 Good afternoon, everyone. My name is Donald. I work from the government. I work as a veterinarian in the country government of courage. And also an affiliate of the Kenya field epidemiology and about training units training units. Intermediate class of 2018. My presentation today is about football this is outbreak in creature county background globally football disease are important cause of illness and death among. Among human populations, and they also impair on socio economic development of the entire population. In this week now, there's no sufficient data or information to actually put a quantity figure on the global burden due to football this is outbreaks bacteria is said to be responsible for almost two thirds of human football disease outbreaks worldwide. The CDC has estimated that football disease diseases are responsible for 76 million human illnesses to 25,000 hospitalization and 5,000 deaths in the USA. In Kenya. He said that under reporting inadequate investigation of disease outbreaks, and in the liquid diagnostic facilities suggest that football diseases are more than what's recorded by the Minister of Health. In addition, I will try to relay the findings about a football disease outbreak investigation. And also how interdisciplinary partnership played along to bring out this investigation into perspective perspective on Monday of the 23rd, August 2021. The county disease surveillance or response team notified by the hospital clinician that you are that five patients who had been reported to the hospital in symptoms of diarrhea for meeting and headache. Five patients, a total of that five patients were admitted with these symptoms, and later on the course of the day that the 38 year old made passed away. Five patients were immediately admitted. At 29 were treated at the casualty and released to go home. On the same evening, the story was carried on the national media. And now it was a big news. The following day that is on 24th. This is the, the Department of Health, constitution and interdisciplinary team. That was having a task of establishing the existence of a possible outbreak of a zoonotic football disease. And the team was, was given a minute to go to the ground and establish existence of football disease outbreak. And also come with the ways of managing it, bring it under control. The team went to the ground. We found from the key informants that a sick goat had been slaughtered in that village on Friday. And the meat was sold out locally. And people ate it on further questions before that the goat was sick. Previously, maybe on Tuesday, the owner sold it to a butcher. And the butcher stayed with it on Wednesday. And brought it back to the owner because he realized that the goat was sick and never signs was bloated. And that the funny behavior so he brought back to the goat, then on Friday, that's when the owner slaughtered it to recover his costs. So the team that went to the ground to do to establish disease. If there was a disease outbreak and find out reasons as to why had the following composition. The human clinical laboratory staff, public health team, but not a public health and place of disease surveillance and also people from the regional veterinary research laboratory in the country. Also in the team we had the community health workers, as well as the media kumi and the provision on the national administration. The main objective of this team was just to describe the football disease outbreak. In a, in, in, in person, place and time, and also characterize the risk factors that resulted to people getting into contact with the unsafe food. So this study was done in Saliatu Ward. This is the first one since a great sub county of Kichu County. It lasted from the 23rd, when the outbreak was detected at the 31st, when symptoms are resolved. Then we did that is respective courts, premium custody. So we had a case definition, because we are doing a line list of people who are exposed. So we were listing anybody, or any person of any age who ate the goat that was slaughtered on Friday, on the 23rd of August 2021 at the same village, at the same word Saliatu Ward. Then we commenced to do an active case search the following day. We did a structured question there. That was a multi disciplinary supported. So we had a knowledge attitude and practice questions in it, so that you could get prongs into all areas where we could generate data. So, socio demographic variables clinical exposure factors were considered. After that, there were samples that were considered for laboratory analysis, the human samples that are collected in the hospital. So the RVL creature went ahead and took the environmental samples and screened a few animals within the homesteads. The samples were the human samples were analyzed, missing certain culture and molecular typing for pathogenic enterics. This was done at the water in the human laboratory diagnostics in creature that was collected by training numerators. We got a training. So this was my disciplinary. It was one setting, and that was entered and clean in the Microsoft Office Excel. Continuous data was analyzed by measures of center tendency, and his passion, we reported they must mean and medium. This data was analyzed by frequency of counts and proportions and presented in terms of graphs, where we analyze hypothesis we calculate the relative risks. In areas where the risk factors are the epidemiological significance results in the descriptive findings. Three cases online is listed actively on the ground during the case search. The median age was 27 years. 29 of them were female that was 54 or 70%. Then we find that the median incubation period of the disease that was 15 hours. The total of 58% of the property cases sort medical care within 24 hours of onset of clinical science, a symptom solution period had a median of 5.5 days. So it means the convalescence period was around one week. The table below shows the proportion of football disease mobility, characterizing times of age and sex. And between age six and 15. Those are children that bought the branch of this football disease outbreak. And most of them were young children of female gender. Okay. When we describe, we describe symptoms among the outbreak cases so that we could know which ones are more predominant. 53 cases that will I listed 24 of them came down with the clinical disease and this was the predominant symptoms that they complained about. headache was number one at 87% for the body fever 79 abdomen opens diarrhea, nausea fatigue and vomiting. So these ones we saw them as quite characteristics of a football. A bacterial football disease outbreak that we are going to describe. Yeah, then we did a bivariate analysis. We conducted hypothesis testing, a lot of it. And now we found significant relationship on this independent variables. We found that in terms of gender and the residents of a particular village called keeps it on where the animal was loaded. The group had the higher relative risk of developing disease. So we thought is a group problem. And maybe the particular behavior of these groups could have predisposed them to a risky public health behavior that is gender in terms of the male or more at risk developing disease than female. And also the rest days of that particular village. I think they are consumption and the utilization of the meat in greater quantities could have come to that. And then we analyze those who eat at the roast meat, the method of cooking, category of yes or no, because they were eating roast roasted some ate it raw. Some ate it boiled. So those who ate it roasted were more likely to develop disease than the other methods of cooking. Then eating types that is the so-called matumbo. They were more at higher risk of coming down with the disease. So the battle is as from human samples. When does follow the we isolated the five pathogenic microorganisms of which two were several types of E. coli and one was salmonella. As shown in the table above. So enter a toxic unique E. coli. We had two isolates. She got toxic producing E. coli. We had two isolates enter aggregate to E. coli. We had two isolates salmonella to enter pathogenic E. coli. There was one isolate. So it seems like there was a mixed like kind of infection or pathogenic bacteria. In this population discussion. After analyzing the data presented before us, we could say that this disease was an outbreak of bacteria is no disease caused by pathogenic E. coli and salmonella organisms in primary transmission because people ate it directly. There was no vehicle involved. Then progression of clinical symptoms, as we described them, like incubation periods of 15 of a medium of 15 hours. For a period lasting for almost a week, 5.5 days in a medium and the presently consigns of headache, fever, diarrhea and stomach aches. These are not consistent with the isolates that were confirmed in the laboratory of the human samples. Then children are the greatest but the greatest burden of clinical disease. We perceived it may be due to the low immunity or lack of exposure to such kind of pathogenic organisms. The males and the residents of that particular village, we perceived that they were a high risk group, maybe due to a behavior that could put them to a public health risk. I don't know whether this is gender like it was discussed yesterday that males tend to behave in a particular manner that could endanger them or make them risky to succumb to disease. In this community, it is an agro-pastoral community and people believe that maybe eating raw parts of a goat is more traditional or healthier than eating the cooked ones. Because what this, the old guys tend to get some organs and eat them raw first is when the women can go and cook. So we thought that is a risky behavior that was being practiced by a particular group of these populations. Then people having eaten the roasted meat, the types that is the matumbo or high disease risk due to, if you look at the kind of cooking, maybe for the roast meat, there's insufficient heat penetration and also there's a lot of handling. So that if there was a contamination, it could easily be passed from a person to the food and to the consumer who is likely more to get ill. And also the tribes, we perceive them to be, to have a high dose of the pathogens because these pathogens, the E. coli and salamonera are most of them are enterics and they are found as number of Laura within the fecal material of animals. And then we found that health seeking duration was very short. That is within 12 to 24 hours of development of clinical science. So we could say that this was due to the severity of this foodborne disease outbreak, because the health seeking pattern of most people in the society, people tend to stay with the disease waiting resolution before they seek medical help. But all these ones everybody just all of a sudden sort medical intervention. Then the limitations to our study was that there was an availability of samples from the sort of animals. So that we could take it also for bacteriology. The sort of animals you could not get even the fecal material, even the hides the schemes, even the bones. Everything was not there. This one we attributed to maybe there was a kind of a destruction of evidence, because people are now apprehensive. A person died in this village. The person who started the animal is a pastor. And also has got a lot of influence. Then it was also under arrest by the police but the time we are going there was already arrested. So we thought that the villagers were now trying to conceal. So that we don't break through with any investigation that could put him at the center of this. So that was a limitation. We could not directly link the animal slaughtered the food to the pathogens found or isolated within the human population. So what are the public health actions and the importance of this my team response that we played from 23rd when the case, the first cases, the outbreak was detected. And the team was constituted. That was veterinary public health, medical laboratory, and all of us, we came together and we played a very pivotal role in the detection of disease outbreak verification of diagnosis and confirmation of disease in the laboratory. The case definition we worked on it as a team. The team that structured questionnaires. This also included the knowledge added to the practice about animal health, about public health and health seeking behavior of people in the population. So it was a very big study, some of the findings we've not reported here. So we also did the tabulation and orientation of that in time place a person so that you could describe actually what was going on. Then there was formulation and test of hypothesis this one we did it because the interdisciplinary approach was very important. Like in case of epidemiologic consultation. The medical side was the one that was leading this team, but now the veterinary side also came in to bring out epidemic information that could help develop hypothesis actually to determine risk factors that could have led to the development of the food bond disease outbreak. Then as a team when we conducted the implementation of control measures, and we communicated and submitted the findings about the food bond disease outbreak. In conclusion, I can say that the food bond disease outbreak was caused by proteolytic E. coli and salamonella bacteria. And this was rapidly managed. Check the importance of having a coordinated county to display one health team. And the next behaviors in gender and geographical defined groups in increased food handling inadequate cooking time. The middle role in the food bond disease outbreak. Then we can say that children bought the greatest health burden of the food bond disease outbreak in a recommendation. We are recommending continuous public health education on food hygiene practices and change of attitudes regarding public health risk behaviors. This may be attributed to particular groups, like men or particular groups in the village. Then we also recommend that there should be anchoring the county one health into business teams on disease control policy in each and every county, so that there by giving it a formal institutional platform for efficient communication, coordination and leadership, because without leadership. And the team cannot work harmoniously. Like the one we did because we did not have a formal platform to carry out this work. We also want to acknowledge the country government of creation department of health, led by our epidemiologist Dr Kagan taboo. He coordinated this work. Our director to fit in our services. We also want to thank Walter in the project. Medical research is to encourage you for having done the laboratory work. Isolation and character and the character decisions of the various isolates. The molecular work. We also want to thank the area because they try to look at the environmental samples to screen some elements of this same population to see the spread of the pathogenic organisms in the environment. And the least one last but not least, they can all have conference. For having a given this response to further disseminate this information. General populace. So those are some of my references. In the picture form this is a. We are doing key informant interview as a lead word, this is a grounds, and this is the RVL team. They're trying to pick some environmental samples for laboratory work. I say thank you. Thank you very much. Dr. There are several questions that have come through from the chat. I can see Dr. I tried to help you address some of them. But if you can just go through the chat and address those questions because you're pressed for time. I think the important thing is the fact that you have elucidated that incurring the country one health teams in the county is critical and important. I think it's a discussion that will be having with the panelists at the policy level when Dr. Barraza will be leading.