meeting to accelerate prevention and control of … › ... › 10665.1 › 14543 ›...
TRANSCRIPT
16–18 October 2018Luang Prabang, Lao People’s Democratic Republic
Meeting Report
MEETING TO ACCELERATE PREVENTION AND CONTROL OF NEGLECTED FOODBORNE
PARASITIC ZOONOSES IN SELECTED ASIAN COUNTRIES
Food and Agriculture Organization of the United Nations
World Organisation for Animal Health
World Health Organization
English only
MEETING REPORT
Meeting to Accelerate Prevention and Control of Neglected Foodborne Parasitic
Zoonoses in Selected Asian Countries
Convened by:
Food and Agriculture Organization of the United Nations
World Organisation for Animal Health
World Health Organization
Luang Prabang, Lao People’s Democratic Republic
16–18 October 2018
Not for sale
Published by:
Food and Agriculture Organization of the United Nations
World Organisation for Animal Health
World Health Organization
May 2020
NOTE
The views expressed in this report are those of the participants of the Meeting to Accelerate
Prevention and Control of Neglected Foodborne Parasitic Zoonoses in Selected Asian Countries and do
not necessarily reflect the policies of the conveners.
Preparation of this report was led by the World Health Organization Regional Office for the Western
Pacific in collaboration with the Regional Tripartite partners for those who participated in the Meeting
to Accelerate Prevention and Control of Neglected Foodborne Parasitic Zoonoses in Selected Asian
Countries in Luang Prabang, Lao People’s Democratic Republic from 16 to 18 October 2018.
CONTENTS
SUMMARY ........................................................................................................................................................... 1
1. INTRODUCTION ............................................................................................................................................. 2
1.1 Meeting organization ............................................................................................................................ 2
1.2 Meeting objectives ................................................................................................................................ 2
2. PROCEEDINGS ................................................................................................................................................ 2
2.1 Opening session .................................................................................................................................... 2
2.1.1 Welcome address .............................................................................................................................. 2
2.1.2 Background and objectives of the meeting ....................................................................................... 3
2.2 Global, regional and country updates on prevention and control of neglected foodborne parasitic
zoonoses through the food value chain ............................................................................................................... 3
2.2.1 Global and regional burden of disease and socioeconomic impacts ................................................. 3
2.2.2 Guidance on interventions through the food value chain .................................................................. 4
2.2.3 Country status updates ...................................................................................................................... 7
2.3 One Health interventions ..................................................................................................................... 13
2.3.1 Basic considerations for control of neglected foodborne parasitic zoonoses through One Health
approach ....................................................................................................................................................... 13
2.3.2 Sharing experience on One Health approach – action, challenges and lessons learnt .................... 16
3.1 Health risk communication and community engagement ................................................................... 18
3.1.2 Sharing country experiences on multi-disciplinary approach ......................................................... 18
3.1.3 Food safety risk communication training ........................................................................................ 20
3.1.4 Field trip and observations / country practices and recommendations ........................................... 21
4.1 Mapping, monitoring and evaluation, and surveillance ...................................................................... 23
4.1.1 Basic considerations for identification of risk areas and monitoring and evaluation of interventions
23
4.1.2 Effective information sharing across sectors .................................................................................. 25
5.1 The way forward – multisectoral action priorities for accelerating prevention and control of
foodborne parasitic zoonoses ............................................................................................................................ 27
3. CONCLUSIONS AND RECOMMENDATIONS .......................................................................................... 27
3.1 Conclusions ......................................................................................................................................... 27
3.2 Recommendations ............................................................................................................................... 27
3.2.1 Recommendations for Member States ............................................................................................ 27
3.2.2 Recommendations for the FAO-OIE-WHO Tripartite.................................................................... 28
3.2.3 Recommendations for WHO........................................................................................................... 28
ANNEXES ........................................................................................................................................................... 29
Annex 1. Agenda
Annex 2. List of participants
Annex 3. Characteristics of diagnostic tests for neglected foodborne parasitic zoonoses
Annex 4. Country priorities and support needs for control of neglected foodborne parasitic zoonoses
ABBREVIATIONS
ACIAR Australian Centre for International Agricultural Research
CCA cholangiocarcinoma
CL-SWASH Community-led initiative to eliminate schistosomiasis through
deworming humans and animals, and improving access to water and
sanitation, and improved hygiene
ELISA enzyme-linked immunosorbent assay
FAO Food and Agriculture Organization of the United Nations
FBT foodborne trematode
MDA mass drug administration
M&E monitoring and evaluation
NTD neglected tropical disease
OIE World Organisation for Animal Health
PCR polymerase chain reaction
WAHIS World Animal Health Information System
WASH water, sanitation and hygiene
WHO World Health Organization
1
SUMMARY
The Meeting to Accelerate Prevention and Control of Neglected Foodborne Parasitic Zoonoses in
Selected Asian Countries was held in Luang Prabang, Lao People’s Democratic Republic, on
16-18 October 2018. In addition to nine temporary advisers, the meeting was attended by: 40 national
focal points of neglected tropical diseases, animal health, food safety, and water, sanitation and hygiene
(WASH) programmes from 14 countries; representatives from seven partner agencies; and 16
representatives from the World Health Organization (WHO), the Food and Agriculture Organization of
the United Nations (FAO) and the World Organisation for Animal Health (OIE) at global, regional and
country levels.
The meeting provided valuable opportunities to bring together different sectors involved in the
prevention and control of neglected foodborne parasitic zoonoses – public health, animal health, food
safety, and WASH. The meeting participants shared insights, experiences and updates on new guidance
and development to accelerate the prevention and control of neglected foodborne parasitic zoonoses,
particularly taeniasis/cysticercosis, echinococcosis and foodborne trematode infections. The meeting
also included a field trip to a local pig slaughterhouse, a fish and meat market, and a community where
pigs are raised at the household level. These visits illustrated the reality of animal production, food
safety and hygiene practices in rural communities in Asia. The meeting also provided an opportunity to
develop the first sets of food safety risk communications, as well as country-specific action plans to
accelerate the prevention and control of neglected foodborne parasitic zoonoses.
The meeting participants agreed to strengthen political commitment through high-level advocacy and
push forward with cross-sectoral collaboration to develop a multisectoral road map to accelerate the
prevention and control of neglected foodborne parasitic zoonoses. They were also encouraged to
identify practical, feasible and cost-effective interventions and monitoring and evaluation approaches
for assessing impacts of interventions in the local context and explore opportunities for aligning
implementation with ongoing programmes or activities.
The OIE–FAO–WHO Tripartite was requested to continue providing technical support and guidance
and facilitate cross-sectoral collaboration among public health, animal health, food safety and WASH
sectors at national and regional levels by identifying and engaging relevant partners to accelerate the
prevention and control of neglected foodborne parasitic zoonoses, and develop a network for the control
of neglected foodborne parasitic zoonoses to facilitate sharing of experience across countries.
2
1. INTRODUCTION
1.1 Meeting organization
The Meeting to Accelerate Prevention and Control of Neglected Foodborne Parasitic Zoonoses in
Selected Asian Countries was held in Luang Prabang, Lao People’s Democratic Republic on
16-18 October 2018. In addition to nine temporary advisers, the meeting was attended by: 40 national
focal points of neglected tropical diseases (NTDs), animal health, food safety and water, sanitation and
hygiene (WASH) programmes from 14 countries; representatives from seven partner agencies; and 16
representatives from the World Health Organization (WHO), the Food and Agriculture Organization of
the United Nations (FAO) and the World Organisation for Animal Health (OIE) at global, regional and
country level.
The programme agenda is available in Annex 1 and a list of participants in Annex 2.
1.2 Meeting objectives
The objectives of the meeting were:
1) to review the progress of prevention and control of neglected foodborne parasitic zoonoses in
Asia;
2) to share experience, issues, challenges and opportunities to leverage existing platforms and
frameworks and strengthen intersectoral collaboration and partnership for accelerating
prevention and control of neglected foodborne parasitic zoonoses; and
3) to agree on multisectoral action priorities to address identified issues and challenges and
accelerate prevention and control of neglected foodborne parasitic zoonoses in Asia.
2. PROCEEDINGS
2.1 Opening session
2.1.1 Welcome address
WHO Representative in the Lao People’s Democratic Republic Momoe Takeuchi delivered the
welcome address on behalf of WHO Regional Director for the Western Pacific Shin Young-soo,
Assistant Director-General Kundhavi Kadiresan at the FAO Regional Office for Asia and the Pacific,
OIE Regional Representative for Asia and the Pacific Hirofumi Kugita and WHO Regional Director
for South-East Asia Poonam Khetrapal Singh. Significant progress had been achieved in the elimination
and control of parasitic diseases in Asia in recent years, particularly after decades of mass drug
administration (MDA) and regular deworming. However, foodborne parasitic zoonoses, particularly
foodborne trematode (FBT) infection, taeniasis, cysticercosis and echinococcosis, remained significant
public health problems in Asia. Transmission was linked to practices of raising livestock and producing,
processing and preparing foods. These diseases were also zoonotic infections involving domestic or
wild animals. Therefore, it is essential to have stronger coordination and cooperation between public
health, animal health, food, agriculture, and WASH sectors to improve food production, processing and
hygiene practices, to treat or vaccinate animals, and to improve sanitation to prevent contamination of
the environment and infection of animal reservoirs to control the diseases. For these reasons, FAO, OIE
and WHO had joined forces to organize the meeting, to provide better guidance on combinations of
multisectoral interventions that would help countries accelerate the prevention and control of the
diseases, and facilitate coordination among all relevant sectors. She thanked participants for sharing
experiences, discussing solutions to challenges, and strengthening coordination and cooperation among
all relevant sectors to collectively achieve health impacts in the area of foodborne parasitic diseases in
Asia.
3
2.1.2 Background and objectives of the meeting
A WHO expert consultation meeting in Vientiane, Lao People’s Democratic Republic, in 2009
discussed the acceleration of control of FBT infections. The meeting produced several
recommendations on FBT disease control, which included:
• the development and adoption of policies and recommendations to control zoonotic parasitic
diseases by the governments of endemic countries and all implementing agencies and
institutions;
• the allocation and mobilization of human and financial resources by governments for projects
relating to FBT infections;
• the establishment of intersectoral task forces to ensure One Health coordination;
• the completion of a disease risk map using available country-level epidemiological data;
• the continued use of preventive chemotherapy to control opisthorchiasis, clonorchiasis,
taeniasis and fascioliasis; and
• the development of disease-specific guidelines for coordinated disease control.
In 2015, WHO assembled a framework for taeniasis control and organized a stakeholders’ meeting to
discuss the various diagnostic tools for taeniasis and cysticercosis. In 2016, WHO published a rationale
for the investment in taeniasis control and FAO developed a Codex guideline for control of foodborne
parasites. In May 2017, the WHO Regional Office for the Western Pacific convened the Expert
Consultation to Accelerate Control of FBT Infections, Taeniasis and Cysticercosis in Seoul, Republic
of Korea. Attendees reviewed the current burden and endemicity of FBT infections, taeniasis and
cysticercosis in the Western Pacific Region, along with country experiences and relevant research
projects. The meeting aimed to provide strategic actions and research priorities to accelerate the control
of such diseases in the Region.
The meeting called for several reforms, including the implementation of a One Health approach as the
core strategy to accelerate and sustain control of FBT infections, taeniasis and cysticercosis. This
consisted of effective risk communication, animal and human treatment, agricultural interventions, food
safety and WASH. Additionally, WHO was urged to collaborate with other relevant international
agencies, such as FAO and OIE, to share information and jointly support countries in building capacities
around intervention options throughout the food value chain for effective control of foodborne parasitic
diseases. The 2017 meeting in Seoul thus called for the present Tripartite meeting to target each of the
goals through close collaboration among WHO, FAO and OIE. They asked relevant multisectoral focal
points from Member States to jointly discuss intervention methods, health risk communication and
community engagement as well as mapping, monitoring and evaluation (M&E) and surveillance, and
also to draft multisectoral action priorities for the near future.
2.2 Global, regional and country updates on prevention and control of neglected foodborne
parasitic zoonoses through the food value chain
2.2.1 Global and regional burden of disease and socioeconomic impacts
NTDs are a diverse group of diseases that affect populations with limited access to adequate sanitation,
basic living conditions and health services. Affected individuals often face stigma and discrimination,
and experience morbidities and even mortality in association with their conditions. As a result, there is
a global response in addressing NTDs as a health priority. There are tools and strategies in place for the
broad control, elimination and eradication of NTDs in endemic countries.
Throughout the years there have been many changes in intervention strategies and validation methods
for the various NTDs in order to address the numerous challenges that have arisen during the
programme implementation process. Four important considerations to note when tackling NTDs are:
1) NTDs are focal diseases that often affect specific areas and/or communities;
2) there is a lag of several years between infection and clinical signs;
3) a control programme with a combination of strategies will be more effective; and
4
4) it is important to understand that the transmission cycle for a majority of NTDs exists on a
continuum and that control methods must target each possible transmission route.
For control of foodborne parasitic zoonoses, multisectoral participation from public health, animal
health, environmental health and food safety is essential (Fig. 1). It is equally important to understand
the transmission cycle of each disease and intercept it at each possible transmission route. It may not be
necessary to design an intervention programme from the beginning. In most countries, there are similar
intervention and control programmes for certain diseases already in place, such as livestock vaccination
programmes for brucellosis or traditional swine fever, dog vaccination for rabies or abattoir meat
inspection in food safety programmes. It may be more beneficial to build on these existing programmes
in order to increase resource efficiency.
Fig. 1. The concept of multisectoral participation through the food value chain for control of
foodborne parasitic zoonoses
The generic process to track the movement of NTD programmes consists of:
1) Situation analysis
2) Strategies, policies and plans
3) Process
4) Results towards attaining objectives
5) Impact evaluation.
The process consists of a planning phase and an implementation phase. During the planning phase, a
situation analysis is conducted through disease mapping and prioritization of agenda items. This is
followed by the creation of strategies and policies that will lead to an action plan. During the
implementation phase, there is constant surveillance and monitoring to ensure that there are no
significant adverse events or potential harms to the population. A system to track the progress of the
programme and measure outcome indicators should be in place. Once the project nears its end, an
impact evaluation should be conducted to ensure the goals of the programme have been met.
It is important to note that not all programmes follow this generic route. Some diseases may not be
eligible for elimination from the country. As a result, the programme may need to be adjusted to target
only disease control. Member States are encouraged to request technical assistance to help design a
programme or seek advice on how to collaborate with other existing programmes.
2.2.2 Guidance on interventions through the food value chain
Before generating any programme, it is essential to understand the transmission cycle of each parasite
in order to design interventions to break its cycle. Understanding the burden of diseases is important in
the prioritization of agendas and programmes. For each disease, it is important to know which
5
intervention methods are available and whether the agencies have the resources and capacity to
implement them. Lastly, in conjunction with any intervention programme, it is necessary to raise public
awareness about the disease, especially its transmission cycle. This knowledge may help to improve
hygiene reflexes and, overall, promote good production practices.
Production
WHO, the OIE and FAO have produced various guidance materials, both independently and jointly,
some focusing on specific diseases and others more general, which explain good practices along with
internationally agreed standards on the production chain. The OIE and the Codex Alimentarius
Commission cooperate to address the whole food continuum, particularly in products with animal
origins. The OIE produces codes and manuals providing guidance with international standards on
terrestrial and aquatic animal health. The OIE codes include a chapter on echinococcosis and porcine
cysticercosis. This includes the importance of breaking the cycle of the parasites using a combination
of management and treatment through the prevention of infection in livestock and dogs by stopping
exposure to contaminated feed and environments, vaccinating animals and providing prophylactic
treatments, and controlling infection in livestock through post-mortem meat inspection and an
investigation on the potential origins of infection, if any is found.
Food safety
The Codex Alimentarius Commission is a science- and consensus-based international food standard-
setting body established by FAO and WHO. Other international expert scientific committees sponsored
by FAO and WHO are the Joint FAO/WHO Expert Committee on Food Additives, the Joint FAO/WHO
Meeting on Pesticide Residues and the Joint FAO/WHO Expert Meetings on Microbiological Risk
Assessment (JEMRA). These committees meet regularly to address issues related to food safety within
their field of expertise.
As part of their scientific advice, JEMRA introduced parasite risk ranking in 2010, risk management
guidance and risk assessments. Of the 95 priority parasites selected, 24 were ranked as highest priority
and the most important global foodborne parasites to consider. This list, along with the ranking criteria,
can be found in the FAO/WHO joint report titled Multicriteria-Based Ranking for Risk Management of
Food-borne Parasites. The Codex Alimentarius also created a Guidelines on the Application of General
Principles of Food Hygiene to the Control of Foodborne Parasites to refer to for technical support.
Food safety regulators may consider making a priority list of parasites through risk ranking methods,
creating a systematic approach for risk communication to fill in knowledge gaps and developing
practical risk management guidance. Technical guidance for each of these steps can be provided and is
highly encouraged for countries intending to begin a programme.
Potential food safety control measures to include in a risk management are:
1) identify control points in food production and use good hygiene practices such as freezing,
heat treatment, salting, drying, etc. on produce and meat;
2) conduct risk-based food inspection by verifying control measures used by food businesses
and ensuring proper documentation;
3) collect samples and conduct laboratory analysis;
4) conduct pest control activities to reduce risk of insects and rodents contaminating food;
5) encourage the community to practise personal hygiene;
6) train food producers and handlers on good hygiene practices to reduce contamination risks; and
7) provide consumer education and awareness, especially to vulnerable populations, about the
five keys to safer food.
Public health
From the public health perspective, three important steps for an intervention programme are:
1) identification of endemic areas, particularly districts with active transmission or high risk;
2) delimitation at the local level; and
3) confirmation of cases for treatment.
6
At the national level, it is important that districts and endemic areas are identified through active
infection and transmission rather than the number of cases treated in a hospital (Fig. 2). If necessary,
hospital referral cases can be utilized to trace a district and further tests can be conducted to determine
the infection rate within the district. Disease information can be found in literature reviews, medical
data and veterinary data. Risk factors to consider for these districts are, for example, the presence of
backyard pigs along with sanitation data and the adjusted human development index.
Fig. 2. Guidance on identification of endemic areas, with pork tapeworm as an example
Once the districts are identified, there should be a delimitation at the local level to target specific
communities (Fig. 3). Disease information can be gathered from recent epidemiological studies, data
and information from local health facilities and health workers, along with data from individuals
working closely with local animals or meat products such as veterinarians and butchers.
Fig. 3. Guidance on delineation of target area at the local level, with pork tapeworm as an
example
Confirmation of disease prevalence can be determined through local data gathered from research and
health facilities or through interviews with local butchers and community members (Fig. 4).
7
Fig. 4. Guidance on confirmation of disease transmission, with pork tapeworm as an example
2.2.3 Country status updates
Each participating country gave a brief presentation on their country’s foodborne parasitic zoonosis
status and whether there were programmes and policies in place to address the issues.
Bhutan
Currently, Bhutan’s Health Management Information System under the Ministry of Health maintains a
passive surveillance system that tracks only reports of intestinal worms. According to the Ministry, the
country had about 30 000 reported cases of intestinal worms between 2013 and 2017.
A study conducted in 2016 showed that 6–25% of epilepsy cases in Bhutan were due to
neurocysticercosis.1
Another study conducted in 2017 showed that Echinococcus spp. were primarily detected in local and
community dogs living around slaughterhouses.2 These dogs are a key factor in the disease transmission
cycle and pose a significant risk of human infection.
The country has a One Health Strategic Plan (2017–2021) endorsed by the cabinet and signed by the
Ministry of Health and Ministry of Agriculture and Forests. A biannual deworming programme has
been used in schools since 1988, 96% of the schools have a trained School Health Coordinator, and
there is an integrated school WASH programme.
Cambodia
Cambodia has a burden of foodborne parasitic zoonoses. It is estimated that 10.1% of the country is
endemic with Opisthorchis viverrini. The country is also endemic with taeniasis/cysticercosis due to
Taenia solium, but countrywide data are lacking. Currently, there are no case reporting or notification
systems to track these patients.
Animals within the country also experience a heavy disease burden. Cattle in Kampong Cham, Kandal
and Takeo provinces are prone to FBT infections with Fasciola species and Paramphistomum species.
T. solium taeniasis/cysticercosis is commonly seen in slaughterhouses in Mondulkiri, Rattanakiri and
Stung Treng provinces. There are no case reporting or notification systems in place for tracking the
infection rates in these animals.
Cambodia has a zoonosis surveillance system for rabies in humans and for avian influenza in humans
and animals. The country also has event-based surveillance for conditions such as food poisoning. There
1 Brizzi K, Pelden S, Tshokey T, Nirola D, Diamond M, Klein J et al. Neurocysticercosis in Bhutan: a cross-sectional study in people with
epilepsy. Trans R Soc Trop Med Hyg. 2016 Sep;110(9):517–26. doi:10.1093/trstmh/trw066. 2 Thapa NK, Armua-Fernandez MT, Kinzang D, Gurung RB, Wangdi P, Deplazes P. Detection of Echinococcus granulosus and Echniococcus ortleppi in Bhutan. Parasitol Int. 2017 Apr;66(2):139–41. doi:10.1016/j.parint.2016.12.010.
8
is a legal provision (sub-decree No. 108), covering slaughterhouse management along with animal and
animal product inspection. Control activities that Cambodia is implementing in the animal sector
include animal movement inspection at the borders and certain checkpoints, training for farmers in
livestock production, and vaccination for haemorrhagic septicaemia. In the human health sector,
ongoing activities include an annual vaccination campaign for foot and mouth diseases and MDA along
with health education for O. viverrini in settings with a prevalence above 30%.
Furthermore, Cambodia has a system of inspections in place through various ministries responsible for
different components of the food supply chain. The Ministry of Agriculture, Forestry and Fisheries is
in charge of all aspects of farming, the Ministry of Mines and Energy is responsible for the processing
of the products, the Ministry of Commerce is responsible for both the standardization at the distribution
centres and at the retail level, and the Ministry of Health and Ministry of Tourism share joint
responsibility for overseeing food safety within restaurants.
China
China is endemic with certain foodborne parasitic zoonoses but has made significant efforts to monitor,
control and evaluate impacts. Currently, there is a national programme for the prevention and control
of echinococcosis and other key parasitic diseases (2016–2020). This programme was issued by the
National Health Commission along with 11 other national ministries. The objective of the control
programme was to establish a surveillance system for key parasitic diseases, control echinococcosis and
reduce the infection rate of Clonorchis sinensis and other parasitic diseases by 2020. Measures for
echinococcosis and C. sinensis include controlling the infection sources as a priority, followed by
intermediate host controlling, treating patients and providing health education.
China has a national special project labelled Risk Assessment of Quality & Safety of Agricultural
Products and is working on major research and development to supplement it.
There are currently regulations in place to control pig slaughtering, along with quarantine specifications
for pig, cattle and sheep slaughtering.
The Chinese Center for Disease Control and Prevention, along with the National Institute for Parasitic
Diseases, has several ongoing activities which include a national surveillance system for C. sinensis
and taeniasis, and other parasitic diseases, along with comprehensive demonstration zones for
C. sinensis and taeniasis, and control pilot studies for echinococcosis and C. sinensis.
The China Animal Health and Epidemiology Center maintains surveillance for T. solium
taeniasis/cysticercosis in farms and slaughterhouses, and surveillance for echinococcosis in farms and
slaughterhouses for sheep, beef and yaks, as well as vaccination for any susceptible animals.
Lao People’s Democratic Republic
A survey conducted in 2002 showed that the prevalence of FBT infection in the Lao People’s
Democratic Republic varied between 0.1% and 77% at community level. There are seven provinces
with an infection prevalence higher than 20%, two that are between 5% and 20%, and eight with less
than 5%. Data for taeniasis/cysticercosis prevalence are limited.
In 2015, the National Policy and Strategy on NTD Prevention and Control was established, with a five-
year activities plan (2018–2022) to control opisthorchiasis and taeniasis/cysticercosis. This
multisectoral plan involved the animal health, human health and education sector. Some strategies
outlined include promoting health education for behaviour changes; improving water, sanitation and
latrines; providing diagnosis and treatment; improving animal feeding using correct principles; and
periodically monitoring areas to determine programme effectiveness.
Currently, there are MDA ongoing in two districts in Champasak province and in Bolikhamsay and
Savannakhet provinces.
India
The true burden of foodborne diseases in India is not known due to underreporting. Reporting is usually
done either when the diseases have a high morbidity, and/or when they occur in urban areas. In 2004,
India launched the Integrated Disease Surveillance Programme network, which collects nationwide
9
data. Between 2011 and 2016, nearly half of all reported outbreaks were classified as foodborne
outbreaks with acute diarrhoeal diseases.3 The most common foodborne parasitic zoonoses affecting
human health in India are taeniasis/cysticercosis and hydatidosis.
There are several nodal agencies that work to address parasitic diseases within India such as the National
Centre for Disease Control, the Food Safety and Standards Authority under the Ministry of Health and
Family Welfare, and the Department of Animal Husbandry, Dairying and Fisheries under the Ministry
of Agriculture and Farmers’ Welfare.
India’s National Centre for Disease Control was established to create countrywide disease surveillance,
training and applied research using a multidisciplinary integrated approach. The institute is also
expected to provide expertise on rapid health assessment and laboratory-based diagnostic services. The
Department of Animal Husbandry, Dairying and Fisheries has several control programmes in place for
foot-and-mouth disease and peste des petits ruminants, to name a few. The Food Safety and Standards
Authority has regulations for all aspects of the food supply chain and mandates training for food
handlers as well as a certified food safety supervisor in all food service establishments.
India has produced various guidance documents to address food safety concerns. Food safety display
boards are displayed throughout the markets and areas where food is handled. Overall, the country
practises adequate cooking of meat, fish and vegetables. However, there are still high transmission rates
of foodborne parasitic zoonoses in the country because of unhygienic living conditions, poverty and
lack of education.
To develop a more countrywide and specific strategic control programme, surveillance data must be
regularly updated to identify the prevalence and risk factors for these infections.
Indonesia
Indonesia’s Ministry of Agriculture lists 15 major zoonotic diseases in animals, two of which are
foodborne parasitic diseases: echinococcosis and taeniasis. Foodborne zoonotic diseases are of higher
priority than foodborne parasitic diseases, and most zoonotic diseases come from bacteria. There is a
surveillance system for the foodborne zoonotic diseases, but not for foodborne parasitic diseases.
Additionally, there is surveillance for parasitic diseases in live animals, but this is not the case for animal
products.
There are various ministries and institutions that regulate food products and ensure food safety. Their
work includes: to standardize, control, inspect and certify processed foods, drugs and cosmetics; to
ensure border control for animals; to implement halal regulations, standards, policies and certifications;
to issue import permits; and to facilitate the food industries.
Ongoing control activities throughout the nation include the surveillance of parasites in live animals,
deworming programmes, and raising public awareness on food processing and WASH practices. There
are approximately 41 veterinary public health laboratories, but they are not all equipped to diagnose
foodborne parasitic infections. Only one has the capacity to find parasites in animal products and foods
for the Indonesian Government. As a result, there is a call for greater capacity-building, improvement
of facilities and infrastructure, and technical support from the OIE, FAO and WHO.
Malaysia
In government hospitals in Malaysia, the primary diagnosis of a majority of the helminthiasis cases is
cysticercosis, with over 60% of helminthiasis diagnoses attributed to cysticercosis of the central nervous
system. In Peninsular Malaysia, the prevalence of fascioliasis in animals is primarily seen in the north
and south-eastern parts of the region.
Currently, the country has an infectious disease surveillance system with an established list of notifiable
diseases and a surveillance system of animal diseases. The Inter-Ministerial Committee on the Control
of Zoonotic Diseases enables various stakeholders to unite and focus on zoonotic disease monitoring,
control and research.
3 According to CD Alert of the National Centre for Disease Control of India.
10
Myanmar
In humans, there has been a relatively low burden of neglected foodborne parasitic zoonoses in recent
years. However, research projects to identify parasites in livestock initiated by the Australian Centre
for International Agricultural Research (ACIAR) during 2014–2017 and an FAO project funded by the
Livelihoods and Food Security Fund, or LIFT, found a greater burden in animals.
Porcine cysticercosis was found in 23.67% of samples during a meat inspection in veterinary diagnostic
laboratories. This high prevalence negatively affects farmers’ livelihoods, as it causes a significant loss
of income. Schistosomes were found in 119 out of 379 cattle stool samples. In the project by FAO–
LIFT, 57% of all animals tested contained some species of parasitic eggs. In the ACIAR project, 86.6%
of cattle samples contained parasites, whereas 99.8% of sheep/goat samples were infested with
parasites.
Meat inspection from samples in processing plans and wet markets is being done to control the spread
of infection. Gross examinations are conducted within slaughterhouses by the municipal veterinarian.
The Myanmar National One Health Strategic Framework contains priority topics including
antimicrobial resistance and six priority diseases. Foodborne diseases constitute one of the Framework’s
priorities. Furthermore, the country formed a steering committee of ministries facilitating One Health
collaboration initiatives.
Ongoing activities in Myanmar include putting together a platform for electronic-based data sharing,
working on laboratory capacity-building, and developing an M&E framework and action plan for the
current programmes.
Mongolia
Throughout Mongolia, there is a burden of foodborne parasitic zoonosis in both humans and animals.
A number of studies on echinococcosis have been conducted in the country. For instance, Ito et al.
reported that 19% of 1707 animal samples tested were found to be infected with cystic echinococcosis.4
However, the exact prevalence in humans is unknown. Efforts to study foodborne parasitic diseases
have been a priority, and the Government is providing extensive institutional support and capacity-
building. The country must continue to improve the collaboration between the human and veterinary
sectors to better conduct surveillance, identify certain risk factors for the diseases, and implement an
action plan to alleviate the transmission and infection risk.
Nepal
Nepal is endemic with neglected foodborne parasitic zoonoses. The country’s economy is highly
dependent on livestock. Unfortunately, the disease burden of neglected foodborne parasitic zoonoses in
livestock is very high. The priority zoonotic diseases include cysticercosis, hydatidosis, trichinellosis,
toxoplasmosis and trematodes. The seventh most common outpatient diseases seen in hospitals are
attributed to worm infestations though previous years have seen a downward trend. Health facilities
often treat patients with ascariasis, neurocysticercosis, cystic echinococcosis and toxoplasmosis. In
endemic areas, T. solium is believed to cause 30% of epilepsy cases.
The One Health Strategic Framework for Nepal was drafted in 2015 but has not yet been approved by
all ministries. A pandemic preparedness plan for neglected foodborne parasitic zoonoses and other
potential pandemic issues is currently under preparation.
Ongoing prevention and control activities practised in the animal sector include: providing
anthelmintics for pigs, dogs, sheep and other animals on a needs basis; monitoring meat inspection and
practicing slaughterhouse hygiene during the processing of meat products; discouraging the use of
unprocessed human and animal faecal waste manure; and conducting a district trial for CYSVAX
(TSOL18) vaccine in 2017.
4 Ito A, Dorjsuren T, Davaasuren A, Yanagida T, Sako Y, Nakaya K et al. Cystic echinococcosis in Mongolia: molecular identification, serology and risk factors. PLoS Negl Trop Dis. 2014 Jun;8(6):e2937. doi:10.1371/journal.pntd.0002937.
11
From the public health standpoint, Nepal has initiated a school health nutrition programme to promote
health and sanitation at a young age and discourage the practice of eating raw meats by encouraging
families to cook food thoroughly.
From the food technology and quality control perspective, food inspection has improved by classifying
foods based on risk. In addition, stricter food laws are being enforced, including punishment for the
production and sale of food products containing health-threatening agents. Food safety awareness
programmes have been set up, and a new primary food law, which includes risk-based inspection
management along with a provision on risk analysis, has been drafted.
Philippines
Several neglected foodborne parasitic zoonoses are endemic in the Philippines. Eight out of 17
administrative regions in the country are known to be endemic for paragonimiasis. Data from 2017
showed that Eastern Visayas had 24.6% prevalence of cysticercosis.5 In the Southern Philippines, the
prevalence of heterophyids in 2004 was 36%.6 Schistosomiasis affects 12 of the 17 administrative
regions in the Philippines.
One of the Philippines’ strengths is its political commitment and abundance of policies to address the
prevention and control of neglected foodborne parasitic zoonoses. In 2011, an administrative order on
“Creating the Philippine Inter-Agency Committee on Zoonoses” was released to develop a national
strategy on prevention, control and elimination of zoonoses. This body committed to the establishment
of a functional and sustainable partnership between the animal and human health sectors in order to
prevent, control and eliminate zoonotic diseases. In 2013, the Food Safety Act was passed to strengthen
the food safety regulation system. To specifically address paragonimiasis, the Department of Health
Infectious Disease Office issued an administrative order on the “Diagnosis and Treatment Guidelines
for Paragonimiasis.” In 2018, the Department created a memorandum to integrate paragonimiasis
treatment guidelines into the current National Tuberculosis Programme Microscopy Services. The goal
of the memorandum was to build on an existing programme to broaden the capacity, since
paragonimiasis symptoms clinically present in a similar fashion to those of tuberculosis. A
memorandum of agreement was also signed in 2017 between the Department of Health and the
Department of Agriculture to control and prevent animal schistosomiasis.
The Philippines have several notable ongoing activities to control and prevent foodborne parasitic
diseases. These include: the promotion of WASH in schools; the creation of a national meat inspection
service under the Department of Agriculture; ongoing advocacy for deworming of livestock initiated
by the Bureau of Animal Industry; MDA programmes for preschool-aged children and school-aged
children conducted through the Department of Education, and training on integrated laboratory
microscopy from the Department of Health and the Department of Agriculture.
The country has several projects on its current agenda, including:
1) the mapping of neglected foodborne parasitic zoonoses in endemic areas;
2) the development of clinical guidelines on foodborne trematodes;
3) the establishment of a joint memorandum of agreement between the Department of
Agriculture and the Department of Health to prevent and control neglected foodborne
parasitic zoonoses;
4) the integration of the NTD-Management Information System (NTDMIS) with a reporting
system for neglected foodborne parasitic zoonoses;
5) the development of the National Department of Agriculture Policy on Animal Schistosomiasis
Control and Elimination; and
6) the implementation of more research and capability initiatives on foodborne helminths,
Trichinella spp. and Toxoplasma gondii.
5 Expert Consultation to Accelerate Control of Foodborne Trematode Infections, Taeniasis and Cysticercosis [meeting report]. Manila:
World Health Organization Regional Office for the Western Pacific; 2017. 6 Belizario VY Jr, de Leon WU, Bersabe MJJ, Purnomo, Baird JK, Bangs MJ. A focus of human infection by Haplorchis taichui in the Southern Philippines. J Parasitol. 2004 Oct;90(5):1165–9. doi:10.1645/GE-3304RN.
12
Republic of Korea
In recent years, the Republic of Korea has seen a decline in parasitic infection rates. Clonorchiasis
remains endemic in the country, and mass screenings and treatment of infected populations residing in
certain endemic riverside areas continue. The prevalence reported in endemic areas declined
accordingly: 4% in 2018, compared to 10% in 2005. The highest risk group is male and over 50 years
of age (9.4% prevalence in the group aged 50–59 years in 2018). No new cases of cysticercosis are
reported, but there are occasionally a few imported cases of echinococcosis.
Thailand
Due to Thailand’s traditional practice of eating raw fish and meats, there is a relatively high burden of
neglected foodborne parasitic zoonoses. 7 Recently, Thailand has seen a reduction in liver fluke
infections from approximately 10% in 2001 to less than 6% in 2014. The highest prevalence of liver
fluke is in the north and north-east regions. On the other hand, taeniasis and cysticercosis prevalence
has remained less than 1% since 2001.
Ongoing activities to control liver fluke disease are: modifying the behaviour of consuming raw fish
within endemic communities; organizing media campaigns to provide education on liver fluke, disease
prevention and safe consumption of fish; and conducting six-monthly follow-ups of liver diseases in
high-prevalence areas. Activities throughout Thailand to control for general parasites include screening,
support for scientific equipment and medicine, development of a school mode, moving of policy to risk
areas, and monitoring and evaluation of the programme when it is completed.
Viet Nam
Viet Nam has a significant burden of foodborne parasitic diseases, with 1–2 million individuals
estimated to be infected with clonorchiasis and opisthorchiasis throughout 32 provinces. A total of 51
of 63 provinces report human cases of fascioliasis, 50 provinces report human cases of cysticercosis,
and 28 northern provinces report echinococcosis. Of these, 80% of cysticercosis cases are males, with
the central provinces having the highest prevalence rates throughout the country.
Between 2012 and 2016, the average prevalence for fascioliasis cases remained below 5000 cases per
year. However, in 2017, the number surpassed 11 000.8 The cause for this increase is unknown.
Consecutive MDA programmes have proven effective in lowering the prevalence of foodborne parasitic
diseases except for fascioliasis in endemic communities in Viet Nam.
Challenges to the control of foodborne parasitic zoonosis in the country include the cultural habit of
eating raw fish, raw meat and uncooked vegetables. Moreover, there is the continued practice of using
human and animal faeces as fertilizer and allowing pigs to roam freely in rural areas. Health systems
have shown little interest in targeting NTDs as there is no surveillance system for parasitic diseases, no
reporting system, and no diagnosis and treatment in lower-level health facilities. The veterinary system
is also not sufficiently robust to monitor and manage meat inspection within communities, especially
in local slaughterhouses. Furthermore, there are no policies requiring meat inspection in markets,
particularly in the rural areas. There is minimal and inconsistent coordination between the human and
animal health sectors, which is problematic when trying to share data and prioritizing disease
surveillance. Due to the slow coordination, the implementation of a prevention and outbreak treatment
plan may be slower than expected.
There are currently no national programmes to address parasitic diseases. In the future, Viet Nam hopes
to establish integrated control activities for parasitic zoonoses in all components of the health sector,
develop food safety assessment indicators for parasitic zoonoses, establish M&E activities for parasites
and hosts, improve diagnosis and treatment capacity, and develop an NTD reporting system.
7 Waikagul J, Dekumyoy P, Anataphtuti MT. Taeniasis, cysticercosis and echinococcosis in Thailand. Parasitol Int. 2006;55 Suppl:S175–80.
doi:10.1016/j.parint.2005.11.027. 8 According to data from the National Institute of Malaria, Parasitology, and Entomology (NIMPE) and provincial IMPE Quy Nhon (QN) and IMPE Ho Chi Minh City.
13
2.3 One Health interventions
2.3.1 Basic considerations for control of neglected foodborne parasitic zoonoses through One
Health approach
Control of T. solium taeniasis
The transmission cycle of cestodes, whether T. solium or E. granulosus, is maintained between the
definitive host that harbours the adult tapeworm and the intermediate host that harbours the larval
stages. Cysticercosis, neurocysticercosis or hydatid diseases occur among accidental hosts which ingest
the larval stage of the parasite outside the transmission cycle. Actions to treat such cases do not affect
the transmission cycle.
Intervention methods for the control of T. solium targeting humans include health promotion and
education along with preventive chemotherapy, which is either a single dose of niclosamide or
praziquantel, or multiple doses of albendazole. The treatment acts on the definitive host and helps
prevent transmission to accidental hosts. However, despite the preventive chemotherapy interventions,
people can still be reinfected through perpetual exposure to the infecting agent.
To reduce exposure to the infecting agent, there must be changes to the environment. Environmental
interventions for T. solium include the promotion and implementation of WASH practices. These
practices help to stop the definitive host (humans) from spreading it to other accidental hosts.
Lastly, to reduce the transmission at the source, there must be control interventions targeting pigs
(Fig. 5). Control mechanisms include rearing pigs exclusively in pens throughout their lives,
vaccinating pigs with two intramuscular doses of TSOL18 to prevent infection, or treating pigs with
oxfendazole (30 mg/kg, oral). After administration of oxfendazole, farmers must refrain from
slaughtering and eating the animal for three weeks. These pig control methods work to break the
transmission of infection between the intermediate host (the pig) and the definitive host (the human).
Fig. 5. Veterinary interventions for control of T. solium transmission
In theory, the combination of all interventions (human, environment and pig control) should reduce the
transmission of infection and ideally control and eliminate T. solium-related cases. However, there is
no single universal strategy. Instead, the various control methods should be taken into consideration
and adapted to the local situation, its resources and financing mechanisms (Fig. 6).
14
Fig. 6. Example of One Health interventions in combination for control of T. solium
transmission
Control of echinococcosis
Echinococcus has two important pathogenic species, E. granulosus and E. multilocularis. Control of
alveolar echinococcosis caused by E. multilocularis is complex because wild animals can be both
definitive and intermediate hosts. The session focused on control of cystic echinococcosis (hydatidosis)
caused by E. granulosus.
Successful interventions to control Echinococcus include a combination of treating dogs, vaccinating
sheep and educating the public to achieve community acceptance. The control of E. granulosus in dogs
includes managing stray dogs through sterilisation, deworming dogs with praziquantel (5 mg/kg) every
six weeks and refraining from feeding offal to dogs by providing commercial dry food if possible
(Fig. 7).
Fig. 7. Recommended interventions in dogs for control of E. granulosus
The control of E. granulosus in sheep includes vaccinating them with EG95, a commercial vaccine
produced in China and Argentina (Fig. 8). The vaccine should be given three times with the following
regimen: initial vaccination, second vaccination one month later and a booster vaccination one year
after that. Another method is to cull old sheep as these animals tend to be infested with the most infective
cysts. These methods will help to stop transmission between the intermediate host (sheep) and the
definitive host (dogs).
15
Fig. 8. Recommended interventions in sheep for control of E. granulosus
For E. multilocularis, domestic cats and dogs with access to rodents are a health risk to humans in rural
and urban communities. The recommended treatment for dogs and cats includes the use of praziquantel
at 5 mg/kg. To reduce the transmission risk between definitive host and humans, good personal hygiene
should be practised after exposure to dogs and cats, and after working in gardens. Furthermore, it is
important to thoroughly wash salad vegetables, and carefully wash or cook fungi and berries before
consumption, especially those that were in the wild and growing on the ground.
Control of FBT infections
There are various types of FBT. Optimal control of foodborne parasitic diseases requires an
understanding of all tools that can be used for the different hosts and environments. Preventive
chemotherapy is the primary intervention for humans. Depending on the diseases, animals to consider
treating may include livestock, domestic animals and various wildlife. Once the tools are selected, the
programme should be adapted to local circumstances. Realistic targets and expectations should be set
based on the local situation, resources and capacities. It is essential that both human and animal sectors
coordinate with these initiatives since both sectors are affected by the intervention mechanisms.
Control of FBT infections in humans includes a behavioural prevention component along with a
medication intervention for treatment and prevention. Since human infection is primarily caused
through the consumption of infected crustaceans and contaminated foods, high-risk populations should
consider cooking fish and crab thoroughly and cleaning aquatic plants before consumption.
Interventions targeting the reservoir host include the management of stray dogs and cats with the
administration of praziquantel. Furthermore, the prevention of infection can be managed by ensuring
that dogs and cats are not fed with infected fish offal by properly disposing of the offal.
Managing fish-borne FBT can also occur through sanitation interventions targeting the first and second
intermediate hosts (snails, crustaceans and fish). Interventions include managing faecal materials and
caring for fishing plantations. Building septic tanks and sewage disposal systems will help to prevent
water from becoming contaminated by parasitic eggs transmitted from faeces. Fish plantations can be
monitored for snails, which should be controlled and removed as necessary.
Paragonimiasis control is primarily based on preventive chemotherapy interventions for humans using
triclabendazole and praziquantel. Furthermore, changes in dietary habits will help to prevent human
infection. Methods to control the reservoir host for paragonimiasis are limited.
Fascioliasis caused by F. hepatica and F. gigantica can be controlled via medications for infection and
by adjusting dietary and cooking practices. The behaviour change includes thoroughly washing and
16
cooking aquatic plants before consumption. The intervention methods for reservoir hosts and snails
include managing livestock through preventive medication and practising snail control in water
vegetable plantations where feasible.
2.3.2 Sharing experience on One Health approach – action, challenges and lessons learnt
Control of taeniasis/cysticercosis in the One Health Smallholder Pig Systems Project in the Lao
People’s Democratic Republic
Between 2011 and 2015, ACIAR funded a pilot intervention project in Phongsaly, Lao People’s
Democratic Republic, called the One Health Smallholder Pig Systems Project. The Project worked with
the animal and human health sectors to develop a One Health approach to decrease the burden of
T. solium by addressing the various health issues facing the human and animal population in Phongsaly.
Between October 2013 and January 2015, the project administered a biannual treatment of albendazole
at 400 milligrams for three days to those aged over 6 years. Albendazole may not be the primary drug
of choice to treat T. solium, but it is an anthelmintic and also treats and prevents soil-transmitted
helminthiases. To treat pigs, the programme administered a combination of TSOL18, oxfendazole (at
30mg/kg) and traditional swine fever vaccine. A survey was conducted in the early stages of the Project
to gauge the communities’ interests and opinions on the project agenda and actions. A biannual
questionnaire was used for quality M&E purposes and to determine economic trends such as the
livelihood of the farmers, their satisfaction with the quality of their pigs and the economic benefits they
have experienced with their healthier pigs.
The Project benefited from the buy-in of the Ministry of Health and the Ministry of Agriculture. It
gained support from the Ministry of Agriculture by creating a comprehensive package that helped to
treat several pig-related burdens such as T. solium and traditional swine fever. Addressing traditional
swine fever swung the balance with the Ministry of Agriculture because it causes significant economic
loss for farmers whose pigs are infected. Furthermore, farmers were also more willing to participate
and advocate this Project as it kept their pigs visually healthy.
After this intervention, the adjusted prevalence of T. solium in Phongsaly dropped from 29.5% to 0%.
The crude prevalence fell 78.7% from 30.6% to 6.52%. Furthermore, the One Health approach proved
to be cost-effective, since it encompassed many different interventions in both the human and pig
sectors. A key takeaway from this Project was the added value of coordinating with existing health
initiatives for a genuine One Health approach. In addition, it is essential that cost-effectiveness is
measured to influence and drive policy implementation. Lastly, this Project was initiated at a time when
global momentum for the reduction of NTDs was highlighted in the 2013 World Health Assembly
resolutions on NTDs. Political momentum at any scale (regional, national or international) is important
as it will encourage support from individuals and organizations who are passionate about the cause.
GALVmed’s experience with technology transfer and vaccination trials in pig populations in
India and Nepal
The Global Alliance for Livestock Veterinary Medicines (GALVmed) is a not-for-profit organization
based in Edinburgh, United Kingdom of Great Britain and Northern Ireland, which helps smallholder
farmers improve the health of their livestock through product development.
In this specific project, GALVmed provided assistance in developing an affordable and effective
pharmaceutical drug to address T. solium infection in pigs.
Globally, T. solium was ranked the fourth highest foodborne hazard to create an economic burden in
disability-adjusted life years.9 To address this, GALVmed took two known drugs (an anthelmintic and
a porcine vaccine) and scaled up its production to make a safe yet more affordable product for low-
income, endemic countries. Specifically, it expanded research on the anthelmintic oxfendazole 10%,
also labelled Synanthic 9.06% and 22.5%, and contracted M.C.I. Santé Animale to mass-produce the
drug in an affordable manner. It also used the experimental vaccine TSOL18, originating from the
University of Melbourne. The experimental drug was proven effective in reducing porcine cysticercosis,
9 According to data from the Foodborne Disease Burden Epidemiology Reference Group (2007–2015).
17
so they partnered with India Immunologicals Limited (IIL) to develop a more affordable version of the
vaccine. The commercial vaccine that was produced underwent animal trials in Peru and Spain and
became the first registered vaccine for porcine cysticercosis in 2016.
GALVmed then began field trials in India and Nepal. In Hyderabad and Chennai, India, the project
worked to determine the field safety and efficacy (seroconversion) of TSOL18, whereas Nepal tested
the effectiveness of both TSOL18 and oxfendazole 10% in reducing porcine cysticercosis.
In Hyderabad and Chennai, 180 pigs were used in this trial (90 treated and 90 control). The pigs ranged
in age from 2 months to 2 years and were randomly selected for vaccination. Blood samples were
collected before each vaccination and on days 20 and 35 post-vaccine. After day 35 of vaccine
administration, 97.2% seroprotection was detected in the TSOL18-treated pigs in Hyderabad, and 100%
seroprotection in Chennai.
Another field trial was conducted in Banke District in Nepal to evaluate the effectiveness of TSOL18
and oxfendazole 10%, administered four times at three-month intervals, to control porcine cysticercosis
in field conditions and determine the feasibility of this intervention in free ranging pigs. The study
design included having 500 control pigs and 500 pigs treated with TSOL18 (1 mL injected
intramuscularly) and oxfendazole (30 mg/kg per os) every three months, and within 15 days of each
time frame. Pigs were selected for vaccination as long as they were healthy and older than 2 months;
they were excluded if they were sick, less than 4 weeks to giving birth or less than 3 weeks before
slaughter. A minimum of 55 pigs needed to be slaughtered for post-mortem examination for cysts within
each group (a total of 110 pigs were slaughtered). In this trial, a baseline survey on knowledge and
practice showed that 92% of pigs were free ranging and 95% had access to latrines, and 90% of farmers
saw cysts but were not aware that they caused disease. There were four treatment interventions every
three months, with a total of 828 vaccinations in total. Coverage was approximately 90–95%, and the
main reasons for pigs not being treated were age under 2 months (57%), pregnancy (20%) or running
away (17%).
Results from the trial showed that porcine cysticercosis for the control group remained high from
baseline to the end of the trial (24% to 17%, respectively), whereas post-mortem examination showed
no cysts in the pigs that were treated (35% baseline and 0% end). Of the 110 pigs slaughtered, 32 were
found to have T. solium cysticerci infection, of which 30 had viable cysticerci. This proved the
effectiveness of the drugs.
During this intervention, there was strong capacity-building within Nepal entailing comprehensive
training in the dissection and identification of T. solium cysts. The project helped train one professor,
three chief veterinarians and 22 veterinarians. Researchers noted that the most time-consuming task was
to catch the pig and offered extensive practice and tips on how to handle the free-range pigs, including
use of boards and pig snares. Additionally, where feasible, it was recommended that the intervention be
conducted at a vaccination centre rather than house-to-house. Having a central point significantly
reduced transportation costs and was more efficient as the pigs were generally tethered and did not need
catching. However, if house-to-house vaccination was needed, it was recommended that researchers
notify the pig owners prior to their arrival and ask for the pigs to be placed in pens or at least tethered
to reduce the time it took to catch them. Overall, there was good vaccine coverage (>90%), but up to
57% of the pigs had only one vaccination. Although it is ideal to have all four treatments, a single
vaccine helps to reduce the prevalence. Furthermore, in such field situations, the vaccines may need to
be refrigerated and this can be done within a medical centre fridge. The vaccine can be transported in
cool boxes with temperature monitors.
Key takeaways from this intervention included the importance of the training in dissection and
identification of T. solium cysts, the training in catching and handling free-range pigs, and the
importance of speed during the process of tagging, vaccinating and deworming the pigs.
18
3.1 Health risk communication and community engagement
3.1.2 Sharing country experiences on multi-disciplinary approach
Community-led WASH-NTD initiative for elimination of schistosomiasis in the Lao People’s
Democratic Republic and Cambodia
Communities endemic with NTDs that have poor access to WASH are likely to experience a cycle of
disease and poverty. The primary and most cost-effective strategy in reducing NTD transmission is
preventive chemotherapy. However, poor sanitation is the root cause for disease transmission in most
NTDs. As a result, control and elimination programmes must consider adding WASH initiatives as a
complementary strategy.
Schistosomiasis in Cambodia and the Lao People’s Democratic Republic is caused by S. mekongi.
Along the Mekong River, schistosomiasis infection is endemic in about 200 villages in one province of
the Lao People’s Democratic Republic and 100 villages in two provinces of Cambodia. For the past 20
years, there have been annual MDA campaigns in the endemic areas, which has helped to reduce the
prevalence of infection among all affected communities. However, evidence showed that when MDA
campaigns cease, there is an immediate increase in the prevalence of S. mekongi infection in the
endemic villages as a result of ongoing transmission, itself due to persistent lack of sanitation. To disrupt
this trend and eliminate the residual transmission sites of schistosomiasis, a complementary WASH
programme must be put in place within the communities.
A Community-Led initiative to eliminate Schistosomiasis through deworming humans and animals, and
improving access to Water and Sanitation, and improved Hygiene along with safe nutrition practices,
or CL-SWASH, was launched in Cambodia and the Lao People’s Democratic Republic in 2016 to
accelerate elimination of schistosomiasis. The communities primarily focus on implementing
defecation-free areas by building individual household latrines and improving WASH levels.
Recommended latrine designs include a pit latrine, a twin pit latrine and a ventilated improved pit
latrine.
CL-SWASH activities are shown in Fig. 9. The goals of this intervention are:
1) to strengthen health literacy at the community level,
2) to institutionalize multisectoral cooperation, and
3) to facilitate the replication of activities in all endemic communities.
Fig. 9. The seven CL-SWASH steps in Cambodia and the Lao People’s Democratic Republic
To increase health literacy, community members are informed about schistosomiasis transmission and
certain hygiene behaviours that put communities at risk of infection. With this information,
communities are empowered to plan and initiate their own programmes to interrupt transmission.
19
The CL-SWASH initiative targets WASH, NTD and nutrition. There should be multisectoral
collaboration between all three sectors at the central, provincial and district levels. CL-SWASH should
avoid a parallel programmatic approach by building on and supplementing existing national efforts.
These programmes should work towards creating a water safety/sanitation plan within all communities.
In both Cambodia and the Lao People’s Democratic Republic, there has been an increase in latrine
construction among communities implementing the CL-SWASH. These latrines are built independently
by the community members from their own pockets. In communities where latrines were subsidized by
programmes, often nobody took the initiative in maintaining the facilities and as a result they became
inoperable over time.
One notable challenge that arose during this programme was the sustainability of multisectoral
collaboration. Since different ministries or divisions are responsible for NTD and WASH initiatives, it
may be worth considering institutionalizing all inter-ministerial collaborations. This will help facilitate
coordination while helping to balance the responsibilities and leadership roles between the WASH and
NTD sectors. To improve multisectoral efforts, programme leaders should encourage WASH partners
to prioritize their efforts to NTD-endemic areas. WASH initiatives decide where they should implement
on the basis of economic, accessibility, convenience and even political factors. By focusing on NTD-
endemic areas, WASH activities can also monitor their health impact. This collaboration will have many
benefits for community health and can be a framework for future health initiatives.
Lawa Model for control of FBT infections in Thailand
C. sinensis, or Chinese liver fluke, is a foodborne trematode that infects approximately 15 million
individuals in the Greater Mekong Subregion. Humans infected with this parasite may be asymptomatic
for long periods of time before experiencing hepatobiliary diseases such as cholangiocarcinoma (CCA),
or bile duct cancer. Annually, Srinagarind Hospital in Khon Kaen University sees approximately 1000
new cases of liver and bile duct cancers. Despite initiating a disease control programme 30 years ago,
Thailand continues to have one of the highest global burdens of the trematode.
Between 2005 and 2007, researchers conducted community-based research and looked at stool samples
of individuals living around the Chi River basin in Khon Kaen Province in northeast Thailand. The
survey found the average prevalence of O. viverrini infection to be 40%, with some communities
showing a prevalence of over 60%. 10 There were disease hotspots throughout the country and
particularly in the villages surrounding Lawa Lake. In 2007, Khon Kaen University aimed to create a
sustainable and community participatory disease treatment programme called the Lawa Model, to target
13 endemic communities surrounding the lake. After the implementation of this pilot programme, the
infection rates throughout all disease hosts (humans, snails, fish, cats and dogs) within the 13 districts
significantly declined. In January 2016, the model was implemented nationwide to target 84 endemic
districts throughout Thailand.
The Lawa Model is a community-based, EcoHealth/One Health model that consists of several
components: preventive chemotherapy, intensive community and school health education, ecosystem
monitoring, empowerment of village health volunteers and the local hospital staff, and active
community participation. The model requires stakeholders from all different sectors to endorse the
project and become responsible for its implementation, including physicians, veterinarians,
environmental specialists, teachers, village health volunteers, the local government and even monks.
The diversity in stakeholders ensures the programme remains sustainable regardless of changes in
government and political parties. Furthermore, the programme empowers the community to lead the
efforts by training local leaders, such as primary care unit doctors, head villagers and the senior monks,
to direct all components of the control phase. Once these selected community programme leaders are
trained, they go back to their communities to implement it.
10 Sripa B, Tangkawattana S, Sangnikul T. The Lawa model: A sustainable, integrated opisthorchiasis control program using the EcoHealth approach in the Lawa Lake region of Thailand. Parasitol Int. 2017 Aug;66(4):346–54. doi:10.1016/j.parint.2016.11.013.
20
To initiate campaign efforts within a community, local programme leaders and local health staff
facilitated community-wide health education discussions and activities. There were several traditional
folk songs and local dances created and performed to address the disease profile.
Infected individuals and schoolchildren with O. viverrini infection were treated with praziquantel
(40mg/kg body weight). Additionally, some reservoir hosts were also treated to interrupt parasite
transmission.
Village health volunteers received training and information on the disease cycle and potential
transmission routes. Each village health volunteer was assigned to 10–15 households and was
responsible in going door-to-door to explain the disease transmission to each household.
During the pilot project, eight schools located within the villages implemented a strong education
curriculum targeting the control of the disease. Within three years, all participating schools became
liver fluke-free. The declaration of liver fluke-free schools helped to increase awareness on liver fluke
infection and CCA. Billboards were placed throughout the villages with information on the liver fluke
campaign.
Local health workers and hospital staff were given extensive training on how to check stool samples.
Having the local staff conduct project implementations helped to sustain the programme, since they felt
personally invested in the project outcomes.
As more community members became aware of the disease and more stakeholders got involved, an
earmarked funding source was established from the local governor’s office to fund the training and
projects. These sustainable efforts and the ensuing drop in infection prevalence caught the attention of
the Ministry of Public Health, which adopted them and is currently implementing a nationwide
campaign.
3.1.3 Food safety risk communication training
Risk communication is an important component of public health. For risk communication to be most
effective, the programme’s goals must be clear and reflected on during each component of the control
programme.
When designing the risk communication process, it is important to determine the logical extent of the
intervention. The intervention may need to change the use of technology by introducing new equipment;
it may need to modify certain behaviours and practices and even adapt certain cultural practices.
However, these interventions must be discussed to determine whether they are feasible and reasonable
to the community. This step may require focus group discussions from community members or involve
an important community leader in the discussion of potential interventions.
Programme managers should also cross-reference their project’s agenda with existing projects to
determine if there are any activities that are duplicated or overlap. If programmes are already in place,
it is important to analyse their progress and results to determine if modifications are necessary. The
analysis of results will also determine if the programme should start from scratch, be incorporated with
an existing programme or replace an existing one.
The perceptions of food safety have a cognitive and an emotional component. The public can understand
the likelihood and consequences of certain food safety practices and how they may pose a threat to
them. They may also have certain opinions about food handling processes. For example, people can
understand that eating certain raw dishes is dangerous, but they will still consume them because they
do not have an emotional sense of the risk. On the other hand, if an individual experiences fear or guilt
about certain food handling practices, they are more likely to change their behaviour. As a result, guilt
and fear are the two targeted emotions to consider during the risk communication process.
In many situations, there is a gap between knowledge and behaviour. People may know that certain
practices are dangerous, but they do not have the agency or motivation to change. It is important to note
that dispensing information materials may not always be the wisest practice for all disease control
programmes. Rather, methods to mediate the challenges between programme implementation should
be considered.
21
A guideline was given on effective material presentation. Such guidelines help with the design of
infographics or informational materials by making recommendations such as:
1) Focus on what is most important.
• Only 3–5 main ideas should be presented, along with supporting details. This will limit
the amount of text and motivate the audience to read.
2) Write from the audience’s point of view.
• When writing, it is important to consider what the audience wants to know and needs
to know. It may also be necessary to clarify any misconceptions or misinformation.
3) Use plain language.
• Since the target audience may not always be educated, it is important to clarify and
simplify all aspects of the informational materials. This can be done by using local or
common names of foods, diseases, animals or parasites. Furthermore, important ideas
should be expressed using short and memorable phrases.
4) Use appropriate graphics.
• To enhance the aesthetics and get the audience engaged, simple graphics help to capture
the audience’s attention. These graphics should demonstrate how to complete the
actions associated with risk communication. Furthermore, graphics of people should
be representative of the target audience.
The examples and guidelines are all suggestions from the programme’s best practices. In the exercise,
country participants were asked to specify a certain disease, or a related group of diseases, and create a
risk communication document along with informational materials to be dispensed to their audience.
3.1.4 Field trip and observations / country practices and recommendations
In the afternoon of the second day of the meeting, participants visited a slaughterhouse, a community
pig pen and a food market in Luang Prabang to observe the conditions of the facilities. Following the
field visit, there was a discussion on the observed practices, potential routes for disease transmission
and methods to intercept transmission.
When visiting the community pig pens, participants observed several good practices along with
situations that could lead to disease transmission (Fig. 10). It was understood that the community pigs
were not allowed to roam freely, which is recommended as a good pig rearing technique. However,
some pig pens were located at the top of a hill, with a river flowing beneath a ledge. Theoretically, if
the pigs were infected with parasites, larvae in the faeces could drop into the water and contaminate the
river. As a result, the fish or snails within the water could harbour the disease until an intermediate host
consumed them or was exposed to the contaminated water. Moving the pig pen and properly disposing
of their faeces could help to intercept disease transmission.
22
Figure 10. Pictures taken during the field visit to a local community in Luang Prabang, Lao
People’s Democratic Republic
After touring the slaughterhouse, participants observed how the usage of the facilities was inadequate
(Fig. 11). The hooks to hang the slaughtered pork were not in use, suggesting that the butchers were not
trained in modern slaughter techniques. Instead, slaughtering was done on the ground, which could
expose helminths if different cuts of meats were cross-contaminated. The abattoir owner mentioned that
district veterinarians came daily to stamp the meat for approval, but they performed only visual
inspections of the slaughtered pigs. Portions of the pigs were not cut to be further inspected for
miniscule parasites. To reduce potential transmission routes, butchers should be taught how to slaughter
the pig without risking cross-contamination. They should also be trained on how to recognize common
parasites or diseases endemic to that region and to properly dispose of the infected meat to reduce
contamination. This training will enable the butchers to intervene at critical points to stop disease
transmission.
Fig. 11. Pictures taken during the field visit to a local abattoir in Luang Prabang, Lao People’s
Democratic Republic
23
A walk around the local food market showed various risks of cross-contamination (Fig. 12). Some stalls
had raw meat next to their fresh vegetables while other stalls had flies surrounding the meat products.
However, some sealed their meat products in bags in the interest of sanitation and hygiene.
Fig. 12. Pictures taken during the field visit to a local food market in Luang Prabang, Lao
People’s Democratic Republic
During the discussion, national representatives explained their country’s best slaughterhouse practices.
In the Philippines, there are routine slaughterhouse inspections to ensure the quality of meat and level
of sanitation. An established and regulated ranking system helps distinguish the quality of meat and
identify meats that meet international standards. Differentiating the various meats also helps to educate
consumers on the quality of the product they are buying. Bhutan requires all meat handlers to have a
license, which is periodically verified by inspectors roaming the markets. The Lao People’s Democratic
Republic has legislation and regulation mechanisms for their markets, slaughterhouses and veterinarian
shops. Nepal implements and regulates hygienic practices in their slaughterhouses and markets. In
Indonesia, there are separate areas within food markets for meats and for fish. Additionally, Indonesia
implements slaughterhouse inspections and stamps inspected carcasses. In India, there are regulated
market vendor inspections. Results from the inspections are visually ranked with a display of smiley
faces. Vendors receive any of one to five smiley faces, which advertise the quality and sanitation of a
food stall.
As a group, participants agreed on best practices to avoid disease transmission. In community pig pens
and slaughterhouses, there should be proper disposal and disinfection of solid and liquid waste.
Slaughterhouses should be equipped with tools that promote the sanitary slaughter of pigs. Furthermore,
slaughterhouse employees should be trained on how to identify and properly handle/dispose of endemic
parasites. In the local market, there should be separation of produce, meat and fish. Ideally, if these
practices are implemented, foodborne parasitic zoonoses infections may be reduced.
4.1 Mapping, monitoring and evaluation, and surveillance
4.1.1 Basic considerations for identification of risk areas and monitoring and evaluation of
interventions
In this session, updated methods on disease mapping and programme M&E were discussed for the
following infections/diseases: taeniasis, neurocysticercosis, porcine cysticercosis, E. granulosus and
foodborne trematodiases. It is important to note that different characteristics of diagnostic tests are
required for different purposes, such as to diagnose a disease at individual or population level or to
monitor impacts of a control intervention.
24
Diagnostics for T. solium
For the purposes of mapping endemic or risk areas for T. solium taeniasis, communities can be screened
with low sensitivity and specificity tests, such as microscopy. However, it is important to note that the
prevalence of taeniasis at community level is typically very low (1–2%), and therefore a large sample
size may be necessary. Additionally, to map the disease within the community, there must be laboratory
confirmation of the positive cases to differentiate the Taenia species. On the other hand, M&E of the
impacts of the control programme calls for highly specific tests such as copro-DNA methods, though
independent validation of existing methods is required in advance. When using copro-analysis,
vigilance is recommended due to the possible exposure to infectious materials during the process of
sample collection and laboratory analysis. A summary of the various tests to identify taeniasis infection
can be found in Annex 3.
Tools for detecting neurocysticercosis include an antibody and antigen test and diagnostic imaging. It
is important to recognize that antibody tests do not differentiate between patients with viable and non-
viable cysts and can lead to the detection of transient positives in endemic areas. As a result, clinical
imaging to detect viable cysts before treating patients is critical. Since neurocysticercosis often has a
long incubation period and slow disease progression, patients might not be recent cases. Therefore, the
presence of neurocysticercosis cases might give some useful indication, but ongoing transmission
should be confirmed with further information. Moreover, neurocysticercosis cases are not
recommended as an indicator for M&E of a control programme, given the long disease timeline.
Porcine cysticercosis has a higher expected prevalence than taeniasis, and the detection of porcine
cysticercosis accordingly requires lower sample sizes and less specific diagnostic tools. Antibody and
antigen tests present sensitivity and specificity problems. Current commercial antigen tests are known
to cross-react with other Taenia species such as T. hydatigena and T. asiatica, and many positive pigs
are found to be cyst-free during necropsy. Transient positives are also often observed with both tests.
Visual tongue inspections and slaughter checks can be very specific but are only useful if pigs have a
large number of cysts. Porcine necropsy and carcass dissections are time-consuming, but this method
is the best for detecting the cysts. The disease can be mapped through porcine tongue inspection and
serology tests. However, to initiate a programme, the serology test must be confirmed with necropsies
of the pig. Monitoring and evaluation of control programmes must include necropsies to confirm
positive cases.
Diagnostics for E. granulosus
There are several methods for detecting echinococcosis in dogs, including the examination of the dog
post-mortem, purging dogs with arecoline hydrobromide, direct microscopy, copro-enzyme-linked
immunosorbent assay (ELISA) and copro-polymerase chain reaction (PCR). Though examining dogs
post-mortem is the gold standard, it is not ideal for the dog owners. Purging dogs presents highly
specific test results, but it is not easily done and can be dangerous, with infection risks if people are not
properly trained to collect the infectious samples. Microscopy detection of eggs in faeces is not specific
and cannot differentiate between eggs of different taeniid cestodes. Copro-antigen is detectable three
weeks after infection, and some level of cross-reactivity with other Taenia species is reported. There
are currently no commercial kits for copro-antigen and copro-PCR, and proper validation of both copro-
antigen and copro-PCR protocols is required. For mapping endemic areas, microscopy or copro-antigen
tests can be used, followed by copro-PCR confirmation. Monitoring and evaluation of control
programmes will require properly validated copro-antigen detection and copro-PCR.
Detecting echinococcosis, or hydatid cysts, in humans requires the use of imaging techniques – that is,
X-ray for lungs and ultrasound for liver. In particular, ultrasound in children below 5 years of age can
indicate new infections and active transmission, making it useful for both mapping and M&E of the
control programmes. Serology can be used as an adjunct to imaging and is particularly valuable for
post-treatment follow-up and differentiating those with continuing viable infection (post-surgical
recurrences). Most patients are serologically positive using indirect haemagglutination tests, ELISA or
western blot, but accuracy improves when two tests are used together.
25
Methods for echinococcosis detection in livestock include use of an ultrasound to detect the cysts,
conducting necropsies along with liver and lung inspections, and carrying out meat inspections at
abattoirs. It is important to bear in mind the high likelihood of co-infections with species in the same
taeniid genus, and thus cross-reaction in serology. Additionally, necropsies may not be able to identify
cysts, as they often take a year to develop. Though meat inspection at abattoirs provides a valuable
opportunity for echinococcosis detection in livestock, it is also important to recognize that animals are
typically home-slaughtered in endemic areas. A summary of the various diagnosis tests for
E. granulosus can be found in Annex 3.
Diagnostics of FBT infections
There are different types of FBTs of public health importance in Asia: Clonorchis sinensis, Opisthorchis
viverrini, Fasciola hepatica, Paragonimus spp., Metagonimus and other intestinal trematodes. Existing
detection methods are more or less similar. To map endemic areas of clonorchiasis and opisthorchiasis,
stool microscopy to detect eggs is the standard procedure. However, in areas with light infections the
tests have a low sensitivity. The eggs of the two species have similar structures and can thus be difficult
to differentiate morphologically. As a result, ELISA and ultrasonography are used to supplement case
detection. For M&E of control programmes, duplicate Kato–Katz smears or ELISA are commonly used.
Reported ELISA negative conversion is over one year after cure.
Diagnosis of infections with Paragonimus spp. is effected through the recovery of parasites, stool
microscopy, sputum microscopy, image diagnosis and serology. Paragonimus mapping can use
serological testing of antibodies. This method has high sensitivity and specificity. Environmental and
sociocultural parameters such as consumption of freshwater crabs can be used for screening. ELISA is
commonly used when conducting M&E of a control programme. However, this method may cross-react
with other trematodes. Stool and sputum microscopy often have low sensitivity. Furthermore, for image
diagnosis, paragonimus infections often look similar to tuberculosis.
Fascioliasis infections can be detected through endoscopy or biopsy, recovering the parasite or
fragments of the parasite, stool microscopy and serological testing of antibodies. ELISA testing for
antibodies is sensitive, but it often cross-reacts with species of clonorchiasis, opisthorchiasis and
Paragonimus westermani. There is also currently no commercial serology kit. Tools often used for
mapping and M&E of the disease and its control programmes include stool microscopy and ELISA for
the detection of antibodies. A summary of the various tests for foodborne trematodes can be found in
Annex 3.
4.1.2 Effective information sharing across sectors
Application of food safety surveillance for identification of risk areas
Since 2000, China has established various surveillance systems to trace foodborne parasitic diseases
along with other food safety measures and standards. In 2000, a monitoring programme was initiated
to detect food contaminants and foodborne diseases. In 2009, China issued the Food Safety Law, and a
large-scaled, food safety surveillance programme began in 2010 with the introduction of monitoring for
parasites. The China National Center for Food Safety Risk Assessment was established in 2011,
covering 94% of the country.
In 2015, there was an emphasis on detecting parasites in food during the surveillance. When a case of
paragonimus was detected, researchers tracked the patient and questioned them about their diet. The
researchers traced the source of the fish that the patient consumed, and another surveillance system was
used for the relevant area to determine whether or not there were more infected fish.
In another case, Paragonimus metacercaria was detected from freshwater crabs purchased online.
Researchers then purchased 40 more crabs of which none were infected with Paragonimus
metacercaria. Another infection occurred after an online purchase of Achatina fulica, and
Angiostrongylus was detected in five out of eight samples. It is believed that online shopping can be a
new mode of transmission given the lack of control and regulations over purchases and exchanges.
In a conversation on risk management and risk communication, China representatives identified several
key interventions to be implemented in future control programmes. These included stopping restaurants
26
from supplying fish commonly known to have high parasitic infection rates and informing the public of
these vulnerable species of fish and how to properly prepare them to reduce the risk of infection.
Another proposed risk reduction method is to have pork undergo a quarantine inspection prior to
entering the market to reduce the risk of porcine cysticercosis and other pork-based parasitic zoonoses.
Lastly, environmental planners can work with the community to stop the practice of using untreated
faeces to fertilize ponds as well as to move toilet facilities away from these ponds. This will help reduce
the transmission of parasitic eggs between humans and fish.
An analysis of China’s current practices identified potential vehicles for improvement. These
improvements include:
1. further emphasizing the surveillance of parasites in food safety surveillance systems;
2. encouraging the national government to pay more attention to foodborne parasitic diseases by
strengthening the personnel training at the Chinese Center for Disease Control and
Prevention;
3. increasing continuous, large-scale food safety surveillance for parasites;
4. conducting a risk evaluation by identifying the infection rate, extent of infection and primary
parasitic species of the reported cases; and
5. implementing effective risk management and risk communication components in control
programme initiatives.
With these practices, China looks forward to reducing the incidence of foodborne parasitic infections
and improving its food safety records.
Public health data reporting on disease burden and M&E
WHO currently has an annual NTD data reporting mechanism in place for NTDs that require preventive
chemotherapy intervention. Most country NTD focal points are aware and familiar with using this
system. The purpose of any surveillance system is to use the data to ensure that the control programmes
are running effectively. Furthermore, the surveillance system helps with early case detection, which
will lead to prompt treatment. A surveillance system also helps to monitor trends and can assist with
forecasting the need for procurement of different resources and drugs. The system stores all collected
information in a databank that countries can later use to make evidence-based decisions. The databank
can also help countries going through a disease elimination or eradication phase to monitor and evaluate
the progress of their status.
There are three forms that are used in this reporting mechanism and these forms are submitted annually
by the relevant ministry focal points through the WHO country offices to the regional offices and
headquarters. The forms include:
1) Preventive Chemotherapy Joint Reporting Form,
2) Joint Request for Selected Preventive Chemotherapy Medicines, and
3) Preventive Chemotherapy Epidemiological Data Reporting Form.
The forms all share a similar Excel format to make them easy for country representatives to fill out. The
national programme manager will submit these forms with their request for preventive chemotherapy
to their respective WHO regional office. The regional offices will validate the information and submit
the request to headquarters. They will then begin the process of procuring the medications to be
delivered to the respective countries.
This system has been in place for many years and has become an effective tool to monitor NTD
programmes annually. An analysis determined that there is potential for the system to be expanded to
encompass neglected foodborne parasitic diseases. There are current discussions underway with WHO
headquarters to scale up the current reporting mechanism for more diseases.
Animal health data reporting
One of the main missions of the OIE is to ensure that the worldwide animal disease situation, including
zoonosis, is transparent. All Member Countries have a legal obligation to report to the OIE. The World
Animal Health Information System (WAHIS) was established to allow users from Member Countries
27
to electronically submit the notification reports on animal diseases for each listed disease, including
infection with E. granulosus /E. multilocularis and infection with T. solium (porcine cysticercosis), as
specified in Articles 1.1.3. and 1.1.3 of the OIE Terrestrial & Aquatic Animal Health Codes (2016).
The reported data can be accessed online through the WAHIS portal for animal health data. According
to the 2017 data, five countries reported the presence of E. granulosus and one reported its suspected
presence. One country reported the presence of E. multilocularis and another its suspected presence.
Two countries in Asia and the Pacific reported the presence of porcine cysticercosis. The system is
linked with the country-level animal health information system in each Member Country. However,
few countries routinely report data on parasitic zoonoses, and, in particular, limited information is
available on species and numbers of animals affected. The OIE is encouraging national focal points to
use WAHIS, particularly quantitative data, and is also exploring synergies through partnership and
coordination across multiple similar platforms at the local level to obtain more data from Member
Countries.
5.1 The way forward – multisectoral action priorities for accelerating prevention and control
of foodborne parasitic zoonoses
In this breakout session, country representatives held group discussions to determine country-specific
action priorities to realize multisectoral collaboration for control of foodborne parasitic zoonoses, and
support needs from the Tripartite and partners. The outcome of the breakout session is summarized in
Annex 4.
3. CONCLUSIONS AND RECOMMENDATIONS
3.1 Conclusions
1) The meeting provided valuable opportunities to bring different sectors involved in the prevention
and control of neglected foodborne parasitic zoonoses together – public health, animal health,
food safety and WASH.
2) The meeting participants shared insights, experience and updates on new guidance and
development to accelerate prevention and control of neglected foodborne parasitic zoonoses.
3) The meeting included a field trip to a local pig slaughterhouse, a fish and meat market, and a
community where pigs were raised at the household level. These examples illustrated the reality
of animal production, food safety and hygiene practices in rural communities in Asia.
4) Further, the first sets of food safety risk communication and country-specific action plans to
accelerate prevention and control of neglected foodborne parasitic zoonoses were developed.
3.2 Recommendations
3.2.1 Recommendations for Member States
Member States are encouraged to consider the following priorities:
1) Strengthen political commitment through high-level advocacy to accelerate prevention and
control of neglected foodborne parasitic zoonoses.
2) Make progress on cross-sectoral collaboration to develop a multisectoral road map to
accelerate prevention and control of neglected foodborne parasitic zoonoses.
3) Identify practical, feasible and cost-effective interventions and M&E approaches for assessing
impacts of interventions in the local context and exploring opportunities for aligning
implementation with ongoing programmes or activities.
4) Strengthen surveillance and diagnostic capacity required at all levels, both in the human and
animal health sectors, for early case detection and identification of active transmission foci.
28
5) As part of broader food safety risk communication strategies, enhance health and food safety
risk communication for prevention and control of neglected foodborne parasitic zoonoses
targeting farmers and consumers at the community level.
6) Establish mechanisms for data sharing across sectors to facilitate intersectoral collaboration
and joint actions for control of neglected foodborne parasitic zoonoses.
3.2.2 Recommendations for the FAO-OIE-WHO Tripartite
The FAO-OIE-WHO Tripartite is requested to consider the following:
1) Continue to coordinate among the Tripartite to support Member States in facilitating
multisectoral collaboration involving public health, animal health, food safety and WASH
sectors to accelerate prevention and control of neglected foodborne parasitic zoonoses.
2) Provide technical support and guidance and facilitate cross-sectoral collaboration among
public health, animal health, food safety and WASH sectors at national and regional level by
identifying and engaging relevant partners to accelerate prevention and control of neglected
foodborne parasitic zoonoses.
3) Facilitate regular communication and sharing of data pertaining to foodborne parasitic
zoonoses among public health, animal health, food safety and WASH sectors.
4) Develop a network for the control of neglected foodborne parasitic zoonoses to facilitate
sharing of experience across countries.
5) Facilitate public–private partnerships to accelerate prevention and control of neglected
foodborne parasitic zoonoses.
3.2.3 Recommendations for WHO
WHO is requested to consider the following:
1) Carry out operational and social research to guide countries in accelerating prevention and
control of neglected foodborne parasitic zoonoses, particularly in the area of diagnosis and
interventions.
2) Mobilize resources to accelerate prevention and control of neglected foodborne parasitic
zoonoses.
29
ANNEXES
Annex 1. Agenda
Day 1: Tuesday, 16 October 2018
08:00 – 08:30 Registration
Opening Session
08:30 – 09:00 Welcome address - Momoe Takeuchi, Acting WHO
Representative in Lao PDR
Background and objectives of the meeting - Aya Yajima (WPRO)
Self-introduction of participants and observers
Nomination of the co-chairs and rapporteur
Administrative announcements - Raquel Amparo (WPRO)
Session 1: Global, regional and country updates on prevention and control of neglected foodborne parasitic zoonoses
through the food value chain
09:00 – 09:20 Global and regional burden of diseases and socioeconomic
impacts
- Bernadette Abela-Ridder (WHO HQ),
Gongal Gyanenda (SEARO) and Aya Yajima
09:20 – 10:10 Guidance on interventions through the food value chain:
• Production
• Food safety
• Public health
- Katinka De Balogh (FAO RAP) and Maho
Urabe (OIE RRAP)
- Masami Takeuchi (FAO RAP) and Peter
Hoejskov (WPRO)
- Bernadette Abela-Ridder
10:10 – 10:30 Discussion All
10:30 – 11:00 Group photograph followed by coffee/tea break
11:00 – 12:30 Country status updates – disease burden, existing One Health
platforms/frameworks/policies and control activities (5-8 min per
country)
• Bhutan
• Cambodia
• China
• Lao People's Democratic Republic
• India
• Indonesia
• Malaysia
Country participants
Discussion All
12:30 – 13:30 Lunch break
13:30 – 15:00 Country status updates (continued)
• Myanmar
• Mongolia
• Nepal
• Philippines
• Thailand
• Viet Nam
Country participants
Discussion All
15:00 – 15:30 Coffee/tea break
Session 2: One Health interventions
30
15:30 – 16:10 Basic considerations for control of neglected foodborne parasitic
zoonoses through One Health approach
- Meritxell Donadeu (University of
Melbourne, Australia), Sung Tae Hong
(SNU, Korea) and David Jenkins (Charles
Sturt University)
Discussion All
16:10 – 17:00 Sharing experience on One Health approach – actions, challenges
and lessons learnt
• Sichuan province, China
• Lao PDR (pilot operational research)
• GALVMED experience on technology transfer and
vaccination trial in pig population in India and Nepal
- Li Tianying (Sichuan CDC, China)
- Anna Okello (ACIAR, Australia)
- Angie Colston (GALVMED, Kenya)
17:00 – 17:30 Discussion on key lessons learnt for implementation of One
Health
All
18:30 – 20:00 Cocktail reception
Day 2: Wednesday, 17 October 2018
09:00 – 09:30 WASH intervention options for control of foodborne parasitic
zoonoses in resource-poor settings
- Alex Hildebrand (SEARO) and Kim Rok Ho
(WPRO)
Discussion
Session 3: Health risk communication and community engagement
09:30 – 10:00 Sharing country experiences on multi-disciplinary approach
• Community-led WASH-NTD initiative for elimination of
schistosomiasis in Lao PDR and Cambodia
• LAWA model for control of foodborne trematodiases in
Thailand
- Cambodia and Lao PDR
- Banchob Sripa (Khon Kaen University,
Thailand)
Discussion
10:00 – 10:30 Coffee/tea break
10:30 – 12:30 Food safety risk communication training William Hallman (The State University of
New Jersey, USA), Masami Takeuchi, and
Peter Hoejskov
12:30 – 13:30 Lunch break
13:30 – 14:30 Food safety risk communication training (continued)
14:30 – 17:30 Field trip (abattoir, fish markets, pig pens, community
environment)
All
Day 3: Thursday, 18 October 2018
08:30 – 09:00 Observations and findings from the field trip - Panpilad Saikaew (FAO RAP) and May-
Linh Huynh (WPRO)
Session 4: Mapping, M&E and surveillance
09:00 – 10:00 Basic considerations for identification of risk areas and
monitoring and evaluation of interventions
- Meritxell Donadeu (University of
Melbourne, Australia), Sung Tae Hong (SNU,
Korea) and DDavid Jenkins (Charles Sturt
University)
Discussion
10:00 – 10:30 Coffee/tea break
10:30 – 11:30 Effective information sharing across sectors
31
• Application of food safety surveillance for identification of
risk areas
• Public health data reporting on disease burden and M&E
• Animal health data reporting
- Zhu Huihui (NIPD/China CDC)
- Aya Yajima
- Ashish Sutar (OIE)
Discussion - action priorities to improve surveillance and
information sharing of foodborne parasitic zoonoses
All
11:30 – 12:30 World café on post-2020 targets, minimum indicators to measure
progress and remaining evidence gap
All
12:30 – 13:30 Lunch break
Session 5: The way forward – multispectral action priorities for accelerating prevention and control of foodborne parasitic
zoonoses
13:30 – 14:30 Breakout sessions – Country-specific action priorities to realize
multi-sectoral collaboration for control of foodborne parasitic
zoonoses and support needs from tripartite and partners
All
14:30 – 15:30 Plenary presentations from breakout sessions Country participants
15:30 – 16:00 Coffee/tea break
16:00 – 16:30 Remarks from partners – opportunities for collaboration and
resource mobilization
Partners
16:30 – 17:00 Conclusions and recommendations Aya Yajima
Closing Momoe Takeuchi
32
Annex 2. List of participants
Monu Gurung, Senior Regulatory And Quarantine Inspector, Bhutan Agriculture and Food
Regulatory Authority (BAFRA), Zhemgang, Bhutan, Tel. No.: +0097517698887,
Email: [email protected]
Rinzin Kinga Jamtsho, Program Office, CDD, DoPH, Zoonotic Disease & Avian Influenza Program,
Communicable Disease Division, Department of Public Health, Ministry of Health,
Royal Government of Bhutan, P.O. Box: 726, Kawajangsa, Thimphu, Bhutan,
Tel. No.: +975-2-328091/92/93 Ext: 244, Email: [email protected]
Pema Wangchuk, Senior Veterinary Officer, Animal Health Unit, Regional Livestock Development
Center, Zhemgang, Bhutan, Tel. No.: +0097577659419,
Email: [email protected]
Phala Chea, Microbioloigst, Microbiological Laboratory/ CAMCONTROL Department/ Ministry of
Commerce, Phnom Penh, Cambodia, Tel. No.: +85517328345, Email: [email protected]
Virak Khieu, Manager, National Helminth Control Programme, National Center for Parasitology,
Entomology and Malaria Control, #477, Corner Street 92, Trapeang Svay Village, Phnom Penh,
Cambodia, Tel. No.: +855 12 677244, Email: [email protected]
Heng Morany, Deputy Director, Department of Animal and Veterinary Public Health,
#317, Sangkat Steung Mean Chey, Khan Mean Chey, Phnom Penh, Cambodia,
Tel. No.: +855 12253365, Email: [email protected]
Lon Sayteng, Deputy Director, Department of Rural Health Care, Ministry of Rural Development,
Corner Street 169 and Russian Building, Phnom Penh, Cambodia, Email: [email protected]
Liu Jihong, Professor, Center for Agro-Food Quality & Safety, Ministry of Agriculture and Rural
Affairs, P.R. China, Beijing, China, Tel. No.: +008613621140305, Email: [email protected]
Junwei Wang, Director, Department of Safety Supervision of Animal Products, China Animal Health
and Epidemiology Center, 369, Nanjing Road, Qingdao, Shandong, China,
Tel. No.: +86 53285633936, Email: [email protected]
Sujata Singh, Assistant Director (Technical), Food Safety and Standards Authority of India,
New Delhi, India, Tel. No.: +91 9540855967, Email: [email protected]
Ahmad Muhamad Mutaqin, Head Section of Standard Formulation - Directorate of Fish Processing
and Quality Development, Ministry of Marina Affairs and Fisheries Republic of Indonesia, Jakarta,
Indonesia, Tel.No.: +6281514139694, Email: [email protected]
Puguh Wahyudi, Medic Veteriner Officer, Directorate General of Liverstock Services and Animal
Health, Ministry of Agriculture, Harsono TRM Street No. 3, Ragunan, South Jakarta, Indonesia,
Tel. No.: +628562979713, Email: [email protected]
Helen Ullyartha, Directorate Preventive & Controlling Vector Borne and Zoonotic Disease,
Ministry of Health Republic of Indonesia, Jakarta, Indonesia, Tel. No.: +6281213991507
Soutsakhone Chanthaphone, Director, National Center for Environmental Health and Water Supply,
Ministry of Health, Vientiane, Lao People's Republic Democratic, Tel. No.: +856 21 352237
Email: [email protected]
33
Souk Phomhaksa, Head of the parasitologyNational Animal Health Laboratory, Department of
Livestock and Fisheries, Ministry of Agriculture and Forestry, Vientiane, Lao People's Republic
Democratic, Tel. No.: +856 21216380, Email: [email protected]
Bounnaloth Insisiengmay, Chief, Parasite and NTD Control Division, Department of Communicable
Diseases Control, Ministry of Health, Vientiane, Lao People's Republic Democratic,
Tel. No.: +856 21 264324, Email: [email protected]
Khamphok Phitacthep, Deputy Head of Parasitology Unit, Department of Livestock and Fisheries,
National Animal Health Laboratory, Vientiane, Lao People's Republic Democratic,
Tel. No.: +856 20 54748515, Email: [email protected]
Siti Munirah Binti Jusoh Kamal, Principal Assistant Director, Food Safety and Quality Division,
Ministry of Health Malaysia, Putrajaya, Malaysia, Tel. No.: +6019-9847185
Email: [email protected]
Siti Hafizah Mohd Salleh, Veterinary Officer, Department of Veterinary Services, Wisma Tani,
Podium Blck Level 2, Lot 4G1, Precint 4, 62630 Putrajaya, Malaysia, Tel. No.: +60173225730,
Email: [email protected]
Mohd Hanif Zailani, Medicine Specialist, Disease Control Division, Ministry of Health, Level 3,
Block E10, Parcel E, Federal Government Administration Centre, 62590 Putrajaya, Malaysia,
Tel. No.: +603 88834503, Email: [email protected]
Sarandagina Narantungalog, Officer-in-Charge, Department of Coordination for Food Production
Policy Implementation, Ministry of Food, Agriculture and Light Industry, Ullanbaatar,
Mongolia, Tel. No.: +976 51 261962, Email: [email protected]
Ganzorig Sainkhuu, Specialist, Chronic Disease, Parasite and Zoonosis of GAVS, Government Bldg
9A, Enkhtaivan Avenue 16A, Bayangzurkh District, Ulaanbaatar, Mongolia
Tel. No.: +976 51261601, Email: [email protected]
Otgontsetseg Tseden, Epidemiologist, National Center for Zoonotic Diseases, Ministry of Health,
Songinokhairhan, Ulaanbaatar, Mongolia, Tel. No.: +976 931 21499, Email: [email protected]
Myint Myint Khin, Assistant Director, Mandalay Veterinary Diagnostic Laboratory, Mandalay,
Myanmar, Tel. No.: +959797340465, Email: [email protected]
Thet Wai New, Assistant Director (CEU), Department of Public Health, Naypyitaw, Myanmar, Email:
Samir Kumar Adhikari, Public Health Administrators, Chief Zoonotic and other Communicable
Disease, Epidemiology and Disease Control Division, Department of Health Services, Ministry of
Health and Population, Ramshan Path, Kathmandu, Nepal, Tel. No.: +977 9851054699
Email: [email protected]
Salina Manandhar, Senior Veterinary Officer, Department of Livestock Services, Harihar Bhawan,
Pulchowk, Lalitpur, Nepal, Tel. No.: +97715522056, Email: [email protected]
Hasta Bahadur Rai, Senior Food Research Officer, Department of Food Technology and Quality
Control, Nepal, Nepal, Tel. No.: +977 9857015157, Email: [email protected]
34
Riva Marie Gonzales, Veterinarian III, Animal Disease Diagnosis and Reference Laboratory,
Veterinary Laboratory Division, Bureau of Animal Industry, Visayas Avenue, Diliman,
Quezon City, Philippines, Tel. No.: +632 9212177, Email: [email protected]
Theodora Cecile Magturo, Program Manager, Disease Prevention and Control Bureau, Department of
Health, San Lazaro Compound, Tayuman, Sta Cruz, Manila, Philippines,
Tel. No.: +63 9209243561, Email: [email protected]
Meriam Ultra Nival, Laboratory Analyst/ Meat Inspector III, National Meat Inspection Service
(NMIS), Quezon City, Philippines, Tel. No.: +63 9176305929,
Email: [email protected]
Jinhyeong Noh, Veterinary Researcher, Bacterial Disease Division, Animal and Plant Quarantine
Agency, Ministry of Agriculture, Food and Rural Affairs, 177 Hyeoksin8-ro, Gimcheon-si,
Gyeongsangbuk-do, 39660, Republic of Korea, Tel. No.: 82-54-912-0745, Email: [email protected]
Bunikar Chullabodhi, Veterinary Officer, Senior Professional Level, Department of Livestock
Development 69/1 Phyatai Road, Ratchatewee, Bangkok 10400, Thailand,
Tel. No.: +6626534444 ext 1005, Email: [email protected]
Montakan Jiratanh, Government Officer, Veterinarian, Parasitology Section, National Institute of
Animal Health, Department of Livestock Development, Bangkok, Thailand,
Tel. No.: +662-5165-7537, Email: [email protected]
Sirivalai Maneesridet, Public Health Technical Officer, Senior Professional Level, Bureau of General
Communicable Diseases, Department of Disease Control, Ministry of Public Health,
Bangkok, Thailand, Tel. No.: +662-590-3187, Email: [email protected]
Chanatda Tungwongjulaniam, Public Health Technical Officer, Senior Professional Level,
Bureau of General Communicable Diseases, Department of Disease Control, Ministry of Public
Health, Bangkok, Thailand, Tel. No.: +662-590-3187, Email: [email protected]
Toan Bui Khanh, Head, Division of Legislation and Inspection, Health Environment Management
Agency, Ministry of Health, 8 Ton That Thuyet, Nam Tu Liem, Hanoi, Viet Nam,
Tel. No.: +84 24 32272854, Email: [email protected]
Hien Pham Thi Thu, Specialist, Veterinary Public Health, Department of Animal Health,
15/78 Giai Phong, Phuong Mai, Dong Da, Hanoi, Viet Nam, Tel.No.: +84 38685954
Email: [email protected]
Hung Lam Quoc, Chief of Division of Food Poisoning Surveillance and IEC, Vietnam Food
Administration, Ministry of Health, Hanoi, Viet Nam, Tel.No.: +84 91319936,
Email: [email protected]
Trung Do Dung, Director, Parasitology Department, National Institute of Malariology, Parasitology
and Entomology, 245 Luong The Vinh Street, Tu Liem District, Hanoi, Viet Nam,
Tel. No.: +84 912116965, Email: [email protected]
Anna Okello, Associate Research Program Manager, Australian Centre for International Agriculture
Research (ACIAR), 38 Thynne Street, Fern Hill Park, Bruce ACT 2617, Canberra ACT, Australia,
Email: [email protected]
David James Jenkins, Senior Research Fellow, School of Animal and Veterinary Sciences, Charles
Sturt University, PO Box 588, Wagga Wagga, New South Wales, Australia,
Tel. No.: +61 0269334179, Email: [email protected]
35
Gagan Deep Singh, Professor & Head, Department of Neurology, Dayand Medical College,
Ludhiana, India, Tel. No.: +91 9815500720, Email: [email protected]
Li Tiaoying, Senior Research Fellow, Sichuan Provincial Center for Disease Control and Prevention,
6 Zhong Xue Lu, Chengdu, Sichuan, China, Email: [email protected]
Mingyuan Liu, Dean, Collaboration Centre for Food-Borne Parasites from the Asian Pacific Region,
College of Veterinary Medicine, Jilin University, Jilin, China, Tel. No.: + 008643187836151,
Email: [email protected]
Banchob Sripa, Professor, Department of Pathology, Faculty of Medicine, Khon Kaen University,
Khon Kaen, Thailand, Email: [email protected]
Shiba Kumar Rai, Research Director, Institutional Review Committee, Nepal Medical College and
Teaching Hospital, Gokarnesowr, Kathmandu, Nepal, Tel. No.: +977 1 4374690, 9851040480,
Email: [email protected]
Sung-Tae Hong, Professor, Department of Parasitology and Tropical Medicine,
103 Daehak-ro, Jongno-gu, Seoul, Korea, Tel. No.: +82 2 7408343, Email: [email protected]
William Hallman, Professor, Department of Human Ecology, School of Environmental and Biological
Sciences, Rutgers, The State University of New Jersey, Cook Office Building, 55 Dudley Road, New
Brunswick, New Jersey, USA, Tel. No.: +848 932 9227,
Email: [email protected]
Meritxell Donadeu, Visiting Research Fellow, Faculty of Veterinary and Agricultural Sciences,
Veterinary Clinical Centre, Werribee, Victoria, Australia, Mob. No.: +61 498 115073
Email: [email protected]
Amanda Ash, Research Parasitologist, School of Veterinary and Life Sciences, Murdoch University,
Murdoch WA 6150, Australia, Tel. No.: +61 9 9360 2729, Email: [email protected]
Viengxay Vanisaveth, Deputy Director, Khoualuang tai village, Chanthabouly district,
Vientiane, Lao People's Democratic Republic, Tel. No.: 856 20 22220316
Email: [email protected]
Angela Colston, Consultant, P. O. Box 52773 – 00100, Valley Arcade, Nairobi, Kenya,
Tel. No.: +254 705 687999 or +44 759 441 8083, Email: [email protected]
Phonepadith Khattignavong, Junior Scientist, Samsenthai Road, Kao-Gnot village, Sisattanak district,
Vientiane, Lao People's Democratic Republic, Tel. No.: +856 21 285321,
Email: [email protected]
Fred Unger, Veterinary Epidemiologist and CIM Expert , 298 Kim Ma Street, Ba Dinh District Hanoi,
Viet Nam, Tel. No.: +84 0 1292951750, Email: +84 4 32373996
Sengphet Keomany, Division head, Phontongsavat, unit14, Chanthabouly, Vientiane Capital, Lao
People's Democatic Republic, Tel. No.: 856 20 59473995, Email: [email protected]
Zhu Huihui, Researcher, Department of Food- and Soil-borne Parasitic Diseases, Chinese Center for
Disease Control and Prevention, 207 Rui Jin Er Road, Shanghai 200025, China,
Tel. No.: +86-21-64739075, Email: [email protected]
36
Bernadette Abela-Ridder, Team Leader, Neglected Zoonotic Diseases, Department of Control of
Neglected Tropical Diseases, Avenue Appia 20, 1211 Geneva 27, Switzerland
Tel.No.: +41 22 791 2072, Email: [email protected]
Gyanendra Gongal, Technical Officer, Country Health Emergency Preparedness & IHR
Regional Office for South-East Asia (SEARO), World Health House, Indraprastha Estate Mahatma
Gandhi Road, New Delhi, India, Tel.No.: +911123370804, Email: [email protected]
Aya Yajima, Technical Officer, Neglected Tropical Diseases (NTDs), Malaria, other Vectorborne and
Parasitic Diseases Unit, Division of Communicable Diseases, P.O. Box 2932, 1000 Manila,
Philippines, Tel.No.: +632 528 9754, Email: [email protected]
Peter Sousa Hoejskov, Technical Officer, Food Safety (FOS), Division of Health Security and
Emergencies, P.O. Box 2932, 1000 Manila, Philippines, Tel.No.: +63 2 5289914
Email: [email protected]
Vibol Chan, Climate Change and Health Coordinator, No. 151-153 Avenue Kampuchea Krom,
Phnom Penh, Cambodia, Tel.No.: +855768879999, Email: [email protected]
Momoe Takeuchi, Acting WHO Representative, P.O. Box 343, Vientiane, Lao People's Democratic
Republic, Tel.No.: +856 21 353902, Email: [email protected]
Thipphavanh Chanthapaseuth, National Professional Officer, Malaria, Other Vectorborne and
Parasitic Diseases, P.O. Box 343, Vientiane, Lao People's Democratic Republic
Tel.No.: +856 21 353902, Email: [email protected]
Souvanaly Thammavong, Technical Officer, Environmental Health, P.O. Box 343
Vientiane Capital, Lao People's Democratic Republic, Email: [email protected]
Dai Tran Cong, National Professional Officer, Malaria, Other Vectorborne and Parasitic Diseases
P.O. Box 52, Hanoi, Viet Nam, Tel.No.: +84 4 39433734, Email: [email protected]
Nghia Ton Tuan, National Professional Officer, Water, Sanitation and Environmental Health
P.O. Box 52, Hanoi, Viet Nam, Tel.No.: +84 4 39433734, Email: [email protected]
May-Linh Huynh, Intern, Malaria, Other Vectorborne and Parasitic Diseases, Division of
Communicable Diseases, P.O. Box 2932, 1000 Manila, Philippines, Tel.No.: +63 9951060366
Email: [email protected]
Katinka DeBalogh, Senior Animal Production and Health Officer, FAO Regional Office for Asia and
the Pacific, 39 Phra Atit Road, Bangkok 10200 Thailand, Tel.No.: +662 6974326
Email: [email protected]
Yooni Oh, Regional One Health Advisor, FAO Regional Office for Asia and the Pacific
39 Phra Atit Road, Bangkok 10200 Thailand, Tel.No.: + 66 2 697 4220, Email: [email protected]
Masami Takeuchi, Food Safety Officer/FAO GM Foods Platform Manager, FAO Regional Office for
Asia and the Pacific, 39 Phra Atit Road, Bangkok 10200 Thailand, Tel. No.: +662 697 4166
Email: [email protected]
Panpilad Saikaew, Project Coordinator, FAO Regional Office for Asia and the Pacific
39 Phra Atit Road, Bangkok 10200 Thailand, Tel. No.: +662 697 4354
Email: [email protected]
37
Maho Urabe, Regional Veterinary Officer, Food Science Building 5F, University of Tokyo
1-1-1 Yayoi, Bunkyo-ku, Tokyo, Japan, Tel. No.: +81358051931, Email: [email protected]
Ashish Sutar, Project Officer, Ban Kounta, Sikhothabong, Vientiane, Lao People's Democratic
Republic, Tel. No.: +8562028027515, Email: [email protected]
38
Annex 3. Characteristics of diagnostic tests for neglected foodborne parasitic zoonoses
Taenia Solium
Tools Se/Sp Advantage Limitation Mapping M & E
Taeniasis by T. solium
Microscopy L/L Inexpensive Not specific Screen Screen
Copro-Ag H/L
Not specific. Not available. Screen Screen
Copro-
DNA
H/H High Se, high Sp Expensive. Not available. Yes Yes
Serology H/M Serum samples Detects exposure, not only active
infection
Screen No
Porcine cysticercosis
Ag H/L Commercial tests Low specificity Screen Screen
Antibodies H/L
Low specificity Screen No
Tongue
inspection
L/H Inexpensive Low sensitivity Yes No
Slaughter
inspection
L/H Routinely done in
some places
Many pigs are home slaughtered.
Low Sensitivity
Supportive
data
No
Necropsies H/H High Se and Sp Laborious (pre-selection can be
done by serology)
Yes Yes
Se: sensitivity; Sp: specificity; H: high; L: low; Ag: antigen;
Echinococcus granulosus
Tools Se/Sp Advantage Limitation Mapping M & E
Dogs
Post-
mortem
H/H High Sp Unpopular among dog owners Yes No
Arecoline M/H High Sp Some dogs do not purge Yes Yes
Microscopy L/L Inexpensive Low sensitivity Screen No
Copro-Ag H/M Practical Lack of availability. Needs
validation
Yes Yes
Copro-PCR H/H High Se/High Sp Needs validation Yes Yes
Humans
Imaging ?/H Well accepted,
non-invasive
In children indicates active
transmission
Yes Yes
Serology M/M Widely available Indicates exposure Screen No
Livestock
Necropsy H/H High Sp Slow cyst development No Yes
Abattoir M/H Routinely done Home slaughter not applicable Yes Yes
Se: sensitivity; Sp: specificity; H: high; L: low; Ag: antigen;
39
Clonorchis sinensis and Opisthorchis viverrini
Tools Se/Sp Advantage Limitation Mapping M & E
Kato-Katz H/H Cheap, mass
screen, EPGs
Species identification, well
trained expert needed
Screen
Yes
Screen
Yes
Formalin-ether
concentration
technique
H/H Sensitive for
light inf, easy
identification
Complicated procedure, limited
for mass screen
Yes Yes
Direct smear L/H Simple, cheap Less sensitivity for light
infection
Low Se Low Se
Copro PCR H/H Sensitive 95% DNA extraction and
complicated procedure, research
No No
Loop-mediated
isothermal
amplification
H/H Sensitive 97% DNA extraction and
complicated procedure, research
No No
Real time PCR H/H Diff diagnosis Complicated, expensive No No
ELISA IgG M/M Cheap, mass
screen, sensitive
88%
Low sensitivity in light
infection, cross reaction
Screen Screen
ELISA IgM L/L Not acceptable No No
ELISA Ag M/H Active infection Less sensitivity for light inf No No
Ag in urine
(Opisthorchis
viverrini)
M/M Sampling Research only Screen No
Se: sensitivity; Sp: specificity; H: high; L: low; IgG: immunoglobulin G; IgM: immunoglobulin M;
Ag: antigen
Paragonimus species
Tools Se/Sp Advantage Limitation Mapping M & E
Kato-Katz L/M Cheap, mass screen Limited sensitivity, many
false negatives
Screen
Yes
Screen
Yes
Formalin-
ether
concentration
technique
L/H Sp identification Limited sensitivity, limited
for mass screen
Yes Yes
ELISA IgG H/M Cheap, mass screen, Se
95%
No commercial kit, cross
reaction
No No
Se: sensitivity; Sp: specificity; H: high; L: low; IgG: immunoglobulin G
Fasciola species
Tools Se/Sp Advantage Limitation Mapping M & E
Kato-Katz L/L Cheap, mass screen Limited sensitivity, many
false negatives, diff diagnosis
Screen
Yes
Screen
Yes
Formalin-
ether
concentration
technique
L/M Sp identification Limited sensitivity, limited
for mass screen
Yes Yes
ELISA IgG H/M Cheap, mass screen No kit, unknown sensitivity
and specificity, cross reaction
No No
Se: sensitivity; Sp: specificity; H: high; L: low; IgG: immunoglobulin G
40
Annex 4. Country priorities and support needs for control of neglected foodborne parasitic zoonoses
Country Priority diseases Priority actions in 2018-2020 Priority actions in 2020-2025 Support need
Bhutan Cysticercosis
Echinococcosis
Fascioliasis
- Organization of baseline prevalence survey
in two districts for echinococcosis
- Enhancement of food safety risk
communication
- Planning and implementation of small scale
One Health interventions (for humans and
animals)
- Organization of nationwide prevalence study
for echinococcosis
- Establishment of One Health surveillance (for
humans and animals)
- Expansion of One Health interventions
- Development of national elimination strategy
- Capacity-building (diagnosis,
laboratory confirmation,
vaccinations of animals)
- Linkage with reference
laboratories and institutes for
echinococcosis
- Research and development
India Cestodes
Trematodiases
- Mapping of disease burden in the country
- Development of food safety risk
communication materials
- Development and dissemination of One
Health education material through different
media platform
- Selection of pilot areas for One Health
interventions
- Implementation of pilot One Health
interventions in targeted endemic areas
- Advocacy support to influence
policy and decision makers
- Resource materials
- Networking opportunity
- Capacity-building
- Research and development
Indonesia Taeniasis/cyticerc
osis
- Regular organization of inter-sectoral
meetings
- Strengthening case detection and treatment
in humans
- Strengthening of animal surveillance
- Dissemination of good farming practices
- Food safety system improvement
- Regular organization of inter-sectoral meetings
- Strengthening case detection and treatment in
humans
- Strengthening of animal surveillance
- WASH and health education campaign
- Anthelmintic treatment of pigs;
- Dissemination of good farming practices
- Food safety system improvement
- Capacity-building
- Donation of anthelmintic for
animals
41
Myanmar Taeniasis
Fascioliasis
Echinococcosis
- Situation analysis both in human and animal sector (-2019)
- Organization of mapping and baseline survey (-2020)
- Establishment of electronic based surveillance system adding to DHIS2/ HMIS platform and
IRIS platform (2018-2020)
- Selection of three pilot implementation units
- Implementation of the targeted One Health interventions (preventive chemotherapy, animal
vaccination and WASH) (-2021)
- Establishment of regular food safety inspection (-2021)
- Establishment of relevant laws and regulations (-2021)
- Development and launch of IEC materials for food safety risk awareness raising
- Expanding of One Health interventions to three more implementation units (-2022)
- Expanding of One Health interventions to four more implementation units and five-year review
(2018-2023)
- Expanding of One Health interventions to ten implementation units per year
- Technical and funding support
for stakeholder workshops
- Development of plans and
proposals for mapping and baseline
surveys
- Development of M&E indicators
for surveillance system
- Development of national action
plans
- Medicine and vaccine supplies
- Funding
Nepal Cysticercosis - Development of national action plan with
budget estimates
- Formation of steering committee and
technical working committee
- Development of information sharing
mechanism
- Development of standard operating
procedures and their effective implementation
- Mapping and selection of districts with high
prevalence
- Piloting One Health interventions in three
districts
- Acceleration of Open Defecation Free
campaigns
- Declaration of elimination at local level
- Sustaining elimination capacity and activities
- Multisectoral meetings
- Training for programme capacity
development in SOP preparation
- Capacity-building in mapping,
awareness creating, diagnosis,
surveillance, M&E
- Tripartite collaboration at country
level
- Operational research
Thailand Opisthorchiasis Continuous implementation of the national 10-year strategic plans for eliminating of O. viverrini
and CCA (2016-2025); composed of:
1. Environmental management, fish safety, human safety: sub-district health organizing offices
2. O. viverrini transmission control through case funding for treatment
3. CCA diagnosis: screening test/treatment
4. Continuing home health care: holistic care for patients by hospital and community staffs
5. Supportive management: setting a strategic plans/risk communication/ Isan-cohort data base
programme (reporting programme)
Korea Clonorchiasis - Food safety risk communication targeting risk areas (education & behaviour change) - Monitoring in animal sector and
at farm level
42
- Meat inspection in abattoirs
(macro test)
Lao
People’s
Democratic
Republic
Foodborne
trematodiases
- Mapping disease burden both in human and
animals
- Selection of pilot One Health intervention
target areas
- Pilot implementation of one health
intervention (MDA both animal and human,
CL-SWASH, integrated food safety materials,
surveillance in human and animals, school
health education)
- Expanding pilot One Health intervention in
highest prevalence provinces
- Capacity-building for human and
animal health
- Donation of anthelmintics and
animal vaccines
- Improving lab capacity (including
lab equipment and reagents)
Cysticercosis - Mapping disease burden in humans and
animals
- Selection of pilot One Health intervention
target areas
- Pilot one health intervention (MDA both
animal and human, animal vaccination, CL-
SWASH, food inspection in slaughterhouse
and market, integrated food safety materials,
surveillance in human and animals, school
health education)
- Expanding pilot One Health intervention in
highest prevalence provinces
Malaysia Cysticercosis 1. Development of the National Plan for Action (2019)
2. Mapping disease burden through veterinary, public health and referral laboratories (2019-2020)
3. Establishment of neurocysticercosis surveillance (2020-2025)
4. Enhancement of awareness and food safety risk communication (2019-2025) - pig farms,
professionals, communities
5. Implementation of national plans at all farms (2023-2025)
6. Update/development of relevant regulations and their enforcement (2019-2025)
1. Advocacy
2. Capacity-building
3. Guidelines development
4. Information sharing
5. Funding
6. Research collaboration
Mongolia Echinococcosis
Toxoplasmosis
Cryptosporidiosis
- Strengthening of national intersectoral
collaboration mechanism
- Organizing One Health surveillance system
(human, animals)
- Development and pilot implementation of
national action plan
- Continued active One Health surveillance
- Cascade training and implementation of the
national action plan
- Epidemiological assessment
- Policy development
43
Philippines Cysticercosis
Foodborne
Trematodes
(Paragonimiasis,
Fascioliasis etc.)
2019:
1. Review of existing policies and guidelines
2. Strengthening of intersectoral collaboration
(Interagency Committee on Environmental
Health and its collaborative links (IACEH,
NEHAP, RIACEH))
3. Strengthening of implementation of
WASHed (WASH + Education)
4. Strengthening of implementation of rules
and regulation of meat inspection code
(Republic Act 9296)
5. Enhancement of meat inspection reporting
system to include cysticercosis and foodborne
trematode infections
6. Enhancement of collaboration with
international partners and the Tripartite
2020:
7. Mapping of endemic areas for cysticercosis
and foodborne trematode infections
- Gap analysis on available data and tests for
mapping
- Capacity-building on the diagnostic
techniques and mapping
- Funding support for implementation of
mapping activities in humans and animals
8. Development of prototype integrated food
safety communication materials
9. Incorporation of good practices for control
and prevention of cysticercosis and foodborne
trematode infections to the food safety chain
10. Development of guidelines on control of
foodborne trematodes and taenia solium in
animal health
1. Issuing of joint Memorandum of Agreement
between the Department of Agriculture (DA)
and Department of Health on the
Implementation of the prevention and control of
neglected tropical parasitic zoonoses programme
2. Organization of stakeholders meeting for
technical support
3. Development of National DA Policy on
control of cysticercosis and foodborne trematode
infections
4. Diagnosis and treatment for animal health
- Estimation of costs of diagnosis and
treatment (kits and medicines)
- Funding support
- Development of manual of operations on
the diagnosis and treatment of animals
- Implementation of testing and treatment
5. Integration of reporting system of the
neglected tropical parasitic zoonoses with the
Neglected Tropical Diseases Management
Information System (NTDMIS)
6. Surveillance and Monitoring
- data reports from hospitals and field
- data from the animal health information
system
- continuous testing from farms and backyard
pigs from endemic areas
7. Research on cysticercosis and foodborne
trematode infections
44
Vietnam Clonorchiasis
Opisthorchiasis
Fascioliasis
Taeniasis
Cysticercosis
- Disease mapping and selection of pilot sites
for One Health intervention models to be
conducted (2019)
- Pilot implementation of One Health
interventions in five districts in five provinces,
including:
・ preventive chemotherapy for human
・ treatment for animal, vaccination
・ WASH intervention
・ food safety risk communication
・ IEC activities
・ Inter-sectoral collaboration
・ Monitoring and evaluation
- Expanding pilot One Health intervention in
more provinces
- Training on designing integrated
programme, diagnosis, surveillance
- Development of M&E indicators
- Medicine support (praziquantel,
triclabendazole)
- Equipment support (testing kits,
laboratory equipment)
- Funding support (IEC,
implementation)