Responsible and prudent use of antimicrobial agents in veterinary medicine (Appendix 3.9.3)
4. Laboratory methodologies for antimicrobial susceptibility testing (AST) (Chapter I.1.10).
A fifth guideline (Terrestrial Animal Health Code, Section 3.9) was accepted during the General Assembly of 2004 - Risk analysis methodology (Appendix 3.9.4).
OIE, FAO and WHO organized two joint Expert Workshops on Non-Human Antimicrobial Usage and Antimicrobial Resistance in Geneva, Switzerland, in December 2003, (Scientific Assessment) and in Oslo, Norway, in March 2004 (Management Options). It was recommended that OIE should develop a list of critically important antimicrobials in veterinary medicine and that WHO should also develop such a list for critically important antimicrobials in human medicine. OIE also suggested the creation of a joint OIE/Codex Alimentarius task force on antimicrobial resistance in order to work towards a common scientific position and to avoid gaps and/or duplications in OIE and Codex Alimentarius standards. This proposal is yet to be adopted by the Codex Alimentarius member countries.
Dr Schneider pointed out that antimicrobial resistance and the misuse of antibiotics are worldwide problems affecting both developed and developing countries. Developing countries needed to be assisted most in setting up structures for surveillance of antimicrobial resistance. Most private veterinarians in developing countries sell antimicrobials as a major component of services rendered to the livestock community and the problem of antibiotic residues in meat and eggs poses problems in the development of antimicrobial resistance. Dr Meslin informed the group that the Republic of Uganda requested assistance from WHO for the destruction of tonnes of expired antibiotics. Awareness campaigns are of particular importance in limiting the indiscriminate use of antibiotics. WHO was willing to cooperate with FAO/OIE in the use of antimicrobials. A WHO scientific assessment is that non-human use is essential. There was the need to monitor antimicrobial resistance from the animal side so as to use the necessary data for risk management of antimicrobial use.
Mediterranean Zoonoses Control Programme: Activities for zoonotic disease control
Zoonoses and food-borne infections cannot be controlled effectively by countries acting alone. The situation of zoonoses and food-borne infections in the Mediterranean countries was first addressed by member states of WHO at the 31st World Health Assembly held in 1978, which endorsed a resolution on the "Prevention and Control of Zoonoses and Food-borne Diseases due to Animal Products". Following the adoption of this resolution, WHO created the Mediterranean Zoonoses Control Programme (MZCP). To coordinate and manage its activities the Mediterranean Zoonoses Control Centre was established in 1979 in Athens, Greece. The MZCP collaborates closely with the Department of Communicable Diseases Control Prevention and Eradication at WHO headquarters, Geneva, as well as with the WHO Regional Office for the Eastern Mediterranean, EMRO, in Cairo, Egypt, specialized WHO collaborating centres and the MZCP network of national participating institutions. It maintains close relationships with OIE and the Animal Health and Production Division of FAO.
The main objectives of the programme are to:
foster, at national and interregional levels, programmes for the prevention, surveillance and control of zoonoses and food-borne diseases as an integral part of national health programmes;
and to strengthen the cooperation between veterinary and public health services, and to foster collaboration between the MZCP member states.
The MZCP is a self-financed activity that depends on the annual contributions of its member countries and on the support of its collaborating institutions for the implementation of its activities. The participating countries are Bulgaria, Cyprus, Egypt, Greece, Lebanon, Kuwait, Portugal, Saudi Arabia, Spain, the Syrian Arab Republic and Turkey. Countries associated with the programme are Algeria, Italy, Jordan, Malta, Morocco, Tunisia and Yemen. Countries wishing to join should accept the statutes and pay an annual contribution of 20 000 US$. During 26 years of operation, WHO/MZCP activities have focused on the concept of intercountry cooperation. Workshops and consultancies have been recognized as effective tools in developing common approaches to zoonoses and food-borne diseases in their prevention, surveillance and control. Over the past five years, the programme has been focusing on activities in capacity building in human resource development. Attention has been paid to the training of physicians, veterinarians, health inspectors and laboratory technicians in areas related to prevention, surveillance and control of major zoonoses and related food-borne diseases. A pilot brucellosis surveillance programme in the Syrian Arab Republic, with a computerized system linking public health and veterinary laboratory data, has recently been completed.
Asked on avenues for communication in the project in the Syrian Arab Republic, participants were informed by Dr Seimenis that public education was often through publications, presentations and indirectly through radio and television. These were the common avenues utilized in public education on the transmission of brucellosis from animals to humans. There was the possibility of connecting member countries of the MZCP to the VPH network. Dr Eddi wanted to know whether MZCP was concerned with the control of echinococcosis. Dr Seimenis responded that, at present, there were no activities geared towards the control of echinococcosis in the region. Many sectors needed assistance in the control of zoonoses, but these have been cancelled owing to lack of funds. The activities of MZCP are limited by its self-financing arrangements. He further explained that annual dues are paid to WHO in Geneva and WHO deducts 13 percent. Thus 18 700 US$ are received by MZCP. However, the contributions from member countries and payments are irregular and the financial situation is difficult. FAO has supported the activities of MZCP three times during the past five years in organizing workshops and supporting participants to some of the workshops. Dr Speedy pointed out that risk analysis and risk management are very important issues in VPH. There was the need to look at management systems on farms that do not rely on the extensive use of antimicrobials. Dr Seimenis responded that good agricultural practices are required to reduce the burden of zoonoses and these are actively promoted by the MZCP. According to Dr Seimenis, the establishment of a VPH coordinating unit in the Syrian Arab Republic was found to be extremely useful. A new technical environment and new professional mentality is needed to enhance the control of zoonoses in many countries. Tuberculosis centres where data are collected could serve as a focal point for the analysis and evaluation of brucellosis data.
Veterinary public health activities at FAO: current actions & what is needed
C. Eddi, K. de Balogh, J. Lubroth, W. Amanfu, A. Speedy, D. Battaglia, A.C. Bertrand and J. Domenech
This was a joint presentation by Carlos Eddi and Katinka de Balogh. The development of the VPH group in the Animal Health Service of FAO started in 2001 with members from the Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases/Infectious Diseases Group, the Parasitic Diseases Group, the Feed Resources Group of the Animal Production Service, and the Pro Poor Livestock project supported by the Department for International Development-UK. Activities of the Veterinary Public Health Group over the past four years were highlighted to include:
an expert consultation on community-based veterinary public health systems;
the establishment of a database of world veterinary schools;
a database of VPH professionals; and
the establishment of regional networks in Africa, Asia, Europe and South America.
An electronic exchange with these centres is coordinated from FAO headquarters. The VPH activities - 213B4 - in FAO is to have three major outputs in 2006, namely:
001 - integrated control of major zoonotic diseases;
002 - inputs to, and implementation of, Codex Alimentarius and SPS agreements; and
003 - good practices for reduction of food-borne human health risks.
Specific TCP projects that have direct relevance to the major outputs of the VPH programme were also highlighted. The key elements of these projects were:
TCP/SYR/2908 - Support the national brucellosis control programme through the establishment of local production of Brucella vaccines for cattle, sheep and goats. Establishment of a Brucella vaccine (B. abortus S19; B. melitensis Rev 1) seed lot and quality control system.
TCP/MOR/2904 - Improvements in diagnostic facilities and abattoir recognition of lesions of bovine tuberculosis. Definition of control strategies for bovine tuberculosis based on prevalence studies and cost-benefit analysis of control options as a basis for seeking future donor assistance in control of bovine tuberculosis in the Kingdom of Morocco.
TCP/LIT/3001 (T) - Training of staff in surveillance and control of echinococcosis. Determination of prevalence and risks for echinococcosis. Identification of the sources of infection. Reduction of cases in animals and humans. Preparation of national legislation harmonized according to EU standards.
TCP/ARG/3003 (A) - Determination of prevalence of Trichinella in endemic areas. Identification of the sources of infection. Training of veterinarians and laboratory technicians of the public and private sectors. Development of an ELISA test. Improvement of current diagnostic methods at slaughterhouses.
Answers from a survey conducted via the FAO/VPH mail list were analysed and presented by Katinka de Balogh. The survey sought answers to the following questions:
What are the five most important zoonoses to be addressed by FAO?
What three topics should be included in an FAO e-mail conference?
What importance is given to VPH in your country? Is it very important; important; low priority; or not addressed?
Rabies, brucellosis, tuberculosis, influenza and salmonellosis were the top five diseases of VPH concern in the countries that responded to the questionnaire in 2005. In comparison with a similar survey carried out in 2002, concerns over influenza featured prominently in this year's survey because of the current outbreaks of avian influenza in parts of Asia. In the delivery of VPH services, means of improving cooperation between the Ministries of Agriculture and Health should be sought. The need for data, and for assessment of the economic impact of zoonotic and food-borne diseases to be made so as to justify financial requirements for their control, was emphasized. On capacity building, it was noted that the VPH Group could liaise with universities and academic institutions in VPH curriculum development, and harmonization of training programmes, with due recognition of regional specificities based on sociocultural factors. In-service training and continuing educational programmes could be facilitated to improve capacity in VPH activities.
The possibility of having a joint FAO/WHO division on VPH (on a similar basis as the joint FAO/International Atomic Energy Agency (IAEA) division in Vienna) was raised by Dr Speedy. There was a general consensus that this idea could be further pursued in view of the rapidly evolving changes in VPH issues on the global front. Concern was raised by Dr Meslin on the scientific basis for administering the questionnaire and it was stated that this was just a snapshot of people's ideas on the control of zoonotic diseases. Food safety is now in the forefront of VPH concerns and this should be addressed by the international organizations. Dr Katinka de Balogh further stated that the current rejuvenation of VPH is refreshing, and the years of equating VPH with meat inspection are now over. In some areas of zoonoses, the role of FAO was found to be nebulous. The function of FAO in setting standards and guidelines in fish zoonoses was raised. Dr Amanfu pointed out that there was widespread use of antibiotics in aquaculture with potential for the development of antibiotic resistant strains of bacteria that could affect human populations. The need for a formal structure for VPH in FAO to meet the ever expanding VPH issues at both normative and field levels was stressed by participants.
Anthrax in animals: surveillance and control
Anthrax is primarily a disease of herbivores caused by a bacterium, Bacillus anthracis. The disease has been one of the most important causes of uncontrolled mortality in cattle, sheep, goats, horses, pigs and wildlife worldwide. Humans contract anthrax directly or indirectly from animals. Anthrax is still enzootic in many countries of Africa, Asia, a number of European countries, parts of the American continent and parts of Australia. Human case rates for anthrax are highest in Africa, the Middle East, and central and southern Asia. Where the disease is infrequent or rare in livestock, it is rarely seen in humans. Consumption of meat from animals that have died suddenly, or the skinning of these animals, have been the principal causes of anthrax outbreaks in humans. The report of the deliberate release of anthrax in 2001 in Florida, USA, rekindled the use of B. anthracis as an instrument of biological weapon/warfare and created a lot of panic throughout the international community.
Factors that favour the use of anthrax as a biological warfare agent are:
the low cost of culturing the anthrax organism;
no high-tech production - knowledge is widely available, it is easy to produce in large quantities; and
it is easy to weaponize - extremely stable and can be stored almost indefinitely as a dry powder.
The Malilangwe Wildlife Reserve in Zimbabwe experienced massive outbreaks of anthrax that affected wildlife species, in 2004. Epizootics of anthrax were experienced in wildlife in Botswana, Namibia and Uganda involving hippos, kudu, elephants, buffaloes and other wildlife. Diagnosis of the disease is made through the characteristic staining, the MacFaydean reaction, of the encapsulated bacilli in blood smears stained with polychrome methylene blue. There is little use of serological/immunological tests in anthrax diagnosis. Biosurveillance is very important in providing the basis for control. Anthrax control measures are aimed principally at breaking the cycle of transmission. Control methods used either singly or in combination can be employed to control anthrax. The following are the key elements of anthrax control:
correct disposal of anthrax carcasses;
disinfection, decontamination and proper disposal of contaminated materials;
vaccination of exposed susceptible animals and humans at risk;
adoption of quarantine and animal movement management controls; and
an important adjunct to control of anthrax is public awareness creation and intersectoral collaboration between the Ministry of Health and Veterinary Departments of the Ministry of Agriculture - farmer education and general public awareness on the dangers of consuming animals that die suddenly are very important in this regard.
Although anthrax is relatively simple to diagnose, many veterinary laboratories in developing countries lacked the necessary infrastructure for a rapid diagnosis of anthrax that could underpin control of the disease. This was regarded as one of the reasons for the low and inconsistent reporting of outbreaks of the disease. Professor Mantovani wanted to know about data on anthrax prevalence in humans. Dr Amanfu responded that such data were often lacking in official reports to OIE. Reports of anthrax outbreaks were frequently made through the press when there were human deaths caused by consumption of anthrax-infected carcasses, or skinning of animals that had died of the disease. Dr Meslin asked a question on the prevalence of anthrax in humans. Again the paucity of data in this area was pointed out. An example of the anthrax outbreak in Guinea-Bissau was given in which eighty people were affected, thirteen were hospitalised, and four died from the disease. The importance of proper disposal of anthrax-infected carcasses was stressed. The logistics of doing this in the field for the death of large domestic ruminants and wildlife due to anthrax should never be underestimated.
Food-borne diseases: Surveillance and control
A. Caprioli, L. Busani
Food-borne infections are an important public health concern worldwide. WHO and the US Centers for Disease Control and Prevention (CDC) report annually on the large number of people affected by the consumption of contaminated food and drinking water. The epidemiology of food-borne infections has profoundly changed during the past 20 years. Classical food-borne pathogens such as Mycobacterium bovis and Trichinella spp have been controlled or eliminated in industrialized countries. However, many other zoonotic pathogens have been newly described or newly associated with food transmission within the past 25 years such as E. coli 0157 in cattle and Salmonella Enteritidis in layer hens. The animal reservoirs are usually not affected by these pathogens. The trade of infected healthy animals has facilitated the global spread of many zoonotic agents. Therefore, surveillance must consider the monitoring of healthy animal populations and public health concerns must include events happening around the world.
Another important issue common to many emerging zoonotic pathogens is antimicrobial resistance, largely because of the widespread use of antibiotics in animal production. Campylobacter strains isolated either from human patients or from poultry are increasingly resistant to fluoroquinolones, after these agents were introduced for use in animals. Multiresistance has become a feature of some Salmonella serotypes such as S. Typhimurium, S. Blockley and S. Hadar. Therefore, public health concerns must include the improvement of prudent use of antimicrobials in husbandry productions.
The epidemiology of food-borne infections in industrialized countries has remarkably changed during the past ten years. An increasing number of unusual food vehicles have been associated with human infections. Many of these foods were previously considered safe from a microbiological standpoint. Dry-fermented sausages, considered safe because of their low pH and water activity, have now been associated with outbreaks of E. coli 0157 and Salmonella infections. The marked acidic and environmental resistance of E. coli 0157 also allows the organism to survive in apple cider and dried venison jerky. The internal contamination of intact eggs with Salmonella enteritidis is a consequence of the peculiar biological niche of this Salmonella serotype in egg-laying flocks. The dispersion of untreated animal excrements in the environment can cause the contamination of different items, which can then act as secondary vehicles of human infections. An increasing spectrum of fruits and vegetables fertilized with animal faeces or contaminated during harvesting or processing have been involved in food-borne outbreaks. Contaminated sprouts have caused episodes of salmonellosis and represent an emerging source of food-borne infections. Preventing food-borne infections is a multifactorial process.
Understanding the mechanisms by which contamination can occur along the chains of production and infections can be transmitted to human beings should be the basis for any prevention strategy. Prevention can be achieved by identifying and controlling the key points, from the farm to fork, at which contamination can either occur or be eliminated. The general strategy known as the Hazard Analysis and Critical Control Points System (HACCP) has replaced the strategy of final product inspection. Moreover, traditional food inspection, which mainly relies on visual identification of hazards, is often not adequate to detect contamination with the new food-borne zoonotic agents, which requires new control strategies. Prevention of food-borne zoonoses must begin at the farm level. Therefore, understanding how pathogens arrive at and persist in animal herds is a crucial step in prevention strategies. Controlling contamination of feed and water consumed by animals is an important part of such strategies. Consumer education about basic principles of food safety remains an important component of prevention. The main clinical manifestation of food-borne infections is diarrhoea, and the clinical syndromes caused by different food-borne pathogens are usually not distinguishable. As a consequence, reporting of disease episodes without indication of the aetiological agent will not distinguish between infections caused by agents (bacteria, protozoa, viruses) with different epidemiological cycles, including different animal reservoirs and different routes of transmission. National control programmes for food-borne zoonoses should therefore be laboratory-based, and networks of designated national reference laboratories capable of a full characterization of the food-borne agents should be implemented.
Tourism was important for both developed and developing countries and it was essential that developed countries and the international organizations helped developing countries improve capacity for surveillance activities in food safety. It was suggested that the EU should be interested in supporting developing countries to improve food safety standards because many of the tourists are from developed countries. There was the need for an advocate for good public health infrastructure for food safety standards and quality assurance as a means of ensuring food safety for nationals and for tourists as well. Food safety is a strategic priority, which requires definition of responsibility for both the producer and public health authorities in control and surveillance.
World health organization global salm-surv: A worldwide capacity building programme for the surveillance of salmonella and other food-borne pathogens
The WHO Global Salmonella-Survey (GSS) was initiated in 2000 as a global network of national and regional public health, veterinary and food laboratories involved in isolation, identification and antimicrobial resistance testing of Salmonella and surveillance of salmonellosis. From 2001, Campylobacter was included in GSS and more recently E. coli and V. cholera were introduced. The mission of GSS is to reduce the global burden of food-borne illness by strengthening laboratory-based surveillance and outbreak detection and response. GSS is a collaborative effort between WHO, the Danish Institute for Food and Veterinary Research, the US Centers for Disease Control and Prevention, Institut Pasteur, the Public Health Agency of Canada, the US Food and Drug Administration, the EU EnterNet, the Australian OzFoodNet, and the Dutch Animal Sciences Group. As of April 2005, WHO Global Salm-Surv had 862 general members from 140 countries. The mission of GSS is achieved through five project components that promote capacity building, collaboration, and communication. These components include international training courses, an External Quality Assurance System (EQAS), focused regional and national projects, an electronic discussion group (EDG), and a Country Data Bank.
International training courses - Since GSS began in year 2000, training courses have been conducted for over 300 microbiologists and epidemiologists from 91 countries in English, Spanish, French, Chinese, Russian, and Arabic. There are currently four training sites (Trinidad, Cameroon, the Russian Federation and China) and four Regional Centres (Mexico, Argentina, Poland and Thailand).
External Quality Assurance System - The system encourages laboratories to achieve the highest quality isolation, identification, serotyping and antimicrobial susceptibility testing results in collaboration with the Danish Institute for Food and Veterinary Research.
Focused regional and national projects - One other mechanism for encouraging collaboration between countries and different scientists is through focused regional and national projects. These were created to promote the continued development and application of skills or concepts introduced or learned at GSS training courses. Focused regional projects were developed between training course participants and GSS steering committee partners focusing on regional food-borne pathogens, serotypes, or public health practices of interest.
Electronic discussion group - The EDG links GSS members through a listserv. Messages from the EDG range from programmatic issues, through solicitations for information on outbreaks or rare serotypes, to training materials and recent publications on food-borne diseases. Messages are provided in English, Spanish, and French. An Arabic translation is posted on the web.
GSS Web-based Country Data Bank - The WHO Global Salm-Surv Country Data Bank reports annual surveillance summary results of the fifteen most frequently isolated Salmonella serotypes by member institutions. It is the only publicly available database of Salmonella serotypes isolated globally. Data may be from human, animal, food, feed, or environmental sources. Members are then able to trace sources and follow patterns of food-borne disease by comparing serotypes from human and non-human sources in different countries.
The international training courses served as excellent platforms for international and intersectoral cooperation in Salmonella and other food-borne pathogens (microbial) surveillance. The regional centres of excellence also offered training courses in surveillance capacity improvements on a regional basis and sharing of relevant surveillance data. Current trends indicate that surveillance and reporting systems in participating countries are gradually improving and therefore offer a basis for development of strategies to control food-borne pathogens. Surveillance for Salmonella enteritidis shows a gradual decline of pathogens in eggs and other poultry products. This suggests that control of Salmonella enteritidis at farm level is improving. Sharing of information and data on the GSS survey is critical to the future performance of GSS in food-borne pathogen control.
Dr Seimenis said that brucellosis can be readily controlled but it required a good state structure with well-trained people who were motivated to implement animal disease control rules and regulations. It required sufficient funds. It also needed intersectoral collaboration. Collaboration between veterinary services and public health departments is generally poor. Without this collaboration, eradication cannot be achieved. We need reliable serological diagnostic tests that can reach the efficiency of ELISA. He referred to a brucellosis control project in the Syrian Arab Republic. The cost of diagnostic tests should be taken into account. Public perception (or ignorance) is a major problem. Brucellosis has been eradicated or controlled by developed and rich countries.
Dr Speedy thought that the issue of priorities should be extended. He requested that the experts consider making a recommendation about the priority of VPH in the whole FAO livestock and agriculture programme. Dr Meslin said that whilst visiting the Ministry of Health in the Kingdom of Morocco in 2000, three diseases, i.e. rabies, leishmaniasis and echinococcosis, were the priorities set by public health authorities. He asked how the TCP objectives were set by FAO without Ministry of Health involvement. Dr Schneider noted that priorities for VPH change with time and economic circumstances. In Namibia, brucellosis had been effectively dealt with in the past. Now ovine and caprine brucellosis had become a priority because of EU requirements for export. They urgently need capacity to address EU requirements.
Dr El-Idrissi agreed that trade and economics are important issues. Avian influenza and BSE have a high impact on trade. The lack of intersectoral coordination is a problem of developing countries. Zoonotic diseases can only be eradicated in developing countries. Control of zoonotic diseases is not a problem of tests and strategies, but how capacity can be sustained. These are long-term disease eradication and control problems and they cannot be donor funded alone. There needs to be budget allocation by the national governments. Donor support could be expected for a maximum of five years. Recommendation should be made for governments to give financial support to animal disease control in general and zoonotic diseases in particular. Dr Sammartino agreed that long-term programmes were needed.
Dr Eddi agreed that political will was needed. Intersectoral collaboration is a human problem. He noted the difference of opinion on collaborating and reference centres; one view was that they should be based in developed countries; the other was that they should be in developing countries. We need to have a common FAO/WHO/OIE position on this issue. Dr Sammartino noted that the Pan American centre for cysticercosis had now been closed down.
Dr Kihm wanted to know whether there was a minimum standard that has to be complied with in order to control a disease? Disease awareness, diagnostic tools, etc. were required. Dr Nari informed the participants that, in parasitology, there used to be a centre on tick resistance in Germany. The cost was 3 million US$ per year and it was impossible to keep going. In South America, they had established different levels of laboratories. They found three types of laboratory: basic diagnostics, intermediate, and a few at a higher level. On the issue of sustainability, he noted that brucellosis vaccination had been carried out in the Eastern Republic of Uruguay for many years. Now the FMD crisis had diverted attention.
Lee Willingham raised the issue of cysticercosis. There had been a meeting in the United Republic of Tanzania. A report had been submitted to WHO in December but no reply had been received. Of all the countries considered, there were only three countries where there was enough quality of information. It was found that this was a serious problem in these countries. Health and trade were affected. There was a need for a practical test for surveillance in endemic countries. The availability and costs of tests needs to be considered, including those for tapeworms. Oxfendazole is used for control. There is a need to consider the safety of its use in pigs at an increased dose rate when compared to ruminants. A meeting on diagnostics, surveillance and control would be very helpful. On health information systems: it would be helpful if zoonotic diseases were included.
Dr Mantovani pointed out that cysticercosis was a disease of poor people in developing countries. In rich countries, BSE received a lot of attention. We should develop different strategies because they required very different approaches. There was a necessity for funds not only to eliminate infections but also to keep an area clean. Dr Schneider noted that the term cysticercosis was used here exclusively for porcine disease. There was the problem of bovine cysticercosis in Namibia. Although less serious, it caused zoonoses and economic losses. Dr Meslin observed that, for human parasitic diseases, WHO brainstorming sessions had decided on the most effective single intervention - usually mass drug treatment. There were a limited number of approaches for groups of diseases. Can this be done for zoonoses?
Dr Berrada supported the point made by Dr Amanfu. There was limited use in building capacity if it was subsequently lost. One of recommendations should be to sustain capacity for effective surveillance and control of zoonoses. Dr Kihm asked if something had been achieved with the WHO campaign for smallpox or the FAO campaign against rinderpest. Did we achieve something that was sustainable? Dr Eddi asked when Europe had been made free of cysticercosis. It was agreed that the only way to eradicate the disease was through socio-economic development.
From the general discussions throughout the meeting the following conclusions were recognized:
That VPH has an important contribution to make to the achievement of the Millennium Development Goals (MDGs) by directly enhancing human health and well-being through the prevention and control of zoonotic and food-borne diseases.
In addition, VPH programmes are able to reduce poverty and hunger through the provision of safe food and income-generation by increasing access to local, regional and international markets for animal products. Veterinary public health, and particularly capacity building activities in this area, should be assigned a higher priority in the livestock programme of FAO.
The complementary roles, experience and responsibilities of FAO, OIE and WHO suggest close collaboration within the Regular Programme and the TCPs.
Finally, activities within the FAO VPH programme of the Animal Production and Health Division (AGA) and FAO Food Quality and Standards Service (ESNS), and WHO Zoonotic Disease and Food Safety programmes need to be coordinated.
Recommendations of the FAO Expert Consultation On Capacity Building for Surveillance and Control of Zoonotic Disease.
Veterinary public health has an important contribution to make to the achievement of the MDGs of directly enhancing human health and well-being by preventing and controlling zoonotic and food-borne diseases. In addition, VPH programmes are able to reduce poverty and hunger through the provision of safe food and income-generation by increasing access to local, regional and international markets for animal products. Veterinary public health, and particularly capacity building activities in this area, should be assigned a higher priority in the FAO livestock programme.
The complementary roles, experience and responsibilities of FAO, OIE and WHO suggest close collaboration within the Regular Programme and TCPs. Activities within the FAO VPH and ESNS, and WHO Zoonotic Disease and Food Safety programmes need to be coordinated.
A. FAO organizational effectiveness:
1. Formalize a dedicated unit for VPH in AGA, with the direct cooperation of other services. In addition, consideration should be given to enhancing VPH capabilities at FAO regional and subregional offices (for example through the placement of VPH officers). The unit should assist with VPH systems development, service delivery and coordinate VPH activities in member countries.
B. FAO should maximize its resources by promoting regional approaches to VPH by:
2. Expanding at regional levels its networks of collaborating and reference centres for training, surveillance, diagnosis and research on zoonoses and VPH issues. These new and existing centres should be located mainly in developing countries, in order to promote knowledge, techniques, and control programmes on zoonotic and food-borne diseases. These centres should also provide regional training on internationally standardized laboratory diagnostic techniques and research. Professional expertise and support should be made available for the regional harmonization of training for veterinary and public health personnel and for veterinary paraprofessionals.
3. Strengthening human resource and institutional capabilities at the regional level in developing countries by designing participatory, intersectoral multidisciplinary approaches to defining VPH priorities, by conducting surveillance, risk and disease burden assessments using appropriate techniques such as risk analysis, and by initiating control activities. This should include training and support on more effective advocacy for VPH at the national and regional decision-making and standard-setting levels.
4. Promoting the organization of electronic conferences at the regional level. It is strongly recommended that these conferences be conducted in the major regional languages. The topics should be selected after consultation with the relevant professional groups in the regions.
5. Assisting in the establishment by regional organizations and academic institutions of educational programmes at regional level, including continuous professional development and extension programmes on VPH for veterinary and medical public health personnel. These should include paramedical and paraveterinary staff, as well as farmers and other professional groups at risk. Also develop educational/awareness programmes for the general population at risk. Assist and provide guidance for pre- and postgraduate training in epidemiology, disease prevention, food safety, and zoonosis control. These programmes should include HACCP implementation, the risk of antimicrobial resistance due to the non-human use of antimicrobials, and pesticides and veterinary drug residue issues.
6. Supporting the development, among the national and regional VPH staff, of improved management, organizational and communication skills to organize and manage large-scale control programmes, especially regional programmes, with emphasis on supervisory and evaluation training.
7. Assisting and encouraging the joint participation and collaboration of the animal and public health sectors on significant zoonoses and in new areas of common concern relating to VPH such as environmental degradation, prevention of antimicrobial resistance due to non-human use of antimicrobials, food safety (microbiological and chemical hazards) and natural and man-made disasters.
8. Facilitating and encouraging national and regional intra- and intersectoral collaboration in developing and implementing VPH and zoonoses control programmes. This should include high level decisions made at ministerial levels as well as educational efforts directed in particular at veterinary and medical public health sectors and organizations, and other sectors such as finance, planning and trade. Government should enable combined action (political, legislative and administrative) by their Ministries of Agriculture, Health and Trade.
9. Providing information related to VPH issues in emergency conditions by creating a database of experts, developing guidelines for relief actions in emergency situations, and developing a strategic training system dealing with VPH in emergency situations.
10. Working closely with private industry in order to mobilize resources and share knowledge and experience for the implementation of mutually beneficial activities in the field of zoonoses and food-borne diseases.