36 H. Yahyaoui Azami and J. Zinsstag
M. bovis has not been officially considered or
investigated as the causal agent of human TB. In
countries where bovine TB has a high preva-
lence in cattle, and where no prevention control
measures are applied (e.g. mandatory milk pas-
teurization), the proportion of M. bovis infec-
tions among human patients could potentially
be higher than expected.
3.6 One Health Economics of
Bovine TuberculosisOH approaches to control zoonoses have been
applied in developing countries, mainly in epide-
miological investigations. Examples include
human and animal seroprevalence studies per-
formed in Kyrgyzstan (Zinsstag et al., 2009;
Kasymbekov et al., 2013) and in Mongolia
(Tsend et al., 2014). Moreover, OH showed a
great potential in the contribution to rabies elim-
ination in Africa as explained by Léchenne et al.
(2015).
To apply an OH approach to bovine TB, the
first step to be undertaken is to investigate the
burden of M. bovis among human TB patients.
This information could be used in order to start a
dialogue between the human and animal health
sectors. Before an integrated approach to con-
trol human TB and bovine TB can be developed,
an economic study assessing the cost of the con-
trol of human TB using an OH approach should
be performed, in addition to the evaluation of
the added value of this approach. Potential sav-
ings achievable through the implementation of
OH concept in 139 World Bank client countries
have been estimated to range from 0% to 40%
depending on the task considered (World Bank,
2010).
The adequate resources needed to achieve
this collaboration should be available; in addi-
tion, the persons involved in OH interventions
should be trained in order to have the necessary
skills needed for a better management of the
intervention (WHO et al., 2012).
Decision makers are a key stakeholder in
bovine TB control strategy, and they should be
involved in the process from the beginning. The
economic and societal impact of each approach
suggested must be communicated to the deci-
sion makers, in addition to a time line for inter-
vention and a cost-effectiveness analysis (WHO
et al., 2012). Interventions to control a zoonosis
should be performed in parallel with a health
education campaign, as this will contribute to a
better acceptance of the control programme
by the local population and its sustainability
(Ducrotoy et al., 2015).3.7 Bovine Tuberculosis as a
One Health IssueThe burden of M. bovis for public health is very
low for developed countries, where the disease in
cattle has a low prevalence or has been eradi-
cated. In developing countries, the burden of
M. bovis in humans is known for only a few
countries. In a systematic review and meta-
analysis, Müller et al. (2013) reported an aver-
age prevalence of M. bovis among humans of
about 2.8% (7 zoonotic TB cases/100,000Table 3.1. Direct and indirect economic losses associated with bovine tuberculosis in human and
animal sectors.
Animal HumanDirect Condemned meat in slaughterhouses
Diminution of the animal value
Diagnostic and hospitalization (ministry of health)
Out-of-pocket expenses for healthcare
(contribution of the patient)
Indirect Diminution of milk production
Diminution of fertility
Change of herd demographic composition
DALY’s lost
Transport costs (travel expenses)
Expenses related to the patient visitors and
accompanying person
Jobs lost (change in the household income)