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One Health: A Concept for the 21 st Century Laura H Kahn, MD, MPH, MPP, FACP Research Scholar Program on Science and Global Security, Princeton University Eighth Annual International Society for Disease Surveillance Conference December 3, 2009 Acknowledgments Present Collaborators:

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one health a concept for the 21 st century

One Health: A Concept for the 21st Century

Laura H Kahn, MD, MPH, MPP, FACP

Research Scholar

Program on Science and Global Security, Princeton University

Eighth Annual International Society for Disease Surveillance Conference

December 3, 2009

acknowledgments
Acknowledgments
  • Present Collaborators:
    • Bruce Kaplan DVM, Dipl. AVES (Hon)
    • Tom Monath MD
    • Jack Woodall, PhD
  • Past Leaders:
    • Calvin Schwabe DVM, DSc
    • 19th century: Virchow, Osler
many organizations and individuals support the one health initiative
Many organizations and individuals support the One Health Initiative
  • American Veterinary Medical Association
  • American Medical Association
  • American Society for Microbiology
  • American Society of Tropical Medicine and Hygiene
  • American Phytopathological Society
  • Association of Schools of Public Health
outline
Outline
  • The One Health Initiative
  • A Brief History of One Health
  • The Challenge of Zoonotic Diseases
  • National and International Human and Animal Disease Infrastructures and Surveillance Activities
  • A Tale of Three Outbreaks
  • Challenges Ahead
i the one health initiative
I. The One Health Initiative
  • Recognizing the inter-connectedness between human, animal, and ecological health, the OHI seeks to increase communication, collaboration, and cooperation across a wide variety of disciplines including human medicine, veterinary medicine, public health, microbiology, ecology, and others.
  • http://www.onehealthinitiative.com
a brief history of one health beginnings of veterinary medicine
A Brief History of One Health: Beginnings of Veterinary Medicine
  • Pope Clement XI instructed his physician, Dr. Giovanni Maria Lancisi, to do something about rinderpest
  • Rinderpest is a highly lethal viral disease of cattle that was devastating the human food supply
animal disease control measures
Animal Disease Control Measures
  • Lancisi recommended that all ill and suspect animals be destroyed.
  • Principles were a milestone in controlling the spread of contagious diseases in animals.
one health in the 19 th century
One Health in the 19th Century
  • Rudolf Virchow (1821-1902), a German physician and pathologist said, “between animal and human medicine there are no dividing lines--nor should there be.”
early meat inspection programs
Early Meat Inspection Programs
  • Virchow’s father was a butcher.
  • Animal experiments on life cycle of Trichinella spiralis in porcine muscular tissue.
  • Cysticercosis and tuberculosis in cattle.
many emerging infectious diseases are zoonotic
Many Emerging Infectious Diseases are Zoonotic
  • Pandemic Influenza A
  • HIV/AIDS
  • West Nile virus
  • SARS
  • Monkeypox virus
  • Bovine Spongiform Encephalopathy
  • Rift Valley Fever
many of the agents of bioterrorism are zoonotic
Many of the Agents of Bioterrorism are Zoonotic

CDC Category A Agents:

Anthrax (Bacillus anthracis)

Plague (Yersinia pestis)

Tularemia (Francisella tularensis)

Viral Hemorrhagic Fever Viruses (Ebola, Marburg, Lassa, Machupo)

reasons for the emergence of zoonotic diseases
Reasons for the Emergence of Zoonotic Diseases
  • Better Reporting and Technology
  • Microbial Adaptation
  • Human Population Pressures
  • Poverty and Susceptibility to Infection
  • Economic Development and Land Use
  • Bush Meat Consumption
  • International Travel
  • Exotic Animal Trade
  • Intent to Cause Harm
human and animal disease infrastructures
Human and Animal Disease Infrastructures
  • U.S. National
    • Comparison of Human and Animal Health Infrastructures
    • Surveillance Activities
  • International
    • Comparison of Human and Animal Health Infrastructures
    • Surveillance Activities
u s federal human health infrastructure
U.S. Federal Human Health Infrastructure
  • U.S. Department of Health and Human Services (DHHS) is lead agency at federal level.
  • U.S. Department of Homeland Security (DHS) is involved in human health.
  • U.S. Department of Defense (DoD) helps in times of crisis.
u s federal animal health infrastructure
U.S. Federal Animal Health Infrastructure
  • U.S. Department of Agriculture (USDA) Animal Plant Health Inspection Service (APHIS) is lead agency for livestock.
  • U.S. Department of Homeland Security (DHS) now has parts of APHIS.
  • U.S. Department of Health and Human Services (HHS) established National Center for Zoonotic, Vector-borne and Enteric diseases at CDC.
  • U.S. Department of Interior (DOI) Fish and Wildlife Service is responsible for wildlife, endangered species, and wildlife imported into the U.S.
  • U.S. Department of Commerce (DOC) oversees fisheries management.
slide18
U.S. federal agencies addressing animal diseasesAnimal Health at the Crossroads, National Academies Press 2005, page 36
a tale of three outbreaks west nile virus
A Tale of Three Outbreaks: West Nile Virus
  • 1999 NYC West Nile Virus outbreak
  • Two simultaneous outbreaks: one in animals and one in humans.
  • Outbreak highlighted the importance of disease surveillance in wildlife and zoo animals.
  • Animals were sentinels for human health but were largely ignored.
u s response to west nile virus outbreak
U.S. Response to West Nile virus Outbreak
  • In 1999, the CDC established ArboNET.
  • A success story…
mosquito wnv infections 2002 http westnilemaps usgs gov 2002 usa mosquito apr 22 html
Mosquito WNV Infections 2002http://westnilemaps.usgs.gov/2002/usa_mosquito_apr_22.html
wnv positive wild birds 2002 http westnilemaps usgs gov 2002 usa avian apr 22 html
WNV Positive Wild Birds 2002http://westnilemaps.usgs.gov/2002/usa_avian_apr_22.html
human wnv cases 2002 http westnilemaps usgs gov 2002 usa human apr 22 html
Human WNV Cases 2002http://westnilemaps.usgs.gov/2002/usa_human_apr_22.html
zoos as a public health resource
Zoos as a public health resource
  • Distributed throughout the U.S.
  • Located in urban and rural areas
  • Close to humans
  • Stationary population
  • Populated with variety of species with different levels of susceptibility
  • Serial sampling
  • Highly trained veterinarians closely monitor the animals’ health
west nile surveillance system for zoological institutions
West Nile Surveillance System for Zoological Institutions
  • Initially funded by CDC and operational from 2001 to 2006.
  • Collected data from > 13,000 animals
  • ~13% (633/4711) confirmed positive animals (virus isolated and PCR) to date
  • ~17% (1716/9760) sero-positive animals (serum neutralization)
slide27

Animals tested in 2001

Zoo animals tested in 2001: Preliminary Count 641

Preliminary count 641 for 2001

slide28

Animals tested in 2002

Zoo animals tested in 2002: Preliminary Count 6529

Preliminary count 6529 for 2002

slide30

Animals tested in 2004

Zoo animals tested in 2004: Preliminary count 2700

Preliminary count 2700 for 2004

slide31

Animals sampled in 2005

Zoo animals sampled in 2005: Preliminary count 1161

Preliminary count 1161 for 2005

slide32

Animals sampled in 2006

Zoo animals sampled in 2006: Preliminary count 814

Preliminary count 814 for 2006

zoo animal health network zahn
Zoo Animal Health Network (ZAHN)
  • USDA
  • American Zoological Association (AZA)
  • Lincoln Park Zoo
  • National Animal Health Laboratory
  • http://www.zooanimalhealthnetwork.com/
a tale of three outbreaks monkeypox
A Tale of Three Outbreaks: Monkeypox
  • Monkeypox outbreak of 2003 in U.S. Midwest started with the importation of giant Gambian rats exposing prairie dogs in a pet distribution center.
  • Outbreak highlighted the problems of importing millions of exotic animals into the U.S.
  • Little attention paid to the sick and dying prairie dogs until after humans became sick.
  • A total of 71 human cases of monkeypox were reported to CDC; 35 (41%) were lab confirmed.
  • 18 people were hospitalized.
  • Minimal disease surveillance of companion animals.
u s response to monkeypox outbreak
U.S. Response to Monkeypox Outbreak
  • CDC and FDA issued order prohibiting importation of African rodents
  • And prohibited sale, transfer, or release of prairie dogs
  • Replaced by interim final rule
  • No surveillance system of pets developed.
disease surveillance in companion animals
Disease Surveillance in Companion Animals
  • Approximately 63% of all U.S. households own at least one pet.
  • Most commonly owned animals include:
    • Cats (90.5 million)
    • Dogs (73.9 million)
    • Small mammals (18.2 million)
    • Birds (16.6 million)
    • Aquarium Fish (140 million freshwater/9 million saltwater)
new york times september 21 2009

http://www.nytimes.com/2009/09/22/health/22mrsa.html?_r=2

New York Times September 21, 2009

“Tie to pets has germ jumping to and fro” Methicillin Resistant Staph aureus (MRSA) is infecting both humans and animals.

purdue university banfield national companion animal surveillance program
Purdue University-Banfield National Companion Animal Surveillance Program
  • Established in 2004 at Purdue University School of Veterinary Medicine
  • Banfield, the Pet Hospital, largest provider of companion animal health care in U.S.
  • Serve approx. 2% of entire pet dog and cat population in U.S.
  • Includes guinea pigs, other rodents, birds, rabbits, ferrets, and reptiles.

Glickman LT, Moore GE, Blickman NW, et al. Purdue University-Banfield National Companion Animal Surveillance Program for Emerging and Zoonotic Diseases, Vector-Borne and Zoonotic Diseases. 2006: 6: 14-23.

purdue university banfield national companion animal surveillance program study
Purdue University-Banfield National Companion Animal Surveillance Program Study
  • Banfield hospital database searched for influenza-like illness in cats using syndromic surveillance (fever, cough, difficulty breathing) in 18 hospitals within 50 miles of Washington DC area.
  • Compared cat data to ILI in humans from emergency room data.

Glickman LT, Moore GE, Glickman NW, et al. Purdue University-Banfield National Companion Animal Surveillance Program for Emerging and Zoonotic Diseases. Vector-borne and Zoonotic Diseases. 2006; 6: 14-23.

international animal health infrastructure
International Animal Health Infrastructure
  • World Health Organization
  • World Animal Health Organization (OIE: Office International des Epizooties)
  • Food and Agriculture Organization
global surveillance systems
Global Surveillance Systems
  • WHO—Revised 2005 IHR and Global Outbreak Alert and Response Network (GOARN)
  • OIE—Terrestrial Animal Health Code
  • FAO—Emergency Prevention System for Transboundary Animal Diseases (EMPRES)
a tale of three outbreaks hpai influenza a h5n1
A Tale of Three Outbreaks: HPAI Influenza A (H5N1)
  • 1997 highly pathogenic avian influenza A (H5N1) outbreak in Hong Kong.
  • Surveillance of wild water fowl and domestic poultry facilitated early recognition of virus in humans.
  • Resurgence of virus in SE Asia in 2003 prompted an international response and global surveillance.
international response to hpai influenza a h5n1 outbreak
International Response to HPAI Influenza A (H5N1)outbreak
  • In 2006, global surveillance of H5N1 avian influenza in wild birds, poultry, and humans began.
  • Global Early Warning and Response System for Major Animal Diseases including Zoonoses (GLEWS)
  • Global Avian Influenza Network for Surveillance (GAINS)
slide46

Cumulative Human Avian Influenza (H5N1) Cases as of Sept. 24, 2009http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1inHumanCUMULATIVE_FIMS_20090924.png

nations with confirmed cases of avian influenza h5n1 as of july 7 2006
Nations with confirmed cases of avian influenza H5N1 as of July 7, 2006

http://www.flu.gov/map.html

predict
PREDICT
  • New project funded by USAID
  • Up to $75 million over 5 years
  • UC Davis School of Veterinary Medicine will lead consortium of organizations
  • Wildlife Conservation Society
  • Wildlife Trust
  • Global Viral Forecasting, Inc.
  • Smithsonian Institution
challenges ahead
Challenges Ahead
  • As the human population explodes, interactions with new zoonotic agents (e.g. viruses) from animal populations will continue to increase.
  • Can expect more emerging zoonotic diseases.
  • The One Health Initiative addresses the need for greater collaboration on many levels (individual, public health, and research) between human, animal, and public health professionals.
  • Many organizations and individuals endorse the One Health Initiative, but considerable effort remains to implement the concept nationally and globally.
challenges ahead50
Challenges Ahead
  • Legal
  • Logistical
  • Financial
  • Organizational
  • Philosophical