EFFECTS OF CLIMATE CHANGE ON THE EPIDEMIOLOGY OF VECTOR BORNE ZOONOSES IN DEVELOPING COUNTRIES (A case study of Rift Valley Fever

in Kenya)

1. INTRODUCTION 1.1

Preamble.

Volatility of infectious diseases may be one of the earliest biological expressions of climate instability (Epstein P, 2008). Changes in climatic patterns and in seasonal conditions may affect disease behaviour in terms of spread pattern, diffusion range, amplification and persistence in novel habitats (Martin et al, 2008). Vector-borne and zoonotic diseases, such as, Lyme disease, West Nile virus, Malaria, Rift Valley Fever (RVF), Plague, Hantavirus pulmonary syndrome, and Dengue fever have been shown to have a distinct seasonal pattern, and in some instances their frequency has been shown to be weather sensitive. Because of the sensitivities of the vectors and animal hosts of these diseases to climatic factors, climate change-driven ecological changes, such as variations in rainfall and temperature, could significantly alter the range, seasonality, and human incidence of many zoonotic and vector-borne diseases (FAO/IAEA, 2010). Rift Valley Fever is a vector borne zoonotic disease of importance in Kenya. It is a peracute or acute disease of domestic ruminants caused by a mosquito borne virus and characterized by necrotic hepatitis and a hemorrhagic state. Humans become infected from contact with tissues of infected animals or mosquito bite. Infection in humans is usually associated with mild to moderately severe influenza-like illness, but severe

complications such as ocular sequelae, encephalitis and hemorrhagic disease, occur in some patients. Outbreaks of the disease occur when particularly heavy rains favour the breeding of mosquito vectors (Swanepoel and Coetzer, 2003). Climate change is likely to affect the epidemiology of RVF owing to its effect on the frequency of extreme weather patterns like droughts and floods hence the effect on the population of the mosquitoes and other biting insects which are the main vectors. Ironically, the countries that have contributed least to global warming mainly the developing countries are the most vulnerable to its impact especially from diseases that higher temperatures can bring (FAO/IAEA, 2010). This is because they lack not only the technology, but also the financial resources and the public-health infrastructure. (Barnhill H, 2008). Rift Valley fever (RVF) disease was first reported in Kenyan livestock in 1912 and the country has reported the most frequent epidemics of the disease involving both humans and livestock (Murithi et al, 2010). Although low-level RVF virus transmission likely occurs within enzootic regions each year, the emergence of virus activity in large epizootic-epidemic cycles is periodic and associated with abnormally high rainfall events that allow for the abundant emergence of Aedes species floodwater mosquitoes transovarially infected with RVF virus and secondary vectors ( Bird et al, 2008). This project seeks to analyze the change in weather patterns (specifically temperature and rainfall) and its relationship with RVF outbreaks in Kenya in the last 15 years. This will help to give a general understanding on how the epidemiology of vector borne zoonotic diseases is likely to change as a result of climate change and suggest ways in which

Kenya and other developing countries can constitute public health modalities by which to deal with the resulting health challenges. 1.2. Problem statement. Climate change is emerging as one of the main challenges that humankind will have to face for many years to come. Human and animal health issues are only two of many concerns, albeit quite crucial. Climate change could also become a major threat to world food security, as it has a strong impact on food production, access and distribution. Abnormal changes in air temperature and rainfall and the increasing frequency and intensity of drought and floods have long-term implications for the viability and productivity of world agro-ecosystems (Martin et al, 2008). While the implications of future climate change are complex and difficult to assess, it is certain that infectious zoonotic diseases will have an increased impact on global health issues and their control will be a major factor in social wellbeing. If vulnerable communities can be helped by significant investments in health services and improved management of climate-sensitive diseases in the immediate future, then humans will at least face the potential impacts of climate change with a lower baseline of infections (Martin et al, 2008). Based on the problem stated, this study seeks to analyze the periodic prevalence of RVF in the last 15 years versus the climatic trend(rainfall and temperature) in this period and in this way show how climate change is likely to affect the epidemiology and the resultant socioeconomic impacts of RVF and the steps that should be taken in terms of early prediction, prevention and control, in order to minimize or eradicate the negative impacts of this disease as well as other vector borne zoonoses.

1.3. Objectives
1. To determine how many outbreaks of Rift Valley Fever have occurred in Kenya between

1995 and 2009. 2. To assess the climatic trend between 1995 and 2009 using rainfall, temperature and humidity.
3. To assess the relationship between Rift Valley Fever outbreaks and climate (rainfall and

temperature) between 1995 and 2009.

4. To study the trend of average annual temperatures in a representative district of each

province between 1995 and2009 to ascertain if temperatures have generally been increasing or decreasing. 1.4. Justification Climate change has far reaching consequences that go beyond health and touch on all life-support systems. It is therefore a factor that should be rated high among those that affect human health and survival (Githeko et al, 2000). Studying how climate change impacts the epidemiology of RVF in Kenya helps us use this as a model to project the expected changes in epidemiology of vector borne zoonotic diseases in developing countries in general. Greenhouse gas emissions which are the major culprits of global warming are bound to be on the increase as the country aims to transform itself into a newly industrializing, Middle-income country providing a high quality life to all its citizens by the year 2030. To combat poverty, Kenya is expected to raise income in agriculture, livestock and fisheries even as the industrial production and the service sector expand. The country plans to implement 4-5 disease free zones and livestock processing factories to enable Kenyan meat, hides and skins to meet

international standards (Government of the Republic of Kenya, 2007). It also aims at having a sustainable environment and reducing losses attributed to environment related disasters. To do this, Kenya seeks to enhance disaster preparedness in all disaster prone areas and improve capacity for adaptation to global climate change. Incorporating or integrating adaptation to climate change into planning processes is a necessary strategy for sustainable development over the long term (Government of the Republic of Kenya, 2007). This study will help come up with solutions that will bring the country one step closer to realizing its vision 2030 goals as well as implementing changes that will benefit the developing countries in general to be in line with the Millennium Development Goals

2. LITERATURE REVIEW: CLIMATE CHANGE AND VECTOR BORNE ZOONOSES.

2.1 CLIMATE CHANGE 2.1.1 What is climate change? As defined by the Encyclopedia of Climate Change and Global Warming complied by Prof. S. George Philander, climate change is commonly used to describe any systematic alteration or statistically significant variation in either the average state of climate elements such as precipitation, temperature, winds, or pressure; or in its variability, sustained over a finite time period (decades or longer). (Nsikak Benson, 2008). 2.1.2 Causes of climate change The earths main source of energy is the sun, but this planet would be far too cold for most of its inhabitants were it not for its atmosphere, the thin veil of transparent gases that covers the globe. The atmosphere serves as a parasol that reflects sunlight, thus keeping the planet cool, and as a blanket that traps heat from the Earths surface, thus keeping us warm. The blanket is the greenhouse effect, which depends not on the two gases nitrogen and oxygen that are most abundant, but on trace gases that account for only a tiny part of the atmosphere. These gases warm the air in their interior mainly by blocking convective mixing with the outside (Philander ,2008) .They include carbon dioxide, methane and nitrous oxide, along with water vapor and are known as the Green House Gases (GHGs) as the working principle is the same as that of a greenhouse. Just as the glass of the greenhouse prevents the radiation of excess energy, this gas blanket

absorbs some of the energy emitted by the earth and keeps temperature levels intact (Shrivastava, 2001). The earths temperature is controlled by the balance between input energy from the sun and its loss back into space. Green house gases are critical to this temperature balance in that the energy received from the sun is in the form of short-wave radiation that warms the earths surface and as a result emits long-wave infrared radiation. The greenhouse gases trap and re-emit some of this long-wave radiation, and warm the atmosphere. On average, one-third is reflected back into space and two-thirds warms the planet and drives its weather engine. This warming takes place through a shield known as the ozone layer that limits the loss of heat from the Earths surface and increases the average global temperature by 33oC, without which the Earth would be frozen and life on the planet would cease. It is a well established fact that the emission of greenhouse gases that produce greenhouse effect; most notably carbon dioxide (CO2), nitrous oxide (N2O), chlorofluorocarbons (CFCs), methane (CH4), and ozone (O3), are increasing in the atmosphere and thereby deflecting more long-wave infra-red solar radiation back to Earth, hence global warming and the ongoing climate changes. This is threatening the survival of many plants and animals as well as the well being of people around the world. The industrial revolution in the19th century saw the large use of fossil fuels for industrial activities (Shrivastava, 2001). These industries created jobs and over the years there has been urban migration, a trend that continues to date. More and more land that was covered with vegetation has been cleared to make way for houses. Natural resources are being used extensively for construction, industries, transport and consumption. In its 2007 report, the

Intergovernmental Panel on Climate Change (IPCC,2007), a large International panel of scientists, all experts on the Earths climate, concluded that human activities, specifically those that cause an increase in the atmospheric concentration of carbon dioxide, have started affecting the Earths climate. The panel further predicted that far more significant climate changes are imminent (Shrivastava, 2001). 2.1.3 Effects of climate change According to Wikipedia, the following are some of the effects of climate change. Glacier retreat and disappearance This widespread decrease in glaciers and ice caps has contributed to observed sea level rise. With very high confidence, IPCC (IPCC, 2007) made the following projections relating to future changes in glaciers:

In Polar Regions, there will be reductions in glacier extent and thickness. More than one-sixth of the world's population is supplied by meltwater from major mountain ranges. Changes in glaciers and snow cover are expected to reduce water availability for these populations.

a) Oceans

Global warming is projected to have a number of effects on the oceans. Ongoing effects include rising sea levels due to thermal expansion and melting of glaciers and ice sheets, and warming of the ocean surface, leading to increased temperature stratification. Other possible effects include large-scale changes in ocean circulation. The oceans serve as a

sink for carbon dioxide, taking up much that would otherwise remain in the atmosphere, but increased levels of CO2 have led to ocean acidification (Wikipedia). b) Extreme weather Climate change is likely to change the frequency of extreme weather events, such as tropical cyclones, floods, droughts, heatwaves and hurricanes, and may destabilize and weaken the ecosystem services upon which human society depends.

c) Health

Climate change is also expected to affect animal, human and plant health via indirect pathways. It is likely that the geography of infectious diseases and pests will be altered, including the distribution of vector borne zoonotic diseases such as RVF, which are highly sensitive to climatic conditions.

2.1.4 Adaptation to effects of climate change Africa is the most vulnerable region to climate change, due to the extreme poverty of many africans, frequent natural disasters such as droughts and floods, and agricultural systems heavily dependent on rainfall(IPCC, 2001). It is, therefore, essential for these countries to prepare themselves for coping with or, one can say, adapting to such adverse impacts and to ensure that such adaptation measures and policies are built-in to their existing national and sectoral development activities (Chowdhury, 2003). Climate change has the potential to undermine sustainable development, increase poverty and delay or prevent the realization of the MDGs. An effective way to address the impacts of climate change is by integrating adaptation measures into sustainable development strategies so as to

reduce the pressure on natural resources, improve environmental risk management, and increase the social well-being of the poor (United Nations Framework Convention on Climate Change,2006). The public health and medical community have made enormous strides in control of infectious diseases during the past half-century. Widespread availability of antimicrobial drugs, vectorcontrol systems, diagnostics, vaccines, and increasingly sophisticated predictive models represent a powerful set of tools to protect public health from emerging diseases (Rosenthal, 2010). 2.2 VECTOR BORNE ZOONOSES According to the World Health Organization, zoonoses are diseases naturally transmitted to people from non-human vertebrates e.g. dogs, raccoons, etc as well as invertebrates e.g. arthropods. From the perspective of infectious diseases, vectors are the transmitters of disease-causing organisms that carry the pathogens from one host to another. By common usage, vectors are considered to be invertebrate animals, usually arthropods. Technically, however, vertebrates can also act as vectors, including foxes, raccoons, and skunks, which can all transmit the rabies virus to humans via a bite. Arthropods account for over 85 percent of all known animal species, and they are the most important disease vectors. Arthropods may affect human health either directly by bites, stings, or infestation of tissues, or indirectly through disease transmission.. The most significant mode of vector-borne disease transmission is by biological transmission by blood-feeding arthropods. The pathogen multiplies within the arthropod vector, and the pathogen is transmitted when the

arthropod takes a blood meal. Mechanical transmission of disease agents may also occur when arthropods physically carry pathogens from one place or host to another, usually on body parts. The transmission of vector-borne diseases to humans depends on three different factors: the pathologic agent; the arthropod vector; and the human host. A majority of vector-borne diseases survive in nature by utilizing animals as their vertebrate hosts, and are therefore zoonoses.There are different patterns of vector-borne disease occurrence; parasitic and bacterial diseases, such as malaria and Lyme disease, tend to produce a high disease incidence but do not cause major epidemics. In contrast, many vector viral diseases, such as Yellow Fever, Rift Valley Fever, dengue, and Japanese encephalitis, commonly cause major epidemics. (enotes.www.enotes.com) Globalization and climate change have had an unprecedented worldwide impact on emerging and re-emerging animal diseases and zoonoses. Climate change is disrupting natural ecosystems by providing more suitable environments for infectious diseases allowing disease-causing bacteria, viruses, and fungi to move into new areas where they may harm wild life and domestic species, as well as humans. Diseases that were previously limited only to tropical areas are now spreading to other previously cooler areas e.g. malaria. Pathogens that were restricted by seasonal weather patterns can invade new areas and find new susceptible species as the climate warms and/or the winters get milder. There is evidence that the increasing occurrence of tropical infectious diseases in the mid latitudes is linked to global warming. (FAO/IAEA, 2010).

2.3 RIFT VALLEY FEVER 2.3.1 Introduction Rift Valley Fever (RVF) is a peracute or acute disease of domestic ruminants caused by a mosquito-borne virus and characterized by necrotic hepatitis and a hemorrhagic state, but infections are frequently inapparent or mild. The aetiologic agent is a mosquito-borne, RNA virus of the family Bunyaviridae, genus Phlebovirus (Swanepoel and Coetzer, 2003). The disease is most severe in sheep, cattle and goats, producing high mortality in newborn animals and abortion in pregnant animals. It is a zoonosis and humans get infected from contact with tissues of infected animals or mosquito bites. Outbreaks of the disease occur when particularly heavy rains favour the breeding of the mosquito vectors (Swanepoel and Coetzer, 2003). 2.3.2 Clinical Findings a) The disease in animals Signs of the disease in domestic ruminants tend to be non-specific, rendering it difficult to recognize individual cases of RVF. During epidemics however, the simultaneous occurrence of numerous cases of abortion and disease in ruminants, together with disease of humans, tends to be characteristic of RVF (Swanepoel and Coetzer, 2003). In the peracute disease animals die suddenly without exhibiting noteworthy signs of illness. Under field conditions, most animals develop the acute disease. Following an incubation period of 24-72 hours, there is fever of up to 42 oC that lasts for 24-96 hours, anorexia, weakness, listlessness and an increased respiratory rate. Some animals may regurgitate ingesta, and develop melaena or foetid diarrhea and a blood tinged, mucopurulent nasal discharge. A few animals may be icteric (Swanepoel and Coetzer, 2003).

Pregnant animals may abort at any stage as a result of the febrile reaction and/ or infection of the fetus. Aborted fetuses are usually autolysed. Although there is no evidence that infertility is impaired after abortion, this is possible in instances where retained placenta and purulent metritis occur as complications to abortion, particularly if there is also salpingitis (Swanepoel and Coetzer, 2003). b) The disease in humans Humans acquire RVF through bites from infected mosquitoes and through exposure to blood, body fluids, or tissues of infected animals. Direct exposure to infected animals can occur during handling and slaughter or through veterinary and obstetric procedures. Laboratory technicians are at risk of acquiring disease by inhalation of infectious aerosols generated from specimens. (Anyangu et al, 2010). Human RVF outbreaks are primarily characterized by mild, acute febrile illness with spontaneous recovery, although in a few cases (< 8%) the disease can be associated with severe jaundice, rhinitis, encephalitis and hemorrhagic manifestations, hence fatal (Mohammed et al, 2010). 2.3.3Mosquitoes as RVF vectors Laboratory studies indicate that numerous species of mosquitoes and sand flies are susceptible to oral infection, some of which are able to transmit RVF virus by bite to domestic animals including sheep, goats, cattle and camels, as well as human beings (Sang et al, 2010). The Aedine mosquitoes are the main vectors of the virus though other species, as explained in the later in this section, are involved in the spread of the disease. The virus is also present in milk, feces and aborted fetuses (Turell et al, 1984).

Following the ingestion of an infective blood meal by a susceptible mosquito, there is an extrinsic incubation period of approximately one to two weeks before transmission can occur. During this time RVF virus replicates in the cells of the midgut, escapes to the haemocoel and is disseminated via the haemolymph to replicate in the salivary glands and other organs, but in a proportion of some mosquitoes infection is confined to the midgut, implying that there is a mesenteroneal barrier to spread of infection (Swanepoel and Coetzer, 2003). In Aedine mosquitoes, transovarial transmission of virions occurs from the female mosquito to her progeny, and females of the next generation can transmit the virus orally without having become infected by a prior blood meal. It is obligatory for Aedine eggs to be subjected to a period of drying as the water recedes before being wetted again next time the dambo floods. Dambos are topographic depressions which suddenly flood during heavy rains causing the eggs of dormant RVF virus-infected floodwater Aedes spp. mosquitoes to hatch. Aedine eggs can survive for long periods in dried mud, possibly for several seasons if the dambo remains dry. Moreover, only a proportion of eggs hatch at each successive flooding, which clearly represents a survival mechanism to prevent the mosquito population from being lost when precipitation has been inadequate to sustain breeding. Dams with shallows that are subject to periodic drying and flooding also provide suitable habitat for floodwater breeding Aedines (Swanepoel and Coetzer, 2003). These mosquitoes maintain RVF virus through transovarial transmission and transmit it to domestic and wild ungulates that come to the dambos for water, functioning as enzootic vectors. As amplification ensues, epizootic vectors such as Culex theileri become important in transmission to domestic livestock. A variety of mosquitoes have been associated with RVF virus, including Culex pipens in the Egyptian outbreak. Rift Valley Fever virus has also been

isolated from Culex zombaensis and Mansonia africana in Kenya (Swanepoel and Coetzer, 2003). In the proportion of mosquitoes in which theres infection, internal dissemination of infection and transmission of the virus occur, and the duration of the extrinsic incubation period tends to be characteristic for each vector species and does not appear to be influenced by the strain of RVF virus, but by increased doses of virus, and higher ambient temperatures during extrinsic incubation which produce disseminated infection in a greater proportion of mosquitoes and shorter extrinsic periods (Turell et al, 1985). Thus, apart from favoring the breeding of vectors, warm weather may be an accessory factor in precipitating outbreaks of RVF through increasing vector efficiency (Swanepoel and Coetzer, 1994). 2.3.4 Epidemiology of Rift Valley Fever. According to the American Journal of Tropical Medicine and Hygiene, vol. 83(2), outbreaks are associated with unusually heavy rainfall, leading to flooding and a synchronous generation of a large number of infected mosquitoes (Anyangu et al, 2010). These are thought to occur when topographic depressions called dambos suddenly flood, causing the eggs of dormant RVF virus-infected floodwater Aedes spp. mosquitoes to hatch. In the interepidemic period the virus is maintained within the eggs of Aedes mosquitoes embedded in soils where previous RVF outbreaks have occurred. Other findings suggest that the virus may also be maintained by cryptic cycling between domestic livestock or wild herbivores and mosquitoes. During the epizootics, heavy rainfall and flooding provide an environment for Aedes mosquitoes to rapidly multiply and become the predominant mosquito population, which results in extensive livestock transmission and amplification of the virus. After an initial burst of

transmission, other mosquito species (e.g. Culex, Anopheles, Mansonia, etc) and biting insects can become infected and transmit the virus among animals and from animals to human beings (Mohamed et al, 2010). The flooding of dambos and the humid weather conditions prevailing in epidemics favour the breeding not only of the Aedine maintenance vectors, and the non-aedine mosquitoes which serve as epidemic vectors, but also of other biting insects which are potential mechanical transmitters of RVFV (Swanepoel and Coetzer, 2003). Eggs of species which breed in water, other than aedine mosquitoes, cannot survive dry conditions and these insects re-colonize flooded dambos from suitably close rivers and dams, so that a succession of vector species occurs once flooding takes place. Infected livestock circulate high levels of virus and mechanical transmission of infection by mosquitoes, midges, phlebotomids, stomoxids, simulids and other biting flies is thought to play a significant role in epidemics (Logan et al, 1991). Infected animals appear to be more attractive to mosquitoes, and by implication other biting flies, than non-infected animals and it has been shown that probing for blood and feeding proceed more rapidly and efficiently on viraemic hosts. (Bailey, 1981) Factors which determine the morbidity and mortality associated with outbreaks of RVF include the virulence of the strain of virus and the susceptibility of the vertebrates involved (Anderson & Peters, 1988). The RVF epizootics and epidemics are closely linked to the occurrence of the warm phase of the El Nino / Southern Oscillation phenomenon and elevated Indian Ocean temperatures that lead to heavy rainfall and flooding of habitats suitable for the production of Aedes and Culex mosquitoes that serve as the primary RVF virus vectors in East Africa. El Nino-Southern Oscillation events

are a combined ocean atmosphere phenomenon, involving changes in the temperatures of surface waters in the tropical Pacific and in its closely linked atmospheric counterpart, the Southern Oscillation. El Nino-Southern Oscillation events involve a large exchange of heat between the ocean and the atmosphere, and affect: Global mean temperature Trade winds Tropical circulation Precipitation. Such events occur about once every three to seven years (Martin et al, 2008).

2.3.5. Rift Valley Fever in Kenya. An acute and highly fatal disease to lambs associated with heavy rains and accompanied by reports of illness in humans was first recognized in the Rift Valley in Kenya at the turn of the century, but the causative agent was not isolated until 1930. Major outbreaks of the disease affecting sheep and cattle were recorded in Kenya in 1930-31, 1968, 1978-79, 1997-98, 2006-07 and lesser outbreaks at irregular intervals during intervening years (Davies et al, 1985). The 1997-98 epidemic which started in Garissa district, North Eastern Kenya and adjacent parts of Somalia in October 1997, occurred in an essentially arid area following exceptionally heavy rains (Woods et al, 2002). In mid-December 2006, the Ministry of Health in Kenya received reports of fatal cases of a febrile haemorrhagic illness of unknown aetiology among people living in Garissa district in the North eastern province, after unusually heavy rains and flooding in the area as shown in figure 2. The RVF virus was isolated and Immunoglobulin M (IgM) antibodies to RVFV were detected in

clinical specimens from affected patients and animals. During the next 4 months, approximately 700 suspected cases of RVF with 272 confirmed and 120 probable cases were reported in 18 districts within six of eight provinces in Kenya. During this period, RVF outbreaks were also reported in Somalia and Tanzania (Amwayi et al, 2007).

2.3.6 Impact of climate change on RVF At present, the world climate is in a warming phase. In 1996, The Intergovernmental Panel on Climate Change (IPCC) concluded that, the balance of evidence suggests a discernible human influence on global climate (IPCC, 1996). Indeed, evidence suggests that human activities contribute to warming the planet and climate models predict an increase in global mean temperatures of between 1 C and 3.5 C during the 21st century, with large differences in trends between locations. Temperature changes are one of the most obvious and easily measured changes in climate, but atmospheric moisture, precipitation and atmospheric circulation also change as the whole system is affected. These effects alter the hydrological cycle, especially the characteristics of precipitation/rainfall (amount, frequency, intensity, duration, type) (Trenberth et al. (2007). Finally, it is anticipated that global climate change will induce changes in the magnitude and frequency of extreme events and have significant effects on the geographical range and seasonal activity of many vector species (McMichael et al, 1996). It is therefore expected that global climate change will alter the distribution and increase the risk of some vector-borne zoonoses, including Rift Valley fever (RVF), leading to significant changes in the geographical distribution and frequency of RVF epidemics.

As mentioned in the IPCC report ( IPCC, 1996), heavy rainfall events are likely to become much more frequent in years to come and extremes of the hydrological cycle, such as floods and drought will invariably be enhanced with global warming. In fact, the increase in rainfall in East Africa, extending into the Horn of Africa, is robust across the entirety of the models surveyed in the IPCC report. Thus, it may be assumed that the frequency and severity of RVF outbreaks on this part of the continent will increase. This could also affect other countries that import animals from Africa, such as some islands in the Indian Ocean. Climate changes may also affect the three fundamental components of the epidemiological cycle of RVF, namely: vectors, hosts and virus. The consequences of global warming on vectors, in particular, may be many. The greenhouse effect, through changes to temperatures and the pattern of seasonal and geographical variation in rainfall, will alter the prevalence of mosquito vector populations. Temperature has a direct effect on mosquitoes. It leads to increased activity, increased reproduction and therefore increased frequency of blood meals and faster digestion of blood (Martin et al, 2008). Pathogens harboured by mosquitoes also mature faster. Increased water temperature cause mosquito larvae to develop faster also increasing overall vector capacity (Reiter, 2008). The effect of precipitation on vectors is indirect. Increased precipitation creates more potential breeding sites for mosquitoes. The vegetation is dense after rainfalls and this provides shelter and resting grounds for vectors (Githeko et al, 2000). Heavy rainfalls are predicted for East Africa and therefore more RVF outbreaks. In turn, this may affect the potential for transmission of Rift Valley Fever. As far as hosts are concerned, climate changes may induce modifications in their distribution and density, as well as their migratory pathways. Historically, the dissemination of RVF has been

attributed in part to nomadic herds: the modification of migratory pathways could introduce the virus into previously virus-free areas. Climate modification may also result in the selection of a strain that is either more or less virulent (Martin et al, 2008).

2.3.7. Prevention and control. a) Vectors The viability of mosquito eggs in dambo soil can be reduced by burning of the grass cover, and strategically timed application of larvicides can be used to suppress mosquito breeding (Logan et al, 1990). Other measures such as chemical control of adult vectors, movement of stock from low-lying areas to well-drained and wind-swept pastures at higher altitudes, or confining of animals to mosquito proof stables, are usually impractical, instituted too late and at best palliative in the face of a RVF epidemic (Swanepoel and Coetzer, 2003). b) Immunization Immunization remains the only effective way of protecting livestock. Two vaccines are currently available for vaccination of animals against RVF. The first being, formalin inactivated vaccine available in South Africa and Egypt. This vaccine safe in pregnant ewes, but is poorly immunogenic, thus requiring a booster dose to achieve immunity and regular revaccination to maintain immunity. The second is a live vaccine based on the attenuated Smithburn strain. This vaccine is widely used in Africa and the Middle East. It is more immunogenic than the formalin inactivated alternative, but may cause abortion and foetal teratogenicity when ewes are vaccinated during pregnancy. A live Clone 13 RVF vaccine has recently been registered for use in cattle, sheep and goats in South Africa. The vaccine is based on a natural RVF virus mutant

with a large deletion in the NSs gene. Evidence so far indicates that the vaccine is highly immunogenic, and does not cause abortion or foetal teratogenicity in ewes vaccinated during pregnancy. The risk of reversion to virulence is believed to be negligible given the substantial genetic deletion present in the vaccine virus. The Clone 13 RVF vaccine therefore seems to be a safer and more effective alternative to RVF vaccines currently being used to protect livestock in Kenya. (GALV Med, 2010) Epidemics of RVF tend to occur at irregular intervals of many years and it is usually difficult to persuade farmers to vaccinate livestock during the long inter-epidemic periods. The occurrence of epidemics is usually difficult to predict as they usually have a very sudden onset. Hence it is advisable in African countries with large sheep and goat populations to immunize the offspring of vaccinated ewes and nannies on a regular basis (at six months of age), when colostral immunity has waned, with a single dose of the modified live Smithburn vaccine. This should offer life-long protection (Assad et al, 1983). Lambs and kids of susceptible dams can be immunized at any age. On the other hand, veterinarians and others engaged in the livestock industry should be made aware of the potential dangers of exposure to zoonotic agents in handling tissues of diseased animals, and precautions should be increased during RVF epidemics. A formalin-inactivated cell culture vaccine produced in the USA is used on an experimental basis to immunize persons such as laboratory and field workers who are regularly exposed to RVF infection (Eddy, et al 1981). c) Technology use Advancing technologies are creating exciting possibilities for prevention and control of emerging diseases. They include: far-reaching and constantly improving communication tools, including use of mobile text messaging resulting in improved surveillance approaches, and state-of-the-art

satellite imagery and mapping capacity to forecast and detect ecologic changes and climate anomalies relevant to disease prevalence (Ford, et al, 2009). In addition, monitoring of animal and insect vector motility and geographic distributions and, development of highly sensitive diagnostic tools for use in human, animal and vector surveillance are enhancing the ability to detect new` pathogens or changes in reservoir patterns for known pathogens. These new capacities will dramatically improve the ability to detect early and, ultimately to forecast in advance, the emergence of disease threats so that effective measures can be taken to avert or minimize the public health impact (Breiman et al, 2010).

3. METHODOLOGY 3.1 Research Design This will be a retrospective cross-sectional study that will utilize quantitative techniques of data collection, on the prevalence of RVF versus the weather patterns; specifically temperature and rainfall between the years 1995 and 2010. This will meet the outlined objectives in chapter 1 in a bid to show the relationship between climate and RVF outbreaks in order to project the likely effects of climate change on its epidemiology in terms of increased frequency of outbreaks. 3.2 Study areas and data collected By the year 2007, six of the eight provinces in Kenya had reported outbreaks of RVF i.e. Rift Valley, Eastern, Central, North Eastern, Coast and Nairobi provinces. In each of these provinces data will be obtained on the year when outbreaks occurred within the years 1995-2010. Because heavy rains and flooding have been associated with RVF epizootics, rainfall data as well as the prevailing temperatures between the years 1995-2010 available will be examined. Annual rainfall data and prevailing temperatures from one representative station will be reported in each of the six provinces between 1995 and 2010. In the six provinces where RVF outbreaks have been reported, the representative stations will be those closest to the districts reporting RVF; i.e. Nakuru station

(Rift Valley province), Garissa station (Northeastern province), Meru station (Eastern province), Malindi station (Coast province), Thika station (Central province), and Wilson airport station (Nairobi province). Though Western and Nyanza provinces have never reported RVF, they will be part of this study and the representative stations will be Kakamega and Kisumu respectively. 3.3 Data collection procedures This will entail:
a) Collection of recorded cases of RVF in Kenya from The Central Veterinary Research

Laboratories, the Kenya Medical Research Institute, Nairobi, Kenya and the Department of Disease Surveillance, Ministry of Health, for the period between 1995 and 2010.
b) Collection of recorded weather patterns i.e., temperature and rainfall from the Kenya

Meteorological Department for the period between 1995 and 2010. c) Study of published and unpublished material as well as relevant case studies sourced from the internet, including all support documentation and articles unavailable locally, graphic representations in form of photographs and drawings of relevance to climate change and its effect on RVF epidemiology. d) Data collected will be entered in data collection sheets.

3.4 Data analysis. This will be analyzed as follows:

i.

Tabulation of data and calculation of averages for annual temperature and rainfall in 1995-2009 for the representative districts in the 8 provinces using Microsoft Excel.

ii.

Tabulation of administrative districts that reported cases of rift valley fever during the 1997-98 and 2006-07 outbreaks showing percentages and bar graphs to show proportion of the country involved in the two outbreaks.

iii.

Graphical representation of annual temperature, and rainfall in 1995-2009for the representative districts in the 8 provinces as well as the magnitude of both outbreaks (1997/1998 & 2006/2007) in terms of the number of districts involved in the province expressed as a percentage of total administrative districts in the same province. For the purpose of uniformity the administrative districts used are based on the geographic boundaries of the eight provinces and 69 administrative districts in place in 1999 as the number and size of districts have recently been restructured.

iv.

Graphical representation of average annual temperatures per province between 1995 and 2009 using Microsoft Excel and using the trend line to study the trend of average annual temperatures in each representative district.

DATA ANALYSIS INTRODUCTION A total of 38/69 (55%) administrative districts in the country had reported RVF epizootics by the end of 2007. The Western and Nyanza provinces, located on the southwestern region of the country, had never reported RVF infections by 2007 (Murithi et al, 2010). As shown below, the 2006/2007 outbreak involved 36/69 administrative districts (52.2%) compared to the 1997/1998 outbreak which involved 22/69 administrative districts (31.8%). DISTRICTS PER PROVINCETHAT REPORTED RVF IN 1997/1998 OUTBREAK AND THE 2006/2007 OUTBREAK 1997/1998 0UTBREAK (22/69 DISTRICTS- 31.8%)
1. Rift Valley Province: West Pokot, Uasin Gishu, Trans Nzoia, Narok, Nakuru, Laikipia,

Kajiado. 2. Eastern Province: Isiolo, Makueni, Marsabit, Machakos. 3. North Eastern Province: Garissa, Mandera, Wajir. 4. Coast: Kilifi, Kwale, Tana River. 5. Central: Kiambu, Maragua, Nyeri, Thika. 6. Nairobi 7. Western Province: None. 8. Nyanza Province: None.

2006/2007 OUTBREAK (36 DISTRICTS- 52.2%)

1. Rift Valley Province: West Pokot, Uasin Gishu, Nakuru, Laikipia, Kajiado,

Baringo, Samburu, Marakwet, Kericho.

2. Eastern Province: Isiolo, Makueni, Machakos, Mbeere, Embu, Moyale, Meru

Central, Meru North, Meru South, Mwingi, Kitui. 3. North Eastern Province: Garissa, Mandera, Wajir, Ijara. 4. Coast: Kilifi, Kwale, Tana River, Taita Taveta, Lamu, Malindi. 5. Central: Kiambu, Maragua, Thika, Muranga, Kirinyaga. 6. Nairobi. 7. Western Province: None. 8. Nyanza Province: None.

PROVINCE

TOTAL NUMBER OF ADMINISTRATIVE DISTRICTS 18 12 4 7 7 8 12 8

DISTRICTS INVOLVED IN 1997/1998 0UTBREAK (%) 7 (39%) 4 (33%) 3 (75%) 3 (43%) 4 (57%) 0 (0%) 0 (0%)

DISTRICTS INVOLVED IN 2006/2007 OUTBREAK (%) 9 (50%) 11 (92%) 4 (100%) 7(100%) 5 (71%) 0 (0%) 0 (0%)

Rift Valley Eastern North Eastern Coast Central Nairobi Nyanza Western

1. RIFT VALLEY PROVINCE Nakuru

YEAR RAINFALL TEMPERATURE OUTBREAKS 1995 59.5 18.57 0 1996 72.7 18.14 0 1997 93.7 18.56 39% 1998 95.8 18.72 39% 1999 55.79 18.85 0 2000 50.83 19.32 0 2001 101.85 18.69 0 2002 83.24 18.87 0 2003 94.67 18.77 0 2004 80.97 18.74 0 2005 77.1 6 18.7 7 0

2. NORH EASTERN PROVINCE Garissa

YEAR RAINFALL TEMPERATU RE OUTBREAKS 1995 34.21 28.92 0 1996 11.76 28.99 0 1997 79.2 28.62 75% 1998 53.25 28.71 75% 1999 25.09 28.57 0 2000 13.44 28.84 0 2001 21.68 29.05 0 2002 46.71 28.91 0 2003 33.2 0 2004 15.4 0 2005 11.85 28.74 0

3. EASTERN PROVINCE Meru

1995 126.9 8 18.42 0 1996 81.15 18.54 33 1997 184.9 9 18.55 33 1998 127.5 2 18.31 0 1999 84.67 18.24 0 2000 49.85 18.58 0 2001 101.4 4 18.47 0 2002 152.1 18.34 0 2003 127.5 5 18.93 0 2004 118.1 4 0 2005 68.11 19.43 0

RAINFALL TEMPERATU RE OUTBREAKS

4. COAST PROVINCE Malindi

1995 RAINFALL TEMPERATU RE OUTBREAKS 65.21 26.28 0 1996 87.47 27.45 0 1997 177.9 2 26.45 48 1998 117.9 2 27.01 48 1999 103.8 2 26.5 0 2000 85.05 26.43 0 2001 81.55 26.66 0 2002 89.5 26.84 0 2003 89.35 27.2 0 2004 75.1 26.97 0 2005 72.59 27 0

5. CENTRAL PROVINCE Thika

1995 RAINFALL TEMPERATU RE OUTBREAKS 63.33 14.09 0 1996 66.7 14.03 0 1997 116.6 7 15.29 57 1998 115 14.63 57 1999 75 13.97 0 2000 29.1 14.31 0 2001 66.7 15.27 0 2002 108.3 15.04 0 2003 58.3 14.07 0 2004 63 14.93 0 2005 50 15.65 0

6. NAIROBI PROVINCE
YEARS RAINFALL TEMPERATU RE 1995 73.56 18.98 1996 56.61 18.35 1997 81.94 20.39 1998 117.5 19.38 1999 62.75 19.45 2000 44.1 19.71 2001 120.1 19.56 2002 79.35 19.89 2003 78 19.8 2004 70.56 19.73 2005 60.48 19.82

7. WESTERN PROVINCE

Kakamega
1995 167.2 5 1996 174.6 3 20.61 0 1997 134.9 21.1 0 1998 159.2 5 20.81 0 1999 145.8 20.45 0 2000 117.8 5 20.91 0 2001 185.5 6 20.76 0 2002 178.7 8 21.05 0 2003 175.8 5 21.34 0 2004 129.5 21.24 0 2005 134.0 6 21.47 0

RAINFALL TEMPERATU RE 20.56 OUTBREAKS O

8. NYANZA PROVINCE Kisumu

1995 120.9 8 23.5 0 1996 128.3 5 23.28 0 1997 134.2 23.85 0 1998 104.7 3 23.87 0 1999 128.6 6 23.25 0 2000 101.2 4 23.6 0 2001 124.2 9 23.31 0 2002 134.8 7 23.66 0 2003 104.3 6 23.67 0 2004 115.9 9 0 2005 99.5 24.11 0

RAINFALL TEMPERATU RE OUTBREAKS

GRAPHICAL REPRESENTATION OF AVERAGE ANNUAL TEMPERATURES PER PROVINCE BETWEEN 1995 AND 2009 1. RIFT VALLEY PROVINCE Nakuru

2. NORTH EASTERN PROVINCE Garissa

3. EASTERN PROVINCE Meru

4. COAST PROVINCE Malindi

5. CENTRAL PROVINCE Thika

6. NAIROBI PROVINCE Nairobi

7. NYANZA PROVINCE Kisumu

8. WESTERN PROVINCE Kakamega

SUMMARY The purpose of this project was to study the climatic trends in terms of rainfall and temperature between 1995 and 2009 and how the epidemiology of RVF has changed over the same period. Findings of the study are summarized below; 1. There have been two major outbreaks between 1995 and 2009, i.e. 1997/1998. 2. These outbreaks occur when the affected regions record extremely high rainfall having been preceded by a relatively dry period. E.g. as seen in the 1997/98 outbreak, Garissa went from 11.7mm in 1996 to 79.2mm in 1997 and Thika from 66.7mm in 1996 to 116.67mm in 1997. 3. Comparison of the two outbreaks shows that the 2006/2007 one was more extensive, involving 52.2% of the country as compared to that of 1997/1998 that only involved 38.1% of the country.
4. From the graphical analysis of average annual temperatures per province it is clear from

the trend line in the graphs that the temperatures have been gradually increasing during this period. DISCUSSION

The challenges of climate change and development in Africa are closely linked. But we urgently need to improve our understanding of how climate change will affect Africa Beckett (2004). This study reveals that temperatures have been gradually increasing and that the magnitude in terms of number of regions involved in the outbreak has increased. This may partly be explained by what is in chapter 2 of this report under the subtopic on effects of climate change on RVF (2.3.7) which states that it is therefore expected that global climate change will alter the distribution and increase the risk of some vectorborne zoonoses, including Rift Valley fever (RVF), leading to significant changes in the geographical distribution and frequency of RVF epidemics. This is further explained by the fact that temperature has a direct effect on mosquitoes, the principal vectors of RVF virus. It leads to increased activity, increased reproduction and therefore increased frequency of blood meals and faster digestion of blood (Martin et al, 2008). Pathogens harboured by mosquitoes also mature faster. Increased water temperature cause mosquito larvae to develop faster also increasing overall vector capacity (Reiter, 2008). If this trend goes unchecked, RVF may further extend to involve more regions and this will be detrimental to Kenya as a developing country. By 2100 it is estimated that average global temperatures will have risen by 1.03.5 oC, increasing the likelihood of many vector-borne diseases in new areas. Human settlement patterns in the different regions will influence disease trends in that this will lead to introduction of pathogens to new areas and due to global warming which accompanies climate change, these pathogens and their vectors thrive and cause disease since the climatic conditions are now conducive (Githeko et al, 2000).

RVF has negative socioeconomic impacts which retard development. Outbreaks result in substantial hardship, directly through illness and through direct economic impact (as a result of animal deaths and abortions, and because of a variety of commercial bans.). Specifically hard hit by the latest outbreak were the pastoral communities of the north eastern (NE) part of Kenya. In this region, livestock serve an important livelihood function for pastoralists, with livestock trade representing over 90% of pastoral incomes (Mutunga, 2010). Moreover, NE Kenya has the highest incidence of poverty within Kenya, with poverty rates of approximately 70% in 2004 (Society for International Development, 2010). It is important to note that RVF does not just affect producers, but also impacts a host of other service providers within the livestock supply chain and other parts of the larger economy. Beyond livestock producers in the affected areas, traders, slaughter-house workers, butchers, transporters, and a range of small-scale businesses, such as operators of food kiosks who served these workers, all incurred losses. It was reported that significant numbers of livestock traders and butchers were unable to resume their business activities after the bans on livestock movement and slaughter were lifted because of depletion of capital. Cumulatively, these downstream impacts can often dwarf the impacts of the disease at the farm level (Rich et al, 2010). This shows that there is increasing need for us as a country to adapt ways in which we can mitigate climate change and to adapt to its impacts especially when it comes to health. RECOMMENDATIONS

1. As the world embraces the one health initiative, there should be better

coordination between veterinary epidemiologists, medical epidemiologists and environmentalists and through the combination of their different areas of expertise study the new trend of diseases, especially vector borne diseases as a result of climate change and therefore come up with better methods of surveillance, prevention and control of such diseases. 2. Veterinary and medical experts, through extension services should educate and create awareness to the public, especially in marginalized areas where poverty and illiteracy is at its highest, on what climate change is and the effects we are likely to experience. We should enlighten them on coping strategies which might include educating people in areas solely dependent on livestock for their livelihood on alternative sources of income. 3. It is our responsibility as veterinary extension officers to educate people on the importance of livestock insurance as most insurance companies nowadays insure animals against losses due to epidemics. 4. We cannot ignore the fact that we have started experiencing effects of climate change on epidemiology of most diseases, among many others. It would be advisable to introduce studies on global warming and climate change into the curriculum in both veterinary and medical schools so that we are well equipped to deal with some of the unexpected changes seen in terms of disease epidemiology e.g. whereby a while ago wed disregard the likelihood of a certain disease occurring in a certain area based on the fact that the environment wasnt

conducive for the causative agent to thrive and cause disease. This is bound to change and it would be quite costly to be ignorant on such issues.

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