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McCarthy, Simone. “New Langya Virus Found in China Could Be ‘tip of the Iceberg’ for Undiscovered Pathogens, Researchers Say.” CNN, 12 Aug. 2022, www.cnn.com/2022/08/12/china/china-new-virus-disease-animal-spillover-intl-hnk/index.html. 

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McCarthy, Simone. “New Langya Virus Found in China Could Be ‘tip of the Iceberg’ for Undiscovered Pathogens, Researchers Say.” CNN, 12 Aug. 2022, www.cnn.com/2022/08/12/china/china-new-virus-disease-animal-spillover-intl-hnk/index.html. 

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1. The argument in this article is that there is a need for a higher level of pandemic zoonotic disease surveillance placed in China due to the high amount of cases of disease that are spreading at potential-pandemic levels.
2. The argument is presented with a piece of data saying three highly deadly diseases were already found widespread in China at the beginning of 2022. This data helps the case and shows that there are issues that need to be monitored in China, just like everywhere else in the world.
3. The author takes the stance that there is not enough surveillance for zoonotic disease prevention in China, and there needs to be more. There seems to be a bias because, in many places throughout the world, there are issues with surveillance, but this focuses mainly on China.
4. Many ideas relating to zoonotic disease surveillance and early detection are similar, making this article have some new viewpoints like the number of zoonotic cases in the world and how much they vary from disease to disease, but the majority are similar ideas relating to prevention tactics.
5. This source supports my ideas because it addresses issues with the world's current surveillance system and early prevention methods. I believe that there are valid points of how badly we are underestimating the severity and amount of these diseases that could rapidly spread at any moment.
6. This author's intended audience would be individuals who are often news readers and want to know about the latest in world health. The author's purpose in writing was to show that there is a new prominent disease called the Langya Virus which is showing high levels of contagiousness.

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Editor's Note: A version of this story appeared in CNN's Meanwhile in China newsletter, a three-times-a-week update exploring what you need to know about the country's rise and how it impacts the world. Sign up here.

More surveillance is needed of a new virus detected in dozens of people in eastern China that may not cause the next pandemic but suggests just how easily viruses can travel unnoticed from animals to humans, scientists say.

The virus, dubbed Langya henipavirus, infected nearly three dozen farmers and other residents, according to a team of scientists who believe it may have spread directly or indirectlyto people from shrews - small mole-like mammals found in a wide variety of habitats.

The pathogen did not cause any reported deaths, but was detected in 35 unrelated fever patients in hospitals in Shandong and Henan provinces between 2018 and 2021, the scientists said - a finding in tune with longstanding warnings from scientists that animal viruses are regularly spilling undetected into people around the world.

"We are hugely underestimating the number of these zoonotic cases in the world, and this (Langya virus) is just the tip of the iceberg," said emerging virus expert Leo Poon, a professor at the University of Hong Kong's School of Public Health, who was not involved in the latest study.

The first scientific research on the virus, published as a correspondence from a team of Chinese and international researchers in the New England Journal of Medicine last week, received global attention due to heightened concern over disease outbreaks. Hundreds of thousands of new Covid-19 cases are still being reported worldwide each day, nearly three years since the novel coronavirus behind the pandemic was first detected in China.

However, the researchers say there is no evidence the Langya virus is spreading between people or that it had caused a local outbreak of connected cases. More study on a larger subset of patients is needed to rule out human-to-human spread, they added.

Veteran emerging infectious disease scientist Linfa Wang, who was part of the research team, told CNN that although the new virus was unlikely to evolve into "another ' disease X ' event," such as a previously unknown pathogen that sparks an epidemic or pandemic, "it does demonstrate that such zoonotic spillover events happen more often than we think or know."

In order to reduce the risk of an emerging virus becoming a health crisis, "it is absolutely necessary to conduct active surveillance in a transparent and internationally collaborative way," said Wang, a professor at the Duke-National University of Singapore Medical School.

Tracking a new virus

The first clues to the presence of a novel virus emerged when a 53-year-old farmer sought treatment at a hospital in Shandong province's Qingdao city in December, 2018 with symptoms including a fever, headache, cough and nausea, according to documentation from the researchers.

As the patient indicated she had contact with animals within the past month, she was enrolled in additional screening being conducted across three hospitals in eastern China focused on identifying zoonotic diseases.

When this patient's test samples were examined, scientists found something unexpected - a virus that had never been seen before, related to the Hendra and Nipah viruses, highly fatal pathogens from a family not typically known for easy human-to-human spread.

Over the next 32 months, researchers across the three hospitals screened for this virus in similar patients, ultimately detecting it in 35 people, who had a range of symptoms included cough, fatigue, headache, and nausea, in addition to fever.

Nine of those patients were also infected with a known virus, like influenza, so the source of their symptoms was unclear, but researchers believe symptoms in the remaining 26 could have been cased by the novel henipavirus.

Some displayed severe symptoms like pneumonia or abnormalities of thrombocytopenia, a blood platelet condition, according to Wang, but their symptoms were a far cry those seen in Hendra or Nipah patients, andno one among the group died or was admitted to the ICU. While all recovered, they weren't monitored for longer-term problems, he added.

Of that group of 26, all but four were farmers, and while some were flagged by the same hospital as the initial case detected, many others were found in Xinyang, more than 700 kilometers (435 miles) away in Henan.

Because similar viruses were known to circulate in animals from southwestern China to South Korea it was "not surprising" to see spillover into humans occurring across such long distances, Wang explained.

There was "no close contact or common exposure history among the patients" or other signs of human-to-human spread, Wang and his colleagues wrote in their findings. This suggests cases were sporadic, but more research was needed, they said.

Once they knew a new virus was infecting people, the researchers, who included Beijing-based scientists and Qingdao disease control officials, got to work to see if they could uncover what was infecting the patients. They tested domesticated animals where patients lived for traces of past infection with the virus, and found a small number of goats and dogs that may have had the virus previously.

But the real breakthrough came when they tested samples taken from small wild animals captured in traps - and found 71 infections across two shrew species, leading the scientists to suggest these small, rodent-like mammals could be where the virus naturally circulates.

What remains unclear is how the virus got into people, Wang said.

Further studies screening for Langya henipavirus would follow and should be conducted not only in the two provinces were the virus was found, but more widely within China and beyond, he said.

China's National Health Commission did not immediately respond to a request for comment on whether monitoring for new infections of the virus was ongoing.

Risk reduction

Globally, 70% of emerging infectious diseases are thought to have passed into humans via contact with animals, in a phenomenon scientists say has accelerated as growing human populations expand into wildlife habitats.

China has seen major outbreaks from emerging viruses in the past two decades, including SARS in 2002-2003 and Covid-19 - both first detected in the country and from viruses thought to originate in bats.

The devastating effects of both diseases - particularly Covid-19 that has to date killed more than 6.4 million people worldwide - demonstrate the importance of identifying cases of novel viruses quickly, and sharing the information about potential risks.

Scientists not involved in the new research agreed more work was needed to understand the Langya virus and confirm the latest findings, and said the discovery underlined the importance of tracking which viruses may be spreading from animals to people.

"Because this (new henipavirus) may not be only circulating in China, sharing this information and allowing others to get prepared or do some further investigation in their own countries is important," said Poon in Hong Kong.

Scientists say critical questions need to be answered abouthow widespread the new virus may be in nature,how it is spilling into people and how dangerous it is to human health - including the potential for it to spread between people or gain this ability if it continues to jump from animals into humans.

The geographic span of where the infections have been found "suggests that this infection risk is rather widespread," said virologist Malik Peiris, also of the University of Hong Kong, adding studies elsewhere in China and neighboring countries were important "to ascertain the geographic range of this virus in the animals (shrews) and in humans."

He, too, said the latest findings hinted at the large number of undetected infections spilling over from wildlife to people, and the need for systematic studies to understand not just this virus, but the broader picture of human infection with viruses from wildlife.

"This is important so that we are not taken unawares by the next pandemic, when - not if - it comes," he said.

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New Langya virus found in China could be 'tip of the iceberg' for undiscovered pathogens, researchers say | CNN

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Editor's Note: A version of this story appeared in CNN's Meanwhile in China newsletter, a three-times-a-week update exploring what you need to know about the country's rise and how it impacts the world. Sign up here.

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London School of Economics and Political Science. “Local Understandings of Zoonotic Disease Should Be Built into Epidemic Preparedness and Response.” PreventionWeb, www.preventionweb.net/news/local-understandings-zoonotic-disease-should-be-built-epidemic-preparedness-and-response. Accessed 4 June 2023. 

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London School of Economics and Political Science. “Local Understandings of Zoonotic Disease Should Be Built into Epidemic Preparedness and Response.” PreventionWeb, www.preventionweb.net/news/local-understandings-zoonotic-disease-should-be-built-epidemic-preparedness-and-response. Accessed 4 June 2023. 

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1. This author stands with the argument that it is crucial for people to use local data to base prevention strategies on large pandemic scenarios. This argument is clearly shown but does take a good read-through to understand what the author means by these local viewpoints.
2. I find the author's argument very persuasive because of the use of multiple instances of successful findings like when looking at rats spreading the Lassa Fever more in the dry season.
3. In this article the author is looking into better ways of pandemic prevention and surveillance using tactics like going into villages in Africa and listening to local views and studying the ways animals move and come into contact with humans. There are many people that would argue with the ethics of this because they are intruding on a small population's way of life for their research. The author defends this with many examples of how this research has benefitted so many.
4. There are many ideas that are in this source that are commonplace in many sources across the board because I am looking at one specific issue.
5. This source challenges and sides with my viewpoints on this study. I think that there needs to be more research that is not centralized on villages in Africa. There was a recent global pandemic that affected even the most put-together places, so I believe that there needs to be research heavily focused on all parts of the world.
6. The intended audience for this paper was not the entirety of the population, but a large amount interested in what is being done to prevent another global pandemic caused by zoonotic disease from happening again. The purpose is to show that there are concentrated efforts in areas of high animal-to-human contact that these pandemics often stem from.

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People in many global regions can make complex trade-offs between the risk of contracting disease and the need to support their livelihoods, particularly in situations of poverty. Interventions to promote epidemic preparedness should therefore be sensitive to local contexts. These should incorporate knowledge within communities to ensure more effective zoonotic disease surveillance and control, while appreciating broader local priorities for health and well-being.

This article is part of the series "Rethinking zoonoses, the environment and epidemics in Africa", which examines the effect of changing relationships between human, animal and environmental health on epidemic risk. Published every Wednesday.

As global institutions such as the World Health Organization (WHO) double down on efforts to control the ongoing COVID-19 pandemic, and orient to rethinking preparedness for future events, a strong focus on vaccines and surveillance is evident. Areas where conditions encourage close interactions between humans and animals are considered "hotspots", where there is potential "risky" contact between species and the transfer of pathogens by "spillover".

Standard interventions to reduce the transmission from animals to humans have consequently focused on the human-animal interface: avian influenza saw the culling of poultry flocks; Ebola in West Africa drew attention to human-bat interactions; COVID-19 has seen a spotlight again on wild animal markets. In keeping with the focus of conventional preparedness strategies on identifiable risks, interactions between people, livestock and wildlife are assessed within a risk framework. Drivers of disease transmission such as climate change, deforestation, encroachment upon wildlife habitats, urban growth and low biosecurity on farms have been identified as salient for wider policy responses.

However, purely technical approaches to surveillance, early detection and risk reduction can belie the complexity of contexts and of relations between humans, animals and their environments. These are dynamic and characterised by multiple uncertainties. On the ground, such relations are shaped by socio-cultural, religious, livelihood and economic factors, but these perspectives are often ignored in policy related to pandemic preparedness and zoonotic disease control.

The gap between policy interventions and understanding local contexts

Our research highlights the importance of appreciating the realities of local contexts and the complex trade-offs that people make between disease risk and livelihood factors, particularly in situations of poverty. People's own understandings of priority threats to health and well-being might differ from the views of those designing interventions. Changes in behaviour related to farming, hunting or marketing practices might be constrained by wider structural realities and the precarities of subsistence livelihoods. Interventions that do not take account of these realities can reinforce deep social and economic inequalities and perpetuate unequal health outcomes.

Local knowledge of patterns of disease and vulnerabilities can provide valuable information. Considering local understanding of zoonotic diseases and the conditions associated with their emergence can assist in attuning interventions to address disease outbreaks to different contextual realities and, therefore, increase the likelihood that these are proportionate, socially just and considerate to vulnerabilities and social inequalities.

Gaining a perspective on local understandings and priorities requires a commitment to interdisciplinary research - unfortunately still rare. Research on zoonotic disease often occurs in disciplinary silos, inadequate for a full analysis of problems and the development of effective and acceptable interventions. Our Dynamic Drivers of Disease in Africa programme (2011-16) serves as an example of interdisciplinary research involving ecologists, epidemiologists, zoologists, disease modellers and social scientists. In addition, participatory methods that engaged local people in identifying disease patterns, manifestations and solutions through "participatory modelling" enabled the inclusion of such perspectives in recommendations for interventions.

Our work highlights that debates related to zoonotic disease can all too often centre on professional and bureaucratic concerns. Meanwhile, those actually living with disease in poor and marginal areas have little or no say in the particular interests prioritised, or how they are studied. Commonly, local people and their leadership are considered insufficiently knowledgeable to engage in scientific debates on the issues that might affect them. However, they can provide vital information, including knowledge unavailable anywhere else, and this requires greater recognition in designing research and policy.

Using local understandings to mitigate spillover

Our fieldwork in this programme demonstrated the importance of local perspectives for gaining understandings of changes in human-ecological-disease relations. For example, our study of Lassa fever in Sierra Leone worked with local understandings to identify who is at risk, when and where, and how this is changing. These considerations are useful for mitigating spillover threats.

For instance, Mastomys rodents inhabit bush fallows. When these are burned in the dry season, they are pushed towards dry season gardens in peri-village swamps and into village areas. The shortening of fallows, coupled with a rise in gardening by women as a source of independent income, is changing disease risk levels, with women gardeners particularly vulnerable. This could help explain a higher incidence of Lassa fever in humans during the dry season, when hospital admissions are also higher; however, participatory modelling also revealed a range of reasons why people did not present at hospital during the rainy season, such as flooded roads and a poorer financial situation. Local understandings and reactions to disease can therefore assist in ensuring accurate timings of preparedness and response.

Attention to community understandings and knowledge is thus crucial to ensure more effective zoonotic disease surveillance and control - the first point for strengthening epidemic preparedness and response. Indeed, we contend that a commitment to learning from local level experiences and responses to threats to health should be an important principle for epidemic preparedness and response overall. If diseases with epidemic potential spread more widely through established human to human transmission, as happened with the COVID-19 pandemic, attention to community level perspectives is similarly vital.

This became evident during the West African Ebola outbreak from 2013-16, where the biomedical, disease-focused response initially clashed with villagers' more socially and ecologically integrated understandings of health and approaches to care. "Safe burials" led by external teams, focused on biomedical infection control, often disrupted key aspects of care and funerals that villagers viewed as essential to ensure that the deceased becomes a good ancestor or to avoid societal disaster. Through respectful dialogue that enabled people to adapt safe burials to balance infection risk and social needs, disease transmission was reduced.

In our research on pandemic preparedness in Africa, we have also analysed how people in rural Uganda and Sierra Leone negotiated public health restrictions related to COVID-19 in 2020, at a time of very low case levels in the fieldwork villages. They mobilised to navigate intersecting precarities, responding to market closures, restrictions on getting to their fields and violent enforcement (in Uganda), while also dealing with food price rises, floods and other health threats.

The establishment of a new unit in the WHO focused on "community readiness and resilience" seems a timely recognition of the value of local level perspectives, although it is important to add that longstanding structural inequalities can undermine response efforts. As the focus shifts to learning from COVID-19 for future preparedness, attention to systems strengthening is more crucial than ever, alongside a consideration of local level experiences, in order to detect and respond to (re)emerging pathogens more effectively. Epidemic preparedness and response need to go beyond technical approaches to predict and control the risk of disease. An appreciation of multiple uncertainties and complex dynamics is crucial, including how people understand and respond to them in the midst of everyday precarities and competing priorities for well-being.

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Local understandings of zoonotic disease should be built into epidemic preparedness and response

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People in many global regions can make complex trade-offs between the risk of contracting disease and the need to support their livelihoods, particularly in situations of poverty. Interventions to promote epidemic preparedness should therefore be sensitive to local contexts.

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MacMillan, Carrie, and Jeremy Ledger. “The 12 Best Covid-19 Prevention Strategies.” Yale Medicine, 12 Oct. 2020, www.yalemedicine.org/news/12-best-covid-19-prevention-strategies. 

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MacMillan, Carrie, and Jeremy Ledger. “The 12 Best Covid-19 Prevention Strategies.” Yale Medicine, 12 Oct. 2020, www.yalemedicine.org/news/12-best-covid-19-prevention-strategies. 

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1. this author is arguing that there are straightforward steps to help with the early prevention of zoonotic disease pandemics.
2. I believe that because there is a simplistic use of delivering instructions people could find this argument fairly convincing. I also think that the information here is well-supported making it credible and many would listen to it.
3. The author is taking a more scientific stance when compared to the many controversial opinions about the recent pandemic.
4. The ideas presented in this source can be seen from paper signs posted on storefronts to some of the most decorated and reviewed articles about ways to prevent the spread of pandemic disease. So, yes, I would say that these ideas are seen in many other sources.
5. I believe that this source supports my own opinion based on the fact that it is not taking any political side. This source is more of a science-based how-to on early prevention and surveillance of zoonotic disease.
6. This author likely was trying to share with the world that was taking the brunt of a global pandemic. The author needed to not be super biased and share important and easy tips to help prevent the spread early on in this pandemic.

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Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.
It's been many months since COVID-19 upended our lives. We've adjusted to wearing masks, social distancing, constantly our washing hands, and working and learning remotely. But what do we really know about how to prevent COVID-19 infection?

Scientists, doctors, and public health officials are still trying to fully understand how the virus spreads, what to do to prevent it, and the best ways to treat it. New findings sometimes lead to advice that conflicts with what we've been told previously-and it can be a challenge to keep track of it all. Fortunately, there is plenty of solid advice we can still follow.

"It can be really exhausting to be constantly vigilant and to take precautions, like wearing a mask and physically distancing, which may be physically and emotionally uncomfortable," says Jaimie Meyer, MD, MS, a Yale Medicine infectious disease expert. "But sustaining these types of behaviors is really key to curbing this pandemic, especially before a vaccine is available."

Plus, cooler weather is bringing more of us indoors, which is riskier than being outside because there is less airflow and it can be more difficult to keep people 6 feet apart. What's more, says Dr. Meyer, there's the possibility that SARS-CoV-2, the virus that causes COVID-19, is airborne, making ventilation even more important.

The upcoming months also bring seasonal respiratory viruses, like cold and flu, leading to concern about the possibility of a "twindemic" that may overwhelm health care systems already spread thin by COVID-19. These other illnesses can bring confusion because symptoms are very similar to those of COVID-19.

Meanwhile, COVID-19 remains with us, resulting in more than 210,000 deaths in the U.S. to date. As we leave a chaotic spring and summer behind and head into fall, now is a good time to check in with Yale Medicine experts and review the standard-and most recent-advice on how to stay safe.

1. Wear your mask

Wearing a mask that covers your mouth and nose can prevent those who have COVID-19 from spreading the virus to others. Recent evidence suggests that masks may even benefit the wearer, offering some level of protection against infections.

The Centers for Disease Control and Prevention (CDC) recommends that everyone age 2 years and older wear masks in public settings and around people who don't live in the same household-when you can't stay 6 feet apart from others.

Masks should be made of two or more layers of washable, breathable fabric and fit snugly on your face. "A quick and easy test is to hold your mask up to the light. If light passes through, it's too thin," Dr. Meyer says. "Masks only work when they cover the nose and mouth because that is where infected droplets are expelled and because the virus infects people through the mucous membranes in their nose and throat."

2. Stay socially distant

COVID-19 spreads mainly among people who are within 6 feet of one another (about two arms' length) for a prolonged period (at least 15 minutes). Virus transmission can occur when an infected person coughs, sneezes, or talks, which releases droplets from the mouth or nose into the air.

People can be asymptomatic and spread the virus without knowing that they are sick, which makes it especially important to remain 6 feet away from others, whether you are inside or outside. Plus, the more people you interact with at a gathering and the longer time you spend interacting with each, the higher your risk of becoming infected with the virus by someone who has it.

If you are attending an event or gathering of some kind, it's also important to be aware of the level of community transmission. One method of estimating how high the risk may be is referred to as R 0.

"Pronounced 'R naught,' and also known as the reproduction number, this is a measure of how fast a disease is spreading," explains Onyema Ogbuagu, MBBCh, a Yale Medicine infectious disease expert. "If the reproduction number is 5.0, that means one infected person will spread the virus to an average of five people. Therefore, the lower the rate, the safer it is."

The R 0 for COVID-19 is believed to be in the range of 1.4 to 2.9. For comparison, measles, which has the highest reproduction number known among humans, ranges from 12 to 18. Seasonal influenza is around 0.9 and 2.1.

While R 0 refers to the basic, or initial, reproduction number, there is another measurement called R t, which is the current reproduction number and is the average number of people who become infected by an infectious person. If R t is above 1.0, it spreads quickly. If it's below 1.0, it will eventually stop spreading. You can check the number for each state here.

3. Keep washing your hands

Washing your hands-and well-remains a key step to preventing COVID-19 infection. Wash your hands with soap often, and especially after you have been in a public place or have blown your nose, coughed, or sneezed, the CDC recommends.

You should wash your hands for at least 20 seconds and lather the back of your hands and scrub between all fingers, under all fingernails, and reach up to the wrist, the CDC advises. After washing, dry them completely (with an air dryer or paper towel) and avoid touching the sink, faucet, door handles, or other objects. If no soap is available, use a hand sanitizer with at least 60% alcohol content, and rub the sanitizer on your hands until they are dry.

Though the CDC states that the primary way the virus spreads is through close person-to-person contact, it may be possible to become infected with COVID-19 by touching a surface or object that has the virus on it and then touching your own mouth, nose, or eyes.

Therefore, you should also wash your hands after touching anything that may have been contaminated-such as a banister or door handle in a public place-and before you touch your face.

While the virus can survive for a short period on some surfaces, it is unlikely to be spread from mail or from products or packaging, the CDC says. Likewise, the risk of infection from food (that you cook, is prepared in a restaurant, or is ordered via takeout) is considered to be very low, as is the risk from food packaging or bags.

Still, there is much that is unknown about the virus, and it remains advisable to wash hands thoroughly after handling any food or products that come into your home.

4. Keep holiday gatherings small

Fall and winter also bring holidays, when many families get together. This can be especially tricky for those of us who live in parts of the country where it will no longer be easy to gather outside. "After months apart during this pandemic, families may be less willing to do a group Zoom call," says Dr. Meyer. "This may be a year where we need to get creative and rethink how to celebrate together."

That may simply mean more planning for the holidays, Dr. Meyer says. "Consider quarantining for 14 days prior to the event and/or having everyone get tested for COVID-19 if tests are available in your community," she suggests. "If possible, limit gatherings to as few people as possible-perhaps just immediate family and close friends. When it is not possible to be outside, encourage your guests to wear masks indoors. Consider spreading out food and eating areas so people are distanced while eating with their masks down."

Remember that your elderly family members and those with other medical conditions are most vulnerable to COVID-19, so take extra measures to protect them, says Dr. Meyer.

5. Dine out carefully

Although many restaurants offer outdoor dining, which experts say is the safer option, a recent CDC study showed that adults with COVID-19 infections were twice as likely to have visited a restaurant in the two weeks preceding their illness than those without an infection.

The study did not distinguish between indoor or outdoor dining, or consider adherence to social distancing and mask use. (Those with COVID-19 infections were more likely to report having dined out at places where few other people were wearing masks or socially distancing.)

"If you are meeting with others at a restaurant and sharing tables while eating, which does not allow for appropriate social distancing and mask use, it provides opportunities for the virus to spread from person to person," Dr. Ogbuagu notes. "The probability of spreading infection is higher with each additional person you are in contact with, especially when people congregate."

6. Travel safely

While you should avoid traveling if you can-as the CDC says staying home is the best way to avoid COVID-19-sometimes, it is necessary. But before you leave, you can check to see if the virus is spreading at your destination. More cases at your destination increases your risk of contracting the virus and spreading it to others. You can view each state's weekly number of cases here on the CDC web site.

"Also, don't forget to check the regulations for quarantining or testing at your destination or for when you return home," says Dr. Meyer. Whether you are traveling by car, plane, bus, or train, there are precautions you can take along the way. The CDC has a detailed list of recommendations for each mode of transportation that mostly follows the advice listed above of practicing social distancing, wearing a mask, and washing hands, but also includes specific advice for various scenarios.

7. Get your flu shot

Health officials are concerned about an influx of flu and COVID-19 cases overwhelming hospitals. In the 2018-2019 flu season, 490,600 Americans were hospitalized for the flu, according to the CDC.

Public health experts say this is not the year to skip the flu vaccine. While measures to prevent COVID-19, including mask-wearing, washing hands, and social distancing, can also protect against the flu, the vaccine is especially important-and safe, doctors say.

Though many people claim that the flu shot "gave them the flu," it is not possible to get infected with the influenza virus from the vaccine itself, Dr. Meyer says. "The vaccine is made up of inactivated virus and is designed to 'tickle' the immune system to respond to the real thing when it sees it," she explains. "The most common side effect from the flu shot is soreness or redness at the site of the injection, which resolves within a day or two."

The flu vaccine is recommended for everyone 6 months old and up. Talk to your doctor about finding a vaccine near you.

8. Differentiate between flu, colds, and COVID-19

Many people will likely struggle to differentiate between the flu, the common cold, and COVID-19, all of which have similar symptoms.

For example, both COVID-19 and the flu can cause fever, shortness of breath, fatigue, headache, cough, sore throat, runny nose, muscle pain, or body aches, as well as vomiting and diarrhea (though these last two are more common in children). Meanwhile, colds may be milder than the flu and are more likely to involve a runny or stuffy nose. One difference, however, is that COVID-19 is associated with a loss of taste and smell.

So, if you or someone in your family comes down with any of these symptoms, what should you do?

"First, you should stay away from others as much as possible and perform hand washing before you make contact with your face," Dr. Ogbuagu says. "And certainly go see a doctor or to the hospital if you have serious symptoms, such as a high fever or shortness of breath. Otherwise, getting a COVID-19 test at a testing facility near you would help to define what type of respiratory illness you have and also how to advise people you had been in contact with."

Parents, Dr. Meyer adds, will need to contact their children's pediatricians about these symptoms because otherwise their children likely won't be able to return to school.

"I would also add that people who are older and have underlying medical conditions should have a low threshold to seek care for any of these symptoms," she says. "Earlier is better, especially for influenza, as we have antiviral medications that work if given within 72 hours of the onset of symptoms."

9. Seek routine medical care

You should continue to seek any routine or emergency medical care or treatments you need. Many health centers and doctors are offering telehealth appointments (via video or phone) and most have protocols to minimize risk of exposure to the coronavirus.

Getting emergency care when you need it is especially important. Earlier in the pandemic, pediatric and adult physicians reported fewer emergency department visits, leading to a concern that patients were avoiding seeking care due to fears of contracting COVID-19.

"As important as it is to continue to engage in care for known medical issues, there is also a concern that people are falling behind on their preventive healthcare, like getting routine procedures including colonoscopies and pap smears, as well as vaccines," Dr. Meyer says. "Those other health issues don't go away just because there is a pandemic. Reach out to your primary care doctor if you're unsure what you are due to receive."

10. Be mindful of your mental health

Many people are experiencing anxiety, depression, and other mental health issues during the pandemic as it is a time of stress and uncertainty. All of this is normal, say mental health experts, who recommend that you allow yourself to embrace all emotions, including those that are unpleasant, in order to better manage them.

Experts advise limiting exposure to news if the events of the world are too much right now, practicing mindfulness (even just breathing exercises), eating healthy, and remaining physically active.

For kids, who are still adjusting to a lack of play dates, canceled activities, and different school schedules, parents can help by fully listening to their concerns and providing age-appropriate answers to their questions. By talking with kids about what they know and how they are doing, parents may be able to determine if further emotional support is needed.

11. Watch your weight

At a time when routines are disrupted and many people are working at home-where snacks are readily available-some may be gaining weight (the so-called quarantine 15). Now more than ever, Yale Medicine doctors recommend that you focus on eating a healthy diet, incorporating regular exercise, getting good sleep, and finding healthy ways to manage stress.

Meanwhile, obesity is emerging as an independent risk factor for severe COVID-19 illness-even among younger patients. One study, which examined hospitalized COVID-19 patients under age 60, found that those with obesity were twice as likely to require hospitalization and even more likely to need critical care than those who did not have it. Given that an estimated 42% of Americans have obesity (having a body mass index equal to or more than 30), this is important.

12. Keep up the good (safety) work

It is likely that COVID-19 will be with us for a while. "But with good efforts to continue to follow the public health measures to protect each other, and, hopefully, a successful vaccine in the future, there is a light at the end of the tunnel," Dr. Ogbuagu says.

But even before a safe and effective vaccine is available, COVID-19 is a preventable disease, Dr. Meyer points out. "It just requires all of us to do the hard work of practicing the behaviors-described above-to keep our communities safe and healthy."

Note: Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.

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The 12 Best COVID-19 Prevention Strategies

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Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.

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Bernstein, Aaron, et al. “The Costs and Benefits of Primary Prevention of Zoonotic ... - Science.” The Costs and Benefits of Primary Prevention of Zoonotic Pandemics, www.science.org/doi/10.1126/sciadv.abl4183. Accessed 10 June 2023. 

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Bernstein, Aaron, et al. “The Costs and Benefits of Primary Prevention of Zoonotic ... - Science.” The Costs and Benefits of Primary Prevention of Zoonotic Pandemics, www.science.org/doi/10.1126/sciadv.abl4183. Accessed 10 June 2023. 

# data[].attributes.body
1. The argument made by the authors is that there is a fair amount of prevention strategies for zoonotic diseases, but there are many costs that may outweigh the benefits. Things like that prevention only truly start when humans are getting sick.
2. I believe that this argument is backed by lots of scientific information, making it very persuasive to me. I think that if you did not read into the science-based evidence behind it then there would be less of a persuasion factor.
3. The author's stance in this paper is that there need to be zoonotic disease studies run on animals because that is where the majority start. If we can gather information while they are still in animals then we can better prevent pandemics.
4. There are many similar ideas like the issues with current prevention strategies and there is much, much more that needs to be studied.
5. This paper is aligned very well with where I stand. Specifically, this aligns with the scientific views I have on the subject.
6. The intended audience is scientific groups and corporations that are addressing zoonotic disease out breaks. The purpose is to propose new ideas to make these highly contagious diseases less transmittable.

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Loh, Elizabeth, et al. “Targeting Transmission Pathways for Emerging Zoonotic Disease Surveillance and Control.” Targeting Transmission Pathways for Emerging Zoonotic Disease Surveillance and Control, www.liebertpub.com/doi/abs/10.1089/vbz.2013.1563. Accessed 11 June 2023. 

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Loh, Elizabeth, et al. “Targeting Transmission Pathways for Emerging Zoonotic Disease Surveillance and Control.” Targeting Transmission Pathways for Emerging Zoonotic Disease Surveillance and Control, www.liebertpub.com/doi/abs/10.1089/vbz.2013.1563. Accessed 11 June 2023. 

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1. The argument made in this article is that there is need for more advanced transmission protocols. The authors used research of literature databases to make a better option for the current protocols.
2. Because they used so many sources to back up there treatment plan I found this paper very persuasive.
3. The author stands with the bettering of making transmission of zoonotic diseases lessened with scientific protocols.
4. The ideas of finding better protocols to prevent transmission are more rare to find, but with the specific research that I have found while doing this research has had many of the same ideas.
5. The position I hold on better transmission is that it needs to be scientifically based. Things like basic masks hold little to no value in spread of these diseases and that is shown in this paper, so, it does align.
6. The audience is major decision makers of the world and the general population. The purpose is to better align the ways that humans use to lower rates of transmission of zoonotic diseases.

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EcoHealth 12, 98-103 (2015) Cite this article

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Abstract

Diseases transmitted between animals and people have made up more than 50% of emerging infectious diseases in humans over the last 60 years and have continued to arise in recent months. Yet, public health and animal disease surveillance programs continue to operate independently. Here, we assessed whether recent emerging zoonotic pathogens ( n = 143) are known to cause morbidity or mortality in their animal host and if so, whether they were first detected with an animal morbidity/mortality event. We show that although sick or dead animals are often associated with these pathogens (52%), only 9% were first detected from an animal morbidity or mortality event prior to or concurrent with signs of illness in humans. We propose that an animal morbidity and mortality reporting program will improve detection and should be an essential component of early warning systems for zoonotic diseases. With the use of widespread low-cost technology, such a program could engage both the public and professionals and be easily tested and further incorporated as part of surveillance efforts by public health officials.

Over the last 60 years, more than half of the emerging infectious diseases appearing in humans have been transmitted from animals (Jones et al. 2008), and of these, 72% are of wildlife origin. The numbers are likely to increase as zoonoses continue to appear, such as the avian Influenza H7N9 virus which emerged in China in the spring of 2013 from direct contact with poultry (Gao et al. 2013; Li et al. 2014) and the Middle East respiratory syndrome coronavirus (MERS-CoV) that emerged in countries near the Arabian Peninsula in 2012 of putative animal origins (Assiri et al. 2013, Reusken et al. 2013), specifically from dromedary camels (Alagaili et al. 2014). These zoonotic disease outbreaks have posed and continue to pose substantial burdens on public health systems, global politics, wildlife populations, as well as local and global economies (Leroy et al. 2004; Rouquet et al. 2005; LaDeau et al. 2007; Karesh et al. 2012). For example, the West Nile virus (WNV), which was primarily transmitted to humans from infected mosquitoes and bird reservoir hosts, resulted in over 30,000 reported cases of encephalitis and caused 1,350 human deaths in the United States from 1999 through January 2011 (Centers for Disease Control and Prevention 2011). In 1 year (2002), the cost of WNV was over $20 million for the state of Louisiana alone (Zohrabian et al. 2004) and prompted several local and state agencies to initiate expensive mosquito-control programs. On a global scale, zoonotic disease outbreaks are estimated to have cost over US$20 billion in direct and US$ 200 billion in indirect costs between 2000 and 2010; the Severe Acute Respiratory Syndrome (SARS) virus was one of the most devastating, costing over US$ 40-50 billion in losses in East Asia and Canada alone (World Bank 2010).

Moreover, the effects of such zoonotic pathogens can be severe on both wildlife and human populations. The Ebola virus, which causes hemorrhagic fever in humans and non-human primates, had caused, as of 2009, >1,500 human deaths since its emergence in Democratic Republic of Congo (formerly Zaire) in 1976 (Centers for Disease Control and Prevention 2010). Non-human primate numbers drastically declined (Walsh et al. 2003) in the Republic of Congo alone during the two-year Ebola outbreak from 2001 to 2003 (e.g., 56% in gorillas and 89% for chimpanzees, Leroy et al. 2004). Equally devastating was the introduction of WNV into the Americas, which lead to a precipitous population decline for North American birds, most notably in the American Crow ( Corvus brachyrhynchos) whose numbers declined by 45% since the emergence of the virus (LaDeau et al. 2007).

When an animal first contracts a pathogen such as highly pathogenic avian influenza (HPAI H5N1) or West Nile virus, an immunological response ensues and animals exhibit clinical symptoms of the disease such as severe weakness, tremors, incoordination, and general lethargy (Komar et al. 2003, Brown et al. 2006). In some cases, the animals die shortly after being infected without the onset of clinical signs (Brown et al. 2008) or the animal survives infection, seroconverts, and is no longer infectious. When the infection is fatal, the animal dies within a week of pathogen infection and disease emergence (Komar et al. 2003, Brown et al. 2006, 2008). However, certain infections in animals are asymptomatic such as H7N9 infections in poultry (WHO 2013).

The most challenging issue, and to date, one of the most important for reducing the impacts of zoonotic diseases, is the early detection of viral emergence and movement over space and time. Viruses cannot be seen and are detected most commonly through the morbidity or mortality events they cause in their animal hosts. Despite the enormous economic and ecological impacts and despite the recognized utility of animals as sentinels for disease surveillance (Halliday et al. 2007; Rabinowitz et al. 2005), to date, few, if any, effective animal morbidity or mortality surveillance mechanisms exist globally. Moreover, the public health sector is slow to adopt strategies that include animals as sentinels. Here, we demonstrate, through our own review and examples of emerging infectious disease events, that most zoonotic diseases could have been detected first by animal morbidity/mortality events (in both domestic and wild animals), but because of a lack of organized and comprehensive surveillance, they are detected too late to limit the spread of the pathogen and the resulting impact it has on human populations.

Materials and Methods

We used the list of zoonotic diseases of wildlife origin compiled by Jones et al. ( 2008) to quantify the number of diseases emerging between 1940 and 2004 that (a) are known to cause disease or death in animal hosts and (b) were first detected through an animal morbidity/mortality event. Our general thesis is, an animal mortality monitoring system is an essential component to surveillance systems to minimize human morbidity and mortality impacts. We considered a zoonotic disease to have been first detected in animals if the detection of sick or dead animals preceded or were concurrent and associated with the emergence of the disease in humans as reported in peer-reviewed publications (Online Appendix 1). For example, dead voles infected with Francisella tularensis, which causes Tularemia, were found in the hay with which Swedish farmers worked at the time of the 1966 emergence and outbreak of the disease in these same farms (Dahlstrand et al. 1971); it was also previously known to cause die-offs in rodents (McCoy and Chapin 1912). We therefore considered the Tularemia outbreak first detected in animals. We concomitantly verified whether each pathogen was known to produce extended morbidity in their animal hosts (fever, diarrhea, or other symptoms) or was fatal. We performed our literature search using ISI web of Knowledge and Google Scholar using pathogens (common and scientific terms) as search terms or close variants of the combination of 'first detected(ion)' and 'clinical representation in animals', respectively. Each pathogen was tagged as "yes" if it had been shown to cause disease in non-human animals or "no/unknown" when it had been demonstrated not to cause disease or the results were inconclusive (Online Appendix I). Because the majority of zoonotic pathogens have a known wildlife origin (Jones et al. 2008), we restricted our analysis to the 143 pathogens listed as a combination of being (a) zoonotic; disease emerged via non- human to human transmission and (b) wildlife; zoonotic emerging infectious disease event caused by a pathogen with a wildlife origin in Jones et al. ( 2008).

Results and Discussion

We show that although 75 (52%) of the zoonotic pathogens listed in Jones et al. ( 2008) are known to produce extended morbidity or mortality in animal hosts (Online Appendix 1), only 13 of the 143 pathogens (9%), including two that do not produce signs of illness (Seoul and Whitewater Arroyo viruses; Table 1), were first detected in animals and subsequently reported prior to, or concurrent with, signs of morbidity and mortality in humans (Figure 1; Table 1). Therefore, for 64 (45%) more zoonotic pathogens listed here, outbreaks of these diseases could have been first detected in animals had a surveillance mechanism been in place (Figure 1). Furthermore, 10 of the 13 animal morbidity or mortality events reported were from domestic or peridomestic animals (Table 1). For example, the anthrax ( Bacillus anthracis) outbreak of 1979 in Sverdslovsk (former USSR) was detected in sick and dying livestock (primarily sheep) shortly before the 64 documented human deaths (Meselson et al. 1994), most likely because sheep, and more generally, herbivores appear to be more susceptible to anthrax inhalation than humans (Young et al. 1946, Watson and Keir 1994). However, anthrax is well known to cause animal die-offs in the wild (Clegg et al. 2007; Mapesa et al. 2007), therefore, signs of the disease could have also been detected in wild animal populations. Comparatively, HPAI H5N1, which is fatal in some wild bird species (Brown et al. 2008), appeared simultaneously in a sick child in Hong Kong and in chickens at local poultry farms in the same year (1997; Subbarao et al. 1998). However, in both cases, no official and comprehensive surveillance program existed that would have systematically alerted local officials of the presence of a pathogen.

Table 1 Emerging Infectious Human Pathogens of Zoonotic Origin Detected in Non-human Hosts (Domestic or Wild) Prior to or Concurrent with Emergence in Human Populationsa

Proportion of emerging infectious human pathogens of zoonotic origin (Jones et al. 2008) that were first detected in humans versus animals (domestic or wild) prior to or concurrent with signs of illness in humans in relation to their pathogenicity in non-human hosts.

Recent reviews (Kuiken et al. 2005; Halliday et al. 2007; Gubernot et al. 2008; Olson et al. 2012) and empirical studies of zoonotic diseases (Eidson et al. 2001; Leroy et al. 2004; Rouquet et al. 2005) suggest that animal surveillance, including sampling of live animals (i.e., active sampling), is an essential component to predicting, responding to, and managing zoonotic disease emergence. We further propose that animal mortality monitoring of both domestic and wild animals (i.e., passive sampling) should be a well-integrated and complimentary component to any surveillance program to prevent the emergence, re-occurrence, and spread of such diseases. At least three empirical studies provide evidence that sampling both healthy (mammals; Levinson et al. 2013) and dead animals (Eidson et al. 2001; Rouquet et al. 2005; Komar and Olsen 2008) are effective strategies for zoonotic pathogen detection and disease prevention (Olson et al. 2012). Rouquet et al. ( 2005) demonstrated that a dead animal reporting mechanism would have likely prevented further spread of Ebola virus in West Africa. Human infections initially occurred by handling dead non-human primates, carcasses putatively heading to or present at markets for human consumption (gorillas, duiker, and chimpanzees; Leroy et al. 2004). During the outbreak, an Animal Mortality Monitoring Network (AMMN) was implemented briefly (2001-2003) in northeastern Gabon and northwestern Republic of Congo as a predictive and preventive measure for the spread of the Ebola virus (Rouquet et al. 2005). Over 60% of the 21 carcasses reported (primarily by hunters) and tested were infected with the Ebola virus. All animal deaths occurred before any apparent infection in humans. By reporting the dead primates, diagnostics were performed and local authorities were immediately alerted of infected carcasses putatively minimizing the continued risk of pathogen spread to humans. Corroborating this study is a recent review by Olson et al. ( 2012), which shows that sampling animal carcasses for the presence of the Ebola virus proved to be more effective in recovering the virus than live animal sampling. Because no known vaccine for Ebola exists, stopping the spread of the pathogen is essential. Similarly, dead crow ( Corvus brachyrhynchos) reports in the northeastern United States helped to identify the geographical scope of West Nile virus outbreaks (Eidson et al. 2001; Mostashari et al. 2003) and preceded the onset of viral activity in humans (Eidson et al. 2001; 2005; Johnson et al. 2006). It was the reporting of dead crows that led many state officials to effectively pinpoint disease hotspots (Eidson et al. 2001) and ultimately helped to better understand disease dynamics (Marra et al. 2004; Kilpatrick 2011). However, these mechanisms were put in place long after the pandemic hit the United States (U.S. General Accounting Report 2000) and moreover, health officials in the affected states were not properly prepared to deal with dead bird reports or bird necropsies, which prevented officials from tracking the disease in a way that would allow quantification of virus prevalence. To this day, no systematic and extensive animal mortality surveillance program exists despite the ongoing threat of the next zoonotic disease outbreak and the demonstrated importance of such a network as an early warning system for disease emergence.

Conclusion

Despite the significant increase and overall occurrence of zoonotic diseases, very few public health platforms incorporate animal sampling in their disease surveillance programs. Vital to reducing the spread and impact of zoonotic pathogens to humans and among animal populations is early detection and isolation, which first requires observations of the affected animal hosts either when they are sick or dead. Because the transmission route for zoonotic pathogens from animal host to humans is inherently complex, evidence can be presented to advocate for both active and passive animal surveillance (Olson et al. 2012). We suggest that, in part because of this complexity, both should co-occur in comprehensive surveillance programs for disease prevention in humans and wildlife. We have shown that 75 zoonotic pathogens are known to cause extended morbidity or mortality in their animal hosts, and we argue that the quick reporting of these sick or dead animals could have prevented the subsequent or concurrent emergence in humans. Active animal surveillance programs, although essential, are often costly and must be operated by extensively trained personnel thus limiting the scope of surveillance efforts. Passive animal reporting monitoring, on the other hand is a monitoring system that can employ low-cost technology available to civil servants (e.g., park rangers) and the public (e.g., hunters, farmers, citizens) of all income levels, greatly expanding the geographic range of surveillance efforts. If zoonotic disease surveillance and monitoring were limited to the sampling of live animals, it would greatly limit the scope of the search to a small proportion of the public trained for such sampling.

We therefore propose that integrating an animal morbidity and mortality surveillance program is fundamental for the success of public health surveillance systems. Pilot tests can easily be included in public health platforms initially in one to two zoonotic disease hotspots by merging public health surveillance systems with wildlife management efforts. Peri-urban regions near wildlife conservation areas would be ideal interfaces for such pilot tests and disease hotspots would provide a more opportunistic environment to evaluate the effectiveness of reporting sick or dead animals for pathogen detections. Recent use of mobile phone technology has proven highly successful in the public health sector (e.g., 'Outbreaks Near Me' application, 29-31, FrontlineSMS, 32; EpiSurveyor, 33). It also offers a similar utility for animal morbidity and mortality monitoring because it can easily be integrated in citizen science approaches that encourage people to report animal mortality events as well as prioritization of reporting in high-risk pathogen transmission zones, such as conservation areas and regions where agriculture and wildlife overlap. We propose that mobile-based data collection could facilitate and rapidly mobilize surveillance teams for pathogen sampling by linking reporting by the public and civil servants to alerting mechanisms with local authorities. Once local authorities are alerted, dead animals can be sampled for the presence of pathogens and surveillance efforts can be initiated if animals have tested positively for zoonotic pathogens, thus focusing surveillance on target animals, pathogens, or areas. The challenges inherent in any system requiring large-scale surveillance of potentially small targets are both in the survey and reporting. For animal morbidity or mortality surveillance, reports may be biased toward larger animals-not only because they are more visible but because carcasses may persist for a longer period of time (Santos et al. 2011)-, animals that are found near or in human habitations, or domestic animals (Table 1) because of their proximity to humans and financial value.

The success of these programs will largely depend on first implementation by international agencies and by continued efforts at a local level. Finally and equally importantly, animal morbidity and mortality reporting is also an indispensable tool for wildlife conservation as it will not only stop the spread of disease in wildlife populations but will also help to quickly mobilize rescue efforts for animals in distress.

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Acknowledgements

We thank C. Chapman and A. M. Kilpatrick for valuable comments on the manuscript. This research was supported by the American people through the United States Agency for International Development (USAID) Emerging Pandemic Threats program, PREDICT project.

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Authors and Affiliations

1. Migratory Bird Center, Smithsonian Conservation Biology Institute, National Zoological Park, PO Box 37012, MRC 5503, Washington, DC, 20013-7012, USA

Isabelle-Anne Bisson & Peter P. Marra

2. Mountain Gorilla Veterinary Project, Wildlife Department Plot 42 Nakasero Rd., Kampala, Uganda

Benard J. Ssebide

Corresponding author

Correspondence to Isabelle-Anne Bisson.

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Bisson, IA., Ssebide, B.J. & Marra, P.P. Early Detection of Emerging Zoonotic Diseases with Animal Morbidity and Mortality Monitoring. EcoHealth 12, 98-103 (2015). https://doi.org/10.1007/s10393-014-0988-x
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Keywords

zoonotic diseases

disease detection

disease surveillance

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mortality

# data[].attributes.attachment_link.title
Early Detection of Emerging Zoonotic Diseases with Animal Morbidity and Mortality Monitoring - EcoHealth

# data[].attributes.attachment_link.description
Diseases transmitted between animals and people have made up more than 50% of emerging infectious diseases in humans over the last 60 years and have continued to arise in recent months. Yet, public health and animal disease surveillance programs continue to operate independently.

# data[].attributes.headline
The creation of One Health and the benefits created when using it for early prevention and detection of zoonotic diseases. 

# data[].attributes.subject
The creation of One Health and the benefits created when using it for early prevention and detection of zoonotic diseases. 

# data[].attributes.body
1. The argument made by the authors of this paper is that there is a need for more cooperative and preventative measures. The fix to this was proposed as a new organization called One Health.
2. The argument is made persuasive by the examples and realism that the creation of One Health has created. The corporation is going to be very helpful in the prevention of zoonoses.
3. The stance of the authors of this paper is that they need to prevent zoonoses with surveillance and early prevention.
4. The ideas of this are similar to the other articles but it puts a stellar organization's main goals into view. It also explains the benefits that will be brought because of this organization.
5. This source, like all the others, supports my position because it uses science-based claims to describe an organization's goals and uses. One-Health is a great organization that will work to prevent killer diseases from spreading with early prevention and surveillance.
6. The audience is the entirety of the population that is interested in the prevention of deadly disease which is a large amount. The purpose is that there is a new organization that is making headlines for new and advanced practices that are making the early detection of zoonotic disease easier.

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Abstract

Zoonotic diseases represent critical threats to global health security. Effective mitigation of the impact of endemic and emerging zoonotic diseases of public health importance requires multisectoral collaboration and interdisciplinary partnerships. The US Centers for Disease Control and Prevention created the One Health Zoonotic Disease Prioritization Tool to help countries identify zoonotic diseases of greatest national concern using input from representatives of human health, agriculture, environment, and wildlife sectors. We review 7 One Health Zoonotic Disease Prioritization Tool workshops conducted during 2014-2016, highlighting workshop outcomes, lessons learned, and shared themes from countries implementing this process. We also describe the tool's ability to help countries focus One Health capacity-building efforts to appropriately prevent, detect, and respond to zoonotic disease threats.

Keywords: One Health, global health, zoonoses, disease prioritization, global health security, Global Health Security Agenda, International Health Regulations, IHR 2005, GHSA

Emerging and endemic zoonotic diseases pose a threat not only to the health of animals and humans but also to global health security. An estimated 60% of known infectious diseases and up to 75% of new or emerging infectious diseases are zoonotic in origin (1,2). Globally, infectious diseases account for 15.8% of all deaths and 43.7% of deaths in low-resource countries (3,4). It is estimated that zoonoses are responsible for 2.5 billion cases of human illness and 2.7 million human deaths worldwide each year (5). Emerging zoonoses are responsible for some of the most high profile and devastating epidemics (6-8); however, endemic zoonoses (9,10) may actually pose a more insidious and chronic threat to both human and animal health. As one comparison, the 2014 Ebola epidemic was responsible for 11,316 deaths and $2.2 billion in economic losses (11), whereas each year rabies accounts for ≈59,000 human deaths and roughly $8.6 billion in economic losses worldwide (12). The global impacts of emerging and endemic zoonoses on both human and animal populations make fostering collaboration between human and animal health sectors using a multisectoral, One Health approach a critical step toward improving animal and human health.

Early detection of zoonotic pathogens through enhanced laboratory capacity and surveillance at the animal-human interface is a crucial step toward controlling and preventing zoonoses (13-20) and a core capacity for implementation of the World Health Organization International Health Regulations 2005 (IHR 2005) and the Global Health Security Agenda (GHSA; https://www.ghsagenda.org/) (21). Rapidly detecting, responding to, and controlling public health emergencies at their source, including those caused by outbreaks of zoonotic diseases, is essential for global health security. However, in low-resource settings, capacity-building efforts should be initially focused on a few key diseases (22). Disease prioritization enables effective capacity building and resource allocation to increase surveillance, guide research, and improve preparedness and response protocols, further advancing global health security and the international health regulations (23-25).

To address this prioritization need, the US Centers for Disease Control and Prevention (CDC) developed the One Health Zoonotic Disease Prioritization (OHZDP) tool (22,26) as a multisectoral approach to rank a country's zoonotic diseases using an objective, semiquantitative method. The OHZDP tool enables a country or region to bring together representatives from human, animal, and environmental health sectors to prioritize the endemic and emerging zoonoses of greatest national concern that should be jointly addressed by human, animal, and environmental health ministries using country- or region-specific criteria. Zoonotic diseases can be prioritized even in the absence of reliable prevalence data by using alternative measures for disease burden so that outcomes are provided in a timely manner, enabling country representatives to give immediate feedback, develop action plans, and capitalize on collaborations built during the prioritization process.

During 2014-2016, CDC implemented 7 OHZDP workshops. We summarize overarching themes identified from these workshops and highlight successes and lessons learned to best support additional countries in prioritizing zoonotic diseases by using this tool.

Methods

CDC conducted OHZDP workshops using methods previously described (22,26). CDC maintains a pool of trained OHZDP workshop facilitators to conduct workshops and to train in-country facilitators to promote country ownership of the prioritization process and to leave the capacity to conduct future prioritization workshops in each country. We interviewed workshop facilitators, reviewed data from workshop materials maintained as part of our routine monitoring and evaluation activities, and reviewed available publications for information on alternate methods and outcomes. Variables collected are number and type of workshop participants by sector (voting members and observers), disease assessment criteria selected during the workshop and the resulting zoonoses rankings, and outcomes or planned next steps for multisectoral capacity building activities. Where appropriate, data for certain variables (e.g., disease ranking criteria) were standardized and combined into larger categories to look for overarching themes. Data were analyzed using Microsoft Excel (Microsoft, Redmond, WA, USA).

Results

During 2014-2016, at countries' request, CDC conducted OHZDP workshops in Thailand, Kenya (27), Ethiopia (28), Azerbaijan, Cameroon, South Africa, and the Democratic Republic of the Congo. All countries prioritized diseases on a national level; 4 (57.1%) workshops were specifically conducted to advance GHSA implementation in the country, but all countries had a goal to strengthen multisectoral collaboration and focus laboratory, surveillance, and prevention efforts. All workshops took place over a 2-day period, with an additional 1-2 days for training local facilitators, when requested.

All workshops used standard methods as previously described (22,26) for conducting the preworkshop activities and the in-country facilitated group work. Two countries (Kenya and Thailand) diverged from the standard methods by including more than the recommended number of voting members. Kenya placed voting members into 5 groups, then used group discussion and consensus to assign weights to the individual criteria (27). Thailand held 2 separate, concurrent workshops that produced 2 different outcomes; these outcomes were then combined at a separate meeting held 1 month later to develop a final list of criteria by discussion and consensus. Members were then grouped by their agencies and voted on the ranking or weight applied to each criterion before conducting a final ranking of the diseases.

Facilitators and Participants

Fourteen CDC-trained OHZDP workshop facilitators were used for the 7 workshops and represented interdisciplinary backgrounds with expertise in zoonoses. A total of 21 in-country facilitators were trained at 5 of the 7 workshops, with an average of 4 (range 2-6) facilitators per workshop. In-country facilitators represented ministries of health (n = 8), agriculture (n = 5), environment (n = 1), and wildlife (n = 1); research institutes (n = 2); CDC in-country staff (n = 2); and other partners (n = 2). Field Epidemiology Training Program graduates were a resource for in-country facilitators in 2 workshops. Postworkshop debrief meetings and CDC facilitator interviews revealed specific lessons. For example, facilitators who held high-level positions were not available for the entire workshop because of competing priorities. In addition, it was deemed important that in-country facilitators be seen as unbiased during the facilitation process.

A total of 107 voting members participated in the 7 workshops (range 5-33), and multiple sectors were represented ( Table 1 ). The average number of voting members per workshop was 15, but excluding 2 outlier workshops that grouped voting members (Kenya, n = 33; and Thailand, n = 22), the average was 10 (range 5-11).

Table 1

Sector and no. workshops where present

Median no. voting members/workshop (IQR)

% Total for all workshops (range)

Six of workshops included observers from partner organizations or ministries. The number of observers averaged 10 (range 1-26) per workshop. Observers typically included in-country representatives from ministry partners, universities and research institutes, the World Health Organization, the Food and Agriculture Organization of the United Nations, Defense Threat Reduction Agency, the US Agency for International Development and its implementing partners, and CDC.

Zoonotic Disease Lists

All countries provided an initial list of zoonotic diseases from the relevant ministries to the OHZDP core planning team. Many of these lists were initially created by referencing the countries' human and animal health sector reportable disease lists. The presence of a reportable disease list did not reflect the surveillance capacity, and this variable, if selected, was assessed on-site by in-country subject matter experts. The core planning team conducted an extensive country and regionally specific literature review on the disease list. Voting members reviewed and approved the disease list on the first day of the workshop for use in the prioritization process.

Each list, on average, included 37 (range 25-43) diseases or syndromes. Zoonoses on these lists were classified as 41.4% (range 27.8%-51.3%) bacterial, 37.7% (range 28.0%-44.4%) viral, 18.3% (range 13.9%-25.0%) parasitic, 2% (range 0%-11.1%) fungal, and 0.8% (range 0%-4%) prion in nature. All lists included endemic and emerging zoonotic diseases relevant to the country or region.

All 7 initial country lists included the following bacterial zoonoses: anthrax, brucellosis, leptospirosis, plague, Q fever, salmonellosis, and zoonotic tuberculosis. All lists also included the following viral zoonoses: Crimean-Congo hemorrhagic fever; coronaviruses, including Middle East respiratory syndrome and severe acute respiratory syndrome; flaviviruses, including yellow fever and West Nile; hemorrhagic fever viruses, including Ebola and Marburg; rabies; and zoonotic influenza viruses. Six of the country lists included the following parasitic diseases: cysticercosis or taeniasis, echinococcosis, and toxoplasmosis.

Prioritization Criteria

Six of the 7 countries selected 5 disease-ranking criteria; 1 country selected 6 criteria. All selected criteria were categorized into 7 overarching topic areas; 4 of those topics were further broken down into 2-3 more specific subtopics ( Table 2 ). All 7 countries ranked diseases on the basis of social, economic, or environmental impact. Six of 7 countries ranked zoonotic diseases on the basis of availability of proven interventions, epidemic or pandemic potential, and severity of disease in humans; 5 ranked zoonoses on the basis of documented presence of disease in the country or region.

Table 2

Disease ranking criteria

No. countries

Average assigned weight† (range)

When looking at the weighting, or level of importance, voting members assigned severity of disease in humans and epidemic/pandemic potential as the 2 criteria with the highest average weight. Next were documented presence of disease in the country or region, and economic, environmental, or social impact. Last, availability of proven interventions and all other remaining criteria categories were assigned the lowest weight. However, no single criterion stood out across all 7 workshops.

Criteria Questions and Responses

Six of the 7 countries created 1 single or compound question for each selected criterion. One country created 2 separate questions for 4 of their 5 criteria, for a total of 9 questions. Voting members chose ordinal variables for all responses assigned to each criteria question. Seven (17.5%) questions had a binary response (yes/no), whereas most (82.5%) had >3 possible responses per criteria question. Regardless of the number of responses per question, all scores were normalized among criteria by using standard OHZDP tool methods (22).

A higher ordinal value (or score) was assigned to the responses for each question that correlated with a more severe, or negative, outcome. For example, a disease with a 50% case-fatality rate would receive a higher ordinal value than a disease with a 10% case-fatality rate. For questions that evaluated existing preventive measures, diagnostic capacity, and multisectoral collaboration, a higher ordinal score was given to responses indicating existing capacity or resources. For example, a zoonosis that could be diagnosed in the country would receive a higher score than one that could not.

Zoonotic Disease Ranking

As a result of the tool's ranking process in these 7 countries, 19 diseases or syndromes were ranked as prioritized diseases ( Table 3 ). Of those, zoonotic influenza virus (n = 5), rabies (n = 5), brucellosis (n = 5), and anthrax (n = 4) were ranked by the most countries. Four of the 7 countries ranked a mix of endemic and emerging zoonoses; 2 ranked only endemic zoonoses (27,28), and 2 ranked only emerging zoonoses. Of the 4 countries that listed endemic and emerging diseases, on average, 76% (range 60%-83%) of the zoonoses on the final list were known to be endemic in the country. Six countries ranked viral, bacterial, and fungal zoonoses, and 2 countries also ranked parasitic diseases; 1 country ranked only viral diseases.

Table 3

Zoonosis

No. countries listing disease, by rank order

Total no. countries

1

2

3

4†

5‡

6

Brucellosis ( Brucella abortus and B. melitensis)

1

1§

4§

5§

Zoonotic tuberculosis ( Mycobacterium bovis)

1

1

Final Prioritized List of Zoonotic Diseases

Four of the 7 counties used the original zoonoses produced by the OHZDP tool as their final prioritized list. Two countries agreed to adjust their lists to incorporate other zoonoses that the voting members felt should be in the top 5, and 1 country chose to adjust the order of the rankings to better reflect importance but retained the same zoonoses. Five countries chose a final list of 5 prioritized zoonoses, 1 country chose 6, and 1 country chose 3.

The most common zoonoses seen on the final prioritized lists remained the same as the original ranked list with the exception that rabies was selected in an additional country and brucellosis was removed in 1 country ( Table 4 ). Five of the seven countries included both endemic and emerging zoonoses on their final prioritized lists; 69% (range 33%-83%) of these prioritized zoonoses were considered endemic to the country prioritizing the disease. Two countries prioritized only endemic zoonoses (27,28). All of the emerging zoonoses prioritized by each country were viruses. All voting members came to consensus on the final prioritized zoonoses list, modified or not. This final list was then endorsed and adopted by the participating ministries.

Table 4

Zoonosis

No. countries listing disease, by rank order

Total no. countries

1

2

3

4

5

6

Brucellosis ( Brucella abortus and B. melitensis)

1

2†*

2†*

4†*

Zoonotic tuberculosis ( Mycobacterium bovis)

1

1

2

Outcomes

Six of 7 countries planned follow-up activities as part of the workshop. Twenty postworkshop action themes were identified ( Table 5 ). All 6 countries sought to ensure that the final prioritized list and any after-action items were approved by all participating ministries. Developing or updating and approving some type of national One Health strategy, guiding principles, or workplan was also universally identified as a desired outcome of this prioritization process. Four of the 6 countries indicated plans to use this list to establish recurring meetings, a multisectoral One Health working group or coordinating mechanisms, or both; 1 country that did not list this as an outcome already has a One Health coordination mechanism in place. The remaining action areas focused on various aspects of capacity building ( Table 5 ).

Table 5

Action item themes

Total no. workshops

Obtain ministry approval of prioritized list and activities

6

Obtain ministry support of a new or updated national plan

6

Develop a national One Health strategy, guiding principles, or work plan

5

Identify funding and technical assistance

4

Create a One Health coordinating mechanism

3

Improve data sharing across sectors

3

Establish recurring meetings

3

Develop disease-specific subcommittees

3

Strengthen the One Health workforce

3

Improve community outreach/communication

3

Improve surveillance

2

Perform a One Health capacity gap analysis

2

Link activities back to GHSA/IHR 2005

2

Improve reporting

2

Conduct research studies

2

Improve or develop laboratory capacity

1

Improve prevention and control

1

Improve outbreak response

1

Evaluate One Health impact

1

Perform the prioritization on local level

1

Kenya, which did not plan postworkshop activities, had previously created a One Health strategic plan in 2012 (29). Their plan included many of the same capacity-building activities stated by other countries, and prevention and control activities were already under way for 4 of the 5 prioritized zoonoses. Kenya's prioritized list validated existing activities and enabled the Zoonotic Disease Unit, the One Health coordinating mechanism for Kenya, to garner further support from the Government of Kenya to continue these efforts.

Discussion

During 2014-2016, CDC successfully carried out 7 OHZDP workshops in Thailand, Kenya (27), Ethiopia (28), Azerbaijan, Cameroon, South Africa, and the Democratic Republic of the Congo. Several other tools and methods have been applied to prioritize zoonotic diseases (30-36), but the OHZDP process is unique in that it enables country-led decisions using a multisectoral approach to prioritize both emerging and endemic zoonotic diseases while strengthening One Health collaborations and developing action plans to build capacity for the prioritized zoonoses. In addition, the OHZDP tool can meet the needs of those working in areas where quantitative data on zoonoses are lacking. Last, the OHZDP process provides outcomes in a timely manner so that participants may give immediate feedback and capitalize on One Health collaborations built during the prioritization process.

We have found key successes and lessons learned through the review of these workshops. First, successful outcomes are dependent on trust, transparency, equal representation, and consensus from all relevant sectors participating in the prioritization process and approving the final prioritized list of zoonoses. The CDC-trained OHZDP workshop facilitators not only conduct workshops but also train in-country facilitators to promote country ownership of the process and to build in-country capacity to conduct future workshops. Trained facilitators ensure that the prioritization process is standardized and conducted effectively. We found that using an interdisciplinary team of trained facilitators who remained neutral, unbiased, and did not focus on their specific sector, affiliation, or area of expertise enabled voting members' voices to be heard and recognized. Our review found that most voting members were from the human (35.5%) and animal (30.8%) health sectors, but additional sectors were represented where available, ensuring the multisector nature of this process.

To accommodate a larger number of voting participants, methods were modified in 2 workshops. However, because these methods have not been rigorously tested, it is still advised that future workshops maintain the recommended number of participants (8 to 12) to enable more focused discussion during and timely results from the 2-day workshop.

Funding partner advocacy and support of the process and future activities is a potential benefit of observer participation. However, care is needed to ensure that the number of observers in their role as advisors and participants during discussions do not overwhelm or influence the process. Keeping to the recommended 10-15 total observers (26) is needed so that voting members can focus on the workshop process. We recommend having an overview summary at the end of the workshop that is open to a larger group of higher level in-country representatives and other partners to share the workshop outcomes in a timely way.

The OHZDP tool was designed to accommodate diversity in location (i.e., globally) and scale (i.e., local, national, regional) into the prioritization process so participants can select criteria relevant to their needs. We found that most countries were interested in selecting criteria that targeted zoonoses known to be present in country with the following attributions: high illness and death rates in humans; pandemic potential; availability of proven interventions; and economy, environment, or societal impact. Most prioritized zoonoses were endemic diseases, illustrating that countries wanted to first focus their limited resources on diseases for which they could successfully implement enhanced diagnostic capacity, surveillance, and proven interventions.

Common priority action items identified in these workshops are highly relevant to advancing global health security, including improving data sharing between ministries, improving communication to the public, strengthening the One Health workforce, developing disease-specific subcommittees, and increasing general surveillance and outbreak response capacity. Such activities will enhance the capacity of countries to rapidly detect, respond to, and contain public health emergencies, including outbreaks of zoonotic diseases, at their source and thereby ensure global health security. Most countries with identified priority action items planned to use this list to solicit or engage funding partners, which highlights countries taking ownership of the prioritization process, and recognizing and advocating for support around their country-specific priorities. Six countries made sure that the prioritized list and any after-action items were approved by all participating ministries and that a national One Health strategy or multisectoral coordination mechanism was established if it had not been already. By forming or hosting these prioritization workshops with a ministerial One Health coordinating committee, these after-action plans are more readily taken up.

Four of the 7 countries conducted this activity to meet Joint External Evaluation and GHSA zoonotic disease prioritization and collaboration goals. The next step is that these countries then build these plans into their existing activities. These countries are supported by global health partners to help meet these goals.

As part of the continual improvement process for the OHZDP tool, we are employing postworkshop evaluations, in addition to continuing the postworkshop debriefs and facilitator interviews to ensure that these workshop continue to have successful outcomes. Moving forward, lessons learned from OHZDP workshops conducted during 2014-2016 will be applied to standardize and enhance the prioritization process in the future.

All 7 prioritizations were conducted during or in the wake of the 2014 West Africa Ebola outbreak (11). This event likely influenced the outcome for 1 country that prioritized Ebola despite the disease not being endemic or a likely risk in the country or region. Periodically repeating this prioritization process could help eliminate bias from current events, as well as aid in reevaluating if currently prioritized diseases still pose a public health threat, if sufficient capacity has been built, and if newly emerging diseases or other zoonoses need to be considered.

In summary, the GHSA uses a One Health multisectoral approach to strengthen the capacity at the global and national levels to prevent, detect, and respond to human and animal infectious disease threats, whether naturally occurring or accidentally or deliberately spread, that threaten global health security. Both endemic and emerging zoonotic diseases are recognized as being critical for global health security and related efforts. The OHZDP tool aids the GHSA mission by helping countries and regions prioritize their zoonotic diseases of greatest national concern and focusing GHSA capacity-building efforts on improving laboratory capacity, surveillance, outbreak response, and prevention activities on a few key zoonoses at first. The OHZDP process also supports progress toward the Joint External Evaluation, specifically for the zoonotic disease indicators, on having national laboratory, surveillance, and joint outbreak response plans and strategies in place for priority endemic/emerging zoonotic diseases with evidence of a multisectoral, coordinated approach. A multisectoral zoonotic disease prioritization with equal engagement from all sectors active in zoonotic disease work is one of the most cost-effective ways a country, especially one with limited resources, can begin using a One Health approach to prevent, detect, and respond to public health threats. By building these capacities and strengthening One Health partnerships for prioritized diseases, a country will not only more effectively address existing diseases but also have the systems in place to be better prepared to detect and respond to new and emerging diseases that may occur and become a threat to global health security.

Acknowledgments

We thank all of the participating ministries for their engagement in the OHZDP process. In addition, we thank the OHZDP facilitators who conducted these workshops: Mehriban Bagırova, Abednego Baker, Colin Basler, Ermias Belay, Pornpirun Chinnason, Aron Hall, Hashim Hashimov, Benoit Kebela, Grishma Kharod, Paisin Lekcharoen, Nlemba Mabela, Benjamin Monroe, Peninah Munyua, Paidamwoyo Mutowembwa, Megin Nichols, Asaf Omarov, Pawin Padungtod, Emily Pieracci, Wayne Ramkrishna, Cassidy Rist, Carol Rubin, Elshad Rzayev, Onpirun Sagarasearanee, Bencharong Sangkrak, Kendra Stauffer, Kitipat Sujit, Rita Traxler, Marietjie Venter, Deborah Weiss, Jacqueline Weyer, and Shahin Xasiyev.

Biography

Dr. Salyer is a veterinary epidemiologist with the Division of Global Health Protection, Center for Global Health, and the One Health Liaison for Global Health in the One Health Office at the Centers for Disease Control and Prevention. Her interests include systems strengthening, global health, One Health, and emerging, zoonotic, and infectious diseases.

Footnotes

Suggested citation for this article: Salyer SJ, Silver R, Simone K, Barton Behravesh C. Prioritizing zoonoses for global health capacity building-themes from One Health zoonotic disease workshops in 7 countries, 2014-2016. Emerg Infect Dis. 2017 Suppl [ date cited]. https://doi.org/10.3201/eid2313.170418

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Prioritizing Zoonoses for Global Health Capacity Building-Themes from One Health Zoonotic Disease Workshops in 7 Countries, 2014-2016

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Zoonotic diseases represent critical threats to global health security. Effective mitigation of the impact of endemic and emerging zoonotic diseases of public health importance requires multisectoral collaboration and interdisciplinary partnerships. The US Centers for Disease Control and Prevention created the One Health Zoonotic Disease Prioritization Tool to help countries identify zoonotic diseases of greatest national concern using input from representatives of human health, agriculture, environment, and wildlife sectors.