Veterinary Medicine and One Health Protecting the health of people, animals, and the environment

1. Veterinary Medicine andOne HealthProtecting the health of people, animals, and the environment Andrew T. Maccabe, DVM, MPH, JD Executive Director, AAVMC August 25, 2012 University of Saskatchewan

2. Veterinary Medicine andOne Health • What veterinarians do – a brief history • How veterinary medicine contributes to One Health • How health professionals can collaborate to advance One Health

3. One Health Animal Health Human Health Environmental Health

4. “Between animal and human medicine there are no dividing lines – nor should there be. The object is different but the experience obtained constitutes the basis of all medicine” - Rudolph Virchow, 1821-1902

5. First Wave – Late 1800’s • Veterinary medicine emerges as a separate profession • Horses provide critical infrastructure • Transportation, agriculture, war effort • Land Grant Act of 1862 • “To teach such branches of learning as are related to agriculture and the mechanic arts”

6. Second Wave – Early 1900’s • Steam engine, internal combustion engine • The end of veterinary medicine? • Increasing value of livestock • Agricultural Experiment Stations • Smith-Lever Act of 1914 – cooperative extension • Disease control and eradication • Tuberculosis, Brucellosis control programs • Golden Age of antibiotics

7. Third Wave – Late 1900’s • Integrated food animal production systems • Rural community service veterinarians • Food supply veterinarians • Increasing Urbanization • Changing role of companion animals • Increasing specialization

8. Board-certified specialties • Surgery • Toxicology • Dermatology • Ophthalmology • Anesthesiology • Internal medicine • Emergency care

9. Board-certified specialties Surgery Toxicology Dermatology Ophthalmology Anesthesiology Internal medicine Emergency care Animal Behavior Animal Welfare Laboratory Animal Theriogenology Poultry Medicine Preventive Medicine Zoological Medicine

10. Fourth Wave – Early 2000’s • Antibiotic resistance • Population growth, globalization • Emerging and re-emerging infectious diseases

11. Veterinary Medicine andOne Health “Today’s veterinarians are trained to protect the health of both animals and people. They address the health needs of every species of animal and they also play a critical role in environmental protection, food safety, animal welfare, and public health.”

12. Veterinary Medicine andOne Health “Today’s veterinarians are trained to protect the health of both animals and people. They address the health needs of every species of animal and they also play a critical role in environmental protection, food safety, animal welfare, and public health.” Comparative Medicine Population Health Ecosystem Health Food Safety Zoonoses

13. Consume food 0

14. Onset of symptoms Consume food 0 2

15. Onset of symptoms Consume food Collect stool sample 0 2 4

16. Onset of symptoms Stool culture result Consume food Collect stool sample 0 2 4 7

17. Onset of symptoms Stool culture result Consume food Collect stool sample Case report to PH dept 0 2 4 7 9

18. Onset of symptoms Stool culture result Submit isolate to PH lab Consume food Collect stool sample Case report to PH dept 0 2 4 7 9 10

19. Onset of symptoms Stool culture result Submit isolate to PH lab Consume food Collect stool sample Case report to PH dept Case interview 0 2 4 7 9 10 14 Hedberg, CW, et al. Timeliness of enteric disease surveillance in 6 US states. EmergInfDis J 14(2), February, 2008.

20. PFGE Subtyping Upload to PulseNet Onset of symptoms Stool culture result Submit isolate to PH lab Consume food Collect stool sample Case report to PH dept 0 2 4 7 9 10 18

21. National Cluster Detection (CDC) PulseNet laboratory network detects widespread clusters of infections DNA “Fingerprint” patterns of Salmonella PulseNet National Database (CDC) Public Health Labs in Each State All State labs and many big city labs participate in PulseNet, along with CDC, USDA and FDA Cluster Evaluation by CDC and States

22. PulseNet Data Analysis: Searching for Clusters • State health depts submit patterns electronically • CDC searches for similar patterns in past 2-4 months • CDC compares patterns visually • When cluster identified, PulseNet contacts epidemiologists Cluster of indistinguishable patterns

23. PFGE Subtyping Upload to PulseNet Onset of symptoms Stool culture result Submit isolate to PH lab Consume food Collect stool sample Case report to PH dept Cluster ID 0 2 4 7 9 10 18

24. PFGE Subtyping Upload to PulseNet Onset of symptoms Stool culture result Submit isolate to PH lab Epi investigation Consume food Collect stool sample Case report to PH dept Cluster ID 0 2 4 7 9 10 18

25. PFGE Subtyping Upload to PulseNet Onset of symptoms Stool culture result Submit isolate to PH lab Epi investigation Consume food Collect stool sample Case report to PH dept Cluster ID Case interview 0 2 4 7 9 10 18

26. PFGE Subtyping Upload to PulseNet Onset of symptoms Stool culture result Submit isolate to PH lab Epi investigation Product implicated Consume food Collect stool sample Case report to PH dept Cluster ID Case interview 0 2 4 7 9 10 18

27. PFGE Subtyping Upload to PulseNet Onset of symptoms Stool culture result Submit isolate to PH lab Epi investigation Product implicated Consume food Collect stool sample Case report to PH dept Cluster ID Case interview 0 2 4 7 9 10 18 Days Weeks Months

28. Estimates of Foodborne Illness (US)Scallan, et. al., Emerg Infect Dis, Jan 2011.

29. Outbreak Investigations • Goals of investigations • Immediate control of outbreak; prevention of illnesses • Identify gaps in food safety systems • Outbreak epidemiology changing • Globalization, centralization, industrialization • Number of outbreaks detected has grown substantially • Effective investigation is key to reducing burden of foodborne disease • Identify food vehicles and factors which lead to outbreaks

30. Old Focal scenario Large number of cases in one jurisdiction Detected by affected group Local investigation Local food handling error Local solution Foodborne Disease Outbreaks

31. Old Focal scenario Large number of cases in one jurisdiction Detected by affected group Local investigation Local food handling error Local solution Foodborne Disease Outbreaks • New dispersed scenario • Small numbers of cases in many jurisdictions • Detected by lab-based subtype surveillance • Multistate/Country investigation • Industrial contamination event These changes make coordination among multiple states and agencies, and countries even more important than before

32. Preventing Foodborne Disease “Farm to Fork” On-farm good agricultural practices Good manufacturing practices & inspection Designing processes for safety Microbial monitoring Restaurant/store codes & inspection Consumer education 32

33. Challenge: New Food Vehicles 12 new food vehicles since 2006: Bagged spinach E. coli O157 Carrot juice Botulism Peanut butter/peanut paste Salmonella Broccoli powder on a snack food Salmonella Dog food Salmonella Turkey pot pies Salmonella Canned chili sauce Botulism Hot peppers Salmonella White pepper Salmonella Raw cookie dough E. coli O157 Puffed breakfast cereal Salmonella Cracked red and black pepper Salmonella on salami

35. Zoobiquity • Animals and humans get the same diseases, yet physicians and veterinarians almost never talk to each other • Zoobiquity brings together human doctors and animal doctors to treat the diseases shared by patients of many species

36. Self-injury in a German Shepherd Osteosarcoma in a Golden Retriever Obesity in a Domestic Shorthair Panda in utero Self-injury in an adolescent female Osteosarcoma in a teenage male Male fetus in utero Obesity in an adult female

37. Zoobiquity • Capture Myopathy in prey animals • Animals caught by predators experience a catastrophic surge of adrenaline • Results in widespread myopathy, including cardiomyopathy • TakotsuboCardiomyopathy in humans • Classic heart attack symptoms, but no blockage • Caused by intense painful emotion

38. Surge of stress hormones Emotional trigger Failing heart Possible death Same syndrome, different names?

39. Surge of stress hormones Emotional trigger Failing heart Possible death • Same syndrome, different names? • Not the overlap, but the GULF • Capture myopathy was described over 40 years ago • Takotsubocardiomyopathy was discovered in early 2000

40. Zoobiquity • Siamese cats and Dobermans get OCD; many are on Prozac • Canaries, fish, and Yorkiedogs faint when they’re stressed out • Mares can become nymphomaniacs • Koalas catch Chlamydia, rabbits get syphilis • Reindeer seek out narcotic escape in hallucinogenic mushrooms

41. Deep Homology • The human genome is 98.6% similar to chimpanzees • Nearly identical clusters of genes link mammals, reptiles, birds, and insects • Genes from a sighted mouse placed into a blind fruit fly can cause the fly to grow structurally accurate eyes • Visual acuity in a hawk, based on responsiveness to light, is linked to photosensitivity in green algae

42. Epigenetics • Describes how infections, toxins, food, and even cultural practices can turn genes on and off to alter an animal’s development • Helps explain rapid evolutionary change and highlights the role of the environment

43. One Health Animal Health Human Health Environmental Health

44. One Health Deep homology Animal Health Human Health Epigenetics Environmental Health

45. Person becomes ill

46. Person seeks medical care Person becomes ill

47. Stool sample collected Person seeks medical care Person becomes ill

48. Pathogen identified Stool sample collected Person seeks medical care Person becomes ill

49. Isolate submitted to PH lab Pathogen identified Stool sample collected Person seeks medical care Person becomes ill

50. PFGE subtyped and uploaded Isolate submitted to PH lab Pathogen identified Stool sample collected Person seeks medical care Person becomes ill