Epidemiology Policy

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H.E. Mr. Abdul Rauf Ibrahimi, Speaker/Leadership 

Wolesi Jirga (House of the People of Afghanistan)

Kabul, Afghanistan Feb 17 2019

POLICY BRIEF PLAN FOR THE ESTABLISHMENT OF A NATIONAL SURVEILLANCE SYSTEM TO SUPPORT EARLY DETECTION, PREVENTION AND CONTROL OF BRUCELLOSIS IN AFGHANISTAN:

Brucellosis is an endemic disease in Afghanistan, yet an overall systemic disease surveillance data of the country is missing to successfully implement the preventive and control measures to reduce the level of disease exposures among the human and animal populations. Brucellosis is an infectious disease caused by a group of bacteria from the genus brucella, whose host is animals. The infection in human can transmit through the direct contact with infected animals or indirectly by ingestion of dairy products and by inhalation of airborne agents. Another major source of infection is through the consumption of unpasteurized animal products. More than 500,000 people are affected by Brucellosis each year worldwide (Saeed K. 2014), which makes the disease a major health concern for the people and an economic burden for Afghanistan. The Brucellosis is a zoonotic disease that has attracted the attention of health organizations across the world. The major challenges to this problem are lack of intervention methods due to inaccuracy in data, collaborations among the stakeholders and awareness raising at the community health workers level. This policy plan aims to help prevent the increasing spread of brucellosis disease among human and animal populations in Afghanistan. The program will work with relevant agencies to strengthen the disease early warning systems to improve the disease prevention and control methods in Afghanistan. The preventative strategies will help minimize the spread of the infectious disease within the targeted populations. Thus, reducing the incidence of the infectious pathogens in nature as well as reducing the incidence of zoonotic diseases in Afghanistan. Moreover, the program can support stability and security by increasing animal production and yield, which enhances food security and economic stability. Stable populations are more resistant to coercion.

Brucellosis in animals causes a decrease in milk production, stillbirth and abortion. The people in Afghanistan are dependent on the livestock production. This poses a problem for their livelihood (Khan, 2017). The disease also threatens trade of animal products that later lead to poverty among the livestock rearing families. This brings the burden of disease to the people especially the farmers and frontline community health workers who rarely consume these products but the daily care for animals increases their chances of exposure to the disease (Grace, D. 2015).

There is a lack of improved infrastructure for disease early detection, prevention and control methods in Afghanistan. This has been contributing by inadequate knowledge and ignorance about the infectious diseases and an inappropriate surveillance system to collect systematic data for analysis and interpretation purposes, which integrates with the timely dissemination of these data to those responsible for preventing and controlling disease.  For instance, there is no active or passive surveillance data available to present the total number of infected animals with brucellosis in country; thus, intervention methods such as implementation of welfare slaughter of livestock in emergencies to prevent the spread of disease is impossible. Seclusion and quarantine of the animals that are infected is one of the best prevention method. Sanitation, disease surveillance and the field biosecurity can be applied in the prevention of infected herds (Jones, Dewell & Davis, 2018, pp. 233-248). However, disease surveillance and monitoring for symptoms in Afghanistan are deficient and cannot support the health regulatory bodies with accurate “passive surveillance” data to ensure appropriate quarantine procedures have been implemented and those with certain infectious diseases have not been distributed to the local markets and the farmers for production and consumption.

In order to ensure a valid and sustained disease reporting system exists that ultimately communicates a timely result of brucellosis outbreaks for the prevention and control actions; the implementation of an enhanced national surveillance system in the country is highly required. Thus, policy plan requests the Wolesi Jirga for a 2 million USD funds allocation to support the establishment of a national surveillance system and strengthening collaborations and coordination among the public and animal health sectors. With the allocated funds by Wolise Jirga, the policy plan will expand on building the public and animal field units’ capacity to respond to zoonotic diseases incidence and risk events. The policy plan will also support creation of a zoonotic diseases committee between the public, animal health as well as the border protection agencies for a sustainable collaborations and an approach to prevent and control the brucellosis in Afghanistan.

The diversion of focus by the Afghan government on a different program other than empowering national surveillance system and strengthening collaborations and coordination among public and animal health sectors may lead to insufficient funds for the early disease detection, prevention and control programs for brucellosis in Afghanistan. In case of a possible diversion, the policy plan proposes to work collectively with the govenrmental instituations to seek funds from the national and international health organizations such as the Health Protection and Research Organization, World Organization for Animal Health, World Health Organization, Dutch Committee for Afghanistan, as well as the US Center for Disease Control to support this program. This would ensure that the policy plan has reached its goal and objectives in establishing the national surveillance system and has build required capaciies within the public and animal health communities to prevent and control infectious diseases in Afghanistan.

Looking forward to your approval!

Yours sincerely,

References

Akbarian, Z., Ziay, G., Schauwers, W., Normal, B., Saeed, I., Qanee, A. H., ... & Jackson, R. (2015). Brucellosis and Coxiella burnetii infection in householders and their animals in secure villages in Herat Province, Afghanistan: a cross-sectional study. PLoS neglected tropical diseases, 9(10), e0004112.

Amiri, W. (2016). Early Warning System for Priority Infectious Diseases in Afghanistan: Analysis of Nine Years Data, 2007-2015. MEDICAL JOURNAL (GMJ), 1(007), 75.

Grace, D. (2015). Zoonoses of poverty: Measuring and managing the multiple burdens of zoonoses and poverty. In Zoonoses-Infections Affecting Humans and Animals (pp. 1127-1137). Springer, Dordrecht.

Khan, A. Q., Haleem, S. K., Shafiq, M., Khan, N. A., & ur Rahman, S. (2017). Seropositivity of brucellosis in human and livestock in Tribal-Kurram Agency of Pakistan indicates cross circulation. The Thai Journal of Veterinary Medicine, 47(3), 349.

Rossetti, C. A., Arenas-Gamboa, A. M., & Maurizio, E. (2017). Caprine brucellosis: A historically neglected disease with a significant impact on public health. PLoS neglected tropical diseases, 11(8), e0005692.

World Health Organization. (2017). Joint external evaluation of IHR core capacities of the Islamic Republic of Afghanistan: mission report 4-7 December 2016 (No. WHO/WE/CPI/REP/2017.43). World Health Organiza Saeed, Islam & Ansari, J &

Asghar, Rana & Ahadi, J. (2012). Concurrent brucellosis and Q fever infection: A case control study in Bamyan Province, Afghanistan in 2011. International Journal of Infectious Diseases. 16. e37. 10.1016/j.ijid.2012.05.094. tion.

Saeed, K., Ahadi, J., Sahak, M. N., Ghiasi, A. F., & Ashgar, R. J. (2014). Concurrent Brucellosis and Q Fever Infection: a Case Control Study in Bamyan Province, Afghanistan. Central Asian journal of global health, 2(2), 58. doi:10.5195/cajgh.2013.58

Jones, A. L., Dewell, R. D., & Davis, J. (2018). Cattle Assessment On-Site During Emergencies. Veterinary Clinics of North America: Food Animal Practice, 34(2), 233-248.