One Health: A New Paradigm to Address Infectious Diseases · Food safety and security Global Trade/commerce Ecosystems Climate change Land use Mental health ... Under-nutrition vs

09/12/2012

Tennessee Public Health Association_2012 1

One Health: A New Paradigm to Address Infectious Diseases

TPHA Franklin, TN

September 12, 2012

Lonnie King, DVM, MS, MPA, DACVPMDean College of Veterinary Medicine

Executive Dean Health Science Colleges

Ruth Stanton Chair in Veterinary Medicine

The Ohio State University

OBJECTIVES OF PRESENTATION

Discuss the definition and scope of One health

Elucidate the factors and forces creating the new EID Era and the need for One Health

Demonstrate how the changes in human, animal and environmental domains will challenge PH’s future

Help you envision how One Health will allow you to better improve health in your work and jobs

Give you a foundation to better appreciate other presentations and the focus on this conference on One Health, One Environment and One World

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Historical Epidemiological Transitions

Paleolithic Age

Hunters and gatherers

Nomadic

Small populations

Parasitic infections

Historical Epidemiologic Transitions –1st Transition

10,000 years ago

New social order due to agriculture

Zoonoses through animal domestication

Increases in infectious diseases

Epidemics in non-immune populations

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Deadly Gifts

Human Diseases Animal Origin

Measles Rinderpest of cattle

TB M. bovis of cattle

Smallpox Cowpox

Influenza Pigs and Ducks

Pertussis Pigs and Dogs

Malaria Birds

Guns, Germs and Steel J. Diamond

Historical Epidemiologic Transitions –3rd Transition

Last 30 years

Emerging infectious diseases globally

New diseases and increases in mortality;first since 19th century

Re-emergence

Antimicrobial resistance

75 percent are zoonotic

Anthropogenic factors of emergence;the microbial “perfect storm”

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Physical and Environmental

Factors

Ecological Factors

Humans

Wildlife

Animals

E I D

Social, Political, and Economic

Factors

Genetic and Biological Factors

Convergence Model

Why Diseases EmergeGenetic and biological factors

Microbial adaptation and changeHuman susceptibility to Infection

Physical environmental factorsClimate and weatherEconomic development and land use

Ecological factorsChanging ecosystemsHuman demographics and behavior

Social, political, and economic factorsInternational Travel and commercePoverty and Social inequityWar and FamineLack of political willIntent to harm

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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)

H5N1 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 – H5N1 Influenza

2006 – E. coli

2007 – P.I.N.

2008 – Salmonella StPaul

2009 – H1N1 Influenza

2010 – Cryptococcus

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Microbial View

Multihost Pathogens

60% of all humanpathogens are zoonotic

80% of animal pathogens

Ecological generalists

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Wicked Issues/Dilemmas

Characteristics of a Wicked Problem or Dilemma:

Complex and tangled

Unprecedented

Difficult to define and enigmatic

Solution is not binary; many choices

Often generate unexpected consequences

Unique and past experiences not helpful

Threatening

Often a symptom of another issue/problem

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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.

What is One Health?

Definition

Holistic, integrative and collaborative

New scientific niche for health

Emphasis on: multiple disciplines and professions; prevention and expansion of professionalknowledge and experiences

Appreciation of the connectivityof domains of health

Targeted research portfolio

One Health

Environment

Human disease

Animal Disease

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The Scope of One Health

Agriculture systems

AMR

Biomedical research

Comparative medicine

Conservation medicine

Diagnostics

Entomology

Food safety and security

Global Trade/commerce

Ecosystems

Climate change

Land use

Mental health

Occupational health

Public policy

Biodiversity

Wildlife health/manage

The Convergence: A New Public Health Kaleidoscope Emphasizing One Health

Animal Health

EnvironmentalHealth

Human Health

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Animal HealthEnvironmental

Health

Human Health

Less developed countries

More developed countries

1950 20000

1

2

3

4

5

6

7

8Billions

1005959085807570656055 15

Year

Global Population: 1950-2015

Source: US Bureau of the Census

Trends in Global Population

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Greatest migration of people in history

• 1900 – 13% urban;

• 2007 – 50%+ urban

Peri-urban areas – newest sitesof confluence

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

Creation of new niches for microbes,vectors, and animals

Shift to MegaCities and Urban Sites

www.basgweb.org

The Black Death

(www.scienceclarified.com )

Peri-Urban Slum

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International Tourist Arrivals, 1950-2020

Source: World Tourism Organization (WTO)

World Flights

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Grand Princess and U.S. Capitol

Transportation Revolution Is the Connectivity Revolution for Microbes

1.5 million people move into cities worldwide weekly

Over 50,000 airports

20 million miles of roads

700,000 mile of railroad tracks

Typical manufacturing company relies on more that 35 different contract manufacturers worldwide

300,000 facilities in 150 countries send over 24 million shipments through 300 U.S ports of entry; these represent FDA inspections (only 10% imports)

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Movement Ecology

Migration and

Immigration

Travel and Trade

Microbiome

Global Food Supply

Transboundary Diseases

Diasporas of the Future

Human Demographics

Recreational practices

Shift to foods from animal-proteins

Under-nutrition vs. Over-nutrition

Healthcare vs. health promotion and prevention

Health disparities and exposure bias

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

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Animal HealthEnvironmental

Health

Human Health

Last year, almost 24 billion food animals were produced to help feed a population of approximately 7 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.

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World Meat Consumption,1983 - 2020

Source: Newcomb, J., One World – One Health: An Economic Perspective, 2004

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Trade and Travel

Food and Ag part of $12 trillion global trade

Travelers are interactivebiological units

Create sequential sharedenvironments

Risk of exposure increases 4X when size of conveyances/passengers double

Movements of world’s biota iscreating new interfaces

Trade agreements outpace health agreements

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

Poultry population density

Human population density

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Hu

man

an

d a

nim

al d

ensi

ty

140

120

100

80

60

40

20

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Mea

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50

40

30

20

10

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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)

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

Ecosystem

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World’s Most Dangerous Animals

Enzootic (Maintenance/Amplification)

Amplifying hosts

Incidental hosts

West Nile Virus:Basic Transmission Cycle

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Reported Human West Nile Virus Cases, by Date of Symptom Onset; and Date of First Positive Surveillance Event, Colorado, 2003

0

10

20

30

40

50

60

70

80

90

100

110

6-Ju

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Jul

18-J

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1-Aug

15-A

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29-A

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12-S

ep

26-S

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10-O

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24-O

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Symptom onset date

No.

of

case

s

Fever(n=2323)Neuroinvasive(n=621)mosquito

human

chicken

bird

horse

Source: John Pape, CO DOH

West Nile Virus in the U.S.cumulative data as of Aug 28, 2012

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West Nile Virus

326 species of birds

Mostly subclinical

Flavivirus

1.5 million cases in U.S.

Culex Mosquitoes

Robins as reservoir

Zoonotic

Ecologically complex

Emerging Fungal Pathogens

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Emerging Fungal Pathogens

Threats to crops, forests and animals

1.5 to 5 million species (70,000 known)

Trade, travel and tourism with environmental persistence

Batrachochytrium dendrobatidis – fungus responsible for the greatest disease-driven loss of biodiversity on record (40% amphibian populations in Central Am.)

Geomyces destructans – White-nose Syndrome of Bats – caused deaths of 6 million bats – E. U.S.A.

Cryptococcus - meningitis – 1 million cases

The edge or transition zone between two adjacent ecological systems

Ecotone

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Winding through rice paddies, tea plantation, and villages in Malaysia, Thailand, Laos, and China, the road mirrors an ancient trade route linking Southeast Asia to the southern branches of the Silk Road.

Route 3 makes it possible to drive from Singapore to Beijing.

Challenges of trans-boundary transmission of communicable

diseases, environmental degradation, and illegal

migration are being addressed.Along Route 3 in Laos

Photo: Justin Mott for The New York Times

Man-made Ecotone

The road rarely follows a straight line as it meanders through rice fields and tea plantations.

Built environmentHuman-Animal InterfaceEcologies and a new researchportfolio

Evidence-based public health

Vector-borne diseases

Water-borne diseases

Agriculture Production

Migration of Animals

Changing ecosystems for wildlife and animals

Climate Change’s Impact onInfectious Diseases

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Lyme Disease

Brownstein et al., 2005

Social

ClimateEcological

Today 2080

Density of Poor Livestock Keepers - 2010

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Poverty, Hunger, Livestock Keeping and Zoonoses (ILRI)

70 % rural poor and 30% urban poor depend on livestock

Assessing 56 zoonoses globally, they are responsible for 2.5 billion cases of human illness and 2.7 million deaths annually

Massive under-reporting yet huge burden of illness especially in the 1 billion people worldwide earning less than $2 a day

Of top zoonoses, most have high impact on L/S, wildlife interfaces and ag amenable

Divided Constituencies: Medical Needs and Veterinary Responsibilities

The crux of the problem is that for many zoonoses, it is the risk to human health that is most important, while the most effective control route is via the animal

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Emerging Retrovirus Zoonoses

2 new retroviruses –Cameroon – Africa

Human T-lymphotropic virus (HTLV) types 3 and 4

Recovered from hunters of nonhuman primates

Role of bushmeat and butchering primates

STLV and HIV withsimilar origins

Risk

Number of catastrophes between 1970 & 2003Source: Swiss Re, Sigma No. 1, 2004

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Why is One Health Important?

Interconnectivity of the world; Triple Threat to Health

Complex, difficult and “wicked” problems

The great convergence and 21st century mixing bowl

Microbial swarms

A world in rapid motion with collapsed space

Food safety, security and water issues

Climate change and consequences

Infectious disease ecology

Shift to new points of intervention; “upstream” shift from clinical care to prevention (ratio 97%:3%)

What Can We Do?

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IOM Consensus of Recommendations

Improve infrastructures – animal/human

Integrate surveillance and diagnostics

Increase R&D investments

Build a new infectious disease workforce

Consider a global perspective

Create zoonosis and EID centers

Improve public understanding

Meet critical needs for leadership/skills

Prevention Intervention

Outbreak prediction

Outbreak investigationand response

CaseReporting

Surveillance

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The scale and complexity of animal and human medical problems embedded in a

changing environment, demand that scientists move beyond the confines of their own disciplines and explore new

organizational models for team science.

Rather than focusing primarily on humans and their interaction with disease-causing organisms, shift focus on interplay among humans, animals, and the environment.

Shift to a holistic view of health, interactions, and exposure.

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Working Successfully at the H-A-E Interface: Key Challenges

Trans-disciplinary efforts

AH-PH Continuum; Integrate Plans and Actions

Shift Attention “Upstream”

New Appreciation for ID Ecology

Addressing Diasporas and Ecotones Earlier

Developing Community Health Teams

Acquiring New Skills and Knowledge

Shift From Reaction to Prevention

Adopting a One Health Mindset

Paradigm Shift

Thomas Kuhn – The Structure of Scientific Revolutions

Characterized by a time when old models don’t work as well and new models have yet to be created.

A time when assumptions must be questioned

Changes may not be led by the scientific community

One Health the final need is a changing value proposition; evidence of reduced morbidity, mortality and costs

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Hicks, Edward. Peaceable Kingdom c. 1834

Documents

One Health: A New Paradigm to Address Infectious Diseases · Food safety and security Global Trade/commerce Ecosystems Climate change Land use Mental health ... Under-nutrition vs