Kenya tackles growing threat of deadly animal viruses transmitted to humans

A debate in an online forum for veterinarians cracked jokes about the attenuated romantic gene in veterinarians, their inability to sweep a woman off her feet.

The social scientists – sociologists, communication lecturers and others - expressed their frustration at dating the “cattle doctors”.

For a minute, the two groups looked like they would never agree until fishermen in Uganda noticed dead birds on the shores of Lutembe beaches and reported to the authorities last month, and an alert was then issued that they had died of avian flu.

When the news reached Kenya, an emergency meeting between veterinarians and doctors was held at Kabete Veterinary Labs in Nairobi and a team knowledgeable in tracking diseases—epidemiology— assembled. Alongside those who would be consulted were the social scientists.

On this one— that this was no ordinary disease, a family of several strains of the flu wreaking havoc in Europe and Asia specially during winter— they agree.

This flu, like more than 1,000 others, is a zoonosis, meaning it can be transmitted from animals to mankind. Seven in 10 diseases that affect humans are zoonotic.

In the list are Aids, Ebola, Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

This partnership was hardly a knee-jerk reaction as the decisions that went into setting up the meeting would reveal.

In a commentary published in science magazine Nature in 2012, Wellcome Trust director Jeremy Farr noted that the tools and training for responding to emerging and re-emerging diseases are in the developed world, yet a majority of such ruthless viruses are in the developing world.

Avian flu has becoming a concern the world over, with the World Health Organisation (WHO) noting that nearly 40 countries have reported finding potentially dangerous flu strains in poultry or in captured or dead wild birds since November 2016.

The Centres for Disease Control and Prevention (CDC) reports that 648 human cases of H5N1 infections alone have been detected since 2003.

The reason for the dread and the hyper vigilance among Kenyan scientists was necessary even though the outbreak was in Uganda.

Prof Njenga Kariuki, chief research officer at Kenya Medical Research Institute (Kemri), who attended the meeting, confessed that he was afraid of the virus in Uganda. That fear did not exist in a vacuum.

He described the virus as “intriguing” adding that “H5 can decimate a whole population before you respond”.

Contrary to reports in the media that had labelled the virus H5N1, Prof Kariuki said that it was only confirmed that it is in the same family that caused the avian flu scare in 2005 in Asia.

It is probably a descendant from the same strain that killed about 700,000 people in Hong Kong in 1968 and many others in the Middle East.
There are influenza A,B and C.

A and B are covered on the surface by Haemagglutinin (H), which the virus attaches itself on another cell like the human’s so as to infect it, and Neuraminidase (N), which opens up infected cells so that the virus can escape and go on infecting others.

The H family ranks from H1 to H9, and the N from N1 to N17.

“We know it is H5, but the N part is yet to be identified,” Prof Kariuki said.

Scientists are always playing catch up because of the ability of this family of viruses to “marry” other equally lethal viruses in a process epidemiologists call “reassortment”.

“From that marriage, another monster that will neither be understood by scientists or be sensitive to the vaccines that are available may emerge”, Prof Kariuki said.

Coupled with its agility, is the fluid and quick way in which it is spread: “It is aerosolised, meaning one sick person in a plane or matatu will infect all the other passengers in a second.”

Yet the manner in which these lethal viruses move is what necessitated the unlikely relationships between scientists and other professionals.

The outbreak of the flu in Uganda, an example that there are new factors that drive disease emergence, has necessitated collaborations between scientists and professionals that were never in the business of epidemiology.

Now it is not unusual to find a sociologist, anthropologist or a counselling psychologist being a key player in a team that is concerned with disease control.

These meetings are evidence of a global movement that views diseases in the nexus of mankind, animals and the environment, an approach called “One Health”

There are biotic and abiotic drivers of disease, and therefore public health strategies of vaccination, quarantine and treatment that target the pathogen only are not enough.
For instance, the Ebola virus that had killed 11,325 people by April 2016—according to data from the CDC — thrived because of three things: It came to man because of the closer contact between people and the fruit bats in Guinea; a weak public healthcare system that was ill equipped to detect and contain the virus that changes so quickly to survive; and a communal culture where people hugged and touched bodies during funerals as the medical anthropologists would point out.

Now, scientists are collaborating with people who understand human behaviour to know what people do that places them in the path of viruses.

A study — such as Emerging Infectious Diseases: Threats to Human Health and Global Stability published in the journal Plos Pathogen in 2014— listed these drivers: climate change, intensified food production as well as the closer interaction between man and animals in wild or domestic environments.

Prof Eric Fèvre, a researcher of veterinary infectious diseases at the Institute of Infection and Global Health at the University of Liverpool and the International Livestock Research Institute (ILRI) in Nairobi told the Business Daily the close interaction between people and animals worsened the situation.

Prof Fèvre, wrote a blog post, Zoonoses in Africa on the website microbiologysociety.org, in which he said that urbanisation is presenting opportunities for organisms, such as the viruses that cause avian flu, to find new hosts to survive.

The post, published on November 11, 2015 read: “The intensification of farming, for example, leads to closer relationships between individuals and animals, generating opportunities for more rapid mutations as organisms move from host to host, while also providing a structured way for those pathogens to enter highly ordered food chains that branch out and reach very large numbers of people”.

Prof Fèvre’s colleague Delia Grace pointed out that the bird population in Africa is not as huge so as to make the avian flu a catastrophic outbreak as it would in Asia or other parts of the world.

Besides the advantage of less population, East Africans are vulnerable because of the close way they relate to animals.

Citing his previous studies from his career that spans over three decades, including 11 years in Uganda, Prof Kariuki said that migratory birds, the natural hosts of the virus, escape the cold weather in North America to come to Uganda, as well as Kenya.

From there they infect the bird population in Uganda, and potentially poultry who then pass the virus to man. “People share a house with chicken,” Prof Kariuki said.

It is not unusual to see people walking across Kenya’s borders with chicken under their arms.

Yet there are laws that have been in existent from as early as 1948 that forbid the casual transportation of animals unless with permit and the containers used to facilitate the movement should be certified by a trained veterinarian. Then there is climate change.

Change in temperatures and humidity is creating suitable habitats for species and their pathogens, catalysing the emergence of new diseases or re-emergence of those that had been subdued.

The WHO and other globally acclaimed researchers have raised the alarm of more than 300 pathogens getting comfortable in places they were previously not known to thrive in. For instance, Chikungunya which had attacked 1,792 in Mandera, Kenya as at August 2016.

Prof Fèvre has worked across Africa, and Europe and applauded Kenya for embracing the multidisciplinary approach in tackling emerging diseases.

He is in charge of Urban Zoo, a project that brings together anthropologists and sociologists to “tell scientists about issues like how Kenyans prepare their food, what goes into the decision on what to eat… we are all trying to see the city through the eyes of a pathogen.”

Kenya formed the Zoonotic Disease Unit (ZDU) in 2005 after observing the global pandemic that zoonotic diseases cause.

The country experienced several cases of zoonotic attacks, the worst being the Rift Valley Fever that killed 118 people as of early 2007 as per CDC records.

Kenya an example of One Health

Other East African nations are following suit. In an email, Immaculate Nabukenya from the Ministry of Health in Uganda said that four ministries – Health, Agriculture, Animal Industry & Fisheries, Water and Environment as well as Uganda Wildlife Authority— signed a One Health framework to guide the relations and activities related to diseases and public health events across the sectors. 

The country has also created Zoonotic Diseases Co-ordination Office (ZDCO), an equivalent of Kenya’s ZDU. In Tanzania, veterinarians and doctors collaborate in rabies control activities in the impoverished area inhabited by the Kuria people around Serengeti National Park. They are supported by the Washington State University veterinary school in the United States.

With this preparedness comes better diagnostic capability. Kenya has labs that are known to carry out research and conduct tests that would isolate such diseases in the region quickly: Central Veterinary Labs (CVL), CDC Labs, ILRI and the ones at Kemri.

Prof Kariuki’s analysis of the severity of the flu? “Maybe a 2, but should it move to poultry from the birds, it would escalate to 3 and then higher when it moves from the chicken to man,” he said.

Before an influenza outbreak is labelled as “low”, “moderate” or “high” risk, there are several tests that the disease is put through. The CDC- developed Influenza Risk Assessment Tool (RIAT) has ten tests that observe the virus through a number of considerations: its ability to spread, how fast and whether it would get into and bind to human receptors, whether it is sensitive to the antiretroviral available; severity on human beings in terms of how many would die, get hospitalised and interrupt normal hospital workings; whether the population at risk has even developed immunity against the disease.

The public or even government officials who are unaware of scales such as RIAT, make decisions that hurt the economy of those affected in case of a pandemic.

On Wednesday last week, Kenya’s Agriculture secretary Willy Bett cancelled all permits that had been issued for the import of poultry, in a bid to safeguard 32 million chicken in the country.

However, he assured the public that they did not need to fear feeding on local chicken, but nonetheless the Nairobi County health executive Benard Muia went on to ban sale of food by the roadside in the capital.

Nearly all of these interventions are donor funded, raising the question of sustainability.

Countries that have managed to respond to disease outbreaks quickly, had prior preparations.

With only cursory explanations on where a disease comes from, say MERS from camels, scientists need funds to monitor viruses in animals and the people around them.

The results from that monitoring allow for early preparations for vaccines and training of healthcare workers.

It is worth noting that Kenya was the first country in Africa in 2004 to train epidemiologists in a programme called Kenya Field Epidemiology and Laboratory Training (FELTP). Its graduates are qualified to respond to disease outbreaks in Kenya and anywhere else in the world.

The science of predicting what a virus is likely to do, or how it is able to move from its animal host to human beings is still young. That is why funding, from governments, is crucial.

In Tanzania’s rabies control near Serengeti veterinarian Ahmed decried the lack of money to enable the doctor-veterinarian collaborations in the area. 

Dr Michel Dione, an animal health and epidemiology expert in Uganda, wrote to the Business Daily about his observation in Uganda thus:

“However, this increased One Health awareness is not yet matched by the level of One Health investments, both human and financial, that will be needed to put One Health into wide practice in Uganda. New institutional frameworks are needed, for example, as well as better coordination and communication among veterinary and medical doctors and researchers and experts in environmental and other related disciplines.’’