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One Health: The Human Public Health Perspective RADM Ali S. Khan, MD MPH Assistant Surgeon General, USPHS Acting Deputy Director, National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention ASTHO One Health Webinar – April 15, 2010 Emergence of 2009 H1N1 Influenza March – April 2009 • Human infections with a novel H1N1 influenza virus of swine origin reported in California and Texas • Patients had no known contact with pigs, indicating human-to-human transmission • Virus: Quadruple-reassorted swine H1N1 virus 2009 H1N1 Flu: Current Global Situation As of March 21, WHO reports at least 16,981 deaths due to 2009 H1N1 Human-Animal Cooperation • Veterinary diagnostic labs are soliciting animal samples from practicing veterinarians • USDA-APHIS requesting expansion of SIV surveillance funds to cover testing for influenza in other animals, with a focus on companion animals • 12 of 36 NAHLN labs requested and were granted a waiver by NVSL allowing them to use NVSL swine 2009 H1N1 assays in non-swine animal species • Renewed surveillance for novel influenza isolates in swine Influenza A Subtypes H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15, H16 N1 N2 N3 N4 N5 N6 N7 N8 N9 Emerging and Re-emerging Infectious Diseases Rate per 100.000 Population Death Rates for Typhoid Fever in the U.S Year Factors in Emergence • Genetic and biological factors • Microbial adaptation and change • Human susceptibility to Infection • Physical environmental factors • Climate and weather • Economic development and land use • Ecological factors • Changing ecosystems • Human demographics and behavior • Social, political, and economic factors • • • • • International travel and commerce Poverty and social inequity War and famine Lack of political will Intent to harm SARS Clusters Linked to Hotel M Canada Guangdong Province, China F,G A 18 HCW F,G A Hotel M Hong Kong A Hong Kong SAR 95 HCW H,J H,J K B Ireland K 0 HCW I, L,M C,D,E I,L,M >100 close contacts B C,D,E Vietnam Singapore 37 HCW 34 HCW United States 1 HCW First Report of Illness, October 2007 • MN Dept. of Health notified of cluster of 10 cases of unusual neurological illness • Numbness, tingling, weakness in arms and legs • Difficulty walking • All workers at pork processing plant • Number of ill workers far exceeded expected background rate of peripheral neuropathies • Incidence: 830 cases/100,000 workers MN Investigation: Clinical Diagnosis • Illness suggestive of autoimmune inflammatory neuropathy • Guillain-Barré Syndrome (GBS) • Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP) • Test results showed something new • Nerve root inflammation on spinal MRI • Distinctive, abnormal electrodiagnostic testing • “Progressive Inflammatory Neuropathy” (PIN) Progressive Inflammatory Neuropathy (PIN) Minneapolis Star-Tribune MN Plant Investigation: Findings • Almost all cases worked at “head table” • Compressed air used to remove pig brains (“blowing brains”) • Liquefied brain collected in bucket • Led to brain splattering and a “brain mist” • Additional cases of PIN identified at plants in Nebraska and Indiana • • Cases were not identified through active investigation Proverbial “astute clinician” heard about the MN situation and remembered seeing similar cases Actions Taken • Plants discontinued brain blowing and increased personal protection, including goggles and face shields • Notice sent out to state neurologists, other physicians • Further investigation of PIN is in progress 17 Confirmed Cases of E. coli 0157:H7 By Date of Illness Onset August-September 2006 Source: USDA Need for a New Approach Example – E. coli outbreak in spinach, 2006 Viewed through public health lens: focus on morbidity, mortality, diagnosis, treatment Viewed through animal health lens: organism found in cattle and wild swine in spinachproducing region Viewed through ecology/hydrology lens: irrigation system strained due to weather anomalies Investigation succeeded only when information was integrated. Opportunities for One Health Embracing One Health • Recognizing and addressing disease emergence at the interface of animal, humans, environmental health • Looking beyond humans to expand opportunities for disease detection, control, and prevention. Upstream prevention • Environmental stewardship • Examples of human diseases we currently prevent by concurrently protecting animals: • • • • Rabies Rift valley fever Brucellosis Variant spongiform encephalopathy Putting One Health into Action • Leadership • Investment • Integration • Research • Respectful partnerships The Way Forward • Insightful leaders have provided vision • Sometimes the shelf life for vision can be short • Crossroads between talking about One Health and truly embracing the new paradigm • Challenge to us as health professionals Thinking is easy, acting is difficult, and to put one's thoughts into action is the most difficult thing in the world. -Goethe Thank You! RADM Ali S. Khan [email protected] 404.639.7377 http://blogs.cdc.gov/publichealthmatters/ The views and conclusions of this report are those of the authors and do not necessarily represent the views of the CDC. Acknowledgements • • • • • • Lonnie King Carol Rubin Alison Laing Millie Trotter Marguerite Pappaioanou Brynn Berger