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PERSPECTIVE
Year : 2020  |  Volume : 151  |  Issue : 2  |  Page : 132-135

Need for integrated surveillance at human-animal interface for rapid detection & response to emerging coronavirus infections using One Health approach


Former Director, Communicable Diseases, World Health Organization South-East Asia Region Office, New Delhi 110 002, India

Date of Web Publication28-Apr-2020

Correspondence Address:
Rajesh Bhatia
Former Director, Communicable Diseases, World Health Organization South-East Asia Region Office, New Delhi 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_623_20

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How to cite this article:
Bhatia R. Need for integrated surveillance at human-animal interface for rapid detection & response to emerging coronavirus infections using One Health approach. Indian J Med Res 2020;151:132-5

How to cite this URL:
Bhatia R. Need for integrated surveillance at human-animal interface for rapid detection & response to emerging coronavirus infections using One Health approach. Indian J Med Res [serial online] 2020 [cited 2020 Jul 15];151:132-5. Available from: http://www.ijmr.org.in/text.asp?2020/151/2/132/281061

The World Health Organization (WHO) on January 30, 2020 declared the coronavirus disease (COVID-19) event as the Public Health Emergency of International Concern. The event that commenced in Wuhan, Peoples' Republic of China, in December 2019, continues to spread relentlessly. Till February 28, 2020, the WHO has reported 85,403 confirmed cases of COVID-19. Of these cases, spread over 53 countries, 2,924 have died[1]. The causative agent of COVID-19 has been designated by the International Committee on Taxonomy of Viruses[2] as severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2) because of genetic similarities of this virus with the corona virus (SARS-CoV-1) that caused SARS.

The United Nations had earlier linked national security with pandemics[3]. COVID-19 has also assumed immense global implications for human health, economy and development. The spread of the virus seems to be unstoppable. Swift international travel seeds the virus in hitherto virgin areas. Explosive human-to-human transmission becomes a possibility because of non-immune status of almost the entire population. The inherent characteristic of the coronavirus further fuels rapid transmission. Several other factors such as overcrowding, lack of awareness on proper use of non-pharmaceutical measures, weak health system and inadequate resources for isolation of patients and contacts and infection prevention and control practices in health facilities further facilitate the spread of the virus.


   Recent pandemics Top


The past four decades have seen emergence and spread of several new viral diseases. These have transformed the microbial landscape of global public health. A large number of human infectious diseases arise from animals; 60 per cent of these are transmitted from animals, and 75 per cent of emerging infectious diseases originate from animals[4]. Many of the viruses originated from animals have caused pandemics associated with substantial mortality, misery, social chaos and colossal economic losses. Non-availability of specific antivirals or vaccines during these crisis periods made it extremely difficult to provide pharmaceutical interventions to combat these emerging viruses.

During current millennium itself, apart from Influenza H1N1 pandemic of 2009 due to Influenza H1N1 pdm 2009 virus, avian flu (Influenza H5N1), SARS (SARS-Cov-1), Middle East respiratory syndrome (MERS)-CoV and COVID-19 (SARS-CoV-2) have severely hit the world[5]. Nipah virus outbreak in Kerala, India, is yet another example of a zoonotic infection causing social upheaval requiring emergency public health actions[6]. One of the major reasons for these epidemics to spread rapidly is the delay in early detection of appearance of viruses because of weak surveillance at human-animal interface.

Three major events during the current millennium (SARS, MERS and COVID-19) have been due to coronaviruses. There are many more corona and other viruses lurking among wild animals. Most of these have the potential to jump the species and cause novel infection in human beings, which may explode into uncontrollable pandemic. It has been estimated that “there are over 1.6 million unknown viral species in mammalian and avian populations, of which approximately 700,000 have the potential to infect and cause disease in humans”[7]. Compared to just over 260 viruses that are currently known to cause diseases in humans, the unknown viruses represent 99.9 per cent of potential zoonoses[8]. We need to be better prepared to detect these viruses through an efficient surveillance and characterize such significant viral threats available for spillover from animal reservoirs. Strong surveillance of these viruses for early detection is critical to contain these viruses during initial phase of emergence of virus only.


   Need for a sensitive surveillance system at human-animal interface Top


The recent events have reinforced the need for a global sensitive surveillance system that can detect these viruses during early phase of outbreak and facilitate mounting of appropriate non-pharmaceutical interventions to prevent their spread and amplification. Since these viruses have originated from human-animal interface, a system that integrates surveillance by human health and animal health sectors needs to be evolved in true spirit of One Health for early detection and efficient response to spillover of such viruses. The WHO in cooperation with international animal health agencies (Food and Agriculture Organization of the United Nations and OIE-World Organisation for Animal Health) has been encouraging “collaboration, networking and technical consultation for the purpose of jointly analyzing epidemiological, virological and human-animal interfaces and promptly sharing and distributing public health information”[9].

The Global Virome Project (GVP), an innovative 10 years partnership, is striving to detect the majority of the unknown viral threats. GVP discoveries can catalyze activities that facilitate proactive preparations for them. It may be the beginning of the end of the pandemic era[7].


   Surveillance is a core capacity agreed to under legally binding International Health Regulation (IHR) (2005) Top


In 2005, the International Health Regulations (IHR 2005) were adopted as WHA Resolution 58.3[10]. The scope and purpose of IHR (2005) has been to prevent, protect against, control and provide a public health response to the international spread of diseases in ways that are commensurate with and restricted to public health risks. Since its entry into force in 2007, signatory States have been working, individually and collectively, to meet their core capacity requirements under the new framework. Surveillance is one of the important core capacities within the framework of IHR (2005)[10].

The WHO and the international organizations in charge of animal health are working together to strengthen the contribution of the veterinary sector in the implementation of the IHR (2005) and surveillance of zoonotic infections[10]. Tools have been developed through joint efforts and assessments in countries have been undertaken. The results of these assessments have unequivocally demonstrated the need for a greater interface between human and animal health sectors to benefit global health security[11].


   International Health Regulation (2005) and One Health approach Top


In consonance with IHR (2005), One Health approach that is a validated, integrated and holistic concept is being advocated by the WHO, the Food and Agriculture Organization of the United Nations (FAO)[12] and the World Organisation for Animal Health (OIE)[13] for combating health threats to humans and animals through human-animal-plant-environment interface. A tripartite agreement[14] between these three organizations has been in vogue since 2010 to apply One Health approach. This needs to be percolated down to the field level where surveillance at human-animal interface should take place.

One Health concept warrants multi-sectoral, multi-disciplinary, multi-institutional and multi-specialty coordination, in all aspects of response to outbreaks. Joint surveillance by the human health and animal health can detect emergence of new viruses from animals at initial phase thus helping in early containment[15].

There have been several barriers to successful implementation of One Health approach including fragmented and disconnected governance of health, animal health and environment, lack of clarity about the definition, concept and scope of One Health approach, under-recognition of its economic benefits, absence of an agreement between professionals on way forward and inadequate training activities. At the same time, successful outcomes have been observed in implementation of One Health in developing countries, namely, Rwanda and Zambia[16],[17].

It is imperative that all those working in the fields of human, animal and ecological health with focus on surveillance must agree on operational aspects which are coordinated through a governance mechanism run by senior policy makers. Interdisciplinary training on surveillance may encourage cross-disciplinary collaboration[18].

Countries may consider adopting the framework for effective implementation of One Health that incorporates political commitment, policy formulation, sustainable financing, programme development, knowledge sharing, institutional collaboration, capacity enhancement, research to generate evidence, engagement of civil society and active participation of the communities[19],[20]. A beginning can be made with integrated surveillance.

Animal and public health authorities should collaborate to develop protocols for surveillance, and capacity building for responding to zoonotic infections. In addition, appropriate research needs to be undertaken and results of national and international research be integrated into surveillance and response protocols[21], so that evidence-based surveillance and response be undertaken. Data and science should be the cornerstones of planning, implementation and monitoring epidemiology of pandemic-prone diseases.


   Conclusions and way forward Top


In the early phase of future emergence (early warning) of coronaviruses from animals, veterinarians and stakeholders play an important role in early detection at the human-animal interface. Principles of one health must be applied in these settings. Although One Health is a simple and powerful concept, it has an extremely complex implementation process which has to overcome well-established silo approaches in all countries. It is imperative to bring about a change in the narrative in national response to zoonoses, especially integrated surveillance. The success of One Health implementation shall depend on the extent of attainment of institutional collaboration, joint planning and coordinated comprehensive surveillance for the early detection and prevention of zoonoses, especially coronaviruses to mitigate any future outbreaks due to these viruses.

Conflicts of Interest: None.

 
   References Top

1.
World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report - 39. WHO; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200228-sitrep-39-covid-19.pdf?sfvrsn=5bbf3e7d_4, accessed on February 29, 2020.  Back to cited text no. 1
    
2.
Gorbalenya AE, Baker SC, Baric RS, Raoul J. de Groot, Drosten C, et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses-a statement of the oronavirus Study Group. bioRxiv 2020. doi: https://doi.org/10.1101/2020.02.07.937862.   Back to cited text no. 2
    
3.
Davies SE. National security and pandemics. UN Chronicle; 2013. Available from: https://unchronicle.un.org/article/national-security-and-pandemics, accessed on February 29, 2020.  Back to cited text no. 3
    
4.
Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, et al. Global trends in emerging infectious diseases. Nature 2008; 451 : 990-3.  Back to cited text no. 4
    
5.
Brazier Y. Report everything you need to know about pandemics. Medical News Today; 2018. Available from: https://www.medicalnewstoday.com/articles/148945, accessed on February 29, 2020.  Back to cited text no. 5
    
6.
Arunkumar G, Chandni R, Mourya DT, Singh SK, Sadanandan R, Sudan P, et al. Outbreak investigation of Nipah virus disease in Kerala, India, 2018. J Infect Dis 2019; 219 : 1867-78.  Back to cited text no. 6
    
7.
Daszak P, Carroll D, Wolfe N, Mazet J. The global virome project. Available from: https://www.ijidonline.com/article/S1201-9712(16)31315-7/abstract, accessed on February 29, 2020.  Back to cited text no. 7
    
8.
Carroll D, Watson B, Togami E, Daszak P, Mazet JAK, Chrisman CJ, et al. Building a global atlas of zoonotic viruses. Bull World Health Organ 2018; 96 : 292-4.  Back to cited text no. 8
    
9.
World Health Organization. Implementation of the IHR at the human-animal-health interface. Geneva: WHO; 2015.  Back to cited text no. 9
    
10.
World Health Organization. Revision of the international health regulation. Geneva: WHO; 2005.  Back to cited text no. 10
    
11.
Queenan K, Garnier J, Rosenbaum N, Buttigieg S, de Meneghi D, Holmberg M, et al.. Roadmap to a one health agenda 2030. CAB reviews: perspectives in agriculture, veterinary science. Nutr Nat Resour 2017; 12 : 1-2.  Back to cited text no. 11
    
12.
Food and Agriculture Organization of the United Nations. One Health. Available from: http://www.fao.org/3/al868e/al868e00.pdf, accessed on February 29, 2020.   Back to cited text no. 12
    
13.
OIE-World Organisation for Animal Health. One Health. Available from: http://www.oie.int/en/for-the-media/onehealth, accessed on February 29, 2020.  Back to cited text no. 13
    
14.
World Health Organization. The Tripartite's commitment providing multi-sectoral, collaborative leadership in addressing health challenges. Geneva: WHO; 2017.   Back to cited text no. 14
    
15.
Stärk KD, Arroyo Kuribreña M, Dauphin G, Vokaty S, Ward MP, Wieland B, et al. One Health surveillance - More than a buzz word? Prev Vet Med 2015; 120 : 124-30.  Back to cited text no. 15
    
16.
Mwacalimba KK, Green J. 'One health' and development priorities in resource-constrained countries: Policy lessons from avian and pandemic influenza preparedness in Zambia. Health Policy Plan 2015; 30 : 215-22.  Back to cited text no. 16
    
17.
Nyatanyi T, Wilkes M, McDermott H, Nzietchueng S, Gafarasi I, Mudakikwa A, et al. Implementing One Health as an integrated approach to health in Rwanda. BMJ Glob Health 2017; 2 : E000121.  Back to cited text no. 17
    
18.
Johnson I, Hansen A, Bi P. The challenges of implementing an integrated One Health surveillance system in Australia. Zoonoses Public Health 2018; 65 : E229-36.  Back to cited text no. 18
    
19.
Kelly TR, Karesh WB, Johnson CK, Gilardi KV, Anthony SJ, Goldstein T, et al. One Health proof of concept: Bringing a transdisciplinary approach to surveillance for zoonotic viruses at the human-wild animal interface. Prev Vet Med 2017; 137 : 112-8.  Back to cited text no. 19
    
20.
Bhatia R. Implementation framework for One Health approach. Indian J Med Res 2019; 149 : 329-31.  Back to cited text no. 20
    
21.
Cardoen S, De Clercq K, Vanholme L, De Winter P, Thiry E, Van Huffel X. Preparedness activities and research needs in addressing emerging infectious animal and zoonotic diseases. Rev Sci Tech 2017; 36 : 557-68.  Back to cited text no. 21
    



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