One Health evaluation of brucellosis control in Kazakhstan.

Brucellosis is one of the main livestock disease risks in Kazakhstan. It's been endemic there since 1930, accounting for over 1300 human cases per annum. The economic loss was 45 million USD in 2015 alone. Since 1952, Kazakhstan has implemented various control strategies with little success. One Health approaches have been suggested to tackle brucellosis, however, there is a lack of evidence for best practices to operationalise One Health in the literature, and methods for implementation are not established. The intention of this study was to introduce the One Health approach during the evaluation phase of the policy cycle. A two-day workshop was organized by the authors to familiarize participants with the evaluation methodology. Twenty-one specialists representing veterinary and public health sector, together with researchers, took part in this study. For two weeks following the workshop, first author conducted individual interviews with workshop participants to obtain individual scorings to assess knowledge integration capacity (One Health-ness). The evaluation results show that there is a lack of knowledge about the perceived damage caused by brucellosis to animal owners and other stakeholders. There is insufficient data available about farmers' practices, interests and motivations, and also data is missing for important transmission processes such as the amount of unsafe dairy consumption. The absence of such data illustrates the extent of the uncertainty to which decision-makers are exposed despite well-elaborated transmission models and supports the importance of co-producing solutions with participatory methods. The results suggest the need for broader involvement of stakeholders. Outputs of this study could help navigate the initial stages of One Health operationalization.

The dual burden of animal and human zoonoses: A systematic review.

BACKGROUND: Zoonoses can cause a substantial burden on both human and animal health. Globally, estimates of the dual (human and animal) burden of zoonoses are scarce. Therefore, this study aims to quantify the dual burden of zoonoses using a comparable metric, "zoonosis Disability Adjusted Life Years" (zDALY). METHODOLOGY: We systematically reviewed studies that quantify in the same article zoonoses in animals, through monetary losses, and in humans in terms of Disability Adjusted Life Years (DALYs). We searched EMBASE, Web of Science, Scopus, PubMed, and Google Scholar. We excluded articles that did not provide the data to estimate the zDALY or those for which full text was not available. This study was registered at PROSPERO, CRD42022313081. PRINCIPAL FINDINGS/SIGNIFICANCE: We identified 512 potentially eligible records. After deduplication and screening of the title and abstract, 23 records were assessed for full-text review. Fourteen studies were included in this systematic review. The data contains estimates from 10 countries, a study at continental level (Asia and Africa), and 2 studies on a global scale. Rabies was the most frequently reported zoonosis where zDALYs were calculated, based on the following included studies: for Kazakhstan 457 (95% CI 342-597), Viet Nam 5316 (95% CI 4382-6244), Asia 1,145,287 (90% CI 388,592-1,902,310), Africa 837,158 (90% CI 283,087-1,388,963), and worldwide rabies 5,920,014 (95% CI 1,547,860-10,290,815). This was followed by echinococcosis, the zDALYs in Peru were 2238 (95% CI 1931-2546), in China 1490 (95% CI 1442-1537), and worldwide cystic echinococcosis 5,935,463 (95% CI 4,497,316-7,377,636). Then, the zDALYs on cysticercosis for Mozambique were 2075 (95% CI 1476-2809), Cameroon 59,540 (95% CR 16,896-101,803), and Tanzania 34,455 (95% CI 12,993-76,193). Brucellosis in Kazakhstan were 2443 zDALYs (95% CI 2391-2496), and brucellosis and anthrax in Turkey 3538 zDALYs (95% CI 2567-6706). Finally, zDALYs on leptospirosis in New Zealand were 196, and Q fever in Netherlands 2843 (95% CI 1071-4603). The animal burden was superior to the human burden in the following studies: worldwide cystic echinococcosis (83%), brucellosis in Kazakhstan (71%), leptospirosis in New Zealand (91%), and brucellosis, and anthrax in Turkey (52%). Countries priorities on zoonoses can change if animal populations are taken into consideration.

Economic and health burden of brucellosis in Kazakhstan.

Brucellosis is a widespread zoonotic disease considered as an emerging and re-emerging disease with a resulting threat of public health and animal health. Official reports document an animal incidence in Kazakhstan of about 0.6% per year, and the country still registers high number of human cases annually . The main objective of this paper was to evaluate the distribution and economic impact of brucellosis in Kazakhstan. We analysed human disease incidence data obtained from the Government Sanitary & Epidemiological Service with the aim to estimate the burden of disease in terms of disability-adjusted life years (DALYs). We also estimated the economic impact in terms of monetary losses. Additionally, we mapped the geographical distribution of the disease throughout Kazakhstan. In total, 1,334 human cases of brucellosis were registered in 2015 in Kazakhstan that resulted in 713 DALYs. Around $21 million was spent on compensation for animals that had to be slaughtered due to brucellosis, and an additional $24 million was spent on testing animals. Animal brucellosis and human brucellosis occur throughout the whole country, some trends of which are reviewed in this paper. We estimated the burden of the disease and explored possible explanation for high human incidence rates. This paper is the first to estimate the human burden of disease and the economic costs in Kazakhstan. Both of these are substantial.