Veterinary Medicine and One Health Protecting the health

Veterinary Medicine and One Health Protecting the health

Veterinary Medicine and One Health Protecting the health of people, animals, and the environment Andrew T. Maccabe, DVM, MPH, JD Executive Director, AAVMC August 25, 2012 University of Saskatchewan Veterinary Medicine and One Health What veterinarians do a brief history How veterinary medicine contributes to One Health How health professionals can collaborate to advance One Health One Health Animal Health

Human Health Environmental Health Between animal and human medicine there are no dividing lines nor should there be. The object is different but the experience obtained constitutes the basis of all medicine - Rudolph Virchow, 1821-1902 First Wave Late 1800s Veterinary medicine emerges as a separate profession Horses provide critical infrastructure Transportation, agriculture, war effort

Land Grant Act of 1862 To teach such branches of learning as are related to agriculture and the mechanic arts Second Wave Early 1900s Steam engine, internal combustion engine The end of veterinary medicine? Increasing value of livestock Agricultural Experiment Stations Smith-Lever Act of 1914 cooperative extension Disease control and eradication Tuberculosis, Brucellosis control programs Golden Age of antibiotics Third Wave Late 1900s Integrated food animal production systems Rural community service veterinarians

Food supply veterinarians Increasing Urbanization Changing role of companion animals Increasing specialization Board-certified specialties Surgery Toxicology Dermatology Ophthalmology Anesthesiology

Internal medicine Emergency care Board-certified specialties Surgery Toxicology Dermatology Ophthalmology Anesthesiology Internal medicine Emergency care

Animal Behavior Animal Welfare Laboratory Animal Theriogenology Poultry Medicine Preventive Medicine Zoological Medicine Fourth Wave Early 2000s Antibiotic resistance Population growth, globalization Emerging and re-emerging infectious diseases

Veterinary Medicine and One Health Todays veterinarians are trained to protect the health of both animals and people. They address the health needs of every species of animal and they also play a critical role in environmental protection, food safety, animal welfare, and public health. Veterinary Medicine and One Health e n i Todays veterinarians c are htrained tothprotect i d

l t and people. l the health of both e animals a a e M e H of every They address the health needs H e y v t i

n m t animal e speciesaof and they also play a o e f s i t t r a e

s a a s S l y critical role in environmental protection, p o s u d n o p

m o food safety, animal welfare, and public c o o o o o E P C F Z health.

Consume food 0 Onset of symptoms Consume food 0 2 Onset of symptoms Consume food

0 Collect stool sample 2 4 Onset of symptoms Consume food 0 Stool culture result Collect stool

sample 2 4 7 Onset of symptoms Consume food 0 Stool culture result Collect stool sample

2 4 Case report to PH dept 7 9 Onset of symptoms Consume food 0 Stool culture

result Collect stool sample 2 4 Submit isolate to PH lab Case report to PH dept 7 9 10

Onset of symptoms Consume food 0 Stool culture result Collect stool sample 2 4 Submit isolate to PH lab

Case report to PH dept 7 9 Case interview 10 14 Hedberg, CW, et al. Timeliness of enteric disease surveillance in 6 US states. Emerg Inf Dis J 14(2), February, 2008. PFGE Subtyping

Onset of symptoms Consume food 0 Stool culture result Collect stool sample 2 4 Submit isolate to PH lab

Upload to PulseNet Case report to PH dept 7 9 10 18 PulseNet laboratory network detects widespread clusters of infections Public Health Labs in Each State DNA Fingerprint

patterns of Salmonella PulseNet National Database (CDC) National Cluster Detection (CDC) All State labs and many big city labs participate in PulseNet, along with CDC, USDA and FDA Cluster Evaluation by CDC and States PulseNet Data Analysis: Searching for Clusters State health depts submit patterns electronically

CDC searches for similar patterns in past 2-4 months CDC compares patterns visually Cluster of indistinguishable patterns When cluster identified, PulseNet contacts epidemiologists PFGE Subtyping Onset of symptoms Consume food 0

Stool culture result Collect stool sample 2 4 Submit isolate to PH lab Upload to PulseNet Case report to PH dept

7 9 Cluster ID 10 18 PFGE Subtyping Onset of symptoms Consume food 0

Stool culture result Collect stool sample 2 4 Submit isolate to PH lab Upload to PulseNet Case report to PH dept 7

9 Epi investigation Cluster ID 10 18 PFGE Subtyping Onset of symptoms Consume food 0

Stool culture result Collect stool sample 2 4 Submit isolate to PH lab Upload to PulseNet Case report to PH dept

7 9 Epi investigation Cluster ID 10 18 Case interview PFGE Subtyping Onset of symptoms

Consume food 0 Stool culture result Collect stool sample 2 4 Submit isolate to PH lab Upload to PulseNet

Case report to PH dept 7 9 Epi investigation Cluster ID 10 18 Product implicated

Case interview PFGE Subtyping Onset of symptoms Consume food 0 Stool culture result Collect stool sample 2

4 Submit isolate to PH lab Upload to PulseNet Case report to PH dept 7 9 Epi investigation Cluster ID

10 18 Days Product implicated Case interview Weeks Months Estimates of Foodborne Illness (US) Scallan, et. al., Emerg Infect Dis, Jan 2011. Foodborne

Agents Estimated annual number of Estimated annual number of Estimated annual number of illnesses hospitalizations deaths (90% CI) (90% CI)

31 known pathogens 9.4 million 55,961 1,351 (6.612.7 million) (39,53475,741) (7122,268) Unspecified agents 38.4 million

71,878 1,686 (19.861.2 million) (9,924157,340) (3693,338) 127,839 3,037 (62,529215,562 (1,4924,983) 47.8 million

Total (28.771.1 million) (90% CI) Outbreak Investigations Goals of investigations Immediate control of outbreak; prevention of illnesses Identify gaps in food safety systems Outbreak epidemiology changing Globalization, centralization, industrialization Number of outbreaks detected has grown substantially Effective investigation is key to reducing burden of foodborne disease Identify food vehicles and factors which lead to outbreaks Foodborne Disease Outbreaks

Old Focal scenario Large number of cases in one jurisdiction Detected by affected group Local investigation Local food handling error Local solution Foodborne Disease Outbreaks Old Focal scenario New dispersed scenario Large number of cases in

Small numbers of cases in one jurisdiction Detected by affected group Local investigation Local food handling error Local solution many jurisdictions Detected by lab-based subtype surveillance Multistate/Country investigation Industrial contamination event

These changes make coordination among multiple states and agencies, and countries even more important than before Preventing Foodborne Disease Farm to Fork On-farm good agricultural practices Good manufacturing practices & inspection Designing processes for safety Microbial monitoring Restaurant/store codes & inspection Consumer education 32 Challenge: New Food Vehicles

12 new food vehicles since 2006: Bagged spinach E. coli O157 Carrot juice Botulism Peanut butter/peanut paste Salmonella

Broccoli powder on a snack food Salmonella Dog food Salmonella Turkey pot pies Salmonella Canned chili sauce Botulism Hot peppers Salmonella White pepper Salmonella Raw cookie dough E. coli O157 Puffed breakfast cereal Salmonella Cracked red and black pepper Salmonella on salami

Zoobiquity Animals and humans get the same diseases, yet physicians and veterinarians almost never talk to each other Zoobiquity brings together human doctors and animal doctors to treat the diseases shared by patients of many species Panda in utero Male fetus in utero Self-injury in a German Shepherd

Osteosarcoma in a Golden Retriever Self-injury in an adolescent female Osteosarcoma in a teenage male Obesity in a Domestic Shorthair Obesity in an adult female Zoobiquity Capture Myopathy in prey animals Animals caught by predators experience a catastrophic surge of adrenaline

Results in widespread myopathy, including cardiomyopathy Takotsubo Cardiomyopathy in humans Classic heart attack symptoms, but no blockage Caused by intense painful emotion Emotional trigger Surge of stress hormones Failing heart Same syndrome, different names? Possible

death Emotional trigger Surge of stress hormones Failing heart Possible death Same syndrome, different names? Not the overlap, but the GULF - Capture myopathy was described over 40 years ago - Takotsubo cardiomyopathy was discovered in early 2000

Zoobiquity Siamese cats and Dobermans get OCD; many are on Prozac Canaries, fish, and Yorkie dogs faint when theyre stressed out Mares can become nymphomaniacs Koalas catch Chlamydia, rabbits get syphilis Reindeer seek out narcotic escape in hallucinogenic mushrooms Deep Homology The human genome is 98.6% similar to chimpanzees Nearly identical clusters of genes link mammals, reptiles, birds, and insects Genes from a sighted mouse placed into a blind fruit fly can cause the fly to grow structurally accurate eyes Visual acuity in a hawk, based on responsiveness to light, is linked to photosensitivity in green algae

Epigenetics Describes how infections, toxins, food, and even cultural practices can turn genes on and off to alter an animals development Helps explain rapid evolutionary change and highlights the role of the environment One Health Animal Health Human Health Environmental Health One Health Deep homology

Animal Health Human Health Epigenetics Environmental Health Person becomes ill Person seeks medical care Person becomes ill Stool sample collected Person seeks medical care

Person becomes ill Pathogen identified Stool sample collected Person seeks medical care Person becomes ill Isolate submitted to PH lab Pathogen identified Stool sample collected Person seeks medical care Person becomes ill

PFGE subtyped and uploaded Isolate submitted to PH lab Pathogen identified Stool sample collected Person seeks medical care Person becomes ill PFGE subtyped and uploaded Isolate submitted to PH lab Pathogen identified Stool sample collected Person seeks medical care

Person becomes ill Veterinarians Oath Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge. I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics. I accept as a lifelong obligation the continual improvement of my professional knowledge and competence. Veterinarians Oath Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the

protection of animal health and welfare prevention and relief of animal suffering conservation of animal resources promotion of public health advancement of medical knowledge

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