One Health: A Concept for the 21 st Century

Transcription

1 One Health: A Concept for the 21 st Century Laura H Kahn, MD, MPH, MPP, FACP Virginia Veterinary Medical Association Conference February 17, 2017 What is One Health? The concept: human health is inextricably linked with animal and environmental health. One Health seeks to increase communication and collaboration between human, animal, environmental health professionals. Why One Health? Zoonotic disease risks from wildlife, livestock, and pets. Over 75% of emerging g infectious diseases are zoonotic 60% of human pathogens are zoonotic. Most agents of bioterrorism are zoonotic. Beyond zoonoses: Disease processes across species are shared. The Price of Agriculture and Domestication of Animals Agriculture about 10,000 years ago. Agriculture (aka food security) is foundation of civilization. Why is food security so important? Paleozoic Era Time of Complex Life on Earth Cenozoic Era Agriculture and food security (a.k.a. preventing hunger) form the foundation of civilization. Food security is inextricably linked with global health, global sustainability, and international security. There is no global health without global food security. Many diseases (i.e. Ebola, Zika, Chikungunya, SARS, Nipah, etc.) are emerging and spreading because of widespread deforestation, environmental degradation, and bushmeat consumption linked to food security. Global climate change affects food security. Early hominids Permian-Triassic Extinction Cambrian Explosion: Thriving life in seas but barren land Earth is 4.5 Billion Years Old 1

2 Diminishing Water Supplies in U.S. Price of Agriculture Measles (Rinderpest) Brucellosis Q fever Tularemia BSE Cattle Goats/Sheep Goats/Sheep Rabbit/Squirrels Cattle Went both ways Mycobacterium tuberculosis appeared about 40,000 years ago, coincided with human migration out of Africa. Two main lineages 20-30,000 years ago: 2 nd lineage associated with animals. Humans probably infected livestock. nal.ppat Hippocrates (ca. 460 BCE--ca. 370 BCE) Recognized the link between human health and the environment. Malaria= mal + aria. Middle Ages (14 th Century): Black Death Beginning in the 18 th century Bacteria: Yersinia pestis Spread by fleas carried by rats Some of the greatest discoveries in the history of medicine and public health were made at the intersection between human and animal health. 2

3 18 th Century: Vaccination against smallpox Opposition to Vaccination Vacca is Latin word for cow. Dr. Edward Jenner vaccinating 8 yr old boy 19 th Century: Germ Theory of Disease Louis Pasteur, French chemist studied chicken cholera Robert Koch, German physician studied anthrax Additional 19 th Century Developments Rudolf Virchow ( ), a German physician and pathologist said, between animal and human medicine there are no dividing lines--nor should there be. Coined term zoonosis Early Meat Inspection Programs Improved Food Safety Virchowʼs father was a butcher. Animal experiments on life cycle of Trichinella spiralis in porcine muscular tissue. Studied cysticercosis and tuberculosis in cattle. 19 th Century Developments Sir William Osler received his medical degree from McGill University, Canada Went to Berlin to work with Virchow Returned to Canada in 1874 Est. veterinary pathology as an academic discipline in North America 3

4 19 th Century Discovery: Diseases can be transmitted by arthropods Theobald Smith, MD (pictured) and F.L. Kilbourne, DVM discovered cause of cattle fever Babesia bigemina transmitted by the cattle tick. Set the stage for Walter Reed and colleaguesʼ discovery that mosquitoes transmit yellow fever. 20th Century Developments Scientific knowledge exploded Medicine became increasingly specialized Medicine and veterinary medicine diverged Emergence of new infectious diseases in 20 th century Why are these diseases emerging? Increasing global population pressures Deforestation and environmental destruction Intensive agriculture Global trade and travel Climate change 1999 West Nile Virus Outbreak in NYC Two Simultaneous Outbreaks 4

5 Solving the Mystery Challenges of the 21 st century Dr. Tracey McNamara, Chief Veterinary Pathologist, Bronx Zoo Birds native to North America Requires a new paradigm, One Health: Zoonotic diseases Cancer Cardiovascular Diseases Metabolic Diseases Neurological Diseases Degenerative Diseases and Injuries And others Humans and Animals Get the Same Diseases: New Therapeutic Discoveries Can Benefit All Species Human and Animal Health: A Symbiotic Relationship Pets, Livestock, Wildlife Benefits our physical health Benefits our mental health Benefits our social health Benefits our environmental health Pets Livestock 5

6 Wildlife Physical Health Owning a pet improves human health. But risks must be acknowledged and addressed. Pets American Pet Products Association Owners Survey: 68% of U.S. households own a pet Approx million homes 56.7 million households own a dog 45.3 million households own a cat In 2013, est. $55.53 billion spent on pets in U.S. Physical Health Benefits Lower high blood pressure Reduces risk of allergies in children Increases exercise motivation University of Missouri Human-Animal Center Established a Walk a Hound, Lose a Pound Program Dog Walking Eric and Peety video: 6

7 Risks of Pet Ownership: Microbes are shared New York Times, September 21, 2009 Dr. Elizabeth A. Scott et al. swabbed household surfaces at 35 randomly selected addresses. Nearly half of homes had MRSA on surfaces. Cat owners were 8 times more likely than others to have MRSA at home. Tie to pets has germ jumping to and fro Methicillin Resistant Staph aureus (MRSA) is infecting both humans and animals. American Journal Infection Control Aug. 2009: 37: Zoonotic diseases and pets Some people are at greater risk: Chronically immunosuppresed HIV/AIDS Organ transplant recipients People with autoimmune diseases Pregnant women Infants and very young children Grant and Olsen Study, 1999 Grant and Olsen, EID, Preventing zoonotic diseases in immunocompromised persons. Surveyed MDs and DVMs in Wisconsin MDs generally not comfortable discussing i role of animals in zoonotic disease transmission. DVMs typically didnʼt know pet ownerʼs health status. Found nearly a complete lack of communication between MDs and DVMs. Result: Zoonotic disease risk communication to patients falls through the cracks. Grant and Olsen Study, 1999 MDs and DVMs asked to rank animals posing greatest risk to immunocompromised patients. DVMS: ranked reptiles (Salmonella) and puppies (Campylobacter) MDs: ranked cats and kittens Both groups ranked Salmonella and Toxoplasma gondii as microbes of greatest risk. Risks of Pet Ownership for Immunosuppressed Risks of Exotic Pet Ownership Reptiles carry Salmonella in their guts. In U.S., exposure to these animals leads to 100, cases of reptileassociated salmonellosis each year. Reptiles are popular pets: In 2001, estimated households with reptiles 1.7 million 249a3.htm 7

8 Monkeypox Outbreak 2003 Orthopoxvirus group: Includes smallpox, cowpox, and other pox viruses. Viral disease found mostly in rainforest countries of Central and West Africa. Called monkeypox because first identified in lab monkeys in Natural host may be African squirrel Shipment of rodents from Africa to U.S. set off Midwest outbreak requiring smallpox vaccinations to stop it. Root Cause of Outbreak: People buying wild exotic animals as pets Giant Gambian Rat Brushtail Porcupines Striped Mice April 9, 2003: Shipment of 800 small mammals from Ghana (including 762 African rodents) arrived in Texas. Dormice Tree Squirrel Monkeypox Chain of Transmission Giant Gambian Rat Prairie Dog Human 35 laboratory confirmed cases. 28 adults and 2 children in 6 states received the smallpox vaccine to prevent further monkeypox transmission. Trade in Exotic Animals 2000 to 2006: 1.5 billion live wild animals legally imported into U.S. Approx. 120,000, per year. 90% destined for pet industry. Minimal surveillance; health risks unknown. pone #pone smith1 Some animals simply shouldnʼt be pets Mental Health Benefits More tigers are now kept as pets in the U.S. than living in the wild. BuyTigers.com 15,000 big cats and 15,000 primates in private hands in U.S. according to Humane Society Socety of US. 400 tigers left in Sumatra. Only 18 states have outright bans on exotic animals as pets. NYTimes Jan. 10, Hurricane Katrina 2005 Human-animal bond: Lower feelings of loneliness Reduces depression 32% of dog owners take their pets with them when gone for 2 or more nights. Animal-assisted therapy 8

9 Social Health Benefits Social Health Benefits For elderly or people living alone, pet might be only family member. Increases social interactions. Increases sense of well-being. Puppies for Prisoners Animals teach responsibility and caring Animals give people a sense of purpose and self esteem Animals provide unconditional love Environmental Health Benefits Environmental Health Benefits Which scene would you rather look at? Plants and animals help people heal Healthy Environment = Healthy People and Animals How can VVMA promote One Health? VVMA is well positioned to promote One Health. Reach out to the medical societies of Virginia and forge ties. Establish inter-disciplinary, inter-species conferences. Develop collegial relationships with human and environmental health professionals. Educate policy makers and the public about the importance of One Health. Take Home Messages Human, animal, and environmental health are linked. One Health concept provides an important strategy to improve the lives of all species Animals suffer from many of the same diseases as people: new therapies would benefit all species. Animals (and plants) improve peopleʼs physical, mental, social, and environmental health. A healthy environment benefits everybody. Animal health professionals should work with human health professionals to prevent zoonotic disease transmission, especially in high risk groups, that rely on pets for mental and social well-being. 9

10 The One Health Umbrella One Health Endorsements American Medical Association American Veterinary Medical Association American Nurses Association American Association of Medical Colleges American Association of Veterinary Medical Colleges American Society for Microbiology American Society of Tropical Medicine and Hygiene Council of State and Territorial Epidemiologists Association of Schools of Public Health Thank you! Acknowledgements Collaborators: Bruce Kaplan DVM, Dipl. AVES (Hon) Tom Monath MD Jack Woodall, PhD Lisa Conti, DVM, MPH 10