About the One Health Intellectual Exchange Series

This interdisciplinary course will introduce the concept of One Health as an increasingly important approach to a holistic understanding of the prevention of disease and the maintenance of both human and animal health. The list of topics will include a discussion of bidirectional impact of animal health on human health, the impact of earth’s changing ecology on health, issues of food and water security and preparedness, and the benefits of comparative medicine. Learning objectives include 1) to describe how different disciplines contribute to the practice of One Health, 2) to creatively design interdisciplinary interventions to improve Global Health using a One Health model, and 3) to interact with One Health-relevant professionals in the Triangle and beyond. The course aims to include students from Duke, UNC and NC State from diverse disciplines relevant to One Health, including: human medicine, veterinary medicine, environmental science, public health, global health, public policy, and others.

Sunday, April 29, 2012

Summer/Fall One Health Sessions 2012

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!

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.

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, DVM, PhD, DACZM got an early start in the field of One Health. With role models such as Jane Goodall and Diane Fossey, Dr. Nutter informed her mother that she wanted to be a veterinarian and live with the apes in Africa while she was still in elementary school. She did go on to receive her DVM from Tufts University. It was here that Dr. Nutter had the opportunity to complete a fellowship in Tanzania working with apes and humans in Gombe National Park. After that she had an internship in small animal medicine, a residency in zoological medicine, and she completed her PhD in Comparative Biomedical Science at NC State University. Dr. Nutter worked with the Mountain Gorilla Veterinary Project for five years. The project originally concentrated strongly on conservation, but made a transition to a One Health focus. Dr. Nutter continued to make One Health connections as a Staff Veterinarian at the Marine Mammal Center in Sausalito, CA. 

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.

Post authored by Amanda Gammon, BSN, UNC MSN (Family Nurse Practitioner) Candidate

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):
                     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 Project Senior Technical Officer
                       
The USAID PREDICT Project: Building a global early warning system for
emerging zoonoses
Chris Whittier, DVM, PhD, Associate Veterinarian at Smithsonian