Advancing Global Health with One Health Concept Kumar

Advancing Global Health with One Health Concept Kumar Venkitanarayanan, DVM, MVSc, MS, Ph. D. Professor of Microbiology & Graduate Programs Chair Department of Animal Science University of Connecticut, USA

Global Health Human population growth http: //www. globalchange. umich. edu/globalchange 2/current/lectures/human_pop/human_

Emergence of infectious diseases Global Health

Emerging and re-emerging diseases Morens et al. , 2004, Nature 430, 242 -49

Factors influencing emerging and reemerging zoonoses Human Animal Ecological Cohen et al. , 2000. Nature ; Cutler et al. , 2010 Emerg Infect D

The one health concept in advancing global health Global Collaborative Multidisciplinary Effort Promote humans, animals and environment 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

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 1 st One health congress held in Melbourne, Australia The 1 st One Health Conference held in Africa • 2012: The Global Risk Forum sponsors the first one Health Summit. in Switzerland. • 2013: The 2 nd International One Health Congress in Thailand;

Implementation of One Health concept for controlling infectious diseases • Rabies • Escherichia coli O 157: H 7 • Mad cow disease • Lead poisoning • Bacterial antibiotic resistance

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 completed 210, 000 dogs vaccinated (70% dog population) • Outcome: 84 human cases in 2011 Only 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

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 12 th 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)

Escherichia coli O 157: H 7 (EHEC) 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 (Scallan et al. , 2011) 20

Epidemiology ØPrincipal reservoir host: cattle Recto anal junction Terminal rectum Rumen Colon (Naylor et al. , 2003) 21

Routes of E. coli O 157: H 7 transmission

E. coli O 157: H 7 - 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 (Gb 3) receptor • Treatment - Supportive therapy - Antibiotics are contraindicated - No vaccines are available

E. coli O 157: H 7 and One Health • Farm level: Surveillance, Intervention strategies, Vaccines • Slaughter house and meat hygiene • Environmental hygiene: Considering animalecosystem 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 O 157: H 7 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 v. CJD 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 (v. CJD) 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

Lead poisoning investigation in Zamfara, Northern Nigeria • 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

Application of One Health to control antibiotic resistance • 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

Veterinary profession in One Health • The Veterinary profession: Strong advocate and leader of One Health. • Advantages: Holistic understanding and occupational interaction with a multitude of animal species

Role of Veterinarians in One Health Human Health Animal Health Disease surveillance and control Animal Welfare Increase Domestic Animal Production Control Zoonotic Diseases Biomedical Research Food Quality and Safety Ecological Health Protect Biodiversity Natural Resource Conservation Wildlife Management Gibbs and Gibbs, 2012

Education of professionals for One Health • Multidisciplinary and core public health coursework including Epidemiology and Biostatistics Public health and Zoonotic diseases Wildlife diseases and management Environmental Health Veterinary medicine Human Medicine Environmental Sciences • Supervised teaching and research • Collaborative programs connecting the three disciplines. http: //egh. phhp. ufl. edu/academic-programs/doctoral-programs/phd-in-one-health/

Conclusion • One world-one health concept for a healthier planet • Be prepared for future challenges in global health • Addressing connections between health and environment