Reports & Publications


Policy Briefs

Dog Bite Management Essential for Rabies Control: Suggested Policy Initiative for Tamil Nadu
As part of ongoing research work being done by PHFI/RCZI , various policy concerns have emerged around issues related to feasibility, sustainability and cost effectiveness of rabies control in India. Researchers along with collaborators conducted a cost effectiveness analysis of rabies control in the state of Tamil Nadu. The findings clearly showed that while canine vaccination was effective in reducing rabies transmission, it may not be as cost effective in the longer term as compared to the combination of female sterilisation and vaccination among dogs. A Policy Brief developed by the team attempts to put the issue in perspective and suggests a way forward.
Click here for the Policy Brief

Scientific & Peer Reviewed Papers

Identifying sources, pathways and risk drivers in ecosystems of Japanese Encephalitis in an epidemic-prone north Indian district
Despite growing concerns over the emergence of JE in India, it remains poorly understood, mainly because the problem has been approached in a compartmentalised manner, with human health, animal health, environment, socio-economic factors, policy design and implementation being examined in isolated silos. A PHFI/RCZI study in 2015 was undertaken in a high endemic district of Uttar Pradesh to understand the human-animal-ecosystem interactions, as well as the social and environmental factors that influence disease transmission in this region. The first biotope-based study of the sources, pathways, and drivers of JE in a highly endemic district of India revealed the predominant drivers of JE infection in children as well as amplifier hosts (pigs). Results from the findings provide valuable insights for programme managers to design transdisciplinary interventions to combat JE infections in the community. Further, this study provides a template to study JE and other vector borne diseases through the agent-host-vector-environment interactions in the context of different biotope. A May, 2017 issue of Plos One has published a paper.
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Antibiotic resistance is the quintessential One Health issue
The emergence of a plasmid-mediated resistance gene (mcr-1) to colistin, a last resort antibiotic, identified in human and pig samples in China, followed by its rapid spread across Europe, from Canada to the USA, makes AMR a ‘One World’ issue as dealing with it is central to the long-term economic development of countries and to our global well-being.
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A Comparative Analysis of how Media in United Kingdom and India Represented the Emergence of NDM-1
The Journal of Public Health Policy published in its October 2015 issue, findings of a comparative analysis of how Indian and UK print media represented emergence of the New Delhi metallo-β-lactamase (NDM-1) which provoked considerable but different media coverage in both countries. As many as 16 newspapers from India and UK were studied for the period July 2010 to June 2011. They searched the term NDM-1 ‘NDM1’, or ‘New Delhi metallo-β-lactamase-1’, with ‘superbug’. The research paper described how media represented this research using qualitativethematic analysis of contemporary coverage by 54 articles in UK and 187 in India mentioned NDM-1, describing it as the‘new super superbug’ resistant to most antibiotics. The paper drew attention to the need for researchers to anticipate the way their work is reported and how they must proactively engage with media to maximise the public health impact of their findings.
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Animal Production and Antimicrobial Resistance in the Clinic
In an online series published by The Lancet in its November 16, 2015 issue, a commentary titled "Animal Production and Antimicrobial Resistance in the Clinic" was authored by Timothy P Robinson, Heiman F L Wertheim, Manish Kakkar, Samuel Kariuki, Dengpan Bu and Lance B Price. The Series presented evidence on universal access to antibiotics, sustainability and effectiveness. It focused on use and misuse of antimicrobials in human medicine while taking into account other sources of antimicrobial resistance development, The authors reinforced the need to address these issues from health perspectives of people, animals and environment. According to them, this perspective sits at the very core of the “One Health” approach, which recognises that the health of people is connected to the health of animals and the environment. Such an inclusive approach will reduce selection pressure for antimicrobial resistance genes and protect medically important antibiotics.
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Rabies Control in India: A Need to Close the Gap Between Research and Policy
Published as a perspective in the Bulletin of the World Health Organization in their 2014 edition, it highlighted hidden complexities of the landscape of rabies control especially with the relationship it shares with multiple sectors of animal welfare, public health, veterinary medicine and civil administration. Against this backdrop the writers drew attention to different aspects as also expectations that currently existed in the domain of rabies control in India. The paper referred to the linkages between choice of vaccination route and government cost savings.
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Costs Analysis of a Population Level Rabies Control Programme in Tamil Nadu, India
In this 2014PLoS Neglected Tropical Diseases publication, the paper published by RCZI, shared details of a study done in Tamil Nadu. It determined costs to the state government in implementing different interventions for controlling rabies among the entire human and animal population in the state. Recommendations emanating from the study were directed at policymakers urging them to consider long-term financial sustainability before taking the initiative to scale at state/national level.
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Wishful Thinking Blurs Interpretation of AES data in a High Endemic Region of India
In a powerful letter to the editor published in the Journal of Infection in 2014, the authors drew attention to gaps in an earlier letter published in the same journal. It challenged the false impression of changing epidemiology of AES/JE in Gorakhpur and its disregard for important factors that influenced AES/JE epidemiology in the region, based especially on an evidence-based study conducted by RCZI in Kushinagar district of Northern Uttar Pradesh.
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Research and Policy Disconnect: The Case of Rabies Research in India
In a paper published in the Indian Journal of Medical Research in 2013, concerns around translating evidence into informed policies in public health, particularly in diseases like rabies were taken up. It emphasised the need to move beyond having a researcher driven agendas towards a more rabies control agenda in an effort to control and manage rabies.
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Acute Encephalitis Syndrome Surveillance, Kushinagar District, Uttar Pradesh, India, 2011–2012
Published in the Emerging Infectious Diseases 2013 edition, the paper presented key findings of a review of AES surveillance data from January 2011- June 2012 from Kushinagar District of Uttar Pradesh. The paper brought out the gaps that resulted from having low quality AES/JE surveillance data which in turn provided little evidence to support development of prevention and control measures. It also estimated the effect of interventions and wastage of public resources.
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Veterinary Public Health Capacity Building in India: A Grim Reflection of the Developing World’s under preparedness to Address Zoonotic Risks
The paper published in the WHO South-East Asia Journal of Public Health 2013 discussed the need to strengthen capacities of Veterinary Public Health (VPH) professionals in the context of rising emerging infectious and zoonotic diseases. It discussed the need to address risks at the human-animal interface being a major reason to reform and refine current VPH capacity building efforts.
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Systems Thinking Needed for Rabies Control
The Lancet Infectious Diseases 2013 edition published the above letter to the editor, talking of intra dermal rabies vaccination’s promotion as a solution for rabies control. With most rabies research focusing on biomedical solutions to complex systemic challenges, the authors emphasised the need for the research community to understand systemic challenges facing development of effective and practical solutions for rabies.
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Dengue Fever is Massively Under reported in India, Hampering our Response, BMJ
Against the backdrop of the dengue outbreak in India followed by large media reaction to individual cases, medical preparedness and government response, BMJ invited Dr. Manish Kakkar to share his views on the under-reporting of dengue fever. The short paper published in the2012 issue looked at some of the pressing technical, operational and political dimensions of under-reporting, suggesting best practices in dengue surveillance. It highlighted the need for a transparent disease reporting system, improved assessment of burden, simplified case reporting and rapid turnaround of results, amongst others.
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Moving from Rabies Research to Rabies Control: Lessons from India
PLoS Neglected Tropical Diseases published in its 2012 edition, a review of the research output on rabies from India and its alignment with national policy priorities. The paper analysed systematic literature review done of all research articles published from India between 2001 and 2011.
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Rabies Control Initiative in Tamil Nadu, India a Test Case for ‘One Health’ Approach, International Health
The paper, published in the International Health, 2011 issue, reviewed research output on rabies from India and examined its alignment with national policy priorities. It highlighted gaps between rabies research and policy needs, making the case for developing a strategic research agenda that focused on rabies control as an expected outcome.
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One Health Moving from Concept to Reality
The Lancet Infectious Disease, 2011 edition published a letter by Dr Kakkar and Dr Syed Abbas, drawing attention to the importance of local needs and priorities to form the basis of research agendas for emerging zoonoses. These included large knowledge gaps that exist in epidemiological research in India and other developing countries.
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Continuing Challenge of Infectious Diseases in India
The paper published in The Lancet 2011 edition talked of the range and burden of infectious diseases in India with a focus on addressing gaps in the surveillance and response systems with respect to infectious diseases in the country.
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"Zoonoses? Not Sure What That Is,"
A study based on an assessment of knowledge of zoonoses among medical students in India was published in the "Transactions of the Royal Society of Tropical Medicine and Hygiene" estimating knowledge of zoonoses among medical students and recent graduates. It recognised the changing landscape of infectious diseases and need for revision in current medical curriculum to improve understanding of existing zoonoses and emerging diseases.
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Rationalising Antibiotic use to Limit Antibiotic Resistance in India, Indian Journal of Medical Research
The paper published in the Indian Journal of Medical Research in 2011, suggested recommendations, highlighting priority areas that could help in controlling spread of antibiotic resistance, improving public health and reducing pressure on the healthcare system. The paper was authored by the Global Antibiotic Resistance Partnership (GARP) - India Working Group and was co-authored by human health and veterinary side members of RCZI’s Joint Working Group. Click here to read

Influenza Pandemic Preparedness and Response: Review of Legal Frameworks in India, Indian Journal of Public Health
The study reviewed India's legal preparedness in the face of an epidemic, analysing findings based on a review conducted by national experts. It concluded that India needs a critical mass of public health legislations to make impact and not just a series of police acts that aim to control epidemics. Click here to read

Research Options for Controlling Zoonotic Disease in India, 2010–2015
The paper identified priority zoonotic diseases for India based on structured interviews with a multidisciplinary group of national experts on zoonoses in the country. It identified and prioritised research needs for controlling zoonotic diseases over the next five years. Click here to read

Scrub Typhus in Darjeeling, India: Opportunities for Simple, Practical Prevention Measures
The paper published in the 2009 edition of the Royal Society of Tropical Medicine and Hygiene identified the risk factors for scrub typhus in Darjeeling, India with 62 neighbourhood controls. Click here to read

Meeting Reports & Documents

Costing of Interventions for Rabies Control
A national expert consultation on costing of rabies control was organised by RCZI on 7th December, 2012 in New Delhi. The consultation took forward the dialogue on the need for a state-wide rabies control strategy for the state of Tamil Nadu and to inform the planning process for national rabies control policies. Experts reviewed national strategies for control of rabies among human and animal populations and validated the methodology used for cost analysis for rabies control conducted by PHFI/RCZI. The group agreed that a rabies costing model would need to be revised based on the feedback received during the consultation.
Click here for meeting report

Recent Developments in Rabies Epidemiology & Sources of Information in India
PHFI/RCZI organised a brainstorming meeting in New Delhi in January, 2014 identifying information needs and gaps for conducting assessments of impact of rabies and its interventions in India. The meeting brought together experts from the human, wildlife and animal sectors, with the aim to encourage sharing and discussion on recent developments in rabies while identifying potential resources/information sources, providing clarity on transmission routes and outlining working relationship between sectors.
Click here for meeting report

Impressions, Anecdotes and Images from a Japanese Encephalitis Prone District of North India
The study team that worked on “Identifying Sources, Pathways and Risk Drivers in Ecosystems of JE in an Epidemic-Prone North Indian District”, as part of their data collection amassed interviews, built an impressive photo bank and captured nuggets from multiple interactions in formal and semi-formal settings. Based on experiences of data collectors, NGO partners, researchers, field staff and core team members, it captured anecdotal experiences through words and visuals, adding depth and meaning to the overall narrative. Designed as a visual journey “Experience, Anecdotes and Images: Reflections from an EcoHealth study in a Japanese Encephalitis prone district of North India” emerged out of the conviction that there was a larger story to be told. Click here to access

Regional Public Health Consultations with CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
IFPRI leads two CGIAR Research Programs: Policies, Institutions and Markets (PIMs) and Agriculture for Nutrition and Health (A4NH). For the A4NH program, RCZI/PHFI is a strong partner in the planning and management committee. Its research outputs are designed to support agricultural researchers, programme implementers and policymakers to reshape actions they undertake to contribute to better nutrition and health outputs. For its recent South Asian consultation, IFPRI partnered with PHFI/RCZI in May 2015.

Organising One Health Symposium and Strengthening the One Health Hub in India, 2014
A regional training programme in animal and human health epidemiology in South Asia was recently implemented by Massey University, New Zealand in seven countries of South Asia, including India. The programme, funded by European Commission Avian and Human Influenza Trust Fund and administered by World Bankculminated in the National One Health Symposium. The consultation summarised progress in implementing a One Health approach to zoonotic disease control within national institutions, to assess effectiveness of cross-sectoral collaboration and to formulate proposals for actions that can contribute to a sustainable One Health agenda. The capacity building initiative aimed at strengthening collaborative networks functioning as ‘One Health Hubs’ in each of the countries.

RCZI’s 5-Year Story (2009-2013)
Published in December 2013, the report presents the work done by RCZI in the first five years of its inception. It describes initial steps taken to map strategic objectives related to collaborative research, capacity building and communication & advocacy. The book summarised progress made in these domains, pointing towards the findings, networks and linkages that RCZI had established and the increasing recognition it was receiving as a respected think tank in the zoonoses space, not just in India and South Asia region but worldwide. The report provides highlights of projects and narratives of interactions with experts in the human-animal-wildlife health spheres.

National Expert Consultation on Intersectoral Coordination
A National Expert Consultation on Intersectoral Coordination for Prevention and Control of Zoonoses in India was held on 27th November in New Delhi. Organised by RCZI and supported by World Health Organization (WHO), it built upon RCZI’s recent activities, aiming to inform the national policy discourse and upcoming policies promoting coordination among multiple sectors for prevention and control of zoonoses. Participants representing human health, animal health and environmental health, donor agencies, international organisations and government representatives of Tamil Nadu, Punjab, Karnataka and Andhra Pradesh took part in the discussions.

Regional Consultation on One Health in South Asia
India was the partner country selected to host the 2ndRegional Consultation on One Health Alliance of South Asia (OHASA) on 31st July-1st August, 2012. Experts from Nepal, Bangladesh and Pakistan reviewed earlier OHASA meetings, shared case studies of national and regional One Health initiatives in Asia and developed a roadmap for 2013-14. A white paper and set of recommendations were presented on the way forward for the Alliance. Click here to access summary of the report

Roadmap for Preparing National Public Health Laboratory Services Framework
The document outlines the key strategic challenges and a possible roadmap for creating a National Public Health Laboratory Services Network. It documents RCZI’s findings from field assessment of rabies control initiative in Tamil Nadu and presented recommendations for policy and programme. Click here to access full report.

RCZI Brainstorming Meeting Report
An expert group meeting involving 33 representatives from 23 national and international agencies was held on 13th June 2008 to create a roadmap for combating zoonoses in India. It outlined RCZI’s initial research agenda and priority themes, building a case for contributing meaningfully to the human-animal-wildlife-veterinary health space. For reading the full report click here.

Paper & Poster Presentations made by RCZI

RCZI Represented at National and International Forums
Key findings and outcomes of some of the studies and initiatives taken by RCZI, have been presented at various prestigious fora. Some of these are summarised below:

Cost Estimation of a State-level Rabies Control Programme
The presentation made at the 3rd National Conference of Consortium Against Rabies, New Delhi,
20th April, 2013 organised by the University College of Medical Sciences It described the costs that were likely to be incurred by the state of Tamil Nadu in implementing a state-wide population level rabies control programme The study identified major driver of these costs and identified measures to bring them down.


Rabies Control in India: Bridging the Research-Policy Gap
Rabies research in India suffers from a disconnect, especially vis-à-vis the needs of policy makers. In contrast to the identified research priorities around epidemiologic and policy-related issues, bulk of the rabies research conducted in India pertains to basic science research related to development of new interventions. This was the focus of the presentation made by RCZI at the National Rabies Symposium at NIMHANS, Bangalore, March 25, 2013 and the Annual Conference of Consortium against Rabies, New Delhi, April 20, 2013.

Pathogen Diversity and the Big Picture: Case of Japanese Encephalitis in Northern Uttar Pradesh

Japanese encephalitis as the aetiology of acute encephalitis syndrome (AES) in northern Uttar Pradesh has been under question and a topic of recent debate. Several factors including quality of surveillance, timely and quality laboratory diagnosis, delivery of interventions and access to care need to be looked into before pathogen diversity can be implicated. Answers to these research questions will ensure specificity of public health action. A presentation was made by RCZI at a conference on Pathogen Diversity: Exploiting Pathogen Genetics for New Control Strategies in New Delhi on March 6-7, 2013 organised jointly by ICMR, PHFI, ICGEB & London School of Hygiene and Tropical Medicine.

Research Priorities in AES/JE

Research on AES needs to broaden its focus beyond the pathogen and include knowledge gaps related to the pathogen, host-pathogen interaction, host-immune system interaction, laboratory diagnosis, disease surveillance system, immunization, health care delivery and access as well as community perceptions and knowledge. Research priorities in AES/JE were highlighted in a presentation made at a two-day workshop on Disease Surveillance, Laboratory Networking and Other Related Aspects of Japanese Encephalitis held in Gurgaon on March 5-6, 2013. Organised by National Vector Borne Disease Control Programme, Ministry of Health & Family Welfare, GoI, it was mainly for State Programme Officers and those in-charge of laboratories.

Identifying Research Priorities for Zoonoses Research in India
Presented at the 1stInternational OneHealth Congress in 2011, the paper identified priority areas, examining the multisectoral and system-based determinants of priority research on zoonoses. The presentation described how this exercise allowed preparation of a strategic research agenda to inform systemic interventions for zoonoses prevention and control. The paper was authored by Drs. Syed Abbas, Nitin Sekar, Naman Shah and Manish Kakkar. To read more, click here

Developing One Health Approaches in India
Presented at the 1stInternational OneHealth Congress in 2011 in Australia, the paper examined the relevance, constraints and approaches related to the OneHealth model in India. With increasing risk of infectious diseases at the human-animal-environment interface, OneHealth is being increasingly recognised as the most suitable approach to deal with and manage emerging zoonotic threats. Strong political will, evidence-based policy innovations, clearly defined roles and responsibilities of agencies, coordination mechanisms at all levels and a culture of open information exchange, rooted in the OneHealth approach were seen as factors that could contribute to the early success of these models. To read more, click here

RCZI’s Contribution to Collaborative Research and Capacity Building on Zoonoses The presentation was made to visiting teams from IDRC and ILRI in February, 2011. It outlined the strategic vision of RCZI and how it has evolved since its inception. It described the experience of the Initiative in conducting collaborative research and capacity building with diverse sectors. Click here to access full presentation

Developing One Health Approaches in India
India has been identified as a global hotspot for the emergence and spread of EIDs, including zoonoses and those that are likely to arise from wildlife reservoirs. The presentation was delivered at a symposium convened by the One Health Alliance of South Asia (OHASA) at the 1stInternational One Health Congress in Melbourne on February 14-16. Click here to access full presentation

Identifying Research Priorities for Zoonoses research in India
The presentation related to the systematic research prioritisation exercise organised by RCZI earlier. It aimed to identify priority areas of research on zoonoses control in India with an implementation perspective while looking closely at the multisectoral and systems-based determinants of priority research on zoonoses. Click here to access the presentation.

Useful Links to Multimedia and Print Content on Zoonoses

A list of useful web resources on zoonoses have been compiled and listed below. These cover organisations and recommended links that provide information on H1N1, food safety, One Health and conservation medicine.

Useful links & Web resources

ORGANISATIONS

World Health Organization
Webpage lists Information, alerts and institutions working on Zoonoses.
Website:- http://www.who.int/zoonoses/en/

World Organization for Animal Health
Website on animal diseases prevention and control.
Website:- http://www.oie.int

Food & Agriculture Organization (FAO)
Provides information on agriculture, forestry and fisheries.
Website:- http://www.fao.org

U.S. Geological Survey (USGS)
The Biological Resources Discipline (BRD) of the USGS provides scientific information on technologies needed to support management and conservation of biological resources.
Website:- http://biology.usgs.gov/

International Veterinary Information Service
Provides free access to information on veterinary medicine.
Website:-http://www.ivis.org/home.asp

US CDC's National Center for Emerging and Zoonotic Infectious Diseases
Provides information on endemic diseases,, emerging diseases , and zoonotic diseases from "One Health" strategy perspective.
Website:- http://www.cdc.gov/ncezid/

WEB RESOURCES ON H1N1 CDC H1N1 Flu

The US Center for Disease Control and Prevention offers information to the general public, as well as the latest research and recommendations to practitioners.
Website: http://cdc.gov/h1n1flu/

NIH Medline Plus- H1N1 Flu (Swine Flu)
The US National Institutes of Health provide a comprehensive library on the latest research news, developments and publications on H1N1 and influenza related research.
Website: http://www.nlm.nih.gov/medlineplus/h1n1fluswineflue.html

WEB RESOURCES ON FOOD SAFETY

World Health Organization. Food Safety
The World Health Organization’s micro site provides updates on recent events, fact sheets on food safety and an umbrella of information along with videos and publications by the WHO Department Food Safety and Zoonoses.
Website: http://www.who.int/foodsafety/en/

Food and Agriculture Organization (FAO) of the United Nations, Food Safety and Quality
The FAO’s Food Safety and Quality micro site provides a comprehensive library on the latest publications, news, developments related to food safety and quality work at FAO.
Website: http://fao.org/food/food-safety-quality/en/

WEB RESOURCES On "One Health"

Thailand uses ‘One Health’ Approach to Control Spread of H5N1
Watch this video



In Thailand, H5N1 virus (Avian flu) was first confirmed in 2003. The video shows a case study that talks of the infectious disease found in chicken and ducks, which rarely passes to humans, but is deadly enough. It establishes the importance of One Health to control spread of the virus by focusing on improved surveillance, increased capacity, better collaboration, early detection, proper diagnoses and timely treatment.

US CDC’s office for One Health
The CDC office coordinates all One Health activities. This page provides information about the principles of One Health discussions that are organised globally with useful information, trends and research findings.
Website:- http://cdc.gov/onehealth/

US 'One Health Initiative'
This is an academic collaboration of American Veterinary Medical Association, American Medical Association, American Society of Tropical Medicine and Hygiene, American Society for Microbiology and CDC. It provides basic information and updates on academic activities in the field of One Health in the US.
Website:- http://www.onehealthinitiative.com/

Wildlife Conservation Society
The website is a useful resource for updates on global developments and activities in the field of One Health.
Website:- http://www.oneworldonehealth.org/

FAO, WHO and OIE Tri-partite Partnership

A useful resource which describes the contours of the partnership between the principle multilateral institutions working in agriculture, health and veterinary sectors.
Website:- http://www.fao.org/ag/againfo/home/en/news_archive/AGA_in_action/2013_Tripartite_partnership_at_the_human-animal-ecosystem_interface.html

Hubnet One Health Network South Asia
This is a virtual network for researchers and practitioners in zoonoses and One Health who are taking up issues from multiple sectors. This newly launched platform has several pages for country level national hubs and provision for researchers from different regions and sectors bringing them together to execute collaborative projects.
Website:- http://www.hubnet.asia/

WEB RESOURCES ON CONSERVATION MEDICINE

Wildlife Trust of India
Provides information on news, activities and programmes on wildlife conservation in India.
Website:- http://www.wildlifetrustofindia.org/

The Bombay Natural History Society
Dedicated website with information on research, book reviews and publications on nature conservation in the Indian sub-continent.
Website:- http://www.bnhs.org/

Tufts Center for Conservation Medicine
Provides information on latest developments in research, education and training in ecosystem health.
Website:- http://www.tufts.edu/vet/ccm/

Wildlife Trust
Wildlife Trust’s micro site on Conservation Medicine has details on its programmes, projects and publications.
Website:- http://wildlifetrust.org/conservation_medicine/

Consortium for Conservation Medicine
This is a repository of news, web resources, latest developments in research and peer reviewed publications on conservation medicine.
Website:- http://www.conservationmedicine.org/