Integrated management-based approach for surveillance and control of zoonoses in emerging livestock systems: South East Asia Pig & Poultry Partnership

人类不断面临新的传染病挑战，其中许多是动物来源的（人畜共患），然后在动物和人类群体中成为地方病。目前，低收入和中等收入国家，特别是东南亚国家畜牧生产系统的快速发展和多样化，可能使这些人畜共患病风险恶化。这些新兴的牲畜系统与人们不断变化的食物消费习惯、经济状况、愿望和人口变化以及政治背景有关。ELS的主要特点包括强化动物饲养、增加抗生素使用和延长供应链——从食品安全的角度来看，所有这些都可能有缺点。新闻标题合理地集中在新出现的人畜共患疾病上，例如高致病性流感（HPAI），但对穷人的健康及其牲畜的生产力和盈利能力造成最沉重全球负担的，是被遗忘的地方性人畜共患疾病，主要是胃肠道感染（国际畜牧研究所，2012年提交给英国国际发展部的报告）。据估计，由沙门氏菌和弯曲杆菌等细菌以及相关抗生素耐药性引起的人畜共患胃肠道疾病每年在全球造成约100万人死亡，约有8亿人受到影响，其中大多数是五岁以下儿童；这种情况也反映在我们的研究国家越南和缅甸，这两个国家在其ELS的速度和多样性方面排名前5位（向英国国际发展部提交的ILRI报告）。我们的工作验证了这样一种观点，即各种ELS，特别是这些人越来越依赖的猪和家禽生产，是这些感染的主要来源。我们还假设，这些人畜共患威胁受到风险环境、病原体和宿主相关因素的影响，而这些因素反过来又受到不同ELS的规模和多样性的影响。越南和缅甸处于快速但不同的发展轨迹的不同阶段，我们将研究这些差异，以支持制定新的“同一个健康”方针。我们提议的目的是利用包括缅甸、越南和英国的社会、生物和政府参与者在内的跨学科专业知识，利用知识驱动和与文化相关的战略，逐步改变有利于穷人的控制措施，从而改善动物健康和生产力，从而改善和保护人类健康。实现这一目标的目标涉及在越南和缅甸的平行工作：(1)表征猪和家禽生产系统和供应链。(2)描述主要利益相关者对牲畜疾病、人畜共患病风险和基线预防机制的现有认识和做法。(3)确定不同畜牧系统对细菌性人畜共患感染流行率和多样性以及抗菌素耐药性的影响。(5)在越南和缅甸确定、试点和评估适当和有效的ELS知识培训计划，并考虑如何将这些计划转化为其他情况。我们的研究将为改善消费者的食品安全和福祉、改善食物链工人的经济安全和健康、改善牲畜集约化管理带来的社区层面和环境效益、为有效和文化相关的细菌性人畜共患病控制政策提供证据、试点微生物实验室、基础设施、培训是今后可持续监测细菌性地方性人畜共患病的基础（对新出现的人畜共患病的监测可以与此分开），以及可适应其他国际环境的人畜共患病风险评估和控制方法。最后，该项目为跨学科团队在处理全球卫生问题方面的作用提供了新颖的学术见解。

Human populations repeatedly face new infectious disease challenges, many of which are of animal origin (zoonotic) and then become endemic in animal and human populations. These zoonotic risks may be worsened by rapid development and diversification of livestock production systems now occurring in low- and middle-income countries, especially in South East Asia. These emerging livestock systems (ELS) are linked to peoples' changing food consumption habits, economic status, aspirations and population shifts, and to political contexts. Key features of ELS include intensification of animal keeping, increased use of antibiotics, and extended supply chains - all of which can have disadvantages from a food safety perspective. Headlines reasonably focus on the emerging zoonotic diseases, for example highly pathogenic influenza (HPAI), but it is the forgotten endemic zoonotic diseases, and primarily gastrointestinal (GI) infections that put the heaviest global burden on the health of poor people, and on productivity and profitability of their livestock (ILRI Report to DfID, 2012). It is estimated that zoonotic gastrointestinal disease, caused by bacteria such as Salmonella and Campylobacter and related antibiotic resistance, accounts for around 1 million human deaths per year globally with around 800 million people being affected, most of them children under five; a situation also reflected in our study countries Viet Nam and Myanmar which rank in the top 5 hotspots for rapidity and diversity of their ELS (ILRI report to DfID). Our work tests the idea that diverse ELS, specifically pig and poultry production, upon which these people increasingly depend for food, are major sources of these infections. We also hypothesise that these zoonotic threats are impacted by the risk environment, and pathogen- and host-related factors and that these, in turn, will be affected by the scale and diversity of different ELS. Viet Nam and Myanmar are at different stages of rapid but different development trajectories and we will study these differences to support development of new One Health approaches. Our proposal's aim is to exploit interdisciplinary expertise that includes social, biological, and governmental players from Myanmar, Viet Nam and UK to bring about step changes in pro-poor control measures using knowledge-driven and culturally relevant strategies that concomitantly improve animal health and productivity and thus improve and protect human health. The objectives to achieve this aim involve parallel work in Viet Nam and Myanmar:(1) To characterise pig and poultry production systems and supply chains.(2) To characterise key stakeholders' existing perceptions and practices related to livestock disease, zoonotic risk and baseline preventive mechanisms.(3) To identify the impact of different livestock systems on the prevalence and diversity of bacterial zoonotic infections and on antimicrobial resistance.(4) To up-scale regionally accessible diagnostic laboratories(5) To identify, pilot and evaluate appropriate and effective knowledge-based training programmes in ELS in Viet Nam and Myanmar, and consider how these might be translated to other contexts.Our research will underpin improved food safety and wellbeing for consumers, improved economic security and health for food chain workers, community-level and environmental benefits from improved management of livestock intensification, evidence on which to base effective and culturally relevant policy for bacterial zoonosis control, pilot microbiology laboratories, infrastructure, and training as the basis for sustainable future surveillance for bacterial endemic zoonoses (to which surveillance for emerging zoonoses could be bolted), and zoonotic risk evaluation and control methods that can be adapted to other international contexts. Finally, the project provides novel academic insights into the role of interdisciplinary teams in tackling global health issues.