Kumar Venkitanarayanan, DVM, MVSc, MS, Ph.D.

Professor of Microbiology & Graduate Programs Chair

Department of Animal ScienceUniversity of Connecticut, USA

Advancing Global Health with

One Health Concept

http://www.globalchange.umich.edu/globalchange2/current/lectures/human_pop/human_pop.html

Global HealthHuman population growth

Emergence of infectious diseases

Global Health

Emerging and re-emerging diseases

Morens et al., 2004, Nature 430, 242-49

Factors influencing emerging and re-emerging zoonoses

Cohen et al., 2000. Nature ; Cutler et al., 2010 Emerg Infect Dis.

Human AnimalEcological

Global Collaborative Multidisciplinary Effort

Promote humans, animals and environment health

The one health concept in advancing global health

Aims of One Health

• Enhance integration, cooperation and collaboration between Human Medicine, Veterinary Medicine and Environmental Science

• Expand the scientific knowledge base• Accelerate biomedical research

discoveries• Improve human/animal medical

education and clinical care• Enhance public health efficacy

One Health-Organizations

• World Health organization (WHO)• World organization for Animal Health (OIE)• American Medical Association (AMA)• American Veterinary Medical Association

(AVMA)• American Society of Tropical Medicine and

Hygiene (ASTMH)• The Centers for Disease Control and

Prevention (CDC)• The United States Department of

Agriculture (USDA)• U.S National Environmental Health

Association (NEHA)

History of One Health

• 1821-1902: Rudolph Virchow- the link between human and animal health

• 1947: James Steele- The Veterinary Public Health Division at CDC

• 1927-2006: Calvin Schwabe- coined "One Medicine”

Historical milestones in One Health

• 2004: The Wildlife Conservation Society published the Manhattan principles.

• 2009: The one health office at CDC Key recommendations for one health developed

• 2011: The 1st One health congress held in Melbourne, Australia

The 1st One Health Conference held in Africa • 2012: The Global Risk Forum sponsors the first one

Health Summit. in Switzerland.

• 2013: The 2nd International One Health Congress in Thailand; 1000 attendees from 70 countries.

• Rabies

• Escherichia coli O157:H7

• Mad cow disease

• Lead poisoning

• Bacterial antibiotic resistance

Implementation of One Health concept for controlling infectious diseases

Rabies

• The oldest known zoonosis and may be the oldest known infectious disease

• Annually, kills 55,000 people in the world, 30,000 in India (60% total)

• 60% victims - Children under 16

• Dog bite - 95% human cases

• 100% case fatality rate

Rabies-Urban Cycle and Sylvatic cycle

(Pasteur Institute)

Rabies

• “Rabies is a vaccine preventable disease. The MOST COST EFFECTIVE STRATEGY for preventing rabies in people is to eliminate rabies in dogs through vaccination” (World Health Organization, 2010)

• Vaccinating 70% of dog population prevents 99% human infections

Case study in Bali, Indonesia

• Island wide mass vaccination program:March 2011- first phase of mass vaccination

program completed210,000 dogs vaccinated (70% dog population)

• Outcome: 84 human cases in 2011Only 8 reported cases in 2012

Philippines

• Community mobilization

– 15,000 persons involved in the program• Vaccination, CDC

training in field level diagnostic tests, Rabies education in school curriculum

Outcome:• No rabies reported

since 2008• Program strategy to be

self- sustainable when outside funding is no longer available

Latin America

• Surveillance• Community education and outreach• Mass vaccination program:

1977- 2011 99% decrease in both human and canine cases

One Health in Rabies-India

In India:• Rabies control is generally confined to small urban

pockets, with minimal interdisciplinary co-ordination

• Animal birth control and vaccination programs have limited success on an all India basis

• National Rabies control program in 12th plan of Gov. of India - Need of intensive 'One Health' program

Rabies- One Health Framework

Key Components• Recognize the importance of human-animal-

environment interface• Develop an Integrated, Multidisciplinary, and

Multiagency approach toward Rabies management

• Investment in risk-based rabies surveillance, intervention, outbreak prevention, control and elimination programs in primary host species

• Increased investment in rabies virus research, vaccine research, and development of prioritized targeted programs through research

• Public health education and awareness

(USDA 2012)

20

Major foodborne pathogen in the United States

Causes about 63,000 cases annually in the United

States

Cost the US economy ~ $1 billion per year

Causes hemorrhagic colitis, Hemolytic Uremic

Syndrome, kidney damage and brain damage

Escherichia coli O157:H7 (EHEC)

(Scallan et al., 2011)

21

Epidemiology

Recto anal junction

Terminal rectum

Colon Rumen

Principal reservoir host: cattle

(Naylor et al., 2003)

Routes of E. coli O157:H7transmission

E. coli O157:H7- Animal-Human-Ecosystem Dynamics

• Food-borne transmission• Contamination of environment/water from cattle

and other animal reservoirs• Cattle-to-cattle transmission• Cattle-to-human transmission• Human-to-human transmission

Verotoxin/Shiga toxin

• Major virulence factor• Binds with globotriaosylceramide (Gb3)

receptor

• Treatment- Supportive therapy- Antibiotics are contraindicated- No vaccines are available

E. coli O157:H7 and One Health

• Farm level: Surveillance, Intervention strategies, Vaccines

• Slaughter house and meat hygiene • Environmental hygiene: Considering

animal- ecosystem dynamics of water systems

• Agriculture: pre- and post-harvest interventions

• Community education: Adequate cooking and hygienic practices

• Medical Professionals: Scrutiny of suspected cases for E. coli O157:H7 and restrict antibiotic usage that potentially predisposes to HUS

Prion Diseases

• Infectious neurogenerative diseases

• Misfolded protein

• Transmissible particles devoid of nucleic

acid

• Humans (Creutzfeldt-Jakob disease (CJD),

variant CJD

• Cattle (BSE, mad cow disease)

• Sheep and goats (scrapie)

• Deer and elk (chronic wasting disease)

Bovine Spongiform Encephalopathy (Mad Cow Disease)

• The first case: United Kingdom in the mid 1980’s

• ~ 200,000 documented total cases in the UK

• Detected all over Europe, Japan and North America

• Meat and bone meal as a feed supplement

BSE in humans

• Linked to consumption of BSE-infected beef• Fewer than 200 vCJD cases worldwide• Long periods of asymptomatic infection (years to

decades in humans) • Destruction of brain cells – 100% fatal

Charlene Singh, first human form of mad cow disease (vCJD) victim in the U.S.

Mad cow disease- One Health Concept

• Co-ordinated control and research effort of veterinary, medical and environmental professionals for surveillance of BSE incidents in humans, animals and food chain

• 180,000 cattle have been infected and 4.4 million slaughtered during the eradication program in the UK

• Ruminant to ruminant feed ban• Complete ban of specified risk materials in

animal feed• Intensive surveillance for the disease

Annual Incidence of BSE

• Early 2010, Ducks began to disappear in Zamfara district.

• May 2010, Hundreds of children sick with vomiting, abdominal pain, headaches, seizures and death.

• Dr. Lora Davis, CDC animal-human interface officer

• Investigation found unsafe, high levels of lead in homes, community wells, and blood samples.

• Warning signs were missed: Ducks sentinels of environmental hazard

Lead poisoning investigation in

Zamfara, Northern Nigeria

• Judicious use of antibiotics in animals

• Preventing infections and the spread of resistance

• Tracking of infections due to resistant pathogens

• Improving antibiotic prescription/stewardship

• Developing new drugs and diagnostic tests

Application of One Health to control antibiotic resistance

• The Veterinary profession: Strong advocate and leader of One Health.

• Advantages: Holistic understanding and occupational interaction with

a multitude of animal species

Veterinary profession in One Health

Role of Veterinarians in One Health

Human Health

Ecological HealthAnimal Health

Control Zoonotic DiseasesBiomedical ResearchFood Quality and Safety

Disease surveillance and controlAnimal WelfareIncrease Domestic Animal Production

Protect BiodiversityNatural Resource ConservationWildlife Management

Gibbs and Gibbs, 2012

Education of professionals for One Health

• Multidisciplinary and core public health coursework includingEpidemiology and BiostatisticsPublic health and Zoonotic diseasesWildlife diseases and managementEnvironmental Health

• Supervised teaching and research

• Collaborative programs connecting the three disciplines.

• Internships in research laboratories

http://egh.phhp.ufl.edu/academic-programs/doctoral-programs/phd-in-one-health/

Veterinary medicine

Human Medicine

Environmental Sciences

• One world-one health concept for a healthier planet

• Be prepared for future challenges in global health

• Addressing connections between health and environment

Conclusion