Transcript Human and Animal Public Health Systems: Results of a Four

One Health: A Concept for
st
the 21 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
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Present Collaborators:
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Bruce Kaplan DVM, Dipl. AVES (Hon)
Tom Monath MD
Jack Woodall, PhD
Past Leaders:
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Calvin Schwabe DVM, DSc
19th century: Virchow, Osler
Many organizations and individuals
support the One Health Initiative
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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
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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
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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
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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
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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 19th Century
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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
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Virchow’s father was
a butcher.
Animal experiments
on life cycle of
Trichinella spiralis in
porcine muscular
tissue.
Cysticercosis and
tuberculosis in
cattle.
The Challenge of Zoonotic
Diseases
Many Emerging Infectious
Diseases are Zoonotic
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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
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
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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
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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
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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. Department of Health
and Human Services
U.S. Federal Animal Health
Infrastructure
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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.
U.S. federal agencies
addressing animal diseases
Animal Health at the Crossroads, National Academies Press 2005, page 36
A Tale of Three Outbreaks:
West Nile Virus
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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
In 1999, the CDC established
ArboNET.
 A success story…
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Mosquito WNV Infections 2002
http://westnilemaps.usgs.gov/2002/usa_mosquito_apr_22.html
WNV Positive Wild Birds 2002
http://westnilemaps.usgs.gov/2002/usa_avian_apr_22.html
Human WNV Cases 2002
http://westnilemaps.usgs.gov/2002/usa_human_apr_22.html
Zoos as a public health
resource
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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
Association of Zoos and
Aquariums
West Nile Surveillance System
for Zoological Institutions
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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)
Animals tested in 2001
Zoo animals tested in 2001: Preliminary Count 641
Preliminary count 641 for 2001
Animals tested in 2002
Zoo animals tested in 2002: Preliminary Count 6529
Preliminary count 6529 for 2002
Zoo animals tested in 2003: Preliminary count 3817
Preliminary count 3817 for 2003
Animals tested in 2004
Zoo animals tested in 2004: Preliminary count 2700
Preliminary count 2700 for 2004
Animals sampled in 2005
Zoo animals sampled in 2005: Preliminary count 1161
Preliminary count 1161 for 2005
Animals sampled in 2006
Zoo animals sampled in 2006: Preliminary count 814
Preliminary count 814 for 2006
Zoo Animal Health Network
(ZAHN)
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USDA
American Zoological Association (AZA)
Lincoln Park Zoo
National Animal Health Laboratory
http://www.zooanimalhealthnetwork.com/
A Tale of Three Outbreaks:
Monkeypox
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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
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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
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Approximately 63% of all U.S. households
own at least one pet.
Most commonly owned animals include:
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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)
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
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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
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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.
Human and Cat Flu in Washington
DC, 2004 Findings
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6
5
4
Cats (N=15,461)
3
Humans (N=40,999)
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1
Month
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Ju
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Ap
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% of Individuals
with Influenza-like
Illness
International Human Health
Infrastructure
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World Health Organization
International Animal Health
Infrastructure
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World Health Organization
World Animal Health Organization (OIE:
Office International des Epizooties)
Food and Agriculture Organization
Global Surveillance Systems
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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)
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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
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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)
Cumulative Human Avian Influenza
(H5N1) Cases as of Sept. 24, 2009
http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1inHumanCUMULATIVE_FIMS_20090924.png
Nations with confirmed cases of avian
influenza H5N1 as of July 7, 2006
http://www.flu.gov/map.html
PREDICT
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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
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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 Ahead
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Legal
Logistical
Financial
Organizational
Philosophical
Time to Embrace One Health
Thank you!