One Health in Action (2014-2020)
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GHANA One Health in action (2014-2020) Using a One Health approach to enhance national health security by strengthening disease surveillance and laboratory capacities for detection, response, and prevention of current and emerging zoonotic viral threats. GHANA In Ghana, a rapidly growing harm to the monkeys in the sanctuary, conducted syndromic surveillance in economy and population have which come into the village daily patients presenting with acute febrile led to deforestation, agricultural to enter peoples’ homes, raid food illness of unknown origin to clinics, expansion, human migration, and stores, and feed alongside livestock in including a large referral hospital vibrant regional trade – all factors the agricultural fields. Tourists visiting in Accra’s city center, that receives associated with risk for disease the sanctuary also feed the monkeys, cases for most medical disasters and emergence and spread (Daszak et a practice which increases the disease outbreaks in the country. The al. 2001). PREDICT was initiated in populations’ dependence on artificial clinics served the communities where Ghana in 2016 to enhance existing food and is thought to contribute to PREDICT conducted surveillance. capacities to conduct surveillance for population growth, leading to human- Through analysis of project data and emerging viral zoonoses of pandemic primate conflicts and heightened risk findings, PREDICT was able to identify potential (filoviruses, coronaviruses, of shared diseases. risks and educate communities and paramyxoviruses, flaviviruses, PREDICT also targeted for surveillance, health professionals on behavior arenaviruses (humans only), and one of the largest known urban bat change and intervention strategies influenza viruses) at high-risk disease roosts in West Africa, an Eidolon designed to protect people and transmission interfaces between helvum colony in Accra’s city center. wildlife from disease threats. When wildlife, livestock, and people. Recent studies in Ghana suggest requested by the government of PREDICT used a One Health approach that E. helvum harbor zoonotic or Ghana, PREDICT also utilized a One to conduct disease surveillance in potentially zoonotic viruses, including Health approach to assist with disease bat, rodent, primate, and human henipaviruses (Drexler et al. 2012; outbreak investigations. In addition, populations in a rural setting near the Hayman et al. 2008a), lyssaviruses the team played a key role in activities Boabeng-Fiema Monkey Sanctuary (Hayman et al. 2008b; Suu-ire et al. under the Global Health Security and in a highly urban setting in the 2017), and ebola viruses (Hayman et Agenda, including evaluation of the capital city. In the rural communities of al. 2010). This is notable because E. country’s strengths, gaps, and priority the Nkoranza North District, people helvum migrate long distances, roost actions for enhancing national health depend heavily on agriculture for in high densities in large colonies security; prioritization of zoonoses their livelihoods and come into close across Africa, and are hunted for of public health concern in Ghana; contact with bats and rodents in their consumption (Kamins et al. 2011). and development of a national One homes and while working and hunting In addition to sampling people in Health policy. in their agricultural fields. Traditional the high-risk communities, PREDICT beliefs and local law forbid physical IMPLEMENTING PARTNERS OTHER PARTNERS • 37 Military Hospital • Ghana Armed Forces • Ghana Health Service • Food and Agriculture Organization of the • Noguchi Memorial Institute for Medical United Nations Research, University of Ghana • Ministry of Health Emergency Operations • United States Agency for International Center Development • Ministry of the Interior National Disaster • University of California, Davis Management Organization • Veterinary Services Department, • NAMRU-3 Ministry of Food and Agriculture • National Public Health Reference Laboratory • Wildlife Division of the Forestry • Partnership for Health Care Improvement Commission, Ministry of Land and • United States Centers for Disease Control & Natural Resources Prevention • World Health Organization LABORATORY STRENGTHENING • Accra Veterinary Laboratory • Noguchi Memorial Institute for Medical Research, University of Ghana 20,480 TESTS Global Health Security Agenda COL SAMUEL “PREDICT is a versatile project that brings together disease surveillance and diagnostic laboratory networks to support the Global BEL-NONO Health Security Agenda and One Health platform in Ghana. Country Coordinator The project has expanded the tools and approaches to viral disease Retired from the Ghana Armed investigations and strengthened national capacities for prevention, Forces Medical Services detection, and response to zoonotic viruses.” “PREDICT is directly encouraging inter-ministerial collaboration EVANGELINE and providing the opportunity for partners to work together in the field and laboratories; directly strengthening cross-sectoral information OBODAI and data sharing; and helping to enhance capabilities for early Human Laboratory Lead zoonotic disease detection, prevention, and response. PREDICT Noguchi Memorial Institute has been able to strengthen laboratory capacity for zoonotic disease for Medical Research, detection in Ghana by providing a useful basic PCR tool/platform University of Ghana that comes in handy for screening for novel viruses.” ACHIEVEMENTS • Expanded the scope of national disease surveillance • PREDICT Ghana’s two human syndromic activities in Ghana to include a focus on zoonotic surveillance sites in the Nkoranza North District viruses of major public health significance of the Bono East Region were recommended for • Strengthened national capacities to detect novel designation as sentinel sites for zoonotic disease viruses that may be the cause of undiagnosed surveillance by the Head, Disease Surveillance illnesses in Ghana. The Virology Department Department, Ghana Health Service at NMIMR conducts diagnostic testing for viral • Enhanced national health security by playing a pathogens in clinical cases, for the Ministry of Health/ key role in the Joint External Evaluation of IHR Ghana Health Service. PREDICT virus detection core capacities, Zoonotic Diseases Prioritization protocols for filo-, arena-, flavi-, influenza, corona-, Workshop, and development of the implementation and paramyxoviruses are now included in the plan for the Global Health Security Agenda molecular diagnostic suite used to investigate the Zoonoses Action package for Ghana cause of illness for these referred cases • Strengthened institutional collaboration for • Enhanced capacity for the Ghana Health Service implementation of One Health approaches vector surveillance system by incorporating through increasing awareness of One Health at the PREDICT’s protocol for safe specimen collection ministerial level and contributions to development of into the field activities and PREDICT’s virus detection the national One Health policy protocols into the suite for molecular-based assays • Implemented One Health approach to support the used to screen rodent and mosquito samples for Ghana government in investigation of a suspected evidence of viruses of public health importance, Lassa fever case including Ebola, Marburg, Crimean Congo Hemorrhagic Fever, Dengue, Zika, Chikungunya, Yellow fever, Lassa, and other Arenaviruses ONE HEALTH SURVEILLANCE PREDICT’s One Health surveillance approach was designed to strengthen capacity for detection of emerging viral threats and to improve our understanding of risk of zoonotic diseases in communities with close and frequent animal contact. Our team safely and humanely sampled wildlife (bats, rodents, and non-human primates) and people concurrently, targeting high risk populations for virus spillover, amplification, and spread in rural and highly urbanized settings in Ghana. We also conducted syndromic surveillance of patients presenting to local clinics serving the communities at our sites. Data collection and sampling was performed longitudinally over a three-year period during both the rainy and dry seasons. Species identification of bats and rodents was confirmed Nkoranza North District - Community Nkoranza North District Health Center 1 using DNA barcoding, a molecular-based laboratory assay. Nkoranza North District Health Center 2 37 Military Hospital NKORANZA NORTH DISTRICT PREDICT surveillance sites in Ghana ACCRA Numbers of individuals sampled by taxa group in Nkoranza North District Our team conducted surveillance in communities within Numbers of individuals sampled by taxa group in Accra the Nkoranza North District near the Boabeng-Fiema Monkey Sanctuary. These community members are Our team also conducted surveillance on the grounds primarily farmers who rely on extensive small-scale of the 37 Military Hospital in Accra’s bustling city center, crop and livestock production (primarily domestic fowl, which is home to one of the largest known urban fruit sheep, and pigs) and to a lesser degree hunting for their bat (Eidolon helvum) colonies in West Africa (~250,000 livelihoods. The Boabeng-Fiema Monkey Sanctuary, which bats). The bats migrate long distances, congregating in their draws visitors from around the world, is home to over urban roosts during the dry season and migrating into the 700 monkeys (Black and White Colobus and Lowe’s Mona northern savannas at the onset of the wet season. The monkey) that interact with the communities through daily bats