Analysis of the movement of live broilers in Guangxi, China and implications for avian influenza control.

Most Chinese provinces have a daily-updated database of live animal movements; however, the data are not efficiently utilized to support interventions to control H7N9 and other avian influenzas. Based on official records, this study assessed the spatio-temporal patterns of live broilers moved out of and within Guangxi in 2017. The yearly and monthly networks were analyzed for inter- and intra-provincial movements, respectively. Approximately 200,000 movements occurred in 2017, involving the transport of 200 million live broilers from Guangxi. Although Guangxi exported to 24 out of 32 provinces of China, 95% of inter-provincial movements occurred with three bordering provinces. Within Guangxi, counties were highly connected through the live broiler movements, creating conditions for rapid virus spreading throughout the province. Interestingly, a peak in movements during the Chinese Lunar New Year celebrations, late January in 2017, was not observed in this study, likely due to H7N9-related control measures constraining live bird trading. Both intra- and inter-provincial movements in March 2017 were significantly higher than in other months of that year, suggesting that dramatic price changes may influence the movement's network and reshape the risk pathways. However, despite these variations, the same small proportion of counties (less than 20%) exporting/importing more than 90% of inter- and intra-provincial movements remains the same throughout the year. Interventions, particularly surveillance and improving biosecurity, targeted to those counties are thus likely to be more effective for avian influenza risk mitigation than implemented indiscriminately. Additionally, simulations further demonstrated that targeting counties according to their degree or betweenness in the movement network would be the most efficient way to limit disease transmission via broiler movements. The study findings provide evidence to support the design of risk-based control interventions for H7N9 and all other avian influenza viruses in broiler value chains in Guangxi.

A mixed methods study of stakeholders' practices and attitudes on avian influenza H7N9 vaccination for the yellow broiler industry in Guangxi, China.

In response to a sudden increase in H7N9 human infections, China introduced an H5/H7 bivalent inactivated vaccine for poultry in Guangxi and Guangdong provinces in July 2017, which subsequently became integrated into the existing compulsory national H5N1 vaccination programme from September 2017. Although the vaccination programme effectively reduced H7N9 infections in humans and poultry, there are ongoing arguments against continuing this long-term vaccination. These discussions have drawn policymakers to think about the possibility of stopping routine vaccination for H7N9 avian influenza viruses (AIVs) in China; however, they have not considered the poultry industry stakeholders' practices on and attitudes towards this vaccination. This study investigated H7N9 vaccination practices in the yellow broiler industry in Guangxi and stakeholders' attitudes on H7N9 vaccination, using a mixed methods design. The study found H7N9 vaccination was well adopted in the yellow broiler industry in Guangxi regardless of the source of the vaccines. Most stakeholders believed vaccination was the best measure to control H7N9 and H5N1 AIVs, and they showed a strong willingness to continue with vaccination even without government subsidies or freely provided vaccines. The motivations by stakeholders for using vaccines to control H7N9 and H5N1 were different due to the epidemiological differences between the two strains. Understanding poultry industry stakeholders' practices and attitudes on H7N9 vaccination has important practical implications in planning vaccination policies, particularly when considering the possibility of vaccination withdrawal.

Value chain analysis of yellow broiler industry in Guangxi, China to inform H7N9 influenza control strategies.

Yellow broilers are the primary source of poultry consumption in China and the predominant trade of live poultry. However, knowledge of the value chain is limited, which is vital evidence for the effective control of H7N9 and other zoonotic avian influenzas. The aim of the study was to map the yellow broiler value chain in Guangxi Zhuang Autonomous Region, China and investigate its governance structure and practices relevant to the risk of H7N9 transmission. A value chain analysis was conducted in five areas of Guangxi from May to August 2018. To map the value chain, three focus group discussions (FGDs) were conducted and stakeholders, products and premises involved and their interactions were identified. Then, 55 key informant interviews (KIIs) collected qualitative data on stakeholders' profile, practices and interactions with other stakeholders and rules/norms that exist along the value chain. On-site observations were also carried out at different types of premises along the value chain to complement and validate findings of KIIs and FGDs. Participants were also asked to provide proportional estimates of each component in the value chain where possible. The qualitative data from FGDs, KIIs and on-site observations were analysed to create stakeholder profiles and a diagram of product flows and stakeholders' interactions. Thematic analysis was used to identify the governance structure of the value chains and practices relevant to the risk of H7N9 transmission. The stakeholders and premises involved in Guangxi yellow broiler production, wholesale and retail were described, as well as their interactions. Contract farming is extensively adopted in Guangxi; consequently yellow broiler grower companies are the dominant stakeholders. The trading platform was identified as a key premise linking farms and live bird markets. The thematic analysis highlighted poor biosecurity practices in different premises along the value chain, which was supported by on-site observations. The operation of trading platforms reported in this study presents a disease risk but is not considered in the current H7N9 control programs. The study suggested that biosecurity management gaps need to be addressed through government-industry partnerships that require engagement with private stakeholders in the planning and implementation of H7N9 control strategies incentivising participation of grower companies, wholesalers and retailers.

Vaccination demonstration zone successfully controls rabies in Guangxi Province, China.

BACKGROUND: Guangxi is the province most seriously affected by rabies virus (RABV) in China. Those most affected by RABV each year are people in rural areas, where dogs are the main cause of human infection with the virus. METHODS: In this study, we established a rabies vaccination demonstration program that included eradication, core, and peripheral areas. This program was implemented for 9 years and comprised three stages: 12 counties in the first stage (2008-2010), 21 counties in the second stage (2011-2013), and then extending to all counties of Guangxi Province in the third stage (2014-2016). The program included a dog vaccination campaign, surveillance of clinically healthy dogs who may be potential RABV carriers, monitoring anti-RABV antibody titers in vaccinated dogs, and compiling and reporting statistics of human rabies cases. RESULTS: The target effectiveness was achieved in the eradication, core, and peripheral areas in all three stages. The vaccination demonstration program successfully promoted RABV vaccination of domestic dogs throughout Guangxi Province by drawing upon the experience gained at key points. Compared with a vaccination coverage rate of 39.42-46.85% in Guangxi Province overall during 2003-2007, this rate gradually increased to 48.98-52.67% in 2008-2010, 60.24-69.67% in 2011-2013, and 70.09-71.53% in 2014-2016, thereby meeting World Health Organization requirements. The total cases of human rabies in the province decreased from 602 in 2004 to 41 cases in 2017. CONCLUSIONS: The present pilot vaccination program obviously increased the rabies vaccination and seroconversion rates, and effectively reduced the spread of rabies from dogs to humans as well as the number of human rabies cases, thus successfully controlling rabies in Guangxi.

Community-based interventions to enhance knowledge, protective attitudes and behaviors towards canine rabies: results from a health communication intervention study in Guangxi, China.

BACKGROUND: In China canine rabies poses a serious public health problem in that human mortality ranks the second highest globally. While rabies health education interventions are advocated by WHO to be critical components of modern rabies control and prevention programs, available studies have not adequately investigated the relative efficacy of their implementation in at-risk populations. This study aims to measure and compare the effect on knowledge and protective behavior towards rabies of health education interventions that include a novel Short Messaging Service via cell phone (SMS) and rabies health information sessions (IS). METHODS: The study used a between-subject design involving repeated measures of rabies-related KAP (knowledge, attitude and practice). A total of 350 randomly selected villagers were randomly allocated into three intervention (SMS, IS and SMS + IS) and one control group. The content of SMS and IS covered topics about rabies prevention and route of transmission. The SMS intervention consisted of ten separate messages delivered three times two weeks after the pretest; the IS intervention was conducted once immediately after the pretest. A validated questionnaire was used to capture demographic information and KAP information. Ordinary Least Squares regression was used to contrast the effects of interventions. RESULTS: Our results indicate that overall SMS outperforms IS at improving knowledge and protective behavior against rabies. Our results suggest that a combined intervention of SMS and IS can result in higher scores than any of the two in isolation. The impact of SMS, IS and SMS + IS is greatest on knowledge, followed by attitude and practice scores. CONCLUSION: This study demonstrated that health communication modes based on SMS, IS and a combination of the two are all effective to improve rabies-related KAP in the short term. These findings highlight the potential usefulness of SMS as an additional tool for public health communication and promotion; further studies are needed to investigate the long term benefits of these interventions on the reduction of dog bites and resulting human rabies incidence.