i REDUCING URBAN WILDLIFE CONSUMPTION: RAISING PUBLIC AWARENESS OF ZOONOTIC DISEASE RISKS LINKED TO WILDLIFE TRADE IN LAO PDR A Project Paper Presented to the Faculty of the Graduate School of Cornell University in Partial Fulfillment of the Requirements for the Degree of Master of Professional Studies Graduate Field of Natural Resources and the Environment By Kongsy Khammavong December 14, 2024 ii © 2024 Kongsy Khammavong iii ABSTRACT In recent decades, public health events like the SARS outbreak and COVID-19 pandemic have raised significant concerns about the health risks associated with wildlife trade chains. Wildlife trade and consumption are common in Lao PDR. The increasing demand for wildlife in urban areas has driven a rise in poaching and trade, posing significant threats to wildlife populations and biodiversity in Laos and neighboring countries. However, the impact of wildlife trade extends beyond ecological harm, as it also elevates public health risks by facilitating the spread of infectious diseases. The close contact between wildlife, domestic animals, and humans during the trade process creates opportunities for disease spillover. This study aims to identify effective communication strategies by targeting specific audiences, crafting relevant messages, and utilizing accessible tools to raise awareness about serious health risks, such as zoonotic disease transmission, associated with consuming traded wildlife. Experts warning that the mixing of diverse species and increased human-wildlife interactions in trade settings amplify zoonotic spillover potential. Despite limited interventions in this field, research indicates that health warnings can effectively increase risk perception and reduce harmful behaviors. Consequently, this study develops communication tools that incorporate health-related messaging, visual aids, and simplified scientific information on zoonotic pathogens related to traded wildlife. These tools aim to enhance public understanding of the health risks associated with wildlife consumption and trade, mitigate potential disease spread at its source, and support wildlife conservation efforts. iv BIOGRAPHICAL SKETCH Kongsy Khammavong is a dedicated wildlife conservationist with a strong focus on the One Health approach. She earned her undergraduate degree in Forestry Science from the National University of Laos, where her final thesis explored the illegal wildlife trade in Laos. Before joining Cornell University, she accumulated over ten years of experience working in wildlife health and conservation with the Wildlife Conservation Organization’s Laos PDR program. In her role, she coordinated and facilitated wildlife disease surveillance activities and contributed to several significant studies, including nationwide wildlife trade surveys, zoonotic disease research related to wildlife trade, and surveys of wildlife vendors and consumers. These efforts aimed to educate the public on the health risks associated with wildlife trade, leveraging the One Health approach to bridge the gap between human, animal, and environmental health. At Cornell University, Kongsy pursued a Master of Professional Studies in Natural Resources and the Environment. During her studies, she gained advanced knowledge and skills in conservation practices, environmental issues and management, infectious diseases, and public health communication. This education has further empowered her to contribute more effectively to wildlife conservation efforts and to mitigate the health risks associated with illegal wildlife activities. v ACKNOWLEDGMENTS First and foremost, I would like to express my deepest gratitude to my advisor, Professor Stephen Morreale, for his invaluable guidance, support, and encouragement throughout my one-year program at Cornell and the development and completion of this project. His expertise and insights were instrumental in shaping both my studies and this thesis. I am also deeply grateful to the Wildlife Conservation Society (WCS) Laos program, particularly Dr. Santi Saypanya, Country Director, and Manoly Sisavanh, Deputy Director, as well as Dr. Kate Mastro from the WCS Global Conservation Program. Their unwavering support, coordination, and facilitation made this academic journey possible. I also would like to thank Dr. Lucy Keatts for providing the supporting letter that facilitated my acceptance at Cornell University. I am profoundly thankful to Dr. Mathieu Pruvot and Dr. Emily Denstedt for their constructive and comprehensive feedback and thoughtful advice, which significantly enhanced the quality of this work. I would also like to thank Dr. Martin Gilbert for his initial guidance during the brainstorming process that helped generate project ideas. I am especially grateful to Professor Amelia Greiner Safi and Dr. Danielle Buttke for their exceptional teaching and mentorship in public health communication strategies. Their comprehensive reviews and feedback on my communication materials were invaluable to this project. I extend my sincere appreciation to the Wildlife Conservation Society Graduate Scholarship and the Cambodia, Laotian, and Vietnamese Environment Graduate Support Fund Fellowship for vi providing full scholarships, enabling me to pursue and achieve this significant academic milestone at Cornell University. I am fortunate to have worked alongside talented and dedicated colleagues, particularly the WCS Wildlife Health members, whose invaluable assistance and collaboration enriched this experience. I am also grateful to my peers in the Laos Wildlife Health team for their camaraderie and support. My heartfelt thanks go to my family and friends for their unwavering love, patience, and encouragement. Your support has been my anchor throughout this journey. Lastly, I would like to thank everyone who has supported me in any way during this academic journey. Your kindness and encouragement have meant the world to me. vii Table of Contents ABSTRACT ................................................................................................................................... iii 1. Introduction ............................................................................................................................. 1 2. Objective ................................................................................................................................. 4 3. Methodology ........................................................................................................................... 4 4. Result ...................................................................................................................................... 6 4.1 Target audients ................................................................................................................ 6 4.2 Health Risk Warning Messages and Platform. ............................................................... 8 4.3 Selecting Pathogens for Fact Sheet Development ........................................................ 10 Angiostrongylus Cantonensis ............................................................................................... 11 Coronaviruses ....................................................................................................................... 13 Avian Influenza ..................................................................................................................... 15 Scrub Typhus and Murine Typhus ........................................................................................ 18 4.4 Reducing the Risk of Zoonotic Disease Transmission Associated with Wildlife Trade and Consumption. ..................................................................................................................... 22 APPENDICES .............................................................................................................................. 25 REFERENCES ............................................................................................................................. 46 viii Appendix: Fact Sheets by Pathogen Appendix 1 Rat Lungworm Disease (English version)………………………………………….26 Appendix 2 Rat Lungworm Disease (Lao version) …………………………………….….……28 Appendix 3 Coronaviruses (English version) ……………………………………...……………30 Appendix 4 Coronaviruses (Lao version) …………………………………………….…………32 Appendix 5 Avian Influenza (English version) …………………………………………………34 Appendix 6 Avian Influenza (Lao version) …………………………………………….….……36 Appendix 7 Scrub Typhus and Murine Typhus (English version) ………………………...……38 Appendix 8 Scrub Typhus and Murine Typhus (Lao version) ……………………………….…40 Appendix 9 Leptospirosis (English version) ………………………….…………………………42 Appendix 10 Leptospirosis (Lao version) ……………………………….………………………44 1 1. Introduction The history of outbreaks related to wildlife trade and consumption is well-documented (Bell et al., 2004 & Yang et al., 2021). For instance, in the 2003 SARS-CoV outbreak, horseshoe bats were identified as the natural reservoir, with transmission to humans occurring via masked palm civets sold in markets in Guangdong Province, China (Yu et al., 2003, Shi & Hu, 2008). Similarly, the origins of COVID-19 remain uncertain, though several scientists, including those cited in a recent WHO report: WHO-convened global study of origins of SARS-CoV-2: China Part (2021), suggest that the novel coronavirus likely originated in nature and spread to humans through an unknown intermediate host in a wet market in Wuhan, China (Peros et al., 2021; Andersen et al., 2020). In another incident in Lao PDR, seven men fell ill, with five requiring hospitalizations, after sharing a meal of raw wild monitor lizard. Diagnostic analysis revealed that the men were positive for the roundworm Angiostrongylus cantonensis (Yang et al., 2021). These cases underscore the risks associated with consuming wildlife. Wildlife trade not only poses significant threat to public health, but also serves as a major driver of species extinction. Of the more than 31,500 terrestrial wild animal species traded globally, predictions based on currently traded species suggest that future trade could impact an additional 4,000 species, bringing the total to nearly 12,000 species at risk of extinction due to trade (Scheffers et al., 2019). In Laos PDR, wildlife trade and consumption are highly prevalent, and over 33,000 wild animals were observed for sale, including more than 6,000 individuals from protected species (Greatorex et al., 2010). A direct observation study of market stalls indicated an estimated average of 10 kg of wild meat biomass, predominantly mammals, per stall per hour (Pruvot et al., 2019). Additionally, around 1,000 individual birds were detected in the trade within 2 local markets (Xayyasith et al., 2020). Barn swallows alone are trapped for trade on an industrial scale in northern Laos, with estimates exceeding 100,000 individuals per year (Yong et al., 2021). Wildlife trade, whether legal or illegal, creates opportunities for zoonotic pathogens to spread between wildlife-domestic animals and humans (WOAH, 2024; Karesh & Noble, 2009), by increasing exposure, enabling cross-species interactions, and driving viral evolution into new strains capable of efficient transmission within animals and human populations (Parrish et al., 2008), as it provides opportunities for pathogens to spill over from animals to humans. Approximately 60 pathogens posing health risks were identified in 58 wildlife species traded across 15 countries, with several species found to carry one or more pathogens (Peros et al., 2021). A study on coronavirus antibody prevalence along trade chains, demonstrated a significant increase, from low or zero prevalence in farm civets, to approximately 80% in civets tested in markets (Tu et al., 2004). In Laos, a high volume of reservoir and intermediate host species for coronaviruses are commonly traded in markets and consumed across the country (Greatorex et al., 2010, Pruvot et al., 2019). The presence of high-risk animal taxa, live animals, poor hygiene, large market size, high animal density and interspecies mixing, and extensive animal supply chains are identified as key factors in wild meat market affecting human health and biodiversity (Lin et al., 2021). Trade in live and slaughtered wild mammals, under conditions conducive to disease transmission, further exacerbates these risks (Nijman et al., 2023). Disease transmission often occurs through close contact with infected animals (Zhong et al., 2003). Given the potential threats posed by zoonotic diseases from traded animals, a comprehensive strategy is urgently needed to safeguard public health, economic interests, and biodiversity 3 (Nijman et al., 2023). Trade bans alone are insufficient to mitigate the global health risks associated with the trade (TRAFFIC, 2008). Law enforcement typically targets vendors rather than buyers, with only half of the vendors ceasing trade after controls However, the majority of wildlife consumers reported they would stop eating wildlife if they knew it could cause disease, and even more if they faced a fine (Pruvot et al., 2019). This is consistent with a systematic review, where it is suggested to consider incorporating factual health-risk warnings into communications to reduce consumer demand for overexploited wildlife products. (MacFarlane et al., 2022). Public awareness about the risks associated with wildlife trade and consumption is generally limited. For instance, despite high awareness of disease among wild bushmeat handlers after the Ebola outbreak, many did not believe wild animals could transmit virus to humans (Naguib et al., 2021). Similarly, a study in southern China found low knowledge and perceived risk regarding disease transmission through wildlife trade (Li et al., 2021). In Cameroon, many market actors did not fully understand the risks of infection from blood contact (Saylors et al., 2021). In Laos, most consumers lacked awareness of health risks from wildlife but were concerned about chemicals and high blood pressure (Pruvot et al., 2019). Effective communication strategies are essential for educating the public about these risks and promoting behavior change. This study aims to identify key target audiences within urban populations who are major consumers of wildlife and to develop communication tools for government and non-government organizations to use in their campaigns. By targeting these audiences with tailored messages, the campaigns can more effectively reduce urban wildlife trade and consumption while addressing the associated health threats. Specifically, this study will focus on creating bilingual factsheets for five common pathogens including Angiostrongylus cantonensis, Coronaviruses, Avian Influenza, Rickettsia (Scrub Typhus and Murine Typhus), and 4 Leptospira. These factsheets, available in both English and Lao, will emphasize the biological risks linked to bushmeat trade and wildlife consumption, providing crucial information to both local and international audiences. 2. Objective The primary goal of this study is to identify and develop effective communication strategies. These include target audience messaging and identifying accessible tools aimed at raising awareness about the serious health consequences such as zoonotic disease transmission associated with consuming wildlife from trade chains. Ultimately, the strategy seeks to reduce wildlife consumption and purchasing to minimize personal health risks and prevent future disease outbreaks. The specific objectives of this study include: 1) Identify and understand the key demographic groups that make up urban wildlife consumers in Laos, including their consumption patterns and motivations. 2) Identify communication strategies, including messaging and appropriate tools, to effectively promote the reduction of wildlife consumption and trade. 3) Create communication messages and tools based on insights gathered from objectives (1) and (2), designed to reduce potential health risks linked to wildlife consumption in trade chains. 3. Methodology Literature reviews were conducted using Cornell University online library, and Google Scholar to identify previous documents or studies related to the perspectives and attitudes of wildlife 5 consumers, with the goal of characterizing urban wildlife consumers in Laos. The search utilized specific keywords such as "wild meat," "wildlife trade," "wildlife consumers," "perspective," and "attitude". Studies focusing solely on the use of wildlife in traditional medicine, specific wildlife parts (e.g., bear bile), or particular a wildlife species were excluded from this review. This exclusion was made because such studies often target specific wildlife species, like bears or serows, in their survey forms. In contrast, our study focuses on a broader range of wildlife species that are sold and consumed. Target pathogens were selected based on a comprehensive review of existing studies and surveys. This included examining wildlife trade surveys, identifying commonly traded species, and assessing the associated health risks. Pathogens with a high potential for transmission from wildlife to humans through trade activities, as evidenced by previous outbreaks or research findings, were prioritized. The selection also considered the geographical focus on Laos or Southeast Asia. The messages and tools have been developed based on a literature review and are primarily informed by international guidelines and principles aimed at reducing health risks related to public and animal health. This includes guidance from the World Organization for Animal Health (WOAH), the U.S. Centers for Disease Control and Prevention (CDC), the Food and Agriculture Organization (FAO), and the World Health Organization (WHO). Additionally, the materials draw on publicly available studies, research papers, and existing communication tools that address health risks and target pathogens. 6 4. Result 4.1 Target audients The literature review identified a significant gap in documentation on domestic wild meat consumption events in Laos and neighboring countries, with most studies focusing instead on monitoring international trafficking of endangered species, such as pangolins, tigers, and elephant ivory. However, two comprehensive studies conducted in Laos, by Pruvot et al. (2019) and Nguyen (2023), were identified. Studies focusing exclusively on wildlife use in traditional medicine or specific species were excluded. Given the limited research available in Laos, relevant studies from neighboring countries were included, covering two from Vietnam (Venkataraman & Waisburd, 2007; Drury, 2009) and one from China (Zhang et al., 2008). Consequently, target audience selection for the development of this communication tool will be based on findings from these studies. The literature review found that wild animals of various species were widely and popularly consumed by urban residents in all three countries. The characteristics of wildlife consumers showed similar patterns across those countries, particularly in terms of demographics, occupation, and motivation. Food was the primary reason for consuming wild animal products among young urban consumers. Consumption of wild animals was often viewed as a tradition, with many people having eaten wild meat since childhood. Wild meat was also seen as natural, tasty, and healthy. Additionally, eating wildlife was considered a special meal and a rare luxury product, symbolizing social status. Men were identified as significant urban wildlife consumers across the three countries, with wildlife also considered a male food by both male and female respondents. This consumption was 7 typically associated with male activities, such as drinking alcohol, especially in Vietnam. Women, on the other hand, were often influenced or invited by friends, colleagues, and family members to consume wildlife. Wild animals were perceived as tastier and healthier compared to domestic meat because they are from nature. Due to their rarity and high cost, wildlife was seen as a luxury food for high-income individuals. Businesspeople and government officials were reported as the primary urban consumers of wildlife in all three countries. As a rare and expensive food, some interviewees described wild meat as a way to show respect and demonstrate competence when negotiating deals and initiating business relationships. Additionally, the literature review found that wildlife consumption was more prevalent among young people with middle-higher education levels in the three countries. Urban wildlife consumers are a diverse group, so reaching them effectively requires tailored communication tools and messages. The communication materials being developed will be piloted for general government officers, but the messages will be specifically tailored to those working in sectors such as forestry, wildlife, and environmental management. The primary goal is to increase their understanding of the health risks associated with consuming wildlife involved in trade chains. These tools aim to raise awareness about the serious health consequences, such as zoonotic disease transmission, that can result from such practices. At the same time, the messaging is designed to motivate these officers to avoid consuming or purchasing wildlife, not only to reduce their personal risk of exposure to diseases, but also to contribute to the prevention of disease outbreaks, thereby keeping their families and communities safe. 8 4.2 Health Risk Warning Messages and Platform. Risk perception studies in Laos have shown that most respondents are unaware of the health risks associated with consuming and handling wildlife (Pruvot et al., 2019). A similar review by Peros et al. (2021) identified a significant knowledge gap regarding the modes of disease transmission from animals to humans. Similarly, a study found that while there was high awareness of the Ebola virus outbreak among wild meat handlers, many did not believe that wild animals could transmit the virus to humans (Naguib et al., 2021). Additionally, research by Li et al. (2021) revealed low levels of knowledge and perceived risk concerning the emergence of diseases from human-animal interactions in the wildlife trade. Public health events over the past two decades, such as the SARS outbreak in 2003 and the Covid- 19 pandemic, have been likely linked to wildlife consumption and trade. These events significantly increased public concern about the health risks associated with such practices and led to recommendations for regulating public health risks (WHO, 2020). Virologists have repeatedly warned that the greatest risk of zoonotic spillovers comes from the mixing of taxonomically diverse species and increased human-animal interactions, which are common in the wildlife trade (Johnson et al., 2015, 2020). However, public health interventions to reduce health risks related to wildlife consumption and trade have remained limited and often lack proper evaluation of their effectiveness and areas for improvement (MacFarlane et al., 2022). Research suggests that health warnings about the consequences of consuming harmful products are more effective in increasing risk perception and perceived severity compared to other communication strategies (MacFarlane et al., 2022). Health-related messaging has been shown to reduce the intention to use wildlife-based therapeutic products by at least 23% (Hu et al., 2024). 9 Additionally, Sheeran et al. (2014) concluded that raising risk appraisals, such as risk perceptions, anticipated emotions, and perceived severity, had a small but significant effect on consumer behavior, such as reducing smoking. Similarly, Tannenbaum et al. (2015) found that fear appeals positively influenced consumer behaviors, albeit to a small degree. Furthermore, risk warnings are most effective when combined with appeals to self-efficacy, which motivate individuals to adopt behaviors that reduce their risk (MacFarlane et al., 2022). Similarly, a study by Grundy et al. (2022) highlighted that health-related messaging significantly promotes conservation behaviors by strengthening the link between wildlife consumption and individual well-being. As a result, the communication tools being developed will incorporate health-related messages alongside evidence-based findings on the risks of wildlife consumption and trade, combined with visual illustrations that simplify complex scientific information about each pathogen. This combination of clear text and visual aids will make the materials more accessible and straightforward, effectively conveying the health risks associated with wildlife consumption in a way that is easy for audiences to understand and engage with. These tools aim to enhance understanding of the health risks linked to consuming wildlife from trade chains, emphasizing the serious consequences such as zoonotic disease transmission. By raising awareness, the tools not only help reduce potential health risks and prevent disease spread at its source but also support broader wildlife conservation efforts. 10 4.3 Selecting Pathogens for Fact Sheet Development Common wildlife species traded in markets across Laos have been identified based on existing studies and surveys documenting domestic wildlife trade. These include an assessment of zoonotic disease risks in markets, led by Greatorex et al. (2010), and a detailed analysis of the conservation and health risks associated with wildlife trade in Laos, conducted by Pruvot et al. (2019). Both studies surveyed wildlife trade across Laos and provided comprehensive information on the species involved. Additionally, two other studies focused on specific locations: List (2019) and Banjade et al. (2020). Over 33,000 individual wild animals, representing at least 200 species, were observed for sale in more than 90 markets across Laos (Greatorex et al., 2010). Another survey, conducted in a single province, reported over 3,000 wild animals from at least 60 species for sale (List, 2019). Among the most frequently traded species were mammals, particularly rodents (Rodentia, e.g., rats, squirrels, bamboo rats), small carnivores (e.g., civets), and bats (Chiroptera). For example, an estimated 1,400 civets and 11,600 bats are sold annually (Pruvot et al., 2019). Birds were also heavily traded, with an estimated 63,000 wild birds sold annually in local markets and among reptiles, monitor lizards were the most commonly traded, with approximately 4,500 adult individuals sold annually in a single market (Pruvot et al., 2019). The target pathogens were selected based on documented zoonotic diseases carried by wildlife species (Rahman et al., 2020; Shivaprakash et al., 2021; Greatorex et al., 2010) and global trends in disease emergence (Jones et al., 2008). Many wildlife species sold in markets have been linked to zoonotic pathogens, particularly viruses with the potential to spill over into human populations. For example, bats and civets, both commonly traded in Laos, are known carriers of coronaviruses, 11 which have caused outbreaks such as SARS in 2003 (Yu et al., 2003). The rising incidence of zoonotic diseases, especially from wildlife, highlights coronaviruses as a critical focus for surveillance and intervention. The selection process targets pathogens with high transmission potential and severe health impacts, aligning with recent global concerns about pandemics that arise from wildlife-human interactions (Shivaprakash et al., 2021). Five pathogens were chosen to pilot the development of communication tools addressing potential health risks or disease transmission associated with interaction or consumption of wildlife traded in markets in Laos. These pathogens include Angiostrongylus cantonensis, Coronaviruses, Avian Influenza, Rickettsia (Scrub Typhus and Murine Typhus), and Leptospira. Angiostrongylus Cantonensis Angiostrongylus cantonensis, commonly known as the rat lungworm, is a parasitic roundworm that primarily infects rodents. However, it can also infect humans, leading to a condition called angiostrongyliasis, which can cause severe neurological disease. The life cycle of A. cantonensis involves rats as definitive hosts and gastropods, such as snails and slugs, as intermediate hosts. Lizards and amphibians can also serve as transport hosts, though the parasite does not need them to complete its life cycle (CDC, 2019; University of Florida, 2021; NCBI, 2024). Humans and other mammals can become infected by consuming undercooked meat from infected animals, such as rats, monitor lizards (Yang et al., 2021; Panackel et al., 2006), as well as snails, freshwater shrimp, and crabs or by consuming contaminated food, including vegetables, fruits, and water. In humans, angiostrongyliasis can cause symptoms ranging from mild headaches and muscle pain to severe neurological complications, coma, and even death. As an emerging zoonotic 12 pathogen, it is endemic to East Asia and Southeast Asia but has now spread globally (CDC, 2019; University of Florida, 2021; NCBI, 2024). Angiostrongyliasis is a zoonotic disease that poses a significant threat to human health worldwide. By 2010, nearly 3,000 cases had been recorded globally (Wang et al., 2012). In Thailand, between 1995 and 2005, 654 cases were treated in a provincial hospital, and in the year 2000 alone, nearly 1,400 cases were reported across the country (Eamsobhana, 2013). The monitor lizard has been extensively documented as a significant carrier of rat lungworm transmission to humans. A literature review by Turck et al., 2022 and Pandian et al., 2023 reported 42 human cases of angiostrongyliasis linked to the consumption of raw monitor lizards in the Indian subcontinent and Southeast Asia between 1990 and 2022. These cases include 13 from Thailand and 7 from Laos. However, these may only be the officially reported cases; there could be more that are unreported or undiagnosed. In 1990 in Thailand, five patients developed eosinophilic meningitis after eating undercooked monitor lizard. One patient died, and an autopsy revealed numerous fifth-stage larvae of A. cantonensis in the brain (Panackel et al., 2006). Similarly, in 2020, seven men fell ill after consuming raw monitor lizard meat together; five of them required hospitalization for over a month and fully recovered. Some those patients were diagnosed with A. cantonensis infection (Yang et al., 2021). In Laos, monitor lizards are widely consumed and traded. A study by Pruvot et al., 2019 estimated that approximately 4,500 adult monitor lizards are sold annually in a single market. This large volume of trade not only threatens wild monitor lizard populations but also significantly increases the health risks associated with consuming infected lizards. The increased likelihood of urban 13 residents consuming or coming into contact with these wild animals raises the risk of exposure to parasites through direct contact with infected animals or their feces. Refer to the health risk communication tools for Rat Lungworm Disease in Appendix 1 (English version) and Appendix 2 (Lao version). Coronaviruses Major coronaviruses are recognized as zoonotic disease which can transmit from animals to human, and from human to human. They are a large family of viruses that can cause illnesses, ranging from the common cold to more severe diseases in both animals and humans. So far, seven coronavirus species are known to cause human diseases. Four of them typically cause common cold symptoms, while the other three can lead to severe respiratory symptoms or even fatal illnesses, including Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), Middle East Respiratory Syndrome (MERS-CoV), and the novel coronavirus identified in 2019, responsible for the COVID-19 pandemic or SARS-CoV-2 (Zhu et al., 2020). Many human coronaviruses are believed to have originated in bats and rats, often involving mammals as intermediate hosts that transmit the viruses to humans, these mammals include civets, camels, and other domestic and wildlife species (Cui & Shi, 2019). Previous coronavirus outbreaks have been associated with close contact between humans and animals, especially through the bushmeat trade. For instance, during the SARS-CoV outbreak in 2003, humans were likely infected through exposure to civets sold in wildlife markets in China (Yu et al., 2003). Another coronavirus strain, MERS-CoV, emerged in 2012 and involved close contact between humans and camels. Similarly, SARS-CoV-2 (COVID-19) likely originated in wildlife and spread to humans 14 through wild meat at a wet market in Wuhan, China (Peros et al., 2021; Andersen et al., 2020; Temmam et al., 2021). Coronaviruses, particularly SARS-CoV and SARS-CoV-2 have a high transmission rate, allowing them to spread rapidly from person to person and potentially cause large outbreaks. Some strains of the virus can lead to severe illness, resulting in respiratory failure, organ damage, and death, particularly in vulnerable populations such as the elderly and those with chronic disease or pre- existing conditions (e.g., diabetes, lung cancer, kidney disease, HIV/AIDS). The outbreaks of SARS-CoV and SARS-CoV-2 not only heightened public health concerns but also had a huge impact on the global economy. The SARS-CoV outbreak in 2003 spread to 36 countries within 8 months, resulting in over 8,400 confirmed cases and 800 deaths (Zhong et al., 2003). The global economic loss from this outbreak was estimated to be nearly US$ 40 billion, (Lee & McKibbin, 2004). The COVID-19 outbreak, which began in late 2019, has had an even greater impact. By June 2024, there was over 775 million confirmed cases and more than 7 million deaths worldwide, WHO. Early estimates made in 2020 projected that the global economic loss from the pandemic could exceed $8.5 trillion within the next two years, (UN DESA). In Laos, a high volume of reservoir and intermediate host species for coronaviruses are commonly traded in markets and consumed (Greatorex et al., 2010; Pruvot et al., 2019). It is estimated that annually, 11,600 bats and 1,400 civets are sold in a typical Laotian market (Pruvot et al., 2019). The presence of large numbers of both live and dead reservoirs and intermediate host species raises the risk of viral transmission, as mixed-species interactions can lead to pathogen shedding and recombination, increasing the virus’s ability to infect both animals and humans. Additionally, stress from high densities, unfamiliar environments, and interspecies contact weakens animals' 15 immune systems, elevating the risk of zoonotic disease transmission (Naguib et al., 2021; Lin et al., 2021) and creating a significant potential for pathogen spillover and the emergence of novel coronaviruses originating in Laotian markets. Refer to the health risk communication tools for Coronaviruses in Appendix 3 (English version) and Appendix 4 (Lao version). Avian Influenza Avian Influenza, commonly known as bird flu, is a highly contagious viral disease that mainly affects poultry and birds but can also affect mammals, including humans. It primarily spreads from infected birds or poultry to humans and mammals through close contact with birds or contaminated environments, such as in backyard poultry farm settings and at markets where wild birds or poultry are sold. The virus can be categorized into two main types according to the severity of the disease in poultry (WHO, 2023; WOAH, Avian Influenza; CDC, Bird Flu): • Low Pathogenic Avian Influenza (LPAI): Causes mild disease, often unnoticed or without any symptoms. • Highly Pathogenic Avian Influenza (HPAI): Causes serious illness in poultry and wild birds that can spread rapidly, resulting in high death rates in different species of birds and poultry, especially H5N1, H7N9, and H5N6. The H5N1 is the most well-known strain, which has caused significant outbreaks in poultry, birds, some mammals and human infections, while H7N9 and H5N6 is another strain of concern due to its impact on human health. Avian Influenza includes a wide range of strains. Some can cause mild symptoms like the common cold or no symptoms at all, while others can lead to severe respiratory diseases, multi-organ failure, 16 and death. The common symptoms may include fever, runny nose, red eyes, sore throat, cough, headaches, muscle pain, and fatigue. In severe cases, depending on the specific virus and the health condition of persons, the infection can lead to respiratory issues, pneumonia, difficulty breathing, respiratory failure, multi-organ dysfunction, and even death, (WHO, 2023; WOAH, Avian Influenza; CDC, Bird Flu). HPAI viruses have significant consequences for animal health and the agricultural economy and may pose pandemic potential. In 2023 alone, over 26 million poultry, including wild birds, either died or were culled worldwide to control the outbreak (WOAH, 2023. Avian Influenza global situation). HPAI has not only severely impacted poultry farmers worldwide but also raises concerns for mammalian and human health. Since 2003 to July 2024, there have been 896 reported human infections with the avian influenza (H5N1) virus globally, with 463 resulting in death. Of these, 258 cases and 141 fatalities were reported from Western Pacific Region countries, including Cambodia, Vietnam, China, and Laos. Additionally, to date Western Pacific Region countries have reported 93 cases with 57 deaths due to H5N6 and 1,568 cases with 616 deaths due to H7N9, (WHO, 2024. Avian Influenza Weekly Update Number 967). Recent ecological shifts in avian influenza lineages have led to widespread infections in wild birds, fueling viral spread along migration routes and causing die-offs, including among endangered species (WOAH, Avian Influenza). These shifts also pose a potential threat to wild birds and mammals. In early 2021, a mass mortality event involving over 2,000 wild birds was detected in wetlands in Cambodia, where HPAI H5N1 was identified. During the investigation, HPAI H5N1 was also detected in sick and dead free-ranging wild birds in a National Park in Vietnam (WCS. One World – One Health). Additionally, several endangered wildlife species listed on the IUCN 17 Red List, including Lynx rufus (bobcat), Panthera leo (lion), Panthera pardus (leopard), and Panthera tigris (tiger), have been reported with H5N1 infections, according to the FAO, 2024). According to the update reports by WHO, there have been no human cases of HPAI reported from Laos since 2020. However, reporting of morbidity and mortality events in both domestic and wild animals is inconsistent. Often, an event is not recognized as unusual, such as mass mortality of poultry, which is common in Laos, and therefore does not get reported. This inconsistency poses a potential risk for emerging infectious diseases, as in February 2024, H5N1 was detected through a surveillance system in domestic poultry at a market in central Laos (Asia & Pacific, 2024). In Laos, live poultry and wild birds are often sold together in markets with poor environmental and hygiene practices. Annually, over 63,000 wild birds from mixed species are estimated to be sold in local markets (Pruvot et al., 2019; Yong et al., 2021). The presence of live animals in these settings raises the risk of viral transmission, as mixed species interactions can lead to pathogen shedding and recombination, enhancing the virus’s ability to infect both animals and humans. Additionally, stress from high densities, unfamiliar environments, and interspecies contact weakens animals' immune systems, increasing the risk of zoonotic disease transmission (Naguib et al., 2021, Lin et al., 2021) and creating a significant chance for pathogen spillover and potential HPAI outbreaks originating in Laos markets. Refer to the health risk communication tools for Avian Influenza in Appendix 5 (English version) and Appendix 6 (Lao version). 18 Scrub Typhus and Murine Typhus Scrub typhus is caused by the bacterium Orientia tsutsugamushi, and murine typhus, also known as endemic typhus, is caused by the bacterium Rickettsia typhi. Both scrub typhus and murine typhus belong to the order Rickettsiales and the family Rickettsiaceae. Scrub typhus is endemic to regions of East Asia, Southeast Asia, the Pacific (eastern Australia) and several parts of south- central Russia. In contrast, murine typhus is distributed worldwide, primarily in tropical and subtropical climates where rats and rat fleas are present (CDC, Rickettsial; Virginia Department of Health, 2018; NSW, 2024). Humans get infected with scrub typhus and murine typhus through chigger and flea bites, respectively or contact with flea feces from arthropods that have fed on infected rodents, particularly rats. Symptoms of scrub typhus and murine typhus begin abruptly, typically within 7 or more days after infection, and can persist for several weeks if not properly treated. The common symptoms include fever, headache, muscle pain, nausea, vomiting, abdominal pain and rash. Specific to scrub typhus is the eschar, a dark, scab-like mark at the site of the chigger bite. In severe complication case of scrub typhus, acute renal failure, respiratory distress syndrome, pneumonia, meningitis and/or encephalitis may occur. Although murine typhus is generally less severe than scrub typhus in which the case fatality rate can reach 30% or even higher without appropriate treatment, patients with murine typhus can develop multisystem organ failure, like scrub typhus, or other severe sequelae requiring hospital-based management. In severe cases, death can occur (CDC, Rickettsial; Xu et al., 2017; Virginia Department of Health, 2018; NSW, 2024). Scrub typhus and murine typhus pose a serious public health problem in the Asia-Pacific region, threatening one billion people globally and causing illness in one million people each year (Xu et 19 al., 2017. These diseases are documented as common causes of febrile illness in Southeast Asia. The rates of O. tsutsugamushi antibodies vary significantly, over 30% among suburban Bangkok residents, and up to 77% in the northern and northeastern regions in Thailand (Xu et al., 2017). Rickettsial diseases are important and treatable causes of non-malarial fever and R. typhi and O. tsutsugamushi infections are significant causes of central nerve system infections in Laos (Mayxay et al., 2015, and Dittrich et al., 2015). A serologic study conducted among patients at a central hospital in Vientiane, Laos, found acute rickettsial infections in nearly 30% of patients (O. tsutsugamushi 15%; R. typhi 10; the remainder other rickettsial species) (Phongmany et al., 2006). Outdoor workers, especially field workers in rural areas, have historically been most affected by rickettsial infections. However, urban residents are also at risk, particularly in areas with high populations of peri-rodents or wild rodents, such as those hunted and sold in markets. In Laos, wildlife trade is common, and rodents are frequently sold in markets across the country. An average market sells over 40,000 live and dead rodents annually, including more than 4,000 rats (Pruvot et al., 2019). This significant trade volume threatens wild rodent populations, which play a crucial role in biodiversity and ecosystems. Moreover, the wildlife trade increases the risk of pathogen transmission from animals to humans, as 6 out of 35 and 2 out of 34 wildlife rodents confiscated from markets in a province tested positive for R. typhi and O. tsutsugamushi, respectively (Nawtaisong et al., 2022). Therefore, wildlife trade brings rodents into close contact with humans, facilitating the movement of arthropods and the transmission of pathogens like rickettsiae to humans. Refer to the health risk communication tools for Scrub Typhus and Murine Typhus in Appendix 7 (English version) and Appendix 8 (Lao version). 20 Leptospirosis Leptospirosis is a worldwide zoonotic infection, caused by the bacterium Leptospira. Rodents are a significant reservoir for Leptospira, but most mammals, including dogs, horses, cattle, and swine, and many wildlife species, can be infected and shed the bacteria in their urine. Humans get infected through direct or indirect exposure to the urine shed?? from infected animals, and contact with contaminated environments (e.g., water, mud or soil). Pathogenic Leptospira can enter human bodies via cuts or woods on skin, scratch, eyes, nose or mouth by swallowing contaminated food with the urine of infected animals (CDC, Leptospirosis; Haake& Levett, 2015; DDC, MOPH of Thailand, Leptospirosis). The incubation period for leptospirosis can range from 2 to 30 days after exposure to the bacteria, but it typically occurs within 5 to 14 days. Clinical presentations vary from asymptomatic or mild symptoms, which are the most common and often resolve on their own, to severe and potentially life-threatening illness. Leptospirosis usually begins suddenly with symptoms such as headache, fever and chills (typically around 39°C), muscle aches, malaise, and conjunctival suffusion. In some cases, nausea, vomiting, diarrhea, abdominal pain, cough, and rarely, a skin rash, may also occur. In patients who progress to severe disease, clinical symptoms may include irregular heartbeats, circulatory system collapse, bleeding, jaundice, liver failure, aseptic meningitis, lung insufficiency, and kidney failure, and potentially life-threatening illness (CDC, Leptospirosis; Haake& Levett, 2015; DDC, MOPH of Thailand, Leptospirosis). Leptospirosis is a global disease but is more prevalent in humid tropical climates, particularly in areas with poor sanitation. These conditions lead to large populations of rats, which are key animal reservoirs. Regions with the highest reported human cases include sub-Saharan Africa, parts of 21 Latin America, the Caribbean, South and Southeast Asia, and Oceania (CDC, Yellow Book 2024). Leptospirosis poses a significant global health threat, with over 1 million cases annually, including nearly 60,000 deaths worldwide. The annual morbidity of leptospirosis was estimated to be high in countries of South and Southeast Asia where large populations of more than 25,000 cases and over 14,000 deaths were reported from Southeast Asia only (Costa et al., 2015; (CDC, Yellow Book 2024). In Laos, field activities such as farming, rice planting, and animal raising are the main occupations across the country. These activities have been described as having a high potential for exposure to environments contaminated with pathogens that cause leptospirosis (DDC, MOPH of Thailand, Leptospirosis). However, reporting and studying leptospirosis are very limited due to lack of laboratory capacity and other resources. A study on the causes of fever in patients who tested negative for malaria in a provincial hospital found that leptospirosis was the second most common cause of fever, following dengue fever (Mayxay et al., 2015. Another seroprevalence study in rural villages in Laos highlighted that leptospirosis is common, with nearly 24% of the population testing seropositive for Leptospira infection (Kawaguchi et al., 2008). Field workers, especially those in rural areas and agricultural occupations or whether flooding areas, are at great risk of exposure to and infection with Leptospira (DDC, MOPH of Thailand, Leptospirosis). However, the risk of human infection is not limited to wetlands as previously believed. The circulation of Leptospira species is also high in forested and non-floodable lands, suggesting that activities such as forest work, hunting, preparing rodents for consumption, and wildlife trade deserve more attention in future epidemiological studies (Cosson et al., 2014). 22 Rodents, which are commonly hunted and traded in markets across Laos, are often sold alongside other fresh or cooked food (Greatorex et al., 2010). A study testing animals from wildlife trade sites in Laos for zoonotic pathogens found that Leptospira spp. were the most frequently detected infectious agents, present in 20% of animals (Nawtaisong et al., 2022). This indicates a high potential for human infection through direct exposure to the urine of infected animals or through contamination of fresh food. Refer to the health risk communication tools for Leptospirosis in Appendix 9 (English version) and Appendix 10 (Lao version). 4.4 Reducing the Risk of Zoonotic Disease Transmission Associated with Wildlife Trade and Consumption. To mitigate health risks among urban consumers of wildlife, a series of targeted actions can be implemented: Educational Campaigns and Communication Tools: Educating urban populations on the health risks of consuming wildlife, particularly those sold in markets with low hygiene standards, can significantly impact consumption patterns. Materials like bilingual factsheets, infographics, and digital media campaigns should highlight the risks of zoonotic disease transmission from commonly traded species. By presenting clear and straightforward, evidence-based information about pathogens (e.g., Avian Influenza, Leptospirosis, and Rat Lungworm), these tools can effectively raise awareness and motivate behavior change among urban consumers, deterring wildlife consumption as a health protection measure. 23 Policy and Market Interventions: Strengthening regulations in wet markets, particularly regarding hygiene standards and wildlife trade restrictions, can significantly reduce the risk of disease transmission. Implementing strict sourcing controls and enforcing comprehensive bans on wildlife trade, not only helps curb direct consumption risks, but also mitigates broader public health threats by preventing zoonotic disease spread. By reducing opportunities for pathogens to spread from wildlife to humans, these policies protect urban consumers and conserve wildlife populations, allowing for safer, regulated wildlife use in rural settings where traditional consumption may play a key cultural role. In concert with these regulations, ongoing enforcement and consumer education are critical to creating safer markets and supporting biodiversity conservation efforts. 24 5. Conclusion Implementing strategies to address urban wildlife consumption in Laos by highlighting the health risks of infectious diseases may be challenging, but essential. Wild animals have been part of the local diet for centuries, and there is a common belief that consumption has not led to significant health consequences. Even if people became ill, these cases were often not confirmed by health specialists as being linked to wildlife consumption. To overcome this challenge, it is crucial to educate the public about the potential and likelihood for emerging infectious diseases associated with the wildlife trade. This trade brings wildlife, domestic animals, and people into close contact, mixing high-risk species and creating opportunities for cross-species transmission, mutations, and the spread of disease due to poor hygiene and sanitation practices. Providing scientific evidence, real-world examples, and negative consequences can help shift perceptions and attitudes toward illegal wildlife trade and encourage safer consumption practices. However, health risk communication strategies alone may not be effective. These efforts should be combined with other strategies, such as law enforcement, raising awareness about the ecological importance of wildlife, and addressing the social status associated with wildlife consumption as a symbol of luxury and unnecessary indulgence. A comprehensive approach will help to sustainably reduce urban wildlife consumption in Lao PDR and elsewhere. 25 APPENDICES 26 Appendix 1 Rat Lungworm Disease (English version) 27 28 Appendix 2 Rat Lungworm Disease (Lao version). 29 30 Appendix 3 Coronaviruses (English version) 31 32 Appendix 4 Coronaviruses (Lao version) 33 34 Appendix 5 Avian Influenza (English version) 35 36 Appendix 6 Avian Influenza (Lao version) 37 38 Appendix 7 Scrub Typhus and Murine Typhus (English version) 39 40 Appendix 8 Scrub Typhus and Murine Typhus (Lao version) 41 42 Appendix 9 Leptospirosis (English version) 43 44 Appendix 10 Leptospirosis (Lao version) 45 46 REFERENCES Andersen, K. G., Rambaut, A., Lipkin, W. I., Holmes, E. C., & Garry, R. F. (2020). The proximal origin of SARS-CoV-2. Nature medicine, 26(4), 450-452. Asia & Pacific. (2024). H5N1 bird flu detected in Laos. https://english.news.cn/asiapacific/20240205/3defc231c1a84a7cab4acf3a4c2c8b4a/c.html Banjade, M., Adhikari, P., & Oh, H. S. (2020). Illegal wildlife trade in local markets of Feuang and Mad districts of Vientiane Province, Lao People’s Democratic Republic. Journal of Asia-Pacific Biodiversity, 13(4), 511-517. Bell, D., Roberton, S., & Hunter, P. R. (2004). Animal origins of SARS coronavirus: possible links with the international trade in small carnivores. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 359(1447), 1107-1114. Centers for Disease Control and Prevention (CDC). (2019). Angiostrongyliasis, Neural. https://www.cdc.gov/dpdx/angiostrongyliasis_can/index.html Centers for Disease Control and Prevention (CDC). (2024). Rickettsial Diseases.https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/rickettsial-diseases Centers for Disease Control and Prevention (CDC). (2024). Yellow Book 2024. Leptospirosis. https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/leptospirosis Centers for Disease Control and Prevention (CDC). Bird Flu. What Causes Bird Flu Virus Infections in Humans. https://www.cdc.gov/bird-flu/virus-transmission/avian-in-humans.html Cosson, J. F., Picardeau, M., Mielcarek, M., Tatard, C., Chaval, Y., Suputtamongkol, Y., ... & Morand, S. (2014). Epidemiology of Leptospira transmitted by rodents in Southeast Asia. PLoS Neglected Tropical Diseases, 8(6), e2902. Costa, F., Hagan, J. E., Calcagno, J., Kane, M., Torgerson, P., Martinez-Silveira, M. S., ... & Ko, A. I. (2015). Global morbidity and mortality of leptospirosis: a systematic review. PLoS neglected tropical diseases, 9(9), e0003898. Cui, J., Li, F., & Shi, Z. L. (2019). Origin and evolution of pathogenic coronaviruses. Nature reviews microbiology, 17(3), 181-192. Department of Disease Control, Ministry of Public Health (DDC, MOPH) of Thailand. Leptospirosis (Weil Disease). https://ddc.moph.go.th/disease_detail.php?d=16 Dittrich, S., Rattanavong, S., Lee, S. J., Panyanivong, P., Craig, S. B., Tulsiani, S. M., ... & Newton, P. N. (2015). Orientia, rickettsia, and leptospira pathogens as causes of CNS infections in Laos: a prospective study. The Lancet Global Health, 3(2), e104-e112. Drury, R. (2011). Hungry for success: urban consumer demand for wild animal products in Vietnam. Conservation and Society, 9(3), 247-257. https://www.cdc.gov/dpdx/angiostrongyliasis_can/index.html https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/leptospirosis https://www.cdc.gov/bird-flu/virus-transmission/avian-in-humans.html https://ddc.moph.go.th/disease_detail.php?d=16 47 Eamsobhana, P. (2013). Angiostrongyliasis in Thailand: epidemiology and laboratory investigations. Hawai'i Journal of Medicine & Public Health, 72(6 Suppl 2), 28. Food and Agriculture Organization of the United Nations. (2024). Global Avian Influenza Viruses with Zoonotic Potential situation update. https://www.fao.org/animal-health/situation-updates/global- aiv-with-zoonotic-potential/en Greatorex, Z. F., Olson, S. H., Singhalath, S., Silithammavong, S., Khammavong, K., Fine, A. E., ... & Mazet, J. A. (2016). Wildlife trade and human health in Lao PDR: an assessment of the zoonotic disease risk in markets. PloS one, 11(3), e0150666. Haake, D. A., & Levett, P. N. (2015). Leptospirosis in humans. Leptospira and leptospirosis, 65-97. Hu, S., Zhou, K., Liang, Z., Lee, T. M., Veríssimo, D., Ruan, X., & Hinsley, A. (2024). Testing an intervention codesigned with stakeholders for altering wildlife consumption: Health messaging matters. Conservation Letters, 17(4), e13040. Jones, K. E., Patel, N. G., Levy, M. A., Storeygard, A., Balk, D., Gittleman, J. L., & Daszak, P. (2008). Global trends in emerging infectious diseases. Nature, 451(7181), 990-993. Karesh, W. B., & Noble, E. (2009). The bushmeat trade: increased opportunities for transmission of zoonotic disease. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine: A Journal of Translational and Personalized Medicine, 76(5), 429-434. Kawaguchi, L., Sengkeopraseuth, B., Tsuyuoka, R., Koizumi, N., Akashi, H., Vongphrachanh, P., ... & Aoyama, A. (2008). Seroprevalence of leptospirosis and risk factor analysis in flood-prone rural areas in Lao PDR. The American journal of tropical medicine and hygiene, 78(6), 957-961. Lee, J. W., & McKibbin, W. J. (2004, April). Estimating the global economic costs of SARS. In Learning from SARS: preparing for the next disease outbreak: workshop summary (pp. 92- 109). Washington, DC: National Academies Press. Li, H., Daszak, F., Chmura, A., Zhang, Y., Terry, P., & Fielder, M. (2021). Knowledge, attitude, and practice regarding zoonotic risk in wildlife trade, Southern China. EcoHealth, 18, 95-106. Lin, B., Dietrich, M. L., Senior, R. A., & Wilcove, D. S. (2021). A better classification of wet markets is key to safeguarding human health and biodiversity. The Lancet Planetary Health, 5(6), e386- e394. List, T. (2019). Investigations into the illegal wildlife trade in central Lao PDR. Traffic Bull, 31, 19. MacFarlane, D., Hurlstone, M. J., Ecker, U. K., Ferraro, P. J., van Der Linden, S., Wan, A. K., ... & Sutherland, W. J. (2022). Reducing demand for overexploited wildlife products: Lessons from systematic reviews from outside conservation science. Conservation Science and Practice, 4(3), e627. Mayxay, M., Sengvilaipaseuth, O., Chanthongthip, A., Dubot-Pérès, A., Rolain, J. M., Parola, P., ... & Newton, P. N. (2015). Causes of fever in rural southern Laos. The American journal of tropical medicine and hygiene, 93(3), 517. https://www.fao.org/animal-health/situation-updates/global-aiv-with-zoonotic-potential/en https://www.fao.org/animal-health/situation-updates/global-aiv-with-zoonotic-potential/en 48 Naguib, M. M., Li, R., Ling, J., Grace, D., Nguyen-Viet, H., & Lindahl, J. F. (2021). Live and wet markets: food access versus the risk of disease emergence. Trends in microbiology, 29(7), 573- 581. National Center for Biotechnology Information (NCBI). (2024). Angiostrongylus Cantonensis Infection. https://www.ncbi.nlm.nih.gov/books/NBK556067/ Nawtaisong, P., Robinson, M. T., Khammavong, K., Milavong, P., Rachlin, A., Dittrich, S., ... & Newton, P. N. (2022). Zoonotic pathogens in wildlife traded in markets for human consumption, Laos. Emerging infectious diseases, 28(4), 860. New South Wales Government (NSW). (2024). Typhus (epidemic, murine and other rickettsial diseases) fact sheet. https://www.health.nsw.gov.au/Infectious/factsheets/Pages/typhus.aspx Nguyen, T. H. (2023). Factors Influencing the Pattern of Wildlife Product Consumption in Indochina: Case Study of Lao PDR. African Journal of Inter/Multidisciplinary Studies, 5(1), 1-11. Nijman, V., Nekaris, K. A. I., Shepherd, C. R., Vigne, L., Ardiansyah, A., Imron, M. A., ... & Morcatty, T. Q. (2023). Potential mammalian vector-borne diseases in live and wet markets in Indonesia and Myanmar. Microbiology Research, 14(1), 116-131. Panackel, C., Vishad, C. G., Vijayakumar, K., & Sharma, R. N. (2006). Eosinophilic meningitis due to Angiostrongylus cantonensis. Indian J Med Microbiol, 24(3), 220-1. Pandian, D., Najer, T., & Modrý, D. (2023). An overview of Angiostrongylus cantonensis (Nematoda: Angiostrongylidae), an emerging cause of human angiostrongylosis on the Indian subcontinent. Pathogens, 12(6), 851. Parrish, C. R., Holmes, E. C., Morens, D. M., Park, E. C., Burke, D. S., Calisher, C. H., ... & Daszak, P. (2008). Cross-species virus transmission and the emergence of new epidemic diseases. Microbiology and Molecular Biology Reviews, 72(3), 457-470. Peros, C. S., Dasgupta, R., Kumar, P., & Johnson, B. A. (2021). Bushmeat, wet markets, and the risks of pandemics: Exploring the nexus through systematic review of scientific disclosures. Environmental Science & Policy, 124, 1-11. Phongmany, S., Rolain, J. M., Phetsouvanh, R., Blacksell, S. D., Soukkhaseum, V., Rasachack, B., ... & Newton, P. N. (2006). Rickettsial infections and fever, Vientiane, Laos. Emerging infectious diseases, 12(2), 256. Pruvot, M., Khammavong, K., Milavong, P., Philavong, C., Reinharz, D., Mayxay, M., ... & Newton, P. (2019). Toward a quantification of risks at the nexus of conservation and health: The case of bushmeat markets in Lao PDR. Science of the total environment, 676, 732-745. Rahman, M. T., Sobur, M. A., Islam, M. S., Ievy, S., Hossain, M. J., El Zowalaty, M. E., ... & Ashour, H. M. (2020). Zoonotic diseases: etiology, impact, and control. Microorganisms, 8(9), 1405. Saylors, K. E., Mouiche, M. M., Lucas, A., McIver, D. J., Matsida, A., Clary, C., ... & Tamoufe, U. (2021). Market characteristics and zoonotic disease risk perception in Cameroon bushmeat markets. Social Science & Medicine, 268, 113358. https://www.health.nsw.gov.au/Infectious/factsheets/Pages/typhus.aspx 49 Scheffers, B. R., Oliveira, B. F., Lamb, I., & Edwards, D. P. (2019). Global wildlife trade across the tree of life. Science, 366(6461), 71-76. Shi, Z., & Hu, Z. (2008). A review of studies on animal reservoirs of the SARS coronavirus. Virus research, 133(1), 74-87. Shivaprakash, K. N., Sen, S., Paul, S., Kiesecker, J. M., & Bawa, K. S. (2021). Mammals, wildlife trade, and the next global pandemic. Current Biology, 31(16), 3671-3677. Temmam, S., Vongphayloth, K., Salazar, E. B., Munier, S., Bonomi, M., Régnault, B., ... & Eloit, M. (2021). Coronaviruses with a SARS-CoV-2-like receptor-binding domain allowing ACE2- mediated entry into human cells isolated from bats of Indochinese peninsula. Tu, C., Crameri, G., Kong, X., Chen, J., Sun, Y., Yu, M., ... & Wang, L. F. (2004). Antibodies to SARS coronavirus in civets. Emerging infectious diseases, 10(12), 2244. Turck, H. C., Fox, M. T., & Cowie, R. H. (2022). Paratenic hosts of Angiostrongylus cantonensis and their relation to human neuroangiostrongyliasis globally. One Health, 15, 100426. United Nations, Department of Economic and Social Affairs (UN DESA), https://www.un.org/en/desa/covid-19-slash-global-economic-output-85-trillion-over-next-two- years University of Florida. (2021). Rat lungworm - Angiostrongylus cantonensis. https://entnemdept.ufl.edu/creatures/nematode/rat_lungworm.htm Venkataraman, K., & Waisburd, A. C. (2007). The value of the designated market maker. Journal of financial and quantitative analysis, 42(3), 735-758. Virginia Department of Health (2018). Epidemic Typhus Fever (louse-borne) Fact Sheet. https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/epidemic-typhus-fever- louse-borne/ Wang, Q. P., Wu, Z. D., Wei, J., Owen, R. L., & Lun, Z. R. (2012). Human Angiostrongylus cantonensis: an update. European journal of clinical microbiology & infectious diseases, 31, 389-395. Wildlife Conservation Society (WCS). One World – One Health. WildHealthNet in Action: Avian Influenza. https://oneworldonehealth.wcs.org/Initiatives/WildHealthNet/WildHealthNet-in- Action-Avian-Influenza.aspx World Health Organization. (2024). Avian Influenza Weekly Update Number 967. https://cdn.who.int/media/docs/default-source/wpro---documents/emergency/surveillance/avian- influenza/ai_20241004.pdf?sfvrsn=5f006f99_142 World Health Organization. (2021). WHO-convened global study of origins of SARS-CoV-2: China Part. https://www.who.int/publications/i/item/who-convened-global-study-of-origins-of-sars- cov-2-china-part. World Health Organization. (2023). Influenza (Avian and other zoonotic). https://www.who.int/news- room/fact-sheets/detail/influenza-(avian-and-other-zoonotic) https://www.un.org/en/desa/covid-19-slash-global-economic-output-85-trillion-over-next-two-years https://www.un.org/en/desa/covid-19-slash-global-economic-output-85-trillion-over-next-two-years https://oneworldonehealth.wcs.org/Initiatives/WildHealthNet/WildHealthNet-in-Action-Avian-Influenza.aspx https://oneworldonehealth.wcs.org/Initiatives/WildHealthNet/WildHealthNet-in-Action-Avian-Influenza.aspx https://cdn.who.int/media/docs/default-source/wpro---documents/emergency/surveillance/avian-influenza/ai_20241004.pdf?sfvrsn=5f006f99_142 https://cdn.who.int/media/docs/default-source/wpro---documents/emergency/surveillance/avian-influenza/ai_20241004.pdf?sfvrsn=5f006f99_142 https://www.who.int/publications/i/item/who-convened-global-study-of-origins-of-sars-cov-2-china-part https://www.who.int/publications/i/item/who-convened-global-study-of-origins-of-sars-cov-2-china-part https://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic) https://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic) 50 World Organization for Animal Health (WOAH). (2023). Avian Influenza global situations. https://www.woah.org/en/disease/avian-influenza/#ui-id-2 World Organization for Animal Health (WOAH). (2024). Guidelines for Addressing Disease Risks in Wildlife Trade. https://www.woah.org/app/uploads/2024/05/wildlife-trade-guidelines.pdf World Organization for Animal Health. Avian Influenzas. https://www.woah.org/en/disease/avian- influenza/ Xayyasith, S. A. N. T. I., Douangboubpha, B. O. U. N. S. A. V. A. N. E., & Chaiseha, Y. (2020). Recent surveys of the bird trade in local markets in central Laos. Foektail, 36, 47-55. Xu, G., Walker, D. H., Jupiter, D., Melby, P. C., & Arcari, C. M. (2017). A review of the global epidemiology of scrub typhus. PLoS neglected tropical diseases, 11(11), e0006062. Yang, L., Darasavath, C., Chang, K., Vilay, V., Sengduangphachanh, A., Adsamouth, A., ... & Robinson, M. T. (2021). Cluster of angiostrongyliasis cases following consumption of raw monitor lizard in the Lao People’s Democratic Republic and review of the literature. Tropical Medicine and Infectious Disease, 6(3), 107. Yong, D. L., Heim, W., Chowdhury, S. U., Choi, C. Y., Ktitorov, P., Kulikova, O., ... & Szabo, J. K. (2021). The state of migratory landbirds in the East Asian Flyway: Distributions, threats, and conservation needs. Frontiers in Ecology and Evolution, 9, 613172. Yu, D., Li, H., Xu, R., & He, J. (2003). Prevalence of IgG antibody to SARS-associated coronavirus in animal traders-Guangdong Province, China, 2003. MMWR: Morbidity & Mortality Weekly Report, 52(41), 986-986. Zhang, L., Hua, N., & Sun, S. (2008). Wildlife trade, consumption and conservation awareness in southwest China. Biodiversity and conservation, 17, 1493-1516. Zhong, N. S., Zheng, B. J., Li, Y. M., Poon, L. L. M., Xie, Z. H., Chan, K. H., ... & Guan, Y. (2003). Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003. The Lancet, 362(9393), 1353-1358. Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., ... & Tan, W. (2020). A novel coronavirus from patients with pneumonia in China, 2019. New England journal of medicine, 382(8), 727- 733. https://www.woah.org/app/uploads/2024/05/wildlife-trade-guidelines.pdf https://www.woah.org/en/disease/avian-influenza/ https://www.woah.org/en/disease/avian-influenza/