The Southern African Centre for Infectious Disease Surveillance: A One Health Consortium.

1.2 MB·English

by  Rweyemamu, Mark M.

(cid:2)NETWORK
The Southern African Centre for
Infectious Disease Surveillance:
A One Health Consortium
Mark M. Rweyemamu1*, Peter Mmbuji2, Esron Karimuribo1,
Janusz Paweska3, Dominic Kambarage1, Luis Neves4,
Jean-Marie Kayembe5, Aaron Mweene6 and Mecky Matee7
1SACIDS atSokoine University ofAgriculture, Morogoro,Tanzania; 2Department ofPreventiveServices,
Ministry ofHealth andSocial Welfare, Dares Salaam, Tanzania; 3NationalInstitute for Communicable
DiseasesoftheNationalHealthLaboratoryServices,Sandringham,Johannesburg,SouthAfrica;4Facultyof
Veterinary Medicine, EduardoMondlane University, Maputo, Mozambique;5School ofPublicHealth,
UniversityofKinshasa,DemocraticRepublicofCongo;6SchoolofVeterinaryMedicine,UniversityofZambia,
Lusaka;7DepartmentofMicrobiologyandImmunology,MuhimbiliUniversityforHealthandAlliedSciences,
Dares Salaam, Tanzania
Formedin2008,theSouthernAfricanCentreforInfectiousDiseaseSurveillance(SACIDS)isaOneHealth
consortium of academic and research institutions involvedwith infectious diseases of humans and animals.
Operatinginpartnershipwithworld-renownedcentresofresearchinindustrialisedcountries,itsmissionisto
harness innovations in science and technology for improving southern Africa’s capacity to detect, identify,
monitor(DIM)andmanagetheriskposedbyinfectiousdiseases ofhumans,animals,andecosystems.The
consortium’s majorcapacitydevelopment activities include a series of One Health-based Masterof Science
(MSc)coursesandafive-yearDIM-drivenresearchprogram.Additionally,SACIDSorganizedAfrica’sfirst
OneHealthconference,inJuly2011.ThispaperdescribestheseandothermajoractivitiesthatSACIDShas
undertaken to improve infectious disease surveillance across southern Africa. The paper also describes the
role and collaboration of SACIDS with other national, regional and international consortia/networks that
share avision and interest in promoting novel approaches to infectious disease surveillance and outbreak
response.
Keywords: SACIDS;SADC;OneHealth;mobileICT;CORDS;wildlife-livestock-humaninteraction
Introduction sectors; and, ideally, through an approach that is based
Founded in 2008, the Southern African Centre for on ecological systems, which in Africa often transcend
Infectious Disease Surveillance (SACIDS) services the administrative or national boundaries (1).
Southern African Development Community (SADC). The underlying concepts for One Health have long
Operating in partnership with world renowned research been recognized. In the 19th century, Rudolf Virchow
institutions in the United Kingdom, United States, and observed,‘‘Betweenanimalandhumanmedicinethereis
Asia, SACIDS (www.sacids.org) is a virtual center that no dividing line (cid:2) nor should there be. The objective is
links expertise and physical resources across institutions different, but the experience obtained constitutes the
and health sectors with the goal of developing southern basis of all medicine’’ (2). In the 1960’s, Calvin Schwabe
Africa’s capacity for the cost-effective risk management stated, ‘‘There is no difference between human and
of its regional infectious disease burden threat. It has veterinary medicine. Both sciences share a common
becomeincreasinglyapparentthatthemostcost-effective body of knowledge in anatomy, physiology, pathology,
strategyforaddressingthehighinfectiousdiseaseburden on the origins of diseases in all species’’ (3). However,
and risk in southern Africa must be through the sharing only recently, largely through the risk of emerging
of expertise and resources across institutions; through infectious diseases, has the One Health paradigm come
closecollaborationbetweenthehumanandanimalhealth into sharp focus, with the dialogue shifting from one
EmergHealthThreatsJ2013.#2013MarkM.Rweyemamuetal.ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttribution- 1
Noncommercial3.0UnportedLicense(http://creativecommons.org/licenses/by-nc/3.0/),permittingallnon-commercialuse,distribution,andreproductioninany
medium,providedtheoriginalworkisproperlycited. Citation:EmergHealthThreatsJ2013,6:19958-http://dx.doi.org/10.3402/ehtj.v6i0.19958
(pagenumbernotforcitationpurpose)
MarkM.Rweyemamuetal.
centeredonthepracticeofOneHealth(‘‘OneMedicine’’) percent of emerging infectious diseases in humans
to one centered on One Health as an outcome or goal originatedinanimals. Thattrendisexpectedtocontinue
(4,5).Yet,stillthereisnouniversallyagreeddefinitionof in the future, as economic development, changes in
One Health. At the 2007 American Veterinary Medical habitation and farming systems, globalization of travel
Association convention, Lonnie King described One and trade, and climatic variations continue to fuel the
Healthas‘‘aholisticsystems approachtounderstanding emergence and spread of infectious diseases. Many of
health across all species’’ (6). He explained, ‘‘It’s a theseanimal-originatingemergingdiseasesinhumansare
recognition that human and animal health are inextric- endemic to Africa (and Asia) and constitute a high risk
ably linked, and One Health is about how to promote, for future marginalization of Africa; and could severely
improve, and defend the health and well-being of all constrain human mobility and access to international
species,withthecooperationofphysiciansandveterinar- markets for African animal and plant commodities.
ians.’’TheAVMAdescribesOneHealthasa‘‘collabora- Reducingtheriskposedbyanimalandhumanpathogens
tive effort of multiple disciplines working locally, (cid:2) and their interactions (cid:2) requires more than an under-
nationally, and globally to attain optimal health for standing of the diseases themselves. It also requires an
people, animals and our environment’’ (7). An arguably understanding of the social context of disease. SACIDS
more comprehensive description is the European Com- researchers advocate that substantial advances in infec-
missiondefinition:‘‘theimprovementofhealthandwell- tiousdiseasepreventionandmanagementcouldbemade
being through (i) the prevention of risks and the not just by integrating research across health sectors
mitigation of effects of crises that originate at the (human, animal, ecosystem), but also across disciplines
interface between humans, animals and their various (natural and social science) (16).
environments, and (ii) promoting a cross-sectoral, colla- SADC is geographically and culturally linked to the
borative, ‘whole of society’ approach to health hazards, five-country East African Community (EAC): Burundi,
asasystemicchangeofperspectiveinthemanagementof Rwanda, Uganda, Kenya, and Tanzania. Together, the
risks’’ (8). two regional economic communities (RECs) share not
In the absence of a single universally accepted defini- only a vision for inter-regional free trade, but also an
tion of One Health, the trend is for practitioners to abundance of wildlife animals in their savannah
describetheirownOneHealthfocus, oftenreflectingthe and forest ecosystems and an intense wildlife-livestock-
underlying driver or objective of their work. Given that human dynamic (17). Thus, some SACIDS activities
infectious diseases drive the mission of SACIDS, the are conducted in collaboration with the East African
SACIDSfocusonOneHealthseekstoapplytheconcept Integrated Disease Surveillance Network (EAIDSNet)
to the management of infectious disease risk. Accord- (18).
ingly, we have identified the SACIDS focus on One
Health as: a collaborative effort between natural and Governance
social scientiststoadvance theunderstanding ofinterac- The headquarters of SACIDS is located at the Sokoine
tionsbetweenhumans,animals,andtheirenvironmentin University of Agriculture (SUA), Morogoro, Tanzania.
theendemicsettingsofsouthernAfrica.WhileSACIDS’s SACIDS operates as a non-profit inter-institutional
One Health focus broadly relates to definitions for One consortium through the legal frameworkof the SACIDS
Health described by others (2(cid:2)8), the SACIDS focus secretariat host (i.e., SUA) and member institutions. At
firmly reflects its own vision and mission. The vision of the national level, several virtual centers for infectious
SACIDS is a southern African society protected from diseases have been formed. Collectively, these National
devastating infectious diseases affecting the health of Centres for Infectious Disease Surveillance (NatCIDS)
humans, animals (i.e. both terrestrial and aquatic), and form the core of SACIDS (see Table 1). The underlying
ecosystems (i.e., crop, fruit, and ornamental), thereby concept of the consortium’s governance is equitable
promoting livelihoods, socio-economic development representation of the human and animal health sectors
(including market access), and the environment. The at both the national and regional levels in order to
consortium’s mission is to harness innovation in science ensure effective inter-sectoral collaboration. SACIDS
and technology for improving southern Africa’s capacity also operates in partnership with world-renowned
to detect, identify, and monitor infectious diseases of centres of research in several industrialised countries,
humans, animals, ecosystems and their interactions and especially the University of London Colleges, United
to better manage the risk posed by them. Kingdom. For a complete list of partnerships, see
The need for a One Health approach is supported by Table 1.
the findings of several recent studies (9(cid:2)15). Together, SACIDS seeks to enhance the effectiveness of existing
these studies have shown that about 60 percent of all official disease surveillance systems. Thus, at both
infectious pathogens of humans originate from animals national and regional levels, SACIDS is underpinned
and that, over the last 25 to 30 years, some 70 to 75 by sector ministries and regional inter-governmental
2
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SACIDS
organizations,especiallySADC,theNewPartnershipfor humanhealth,livestockandwildanimalhealth;operates
Africa’sDevelopment(NEPAD),andtheAfricanUnion. under the patronage of national chief medical and
At the national level, each NatCIDS includes as active veterinary officers; and is linked to national offices
membersrepresentativesoftheMinistriesresponsiblefor responsible for responding to natural emergencies.
Table1. ParticipantsintheSACIDSConsortium
PartnershipCategory Partners
SouthernAfricanpioneer Partner NationalCoordinator ConstituentMembers
partnersandconstituent
membersofSACIDS
byagreement
TanzanianNational ProfessorMeckyMatee,HeadDept TheNationalInstituteforMedical
Consortium Microbiology,MuhimbiliUniversityof Research(NIMR)
HealthandAlliedSciences,MUHAS, IfakaraHealthResearch&Development
DaresSalaam,Tanzania Centre,Tanzania
TheMuhimbiliUniversityofHealthand
AlliedSciences(MUHAS)
TheFacultyofVeterinaryMedicine,
SokoineUniversity(FVM-SUA)
TheCentralVeterinaryLaboratory(CVL)
TheTanzaniaWildlifeResearch
Institute(TAWIRI)
TheInstituteofResourceAssessment
(IRA),UniversityofDaresSalaam
DemocraticRepublic ProfessorJean-MarieKayembe TheInstituteofPublicHealthoftheFaculty
ofCongo(DRC) Ntumba,AssociateDean, ofMedicineoftheUniversityofKinshasa
NationalConsortium FacultyofMedicine,Instituteof TheFacultyofVeterinaryMedicineofthe
PublicHealthKinshasa,DRC UniversityofLubumbashi
NationalInstituteforBiomedical
Research(INRB)
TheCentralVeterinaryLaboratoryin
Kinshasa
NationalInstituteforNature
Conservation(ICCN)
MozambiqueNational DrLuisNeves,FacultyofVeterinary FacultyofMedicine-Eduardo
Consortium Medicine,EduardoMondlane MondlaneUniversity(FM-EMU)
University,Mozambique FacultyofVeterinaryMedicine(cid:2)Eduardo
MondlaneUniversity(FVM-EMU)
DirectorateofAnimalSciences(cid:2)
InstituteofAgriculturalResearchof
Mozambique-MinistryofAgriculture
(DCA-IIAM)
NationalHealthInstitute(cid:2)Ministryof
Health(INS)
NationalInstituteforFisheries
Inspection(INIP)
ZambiaNational Dr.AaronS.Mweene,Dean,School SchoolofVeterinaryMedicine,
Consortium ofVeterinaryMedicine,Universityof UniversityofZambia
Zambia SchoolofMedicine-Universityof
Zambia
CentralVeterinaryResearchInstitute
(CVRI)
TropicalDiseasesResearchInstitute
(TDRC)
3
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MarkM.Rweyemamuetal.
Table1(Continued)
PartnershipCategory Partners
SouthAfricanInstitutes ProfessorAntonyMusoke,Director, NationalInstituteforCommunicable
intheSACIDS OnderstepoortVeterinaryInstituteof DiseasesoftheNationalHealthLaboratory
Consortium theAgriculturalResearchCouncil Service(NICD/NHLS),Johannesburg,
(ARC-OVI),Pretoria,SouthAfrica SouthAfrica
OnderstepoortVeterinaryInstituteofthe
AgriculturalResearchCouncil(ARC-OVI),
Pretoria
FacultyofVeterinaryScienceUniversityof
Pretoria(FVS-UP),atOnderstepoort
StellenboschUniversity,MedicalSchool,
CapeTown
Londonstrategicsmart LondonInternationalDevelopmentCentre,UniversityofLondon
partners RoyalVeterinaryCollege,UniversityofLondon
LondonSchoolofHygieneandTropicalMedicine,UniversityofLondon
InstituteofEducation,UniversityofLondon
ImperialCollege,London
InstituteforAnimalHealth
South-Southcollaborating EastAfricanIntegratedDiseaseSurveillanceNetwork(EAIDSNet)
institutions FacultyofTropicalMedicineandCenterofExcellenceforBiomedicalandPublicHealthInformatics
(BIOPHICS),MahidolUniversity,Bangkok,Thailand
SouthernAfricanDevelopmentCommunity(SADC)EpidemiologyandInformaticsSub-committeeofthe
LivestockTechnicalCommittee
SADCTrans-BoundaryAnimalDiseases(TADs)ProgrammeofSADCSecretariat
AfricanFieldEpidemiologyNetwork(AFENET)
AfricanResearchConsortiumforEcosystemsandPopulationHealth(AFRIQUEOne)
SouthernAfricanConsortiumforResearchExcellence(SACORE)
ConnectingOrganizationsforRegionalDiseaseSurveillance(CORDS)
MekongBasinDiseaseSurveillance(MBDS)Network
ConsultativeGroupon InternationalLivestockResearchInstitute(ILRI),Nairobi,Kenya
InternationalAgricultural
Research(CGIAR)
partner
Othercollaborating CentreforPopulationandEco-Health,UniversityofGlasgow,UnitedKingdom
institutionsfromthe CentreforInfectiousDiseases,UniversityofEdinburgh,UnitedKingdom
North GlobalHealthandSecurityInitiativeoftheNuclearThreatInitiative(NTI),Washington,D.C.,UnitedStates
CentreforZoonosisControlHokkaidoUniversity,Japan
SchoolofVeterinaryMedicine,UniversityofCalgary,Canada
DepartmentofGeography,UniversityofCambridge,UnitedKingdom
InternationalInstituteforEnvironmentandDevelopment,London,UnitedKingdom
InstituteofTropicalMedicineandInternationalHealth,Berlin,Germany
MeteorologyOffice,HadleyCentre,Exeter,UnitedKingdom
FondationMe´rieux,France
InSTEDD(InnovativeSupporttoEmergencies,DiseasesandDisasters),StanfordUniversity,California,USA
andCambodia
At the regional, or SADC level, SACIDS is developing Activities and Achievements
linkages with sections of the SADC Secretariat that The initial focus of SACIDS is on capacity development
deal with human and animal health matters, not only through employment of the Community of Practice
through desk officers but also directly with the com- (CoP)principle(19).ACoPisaparticipatorypartnership
municable diseases and livestock technical committees amongpeoplewhoshareacommonconcernandinterest,
thatadvise governmentsonprioritydiseasesforregional in this case the vision and mission of SACIDS, andwho
priority. conveneregularlytolearnfromeachother(20).Building
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SACIDS
on existing strengths and programs, SACIDS is focused
on four major sets of activities:
1) Provide training through two ‘‘One Health’’ MSc
courses,oneatSokoineUniversity,Tanzania,witha
focus on molecular biology; the other at the Uni-
versity of Zambia, Lusaka, with a focus on analy-
tical epidemiology. Each course includes core
modules on the understanding of key One Health
challenges.Thecourseshavebeendevelopedandare
being delivered in collaboration with regional in-
stitutions and the University of London’s London
SchoolofHygieneandTropicalMedicine(LSHTM)
and Royal Veterinary College (RVC).
Fig.1. ScientistsfromtheSADCregion,includingaSACIDS-
2) Developresearchcapacity,focusingprimarilyonfive
sponsored postdoctoral research fellow, working in the only
disease-driventhemes:(i)climate-dependent,vector- biosafety level 4 (BSL-4) laboratory in Africa, which is loca-
borne diseases (e.g., Rift Valley fever); (ii) diseases ted at the National Institute for Communicable Diseases,
with potential inter-species concern/spread between Johannesburg,SouthAfrica.Source:SACIDS.
wildlife, livestock, and humans (e.g., tuberculosis);
(iii) diseases of economic and food security impor-
tance (e.g., foot-and-mouth disease); (iv) bacterial
rarediseases(e.g.,plague);and(v)dangerousemer-
ging diseases (e.g., viral haemorrhagic fevers). The
consortium’s research on One Health policy is
focused primarilyon diseaseburdenin the dry land
ecosystems of southern and East Africa and its
impact on livestock-dependent communities (21).
Another cross-cutting area of research is that on
participatory epidemiology (22) and the use of
mobile technologies to collect and transmit field
data.
3) Share expertise and resources across consortium
institutions, especially for disease emergency situa-
tions(SeeFigure.1).Thevalueofthisapproachhas
been demonstrated by the discovery of two new
arenaviruses, LuJo (23, 24) and Luna (25).
4) Examine approaches and mobile technologies for
improving the efficiency of disease alerts, surveil-
lance and response (26).
Additionally, SACIDS organized the first One Health
conference in Africa at the National Institute for Com-
municable Diseases, Johannesburg, South Africa, in July
2011 (Figure. 2). The conference covered the same
research themes listed above (under the second bullet
point).Foreachtheme,youngscientistspresentedaseries
ofshortpapers,followedbyakeynotepaperbyaninvited
specialist of international repute. The final session was
addressed by the special conference guest, Dr. David
Nabarro of the United Nations, who spoke about ways
that the One Healthapproachis contributingnot justto
healthbutalsotofoodsecurityandcommunityeconomic
well-being. Nabarro emphasized the importance ofover-
Fig. 2. A poster for the first One Health conference held in
comingthetendencytoworkin‘‘professionalnichesand Africa,inJuly2011,whichwasconvenedbySACIDS.Source:
bureaucraticsilosand,instead,sharingdataandanalyses, SACIDS.
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MarkM.Rweyemamuetal.
developing joint policies, doing research together, im- percent of the sub-Saharan human population but
plementingjointinvestigationsandbeingaccountablefor accounts for 50 percent of TB cases reported. The
delivering results’’ (27). Nabarro’s address was followed SADC Health Protocolincludes aspecific Article 12
byagranddebatebyinvitedspecialistswhodescribedthe on TB control, advocating for global and regional
variousfacetsofOneHealth.Theconferenceproceedings partnerships to respond to the TB epidemic in the
were published in a special supplement of Onderstepoort SADC region (30). This fact, coupledwith a lackof
Journal of Veterinary Research (28). knowledge about the role of zoonotic Mycobacteria
SACIDS One Health efforts complement other efforts strains in the infection of humans, was a key
to integrate human and animal disease surveillance. For justification for the selection of TB as an exemplar
example, in the spirit of One Health, the Tanzania Field disease for study by SACIDS.
Epidemiology and Laboratory Training Programme
(FELTP) is governed by a multi-sectoral steering com-
mittee whose members include representatives from the
Text Box 2. Piloting mobile technologies and One
Ministry of Livestock Development and Fisheries, and
Health surveillance approaches
efforts are underway to establish a veterinary stream of
theTanzaniaFELTP.TFELTPisacollaborationbetween
With funding from the Rockefeller Foundation,
MOHSW, Muhimbili University of Health and Allied
SACIDS is collaborating with EAIDSNet on the
Sciences (MUHAS), National Institute of Medical Re-
pilot application of a One Health-based mobile
search (NIMR), Centres for Disease Control and Pre-
technology approach to disease surveillance. The
vention(CDC),WorldHealthOrganization(WHO),and
project operates in Tanzania, Zambia, and Burundi.
AfricanFieldEpidemiologyNetwork(AFENET)(25).It
In Tanzania, the approach has been to involve
was established by the Ministry of Health and Social
human,livestock,andwildlifesectorsatthenational
Welfare (MOHSW) in 2008, following an assessment of
and local levels, relying on specialists from both the
Tanzania’sexistingpublichealthandsurveillancesystems
humanandanimalsectorstoagreeonasetoftarget
and recognition of the need for a competently trained
diseases and to design shared data-collection forms.
public health workforce (29). Additionally, most SADC
The forms are programmed into Android-driven
countries have adopted the WHO-AFRO system for
mobile telephones using the EpiCollect and ODK
Integrated Disease Surveillance and Response (IDSR),
which promotes a One Health-based strategy (30). programmes (31). Primary health workers enter
disease data into the mobile telephones; and data
aretransmittedviathemobiletelephonenetworktoa
Case Studies
serveratSACIDSheadquartersforstorage,analysis,
Text Boxes 1 and 2 present case studies illustrating the
and mapping (Fig. 3). Piloting efforts thus far have
ongoing activities and early accomplishments of SA-
shown that for effectiveness and sustainability, a
CIDS. Text Box 1 describes how SACIDS’s selection of
mobile technology-based disease surveillance system
tuberculosis (TB) as a priority disease reflects not only
will require three key elements: i) participatory
SACIDS’s focus on One Health, given the potential
epidemiologicalapproaches;ii)form-basedreporting;
spread of TB between animals and humans, but also
andiii)residentICTexpertiseforprogrammingatthe
seeks to enhance the effectiveness of already existing
discovery end and for local support, database hand-
surveillance systems.
ling,customizedprogramming,trouble-shooting,and
training at the user end (22).
Text Box 1. Tuberculosis as apriority disease
for both SACIDS and SADC
The case study described in Text Box 2 demonstrates
how SACIDS is fostering inter-sectoral collaboration in
Various Mycobacteria strains, the causative agent(s)
OneHealthsurveillanceandresponsethroughtheuseof
of tuberculosis (TB), can infect both animals and
humans.SACIDS’sfocusonTBexemplifiesnotonly mobile technologies. Once rolled out, the One Health-
how SACIDS is focused on developing and imple- based mobile technology system described in Text Box 2
mentingaOneHealthapproachtoinfectiousdisease will help to meet the need for a systemic exchange of
surveillance,butalsohowSACIDSseekstoenhance disease surveillance data across the human and animal
existingsurveillance systemsbyprioritizingthesame health sectors within SADC. There is no such exchange
diseases that the official organs of SADC prioritize. occurring except via vertical programs like the ongoing
SADC prioritizes TB because member states carry a WHO-supported rabies elimination project in Tanzania
disproportionate burden of the dual epidemic of TB and South Africa. The episodes of Rift Valley fever in
and HIV/AIDS compared to the rest of Africa and 1997/8and2007inTanzaniabroughttotheforetheneed
the rest of the world. The region is home to 25 for such exchange (16, 28).
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SACIDS
for One Health infectious disease surveillance and
response.
Butastheburdenincreases,sotoodoopportunitiesfor
reducingtheburden.ItisanticipatedthatSACIDSitself
will continue to evolve as an initiative that promotes
novel One Health approaches to infectious disease
surveillance, such as the application of improved diag-
nostic and information technologies that can be used in
remote rural settings. To be effective, SACIDS will need
to strengthen its ‘‘engagement’’ and convening strategy
for developing smart, shared-vision partnerships at na-
tional, regional, and international levels. CORDS helps
to nurture that strength.
Fig. 3. Images of the SACIDS-EAIDSNet piloting mobile Acknowledgements
technology being used to conduct One Health disease surveil-
lance in Ngorongoro (Tanzania), the Kagera Basin (cross- The work of SACIDS has been possible thanks to the financial
border across Rwanda-Burundi-Tanzania), and the Zambezi support of The Google Foundation, The Rockefeller Foundation,
Basin(Zambia)ecosystems.Source:SACIDS. andTheWellcomeTrust.Wearegratefultothesupportofthehost
institution(SokoineUniversityofAgriculture,Tanzania)andallthe
Relationship to CORDS participating and collaborating institutions in Africa, the United
Kingdom,theUnitedStates,andAsia.
CORDS provides a common vision and goal for disease
surveillance that transcends regions; allows for South-
South-North exchange of experiences and mutual trust;
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