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The Interface Between Human and Veterinary Public Health

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Title: The Interface Between Human and Veterinary Public Health


1
The Interface Between Human and Veterinary Public
Health
  • Emerging Zoonotic Disease Summit
  • Gainesville, Florida
  • August 23, 2005
  • Lonnie J. King
  • Director, Office of Strategy and Innovation, CDC
  • Dean, CVM, Michigan State University

2
Historical Epidemiological Transitions
  • Paleolithic Age
  • Hunters and gatherers
  • Nomadic
  • Small populations
  • Parasitic infections

3
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

4
Deadly Gifts
Guns, Germs and Steel ? J. Diamond
5
Historical Epidemiologic Transitions 2nd
Transition
  • ? Coincided with mid-19th century Industrial
    Revolution
  • ? Decreases in infectious disease mortality
  • ? Increasing life expectancy
  • ? Improved nutrition
  • ? Antibiotics
  • ? Diseases of Civilization cancer, diabetes,
    cardiovascular diseases
  • ? Environmental problems
  • ? Chronic diseases

6
Historical Epidemiologic Transitions 3rd
Transition
  • ? Last 25 years
  • ? Emerging infectious diseases globally
  • ? New diseases and increases in mortality first
    since 19th century
  • ? Re-emergence
  • ? Antimicrobial resistance
  • ? 75 percent of diseases are zoonotic
  • ? Anthropogenic factors of emergence the
    microbial perfect storm

7
The Perfect Storm ? Sebastian Junger
  • an ocean tempest due to a rare combination of
    factors and circumstances that might occur every
    century

8
MICROBIAL THREATS
TO
HEALTH
EMERGENCE, DETECTION,
AND RESPONSE  
INSTITUTE OF MEDICINE

OF THE NATIONAL ACADEMIES

National Academy Press

Washington, DC

2003
9
The Microbial Perfect Storm
  • Due to special combinations and circumstances
  • Relatively common occurrence
  • Doesnt dissipate, but may perpetuate or
    accelerate
  • Convergence model

10
WHO Map on World Emerging Diseases
11
Convergence Model
Physical Environmental Factors
Genetic and Biological Factors
Microbe
Human
Ecological Factors
Convergence Model (Microbial Threats to Health
IOM/NAS, 2003)
12
Factors in Emergence
  • Microbial adaptation and change
  • Host susceptibility to infection
  • Climate and weather
  • Changing ecosystems
  • Economic development and land use
  • Human demographics and behavior
  • Technology and industry

13
Factors in Emergence continued
  • International travel and commerce
  • Breakdown of public health measures
  • Poverty and social inequality
  • War and famine
  • Lack of political will
  • Intent to harm

14
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15
Multihost Pathogens
  • 60 of all human pathogens are zoonotic
  • 80 of animal pathogens
  • Ecological generalists

16
New Dynamic
  • Emerging diseases 70 zoonotic
  • New zoonoses
  • Food safety
  • Antimicrobial resistance
  • Agents of bio- and agro-terrorism 80 zoonotic
  • Global trade and movements

17
Rapidly Increasing Human Population
  • 6.1 Billion people in 2000
  • 9.4 to 11.2 Billion in 2050

18
Rapidly Increasing Urbanization
  • 2000
  • 47 world population living in urban areas
  • 2030
  • 60 world population living in urban areas

19
The Divided World of 2025 8.4 Billion People
  • World 1 Advanced nations
  • (Advances in medicine and food)
  • World 2 Middle class
  • (Livestock Revolution)
  • World 3 People in destitution and poverty
    (Sources of traditional pathogens)

20
El Nino
  • Leptospirosis
  • Hantavirus
  • Rift Valley fever

21
Vectors of Disease
22
Global Warming
  • Shifting and enlarging the incidence and
    distribution of disease
  • Malaria zone 45 of population to 60
  • Habitat change and disruption via weather changes

23
Global Warming Effects on Malaria
24
Ecosystem
25
Waterborne Zoonoses
Humans
Animals
Waterborne Disease
Microbial Pathogens
Water Environment
26
Waterborne Zoonoses Global Threat
  • 4 billion cases of diarrhea per year
  • 2-3 million deaths
  • Poorly reported
  • Zoonotic portion is significant
  • Endemic and epidemic
  • 1.1 billion people with unreliable water supply

27
Waterborne Zoonoses Pathogens
  • Cryptosporidium
  • Giardia
  • E. Coli 0157H7
  • Salmonella
  • Leptospiria
  • Toxoplasma
  • Campylobacter
  • Entamoeba
  • Ascarsis
  • Viruses and Prions? SARS?

28
Concentrated Animal Feeding Operations (CAFOs)
Their Impact on Food Safety and Healthy
Environments
29
Foodborne Infections
  • Worldwide
  • gt 2 million people die from diarrhea caused by
    contaminated food and water each year
  • U.S.
  • 76 million persons experience foodborne
    illnesses (1 in 4 people)
  • 325,000 hospitalizations
  • 5,000 deaths

30
Most Common Foodborne Pathogens
  • Campylobacter
  • Salmonella
  • E. coli 0157H7
  • Yersinia
  • Listeria
  • Cryptosporidium
  • Cyclospora
  • Norwalk-like viruses

31
Livestock 2020 The Next Food Revolution
  • Global increase and demand for protein and food
    of animal origin
  • Shift from poverty of 1-2 billion people to
    middle class
  • Westernization of Asia and Latin America
  • Concerns with sustainability
  • Increases in emerging zoonoses through the
    concentration of people and animals

32
By 2020, There will be 1 Billion People Over the
Age of 60
  • 30 of US population are baby boomers
  • Immuno-compromised population

33
Movement and Interactions of People and Commerce
  • Distance and speed of travel increased 1000 fold
    since 1800
  • 1.4 billion air travelers/year
  • 50 million foreign visitors, to US year through,
    102 sites
  • Antibiotic resistance
  • Global trade of food, animals and plants

34
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35
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36
The Coming Plague
  • Todays mingling of people, animals and microbes
    in new environments has no historical precedent.
  • -We await the coming plague
  • Laurie Garrett

37
Remote Sites
38
Pathogen Pollution
  • Human and domestic animal populations
  • Free-living wild animals
  • Example global decline in amphibian populations
    due to chytridiomycosis
  • Concern with adverse effects on biodiversity

39
Chytridiomycosis
40
Virus Carriers
Fruit bats
41
Flying Foxes
42
Nipah Virus
43
Malaysian Pig Farms
44
Emerging Infectious Diseases
Translocation
Human encroachment Ex situ contact Ecological
manipulation
Encroachment Introduction Spill over Spill
back
Wildlife EID
Domestic Animal EID
Human EID
Global travel Urbanization Biomedical manipulation
Agricultural Intensification
Technology and Industry
Dasazak P. et.al. Science 2000 287443
45
Spill Over and Spill Back
46
Whats Next?
47
Human Monkeypox Cases
Marshfield Clinic and MCW
Matt Kuehnert
48
Exotic Pets
49
SARS
50
Maintenance Host
51
SARS Airport Screening
52
The Lessons of SARS
  • The need for multinational collaboration
  • Public alarm can lead to huge economic impact -
    80 billion
  • Weaknesses in public health infrastructures
  • Consequences of poor reporting disincentives
  • A true zoonosis more to come
  • Constant threat due to Emerging Infectious
    Diseases in less developed countries

53
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54
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55
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56
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57
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58
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59
H5N1 Avian Influenza
60
Pandemic Influenza
61
The Next Influenza Pandemic
  • Not if, but when
  • 1918-1919 Experience 20 million deaths
  • 150 450 increase in patient and hospital
    visits
  • In 2001 (Asia only), 160 million workdays
    lost, and for a pandemic, 6 billion workdays
    lost worldwide

62
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63
  • Bioterrorism Biodefense
  • Agroterrorism

64
Agents of Bioterrorism
65
CDCs Most Significant Global Epidemics Over the
Last Decade
  • 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

66
Implications of Emerging Diseases
  • Political
  • Social
  • Economic
  • Psychological
  • Environmental

67
Animal-borne Epidemics Out of Control
Threatening the Nations Health 2003
  • ? A report from the Trust

for Americas Health
68
Findings from the Report
  • U.S. lacks a national program to prevent and
    control diseases that impact humans, animals and
    our food
  • There is no coordinated effort or single agency
    with a command and control responsibility
  • There is a lack of effective communications with
    the public about these diseases and their impact
  • Disease surveillance systems are not linked

69
Findings from the Report (continued)
  • Funding for bioterrorism has not adequately
    supported efforts to counter zoonotic disease
    threats, especially from the animal health
    perspective and infrastructure
  • There is a fragmentation of jurisdictions,
    authorities, statutes and research e.g. 200
    different government offices and programs
    responding to 5 zoonotic diseases
  • Animal and public health are separated by culture
    and organization

70
Microbial Threats to Health Conclusions
Recommendations
  • 1. Enhancing the global response capability
  • 2. Improving global infectious disease
    surveillance
  • 3. Rebuilding domestic public health capacity
  • 4. Improving domestic surveillance through
    better disease reporting (this includes both
    human health and veterinary health)
  • 5. Exploring innovative systems of surveillance
  • 6. Developing and using diagnostics

71
Microbial Threats to Health Conclusions
Recommendations (continued)
  • 7. Educating and training the microbial threat
    workforce
  • 8. Developing and producing vaccines
  • 9. Developing and producing antimicrobial drugs
  • 10. Controlling the use of antimicrobials
  • 11. Controlling vectorborne and zoonotic diseases
  • 12. Establishing a comprehensive infectious
    disease research
  • 13. Creating interdisciplinary infectious disease
    centers

72
Preventing Emerging Infectious Diseases A
Strategy for the 21st Century CDC
  • Goal 1 Surveillance and Response
  • Goal 2 Applied Research
  • Goal 3 Prevention and Control
  • Goal 4 Infrastructure and Training

73
Public Health at the Crossroad
  • New, inclusive vision of public health
  • Shift to focusing on causes of population health
  • Ensuring that population health is a central
    concern of policymakers
  • Globalization of causes and issues
  • Socioeconomic disparities
  • Emerging threats due to interdependence
  • New team expanded, integrated and
    transdisciplinary

74
  • Population health is a shift from an emphasis on
    individual health to understanding the multiple
    determinants of health.

75
  • Health is an outcome shaped by a wide range of
    social, economic, natural, built, and political
    environments that form a complex and
    ever-changing dynamic. Because of this broad
    perspective, public health teams themselves also
    need to reflect this reality.
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