5/10/2012
One Health
trails of mice and men
Carina Blackmore DVM, PhD, Dipl. ACVPM
State Public Health Veterinarian
State Environmental Epidemiologist
Florida Department of Health
Environmental Epidemiology and
Toxicology
Analytical
Epidemiology
Aquatic toxins
Asthma
Birth defects registry
Chemical poisoning
surveillance
Environmental Public
Health Tracking
Food and Waterborne
Disease
Hazardous Waste
Site Assessment
Toxicology
Vector--borne Disease
Vector
Zoonotic Disease
Who works on
our team?
MPH
MPA
PA
Dr.PH
MD
DVM
PhD in toxicology,
epidemiology, biology
BS
MS/ MSPH
1
5/10/2012
Why work in Public Health?
Connects theory and practice
Meaningful work
On the front line
– In the news
– Disaster response
– Policy priority
– Cutting edge public health science
One Health What?
The collaborative effort
of multiple disciplines
working locally, nationally, and
globally
to
attain optimal health
for people, animals and our
environment.
Animal--human interface
Animal
2
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Melamine
3
5/10/2012
American pets and people
share growing pains!
Known Zoonotic
Diseases
Cats: 27
Dogs: 32
Rodents: 50
Horses: 10
Rabbits: 15
Cattle: 20
Birds: 17
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Known Zoonotic Diseases
Dermatophytosis
E coli 0157:H7
Campylobacter
Leptospirosis
Rabies
Salmonellosis
Toxoplasmosis
Known Zoonotic Diseases
Anthrax
Brucellosis
Plague
Tularemia
Q fever
VEE
Reportable Diseases
In Florida
statute
MDs/ DVMs
Case
definitions
5
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6
5/10/2012
Rabies Pathogenesis
Virus in muscle
Spreads to nerve endings
Migrates to spinal cord and brain
Migrates down to salivary glands and into
saliva
Animal Rabies in Florida
2009
2010
Raccoon
92
75
2409
Bat
23
15
353
18
Fox
21
15
466
23
Cat
11
15
269
13
Dog
1
Skunk
2
3
20-Year Total 20-Year
Average
1990-2009
120
58
3
2409
1
Bobcat
2
4
43
2
Horse
1
0
21
1
Otter
1
1
24
1
Cow
0
0
2
0
Total
154
128
3674
183
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Dog and cat injuries
4.5 million dog bites per year, US
18,000 require medical attention, FL
Responsible ownership
Human behavior
Feral cat problem
Overpopulation of roaming cats
–
–
–
–
Public health concern
Animal welfare concern
Wildlife conservation concern
Animal control ineffective
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5/10/2012
Emerging Diseases a result of
changing ecology
Annual Global Trade in Exotic
Animals
4 million birds
640,000 reptiles
40,000 primates
Illegal trade?
Reverse zoonoses
9
5/10/2012
Whales, environmental disease
sentinels
P H1N1 influenza in swine
(and other critters)
May 2, commercial swine herd, Alberta
July, show pig Minnesota
August, turkey farm Chile
October, ferret Oregon
November, commercial swine herd, Indiana
November, cat, Iowa
November, cat, Oregon (fatal case)
November, dogs, China
November, turkey farm, Virginia
December, cheetah, California
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Cycles of the Asian H5N1 Virus
in Animals and Humans
Waterfowl
Humans
Domestic
birds
Mammals
(primarily
swine)
Waterfowl
Swine Influenza in North
America
1930
Swine influenza
Common respiratory
illness in swine
Usually mild
1-2 human cases/
year
Swine infected by
human influenza
viruses
Swine flu vaccines
11
5/10/2012
E coli 0157:H7
(STEC-Shiga toxin producing E coli)
Primary habitat:
large intestine, rectoanal junction?
• warm, constant
• nutrient rich
• vigorous growth
Secondary habitat:
water, soil, sediment
• cool, fluctuating
• nutrient limiting
• survival
Excretion
Re-colonization
Death
Environment
Spinach, CA, 06
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Direct contact transmission
Indirect contact (environmental)
transmission
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MRSA in animals
Horses
Dogs
Cats
Cattle
Sheep
Rabbits
Pigs
Chickens
Parrots
Seal
Florida Ecology Supports
Arbovirus
Warm Climate
Regular Rainfall
Vectors Identified
Suitable Hosts for
Amplification
Historical Data
SLEV, EEEV, WNV Transmission Cycle
Mosquito vector
Virus
Incidental
infections
Bird
reservoir
hosts
EEEV, WNV
14
5/10/2012
West Nile Virus Spread, 9999-02
1999
2001
2000
2002
Incidence of WNV neuroinvasive
disease by state, 2011
15
5/10/2012
West Nile Virus in Florida, 2011
Through 10/19/11
22 locally acquired
human cases
3 horses
115 sentinel
chickens
11
22
11
11
22
11
GIS RISK Maps
-endemic arboviruses
MWTD values
RISK model
comparison
RISK values
Dr. Jonathan Day
Dengue in Key West
Monroe County Health Department notified
of a New York resident diagnosed with
dengue after travel to Key West
Issued a press release to the public and
notified area physicians of potential for
local transmission of dengue
Florida Keys Mosquito Control District
implemented enhanced trapping and
spraying of Aedes aegypti
16
5/10/2012
World distribution in 2008
Epi curve, Dengue fever, Key West, 2009
3
Extrinsic Incubation Period
Case
2
1
p
12
-S
e
5Se
p
g
29
-A
u
g
22
-A
u
g
15
-A
u
8Au
g
1Au
g
0
Onset date
17
5/10/2012
Obstacles
No vaccine (prospects in development)
Free movement of people from endemic
areas (repeated introduction)
Difficult to control mosquitomosquito-borne
diseases
1
1
2
Imported dengue, 2010
Locally acquired cases 2011 (n=5)
1
18
5/10/2012
Climate Change: Potential Negative Health
Impacts
HEAT
SEVERE WEATHER
Heat stress, cardiovascular failure
Injuries, fatalities
Asthma, cardiovascular disease
AIR POLLUTION
Climate change:
-Temperature
rise
-Sea level rise
-Hydrologic
changes
Respiratory allergies, poison ivy
ALLERGIES
VECTOR-BORNE AND
OTHER ZOONOTIC DISEASES
WATER-BORNE DISEASES
WATER AND FOOD SUPPLY
Malaria, dengue, hantavirus,
Rift Valley fever,
Cholera, cryptosporidiosis,
campylobacter, leptospirosis,
vibriosis, naegleria
Malnutrition, diarrhea, harmful
algal blooms, hygiene-related diseases
MENTAL HEALTH
ENVIRONMENTAL
REFUGEES/
CIVIL CONFLICT
Anxiety, despair, depression,
post-traumatic stress
Morbidity, mortality and migration
CNN, September 2007
Amoeba lurks in Florida lakes
3 boys die from deadly amoeba in OrlandoOrlando-area
lakes this summer
Bathers warned to stay out of water warmer than
80 degrees Fahrenheit
Officials: FluFlu-like symptoms
after swimming in a lake should
spark alarm
Primary Amebic
Meningoencephalitis (PAM)
Naegleria fowleri
Rare
Symptoms
– Abrupt headache, Fever, Vomiting, URI,
Meningitis
– ComaComa-Death in 7
7--10 d
– Naturally occurring in most Florida lakes
– (> 86 F)
– Chlorination effective control
19
5/10/2012
Harmful algal blooms
Surveillance
Cyanobacteria
Puffer Fish Poisoning
Research
Education
Public
Health
Strategies
Ciguatera Fish Poisoning
(Gamberdiscus toxicus)
toxicus)
One Health
Disaster
20
5/10/2012
Opportunities for One Health
Internship
Cute pic?
21
5/10/2012
Employment
People First
https://peoplefirst.myflorida.com/logon.htm
Emory Public Health Employment
Connection
http://cfusion.sph.emory.edu/PHEC/phec.cfm
http://cfusion.sph.emory.edu/PHEC/phec
.cfm
Friends and Contacts
Florida One Health
Newsletter
Elizabeth Radke, Editor
http://www.doh.state.fl.us/environment/medicine/One_Health/OneHealth.html
Questions?
Dr. Carina Blackmore, Carina_Blackmore@doh.state.fl.us 850-245-4732
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