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Tackling the Tip of the Iceberg – Using a One Health Approach to Tuberculosis

M A Miller(1,2,3)

1:Stellenbosch University, Faculty of Medicine and Health Sciences; 2:Department of Science and Innovation – National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research; 3:National Research Foundation South African Research Chair Initiative in Animal Tuberculosis

Tuberculosis, caused by infection with Mycobacterium tuberculosis complex (MTBC) members, is a significant global health concern for humans and animals. Despite the zoonotic and anthropogenic potential of MTBC, there has historically been little interaction between human and animal health. The “Roadmap to Zoonotic Tuberculosis” (2017) was the first step in recognizing the role of wild and domestic animals in the global plan to eradicate human TB. As scientific advances facilitate improved detection in human and animal populations, there is a growing imperative to revisit the complex epidemiology of this multi-host disease and apply transdisciplinary expertise to construct effective management and control programs. South Africa has one of the highest human TB burdens. People in rural communities often have regular contact with communal livestock, yet there is little information on zoonotic TB or MTBC in animals. The lack of resources for animal health surveillance and intervention, communal herding practices, and traditional use of livestock contribute to maintenance of animal TB in communities. In addition, the historical spillover from infected cattle into wildlife populations has resulted in Mycobacterium bovis (M. bovis) reported in 25 African wildlife species, some of which have become reservoir hosts. Endemically infected wildlife populations also present a threat of spillback into livestock and people. Although previously understudied, the role of indirect transmission through environmental contamination may be an important factor in inter-species transmission. Using a One Health approach to TB can provide novel insights and improve strategies to control disease in humans and animals.

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