Establishment of a multi-sectoral strategy for the control of brucellosis in the main peri-urban dairy production zones of West and Central Africa

布鲁氏菌病是世界上最广泛的人畜共患病，由于人类疾病和牲畜生产力下降，给穷人的生计带来了沉重负担。然而，布鲁氏菌病很少是卫生系统的优先事项，因此世卫组织将布鲁氏菌病归类为“被忽视的地方性人畜共患病”。人们可能被感染的主要途径是食用受污染的乳制品和直接接触受感染的动物。因此，人类布鲁氏菌病的控制取决于其在动物（主要是反刍动物）中的控制，而其有害影响包括动物和人类疾病。尽管世界各地有一系列工具（诊断、疫苗）可供使用，并已成功地用于控制布鲁氏菌病，但在其他地区，该病的发病率仍然很高。未能控制该疾病可能是多种因素综合作用的结果，其中有些是技术因素（例如不同疫苗在不同环境下的质量和适宜性），其他是社会经济因素（牲畜饲养者对该疾病的看法和控制该疾病的激励措施）或体制因素（兽医部门对该疾病的重视，动物卫生和公共卫生部门之间缺乏互动）。在这个项目中，我们的目标是布鲁氏菌病可能对撒哈拉以南非洲脆弱人群造成最沉重负担的畜牧系统之一：为西非和中非快速增长的城市人口提供牛奶的奶牛场，我们将通过整合一系列学科来实现这一目标，以便我们考虑与疾病控制相关的不同生物，社会和制度层面。我们将把重点放在控制这一疾病的第一阶段：通过接种疫苗降低其流行率，因为彻底根除需要目标地区目前不具备的条件。所谓的城市周边奶牛场是贫困地区的重要财富来源，也是日益城市化的非洲人口的蛋白质来源。此外，有证据表明，这一地区是撒哈拉以南非洲地区反刍动物布鲁氏菌病发病率最高的地区，我们将开展一系列实地研究，以衡量布鲁氏菌病对15个目标国家主要城市周边乳制品生产地区的牲畜生产力和人类健康造成的负担，查明人们感染的途径，量化疾病对农民的经济后果，并了解农民对疾病的看法和态度。与此同时，我们将开展一系列培训活动，并将与当地机构合作，确定有效和可持续控制的障碍，并克服这些障碍。研究结果将用于设计和实施2年的控制计划，在少数情况下进行疫苗接种。将认真监测这些控制方案的有效性，并在区域内外广泛分享其结果，该项目的核心是达喀尔州际兽医科学和医学学院，这是一个涉及15个西非和中非国家的区域教育中心。EISMV学者将与来自两个领先的兽医和医学教育机构的英国研究人员合作：皇家兽医学院和伦敦卫生和热带医学学院，并与动物卫生兽医实验室机构的布鲁氏菌病国际参考实验室合作。全球牲畜兽药联盟（GALVmed）是一个在全球范围内开展工作的组织，旨在帮助贫困牲畜饲养者获得负担得起的牲畜疫苗、药物和诊断方法，该联盟也将是该联盟的重要组成部分，有助于将我们的研究成果转化为贫困国家弱势群体和牲畜饲养者的切实利益。

Brucellosis is the world's most widespread zoonosis, imposing a substantial burden on the livelihoods of poor people as a result of human disease and reduced livestock productivity. However, brucellosis is rarely a priority for health systems and for this reason the WHO classifies brucellosis as a "neglected endemic zoonosis". The main routes by which people can be infected are consumption of contaminated dairy products and direct contact with infected animals. Therefore, the control of human brucellosis depends on its control in animals, mainly ruminants, while its detrimental effects include both animal and human disease. Although a range of tools (diagnostics, vaccines) are available and have been used, sometimes successfully, to control brucellosis in different parts of the world the disease remains present at high levels in others. It is likely that failure to control the disease is due to a combination of factors, some of them technical (e.g. quality and appropriateness of different vaccines for different settings), others socioeconomic (livestock keepers perceptions towards the disease and incentives for its control) or institutional (priority given by veterinary services to the disease, lack of interaction between animal health and public health services). In this project we target one of the livestock systems in which Brucellosis is likely to pose the heaviest burden on vulnerable populations in Sub-Saharan Africa: dairy farms supplying milk to rapidly growing urban populations in West and Central Africa, and we will do it by integrating a range of disciplines so that we consider the different biological, social and institutional dimensions of the disease that are relevant for its control. We will focus on the first phase of control of the disease: the reduction of its prevalence by means of vaccination, since total eradication requires conditions that are not currently met in the target area. The so-called peri-urban dairy farms are an important source of wealth in poor settings and a source of protein in increasingly urbanised African populations. Furthermore, there is evidence that this region has the highest prevalence of ruminant brucellosis in Sub-Saharan Africa.We will carry out a series of field studies to measure the burden of brucellosis in livestock productivity and human health in the main areas for peri-urban dairy production in the 15 target countries, to identify routes by which people become infected, to quantify the economic consequences of the disease for farmers and to understand farmers' perceptions and attitudes toward the disease. In parallel we will carry out a series of training activities and we will work with local institutions to identify barriers for effective and sustainable control and to overcome those. The results will be used to design and carry out 2-year control programs based on vaccination in a small number of settings. The effectiveness of these control programs will be carefully monitored and the results widely shared within and outside the region.Central to this project is the Interstate School of Veterinary Science and Medicine of Dakar (EISMV) a regional educational hub that involves 15 West and Central African countries. EISMV academics will work in partnership with UK-based researchers from two leading veterinary and medical educational institutions: Royal Veterinary College and London School of Hygiene and Tropical Medicine and with the international reference laboratory for brucellosis at Animal Health Veterinary Laboratories Agency. The Global Alliance for Livestock Veterinary Medicines (GALVmed), an organization which works globally to facilitate access of poor livestock keepers to affordable livestock vaccines, medicines and diagnostics will also be an essential part of the consortium contributing to the translation of our research findings into tangible benefits for vulnerable populations and livestock keepers in poor countries.