ISDS One Health Surveillance (OHS) Case Study CASE STUDY TITLE Promoting the One Health Approach to prevent wildlife-borne zoonotic diseases in Bolivia – Yellow fever outbreak case study PROJECT/ACTIVITY TITLE Emerging Pandemic Threat/PREDICT Program CONTACT INFORMATION NAME: Erika Alandia Robles, MSc MVZ ORGANIZATION: PREDICT - Bolivia; Institute of Ecology – Major University of San Andres COUNTRY: Bolivia Email: [email protected] WHAT DOMAIN(S) DO ___ Environmental ___ Human health _x__ Animal health YOU WORK IN? health _x__ Cross-Agency OHS AREA(S) OF __x_ Training and ___ Technologies and Communication and FOCUS ADDRESSED Resources Methodologies Collaboration BY CASE STUDY ___Other: ____________________________________________ PROBLEM DESCRIPTION (150 word maximum) Summarize the problem/situation that was addressed with a OHS approach. Immediate detection and response to zoonotic disease outbreaks in animals are valuable strategies to prevent infections in humans. Detection and early warning of wildlife-borne pathogens are often limited by the lack of sensitized observers, efficient reporting mechanisms, trained personnel to conduct wildlife sampling, and adequate diagnostic capacity. The Emerging Pandemic Threats PREDICT Program applied a One Health approach in Bolivia to address these limitations. From 2010 to 2013, PREDICT successfully trained and involved different stakeholders in wildlife sampling and surveillance activities, developed molecular diagnostic capacity for priority viral families with zoonotic potential, and facilitated communications among key government agencies. In this context, the present case-study describes a yellow fever (YF) outbreak affecting monkeys in Bolivia, and highlights how prompt investigation and response helped prevent transmission to humans. ACTION TAKEN (500 word maximum) Describe how the problem was addressed and how the action taken was measured. Please include a description of the collaborators and the data sources used. While YF is endemic in certain areas of Bolivia, no YF-mortality had been previously reported in monkeys. However, in March 2012, the finding of six dead Red Howler monkeys (Alouatta sara) near a wildlife sanctuary in eastern Bolivia, triggered a PREDICT-driven multi-institution response that likely prevented a human outbreak. Following the notification from the wildlife sanctuary personnel, PREDICT staff necropsied two monkey carcasses following pre-established procedures. Lesions compatible with YF were observed, and viral family level molecular diagnostics (RT-PCR) were conducted on liver samples at the Institute of Molecular Biology (University of San Andres, La Paz). Results confirmed a flavivirus infection. The Ministry of Public Health (MoH) was immediately notified. After a risk evaluation performed jointly by the MoH, PREDICT and the Panamerican Health Organization (PAHO), preventive measures were promptly implemented in the affected area, including human vaccination campaigns, public outreach, and mosquito control. No human cases were reported during this event, providing the most successful course possible as a result of a previously unimaginable rapid response, which went from discovery to resolution in only eight days. FACILITATORS AND BARRIERS (100 words max each) Please list and describe any factors that contributed positively to this project/activity. 1. Collaborative work between public and private institutions linked to human and animal health was a sensible strategy to prompt detection and response to prevent a zoonotic disease outbreak. The monkey deaths were reported by veterinarians from the Ambue Ari wildlife sanctuary who had been trained by the PREDICT team in Bolivia. Thus, increasing awareness and training veterinarians, biologist, rangers and local stakeholders working/living in proximity with captive and free-ranging wild animals, proved to be an efficient strategy to promote surveillance and facilitate prompt detection of possible zoonotic diseases risks. 2. Improvement of existing infrastructure and capacity for wildlife disease diagnostics in country was critical in quickly identifying the cause of the outbreak. Prior to PREDICT no lab was conducting molecular diagnostics other than PCR for rabies on wildlife samples in Bolivia. As the PREDICT partner laboratory, the Institute of Molecular Biology from the University of San Andres in La Paz received support to enhance its diagnostic capacities for detection of pathogens in wildlife samples. This step was essential in the rapid confirmation of the presumptive diagnosis in our study (results were available 2 days after submission of samples). It also highlighted the importance of investing in establishing local diagnostic capacity. 3. Transdisciplinarity and multisectorial communication and collaboration were essential to ensure a rapid and effective response. Historically, little if any communication and coordination occurred between the wildlife and public health sectors in Bolivia. Nevertheless, the training activities carried out by PREDICT brought together stakeholders with different backgrounds (biologists, veterinarians, public health workers) and institutions (MoH, National Veterinary Service, General Directorate of Biodiversity, universities, NGOs and wildlife sanctuaries/zoos). In so doing, collaborative work was facilitated, while creating an environment of mutual trust and willingness to jointly address common problems. These factors were essential in ensuring the coordinated rapid detection and prompt response to the YF outbreak. Please list and describe any factors that were a challenge or barrier to overcome. Awareness and response to wildlife zoonosis is limited in Bolivia. Currently, the MoH Zoonosis National Program has no specific programs or focal points to address wildlife-borne zoonotic diseases other than those transmitted by rodents. Thus, at the time of the YF outbreak there was no designated point person to deal with the emergency. An impromptu response team had to be formed for timely action, and included the high-level officers such as the national epidemiology and immunizations chiefs in collaboration with the PAHO YF focal point. LESSONS LEARNED (250 word maximum) Please describe any lessons learned or best practices identified by this project/activity. The coordinated efforts between animal and human health agencies and concurrent involvement of wildlife and environmental professionals are key to health security. Furthermore, advancement of these One Health principles could lead to conscious proactive efforts to prevent and mitigate potential harmful outcomes of environmental transformation in the early phases of development planning. 2 ADDITIONAL COMMENTS (75 words max) Summarize the problem/situation that was addressed with a OHS approach. The coordinated efforts between animal and human health agencies and concurrent involvement of wildlife and environmental professionals are key to health security. Furthermore, advancement of these One Health principles could lead to conscious proactive efforts to prevent and mitigate potential harmful outcomes of environmental transformation in the early phases of development planning. 3 .