The first-ever road map to combat animal tuberculosis (bovine TB) and its transmission to people — referred to as zoonotic TB — most often through consumption of contaminated untreated meat or dairy products from diseased animals, calls for close collaboration between those working to improve human and animal health.
The road map is built on a One Health approach, addressing health risks across sectors.
The Roadmap for Zoonotic TB was launched Oct. 12 at the 48th Union World Conference on Lung Health taking place in Guadalajara, Mexico, this week. Four health partners — the World Health Organization (WHO), the World Organization for Animal Health (OIE), the U.N. Food & Agriculture Organization (FAO) and the International Union Against Tuberculosis & Lung Disease (The Union) — have joined forces to develop the road map and address the major health and economic impacts of this disease.
New data released by WHO estimates that more than 140,000 people fall ill and more than 12,000 people die each year from zoonotic TB, mostly in Africa and Southeast Asia.
"We have made progress towards ending TB, yet to a large extent, people with zoonotic TB are left behind. The priorities outlined in this road map highlight the need for multisectoral action to tackle this neglected form of TB and achieve the targets of the U.N. Sustainable Development Goals and WHO's End TB Strategy," said Mario Raviglione, director of the WHO Global TB Program. "Together, we can save lives and secure livelihoods."
Bovine TB is most often spread to people through food consumption, usually of non-heat-treated dairy products or raw or improperly cooked meat from diseased animals. Direct transmission from infected animals or animal products to people can also occur.
"This multidisciplinary road map represents a milestone in the fight against TB in both people and animals," said Paula I Fujiwara, scientific director for The Union. "Better technologies, better science and better governance for affected communities bearing the bovine TB burden in poorer rural areas must become the new mantra if we are to get on the path to eliminating TB absolutely everywhere."
However, zoonotic TB is largely hidden. The advanced laboratory tools are required to diagnose zoonotic TB are frequently unavailable. The disease is resistant to pyrazinamide — one of the standard first-line medications used to treat TB. Patients are, therefore, often misdiagnosed and may receive ineffective treatment.
"We must recognize the interdependence of the health of people and animals in the fight against TB. Specifically, bovine TB, caused by Mycobacterium bovis, affects cattle, threatens people's livelihoods and results in major economic and trade barriers, as well as posing a major risk to food safety and human health," said Berhe Tekola, director of the FAO Animal Production & Health Division.
10 priority actions
The road map, supported by the four partners, articulates 10 priority actions the human and animal health sectors should take and defines milestones for the short and medium term:
Improve the evidence base
1. Systematically survey, collect, analyze and report better-quality data on the incidence of zoonotic TB in people, and improve surveillance and reporting of bovine TB in livestock and wildlife.
2. Expand the availability of appropriate diagnostic tools and the capacity for testing to identify and characterize zoonotic TB in people.
3. Identify and address research gaps in zoonotic and bovine TB, including epidemiology, diagnostic tools, vaccines, effective patient treatment regimens, health systems and interventions coordinated with veterinary services.
Reduce transmission between animals and humans
4. Develop strategies to improve food safety.
5. Develop the capacity of the animal health sector to reduce the prevalence of TB in livestock.
6. Identify key populations and risks pathways for transmission of zoonotic TB.
Strengthen intersectoral collaboration
7. Increase awareness of zoonotic TB, engage key public and private stakeholders and establish effective intersectoral collaboration.
8. Develop and implement policies and guidelines for the prevention, surveillance, diagnosis and treatment of zoonotic TB, in line with intergovernmental standards, where relevant.
9. Identify opportunities for community-tailored interventions that jointly address human and animal health.
10. Develop an investment case to advocate for political commitment and funding to address zoonotic TB across sectors at the global, regional and national levels.
Many of these recommended interventions for controlling bovine and zoonotic TB will also bring substantial benefits for the prevention of other zoonotic and foodborne diseases 1 for example, those caused by brucella.
The effects of zoonotic TB extend beyond human health. OIE deputy director general for international standards and science Matthew Stone noted, "Preventing and controlling bovine TB at its animal source is crucial to avoid its transmission to humans, improve food safety and protect the livelihood of many rural communities. To this aim, the implementation of strategies based on international standards and a cross-sectorial approach will enable improved surveillance and diagnosis of the disease in animals and, consequently, reduce the risks for humans."
Bovine TB also threatens animal welfare and those with livelihoods based on livestock. The disease can economically devastate cattle production, with losses related to animal production, markets and trade, as well as costs incurred to implement surveillance and control programs. In order to eliminate the disease, livestock found to be infected with bovine TB must be slaughtered under veterinary supervision.
Wealthier countries are affected as well. In the U.S., more than $200 million in emergency funding were required between 2000 and 2008 to respond to bovine TB outbreaks. Wildlife can also be infected and serve as a reservoir of infection for livestock and people. This can potentially threaten wildlife conservation efforts.
The road map is a critical call for action to energize the response and the resources urgently needed to tackle zoonotic and bovine TB, the organizations concluded.