Integrated assessment and management of pig health risks – lesson’s learnt

Kate Blaszak, Coordinator and Veterinarian SPSP.

AcknowledgementPresentation on behalf on two projects funded by

ACIAR and ILRI for Lao PDR.

Acknowledgement and thanks to LP and SKT provincial staff, CIAT, Laos partners from NAHC, DHP, NCLE, NAFRI and

Australian partners from AAHL, MORU.

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Outline

• Integrated Project - One health, One system• Integrated Health Risk Assessment

- Concept Planning, Methodology and Training• Integrated Heath Risk Management– Results, Interpretation and Interventions

• Discussion and Lessons • Other possible methods

One health, One system Original SPSP project integrated with EcoHealth – EcoZEID

SPSP Aim: to reduce risks and increase productivity associated with smallholder pig systems in Laos

– Many of the pig related zoonoses are clinically silent in pigs – they are not a direct risk to pig health but potentially to human health (JEV, HEV, T/C, Trichinella+)

– Project is Onehealth, also One system – interested in pig health and production risks in villages & market chains.

– Key clinical pig diseases of interest and impact suspectedCSF, PRRS, FMD, Erysipelas also Salmonella, endemic parasitism, possible multi-factorial lung, piglet diseases in addition to the infection status related to the above zoonoses.

Integrated Assessment of Pig Health Risks

• Planning concepts – One health, risk based questioning• Methodology and Training

– integrated training of human and animal health staff – integrated epidemiology – PPP approach from 2005 human census

so human centric sampling for human and pig disease exposure – integrated system for village data collection– participatory village mapping for health risks (SPSP)– integrated laboratory training and testing for exposure– integrated analysis of crude seroprevalence and health risks

* health risk assessment for actors further along the market chain yet to be done

PPP: Villages are randomly sampled but weighted by human population

2 ECOZEID Provinces – each30 Villages x15 Humans15 Pigs

8 SPSP Villages- Also PPP by village HH number

Survet for integrated questionnaire development, data entry and web storage – www.quest.survet.net concept designed by Peter Durr of

Staff training and village data collection

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Integrated assessment for results of over 700 pig and 1000 human samples

– integrated and contextual results EcoZEID and SPSP– crude seroprevalence (village and provincial)– looking for associated zoonotic, pig health risks– village mapping (perceived and possible geospatial

disease risks)– challenges-interpretation and validation of some

tests in field situation (eg. HEV pigs), retest to confirm some hotspots (T/C) and specificity (JEV)

Human and Pig Hepatitis E Sero-prevalence Results

Human Prev 61.4% Pig Prev 64.0%

Human and Pig Trichinella Sero-prevalence Results

Human Prev 47.3% Pig Prev 13.2%

Some zoonotic risk resultsDisease exposure to humans and pigs (overall crude seroprevalence)

Apparent risk factors from data for increased sero +

Odd’s Ratio (and 95%CI)

Comments and Interventions- Management

HEVHumans:61.4% TBC

Pigs(64%)

<50m from pigsLower education levelUsing non-bottled or non-boiled waterNot using toilets

Pigs E+ also likely HEV sero+Penned pigs in wet or dry season

2.12(1.72,3.00)1.74(1.27, 2.39)

4.01(1.87,8.56)1.77(1.34,2.35)

2.56 (1.87,3.10)

2.70(1.72,4.23)

But clinical human HEV? Sero+ appears independent of owning pigs! Unusual.Clear link and need for water and sanitation mgt – explore constraints, educational campaign. Also would benefit T/C reduction in contamination.Explore possible increased susceptability if pregnant.

Explore the Erysipelas/HEV possible link or not?Explore significance of penning and HEV?

TrichinellaHuman(47.3%)

Pigs (13.2%)

Hmong more at riskLao Loum more at risk

Pigs in Sanam (why?)

1.77 (1.00, 3.12)1.53(1.14, 2.06)

2.12(1.18, 3.82)

Consistent with prior ACIAR project. As was higher education level. What practices or point of the pork chain convey the greatest risk, why are some villages hot spots (ethnicity, other practices?) – how best to target intervention?Data did not show reduced risk from cooking pork!Why? Contamination post cooking? Fermented sausage. More rats in sanam- abherrant?

Taenia (4.7%) and Cysticercosis solium (2.9%)

JEV also…..Human IgM (4.4%)Pigs IgG (75.2%)Pigs IgM (8.5%)

Not using toilets 2.65(1.37,5.12) Clear link with lack of toilet use. Some village ‘hot spots’- why?MGT need for hygiene and sanitation behaviour changeJEV human confirmatory testing – but apparently relatively low seroprevalence of new infections. GOOD mosquito use already found. Pregnancy a known risk factor as is lower age for clinical infection.

Pig CSF Sero-prevalence Results Pig CSF Prev 10.3%

Pig PRRS Sero-prevalence Results

Pig PRRS Prev 8.2%

Pig Erysipelas Sero-prevalence Results

Pig Erysipelas Prev 47.5%

Some pig health and production risk results….also FMD, others

Disease exposure to pigs (overall crude seroprevalence)

Apparent risk factors from data for increased sero +

Odd’s Ratio (and *95%CI)

Comments and Management - Interventions

Erysipelas (47.5%) Wet season pigs in enclosures > pensDry season pigs in enclosures > = pens

5.05 (1.74, 14.69)*

5.21 (1.81, 16.06)*

Significance ? Enclosures with dirt/mud floors increase exposure to Erysipelas a soil borne organism? Clinical significance of Erysipelas in moolaht? Syndromic and further incidence monitoring could be useful. MGT: Consider balance of pen/enclosure use – NB. Higher risk of HEV with penned pigs.

CSF (10.3%) Vaccination at 6 monthly clearly Vaccination 12 monthly No access to sanam**

10.76(3.65, 31.73)*7.40 (3.18, 16.68)*

2.89(0.89,9.4)*

Note- recently introduced pigs were not associated with increased CSF sero+ levels (in this case/survey) ie. not vaccinated or not exposed prior to introduction. MGT: biosecurity education and CSF vaccination already conducted, being assessed

PRRS (8.2%) Sanam not protective nor risk.

Needs more analysis?

This project clearly shows exposure in moolaht & cross pigs and subsequent HP PRRS outbreak in Mai district confirms clinical impact in at least 2 villages. MGT: TBC, biosecurity and movement restrictions? education, possible vaccination

(SPSP) B.Houayloun – suspected risks ?

Village entrance – few pens may reduce biosecurity risk?

Pig pens mostly concentrated in village on periphery or near stream facilitates pig disease transfer but may reduce human infections.

pig pens near river and vegie gardens so may increase HEV risk

Few pig pens near village entrance

Integrated management of pig health and zoonotic risks

• Interventions by *DAFOs and DHOs, supported by PAFOs and PHOs, VVWs, VHWs and NAHC, DHP ……PMC etc

• One Health opportunities – disease investigation, vaccine storage and delivery, education, monitoring

• Zoonotic risk reduction interventions – Sanitation, consumption and vector prevention – education and behaviour change, reducing humane and pig reservoirs of disease where relevant (human taenia carriers, piga with trichinella infection, pen location and HEV?)

• Integrated pig nutrition, health, production solutions for a one system approach

• Pig health and production – interventions and monitoring – initial focus on grower pigs*– CSF vaccination intervention– PV seroconversion, pig mortality, dynamics and growth monitoring– Disease outbreak investigation, pathology and response, prevention– Housing and management training, design, implementation– Forage and nutrition interventions– Economic GMA

Reduce pig disease risk, transfer and impact

Integrated pig management 5 ‘principles of successful livestock management’ Ref: Varney – ACIAR 2008, 5 freedoms – FAWC, 1996.

Suitable shelter, space, bedding –

comfortable resting area.

Fresh Water ad lib and suitable diet – for health, production

and growth

Management and handling

in a stress free manner

Freedom from pain, injury

and disease - prevention,

rapid diagnosis and

treatment

Appropriate breeding

strategies (and ability to conduct normal

behaviours)

we need…………

The challenge – working with farmers to design housing as needed with available resources in

villages* and projectThe need Available in village Possible project contribution

Adequate space (and location)

Mostly – focus on size, room for all needs

Technical – design with farmers. Consider if location important?

Shelter and shade Yes – focus on shade Checking, importance. Heat stress reduces growth.

Flooring Yes – avoid bamboo slats, design to facilitate easy mgt

Technical- part solid/slatted, part raised? Cleaning?

Substrate, farrowing and piglet creep areas

Yes -Rice hulls, or straw, even banana leaves for farrowing sows. Small creep area.

Facilitate discussion on benefits, options, feasibility.Technical design input.

Water and feed systems – all access

Yes simple – gravity system consider cost share.

Discuss challenges. Provide nipples, piping if want.

Handling, holding Yes – but not currently Technical – slide in gate/ board….? Think!!!

Lessons and other options for integrated assessment

• One health, One systems – training, time, silver bullets?• Build in time, expertise for complex statistical analysis• Review existing records, systems (NCLE) more, gap analysis

and capacity building for sustainable disease surveillance• Syndromic assessment and monitoring approaches

– Within recall time frames maybe quite reliable– Action research

• Qualitative and Quantitative risk assessment by matrix – exposure risks (likelihood) and disease consequence (impact)

• Options yet to think of………

Lessons and other options – integrated management of health risks

• Interventions by risk score and achievability (matrix?)• Consult well with interested farmers, convey the benefits, incentives & listen!• Integrate management of pig health risks along the market chain*• How to best work with, incorporate the sanaam, a traditional ‘biosecure’ measure?• Plan and communicate well internally, consult for good educational approaches• Consulting, integrating with other projects or NGOs for effective solutions• Greater consultation and integration with village policy and management• Integrate with existing systems, HH/ PH vaccination and education interventions?• Endorsement by local Governors• Build links for scaling out – Learning Alliance• Only the start……..initial zoonotic interventions pending• Much more to learn!

Thanks to the teams and partners who contribute to these projects. Any questions?

(extra) Summary crude seroprevalence ILRI provincial survey, ACIAR SPSP survey

(extra summary SPS seroprevalence results)Village Name Village code PRRS IgG CSF IgG HEV Ig total Trich IgG Erysipelas IgG JEV (Ig total) JEV (IgM) FMD 3 ABC FMD O FMD A FMD Asia 1

B. Pakxang 801021 6.67 0.00 63.30 33.33 43.33 80.00 10.00 0.00 0.00 0.00 0.00

B. Nongnong 801050 0.00 *55.56 77.78 66.67 77.80 77.78 22.22 0.00 0.00 0.00 0.00

B.Houaykeng 801039 10.00 0.00 80.00 10.00 40.00 60.00 10.00 0.00 0.00 0.00 0.00

B. Houayloun 801049 4.55 0.00 77.27 22.73 68.18 59.09 0.00 4.55 0.00 0.00 0.00

District Ave   5.63 7.04 70.42 30.99 54.93 70.42 8.45 1.41 0.00 0.00 0.00

total +/total samples                    

B. Ompalou 202025 6.67 0.00 60.00 26.67 46.70 80.00 0.00 6.67 6.67 0.00 0.00

B. Omkaneng 202019 9.10 9.10 90.90 0.00 72.70 81.80 0.00 0.00 27.30 0.00 0.00

B. Sophoun 202003 12.00 4.00 88.46 12.00 76.00 84.62 0.00 0.00 40.00 0.00 0.00

B. Poungkhao 202128 0.00 0.00 100.00 16.70 50.00 16.67 0.00 0.00 0.00 0.00 0.00

District Ave   8.33 3.33 83.33 15 63.33 76.67 0.00 1.67 25.00 0.00 0.00Comments: sample taken Oct 2011, end of rainy season

newly found in moolaht

* known vaccinated

Zoonotic relevance?

Risk for consumption

first time tested, clinical relevance?

Phong Khao low - why?

IgM: new infections Nongnong high, why? Many inconclusive results

Many inconclusive results: retest?

High Omkaneng and Sophoun (on main road).Phong Khao FMD 2010, pig turnover?

as expected, Khounsy & Conlan 2008

as expected, Khounsy & Conlan 2008

   

Average for whole sample 6.87% 5.34% 76.34% 23.66% 58.78% 73.28% 4.58% 1.52% 11.36% 0.00% 0.00%

Comparative LP Province 11.48% 7.54% 82.95% 13.77% 67.21% 76.39% 12.46% 1.31% 5.25% 0.98% 0.33%

Note: ACIAR samples are moolaht only.LP included moopan