The North Carolina One Health Collaborative's One Health Intellectual Exchange Sessions will continue monthly throughout the Summer and Fall of 2012. The weekly course will be back in Spring 2013. As always, all sessions are open to the public and held at the North Carolina Biotechnology Center.
The next monthly session will be in June. For scheduling and speaker information, please check:
http://nconehealthcollaborative.weebly.com
and/or
http://triangleglobalhealth.ning.com/group/tghconehealth
Thanks!
Sunday, April 29, 2012
One Health: A Concept for the 21st Century
Dr. Laura Kahn, MD, MPH, MPP, FACP, is a physician and
researcher with the Program on Science and Global Security at the Woodrow
Wilson School of Public and International Affairs, at Princeton University.
Before joining the staff at the University, however, she was a managing
physician for the New Jersey Department of Health and Senior Services, a
medical officer for the United States Food and Drug Administration in
Rockville, Maryland, and attending physician at Prince George’s Hospital in
Cheverly, Maryland and a staff physician at Gouveneur Hospital in New York, New
York. She is a fellow of the American College of Physicians (ACP) and
is a recipient of the New Jersey Chapter’s Laureate Award. Dr. Kahn is also an honorary diplomate of the American Veterinary Epidemiology Society.
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| Dr. Kahn emphasizing the need for One Health with Nipah Virus and Q Fever as examples. |
Dr. Kahn started her presentation with comparing two One
Health case studies, which included the Nipah Virus in Malaysia from 1998-1999,
and Q fever, which occurred in the Netherlands from 2007 to 2009. She explained
that both cases involved the challenges of intensive agriculture, which is
becoming increasingly important as the world population increases. Intensive
agriculture is needed to feed the seven billion people on the planet and so
this issue is becoming ever more pertinent to our lives. Analyzing these cases
may perhaps allow us to learn how to avoid catastrophes, such as these, in the
future.
The Nipah virus outbreak occurred in the Eastern areas of
Malaysia, and was primarily caused by environmental problems. In 1997, a
massive deforestation effort was undertaken in this area of Malaysia, in order
to clear area for new pig farms. This resulted in a thick haze in the area, and
the loss of trees caused fruit bats to lose their natural habitat. As such,
pigs and bats came into contact with each other in an area where they never had
before. As fruit bats ate and came in contact with contaminated fruits, the
bats would transmit viruses and perhaps other pathogens to pigs through their
droppings. The pigs would then be a source of exposure to humans, who fell ill
due to these viruses.
The signs and symptoms of the Nipah Virus, according to Dr.
Kahn, are primarily neurologic, in animals. However in humans, fever, nausea,
vomiting, headache, and dizziness are common. She went on to explain that the
outbreak of the virus was initially mistaken for Japanese encephalitis (JE),
but patients who had been vaccinated against JE were getting sick. Researchers
and public health officials started ruling out other diseases until the virus
was finally identified in March of 1999. It was also found that the natural
host of the virus was in fruit bats and that it was primarily spread by
infected secretions.
The virus yielded severe economic consequences for
Malaysians, as half the pigs had to be culled to contain the outbreak. Trade
with Hong Kong and Singapore, which were strong trade partners with Malaysia
before the outbreak, came to a sudden halt. Dr. Kahn explained that had proper
planning been employed prior to the deforestation, these economic, public
health, and environmental catastrophes could have been avoided.
Similarly, Q Fever could also have been avoided if proper
prior planning had been enforced. This outbreak began in dairy goat farms in
the Netherlands. The “Q” in Q Fever, according to Dr. Kahn, stands for “query,”
because physicians did not know what was causing the disease when it first came
to light in the 1930s. However, it was eventually identified as an obligate
intracellular organism, which spreads through the air. Humans with the fever do
not necessarily show symptoms, unlike in the Nipah virus, as 50% of patients do
not report any symptoms following infection. However, the symptoms that are
reported include pneumonitis, endocarditis, and granulomas, among other
pathologies. In livestock, though, there are very dramatic symptoms. Birth
products are highly infectious and infections in pregnant livestock usually
presents as spontaneous abortions. Ticks can also spread the infection.
Dr. Kahn went on to explain that many of these problems were
due to poor coordination and cooperation between human and veterinary health
officials. The challenge for governments was to balance the farmer’s interests
with public health. Problems also arose due to the fact that initially the
disease was not reportable. Farmers wanted to avoid public stigma and because
veterinarians were not required to report the infections, public health
officials were not notified and therefore, could not warn humans, which lead to
the outbreak spiraling out of control in humans.
These studies illustrate the challenges of
intensive agriculture and balancing the need to provide affordable food with
environmental health and sustainability, now that we have a global population
around seven billion people. Hopefully by remembering the problems that lead to
these aforementioned crises, we may be able to avoid them ourselves. However,
we must employ the use of a One Health approach when viewing public health
problems. It is becoming increasingly difficult, though, because of systematic challenges
that prevent the One Health approach from being used. These are listed below:
- Institutions – Dr. Kahn explained that when viewing and analyzing institutions, their mission statement is critical in understanding its priorities and which issues it will likely pursue. These institutions include international, national, regional, and local infrastructures. Take for example the United States, under the executive branch, the Department of Health and Human Services, and a few other departments, have disease control, prevention, and surveillance for humans in their mission statement. However, no department has animal disease control, prevention, or surveillance in their mission statement, which shows a lack of interest and concern with this issue. Furthermore, it illustrates the fact that these institutions do not understand the interconnectedness between human and animal health.
- Funding – This is responsible for, and determines, programs and activities. Funding is allocated to specific agencies, for specific purposes, and these purposes are typically in line with the mission of the organization. Because no specific organization exists solely, or even in part, for the control, prevention, or surveillance of disease in animals, it is not surprise that almost no money goes into animal disease research, compared to human medical research. For example, the budget for the Centers for Disease Control was $11 Billion in 2010, whereas it was $760 Million for APHIS, which is the Animal Plant Health Inspection Service. “Paucity of funds for animal disease surveillance, control, prevention, and research makes implementing One Health difficult,” Dr. Kahn expressed with concern.
- Education – 137 medical schools exist in the United States, whereas only 28 veterinary schools exist. The same ratio exists around the world, as well. This disproportionate number of medical schools compared to veterinary medical schools is responsible for the vast number of human medical physicians compared to veterinarians, practicing in the United States. Furthermore, a majority of the practicing veterinarians are in small animal care, which is important and is what the public demands, but fewer veterinarians are in large animal practice, which is necessary for proper surveillance of diseases that concern One Health. Dr. Kahn also expressed the need for One Health Degree Programs, which would offer Master’s or Doctoral degree programs in One Health. In addition to biostatistics and epidemiology courses, she elaborated, subjects would include food and water safety and security, environmental health, urban development, agriculture and sustainability, and zoonotic diseases.
-
Attitudes – Perhaps the most challenging issue to tackle, will be this. In a survey of 4897 physicians and 4144 veterinarians across the United States, 80% of MDs and 45% of DVMs replied that they never communicate with their colleagues in the alternate field. They also expressed at a high rate that they would never be interested in doing so. Primarily, specialist physicians said that they would not likely ever encounter rare zoonotic diseases in their practice, so they concluded that conversing with DVMs would not be worth their time. DVMs, though, believe that more interaction would be helpful, but MDs typically have little respect for veterinarians and show little interest in potential zoonotic diseases. This is a cause for major concern, as zoonotic diseases are a stark reality for thousands of people across this country, and physicians should be more educated on this issue.
Dr. Kahn believes that addressing these systematic challenges
could be done by creating One Health Organizations, which would have a unified
interdisciplinary mission. Their priorities would be, equally, human, animal,
and environmental health. Disease surveillance, control, prevention, and
research for humans, animals, and the environment would be a core mission of
the organization and this would be reflected in its budgets for each of these
areas. Furthermore, education could be revamped by implementing Colleges of One
Health. These would have under them, schools of Medicine, Veterinary Medicine,
Nursing, and Public/Environmental Health. This is a good vision to have for the
future.
However, this all depends informing political leaders about
the benefits of approaching public health issues with a One Health perspective.
This may encourage them to influence policies in such a way that funding for
animal, human, and environmental health becomes comparable, unlike the current
situation. Medical leaders must also be convinced, as they must acknowledge the
inherent interconnection between human and animal health.
 |
| Dr. Kahn takes questions from the audience and discusses what small steps can be taken to lead the way for One Health. |
Dr. Kahn finished her presentation, the final one of the
semester, by acknowledging Drs. Kaplan, Monath, Woodall, and Conti, who have
been relentless in their One Health efforts. Following this, she opened the
floor up for discussion and questions. Several questions were posed about what
the most realistic next few steps would be towards implementing more One Health
friendly policies. Several members of the audience, especially physicians,
veterinarians, and public health officials, exchanged their ideas about the
feasibility of these recommendations and what they believe are the current
challenges to implementing One Health in public health issues. This concluded the spring semester of One
Health sessions – leaving us to ponder upon what this generation can do to lead
the way for One Health.
Post Authored by Nasir Khatri, B.S.
Biochemistry, B.A. Chemistry candidate at North Carolina State University.
Saturday, April 21, 2012
Going to the dogs … for a new model organism of non-Hodgkin lymphoma
On Tuesday, April 17th, there were two speakers at the One
Health Session. The speakers had met each other several years ago through a
common veterinary friend. After they discussed their research over lunch for
about a year, they started collaborating in research regarding stem cell
transplantation in B- and T-cell lymphoma. Steven Suter, VMD, MS, PhD, DACVIM
(Oncology) is an Assistant Professor of Oncology in the Department of Clinical
Science at NCSU Veterinary Health Complex. He is a veterinary oncologist and
the Medical Director of the world’s only Canine Bone Marrow Transplant Unit.
Kristy Richards, MD, PhD is an assistant professor in the Department of
Genetics and Department of Medicine, Division of Hematology/Oncology at the UNC
School of Medicine. Kristy Richards is a medical oncologist; she treats
patients with a variety of blood cancers in the Lineberger Cancer Center and
her laboratory in IPIT focuses on finding new and better ways to treat
lymphoma.
Steve Suter described his bone marrow transplantation (BMT)
program in dogs. They have treated 67 dogs since the opening in October 2008
and people are coming from all different states. Lymphoma occurs in a lot of
otherwise healthy dogs that are only 3-4 years old. The 2-year survival with
the lowest radiation dose has been 33% so far and they expect even better
survival rates with the higher doses being used currently. BMT is an
alternative to chemotherapy, which has a cure rate of 0%. The costs are lower
and the treatment regime is shorter than in humans. The description of the BMT
program in dogs was really interesting and it’s not surprising that it’s
similar to the human program.
 |
| Dr. Suter (standing) discusses starting the only canine bone marrow transplant unit in the world. |
The reason for this is that >95% of all human BMT
protocols were first perfected in dogs. Dogs are a better model than mice, not
only because of their size, but also because of the natural occurrence of
lymphoma in dogs. To test new medications, we do not need to develop an animal
model in which we first make the dogs sick, we can use the dogs that develop
lymphoma spontaneously. This way both science and the dogs/owners are helped.
My own concern, the quality of life of these dogs, seems to be well monitored.
After this session, I believe that the dogs do not suffer a lot from the
treatment and that they recover well. In the case of incurable disease, euthanasia
remains an option, just like dogs that do not participate in clinical trials.
Kristy Richards mainly told us about her research. She
explained to us why dogs are more than an animal model to her. By combining the
findings of genetic studies in humans, dogs, and mice, she has been able to
generate hypotheses that she could never have made if she studied only one or
two of the species. B-cell lymphomas are more common in both humans and dogs
and have a better outcome than T-cell lymphoma. She explained to us how
research in humans has discovered GCB- and ABC- subtypes that have different
responses to treatment in research settings. She tried to duplicate these
results, but so far has not been able to do this conclusively in humans or
dogs. However, Dr. Richards did find another subtype, IGHV, which might
correlate better with clinical outcomes.
 |
| Dr. Richards explains how including dogs, mice, and humans in research can yield more information than any two alone. |
During the last minutes, both speakers shared their thoughts
about funding opportunities for their type of research: translational research
that is carried out in animal-patients, instead of animal models. Most of their
funding is coming from medical research societies at the moment. They are also
exploring possible collaborations with pharmaceutical companies, to test
efficacy and pharmacokinetic properties of new drugs in the treatment of
lymphoma.
Post authored by Margreet Harskamp-van Ginkel, MD (MPH student at
UNC School of Public Health and researcher at Duke Clinical Research Institute in Pediatric Pharmacoepidemiology)
Up Next - Final Spring/Weekly Session (24 April):
One Health: A Concept for the 21st
Century
Laura Kahn, MD, MPH, MPP, Department of
Science & Global Security at Princeton University
Monday, April 16, 2012
From Four Legs to Two - Translating Research Findings to Therapy of Spinal Cord Injury
Dogs and Spinal Cord Injury - Another Role for Man's Best
Friend
Dr. Natasha Olby, VetMB, PhD, DACVIM (Neurology) Professor
of Neurology and Neurosurgery at North Carolina State University College of
Veterinary Medicine (NCSU CVM), studied at Cambridge University for her
veterinary and research doctoral studies. She says it is at Cambridge where she
first learned about the One Health application of animal models in biomedical
research. After completing a postdoctoral study at Cambridge, she completed her
residency in neurology/neurosurgery in North Carolina. As a board certified
neurologist in the American College of Veterinary Internal Medicine, Dr. Olby
joined the faculty at NCSU CVM where she has been conducting clinical work and
research in spinal cord injury (SCI).
 |
| Dr. Natasha Olby discusses her work using dogs as models for spinal cord injury. |
Dr. Olby began our session, “Benefits of Comparative
Medicine: Regenerative Medicine?” with a holistic look at canine SCI research.
Dr. Olby explored the ethical dilemmas and solutions of SCI research and
explained that quantifying SCI recovery in dogs with naturally occurring spinal
cord diseases is crucial in creating translatable data to improve human SCI
treatments. She explained that adequate SCI models and outcome measures are
imperative to improving SCI recovery. Dr. Olby explained that dogs are an appropriate
model for human SCI because SCI is common and naturally occurring in dogs, it
is comparable to human SCI, dogs are relatively large and uniform, clinical
research avoids using laboratory animals and, as she showed during the
presentation, the results are quantifiable.
Dr. Olby has advanced SCI treatments as she has created
solutions for several hurdles in the field of SCI recovery. The gait scoring
system she created for quantifying SCI recovery in dogs allows for advancements
in recovery treatments as the field encompasses a variety of injuries, each
with differing degrees of severity which each have specific goals and
treatments. Since the severity of an injury will dictate the type of treatment
an animal receives, Dr. Olby has been able to better identify successful
treatments in SCI patients.
Dr. Olby continues to contribute to SCI
treatment and recovery in her Canine Spinal Cord Injury Program. Through this
clinical research program, Dr. Olby is able to test different treatments in
specifically-defined groups of SCI patients and definitively report their
outcomes. Her contributions to the advancement of SCI recovery in dogs is
applicable to acute and chronic SCI patients and translates to human SCI
suffers.
The Dalfampridine Story - The Making of a Medicine
Dr. Andrew Blight, PhD is the Chief Scientific Officer at
Acorda Therapeutics and a member of the editorial board of the Journal of
Neurotrauma. He began his session by outlining his unique path in One Health.
Dr. Blight first became interested in SCI while studying the miniature potentials
in frog spinal cord synapses. From there, he completed a postdoctoral study in
Germany and subsequently became a Research Assistant Professor in the
Department of Neurosurgery at New York University Medical Center. While there,
Dr. Blight brought an interest in chronic SCI when he joined a research group
studying acute SCI. From there, Dr. Blight became an Associate Professor of
Anatomy at Purdue University School of Veterinary Medicine and then a Professor
and Director of the Research Laboratory in the Division of Neurosurgery at the
University of North Carolina, Chapel Hill. Dr. Blight continued to study the
pathophysiology and treatment of SCI, which brought him to Acorda Therapeutics
as head of research and development.
 |
| Dr. Andrew Blight describes the complex pathway from therapeutic concept to pharmaceutic approval and use. |
Dr. Blight explained that while one would expect a linear
transition from understanding of a dysfunction to conceptual solution, then
animal studies, clinical studies, approval and use, this linearity is actually
much more complex in drug development. He found this to be true while working
on 4-aminopyridine; a drug therapy initially intended to treat SCI but
ultimately approved for treatment of multiple sclerosis (MS). This drug is
called dalfampridine in the United States and while its exact molecular
mechanism is not understood, it has been shown to block unprotected potassium
channels affected by multiple sclerosis demyelination and is effective at very
low doses.
Dr. Blight explained the long path this drug has
taken in its journey to a Food & Drug Administration-approved drug. In the
past, it has been used as an analeptic in anesthesia. It has also been used to
treat botulism, myasthenia, Eaton-Lambert syndrome, Alzheimer’s disease, MS,
and SCI. In Dr. Blight’s experience, there are many ups and downs in the
development of a drug as clinical testing can have promising results, but these
results can be hard to quantify. In Dr. Blight’s experience, the timed walk
responder was found to be the most reliable measurement of treatment outcomes.
Using an appropriate evaluation to measure the effect of dalfampridine also
allowed them to elucidate the optimal dosage for dalfampridine in the treatment
of MS. Thus, Dr. Blight provided an insider’s peek into the complex process of
therapeutic drug development.
Post authored by Josephine Drayton, NCSU MS Candidate in Animal Science & Nutrition
Up Next (17 April):
Going
to the dogs … for a new model organism of non-Hodgkin lymphoma
Steven Suter,
VMD, MS, PhD, DACVIM, Assistant Professor, Oncology at NCSU CVM
Kristy Richards, MD,
PhD, Assistant Professor Department of Genetics at UNC
Sunday, April 8, 2012
One Health Core Competencies - Building Capacity for Response to Emerging Pandemic Threats
 |
| Dr. Felicia Nutter discusses how the USAID RESPOND project is using a One Health approach to develop the framework necessary to improve disease surveillance and outbreak response at the global "hot spots" for emerging pandemics. |
Dr. Nutter now works with the RESPOND project, which was the focus of her presentation. She works with Tufts University and the University of Minnesota and is the liaison to FAO and OIE for the RESPOND project. She provides technical and strategic support to the project headquarters and provides global technical support to the project's offices in a few of the “hot spots” for emerging pandemics. These include the West Congo, East Congo and Southeast Asia.
The Emerging Pandemic Threats Program takes a One Health approach to improve disease surveillance and outbreak response. The program consists of four parts: Predict, Respond, Prevent, and Identify. RESPOND prepares others to respond to pandemic. It uses a multidisciplinary approach to:
• Improve training for skills needed to respond to outbreaks
• Improve cross-sectional links to support coordinated outbreak response
• Improve capacity to conduct investigations of suspected outbreaks
• Introduce technologies to improve training, surveillance, and outbreak investigations
The project took a year to get underway and when it started it had a strong focus on local training. Unfortunately, due to monetary issues, the project now focuses more on professional development training and graduate training. RESPOND receives funding from USAID, which receives its budget from Congress, so sometimes the funding falls short of expectations. RESPOND also receives funding from two private companies: Development Alternatives Incorporated and Training Research Group. The companies develop techniques for training adults. With more funding the project could continue with local training, which would benefit general populations in immeasurable ways and catch outbreaks at their roots. Funding is one of the larger issues that any project faces and as pioneers for One Health we all need to do our part in making sure that potential supporters realize the importance of our mission.
The RESPOND project has successfully assisted with the establishment of two educational organizations in the pandemic hot spots. These are the One Health Central and East Africa (OHCEA) and the Southeast Asia One Health University Network (SEAOHUN). SEAOHUN has more disciplines and a holistic approach. It is composed of 10 universities from Thailand, Vietnam, Indonesia, and Malaysia. There are 14 faculties and schools of veterinary medicine, tropical medicine, nursing, allied health sciences, public health, and medicine.
Dr. Nutter defined some of the concepts central to One Health. She explained the contrast between multidisciplinarity, interdisciplinarity, and trans-disciplinarity. Multidisciplinarity is an additive approach which does not integrate different disciplines, but rather just brings more disciplines together. The disciplinary perspectives are not changed. Interdisciplinarity is an interactive approach, which synthesizes two or more disciplines. This establishes a new level of discourse or integration of knowledge. The interdisciplinary approach is how One Health currently operates. Trans-disciplinarity is a holistic approach that shares conceptual framework with no disciplinary boundaries. This is ideally what One Health will become.
Dr. Nutter defined “competency” as measurable knowledge, skills, attitudes, and behaviors used as a basis for training and education. The “One Health core competencies” are skills that everyone involved with RESPOND need to have to constitute a common baseline. Some core competencies under discussion are values, ethics, cultural competency, team development, leadership, communication, responsibilities, analysis and assessment from a systems perspective, joint planning and management resources, and governance. RESPOND is developing core competencies for One Health with working groups, such as EPT projects, the CDC and the USDA. RESPOND is also combining expert opinion, literature review, and participatory approaches. Furthermore, SEAOHUN is working on regional input and curriculum mapping.
Most discussions during the forum were inquiries as to how long the program would operate and about the movement away from training locals. Dr. Nutter explained that these were budget issues and that the program was a five year project that has two years of funding left. It was also mentioned that this One Health approach to responding to pandemics is actually partitioned into different parts, which is the opposite of One Health. Dr. Nutter and Dr. Whittier explained that this project is new and that ultimately the program will achieve a more holistic organization and that for now, they are serving as liaisons between the different parts.
The presentation by Dr. Nutter was, in my opinion, one of the most interesting of the semester so far. It demonstrated how the One Health Concept is being implemented in real world situations with pandemic outbreak response. With the success of this project and other studies that Dr. Nutter said will soon be underway, hopefully One Health will gain more notoriety and we can all work together to make this world a healthier, safer place.
Post authored by Christon Wiles, NCSU Zoology Major
Up Next (10 April):
From Four Legs to Two - Translating Research Findings to Therapy of Spinal Cord Injury
Dogs and Spinal Cord Injury - Another Role for Man's Best Friend
Natasha Olby, VetMB, PhD, DACVIM, Professor, Neurology at NCSU CVM
The Dalfampridine Story - The Making of a Medicine
Andrew Blight, PhD, Chief Scientific Officer Acorda Therapeutics
The USAID PREDICT Project: Building a global early warning system for emerging zoonoses
Dr. Chris Whittier, DVM, PhD is an Associate Veterinarian and PREDICT Global Coordinator at Smithsonian’s National Zoological Park. He has a DVM from Tufts University and PhD from NC State in molecular diagnosis and epidemiology of infectious disease in wild gorillas. He worked extensively in central Africa for the Mountain Gorilla Veterinary Project as a veterinarian and program manager.
Dr. Whittier took a few minutes at the beginning of his talk to reflect on his “one health journey” and the evolution of his career in veterinary medicine. His One Health path is unique. Like his role model primatologist Jane Goodall, he worked with primates in Africa, which let to his decision to become a wild animal veterinarian. Dr. Whittier even had the opportunity to work with Jane Goodall herself on chimp and gorilla health. His experience working with parasite transmission from human to chimp and public health programming lead him to further study in parasitology and zoonotic disease transmission. His PhD research focused on shared diseases in gorillas and chimps in the Rwandan mountains and included wildlife surveillance and public health teaching.
 |
| Dr. Chris Whittier emphasizes the importance of One Health in emerging zoonotic disease surveillance and explains the goals of the USAID PREDICT project. |
The PREDICT project was initially funded after avian and swine influenza outbreaks demonstrated the increasing transmission of zoonotic pathogens from animals to humans. In fact, 70% of emerging infectious diseases are zoonotic pathogens. Human behavior and increasing human interaction with wildlife has a significant impact on disease transmission. For example, the trade of wildlife and exotic species in Asia has increased transmission risks between animals and humans and the emergence of novel infectious organisms.
USAID PREDICT received funding in 2009 to build “a global warning system for emerging disease that move between wildlife and people” (USAID PREDICT).
PREDICT’s goals
• Identify emerging and novel viral zoonotic pathogens with pandemic potential
• Increase capacity to monitor disease at the animal-human interface
• Develop the capacity to monitor zoonotic diseases through coalition building and the training of existing personnel and optimizing existing lab infrastructure in hotspot areas
• Improve surveillance, reporting and identification of novel diseases in order to hasten response of control of disease outbreaks.
• Focus its efforts in predicted global hot spot areas in South East Asia and Congo Basin
PREDICT uses Smart surveillance, probabilistic modeling, field study and surveillance, and laboratory studies focusing on disease hotspot and predict and monitor disease outbreaks. Target animals include high priority species such as primates, bats, and rodents. Dr. Whittier readily admits that there are shortcomings to this model but sees this project as a long-term investment in global animal and human health.
Monday, April 2, 2012
The Emergence of Visceral Leishmaniasis in the US
During her March 27 lecture, Dr. Christine Petersen, DVM
PhD, Assistant Professor at Iowa State University, offered a One Health
perspective of visceral leishmaniasis in the US. As both a DVM and
immunologist, Dr. Petersen has been involved in many aspects of One Health,
including medical, veterinary, and public health. Her research, focusing on the prevalence and
prevention of zoonotic diseases, has led her to study visceral leishmaniasis in
the American Foxhound population.
 |
| Dr. Christine Petersen, DVM PhD explains her research on visceral leishmaniasis and why the disease should have a One Health focus in the US. |
Dr. Petersen began with a background on the disease,
including theories on how it came to the US and why it remains problematic for
both dogs and humans. Visceral leishmaniasis, a zoonotic, vector borne disease,
exists as a spectrum of clinical disease, from cutaneous sores to disseminated
disease with organ involvement. Positive serology does not guarantee clinical
disease, however. Induction of visceral leishmaniasis seems to be a classic
interplay of genetic background and environmental factors, as malnutrition,
drug use, HIV, and childhood are all associated with disease presentation.
The disease is present in 89 countries, and it exists in “New World” and “Old World” forms. Dr. Petersen explained that the version found in the US appears to have come from colonialists, because it is the type species from Europe, not from South America as one would expect given the land connection. The first outbreak in a Foxhound kennel was reported in 1999, and currently 23 US states have seropositive Foxhounds. As sand flies are the vector in many countries globally, four species of sand flies in the US are potential vectors. However, this vector source does not appear to be the main cause of transmission to humans or animals. There have been very few reports of transmission to other animal species or humans despite contact with seropositive Foxhounds. The containment of the disease within Foxhounds and a few other foreign-borne dog breeds suggests that vertical transmission is the primary form of the disease’s transmission in the US.
Dr. Petersen proposed many thought-provoking One Health questions related to disease control and accountability in the US. She stated that good treatments do not exist for humans or canines, and so we must search for methods of controlling transmission. Although sand fly vector control efforts have been implemented in other countries, the US needs to consider how to address the vertical transmission in Foxhounds. She explained that Brazil has begun a depopulation campaign for seropositive canines. However, this effort has not reduced leishmaniasis cases in humans or animals, and it has taken an emotional toll on Brazilians who have lost beloved pets. She noted that researchers are looking at the human-dog interactions in Brazil to better understand exposure and possible means of containing the disease.
The questions proposed by the audience at the end of Dr. Petersen’s lecture brought forth several other One Health issues. An interesting point was made regarding current military veterans’ relationship to the leishmaniasis issue. Dr. Petersen stated that 4,000 soldiers have come back from Iraq and Afghanistan with leishmaniasis, and many have brought home service dogs and adopted dogs that may also be seropositive. While efforts are being made to address the disease in soldiers, no such effort has been made to monitor dogs coming into the US. Dr. Petersen explained that until we have a “CDC” for animals in US, no one is willing to pay for the testing of animals before they enter the country. In the end, she emphasized the serious need for a One Health approach to this problem, because currently the disease will have to pervade canine populations and begin to affect human health before governmental organizations such as the CDC will intervene.
Interestingly, environmental health arose at the end of the discussion when someone inquired about the effects of climate change on disease prevalence. Dr. Petersen agreed that climate change, particularly global warming, does seem to be influencing the disease, as cases are emerging farther north around the globe. This point brought the discussion in full circle, serving as a perfect demonstration of the inter-relatedness of human health, animal health, and environmental health.
Post authored by Rachel Little, MPH candidate at UNC School of Public Health (Health Care & Prevention Program) & UNC medical student
Up Next (3 April):
The disease is present in 89 countries, and it exists in “New World” and “Old World” forms. Dr. Petersen explained that the version found in the US appears to have come from colonialists, because it is the type species from Europe, not from South America as one would expect given the land connection. The first outbreak in a Foxhound kennel was reported in 1999, and currently 23 US states have seropositive Foxhounds. As sand flies are the vector in many countries globally, four species of sand flies in the US are potential vectors. However, this vector source does not appear to be the main cause of transmission to humans or animals. There have been very few reports of transmission to other animal species or humans despite contact with seropositive Foxhounds. The containment of the disease within Foxhounds and a few other foreign-borne dog breeds suggests that vertical transmission is the primary form of the disease’s transmission in the US.
Dr. Petersen proposed many thought-provoking One Health questions related to disease control and accountability in the US. She stated that good treatments do not exist for humans or canines, and so we must search for methods of controlling transmission. Although sand fly vector control efforts have been implemented in other countries, the US needs to consider how to address the vertical transmission in Foxhounds. She explained that Brazil has begun a depopulation campaign for seropositive canines. However, this effort has not reduced leishmaniasis cases in humans or animals, and it has taken an emotional toll on Brazilians who have lost beloved pets. She noted that researchers are looking at the human-dog interactions in Brazil to better understand exposure and possible means of containing the disease.
The questions proposed by the audience at the end of Dr. Petersen’s lecture brought forth several other One Health issues. An interesting point was made regarding current military veterans’ relationship to the leishmaniasis issue. Dr. Petersen stated that 4,000 soldiers have come back from Iraq and Afghanistan with leishmaniasis, and many have brought home service dogs and adopted dogs that may also be seropositive. While efforts are being made to address the disease in soldiers, no such effort has been made to monitor dogs coming into the US. Dr. Petersen explained that until we have a “CDC” for animals in US, no one is willing to pay for the testing of animals before they enter the country. In the end, she emphasized the serious need for a One Health approach to this problem, because currently the disease will have to pervade canine populations and begin to affect human health before governmental organizations such as the CDC will intervene.
Interestingly, environmental health arose at the end of the discussion when someone inquired about the effects of climate change on disease prevalence. Dr. Petersen agreed that climate change, particularly global warming, does seem to be influencing the disease, as cases are emerging farther north around the globe. This point brought the discussion in full circle, serving as a perfect demonstration of the inter-relatedness of human health, animal health, and environmental health.
Post authored by Rachel Little, MPH candidate at UNC School of Public Health (Health Care & Prevention Program) & UNC medical student
Up Next (3 April):
One Health Core Competencies - Building Capacity
for Response to Emerging Pandemic Threats
Felicia Nutter, DVM, PhD, DACZM, Research
Assistant Professor at Tufts University Cummings SVM, USAID Grantee, RESPOND
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The USAID PREDICT Project: Building a
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Whittier, DVM, PhD, Associate Veterinarian at Smithsonian
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