VPH Journal 5th edition

VPH Journal 5th edition 1

5th Veterinary Public Health Journal by the International Veterinary Students Association, IVSA

The fight against rabies in both hu-mans and animals

IN THIS EDITION

Interview with Prof. Dr. Jakob Zinsstag, author of the book ‘One Health‘


Caroline Bulstra Lawal Temitope

Dear all,

Some weeks ago I walked across two bill boards at the Central Station in Utrecht, The Netherlands and I stopped myself for a few seconds to have a closer look. One of the bill boards was a commercial by our natio-nal Health Centre saying ‘Can you recognize a malaria mosquito?’ The other one was by the Food Safety Cen-tre and it was showing two delicious looking meals while stating ‘you don’t see the pathogens’. Public health and food safety are in our everyday lifes and I once more realized how big of a role vets can play in tackling these human health risks, since 70% of pathogens arise from an animal source. We can do this following the One Health spirit and applying a coordinated, collaborative, multidisciplinary and cross-sector approach to address potential or existing risks that originate at the animal-human-ecosystems interface.

Known and unknown disease pathogens pop up everywhere on our planet, on top of that globalization and increased traveling have made it easier for pathogens to spread faster and further. The ebola crisis is still fresh in our minds and there is always a significant risk of new emerging infectious disease outbreaks. The IVSA brings together veterinary students from over 50 countries worldwide. I feel that together we build a powerful network that is able to fight public health issues, both locally and globally.

The Veterinary Public Health Journal is compromised by students and brings up some of the latest trends and events in the field of Public Health. In this issue the main focus is on rabies, the zoonotic disease with the hig-hest fatality rate after the onset of clinical signs. Also various other veterinary public health related topics will be covered in this edition of the journal.

Enjoy!

Best regards,

Caroline

Publications Team member - Standing Committee on One Health 2015-2016


The VPH Journal is edited and published by the Standing Committee on One Health (SCOH), part of the International Veterinary

Students Association (IVSA).

5th editionDecember 2015

SCOH 2015-2016

Chair Elizabeth Malcolm

Official MemberTaylor Calloway

Publications TeamCaroline BulstraLawal Temitope

Regional CoordinatorSung il Kim

Policy Statement Liaison OfficerGiorgos Polyzois

Project ManagersClara Buxbaum

Claudine Girardo

Webmaster/Social Media DirectorMathijs Knipscheer


In this issue

6

10

12

15

LATEST NEWS

NEW RABIES CASES REPORTED IN MALAYSIA

STUDENTS INVOLVED IN THE FIGHT AGAINST

RABIES

REPORT FROM THE VET STUDENTS OF IBADAN, NIGERIA

MILK, THE PUBLIC AND ECONOMIC DISASTER OF

SRI LANKA

SRI LANKA DAIRY FARMING INDUSTRY VS. MILK POWDER

PRODUCTION

RABIES IN SHORT

LECTURE BY PROFESSOR A.B. OGUNKOYA

17

iNTERVIEW WITH KATINKA DE BALOGH

FROM THE FOOD AND AGRICULTURE ORGANIZATION

(UNFAO)


20

22

26

30

32

INTERVIEW

PROF. DR. JAKOB ZINSSTAG

ONE OF THE AUTHORS OF THE BOOK ‘ONE HEALTH‘

SENT IN BY OUR MEMBERS

CHIKUNGUNYA FEVER OUTBREAKS IN INDONESIA

AMR DAY

ANTIMICROBIAL RESISTANCE DAY, THE IMPORTANCE OF

RAISING AWARENESS

JOBS IN THE FIELD OF VETERINARY PUBLIC

HEALTH

INTERVIEW WITH BARBARA JONES, FOUNDER OF THE

COMPANY ONE HEALTH CONSULTING

IVSA POLICY STATEMENTS

ANTIMICROBIAL RESISTANCE WEEK AND INTERNATIO-

NAL STUDENTS DAY

BRUCELLOSIS AND INFERTILITY IN HUMANS

PROF. CADMUS (DVM, MVPH, PhD)

34


From the December 10 to December 11, the world leading

experts in rabies gathered in a joint conference held by

the WHO, OIE with support of the FAO and GARC. The

outcomes of the meeting was a 5 pillar framework in wor-

king towards total elimination of human dog-mediated

rabies by the year 2030. IVSA were proud to have been

invited and was the voice of not just veterinary students,

but students of all fields.

1. You are a veterinarian by training. Where

did you study, and why were you drawn into be-

coming a veterinarian?

I started my studies in (West) Berlin, in the part that

belonged to West Germany, I then moved to Munich

for my clinical years. For my doctorate I conducted re-

search in Jamaica to study ticks and blood parasites of

goats before moving to do a specialization in tropical

diseases and animal production at the L’Institut d’Ele-

vage et de Medecine Veterinaire des pays Tropicaux in

Maisons Alfort, France and later specialized in veteri-

nary public health in the Netherlands. I have wanted to

be a veterinarian since I was 5 years old. I had grown up

in South America, and used to go out in the field with

my father who worked with the FAO as a marketing ex-

pert. He used to go into the indigenous communities

and try to find markets for them to sell their fruits and

vegetables in cities. Working with communities in deve-

loping countries was something I always wanted to do,

and before taking up my first job in Africa as a District

Veterinary Officer in rural Zambia I had spent one and a

half years working in a zoo in Utrecht, the Netherlands.

2. You have been at the FAO for many years,

and you just finished your last day at the Rome

head office of the FAO and are moving off to

South East Asia. What drew you to joining FAO

initially?

Well, I actually also worked at the WHO-HQ in Geneva,

doing work on rabies prevention and control. My post

as a district veterinary surgeon in rural Zambia, I was

confronted with rabies cases in dogs and livestock. This

is where my passion for rabies started. I also noticed

that the dog population in Africa was different to that

in Asia and Latin America where most of the research

was being done. When I moved back to Zambia to work

at the University of Lusaka we conducted dog ecology

studies which provided us with valuable insights about

dog-human linkages and accessibility of dogs for vacci-

nations and I also was part of the 1st SARC meeting in

1991 in Lusaka. It was during this time that I connected

with people who have remained in contact over time

and was able to meet again during the (ongoing) Global

Rabies Conference in Geneva.

Interview with Dr Katinka de Balogh, UNFAO

By Aqil Jeenah, IVSA ExCo menber and previous Chair of the Standing Committee on One Health


3. The FAO is a large organization with many

different sections. What are your tasks at FAO

and how does your training as a veterinarian as-

sist you in this?

So I have been working in the Animal Health Service

at FAO-HQ in Rome since 2002. The last seven years I

have been leading the veterinary public health activi-

ties of the organization and have become very enga-

ged in One Health and in closely collaborating with the

OIE and WHO. I am able to use my veterinary know-

ledge on a daily basis for my job, but the most impor-

tant element that helps me is the field experience that

I have had. In reality I don’t just have an average desk

job, and having been able to see various realities and

my practical experience helps me a lot. It also assists

me when writing up policies as I can relate to what this

could mean for countries and their communities. I have

also been very privileged to travel to over 100 coun-

tries, which has been an invaluable experience to me.

4. We are having this interview at the side-

lines of the Rabies conference which highlights

the tripartite alliance of the WHO, OIE and

FAO. What are your thoughts on the meeting

so far?

The meeting was great and it has created a lot of mo-

mentum for the elimination of rabies. There is renewed

energy and hopefully this will translate in long-lasting

commitment to the fight. I liked the dynamic interac-

tion between panels, speakers and the participants. It

has certainly moved the rabies agenda (fast) forward.

5. There was an interesting fact that was

pointed out by the FAO about Rabies: that its

socio-economic impact, especially in the poorer

countries, that is often forgotten. What do you

think about this? Do you think this is an issue

that should be addressed in the roadmap that

comes out of the meeting?

I think this is a vital piece of the puzzle that is missing

and is extremely important. Rabies also has an impor-

tant effect on livestock and on the livelihood of people.

Unfortunately there is insufficient data on rabies and

especially in livestock due to very large under-repor-

ting. It was very interesting to note the data from North

Africa and Middle East indicating over 50% of rabies in

livestock. I have come across cases of farmers seeing

cows bellowing, and believing they were in heat. Only

when the bulls did the same rabies was suspected. Of-

ten animals had already been eaten before the sam-

ples could actually be taken. There have been cases

of multiple children bitten by a rabid dog, but some-

times families are only able to afford treatment for one

child. The grief of the parents is something that can’t

be measured. These diverse aspects make it difficult to

clearly assess the impact of rabies.

6. We both know you are an avid supporter


of student involvement within projects. What do

you think the role of students, no matter their

professions; play in the fight against the disease?

Students play a major role in creating awareness about

the disease; they can be important advocates for the di-

sease. Students can be involved and provide vital man

power to especially punctual massive campaigns as lon-

ger-lasting campaigns would need their involvement

over longer periods of time. Veterinary students nor-

mally should have received rabies pre-exposure prop-

hylaxis and therefore can be involved in the actual injec-

ting and handling of animals while other students could

be more involved in (organizational) aspects of a vac-

cination campaigns. I worked with students during my

time in both Zambia and Mozambique where we held

big rabies drives. We mixed teams of older and younger

students to allow the exchange of knowledge within the

student group. The students were vital by going on ra-

dio and speaking the local language to explain rabies,

but also by making and helping connect with the local

communities during the actual vaccination days. I also

advocate for not sticking to the health care profession

of students but look beyond the border to business stu-

dents who can help with the cost benefit or students in-

volved in mass-media and communication.

7. Any words to a student that has a desire of

joining FAO and following in your footsteps?

Never be afraid of taking a risk on trying something new

or going to new places. It’s always an experience, good

or bad, and you can always learn from it. Many univer-

sities push clinical work, but there is a lot more out the-

re to do as a veterinarian. Last, don’t be afraid of taking

that big decision and jumping into the cold water as the

world is a fascinating place.



Transmission

Rabies is a disease transmitted from animals to all

warm-blooded species, especially the dead-end

hosts. It induces an acute encephalitis and neurolo-

gical disorder/irritability disease. The illness rapidly

progresses to coma and death in victims. The disease

is primarily transmitted from the rabid animal saliva

through biting or scratching, but transmission is also

possible through wound licking, aerosol and organ

transplants.

Hosts

Rabies affects all warm-blooded species, both do-

mestic and wild animals. In 96-99% of human cases,

the rabies virus is transmitted by domestic dogs.

Rabies is also present in cattle and buffaloes which

serve as a dead end host.

Geographical distribution

Rabies is present on all continents with the excepti-

on of Antarctica, but more than 95% of human de-

aths occur in Asia and Africa.

Symptoms

“The incubation period for rabies is typically 1–3

months, but may vary from <1 week to >1 year. The

initial symptoms of rabies are fever and often pain or

an unusual or unexplained tingling, pricking or burn-

ing sensation (paraesthesia) at the wound site. As

the virus spreads through the central nervous sys-

tem, progressive, fatal inflammation of the brain and

spinal cord develops.

Two forms of the disease can follow. People with

furious rabies exhibit signs of hyperactivity, excited

behaviour, hydrophobia and sometimes aerophobia.

After a few days, death occurs by cardiorespiratory

arrest.

Paralytic rabies accounts for about 30% of the to-

tal number of human cases. This form of rabies runs

a less dramatic and usually longer course than the

furious form. The muscles gradually become paraly-

zed, starting at the site of the bite or scratch. A coma

slowly develops, and eventually death occurs. The

paralytic form of rabies is often misdiagnosed, contri-

buting to the under-reporting of the disease” (WHO).

History

As far as known, five human patients survived rabies.

These patients were vaccinated prior to exposure and

the onset of clinical signs. They were supported by

the utility of maximum medical intervention.

Rabies prevention in human

Nearly all human rabies cases are related directly to

animal bite incidents and thus, primary disease pre-

vention requires minimization of suspected exposu-

res.

a. by eliminating the virus within animal species

b. by giving adequate post exposure treatment after

an unavoidable suspected real exposure

c. by maintaining good dog management and main

taining a rabies free status on the long run

Rabies in shortLecture by Professor A.B. Ogunkoya


Local treatment of the wound

Wounds from animal bites or scratches should be was-

hed and flushed immediately with soap and water for

10-15 minutes. If soap is not available, flush with water

alone. This is the most effective first-aid treatment

against rabies. Ideally wounds should be cleaned tho-

roughly with 70% alcohol/ethanol or povidone-iodine

if available. Victims should be taken to a health care

facility as soon as possible. Do not cover the wound

with dressings or bandages.

Suturing when possible. When necessary the infiltrati-

on of wounds with rabies immunoglobulin (RIG) is re-

quired. The equine origin (ERIG) or the human (HRIG)

can be used.

Indications for post-exposure rabies prophy-

laxes (PEP)

Post-exposure prophylaxis (PEP) means the treat-

ment of a bite victim that is started immediately after

exposure to rabies in order to prevent rabies infecti-

on. This treatment consists of local treatment of the

wound, initiated as soon as possible after exposure;

effective rabies vaccination; and the administration

of rabies immunoglobulin, if indicated. Effective tre-

atment soon after exposure to rabies can prevent

the onset of symptoms and death (WHO). Recent

evidence has shown that in communities where time

has been spent on rabies education and vaccinatio the

cases of PEP has actually gone up. This is due to peo-

ple bitten now seeking medical attention the moment

they are bitten.

Dog population management

“Rabies is a vaccine-preventable disease. Vaccinating

dogs is the most cost-effective strategy for preven-

ting rabies in people. Dog vaccination will drive down

not only the deaths attributable to rabies but also

the need for PEP as a part of dogbite patient care”

(WHO). Mass vaccination up to at list 70% of the dog

population is needed to development the required

“herd immunity” within the dog population.

Benefits to rabies prevention in dog populations are:

• Improvement of animal welfare

• Human health will be improved and protected

• Socio-economic benefits due to reduced sick-

ness and death of human and livestock

References:

World Health Organization (2013). WHO Expert Con

sultation on Rabies. WHO TECHNIC

AL Report Series 982. Second Rep-

ort. Geneva.


New rabies cases reported in Malaysia

Malaysia had been declared free from rabies by the

World Organization for Animal Health (OIE) since

2012. However, a dog bite incident in a small town in

Perlis was evoking a nationwide panic and resulting

in 3 states in the Northern of Malaysia gazetted as ra-

bies area. The drama came to its climax after an an-

nouncement made by the Chief Minister of Penang

Mr. Lim Guan Eng, advising culling all stray dogs in

the state to prevent the disease from spreading.

On 15 September, around 2000 strays had been cap-

tured and put down by the veterinary authorities.

The mass cull was widely protested by NGOs, who

together submitted a memorandum to urge the sta-

te goverment to put an end to the killing of stray ani-

mals. Within the memomrandum, alternative solu-

tions were given to deal with the crisis. Mr. Lim, the

Chief Minister insisted that the decision was made

after taking into account public health and other re-

levant interests.

At this point of the crists, a heavily debated point

Yee Nin, November 2015

came into play. Within a public health emergency,

what is the balance between animal welfare and pu-

blic health? It must be noted, that multiple studies

and experts agree that the killing of animals has no

significant effect on the spread of the diseases.

Within this context, we needed to consider the

amount of resources available in the country. Accor-

ding to the veterinary department, Malaysia has a

shortage of vaccines against Rabies. There was only

a very limited stock of dog vaccines available to ma-

nage vaccination in the set ‘immune belt area’. The

belt is bordered by Thailand where rabies is ende-

mic after Malaysia was declared free of the disease

in 1999. As the episode reccured, Malaysia was re-

quired to purchase batches of vaccine from OIE to

control the outbreak. In the meantime, the push by

NGOs for mass vaccination of strays instead of mass

culling was having no effect as there was an inade-

quate supply of dog vaccines within the country.

NGOs came up with other alternatives, such as qua-

rantine of infected animals.


This method was meant to be more humane as ani-

mals are allowed to die due to progression of disease

instead of being put down straight away, as Rabies is

usually fatal in 3 to 10 days after presentation of cli-

nical signs. One can doubt if this would be an ethical

solution.

There were several challenges to overcome when

we were talking about putting a batch of animals in

quarantine. Holding a group of strays in a confined

space increased the likelihood of disease transmissi-

on via fighting behavior due to stress (by apparently

healthy individuals), unless the animals were qua-

rantined separately. Note that stress in confinement

also exaggerated other underlying complications.

Vaccination only offers effective cure before mani-

festation of clinical signs, therefore it is pointless to

offer vaccination to rabid animals. In terms of the

five freedoms for animals (freedom from hunger

and thirst, from discomfort, from pain, injury or di-

sease, freedom to express normal behaviour and

the freedom from fear and distress), quarantined

rabid dogs had gone against at least the freedom

from pain, discomfort and disease. In addition, this

is an expensive solution. The process needed con-

sistent human resources and funding for mainte-

nance, as well as achieving optimum welfare.

State government and veterinary authorities had

been placed to lead the steps in resolving the out-


break. It was undeniable that funds allocated, human

power and available resources were always the limi-

ting factors in the decision making processes on how

to deal with the disease. To compensate for the scare

resources, mass culling of stray and free roaming dogs

was the ‘cheapest last minutes measure’, and the im-

mediate action to remove the etiological agent out

of the human population, with the human population

being the main concern of the goverment. However,

this incident should serve as a good lesson for not only

the government, but the citizens themselves to incre-

ase awareness on rabies and other potential zoonosis

and always be well prepared for an outbreak. Going

forward, primary goals are aimed towards reducing

the stray population and revamping the public educa-

tion drastically.

Public awareness and education were major issues to

be tackled in this situation. The panic among citizens

seemed to adversely affect the outbreak since animal

dumping increased. Also people outside of the immu-

ne belt started buying rabies vaccines due to overall

panic and the lack of correct information on the di-

sease. This led to an increased lack of vaccines in the

areas where the were needed.

The risk of disease transmission in human and animals

can be elimated by having a well managed control and

maintaince program in a country. The Department of

Veterinary Services had established a series of pro-

tocols for vaccination of pet dogs. These protocols

should be disseminated and explained to the general

public in coherence with the execution to avoid mis-

understandings and unnecessary circumstances.

According to the Ipoh Society for the Prevention of

Cruelty to Animals president Ricky Soong and Dr. Ran-

jit Kaur Mendhir, founder of the no-kill Noah’s Ark Ipoh

animal sanctuary, lacking of correct information and ir-

responsible ownership had lead many people to act of

dumping their pet dogs, instead of vaccinating them.

This was mainly the case in Ipoh, the closest town to the

immune belt. Pet owners in other states, such as Kuala

Lumpur and Johor, created a panic wave by rushing to

get their pets vaccinated. Thus, responsible ownership

should be educated to the Malaysian citizens, especial-

ly the management of animals in certain endemic out-

breaks. Apart from proper vaccination, owners should

restrict the movement of animals instead of leaving

them roaming as usual, in order to reduce contact with

rabid animals. Correct information regarding rabies vi-

rus transmissions and precaution steps upon bite inci-

dents should be spread more effectively.

In short, the chaos that resulted from the outbreak of

rabies in Malaysia happened due to the lack of public

awareness on the zoonotic disease, lack of correct and

reliable information on the disease agent and transmis-

sion and the lack of general knowledge on crisis ma-

nagement. Meanwhile, this provides a clear example

for the younger generations on how the control of di-

sease outbreaks can fail. Hopefully their roles get clea-

rer when a outbreak occurs in the near future so that we

can effectively address new rabies outbreaks together.

Resources:

WHO, ProMED-mail, The Malaysian Insider, Asia One,

The Straits Times


Students involved in the fight against rabiesReport from the vet students of Ibadan, NigeriaBy Mogbojuri Oluwatobi A (Local Chairman Organizing Committee, World Rabies Day 2015)

The International Veterinary Students Association (IVSA) Ibadan Chapter organised a 3-day event on the occa-

sion of World Rabies Day on the 29, 30 September and 10 October 2015. The events were focussed on creating

awareness, spreading information on rabies and fighting the disease by vaccinating dogs and cats.

On the first day we had organized a public seminar on rabies at our own university (University of Iba-

dan, Nigeria). Students and all other inhabitants of Ibadan who were interested in joining the seminar were

invited. Around 600 people attented the seminar.

On the second day seminars for three secondary schools in the area were given on ‘the zoonotic impli-

cations of rabies’. The main goal was to educate the public on rabies transmission and possible prevention

and control measures to be taken. Another important goal was to make the communities aware of the free


vaccination programme being offered by the IVSA Ibadan Chapter. A lot of secondary school students attended

this day. During the evening session of day 2 an awareness rally took place at a rural area, Egbeda Local Gover-

nment, Ibadan, Oyo State, Nigeria.

On day three there was the awareness rally in Egbeda Local Government (Bankesa, Erunmu, and Oree),

which is a typical rural community. The awareness rally was aimed to sensitize the community and educate them

on the importance of rabies prevention and control and so why their dogs should be vaccinated. We commu-

nicated with them one on one. We tried to answer as many questions as possible, because the majority of the

population does not understand what rabies is exactly and how to prevent the disease from spreading further.

We were able to talk to them in their own language, which ofcourse was a really great advantage.

Rabies is known as “aja digbolugi” in the Yoruba Language which means “mad dog”, literally it means “dog

that bites trees or that hits a tree with his head”. This is similar to the furious form of rabies and the name is based

on the clinical manifestations in dogs affected with the rabies virus.

Finally, the vaccination activities took place on the 10th of October in the same rural area. Twohundred lo-

cal strain anti-rabies vaccines were offered by the Nigerian Veterinary Research Institute (NVRI). Dogs and cats

of various species ranging from our indigenous breeds to exotic breeds were vaccinated. Additional veterinary

services such as deworming, treatment for ectoparasites and advice on pet management and health care prac-

tices were carried out as well. It was a great event an hopefully we have more to follow!


Taylor Calloway, US Davis University of Carlifornia, School of Veterinary Medicine, IVSA SCOH Official

Member

Sri Lanka is an island nation located south of India. The country is known for its rich farming culture of tea

and rice plantations. These practices are a vital part of family income and food consumption throughout

the nation. Livestock farming is also a practice among the people and provides the main intake of multi-

ple protein sources such as chicken, fish and cattle meat or products.

Unfortunately, Sri Lanka is not self-sufficient in its dairy industry, requiring a supplementation of impor-

ted powdered and condensed milk products. Local demand of milk requires 70% of outsourced products

from other countries (Perera et al, 2008). Most recent statistic studies report the cost of imported pro-

ducts to be Rs 27 billion annually (Ministry of Social Services, Welfare and Livestock Development, 2012).

The amount tops the list of one of the largest country expenditures.

The Department of Census and Statistics in Sri Lanka reported in the 2012/2013-year, the average house-

hold expenditure was Rs. 41,444 monthly. Over a third (Rs. 15,651) of the monthly expenditures were

spent on food consumption. The Sri Lankan residents consume rice, wheat flour and bread in the largest

Milk, the public and economicdisaster of Sri LankaSRI LANKA DAIRY FARMING INDUSTRY VS. MILK POWDER PRODUCTION


quantities. This aspect places them at the top of the greater food expenditure list. However the largest ex-

penditure on a protein source is powdered milk by the national household expenditure decile of 2012/2013-

year.

There are various explanations for the countries need of imported powdered milk products. The reasons

include but are not limited to political, technical and socio-economic factors, and a low farm gate price (Pe-

rera et al, 2008). The Ministry of Social Services, Welfare and Livestock Development had plans in 2009 to

increase the country’s milk production (240 million) 300 times by the end of 2015. The plans included impro-

vement in policy support, developmental programs, research, disease control, and strategies to improve

breeding, production, marketing, industrial development and social aspects. In the past ten years, there

has been an increase in the country’s own milk production and consumption. Although there is improve-

ment in the years, there is still a high demand for more planning, implementation of new strategies, and

sustainability of these ideas for the dairy industry in Sri Lanka to succeed.

One Health is a multidisciplinary topic that covers many aspects in the communication between human, en

vironmental and animal health. There are many opportunities to use One Health strategies in issues invol-

ving local or global health. The example of Sri Lanka’s dairy industry is multifaceted with disease issues, cul-

Figure 1: Milk powder imports

Figure 2: Milk production and collection

Year Quantity (MT) Value (Rs./Mn) 2000 52525.8 7779.89 2001 49068.6 9080.06 2002 60768.5 9587.25 2003 58461.2 10106.1 2004 52701.8 11289.2 2005 52788.1 12591.4 2006 65840.3 16254 2007 61241.8 19306.2 2008 65376.1 30849 2009 63873.6 18608.7 2010 75482.6 29029.4 2011 87381.6 37882.9 2012 83817.7 39023

Year Milk production (million liters)

Milk collection (million liters)

2005 192.74 100.18 2006 196.62 113.37 2007 202 120.76 2008 208 117.08 2009 233.32 125.12 2010 247.5 137.66 2011 258.3 143.70 2012 299.25 183.58


tural necessities, nutritional implications within both animal and human sides and economical problems.

These all require a team of diverse specialists to work together and organized large, detailed policies to

set Sri Lanka up for success. So when you think of One Health, remember that it is to solve problems to

promote the health of all.

References:Cow and Buffalo Milk Production (2014). Retrieved November 19, 2015, from http://www.statistics.gov.lk/agriculture/Livestock/MilkProduction.html

Gardew, L., Berhanu, A., Mengesha, D., and Tsegay, G. (2012). Identification of gram-negative bacteria from critical control points of raw and pasteurized cow milk consumed at Gondar town and its suburbs, Ethiopia. BMC Public Health, 12:950

Income and Expenditure (2013). Retrieved November 19, 2015, from http://www.statistics.gov.lk/page.asp?page=Income and Ex-penditure

Milk Collection, Production and Milk Powder Imports. (2013). Retrieved November 19, 2015, from http://www.livestock.gov.lk/site/en/statistics

Perera, B., & Jayasuriya, M. (2008). The dairy industry in Sri Lanka. Retrieved November 19, 2015, from https://www.academia.edu/11428439/The_dairy_industry_in_Sri_Lanka

Ranaweera N F C. (2007). Improved Market Access and Smallholder Dairy Farmer Participation for Sustainable Dairy Development. Central Bank of Sri Lanka, Colombo, Sri Lanka

Ranaweera, N. F C. (2007). Sri Lanka: Opportunities for dairy sector growth. Retrieved November 19, 2015, from http://www.fao.org/docrep/011/i0588e/I0588E08.htm


In 2013, just taking into account the USA, antibiotic resistance was estimated to be

responsible for

How can antimicrobial resistance happen?

This is a worldwide issue

In the world, E. coli is significantly resistant to third generation cephalosporins and fluoroquinolo-

nes, two important and commonly used types of antibacterial medicine. In the world, according to

the regions, from 25% to 90% of Staphyloccocus aureus infections are methicillin-resistant.


WHAT CAN WE DO TO TACKLE ANTIMICROBIAL RESISTANCE?

• Preventing infections by regularly washing hands

• Practicing good food hygiene

• Avoiding close contact with sick people

• Keeping vaccinations up to date

• Using only antibiotics when prescribed

• Taking the full prescription

• Never using left-over antibiotics

• Preventing infections by ensuring hands, instruments and environment are

clean

• Keeping patients’ vaccinations up to date

• Only prescribing and dispensing antibiotics when they are truly needed

• Choosing the right antibiotic, at the right dose, for the right duration

• Developping a robust national plan, including surveillance of antibio-

tic resistant infections, strengthening infection prevention and control

measures

• Making information on the impact of antibiotic resistance available

• Rewarding the development of new treatments, vaccines or diagnostics

• Ensure that antibiotics given to animals are only used to treat infectious disea-

ses and under veterinary supervision

• Vaccinate animals to reduce the need for antibiotics

• Develop alternatives to the use of antibiotics in plants

• Promote and apply good practices at all steps of production and processing of

foods from animal and plant sources.

• Adopt sustainable systems with improved hygiene, biosecurity and stress-free

handling of animals

• Implement international standards for the responsible use of antibiotics, set

out by OIE, FAO and WHO


Brucellosis is a contagious systemic bacterial disease

of wild and domestic animals. The disease has been

eradicated in developed countries like Europe, USA,

and Japan as a result of strict control and eradication

programmes. However, it is still enzootic in developing

economies of South America, Africa, Middle East and

The Mediterranean due to lack or non adherence to

control measures. The disease is present in Nigeria

and has been recorded in livestock and human popu-

lations. The presence of brucellosis in the livestock

population translates to human population infection

because brucellosis is zoonotic. The different Brucel-

la species and the animals they commonly infect are,

Brucella melitensis: sheep and goats; B. abortus: cat-

tle; B. suis: pigs; B. canis: dog; B ovis: ram and marine

mammal Brucella species. Of these, B. melitensis, B.

abortus and B. suis commonly infect humans.

In animal populations, brucellosis is transmitted

through contact with infected uterine discharges, suc-

kling of infected milk or in-utero maternal transfer. In

humans, the common routes of infection include direct

contact with infected animals and uterine discharges,

direct and accidental inoculation through cuts and

abrasions in the skin, inhalation of infectious aerosols,

and consumption of unpasteurized milk or other dairy

products, consumption of uncooked offals from infec-

ted animals. Human-to-human transmission by blood

transfusion, tissue transplantation, obstetrical ma-

nipulation, maternal transfer during birth is possible

but is rare route of infection. Brucella (the causative

agent) have been recovered from banked spermato-

zoa and vaginal discharges (Corbel, 2006) hence sexu-

al transmission is common especially in B. melitensis

infections. The disease therefore commonly affects

herdsmen, abattoir workers, laboratory workers, ve-

terinarians, hides and skin workers and members of

the general public that drink unpasteurized milk.

In animals, the bacteria localize and multiply in

the reproductive organs; hence, it is primarily a repro-

ductive disease. The clinical signs of brucellosis the-

refore are usually visible during pregnancy and they

include abortion (usually in third trimester), still birth,

retained placenta, birth to weak calves and reduced

milk yield. Retained placenta results in sterility but

death is not common except in neonates. The clinical

signs of brucellosis are not obvious in non pregnant

animals and males except sterility, hygroma and or-

chitis which sometimes lead to self-inflicted trauma.

Symptoms of brucellosis in humans most times are

similar to those of endemic diseases like malaria and

typhoid (Muchaal, 2001) and they include recurrent

high fever (hence the name Undulant fever), chills,

drenching sweats, insomnia, anorexia, headache,

constipation, nervousness, encephalitis, spondylitis,

arthritis, endocarditis, depression. Brucella melitensis

is the aetiological agent most frequently reported as a

cause of human disease and the most frequently isola-

ted. Brucella abortus on the other hand, is the most wi-

Brucellosis and infertility in humans

Prof. S.I.B. Cadmus (DVM, MVPH, PhD) Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medi-cine, University of Ibadan, Ibadan, Nigeria


despread cause of infection but associated with much

less human disease.

In contrast to animals, abortion due to brucello-

sis is not common in pregnant women (O’Callaghan.,

2013), however when it occurs, spontaneous abortion

is observed mostly in the first and second trimesters

of pregnancy (Teshager et al., 2014; Addis, 2015). The

first large series about correlation between abortion

and brucellosis was reported in 1954 by Criscuolo and

di Carlo with a total abortion rate of 10% reported in

200 cases of B. melitensis infection in pregnant women

(Kurdoglu, 2015). Spontaneous abortion has been as-

sociated, by different schools of thought, with bacte-

remia or vaginal bleeding at presentation (Memish,

2011). Rare cases of pelvic abscesses and salpingitis

(inflammation of the fallopian tube) due to brucellosis

have also been reported. Brucella may also be localized

in the ovaries and fallopian tubes leading to formati-

on of abscess. Infertility is a common sequel of animal

brucellosis (Addis, 2015). The genitourinary system is

affected in 2-20% of cases having brucellosis (Hizli and

Uygur, 2006). Genitourinary involvement of brucello-

sis includes prostatitis (in which there is formation of

granuloma in the prostate gland), epididymo-orchitis,

cystitis, pyelonephritis, interstitial nephritis, exudative

glomerulonephritis and renal abscess. Epididymoor-

chitis is the most frequent genitourinary complicati-

on of brucellosis (Akinci et al., 2006). Brucella epidi-

dymoorchitis (BEO) occurs usually in the early stage

of active brucellosis and may be the only presenting

symptom. It is mostly a condition of adults, seen less

frequently in children and more commonly observed

in immuno-suppressed individuals such as persons

with HIV/AIDS. Resultant effects include aspermia or

oligospermia.


In nomadic societies however, the acute stage of

the disease is not manifested among adults; although,

there may be many chronic cases due to continuous

exposure to the pathogen and long duration of the di-

sease in the affected person. In such societies there-

fore, the acute disease is commonly observed among

children and the disease becomes a pediatric problem

(Corbel, 2006). While BEO can occur as a separate di-

sease with no symptoms of systemic disease, it can

also be seen in relapses of cases that were inadequa-

tely treated. Clinical features are not specific of the di-

sease and may simulate other conditions. There could

be development of a granulomatous mass (usually

unilateral) in the testis which can mimic a testicular

tumour or tuberculosis (this growth is however notice-

able upon orchiectomy). Bilateral epididymo-orchitis

occurs in up to 59% of affected patients (Papatsoris et

al., 2002). Testicular pain and swelling may start sud-

denly or gradually with variable degrees of pain inten-

sity. Testicular swelling is associated with tenderness

and the testicle may be two to three times the normal

size. Infection may progress in severity; particularly

if the condition is not suspected, appropriate tests

are not performed and infection managed inappro-

priately. It may result in serious complications such as

testicular abscess, atrophy and male infertility. There

is increased evidence of decreased testosterone pro-

duction, decreased libido and decreased sexual activi-

ty due to BEO ( Kassur and Dziubek, 1980).

In the suspicion of the condition, Brucella ag-

glutination tests and blood culture can be used as

diagnostic methods for the differential diagnosis of

epididymo-orchitis in endemic regions of brucellosis.

In endemic areas, the suspicion should be enough to

initiate therapy for brucellosis while awaiting the con-

firmatory laboratory tests. Treatment is by combinati-

on of doxycycline and netilmycin for a month followed

by doxycycline and rifampicin for another month or

two. Abscess can be aspirated and drained although

in most cases, orchiectomy is usually performed on

suspicion of a testicular cancer or tuberculosis.

It is therefore recommended that the following should

be observed in order to avoid human infection with

brucellosis:

i. Individuals assisting during calving should wear

gloves but in the absence of gloves, should co-

ver their hands with polythene bags

ii. Abortion materials, fetuses from the abattoir,

the uterus and mammary glands of animals must

not be touched with ordinary hands.

iii. All abortion materials from animals must be

properly disposed of by deep burial or burning.

iv. Individuals that persistently suffer from malaria,

typhoid and waist pain, should be tested for brucel-

losis especially those with history of regular contact

with livestock and livestock products as well as those

drinking unpasteurized milk.

v. Individuals who drink fresh milk should ende-

avor to boil it properly before consumption.


References:

Corbel, M. J. (2006). Brucellosis in humans and animals (pp. 1–102).

World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Swit-

zerland. Retrieved from http://www.who.int/csr/resources/publica-

tions/Brucellosis.pdf May, 2014

Muchaal, P. (2001). Zoonoses of dairy cattle with reference to Afri-

ca. Ottawa: Cities Feeding People International Development Rese-

arch Centre (IDRC), Canada, 17–19. Retrieved from www.ruaf.org,

May, 2014

Akinci, E., Bodur, H., Cevik ,M.A., Erbay,A., Eren, S.S., Ziraman,

I., Balaban, N., Atan, A., Ergü, G. (2006). A complication of bru-

cellosis: epididymoorchitis. Int J Infect Dis.10(2):171-7

Jequier, Anne.M. (2011). Male Infertility; A Clinical Guide. Cambridge

University Press.

Teshager, Dubie., Mulie, Adugna., Tesfaye, Sisay and Yimer, Mu-

kitar. (2014). The economic and public health significance of bru-

cellosis. Global Research Journal of Public Health and Epidemio-

logy:ISSN-2360-7920: Vol. 1(7): pp 054-064

Corbel, M.J. (2006). Brucellosis in humans and animals. World

Health Organization /Food and Agriculture Organization of the

United Nations / World Organisation for Animal Health

Hizli, F., Uygur, M.C. (2006). Brucella orchitis: a rare cause of testi-

cular mass: report of a case. Int Urol Nephrol 38: 637-639.

O’Callaghan, David. (2013). Novel Replication Profiles of Brucel-

la in Human Trophoblasts Give Insights Into the Pathogenesis of

Infectious Abortion. J Infect Dis.doi: 10.1093/infdis/jit010

Kassur, B. and Dziubek, S. (1980). Andrologic studies and sexual

potency in chronic human brucellosis. Infection 8, 599-602

Addis, Mekonnen. (2015). Public Health and Economic Importan-

ce of Brucellosis: A Review Public Policy and Administration Rese-

arch .www.iiste.org ISSN 2224-5731(Paper) ISSN 2225-0972(Online)

Vol.5, No.7

Kurdoglu, Mertihan., Cetin, Orkun., Kurdoglu, Zehra., Akdeniz,

Hayrettin. (2015). The Effect of Brucellosis on Women’s Health

and Reproduction. International Journal of Women’s Health and

Reproduction Sciences Vol 3 No 4, 176-183

Papatsoris, A.G., Mpadra, F.A., Karamouzis, M.V., Frangides,

C.Y. (2002). Endemic brucellar epididymo-orchitis: a 10-year expe-

rience. Int J Infect Dis. 6: 309-13.

Memish ZA. (2011). Brucellosis and pregnancy. International confe-

rence on brucellosis, Buenos Aires, Argentina.


Interview Barbara Jones One Health Consulting

1. Can you tell us a little bit about yourself

and your career?

I began my career as an equine general practitioner

but was always interested in preventive medicine. I

was particularly interested in the impact of environ-

mental changes on health as well as management of

disease outbreaks – involving intra-species as well as

zoonotic or cross-species transmission. I was able to

pursue that interest through the University of Iowa

Masters of Public Health program; they offer a pro-

gram designed for practicing veterinarians. I obtain-

ed my Masters in Public Health from the University

of Iowa and then become a board-certified specialist

with the American College of Veterinary Preventive

Medicine (ACVPM) in 2012. The ACVPM’s five main

core areas of practice include infectious disease, en-

vironmental health, epidemiology, food safety, and

policy/education. I currently serve on the ACVP-

M’s Continuing Education committee. We organize

webinars not only for ACVPM diplomates, but also

DVMs and MDs/nurses/etc. in collaboration with the

Centers for Disease Control (CDC) and Prevention.

I formed One Health Consulting LLC to fill a need that

is not currently being met in preventive medicine.

Most veterinary clinics/hospitals, farmers, equine

facilities, petting zoos, etc. do not have the time or

expertise to develop standardized protocols to ma-

nage outbreaks, prevent transmission of contagious

diseases, or endure natural disasters.

Currently, I provide consulting services to veterinary

hospitals, equine facilities, petting zoos, and canine

facilities as well as pet owners with animals with an-

tibiotic resistant infections. In addition, I continue

to practice veterinary medicine, with a focus on Tra-

ditional Chinese Veterinary Medicine (acupuncture,

herbal therapy and food therapy) for performance

animals, convalescent care for geriatric animals, and

convalescent care in post-op/ill animals. I also serve

as a Public Health Officer in the Air National Guard,

which has broadened my experience to the human

medicine side of One Health.

2. According to you, what is One Health?

I agree with the general One Health definition; an

integrative effort of multiple disciplines to attain

optimal health for people, animals and the environ-

ment; and that the optimal health of each of those

is dependent on the others. This is contrary to the

hyper-specialization veterinary and human medicine

has experienced in the last decade; in order to prac-

tice One Health, one needs to possess the mind-set

of Leonardo Da Vinci (artist, scientist, anatomist, ar-

chitect, engineer) rather than Stephen Hawking. Da

Vinci’s philosophy is particularly adept at describing

One Health: “saper vedere,” “knowing how to see.”

One Health is being able to see the connections bet-

ween humans, animals and environment and under-


standing that we cannot exist in a vacuum, but must

learn to co-exist in a healthy way without manipula-

ting or destroying the other two.

While the definition for One Health is generally agreed

upon, implementation of One Health principles and

determining which fields fall under the umbrella of

One Health are still occasionally cause for debate.

This is probably because One Health encompasses

so many different professions, disciplines, theories,

conflicting interests and fields of study. How to im-

plement One Health is where most conferences and

scientific discussions are currently focused.

3. Can you tell us something about your

company One Health Consulting?

My company can be described most simply by our

company slogan: Identify-Prepare-Prevent. One

Health Consulting, LLC was started to provide out-

break investigation, disaster preparedness, and in-

fection prevention and control services to veterinary

clinics and hospitals, equestrian facilities, shows, re-

hab centers, hobby farms/backyard poultry, petting

zoos, and multi-pet households. Outbreak investi-

gation is not just for large scale outbreaks like avian

or canine influenza, it is also for individual clinics or

farms dealing with a contagious disease they either

want to PREVENT from spreading to other animals/

people/environment or want to learn how to prevent

future outbreak from occurring. Outbreak investiga-

tion is not restricted to highly contagious diseases,

but involves any increase in disease prevalence abo-

ve baseline: for example, an increase in surgical site

infections. Unless an infectious disease surveillance

system is in place, subtle increases in disease preva-

lence can go undetected. Preventive medicine pro-

grams require constant monitoring and should conti-

nue to evolve with new research.

Infection control and prevention protocols are a vital

part of outbreak investigation. Protocols allow us to

standardize the steps of infection control and isolate

the failure in preventive medicine when an outbreak

occurs. Infection control and outbreak management

protocols are also essential for data collection, which

will help us to determine what role, if any, veterinary

medicine plays in global antibiotic resistance.

Finally, disaster preparedness is one more layer es-

sential to total prevention. This component not only

helps save animal and human lives, but also protects

the environment during disasters. Goals of disaster

preparedness include: minimizing the risk of medical

waste or manure being released into the environment

and preventing disease transmission in the event that

humans and animals are forced into densely popula-

ted areas, to name a few.


4. What do you identify as the most impor-

tant One Health movements/activities/topics

at the moment?

This is the colloquial million-dollar question; but I

think the concern about antibiotic resistance is very

real. Veterinarians are frequently blamed for antibi-

otic resistance, which is shortsighted and potentially

unfounded. Without evidence to refute these claims,

antibiotics may eventually be eliminated from the re-

pertoire of pharmaceuticals that veterinarians are al-

lowed to prescribe. The veterinary profession needs

to demonstrate a proactive approach to monitoring

and preventing antibiotic resistance and minimizing

transmission of antibiotic resistant strains between

animals and from animals to people and the environ-

ment. As the efficacy of antibiotic therapy becomes

in jeopardy, other forms of disease prevention are

going to become a progressively more important as-

pect of veterinary medicine.

While not at the forefront now, transmission of antibi-

otic resistant strains of bacteria from animals into the

environment is one of the areas that I think is going

to quickly become a very important movement/topic.

Just recently, a research paper was published that

showed horizontal gene transfer (plasmid-mediated)

of polymyxin resistance (MCR-1) in Escherichia coli

in animals (pigs) and humans in China. (Liu Y-Y, 2015)

This is concerning because research has shown, in

general, plasmids can transfer between multiple bac-

terial species within the environment, and therefore

antibiotic resistance can spread among a wide range

of bacteria very quickly. The NDM-1 enzyme gene

also provides an example of how environment plays a

critical role: when NDM-1 genes are transferred, it oc-

curs at 1 to a million times more at 30 degrees Celsius

(ambient temperature) than 37 degrees Celsius. (body

temperature). (Walsh, 2011) This demonstrates the

huge impact environment can have on human and

animal health.

Liu, Yi-Yun et al. Emergence of plasmid-mediated

colistin resistance mechanism MCR-1 in animals and

human beings in China: a microbiological and mole-

cular biological study. The Lancet Infectious Disea-

ses. Published Online: Nov 18, 2015.

Walsh, Timothy R et al. Dissemination of NDM-1

positive bacteria in the New Delhi environment and

its implications for human health: an environmental

point prevalence study. The Lancet Infectious Disea-

ses. 2011. Volume 11 , Issue 5 , 355 – 362.

5. According to you, what can we reach/ac-

complish by using the One Health approach?

And how does the company add to this?

Using the One Health approach is the only way human

and veterinary medicine is going to be successful in a


world where everything from economy to health care

is trending towards globalization. However, we need

to develop a better understanding of how the en-

vironmental component impacts animal and human

health. By using the One Health approach, all three

areas, human, animal, and environmental health, will

be improved and stabilized.

In addition, concerns about antibiotic resistance,

zoonotic pandemics, and anti-helminthic resistance

(which has a huge environmental component) will li-

kely have a significant impact on the ability of gene-

ral veterinary practitioners to prescribe drugs that we

currently take for granted – either because the drugs

are no longer effective or because of legal restrictions.

One Health Consulting hopes to implement protocols

to demonstrate that veterinary professionals and ani-

mal industries are being proactive in preventing not

only antibiotic resistance, but also transmission of

contagious disease agents between people, animals

and the environment.


Interview Jakob Zinsstag

1. Can you tell us a little bit about your-

self and your career?

I trained as a veterinarian in Bern, Switzerland. After

a short time in clinical practice I started working in

Trypanosomiasis research at the Swiss Tropical and

Public Health Institute (Swiss TPH). From there we

lived eight years in West Africa, four in the Gambia

working on helminth disease of livestock and four

in Côte d’Ivoire as director of the Centre Suisse de

Recherches Scientifiques. Since 1998 I lead a rese-

arch group again at Swiss TPH on the health of mo-

bile pastoralists and zoonoses control in developing

countries. Today we are 30 people working in almost

ten countries.

2. According to you, what is One Health?

Recognizing the inextricable interconnection of hu-

mans, animals and the environment is a necessary

but not a sufficient component of One Health. We

consider a sufficient condition for a One Health ap-

proach if we can show an added value of closer in-

teraction of human and animal health in terms of

better health of humans and animals and in terms

of financial savings and other benefits.

Doctors and Veterinarians can make the patients

healthy but if they work collaborate they can achie-

ve better human and animal health then what they

could achieve on their owns.

3. Can you tell us something about the his-

tory of One Health? Did we have it before or

is it really something new?

One Health is not new, we have a whole chapter on

its history in our new book. The interaction of human

and animal health has a very dynamic and changing

history. But, there is still a growing need for the two

medicines and other sciences to collaborate in the

face of emerging diseases or growing resistance to

antimicrobials. Hence One Health is still of high ac-

tuality.

4. How do you use the concept in your

work or every day life?

We try to engage with civil society by organizing

participatory stakeholder workshops with commu-

nities and authorities to identify the perceived pro-

blems and problem solving strategies. We call this

transdisciplinary strategies engaging academic and

non-academic knowledge (www.transdisciplinarity.

ch). Then we create mixed research teams of doc-

tors, veterinarians, nutritionists and ecologists. We

also design integrated studies that measure human

and animal health simultaneously. We develop ma-

thematical models that simulate the transmission

between humans and animals and finally we per-

form economic analyses to show the added value of

this closer cooperation. More and more we include


ecosystem considerations under a paradigm of eco-

systemic approaches to health (ecohealth.net). You

could also become student members of the Interna-

tional Association for Ecology and Health.

5. What do you identify as the most im-

portant One Health movements, activities or

topics at the moment?

Developing truly integrated surveillance systems

and build respective capacity for emerging diseases

and antimicrobial resistance surveillance. Team up in

global partnership between industrialized countries

and low and middle income countries to develop

integrated approaches to health for humans and

animals. In the industrialized countries we should

moderate our lifestyles to reduce our resource use.

This is a further challenge of One Health on how to

provide health care not using more than 2000 Watts.

6. According to you, what can we reach/ac-

complish by using the One Health approach?

Better health for humans and animals while pre-

serving ecosystem services for the generations to

come.


Chikungunya fever

“Rise of earth temperature is one of the reasons mos-quitoes can impenetrate subtropical areas”

Afdi Pratama

Veterinary student

Bogor Agricultural University (Bogor, Idonesia)

World veterinary day is an event to remind peo-

ple about contribution of veterinary profession to

the many aspects of life, an important one being the

health of both human and animals. This year, world

veterinary day appointed an emerging issue as a the-

me: Vector Borne Diseases.

Vector borne diseases are becoming a major

public health issue worldwide. In the past time, vec-

tor borne diseases were known as infections in tropi-

cal areas, but today the infections may spread into

subtropical areas. There are many contributing fac-

tors driving this emergence. These factors include but

are not limited to the destruction of habitat, changing

ways in farming primarily in developing countries,

and human invasion and encroachment and climate

change. All of these things caused an imbalance among host, agent and environment. A destroyed

environment can lead to a number of other issues including global warming. Rising of the earth’s

temperature is one of the reasons why mosquitoes can impenetrate subtropical areas. Mosquitoes

usually cannot sustain their life in low temperature zones, but as the temperature rise mosquitoes

can adapt and prolong life.

One very important vector borne disease is Chikungunya. Chikungunya is a viral zoonotic di-

sease caused by Chikungunya virus infection. Chikungunya was first isolated in Tanzania in 1952

from a patient. The word “Chikungunya” comes from the Kimakonde language (an ethic language

of Tanzania), and means to become contorted. Before 2000, Chikungunya outbreaks were very rare.

Since 2000, Chikungunya outbreaks have emerged frequently. In 2000, there was a large outbreak

happened in Democratic Republic of Congo, while another outbreak happened in Indonesia in 2001

to 2003. In addition, Kenya suffered Chikungunya outbreak in 2004. Comoros Island and India suf-


fered Chikungunya outbreak in 2005 and 2007 respectively. Until 2015, Chikungunya fever has been

identified in 60 countries in Asia, Europe, Africa, and America.

As was mentioned earlier, the cause of Chikungunya Fever is Chikungunya Virus. Chikungunya

is an RNA virus, genus Alphavirus, Family Togaviridae. Chikungunya is transmitted through Aedes,

mosquito bites. Two species of Aedes, A. aegepty and A. albopictus, were known to be able to trans-

mit the virus to vulnerable hosts. The mosquitoes are active primarily during the day, and humans

are one of Chikungunya virus’ hosts. In Africa, Chikungunya virus was found in Bats and Non-human

primates.

When an infected mosquito bites, the virus penetrates the body and enters blood stream, the

virus will start to infect cells and replicate rapidly. After 3 - 7 days after mosquito bite, symptoms most

likely will start to emerge. In humans, some common symptoms of Chikungunya include fever and

severe joint pain, and sometimes other symptoms can appear like headache, muscle pain, joint swel-

ling and rash. The symptoms will emerge after 3 to 7 days after being bitten by infected mosquitoes.

At this stage, the virus can be found in the victim’s blood and the infected individual may transmit the

disease to other people through a mosquito bite. When a human is infected, transmission of other

vector borne diseases may occur (for instance dengue), so if you are infected by Chikungunya, you

must protect yourself from mosquito bite because you’re the source of new infection. Usually sick

people will get better within a week, painful joints may remain for months but death is rare.

Chikungunya is not treatable but preventable. So far there is neither vaccine nor medication ap-

proved for treating Chikungunya. We can prevent the infection by avoiding mosquitoes bite. Mosqui-

toes, especially Aedes, are active aggressively during daylight. It is highly recommended to use insect

repellent before you go out during the day. If you stay in the room, make sure the door and window

are always closed and use air conditioning if possible. You can also use insecticide spray to secure the

room, wear long sleeved shirt and long pants. The other method to prevent the infection is by termi-

nating life cycle of mosquitoes. In wet season or rain season, check items that may hold water around

houses, if you find them you have to empty, throw out, bury or at least turn them over so they will not

contain water any longer. Aedes have tendency to lay their eggs in fresh water so by doing this, it may

help to cut their life-cycle.

We can prevent Chikungunya fever more further by spreading this information to your peers

and fellows to increase public awareness. Many diseases can be avoided by taking preventing actions,

so make sure to take care of yourself and others.

“Chikungunya is not treatable but preventable”


IVSA Policy Statement Antimicrobial Resistence Week

During the week of 17-22 November 2015, for the first time, the World Health Organization (WHO) held an Anti-

microbial Resistance (AMR) week in recognition of this growing international problem. The WHO is making a

massive step forward to highlight the immense global danger that AMR presents. Their campaign aims to incre-

ase worldwide awareness of antimicrobial resistance and to encourage best practices among the general public,

health workers and policy makers to avoid the further emergence and spread of antibiotic-resistance (1).

Put eloquently by Dr. Margaret Chan, the Director-General of the WHO, “Antimicrobial Resistance is not a future

threat looming on the horizon. It is here, right now, and the consequences are devastating.” To put this in per-

spective, there have been no newly developed classes of antimicrobial drugs for about the past 30 years. Bac-

terial virulence factors are continuously gaining advantage over our outdated antimicrobials, leading to more

infection and disease paired with increased mortality.

The dramatic rise of AMR in recent times can be attributed to two main causes:

• The limitless and incorrect usage of antimicrobials by a variety of health professionals

• The generalized lack of compliance by patients, owners and users of antimicrobials in regards to the

appropriate manner in which to use these medications.

The veterinary field has recently come under intense pressure to limit the use of antibiotics in multiple areas,

especially concerning livestock. By enforcing regulations on the use of antimicrobials in food animals, there is

an attempt to decrease residual levels of antibiotics found in meat for human consumption. There are copious

amounts of scientific research showing that antibiotic use in livestock contributes to AMR spread in humans, due

to these drug residues (2).

Thus, the IVSA calls that all veterinary students should be well informed about this issue of increasing AMR and

should be actively involved in halting its progression. Students must have the ability to accurately inform animal

owners about the risks of using antimicrobials, as well as to highlight the importance of following prescriber in-

structions. It is imperative that students clearly guide owners to follow directions and use the appropriate dosage

and duration for their animals. Veterinary students must work to correctly diagnose patients and limit the use

of antimicrobials for use only in those that genuinely benefit from them. As future veterinarian, students should

avoid regarding antimicrobials as the panacea of all diseases.


To achieve all of these goals, we need a change in the veterinary curriculum. The educational system must give

students the opportunity to better educate consumers, allowing students to have the proper tools for guiding

clients and educating owners on the importance of appropriate use of antimicrobials. The veterinary curriculum

should also give future veterinarians the ability to correctly prescribe antimicrobials, and to stress the seriousness

of limitless use. Proper usage of antimicrobials should be well understood and followed by veterinarians, and

this usage should be based on clinical proof of active bacterial infection, as well as guided by antibiograms and

susceptibility tests where possible.

References:

1. “Antimicrobial Resistance.” World Health Organization. www.who.int/mediacentre/factsheets/fs194/en/

2. Antibiotic Resistance Threats Report and Foodborne Germs. (2014, April 14). Retrieved from www.cdc.gov/narms/resources/thre-

ats.html


IVSA Policy Statement International Students Day

On this day, November 17, the International Veterinary Students’ Association (IVSA) congratulates the nume-

rous people across history that have stood up for the rights of students: from Jan Opletal in 1939, to the strike

in Athens in 1973, to the Velvet Revolution in Prague in 1989, to the recent shutdown of tertiary education in

South Africa, to the hundreds of thousands of students in the Netherlands who stood up in the name of a free,

fair education for all.

As veterinary students, we know and understand the pain and stress placed on students as they make their way

through their veterinary education, and in particular the pressure they feel due to concurrent financial strain. In

many countries, veterinary education is one of the most expensive degrees to pursue. This high cost of educati-

on not only places a great stress burden on students, but it can also prevent many students from achieving their

dreams of becoming a veterinarian if they cannot afford to appropriately further their education or even afford

it at all. There is an increasing demand for veterinarians due to a changing global perception of a veterinarian’s

role in the betterment of human health following One Health principles, and the consequences of the financial

burden of student education might soon result in the veterinary community not being able to cater to these

demands.

However, the cost of education does not solely have a negative impact on academic pursuance and development.

Studies have shown that veterinary students experience depression more often than human medical students,

with up to one third of first-year students showing symptoms of depression, in one US study (1) financial stress

burden are less likely to be involved in campus life and instead, focus solely on their academic studies in fear of

failing out (2) variety of problems, but perhaps, more importantly, does not foster adequate communication and

social skills for a veterinary graduate to fit appropriately into society. Especially in a profession that requires a

high level of social engagement and empathy with clients, this can have devastating effects in the work field, in

turn, leading to a decrease in work satisfaction and an increase in work-related stress.

With the rising size and number of student loans required to achieve degrees, the financial burden does not

end once a student has graduated. Veterinarians, who study on average for 6 years, earn much less money as

compared to many other academic professions with a comparable degree. Many students find it impossible to

combine the stress and lengthy hours of their education with a stable job during their veterinary studies, and are

therefore left to start paying their debts as soon as they graduate and begin their working life. Although starting


salaries have increased over the years, educational debt has proportionally increased at a much greater rate (3).

The veterinary degree has a very high debt-to-starting-salary ratio, which forces recently graduated veterinarians

to face a very difficult first few years in their working lives as they struggle to pay off a loan that has accumulated

over a considerable time. This adds much stress to veterinarians who are also dealing with being placed in highly

emotional situations on a daily basis during the work day, and contributes to why the veterinary profession has

one of the highest suicide rates across the world (4).

The IVSA, a global body representing over 30,000 veterinary students around the world, therefore calls on stu-

dents and places of tertiary education to work together in decreasing the cost of veterinary education while

maintaining high standards and excellent quality. We call on these institutions to work towards a model of free

veterinary education to allow all students the ability and chance to achieve their goal of one day being high-qua-

lity and stress-free veterinarians. We therefore call on the global community of students to stand together to

demand free, fair and quality education for all.

References:

1. Hafen, M., Reisbig, A., White, M., & Rush, B. (n.d.). The First-Year Veterinary Student and Mental Health: The Role of Common Stres-

sors. Journal of Veterinary Medical Education, 102-109.

2. Fosnacht, K. (2013). Financial Stress and Its Impact on First-Year Students’ College Experiences. Indiana University, Bloomington, In-

diana.

3. Chieffo, C., Kelly, A., & Ferguson, J. (2008). Trends in gender, employment, salary, and debt of graduates of US veterinary medical

schools and colleges. JAVMA, 233(6), 910-917. doi:10.2460/javma.233.6.910

4. Bartram, D., & Baldwin, D. (2010). Veterinary surgeons and suicide: A structured review of possible influences on increased risk. Ve-

terinary Record, 166, 388-397. doi:10.1136/vr.b4794


IVSA. Information Office

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Dyrlægevej 9, Kopenhag

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Website: www.ivsa.org

Email: [email protected]

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VPH Journal 5th edition