If people get infected with zoonotic diseases, it means the system does not function, expert says

According to the Food and Agriculture Organization of the United Nations (FAO), within the last decades’ climate change, globalization and human activities led to the change patterns of occurrence of communicable disease in animals and humans and their considerable spread. This phenomenon was conditioned by mutation of the disease agents, their adaptation to the changing climatic conditions, reservoirs, carriers and hosts, as well as their reallocation lead to the formation of significantly complicated global map of the communicable diseases. Increasing risk of zoonotic diseases (i.e. common diseases for humans and animals) is of particular concern today.

World Health Organization (WHO) and World Organization for Animal Health (WOAH) report that around 70% of infectious diseases that occurred in humanity within the last decades are of animal origin and directly or indirectly connected with consumption of water and food products. FAO, WHO and WOAH agree that aspects of human, animal and ecosystems’ health should not be longer considered separately and advocate for «One Health» approach. This approach is multidisciplinary and assumes prevention and control of infectious diseases based on the study of interactions between ecological, epizootic and epidemiological factors and is implemented with attraction of specialists of different areas including physicians, veterinarians, zoologists, ecologists, sociologists and economists.  

What is the situation with zoonotic diseases in Armenia?

In Armenia, the single cases and sporadic outbreaks of various zoonotic diseases among humans are registered annually, including salmonellosis, brucellosis, echinococcosis and leishmaniosis. During the interview given to NEWS.am Medicine international expert on control of zoonotic diseases and veterinary public health Grigor Grigoryan mentioned that, according to the available data, around 500 cases of zoonotic diseases are registered among the population of Armenia annually, out of which approximately 200-400 cases are attributed to brucellosis only. According to the expert, the cases of zoonotic diseases among the population could be much more since not all infected people apply to the doctors.  Nevertheless, in relation to population, 500 cases are a huge number, which testifies that the system of control of these diseases does not properly function.   

“The risk of zoonotic diseases should be identified at the stage of circulation of their agents in natural reservoirs and focuses of ecosystems, at the very least, at the stage of their circulation among population of host or vector animals. If people get infected with these diseases, it means that the system of their control and prevention does not function. An outbreak of tularemia that occurred among the population of Tavush region month is one of the striking examples,” the expert said.

According to the expert any system of control of communicable diseases has two main components – veterinary surveillance and sanitary-epidemiological surveillance. The activities of both components should be, first of all, directed at preventing cases, whereas in Armenia this activity is directed mainly at the reacting to cases, rather than their prevention. So far, when people are get infected with zoonotic or other infections, the treatment of these infections and their spread are successfully managed by the National Center of Disease Control in cooperation with the hospitals. However, the prevention of zoonotic diseases is more the responsibility of veterinary services, which, in expert`s opinion, are very often unable to cope with this task, and if one of the two main components of the system do not properly function, it means the whole system does not work.

As Grigor Grigoryan said, in order to ensure proper control and efficient prevention of zoonotic diseases in Armenia, it is necessary that veterinary and sanitary-epidemiological services work together on the regular basis and not only in the case when people get infected with some zoonotic disease. This is the concept underlying global «One Health» initiative, which is aimed at protecting human, animal and environmental health through effective interaction of specialists representing various disciplines.  

What is the situation with implementation of «One Health» approach in Armenia?

In 2015 Armenia also joined «One Health» initiative, however, the expert says, that after two years the country has not yet made any serious practical step for the implementation of that approach. As of today, some preparatory work for the implementation of that approach were conducted. For example, the Ministries of Health and Agriculture have established a list of infectious diseases, comprising 85 nozological units among which highlighted 8 most dangerous zoonotic diseases (including anthrax, rabies and brucellosis) and developed common instructions for their control and prevention. Besides, Armenian epizootologists and epidemiologists participated in a series of training courses organized within the framework of US programs on prevention of biological threats. In 2016, WHO conducted an assessment of the health system of Armenia to check its compliance to the principles of the International Health Regulations and appreciated its abilities in the field of control and prevention of zoonotic diseases by significantly high scores. Grigor Grigoryan, however, believes that these scores are subjective since no independent assessment of the risk of zoonotic diseases have been conducted in the country, whereas it is practically impossible in 5 days to evaluate abilities of the system to control and prevent these diseases at the absence of their risk assessment. The expert believes, that Armenia’s achievements in this field could be considered substantial compared with those in some developing countries of Africa and Asia, but not sufficient to properly react on the risk of zoonotic diseases in Armenia.     

What measures and steps should be conducted to change the situation to the better?

According to the expert, first, it is necessary to strengthen technical capacities and operational capabilities of the state veterinary services for early detection and communication of risk posed by zoonotic diseases. At present, these services do not have technical and human resources necessary to implement this task together with the rest volume of work laying on their shoulders. To prevent the infection of people with zoonotic diseases, state veterinary services should be entitled to check any time without special permission from higher authorities and preliminary warnings, and, if necessary, to confiscate suspicious goods and products that are subject to official veterinary controls not only at the border, trade networks or processing facilities, but anywhere in the country (for example, it will help to prevent the entry of infected animal raw material into the processing facilities and in trade network). According to the expert, today, only private veterinarians provide substantial assistance to the state veterinary service in terms of early detection and prevention of zoonotic diseases through vaccination of animals against some of the zoonotic diseases (such as anthrax and rabies) and their testing to detect others (such as brucellosis and tuberculosis).

Diagnostic capacities of veterinary laboratories in another serious issue in the opinion of the expert. Today, ELISA and PCR are the main high precision laboratory methods of early detection of zoonotic diseases available to some of the veterinary laboratories in Armenia.  The use of these methods is quite expensive and therefore they are not routinely applied for detection of zoonotic diseases in animals and are used mainly for confirmation of diagnosis or monitoring of certain animal diseases (such as African and classical swine fever and foot-and-mouth disease). More often zoonotic diseases in animals are diagnosed on the basis of the complex of clinical signs and pathological lesions since they do not require significant expenses or by application of classical diagnostic methods, the choice of which depends on availability of diagnostics and reagents.  If ELISA or PCR are used, one or two samples of pathological material are tested and the rest of cases by default get the same diagnosis. Such a diagnostic practice cannot be called proper as there are many animal diseases (including zoonotic) with similar clinical and pathological pictures, which require differential diagnostics with use of high precision diagnostic methods.

According to Grigor Grigoryan, if technical and operational capacities of veterinary services for early detection of zoonotic diseases are not properly strengthened, it will not be able to efficiently cooperate with public health system, and in this case the «One Health» approach will never be implemented in Armenia.

It should be mentioned that under the auspices of World Veterinary Association, from 27 to 31 of August, the World Veterinary Congress under the «One Health, New Wave» slogan was held in Incheon (South Korea). The Congress was attended by more than 5000 participants from 180 countries and leading international organizations such as OIE and FAO. During the Congress, the «VetVision 2050» declaration assuming approach to ensuring of veterinary-sanitary safety in the countries and protection of their veterinary-sanitary status based on «One Health» approach, was developed. Grigor Grigoryan participated in the Congress as a part of World Veterinary Association team and represented Europe in the commission on development of «VetVision 2050» declaration, which was read out by him at the end of the Congress.

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