1. 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

2. 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

3. One Health
Animal
Health
Human
Health
Environmental
Health

4. “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,

5. First Wave – Late 1800’s
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”

6. Second Wave – Early 1900’s 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

7. Third Wave – Late 1900’s Integrated food animal production systems
Rural community service veterinarians
Food supply veterinarians
Increasing Urbanization
Changing role of companion animals
Increasing specialization

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

9. 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

10. Fourth Wave – Early 2000’s Antibiotic resistance
Population growth, globalization
Emerging and re-emerging infectious diseases

11. Veterinary Medicine and One Health
“Today’s 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.”

12. Veterinary Medicine and One Health
“Today’s 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.”
Comparative Medicine
Population Health
Ecosystem Health
Food Safety
Zoonoses

13. Consume food

14. Onset of symptoms
Consume food 2

15. Onset of symptoms
Consume food
Collect stool sample 2 4

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

17. Onset of symptoms
Stool culture result
Consume food
Collect stool sample
Case report to PH dept 2 4 7 9

18. Submit isolate to PH lab
Onset of symptoms
Stool culture result
Submit isolate to PH lab
Consume food
Collect stool sample
Case report to PH dept 2 4 7 9 10

19. Submit isolate to PH lab
Onset of symptoms
Stool culture result
Submit isolate to PH lab
Consume food
Collect stool sample
Case report to PH dept
Case interview 2 4 7 9 10 14
Hedberg, CW, et al. Timeliness of enteric disease surveillance in 6 US states. Emerg Inf Dis J 14(2), February, 2008.

20. Submit isolate to PH lab
PFGE Subtyping
Upload to PulseNet
Onset of symptoms
Stool culture result
Submit isolate to PH lab
Consume food
Collect stool sample
Case report to PH dept 2 4 7 9 10 18

21. PulseNet laboratory network detects widespread clusters of infections
DNA “Fingerprint” patterns of Salmonella
PulseNet National Database (CDC)
Public Health Labs
in Each State
BioNumerics Client Software from Applied Maths BVBA
Highly customized software for PulseNet
Upload and download information
Client based/Remote identification of PFGE patterns
The network consists of “clients” which are the databases at the local levels (public health laboratories) and the main database and server which is located at CDC. The “clients” upload the patterns and isolate information to the server. They are also able to download PFGE patterns to their local databases for comparison of PFGE patterns.
This system allows for unique remote identification and is highly customizable. Meaning that the “clients” are able to choose what info is uploaded. This is important if patient confidentiality is an issue. And all of this is done via the internet.
All State labs and many big city
labs participate in PulseNet,
along with CDC, USDA and FDA
National Cluster Detection (CDC)
Cluster Evaluation by CDC and States 21

22. 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
When cluster identified, PulseNet contacts epidemiologists
Patterns obtained by PFGE are electronically submitted to the PulseNet national PFGE pattern database at CDC via the internet
For Cluster Detection 60-day cluster searches are performed for all organisms with the exception of Listeria. 120-day searches are used for Listeria because of it’s longer incubation time. We visually compare the patterns using tools within the BioNumerics software and report any matches to foodborne epidemiologists.
Cluster of indistinguishable patterns 22 22

23. Submit isolate to PH lab
PFGE Subtyping
Upload to PulseNet
Onset of symptoms
Stool culture result
Submit isolate to PH lab
Consume food
Collect stool sample
Case report to PH dept
Cluster ID 2 4 7 9 10 18

24. Submit isolate to PH lab
PFGE Subtyping
Upload to PulseNet
Onset of symptoms
Stool culture result
Submit isolate to PH lab
Epi investigation
Consume food
Collect stool sample
Case report to PH dept
Cluster ID 2 4 7 9 10 18

25. Submit isolate to PH lab
PFGE Subtyping
Upload to PulseNet
Onset of symptoms
Stool culture result
Submit isolate to PH lab
Epi investigation
Consume food
Collect stool sample
Case report to PH dept
Cluster ID
Case interview 2 4 7 9 10 18

26. Submit isolate to PH lab
PFGE Subtyping
Upload to PulseNet
Onset of symptoms
Stool culture result
Submit isolate to PH lab
Epi investigation
Product implicated
Consume food
Collect stool sample
Case report to PH dept
Cluster ID
Case interview 2 4 7 9 10 18

27. Submit isolate to PH lab
PFGE Subtyping
Upload to PulseNet
Onset of symptoms
Stool culture result
Submit isolate to PH lab
Epi investigation
Product implicated
Consume food
Collect stool sample
Case report to PH dept
Cluster ID
Case interview 2 4 7 9 10 18
Days
Weeks
Months

28. Estimates of Foodborne Illness (US) Scallan, et. al
Estimates of Foodborne Illness (US) Scallan, et. al., Emerg Infect Dis, Jan 2011.
Foodborne Agents
Estimated annual number of
illnesses (90% CI)
Estimated annual number of hospitalizations (90% CI)
deaths (90% CI)
31 known pathogens
9.4 million (6.6–12.7 million)
55,961 (39,534–75,741)
1,351 (712–2,268)
Unspecified agents
38.4 million (19.8–61.2 million)
71,878 (9,924–157,340)
1,686 (369–3,338)
Total
47.8 million (28.7–71.1 million)
127,839 (62,529–215,562
3,037 (1,492–4,983)

29. 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

30. 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 30 30

31. 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
New dispersed scenario
Small numbers of cases in 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 31 31

32. Preventing Foodborne Disease “Farm to Fork”
On-farm good
agricultural practices
Good manufacturing practices & inspection
Designing processes for safety
Microbial monitoring
Finally, a big challenge is that prevention includes many partners, acting at different points along the food chain from farm to table.
On the farm, good agricultural practices are needed, and oversight comes from industry itself, there is little regulatory oversight.
The food factory, the industry uses good manufacturing processes, and regulatory authorities inspect them: This is where the federal agencies have their primary focus: The USDA Food Safety and Inspection Service (FSIS) for meat, poultry and some egg products, and the Food and Drug Administration (FDA) for all other foods.
Some food processing steps, like pasteurization and canning, are designed to make food safer, with oversight by the regulatory agencies.
Microbial monitoring can verify that processing is done correctly.
For restaurants and grocery stores, the codes and inspections are typically up to local health departments.
Consumer education is a joint effort.
Restaurant/store
codes & inspection
Consumer education 32 32

33. 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 33

35. 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

36. Self-injury in a
German Shepherd
Osteosarcoma in a
Golden Retriever
Obesity in a
Domestic Shorthair
Panda in utero
Male fetus
in utero
Self-injury in an
adolescent female
Osteosarcoma in a
teenage male
Obesity in an
adult female

37. 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

38. Same syndrome, different names?
Surge of
stress
hormones
Emotional
trigger
Failing
heart
Possible
death
Same syndrome, different names?

39. Same syndrome, different names? Not the overlap, but the GULF
Surge of
stress
hormones
Emotional
trigger
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

40. Zoobiquity Siamese cats and Dobermans get OCD; many are on Prozac
Canaries, fish, and Yorkie dogs faint when they’re stressed out
Mares can become nymphomaniacs
Koalas catch Chlamydia, rabbits get syphilis
Reindeer seek out narcotic escape in hallucinogenic mushrooms

41. 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

42. Epigenetics
Describes how infections, toxins, food, and even cultural practices can turn genes on and off to alter an animal’s development
Helps explain rapid evolutionary change and highlights the role of the environment

43. One Health
Animal
Health
Human
Health
Environmental
Health

44. One Health Deep homology Epigenetics Animal Human Health Health
Environmental
Health

45. Person becomes ill

46. Person seeks medical care
Person becomes ill

47. Stool sample collected
Person seeks medical care
Person becomes ill

48. Stool sample collected
Pathogen identified
Stool sample collected
Person seeks medical care
Person becomes ill

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

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

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

52. Veterinarian’s 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.

53. Veterinarian’s Oath for the benefit of society
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