Session 6: Feb 15, 2011: Tick-transmitted Infectious Diseases In North Carolina: Local, National and Global Implications

The One Health Intellectual Exchange "Philosophy to Practical Integration of Human, Animal and Environmental Health", an IEG discussion series, is sponsored by the Triangle Global Health Consortium One Health Collaborative. It is designed to enhance collaborations between physicians, veterinarians, researchers and other local / global health professionals by increasing public awareness of the interconnectedness of people, animals and the environment.

Session 6: Feb 15, 2011: Tick-transmitted Infectious Diseases In North Carolina: Local, National and Global Implications

This session will include a panel with leading researchers, Dr. Ed Breitschwerdt, 
Dr. Charles Apperson, and Dr. Ricardo Maggi. 

Learning Objectives:
1.  Students will be knowledgeable of the tick species that transmit pathogens of public and veterinary health importance.
2.  Students will be knowledgeable of the life cycles of ticks of public and veterinary health importance.
3.  Students will be knowledgeable of the bacterial pathogens and the general disease manifestations of bacterial pathogens of public and veterinary health importance. 

Suggested readings for this session are referenced below:

• Apperson, et al. 2008. Tick-Borne Diseases in North Carolina: Is “Rickettsia amblyommii” a Possible Cause of Rickettsiosis Reported as Rocky Mountain Spotted Fever? Vector-borne and Zoonotic Diseases 8: 5.
• Rhea, et al. 2011. Evaluation of Routinely Collected Veterinary and Human Health Data for Surveillance of Human Tick-Borne Diseases in North Carolina. Vector-borne and Zoonotic Diseases 11: 1.
• Maggi, et al. 2010. Borrelia species in Ixodes affinis and Ixodes scapularis ticks collected from the coastal plain of North Carolina. Ticks and Tick-borne Disease.
• Nicholson, et al. 2010. The increasing recognition of rickettsial pathogens in dogs and people. Trends in Parasitology Vol.26 No.4
• Smith, et al. 2010. Bacterial Pathogens in Ixodid Ticks from a Piedmont County in North Carolina: Prevalence of Rickettsial Organisms. Vector-borne and Zoonotic Diseases 10: 10.

We had a wonderful session with Drs. Charles Rupprecht, Carl Williams, Bob Weedon and Mr. Peter Costa on February 8th. To learn more about Rabies, please see the following Grand Rounds presentation sponsored by the CDC. 


Presentation: Rabies Elimination in the 21st Century?




Rabies, a viral zoonotic disease, can be spread to humans through bites or scratches from infected wild or domestic animals. Without prompt and proper wound cleansing and immunization, rabies can lead to death in humans – more than 55,000 people worldwide die from this disease every year. Fortunately, rabies is a vaccine-preventable disease. The most cost-effective strategy for preventing rabies in people is by eliminating rabies in dogs through vaccination. However, recent increases in human rabies deaths in parts of Africa, Asia and Latin America suggest that rabies is re-emerging as a serious public health issue.

This session of Grand Rounds addressed traditional and new approaches to disease prevention and control, the importance of evidence–based strategies and interventions for human prophylaxis and animal control, and discussed current opportunities and challenges in eliminating this disease in both developed and developing countries.

Presented by: 
Charles E. Rupprecht, VMD, MS, PhD 

Chief, Rabies Program
Director, WHO Collaborating Center for Reference & Research on Rabies, Poxvirus & Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
Presentation: Rabies: A Neglected Re-emerging Zoonosis

Dennis Slate, MS, PhD 
National Rabies Management Coordinator, US Department of Agriculture
Presentation: Management at the Human/Animal Interface

Luis Fernando Leanes, MVD, MSc 
Advisor, Veterinary Public Health Unit, Pan American Health Organization, WHO
Presentation: New Approaches to Rabies Elimination in Latin America

Deborah Briggs, MS, PhD 
Director, Global Alliance for Rabies Control
Presentation: Renewed Advocacy and Effective Partnerships for Prevention Efforts at the Community Level

Facilitated by: 
Tanja Popovic, MD, PhD, Scientific Director, Public Health Grand Rounds
Shane Joiner, Communication Manager, Public Health Grand Rounds

A number of additional interesting presentations from World Rabies Day 2010 are also available here: 

http://www.worldrabiesday.org/EN/Events/wrd-webinar.html

In preparation for our upcoming Rabies presentation in the One Health Intellectual Exchange, here are a few Rabies informational videos produced by the Global Alliance for Rabies Control. For more information visit here. 


What is Rabies?



What Animals are Most Likely to be Rabid?



Rabies Symptoms



Rabies Diagnosis



Preventing Rabies



World Rabies Day



Rabies Medical Research

Polar Bear Swims for Nine Days, Pays Heavy Price

news.discovery.com/earth/polar-bear-swims-for-nine-days-pays-heavy-price.html

Exclusive breastfeeding for six months best for babies everywhere

http://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/index.html

Reduction of Coxiella Burnetii Prevalence by Vaccination of Goatss and Sheep, Netherlands

http://www.cdc.gov/eid/content/17/3/pdfs/10-1157.pdf

Session 5: Feb 8, 2011: Rabies from multiple perspectives: A One Health Exemplar

Session 5: Feb 8, 2011: Rabies from multiple perspectives: A One Health Exemplar

This session will include a 4-part panel with leading researchers, Dr. Charles Rupprecht, Dr. Bob Weedon, Dr. Carl Williams, and Peter Costa. Read on for more information on their presentations. 

Dr. Carl Williams, Rabies: A disease with a comprehensive medical, legal, and public health framework
Rabies is an infectious disease with the highest known case fatality rate, yet human cases of rabies in the US and NC are rare. In fact, a recognized human case of rabies has not occurred in NC since 1955. However, because of the burden of wildlife rabies in NC, and the high numbers of human and animal exposures to the disease, there is a strong public health and legal framework in place to limit the impact of this disease. No other human communicable disease, save perhaps HIV and TB, has such a specific legal framework in place for purposes of control. The success of these legal controls is dependant upon individual citizens and animal owners, physicians and veterinarians, and local and state public health officials working in concert. Rabies control is, and always has been, an ideal example of the concept of “One Medicine.” While rabies control laws are ultimately designed to protect human health, they have the benefit of providing significant benefits to animal health. As a result of compulsory dog, cat, and ferret rabies vaccination laws the number of rabies cases in these species is low. Similarly vaccination of raccoons along the Appalachian ridge against rabies (Oral Rabies Vaccination using Raboral V-RG) has the dual benefit of protecting raccoons in the central US from the raccoon variant of rabies, and protecting people there from many more exposures to rabies.

Learning Objectives:
1.    To understand the rationale for the existence of a legal framework for rabies control.
2.    To know the individual roles and responsibilities of animal owners, bite victims, animal control officers, physicians and veterinarians when dealing with rabies exposures.
3.    To understand basic principles of rabies exposure risk assessment to ensure people exposed receive appropriate care.

Dr. Charles Rupprecht, Rabies: an Epitome of the One-Health Concept
Rabies is one of the oldest infectious diseases, and has the highest case fatality rate of any conventional pathogen. The etiological agents are highly neurotropic, single-stranded, negative-sense RNA viruses in the Family Rhabdoviridae, Genus Lyssavirus. At least 12 different lyssaviruses, all which cause an acute, progressive encephalitis, have been described to date, some with considerable antigenic variation that lack cross reactivity to modern biologics. This zoonosis is distributed on all continents, with the exception of Antarctica. All mammals are considered susceptible, but major reservoirs reside in the Carnivora and Chiroptera. The domestic dog is the major reservoir, and responsible for >90% of human exposures and fatalities. Considering its veterinary impact on the loss of food, fiber, and fur, and public health impact, disability-adjusted life year scores, the burden of rabies lies within the top 10 echelon of global infections. Rabies is the only routine veterinary diagnostic test in which regular concentration upon laboratory results in a suspect animal directly determines human medical intervention. Additionally, animal models serve as the quintessential research subjects for innovative development of modern human prophylaxis and treatment options. Significantly, results of mass immunization programs in domestic and wildlife species demonstrate that rather than concentrate solely upon human rabies prevention, animal rabies can be controlled effectively, and in some cases eliminated locally. Hence, given these key facets alone, of decentralized laboratory-based diagnosis, research model development, and biotechnology/vaccinology, all focused centrally upon the role of non-human animals, with major benefits accruing directly for Homo sapiens, this ancient pariah is an ideal 21st example of the OneHealth concept in action.

Learning Objectives:
1)    To appreciate the value of basic surveillance and laboratory-based diagnosis conducted upon animal reservoirs and their critical role for decision making in human rabies exposures.
2)    To understand the utility of experimental rabies models, as surrogates in pathogenesis studies for relevant disease prevention and treatment in humans and other animals.
3)    To comprehend the historical importance of focusing upon control via vaccine-induced herd immunity, in domestic animals and wildlife, as a barrier to human infection, and a productive means of ultimate disease elimination.

Dr. G. Robert Weedon, The role of animal population control in human rabies prevention
The principal reservoir of rabies in the world is the domestic dog, the cause of >90% of human exposures and fatalities. The World Health Organization has said that control of rabies in domestic dogs can be accomplished by a three-pronged approach: a) epidemiologic surveillance, b) mass vaccination, and c) animal population control.

In most developing nations, only about 5 percent of dogs have owners in the Western sense, compared to 95 percent in the U.S. The rest can be loosely classified as community dogs. These community dogs may be a valued and recognized part of the community, but may not be “owned” in a manner that would provide supervision of movement in the neighborhood and address health needs such as rabies vaccination or population control. Therefore, any attempt to prevent rabies in a community will require both canine vaccination, and, in order to reduce overpopulation of these community dogs, animal birth control.

There is evidence that the combination of sterilization and rabies vaccination of dogs in a community can reduce the incidence of human rabies to zero. Imagine what could be accomplished by incorporating a non-surgical form of sterilization in such programs. The goal of this presentation is to increase awareness of the role of animal population control in rabies prevention campaigns in developing countries.

Learning objectives:
1) To recognize the unique demographics of dog populations, and their role as the principal reservoir of rabies, in developing countries.
2) To appreciate the value of canine sterilization and mass vaccination campaigns in preventing human rabies in communities where the dog is the principal reservoir of rabies.
3) To increase awareness of the potential for non-surgical sterilants and their use in rabies prevention programs in areas where animal overpopulation and human rabies is a problem.

Peter Costa, Health Communication: Bridging Gaps for Rabies Prevention
Rabies is a zoonotic disease that remains a serious public health concern, particularly in Asia and Africa, where the majority of human rabies deaths occur. It is clear that the areas where human rabies remains a major problem are also those areas where canine rabies is endemic. Raising awareness on rabies prevention and control is essential in preventing exposures, increasing the general public’s behaviors towards proper wound care and seeking medical attention. Enhanced awareness can also improve rabies control efforts in animals by increasing reporting of potential rabid animals, improving understanding among the population about the need to vaccinate dogs and behaviors of responsible dog ownership. All of these efforts will lead to improved overall rabies prevention at the local level. The recent establishment of an annual World Rabies Day and the involvement of professional health communicators in rabies outreach represent a major step forward. Fundamental and innovative communication techniques are used to achieve global coordination, galvanize support and empower stakeholders at different levels. Critically, the network also provides rabies advocates in different countries (often working in relative isolation) with an effective support structure and sense of engagement within a concerted international effort.

Learning Objectives:
1.    To list three reasons why rabies remains a neglected zoonotic disease on a global scale
2.    To describe the pivotal role of health communication and community education in effective and sustainable rabies prevention programs
3.    To formulate novel approaches to building partnerships, engaging hard-to-reach populations and overcoming barriers to health communication

Suggested readings for this session are referenced below:

• Blanton JD, Palmer D, Rupprecht CE. Rabies surveillance in the United States during 2009. J Am Vet Med Assoc. 2010 Sep 15;237(6):646-57.
• Rupprecht CE, Barrett J, Briggs D, Cliquet F, Fooks AR, Lumlertdacha B, Meslin FX, Müler T, Nel LH, Schneider C, Tordo N, Wandeler AI. Can rabies be eradicated? Dev Biol (Basel). 2008;131:95-121
• Franka R, Wu X, Jackson FR, Velasco-Villa A, Palmer DP, Henderson H, Hayat W, Green DB, Blanton JD, Greenberg L, Rupprecht CE. Rabies virus pathogenesis in relationship to intervention with inactivated and attenuated rabies vaccines. Vaccine. 2009 Nov 27;27(51):7149-55
• WHO. 2010. Rabies vaccines: WHO position paper. Weekly epidemiological record/ Relevé épidémiologique hebdomadaire. 6 august 2010, 85th year / 6 août 2010, 85e année. No. 32, 2010, 85, 309–320
• Wall, A N. Animal Control. Article 35. County and Municipal Government in North Carolina
• Wall, A. N. 2007.  An Overview of North Carolina’s Rabies Control Laws. Local Government Law Bulletin. No. 109 March 2007
• J. F. Reece, S. K. Chawla. 2006. Control of rabies in Jaipur, India, by the sterilisation and vaccination of neighbourhood dogs. Veterinary Record  159, 379-383
• Humane Society. Slum Dogs by the Millions. humanesociety.org
• S Cleaveland, P Costa, T Lembo, D Briggs. 2010. Catalysing progress in rabies control. Veterinary Record
• P Costa, et al. 2009. World Rabies Day outreach to Asia: empowering people through education. Asian Biomedicine Vol. 3 No. 4 August 2009; 451-457

The biology and control of dengue virus

Session 4: The biology and control of dengue virus: Immune responses, disease dynamics and genetic modification of the mosquito vector

This session included a 3-part panel with leading researchers, Dr. Dr. Aravinda Desilva, Dr. Katia Koelle and Dr. Fred Gould addressing various aspects of vector borne disease related to dengue.

Dr. Aravinda Desilva, is a Microbiologist and immunologist from UNC-CH who talk summarized the pathogenesis of dengue fever and dengue hemorrhagic fever from a global perspective. He concluded his segment with a discussion on the current state of dengue vaccine development.

Dr. Katia Koelle, a Professor of Biology at Duke University has focused on her work with the mathematical modeling of the disease ecology of the dengue virus. Her presentation served to provide a basic understanding of compartmental disease models, a description of her immunity and immunologic interactions between dengue’s four serotypes, and an evaluation of how mathematical modeling can inform vaccination strategies.

Dr. Fred Gould, a professor at NC State University, specializes in apply genetic engineering to the management of disease causing arthropod vectors. He discussed the basics behind transgenic strategies for manipulating mosquito populations as well as the ethical and operational issues related to their use.

A summary of the discussion questions from students, faculty, professionals, community members, and other attendees are below:

1. What are the potential detrimental environmental impact of eradicating mosquitos. (ie, do they perform some beneficial function to the ecosystem as a whole)

2. What is the potential for DENV and YF to jump to another arthopod vector if mosquitos are eliminated? Similarly, what is the likelihood that a virus other than dengue can enter that ecologic niche if dengue is eliminated?

3. What are options for disease control apart from vector annihilation? (ie, sanitation, housing etc) What is the most cost effective?

From a One Health perspective, all three speakers were able to effectively illustrate the intermingling of environmental effects and human behavior on the natural history of dengue virus infection in humans.

One Health in the News-Changing climate of the earth's oceans

GLOBAL WARMING EFFECTS ON SEA LIFE

http://content.usatoday.com/communities/sciencefair/post/2011/01/corals-global-warming/1

Caribbean corals have suffered massive die-offs in recent decades, linked to diseases that thrive in warmer waters, according to the Proceedings of the National Academy of Sciences journal study, led by Laith Yakob of the University of Queensland and Peter Mumby of the University of Exeter. "The strong link between infectious disease outbreaks and rising sea temperature has inevitably led to projections of increased epizootics in the future," says the study.

In the 2010-2040 period, coral reefs are expected to become highly susceptible to more frequent bleaching events. The IPCC sees this as the greatest threat to the world's reef systems.

http://en.wikipedia.org/wiki/Coral_bleaching

Coral bleaching is whitening due to stress-induced expulsion or death of their symbiotic protozoa, zooxanthellae, or due to the loss of pigmentation within the protozoa.The corals that form the structure of the great reef ecosystems of tropical seas depend upon a symbiotic relationship with unicellular flagellate protozoa, called zooxanthellae, that are photosynthetic and live within their tissues. Under stress, corals may expel their zooxanthellae, which leads to a lighter or completely white appearance, hence the term "bleached". Once bleaching begins, it tends to continue even without continuing stress. If the coral colony survives the stress period, zooxanthellae often require weeks to months to return to normal density.

Thailand closing dive sites in order to allow coral to ‘recover’

http://www.bangkokpost.com/news/local/217658/coral-needs-years-to-recover

The Marine and Coastal Resources Department is pressing ahead with a plan to close 10 popular diving sites in five provinces to limit the impact of tourism on severely damaged coral. The sites attract about one million tourists a year, and could be closed for up to 14 months. But diving operators say tourism is but one cause of the bleaching phenomemon, and if the diving sites are closed for as long as proposed, taxpayer help may be needed to keep some companies alive.

"Diving companies are being singled out for blame, when the main cause is a warming of sea temperatures," said one disgruntled company head. Some coral reefs may need several years to recover, not just a matter of months, they say.

Veteran marine biologist Thorn Thanrongnawasawat said closing the coral reefs will give the coral time to recover, but more permanent solutions are still needed.

Mercury cycling:

http://www.eurekalert.org/pub_releases/2011-01/nios-esa012011.php

An international research team working with National Institute of Standards and Technology (NIST) scientists at the Hollings Marine Laboratory (HML) in Charleston, S.C., has suggested for the first time that mercury cycling in the flora and fauna of the Arctic may be linked to the amount of ice cover present.

Exciting call for an "International Society of One Health"

Find the original article on the One Health Initiative website here: http://www.onehealthinitiative.com/news.php

“International Society of One Health” Proposed by One Health 2011 Congress Leaders

Eminent leaders of the 1^st International One Health Congress meeting from 14 – 16 February 2011 http://www.onehealth2011.com/ are proposing establishment of a visionary “International Society of One Health”.  Drs. Martyn Jeggo and David Heymann, a veterinarian and physician respectively, plan to include an all inclusive draft proposal statement* in the satchels of the delegates at the One Health Congress meeting. 

 The all-encompassing nature of the worldwide Society draft proposal notably contains reference to including One Health comparative biomedical clinical research aspects as well as public health (infectious diseases/zoonoses) at subsequent meetings, the next anticipated being in Canada.  Promoting and facilitating expeditious better understanding of disease processes through a comprehensive “One Health” comparative medicine approach involving public health, environmental health, biomedical research and clinical medicine and surgery appears in the offing.  Ostensibly, in addition to the critical and essential public health mission utilizing more efficacious One Health principles, there is expected to be recognition of and engagement with broad-spectrum high profile human and animal health issues such as cancer, cardiovascular disease, obesity, orthopaedic problems and others.

 A goal of institutionalizing the One Health Movement to provide a formal setting for funding acquisition in order to establish a host of cardinal activities is included. TheInternational Society would be established initially by an all inclusive interim international Board as stated in the draft proposal.

 Martyn H. Jeggo, BVetMed, PhD is Director, CSIRO Livestock Industries Australian Animal Health Laboratory (Australia) and David L. Heymann, MD is Director, U.K. Health Protection Agency (United Kingdom) and Editor, Control of Communicable Diseases Manual.  Drs. Jeggo and Heymann are both members of the One Health Initiative autonomous pro bono Team’s Honorary Advisory Board http://www.onehealthinitiative.com/advBoard.php.  At this time, expected attendance for the 1^st International One Health Congress meeting is now known to be over 600.

Anyone reading this News item and unable to attend the meeting are welcome and encouraged to provide feedback by answering the questions listed at the bottom of this proposal and adding any further comment(s).  Please respond to:

Email: onehealth2011@arinex.com.au 
Phone: + 61 3 9417 0888
Facsimile: + 61 3 9417 0899
Mail:
arinex pty limited
91- 97 Islington Street
Collingwood VIC 3066
Australia

____________________________________________

Please see Publications Page http://www.onehealthinitiative.com/publications.php for Original International One Health Society Proposal attachment:

*From 14 – 16 February 2011, Melbourne Australia will host the Inaugural International One Health Congress. The Congress will bring together experts working in the areas of animal and human disease and will address the need and growing interest to broaden the agenda of One Health and incorporate a truly global perspective by including environmental issues.

The “One Health” concept has gained considerable momentum during the planning of the Congress and a clear need for an ongoing Congress forum has been identified. More than that, the idea of establishing an International Society of One Health has emerged as an idea that has great substance and has already garnered worldwide support.

Working alongside other established initiatives such as the One World Website and linking with International and National bodies promoting the One Health concept, Drs. Martyn Jeggo, Chair of the 2011 Congress Committee and David Heymann, Chair of Scientific Committee propose that an International Society of One Health be established and share the following early initial thoughts for your comment(s):

International Society for One Health

The International Congress in Melbourne will allow for open and global consideration of the interrelated issues of animal and human health and the relationship with the environment, and plans are underway for a follow on Congress in two years in Canada. To continue this momentum the Society would:

·          create the framework to foster projects that can work across all three areas of One Health (Humans, animals and the environment)

·          while initially focusing on public health (infectious diseases) at the first Congress meeting, include One Health comparative biomedical clinical research at subsequent meetings

·          institutionalise the One Health Movement to provide a formal setting for funding and activities

·          promote the exchange of research data, information and knowledge

·          promote knowledge exchange through scientific visits and secondments

·          seek funding and related resources for research activities

·          seek funding for fellowships and scholarships

·          host and manage a Biennial International Congress

·          establish a One Health Scientific Journal

·          provide activity updates through a regular Newsletter

·          implement as appropriate priority activities identified by policy setting Organisations (National Governments, WHO, FAO, OIE).

The International Society would be established initially by an interim Board with the following proposed membership:

·          Two senior members of the Organising Committee of the 1^st International One Health Congress

·          A Representative of OIE

·          A Representative of WHO

·          A Representative of FAO

·          A Representative of the UN

·          A Representative of the World Bank

·          A Representative from the major international development agencies

·          A Representative of the US One Health Initiative Autonomous pro bono Team 

·          A Representative of the US CDC or member of the Stone Mountain working group

·          A Representative from each WHO region

·          A Representative of the Next Host Country (in this instance, Canada)

In addition to the interim Board, it is also proposed that there be a Scientific Advisory Committee that would be created before the next Biennial international congress and oversee the Scientific Program.

The Society would be established as a not-for-profit charitable company that is incorporated (within Australia), and have as a key responsibility, the task of mobilising, generating and allocating resources for specific activities as outlined above. Upon the official establishment of the Society, the interim Board would be tasked with preparing drafts of all governance documents for endorsement at the next One Health International Congress.

We invite your comments for discussion during the International Congress in February.

Yours Sincerely,                                                                                  

                                         

Martyn Jeggo                                                                             David Heymann                                                               

Director                                                                                       Chairman, Scientific Advisory Committee 

Chairman, Organising Committee                                                                 

          In order to progress ideas and reach consensus on the way forward delegates at the One Health Congress are invited to provide feedback to the proposal above through answering the     

           following questions and adding any further comment they wish:

                                                                                                                      

          Would you support the establishment of International Society for One

1.                   Health?

          Would you see the aims as appropriate at this stage?

          Would you see the activities as described appropriate at this stage?

2.                Would you see the proposed  Board representation and other organisational

3.                    arrangements as appropriate?

4.                Would you see the composition of the Board as appropriate?

5.                What further suggestions would you make if developing this concept:

6.      

7.                Additional Comments: