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      Prioritization of Zoonotic Diseases in Kenya, 2015

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          Abstract

          Introduction

          Zoonotic diseases have varying public health burden and socio-economic impact across time and geographical settings making their prioritization for prevention and control important at the national level. We conducted systematic prioritization of zoonotic diseases and developed a ranked list of these diseases that would guide allocation of resources to enhance their surveillance, prevention, and control.

          Methods

          A group of 36 medical, veterinary, and wildlife experts in zoonoses from government, research institutions and universities in Kenya prioritized 36 diseases using a semi-quantitative One Health Zoonotic Disease Prioritization tool developed by Centers for Disease Control and Prevention with slight adaptations. The tool comprises five steps: listing of zoonotic diseases to be prioritized, development of ranking criteria, weighting criteria by pairwise comparison through analytical hierarchical process, scoring each zoonotic disease based on the criteria, and aggregation of scores.

          Results

          In order of importance, the participants identified severity of illness in humans, epidemic/pandemic potential in humans, socio-economic burden, prevalence/incidence and availability of interventions (weighted scores assigned to each criteria were 0.23, 0.22, 0.21, 0.17 and 0.17 respectively), as the criteria to define the relative importance of the diseases. The top five priority diseases in descending order of ranking were anthrax, trypanosomiasis, rabies, brucellosis and Rift Valley fever.

          Conclusion

          Although less prominently mentioned, neglected zoonotic diseases ranked highly compared to those with epidemic potential suggesting these endemic diseases cause substantial public health burden. The list of priority zoonotic disease is crucial for the targeted allocation of resources and informing disease prevention and control programs for zoonoses in Kenya.

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          Most cited references 11

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          Asymmetries of Poverty: Why Global Burden of Disease Valuations Underestimate the Burden of Neglected Tropical Diseases

          The disability-adjusted life year (DALY) initially appeared attractive as a health metric in the Global Burden of Disease (GBD) program, as it purports to be a comprehensive health assessment that encompassed premature mortality, morbidity, impairment, and disability. It was originally thought that the DALY would be useful in policy settings, reflecting normative valuations as a standardized unit of ill health. However, the design of the DALY and its use in policy estimates contain inherent flaws that result in systematic undervaluation of the importance of chronic diseases, such as many of the neglected tropical diseases (NTDs), in world health. The conceptual design of the DALY comes out of a perspective largely focused on the individual risk rather than the ecology of disease, thus failing to acknowledge the implications of context on the burden of disease for the poor. It is nonrepresentative of the impact of poverty on disability, which results in the significant underestimation of disability weights for chronic diseases such as the NTDs. Finally, the application of the DALY in policy estimates does not account for the nonlinear effects of poverty in the cost-utility analysis of disease control, effectively discounting the utility of comprehensively treating NTDs. The present DALY framework needs to be substantially revised if the GBD is to become a valid and useful system for determining health priorities.
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            Prioritizing Emerging Zoonoses in The Netherlands

            Background To support the development of early warning and surveillance systems of emerging zoonoses, we present a general method to prioritize pathogens using a quantitative, stochastic multi-criteria model, parameterized for the Netherlands. Methodology/Principal Findings A risk score was based on seven criteria, reflecting assessments of the epidemiology and impact of these pathogens on society. Criteria were weighed, based on the preferences of a panel of judges with a background in infectious disease control. Conclusions/Significance Pathogens with the highest risk for the Netherlands included pathogens in the livestock reservoir with a high actual human disease burden (e.g. Campylobacter spp., Toxoplasma gondii, Coxiella burnetii) or a low current but higher historic burden (e.g. Mycobacterium bovis), rare zoonotic pathogens in domestic animals with severe disease manifestations in humans (e.g. BSE prion, Capnocytophaga canimorsus) as well as arthropod-borne and wildlife associated pathogens which may pose a severe risk in future (e.g. Japanese encephalitis virus and West-Nile virus). These agents are key targets for development of early warning and surveillance.
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              Prioritizing Zoonoses: A Proposed One Health Tool for Collaborative Decision-Making

              Emerging and re-emerging zoonotic diseases pose a threat to both humans and animals. This common threat is an opportunity for human and animal health agencies to coordinate across sectors in a more effective response to zoonotic diseases. An initial step in the collaborative process is identification of diseases or pathogens of greatest concern so that limited financial and personnel resources can be effectively focused. Unfortunately, in many countries where zoonotic diseases pose the greatest risk, surveillance information that clearly defines burden of disease is not available. We have created a semi-quantitative tool for prioritizing zoonoses in the absence of comprehensive prevalence data. Our tool requires that human and animal health agency representatives jointly identify criteria (e.g., pandemic potential, human morbidity or mortality, economic impact) that are locally appropriate for defining a disease as being of concern. The outcome of this process is a ranked disease list that both human and animal sectors can support for collaborative surveillance, laboratory capacity enhancement, or other identified activities. The tool is described in a five-step process and its utility is demonstrated for the reader.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                24 August 2016
                2016
                : 11
                : 8
                Affiliations
                [1 ]Global Disease Detection Program, Division of Global Health Protection, United States Centers for Disease Control and Prevention, Nairobi, Kenya
                [2 ]Zoonotic Disease Unit, State Department of Veterinary Services; Ministry of Agriculture Livestock and Fisheries, Nairobi, Kenya
                [3 ]Zoonotic Disease Unit, Department of Preventive and Promotive Heath; Ministry of Health, Nairobi, Kenya
                [4 ]Division of Vector-Borne Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                [5 ]Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                [6 ]Field Epidemiology and Laboratory Training program, Ministry of Health, Nairobi, Kenya
                [7 ]Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Kenya
                [8 ]Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
                [9 ]Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
                [10 ]Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America
                University of Pretoria, SOUTH AFRICA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: PM AB EO.

                • Data curation: PM AB EO EGP JM MN RG.

                • Formal analysis: PM AB EO SMT.

                • Investigation: PM AB EO KN SMT.

                • Methodology: PM EO EGP SMT.

                • Resources: PM EGP.

                • Visualization: PM KN SMT.

                • Writing – original draft: PM SMT.

                • Writing – review & editing: PM AB EO EGP JM AM MK MN KN SMT.

                Article
                PONE-D-16-17176
                10.1371/journal.pone.0161576
                4996421
                27557120

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                Page count
                Figures: 1, Tables: 3, Pages: 11
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000030, Centers for Disease Control and Prevention;
                Award ID: GH000069
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 110330/Z/15/Z
                Award Recipient : S M Thumbi
                This work partially funded by US Centers for Disease Control and Prevention through cooperative agreements # GH000069, from the Global Disease detection Division. Participation of SM Thumbi was supported by Wellcome Trust # 110330/Z/15/Z. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Infectious Diseases
                Zoonoses
                Biology and Life Sciences
                Veterinary Science
                Veterinary Diseases
                Medicine and Health Sciences
                Public and Occupational Health
                People and Places
                Geographical Locations
                Africa
                Kenya
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Anthrax
                Medicine and Health Sciences
                Infectious Diseases
                Zoonoses
                Anthrax
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Control
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Brucellosis
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                Brucellosis
                Medicine and Health Sciences
                Infectious Diseases
                Zoonoses
                Brucellosis
                Medicine and Health Sciences
                Tropical Diseases
                Neglected Tropical Diseases
                Viral Hemorrhagic Fevers
                Ebola Hemorrhagic Fever
                Medicine and Health Sciences
                Infectious Diseases
                Viral Diseases
                Viral Hemorrhagic Fevers
                Ebola Hemorrhagic Fever
                Custom metadata
                All relevant data are within the paper.

                Uncategorized

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