LONNIE J KING DVM, MS, MPA, DACVPM DIRECTOR, NATIONAL CENTER FOR ZOONOTIC, VECTOR--BORNE, & ENTERIC DISEASES CENTERS FOR DISEASE CONTROL & PREVENTION

One Health: A Contemporary Gateway to Infectious Disease

and Public Health

PulseNet Update MeetingSt. Louis, Missouri

April 15, 2008

Why Diseases Emerge

Genetic and biological factors– Microbial adaptation and change– Human susceptibility to Infection

Physical environmental factors– Climate and weather– Economic development and land use

Ecological factors– Changing ecosystems– Human demographics and behavior

Social, political, and economic factors– International Travel and commerce– Poverty and Social inequity– War and Famine– Lack of political will– Intent to harm

Physical and Environmental

Factors

Physical and Environmental

Factors

Ecological Factors

Ecological Factors

HumansHumans

WildlifeWildlife

AnimalsAnimals

E I DE I D

Social, Political, and Economic

Factors

Social, Political, and Economic

Factors

Genetic and Biological Factors

Genetic and Biological Factors

Convergence Model

Human Health

Animal Health Environmental Health

The Convergence: A New Public Health Kaleidoscope Emphasizing One Health

One Health is the collaborative effort of multiple disciplines – working locally, nationally and globally - to attain optimal health of humans, animals and our environment.

ONE HEALTH

CDC’s Most Significant Global Epidemics Over the Last 15 Years

• 1993 – Hanta virus

• 1994 – Plague (India)

• Ebola virus (Zaire)

• 1996 – New Variant of CJD (UK)

• H5 N1 influenza (Hong Kong)

• 1998 – Nipah virus (Malaysia)

• 1999 – West Nile

• 2000 – Rift Valley Fever

• 2001 – Anthrax

• 2002 – Norwalk-like viruses

• 2003 – SARS

• 2004 – Marburg Virus

• 2005 – H5 N1 Influenza

• 2006 – E. coli

… a multidisciplinary strategy to prevent, control, and, where possible, eliminate infectious diseases within a larger ecological context that includes humans, animals, and plants interacting in a complex, ever-changing natural environment.

Human Health

Animal Health Environmental

Health

The Convergence: A New Public Health Kaleidoscope Emphasizing One Health

Through the Lens of Human Health

Trends in Global PopulationTrends in Global Population

Less developed countries

More developed countries

706560551950 75 80 85 90 95 2000 05 10 150

1

2

3

4

5

6

7

8Billions

TotalGlobal Population: 1950-2015

Source: US Bureau of the Census

www.hat.net

Shift to MegaCities and Urban Sites

• Greatest migration of people in history

• 1900 – 13% urban; 2007 – 50%+ urban

• Peri-urban areas – newest sites of confluence

• Urbanization is now largely a phenomenon of poor/middle class countries

• Creation of new niches for microbes, vectors, and animals

www.basgweb.org

The Black Death

(www.scienceclarified.com )

Animals, Waste, and the Risk of Disease Emergence

Urban and Peri-urban Agriculture

• Water, food security, sanitation, waste, and income

• Informal settlements in city perimeters

• Double health burden: infectious and environmental hazards

• Food security and employment• Nutrient recycling

Source: FAO, WHO, Source: FAO, WHO, RimsaRimsa, Mexico City April 2005, Mexico City April 2005

Poultry population densityPoultry population density

Human population densityHuman population density

Figure 1.2. Human and livestock densities, and main feed production areas as affected by the distance to Bangkok

Hum

an a

nd a

nim

al d

ensi

ty

140

120

100

80

60

40

20

0

Mea

n no

rmal

ized

cro

p pr

oduc

tion60

50

40

30

20

10

0

Distance to Bangkok (km)50 100 150 200 250 300 350 400 450 500

Source: Gerber and others 2005.

human population (nb/km2/10)

chicken (nb/km2/10) cassava (tons/km2/2)

maize (tons/km2)soybean (10 tons/km2)

pigs (nb/km2/10)

www.dec.state.ak.us

PNAS, 2004

There is no where in the world from which we are remote and no one from

whom we are disconnected

Human Demographics

Migration and Translocation is unparalleled

Peri-Urban centers

Immuno-compromised population

Aging population- “baby boomers”

Rapid growth in developing world

Exposures to wildlife and vectors

Recreational practicesShift to foods from animal-proteins Under-nutrition vs. Over-nutritionHealthcare vs. health promotion and

preventionHealth disparities and exposure bias

Human Health

Animal Health Environmental

Health

The Convergence: A New Public Health Kaleidoscope Emphasizing One Health

Through the Lens of Animal Health

Concentrated Animal Feeding Operations (CAFOs)

Their Impact on Food Safety andTheir Impact on Food Safety andHealthy EnvironmentsHealthy Environments

Livestock 2020 – The Next Food Revolution

• Global increase and demand for protein and food of animal origin

• Shift from poverty of 1-2 billion people to middle class

• “Westernization” of Asia and Latin America• Concerns with sustainability• Increases in emerging zoonoses through

the concentration of people and animals

Last year, over 21 billion food animals were produced to help feed a population of over 6 billion people

resulting in trillions of pounds of products distributed worldwide.

Projections toward 2020 indicate that the demand for animal protein will increase by 50%, especially in

developing countries.

Multihost Pathogens

•

60% of all human pathogens are zoonotic

•

80% of animal pathogens

•

Ecological generalists

Microbial View

Burden of Foodborne Illness

• Estimated 76 million cases 1 in 4 Americans

• 323,000 hospitalizations1 in 1000

• 5000 deaths each year in the U.S.

010000200003000040000500006000070000

1996199

719

981999200

020

0120022003200

420

052006200

7PFGE patterns submitted to PulseNet Databases 1996- 2007

Annual Submissions to PulseNet

Prevention Intervention

Outbreak prediction

Outbreak investigationand response

CaseReporting

Surveillance

New Paradigm

Infectious Disease Ecology

• Accelerating prevention, control, & elimination of ecology-mediated microbial threats

• Systems approach with cross-cutting themes

• Global organization

Animal Health Human Health

Ecosystem Health

Nipah Virus

Virus Carriers

Fruit batsFruit bats

Annual Global Trade in Exotic Animals

• 4 million birds• 640,000 reptiles• 40,000 primates• Illegal trade unknown – estimate

$4-6 billion- Wildlife Conservation

Society

Pandemic Influenza

CRITICAL CONTINUUM

Animal and human health are a continuum of causality and events and need to be viewed as a continuum and integration of strategies

Stages of Pathogen Evolution

Wolfe, ND, et al. Nature. May 2007.

Human Health

Animal Health Environmental

Health

The Convergence: A New Public Health Kaleidoscope Emphasizing One Health

Through the Lens of Environmental Health

Ecosystem

Because the urban poor live in these appalling sanitary conditions, urban cities are ideal breeding grounds for vector- borne diseases and are also hot spots for civil uprisings.

Rapid growth (rapid urban growth) in undeveloped countries have led to:• shortages of basic social services• a glaring lack of infrastructure• chronic air and water pollution.

Waterborne Zoonoses

Animals Humans

MicrobialPathogens

WaterborneDisease

Water Environment

What is Happening with Cryptosporidiosis Reporting?

WaterborneChlorine resistant

Median Rank of Annual WNND Incidence by County, 2002 to 2007

The edge or transition zone between two adjacent ecological systems

Ecotone

- are dynamic and more complex constitutes of ecological systems that influence biodiversity and ecosystem function disproportionately to their geographic extent

- are areas where biophysical factors biological activity and ecological evolutionary processes are concentrated and intensified

-Include zones of interaction where large- scale land use change produces moving fronts of human settlements

Ecotones

Despommier D, Ellis BR, Wilcox BA (2007) The role of ecotones in emerging infectious diseases. EcoHealth 3:281–289

• Caused by Borrelia burgdorferi

• Transmitted by Ixodes spp. ticks

• Recognized in 1975 in Lyme, Connecticut

• Causes skin rash, neurological disease, arthritis

Lyme Disease

EID Associated with Ecotones

Lyme disease had been affected by a complex set of mechanisms involving ecotonal factors and forest fragmentation and encroaching human settlements.

The Lyme disease incidence is rising due to…

Expansion of suburbia into wooded areas

Increased exposure opportunities

Overabundant deer populations

Increased numbers of ticks

Whitetail deer serve as hosts to the ticks which carry the bacteria, Borrelia burgdorferi,responsible for Lyme disease.

Lyme disease cases reported to CDC, United States, 1992-2005

0

5,000

10,000

15,000

20,000

25,000

1992 1994 1996 1998 2000 2002 2004

Year

Cas

es

Climate Change: Potential Negative Health Impacts

Climate change:• Temperature

rise• Sea level rise• Hydrologic

changes

HEAT Heat stress, cardiovascular failure

SEVERE WEATHER Injuries, fatalities

AIR POLLUTION Asthma, cardiovascular disease

ALLERGIES Respiratory allergies, poison ivy

VECTOR-BORNE AND OTHER ZOONOTIC DISEASES

Malaria, dengue, hantavirus, Rift Valley fever

WATER-BORNE DISEASESCholera, cryptosporidiosis, campylobacter, leptospirosis, Vibriosis, Naegleria

WATER AND FOOD SUPPLYMalnutrition, diarrhea, harmful algal blooms, hygiene-related diseases

MENTAL HEALTH Anxiety, despair, depression, post-traumatic stress

ENVIRONMENTAL REFUGEES CIVIL CONFLICT

Morbidity, mortality and migration

Adapted from J. Patz

Cholera dynamics in areas of South America (Peru) and the Bay of Bengal were affected by El Niño - Southern Oscillation (ENSO) driven anomalies.

An El Nin˜o event in 1991 may have triggered in the resurgence of cholera in Peru where warm waters along the coast, with plankton blooms driven by El Nin˜o rains, may have amplified the population of V. cholerae already in the environment.

Peru had economic consequences with close to $800 million loss in seafood exports and $250 million loss in tourism.

Commerce and Trade - A New Built Environment of Global

Enterprises• World of “collapsed space” – smaller,

faster and progressively more interconnected

• Annual global trade (2006) - $12 trillion• 6% annual growth projected• 90% of global trade is between private

corporations• Of the top 100 global economies, over half

are private international companies• 6 million food shipments come into the

U.S. each year with a small % inspected

Globalization of Food Supply

Worldwide Ship Traffic

Global Distribution of Foods, Animals and Products

Risk of exotic importation is increasing

• Already imported: West Nile virus, plague, yellow fever, dengue, malaria

• Current threats include Chikungunya, Rift Valley fever, JE, and urban Yellow Fever

• Epidemiology may be very different from that in natural endemic area

Used Tires Stored at Other LocationsUsed Tires Stored at Other Locations

Reported distribution of Aedes albopictus in the U.S., 2005

Global Distribution of Dengue Virus Serotypes, 2007

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3

DEN-1DEN-2DEN-3DEN-4 DEN-1

DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

Global Trends in Emerging Infection Diseases (EID)

335 EID events: 1940-2004 Steady increase with peak decade in 198020.9% drug-resistant microbes22.8% vector-borne (28.8% in the last decade)

Jones, K.E. et al Global trends in emerging infectious disease Nature 451:21 2/2008

Global Trends in Emerging Infection Diseases

A: zoonotic pathogens from wildlife B: zoonotic pathogens from non-wildlifeC: drug-resistant pathogens D: vector-borne pathogens

Surveillance bias and wrong focus

A B

C D

Jones, K.E. et al Global trends in emerging infectious disease Nature 451:21 2/2008

Foresight Analysis• EID are the “New normal”• Expect 3-4 new EID annually; 8-34 by

2015• 87 new EID since 1980

- 58 viruses… 49 RNA - mostly zoonotic

• Found worldwide but proximity to animal populations or products is the key risk factor

• Change in the host-pathogen ecology will be the most important single driver

Convergence Challenges

• Impact and influence beyond health – goods, services and economies

• A shift from problem solving to managing dilemmas

• A new global interdependence and connectivity • Factors creating the microbial storm are well

entrenched• Reconciliation of great change with habitual and

traditional thinking and ways of working• Adopting a “One Health – One Medicine” mindset

and strategy

Gateway for Pulsenet

• Global applications• Expanding to new pathogens• Improving epidemiology • Shift from detection to prevention• New interest: global food system, U.S.

imports, food security, and political • Scalability, throughputs, level of

sophistication and IT capabilities• Linking the domains of One Health

Human Health

Animal Health

Environmental Health

One World −

One Health