A systematic review and analysis of health risks associated with zootherapeutic practices in Africa (preprint)

Background: Over five billion people globally rely on a plant- and animal-based pharmacopoeia for their healthcare needs. The inhalation, topical application, subcutaneous injection, or ingestion of animal products - such as faeces, fur, milk, blood, brain tissue, or meat - likely facilitates the spill over of zoonotic pathogens. Certain practices use species known to be involved in the transmission of pathogens of public health relevance, such as reservoir species for filoviruses, poxviruses, and coronaviruses. These practices and the public health risk they entail have not been previously reviewed and analysed for the African continent. Methods We first conducted a systematic review of literature using web-scraping algorithms targeted at peer-reviewed (PubMed) and peer-reviewed or grey literature (Google Scholar) databases, followed by manual search of reference lists published before July 30th, 2023. We used terms encompassing zoo*, animal*, health*, practice*, tradition* followed by a list of all 54 African countries in combination with Boolean operators. We then created a categorical score reflecting the risk of zoonotic pathogen spill over for each recorded zootherapeutic practice, and compared this risk between geographic regions and between demographic groups. Findings A total of 53 studies were included, reporting the use of over 2,000 zootherapeutic practices. Half of the included studies were published after 2020. Nigerian, Ethiopian, Tanzanian and South African practices were comparatively well documented. The mean total risk score was significantly lower in western (p < 0.0001), central (p < 0.003), and southern (p < 0.0001) Africa, compared to eastern Africa, while there was no significant difference between eastern and northern Africa. Further, we found that physically sick children are overall at increased risk for pathogen spill over (p = 0.001) compared to physically sick adults, and that pregnant or lactating women are exposed to animal tissues of significantly greater infectious potential (p = 0.032). Interpretation The WHO recently hosted its first global summit on Traditional, Complementary and Integrative Medicine (TCIM), highlighting its importance to fulfil SDG 3: Health and Wellbeing. Where other forms of healthcare are unavailable or inefficient, zootherapeutic practices can provide valuable solutions to acute, chronic, physical, and psychological issues. However, significant risks of zoonotic disease transmission exist. This article aims to guide research on sustainable alternatives to mainstream medical treatments that balance cultural significance and public health.

Metadichol: an inhibitor of zoonotic viruses; Nipah, Lassa, and rabies (preprint)

Zoonotic viruses, such as coronaviruses, the Ebola virus, the Zika virus, Nipah, Laasa, and rabies, can be transmitted from animals to humans (1). There is a need to develop inhibitors because they can potentially prevent or treat viral infections in humans and animals (2). Metadichol® is a nanoemulsion of long-chain alcohols that is a potent inhibitor of viruses. We present the results of in vitro assays showing that it inhibits Lassa, rabies, and Nipah viruses at concentrations ranging from 0.8 to 2.6 µg/ml. It is likely that the binding of metadichol to VDR (vitamin D receptor) leads to the regulation of c-MYC (MYC Proto-Oncogene, BHLH Transcription Factor), which controls the expression of SP1 (SP1 transcription factor), which is the key step in controlling the viral replication gene GSPT1 (G1 to S Phase Transition 1). Since metadichol is commercially available and nontoxic, with an LD50 of more than 5000 mg/kg in rats, it could be useful in the treatment of such zoonotic diseases.

Towards Real-Time Airborne Pathogen Sensing: Electrostatic Capture and On-Chip LAMP Based Detection of Airborne Viral Pathogens (preprint)

Considerable loss of life, economic slowdown, and public health risk associated with the transmission of airborne respiratory pathogens was underscored by the recent COVID-19 pandemic. Airborne transmission of zoonotic diseases such as the highly pathogenic avian influenza (HPAI) and porcine reproductive and respiratory syndrome virus (PRRSV) has caused major disruptions to domestic and global food security. Current ambient air pathogen monitoring systems involves the collection of air samples from indoor settings suspected of viral contamination, followed by subsequent processing of capture samples to determine the presence and species of airborne viral matter. Nucleic acid amplification techniques are considered the gold standard for pathogen diagnostics. Currently, the necessary extraction and purification of viral RNA from air collector systems prior to sample analysis is both time consuming and performed manually. A monitoring system with separate air sampling and biochemical detection procedures is prone to delay the response to emergent viral threats. In this paper, we present a pathogen monitoring system that overcomes these limitations related to extraction and purification of viral samples and lays the groundwork for a real-time monitor for airborne viral pathogens. We demonstrate a high flow electrostatic precipitator system, that uses small collection wells as counter electrodes for pathogen collection. Integrated reverse-transcriptase loop-mediated isothermal amplification (RT-LAMP) is used for detection of captured viral matter within wells. On-chip heating of collection wells is enabled by integrated planar heaters and small volumes of reagent (30 L) directly to the collection wells. We present the design of such a system and show experimental results that demonstrate the use of this device for detection of aerosolized SARS-CoV-2 virus like particles (VLPs), a model pathogen for SARV-CoV-2.

Purifying selection and adaptive evolution proximate to the zoonosis of SARS-CoV-1 and SARS-CoV-2 (preprint)

Over the past two decades the pace of spillovers from animal viruses to humans has accelerated, with COVID-19 becoming the most deadly zoonotic disease in living memory. Prior to zoonosis, it is conceivable that the virus might largely be subjected to purifying selection, requiring no additional selective changes for successful zoonotic transmission. Alternatively, selective changes occurring in the reservoir species may coincidentally preadapt the virus for human-to-human transmission, facilitating spread upon cross-species exposure. Here we quantify changes in the genomes of SARS-CoV-2 and SARS-CoV-1 proximate to zoonosis to evaluate the selection pressures acting on the viruses. Application of molecular-evolutionary and population-genetic approaches to quantify site-specific selection within both SARS-CoV genomes revealed strong purifying selection across many genes at the time of zoonosis. Even in the viral surface-protein Spike that has been fast-evolving in humans, there is little evidence of positive selection proximate to zoonosis. Nevertheless, in SARS-CoV-2, NSP12, a core protein for viral replication, exhibited a region under adaptive selection proximate to zoonosis. Furthermore, in both SARS-CoV-1 and SARS-CoV-2, regions of adaptive selection proximate to zoonosis were found in ORF7a, a putative Major Histocompatibility Complex modulatory gene. These findings suggest that these replication and immunomodulatory proteins have played a previously underappreciated role in the adaptation of SARS coronaviruses to human hosts.

Derivation and Characterization of Novel Cytocompatible Decellularized Tissue Scaffold for Cellular Farming (preprint)

Consumption of conventional animal meat is associated with various zoonotic and chronic diseases which is putting an extra burden on the health sector. Previously, COVID-19, an animal-derived zoonotic disease, exerted detrimental effects globally. Thus, an alternative approach to produce safe and disease-free meat could pave the way to reduce the burden on the health sector. Cellular farming has been suggested and emerged as a potential alternative approach to produce the disease-free cultured meat. However, an appropriate scaffold is key to develop an alternative animal protein in the form of cultured meat or lab-grown meat. Decellularized tissues have been suggested as a potential scaffold for cultured meat production as it provides a suitable environment and niche for the proliferation and growth of the cells and helps to develop the 3D tissues in the laboratory. In the present study, decellularized mushroom tissue has been derived, characterized and the myogenic differentiation capacity of the scaffold was evaluated. The outcome of the study would provide an edible and natural scaffold to produce a safe and disease-free source of animal protein.

Absence of SARS-CoV-2 in Wildlife of Northeastern Minnesota and Isle Royale National Park (preprint)

We investigated the presence of SARS-CoV-2 in free-ranging wildlife populations in Northeastern Minnesota on the Grand Portage Indian Reservation and Isle Royale National Park. 120 nasal samples were collected from white-tailed deer, moose, gray wolves, and black bears monitored for conservation efforts during 2022-2023. Samples were tested for viral RNA by RT-qPCR using the CDC N1/N2 primer set. Our data indicate that no wildlife samples were positive for SARS-CoV-2 RNA. Continued surveillance is therefore crucial to better understand the changing landscape of zoonotic SARS-CoV-2 in the Upper Midwest.

Personal historical perspective of HIV: part 11.

All animal life on earth is thought to have a common origin and have common genetic mechanisms. Evolution has enabled differentiation of species. Pathogens likewise have evolved within various species and mostly come to a settled dynamic equilibrium such that co-existence results (pathogens ideally should not kill their hosts). Problems arise when pathogens jump species because the new host had not developed any resistance. These infections from related species are known as zoonoses. COVID-19 is the latest example of a virus entering another species but HIV (and various strains of influenza) were previous examples. HIV entered the human population from monkeys in Africa. These two papers outline the underlying principle of HIV and the differing epidemiologies in Africa, the USA and in Edinburgh. The underlying immunosuppression of HIV in Africa was initially hidden behind common infections and HIV first came to world awareness in focal areas of the USA as a disease seemingly limited to gay males. The epidemic of intravenous drug abuse in Edinburgh was associated with overlapping epidemics of bloodborne viruses like hepatitis B, hepatitis C and HIV.

Hepatitis E virus: has anything changed?

PURPOSE OF REVIEW: Infection with hepatitis E virus (HEV) is a global health concern, yet a clinically underdiagnosed cause of acute and chronic hepatitis. The WHO estimates that 20 million people are infected with HEV annually, yet the epidemiology, diagnosis and prevention remain elusive in many clinical settings. RECENT FINDINGS: Orthohepevirus A (HEV-A) genotypes 1 and 2 cause acute, self-limited hepatitis through faecal-oral transmission. In 2022, the first-ever vaccine campaign was implemented as a response to an HEV outbreak in an endemic region. HEV-A genotypes 3 and 4 are zoonotic infections that primarily cause chronic HEV infection in immunosuppressed populations. Pregnant women and immunocompromised persons are at high risk for severe illness in some settings. Another recent advance in our knowledge of HEV is the zoonotic transmission of Orthohepevirus C (HEV-C) to humans, presumably from contact with rodents and/or their excrement. Previously, HEV infection in humans was presumed to be limited to HEV-A only. SUMMARY: Clinical recognition and accurate diagnosis are essential to the management of HEV infection and understanding the global burden of the disease. Epidemiology affects clinical presentations. Targeted response strategies in HEV outbreaks are needed for the prevention of disease, and vaccine campaigns may prove to be an effective part of these strategies.

[Viral zoonoses in Germany: a One Health perspective]. / Virale Zoonosen in Deutschland aus der One Health-Perspektive.

The COVID-19 pandemic and the increasing occurrence of monkeypox (mpox) diseases outside Africa have illustrated the vulnerability of populations to zoonotic pathogens. In addition, other viral zoonotic pathogens have gained importance in recent years.This review article addresses six notifiable viral zoonotic pathogens as examples to highlight the need for the One Health approach in order to understand the epidemiology of the diseases and to derive recommendations for action by the public health service. The importance of environmental factors, reservoirs, and vectors is emphasized, the diseases in livestock and wildlife are analyzed, and the occurrence and frequency of diseases in the population are described. The pathogens selected here differ in their reservoirs and the role of vectors for transmission, the impact of infections on farm animals, and the disease patterns observed in humans. In addition to zoonotic pathogens that have been known in Germany for a long time or were introduced recently, pathogens whose zoonotic potential has only lately been shown are also considered.For the pathogens discussed here, there are still large knowledge gaps regarding the transmission routes. Future One Health-based studies must contribute to the further elucidation of their transmission routes and the development of prevention measures. The holistic approach does not necessarily include a focus on viral pathogens/diseases, but also includes the question of the interaction of viral, bacterial, and other pathogens, including antibiotic resistance and host microbiomes.

Beta interferons from the extant camelids: Unique among eutherian mammals.

The COVID-19 pandemic is a wake-up call on the zoonotic viral spillover events and the need to be prepared for future outbreaks. Zoonotic RNA viruses like the Middle East respiratory syndrome coronavirus (MERS-CoV) are potential pathogens that could trigger the next pandemic. Dromedary camels are the only known animal source of MERS-CoV zoonotic infections, but little is known about the molecular antiviral response in this species. IFN-ß and other type-I interferons provide the first line of defense against invading pathogens in the host immune response. We identified the IFNB gene of the dromedary camel and all extant members of the family Camelidae. Camelid IFN-ß is unique with an even number of cysteines in the mature protein compared to other eutherian mammals with an odd number of cysteines. The viral mimetic poly(I:C) strongly induced IFN-ß expression in camel kidney cells. Induction of IFN-ß expression upon infection with camelpox virus was late and subdued when compared to poly(I:C) treatment. Prokaryotically expressed recombinant dromedary IFN-ß induced expression of IFN-responsive genes in camel kidney cells. Further, recombinant IFN-ß conferred antiviral resistance to camel kidney cells against the cytopathic effects of the camelpox virus, an endemic zoonotic pathogen. IFN-ß from this unique group of mammals will offer insights into antiviral immune mechanisms and aid in the development of specific antivirals against pathogens that have the potential to be the next zoonotic pandemic.

Detection of SARS-CoV-2 in Terrestrial Animals in Southern Nigeria: Potential Cases of Reverse Zoonosis.

Since SARS-CoV-2 caused the COVID-19 pandemic, records have suggested the occurrence of reverse zoonosis of pets and farm animals in contact with SARS-CoV-2-positive humans in the Occident. However, there is little information on the spread of the virus among animals in contact with humans in Africa. Therefore, this study aimed to investigate the occurrence of SARS-CoV-2 in various animals in Nigeria. Overall, 791 animals from Ebonyi, Ogun, Ondo, and Oyo States, Nigeria were screened for SARS-CoV-2 using RT-qPCR (n = 364) and IgG ELISA (n = 654). SARS-CoV-2 positivity rates were 45.9% (RT-qPCR) and 1.4% (ELISA). SARS-CoV-2 RNA was detected in almost all animal taxa and sampling locations except Oyo State. SARS-CoV-2 IgGs were detected only in goats from Ebonyi and pigs from Ogun States. Overall, SARS-CoV-2 infectivity rates were higher in 2021 than in 2022. Our study highlights the ability of the virus to infect various animals. It presents the first report of natural SARS-CoV-2 infection in poultry, pigs, domestic ruminants, and lizards. The close human-animal interactions in these settings suggest ongoing reverse zoonosis, highlighting the role of behavioral factors of transmission and the potential for SARS-CoV-2 to spread among animals. These underscore the importance of continuous monitoring to detect and intervene in any eventual upsurge.

Mpox neglect and the smallpox niche: a problem for Africa, a problem for the world.

Mpox (formerly known as monkeypox) is a zoonotic viral disease endemic in parts of Africa. In May, 2022, the world was alerted to circulation of monkeypox virus in many high-income countries outside of Africa. Continued spread resulted in a WHO declaration of a Public Health Emergency of International Concern. Although there has been much attention on the global outbreak, most of the focus has been on high-income countries outside of Africa, despite the fact that monkeypox virus has been causing disease in parts of Africa for at least 50 years. Furthermore, the long-term consequences of this event, especially the risk that mpox fills the niche vacated through smallpox eradication, have not been sufficiently considered. The heart of the problem is the historical neglect of mpox in Africa where the disease is endemic, and the actual and potential consequences if this neglect is left uncorrected.

Increasing Local Disease Preparedness and Surveillance Capacity for Global Health Security: A Cluster-Randomised Control Trial (preprint)

Background: Low-income countries are often characterized by poor health infrastructures and lack systems needed to timely detect and control disease outbreaks, such as the 2014-16 Ebola Viral Disease and COVID-19. In such contexts, a “One Health” approach, which involves investing in both human and animal health systems, plausibly improves local health outcomes by enabling early detection of zoonotic diseases before they are transmitted to humans, and by timely triggering a health system response needed to mitigate possible outbreaks. There is an urgent call to translate One Health into action and create inclusive and sustainable policies. There is however limited direct evidence on the gains from One Health approaches. We contribute here by using a randomised intervention to assess the impact of a participatory community-based One Health program.Methods: As part of a cluster-randomised control trial, government and communities recruited, trained and installed Community Animal Health Workers (CAHWs) to work alongside Community Health Workers (CHWs) in 300 randomly selected rural villages in Sierra Leone. Another 63 villages were randomly selected as control sites and had CHWs exclusively. CAHWs provided essential animal health services, disseminated information regarding animal and human health best practices, and actively participated in surveillance efforts by reporting suspected disease symptoms to government supervisors. We investigated program impacts on human health as well as key intermediary outcomes, including animal health, animal and human health-related behaviours, integration into public services, and household wealth. The trial is registered at clinicaltrialregister.nl (# 21660) and OSF (https://osf.io/9xfv3).Findings: In July and August 2017, the community-based One Health program successfully recruited, trained and installed CAHWs across 287 villages. Throughout the program's duration, spanning from July 2017 to July 2019, the CAHWs reported on 17,813 suspected disease-related events. Using survey data from 2,538 respondents, collected in March and April 2020, we found no evidence of impacts on human health (-0.010 standard deviation units (SDU), 95% CI -0.131, 0.111). The program did improve intermediary outcomes including animal health (0.157 SDU, 95% CI 0.022, 0.293), animal husbandry practices (0.127 SDU, 95% CI -0.022, 0.276), human health behaviours (0.137 SDU, 95% CI -0.007, 0.281), integration into public services (0.300 SDU, 95% CI 0.116, 0.484), and households’ attitudes towards disease reporting (0.263 SDU, 95% CI 0.109, 0.418).Interpretation: Participatory community-based One Health interventions can increase preparedness against zoonotic diseases.Trial Registration: The trial is registered at clinicaltrialregister.nl (# 21660) and OSF (https://osf.io/9xfv3).Funding: The study was funded by NWO grant #451-14-001 and #VI.Vidi.191.154, ESRC grant ES/J017620/1, the Royal Netherlands Embassy in Ghana, the International Growth Center, New York University – Abu Dhabi and the World Bank REDISSE program.Declaration of Interest: We declare no competing interests.Ethical Approval: Before the onset of the program, formal approval was obtained from local authorities. We obtained verbal informed consent from all study participants. Ethics approval was obtained from the Office of the Sierra Leone Ethics and Scientific Review Committee (SLERC 16102017) and Columbia University (AAAR5175).

Determinants of the severity of chronic illness of Patients with COVID-19 among patients at Eka Kottebe General Hospital, Addis Ababa, Ethiopia, 2020/21 (preprint)

Background:Coronavirus is a zoonotic disease caused by coronavirus 2 (severe acute respiratory syndrome) which was discovered on December 31, 2019, in Wuhan, Hubei Province, China.  Methodology: The study population was the patients of COVID-19 treated at Eka Kottebe General Hospital from March 2020 to December 2020. Descriptive statistics, chi-square test, and stereotype ordinal logistic regression model were used to analyze our data.  Result: Out of the total (454) patients considered in the study, about 240 (52.86%), 60 (13.22%), 106 (23.35%), and 48 (10.57%) patients were in mild, moderate, severe, and critical stage, respectively. Independent variables like sex, presence of a symptom, fever, headache, chest pain, and shortness of breath, general weakness, cough, co-morbid, diabetes mullets, and hypertension had a significant association with the severity of illness at a 5% level of significance. The stereotype ordinal logistic regression result shows that sex, age, presence of symptoms, shortness of breath, general weakness, and co-morbidity had a significant effect on the severity of illness in patients with COVID-19.  Conclusion: Being male, increasing in age, being symptomatic, having shortness of breath, having general weakness, and having any co-morbidity had led to more severe stage illness in patients.

Zoonoses and global epidemics.

PURPOSE OF REVIEW: The purpose of the review is to summarize recent advances in understanding the origins, drivers and clinical context of zoonotic disease epidemics and pandemics. In addition, we aimed to highlight the role of clinicians in identifying sentinel cases of zoonotic disease outbreaks. RECENT FINDINGS: The majority of emerging infectious disease events over recent decades, including the COVID-19 pandemic, have been caused by zoonotic viruses and bacteria. In particular, coronaviruses, haemorrhagic fever viruses, arboviruses and influenza A viruses have caused significant epidemics globally. There have been recent advances in understanding the origins and drivers of zoonotic epidemics, yet there are gaps in diagnostic capacity and clinical training about zoonoses. SUMMARY: Identifying the origins of zoonotic pathogens, understanding factors influencing disease transmission and improving the diagnostic capacity of clinicians will be crucial to early detection and prevention of further epidemics of zoonoses.

The importance of equally accessible genomic surveillance in the age of pandemics.

Genomic epidemiology is now a core component in investigating the spread of a disease during an outbreak and for future preparedness to tackle emerging zoonoses. During the last decades, several viral diseases arose and emphasized the importance of molecular epidemiology in tracking the dispersal route, supporting proper mitigation measures, and appropriate vaccine development. In this perspective article, we summarized what has been done so far in the genomic epidemiology field and what should be considered in the future. We traced back the methods and protocols employed over time for zoonotic disease response. Either to small outbreaks such as the severe acute respiratory syndrome (SARS) outbreak identified first in 2002 in Guangdong, China, or to a global pandemic like the one that we are experiencing now since 2019 when the severe acute respiratory syndrome 2 (SARS-CoV-2) virus emerged in Wuhan, China, following several pneumonia cases, and subsequently spread worldwide. We explored both the benefits and shortages encountered when relying on genomic epidemiology, and we clearly present the disadvantages of inequity in accessing these tools around the world, especially in countries with less developed economies. For effectively addressing future pandemics, it is crucial to work for better sequencing equity around the globe.

Monkeypox Outbreak in Peru: Reflections after the COVID-19 Pandemic (preprint)

Monkeypox is a zoonotic illness caused by the Orthopoxvirus monkeypox virus (MPXV). Since 1970, outbreaks of MPXV have occurred in several Sub-Saharan African countries. However, from May 2022 to April 2023, recent outbreaks of MPXV occurred in several countries outside of Africa, and these cases quickly spread to over 100 non-endemic countries on all continents. Because of this, in July 2022, World Health Organization declared monkeypox a Public Health Emergency of International. MPXV disproportionately affects men who have sex with men and members of the HIV-infected population. The current strategy for control and pre-exposure prophylaxis or post-exposure prophylaxis for people at high risk is vaccination. In this context, Peru has the fourth-highest number of MPXV cases in Latin America. Because of this, in this review, we describe public health indicators in Peru and reflect on the COVID-19 pandemic so that health authorities can join forces to identify and control MPXV transmission routes.

Zoonotic risk assessment among farmed mammals.

Farmed mammals may act as hosts for zoonotic viruses that can cause disease outbreaks in humans. This SnapShot shows which farmed mammals, and to what extent, are of particular risk of harboring and spreading viruses from viral families that are commonly associated with zoonotic disease. It also discusses genome surveillance methods and biosafety measures. To view this SnapShot, open or download the PDF.

Continuous surveillance and viral discovery in animals and humans are a core component of a one-health approach to address recent viral reverse zoonoses.

Contemporary human and animal viruses have a broad or narrow host range-those with a broad host range are potentially transmitted from animals to humans (ie, zoonosis) or humans to animals (ie, reverse zoonosis). This Currents in One Health article reviews the recent reverse zoonoses involving Coronaviridae, Poxviridae, arboviruses, and, for nonhuman primate species, the human respiratory viruses. The prevention and control of reverse zoonoses are also reviewed. Coronaviruses continue to emerge as new zoonotic agents, including a canine coronavirus, CCoV-HuPn-2018, circulating in people at low levels, and a pangolin coronavirus, MjHKU4r-CoV-1, circulating in Malayan pangolins. Moreover, the risk for SARS-CoV-2 variants to mutate in animal reservoirs and reinfect humans is ongoing. In the case of mpox, the risk of reverse zoonosis is low and there are vaccines for use in humans at risk. The situation with arboviruses is as varied as the number of human arboviruses, and only yellow fever virus and dengue virus have licensed vaccines in the Americas. As for reverse zoonoses in endangered species, solutions require changing human behavior and policies at all levels impacting wildlife. Overall, continuous surveillance and viral discovery in humans and animals remain core components of a one-health approach to reduce and, where possible, eliminate zoonotic and reverse zoonotic diseases. Viral zoonosis and viral reverse zoonosis focusing on recent influenza A virus disease events in humans and other species are the subjects of the companion Currents in One Health by Kibenge, AJVR, June 2023.