Transcript Veterinary profession in One Health

Advancing Global Health with
One Health Concept
Kumar Venkitanarayanan, DVM, MVSc, MS, Ph.D.
Professor of Microbiology & Graduate Programs Chair
Department of Animal Science
University of Connecticut, USA
Global Health
Human population growth
http://www.globalchange.umich.edu/globalchange2/current/lectures/human_pop/human_pop.html
Emergence of infectious diseases
Global Health
Emerging and re-emerging diseases
Morens et al., 2004, Nature 430, 242-49
Factors influencing emerging and reemerging zoonoses
Human
Animal
Ecological
Cohen et al., 2000. Nature ; Cutler et al., 2010 Emerg Infect Dis.
The one health concept
in advancing global health
Global Collaborative Multidisciplinary Effort
Promote humans, animals and environment health
Aims of One Health
• Enhance integration, cooperation and
collaboration between Human Medicine,
Veterinary Medicine and Environmental Science
• Expand the scientific knowledge base
• Accelerate biomedical research discoveries
• Improve human/animal medical education and
clinical care
• Enhance public health efficacy
One Health-Organizations
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World Health organization (WHO)
World organization for Animal Health (OIE)
American Medical Association (AMA)
American Veterinary Medical Association (AVMA)
American Society of Tropical Medicine and Hygiene
(ASTMH)
• The Centers for Disease Control and Prevention (CDC)
• The United States Department of Agriculture (USDA)
• U.S National Environmental Health Association (NEHA)
History of One Health
• 1821-1902: Rudolph Virchow- the link between
human and animal health
• 1947: James Steele- The Veterinary Public Health
Division at CDC
• 1927-2006: Calvin Schwabe- coined "One Medicine”
Historical milestones in One Health
• 2004: The Wildlife Conservation Society published the Manhattan
principles.
• 2009: The one health office at CDC
Key recommendations for one health developed
• 2011: The 1st One health congress held in Melbourne, Australia
The 1st One Health Conference held in Africa
• 2012: The Global Risk Forum sponsors the first one Health Summit.
in Switzerland.
• 2013: The 2nd International One Health Congress in Thailand; 1000
attendees from 70 countries.
Implementation of One Health concept
for controlling infectious diseases
• Rabies
• Escherichia coli O157:H7
• Mad cow disease
• Lead poisoning
• Bacterial antibiotic resistance
Rabies
• The oldest known zoonosis and may
be the oldest known infectious
disease
• Annually, kills 55,000 people in the
world, 30,000 in India (60% total)
• 60% victims - Children under 16
• Dog bite - 95% human cases
• 100% case fatality rate
Rabies-Urban Cycle and Sylvatic cycle
(Pasteur
Institute)
Rabies
• “Rabies is a vaccine preventable disease. The MOST COST
EFFECTIVE STRATEGY for preventing rabies in people is to
eliminate rabies in dogs through vaccination” (World Health
Organization, 2010)
• Vaccinating 70% of dog population prevents 99% human
infections
Case study in Bali, Indonesia
• Island wide mass vaccination program:
March 2011- first phase of mass vaccination program completed
210,000 dogs vaccinated (70% dog population)
• Outcome:
84 human cases in 2011
Only 8 reported cases in 2012
Philippines
• Community mobilization
– 15,000 persons involved in
the program
• Vaccination, CDC training in
field level diagnostic tests,
Rabies education in school
curriculum
Outcome:
• No rabies reported since 2008
• Program strategy to be selfsustainable when outside
funding is no longer available
Latin America
• Surveillance
• Community education and outreach
• Mass vaccination program:
1977- 2011
99% decrease in both human and canine cases
One Health in Rabies-India
In India:
• Rabies control is generally confined to small urban pockets, with
minimal interdisciplinary co-ordination
• Animal birth control and vaccination programs have limited success
on an all India basis
• National Rabies control program in 12th plan of Gov. of India Need of intensive 'One Health' program
Rabies- One Health Framework
Key Components
• Recognize the importance of human-animal- environment
interface
• Develop an Integrated, Multidisciplinary, and Multiagency
approach toward Rabies management
• Investment in risk-based rabies surveillance, intervention, outbreak
prevention, control and elimination programs in primary host
species
• Increased investment in rabies virus research, vaccine research,
and development of prioritized targeted programs through
research
• Public health education and awareness
(USDA 2012)
Escherichia coli O157:H7 (EHEC)
Major foodborne pathogen in the United States
Causes about 63,000 cases annually in the United States
Cost the US economy ~ $1 billion per year
Causes hemorrhagic colitis, Hemolytic Uremic Syndrome, kidney
damage and brain damage
(Scallan et al., 2011)
20
Epidemiology
Principal reservoir host: cattle
Recto anal
junction
Terminal
rectum
Rumen
Colon
(Naylor et al., 2003)
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Routes of E. coli O157:H7
transmission
E. coli O157:H7- Animal-Human-Ecosystem
Dynamics
• Food-borne transmission
• Contamination of environment/water from cattle and other
animal reservoirs
• Cattle-to-cattle transmission
• Cattle-to-human transmission
• Human-to-human transmission
Verotoxin/Shiga toxin
• Major virulence factor
• Binds with globotriaosylceramide (Gb3) receptor
• Treatment
- Supportive therapy
- Antibiotics are contraindicated
- No vaccines are available
E. coli O157:H7 and One Health
• Farm level: Surveillance, Intervention strategies,
Vaccines
• Slaughter house and meat hygiene
• Environmental hygiene: Considering animal- ecosystem
dynamics of water systems
• Agriculture: pre- and post-harvest interventions
• Community education: Adequate cooking and hygienic
practices
• Medical Professionals: Scrutiny of suspected cases for
E. coli O157:H7 and restrict antibiotic usage that
potentially predisposes to HUS
Prion Diseases
• Infectious neurogenerative diseases
• Misfolded protein
• Transmissible particles devoid of nucleic acid
• Humans (Creutzfeldt-Jakob disease (CJD), variant CJD
• Cattle (BSE, mad cow disease)
• Sheep and goats (scrapie)
• Deer and elk (chronic wasting disease)
Bovine Spongiform Encephalopathy
(Mad Cow Disease)
• The first case: United Kingdom in
the mid 1980’s
• ~ 200,000 documented total cases
in the UK
• Detected all over Europe, Japan
and North America
• Meat and bone meal as a feed
supplement
BSE in humans
• Linked to consumption of BSE-infected beef
• Fewer than 200 vCJD cases worldwide
• Long periods of asymptomatic infection (years to decades in
humans)
• Destruction of brain cells – 100% fatal
Charlene Singh, first human form of
mad cow disease (vCJD) victim in the
U.S.
Mad cow disease- One Health Concept
• Co-ordinated control and research effort of veterinary, medical
and environmental professionals for surveillance of BSE
incidents in humans, animals and food chain
• 180,000 cattle have been infected and 4.4 million slaughtered
during the eradication program in the UK
• Ruminant to ruminant feed ban
• Complete ban of specified risk materials in animal feed
• Intensive surveillance for the disease
Annual Incidence of BSE
Lead poisoning investigation in
Zamfara, Northern Nigeria
• Early 2010, Ducks began to disappear in
Zamfara district.
• May 2010, Hundreds of children sick with
vomiting, abdominal pain, headaches,
seizures and death.
• Dr. Lora Davis, CDC animal-human
interface officer
• Investigation found unsafe, high levels of
lead in homes, community wells, and
blood samples.
• Warning signs were missed: Ducks
sentinels of environmental hazard
Application of One Health to control
antibiotic resistance
• Judicious use of antibiotics in animals
• Preventing infections and the spread of resistance
• Tracking of infections due to resistant pathogens
• Improving antibiotic prescription/stewardship
• Developing new drugs and diagnostic tests
Veterinary profession in One Health
• The Veterinary profession: Strong advocate and leader of One
Health.
• Advantages: Holistic understanding and occupational interaction with
a multitude of animal species
Role of Veterinarians in One Health
Human Health
Control Zoonotic Diseases
Biomedical Research
Food Quality and Safety
Animal Health
Disease surveillance and control
Animal Welfare
Increase Domestic Animal Production
Ecological Health
Protect Biodiversity
Natural Resource Conservation
Wildlife Management
Gibbs and Gibbs, 2012
Education of professionals
for One Health
• Multidisciplinary and core public
health coursework including
Epidemiology and Biostatistics
Public health and Zoonotic diseases
Wildlife diseases and management
Environmental Health
• Supervised teaching and research
• Collaborative programs connecting
the three disciplines.
• Internships in research laboratories
Veterinary
medicine
Human
Medicine
Environmental
Sciences
http://egh.phhp.ufl.edu/academic-programs/doctoral-programs/phd-in-one-health/
Conclusion
• One world-one health concept for a healthier
planet
• Be prepared for future challenges in global
health
• Addressing connections between health and
environment