One Health: A Concept for the 21 st Century

1. One Health: A Concept for the 21st 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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.”

9. 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.

10. The Challenge of Zoonotic Diseases

11. Many Emerging Infectious Diseases are Zoonotic • Pandemic Influenza A • HIV/AIDS • West Nile virus • SARS • Monkeypox virus • Bovine Spongiform Encephalopathy • Rift Valley Fever

12. 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)

13. 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

14. 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

15. 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.

16. U.S. Department of Health and Human Services

17. 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.

18. U.S. federal agencies addressing animal diseasesAnimal Health at the Crossroads, National Academies Press 2005, page 36

19. 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.

20. U.S. Response to West Nile virus Outbreak • In 1999, the CDC established ArboNET. • A success story…

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

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

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

24. 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

25. Association of Zoos and Aquariums

26. 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)

27. Animals tested in 2001 Zoo animals tested in 2001: Preliminary Count 641 Preliminary count 641 for 2001

28. Animals tested in 2002 Zoo animals tested in 2002: Preliminary Count 6529 Preliminary count 6529 for 2002

29. Zoo animals tested in 2003: Preliminary count 3817 Preliminary count 3817 for 2003

30. Animals tested in 2004 Zoo animals tested in 2004: Preliminary count 2700 Preliminary count 2700 for 2004

31. Animals sampled in 2005 Zoo animals sampled in 2005: Preliminary count 1161 Preliminary count 1161 for 2005

32. Animals sampled in 2006 Zoo animals sampled in 2006: Preliminary count 814 Preliminary count 814 for 2006

33. Zoo Animal Health Network (ZAHN) • USDA • American Zoological Association (AZA) • Lincoln Park Zoo • National Animal Health Laboratory • http://www.zooanimalhealthnetwork.com/

34. 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.

35. 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.

36. 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)

37. 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.

38. 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.

39. 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.

40. Human and Cat Flu in Washington DC, 2004 Findings

41. International Human Health Infrastructure • World Health Organization

42. International Animal Health Infrastructure • World Health Organization • World Animal Health Organization (OIE: Office International des Epizooties) • Food and Agriculture Organization

43. 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)

44. 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.

45. 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)

46. Cumulative Human Avian Influenza (H5N1) Cases as of Sept. 24, 2009http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1inHumanCUMULATIVE_FIMS_20090924.png

47. Nations with confirmed cases of avian influenza H5N1 as of July 7, 2006 http://www.flu.gov/map.html

48. 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

49. 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.

50. Challenges Ahead • Legal • Logistical • Financial • Organizational • Philosophical