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Table of Contents
EDITORIAL
Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 315-316

Improving public health and national transformation in Saudi Arabia: Leveraging with one health entomology


1 One Health Unit, Communicable Diseases Directorate, Saudi Public Health Authority, Riyadh, Saudi Arabia; Department of Public Health, Nigerian Institute for Medical Research, Lagos, Nigeria
2 Department of Microbiology Faculty of Veterinary Medicine King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia

Date of Submission17-Jun-2021
Date of Decision22-Jun-2021
Date of Acceptance04-Jul-2021
Date of Web Publication06-Oct-2021

Correspondence Address:
Shamsudeen Faisal Fagbo
One Health Unit, Saudi Public Health Authority, King Abdul Aziz Road, Riyadh 13351

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_69_21

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How to cite this article:
Fagbo SF, Solaiman Al-Sabi MN. Improving public health and national transformation in Saudi Arabia: Leveraging with one health entomology. J Nat Sci Med 2021;4:315-6

How to cite this URL:
Fagbo SF, Solaiman Al-Sabi MN. Improving public health and national transformation in Saudi Arabia: Leveraging with one health entomology. J Nat Sci Med [serial online] 2021 [cited 2021 Dec 1];4:315-6. Available from: https://www.jnsmonline.org/text.asp?2021/4/4/315/327602



Historically, the leadership of the Kingdom of Saudi Arabia (KSA) has consistently made efforts to improve public health. To ensure further improvements in public health, the ongoing National Transformation Program is designed to promote health living, enhance healthcare access and early detection of diseases.[1] Four of the 8 themes in the initial National Transformation Program delivery plan are related to the One Health (OH) Approach being heavily advocated for by the WHO and other leading international bodies. OH is defined by the US Centers for Disease Control and Prevention as “a collaborative, multisectoral, and transdisciplinary approach - working at the local, regional, national, and global levels - with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.” To demonstrate this, the Kingdom advocated for and prioritized OH as an approach to global health issues during its G20 2020 presidency. Finally, leaders of the G7 at their 2021 summit requested that the OH approach be fully integrated into pandemic prevention and preparedness.

Undoubtedly, the OH approach has a major role to play in reducing and controlling the public health burden of vector-borne diseases (VBDs): The incidence of these diseases in human, animals, and plants is influenced by interacting biotic and abiotic factors embedded in the various ecosystems they occur. Notably, two of the world's most problematic VBDs, malaria and dengue, remain endemic in the KSA. However, other endemic VBDs affecting human, animals, and plants include West Nile fever, cutaneous leishmaniasis, African Horse sickness, Q fever, lumpy skin disease, and phytoplasma disease. As an approach, OH entomology entails the broad application of entomological knowledge in line with the collaborative and multisectoral OH principles to improve human, animal, and environmental health expanding well beyond the traditional control programs focusing on VBDs of medical and veterinary importance.

The Kingdom has had its own unique experience with novel, emerging diseases; some are vector-borne and/or zoonotic with complex environmental factors contributing to observed epidemiological patterns. To achieve a holistic understanding of these diseases and effectively protect interrelated human, animal, and environmental health, the multidisciplinary, collaborative OH approach is essential. Let us look at one example, Alkhurma hemorrhagic fever (AHF), a tick-borne disease caused by a flavivirus known as the AHF virus.[2] First isolated in Jeddah in 1995 from an acutely ill butcher,[3] it was detected more than a decade later in camel-associated soil-bound Ornithodoros savignyi ticks in Jeddah.[4] However, almost 20 years since this set of ticks was collected, much AHF-related entomological and seroepidemiological data remain lacking. Clinically, serology-only diagnosis of acute suspected cases of the more common and co-endemic dengue fever (caused by another flavivirus) can further confound AHF incidence due to expected cross-reactions and consequent false-positive results.[5] West Nile fever, another endemic flaviviral disease, can produce similar confounding results. AHF serologically misdiagnosed as dengue can lead to inappropriate vector control response focused on mosquitoes. An OH entomological approach can be of assistance in planning comprehensive control plans.

The Kingdom has long been well positioned to leverage with and benefit from the potential benefits OH entomological applications has to offer as the National Transformation Program seeks to further improve public health and health protection in the Kingdom. As an example, the Plant Entomology Department of the King Saud University provided expertise that contributed to the response and control of the first ever Rift Valley fever (RVF) outbreak that occurred in 2000 in the Southwest region.[6] During the same outbreak, veterinary entomological expertise embedded within the Ministry of Health structure contributed to the characterization of the mosquito fauna that generated the outbreak in the Asir area. This led to the documentation of the first record of Aedes (Stegomyia) unilineatus in the KSA. However, none of the A. unilineatus specimens collected were positive for RVF virus.[7] Since 2000, the country has not had any RVF outbreak.[8] Expanding their work beyond the RVF outbreak and endemic areas, the plant entomology experts of King Saud University have recently assessed and updated the mosquito fauna of Saudi Arabia; their assessment has led to the clarification of the total number of mosquito species (culicine and anopheline) from 51 to 49.[9] At last, the country's successful elimination of visceral leishmaniasis[10] presents another example where the utility of integrated approach OH entomology provides can engender more broad-based public health successes by 2030. As a vector-borne zoonosis, leishmaniasis is perpetuated in nature by animal reservoirs. With stray dogs playing roles in visceral leishmaniasis and rabies transmission, control of stray dogs can produce multiple disease prevention outcomes. In all the aforementioned, and many more, incorporating OH entomology principles into prevention programs can facilitate rapid integration of findings and bridge the gaps in our understanding of the transmission and epidemiology of these diseases in the diverse ecosystems in the country.

Antimicrobial resistance (AMR), a serious global public health that predates the COVID-19 pandemic, is illustrative of the possible diverse applications of OH entomology. Systematic literature review has shown that diverse pathogenic bacteria of veterinary and medical importance (Salmonellae, Staphylococci, Streptococci, etc.) colonize the ubiquitous housefly, Musca domestica. Notably, some housefly-associated AMR bacteria are on the WHO AMR list of priority pathogens, some of these (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) being critical. In addition, resistant genes such as mobile colistin and extended-spectrum β-lactamase gene were found in housefly-associated AMR isolates. Antifungal-resistant fungi have also been retrieved.[11] Of heightened OH concern, AMR bacteria have been detected in houseflies associated with hospital and animal farm environments; these flies could play a role in spreading in AMR pathogens as well as AMR genes in the environment.[11] Finally, amplification of spread by other sympatric insect fauna in the farm environment cannot be ruled out.

Recent COVID-19 pandemic research suggests extended roles for OH entomology. It was shown that, under laboratory conditions, M. domestica houseflies can acquire and harbor infectious severe acute respiratory syndrome coronavirus 2 (SARS CoV2) for 24 h.[12] This is worrisome, especially from an OH perspective. The poor hygienic conditions that support populations of houseflies are often associated with low socioeconomic neighborhoods areas. Additionally worrisome, the huge uncontrolled populations of stray cats in the KSA usually congregate at garbage points in such neighborhoods facilitating interface with houseflies that can potentially mechanically transmit SARS CoV2. Cats are known to be susceptible to SARS CoV2.[13] More studies are required to elucidate this potential vector–environment–animal–human SARS CoV2 interface; undoubtedly, OH entomology has a substantial role to play. From a public health perspective, concurrent prevention interventions programs aimed at controlling stray cat population to mitigate transmission risks of rabies, toxoplasmosis, etc., proactively eliminating this new potential SARS CoV2 interface. Consequent gains for or the National Transformation Program will include improvements in healthcare, living standards, and health security ratings that facilitate tourism.[1]

The Saudi Public Health Authority (SPHA), a transformation of the Saudi Center for Disease Prevention and Control, is a leading OH advocate. The 2018 first National OH Workshop it organized came out with recommendations that included engendering OH Entomology in the Kingdom.[14] Consequently, the SPHA developed a formal collaborative relationship with the King Faisal University in Hofuf, seeking to address general OH workforce challenges and the gaps in OH competencies among the limited OH workforce. An expected outcome of this collaboration, a formal graduate training in OH entomology, will produce competent Saudi expertise and further contribute to the National Transformation Program.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kingdom of Saudi Arabia. 2016. National Transformation Program 2020. Available from: http://vision2030.gov.sa/sites/default/files/NTP_En.pdf. [Last accessed on 2020 Dec 01].  Back to cited text no. 1
    
2.
Charrel RN, Zaki AM, Fagbo S, de Lamballerie X. Alkhurma hemorrhagic fever virus is an emerging tick-borne flavivirus. J Infect 2006;52:463-4.  Back to cited text no. 2
    
3.
Zaki AM. Isolation of a flavivirus related to the tick-borne encephalitis complex from human cases in Saudi Arabia. Trans R Soc Trop Med Hyg 1997;91:179-81.  Back to cited text no. 3
    
4.
Charrel RN, Fagbo S, Moureau G, Alqahtani MH, Temmam S, de Lamballerie X. Alkhurma hemorrhagic fever virus in Ornithodoros savignyi ticks. Emerg Infect Dis 2007;13:153-5.  Back to cited text no. 4
    
5.
Memish ZA, Fagbo SF, Assiri AM, Rollin P, Zaki AM, Charrel R, et al. Alkhurma viral hemorrhagic fever virus: Proposed guidelines for detection, prevention, and control in Saudi Arabia. PLoS Negl Trop Dis 2012;6:e1604.  Back to cited text no. 5
    
6.
Abuzaid AA, Aldahan MA, Helal MAA, Assiri AM, Alzahrani MH. Visceral leishmaniasis in Saudi Arabia: From hundreds of cases to zero. Acta Trop 2020;212:105707.  Back to cited text no. 6
    
7.
Balaraman V, Drolet BS, Mitzel DN, Wilson WC, Owens J, Gaudreault NN, et al. Mechanical transmission of SARS-CoV-2 by house flies. Parasit Vectors 2021;14:214.  Back to cited text no. 7
    
8.
Tucker CJ, Melocik KA, Anyamba A, Linthicum KJ, Fagbo SF, Small JL. Reanalysis of the 2000 Rift Valley fever outbreak in Southwestern Arabia. PLoS One 2020;15:e0233279.  Back to cited text no. 8
    
9.
Alahmed AM, Munawar K, Khalil SM, Harbach RE. Assessment and an updated list of the mosquitoes of Saudi Arabia. Parasit Vectors 2019;12:356.  Back to cited text no. 9
    
10.
Jupp PG, Kemp A, Grobbelaar A, Lema P, Burt FJ, Alahmed AM, et al. The 2000 epidemic of Rift Valley fever in Saudi Arabia: Mosquito vector studies. Med Vet Entomol 2002;16:245-52.  Back to cited text no. 10
    
11.
Godsey MS Jr, Abdoon AM, Savage HM, Al-Sharani AM, Al-Mazrou Y, Al-Jeffri MH, et al. First record of Aedes (Stegomyia) unilineatus in the Kingdom of Saudi Arabia. J Am Mosq Control Assoc 2003;19:84-6.  Back to cited text no. 11
    
12.
Monyama MC, Onyiche ET, Taioe MO, Nkhebenyane JS, Thekisoe OMM. Bacterial pathogens identified from houseflies in different human and animal settings: A systematic review and meta-analysis. Vet Med Sci 2021. doi: 10.1002/vms3.496.  Back to cited text no. 12
    
13.
Shi J, Wen Z, Zhong G, Yang H, Wang C, Huang B, et al. Susceptibility of ferrets, cats, dogs, and other domesticated animals to SARS-coronavirus 2. Science 2020;368:1016-20.  Back to cited text no. 13
    
14.
Recommendations of the First National One Health Workshop. Riyadh: SCDC; 2018.  Back to cited text no. 14
    




 

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