Heather Bair-Brake, MS, DVM, Dipl ACVPM

1. Zoonoses: A One Health Perspective Division of Global Migration & Quarantine Centers for Disease Control and Prevention Heather Bair-Brake, MS, DVM, Dipl ACVPM

2. We are not a population of people, in populations of dogs, cats, horses www.ashlandcountyfair.org We are all interconnected.

3. Presentation Overview • Zoonoses • Historical developments • Disease emergence • Transmission • Case Studies • CDC’s role in One Health • Questions & discussion

4. What are Zoonoses? “Animal diseases that are transmissible to humans.” - World Organization for Animal Health (OIE)

5. What are Zoonoses? “Any disease or infection that is naturally transmissible from vertebrate animals to humans. Animals thus play an essential role in maintaining zoonotic infections in nature…” - World Health Organization

6. What are Zoonoses? “Any infectious disease that can be transmitted (in some instances, by a vector) from nonhuman animals, both wild and domestic, to humans or from humans to nonhuman animals.” - Wikipedia

7. Zoonoses Through History

8. Zoonoses: The Distant Past 1885 BC Reports written in the Sumerian Code of Roman soldiers brought down by terrible sickness, now believed to be rabies. 2000 AD 2000 BC 1000 BC 1000 AD

9. Zoonoses: The Distant Past 430 BC, Athens Following the invasion of the Spartans, an epidemic swept across the Mediterranean Sea from Northern Africa and devastated the population. Scholars believe that the outbreak could have been typhus, plague or Rift Valley Fever. 2000 AD 2000 BC 1000 BC 1000 AD

10. Zoonoses: The Distant Past 1347 AD The Black Death spread across Europe, killing ~ 50% of the population. Yersinia pestis was the causative agent. 2000 AD 2000 BC 1000 BC 1000 AD

11. Zoonoses: The Recent Past 1918 - 1919 More than half the world’s population was affected by the “Spanish” Influenza. 40 million deaths were reported. Molecular analysis has identified this influenza as an H1N1 strain of avian origin. 2000 AD 1900 AD 1925 AD 1975 AD 1950 AD

12. Zoonoses: The Recent Past 1994 Hendra virus identified as the cause of neurologicaland respiratory illnesses reported among horses and people in Australia. • 1999 • West Nile virus appeared in New York City. 1976 Ebola virus caused outbreak of hemorrhagic fever in Zaire. 1994 Outbreaks of encephalitis and respiratory illness in Malaysia and Singapore were caused by Nipah virus. 2000 AD 1900 AD 1925 AD 1975 AD 1950 AD

13. Zoonoses: The Recent Past 2003 SARS, a strange respiratory illness first reported in China, swept across the globe, affecting over 8000 people on 4 continents. • 2003 • Highly pathogenic avian influenza A (H5N1), first identified in 1996, began to spread.  As of August 2011, there have been 565 cases and 331 deaths in 15 countries, with the largest number from Indonesia, Viet Nam and Egypt. 2000 AD 1900 AD 1925 AD 1975 AD 1950 AD

14. Zoonoses: The Recent Past 2009 Pandemic H1N1 2009 marked the first influenza pandemic since the “Hong Kong” Flu of 1968. The virus was a quadruple reassortant influenza A virus of one human, one swine and two avian viruses. 2000 AD 1900 AD 1925 AD 1975 AD 1950 AD

15. Zoonoses: The Present 2011 and beyond… Emerging infectious and zoonotic diseases are increasing in incidence. Approximately one new pathogen is discovered each year. Endemic zoonotic diseases continue to cause morbidity and mortality around the world. 2000 AD 1900 AD 1925 AD 1975 AD 1950 AD

16. Zoonoses: The Present • 60% of human pathogens are zoonotic • Approximately 75% of all emerging infectious diseases are of animal origin

17. Credithttp://www.onehealthinitiative.com/map.php

18. Why Diseases Emerge: The Microbial “Perfect Storm”

19. Factors for Emergence • Globalization • Rapid mass movement of people, animals, and goods • Climate change • Microbial adaptation and change • Social and political events

20. Factors for Emergence • Demographic changes • Greater human population and density • Movement into new environments • Increased contact with animals • Habitat encroachment • Lifestyle practices • Intensification of animal production systems

21. Globalization International Tourist Arrivals by Region (in Millions) • UNWTO Tourism Highlights 2010 by the World Tourism Organization

22. There is no where in the world from which we are remote and no one from whom we are disconnected PNAS, 2004

23. Commerce and Trade • World of “collapsed space” – smaller, faster and progressively more interconnected • 6 million food shipments come into the United States each year with a small percentage inspected

24. Globalization of the World’s Food Supply

25. Demographic Changes

26. Demographic Changes • Shift to megacities and urban sites • Greatest migration of people in history • 1900 – 13% urban • 2007 – 50%+ urban • Creation of new niches for microbes, vectors, and animals

27. Increased Contact with Animals • Enteric pathogens • Salmonella • Lymphocytic Choriomeningitis Virus • E. coli • Monkeypox

29. Intensification of Animal Production Systems Concentrated Animal Feeding Operations (CAFO)

30. Modes of Disease Transmission • Direct contact • Indirect contact • Aerosol • Droplet • Fecal-oral • Vectorborne

31. Waterborne Illness • Burden of illness • ~4 billion cases of diarrhea occur annually • 88% attributable to unsafe water • Sources of zoonotic water contamination • Animal feces and urine • Animal carcasses • Agricultural run-off

32. Waterborne Illness • Methods of transmission: • Direct • Contaminated water • Indirect • Water-related activities • Occupational exposure • Contaminated foodstuffs • Inhalation

33. Foodborne Illness Burden of illness in the United States: • 31 major pathogens • 9.4 million episodes of disease annually • 55, 961 hospitalizations • 1,351 deaths • Unspecified agents: • 38.4 million episodes of disease annually • 71, 878 hospitalizations • 1, 686 deaths

34. Foodborne Illness Animals can be a source of these pathogens • Direct • animal products (meat, milk, eggs or related products) • Indirect • contamination of food

35. The Animal’s Role

36. Examples • E. coli in baby spinach • Rift Valley Fever • Cryptosporidiosis at a summer camp

37. Salinas Valley – “Salad Bowl of the World”

38. Leafy green-associated E. coli O157:H7 in the last 12 years 22 outbreaks 12 traced back to California Most traced to fields in the Salinas Valley E. coli and Leafy Greens

39. 205 human cases (in 26 states and Canada) 2006 Spinach-Associated E. coli O157:H7

40. 2006 Spinach-Associated E. coli O157:H7 • Transmitted through bagged, fresh baby spinach • Traced to 1 processing plant • Associated with fields on 4 ranches

41. Baby Spinach Harvesting

42. Role of Livestock: Cattle

43. Role of Wildlife: Feral Swine

44. Role of Environment: Water Source

45. Isolates collected Cattle feces on ranch located 1 mile away Feral swine trapped near spinach fields All matched the outbreak strain by PFGE pattern 2006 Spinach-Associated E. coli O157:H7

46. 2006 Spinach-Associated E. coli O157:H7

48. Rift Valley Fever

49. Rift Valley Fever • 2006-2007, Kenya outbreak • > 400 cases • >100 deaths • Transmission • Mosquito-borne • Exposure to contaminated blood and tissues • Leads to acute, febrile illness in domestic livestock • High mortality rates in young animals • Abortions • Epizootics associated with heavy rainfall

50. Rift Valley Fever: Risk to Humans • Disease presentation is variable: • Asymptomatic • Mild and self-limiting • Hemorrhagic fever • Encephalitis • Ocular disease