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 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”
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
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
Board-certified specialties
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Surgery
Toxicology
Dermatology
Ophthalmology
Anesthesiology
Internal medicine
Emergency care
Board-certified specialties
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Surgery
Toxicology
Dermatology
Ophthalmology
Anesthesiology
Internal medicine
Emergency care
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Animal Behavior
Animal Welfare
Laboratory Animal
Theriogenology
Poultry Medicine
Preventive Medicine
Zoological Medicine
Fourth Wave – Early 2000’s
• Antibiotic resistance
• Population growth, globalization
• Emerging and re-emerging infectious diseases
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.”
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.”
Consume
food
0
Onset of
symptoms
Consume
food
0
2
Onset of
symptoms
Consume
food
0
Collect
stool
sample
2
4
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symptoms
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food
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Stool culture
result
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stool
sample
2
4
7
Onset of
symptoms
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food
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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
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food
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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.
Estimated annual
number of
Estimated annual
number of
Estimated annual
number of
illnesses
hospitalizations
deaths
(90% CI)
(90% CI)
(90% CI)
31 known
pathogens
9.4 million
55,961
1,351
(6.6–12.7 million)
(39,534–75,741)
(712–2,268)
Unspecified
agents
38.4 million
71,878
1,686
(19.8–61.2 million)
(9,924–157,340)
(369–3,338)
47.8 million
127,839
3,037
(28.7–71.1 million)
(62,529–215,562
(1,492–4,983)
Foodborne
Agents
Total
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
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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
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•
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•
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
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Challenge: New Food Vehicles
12 new food vehicles since 2006:
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Bagged spinach
Carrot juice
Peanut butter/peanut paste
Broccoli powder on a snack food
Dog food
Turkey pot pies
Canned chili sauce
Hot peppers
White pepper
Raw cookie dough
Puffed breakfast cereal
Cracked red and black pepper
on salami
E. coli O157
Botulism
Salmonella
Salmonella
Salmonella
Salmonella
Botulism
Salmonella
Salmonella
E. coli O157
Salmonella
Salmonella
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
they’re 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 animal’s 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
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.
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