Prevention of sanitary risks linked to rodents at the rural/peri-urban interface in southeastern Africa: Overview and outcomes of the RatZooMan project Dr Steven R. Belmain and colleagues Natural Resources Institute, University of Greenwich, Central Avenue, Chatham Maritime, ME4 4TB, United Kingdom T: ; F: ; E:

The RatZooMan Project A competitively won research project funded by the European Commission INCO-DEV programme through the theme of water and sanitation. €1.45 million over three years. Proposal developed in January 2001, submitted September 2001, notified of success in January 2002, contract negotiations complete October 2002, project officially starts January 2003, funds received February 2003, project activities start March 2003, project completed in June 2006.

Project focuses on public health risks of rodents as disease vectors and the role they play in the spread and transmission of many diseases, but particularly on plague, leptospirosis and toxoplasmosis. Rodent (RAT) ZOOnosis MANagement to huMANs The RatZooMan Project

 Changes in rural ecology could make previously rare diseases become more common  Increasing connectivity between rural and urban areas could allow these diseases to reach cities  Deteriorating hygiene and increasing urban rodent pests could facilitate these diseases spreading and persisting in cities The RatZooMan Project

 Develop new insights on the risks to public health caused by rodents living in close association with humans in rural and peri- urban areas of south-eastern Africa  Apply this information for the development of risk-management strategies The RatZooMan Project

 Urbanisation  Climate change  Increased connectivity  Rural expansion  Sanitation The RatZooMan Project

Increase understanding of zoonosis prevalence in rural and peri-urban areas and the impact of agro-ecological and anthropogenic factors on disease transmission pathways Establish the impact of rodent-borne diseases on people’s livelihoods Raise the profile of the effects of rodents on people's health Expected outcomes

Inform and influence policy formulation at government, institution and community levels Provide potential risk reduction strategies that can be used to reduce the impact of zoonotic diseases Create predictive and simulation modelling tools to measure the threats of zoonotic disease Expected outcomes

Organisation United Kingdom – lead Natural Resources Institute Belgium University of Antwerp Netherlands Royal Tropical Institute Denmark Danish Pest Infestation Laboratory

Organisation Tanzania Sokoine University of Agriculture Mozambique National Institute of Health National Veterinary Research Institute Zimbabwe Syngenta Plant Protection Research Institute Harare City Health South Africa National Institute for Communicable Diseases ARC-Plant Protection Research Institute Durban Natural Science Museum

Geographic Information System (GIS) WP 8 Predictive Model WP 9 Control strategy WP 10 Land and water factors WP 5 Anthropogenic change factors WP 7 Disease ecology Epidemiology WP 1 & 3 Rodent ecology WP 4 Rodent taxonomy WP 2 Workshop WP 12 Validated tool kit Policy document WP 11 Socio-economic impact and livelihood constraints of disease WP 6 Output dissemination and project co-ordination WP 13

The RatZooMan Information System

Land Use Changes

Plague No serological or molecular detection of Yersina pestis in animals (rodents, dogs) inside or outside of plague foci Serological detection in human samples collected from plague-endemic foci in Mozambique +1.1% (4 out of 373 human samples from Morrumbala District, Zambezia Province +2.3% (9 out of 397 human samples from Mutarara District, Tete Province

Leptospirosis Human results LocationResults positive (Dri-Dot) Morrumbala, Mozambique (rural)51.2 % (191/373) Mutarara, Mozambique (rural)38.8 % (154/397) Morogoro, Tanzania (urban)8.7% (26/300) Mikumi, Tanzania (rural)24.5% (37/150) Durban, South Africa (urban)19.8% (43/217) Mbare, Zimbabwe (peri-urban)29.1% (16/55) Nkayi, Zimbabwe (rural)26.5% (13/49) Hatcliffe, Zimbabwe (peri-urban)20.2% (11/55) Total30.7% (491/1596)

Leptospirosis Rodent results LocationResults positive Mozambique20.6% (40/197) Tanzania10% (50/500) South Africa20.4% (331/1625) Zimbabwe35.5% (88/248) Total19.8% (509/2570) Evaluation was through a mixture of rapid tests, MAT, PCR, Isolation – results sometimes conflict Other animals (shrews, dogs, cats, pigs, sheep, goats) also showed high numbers of positives Serogroup Icterohaemorrhagiae appeared the most prevalent in all species

Modelling leptospirosis infection Holt, J., S. Davis & H. Leirs. (In press) A model of leptospirosis infection in an African rodent. Acta Tropica.

rodent population demography infection routes Juvenile (susceptible) Sub-adult (susceptible) Adult (susceptible) Juvenile (infected) Sub-adult (infected) Adult (infected) Leptospires in environment Juvenile (susceptible) Sub - adult (susceptible) Adult (susceptible) Juvenile (infected) Sub - adult (infected) Adult (infected) Leptospires in environment

Possible effects of rodent management of Leptospirosis risk Killing rodents reduces numbers AND prevalence Rodent killingReducing rodent habitat Prevalence Numbers Prevalence Numbers Strength of management intervention

Toxoplasmosis Never previously considered a threat to human health. However, If acquired during pregnancy there is risk of miscarriage, congenital deformity, encephaly or blindness Reactivation in immuno- compromised, i.e. organ transplants, HIV-AIDS

Toxoplasmosis

Recent surveys of AIDS patients in Maputo, Mozambique indicate 70-80% of patients have cerebro-reactivation (n=1500)

Toxoplasmosis Human results LocationResults positive Morrumbala, Mozambique51.2% (191/373 Mutarara, Mozambique38.8% (154/397) Masasi, Tanzania21.7% (13/60) Ndanda, Tanzania10.0% (3/30) Mtwara, Tanzania23.3% (7/30) Durban, South Africa35.0% (76/217) Mbare, Zimbabwe9.1% (5/55) Nkayi, Zimbabwe4.1% (2/49) Hatcliffe, Zimbabwe5.5% (3/55) Total35.9% (454/1266)

Toxoplasmosis Rodent results LocationResults positive Mozambique21.3% Tanzanianil South Africa15.2% Zimbabwe<1% Animal screening difficulties make these results unreliable

Socio-economic – education, wealth Anthropological – hunting, hygiene Ethno-ecological – concepts of disease Environmental – water sources, sanitation, housing Ecology – rodent species, land use, climate Identifying risk factors

How do we use ratzooman data? Integrating multidisciplinary data

Individual level Reduce contact with rodents Break transmission routes for diseases Community level (village or settlement) Education and information Organize water supply and waste removal Rodent control Governmental level (local, regional, provincial or other relevant authority) Monitoring, warning, education, training, information and funding Managing rodent-borne disease

1. How should we improve surveillance and monitoring of diseases and diagnostic capacities within African countries? 2.How can we influence national and international research priorities and funding opportunities to improve knowledge about rodent transmitted diseases? 3. How do we get Departments of Agriculture, Health and Environment working together to develop national rodent management strategies? 4. How can we improve clinical treatment, prevention and interventions against rodent-borne diseases? 5. How do we raise awareness about the risk of rodents transmitting diseases with the general public, service providers and the international community? Involving stakeholders

Achievements Data generation – new knowledge Scientific reports and publications Integrated data management system Popular publications Local government endorsement Government and public awareness Multidisciplinary research Networking, capacity building Benchmark project – global first

Further work to do Data analysis and interpretation Prioritised management options Identification of key risk factors Policy recommendations

Thank You