"We just considered it to be over there" : A qualitative study exploring urban perspectives for disease introduction

Rift Valley fever virus (RVFV) is a zoonotic arbovirus that is also transmitted to humans from fluids and tissues of infected livestock. Urban areas in Kenya have the hosts, dense vector distributions, and source livestock (often from high-risk locations to meet the demand for animal protein), yet there has never been a documented urban outbreak of RVFV. To understand the likely risk of RVFV introduction in urban communities and guide future initiatives, we conducted Focus Group Discussions with slaughterhouse workers, slaughterhouse animal product traders, and dairy livestock owners in Kisumu City and Ukunda Town in Kenya. For added perspective and data triangulation, in-depth interviews were conducted one-on-one with meat inspector veterinarians from selected slaughterhouses. Themes on benefits of livestock in the urban setting were highlighted, including business opportunities, social status, and availability of fresh milk in the household. Urban slaughterhouses have formalized meat trading, which, in turn, has resulted in regulation for meat inspection and reduction in local livestock theft. High-risk groups have moderate knowledge about zoonotic diseases and consensus was towards lower personal risk in the urban setting compared to rural areas. Risk assessment was focused on hand hygiene rather than the slaughtering process. There was high reliance on veterinarians to confirm animal health and meat safety, yet veterinarians reported lack access to RVFV diagnostics. We also highlighted regulatory vulnerabilities relevant to RVFV transmission including corruption in meat certification outside of the slaughterhouse system, and blood collected during slaughter being used for food and medicine. These factors, when compounded by urban vector abundance and dense human and animal populations could create ideal conditions for RVFV to emerge in endemic regions and establish an urban transmission cycle. Here, we present a qualitative study that provides context for urban RVFV introduction risks and insight for adapting current prevention and control measures. Author summaryRift Valley fever is a globally important zoonotic virus that is also transmitted directly to humans from infected livestock. This qualitative study aimed to explore and understand risk of Rift Valley Fever urban introduction from the perspective of individuals likely at a high-risk of infection in the urban setting. There has never been an urban outbreak of RVFV, however, other arboviruses have caused devastating urban outbreaks driven by urban transmission cycles in vectors. RVFV has a complex epidemiology and urban centers of endemic regions may be particularly vulnerable as they import large quantities of livestock for slaughter and milk to meet the high urban demand for animal sourced foods and have dense vector populations. This qualitative study provides insights on the opinions and lived experiences of urban high-risk groups including slaughterhouse affiliates, livestock owners, and veterinarians. We also demonstrate risks specific to RVFV transmission and regulatory vulnerabilities that would affect ability to detect disease introduction. The results of this study are intended to guide future initiatives aiming to investigate urban introduction of RVFV and determine how the urban disease ecology differs from what has been demonstrated in rural areas.