A qualitative assessment of disease surveillance activities in a resource-limited environment: Perceptions and opinions of volunteer staff working in Northern Uganda.

Annually, groups of health professionals from high-income countries are drawn to work in low- and middle-income countries (LMICs) through timed engagements intended to improve the well-being of people in most disadvantaged communities. The existing evidence on understanding volunteer experience in LMICs often focuses on activities within the medical discipline; whereas little research has been conducted on the experiences of volunteers in other disciplines. This paper focuses on understanding veterinary and public health professional's experiences conducting disease surveillance work in Northern Uganda. Forty US-based health care professionals were recruited to complete multiple-choice and open-ended questions to understand prior and current experiences working in resource-limited settings. Responses were coded using NVivo 10®, qualitative analysis package. Of the 44 volunteers, 50% completed the questionnaire. Responses were largely positive towards surveillance activities; they reported personal and professional gains, new cultural experiences and mutual learning environment with local colleagues. Nevertheless, respondents highlighted challenges during various stages of program implementation-some difficulty with program logistics, inadequacy of preparation materials, in addition to concerns inherent to working in a resource-limited environment. This assessment suggests that international volunteer work could positively influence programmatic outcomes, personal experiences, furthering health organizational goals, often achieved in a limited time-frame. To maximize volunteer impact, these assessments are critical and suggest that volunteer and institutional capacities should be seriously considered when planning placement as it can influence programmatic decision-making, gauge training needs and volunteer readiness.

Cattle-associated risk factors for human tuberculosis in rural livestock-keeping communities, Uganda.

Tuberculosis (TB) is a leading infectious cause of human death worldwide. In cattle, TB infection results in productivity losses, trade barriers and zoonotic transmission via milk, meat or direct contact. We conducted a cross-sectional study in rural communities in Uganda between 2014 and 2016 to evaluate the association between tuberculosis skin test (TST) positivity in humans and cattle-associated risk factors: household herd positivity and raw milk consumption. Human and cattle TSTs were performed in communities followed by a survey of household practices. TST data were available on 493 humans, 184 (37.3%) with positive results, and 1,441 cattle, 50 (3.5%) with positive results. We fit separate log binomial generalized estimating equation models for the herd positivity-human TST positivity association, stratified on sex; and for the raw milk consumption-human TST positivity association, stratified on frequency of milk consumption. Having at least one TST-positive bovid in the household's herd was significantly associated with lower risk of TB among men (prevalence ratio [PR] 0.66, 95% CI 0.49, 0.87) but was not significantly associated with TB among women (PR 1.21, 95% CI 0.76, 1.95). This apparent protective effect was contrary to our a priori hypothesis of higher exposure effect among men, the primary caretakers of cattle. This finding may be the result of residual confounding by socioeconomic status; wealthier individuals may be less likely to be TB positive, but more likely to have TST-positive herds by virtue of larger herd sizes, ability to purchase new and possibly infected stock, and propensity to keep more TB-susceptible European breeds. For raw milk consumption, effect estimates were close to one and not statistically significant. Thus, in settings where bovine TB prevalence is low, such as Uganda, cattle-associated zoonotic transmission may be rare, and cattle-associated risk factors may not be important drivers of human TB burden.

Effect of a monovalent vaccine against Leptospira borgpetersenii serovar Hardjo strain hardjobovis on fertility in Holstein dairy cattle.

OBJECTIVE: To determine whether vaccination with a monovalent vaccine against Leptospira borgpetersenii serovar Hardjo strain hardjobovis would improve reproductive efficiency in Holstein cattle in a commercial dairy setting. DESIGN: Randomized controlled trial. ANIMALS: 1,894 Holstein cows and heifers from a Central California dairy. PROCEDURES: Cattle were assigned to undergo SC administration of a monovalent vaccine against Leptospira borgpetersenii serovar Hardjo strain hardjobovis (n = 986) or a placebo (lactated Ringer's solution; 908). At the end of their lactation period, cows received 2 doses of the vaccine or placebo, 28 to 35 days apart, with the initial dose administered in conjunction with oxytetracycline. Heifers received the same treatments, with the second dose administered at least 2 weeks before their entrance into the heifer breeding pen. Urine and blood samples were collected from randomly selected cattle immediately before and 1 year after the trial began and submitted for fluorescent antibody and microscopic agglutination testing to identify any infecting Leptospira serovar. RESULTS: The initial herd prevalence of active infection with strain hardjobovis was 13% (6/46 tested cattle), followed by 15% (6/40) 1 year after the trial began. The odds of heifers conceiving over the period at risk for conception, regardless of vaccination, was approximately 2.8 times as high as for primiparous and pluriparous cows. Survival analysis of days from parturition to conception revealed that the vaccine protocol had no effect on the probability of conception between the vaccinated and control groups. The vaccine protocol had no impact on pregnancy loss. CONCLUSIONS AND CLINICAL RELEVANCE: The evaluated vaccination protocol against Leptospira strain hardjobovis was not effective in improving reproductive efficiency in commercial Holstein dairy cows or in decreasing urine shedding of leptospires.

Thallium toxicosis in a dog consequent to ingestion of Mycoplasma agar plates.

A 1-year-old dog ingested a mixture of blood agar and Mycoplasma agar plates. The Mycoplasma agar plates contained thallium acetate, which resulted in an estimated minimum dose of 5 mg thallium acetate/kg bodyweight. Clinical signs over the course of 2-3 weeks included vomiting, diarrhea, weight loss, alopecia, dysphonia, ataxia, paresthesia, intension tremors, megaesophagus with subsequent aspiration pneumonia, and several seizure episodes. The dog was treated with intravenous fluids and placement of a gastric feeding tube. Thallium concentrations in hair were 8.2 µg/g in samples taken on day 19, 16.4 µg/g in samples taken 3 months after exposure, 13.4 µg/g in samples taken 5 months after exposure, and nondetectable in samples taken 7 months after exposure. The blood thallium concentration was 190 µg/l on day 19 and nondetec table 3 months after exposure. Megaesophagus and dysphonia continued for 10 months after exposure. This case of thallium poisoning following ingestion of mycoplasma agar plates demonstrates that unusual sources of thallium still exist and suggests that thallium toxicosis should be included in the list of differential diagnoses in dogs presented with megaesophagus, especially if alopecia and other unexplained peripheral neuropathies are present. Hair and blood samples are useful specimens to reach an accurate diagnosis even if taken several weeks post exposure. The postexposure blood and hair thallium concentrations reported in this case are useful data for diagnosticians investigating dogs with potential thallium poisoning.