Transcript The role of veterinary education on zoonotic diseases and emerging

Please cite this presentation as:
• Speare R. The role of veterinary education on
zoonotic diseases and emerging diseases.
Agriculture Fisheries and Conservation
Department Annual Animal Health Workshop:
Veterinary Education; Hong Kong. 23-24
January, 2013.
The role of veterinary education on
zoonotic diseases and emerging
diseases
Emeritus Professor Rick Speare
Tropical Health Solutions
&
James Cook University
Townsville
23 January 2013
[email protected]
My perspective
• Vet, doctor, public health physician
• Researching control of communicable diseases in
animals and humans for over 30 years
• Teaching postgraduate public health (Anton
Breinl Centre for Public Health & Tropical
Medicine) – zoonoses and EIDs – to doctors,
nurses, allied health, veterinarians – 1991-2012
• Highlighting need for human and animal health
professionals to work together
• Realising that the current training for both keeps
them apart
When is a new vet school / college needed?
• Australia agonised over this question in the
late 1990s
• 4 veterinary schools since the 1970s
• Finally decided in early 2000s to add 2 more in
non-capital cities (Rural vet schools)
– James Cook University (Townsville)
– Charles Sturt University (Wagga Wagga)
Residents per veterinary school: Australia
• Population = 22,015,600
• Veterinary schools = 6
• Residents/vet school = 3,669,263
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Canada
New Zealand
UK
USA
= 8,575,021
= 4,327,944
= 9,006,737
= 11,208,838
Global statistics
• 5.5% of world’s population do not have a
veterinary college / school in their country
Distribution of residents/ vet school by
China = 74,624,440
country
18 vet schools
Hong Kong = 7,153,519
1 vet school?
Australia = 3,669,263
6 vet schools
India = 41,554,262
29 vet schools
Taiwan = 5,808,734
5 vet schools
Statistics at www.tropicalhealthsolutions.com/veterinaryeducation
Proportion of countries by “continent”
that have a vet school
Establishing new professional degrees:
Learnings from James Cook Uni (JCU)
• We started 11 professional UG degrees
• 1980s – Bachelor of Nursing Science
• 1990s – B. Occupational Therapy; B. Speech Pathology;
B. Sports & Exercise Science; B. Biomedical Science; B.
Medical Laboratory Science; B. Pharmacy; B.
Physiotherapy; B. Medicine B. Surgery
• 2000s – B. Veterinary Science; B. Dentistry
Although meeting the original needs was important,
the major benefits came from massive increases in
professional capacity in the local area:
specialists, new people, new ideas, higher quality,
research answering local questions, new activities
Accreditation of degrees
• Universities are free to establish degrees in any
discipline
• If a degree is recognised (accredited) by a
professional body, the successful student is
granted admission to that profession
• If the degree is not recognised, the student may
not be granted entry to the profession, or only
granted entry after doing additional training,
and/or sitting a professional exam
• Accreditation saves effort by the student and
gives status to the degree offered
Are zoonotic diseases and emerging
infectious diseases a criteria for
accreditation of veterinary schools?
Are they a core content for
accreditation?
Are they a “must have” rather than a
“should have”?
The Australian & New Zealand
requirements
• Accreditation is granted by the Australasian
Veterinary Boards Council Inc (AVBC)
• Veterinary Schools Accreditation Advisory
Committee (VSAAC) deals with accreditation
of veterinary schools
• They use 12 standards for accreditation
• Key document is the VSAAC Policies,
Procedures and Standards
12 standards of AVBC
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Standard 1: Organisation
Standard 2: Finances
Standard 3: Facilities and equipment
Standard 4: Library and learning resources
Standard 5: Animals and related resources
Standard 6: Admission and students
Standard 7: Curriculum
Standard 8: Clinical resources and clinical learning and teaching
Standard 9: Academic and support staff
Standard 10: Postgraduate training and continuing education
Standard 11: Research
Standard 12: Outcomes assessment
Search of the VSAAC document
• Searched for “zoonoses”, “emerging infectious
diseases”, “biosecurity”, “one health”, “one
medicine”
• Hits:
– “zoonoses” = 5
– “emerging infectious diseases” = 0
– “biosecurity” = 5
– “one health” = 0
– “one medicine” = 0
Standard 7. Curriculum
AVBC recognizes that curricula need to be flexible but the following
areas must be covered:
• “- Instruction in the theory and practice of medicine and surgery
applicable to a broad range of species. The instruction must include
principles and hands-on experiences in physical and laboratory
diagnostic techniques and interpretation (including clinical
pathology, diagnostic imaging and necropsy), disease prevention,
biosecurity, therapy (including surgery), patient management and
care (including intensive care, emergency medicine and isolation
procedures) involving clinical diseases of individual animals and
populations.
• - Instruction in the principles of preventive medicine/epidemiology,
zoonoses, food safety, the interrelationship of animals and the
environment.”
Standard 8: Clinical resources and clinical
learning and teaching
Expectations and Outcomes
• “- Provides instruction on the principles and
practices of biosecurity within a clinical setting,
including the students’ active participation in the
use of isolation facilities.”
Essential Competences Required of the
Veterinary Surgeon
Essential Competences Required of the Veterinary Surgeon
Attributes relating to knowledge and understanding
“Graduates will be able to demonstrate knowledge and understanding
of:
• The principles of epidemiology and zoonoses of disease and their
impact on the environment;” (p28)
Attributes relating to attitudes as they affect professional behavior
“Graduates should have developed the following skills:
• Recognition of the critical role of the veterinarian in biosecurity and
in the management of veterinary issues that have national and
international implications.” (p28)
Annex 8 VSAAC requirements for Universities
Implementing a ‘Distributed’ or ‘Off-campus’
Veterinary Clinical Education Model
Facilities
• “15. The facilities and equipment at off-campus veterinary
clinics, practices and hospitals used for distributed teaching
must meet the applicable state or national standards or
codes, including compliance with all relevant legislation.
The requirements for such facilities is that they meet “best
practice” standards for veterinary hospitals and meet
relevant standards for occupational health and safety,
animal welfare and biosecurity. Ongoing compliance must
be regularly reviewed (at least 12 monthly) by suitably
qualified university staff or others.” (p102)
Accreditation requirements for other
developed countries were similar
• American Veterinary Medical Association
• Royal College of Veterinary Surgeons
Importance of the Topics
• Zoonoses and biosecurity are core content
required for accreditation of veterinary schools.
Very important.
• The newer concepts of emerging infectious
diseases (EIDs) and One World / One Health are
not listed as core content.
• However, EIDs are rapidly increasing in
importance.
• One Health is arguably an approach that will lead
to improved control of zoonotic diseases.
Important, but not yet critically so.
Important Definitions
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Zoonoses
Emerging infectious diseases (EIDs)
Zoonotic EIDs
Biosecurity
One Health
Veterinary Education
Zoonosis
A disease or agent transmitted from nonhuman vertebrate animals to humans
• 816 zoonotic pathogens
• 1,407 human pathogens overall
• Zoonoses = 58%
(Woolhouse & Gowtage-Sequeria EID 2005;11(12):1842)
What animal hosts carry zoonotic
pathogens?
Woolhouse & Gowtage-Sequeria EID 2005;11(12):1842
A scheme for classifying zoonoses
• Zoonoses are complex
• Most zoonoses have R0<1; so do not cause
outbreaks
• Can be classified in many ways
• Agent, route of transmission, occupation,
pathology
• One approach classifies them into types by the
persistence of the zoonotic pathogen in humans
and the ongoing relationship with an animal
source
Zoonoses: type 1
• Vertebrate animal reservoir, spillover to
humans; humans are a dead-end host
• Animal hosts may be single species or multiple
Animal
Animal
Human
• This interaction occurs in an environment
Add climate change!
Example of type 1:
leptospirosis
• Small animal vet in Washington State
(USA) examined a pet rat
• Rat urinated on his hands
• Washed hands routinely
• Developed leptospirosis 10 days later
• Diagnosis delayed until day 16 since
leptospirosis was not considered
Baer et al. Zoonoses and Public Health 2010;57:281
Role for vets
• Protect themselves – good infection control;
recognise risky situations
• Protect staff – as above
• Protect clients – as above; advise them in
prevention
• Remind doctors to think of zoonoses for any
febrile illness
• Conduct hazard analysis - risk reduction
• When reducing infection risks start with higher
order controls (elimination, substitution,
isolation, redesign and engineering)
Higher order controls are more effective
HIGHER ORDER CONTROLS
CONTROL THE PROCESS
Elimination
• Work health and
safety approach
Substitution
Isolation
Redesign and engineering
LOWER ORDER CONTROLS
CONTROL THE PERSON
Administrative controls
Personal protective equipment (PPE)
Thanks to Tricia Coward QWHS
Biosecurity
• Safeguarding of resources from biological threats
• Encompasses the full spectrum of biological risk
whether naturally occurring harmful organisms,
or introduced by accidents and/or negligence
through to their deliberate use as biological
weapons
• Term “biosecurity” is used in many different ways
and often tailored for the particular situation
• Infection control is one component of biosecurity
Zoonoses: type 2
• Vertebrate animal reservoir, spillover to humans;
limited human to human transmission
• About 25% of zoonoses
Animal
Animal
Human
Human
Example of type 2:
Salmonellosis
• 1999; Salmonella
Typhimurium (multi-drug
resistant) killed 9 cats in
an animal shelter
• People who adopted
kittens from the shelter
became infected (primary
human cases)
• One infected child passed
their infection onto 2
children at a day care
centre (secondary human
cases)
Wright et al EID 2005;12(8):1235
Figure 1. Date of death among cats and week
of illness onset among human case-patients,
Minnesota, 1999.
Role for vets
• Protect themselves – good infection control; recognise
risky situations
• Protect staff – as above
• Protect clients – as above; advise them in prevention
• Remind doctors to think of zoonoses for any febrile
illness
• Assist/initiate epidemiological investigations
• Conduct hazard analysis - risk reduction
• If higher order strategies (elimination, substitution,
isolation) are an option, initiate these
Zoonoses: type 3
• Vertebrate animal reservoir, spillover to humans; well
adapted human to human transmission; spillback to
animals
Animal
Animal
Human
Human
Two way transmission = anthropozoonosis
Human to vertebrate animal transmission = humanosis
Example of type 3:
Influenza A
• Influenza A infects humans, birds, pigs and variably
other mammals
• Strains tend to associate with host groups, but can
spillover to other hosts
• If dual infection occurs in an individual host, RNA
strands can mix (reassort), and a new strain can be
excreted
• For humans if i) the new strain transmits readily person
to person, ii) the antigens are novel (no widespread
immunity) and iii) the virus is pathogenic, a pandemic
can occur
• In 2009 a new strain of Influenza A H1N1 with genes
from human, bird and pig influenzas caused a
pandemic
Reassortment
Mixing vessel host
• During this pandemic there were several
instances of humans transmitting H1N1p2009 to
pigs and poultry
• Viral genetics showed that human to pig
transmission was frequent during and after the
pandemic
(Nelson et al. J Gen Vir 2012;93:2195)
Role for vets
• Protect themselves, staff & clients – infection
control against droplet infection
• Encourage influenza vaccination of staff and
clients to decrease risk of reassortment
• Advise clients to protect their pigs and poultry
against risk of transmission from wild birds and
human workers
• Assist with surveillance in animals
• Assist in outbreak investigation and control
How to tell if an arriving flight has bird
flu…
Escaped Zoonoses!
• Many human diseases started as zoonoses, adapted 100%
to humans, and animals are no longer needed (eg, measles)
• Most recent example is HIV
Animal
Animal
Human
Human
Human Immunodeficiency Viruses
Example of a group of viruses that made a crossspecies transmission (zoonosis)
and
Then became a “natural” human pathogen
Simian Immunodeficiency Viruses: Origin of
HIV
Wertheim & Worobey (2009)
Simian Immunodeficiency Viruses:
Origin of HIV
 HIV-1 = from SIVcpz from chimpanzee
(Central Africa: Cameroon)
 HIV-2 = from SIVsm from sooty mangabey
(West Africa: Côte d'Ivoire)
 11 instances of non-human primate to
human transmission of SIV to HIV
Non-Human Primate to Human
Transmission Outcomes
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Wertheim & Worobey (2009)
SIVcpz HIV-1 gp M
SIVcpz HIV-1 gp N
SIVcpz HIV 1 gp O
SIVsm HIV-2 gp A
SIVsm HIV-2 gp B
SIVsm HIV-2 gp C
SIVsm HIV-2 gp D
SIVsm HIV-2 gp E
SIVsm HIV-2 gp F
SIVsm HIV-2 gp G
SIVsm HIV-2 gp H
Non-Human Primate to Human Transmission
Outcomes
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SIVcpz HIV-1 gp M  Human to human transmission
SIVcpz HIV-1 gp N  Human to human transmission
SIVcpz HIV 1 GP O  Human to human transmission
SIVsm HIV-2 gp A  Human to human transmission
SIVsm HIV-2 gp B  Human to human transmission
SIVsm HIV-2 gp C
SIVsm HIV-2 gp D
SIVsm HIV-2 gp E
Group M then caused
SIVsm HIV-2 gp F
pandemic AIDS
SIVsm HIV-2 gp G
SIVsm HIV-2 gp H
Oldest date for the cross-species jump?
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HIV-1 gp M – 1900s
HIV-1 gp N - 1963
HIV-1 gp O – 1920
HIV-2 A – 1932
HIV-2 B - 1935
Wertheim & Worobey (2009)
Why did HIV become a pandemic?
• All about probabilities
• Spillovers = many opportunities
• Bushmeat hypothesis
• Going global
A butchered monkey at a market
in the Congo has been partially
cooked. Nat. Geographic
• Urbanisation hypothesis
• Unsafe sex more frequent
• Rapid transport of infected people long distances
Any role for vets in HIV/AIDS?
• Physicians do not talk to HIV/AIDS patients about
zoonotic diseases (7% in USA Hill et al 2012)
• Vets do talk to HIV/AIDS clients about zoonoses (69% in
USA)
• Physicians should refer patients to vets for advice
….. But they don’t!
• Vets and physicians don’t talk to one another
• Vets have an important role in informing HIV/AIDS
patients and doctors about zoonotic risks
• But their knowledge about specific risks for HIV/AIDS
patients is low (in USA)
Hill et al. JAVMA 2012; 240(12):1432
Zoonoses: type 4
• Vertebrate animal reservoir; human reservoir;
pathogen strains adapted to both; two way
transmission
Animal
Animal
Human
Human
Example of type 4:
Methicillin resistant
Staphylococcus aureus
ICU
Hospital
MRSA: a
humanosis
becomes a
zoonosis
Community acquired
MRSA
Human cases: Is there an animal MRSA
source?
• Recurrent clinical episodes in a patient
– Pet or livestock contact?
• Recurrent MRSA carriage in health care staff
– Live on a farm?
– Pets?
J Hosp Inf 2008;700186
MRSA: an occupational
zoonosis for veterinarians
• Vets have an increased prevalence of
community acquired-MRSA carriage
• Shown in several developed countries
• Australian vets:
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Industry & Govt vets (desk jockeys) 0.9%
Equine-only vets 21%
Vets who treat horses 12%
Small animal vets 4.9%
Jordan et al. Aust Vet J 2011;89(5):152
Carriage of MRSA increases likelihood of invasive disease
Role for vets
• Protect themselves – good infection control; hand
washing is critical
• Protect staff – as above; swabs to detect carriage
of MRSA
• Protect clients – as above; advise them in
prevention
• Conduct hazard analysis - risk reduction
• Remind doctors to think of animal hosts for MRSA
• Work with doctors in controlling any animal
reservoirs of recurrent human infections
Emerging Infectious Disease
Emerging Infectious Diseases (EIDs) are
infections that have newly appeared in a
population, or have existed but are rapidly
increasing in incidence or geographic range,
or threaten to increase
Origin of EID concept
• Federation of American Scientists 1992 report
Emerging Infections: Microbial Threats to Health in the United
States
• To protect USA by controlling diseases in country of
origin
• Proactively implement communicable disease control
in other countries in which outbreaks occur
• Particularly concerned by viral haemorrhagic fevers
in Africa
EIDs
• Newly appeared; or
• Previously recognised, but expanding in
incidence or geographic range; or
• Threaten to increase
• Total human EIDs = 177 (Woolhouse & GowtageSequeria 2005)
Trend to use terms:
EMERGING and RE-EMERGING
INFECTIOUS DISEASES
Relationship of EIDs to zoonoses
• 73% of Human EIDs are zoonoses
(Woolhouse & Gowtage-Sequeria 2005)
Zoonoses
EIDs
Risk factor for zoonotic EIDs: pathogen
found in multiple animal host species
Figure 2. Relationship between breadth of host range and
the fraction of pathogen species regarded as emerging
or reemerging. (Woolhouse & Gowtage-Sequeria 2005)
Severe Acute Respiratory Syndrome
(SARS)
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8,422 cases globally
916 deaths (Case Fatality Rate 11%)
30 countries on 5 continents
Epidemic started Nov 2002 in Guandong Province
Lasted 8 months
Officially over 5 July 2003
Due to a coronavirus (SARS-CoV)
Four subsequent contained outbreaks due to
escape of SARS-CoV from labs
Metropole Hotel
Escape of
SARS!
China to the
world
via the
medical
profession
and jet planes
Animal Hosts
for SARS CoV
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Palm civet cat
Racoon dog
Domestic cat
Fox
Macaque
Original host appears
to be Chinese rufous
horseshoe bat
(Rhinolophus sinicus)
• Closest SLCoV (Yuan et al.
J Gen Virol 2010;91(4):1058)
Spillover of SARS CoV
• Probabilities are important
• Need many spillover events to get the “right”
virus
Bat
Civet cat
Human
Human
Wild Animal Markets
For SARS the driver of spillover was the wild animal
markets that bought humans and animals close
together
Who got
infected?
An extremely
dangerous
disease
… particularly to health professionals
30% were
Health Care
Workers!
• Muller et al (2004) Fig 1.
Role of vets
• Assist in immediate epidemic control
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Identifying agent
Identifying source
Completing the epidemiological picture
Coordinating animal aspects
• Assist in long term control
– Developing vaccines
– Source reduction
– Reducing probability of spillovers
• Work collaboratively with health personnel, zoologists,
ecologists, research laboratory scientists
• Vets have a very important role in zoonotic EIDs since
they are more familiar than human health personnel
with multi-species pathogens and investigations
Non-zoonotic EIDs: Affects animals only
Example: Wildlife EIDs that decrease biodiversity
• Enter wildlife populations and cause massive
mortality
• May be a host species jump or escape of a
pathogen from a restricted location
• Can drive species to extinction
– Highly Pathogenic Avian Influenza H5N1
– Amphibian chytridiomycosis
Amphibian chytridiomycosis
• Global epidemic in amphibians
• High death rates in some species, causing
severe population crashes and some
extinctions
• Most severe threat to amphibian
biodiversity
• Caused by a chytrid fungus,
Batrachochytrium dendrobatidis (Bd)
• Skin fungus that kills frogs through causing
serum electrolyte imbalances (low K+)
resulting in cardiac arrest
• James Cook University has been a leader in
research and assisting in management
strategies
Frog dying from
chytridiomycosis
Epidermis with Bd
discharge tubes
Bd growing on agar
plate
Hong Kong research: Is
chytridiomycosis present
in Hong Kong?
• Hong Kong imports 4.3 million amphibians
annually
• Has chytridiomycosis been imported and escaped
to the wild?
• Wild populations of 4 native species surveyed
2005-2006 by Hong Kong-JCU team which was led
by AFCD (Rowley et al. Dis Aquat Org 2007;78(2):87)
• No B. dendrobatidis found by PCR in 274 frogs
Is chytridiomycosis present in frog trade in
Hong Kong?
• 137 imported amphibians negative (Rowley et al.
2007)
• Amphibians imported into USA from Hong
Kong have tested positive in 2012 (Jon Kolby pers
com)
• Result indicates need for:
– More extensive surveillance in Hong Kong in trade
and wild frogs (monitoring program?)
– Review of risk of B. dendrobatidis infected
imported frog escaping into wild
Role of vets in wildlife EIDs
• Absolutely essential!
• Zoologists and ecologists have very poor
knowledge of disease
• Typically keen to learn, but their basic training is
inadequate
• Vets can contribute greatly to all aspects from
pathogen discovery, epidemiology, to control
strategies
• Major role in devising action based on deficient
evidence
• To be effective vets have to understand Mutual
respect!
perspectives of the scientists
Non zoonotic EIDs: Human only
– Drug Resistant TB
• Mycobacterium tuberculosis is a human pathogen
• Multi-drug resistant M. tuberculosis (MDR-TB) is
increasing
– 310,000 cases (2011) – India, China (6% prev), Russia
• Extensively drug resistant M. tuberculosis (EDRTB) is increasing
– 27,900 cases (2011)
• Totally drug resistant M. tuberculosis (TDR-TB)
has now appeared; Middle East, India
Hot spots in MDR-TB
Muller et al. Trends in Genetics 2013 epub
Pathogen Polution
• Pathogenic micro-organism that contaminates
the environment resulting in human and/or
animal disease
• Becomes an EID when the problem is increasing
• Melioidosis (due to bacterium Burkholderia
pseudomallei in soil and water): EID? Tropical
disease possibly moving into temperate areas
with climate change
• Cryptococcosis (due to fungus Cryptococcus
gattei)
Cryptococcus gatti:
Aussie pathogen moves to Canada
• Environmental fungus that lives on
Eucalyptus trees in Australia
• Causes meningitis and pneumonia in
immunosuppressed people and
animals
• C. gatti arrived in Vancouver Is,
British Columbia (Canada) in 1999
Cryptococcosis:
chronic disease
• Pulmonary granulomas
• Asymptomatic
• Fever
• Cough
• CNS
• Meningitis – slow
• Meningoencephalitis
• Diagnosis
• Demonstrate fungus
• Antigen detection
Canadian outbreak
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38 human cases (as at 2004)
Incidence Vancouver Is 3.7/100000
72% lung (granulomas), 26% CNS
35 animals
• Dogs
• Cats
• Ferrets
• Dall’s porpoises
• C. gattii serotype B – two closely genetically related
strains.
• VGIIa is the more virulent strain
• Found in trees (5 native spp), soil, water, air
Kidd et al. PNAS 2004;101:17258-63
• Humans and many animal species infected
• Even porpoises!
Virulent strain produced by same sex mating
Fraser et al. Nature 2005;437:1360-1364.
C. gattii expands
• Fungus spread to mainland Canada
• Cases have occurred on Canadian mainland
• Found now in Pacific Northwest (Oregon and
Washington, USA)
• Spores on trees, woodchips, air, soil, cars,
footwear sea water
Why has Cryptococcus
gattii spread?
• C. gattii is an endemic Australian fungus found on
Eucalyptus trees
• Eucalyptus have been exported widely as
woodchips, mulch and timber
• C. gattii discovered in Brazil and some tropical areas
• In Canada global warming may have allowed the
fungus to become established once introduced
• Now widespread in environment and using multiple
routes of spread
• Example of “pathogen pollution”
Control of pathogen pollution?
• More difficult than controlling pathogens in
wildlife reservoirs
• With cryptococcosis, veterinarians must be alert
to diagnose disease early
• Vets can assist with research
• Horses – surveillance (Duncan et al 2011)
• Cats & dogs – clinical management (Duncan et al 2006; Trivedi et
al 2011)
• Pet birds, ferrets – clinical (Malik et al 2002; Lester et al 2004)
• Wildlife – epidemiology (Duncan et al 2005)
Managing zoonotic EIDs needs wellfunctioning multi-disciplinary teams
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Health personnel
Veterinarians
Laboratory scientists
Epidemiologists & disease control
experts
Environmental experts
Social scientists
Industries
Policy makers
Same is true of many zoonoses
One Health: unification of the medical and
veterinary professions with the establishment
of collaborative ventures in clinical care,
surveillance and control of cross-species
disease, education, and research into disease
pathogenesis, diagnosis, therapy and
vaccination
• One World, One Health
• Ecosystem and Public Health
“Between animal and human medicine there is no
dividing line – nor should there be.” Rudolph
Virchow
“The spirit behind One Health is mutual respect and
communication across professions. We look for
added value and synergy through surveillance,
outbreak response and data sharing. This is an
important step toward improving health
outcomes incorporating human and animal
health policies in all relevant sectors.”
AFCD "One Health: Past, Present and Future"
workshop 2011
Professional silos
• For One Health to work, the professions have to
understand each other, know their strengths (and
weaknesses), what each can contribute, and how to
maximize this to effectively manage complex problems
to get a synergistic outcome
• Involves a cultural shift in veterinary and human
medicine from disease care to health promotion and
prevention
• Unfortunately, animal health, human health and
environmental health professionals seem to be isolated
• The understanding of the other professions should be
established during the undergraduate years
Differences between professional cultures:
veterinarians and doctors
• Both are healing professions
• Different values; different approaches
• Different jargons; not exactly the same
languages (eg, biosecurity)
• Vets deal with multiple animal species; docs
with only one
Vets and Docs: marked differences
• Vets don’t have to deal with symptoms (how the
patients say they experience their illness); this is very
important in human medicine (especially pain)
• Animals do not follow therapeutic instructions (so have
therapy administered to them); docs expect their
human patients to do so (but they often don’t)
• Legislation around disease can control an animal’s life
and death, movements, behaviour and treatment
given; not for humans
• Herd animals are usually managed as a group with few
rights for the individual animal; not the case in human
medicine
• For vets quality of life of their patient is more
important than life itself; for docs life is paramount
Vets and Docs: marked differences
• Economic issues are a very important factor in veterinary
decisions (life and death at times); costs modify
management for docs, but killing a patient on economic
grounds is not considered
• Consent of patient or guardian is very important for docs;
consent of owner not so critical for vets
• Consent can often be overruled by legislation for vets; very
difficult to overrule for docs
• Animals can be killed because they are ill, suspected of
being ill, or close to another ill animal; not so for humans
• Vets have more power to enforce their decisions; docs have
to convince patients and populations to do what is best
For both professions to work together effectively
each must understand the other’s culture
Veterinary education
Three stages
• Undergraduate (UG)
– First degree (5-6 years)
– Following pre-vet UG degree (4 years)
• Postgraduate (PG)
• Continuing Professional Education (CPE)
UG curricula: Are zoonoses and EIDs taught?
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James Cook University BVSc as an example
Typical of Australian BVSc
Zoonoses – yes, but not as a specific subject
Biosecurity - yes
EIDs – no
One Health – no
Human population health – no
Working with other UG health professions - no
Zoonoses & Biosecurity Curricula: JCU
• Pathogen and disease is the focus
• Risk to veterinarians highlighted
• 2nd Year
– TV2001 Integrated Animal Structure and Function 1: focus on
pathogens: zoonotic risk highlighted
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3rd year
– TV3001 Transitions from Health to Disease 1: Vet Public Health is
emphasised; Biosecurity; Infection control, taught as a risk reduction
approach
• 4th year
– TV4001 Veterinary Clinical Sciences 1 & 2: zoonoses as part of clinical
theory & practice
• 5th year
– TV5005 Veterinary Clinical and Professional Practice: Practice rotations.
One week of lectures at start of year only: During this week 1 lecture on
infection control.
The emphasis on teaching good infection control is a significant
advance!
Hendra virus (HeV): a zoonotic EID
HeV is a threat to equine veterinarians, but a
stark reminder to all the vet profession of the
importance of infection control
HeV: Stimulus for better
infection control
• Importance of infection control in Australia now
emphasised due to death of vets from HeV
• HeV is a Henipavirus similar to Nipah virus
• Spillover from flying foxes to horses; horses to humans
• 7 human cases, 4 deaths
• 2 vets and 1 vet assistant have died; 1 vet nurse severe
sequelae
• Vets left equine practice (Mendez et al EID 2012;18(1):83)
• HeV vaccine for horses now commercially available
• Equine vets will maintain their infection control
protocols & HeV management plans (Mendez et al in press)
Are there better models for teaching
zoonoses and EIDs?
• Unsure. Where is the evidence?
• “Dearth of peer-reviewed research on factors
impacting veterinary medical education” (NAVMEC Board
of Directors JAVMA 2011;38(4):320)
• North American Veterinary Medical Education
Consortium (NAVMEC) proposed a new direction
for veterinary schools (NAVMEC Board of Directors 2011)
– “Responsive, Collaborative, Flexible”
– Core competency: One Health knowledge: animal,
human, and environmental health
– Highlighted need for a research agenda for VME
NAVMEC Roadmap
• Broad areas only; hence a “Roadmap”
• Comparative biomedical approach, BUT focus on
one or a few species or a discipline (eg, public
health)
• One Health a core competency
Interdisciplinary Learning at UG Level
• One interesting strategy - have vet students learning
with health professionals
• Uni of Florida Interdisciplinary Family Health subject
(Waddell et al JAVMA 2010;37:126)
• 1st year vet students work with medical and allied
health students in community visits to disadvantaged
families
• Goal is learning interdisciplinary collaborative practice
– highly successful
• Also learn about
– Challenges of poverty to pet health
– Zoonoses risk from neglected ill animals
One World, One Health: Veterinary
Medicine, Uni of Calgary, Canada
• 4 year DVM (follows pre-vet)
• Integrated core-elective curriculum
• Fundamental core veterinary knowledge across all
years
• One Health taught across all years (as is Global Health)
• Electives in years 2 and 3
Impact?
• Areas of Emphasis in final year
Too early to know!
– Production animal health
st class graduated
1
– Ecosystem and public health
2012
– Equine health
– Investigative medicine
Cribb & Buntan Rev Sci Tech OIE 2009;28(2):753
PG Education and CPE
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More opportunities to gain specialised skills
Masters coursework (MPH, MVPH, etc)
Research degrees
Specialist training (eg, ANZCVS, Diplomats)
CPE
– Business as usual (trend to prefer short seminars)
– Innovative - Cornell Uni & Texas A&M have
combined with Pfizer Animal Health
Future
• Suspect that the core
competencies in the NAVMEC
Roadmap will eventually
become accreditation
requirements for veterinary
schools / colleges in USA
• Strong emphasis on One Health
• Shift from knowing about all
common domesticated species
to few species or disciplines
• Can a new veterinary school
meet the current competencies
as well as the new NAVMEC
ones?
Thank you!
Source of images (if not original)
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Pet rat - http://en.allexperts.com/q/Pet-Rats-3537/2010/2/tumor-removal-extend-life.htm
Sooty Mangabey - http://pin.primate.wisc.edu/factsheets/image/440
Butchered monkey (DRC) http://www.nationalgeographicstock.com/ngsimages/explore/explorecomp.jsf?xsys=SF&id=1
090012
3 silos - http://superiorrotary.areavoices.com/2010/11/25/silos/
Intensive care - http://www.corporeality.net/museion/category/medical-scientificinstruments/
Home - http://www.webwombat.com.au/finance_/articles/first-time-home-ownersgrant.htm
Vet with dog cartoon - http://www.clipartof.com/portfolio/ctsankov/illustration/hispaniccartoon-dog-veterinarian-man-78904.html
Family cartoon - http://www.robertdstrong.com/reviews/family-iq-service-review/
Horse cartoon - http://www.balddog.com.au/illustration.html
Reassortment of influenza A - Nicholson (2003)
Rhinolophus sinicus - http://zmmu.msu.ru/bats/science/fauna/exfauna/rhsin.html