A cross-divisional department spanning

One Health Laboratory at Johns Hopkins University

Zoonotic Spillover Projects

World One Health Congress 2024

INGSA-Asia Guidebook on Countering Zoonotic Spillover in the Southeast Asia Region  

Abstract 1 

How Social Science Strengthens One Health: Promoting Participatory Approaches to Support the Iterative Development of a Guidebook on Countering Zoonotic Spillover in Southeast Asia, 2022-2024 

Eri TOGAMI 1 , Audrey THÉVENON 2 , Elson Ian Nyl GALANG 3 , Jeffrey PETERSON 4 , Hazel Yean Ru ANN 5 , Kelvin LIM 6 , Carmen SHAW2 , Nancy CONNELL 2 , Abhi VEERAKUMARASIVAM 7 , Meghan DAVIS 1 1Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, United States of America (USA); 2National Academy of Sciences, Engineering, and Medicine, USA; 3Department of Natural Resource Sciences, McGill University, Montreal, Canada; 4School of Public and Community Health Sciences, University of Montana & Community Engagement and Outreach Core, Mountain West Clinical Translational Research Infrastructure Network (MT CTRIN), USA; 5 International Network for Governmental Science Advice - Asia Chapter (INGSA-Asia), Malaysia; 6Ministry of Health, Singapore; 7Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia 

Background: Southeast Asia (SEA) is a hotspot for emerging zoonoses. The region is diverse and complex in culture, agricultural and trade practices, animal handling techniques, legislation, and resource distribution, which influences the spread of zoonoses among humans, animals, and their shared environment. Understanding these contexts is essential and requires the participation of relevant actor groups. While there is guidance around operationalizing One Health (OH) at the national level, there is less attention to theory-informed participatory approaches to aid the implementation of recommendations for behavior change. Our objective is to share how social sciences supported the iterative development of a culturally relevant guideline for zoonotic spillover prevention in SEA. 

Methods: The International Network for Governmental Science Advice Asia and the United States National Academies of Sciences, Engineering, and Medicine convened a team of over 75 experts from government, non-profit organizations, and academic institutions across 11 SEA countries. The goal was to develop a guideline for preventing and mitigating zoonotic spillover. Members represented sectors including wildlife conservation, virology, public health, veterinary medicine, and ecology, amongst others. Additionally, a sub-team of social scientists convened to create an open and engaging environment for diverse actor groups by drawing methods from participatory research, implementation science, and a systems approach. 

Results: Developing the guideline was an iterative process, culminating in a series of workshops in 2023. Organizers brought on new experts at each meeting, virtual or in-person, to fill knowledge gaps. Participants role-played actor groups including academic institutions, private industries, local and national governments, and civil society to understand their interests, goals, challenges, and barriers to implementing the guidebook recommendations. Facilitators collected participants' negative and positive feedback and adapted the workshop in real-time, to optimize participant engagement. For example, when non-native English speakers and less outspoken participants seemed less engaged, facilitators shifted to written brainstorming and reflection exercises. This shift enabled them to fully contribute to fast-paced discussions regardless of their perceived or practical conversational barriers. Sharing knowledge in this way elevated discussions of addressing zoonoses in communities and demonstrated how local authorities could benefit from considering the individual, interpersonal, organizational, community, and policy-level contexts. Furthermore, discussions shed light on factors that influence the adoption of behavior change, underscoring the importance of simplicity, observability of impact, and alignment with existing habits and customs. 

Conclusions: This process illustrates how a blend of methodologies, including participatory research, implementation science, and other social sciences can improve the uptake of spillover prevention methods. Participatory approaches help engage diverse actor groups toward a collective vision, which ensures a holistic and context-specific process with local ownership and practical applicability. Attendees of this presentation will learn about participatory exercises they could adapt to address their own OH challenges.

Abstract 2

Evaluating the United States response to the H5N1 avian influenza outbreak in humans and animals, 2024

Meghan DAVIS1, Teri SCHLANSER1, Claire STANDLEY2,3, Ellen CARLIN4, Eri TOGAMI1, Nur Firdaus ISA5, Nancy CONNELL6, Audrey THEVENON6, Monica SCHOCH-SPANA1, Erin SORRELL1

1Johns Hopkins Bloomberg School of Public Health, United States of America; 2Georgetown University, United States of America; 3Heidelberg Institute of Global Health, University of Heidelberg, Germany; 4Parapet Science and Policy Consulting, United States of America; 5International Islamic University Malaysia, Malaysia; 6National Academies of Sciences, Medicine and Engineering, United States of America

Background: The ongoing outbreak of H5N1, a highly pathogenic strain of avian influenza (HPAI), in United States (U.S.) dairy cows is an important test case for One Health surveillance efforts supporting spillover detection and response.

Methods: This report evaluates response efforts using existing frameworks for risk-based surveillance recently adapted by global experts via an International Network for Governmental Science Advice (INGSA)-Asia and National Academies for Sciences, Engineering and Medicine (NASEM) collaboration. The framework highlights opportunities for participatory approaches to evidence-based decision-making and resource prioritization during spillover events.

Results: U.S. authorities tracked H5N1 HPAI cases in poultry, wild birds, and sporadic mammals since late 2021. In February 2024, Texas veterinarians identified symptoms in lactating dairy cows, later confirmed as H5N1 clade 2.3.4.4b. By early April, seven Texas herds and four in other states were confirmed infected. Sequence data implicates a single spillover event into dairy cows in late 2023. U.S. Department of Agriculture (USDA) epidemiologic data indicate cow movement, shared equipment, and shared personnel among dairy farms contributed to transmission.

Despite mandatory testing prior to interstate cow movement (implemented in April), by early August, 13 workers and 178 dairy farms across 13 states were confirmed infected, including nearby poultry facilities, some large-scale (>1 million birds).

U.S. human influenza surveillance relies on established networks for passive case reporting, syndromic surveillance, laboratory surveillance, and active wastewater testing. The H5N1 outbreak prompted active symptom monitoring and testing of symptomatic exposed dairy and poultry workers, with sequencing of identified viruses. However, early delays in public publication of data sequences hampered scientific evaluation by academic and global partners. Wastewater surveillance has been challenged by the heterogeneity of wastewater systems (some permit wild bird contamination) and by affected populations (rural populations not on municipal systems). Engagement of immigrant/migrant worker populations are impacted by communication divides, gaps in access to healthcare, and vulnerable employment—although recent U.S. Centers for Disease Control and Prevention (CDC) efforts to fund partner groups may hold promise.

Conclusions: The federalist division of authority between national and state governance hinders a U.S. national response reliant on state cooperation and voluntary farm participation. By early August, CDC human serosurveillance only had been performed in two states; national-level active surveillance was limited to USDA-mandated testing for interstate cow movement. Given the diversity and regional differences of U.S. dairy production, lack of coordinated and timely reporting results in major gaps in surveillance critical to global efforts to limit spread. Extant One Health governance constructs in the United States—including offices, strategies, and frameworks—are insufficient to overcome established questions regarding authorities and rights. One Health actor groups can leverage this event to strengthen structures for agency coordination, foster participatory surveillance, and promote data sharing using integrated, evidence-based, multi-disciplinary approaches. 

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