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Veterinary Medicine and One Health Protecting the health of people, animals, and the environment Andrew T. Maccabe, DVM, MPH, JD Executive Director, AAVMC.

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Presentation on theme: "Veterinary Medicine and One Health Protecting the health of people, animals, and the environment Andrew T. Maccabe, DVM, MPH, JD Executive Director, AAVMC."— Presentation transcript:

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 Human Health Environmental Health Animal 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 Zoonoses Food Safety Ecosystem Health

13 0 Consume food

14 02 Onset of symptoms Consume food

15 024 Onset of symptoms Collect stool sample Consume food

16 0274 Onset of symptoms Collect stool sample Stool culture result Consume food

17 02974 Onset of symptoms Collect stool sample Case report to PH dept Stool culture result Consume food

18 Onset of symptoms Collect stool sample Case report to PH dept Stool culture result Submit isolate to PH lab Consume food

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

20 Onset of symptoms Collect stool sample Case report to PH dept Stool culture result Submit isolate to PH lab Consume food PFGE Subtyping Upload to PulseNet

21 PulseNet laboratory network detects widespread clusters of infections PulseNet National Database (CDC) Public Health Labs in Each State DNA “Fingerprint” patterns of Salmonella National Cluster Detection (CDC) Cluster Evaluation by CDC and States All State labs and many big city labs participate in PulseNet, along with CDC, USDA and FDA

22 PulseNet Data Analysis: Searching for Clusters Cluster of indistinguishable patterns 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

23 Onset of symptoms Collect stool sample Case report to PH dept Stool culture result Submit isolate to PH lab Consume food PFGE Subtyping Upload to PulseNet Cluster ID

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

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

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

27 Onset of symptoms Collect stool sample Case report to PH dept Stool culture result Submit isolate to PH lab Case interview Consume food PFGE Subtyping Upload to PulseNet WeeksDaysMonths Cluster ID Epi investigation Product implicated

28 Estimates of Foodborne Illness (US) Scallan, et. al., Emerg Infect Dis, Jan Foodborne Agents Estimated annual number of illnesses (90% CI) Estimated annual number of hospitalizations (90% CI) Estimated annual number of 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 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

31 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 Foodborne Disease Outbreaks These changes make coordination among multiple states and agencies, and countries even more important than before

32 32 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

33 Challenge: New Food Vehicles 12 new food vehicles since 2006: –Bagged spinach E. coli O157 –Carrot juiceBotulism –Peanut butter/peanut pasteSalmonella –Broccoli powder on a snack foodSalmonella –Dog foodSalmonella –Turkey pot piesSalmonella –Canned chili sauceBotulism –Hot peppersSalmonella –White pepperSalmonella –Raw cookie doughE. coli O157 –Puffed breakfast cerealSalmonella –Cracked red and black pepper Salmonella on salami

34

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 Male fetus in utero Panda in utero Self-injury in a German Shepherd Self-injury in an adolescent female Osteosarcoma in a Golden Retriever Osteosarcoma in a teenage male Obesity in a Domestic Shorthair 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 Emotional trigger Surge of stress hormones Failing heart Possible death Same syndrome, different names?

39 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

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 Human Health Environmental Health Animal Health

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

45 Person becomes ill

46 Person seeks medical care

47 Person becomes ill Person seeks medical care Stool sample collected

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

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

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

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

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 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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