New PNAS-published study discloses the ‘hot spots’, ‘warm spots’ and ‘cold spots’ of global livestock disease risk

Posted on May 25, 2011 by Susan MacMillan

Small-scale livestock-dependent agriculture in developing countries makes up one of three trajectories of global disease risk; here, cattle belonging to a widowed farmer in Garue, Mozambique, are brought in for the night by a herdsboy (photo credit: ILRI/Mann).

‘Current drivers and future directions of global livestock disease dynamics’ is a special feature published in the (online) 16 May 2011 issue of the Proceedings of the National Academy of Sciences (PNAS) of the USA. The authors of the paper are Brian Perry, Delia Grace and Keith Sones.

Irish veterinary epidemiologist Delia Grace leads a team researching animal health and food safety for trade at the International Livestock Research Institute (ILRI), based in Nairobi, Kenya.

In the PNAS paper, the authors write: ‘The current era of globalization is seeing unprecedented movements of people, products, capital and information. Although this has obvious implications for economies and ecosystems, globalization also affects the health of people and animals. This paper reviews changing patterns of livestock disease over the last two decades, discusses the drivers of these patterns, and plots future trajectories of livestock disease risk in an effort to capitalize on our understanding of the recent past and provide a guide to the uncertain future.’

While acknowledging the complexity of disease dynamics, the authors point to three main drivers of changing livestock disease dynamics: ecosystem change, ecosystem incursion, and movement of people and animals. Underlying these dynamics are the growing demand for livestock products (the Livestock Revolution) and increasing human population size.

The authors identify three trajectories of global disease dynamics:
‘(i) the worried well in developed countries (demanding less risk while broadening the circle of moral concern)
‘(ii) the intensifying and market-orientated systems of many developing countries, where highly complex disease patterns create hot spots for disease shifts
‘(iii) the neglected cold spots in poor countries, where rapid change in disease dynamics is less likely but smallholders and pastoralists continue to struggle with largely preventable and curable livestock diseases.’

On the topics of major trends in disease dynamics, the authors point out that ‘From a centuries-long and whole-world perspective, human wealth and health continue to improve, and animal health parallels this, showing an overall dramatic decline of infectious disease and shift to noncommunicable diseases. (This has been called the second epidemiological transition; the first epidemiological transition was 10,000 y ago, when human settlement led to a surge in zoonoses and crowd-related diseases.)’

However, the authors also say that ‘Although control and management of many endemic diseases in rich countries have improved, new diseases such as BSE and HPAI have emerged. Some consider that we face a third epidemiological transition of disastrous consequence in which globalization and ecological disruption drive disease emergence and reemergence; as occurred in the first epidemiological transition (associated with neolithic sedentarization and the domestication of livestock), the worst of the emerging diseases are likely to be zoonotic.’

The authors go on to consider ‘the drivers with greatest influence on livestock disease dynamics, namely increasing human population size and prosperity and the related demand-driven Livestock Revolution. . . . [W]e identify three overarching sets of animal diseases dynamics and associated control. Each system is facing different risks to livestock health, each has different determinants of disease status and capacity to respond, and each requires different approaches to resolve them.’

‘In the background,’ they say, ‘is the significant component of the world’s livestock enterprises in the hands of the very poor, for whom intensification is just not a realistic option and who are likely to be most vulnerable to disease resurgence. . . .

‘Although we call these [very poor livestock] systems cold spots for disease dynamics and emergence, they are inevitably hot spots for endemic diseases, periodic epidemics (such as Newcastle disease, which regularly wipes out village flocks), and neglected zoonoses, which significantly impact on human health. Because of the low densities of livestock, their remoteness, and the slow change in husbandry practices, these are probably not hot spots for emerging diseases. . . .

‘This review is prognostic rather than therapeutic, presenting implications for livestock disease in the 21st century. In an increasingly globalized world, deepening of the existing balkanization of livestock health status will create inevitable instability. The main challenges are (i) to speed the convergence of livestock health between the intensifying and intensified regions through improved coordination, communication, and harmonization and (ii ) to improve resilience of smallholder livestock systems, including the support of viable exits from livestock keeping.’

Read the whole paper in the Proceedings of the National Academy of Sciences: Current drivers and future directions of global livestock disease dynamics, by Brian Perry, Delia Grace and Keith Sones, 16 May 2011.

Read an ILRI brief: Why animals matter to health and nutrition, February 2011.

Read another ILRI News Blog article related to this topic: Adapting agriculture to improve human health—New ILRI policy brief, 21 February 2011.

Read an ILRI news release: Livestock boom risks aggravating animal ‘plagues,’ poses growing threat to food security and health of the world’s poor, 2 February 2011.

Scientists identify livestock genes to unlock protection against one of Africa’s oldest animal plagues

Posted on May 18, 2011 by Susan MacMillan

Cow suffering from trypanosomiasis (photo credit: ILRI/Elsworth).

An international research team using a new combination of approaches has found two genes that may prove of vital importance to the lives and livelihoods of millions of farmers in a tsetse fly-plagued swathe of Africa the size of the United States. The team’s results were published today in the Proceedings of the National Academy of Sciences (PNAS).

The research, aimed at finding the biological keys to protection from a single-celled trypanosome parasite that causes both African sleeping sickness in people and a wasting disease in cattle, brought together a range of high-tech tools and field observations to address a critical affliction of some of the world’s poorest people.

With increased surveillance and control, sleeping sickness infections in people have dropped ten-fold in the last 13 years, from an estimated 300,000 cases a year in 1998 to some 30,000 in 2009, with the disease eventually killing more than half of those infected. Although best known for causing human sleeping sickness, the trypanosome parasite’s most devastating blow to human welfare comes in an animal form, with sick, unproductive cattle costing mixed crop-livestock farmers and livestock herders huge losses and opportunities. The annual economic impact of ‘nagana,’ a common name in Africa for the form of the disease that affects cattle (officially known as African animal trypanosomiasis), has been estimated at US$4–5 billion.

In a vast tsetse belt across Africa, stretching from Senegal on the west coast to Tanzania on the east coast, and from Chad in the north to Zimbabwe in the south, the disease each year renders millions of cattle too weak to plow land or to haul loads, and too sickly to give milk or to breed, before finally killing off most of those infected. This means that in much of Africa, where tractors and commercial fertilizers are scarce and prohibitively expensive, cattle are largely unavailable for tilling and fertilizing croplands or for producing milk and meat for families. The tsetse fly and the disease it transmits are thus responsible for millions of farmers having to till their croplands by hand rather than by animal-drawn plow.

‘The two genes discovered in this research could provide a way for cattle breeders to identify the animals that are best at resisting disease when infected with trypanosome parasites, which are transmitted to animals and people by the bite of infected tsetse flies,’ said senior author Steve Kemp, a geneticist on joint appointment with the Nairobi-based International Livestock Research Institute (ILRI) and the University of Liverpool.

This genetics of disease resistance research was led by scientists from ILRI in Africa and from the UK universities of Liverpool, Manchester and Edinburgh, and involved researchers from other institutions in Britain, Ireland and South Korea.

The researchers drew on the fact that while the humped cattle breeds characteristic of much of Africa are susceptible to disease-causing trypanosome parasites, a humpless West African breed, called the N’Dama, is not seriously affected by the disease. Having been domesticated in Africa some 8,000 or more years ago, this most ancient of African breeds has had time to evolve resistance to the parasites. This makes the N’Dama a valued animal in Africa’s endemic regions. On the other hand, N’Dama cattle tend to be smaller, to produce less milk, and to be less docile than their bigger, humped cousins.

African agriculturalists of all kinds would like to see the N’Dama’s inherent disease resistance transferred to these other more productive breeds, but this is difficult without precise knowledge of the genes responsible for disease resistance in the N’Dama. Finding these genes has been the ‘Holy Grail’ of a group of international livestock geneticists for more than two decades, but the genetic and other biological pathways that control bovine disease resistance are complex and have proven difficult to determine.

The PNAS paper is thus a landmark piece of research in this field. The international and inter-institutional team that made this breakthrough did so by combining a range of genetic approaches, which until now have largely been used separately.

‘This may be the first example of scientists bringing together different ways of getting to the bottom of the genetics of a very complex trait,’ said Kemp. ‘Combined, the data were like a Venn diagram overlaying different sets of evidence. It was the overlap that interested us.’

They used these genetic approaches to distinguish differences between the ‘trypano-tolerant’ (humpless) N’Dama, which come from West Africa, and ‘trypano-susceptible’ (humped) Boran cattle, which come from Kenya, in East Africa. The scientists first identified the broad regions of their genomes controlling their different responses to infection with trypanosome parasites, but this was insufficient to identify the specific genes controlling resistance to the disease. So the scientists began adding layers of information obtained from other approaches. They sequenced genes from these regions to look for differences in those sequences between the two breeds.

The team at Edinburgh conducted gene expression analyses to investigate any differences in genetic activity in the tissues of the two cattle breeds after sets of animals of both breeds were experimentally infected with the parasites. Then, the ILRI group tested selected genes in the lab. Finally, they looked at the genetics of cattle populations from all over Africa.

Analyzing the vast datasets created in this research presented significant computational challenges. Andy Brass and his team in the School of Computer Science at the University of Manchester managed to capture, integrate and analyze the highly complex set of biological data by using workflow software called ‘Taverna,’ which was developed as part of a UK e-Science initiative by Manchester computer scientist Carole Goble and her ‘myGrid’ team.

‘The Taverna workflows we developed are capable of analyzing huge amounts of biological data quickly and accurately,’ said Brass. ‘Taverna’s infrastructure enabled us to develop the systematic analysis pipelines we required and to rapidly evolve the analysis as new data came into the project. We’re sharing these workflows so they can be re-used by other researchers looking at different disease models. This breakthrough demonstrates the real-life benefits of computer science and how a problem costing many lives can be tackled using pioneering E-Science systems.’

To bolster the findings, population geneticists from ILRI and the University of Dublin examined bovine genetic sequences for clues about the history of the different breeds. Their evidence confirmed that the two genes identified by the ILRI-Liverpool-Manchester groups were likely to have evolved in response to the presence of trypanosome parasites.

‘We believe the reason the N’Dama do not fall sick when infected with trypanosome parasites is that these animals, unlike others, have evolved ways to control the infection without mounting a runaway immune response that ends up damaging them,’ said lead author Harry Noyes, of the University of Liverpool. ‘Many human infections trigger similarly self-destructive immune responses, and our observations may point to ways of reducing such damage in people as well as livestock.’

This paper, said Kemp, in addition to advancing our understanding of the cascade of genes that allow Africa’s N’Dama cattle to fight animal trypanosomiasis, reaffirms the importance of maintaining as many of Africa’s indigenous animal breeds (as well as plant/crop varieties) as possible. The N’Dama’s disease resistance to trypanosome parasites is an example of a genetic trait that, while not yet fully understood, is clearly of vital importance to the continent’s future food security. But the continued existence of the N’Dama, like that of other native ‘niche’ African livestock breeds, remains under threat.

With this new knowledge of the genes controlling resistance to trypanosomiasis in the N’Dama, breeders could screen African cattle to identify animals with relatively high levels of disease resistance and furthermore incorporate the genetic markers for disease resistance with markers for other important traits, such as high productivity and drought tolerance, for improved breeding programs generally.

If further research confirms the significance of these genes in disease resistance, a conventional breeding program could develop a small breeding herd of disease-resistant cattle in 10–15 years, which could then be used over the next several decades to populate Africa’s different regions with animals most suited to those regions. Using genetic engineering techniques to achieve the same disease-resistant breeding herd, an approach still in its early days, could perhaps be done in four or five years, Kemp said. Once again, it would be several decades before such disease-resistant animals could be made available to most smallholder farmers and herders on the continent.

‘So it’s time we got started,’ said Kemp.

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See this news and related background material at ILRI’s online press room.

The International Livestock Research Institute (www.ilri.org) works with partners worldwide to help poor people keep their farm animals alive and productive, increase and sustain their livestock and farm productivity, and find profitable markets for their animal products. ILRI’s headquarters are in Nairobi, Kenya; we have a principal campus in Addis Ababa, Ethiopia, and 13 offices in other regions of Africa and Asia. ILRI is part of the Consultative Group on International Agricultural Research (www.cgiar.org), which works to reduce hunger, poverty, illness and environmental degradation in developing countries by generating and sharing relevant agricultural knowledge, technologies and policies. This research is focused on development, conducted by a Consortium (http://consortium.cgiar.org) of 15 CGIAR centres working with hundreds of partners worldwide, and supported by a multi-donor Fund (www.cgiarfund.org).

The University of Liverpool (www.liv.ac.uk) is a member of the Russell Group of leading research-intensive institutions in the UK. It attracts collaborative and contract research commissions from a wide range of national and international organizations valued at more than £110 million annually.

The University of Manchester (www.manchester.ac.uk), also a member of the Russell Group, is the largest single-site university in the UK. It has 22 academic schools and hundreds of specialist research groups undertaking pioneering multi-disciplinary teaching and research of worldwide significance. According to the results of the 2008 Research Assessment Exercise, the University of Manchester is now one of the country’s major research universities, rated third in the UK in terms of ‘research power’. The university has an annual income of £684 million and attracted £253 million in external research funding in 2007/08.

Canadian vaccine research leader Lorne Babiuk joins the board of trustees of the International Livestock Research Institute

Posted on November 10, 2010 by Susan MacMillan

ILRI biotechnology director Vish Nene (left) and new ILRI board member Lorne Babiuk (right) at the November 2010 meeting of the ILRI Board of Trustees (photo credit: ILRI/MacMillan).

Lorne Babiuk, a leader in Canadian vaccine research and vice-president for research at the University of Alberta, Canada, joined the board of trustees of the International Livestock Research Institute (ILRI) this month (November 2010), when he attended his first board meeting, held at ILRI’s headquarters, in Nairobi, Kenya.

As vice-president of research, Babiuk facilitates the University of Alberta’s research, builds research consortia and strengthens the university’s international research links and collaborations. In 2010, the university opened the Li Ka Shing Institute of Virology, an institute created through a combined gift of $25-million from the Li Ka Shing (Canada) Foundation and $52.5-million from the Government of Alberta. The donation—the largest cash gift in the university’s history—will provide a state-of-the-art home to some of the world’s very best researchers in virus-based diseases. The new institute is working to attract significant private-sector collaboration with multinational pharmaceutical and life sciences companies.

Since 2005, Babiuk has also served as principal investigator on a grant from the Bill and Melinda Gates ‘Grand Challenge in Global Health’ program, in which he and his team are developing vaccines against whooping cough (pertussis) in infants and young children, to be delivered in a single dose, without use of a needle. Children now need five doses of the vaccine to be fully protected and few children in the developing world get all the boosters.

Babiuk also supports Albertan research initiatives such as the Pan Albertan Neuroscience Network. As vice-president, he established an annual event that celebrates the breadth and depth of the university’s research in all disciplines—from social sciences to the arts, humanities, medical, agricultural, natural sciences and engineering. He has consistently fostered research that crosses traditional disciplinary boundaries by, for example, supporting collaborations between social scientists and medical, agricultural and engineering researchers. And he helped develop the infrastructure needed by researchers in all fields to be more successful in individual and team grants.

Before moving to the University of Alberta, Babiuk built up a research institute—the Vaccine and Infectious Disease Organization (VIDO), at the University of Saskatchewan—which became internationally recognized as a leader in new vaccine development. In 2005, he completed a US$19.4 million expansion of VIDO, and just before leaving VIDO, he assembled the funding needed to build a $140-million level-three bio-containment facility for work on infectious diseases.

Earlier in his career, Babiuk was part of a research consortium that developed and began testing a vaccine for SARS (sever acute respiratory syndrome) within 18 months of its outbreak in Canada. In addition to SARS and whooping cough, Babiuk has led research into the herpes virus and the respiratory syncitial virus and created a vaccine against rotavirus in calves, which allowed researchers later to develop a vaccine for rotavirus in children.

After completing a master’s degree in soil microbiology, Babiuk earned a PhD in virology from the University of British Columbia and a DSc from the University of Saskatchewan’s Department of Veterinary Microbiology. He has mentored over 90 graduate students and postdoctoral fellows and published over 500 peer-reviewed manuscripts and 100 book chapters or reviews. He holds 28 issued patents and has 18 patents pending.

Why technical breakthroughs matter: They helped drive a cattle plague to extinction

Posted on October 28, 2010 by Susan MacMillan

Tom Olaka, a community animal health worker in Karamajong, northern Uganda, was part of a vaccination campaign in remote areas of the Horn of Africa that drove the cattle plague rinderpest to extinction in 2010 (photo credit: Christine Jost).

A superb example of why technical breakthroughs matter is reported in the current issue (22 October 2010) of the leading science journal, Science.

The eradication of rinderpest from the face of the earth, probably the most remarkable achievement in the history of veterinary science, is a milestone expected to be announced in mid-2011 pending a review of final official disease status reports from a handful of countries to the World Organisation for Animal Health.

A plague of cattle and wild ungulates, rinderpest would not have been eradicated without such a technical breakthrough. This was the development of an improved vaccine that did not require a 'cold chain' and thus could be administered in some of the most inhospitable regions in the Horn of Africa, where the virus was able to persist due to lack of vaccination campaigns in these hotspots.

Rinderpest is a viral livestock disease that has afflicted Europe, Asia and Africa for centuries. It killed more than 90 per cent of the domesticated animals, as well as untold numbers of people and plains game, in Africa at the turn of the 19th century, a devastation so complete that its impacts are still felt today, more than a century later. The last-known outbreak of rinderpest occurred in Kenya in 2001.

The key technical breakthrough in this effort involved development of an improved vaccine against rinderpest. The original vaccine was developed at the Kenya Agricultural Research Institute (KARI) laboratories. In 1990, Jeffrey Mariner, a veterinary epidemiologist who at that time was at the Tufts Cummings School of Veterinary Medicine and working with the Africa Union-Inter-African Bureau for Animal Resources (AU-IBAR), improved the vaccine by producing a thermostable version that did not require refrigeration up to the point of use. This allowed vets and technicians to backpack the vaccine into remote war-torn areas, where vet services had broken down and international agencies dared not send personnel. The AU-IBAR led the Pan-African Rinderpest Campaign, which coordinated the efforts that resulted in the eventual eradication of rinderpest from Africa.

Now working in the Nairobi laboratories of at the International Livestock Research Institute (ILRI), Mariner says that just as important as this technological advance was getting the development community to begin to address how people work together. Mariner and his colleagues at AU-IBAR themselves took three innovations as lessons from the rinderpest eradication campaign: (1) community-based vaccination programs, (2) participatory surveillance systems based on local knowledge, and (3) optimized control strategies that target high-risk communities through.

‘We must examine issues from the perspective of each group of stakeholders involved and visualize how proposed changes would affect them,’ says Mariner. ‘The power relationships of the groups also need to be considered. Advocates for change must then craft a new vision for how the various stakeholder groups will function that is sufficiently exciting to get people to risk change.’

Excerpts from the Science article, by Dennis Normille, follow.
'Rinderpest, an infectious disease that has decimated cattle and devastated their keepers for millennia, is gone. The United Nations Food and Agriculture Organization (FAO) announced on 14 October in Rome that a 16-year eradication effort has succeeded and fieldwork has ended.

'“This is the first time that an animal disease is being eradicated in the world and the second disease in human history after smallpox,” FAO Director-General Jacques Diouf said in his World Food Day address in Rome the next day.

'“It is probably the most remarkable achievement in the history of veterinary science,” says Peter Roeder, a British veterinarian involved with FAO’s Global Rinderpest Eradication Programme (GREP) from its launch in 1994 until he retired in 2007. For the veterinarians who participated in the effort, the achievement is particularly poignant. . . .

'One formality remains: The Paris-based World Organisation for Animal Health (OIE) still must complete the certification of a handful of countries as rinderpest free. OIE is likely to adopt an official declaration recognizing the demise of the disease at its May assembly. Meanwhile, animal-disease fighters have already been applying lessons learned from the rinderpest campaign and pondering which animal disease might be the next target for eradication.

'Although nearly forgotten in much of the West, as recently as the early 1900s, outbreaks of rinderpest—from the German for “cattle plague”—regularly ravaged cattle herds across Eurasia, often claiming one-third of the calves in any herd. The virus, a relative of those that cause canine distemper and human measles, spreads through exhaled droplets and feces of sick animals, causing fever, diarrhea, dehydration, and death in a matter of days. It primarily affects young animals; those that survive an infection are immune for life.

'When the virus hit previously unexposed herds, the impact was horrific. In less than a decade after the virus was inadvertently introduced to the horn of Africa in 1889, it spread throughout sub-Saharan Africa, killing 90% of the cattle and a large proportion of domestic oxen used for plowing and decimating wild buffalo, giraffe, and wildebeest populations. With herding, farming, and hunting devastated, famine claimed an estimated one-third of the population of Ethiopia and two-thirds of the Maasai people of Kenya and Tanzania. . . .

'In 1994, when rinderpest was entrenched in central Africa, the Arabian Peninsula, and a swath stretching from Turkey through India and to Sri Lanka, FAO brought together three regional rinderpest-control programs into GREP and set the goal of eliminating the disease by 2010. . . .

'The key technical breakthrough was the recognition that the virus was re-emerging from just a handful of reservoirs that could be the targets of intensive surveillance and vaccination campaigns. In 1990, Jeffrey Mariner, then at Tufts University School of Veterinary Medicine (now the Cummings School of Veterinary Medicine), had developed an improved vaccine that did not require refrigeration up to the point of use. This allowed vets and technicians to backpack vaccine into remote areas. One of the reservoirs was in the heart of war-torn eastern Africa, where vet services had broken down and international agencies dared not send personnel. GREP relied on local pastoralists to track the disease and on trained community animal health workers to administer the vaccine to quell outbreaks.

'. . . The virus was last detected in 2001 in wild buffaloes in Meru National Park in Kenya, on the edge of the Somali ecosystem.

'What comes next? Some veterinary experts question whether the international community is ready to take on another massive eradication campaign, but one disease mentioned as a possible eradication target is peste des petites ruminants (PPR), which is highly contagious and lethal among sheep and goats. Related to the rinderpest virus, the PPR virus has long circulated in central Africa, the Middle East, and the Indian subcontinent and has recently spread to Morocco. . . .'

ILRI's Jeff Mariner is now working on an improved vaccine for this disease.

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Read the whole article at Science (registration needed to read the full article): Rinderpest, deadly for cattle, joins smallpox as a vanquished disease, 22 October 2010.

To find out what the eradication of rinderpest means for livestock farmers around the world, listen to the following interview featuring John McDermott, ILRI's deputy director general.

Need for delivery networks for East Coast fever vaccine highlighted in audio interview

Posted on August 18, 2010 by Paul Karaimu

East Coast fever is a major livestock disease in eastern, central and southern Africa. Transmitted by ticks infected with a protozoan parasite (Theileria parva), it kills over 1 million animals each year, damaging livelihoods of poor livestock keepers and farmers in 11 countries. Researchers from organizations such as the International Livestock Research Institute (ILRI) are working to find innovative ways to protect African livestock against this and other ‘orphan’ livestock diseases.

One of the successes in the efforts to fight East Coast fever has been the development of a ‘live’ vaccine, which includes the whole parasite, weakened so as not to cause severe disease thatcame after over 30 years of research by organizations including ILRI and the Kenya Agricultural Research Institute. This long-term research was funded by UK Department for International Development and other donors of the Consultative Group on International Agricultural Research. The vaccine is now registered in Kenya, Malawi and Tanzania and its widespread use is being promoted so that it can give protection to the animals on which many poor people in these countries depend.

In the following audio interview, John McDermott, Deputy Director General-Research at ILRI, speaks in Nairobi of the need ‘to develop networks that can distribute and deliver’ the vaccine to those who need it, which should encourage its widespread use. This interview, produced in July 2010 by AFGAX Radio (http://www.agfax.net), also shares the expectations of a veterinarian from Kenya and a farmer from Tanzania of how the vaccine will help livestock keepers.

To listen to the interview, visit: http://www.agfax.net/radio/detail.php?i=353

More information about the East Coast fever live vaccine is available in the following article.

Livestock vaccine offers lifeline to many

Posted on May 25, 2010 by MNjiru

A vaccine is being made available to save the lives of a million cattle in sub-Saharan Africa against a lethal disease and to help safeguard the livelihoods of people who rely on their cattle for their survival.

East Coast fever is a tick-transmitted disease that kills one cow every 30 seconds. It puts the lives of more than 25 million cattle at risk in the 11 countries of sub-Saharan Africa where the disease is now endemic. The disease endangers a further 10 million animals in regions such as southern Sudan, where it has been spreading at a rate of more than 30 kilometres a year. While decimating herds of indigenous cattle, East Coast fever is an even greater threat to improved exotic cattle breeds and is therefore limiting the development of livestock enterprises, particularly dairy, which often depend on higher milk-yielding crossbred cattle. The vaccine could save the affected countries at least a quarter of a million US dollars a year.

Registration of the East Coast fever vaccine is central to its safety and efficacy and to ensuring its sustainable supply through its commercialization. The East Coast fever vaccine has been registered in Tanzania for the first time, a major milestone that will be recognized at a launch event in Arusha, northern Tanzania, on May 20. Recognizing the importance of this development for the millions whose cattle are at risk from the disease, governments, regulators, livestock producers, scientists, veterinarians, intellectual property experts, vaccine distributors and delivery agents as well as livestock keepers – all links in a chain involved in getting the vaccine from laboratory bench into the animal – will be represented.

An experimental vaccine against East Coast fever was first developed more than 30 years ago at the Kenyan Agricultural Research Institute (KARI). Major funding from the UK Government’s Department for International Development (DFID) and others enabled work to produce the vaccine on a larger scale. When stocks from 1990s ran low, the Africa Union/Interafrican Bureau for Animal Resources and chief veterinary officers in the affected countries asked the International Livestock Research Institute (ILRI) to produce more and ILRI subsequently produced a million doses of the vaccine to fill this gap. But the full potential for livestock keepers to benefit from the vaccine will only be achieved through longer term solutions for the sustainable production, distribution and delivery of the vaccine.

With $28US million provided by the Bill & Melinda Gates Foundation and DFID, a not-for-profit organization called GALVmed (Global Alliance for Livestock Veterinary Medicines) is fostering innovative commercial means for the registration, commercial distribution and delivery of this new batch of the vaccine. A focus on sustainability underpins GALVmed’s approach and the Global Alliance is bringing public and private partners together to ensure that the vaccine is available to those who need it most.

Previous control of East Coast fever relied on use of acaracide dips and sprays, but these have several drawbacks. Ticks can develop resistance to acaracides and regular acaricide use can generate health, safety and environmental concerns. Furthermore, dipping facilities are often not operational in remote areas.

This effective East Coast fever vaccine uses an ‘infection-and-treatment method’, so-called because the animals are infected with whole parasites while being treated with antibiotics to stop development of disease. Animals need to be immunized only once in their lives, and calves, which are particularly susceptible to the disease, can be immunized as early as 1 month of age.

Over the past several years, the field logistics involved in mass vaccinations of cattle with the infection-and-treatment method have been greatly improved, due largely to the work of a private company, VetAgro Tanzania Ltd, which has been working with Maasai cattle herders in northern Tanzania. VetAgro has vaccinated more than 500,000 Tanzanian animals against East Coast fever since 1998, with more than 95% of these vaccinations carried out in remote pastoral areas. This vaccination campaign has reduced calf mortality in herds by 95%. In the smallholder dairy sector, vaccination reduced the incidence of East Coast fever by 98%. In addition, most smallholder dairy farmers reduced their acaracide use by at least 75%, which reduced both their financial and environmental costs.

Notes for Editors

What is East Coast fever?
East Coast fever is caused by Theleria parva (an intracellular protozoan parasite), which is transmitted by the brown ear tick Rhipicephalus appendiculatus. The parasites the tick carries make cattle sick, inducing high fever and lympho-proliferative syndrome, usually killing the animals within three weeks of their infection.

East Coast fever was introduced to southern Africa at the beginning of the twentieth century with cattle imported from eastern Africa, where the disease had been endemic for centuries. This introduction caused dramatic cattle losses. The disease since then has persisted in 11 countries in eastern, central and southern Africa – Burundi, Democratic Republic of Congo, Kenya, Malawi, Mozambique, Rwanda, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. The disease devastates the livelihoods of small-scale mixed crop-and-livestock farmers, particularly smallholder and emerging dairy producers, as well as pastoral livestock herders, such as the Maasai in East Africa.

The infection-and-treatment immunization method against East Coast fever was developed by research conducted over three decades by the East African Community and the Kenya Agricultural Research Institute (KARI) at Muguga, Kenya (www.kari.org). Researchers at the International Livestock Research Institute (ILRI), in Nairobi, Kenya (www.ilri.org), helped to refine the live vaccine. This long-term research was funded by the UK Department for International Development (DFID) (www.dfid.gov.uk) and other donors of the Consultative Group on International Agricultural Research (CGIAR) (www.cgiar.org).

The first bulk batch of the vaccine, produced by ILRI 15 years ago, has protected one million animals against East coast fever, with the survival of these animals raising the standards of living for many livestock keepers and their families. Field trials of the new vaccine batch, also produced at ILRI, were completed in accordance with international standards to ensure that it is safe and effective.

How is the vaccine stored and administered?
Straws of the East Coast fever vaccine are stored in liquid nitrogen until needed, with the final preparation made either in an office or in the field. The vaccine must be used within six hours of its reconstitution, with any doses not used discarded. Vaccination is always carried out by trained veterinary personnel working in collaboration with livestock keepers. Only healthy animals are presented for vaccination; a dosage of 30% oxytetracycline antibiotic is injected into an animal’s muscle while the vaccine is injected near the animal’s ear. Every animal vaccinated is given an eartag, the presence of which subsequently increases the market value the animal. Young calves are given a worm treatment to avoid worms interfering with the immunization process.

Note
Case studies illustrating the impact of the infection-and-treatment vaccine on people’s lives are available on the GALVmed website at: www.galvmed.org/path-to-progress
For more information about the GALVmed launch of the live vaccine, on 20 May 2010, in Arusha, Tanzania, go to www.galvmed.org/

Biologists in Nairobi to take part in two new animal health projects announced this week by the US National Science and Gates foundations

Posted on May 13, 2010 by Susan MacMillan

The National Science Foundation (NSF) of the United States announced on 12 May 2010 that the Foundation, in partnership with the Bill & Melinda Gates Foundation, is awarding 15 grants worth US$20 million in support of basic research for generating sustainable solutions to big agricultural problems in developing countries.

These are the first grants in a new five-year Basic Research to Enable Agricultural Development (BREAD) program, which is jointly funded by NSF and the Gates Foundation.

The awards in this first year of funding will allow leading scientists worldwide to work together in basic research testing novel and creative approaches to reducing longstanding problems faced by smallholder farmers in poor countries.

Scientists from the Nairobi, Kenya, animal health laboratories of the International Livestock Research Institute (ILRI) will participate in 2 of the 15 projects selected among the many submitted to BREAD for funding.

Biologists at New York and Michigan State universities and Regeneron Pharmaceuticals (USA), the Roslin Institute and the University of Edinburgh (UK) and ILRI (Kenya) will test a novel approach to developing cattle that are resistant to trypanosomosis, a deadly cattle disease that is closely related to sleeping sickness in humans and that holds back animal agriculture across a swath of Africa as large as continental USA.

In another project, scientists from the University of Vermont and Plum Island Animal Disease Center (USA) will work with the University of Copenhagen (Denmark) and ILRI on use of advanced genetics to develop vaccines for East Coast fever and other cattle diseases that threaten the livelihoods of millions of smallholder farmers in sub-Saharan Africa.

Go here for a 12 May 2010 news release from the US National Science Foundation: http://www.nsf.gov/news/news_summ.jsp?cntn_id=116932

A complete list of 2010 BREAD awards can be accessed at: http://www.nsf.gov/bio/pubs/awards/bread10.htm

East Coast fever vaccine comes to market in eastern and southern Africa

Posted on April 12, 2010 by Susan MacMillan

As the board of trustees of the International Livestock Research Institute (ILRI) meets in Addis Ababa, Ethiopia, this week, reviewing ILRI’s animal health research among other work, an ILRI vaccine project is highlighted in a new publication, DFID Research 2009–2010: Providing research evidence that enables poverty reduction. The UK Department for International Development (DFID) and the Bill & Melinda Gates Foundation both support the Global Alliance in Livestock Veterinary Medicines (GALVmed), which works to convert existing or near-market technologies into livestock medicines and vaccines for use in developing countries. The notable success of this strategy in 2009, says DFID, is an East Coast fever vaccine produced by ILRI. East Coast fever is a tick-transmitted disease that kills one cow every 30 seconds in eastern, central and southern Africa, where it threatens some 25 million cattle in 11 countries and is now putting at risk a further 10 million animals in new regions, such as southern Sudan, where the disease has been spreading at a rate of more than 30 kilometres a year. The disease is a major cattle killer. In herds kept by the pastoralist Maasai, it kills 20–50% of all unvaccinated calves, which makes it difficult and often impossible for the herders to plan for the future or to improve their livestock enterprises. A vaccine for East Coast fever could save over a million cattle and up to £170 million a year in the 11 countries where the disease is now endemic. An experimental vaccine against East Coast fever, which makes use of live but weakened parasites, has existed for more than three decades, with batches mass produced in ILRI’s Nairobi laboratories. Although constrained by the need for a ‘cold chain’ to keep the ‘live’ vaccine viable, field use of this vaccine in Tanzania and elsewhere has proved it to be highly effective and in demand by poor livestock keepers, who are paying for the vaccine to keep their animals alive. GALVmed has worked with ILRI and private companies, such as VetAgro Tanzania Ltd., to make East Coast fever vaccine available to the livestock keepers who need it most and to scale up production in future. With £16.5 million provided by DFID and the BMGF, GALVmed began working on the registration and commercial distribution and delivery of a new batch of the vaccine produced by ILRI. The vaccine was successfully registered in 2009 in Malawi and Kenya, with Tanzania and Uganda expected to follow soon. If it is approved in Uganda, it will be the first veterinary vaccine formally registered in that country. GALVmed is now working to establish viable commercial production and delivery systems, aiming that by the end of 2011, all aspects of the production and delivery of East Coast fever vaccine are in private hands.

Scottish and Kenyan research groups collaborate to improve control of deadly cattle disease in Africa

Posted on February 17, 2010 by MNjiru

New project launched to investigate how immunity develops in cattle to fatal diseases caused by different strains of tick-borne parasites

More than 1 in 5 people in sub-Saharan Africa live below the poverty line. Many of these people live in rural communities heavily dependent on livestock for their livelihoods. One of the most important diseases of cattle in this region is East Coast fever, a lethal infection of cattle caused by the tick-borne parasite Theileria parva. This disease afflicts cattle populations in 16 countries across eastern, central and southern Africa and is the most economically important cattle disease in 11 of these countries. Losses due to East Coast fever exceed US$300 million annually. Imported high-yielding breeds of cattle, which are increasingly being used to satisfy increasing demands for milk in this region, are particularly susceptible to this disease.

Although East Coast fever can be controlled by treating infected animals with anti-parasitic drugs and by regularly spraying or dipping animals with anti-tick chemicals, these methods are difficult to apply and costly for poor livestock keepers. Vaccination offers a more sustainable means of controlling the disease.

Cattle can be immunized against the disease by infecting them with live parasites while simultaneously treating the animals with long-acting antibiotics. Because several strains of the parasite exist in the field, this vaccination comprises a mixture of strains. A vaccine cocktail mixing three parasite strains is being used successfully in some endemic countries, but applying this so-called ‘live vaccine’ remains hindered by difficulties in maintaining the quality of the vaccine material and in finding ways to distribute the vaccine, which needs to be kept cold, cost-effectively to widely dispersed cattle herders. In addition, it remains uncertain whether the current mix of parasite strains in the vaccine is optimal for obtaining robust immunity.

Recent studies of East Coast fever have shown that the so-called ‘protective’ proteins of the causative parasite—that is, the antigenic molecules that are recognized by the T lymphocytes of the bovine immune system and thus help animals fight development of disease—vary among the different strains of the parasite that exist in the field. This project will build on these advances to investigate the nature and extent of variability in these antigens between parasite strains. This knowledge will help scientists understand the factors that determine which parasite strains induce protective immune responses in animals that have been vaccinated.

Results of the project should provide methods for maintaining high quality of the current live vaccine and identifying parasite strains that could be incorporated into an improved second-generation live vaccine. The information should also help researchers design new, genetically engineered, vaccines, which comprise not whole parasites but rather antigenic molecules of the parasite—and thus are safer, cheaper and easier to distribute than the current live vaccine.

‘This is an important project for us,’ said Philip Toye, a vaccine developer from International livestock Research Institute (ILRI). ‘The information we expect to generate will greatly increase our understanding of the current live vaccine that is being used to protect animals against East Coast fever. We can use this information to get this vaccine into wider use in the region.’

This project is being conducted jointly by scientific groups at the universities of Edinburgh and Glasgow, in Scotland, and at ILRI, in Nairobi. The project is part of a new initiative called Combating Infectious Diseases of Livestock in Developing Countries funded by the UK’s Biotechnology and Biological Services Research Council, the UK Department for International Development and the Scottish Government. ILRI’s research in this area is also supported by members of the Consultative Group on International Agricultural Research.

African cattle to be protected from killer disease

Posted on October 2, 2009 by ILRIComms

Millions of African families could be saved from destitution thanks to a much-needed vaccine that is being mass-produced in a drive to protect cattle against a deadly parasite.

East Coast fever is a tick-transmitted disease that kills one cow every 30 seconds – with one million a year dying of the disease.

Calves are particularly susceptible to the disease. In herds kept by the pastoral Maasai people, for example, the disease kills from 20 to over 50 per cent of all unvaccinated calves. This makes it difficult and often impossible for the herders to plan for the future, to improve their livestock enterprises and thus to raise their standard of living.

An experimental vaccine against East Coast fever was first developed more than 30 years ago. This has been followed by work to allow the vaccine to be produced on a large scale, with major funding from the UK Department for International Development (DFID) and others.

East Coast Fever puts the lives of more than 25 million cattle at risk in the 11 countries where the disease is now endemic, and endangers a further 10 million animals in new regions such as southern Sudan, where the disease has been spreading at a rate of more than 30 kilometres a year. The vaccine could save the 11 affected countries at least £175 million a year.

The immunization procedure – called “infection-and-treatment” because the animals are infected with whole parasites while being treated with antibiotics to stop development of disease – has proved highly effective. However, initial stocks produced in the 1990s recently ran low.

The International Livestock Research Institute (ILRI), at the request of the Africa Union/Interafrican Bureau for Animal Resources and chief veterinary officers in affected countries, produced one million doses of vaccine to fill this gap. However, for the longer term it is critical that sustainable commercial systems for vaccine production, distribution and delivery are established.

With UK£16.5 million provided by DFID and the Bill & Melinda Gates Foundation, the charity GALVmed is fostering innovative commercial means to do just this, beginning with the registration and commercial distribution and delivery of this new batch of the vaccine. This will ensure that the vaccine is made available, accessible and affordable to livestock keepers who need it most and to scale up its production for the future.

International Development Minister Mike Foster said:
“Some 1.3 billion of the world's poorest people rely on livestock for their livelihoods. Many Africans depend on the health of their cattle for milk, meat and as their only hard asset for trade and investment. A smallholder dairy farmer can take years to recover economically from the death of a single milking cow. That’s why it’s vital that every possible step is taken to ensure that these essential vaccine doses are sustainably produced, tested and made available to the people who need them.

“DFID is supporting GALVmed to explore ways of transferring the production and distribution of the vaccine into the private sector through local manufacturers and distributors. This is extremely important in making the vaccine affordable, accessible and – crucially – sustainable.”

GALVmed CEO Steve Sloan said:
“Funded by DFID and the Bill & Melinda Gates Foundation, GALVmed is working to protect livestock and the livelihoods of their owners. Thanks to the highly effective East Coast fever vaccine developed over many years by researchers working in East Africa and then refined and mass produced by ILRI, cattle invaluable to pastoralists such as the Maasai as well as smallholder dairy farmers are being protected.
“The survival of cattle for the millions who live on tiny margins has a direct effect on quality of life and the dignity of choice and self-determination. Collaborating with ILRI and partners in the developing world, including governments and veterinary distributors and those from the private sector, GALVmed is working to embed the vaccine through registration in East African countries and to scale up its production so that it remains accessible to poor people.
“This pioneering registration effort aims to ensure that the vaccine is approved and monitored by affected nations and enables local firms to sell and distribute it, embedding its sustainability. Registration in Malawi is already complete, with significant progress in Tanzania, Kenya and Uganda.”
ILRI veterinary scientist Henry Kiara, who has conducted research on the live vaccine for 20 years, explains that ILRI is “looking forward to commercialising the production, distribution and delivery of the vaccine to the smallholder and emerging dairy producers as well as livestock herders” in this region of Africa. “Now that all the building blocks are in place, thanks to past investments by DFID and others”, he says, “we are excited to be at a stage where this vaccine can ‘take off’.”

About the vaccine
The infection-and-treatment immunisation method against East Coast fever was developed by research conducted over three decades by the East African Community, the Kenya Agricultural Research Institute (KARI) at Muguga, Kenya (www.kari.org), and the International Livestock Research Institute (ILRI), in Nairobi, Kenya (www.ilri.org). This long-term research was funded by the UK Department for International Development (DFID) (www.dfid.gov.uk) and other donors of the Consultative Group on International Agricultural Research (CGIAR) (www.cgiar.org). The first bulk batch of the vaccine, produced by ILRI 15 years ago, has protected one million animals, whose survival raised the standard of living for livestock keepers and their families. Field trials of the new vaccine batch, also produced at ILRI, are being completed in accordance with international standards to ensure that it is safe and effective.

About East Coast fever
East Coast fever was first recognized in southern Africa when it was introduced at the beginning of the twentieth century with cattle imported from eastern Africa, where the disease had been endemic for centuries. It caused dramatic losses with high cattle mortality. It has persisted in 11 countries in eastern, central and southern Africa – Burundi, Democratic Republic of Congo, Kenya, Malawi, Mozambique, Rwanda, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. The disease devastates the livelihoods of small-scale mixed crop-and-livestock farmers and smallholder and emerging dairy producers, as well as pastoral livestock herders, such as the Maasai in East Africa.

East Coast fever, or theileriosis, is a devastating cancer-like disease of cattle that often kills the animals within three weeks of infection. It is caused by the single-celled parasite Theileria parva, which is transmitted by the brown ear tick (Rhipicephalus appendiculatus) as it feeds on cattle. In addition to producing the infection-and-treatment vaccine, ILRI is also working to develop a genetically engineered next-generation vaccine.

Some 70 per cent of the human population of sub-Saharan Africa – around half a billion people – depend on livestock for their livelihoods, with farming and herding families relying on cattle for vital sources of food, income, traction, transportation and manure to fertilise croplands.

A case study showing the impact of the disease on Maasai herders is included below. Further case studies illustrating the impact of the infection-and-treatment vaccine on people’s lives are available on the GALVmed website at: www.galvmed.org/path-to-progress

Case Study: East Coast fever in Tanzania
Maasai herders in Tanzania have been particularly devastated by East Coast fever. In parts of northern Tanzania, more than 1 in 5 calves die before reaching maturity (54 months) in the lowlands and more than one third fail to reach maturity in the (wetter) highlands, where tick-borne and other diseases are more prevalent.

Although the infection-and-treatment vaccine is a “live” vaccine, and thus needs to be stored in liquid nitrogen and administered by skilled practitioners, after which the animals must be monitored by experts for several days, the Maasai here are desperate for the new batch to be ready.

Introduction of the previous batch in recent years has drastically reduced calf mortality, from up to 80 per cent to less than 2 per cent. The protection afforded by the vaccine is so good that Maasai herders are willing to pay for these vaccinations. The vaccine appears to protect the animals against other ailments as well and, in addition, those mature animals that are marked with ear tags as having been vaccinated are fetching up to 50 per cent higher prices in the market. The vaccine is allowing these cattle herders to sell more animals and to invest their new income in, for example, bettering their household diets or paying for their children’s education. The new access to this vaccine is facilitating a transition among the Maasai in herd management, from a subsistence- to a market-orientation.

GALVmed has regular contact with those on the ground to improve access to the vaccine, including a meeting with 25 Masaai livestock keepers in Arusha, in northern Tanzania, earlier this year. At that meeting a Masaai representative stated:

“Please thank all those people who made the vaccine and also those who make it available for us to buy. Tell them not to stop their good work. No cattle means no Maasai – and no East Coast fever vaccine means no cattle.”

Livestock biosciences for poverty alleviation: One more arrow in the quiver!

Posted on June 6, 2007 by ILRIComms

Proceedings of the 4th All Africa Conference on Animal Agriculture ‘The role of biotechnology in animal agriculture to address poverty in Africa’, now available for download

The theme of the 4th All Africa Conference on Animal Agriculture was ‘The role of biotechnology in animal agriculture to address poverty in Africa: Opportunities and challenges’. The conference, which was held in Arusha, Tanzania, in September 2005, was organized by the All Africa Society for Animal Production (AASAP) in association with the Tanzania Society for Animal Production (TSAP), and partnership with the International Livestock Research Institute (ILRI). The recently released proceedings contain over 50 papers by leading experts in biotechnology covering animal health, genetic diversity and improvement and animal feeds and nutrition. The technologies reported ranged from the rather conventional approaches to the more advanced molecular techniques.

ILRI’s director general, Carlos Seré, and ILRI’s director of biotechnology, Ed Rege, presented a paper on Agricultural biotechnology for poverty alleviation at the first plenary session. The paper highlights opportunities for livestock biotechnologies in the areas of animal health through new/improved vaccines and diagnostics, genetic improvement of livestock, conservation of indigenous breeds and genetic diversity, and improving the nutritional quality of feeds. They argue animal agriculture will continue to be of considerable importance for poverty alleviation in Africa for some time to come, and that appropriate applications of biosciences can increase the pace of Africa’s agricultural and economic development.

‘Economic development in Africa will, of necessity, have to be initially linked to agriculture (broadly defined to include crop, livestock, forestry and fish). Staple crops and livestock are most likely to promote economic growth in the continent. To date, public sector investment in biotechnology in Africa has led to few products.

‘However, similar to what is happening in Asia and Latin America, there is a great opportunity for Africa to mobilize science to create wealth for its people and achieve higher economic growth.

‘If a new technology is useful and the price is right, the spread is almost unstoppable. Clearly, biotechnology is not a substitute for other technologies, but is an additional arsenal which should be used as and when appropriate to increase the pace of agricultural development. It is simply another arrow in the quiver!’

Copies of this new publication will be made available at the Africa Agricultural Science Week and the 4th Forum for Agricultural Research in Africa (FARA) General Assembly in Johannesburg on 10– 16 June 2007.

Download the book: https://cgspace.cgiar.org/bitstream/10568/2275/1/Role%20of%20biotechnology.pdf

Vaccine agency to reduce loss of human and animal life in developing countries is launched

Posted on March 12, 2007 by ILRIComms

The Global Alliance for Livestock Veterinary Medicine (GALVmed) recently unveiled animal health projects it will tackle over the next ten years.

GALVmed announced progress on vaccine and treatments for Newcastle disease in poultry and East Coast fever and Rift Valley fever in cattle at its international launch at the Kenya Agricultural Research Institute (KARI), in Nairobi, on Friday 9 March 2007. This marked the beginning of a 10-year program aimed at creating sustainable solutions to the loss of human and animal life caused by livestock diseases, which threaten 600 million of the poorest people in developing countries in Africa, Asia and Latin America.

GALVmed, a non-profit organization funded by the UK Department for International Development (DFID), is partnering with private and public-sector organizations around the world. It has identified 13 livestock diseases as key targets for development of livestock vaccines and animal health diagnostics and medicines. Founder members of the agency include the International Livestock Research Institute (ILRI), FARM-Africa, Pfizer, Intervet and Merial. GALVmed exists to broker partnerships among pharmaceutical companies and other public and private-sector organizations to develop accessible and affordable animal vaccines for the whole world’s poorest farmers.

Zoonotic diseases, which are transmitted between animals and humans, mainly afflict the poorest households, as evidenced by the recent outbreak of Rift Valley fever in livestock in Kenya, which killed 150 people. Brian Perry, a senior scientist at ILRI, warns that ‘Today, combating livestock diseases is everybody’s business – tropical animal diseases are no longer “just a local problem”. For example, there is a threat that diseases like Rift Valley fever will follow bluetongue into Europe.’

GALVmed’s chief executive Steve Sloan explains that ‘Every year, poor farmers worldwide lose an average of a quarter and in some cases half, of their herds and flocks to preventable disease. This devastates developing economies. Many of these are zoonotic and so also cause human deaths.

Livestock play a critical role in helping people escape poverty. Livestock disease is one of the greatest barriers to development for poor livestock keepers. Flocks and herds die every year from diseases for which vaccine simply do not exist or are beyond the reach of the poor. John McDermott, ILRI’s deputy director general for research says, ‘ILRI scientists and partners have done ground breaking science to develop an experimental vaccines to protect cattle against East Coast fever. The next steps are to conduct trials to facilitate the delivery of this vaccine to the farmers. To do that, we need specialist partners who will test, manufacture and market the vaccine and make it accessible and affordable to the thousands of livestock keepers afflicted by this cattle killing disease.

Click here for the GALVmed News release.

To find out more about GALVmed visit the website
www.galvmed.org

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Category Archives: Vaccines