Policy, Pastoralists, Pillars, Pirates, and Pathogens

The One Health Intellectual Exchange was privileged to welcome Dr. Corrie Brown from the University of Georgia College of Veterinary Medicine for the last regular weekly session. Dr. Brown’s talk on “Policy, Pastoralists, Pillars, Pirates, and Pathogens” spoke to the bigger picture of One Health, with the example of Rift Valley Fever in Saudi Arabia.

Given changes in policy and the creation of the World Trade Organization, standards for preventing the spread of disease are an issue of international concern. The example of Rift Valley Fever (RVF) involves pastoralists from the horn of Africa, who provide the majority of animals for ritual sacrifices at Mecca in Saudi Arabia. In 2000, a large outbreak of RVF in Saudi Arabia led to a ban of livestock imports from African countries where the disease is endemic, with huge economic losses to small pastoralists. Dr. Brown talked about an integrated approach to disease prevention involving trade groups, projects focused on increasing human capacity, and risk assessment training.

Since the majority of the semester focused on domestic health issues, Dr. Brown’s experience in the One Health field working across national boundaries provided a new perspective. We would like to thank Dr. Brown for her presentation to the One Health Intellectual Exchange, which was not only informative, but highly entertaining as well!

Animals as sentinels for disease

This week’s intellectual exchange featured guest lecturers Dr. Larry Glickman and Dr. William Stokes. Dr. Larry Glickman is a veterinarian and epidemiologist. He presented on some of his research on surveillance of companion animals as an indicator of disease. One case study he presented was on the transmission of Toxocara canis, or Dog Roundworm infection. The eggs of Toxocara are present in the environment and are extremely resilient, lasting for years without a host. Dogs are a natural host for Toxocara. By our exposure to dogs, people (especially young children), are at risk for acquiring the parasite. As humans are an unnatural host for Toxocara, we can experience debilitating symptoms as a result, including respiratory and eye health issues. Over twenty million children are infected at any one time. Although most cases are asymptomatic, 3000 cases of blindness are caused yearly due to the parasite traveling to the eye. In West Africa, Toxocara is also a serious issue. Due to the high prevalence of pica, or the consumption of earth, transmission of Toxocara is high. Dr. Glickman discussed further about using companion animals as sentinels for environmental exposure, and has constructed a novel database using a centralized medical records system which allows for the surveillance of animal diseases.

Dr. William Stokes, a Rear Admiral, veterinarian and Director of the U.S. National Toxicology Program’s Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM) at the National Institute of Environmental Health Sciences (NIEHS), presented on the history of the United States Public Health Service Commissioned Corps. The Corps is an integrated group of veterinarians, physicians, and epidemiologists among other professions, and is one of seven uniformed services. It is tasked with the role of protecting, promoting, and advancing the health and safety of the nation. Dr. Stokes covered a variety of one health related issues that dealt specifically with the use of animals as sentinels for disease, and presented a unifying scientific framework for addressing environmental health hazards. Dr. Stokes noted that animals are particularly useful for surveillance because their exposures to environmental hazards may be greater than human exposures, resulting in development of adverse effects. Additionally, some species respond more quickly to environmental hazards due to increased susceptibility associated with shorter life spans, thus providing valuable information to the symptoms and consequences of environmental exposure. His presentation provided insight into how the U.S. Public Health Service Commissioned Corps integrates One Health concepts into national surveillance on environmental health.

Integrated Bio-preparedness (4-5)

Integrated Bio-preparedness

Bio-surveillance: “Active, data-gathering, analysis and interpretation of biosphere data related to disease activity and threats to human health and animal health to achieve early warning, detection and situational awareness”

Given the rising threat of zoonotic diseases, this collaborative exchange session explored the use of risk-based disease surveillance strategies from a One Health perspective. The session involved 4 panelists:

1. Dr. Dennis Carroll, Director of the U.S. Agency for International Development’s (USAID) Avian Influenza and other Emerging Threats Unit

2. Dr. Tom McGinn, Senior Health Advisor, North Carolina Bio-Preparedness Collaborative Program Manager, Office of Health Affairs, Department of Homeland Security

3. Dr. Megan Davies, State Epidemiologist and Chief of the Epidemiology Section, NC Department of Health and Human Services

4. Dr. Anna Waller, Research Associate Professor in Emergency Medicine, UNC School of Medicine

Per Dr. Carroll, the incidence of emerging infectious diseases is not an accidental or unique event, but consequence of events that continue to occur in an accelerated fashion. In fact, the threat from zoonotic diseases is intensifying: pathogen emergence expected to increase 5 fold from 2000-2030. The main drivers behind rising threat are population pressures, climate change, food security, economic growth, and globalization.

Dr. McGinn communicated that because disease emergence is proportionately a rare event, the ability to detect and control disease outbreak will rest on surveillance capability. From the One Health perspective, it is critically mportant to have the systems in place for early disease detection in animals as well as humans.

While disease surveillance occurs at geographic hotspots internationally (Amazon, congo basin, southeast asia, area around the Ganges river), Dr. Davies communicated the importance of surveillance at the state and local level. The scope of biosurveillance includes threats, exposures, adverse events, diseases and outbreaks.

Similarly, Dr. Waller reviewed the surveillance system in place in emergency departments in North Carolina. While most of this data is syndromic, it provides vital information to guide the public health response and can only be collected at the local level.

Overall, this session was both informative and collaborative, as all participants were able to not only recognize the components of surveillance in humans and animals, but also to ponder how the collected information could be used in global disease prediction strategies.

Human Metapneumovirus found in Gorillas in Rwanda

In 2009, the deaths of 2 mountain gorillas in the Virunga massif in Rwanda were confirmed to be caused by metapneumovirus, a human respiratory illness. With less than 800 mountain gorillas in the wild, illnesses passed from people is a serious concern given the frequency of gorilla contact with humans. With habitat destruction, these gorillas are limited to parks surrounded by dense human populations. Additionally, wildlife tourism brings many people to the region. Understanding how the transmission of diseases from humans to mountain gorillas occurs will be important in protecting this endangered species. As a result, The UC Davis Wildlife Health Center established the Mountain Gorilla One Health Program, which will work to protect gorillas by improving the health of humans and other animals in the surrounding area.

The research article on this topic, which recently appeared in the online edition of Emerging Infectious Diseases can be found here.

Landscape Ecology, Urban Planning and Disease Prediction/Prevention

Tuesday evening’s event featured an engaging lecture co-presented by Dr. Suzanne Kennedy-Stoskopf and Dr. Chris DePerno. Their talk, entitled Changing Landscapes, Changing Populations, Changing Values, Changing Disease Risks: What Is Happening to Wildlife? covered the natural history of several North Carolina wild animals and their potential to spread infectious disease.

Dr. Kennedy-Stoskopf, a research professor at NC State University, began the presentation by discussing humanity’s intrinsic connection to animals; she remembered, as many of use do, being interested in animals from a young age. She reminded the audience that in spite of this connection, animals do pose a risk to human well being; 60.3% of emerging infectious diseases are zoonosis, and 71.8% originate in wildlife. A lively discussion ensued around what these numbers meant to audience members—some of the more interesting points raised included wondering what humans had done to provoke these statistics and how it really represents a false barrier between humans/domestic animals/and wildlife. Dr. DePerno, Associate Professor in the NC State Department of Forestry and Environmental Resources, then took over, highlighting the changes that have occurred in North Carolina over the past century that have led to a proliferation in certain types of wildlife. These included a decrease in hunting, land fragmentation, urban refugees (city-dwellers moving to the country), and a general growth in cities. He also mentioned a tendency for many Americans to have a low tolerance for wildlife; we like it in zoos and the forest, but not in our backyard or the sides of the road.

For the remainder of the talk, Drs. Kennedy-Stoskopf and DePerno focused on specific animals that have been able to thrive in this new environment, which has led to some interesting confrontations with humans. The audience learned that the deer population plummeted in North Carolina from about 1500-1800 because of intensive hunting for their hides. By the early 1900s, less than 10,000 deer were left in North Carolina, and limits on hunting were instated, in addition to a restocking program. Of course, as we can all attest, the program was almost too successful. The biggest risk that deer overpopulation poses to humans is vehicular collisions. Between 2007-2009, there were 17,370 deer-car collisions and 17 fatalities. The other principle risk is vector amplification: deer can spread a number of diseases including tick borne diseases, chronic wasting disease, mycobacterium bovis, and deer parapoxvirus. The appearance of coyotes in North Carolina during the 1970s and 80s was mentioned as another growing issue. While it is unclear how these animals will play into health issues, it is recognized that coyotes are very adaptable and have long home ranges. Another animal of concern is the raccoon, whose population has also increased in numbers since the late 1980s, in part due to a decrease in trapping.

In closing, our two guests told the audience that this kind of change is happening on a global level and at an accelerated rate, a salient point that certainly has implications for those interested in a one health perspective. As the human/wildlife interface continues to expand, and the issue of disease increases, it will be even more important to recognize the human, animal, and environmental aspects of disease.

A number of excellent questions were posed. These included:

· How effective have surveillance systems been in predicting animal diseases likely to transfer to humans?
· In planning for development, could likelihood of becoming a disease hotspot be used as one criteria in evaluating sites?
· Climate change has generally been associated with an increase in EID's. Is there any data that may suggest a negative correlation for outbreaks of a particular disease in certain affected areas? In other words, have we seen less outbreaks of any particular pathogens potentially due to changes in climate?
· A few of the readings called for a focus on the human dimensions of wildlife disease. Has this approach been used on a global scale as well? How would it look as compared to the research they described that had taken place in the US?
· Many emerging infectious diseases are a result of human population growth and invasion of new frontiers. How can we better protect both human beings and animals from the effects of human population growth?
· Since global resources are poorly allocated to areas where disease emergence is less likely, what will it take to shift resources to countries in which emerging infectious diseases are likely to arise?

Thank you to Dr. Kennedy-Stoskopf and Dr. DePerno for an engaging and informative evening!

FDA blocks certain food imports from Japan due to Radiation Threat

http://www.nytimes.com/2011/03/23/business/23fda.html?_r=1&scp=1&sq=fda%20japan%20imports&st=cse

WASHINGTON (AP) — The Food and Drug Administration said Tuesday it would halt imports of dairy products and produce from the area of Japan where a nuclear reactor is leaking radiation.

The F.D.A. said those foods will be detained at entry and would not be sold to the public. The agency previously said it would step up screening of those foods.

Other foods imported from Japan, including seafood, will continue to be sold to the public but screened first for radiation.

Japan’s Fukushima Daiichi nuclear complex has been leaking radiation after it was damaged in a devastating earthquake and tsunami earlier this month. The sea near the nuclear plant has also shown elevated levels of radioactive iodine and cesium, prompting the Japanese government to test seafood.

Japanese foods make up less than 4 percent of all American imports, and the F.D.A. said it expected no risk to the food supply in the United States from radiation. Officials and health experts say the doses are low and not a threat to human health unless the tainted products are consumed in abnormally excessive quantities.

Still, the World Health Organization said this week that Japan should act quickly to ensure that no contaminated foods are sold. The most common imports from Japan to the United States are seafood, snack foods and processed fruits and vegetables.

Representative Rosa DeLauro, Democrat of Connecticut and the ranking Democrat on the House subcommittee that controls F.D.A. spending, wrote agency officials on Tuesday questioning how they could say with certainty that there was no threat to America’s food supply from Japanese radiation. She noted that the F.D.A. had not always been able to track where food production facilities were located in other countries.

Food Bill Law

http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM238166.pdf

Ensuring national and international food safety

Tuesday’s session on ensuring national and international food safety was addressed by a panel of experts in different fields. The list of speakers comprised of Dr. Noel Greis who is director of the Kenan Institute’s Center for Logistics and Digital Strategy and professor of Operations, Technology and Innovation Management at the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill; Dr. Leslie Wolfe is the Laboratory director of the NC State laboratory of public health, Ms. Sharron Stewart, a graduate of N.C. State University with certificates in both Public Management as well as Community Preparedness and Disaster Response from UNC-School of Public Health, is the Director of Emergency Programs Division, North Carolina Department of Agriculture and Consumer Services and Mr. Brett Weed, Food Defense Coordinator of the Food and Drug Protection Division of the North Carolina Department of Agriculture and Consumer Services.

Dr. Noel Greis presented on an analysis tool, NCFEDA that is being developed to aid outbreak investigation. NCFEDA stands for North Carolina Food Events Data integration and Analysis. The tool works by combining different data sources to establish a pattern and aid investigators and public health officials in establishing outbreaks of food borne illnesses and the pattern of illness. The program will input information from a wide array of data sources such as twitter, physician reports, newspapers, laboratory reports, and google to create its pattern. The main feature of this program is a tool that it enables data fusion, creates visualization of the data, analyzes it, and enables researchers to share the information and collaborate with other researchers and public health officials.

The development is still in its infant stages but there is promise that it will significantly reduce the turnaround time in outbreak investigation. Allusion was made to the peanut salmonella outbreak that took up to 10 months to investigate and completely recall and the hope is that this tool can reduce this turnaround time.

Dr. Leslie Wolf presented on the laboratory side of management of food borne illness outbreaks. She talked about the PulseNet network of accredited laboratories that are involved in food inspection. What is unique about this network is that it is a collaboration of laboratories across different states and between Europe and USA. The aim of these laboratories is to enable early detection of pathogens and share information. This should lead to a reduction of potential morbidity and mortality in the population.

Ms. Stewart shared with us the importance of protecting North Carolina’s agricultural infrastructure. There are more pigs than people in our state and Sampson-Duplin County is the #1 protein producer in the world, making foot-and-mouth disease our biggest threat. Now that people are wondering where their food is coming from, transitional farmers are in need of training to assure the biosecurity of locally grown food. Other danger zones for biosecurity include the 45 agriculturally sanctioned fairs and two State Fairs in NC each year where pony rides and petting zoos are in close proximity to delicious foods. Ms. Stewart hopes that we can start to integrate social media into food safety in North Carolina.

Mr Brett Weed also shared on the food biosecurity in North Carolina.

Some of the questions asked by audience included the following:

1. Is increasing federal, state and local legislature the way to improve the number of cases of food contamination?

2. How legitimate is the suggestion that a more locally sourced and supported food system would reduce the threat to food insecurity and/or foodborne illness?

3. Moving from the US to the low-income countries without an effective food surveillance system, how do we make food safe for consumption? How do we reduce the burden of food borne infections?

Many thanks to the very able presenters who expertly answered all the questions that were raised and for the exciting and informative presentations.

Intensive Swine Production: Antimicrobial Resistance and the Health Impacts of Air Pollution

Dr. Sid Thakur and Dr. Steve Wing shared their expertise on intensive swine production with the One Health Intellectual Exchange this past Wednesday, March 15^th. Dr. Thakur, Assistant Professor in the College of Veterinary Medicine at NC State University, started the evening with a talk on antimicrobial resistance as it relates to the swine industry. Afterwards, Dr. Wing, Associate Professor of Epidemiology at the UNC School of Public Health, presented a different perspective, and spoke about the health impacts of air pollution associated with intensive pig farming. These topics are of particular interest in North Carolina. This state houses more pigs than humans, and is responsible for 14.4% of the total hogs produced in the United States.

In true One Health spirit, Dr. Thakur touched upon the three dimensions of antimicrobial resistance (human, animal, and environmental), but focused primarily on the role of the environment, which has been ignored in many discussions on this topic. In the environment, resistance can potentially be transferred from water, soil, feed, waste lagoons, and transport vehicles.

His presentation demonstrated the need for further studies that focus on One Health and the environment, and the importance of judicious use of antibiotics. Recent developments in the field have shown that soil microbes are resistant to practically all antibiotics, and resistant bacterial strains have a higher fitness than susceptible strains in the absence of antibiotics. Dr. Thakur’s research found that resistant Campylobacter strains were present in comparable levels for anti-microbial free systems and conventional systems in sampled pigs and carcasses in North Carolina. He also confirmed that transport trucks can play a role in the dissemination of antimicrobial resistance in swine production systems.

Dr. Wing’s presentation switched our talk’s focus to the potential impacts of intensive swine production on human health. He cited numerous cross-sectional studies that show people living in close proximity to industrialized swine operations have increased prevalence of respiratory and psychological conditions, and a lower quality of life. With swine operations in North Carolina primarily located in communities of color, this is an issue of environmental injustice.

For an epidemiological study examining the community health effects of industrialized hog operations, Dr. Wing partnered with environmental justice organizations in North Carolina to study acute health effects. He found an association between hog pollutants and physical symptoms.

Some of the questions raised by students, professors, and professionals regarding these topics included:

• How can policies to protect humans from adverse health effects associated with intensive swine production be implemented?
• Why is there not a larger environmental injustice movement to change health disparities?
• Do areas such as North Carolina, with a proportionally larger number of CAFOs than other states, have higher rates of antibiotic resistance in human infections?
• Has there been validation of clinical or epidemiologically relevant transmission of antibiotic resistant strains of bacteria between environmental reservoirs or animal livestock to humans?
• What are possible theories as to why swine from antimicrobial free farms were still found to contain pathogens that showed resistance to antibiotics?
• What is the role of wild animal populations in the transmission of resistance?

Thank you to Dr. Thakur and Wing for engaging and informative presentations that sparked interesting discussions on intensive swine production and how it relates to One Health!

Water and Food Security and the Impacts of Climate Change

On Tuesday, March 1, 2011, the One Health Collaborative Intellectual Exchange Group discussed “Water and Food Security and the Impacts of Climate Change” from the One Health perspective. Presentations on the topic were made by Dr. Jay Levine, Professor of epidemiology and public health at North Carolina State University College of Veterinary Medicine and Adjunct Professor of epidemiology at UNC Chapel Hill, and Ms. Mamie Harris, Africa Programs Director for the UNC Institute of Global Health and Infectious Diseases and Adjunct Assistant Professor in the UNC Public Health Leadership program. These were followed by small-group discussions focused on potential solutions to problems encountered in the field.

Dr. Levine started us off by speaking to access to water, the quantity and quality of that water, and what all of this means to public health. The problem is rooted in the fact that an estimated 13% of the world’s population does not have access to potable water. What’s more, over 41% do not experience adequate sanitation in their day-to-day lives. Dr. Levine described the problems that such a standard of living can create with regards to the poverty cycle. Without the access to potable water and/or with exposure to unsanitary water sources under unhygienic conditions, one’s health becomes jeopardized. Diarrheal diseases, for example, are extremely common in these circumstances but completely preventable with the introduction of potable water. These are just a fraction of the large number of pathogen and chemical-related diseases that are seen in such conditions, and the illnesses that result put their victims out of work, resulting in a lack of income. A lack of income enhances the poverty status of that individual, which increases the likelihood that they will continue to be exposed to the same disease-causing environment. It is a cycle that is perpetuated in many developing nations by the distance of good quality water from those seeking it, as well as the limited quantity of such water. To bring in the One Health perspective, the temperature rises seen in the global climate change have contributed to the severity and duration of droughts in many of these already affected developing regions, a problem that merely exacerbates the scarcity of this potable water. Ultimately, Dr. Levine argued that fresh, sanitary water is becoming a limited and limiting resource that contributes on a foundational level to the overall health of a population.

Ms. Harris then spoke to what is being done to address these problems as well as those involving food security and how well these efforts are being carried out. She did so by presenting two such projects that she has been a part of, one in Ecuador and the other in the Sudan. The Ecuadorian project was aimed at assessing the prevalence of intestinal parasitic infections (IPI’s) in rural Ecuadorian children. Out of the 244 children (0.2-14 yrs) surveyed, over 90% were infected with at least one pathogenic IPI. Additionally, this study found a correlation between giardia and exposure to domesticated animals as well as giardia and stunted growth in children. The information gained from this study initiated an effort among both NGO’s and Ecuador’s Ministry of Health to improve sanitation and hygiene. Ms. Harris’ project in the Sudan, on the other hand, was focused on improving and/or creating supplementary feeding programs as well as health education programs. They also assessed access to water, building latrines and water supply systems when necessary, and access to medical facilities within these communities. These programs were critical to the regions in which they were being carried out, as they experienced many water-associated issues, including diarrheal illnesses. They encountered many issues with the wet and dry seasons in the area as well as with the encouragement of the use of latrines in the communities. Ms. Harris also brought up the incredible interconnectivity of water sanitation and hygiene issues, as humans and animals are affecting their environment, which is in turn affecting both animals and humans. It is an interesting cycle in which all components must be taken into account so that we can prevent an estimated 2.4 million deaths globally.

Following the talks, those attending broke into four groups to discuss case studies involving water sanitation and hygiene and to, then, form a solution to each problem as a group. This lent towards very interesting discussions on topics ranging from epidemiological investigations in developing countries concerning water-related illnesses to the relocation of hippos to build a dam in a national park. It was an interactive and informative night, and we would like to thank Dr. Levine and Ms. Harris for their wonderful presentations!

Deforestation and Emerging Infectious Diseases

Many are aware of the environmental consequences of deforestation: trees absorb carbon, and in a world of escalating carbon levels, this natural process is critical to the effort of slowing global warming. What is less well-known about deforestation, is the part it plays in public health for both humans and animals. In this article, Laura Kahn illustrates the role of deforestation in the spread of emerging infectious diseases among both humans and animals. She does this through the story of the Nipah virus outbreak in Malaysia, an event that continues to affect Southeast Asia both directly and indirectly. Kahn outlines the sequence of events that followed a mass deforestation in Malaysia in 1997, the focus of many studies concerning Nipah virus. Being forced from their natural habitat , tropical fruit bats began to feed from fruits in orchards through which pigs roamed and fed. It is through this exposure that an outbreak of the virus spread throughout the newly industrialized pig industry and consequently, to those humans involved in the industry. By 1999, the virus was isolated, the exportation of pigs from Malaysia was halted, about 1 million pigs were killed, 266 people contracted the disease, and 106 died soon after. The outbreak had enormous economic effects on the region, and outbreaks continue to occur, the latest reported being in Bangladesh (February 6, 2011).

http://thebulletin.org/web-edition/columnists/laura-h-kahn/deforestation-and-emerging-diseases

http://www.ncbi.nlm.nih.gov/pubmed/16329551

http://www.promedmail.org/pls/apex/f?p=2400:1202:2043200362336969::NO::F2400_P1202_CHECK_DISPLAY,F2400_P1202_PUB_MAIL_ID:X,86975

MRSA: From Humans to Animals and back again and other concepts

We welcomed Dr. David Weber, Dr. Jorge Ferreira, and Dr. Vance Fowler on Tuesday, February 22, 2011, to our One Health Collaborative Intellectual Exchange Group meeting to discuss MRSA. Dr. Weber is a Professor of Medicine and Pediatrics and UNC’s School of Medicine and also a Professor of Epidemiology at UNC’s Gillings School of Global Public Health. He kicked off the session with great stories on how people become infected with infectious diseases and common sense ways to avoid infection. He was very adamant on the fact that lessons can lessons can be learned after every infection, no matter how large or small. It was interesting, that during his presentation, he noted that the country with the greatest number of newly emerging diseases were discovered in the United States, based on the sole fact that the United States has better technology than other countries for identifying these new and emerging zoonotic diseases. Dr. Ferreira is currently a Fulbright scholar in the Comparative Biomedical Sciences Ph.D. program at NCSU’s College of Veterinary Medicine, Department of Population Health and Pathobiology. He’s presentation focused on the unknown variables when organisms, humans or animals, become infected with MRSA. One of the major barriers at the moment is determining which organism was infected first, the human or the animal. A lengthy discussion followed addressing the concept of “community associated MRSA” in which one community becomes infected with one strand and another community becomes infected by a different strand. This highlighted some of the harder aspects of studying MRSA outside of clinical settings. His overall message was that this is no longer an individual’s problem, but a societal problem with the potential to involve all living things. A question and answer session followed in which Dr. Fowler contributed. Dr. Fowler was trained at Duke University and is currently an extensively published, Associate Professor. This was the first time the One Health Collaborative Intellectual Exchange Group had an extensive panel discussion session that followed the presentations. The questions asked varied from personal experiences with MRSA and specific risk factors, to ways in which local entrepreneurs are developing microbial resistant textiles, to ways in which individual medical practitioners can become more educated on patient symptoms and to follow the developments of MRSA research and finding.

We want to thank again Drs. Weber, Ferreira, and Fowler, for participating in the One Health Collaborative Intellectual Exchange Group. It is people like you who are ready and willing to share your comments, suggestions, and life experiences, that make the One Health Collaborative Intellectual Exchange Group a truly learning and positive experience.

Tick-transmitted Infectious Diseases In North Carolina: Local, National and Global Implications

Session 6 on 15-February 2011 was entitled “Tick-transmitted Infectious Diseases In North Carolina: Local, National and Global Implications”. The panel consisted of Dr. Ricardo Maggi, and Dr. Ed Breitschwerdt.

Dr. Maggi is Research Assistant Professor of Molecular Microbiology in the Department of Clinical Sciences at the College of Veterinary Medicine at North Carolina State University. He is also Chief Technical Officer and Assistant Director of Research and Development at Galaxy Diagnostics in RTP. Dr. Maggi’s topic of discussion was Borrelia in Ixodes ticks in North Carolina. Borrelia burgdoferi is the leading cause of Lyme disease.

According to Dr. Maggi, while 30-50% of Ixodes scapularis carry B. burgdoferi in New England, only 5% of I. scapularis do in Virginia. This figure drops to 0.3% in North Carolina. In contrast, among Ixodes affini ticks in North Carolina, 64% are infected with B. burgdoferi. This infection is more prevalent in female ticks than male ticks. 55% of male I. affini are infected while 77% of females are infected. Therefore, the epidemiology of B. burgdoferi infection in ticks appears to be different in North Carolina compared to the Northeastern states.

Dr. Ed Breitschwerdt is Professor of Medicine and Infectious Diseases at North Carolina State University College of Veterinary Medicine, Adjunct Professor of Medicine at Duke University Medical Center, and a Diplomate, American College of Veterinary Internal Medicine (ACVIM). Dr. Breitschwerdt discussed several tick-borne illnesses, including his groundbreaking research in Bartonella infections.

Dr Breitschwerdt started his talk by discussing how tick borne diseases are important because they can result in death. Ticks secrete toxins, which target lower motor neurons and cause paralysis. Paralysis can be generalized and cause death by affecting respiratory muscles. Dr Breitschwerdt then talked about dogs as sentinels for tick borne infections and the use of C6 ELISA methodology to detect canine infection with tick borne diseases.

According to Dr Breitschwerdt, Rocky Mountain Spotted Fever is the most important tick borne disease in North Carolina because it is potentially fatal. Features include fever, rash, gangrene and anemia. It is important that veterinarians not miss this diagnosis because a delayed or missed diagnosis can cause death in both animals and their human owners. Even though RMSF is usually thought of as a disease of the countryside, it has been found in places like New York City. After all, it only takes one tick to transmit the disease. Dr Breitschwerdt then proceeded to discuss other tick borne diseases like Ehrlichia, Anaplasma phagocytophilum and Bartonellaceae. Bartonellaceae is unique because it can infect multiple cells in the body, and is becoming an increasingly important cause of tick borne disease in the state. The vector that transmits Bartonella henselae is Ixodes ricinus. Animals are important reservoirs for the vectors.

A theme that Dr. Breitschwerdt returned to throughout his talk was that of the importance of having a high index of suspicion for tick borne illnesses and how every patient whom the veterinarian or physician suspects to have a tick borne illness should be treated with doxycycline. Other measures like removal of fleas and ticks from dogs are also important in preventing the risk of disease transmission.

Questions from students, faculty members, professionals, and attendees covered a wide range of topics:

• Could mandating tick prevention in dogs lessen tick-borne infections in humans?
• What are the possible reasons for the difference in the prevalence of Borrelia in Ixodes scapularis and Ixodes affinis?
• Given that most tick borne illnesses are treated with doxycycline, how does determining the differences in tick and pathogen epidemiology in North Carolina help change management and treatment of tick borne diseases?
• Do tick borne illnesses caused by different bacterial species (rickettsia, borrelia, bartonella) present similarly?
• Since tick borne illnesses affect both humans and their animal pets, is there much collaboration between physicians and veterinarians in managing this group of diseases?
  

The session concluded with a discussion of the need for collaboration and data sharing between veterinarians, physicians, public health professionals, and environmental scientists.