key: cord-1025659-a27ryvaj authors: Kamau, Esther; Ongus, Juliette; Gitau, George; Galgalo, Tura; Lowther, Sara A.; Bitek, Austine; Munyua, Peninah title: Knowledge and practices regarding Middle East Respiratory Syndrome Coronavirus among camel handlers in a Slaughterhouse, Kenya, 2015 date: 2018-09-20 journal: Zoonoses Public Health DOI: 10.1111/zph.12524 sha: 7431503a50614591a421f3fcccb7537dcfcb5bdd doc_id: 1025659 cord_uid: a27ryvaj Dromedary camels are implicated as reservoirs for the zoonotic transmission of Middle East Respiratory Syndrome coronavirus (MERS‐CoV) with the respiratory route thought to be the main mode of transmission. Knowledge and practices regarding MERS among herders, traders and slaughterhouse workers were assessed at Athi‐River slaughterhouse, Kenya. Questionnaires were administered, and a check list was used to collect information on hygiene practices among slaughterhouse workers. Of 22 persons, all washed hands after handling camels, 82% wore gumboots, and 65% wore overalls/dustcoats. None of the workers wore gloves or facemasks during slaughter processes. Fourteen percent reported drinking raw camel milk; 90% were aware of zoonotic diseases with most reporting common ways of transmission as: eating improperly cooked meat (90%), drinking raw milk (68%) and slaughter processes (50%). Sixteen (73%) were unaware of MERS‐CoV. Use of personal protective clothing to prevent direct contact with discharges and aerosols was lacking. Although few people working with camels were interviewed, those met at this centralized slaughterhouse lacked knowledge about MERS‐CoV but were aware of zoonotic diseases and their transmission. These findings highlight need to disseminate information about MERS‐CoV and enhance hygiene and biosafety practices among camel slaughterhouse workers to reduce opportunities for potential virus transmission. list was used to collect information on hygiene practices among slaughterhouse workers. Of 22 persons, all washed hands after handling camels, 82% wore gumboots, and 65% wore overalls/dustcoats. None of the workers wore gloves or facemasks during slaughter processes. Fourteen percent reported drinking raw camel milk; 90% were aware of zoonotic diseases with most reporting common ways of transmission as: eating improperly cooked meat (90%), drinking raw milk (68%) and slaughter processes (50%). Sixteen (73%) were unaware of MERS-CoV. Use of personal protective clothing to prevent direct contact with discharges and aerosols was lacking. Although few people working with camels were interviewed, those met at this centralized slaughterhouse lacked knowledge about MERS-CoV but were aware of zoonotic diseases and their transmission. These findings highlight need to disseminate information about MERS-CoV and enhance hygiene and biosafety practices among camel slaughterhouse workers to reduce opportunities for potential virus transmission. biosafety, camel, Middle East respiratory syndrome, slaughterhouse match suggested zoonotic transmission (Briese et al., 2014; Reusken et al., 2014) . MERS-CoV ribonucleic acid (RNA) has been detected in camel nasal, oral, fecal specimens and in air samples in a barn that held an infected camel . The MERS-Co virus is thought to be transmitted from the nasal mucosa and conjunctiva of infected camels, especially through respiratory secretions because viral load has been found to be high in these sites . Camels have been reported to be infected simultaneously with more than one MERS-CoV and re-infection and viral shedding of camels previously infected with the virus had been reported (Farag et al., 2015) . This makes those exposed to camels potentially at an elevated risk of exposure compared to the general population. Persons with possible occupational exposure include herders, traders and slaughterhouse personnel. Slaughterhouse workers have been demonstrated to be at an elevated risk of MERS-CoV exposure relative to the general population (Muller et al., 2015) . High viral loads have been found in camels in slaughter houses suggesting that they are places of high MERS-CoV circulation and a high-risk area for human exposure (Farag et al., 2015) . An investigation in Egypt, using real-time polymerase chain reaction (RT-PCR) detected MERS-CoV in 3.6% (4 of 110) apparently healthy dromedary camels in a slaughterhouse mainly in camels that had been imported from Sudan or Ethiopia (Chu et al., 2014) . The World Health Organization recommends use of hand and face protection as protection for people working in slaughterhouses. The International Health Regulations relies on rapid national detection and containment of public health threats. Our study sought to assess hygiene and biosafety knowledge and practices among herders, traders and slaughterhouse workers. We assessed biosafety measures undertaken by the slaughterhouse workers which included washing of hands, use personal protective equipment and knowledge of MERS. We also assessed whether they had knowledge of zoonotic diseases and ways in which they are spread. The study was carried out in Athi-river slaughter house which is in Machakos, Kenya, 20 km southeast of Nairobi. All slaughterhouse workers, herders and traders met at the slaughterhouse were interviewed as a convenience sample. A standardized pre-tested questionnaire was used to collect data from participants about MERS-CoV ("camel flu" in Kiswahili) to assess knowledge of MERS and other zoonotic diseases. A check list was used to collect information about hand-washing practices after handling camels and use of personal protective equipment. Data from questionnaires were entered, cleaned and analyzed using EPI Info 7 (CDC, Atlanta, GA). Descriptive statistics were calculated for categorical variables including occupation, hand-washing practices, use of personal protective equipment, and knowledge of MERS and zoonotic diseases among slaughterhouse workers, herders and traders. Twenty-two people who included five herders/traders, 14 slaughter house workers, two meat inspectors and one County supervisor were interviewed. Majority were aged between 31 and 50, and 10 (45.5%) had a Secondary school education. Fourteen (64%) participated in slaughter, and 18 (82%) had worked in the slaughter house for more than 3 years (Table 1) . Of these, 82% wore gumboots (100% among slaughterhouse workers), 65% wore overalls/ dustcoats (88% among slaughterhouse workers). All persons interviewed reported washing hands after handling camels. None reported use of hand gloves or face masks during slaughter. Less than one-third (27%) of the respondents had heard about MERS, but majority (90%) were aware diseases could be transmitted from animals to humans, common ways being through eating improperly cooked meat (90%), consumption of raw milk (68%) and slaughter processes (50%). Three herders (14%) reported drinking raw camel milk. All of the herders and slaughterhouse workers had good hygiene practices which were demonstrated by washing of hands after the Impacts • Our results documented low knowledge of MERS among herders, traders and slaughterhouse workers. • Abattoir workers were unaware of hand and face protection as ways of protecting themselves from exposure to MERS. • Herders and slaughterhouse workers were aware of zoonotic diseases which could potentially reduce opportunity for potential virus transmission. slaughter process or after handling camels. Slaughterhouse workers were also aware of the importance of using protective clothing while handling camels during slaughter, but the use was limited to use of footwear and labcoats/overalls suggesting that they were mainly protecting themselves from dirt. Use of personal protective clothing to prevent direct contact with discharges and aerosols was observed to be low since there was no use of gloves and face masks. As knowledge of camel herders and slaughterhouse workers on MERS-CoV was lacking, these findings provide possible higher-risk activities during slaughter. Slaughterhouse workers' awareness of zoonotic diseases and their transmission was high enabling them to protect themselves from exposure. Three herders reported drinking raw camel milk, which increases overall risk of exposure to zoonosis. Recent studies carried out in Kenya have shown a persistently high level of MERS-CoV antibodies in camels. In a study carried out in a single county in Kenya, 47% of camels were found to have antibodies (Deem et al., 2015) . Another study carried out in Marsabit County showed over 90% sero-prevalence among camels, but none of the humans tested showed presence of antibodies (Munyua et al., 2017) . The true incidence of MERS-CoV infections in humans may not actually be known, as most patients could be asymptomatic or present with symptoms similar to influenza, the common cold or other infections known to cause respiratory disease. Antibodies against MERS have been demonstrated in Kenya in two people in an area that has a high camel density (Liljander, et al., 2016) . In 2015, in a slaughterhouse in Nigeria, sero-prevalence of mature camels coming for slaughter was found to be 95% (Chu et al., 2015) . Due to limited of funding, herders and slaughterhouse workers were not tested for MERS-CoV antibodies to assess putative MERS-CoV transmission from dromedaries to humans. These findings would provide insights into an actual risk of infection in slaughterhouses and could provide an opportunity for further research. In addition, a small number of herders, traders and slaughterhouse workers were enrolled therefore limiting identification of significant differences in the knowledge, practices and beliefs and results may not be generalizable to other traders and herders in Kenya. The low enrollment was because slaughter took place at night and camels were sold to traders back at home. Traders delivered camels to the slaughterhouse and left them in the care of the slaughterhouse workers. Despite these limitations, this study provides useful qualitative information on camel handling and slaughter practices. While neither the infection status in persons working with camels nor the risk of transmission was evaluated, studies have indicated that slaughterhouse workers are at an elevated risk of exposure TA B L E 1 Characteristics, knowledge, attitude and practices regarding MERS among herders, traders and slaughterhouse workers at Athi-river slaughterhouse, 2015 relative to the general population (Muller et al., 2015) . 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