at the HumanAnimalEnvironment Interface S unday Makama DVM MFS PhD ERT drsmakamagmailcom Why 2 All relevant stakeholders are required to fully understand hazards arising at the interface ID: 999532
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1. Joint Risk Assessment Implementation: Anthrax at the Human-Animal-Environment InterfaceSunday Makama (DVM, MFS, PhD, ERT)drsmakama@gmail.com
2. Why?2All relevant stakeholders are required to fully understand hazards arising at the interfaceWhen all relevant sectors are at the table they can:Collectively evaluate where and why risk exists through expertise and data gathered from each sectorMinimise unintended impacts by understanding and addressing the perspectives and needs from each sector
3. Zoonotic diseases require a joint approach to risk assessmentTRUE (T)FALSE (F)
4. The approach to conducting a joint risk assessment in the JRA-OT is…B) QUALITATIVEA) QUANTITATIVE
5. Anthrax Event Summary5Anthrax rare but serious bacterial illnessBacillus anthracis. It occurs naturally in the soil as spores; vegetating when conditions are right.Disease of domestic livestock and wild animalsHumans become infected through contact with an infected animal (or product) and ingestion or inhaling sporesSymptoms depend on the route of infectionskin ulcer with a dark scab (Cutaneous) to difficulty in breathing (Respiratory).Antibiotic treatment cures most infectionsAlert!Confirmed outbreaks in West Africa (Sierra Leone) and East Africa (Uganda) with high mortality in animals and involving human infections
6. Anthrax Event Summary6The top government concerns related to this hazard are: Possibility of the disease crossing international bordersTransmission from wildlife and presence of wildlife reservoirs Ignorance of farmers and the populace including Health care workersPoor surveillance at live animal markets, the international borders and slaughterhouses
7. JRA-OT Modules7MODULE 0IntroductionFigure 2 highlights modules & steps that are recommended vs required.
8. Setting up JRA8Nigeria OH Steering Committee: tripartite ministries (Agric, Env., Health + DG NCDC)JRA Lead designatedJRA Technical Team convened (Physical meeting)Stakeholder groups (already mapped)
9. Risk framing (template)9Risk framing guides the JRA technical process and formulation of risk assessment questionsNote: Risk framing is performed by the JRA steering committee5.1 Define the specific hazard:Anthrax5.2 Define the scope: wider scope?health risks at the human-animal-environment interface; especially in States with International borders (National and Border States)5.3 Agree on the purpose & Objectives:Risk mitigation; provide a basis for management or communication decisions
10. Conducting the JRAStep 6: Identify & diagram risk pathways10Performed by JRA technical teamIt is important to consider all potential risk pathways. You will see that having a comprehensive diagram of pathways is crucial in formulating the risk questions.
11. Step 7: Formulate and document risk questions11Performed by JRA technical teamFormulate appropriate RA questionsCheck the questionsDocument the questionsWhat is the likelihood and impact of at least one person in a LGA having International border(s) to be infected with anthrax from live animals crossing the border in the next six (6) months?What is the likelihood and impact of at least one abattoir worker in a Nigerian state with international border(s) becoming infected with anthrax from an infected animal within the next six months?
12. x8. Characterize the risk & Plot estimates12Q1: What is the likelihood and impact of at least one person in a LGA having International border(s) to be infected with anthrax from live animals crossing the border in the next six (6) months?Q2: What is the likelihood and impact of at least one abattoir worker in a Nigerian state with international border(s) becoming infected with anthrax from an infected animal within the next six months?
13. 8. Characterize the risk & Plot estimates13Risk Char.EstimatesRationaleUncertaintyRationaleQ1LikelihoodHighThe high likelihood estimate is based on surveillance and epidemiologic data, hospital clinical data, research data, veterinary clinic data and quarantine records.LowThe uncertainty for both estimates is low due to the availability of data and expert consensusImpactModerateSince the socio-cultural activities of the communities in question may undertake trans-border trade in livestock, Low index of suspicion and capacity for diagnosis of anthrax by Health Care Workers in border communities, and no animal vaccination program for anthrax in Nigeria and close relationship between people and animals.LowQ2LikelihoodHighReported human case in the Niger Republic; Transborder movement; Porous borderLow vaccination coverage; Disease of international concern in IHR 2005LowImpactModerateHigh morbidity and mortality among humans and animals; impact on food security; trade disruptionsLow
14. 9. Technical Interpretation (Q1)14The JRA technical team assessed the likelihood and impact of at least one person in a LGA having International border(s) to be infected with anthrax from live animals crossing the border in the next six (6) months and concluded that the likelihood is high and the impact, moderate. The conclusion assumed that there is a possibility of infected animals crossing the borders without detection because of limited animal control services at the borders.The high likelihood estimate is based on surveillance and epidemiologic data, hospital clinical data, research data, veterinary clinic data and quarantine records. The impact was estimated to be moderate based on the socio-cultural activities of the communities suggesting high probability of trans-border trade in livestock, low index of suspicion and limited capacity for diagnosis of anthrax by Health Care Workers in border communities. Also, there is no national animal vaccination program for anthrax in Nigeria and people and animals live in close association. The uncertainty for both estimates is low due to the availability of data and expert consensus. This assessment was based on available data and opinions of expert, literature review and information obtained from state clinical records and surveillance data.
15. 9. Risk mgt & Communication Options (Q1)15Based on the estimates of the high Likelihood and moderate impact of at least one person at border communities in Nigeria infected with anthrax from live animals crossing the border in the next six (6) months and the low uncertainty levels, the JRA team recommends as follows:Active surveillance for Anthrax at border statesIncreased risk communication to different target groupsCapacity building of health workforce on the diagnosis of AnthraxMass vaccination of animals against Anthrax in border states
16. 9. Informing JRA stakeholders16Now that recommendations are recorded, the JRA lead and steering committee communicate with the stakeholder group. This ensures they are informed of risk management options and can be involved in implementation.
17. Step 10: Document the Assessment17Completed by the JRA technical team
18. Planning for next steps18Congratulations! You finished the 10-step JRA method. Now use the JRA system to repeat JRAs as needed for existing hazards or mobilize quickly in an emergency. Be sure to inform the JRA lead and steering committee about how you see the JRA being used in the future.Enhancing the JRA
19. Questions?
20. Thank you!More information on the TZG project OIE webpage: www.oie.int/en/for-the-media/onehealth/controlling-health-risks/national-collaboration/ WHO webpage: www.who.int/initiatives/tripartite-zoonosis-guide FAO webpage: www.fao.org/animal-health/en/
21. Define the scopeStep 5.2, p. 2621The scope is the epidemiological boundaries that need to be consideredUsually, an assessment of:Health risksAt the human-animal-environment interfacePosed by the agreed upon hazardWithin the country / regionDuring a specified time periodDefined time and place