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CHAPTER SIX
ONE HEALTH SURVEILLANCE

November, 2023 Yohannes Mulugeta

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One Health surveillance
 One Health surveillance describes the systematic collection,
validation, analysis, interpretation of data and
dissemination of information collected on humans, animals
and the environment to inform decisions for more effective,
evidence- and system-based health interventions.
 One Health surveillance
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 Public health surveillance is “the ongoing, systematic collection,

analysis, and interpretation of health-related data essential to
planning, implementation, and evaluation of public health
practice.

 The central concepts on surveillance have overlapping meaning

and practical application across human and animal health.
 One Health surveillance
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 Public health surveillance in humans and veterinary animals

involves three main categories:
 Endemic diseases
 Exotic diseases and
 Emerging diseases.
 One Health surveillance
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 Endemic diseases are present in a population continuously and

maintain a baseline level.
 Exotic diseases are not present in the population under surveillance
due to control measures or eliminated.
 Emerging diseases increase in time and geographical range.
 Nipah virus, Avian influenza or West Nile virus

 Public health surveillance systems utilize various data sources,

stakeholders, and procedures, ranging from manual to electronic
systems.
 Concepts and definition of One Health
surveillance
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1) Active and passive surveillance

2) Compulsory and voluntary surveillance
3) Comprehensive and sentinel surveillance
4) Syndromic surveillance
5) Participatory surveillance
6) Risk-based surveillance
7) Pathogen surveillance
8) Epidemic Intelligence
 1) Active and passive surveillance
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 Public health surveillance systems utilize various data sources,

stakeholders, and procedures, ranging from manual to electronic
systems.
 Data collection and reporting categorize surveillance as active or
passive.
 Passive surveillance is a common method used to detect and report clinically
sick individuals or outbreaks, often involving clinicians or laboratory staff.
 It is useful in veterinary public health for diseases with clear clinical signs,
but can be affected by under-reporting.
 1) Active and passive surveillance
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 Active surveillance system defined as; where public health

authorities contact relevant sources to report data on high-
quality data standards.
 This is particularly useful in veterinary public health, but its main
disadvantages include significant resources and a focus on high-
priority diseases.
 1) Active and passive surveillance
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 Enhanced passive surveillance: Enhanced passive

surveillance refers to passive surveillance systems refined by
public health professionals to standardize and improve
information usage.
 These systems identify trends from isolated disease events or
syndromes, promoting awareness of co-occurring disease
syndromes in multiple locations or data sources.
 2) Compulsory and voluntary surveillance
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 Surveillance systems can prompt data from sources through

compulsory and voluntary reporting methods (ECDC).
 Compulsory reporting, based on legal demand or policy,
improves system completeness and timeliness but doesn't
guarantee data representativeness or validity.
 Alternative reporting methods are to varying extent voluntary
 3) Comprehensive and sentinel
surveillance
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 Comprehensive surveillance systems is reporting cases from the

entire population.
 Sentinel systems rely on reports from a select group of
stakeholders.

 The choice between these systems depends on the system's

purpose, disease features, and resource availability.
 4) Syndromic surveillance
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 Syndromic surveillance uses clinical signs and data to detect

health-related changes in the population, indicating potential
health threats.
 It detects various diseases, including emerging ones, making it
relevant for early-warning systems and real-time data
collection.
 It is used for early detection of endemic diseases and
environmental threats, detecting undefined events without tests,
and assessing health impacts.
 5) Participatory surveillance
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 Participatory surveillance, is a method in veterinary public

health, began in the 1980s in low-income countries.
 It uses traditional information networks and qualitative
health data to identify livestock problems and develop
solutions.
 6) Risk-based surveillance
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 Risk-based surveillance is a type of surveillance used in veterinary

public health, utilizing information about the likelihood and impact
of a health hazard to plan and interpret results.
 6) Risk-based surveillance
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 Risk-based surveillance can include one or several of the following

methods:
o Risk-based prioritization; (risk assessment to determine which health
hazards should be monitored).
o The risk-based requirement; involves assessing risks to adjust the
surveillance intensity needed for a specific surveillance purpose.
o Risk-based sampling; is a strategy that uses risk evaluation to design a sampling
strategy that reduces costs, enhances surveillance accuracy, and ensures
representativeness.
o Risk-based analysis is a method used to evaluate and adjust the status of a
disease using risk assessment techniques.
 6) Risk-based surveillance
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 Proof of freedom survey and Import Risk analysis are crucial risk
assessment tools in veterinary public health, providing statistical
certainty that a disease is absent in animal populations in a country or
zone, supporting trading partners.
 7) Pathogen surveillance
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 Pathogen surveillance is crucial in animal health surveillance, as

it helps understand the potential for transmission between
species, including humans, as certain pathogen-induced diseases
and infections may not be visible in all species.
 8) Epidemic Intelligence
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 Epidemic intelligence involves identifying potential health

hazards, verifying, assessing, and investigating them to
recommend public health control measures.

 It uses indicator-based and event-based surveillance

components, collecting structured data on specific diseases and
non-traditional sources like news and media.
 Human health, veterinary health and
environmental frameworks
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 The One Health concept aims to deconstruct compartmentalized

structures in human, veterinary, and environment health,
promoting sustainable governance and a new way of defining
and managing health matters.
 This approach is expected to increase efficiency, cost-
effectiveness, and cost-benefits.
 Human health, veterinary health, and environmental
frameworks
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 International projects are encouraging collaboration across

sectors and disciplines, with initiatives focusing on cross-
sector laboratory analyses, multidisciplinary groups, public
communication, and governance structures.
 Dimensions and degrees of collaboration in One Health
surveillance systems.
 Human health, veterinary health …
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 According to a systematic review on the characteristics of One Health

surveillance systems by Bordier et al., current systems can be grouped in any of
four main dimensions, depending on the extent of cooperation across sectors
and disciplines:
 (i) Institutional collaboration across sectors aiming at improving governance

and operation of a given surveillance system;

 (ii) Cooperation along the hierarchical ladder of the decision-making

process;
 (iii) Cooperation across disciplines; and

 (iv) Cooperation through public-private partnerships

 Human health, veterinary health …
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 Institutional cooperation in surveillance system, the degree of

collaboration in surveillance systems can existed at all steps of
surveillance process including; planning, data collection,
laboratory testing, management, sharing, analysis, and
communication of results.
 Human health, veterinary health …
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 Secondly, the commitment of a diverse set of disciplines, such

as biosciences, social sciences and engineering was an
important condition and characteristic of cooperative One
Health surveillance initiatives.
 According to Bordier et al., disciplines referring to
biosciences, namely medicine, microbiology, epidemiology,
entomology, ornithology, and parasitology exhibited greater
preponderance (Bordier et al., 2020).
 Human health, veterinary health …
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 Thirdly, cooperation along the hierarchical scales of the

decision-making process included various administrative and
jurisdictional structures both at different organizational levels
of a given country, either locally, regionally or centrally, as
well as at supra-national structures such as international
bodies and institutions
 Human health, veterinary health …
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 Lastly, cooperation in One Health surveillance can be based on

the development of public-private partnerships across sectors,
primarily represented by organizations focusing on veterinary,
medicine, private laboratory, farming, feed and food logistics and
distribution, pharmaceuticals, or through professional
associations.
 Environmental framework
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 Both humans and animals are potentially exposed to a set of

common chemical elements as they share the same food and water
sources, within the same overarching environmental structure.
 Humans can be further exposed through the ingestion of
contaminated animal food products included into their diet.
 Furthermore, due to their particular and earlier environmental
exposure, animals can serve as sentinels for environmental health
risks to humans
 Environmental framework
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 Considering a more encompassing framework of assessing

environmental hazards and structuring surveillance of
environmental exposures, the surveillance of environmental
hazards includes the following levels of investigation.
 Hazard surveillance

 Exposure surveillance

 Outcome surveillance
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Environmental framework
 Conceptually, all three a aforementioned levels of investigation are
useful to One Health surveillance initiatives and frameworks.
 For example, looking at hazard surveillance, pollutant chemicals in
water, soil or air can potentially affect aquatic and terrestrial
animals, and therefore, monitoring and alleviating their
environmental release will likely be advantageous for all species and
the general environment
 Relevant elements on One Health surveillance
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 The followings are relevant elements on One Health

surveillance.
 Zoonotic diseases surveillance and outbreak investigations

 Foodborne disease outbreak investigations

 Surveillance of emerging pathogens

 Antimicrobial resistance

 Environmental hazards
 Zoonotic diseases surveillance and outbreak
investigations
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 The One Health approach is crucial in low-income countries,

particularly where the outbreaks highlighted the need for
improved access to diagnostics, disease surveillance, and
healthcare workforce capacity.
 Priority areas include early warning systems, local and national
public health systems reinforcement, and strengthening.
 However, insufficient resources often limit One Health efforts in
low-income settings.
 Zoonotic diseases surveillance ….
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 There an indication for the need to improve surveillance of

potential zoonotic viruses using risk-based surveillance.
 In high-income settings, the recurrent West Nile virus in Europe
raises the need for better surveillance and interaction between
human and veterinary domains.
 A One Health approach could boost surveillance and generate a
more comprehensive epidemiologic understanding, involving a
joint surveillance system for humans, horses, mosquitos, and
birds.
 Zoonotic diseases surveillance ….
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 Zoonotic disease surveillance systems worldwide include

 Global Early Warning System for Major Animal Diseases
(GLEWS),
 Global Public Health Intelligence Network (GPHIN),
 Global Outbreak Alert and Response Network (GOARN), and
 Program for Monitoring Emerging Diseases (ProMED).
 Zoonotic diseases surveillance ….
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 GLEWS, a joint initiative by WHO, FAO, and OIE, collects data on

disease events.
 GPHIN uses web crawling and data scraping to track disease
outbreaks in humans, animals, and plants.
 GOARN provides resources and technical assistance for emergency
response.
 ProMED detects uncommon health events related to emerging
infectious diseases, producing daily reports and commentary.
 Foodborne disease outbreak investigations
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 Food production and safety are crucial for preventing, controlling, and
mitigating foodborne diseases.
 Animal feed manufacturers, farmers, retailers, and consumers must
adhere to guidelines to prevent contamination.
 For example, Campylobacter and Salmonella bacteria often infect poultry,
which can result in subsequent contamination of chicken meat and eggs.
 Similarly, human and animal microorganisms can also contaminate fruit
and vegetables during the production chain, namely during washing,
packaging and transportation.
 Foodborne disease outbreak investigations
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 As an essential public health function, food-borne diseases

surveillance will likely benefit from a One Health approach, in
particular through the creation of epidemiologic and laboratory
teams.
 Surveillance of emerging pathogens
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 The emergence of Middle East respiratory syndrome (MERS-CoV) has

emphasized the preponderance and urgency of applying a One Health
approach, particularly because there are various possible animal reservoirs
for human diseases.
 The identification and detection of this emerging pathogen was a Multi-
institutional cooperation effort, among WHO, the Qatar Ministry of
Health, and Erasmus Medical Center.
 Within a One Health perspective, this joint initiative allowed for a swift
gathering of data and knowledge improvement on MERS-CoV, and later
advanced a more detailed understanding on the disease incidence and
transmission.
 Surveillance of emerging pathogens
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 Nevertheless, this experience has also underlined several

challenges in One Health preparedness:
 Limited governmental cooperation,
 deficient support on the veterinary health sector,
 knowledge gaps on disease transmission between humans and camels,
 deficient screening of animal imports and exports, and
 the lack of coordination and guidance on laboratory procedures and
microbiological sampling standards
 Environmental hazards
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 Chemical contamination within the environmental domains can

serve as a sentinel event for hazardous exposures both for
humans and animals.
 Mercury is an important example of valuable application of the
One Health surveillance principle.
 Fish ----- human ---- and animal contaminated
throughout food chain.
 Environmental hazards
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 Lead poisoning is also an important example of applied animal

sentinel surveillance within One Health surveillance.
 In 2006, in Western Australia, an unexpected event with over 10,000
dead song birds alerted authorities to a potential environmental
catastrophe.
 This sentinel event in animals triggered an investigation that
ultimately showed lead poisoning in samples collected from
humans, birds, and the environment, particularly in drinking
water and soil
 Environmental hazards
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 The attributed source was the transportation of lead concentrate

through the involved location, despite the involvement of other
unidentified sources
 Barriers to surveillance
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1) Communication and coordination

2) Lack of conceptual framework
3) Integration and sharing of data and biological samples
4) Capacity building
5) Risk perception
6) Associated costs
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