Use of herbal remedies by small-scale farmers to treat livestock diseases in Central Eastern Cape Province, South Africa

The use of herbal remedies by African farmers in the treatment of livestock diseases was investigated using a range of methods, including group interviews, structured interviews, semi-structured interviews and participant observation. The study was concerned mainly with the 'why' and 'how' of herbal remedy use among African livestock holders farming on communally-owned land in central Eastern Cape Province. We found that the use of herbal remedies was still widespread because these remedies were cheap, locally available and convenient to administer. Farmers also used herbal remedies because they did not have knowledge of conventional remedies or found these too expensive and therefore used herbal remedies as a last resort. Most of the farmers interviewed (73%) had used some form of herbal remedy. A small number of farmers did not use herbal remedies at all. They rejected them because they had bad experiences in the past or because they considered the practice outdated and socially inferior. Often farmers used herbal remedies in combination with conventional ones, but a substantial number relied on herbal remedies only. Farmers obtained herbal remedies principally by preparing their own or by purchasing from herbalists. Different plant parts were used to prepare herbal remedies in the form of infusions, decoctions, powders, pastes, and juices from fresh plant material. Preparations were made from a single plant or from a range of plants. Application of a remedy was by different routes and methods, depending on the perceived cause of the disease condition. Topical applications were used for skin conditions, powders were rubbed into incisions, drenches were common in the treatment of systemic conditions, and drops to treat ears and eyes. We identified several aspects of herbal remedy utilisation that could be subject to improvement, which included the absence of standard dose regimes, the potential toxicity of certain compounds present in plants used, over-exploitation of the plant resource and a lack of interest by the youth to learn the art.     

Use of ethnoveterinary medicinal plants in cattle by Setswana-speaking people in the Madikwe area of the North West Province of South Africa

Rapid Rural Appraisal (RRA) methods were employed to document the use of ethnoveterinary medicinal plants in cattle by Setswana-speaking people in the Madikwe area of the North West Province of South Africa. The study indicated that Setswana-speaking people in the North West Province have a rich heritage of ethnoveterinary knowledge, which includes all aspects of ethnoveterinary medicinal plant use. Information was gathered from informants through individual interviews, group interviews, guided field walks and observations. Ethnoveterinary uses in cattle of 45 plant species representing 24 families were recorded. Plants were used in 84% of the total number of recorded ethnoveterinary remedies. These plants were used alone (64%) or in mixtures (36%) for 29 indications. The most important indications were retained placenta, diarrhoea, gallsickness, fractures, eye inflammation, general ailments, fertility enhancement, general gastrointestinal problems, heartwater, internal parasites, coughing, redwater and reduction of tick burden. Plant materials were prepared in various ways including infusion, decoction, ground fresh material, sap expressed from fresh material, charred and dried. The most common dosage form was a liquid for oral dosing. Other dosage forms included drops, licks, ointments, lotions and powders. Liquid remedies for oral dosing were always administered using a bottle. Medicinal plant material was preferably stored in a dried form in a cool place out of direct sunlight and wind. Lack of transfer of ethnoveterinary knowledge to younger generations puts this knowledge at risk. RRA was found to be a successful method of investigation for the study of ethnoveterinary medicine.     

Plants as de-worming agents of livestock in the Nordic countries: historical perspective, popular beliefs and prospects for the future.

Preparations derived from plants were the original therapeutic interventions used by man to control diseases (including parasites), both within humans and livestock. Development of herbal products depended upon local botanical flora with the result that different remedies tended to develop in different parts of the world. Nevertheless, in some instances, the same or related plants were used over wide geographic regions, which also was the result of communication and/or the importation of plant material of high repute. Thus, the Nordic countries have an ancient, rich and diverse history of plant derived anthelmintic medications for human and animal use. Although some of the more commonly used herbal de-wormers were derived from imported plants, or their products, many are from endemic plants or those that thrive in the Scandinavian environment. With the advent of the modern chemotherapeutic era, and the discovery, development and marketing of a seemingly unlimited variety of highly efficacious, safe synthetic chemicals with very wide spectra of activities, herbal remedies virtually disappeared from the consciousness--at least in the Western world. This attitude is now rapidly changing. There is a widespread resurgence in natural product medication, driven by major threats posed by multi-resistant pest, or disease, organisms and the diminishing public perceptions that synthetic chemicals are the panacea to health and disease control. This review attempts to provide a comprehensive account of the depth of historical Nordic information available on herbal de-wormers, with emphasis on livestock and to provide some insights on potentially rewarding areas of "re-discovery" and scientific evaluation in this field.     

Natural Remedies and Nutraceuticals Used in Ethnoveterinary Practices in Inland Southern Italy

Traditional animal health practices are today only rarely used in Europe, as many natural remedies applied for the treatment of animals have been replaced by modern pharmaceuticals. Modern institutionalized veterinary services tend to cover every aspect of animal health care, and influence most of the veterinary practices carried out by shepherds and farmers. However, in some areas, particularly of the Mediterranean, such traditional practices persist. Few ethnoveterinary studies have been conducted in the Mediterranean. In this survey, we analysed the natural remedies that are still in use or were used until very recently to treat animals in central Lucania (inland southern Italy). Plants constitute the mainstay of the folk-veterinary regimen (about 40 preparations), but there are also a few animal- and mineral-derived preparations. Among them, the veterinary use of Cistus incanus, Colutea arborescens, Daphne laureola, and Erigeron acer is reported for the first time. Moreover, the study identified diverse traditional plant nutraceuticals used to improve animal health, as well as the quality of milk and dairy products. An important potential output of this study may be the development of eco-sustainable integrated projects focused on the maintenance of traditional animal breeding and healthcare systems. Pharmacological and toxicological considerations relating to possible applications of the recorded traditional knowledge in modern evidence-based veterinary medicine are also discussed.     

Investigations of the motivation underlying Norwegian dairy farmers' use of homoeopathy

Eighteen Norwegian dairy farmers were interviewed to examine their reasons for using homoeopathic treatments in managing their herds' health. Overall, they chose the treatments on the basis of factors related to their personal experience, considerations of individual animals and the framework for dairy production. For individual animals homoeopathy was used as an alternative to conventional veterinary treatment, but at the herd level it was used to complement it. The farmers' use of homoeopathic treatment for personal health problems and the experience of their colleagues with its use in dairy production were important factors motivating their initial use of homoeopathy. Other factors included a desire to decrease the use of antibacterial drugs, reduce costs and find alternatives when conventional veterinary medicine provided no effective treatment. In individual cases, the severity of disease, previous experience and the farmers' personal knowledge and resources were important. These factors parallel those found to influence the use of complementary and alternative therapies in human medicine. The lack of understanding and documentation of the effects of homoeopathic remedies was not important to the farmers, and they valued personal experience more highly than scientific evidence or the opposition to homoeopathy encountered within the veterinary profession.     

Delivery of health and husbandry improvements to working animals in Africa

Problems have been identified in the delivery of extension messages about the maintenance of healthy and well-fed working animals. The different factors that need to be considered in developing effective disease control and prevention programmes for working oxen and equids including vector-borne diseases, helminth disease, and vaccination programmes have been reported and discussed and experiences in improving husbandry including footcare, harness, and worm management reported. Most draught animals are owned by people who lack the financial means to pay for or to access the information needed on nutritional supplements, vaccinations and drug treatment. Smallholder farms are often remote from veterinary services, thereby requiring greater emphasis on preventive measures and local remedies. Several NGOs have traditionally provided static and mobile treatment teams for equines and training courses for farriers and harness makers. The effectiveness and sustainability of these services and ways in which delivery of health care and husbandry messages could be delivered to improve impact are discussed.     

Challenges to human rabies elimination highlighted following a rabies outbreak in bovines and a human in Punjab,India

In August 2015, a rabies outbreak occurred in bovines in a Punjab village, India; subsequently, a farmer in the same village died of rabies in October 2015. We surveyed farmers to describe the outbreak, the demographics and rabies prophylaxis administered to householders on case farms, and farmers’ knowledge of rabies prevention and treatment. We used multiple correspondence analysis to guide investigation of associations between demographics, farm status and rabies knowledge, attitudes and practices. The number of affected bovines was unusually high; 15 cattle and buffalo died on 13 smallholder farms (attack rate 4%). Post‐exposure vaccinations were administered to 24 people (median 2 doses). Affected farms had significantly larger households and were more likely to keep their livestock outside (therefore, accessible by stray dogs), suggesting that the impact of the outbreak was disproportionally borne by households of lower socio‐economic status. Primary sources of rabies information were friends and neighbours, not health authorities or media. Women who had not received formal education were less likely to have heard of rabies. Although case farm participants were more likely to have heard about rabies from a veterinarian, their knowledge and practices to prevent rabies did not reflect the level expected considering their contact with a health professional; they were more likely to believe that traditional remedies prevent rabies and less likely to tell their children to avoid playing with stray dogs than participants from other farms. This study highlights knowledge dissemination disparities that, if typical of rural locations, could obstruct attempts to eliminate canine‐mediated human rabies in India. Therefore, understanding the pervasiveness and influence of traditional medical beliefs on treatment‐seeking behaviour, communication structures within villages and the impact of local practices such as carcass disposal on dog populations will be essential to ensure that rabies control strategies are effective in rural India.     

Traditional remedies used for the treatment of cattle wounds and myiasis in Amatola Basin, Eastern Cape Province, South Africa

A questionnaire survey was carried out to document traditional remedies used in the treatment of cattle wounds and myiasis in Amatola Basin. Eighty-three cattle farmers from nine villages were interviewed. The majority of respondents (67.9%) use traditional remedies for treatment of these conditions. However, 25.9% of them use a combination of traditional remedies with conventional medicines. The survey revealed that 13 medicinal plants belonging to 11 families were used. Aloe ferox, Prunus persica and Phytolacca heptandra were, however, the most commonly used. Leaves are the most frequently used plant part, often prepared as an infusion. Other non-plant remedies used include disinfectants, antiseptics as well as diesel and petrol. Manual removal of maggots from wounds was also practise and treatment is usually continued until the wound heals.     

Comparison of disease severity scoring systems for dairy cattle with acute coliform mastitis

OBJECTIVE: To compare use of 4 disease severity scoring systems to predict bacteremia (yes vs no) and outcome (survived vs died or culled) in dairy cows with acute coliform mastitis (ACM). DESIGN: Retrospective cohort study. ANIMALS: 99 dairy cows with ACM. PROCEDURES: Cows were classified as having mild, moderate, or severe disease with a scoring system based on systemic disease signs alone (systemic severity score [SSS] system), a system based on local disease signs alone (local severity score [LSS] system), and 2 previously described systems based on a combination of local and systemic signs (local-systemic score 1 [LS1] and local-systemic score 2 [LS2] systems). Test performance was calculated to determine whether a severe disease classification could be used to predict bacteremia or outcome. RESULTS: 21%, 53%, 63%, and 38% of cows were classified as having severe disease with the SSS, LSS, LS1, and LS2 systems, respectively. For both bacteremia and outcome, sensitivity was highest for the LS1 system, but specificity and accuracy were highest for the SSS system. Examination of a scatterplot of true-positive rate versus false-positive rate for each of the scoring systems indicated that the SSS and LS2 systems were similar in their ability to correctly identify cows with bacteremia or an adverse outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the SSS scoring system was better for identifying cows with bacteremia or an adverse outcome than was the LSS system and that the LS1 and LS2 systems were intermediate in their discriminatory abilities.     

Herbal medicine: potential for intoxication and interactions with conventional drugs

The use of herbal remedies for the prevention and treatment of a variety of illnesses in small animals has increased tremendously in recent years. Whereas most herbal remedies, when used as directed and under the supervision of knowledgeable individuals, are safe, the potential for adverse effects or intoxications certainly exists. Due to inherent toxicity, some herbal remedies should not be used under any circumstance. In addition, because nearly all herbal remedies contain multiple, biologically active constituents, interaction with conventional drugs is a concern. It is incumbent upon clinicians to be aware of those herbs that can cause intoxication, and to be cognizant of potential herb-drug interactions. There are a number of evidence-based resources available to assist clinicians in the safe use of herbal remedies.     

Prevalence of serum antibodies against Bartonella species in the serum of cats with or without uveitis

Bartonella henselae has been implicated as a causative agent of chronic uveitis in people and in some cats. The objective of this study was to determine whether Bartonella species seroprevalence or titer magnitude varies among cats with uveitis, cats without ocular diseases recorded and healthy cats, while controlling for age and risk of flea exposure based on state of residence. There was no difference in seroprevalence rates or titer magnitude between cats with uveitis and cats with non-ocular diseases. Healthy cats were more likely to be seropositive for Bartonella species than cats with uveitis. The median Bartonella species titer was 1:64 for all groups, although healthy cats were more likely to have higher titers than cats with uveitis and cats with non-ocular disease. The results suggest that serum antibody tests alone cannot be used to document clinical uveitis associated with Bartonella species infection.     

Dose-dependent in vivo effect of Rhodiola and Echinacea on the mitogen-induced lymphocyte proliferation in mice

Echinacea purpurea (EP) and Echinacea angustifolia (EA) are ones of the most important world's herbs with immunotropic activity. They were traditional medicinal plants used by North American Indians for the treatment of various illnesses. Now they are cultivated in many countries and are used mainly to treat respiratory tract infections. Rhodiola rosea (RR) and Rhodiola quadrifida (RQ) are medicinal plants originated from Asia and used traditionally as adaptogens, antidepressants, and anti-inflammatory remedies. We previously reported, that extracts of underground parts of RR and RQ exhibited immunotropic activity. We have demonstrated in pigs that in vitro RR or RQ supplementation of blood lymphocyte cultures stimulated T cell proliferative response to Con A in lower, and inhibited it in higher Rhodiola extract concentrations. The aim of this work was to evaluate the in vivo effect of these herbal remedies on the in vitro proliferative response of mouse splenic lymphocytes to another T-cell mitogen- Phaseolus vulgaris haemagglutinin (PHA). We have found significant stimulation of proliferative response, in comparison to the controls, in mice fed lower doses of tested remedies, and inhibition, no effect or lower stimulation, in mice fed higher doses of these drugs.     

An investigation into the aetiology of 'wool slip': alopecia in ewes which are housed and shorn in winter

Alopecia in housed ewes which are shorn in winter, 'wool slip', was investigated by taking wool and blood samples, skin scrapings and biopsies from affected and unaffected animals. Epidemiological information was also obtained from farm records, and reports from a local weather station. No pathological lesions were seen and no ectoparasites or forage mites were seen in wool samples or skin scrapings. The plasma zinc and copper concentrations of both groups were within the normal range but the copper concentrations were significantly lower in the unaffected animals. There was no difference between the prevalence of the disease in ewes of different breeds or between those producing single or twin lambs. A comparison of the mean temperatures during years of summer and winter shearing suggested that cold stress alone was not involved. Skin biopsies revealed that the wool follicles of affected animals were in an early growth phase (anagen) whereas those of unaffected animals were in the inactive phase (telogen). The clinical and histological signs of the disease were similar to those seen experimentally when corticosteroids are used as chemical depilatory agents. It is suggested that wool slip is due to the high levels of corticosteroids which occur as a result of the combination of housing and shearing and on this basis methods of control are proposed.     

Reaction of the local public to large-scale swine facilities

Newspaper stories of building or expanding large-scale animal operations generally indicate that nearby communities, or at least a vocal minority, oppose the development of concentrated operations. However, conflict about the beginning or intensification of operations says little about the persistence of the controversy or the negative public opinion. A survey of 53 large-scale swine facility pork producer, their nearby neighbors, and local community hog facility activists several years after the hog facility was established or expanded indicates that there was no longer active resistance to the facilities, but negative public opinion persisted. Farmers were significantly more positive than other local residents or activists about the advantages of large-scale operations for farmers, the community, and the state and were significantly more likely to minimize any potential or actual negative impacts, including odor, coming from their facility. Residents and activists could best be described as resigned to the operations; most thought that they had little power to remove the facilities under current conditions. The majority of farmers indicated that people in the area had accepted their operation, which was a significant misreading of the residents' level of support. Residents and activists did not differ significantly on most measures of opinion; the primary difference was that activists were willing to say publicly what many thought privately. The level of controversy in the community when the hog farms were established or intensified was significantly correlated with the respondent's attitudes about the impacts of the facilities years later. Farmers who had lived in the community longer, had smaller operations, and interacted more with the community were less likely to have high initial levels of controversy.     

Prevalence, clinical features, and causes of epistaxis in dogs: 176 cases (1996-2001)

OBJECTIVE: To determine prevalence, clinical features, and causes of epistaxis in dogs. DESIGN: Retrospective case series. ANIMALS: 176 dogs with epistaxis. PROCEDURES: Medical records were reviewed for information related to signalment, clinical features, diagnosis, and outcome. RESULTS: 132 (75%) dogs were initially examined by the hospital's emergency service; prevalence of epistaxis was 0.3%. Dogs with epistaxis were more likely to be old (> or = 6 years), male, and large (> or = 26 kg [58.5 lb]) than were dogs in a reference population. In 109 (62%) dogs with epistaxis, an underlying cause was identified; 115 underlying disorders were identified, with 90 classified as local and 25 classified as systemic. Local causes of epistaxis included nasal neoplasia (n = 35), trauma (33), idiopathic rhinitis (20), and periapical abscess (2). Systemic causes included thrombocytopenia (12), thrombocytopathia (7), coagulopathy (3), hypertension (2), and vasculitis (1). Dogs with local causes were more likely to have unilateral than bilateral epistaxis, but 11 of 21 (52%) dogs with systemic disorders also had unilateral epistaxis. Dogs with systemic disorders were more likely to have clinical signs of systemic disease. Duration of epistaxis (acute vs chronic), severity, and duration of hospitalization were similar for dogs with local versus systemic disorders. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that epistaxis was a common disorder in dogs and frequently regarded as an emergency. Local causes of epistaxis were predominant, but clinical features traditionally thought to be helpful in distinguishing local versus systemic causes could not be reliably used for this purpose.     

The Impact of Donkey Ownership on the Livelihoods of Female Peri-Urban Dwellers in Ethiopia

This paper is based on an impact assessment of a donkey provision programme in Ethiopia. The work was carried out in 2001 as part of a DFID Livestock Production Programme project ‘Use and management of donkeys by poor societies in peri-urban areas in Ethiopia’. In order to establish whether donkey ownership was a cause or an effect of improved livelihoods, an investigation was carried out that compared non-donkey-owning households with households that had owned no donkey until they were given one by a local NGO. Indicators that poor people use to express their well-being, wealth and health status (components of their livelihoods) were identified and used to compare communities. Guidelines were prepared for project managers for carrying out livelihood indicator identification and impact assessment. The results showed that the informants used a range of indicators to assess their livelihoods. A selection of these were investigated in depth, including number of children per household attending school, number of people per household earning an income, type and quantity of staple foods bought, and ability to save. A trend was identified that demonstrated that donkey owners' livelihoods were improved compared to non-donkey owners.     

The impact of donkey ownership on the livelihoods of female peri-urban dwellers in Ethiopia

This paper is based on an impact assessment of a donkey provision programme in Ethiopia. The work was carried out in 2001 as part of a DFID Livestock Production Programme project 'Use and management of donkeys by poor societies in peri-urban areas in Ethiopia'. In order to establish whether donkey ownership was a cause or an effect of improved livelihoods, an investigation was carried out that compared non-donkey-owning households with households that had owned no donkey until they were given one by a local NGO. Indicators that poor people use to express their well-being, wealth and health status (components of their livelihoods) were identified and used to compare communities. Guidelines were prepared for project managers for carrying out livelihood indicator identification and impact assessment. The results showed that the informants used a range of indicators to assess their livelihoods. A selection of these were investigated in depth, including number of children per household attending school, number of people per household earning an income, type and quantity of staple foods bought, and ability to save. A trend was identified that demonstrated that donkey owners' livelihoods were improved compared to non-donkey owners.     

Investigation on the clinical efficacy and safety of 0.1% tacrolimus ointment (Protopic) in canine atopic dermatitis: a randomized, double-blinded, placebo-controlled, cross-over study

Topical tacrolimus is successfully used in people with atopic dermatitis. Preliminary studies in dogs with atopic dermatitis using tacrolimus in a compounded lotion formulation indicated that tacrolimus significantly decreased erythema and pruritus according to investigator, but no significant improvement was reported by the dog owners. The objectives of this study were to evaluate the clinical efficacy and safety of the commercially available 0.1% tacrolimus ointment (Protopic) in dogs with atopic dermatitis. The study was designed as a double-blinded, placebo-controlled, cross-over study. Selected dogs were allocated to either tacrolimus or placebo for 4 weeks. After 4 weeks there was a wash-out period of 2 weeks and treatments were switched. Twelve dogs completed the study. Clinical signs were scored. Blood samples were collected for complete blood count, chemistry panels and tacrolimus levels at week 0 and 4 of each treatment. Tacrolimus ointment significantly decreased severity of symptoms for both owners and investigators at the end of the trial. When the same dogs received the placebo, there were no differences between week 0 and week 4 scores. Dogs with localized disease responded better than dogs with generalized disease. Tacrolimus was detected in the blood of animals receiving the active ingredient. Levels were below the level of toxicity and no adverse effects were reported in any of the dogs. No changes in complete blood count and chemistry parameters were detected between groups or within groups. In conclusion, tacrolimus appears to be a safe alternative treatment in dogs with atopic dermatitis, especially in those with localized disease.     

Disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements

OBJECTIVE: To estimate disease prevalence among dogs and cats in the United States and Australia and proportions of dogs and cats that receive therapeutic diets or dietary supplements. DESIGN: Telephone survey. Sample Population-Dog and cat owners located in 5 geographic areas. PROCEDURES: A telephone survey was administered to dog and cat owners. RESULTS: Of 18,194 telephone calls that were made, 1,104 (6%) were to individuals who owned at least 1 dog or cat and agreed to participate. Information was collected for 635 dogs and 469 cats. Only 14 (1%) respondents indicated that their pet was unhealthy, but 176 (16%) indicated that their pets had 1 or more diseases. The most common diseases were musculo-skeletal, dental, and gastrointestinal tract or hepatic disease. Many owners (n = 356) reported their pets were overweight or obese, but only 3 reported obesity as a health problem in their pets. Owners of 28 (2.5%) animals reported that they were feeding a therapeutic diet, with the most common being diets for animals with renal disease (n = 5), reduced-calorie diets (5), and reduced-fat diets (4). Owners of 107 of 1,076 (9.9%) animals reported administering dietary supplements to their pets. Multivitamins (n = 53 animals), chondroprotective agents (22), and fatty acids (13) were the most common dietary supplements used. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that most dogs and cats reported by their owners to have a health problem were not being fed a therapeutic diet. In addition, the rate of dietary supplement use was lower than that reported for people.     

Public perceptions of the transmission of pandemic influenza A/H1N1 2009 from pigs and pork products in Australia

A cross-sectional study was conducted at the height of the pandemic influenza H1N1/09 outbreak in Australia in 2009. The objectives of the study were to evaluate public perceptions about transmission and prevention of the disease, to understand their concerns and preparedness to cope with the disease, and to investigate drivers influencing their behaviour. A questionnaire was designed and administered to 510 customers visiting 15 butcher shops in the Greater Sydney region between 26th June and 2nd August 2009. Data were analysed to estimate the proportion of people with certain perceptions and to evaluate the influence of these perceptions on two binary outcome variables: (1) whether or not people believed that avoiding pork would protect them from contracting H1N1/09, and (2) whether or not they actually made some changes to pork consumption after the outbreak. A majority of the respondents had perceptions based on fact about transmission and prevention of H1N1/09. As many as 96.8% of the respondents believed that washing their hands frequently was likely to protect them from contracting H1N1/09. Similarly, most believed that they could contract H1N1/09 by travelling on public transport with a sick person present (94.1%), by shaking hands with a sick person (89.2%), or by attending a community gathering (73.7%). Women were more likely than men to have factual perceptions about protective behaviours. Misconceptions regarding transmission of the disease were evident, with 21.7% believing that avoiding eating pork could protect them against H1N1/09, 11.1% believing that they could contract H1N1/09 by drinking tap water, 22.8% by handling uncooked pork meat and 15.6% by eating cooked pork. Approximately one third of respondents believed that working in a pig farm or an abattoir increased their likelihood of contracting H1N1/09 (36.9% and 32.3%, respectively). Younger people (<35 years old) were more likely to have these misconceptions than older people. Reduction in consumption of pork, ham or bacon was significantly associated with misconceptions regarding the risk of contracting H1N1/09 from eating pig meat products. It is recommended that in the event of a future disease emergency, communication activities providing factual information and targeting younger people should be used.