European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Water- related-diseases Workshop A European - Southeast-Asian Experts workshop

Conference Center of CICML Vientiane, Lao PDR 15th and 16th February 2016

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Table of Content WORKSHOP CONTEXT ......................................................................................................................... 3 1.

PRESENTATION OF THE WORKSHOP AND OBJECTIVES ............................................................... 3

2.

WORKSHOP PROCEEDINGS ......................................................................................................... 4 2.1

AGENDA ............................................................................................................................... 4

2.2

GROUP WORK - METHODOLOGY ........................................................................................ 7

2.2.2

Questionnaire – state of the art ...................................................................................... 7

2.2.3

Groups Works .................................................................................................................. 7

3.

WORKSHOP OUTPUTS ................................................................................................................. 9

4.

WORKSHOP CONCLUDING REMARKS........................................................................................ 12

5.

ANNEXES .................................................................................................................................... 14 ANNEXE 1 : PRESENTATIONS OF EACH SPEAKER........................................................................... 15 ANNEX 2 : LIST OF CURRENT RESEARCH PROJECT ON WATER AT THE INTERFACE OF HEALTH, ECONOMICS AND ENVIRONMENT IN SOUTH-EAST ASIA (SYNTHESIS OF QUESTIONAIRES)......... 25 ANNEX 4 : LIST OF PARTICIPANTS.................................................................................................. 30

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

WORKSHOP CONTEXT Population within SEA is growing at an exponential rate, with rapid urbanization and rapidly degrading key ecosystems with huge impact on the most vulnerable populations. Clean fresh-water is essential to maintain the production of adequate food supply for the human and animal population. Climate change, environmental disturbances – e.g. dam building, irrigation, wetland modification - globalisation of trade, loss of biodiversity are important drivers of infectious and parasitic diseases including water-related diseases in SEA and could have a negative impact on the health systems. Water pollution can severely reduce biodiversity in aquatic and terrestrial ecosystems, and facilitate the spread of serious human and zoonotic diseases. Water management and the risks and benefits to human health are complex environmental health challenges, and should be tackled through fully interdisciplinary research in order to promote systems model approach. The CIRAD (French agricultural Research Center for International Development), in collaboration with the Centre Merieux of Laos, National Institute of Health Laos and Pasteur Institute of Laos, have organized a "Water-related diseases workshop", which was held from 15th to 16th of February 2016 in Vientiane, Lao PDR. This workshop, in the framework of FP7 European SEA-EU-NET programme, merged 3 topics: Health, Water-Management and Food Security.

1. PRESENTATION OF THE WORKSHOP AND OBJECTIVES This expert workshop gathered 25 participants and managed to obtain the following objectives: i) To share information (programs and projects) and scientific knowledge on water-related diseases. ii) To stimulate EU-SEA cooperation by promoting exchanges between EU and ASEAN experts, and build up coordinated international projects iii) To develop networking on water related diseases

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Expected outputs

-

A policy note to be published late 2016 Teaming up and building of consortia proposals to addresss calls

The main themes/sessions of the workshop were organized by important diseases (Leptospirosis, Cryptosporidium, vector-borne, Opistorchis and other flukes, ...) and by topics (water management, biodiversity, climate change, antimicrobial resistance, ...), as we wanted to promote a multisectorial and interdisciplinary approach.

Workshop speakers and participants The workshop gathered 25 experts, 11 experts from SEA, and 14 experts from EU/Int. Experts, from the public health sector, animal health sector, and environment (water, climate, biodiversity, antimicrobial resistance), and wildlife sector were invited (cf. list of participants in Annex 3), chosen by Dr Serge Morand (CNRS / CIRAD), Dr François Roger (CIRAD) and Dr Flavie Goutard (CNRS / CIRAD)

2. WORKSHOP PROCEEDINGS 2.1

AGENDA

Monday 15 February 08:00

Registration

08:30

Opening Speech: Dr Phimpha Paboriboune (DS Centre Mérieux, Laos)

09:00

Keynote Speaker: E. Boelee: Management of water and related diseases

09:30

Session 1 4

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

A. Aebischer: Giardiasis in the perspective of water-borne parasitic infections S. Caccio: Cryptosporidium, the paradigm of a waterborne pathogen

10:30 11:00

D. Dance / A. Pierret: Land use and soil type determine the presence of pathogen Burkholderia pseudomallei in tropical rivers Break

the

Session 2 P. Echaubard: Liver flukes sustainable control in SEA, frontiers in ecology and global health Y. Suputtamongkol: Human Leptospirosis: An Update J. Ledieu: Remote sensing flooding indicator and leptospirosis in Cambodia K. Nakhapakorn: Climate change impacts on Dengue Fever in Thailand Using Geoinformation Technology

12:30

Lunch

14:00

C. Khoury: SEA-EU-NET presentation

14:20 15:30 16:00

19:00

Group Work Break Group restitution / Discussion

Diner

Tuesday 16 February

09:00

Keynote Speaker: B. McMahon: Antimicrobials Resistance: Wildlife & the Environment

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

09:30

Session 3 Y. Trisurat: Watershed management S. Sayasone: Health geography D. Jourdain: Ecosystemic services

10:30 11:00

Break Session 4 A. Ribas: Edibles frogs S. Morand: Biodiversity N. Peng Bun: Aquaculture / Fishing U. Suntornratana: Fishing and health related problems

12:30

Lunch

14:00

F. Goutard: GREASE presentation

14:20

Group Work

15:30

Break

16:00

Group restitution / Discussion

19:00

Diner

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

2.2

GROUP WORK - METHODOLOGY

2.2.2 Questionnaire – state of the art In order to summarize the different research initiatives that are currently implemented in SEA, a questionnaire (see attached in annex) have been prepared and sent to each participant 2 weeks prior the meeting, which describes current research Project on Water at the Interface of Health, Economics and Environment IN SOUTH-EAST ASIA The objective was to start the workshop with a state of art of the existing projects in SEA which are covering these thematic, in order to identify during the workshop the gaps in research for future collaborative projects.

2.2.3

Groups Works

3 groups of 8 experts were set up, and a brainstorming protocol was proposed, with facilitators and rapporteurs identified for each group :

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Brainstorming protocol 1. Identify gaps and needs: Ask each expert to write 3 most important gaps/needs in research according to his point of view (1 per post it note) 2. Categorize the gaps/needs : Ask each expert to stick his post it note on the board and to group it according to the topics identified by the previous person 3. Identification of potential topics : Ask experts to work by group of 3 to brainstorm on research topics which could be developed based on the gaps/needs identified in steps 1 and 2 4. Identification of research topics based on a template - Ask participants to work by 2/3 on 1 topic and to fill in a appropriate template (title / objectives/ research area/ Potential relevance or utility of expected research output to the region) – see in annex Next day 5. Topic Development by group: Ask each group to develop their topic (why this topic, which components or workpackages; Present and brainstorm with the whole group on the relative importance of this topic. 6. Topic synthesis: Discuss with the whole group and synthesize the information of the whole topics arising from the session.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

3. WORKSHOP OUTPUTS Several research issues have risen from the workshop:

Research issue Water – health related issues in SEA

Objectives Understanding the impact of regional dynamic changes on water health related issues and risks How to increase awareness about water diseases health risks from local to global priorities Transversal evaluation of water health related diseases burden and management needs: from local to international priorities (bottom up approach);

Potential relevance or utility of expected research, output to the region Key words : AMR resistance, impact assessment; ethics, laws, knowledge transfer, governance, participatory approaches, dynamic changes

Promote communication : from local to national to international; from scientific N/S (interventions, choice of 9

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

methodologie) Improving self/community Improve individual and social health resilience in changing SE resilience Asian environments Individual and evolutionary medicine Ecological community health, maintaining equity / sustainability

Health threats: infectious diseases, antimicrobial resistance, noncommunicable diseases

Platform for transfer, innovation and knowledge sharing in environment and health

Public sector: smart governance Private sectors: support of new sustainable activities

To enhance and facilitate research transfer from environmental (climate, soil, water), ecological (biodiversity, living resources) and health (human, veterinary) sciences; To develop innovative tools to facilitate transfer / translation research toward public and private sectors; To develop systems for open data and knowledge representation

integrated surveillance of Mechanisms, surveying systems by sentinel organism until action (control AMR and prevention) in environmental management and agriculture practices Key Words: Wildlife, domestic animal, humans, interaction, AMR, sentinels Action research on the - test multi-barrier approach (e.g. health impacts of water protective clothing, alternative facilities, bathing contact interventions practices/hygiene behavior/education) in practice and evaluate - assess ,pact by monitoring widely (e.g. pathogens [incl. Vibrio, Lepto), vectors, environmental bacteria, symptoms) and quantitatively, to see whether instead of a decrease of disease, there are multiple benefits that lead to improved health) - to develop methodology

Impact in the study sites: improved health Generic outcome: methodologies for - Identifying appropriate interventions - Monitoring health rather than disease (multiple pathogens / symptoms /health

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

ASSESSING THE HEALTH CONSEQUENCES OF WATERSCAPE MODIFICATIONS IN GMS

1- CHARACTERIZING WATERSCAPE MODIFICATIONS (selecting specific relevant areas) - Irrigation practices (traditional vs commercial; local scale) - Dams (regional scale) This include assessing landscape connectivity/fragmentation (GIS), water movement including flooding regimes, water quality (i.e. safety ; agrochemicals), freshwater communities structure and function (emphasis on snails and parasite transmission dynamics), vegetation cover (medicinal plants?) 2- HEALTH ASSESSMENT - ID surveillance (lepto, melioidiosis, Liver flukes) - Food safety/nutrition (fisheries, plants) - Psychosocial dimensions of health in a context of livelihood transitions (sense ofcoherence; medical anthropo, etc.)

Research to policy/wise governance Community empowerment through co-creation of “best practices information package on water management and health outcomes” Creation of methodology/protocols for ID surveillance, modelling impacts of irrigation practices on ID transmission Together these deliverables can be combined in a Health Assessment Package

Water safety: AMR and infectious diseases surveillance in water along the Mekong

- to assess role of water sources in the spread of infectious diseases (Cryptospora, B. pseudomallei) + AMR organisms (E.coli, Klebsiella, Campylobacter) + other potential sources (Med: hospital + Agri: farming) - to develop standards to assess water quality + risk factors related to pathogen + AMR - to identify sources and develop tools for health interventions

Provide scientific data for informal policy decisions PH Establish surveillance standards and networks for quick mobilisation of interventions Public engagement opportunities Better animal health management Improved waste water management

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

4. WORKSHOP CONCLUDING REMARKS This workshop has allowed to successfully pointing out some research issues :

On AMR: The experts group identified that a lot of researchers in SEA are already working on the molecular and ecological mechanisms of AMR emergence through descriptive study. There is a need to develop more analytical studies in order to understand the mechanisms of resistance transmission between different compartment (animals, human and environment), the role of water and waste (farm or hospital) as a vector of transmission and to propose more practical recommendations for antimicrobial management at farms and hospitals. The group proposed to investigate key risk factors of AMR emergence and spread in varied farming systems in SEA, characterising these systems in relation to practices -crucially antimicrobials usage- and their contribution to AMR and risk of human infection. The idea will be to focus on key indicator bacteria, modelling and epidemiological tools, such as contact networks, risk estimation and case-control studies, to assess the risk of AMR transmission between compartments. The impact of changes in farming practices at farm level could be assessed and One Health surveillance system could be tested. The results of these interventions studies could then help in the design of efficient and adapted policies and recommendations for AMR control/surveillance. On Water : From the different presentation given during the meeting, the need of assessing the health consequences of water modification in the great Mekong Bassin received the full attention of the researchers and expert. They proposed first to characterize the waterscape modifications. This could include the assessment of landscape connectivity/fragmentation, the water movement including flooding regimes, water quality (i.e. safety ; agrochemicals), the freshwater communities structure and function (emphasis on snails and parasite transmission dynamics), the irrigation practices (local level) and the dam impacts (at regional level). Then the most important diseases link with waterscape modification, in term of health impact, economics importance, livelihood, side effects should be identified and prioritized. The objectives will be to develop statistical or mathematical models to test changing scenario and then assess the impact of the changes on the system before setting up interventions.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

A draft policy note was prepared during the conclusion session with the experts present: Issues about changes in water system dynamic (especially in the area of the Mekong basin) and the impact of human actions (agricultural and cultural/behaviour practices), climate changes and socioeconomic context evolution, are complex questions that need integrated framework (One Health, Ecohealth or Global Health). Some tools have been developed by researcher to addresses these issues but innovation are still required. The first challenge identified during this meeting was the lack of proper mechanism or tools to implement surveillance on water related health issues: experts highlighted the fact that few methods exist to implement surveillance on water or related environment. Questions remain about what to detect and at which threshold, for which action (simple monitoring or action from environmental data) and how to share and use these data. Methodological issue of scale (geographic, and time) between water systems, agriculture systems and public health were as well identified as very important in order to be able to integrate the data and to make relation between the water system and the food system (e.g. for antimicrobial resistance in the environment). Surveillance and monitoring data are required to implement tailor-made intervention and to be able to make trade off decisions between economic benefits and health consequences or local, national, international issues (transboundary issues). When considering water-borne diseases in SEA, several questions still remains, very limited information exist on the impact of these diseases on the health and the livelihood of the local communities and there is poor knowledge about the different biodiversity of the pathogens and their associated virulence. There is no standardisation about methods of detections. One suggestion will be to use syndromic surveillance (diarrhoea, liver disease syndrome, chronic fever, encephalitis) for detection and estimation of their prevalence, and to try to develop some indicators about factors associated with syndrome and pathogens. Integrated research project will be needed to answer these questions, with the involvement of environmental experts, forestry, public health and agriculture specialists. The problem is how to involved different sectors in an OH or Ecohealth approaches, how to work on a small interface between the different discipline and how to show the benefits of an ecosystem approach. Water management is a multi-country, multi-cultural and multi-sites issue which needs the involvement of the right experts but as well the enrolments of local communities that will bring their knowledge about local resources management, and cultural diversity. Traditional knowledge need to be identified thought the help of sociological surveys in order to be a source of innovation in the field of water resource management and health.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

5. ANNEXES ANNEXE 1 : PRESENTATIONS OF EACH SPEAKER ANNEX 2 : LIST OF current research Project on Water at the Interface of Health, Economics and Environment IN SOUTH-EAST ASIA (SYNTHESIS OF QUESTIONAIRES) ANNEX 4 : LIST OF PARTICIPANTS

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

ANNEXE 1 : PRESENTATIONS OF EACH SPEAKER Keynote Speaker Management of water and related diseases Presentation Eline Boelee (Water Health) ABSTRACT Several infectious diseases are related to water in many different ways. Various types of disease agents and vectors lead to complicated and highly specific modes of transmission, influenced by water use, quality and management. Water supply for people, animals, food or energy is usually managed by separate sectors that are not always aware of the positive or negative health impacts of their infrastructure and its operation. The main exception to this is safe domestic water supply, often promoted as a key intervention for the prevention of water-borne diseases, especially when coupled with sanitation and hygiene. Contrarily, where water management for irrigation or power generation leads to increased transmission of malaria or other water-related diseases, this tends to be considered as inevitable side effect, if recognized at all. Prevention and control of water-related diseases are usually driven by the public health sector and primarily destined at the disease or pathogen itself and less at its vectors or transmission. Theoretically, wherever water is artificially managed, this could be done in such a way that it has hampers transmission or spread of water-related diseases. For instance, breeding of mosquito larvae and intermediate host snails is often disrupted when water levels fluctuate or flow velocity is high. This may reduce disease transmission and become complementary to public health interventions. In practice, few recent examples are available of this environmental control. Existing tools for impact assessment may not be adequate to determine the health risks associated with water management interventions across scales from farm to landscape levels, let alone help the development of remedial measures. Trans-disciplinary research can increase awareness of the interlinkages among the health, water and agricultural sectors. Concepts such as One Health and EcoHealth may be helpful to identify risks and opportunities for preventing or reducing water-related diseases and benefitting human health. 15

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Giardiasis in the perspective of water-borne parasitic infections Toni Aebischer, Robert Koch-Institute, Berlin, Germany ABSTRACT Giardiasis is a major cause of diarrheic disease in humans worldwide. The causative agents Giardia duodenalis protozoan parasites belong to mainly two distinct genetic groups (referred to as G. duodenalis assemblages A and B), which appear to have a comparatively broad host range and can be detected in animals as well. Thus, from an epidemiologist point of view the infection, the organism may circulate through anthroponotic as well as through zoonotic cycles. The infection can be contracted by a number of different routes but the relevance of a particular route is to differ depending on the epidemiological setting. Of these routes, consumption of contaminated water is thought to be a major way of transmission. I will report on recent analyses that took a look at the correlation of microbiologically qualified water supply and prevalence of infection. I will also refer to existing guidelines to the monitoring of Giardia spp. contamination in water sources and food items, respectively. To analyse relevant infection cycles properly, genotyping by molecular methods is required. Thus, an overview over current molecular typing approaches will be presented. Application and usefulness of such an approach will be illustrated using recent examples of our own published and unpublished work. This will cover the analysis of field samples, the suitability of current methods to investigate outbreaks of giardiasis, and, the characterization of clinical samples from patients with chronic infections. Our efforts aim at developing also a workflow to test for drug sensitivity since therapy refractory infections occur comparatively frequently and, depending on country, contribute significantly of disease burden.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Cryptosporidium: the paradigm of a waterborne pathogen Simone M. Cacciò, European Union reference laboratory for Parasites, Istituto Superiore di Sanità, Rome, Italy ABSTRACT Cryptosporidium has emerged as a significant cause of diarrheal disease, with particularly severe health consequences for very young children living in endemic areas. Two species, the zoonotic C. parvum and the anthroponotic C. hominis, are responsible for the vast majority of human cases, but many other species are known to infect wild and domestic animals. Infected hosts can shed very large number of oocysts with their faeces and, as a result, contamination of water with oocysts from animal waste, run-off from contaminated land, or from anthroponotic sources commonly occur globally. The remarkable robustness of the oocysts accounts for their ability to withstand environmental stress and to persist for months in aquatic environments, particularly in cold water, while retaining their infectivity. Furthermore, oocysts are resistant to chlorine disinfection at the concentrations typically applied during water treatment. Finally, few oocysts are sufficient to cause infection. Under these circumstances, it is easy to understand the important role played by water in the complex epidemiology of cryptosporidiosis. Over the last decades, many waterborne outbreaks have occurred, sometimes involving very large number of individuals. However, new regulations, better water treatment and operational improvements have contributed to a decline in the number of outbreaks caused by drinking water. During the same period, an increase in the number of outbreaks due to recreational water, particularly swimming pools, has been observed. Here, I will review the current knowledge on waterborne cryptosporidiosis, with special emphasis on the epidemiological context of South East Asia.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Land use and soil type determine the presence of the pathogen Burkholderia pseudomallei in tropical rivers

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Liver flukes sustainable control in SEA frontiers in ecology and global health Pierre Echaubard 1

WHO Collaborating Centre for Research and Control of Opisthorchiasis, Tropical Disease Research laboratory, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand. 2 Department of Biology, Laurentian University, Sudbury, Ontario, Canada P3E 2C6 3 Global Health Asia, Faculty of Public Health, Mahidol University, Bangkok, Thailand

ABSTRACT Wetland ecosystems (rivers, lakes marshes rice fields, coastal areas) are settings that determine human health and well-being through a number of characteristic influences, such as: a source of hydration and safe water; a source of nutrition; sites of exposure to pollution or toxicants; sites of exposure to infectious diseases; settings for mental health and psychosocial well-being; places from which people derive their livelihood; places that enrich people’s lives, enable them to cope and to help others; and sites from which medicinal products can be derived. These influences can either enhance or diminish human health depending on the ecological functioning of wetlands and their capacity to sustainably provide the products and services we derived from them. It follows then that losses of wetland components, and disruptions to wetland functions, will have consequences for human health along any or all of these lines (Horwitz et al., 2012). Seen in this way, problems in which the environment is considered to have been implicated in health outcomes cannot be solved by medical approaches to health alone. Rather, broader approaches are needed, drawing on a wider scientific base, including ecological and social sciences. Opisthorchis viverrini (Ov), the Southeast Asian liver fluke, is a fish-borne complex life cycle trematode endemic in rice field ecosystems of Thailand, Lao PDR, Cambodia and southern parts of Vietnam where an under-estimate of 10 million people are reported to be at risk of Ov infection. The northeast region of Thailand is known in particular to be a hotspot of Ov transmission, which despite nationwide public health prevention campaigns led by the government and private organizations, still present high infection prevalence. The persistence of high infection rates in the region, we argue, is due to 1) its cultural and ecological particularities — where wet rice agrarian habitats; centuries old raw food culture and the parasite complex biology combine to create an ideal transmission arena — and 2) the biomedical-based research and control interventions ill-equipped both conceptually and methodologically to apprehend such complex social-ecological issues and provide sustainable solutions. Here we review the state of our knowledge regarding the ecology of the Asian liver fluke transmission. We also discuss the limitations of inductive epistemological and surveillance type of approaches that have dominated the research initiatives in liver fluke epidemiology, 19

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

highlight the lack of hypothesis driven research and identify a series of themes — ranging from environment-mediated hosts ecological release to human ecology, landscape connectivity and management as well as globalization – that have been overlooked despite their critical influence in shaping transmission dynamics. Finally, we describe an integrative ‘biomedical-ecologic’ research model intended to bridge disciplinary gaps, enhance collaborative research and education as well as provide a broader human health and sustainable development framework in the context of the rapidly changing SEA waterscape.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Human Leptospirosis: An Update Yupin Suputtamongkol Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ABSTRACT Leptospirosis is a widespread and potentially fatal zoonosis that is endemic in many tropical countries and causes large epidemics after heavy rainfall and flooding. It is caused by the pathogenic Leptospira spp. Infection results from direct or indirect exposure to infected reservoir animals, mainly rodents. Leptospirosis typically presents as a nonspecific, acute febrile illness characterized by fever, myalgia, and headache and may be confused with other entities such as influenza and dengue fever. In endemic countries, it is one of the most important cause of acute undifferentiated fever. Severe pulmonary haemorrhage and multiorgan failure is now recognized as the most common cause of fatal leptospirosis. Early diagnosis of leptospirosis is largely a clinical diagnosis and relies on a high index of suspicion based on the patient’s risk factors, exposure history, and presenting signs and symptoms. Rapid diagnostic tests for leptospirosis are improving, but a negative result should not be relied on to rule out early infection. For these reasons, empirical therapy should be initiated as soon as the diagnosis of leptospirosis is suspected.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Remote sensing flooding indicator and leptospirosis in Cambodia MSc Julia LEDIEN Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, BP983, Phnom Penh, Cambodia. jledien@pasteur-kh@org

ABSTRACT Remote sensing can contribute to early warning for diseases with environmental drivers, such as flooding for leptospirosis. In this study we assessed the performance of six remotelysensed flooding indicators in Cambodia and evaluated their potential in predicting the spatial distribution of human leptospirosis seroconversions. The performance of the flooding indicators was assessed by ground truthing. The best indicator, the Modified Normalized Difference Water Index (MNDWI), was used as an explanatory variable in a boosted regression tree model of leptospirosis seroconversions. MNDWI was the most influential explanatory variable in our model (relative influence: 26%), followed by time since the first flooding of the year (19%) and age (16%). Interestingly, MNDWI thresholds for both detecting water and predicting the risk of leptospirosis seroconversion were independently evaluated at -0.3. Value of MNDWI greater than -0.3 were significantly associated with an increased risk of leptospirosis seroconversion (RR= 1.59 [1.07 – 2.40]). MNDWI may be useful as a risk indicator for flood driven diseases in South East Asia.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Climate change impacts on Dengue Fever in Thailand Using Geo-information Technology Kanchana Nakhapakorn1, Somwang Kurusarttra1, Chiit Chansang2, Supet Jirakajohnkool3 1

Faculty of Environment and Resource Studies, Mahidol University, Salaya, Nakhonpathom Thailand Medical Science Department, Ministry of Public Health, Nonthaburi, Thailand 1 Faculty of Science and Technology, Thammasart University, Rangsit, Pathumthani, Thailand 2

ABSTRACT Dengue haemorrhagic fever is a mosquito-borne viral infection that poses a constant and serious risk to most tropical regions. As countries become more developed and environmentally transformed from rural to urban, the human population’s inexorable growth will change global patterns of the disease and mortality. Furthermore, changes in climate pattern phenomenon are thought to be a major contributing factor to the disease’s spread. The aim of the study was to identify the potential risk of dengue fever in relation to environment factors, in particular, on changes in climatic factors. Results show that the incidence of dengue increased during the rainy season and reached a maximum around the peak of rainfall. Pooled data for all the three seasons revealed that dengue cases were significantly associated with climatic variables. The two most significant ones were mean minimum bi-weekly temperatures at t-1 (n = 2530, r2 = 0.245, P < 0.001) and total bi-weekly rainfall during t-2 (n = 2530, r2 = 0.137, P < 0.001). Increases in dengue cases were positively related to rising temperatures in all seasons. However, increasing rainfall was weakly associated with dengue cases in summer and winter seasons and not significantly related during the rainy season. KEY WORDS: GEOINFORMATION/ DENGUE / CLIMATIC FACTORS

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Keynote Speaker

Antimicrobials Resistance: Wildlife & the Environment Barry J. McMahon UCD School of Agriculture & Food Science, Dublin, Ireland

ABSTRACT Antimicrobial resistance (AMR) is the greatest challenge facing global public health in the next 20-30 years. The causes have been linked with overuse, and even abuse, of antimicrobial compounds in veterinary and human medicine but the symptom of the problem have been far wider than domestic and domiciliated environments. Data will be presented from wild birds species that were screened for AMR from a range of locations across Europe and Ireland which are associated with aquatic and marine ecosystems. There is widespread prevalence of AMR, including ESBL producing bacteria. These data confirm that AMR is present in range of different locations but the implications of the finding need to be realised. The major concern is that the symptoms of AMR i.e. widespread AMR in wildlife, could now become a source of bacteria that are no longer susceptible to available therapeutic treatment. Indeed, marine and aquatic ecosystems warrant further investigation in order to minimise the risk of the proliferation of AMR bacteria back into environment that’s that could cause serious public health problems. It is now time to consider AMR as modern zoonoses.

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

ANNEX 2 : LIST OF CURRENT RESEARCH PROJECT ON WATER AT THE INTERFACE OF HEALTH, ECONOMICS AND ENVIRONMENT IN SOUTH-EAST ASIA (SYNTHESIS OF QUESTIONAIRES)

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European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Title

Leading

CGIAR Research Program on Water, Land and Ecosystems – Greater Mekong (WLE)

WLE

ComAcross : Companion Approach for crosssectoral collaboration in health risk management in SEA - Case study JE

SEAe: Encephalitis in Southeast Asia

AMR in wild species of bird and mammal

Assessing the performance of remotely sensed flooding indicators and their potential contribution to leptospirosis risk mapping in Cambodia

Bioprospecting on Biological Materials of Cambodia (KRIBB-UBB)

CIRAD

CIRAD

Dublin University

Pasteur Institute

Location

Objectives

Cambodia, China, Management of water development, and the Laos, Myanmar, mitigation of negative impacts Thailand Vietnam

Areas of research (a) Water governance; (b) Healthy rivers; (c) River food systems; (d) Healthy landscapes and ecosystems. (e) Capacity building and professional development.

(a) Water management JE Human case occurrence is linked to the intensity (b) agriculture Cambodia, China of transmission between pigs, thus to the (c) public and vet health environment and pig herd management (d) climate and environment (e) social sciences Improved understanding of JE and Nipah encephalitis epidemiology and risk factors. Recommendations in terms of control measures. Cambodia, Laos, Identification of the main causes of encephalitis in Vietnam Southeast asia Improved diagnostic

(a) Water management (b) agriculture (c) public and vet health (d) climate and environment

Europe

Using molecular techniques, screen and characterise AMR in wildlife and to link with food chain integrity.

Cambodia

(i) to assess the performance of various remotely sensed indicators to detect flooded areas (ii) to evaluate their potential use in predicting the (a) climate distribution of human leptospirosis (b) public health seroconversions at local level in Kampong Cham, Cambodia.

Battambang U. Cambodia (UBB)

OH/EH

Funding

Ecohealth

WLE/Australia

Ecohealth

Europaid

Budget

10 Millions 2015-18

2014-18

Total One Health FoundationAviesan

(a) agriculture (b) public health One Health University (c) environment and biodiversity

One Health

(a) agriculture to further expand the knowledge of medical plants (b) public health of Cambodia, develop nutraceuticals, and discover One Health (c) environment and biodiversity new potential drugs. (e) food

Period

2012-17

20 000 €

2009ongoing

2014-16

26 Korea Research Institute of Bioscience and 30 000 USD 2015-16 BiotechnologyKRIBB, South Korea

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Title

Leading

Location

Objectives

Areas of research

OH/EH

Funding

Budget

Period

SEA-EU Partnering Initiative: Regional Battambang U., Universities Network for Research and Ghent U., Cambodia, Development of Neglected and Czech U., Los Philippines, Underutilised Crop Species in Southeast-Asia Baños U., Khon Thailand (RUN-NUS) Kaen U.

to bring together partner universities from SEA and EU to discuss the future development and (a) agriculture implementation of the conservation, use and (b) public health One Health (c) environment and biodiversity research on indigenous neglected and underutilised crop species (NUS) in Southeast Asia

An intervention to reduce antimicrobial usage in chicken farming systems in the Mekong Delta of Vietnam.

Vietnam

To reduce levels of antimicrobial usage in chicken farm systems in the Mekong Delta of VN. To measure the impact of these reduction on AMR (a) agriculture flora (b) Vet public health To formulate a package of sustainable (c) Economics interventions to the Government of VN and other regional stakeholders.

One Health Welcome Trust 1.5M USD

2016-20

Europe

COMPARE is a large EU project with the intention to speed up the detection of and response to disease outbreaks among humans and animals worldwide through the use of new genome technology. The aim is to reduce the impact and cost of disease outbreaks.

One Health EU commission >20M €

2014-19

One Health Welcome Trust 57 00 USD

2016-17

Ecohealth

2016

COllaborative Management Platform for detection and Analyses of (Re-)emerging and foodborne outbreaks in Europe (COMPARE)

OUCRU

29 Institutes from 11 EU countries

(a) public and veterinary public health (b) food (c) molecular technology

Whole genome approach to investigate the potential zoonotic transmission of Escherichia coli and their antimicrobial resistance genes in chickens and humans in Vietnam

OUCRU

Vietnam

To quantify the level of zoonotic transmission of E. coli strains and their antimicrobial resistance (a) public and veterinary public determinants in chickens and humans through health occupational exposure in Vietnam.

Predicted Climate Change Impact on Water Resources in the Lower Mekong Basin and Livelihood Related Issues

MRC

Thailand

To quantify and compare water yields between the (a) Environment and Climate baseline and future climate change scenarios (b) Water management

SEA-EU-NET II 19 000 €

MRC

2016

27

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Title

Burkholderia pseudomallei and associated environmental factors in major rivers in Lao PDR

Investigations on endemic parasitoses, imported mycoses and non-tuberculoid mycobacterioses of Publication Health concern

Liver fluke sustainable control: frontiers in ecology and global health

Leading

LOMWRU

Robert Koch Institute

Location

Laos

Europe

Global Health Asia, Mahidol Laos Thailand U.

Baseline survey on chemical and veterinary d Departlment of Thailand rug used in shrimp culture Thailand Fisheries

Objectives Areas of research OH/EH Funding (i) the presence and abundance of B. pseudomallei in the water major rivers draining into the Mekong and the Mekong itself and in the water and streambed sediment along the course of the Nam Theun river (ii) the influence of physicochemical factors as well as land use, soil type and geology on B. pseudomallei presence and abundance in the (a) Environment One Health Various water and sediments, (b) Vetrerinary and public health (iii) the seasonal dynamic of B. pseudomallei presence and abundance, (iv) the relationship between the presence of faecal indicator bacteria and the microbial diversity in the water and sediments and the presence of B. pseudomallei.

Period

2016-17

Public by federal One Health government and ministry of health

Obtain scientific base to assess the risk of said Infectious agents by Laboratory investigations

(a) Public health (b) Policies

Assessing the influence of deagrarianization/urbanization on liver fluke transmission ecology, rural communities vulnerability

(a) Environment and biodiversity (b) Water management Ecohealth (c) Agriculture (d) Public health

To gather information on situation of various chem ical and vet drug possibly used in shrimp culture. (a) agriculture To provide information to policy in managing fish-f ood Safety at farm-level.

Budget

/

WHO – Institutional (NUS – KKU – Laurentian U – Mahidol – CDC)

2015-20

DOF, Thailand

2015-16

28

ComAcross: how to improve water/waste management at municipality level with more CIRAD benefits for people wellbeing (health, environment, livelihood)?

Thailand

• Improve communities' wellbeing and public health trough Cross-sectoral approach, and taking into account social and environmental aspects • Improve stakeholders' cross-sectorial collaboration (interactions between stakeholders at the scale of the preparedness/response system; cross-sectoral integration at local level) • Better understand waste management impact on human diseases and health problem • Better understand waste and water management at the province level and propose tools for actions

(a) Water management (b) agriculture and environment (c) public and vet health (d) social science and policy

Ecohealth

Europaid

2014-18

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

ANNEX 3 : QUESTIONNAIRE FOR GROUP WORK

QUESTIONNAIRE ON CURRENT RESEARCH PROJECT ON WATER AT THE INTERFACE OF HEALTH, AGRICULTUREN ENVIRONMENT AND SOCIO6ECONOMICS IN SOUTH-EAST ASIA

Research Title

Objective/s

Area of investigation

SEA Country (ies) involved

☐ Environment ☐ Water Management ☐ Climate ☐ Agriculture

☐ Brunei Darussalam ☐ Cambodia ☐ China ☐ Indonesia

☐ Biodiversity ☐ Public Health ☐ Veterinary health ☐ Social sciences

☐ Lao PDR ☐ Malaysia ☐ Myanmar ☐ Philippines

☐ Policy ☐ Economics ☐ Other:______________

☐ Singapore ☐ Thailand ☐ Vietnam

Research Area

Potential relevance or utility of expected research output to the region F 29

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

ANNEX 4 : LIST OF PARTICIPANTS

Speaker Speaker Speaker Speaker Speaker Speaker Speaker Speaker Speaker Speaker Speaker Speaker Speaker Speaker Speaker

Participants Europe Eline Boelee Barry McMahon Anton Aebischer Simone Maro Caccio Alexis Ribas Pierre Echaubard Damien Jourdain Julia Ledieu Alain Perret David Dance Yupin Suputtamongkol Yongyut Trisurat Ngor Peng Bun Kanchana Nakhapakorn Ubolratana Suntornratana

Speaker Observer Observer Observer Observer Observer Observer Observer Observer Observer Coordination Coordination Coordination Coordination Coordination Coordination

Somphou Sayasone Kim Geheb Marisa Peyre Véronique Chevalier Michel de Garine Marc Souris Samnag Nguon Nguyen Binh Minh Ngo Chung Thuy Vinh Trung Flavie Goutard Serge Morand Claire Khoury Jintana Phimpa Paboriboune Kong Chen

Email [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] ; [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] 30

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Participants

Institution

Country

Email

Eline Boelee

Water health

[email protected]

Barry McMahon

University College Dublin

Netherlan d Ireland

Anton Aebischer

Robert Koch Institute

Germany

[email protected]

Simone Maro Caccio

Istituto Superiore di Sanità

Italy

[email protected]

Alexis Ribas

Barcelona University

Spain

[email protected]

Pierre Echaubard

Khon Kaen university

Thailand

[email protected]

Damien Jourdain

CIRAD

Thailand

[email protected]

Julia Ledieu

IPC

Cambodia

[email protected]

Alain Perret

IRD

Laos

[email protected]

David Dance

LOMH Welcome trust

Laos

[email protected]

Yupin Suputtamongkol Yongyut Trisurat

Mahidol University

Thailand

[email protected]

Kasetsart University

Thailand

[email protected]

Ngor Peng Bun

Mekong River Commission

Cambodia

[email protected]

Kanchana Nakhapakorn Ubolratana Suntornratana Somphou Sayasone

Mahidol University

Thailand

[email protected]

Department of Fisheries

Thailand

[email protected]

[email protected]

[email protected]

Kim Geheb

National Institute of Public Laos Health WLE-Laos Laos

Marisa Peyre

CIRAD

Vietnam

[email protected]

Participants

Institution

Country

Email

Véronique Chevalier

CIRAD

France

[email protected]

Michel de Garine

CIRAD

[email protected]

Patrick d'Aquino

CIRAD

Zimbabw e Laos

Paul Brey

Pasteur Laos

Laos

[email protected]

[email protected]

patrick.d'[email protected]

31

European – Southeast-Asian Experts Water related diseases Workshop: th th Vientiane, 15 -16 February 2016

Daniel Reinharz

FMED, Laval University

Laos

[email protected]

Marc Souris

IRD

Laos

[email protected]

Emma Zalcman

VSF Canada

Laos

[email protected]

Samnag Nguon

University of Battambang

Cambodia

[email protected]

Nguyen Binh Minh

NIHE

Vietnam

[email protected]

Ngo Chung Thuy

NIVR

Vietnam

[email protected]

Kongsap Akkhavong Vinh Trung

National Institute of Public Laos Health OUCRU Vietnam

[email protected]

Flavie Goutard

CIRAD

Thailand

[email protected]

Serge Morand

CNRS / CIRAD

Laos

[email protected]

Claire Khoury

CIRAD

France

[email protected]

Jintana

CIRAD / KU

Thailand

[email protected]

Phimpa Paboriboune

CCM

Laos

[email protected]

Kong Cheng

FCO

Singapour

[email protected]

[email protected]

32