one health and important zoonoses in myanmar -...
TRANSCRIPT
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One Health and important zoonoses in Myanmar Nay Pyi Taw, January 25, 2018
Dr. Min Thein Maw (BVSc, MAg, PhD)
မြေးမြမေးနငကသမေးဦးစးဌာန
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Contents
• Zoonoses
• One health
• One Health collaboration in Myanmar
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Zoonotic Diseases
• Diseases that can be passed between animals and humans
• At least 61% of all human pathogens are zoonotic.
• ~75% of all emerging pathogens in the past decade have been zoonotic.
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Why do you think this is true?
1. We interact with animals in our daily lives.
2. We raise animals for food or enjoyment.
3. We keep them in our homes as pets. 4. We come into close contact with
animals at fairs and zoos. 5. We encounter wildlife when we are
outdoors or bugs that transmit disease.
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Zoonotic Disease and Spill over
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Zoonotic phases
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Spill over and Pandemic Properties
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Pet Ownership and Zoonoses
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Livestock and Zoonoses
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Routes of Transmission
• Direct contact – Bite, scratch, contact with infected tissues
– Ex. Rabies
• Indirect contact – Food/water-borne or touching infected object (fomite)
– Salmonella, E. coli, Giardia
• Aerosolization – Inhalation, contact with respiratory droplets
– Ex. Brucellosis, Psittacosis
• Vector-borne (animal serves as reservoir) – Mosquitos, ticks, fleas
– Ex. Rocky Mountain Spotted Fever, West Nile Virus
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Zoonotic Diseases Commonly Associated with Livestock & Poultry
• Influenzas – swine, poultry, humans
• Salmonella
• Anthrax
• E. coli
• Psittacosis
• Q-fever
• Brucellosis
• Tubercullosis
• And others….. Rabies
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Significant zoonotic important Events
2006-2017: (9) waves of outbreaks associated with public animal exhibitions – mostly Avian Influenza
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Influenza in Poultry Significant zoonotic important Events
• H5N1 – 858+ human cases reported in 15 countries in Asia, Africa, Pacific, Near East since 2017. 60% cases were fatal.
• Almost all cases had poultry exposures.
• H7N9 – 1623+ cases in China & Malaysia in 2013 & 2014. source was poultry.
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“One Health”
1. • Animal Influenza
2. • Rabies
3. • Antimicrobial
resistance
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One Health Concept
One Health
Animal Health
Human Health
Ecosystem Health
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One Health Concept Approach One Health advocates for the collective and cohesive investment in addressing health threats through a coordinated, collaborative, multi-disciplinary and cross sectoral approach.
This concept is evolved through several
recommendations of world bodies for
establishing a suitable approach towards preventing emerging & re-emerging diseases
maintaining ecosystem
integrity
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One Health Drivers
• 75% of emerging diseases are zoonotic
• The world bank estimates that an influenza pandemic could cost the global economy 2 trillion dollars
• 80% of agents having a potential bioterrorist use are zoonotic pathogens
• 60% of human pathogens are zoonotic
Approximate growth of the global population (Evans et al.,)
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Our OH Goals
• Open communication/networking
• Provide disease prevention education
• Enhance surveillance for disease risk
• Work together to mitigate zoonotic disease outbreaks when they occur
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On Health Myanmar Development
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Myanmar One Health (OH) Strategy
The One Health (OH) Strategy Workshop
(Nay Pyi Taw on 09 and 10 March 2016.)
One Health priority topics
• antimicrobial resistance (AMR) and
• six priority zoonotic diseases/syndromes, i.e.
– rabies
– zoonotic influenza
– tuberculosis
– food-borne diseases
– anthrax, and
– Japanese encephalitis.
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Why One Health in Myanmar?
Population density
Vulnerable food security & safety
Natural Disaster
Hotspots for EID & rEID
Fragile ecology
Close contact to human-Animal
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Zoonotic Disease Prevention and
Control: Global Rabies Elimination
Strategy
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Myanmar Rabies Elimination Framework
Nat
iona
l Pla
n fo
r Rab
ies
Elim
inat
ion
in D
ogs
Social-cultural
Technical
Organisational
Political
Resources
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Rabies control and prevention 4
• STANDZ Rabies Project • Philippines (ongoing) • Myanmar (ongoing) • Small Grant Facility in Cambodia (2015)
• OIE Regional Vaccine Bank for Rabies • EU-HPED Programme (finished last December 2014)
• The Vaccine Bank mechanism still exists and continues to operate (funds now provided by countries or other donors)
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Mass Dog Vaccine Campaign:
A One Health approach (A perfect Model)
Effective Mass Dog Vaccine
Campaign
Inter-ministerial collaboration
Public private partnerships (e.g. private vets, NGO’s)
Community involvement
and awareness
Ecosystem: Stray dog
populations, wildlife
reservoir
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OIE Myanmar Rabies Project:
A One Health example
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နဒါနး
ဧေယာ- 261228 sq miles
လဦးမေ-52 million
ခရင-72
မြ နယ-330
မကျေးေော-64,917
မခေးမကာငမေ (ခနြနး) -4 million
မခေးနငလဦးမေအချေး- 1:6
လြးမေးမခေး-70%
နစစဉမခေးကကခေြ(လ)-15,000-20,000
တေ စဆာနြျေားမခေးကကခေြ-unknown
လတေငမခေးရးမောဂါမတေေြ- 200
တေ စဆာနမခေးရးမောဂါမတေေြ-unknown
အြျေားဆးထခကြ -ကမလးငယြျေား?
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36 Source: DoH
Human rabies Cases (Reported)
Endemic situation
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Rabies in Animals (lab Confirmed)
Source: LBVD, Yangon Veterinary Diagnostic lab
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Myanmar’s Strategic Vision: Zero Dog Mediated rabies fatality by 2020
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2015
2016-17
2030
2027-29
2017-22
2023-27
Time Line Stages in Progressive Control Pathways
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Piloting Mass Dog Vaccination in Lewei and Nyaung Oo(2016-2017)
လယမေးနငမောငဦးမြာေမြ နယတေငမေးမမြေးမခေးရးမောဂါ
ကာကေယမဆးထးလြေငနးမဆာငေေကချေက
Livestock Breeding and Veterinary Department, LBVD
17 November World Rabies Day 2017
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ေလဒမကာငးြျေား
• ၂၀၁၃ ခနစြ ၂၀၁၇ ခနစအတေငး မခေးမကာငမေ
(၃၃၀,၀၀၀) ခနကာကေယမဆးထးနမြေးနငခ
• Pilot မဒသတေင 70% ကာကေယမဆးလြးမခ ြေေမခငး
• မလကျေငထားမသာ ကျြးကျေငြေသေ
ကာကေယမဆးထးလြေသားြျေားစဖေ နငခမခငး
• SOP and vaccination Guideline ေေလာမခငး
• One Health မဖငမဆာငေေကနငမခငး
• အစလကမခေးရးမောဂါကာကေယမဆးထးမခငးမြေလြေနငမခငး
• အမတေအကကြျေားြျမေမြေးနငမခငး
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ကြဘာမခေးရးမောဂါတကဖျေကမေးမနအခြးအနားြျေားနစစဉကျေငးြေ လတေားမခငး
• ကာကေယမဆးထးမြေးမခငး
• ြေောမြေးမခငး
11th
(၁၁) ကြ မ မြာ ကြမ ြ ဘကြ ေးရးြေကဂါြကြေယမတမြမဖျြမြေးြေအ မးအေကး
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မြေေသြျေားြေးမြေါငးြေါေငြ
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Public Awareness
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Implementation:
Community Involvement (CAHW)
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Implementation Training: LBVD officers
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Implementation Training
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Implementation – in the field
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One Health Approach
‘It is amazing what can be accomplished
when you don’t care who gets the credit.’
United States President Harry S. Truman
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Avian Influenza Surveillance
Livestock Breeding and Veterinary department
22 December 2017 Nay Pyi Taw, Myanmar
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Preparedness (brief) • Contingency plans for avian influenza: HPAI Contingency plan and H7N9
Contingency Plan (LBVD) • National Steering Committee on prevention and control of Avian Influenza and
Human Influenza Pandemic Preparedness & Response • Table Top exercise and simulation exercises (One Health ) • National surveillance: Active and passive AI surveillance in border area, LBM
and farms • Strengthening laboratory capacity , resources • control measures include: Joint outbreak response, investigation
• No vaccination • Zoning • Movement control • Cleaning and disinfection • Public awareness and risk communication • Active and passive surveillance • One health Coordination
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LBVD Laboratory capacities
Capacities Yangon Mandalay ShweMyo
(NPT) Taungy
i Pathein
4 Quarantine Labs:
BSL2 enhanced Yes Yes Yes No No No
Biosafety Cabinet Class II
Yes Yes Yes Yes Yes No
Serology (HA, HI,) Yes Yes Yes Yes Yes Yes
Serology (ELISA, IPMA, FAT)
Yes Yes Yes No No No
Virus Isolation Yes Yes Yes No No No
Conventional PCR Yes Yes Yes No No No
Real Time PCR Yes Yes Yes No No No
Gene Sequencer Yes No No No No
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Routine and risk-based surveillance has been conducting in collaboration with FAO since 2006-2017
Since 2013 total of 6th Round of risk-based surveillance implemented to 2017
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Lesson learnt, benefit • Lesson- Learnt from H5N1 Poultry Outbreak • Benefit:
• Rapid response and reduced impact • Contingency Plan, SOP, guidelines , structure in place • Joint investigation and response One Health
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AI epidemiology changes
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Tackling Antimicrobial Resistance (AMR) by One
Health Approach and role of veterinarian in Myanmar
by
Dr Min Thein Maw
Livestock Breeding and Veterinary Department
(10-1-2018)
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“One Health”
1. • Animal Influenza
2. • Rabies
3. • Antimicrobial
resistance
• Three important topics
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The Global Health Security Agenda (GHSA)
The 11 Action Packages of GHSA Prevent 1: Antimicrobial Resistance Prevent 2: Zoonotic Disease Prevent 3: Biosafety and Biosecurity Prevent 4: Immunization Detect 1: National Laboratory System Detect 2 & 3: Real-Time Surveillance Detect 4: GHSA Reporting Detect 5: Workforce Development Respond 1: Emergency Operations Centers Respond 2: Linking Public Health with Law and Multisectoral Rapid Response Respond 3: Medical Countermeasures and Personnel Deployment Action Package
Office of the Spokesperson, Washington, DC September 14, 2016
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PVS vs IHR-JEE and AMR MYANMAR
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What is antimicrobial resistance?
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Antibiotics vs AMR: Antimicrobial Resistance
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Deaths attributable to antimicrobial resistance every year compared to other major causes of death
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Types of Antibiotic Uses in Livestock
Growth Promote
r
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Authorization of antimicrobial growth Promoters in OIE member countries (2015)
• Antimicrobial growth promoters authorized (26%) • Antimicrobial growth promoters not authorized (74%)
74%
26%
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U D
ata
Co
llect
ion
ANTIMICROBIAL USAGE
DATA COLLECTION
IN ANIMALS Submissions from
ASEAN Member States
3
2
1
2
3
1
4
3
2
1 1
0 0
1 1 1
0
Terrestrial animals covered, based on submissions from AMS
(N=4)
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3
2
0 0 0
Fishaquacultureproduction
Fish farmed infresh water
Crustaceans Molluscs Amphibians
Food-producing aquatic animals covered,
based on submissions from AMS (N=4)
AM
U D
ata
Co
llect
ion
ANTIMICROBIAL
USAGE DATA COLLECTION
IN ANIMALS
Submissions from ASEAN Member States
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Spread of AMR animal-human interface
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Issues of AMR for the Vet
• Reduced efficacy of treatment • AMR in zoonotic bacteria
• Consumer protection/food safety • Self protection from occupational disease
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Measure taken by LBVD • National Planning for Responsible and prudent use of
antibiotics • Veterinarian are parts of solution
• Well trained Vets • Well supervised • Veterinary Council • Myanmar Veterinary Association
• Raised awareness among players • National Authorities • Veterinarians • Breeders and animals owners
• Campaigns World Antibiotic Weeks • Standards (HACCP, GMP, GAHP) • One health Approach
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National Livestock AMU/AMR Control Plan
1. IMPROVE awareness and understanding of AMR through effective communication, education and training;
2. STRENGTHEN knowledge and evidence base through surveillance and research;
3. REDUCE the incidence of infection through effective sanitation, hygiene and infection prevention measures;
4. OPTIMIZE the use of antimicrobial medicines in human and animal health; and
5. DEVELOP the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines, and other interventions.
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What Policy makers can do?
• Control the use of antibiotic through veterinary supervision ( strengthen regulatory and supply chain)
• Guidelines and recommendations on the use of antibiotics in food animals
• Ensure the existence of appropriate veterinary legislation
• Advocate responsible and prudent use • Ban antibiotic as growth promoter or phase out non
therapeutic use of antibiotics in food animals
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What Veterinarian can do?
• Only prescribe when necessary • Test bacterial sensitivity • Raised awareness among animal owners • Encourage good practice (GAHP) • Keep your knowledge update
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What Breeder and Animal Owners can do?
• Only use antibiotics prescribed by your veterinarian
• Respect the treatment dose and duration • Always procure antibiotic from
authorized sources • Prevent infection by following good
Husbandry practices • Keep records of antibiotics administered
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National Plan (livestock) Implementation
1. Strengthening Veterinary Supervision • Veterinary medical and feed stuff in Aquaculture
Committee • VmfAq-TWG
• Proposed Prohibited substances list by VMFAq
1. Chloramphenicol
2. Chloroform
3. Chlorpromazine
4. Colchicine
5. Dapsone
6. Dimetridazole
7. Metronidazole
8. Nitrofurans (including
furazolidone)
9. Ronidazole
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An Integrated management-based approach for surveillance and control of zoonoses in emerging livestock systems (ZELS)
2015-2020 FOCUS: AMR zoonoses in Pig Supply chain
Salmonella
Streptococcus suis
E.coli
Retail shop Farm Abattoir Supermarket
2. Evidence based research surveillance of AMR
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3. Education and Awareness to Veterinary drug and feed shops
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World Antibiotic Awareness Activities
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4. Antimicrobial Usage Baseline-Data Collection in Livestock Sector
0
200000
400000
600000
Amou
nt in
(Kg)
Antibiotic Class
Comparison of AMU in Livestock (2014-2017)
2014-20152015-20162016-2017
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5. Development of GAHP and promotion of GAHP
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• AMR/Food safety ကစစတေင Multi-agency control process ြျေားေမခငး
• Limited capacity on Collection and Analysis of AMU data (species basic)
• အစာနငမဆးြျေားနငြေတသက၍ ထနးချေြေသေ စနစအားနေးမခငး (Weak Regulatory control on registration, prescription, distribution, selling, usage of Veterinary drugs in animal sector)
• Post marketing surveillance စနစ အားနေးမခငး
• ဥြေမဒ/အြနညနကကားချေကြျေားလအြေမခငး (Needs sound regulatory framework)
• Needs stakeholder participation
Challenges on AMR control
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Mitigating AMR with One health Approach
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On Health Myanmar Development
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Participating in AMR National Action Plan, Myanmar
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Thank you for attention