One Health - A Promising Approach to Difficult
Public Health Problems
Gregory C. Gray, MD, MPH, FIDSA Gregory C. Gray, MD, MPH, FIDSA
Professor and Chair, Department of Environmental and Global Health, College of Public Health and Health Professions
Professor, Infectious Diseases and Pathology, College of Veterinary Medicine
Director, Global Pathogens Laboratory, Emerging Pathogens Institute
University of Florida, Gainesville, Florida, USA
• Emerging infectious diseases –infectious diseases whose incidence in humans has increased in the past 2 decades or threatens to increase in the near future. They include:
- New infections resulting from changes or evolution
- Known infections spreading to new geographic areas or populations
- Previously unrecognized infections appearing in areas undergoing ecologic transformation
- Old infections reemerging as a result of antimicrobial resistance in known agents or breakdowns in public health measures
From Emerging Infectious Diseases journal
Red represents newly emerging diseases; blue, re-emerging/resurging diseases; black, a
'deliberately emerging' disease from Nature 430 , 242-
249(8 July 2004)
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NIEHS WS Sep 8-9, 2011 |
Factors Influencing Spread of Infectious Diseases
• Global travel.
• Globalization of the food supply and centralized processing of food.
• Population growth and increased urbanization and crowding.
• Population movements due to civil wars, famines, and other man-made or natural disasters.
Irrigation, deforestation, and reforestation projects that alter the habitats of disease-carrying insects and animals.
• Human behaviors, such as intravenous drug use and risky sexual behavior.
• Increased use of antimicrobial agents and pesticides, hastening the development of resistance.
• Increased human contact with tropical rain forests and other wilderness habitats that are reservoirs for insects and animals that harbor unknown infectious agents.
Preventing Emerging Infectious Diseases, CDC, 1998
Group I—Pathogens Newly
Recognized in the Past Two
Decades
Acanthamebiasis
Australian bat lyssavirus
Babesia, atypical
Bartonella henselae
Ehrlichiosis
Encephalitozoon cuniculi
List of NIAID Emerging &
Re-emerging Diseases
Group II—Re-emerging
Pathogens
Enterovirus 71
Clostridium difficile
Enterocytozoon bieneusi
Helicobacter pylori
Hendra or equine morbilli virus
Hepatitis C
Hepatitis E
Human herpesvirus 8
Human herpesvirus 6
Lyme borreliosis
Parvovirus B19
Streptococcus, Group A
Staphylococcus aureus
From www.niaid.nih.gov/topics/emerging/pages/list.aspx , Oct 2, 2011
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Preventing Emerging Infectious Diseases, CDC, 1998
SARS
Swine influenza Shiga toxinproducing E. coli
(STEC)
Nipah virus
Methicillin-resistant
S. aureus (MRSA) Salmonella
Most Human Emerging Diseases are Zoonotic
Among 132 emerging human pathogens, 75% are considered zoonotic
Zoonotic pathogens are twice as likely to be associated with emerging diseases than non-zoonotic pathogens.
Taylor LH , Latham SM, Woolhouse ME Philos Trans R Soc Lond B Biol Sci. 2001; 356:983-9
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•15 research personnel
(2 DVM/PhDs,
1DVM/MS, 2 PhDs)
•3000 sq-ft of BSL2,
BSL2+Ag, and BSL3 space
•6 BSL3 suites
•Access to much more BSL3 animal space
•High throughput deep sequencing and other core facilities http://gpl.phhp.ufl.edu/index.html
GPL International Research Collaborations
Michael Snyder photo, C
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Often We Work with Veterinarians and Study Disease
Transmission at the Human-Animal Nexus
Human-Animal-Environmental Nexus is
Ignored as a research or training area
• Most human disease studies involve clinical ill patients who first appear in medical facilities
• Most animal disease studies involve clinical
• Most environmental health studies are developed in response to recognized illness in man or animals
• No major effort to anticipate the next emerging disease threat
Nipah virus
From September 1998 to April
1999, an epizootic of illness among pigs was associated with illness and deaths of 105 humans
A previously unrecognized
Nipah virus, was discovered as etiologic
Many farm families abandoned their farms
Mass culling of pigs in outbreak seemed to have controlled the epidemics.
Photo from www.bbc.co.uk
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Many Questions Must Be Answered Before
Nipah Virus Infections Can Be Stopped
• Example questions:
• How many Nipah viruses are there?
animals, and the environment?
• Which animals can be reservoirs?
Some Disease Problems Like Nipah Virus Are
Complex and Require Problem Solving Help from
Professionals form Various Disciplines
Hypothesize
Test
•Epidemiologists
•Physicians
•Veterinarians
•Wildlife Biologists
Hypothesize
Test
Hypothesize
•Meterorologists
•Virologists
•Behavioral scientists
•Vaccine developers
•Vaccine testers
Test
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Date Palm Sap Harvesters = Traditional Drink
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The term One Health has been defined… as the collaborative efforts of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals, and our environment..
…we need to adopt an integrated, holistic approach that realization that we are part of a larger ecological system— exquisitely and elaborately connected.
– from the AVMA
Which human, animal, and environmental risk factors predict disease?
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CDC 2011 estimates
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CDC 2011 estimates
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CDC
EPA USDA
Industry
Poor cooperation
FDA
Consumer
Frustration
A One Health research approach that gains cooperation from various organizations would bring balance to solving difficult public health problems
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16 H types – types 1, 2, and 3 in man
9 N types – types 1 & 2 found in man
Wild Bird Population
Human Influenza
A Viruses
Avian Influenza
H1 – H16
H1 – H3
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Hong Kong H5N1
•
In May 1997, investigations revealed 18
(H5N1) human cases (6 deaths) by the end of
1997, all of them in Hong
Kong. Exposure to birds
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This led to the culling of
1.2 million birds and cost the government 245 million in Hong Kong dollars in compensation.
Amy L. Vincent, Wenjun Ma, Kelly M. Lager, Bruce H. Janke, and Jürgen A. Richt, Swine Influenza Viruses: A North
American Perspective. In Karl Maramorosch, Aaron J. Shatkin, and Frederick A. Murphy, editors: Advances in Virus
Research, Vol. 72, Burlington: Academic Press, 2008, pp.127-154
.
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Population-based Surveillance for
Zoonotic Influenza A (NIAID R21)
•
• Design – 2-year prospective, controlled study of farmers who were occupationally exposed to swine or poultry (n=805); 29 counties in Iowa
• Exposure questionnaires at enrollment, 12-months, and 24 months
• Specimen collection – Sera collection upon enrollment, at
12 months and 24 months; viral specimens and questionnaire when ill
Gray GC, McCarthy T, Capuano AW, Setterquist SF, Olsen CF, Alavanja MC, Lynch CF. Swine
Workers and Swine Influenza Virus Infections. Emerg Infect Dis 2007;13:1871-78
• Gray GC, McCarthy T, Capuano AW, Setterquist SF, Olsen CF, Alavanja MC, Lynch CF. Swine
Workers and Swine Influenza Virus Infections. Emerg Infect Dis 2007;13:1871-78
Table 3. Enrollment - analyses of risk factors using proportional odds model, university controls as reference.
Adjusted
OR (95% CI)
Swine exposure
AHS - worked in swine production
AHS - Never worked in swine production
Non AHS - Controls
Age continuous
707
80
79
866
54.9 (13.0-232.6)
28.2 (6.1-130.1) reference
0.97(0.96-0.98)
Adjusted
OR (95% CI)
13.5 (6.1-29.7)
6.9 (2.8-17.2) reference
---
Male
Female
484
382
3.3(2.4-4.5) reference
3(2.2-4) reference
Received flu shot in the past 4 years
Yes 479
No/Unsure 387
1.4(1.1-1.9) reference
---
---
Human H1N1
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Positive 347
Negative 519
---
---
1.8(1.4-2.4) reference
Gray GC, McCarthy T, Capuano AW, Setterquist SF, Olsen CF, Alavanja MC, Lynch CF. Swine
Workers and Swine Influenza Virus Infections. Emerg Infect Dis 2007;13:1871-78
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Generated from OIE data available from World Animal Health Information
Database & sequences deposited in GenBank, August 2010…Courtesy of
Dr. Amy Vincent of National Animal Disease Center, Ames, IA
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How Common Are these
Clinically Important Influenza
Reassortants in US Pigs?
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• To train professionals to conduct
“one health” investigative and experimental research
Master’s, PhD programs
• To attract outstanding US and international researchers to such a training program
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• Environmental health
• Modern laboratory techniques
• Epidemiology
• Biostatistics
• Food safety
• Animal science
• Meat science
• Soil and water engineering
• Modern animal production
• Human and animal
• Agriculture engineering
• Climate change
• Geographical information systems
• Zoonotic infections
• Toxicology
Global Pathogens Laboratory http://gpl.phhp.ufl.edu
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