Dr Victor Del Rio Vilas
In recent years, global public health security has been threatened by zoonotic disease emergence as exemplified by outbreaks of H5N1 and H1N1 influenza, SARS, and most recently Ebola and Zika. Additionally, endemic zoonoses, such as rabies, burden countries year after year, placing demands on limited finances and personnel. To survey the baseline status of the emerging and endemic zoonoses programmes of the Latin American and the Caribbean (LAC) countries, the Pan American Health Organization (PAHO) conducted a survey of priority emerging and endemic zoonoses, countries´ prioritization criteria and methodologies, and suggestions to strengthen countries capacities and regional approaches to zoonoses control.
A fillable online questionnaire was sent to the zoonoses programme managers of the Ministries of Health (MOH) and Ministries of Agriculture (MAg) of 33 LAC countries from January to April of 2015. The questionnaire comprised 36 single, multiple choice and open-ended questions to inform the objectives of the survey. A descriptive exploratory analysis was completed.
Fifty-four ministries (26 MOH, 25 MAg, and 3 combined responses) in 31 LAC countries responded to the survey. Within the ministries, 22 (85%) MOH, 5 (20%) MAg, and 2 (67%) combined entities indicated they had specialized zoonoses units. For endemic zoonoses, 32 of 54 ministries responded that they conduct formal prioritization exercises, most of them annually (69%). The three priority endemic zoonoses for the MOHs were leptospirosis, rabies, and brucellosis while the three priorities for the MAgs were brucellosis, rabies, and tuberculosis. Diagnosis for rabies and leptospirosis were cited as the capacities most in need of development. The most needed cross-cutting capacity was coordination between stakeholders. For emerging zoonoses, 28 ministries performed formal prioritization exercises. The top prioritization criteria were probability of introduction into the country and impact. The three priority emerging zoonoses for the MOHs were Ebola viral disease, avian influenza, and Chikungunya while for the MAgs were avian influenza, bovine spongiform encephalopathy and West Nile virus disease. Surveillance for avian influenza and Ebola, and diagnosis for BSE were quoted as the capacities most needed. For all zoonoses, the majority of respondents (69%) ranked their relationship with the other Ministry as productive or very productive, and 31% minimally productive
populations are to diseases, especially for zoonoses (i.e. diseases transmitted
from animals to humans) given their pandemic potential. These measures
would be valuable to support strategic and operational decision making
and allocation of resources. But, vulnerability is well defined for natural
hazards, for public health threats the concept remains undetermined.
Here, we developed new methodologies to: (i) quantify the impact of zoonotic
diseases and the capacity of countries to cope with these diseases, and
(ii) combine these two measures (impact and capacity) into one overall
vulnerability indicator. The adaptive capacity is calculated from estimations
of disease mortality although the method can be adapted for diseases with
no or low mortality but high morbidity. As example, we focused on the
vulnerability of Nigeria and Sierra Leone to Lassa Fever and Ebola. We
developed a simple analytical form that can be used to estimate vulnerability
scores for different spatial units of interest, e.g. countries or regions. We
showed how some populations can be highly vulnerable despite low
impact threats. We finally outlined future research to more comprehensively
inform vulnerability with the incorporation of relevant factors depicting
local heterogeneities (e.g. bio-physical and socio-economic factors).