1. 1 One Health In Kenya Ian Njeru, MD Ministry of Public Health & Sanitation Kenya One Health Meeting In The African Region Libreville, Gabon, 12-14 November 2012

2. Presentation Outline Background Key steps in OH Outline of milestones in OH Application: One Health in Action 2

3. Background Land mass: 580,367 km 2 Human population – 38,610,097 (2009) Livestock Pop (2009) – Cattle 18 million – Sheep 17 million – Goats 28 million – Camels 3 million – Poultry 32 million Wildlife – Rich in diversity and numbers 3

4. Kenya: Key OH Steps (2006-2012) Formation of National Influenza Task force(NIT) - 2005 NIT responded to Rift Valley Fever (RVF) outbreak as RVF Task force - 2006/7 Formation of Zoonotic Technical Working Group (ZTWG)- 2008 Formation of One Health in Central and Eastern Africa (OHCEA) Kenyan chapter - 2010 Development of Kenya’s priority zoonotic diseases list – 2011 4

5. Kenya: Key OH Steps (2006-2012) Revision of Integrated Disease Surveillance and Response (IDSR) technical guidelines to incorporate zoonotic diseases -2011 Creation of One Health office: Zoonotic Disease Unit (ZDU) - 2011 Development of Strategic Plan for Implementing One Health in Kenya (2012 - 2017) – 2012 Revision of national policies to incorporate One Health- ongoing 5

6. OH Milestones in Kenya (2006-2012) 6

7. 1. Formation of Zoonotic Technical Working Group (ZTWG) – Formed in 2008 – Multi-sectoral, including Government – Ministry of Public Health (MoPHS), – Ministry of Livestock Development (MoLD), – Kenya Wildlife Service (KWS) – Kenya Medical Research Institute(KEMRI) – Kenya Agricultural Research Institute (KARI) Universities WHO, FAO, AU-IBAR, CDC, ILRI, ICIPE etc – Meets quarterly – Chaired alternately by Director of Veterinary Services or Director of Public Health and Sanitation 7

8. Role of ZTWG Advise the government on policy issues on Zoonoses Advise government on technical issues on implementation of One Health Monitor and Evaluate One Health implementation 8

9. 2. Creation of One Health office: Zoonotic Disease Unit (ZDU) MOU: Signed by MoPHS and MoLD in Aug 2011 Housing: Office constructed on government land and officially opened by the Minister for MoLD and Minister for MoPHS – Oct 2012 Staff: Two Epidemiologists deployed by government Support staff: Admin Assistant and Data Manager (supported by donor) 9

10. ZDU Formation 10 Zoonotic Disease Forum: Sept 22-24, 2010

11. ZDU Vision and Mission Vision A country with reduced burden of zoonotic diseases and better able to respond to epidemics of emerging and re-emerging infectious diseases Mission To establish and maintain active collaboration at the animal, human, and ecosystem interface towards better prevention and control of zoonotic diseases 11

12. ZDU Organogram DPHSDVS Zoonotic Technical Working Group DDSR (MoPHS) VEEU (MoLD) Zoonotic Disease Unit 1 Medical Epidemiologist (MoPHS) 1 Veterinary Epidemiologist (MoLD) 1 Data Manager 1 Adminstrative Assistant Other experts on an as needed basis (Epidemiologist, Ecologists, Microbiologists, Climatologists, Environmentalists, Sociologists, Economists, Geospatial experts e.t.c.) DVS- Director of Veterinary Services DPHS- Director of Public Health and Sanitation DDSR- Division of Disease Surveillance and Response VEEU- Veterinary Epidemiology and Economics Unit MoPHS- Ministry of Public Health and Sanitation MoLD- Ministry of Livestock Development

13. Launch of the ZDU – 3 rd Oct 2012 13 Minister, MOLD and PS MoPHS officially open ZDU office

14. 3. Development of Kenya Priority Zoonotic Diseases List –2011* 1.Viral Hemorrhagic Fevers i.Crimean Congo Hemorrhagic Fever ii.Dengue Fever iii.Rift Valley Fever iv.Yellow fever v.Ebola vi.Marburg Virus Fever 2.Avian influenza & influenza A H1N1 3.Brucellosis 4.Leishmaniasis 5.Leptospirosis 6.Anthrax 7.Rabies 8.Bovine TB 9.Plague 10.Tularemia (Rabbit Fever) 11.Protozoa Infections i.Cryptosporidiosis ii.Toxoplasmosis 12.Salmonellosis 13.Helminths and Ecto parasites i.Trichinosis ii.Cysticercosis iii.Hydatidosis iv.Sarcoptic mange v.Diphyllobothrium 14.Fungal Diseases i.Dermatophilosis ii.Histoplasmosis iii.Cryptococcosis iv.Aspergillosis 15.Schistosomiasis 16.West Nile Virus 17.Trypanosomiasis *Not ranked in any order 14

15. 4. Kenya Revised IDSR Technical Guidelines Key changes Addition of zoonotic diseases in the priority disease list Inclusion of Veterinary and Wildlife Officers in both the district and county Public Health Emergency Management Committees(PHEMC) Section added on coordination with Animal Health and other relevant Sectors Changes were made in consultation with relevant stakeholders 15

16. 5. Strategic Plan for Implementing OH in Kenya (2012-17) :Highlights 16

17. Goal 1: Strengthen surveillance, prevention and control of zoonoses Conduct risk mapping for 4 priority zoonotic diseases (RVF, Brucellosis, Anthrax, Rabies,) Develop and implement OH plans/SOPs for jointly responding to zoonotic disease outbreaks Strengthen laboratory diagnosis for zoonosis Develop and implement prevention and control strategies for 4 priority zoonotic diseases Identify and designate subject matter experts for each priority disease 17

18. Goal 2: Establish structures and partnerships to promote OH Incorporate OH in existing MOLD and MOPHS policies Develop OH communication strategy Cascade OH approach to the county and district levels Lobby line ministries to allocate budget lines for OH program Strengthen partnerships 18

19. Goal 3: Conduct and Promote Applied Research To better understand the mechanisms of zoonotic pathogen maintenance and transmission to humans Hold workshops for universities, research institutions and individual scientists on neglected zoonotic diseases Provide training and mentoring to veterinary, medical and public health trainees Promote applied research collaboration among human, animal and ecosystem sectors 19

20. Strategic Plan Outcomes Greater compliance with WHO/IHR and OIE guidelines on public health threats Risk maps for priority zoonotic diseases available Disease prevention and control strategies for zoonoses developed and implemented 20

21. Strategic Plan Outcomes… Capacity for early epidemic detection, diagnosis, and rapid response strengthened Better understanding of socio-economic impacts of zoonotic diseases 21

22. 6. Revision of National Policies to Incorporate OH The Veterinary Policy – on going The National Health Policy Framework, 2011 to 2030 – ongoing 22

23. 7. Capacity building activities on OH Spearheaded by OHCEA Kenya Membership of OHCEA Kenya: – University of Nairobi Faculty of vet medicine School of public health – Moi University School of Public Health – MOLD – MOPHS – KWS – KEMRI – National Environment Management Authority 23

24. Objective of OH capacity building Transform future workforce to be OH compliant – Pre-service curriculum review: Being initiated November 2012 Targets undergraduate and postgraduate curricula in universities e.g. BVM, MBChB, MPH, wildlife programs Transition the current workforce to be OH compliant – In-service training: Joint trainings involving staff from e.g. MOLD, MOPHS, Environment and Nursing Needs assessment for training to be done January 2013 Curriculum development: February and March 2013 In-service training commences April 2013 at county level 24

25. 8. Other OH Steps and Activities in Kenya Inclusion of Veterinary students and Veterinary module in FELTP-since 2008 Kenya hosted HPAI field simulation exercise in 2010 OIE Performance of Veterinary Services (PVS) “One Health” Evaluation Mission in Kenya – 2011 Research projects incorporating OH approach – Arbo-viruses Incidence and Diversity (RVF) – Brucellosis study in three counties – IDRC Echo-Health Project 25

26. Other OH Activities in Kenya… Influenza surveillance – Avian Influenza surveillance in wild birds and domestic birds in the market – Ongoing – Human influenza sentinel surveillance- Ongoing Rift Valley Fever (RVF) - sentinel herd and entomological surveillance - Ongoing Establishment of a molecular diagnostic laboratory at KWS for bush meat identification for public health and law enforcement - Ongoing 26

27. One Health in Action 27

28. Introduction In March 2012, two case reports of Human African Trypanosomiasis (HAT) reported from a national reserve Joint outbreak investigation conducted 3 teams – Human team – Animal team – Entomological team 28

29. Human Investigation 29 Active surveillance Setting up sentinel surveillance sites.

30. Animal Investigation 30

31. Entomological Investigation 31 Ngu trap Biconical trap

32. Findings/Actions No human infective forms of Trypanosoma brucei detected in human, animals or tsetse flies Five human sentinel surveillance sites established after the study 32

33. Next Steps for OH in Kenya Implement the Strategic plan 2012-2017 Priorities – Develop guidelines for inter-sectoral collaboration – Develop communication strategy to guide communication across sectors 33

34. Thank You for more information visit www.zdukenya.org 34