Design and Implementation of a One Health Framework for Evaluating the Transmission Potential of Pathogens of Public Health Interest for Surveillance Studies.

Abstract

Globalization, over the past century, has extended the geographic range of infectious pathogens. Where physical distance previously protected populations from pathogens circulating in distant places, factors such as population growth, urbanization, modern transportation networks, and climate change have increased local expansion and amplification and cross-boundary spread of pathogens into naïve locations. Despite this possibility, a lack of historical endemicity of a pathogen in a region can delay its detection due to unfamiliarity with the symptomatology or limited diagnostics. We developed the One Health transmission potential framework for assessing a pathogen, using a history-agnostic approach, that incorporates-but does not rely solely on-prior detection of it, to determine its transmission potential within a region. This framework was applied to 71 pathogens for Nigeria, and the results were used to inform the selection of pathogens for the Surveillance of Acute Febrile Illness Aetiologies in Nigeria (SAFIAN) study. The assessment identified transmission potential for 16 pathogens for which no previous detection in humans in Nigeria was found. The SAFIAN study screened 1200 patients for 25 pathogens with transmission potential in Nigeria. Outcomes included the detection of 11 pathogens, with no previous molecular detection in humans in Nigeria, and 9 pathogens ranked as high risk for causing Public Health Emergencies of International concern. These results indicate the utility of the One Health transmission potential framework and its role in global health security. To prepare for surreptitious circulation of a pathogen, a history-agnostic approach is needed, whereby evidence, beyond previous detection in a region, is used to determine pathogens' potentials.