One Health: A Concept for the 21st Century

Laura H Kahn, MD, MPH, MPP, FACPResearch Scholar

Program on Science and Global Security, Princeton UniversityEighth Annual International Society for Disease Surveillance

Conference

December 3, 2009

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

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 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

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

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

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

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 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

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 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

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. 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 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

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…

Mosquito WNV Infections 2002http://westnilemaps.usgs.gov/2002/usa_mosquito_apr_22.html

WNV Positive Wild Birds 2002http://westnilemaps.usgs.gov/2002/usa_avian_apr_22.html

Human WNV Cases 2002http://westnilemaps.usgs.gov/2002/usa_human_apr_22.html

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

Association of Zoos and Aquariums

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)

Animals tested in 2001

Preliminary count 641 for 2001

Zoo animals tested in 2001: Preliminary Count 641

Animals tested in 2002

Preliminary count 6529 for 2002

Zoo animals tested in 2002: Preliminary Count 6529

Preliminary count 3817 for 2003

Zoo animals tested in 2003: Preliminary count 3817

Animals tested in 2004

Preliminary count 2700 for 2004

Zoo animals tested in 2004: Preliminary count 2700

Animals sampled in 2005

Preliminary count 1161 for 2005

Zoo animals sampled in 2005: Preliminary count 1161

Animals sampled in 2006

Preliminary count 814 for 2006

Zoo animals sampled in 2006: Preliminary count 814

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 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

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

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

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

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

0

1

2

3

4

5

6

7

Month

% of Individuals with Influenza-like

Illness

Cats (N=15,461)

Humans (N=40,999)

International Human Health Infrastructure

World Health Organization

International Animal Health Infrastructure

World Health Organization World Animal Health Organization

(OIE: Office International des Epizooties)

Food and Agriculture Organization

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)

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

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, 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

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

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 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

Legal Logistical Financial Organizational Philosophical

Time to Embrace One Health

Thank you!