New emerging zoonoses: a challenge and an

opportunity for the veterinary profession *

Bruno B. Chomel
WHO/PAHO Collaborating Center on New and Emerging Zoonoses, Department of Population Health
and Reproduction, School of Veterinary Medicine, University of California, Davis, CA 95616, U.S.A.
Received for publication 1 August 1997
Abstract
The concept of emerging infectious diseases appeared in the late 1980s, when major out-
breaks occurred around the globe and surprised many scientists who considered infectious
diseases to be maladies of the past or limited to the under-developed world. Several reports
identied erosion of the public health infrastructure among the factors contributing to new
and re-emerging infectious diseases. As indicated by Morse, ``Disease emergence often fol-
lows ecological changes caused by human activities such as agriculture or agricultural
change, migration, urbanization, deforestation, or dam building''. ``Among these new dis-
eases, surprisingly, most emergent viruses and many emergent bacteria are zoonotic''. Sev-
eral new zoonoses have been recently identied. Many of these diseases were either
unknown, because we were not able to isolate the infectious agent or to distinguish them
from other clinical syndromes, or discovered accidentally. Much of the recent identication
of new pathogens has been based on new molecular biology tools or epidemiological stu-
dies. For all these diseases or infections, veterinarians played a key role in their identi-
cation, isolation of the causative organisms and understanding of the epidemiology of the
infection. The role of the veterinary profession is very important in public health and on
the rise again in the U.S.A., as it should be in many other countries. Surveillance, clinical
curiosity and awareness, epidemiology and laboratory training are the essential tools and
competency that the veterinary profession must use to meet the challenge of new emerging
zoonoses. # 1998 Elsevier Science Ltd. All rights reserved.
Keywords: Emerging zoonoses; Veterinary public health; Factors of emergence
Comp. Immun., Microbiol. Infect. Dis. 21
(1998) 114
0911-6044/98/$19.00 # 1998 Elsevier Science Ltd. All rights reserved.
PII: S0147- 9571( 97) 00018- 0
C OMPARATIVE
I MMUNOLOGY
M ICROBIOLOGY &
I NFECTIOUS
D ISEASES
PERGAMON
* Adapted from the conference presented at the 64th Philippine Veterinary Medical Association
Meeting, Cebu, The Philippines, February 2021, 1997.
Re sume
Le concept de maladies infectieuses e mergentes est apparu a la n des anne es 1980, lors-
que de graves e pide mies se sont produites un peu partout sur le globe a la surprise de nom-
breux scientiques qui avaient de ja rele gue s les maladies infectieuses au domaine du passe
ou aux pays du tiers-monde. Divers facteurs associe s a l'e mergence ou la re-e mergence des
maladies infectieuses ont e te identie s, dont l'eondrement partiel des structures de sante
publique. Selon Morse,``l'e mergence des maladies suit souvent des modications de l'envir-
onnement cre e es par les activite s humaines telles que l'agriculture ou des changements des
pratiques agraires, les migrations, l'urbanisation, la de forestation ou la construction de bar-
rages hydro-e lectriques''. La plupart des maladies e mergentes sont des zoonoses identie es
re cemment soit a l'occasion d'une de couverte fortuite, soit parce qu'on ne savait pas isoler
l'agent infectieux ou les distinguer cliniquement d'autres entite s pathologiques. L'identica-
tion de ces nouvelles zoonoses est principalement le re sultat de la biologie mole culaire ou
d'enque tes e pide miologiques. Les ve te rinaires ont joue un ro le majeur dans la de couverte de
ces zoonoses, l'isolement de l'agent infectieux et la connaissance de leur e pide miologie. Le
ro le de la profession ve te rinaire est tre s important en sante publique, comme c'est le cas aux
Etats-Unis et devrait l'e tre dans beaucoup d'autres pays. Les compe tences cliniques et diag-
nostiques du clinicien, une bonne formation en e pide miologie et aux techniques de labora-
toire sont les outils que les ve te rinaires doivent acque rir et posseder pour pre venir et
controler les zoonoses e mergentes. Mots cle s: zoonoses e mergentes, sante publique ve te ri-
naire, facteurs d'e mergence # 1998 Elsevier Science Ltd. All rights reserved.
Mots-clefs: Emerging zoonoses; Veterinary public health; Factors of emergence
1. Introduction
Charles Nicolle, in his book: Infectious Diseases Destiny wrote more than half
a century ago: ``If human civilization persists, if it continues to develop and
expand, infectious diseases will increase in number in all the regions of the
earth'' [1].
The concept of emerging infectious diseases appeared in the late 1980s, when
major outbreaks occurred around the globe and surprised many scientists who
considered infectious diseases to be maladies of the past or limited to the
under-developed world. Once expected to be eliminated as a public health pro-
blem, infectious diseases remain the leading cause of death and disability-
adjusted life years worldwide [2]. The spectrum of infectious diseases is chan-
ging rapidly in conjunction with dramatic societal and environmental changes.
Worldwide, explosive population growth with expanding poverty and urban mi-
gration is occurring; international travel and commerce are increasing; and
technology is rapidly changingall of which aect the risk of exposure to
infectious agents.
The term `emerging infectious diseases' refers to diseases of infectious origin
whose incidence in humans has either increased within the past two decades or
threatens to increase in the near future and widen its geographic range [3]. It also
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 2
includes diseases that have newly appeared in the population, such as AIDS,
Brazilian purpuric fever or hantavirus pulmonary syndrome.
As indicated by Morse [4], ``Disease emergence often follows ecological changes
caused by human activities such as agriculture or agricultural change, migration,
urbanization, deforestation, or dam building. Among these new diseases, surpris-
ingly, most emergent viruses and many emergent bacteria are zoonotic''.
`Emerging zoonoses' are dened as zoonotic diseases caused either by appar-
ently new agents, or by previously known microorganisms, appearing in places or
in species in which the disease was previously unknown [5]. Natural animal reser-
voirs represent a more frequent source of new agents of human disease than sud-
den appearance of a completely new agent. Most emerging infections appear to be
caused by pathogens already present in the environment, brought out of obscurity
or given a selective advantage by changing conditions and aorded an opportunity
to infect new host populations. The ``zoonotic pool'' as mentioned by Morse [4], is
an important and potentially rich source of emerging diseases. Of the 22 major
etiologic agents causing infectious diseases identied between 1973 and 1994 that
are reported by Satcher [6], 14 (63%) are zoonotic agents. Since then, equine mor-
billivirus (EMV), South American hantaviruses, new ehrlichia and babesia species,
new rabies viruses (pteropid lyssavirus also known as Lyssavirus genotype 7) have
been identied as causes of human diseases or deaths. There is more and more
suggestion that the new variant of Creutzfeldt Jakob disease could be of animal
origin! The list established by Satcher [6] has not even included several other zoo-
notic agents, such as the identication of the European bat Lyssaviruses (EBL1
and EBL2) or the identication of new hantaviruses in Europe, such as the
Dobrava virus.
2. Emerging zoonoses: why now? Causes for emergence or re-emergence
Factors explaining the emergence of a zoonotic or potentially zoonotic disease
are usually complex, and related to (i) the infectious agent itself, involving mech-
anisms at the molecular level such as genetic drift and shift enhancing the viru-
lence (many viral infections) or acquisition of multidrug resistance (bacteria); (ii)
modications of the immunological status of individuals or populations; but more
likely (iii) environmental and social changes: ecological changes caused by human
activities such as agriculture or agricultural change, migration, urbanization,
deforestation, or dam building, human demographic changes and behavior, travel
and trade, technology and industry, and breakdown of public health measures
(Table 1).
2.1. Ecological changes
As indicated by Morse [4], ecological changes, including those due to agricul-
tural or economic development, are among the most frequently identied factors
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 3
in emergence. Ecological changes, led by agricultural practices, that modify the
natural equilibrium or natural `eco-niche', are often at the origin of outbreaks of
previously unknown diseases with high case-fatality rates; for instance,
Argentinian or Bolivian hemorrhagic fever, which is caused by the arenaviruses
Junin and Machupo, respectively. Conversion of grassland to corn elds led to the
increase of a specic rodent species, Calomys musculinus, a critecid rodent, which
is the natural reservoir of the Junin virus. With the expansion of maize agriculture,
human cases have increased [4]. Similarly, the deforestation in the Indian state of
Karnataka (ex-Mysore) and the grazing by cattle of this deforested areas led to
the emergence of Kyasanur forest disease, a tick-borne encephalitis, which was
rst described in 1957 and which has expanded from its initial 300 square miles to
more than 2000 square miles [7]. Water irrigation is certainly one of the most im-
portant agricultural techniques used to expand agricultural land. It may also be
associated with the emergence of mosquito-borne diseases and snail infestation. In
Asia, the incidence of Japanese encephalitis, which causes almost 30 000 human
cases and 7000 deaths annually, is closely associated with rice eld irrigation,
creating large areas of stagnant water [4]. In Africa, the dramatic expansion of
Rift valley fever in Egypt in 1977 and later in 1987 in Mauritania, appears to have
been associated with dam construction and irrigation in areas either densely popu-
lated with humans and domestic animals (Egypt) and with large naive ruminant
Table 1
Examples of emerging zoonoses and factors contributing to emergence (adapted from [4])
Infection or agent Factor(s) contributing to emergence
Non-conventional agent
Bovine spongiform encephalopathy Changes in rendering process
Viral
Argentinian, Bolivian hem. fever Changes in agriculture favoring rodent host
Dengue, dengue hemorrhagic fever Transportation, travel and migration; urbanization
Ebola Unknown, nosocomial
Hantaviruses
Ecological/environmental changes increasing
rodent contacts
Lassa fever
Urbanization favoring rodent host, increasing
exposure
Rift Valley fever
Dam building, agriculture, irrigation; possible
change in virulence or pathogenicity
Bacterial
Helicobacter pylori (gastric ulcers)
Probably has been long widespread, now
recognized
Escherichia coli O157:H7 (hemolytic
Mass food processing technology allowing
contamination of meat
Uremic syndrome)
Borrelia burgdorferi (Lyme disease)
Reforestation around homes, suburbanization, and
other conditions favoring tick vector and deer
population
Parasitic
Cryptosporidium and other pathogens
Contaminated surface water, faulty water
purication
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 4
populations in both Egypt and Mauritania [5]. Schistosomiasis is another disease
that is directly associated with agricultural practices of water irrigation, as demon-
strated in Egypt [8]. Zoonotic cutaneous leishmaniasis has become a sizeable pro-
blem in central and south-western Tunisia. The disease was endemic in this area,
but a major outbreak occurred in 1982 close to the Sidi Saad dam shortly after
the project was completed. The dam and vast programmes of agricultural develop-
ment led to the proliferation of the rodent reservoir and the phlebotome vector [5].
2.2. Changes in human demographics and behavior
Human population movements or upheavals, caused by migration or war, are
often important factors of disease emergence. Urbanization has led to mass move-
ment of workers from rural areas to cities. There have been recent outbreaks of
brucellosis in urban communities, such as in Lima, Peru (Arambulo, personal
communication) and in some of the conictual areas of the Gaza strip and West
bank in Israel and Palestine. The expansion of dengue fever in many parts of Asia
and Central and South Americas has been clearly associated with mass migration
of human population in urban centers and the creation of open air containers
needed for water storage, which also provide breeding grounds for the mosquito
vector [9]. Rain-lled tires or plastic bottles are the breeding grounds of choice for
the mosquitoes. High human density increases the chances of stable transmission
cycles between infected and susceptible persons. The adaptation of mosquito
populations to the use of insecticides, associated with the ban on remnant insecti-
cides, such as organochlorides, for evident ecological reasons, has created con-
ditions for the dengue vector population to dramatically take a biological
advantage.
The continuous spread of human populations to new living areas is also a factor
to consider in the emergence of new zoonoses. In South America, major outbreaks
of vampire bat rabies occurred in Peru and Brazil following settlement of new
agricultural communities in the remote jungle [10]. In the Peruvian outbreak, it
was clearly shown that human mortality followed discontinuation of a pig-raising
project, after these pigs were destroyed as a threat to traditional crops. The vam-
pire bat population had increased, as it fed on pigs. The elimination of the major
source of blood from the vampire bat population associated with the primitive liv-
ing conditions of the farmers led to the feeding of the vampire bats on humans at
night.
Farming of new animal species may lead to new outbreaks. Recently, an out-
break of Congo-Crimean hemorrhagic fever occurred in a slaughterhouse that
specialized in slaughtering ostriches in South Africa. Ostriches have become a new
`game farming' animal. In that outbreak, 16 cases were suspected, with at least
one death. Infected ticks may have been the source of human infection or ex-
posure to viremic birds [11]. Similarly, major concern has been raised with deer
farming and outbreaks of bovine tuberculosis occurring in these herds [12]. It
could be a possible source of human contamination. Translocation of exotic ani-
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 5
mal species for farming can also lead to new diseases or new reservoirs of infec-
tion. An outbreak of western equine encephalitis occurred in 1992 in emus in
Texas [13]. Cases were also reported in emus and rheas in California in 1994.
These birds suered clinical signs of infection, but could also play a role of virus
amplier.
The need for new exotic pets can also lead to the emergence of new zoonotic
diseases, such as the epidemic of chorio-lympho-meningitis seen in pet hamster
owners in the U.S.A. and Germany in the early 1970s [14] and more recently the
epidemic of iguana-related salmonellosis in the U.S.A. [15].
2.3. International travel and trade
Spread of diseases has been associated for centuries with human migration.
From the plague epidemics of the 6th, 14th and 19th centuries to the dispersion of
yellow fever from Africa to the Americas, or dog rabies from Europe to the
Americas, zoonotic diseases have found new reservoirs to adapt to, while humans
were expanding their territories. One of the major concerns of the present time is
the large amount of human ux associated with the dramatic reduction in the time
to travel over long distances, which has increased the possibility of the rapid glo-
bal transport of infectious agents [16]. The use of steamer and the reduction of
transoceanic travel was incriminated for the wide spread of the third plague pan-
demic at the end of the 19th Century. Today, any place on the globe can be
reached within 24 hr. The recent outbreak of Ebola fever clearly exemplies the
risk. The rst case of Ebola fever reported from South Africa was caused by a
sick patient seeking care far from the initial outbreak [17]. Lapeyssonie ironically
discussed a new vector agent of vector-borne diseases: ``aeroplanus
celerissimus'' [18]. The world panic that resulted from the epidemic of pulmonary
plague in India in 1994 illustrates the permanent risk with which we all must live.
Importation of monkeys for research was the source of the rst Ebola-like out-
break investigated in the United States. In September 1989, numerous cynomolgus
monkeys shipped from the Philippines died during their quarantine of what was
suspected to be simian hemorrhagic fever, but was caused by the Reston virus [19].
Had this virus been very pathogenic for humans, the story could have been horri-
c (highly used by the media and movie industry!).
The raccoon rabies epidemic in the U.S.A. was created by the importation of
infected animals which incubated the disease to disease-free areas that were highly
populated with a susceptible population [20]. Similar outbreaks could have been
repeated in the recent years when a Texas coyote rabies strain was identied in a
hunting dog colony in Florida! Expanding our habitat to suburban areas lead us
to be in contact with the wildlife reservoir of these expanding zoonoses. The dra-
matic increase of Lyme disease cases in the U.S.A. or the considerable number of
post-exposure rabies treatments in the north-eastern part of the U.S.A. are direct
consequences of our expansion.
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 6
2.4. Technology and industry
The increasing international trade in live animals and foodstu has favored the
spread of enteric zoonotic infections, especially salmonellosis. Globalization, cost
reduction and the use of easy to access raw material may sources for the spread of
infection. Food-borne zoonoses are increasing in both developed and developing
countries. According to the Pan American Health Organization, many of these
diseases have increased as much as 100% within a few years. In some countries,
the incidence is estimated to be as high as 10% of the population [5]. Salmonella
outbreaks caused by new serotypes or multidrug resistant serotypes are reported
more and more frequently. The identication of infection caused by Escherichia
coli O:157;H:7 is also an example of how better tools are needed for the diagnosis
of infectious diseases, and that also allow the assessment of an increasing patho-
gen which is associated with our food chain.
The spread, expensively-controlled, of the screwworm from South America to
Africa (Lybia) in 1988 was also another example of trade-related zoonoses [5], not
to mention the more recent and more dramatic spread of BSE through animal
feed to many European countries for short-term purely monetary benet. It is sus-
pected that modications in the processing of rendering products led to the BSE
epidemic in Great Britain [5].
Recognition of zoonotic diseases may also be related to a better technology with
which to investigate and identify the pathogens. It is striking to observe that many
new infectious agents have been identied following carefully conducted epidemiolo-
gical investigations leading, for instance, to suspicion of animal contacts (such as
bacillary angiomatosis and cat scratch disease, or hantavirus pulmonary syndrome)
and the use of modern molecular techniques. Molecular epidemiology is one of the
promising products of the interaction between epidemiology and the laboratory.
The agent of the hantavirus pulmonary syndrome was rst identied by detecting
genetic material in specimens collected from dead and sick patients with polymerase
chain reaction (PCR). It was one of the rst cases where a disease of unknown origin
was identied through molecular epidemiology [21]. In other instances, molecular
epidemiology was essential for the detection and identication of bacteria that were
resistant to cultivation. Although bacillary angiomatosis, an infection observed in
AIDS patients, characterized by vascular proliferation and lesions similar to
Kaposi's sarcoma, was rst described in 1983, the etiology remained unclear until
1990. Using broad-range PCR primers, Relman et al. [22] detected and amplied
segments of the bacterial 16S rRNA gene from skin lesions. Nucleotide sequences of
Bartonella henselae were found to be very close to B. quintana.
2.5. Microbial adaptation and change
Among the various factors associated with emergence of new zoonoses, mi-
crobial adaptation needs to be considered. Such an event seems to be more likely
to occur in the viral world than the bacterial world. Inuenza viruses are examples
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 7
of genetic shift and drift, which may lead to new variants and recombinant strains,
causing worldwide pandemics [4]. In wildlife, recent outbreaks of distemper-related
viruses are also a cause for concern, especially when one of these viruses could be
shown to aect not only wild animals but also domestic animals and humans. The
few cases of equine morbillivirus in Australia clearly exemplies the risk of new
zoonoses from an unknown reservoir [23]. Why these few cases occurred is still
questioned. It is thought that Western equine encephalitis virus arose from a
recombination event that seems to have involved a Sindbis-like virus and Eastern
equine encephalomyelitis virus probably 100200 years ago [24].
Resistant strains of Salmonella to various antibiotics are emerging in the indus-
trial farming environment of poultry, pig and calf industries. The risk that these
strains may be entering the food chain is of major concern.
2.6. Breakdown of public health measures and deciencies in public health
infrastructure
Among the various risk factors associated with disease emergence or re-emer-
gence, the breakdown of public health measures and deciencies in public health
infrastructure must not be neglected. The economic crisis of the late 1980s and
early 1990s has had a major impact on the nancial and human resources avail-
able to prevent and control infectious diseases. Disease prevention is only a few
percent (3%) of all the billion of dollars devoted to human health in the U.S.A.,
and even less is devoted to public health surveillance and information systems.
Inadequate funding has been cited as a problem with current systems of surveil-
lance. Surveillance of AIDS/HIV, tuberculosis, and sexually transmitted diseases
accounts for 89% of all federal funding and 77% of total (local, state, and federal)
funding for infectious disease surveillance. Obviously, therefore, surveillance of all
other infectious diseases receives <25% of surveillance funds [25].
Increased urban population, increased poverty, increased susceptibility to infec-
tious agents by lack of immunization (i.e. yellow fever), reduction of public health
support and privatization, and reduction of vaccination programs have led to an
explosive situation where infectious diseases can claim more ground. Outbreaks in
politically disrupted countries, i.e. central Africa, spread of cholera in South and
Central America, brucellosis in the Middle-East, and rabies, which has reappeared
in cities such as Lima, Peru, and Guayaquil, Ecuador or in countries where the
disease was almost eliminated, such as Tunisia.
3. A challenge for the veterinary profession
Emerging zoonoses are a direct challenge to the veterinary profession. We need
to be able to recognize these new diseases, we need to contain them before a
major epidemic, we need to set appropriate surveillance systems into place and we
need the appropriate tools to recognize them.
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 8
3.1. How to recognize zoonoses?
Many emerging zoonoses are not easily identied because the clinical signs
observed are not highly specic or distinguishable from other clinical infections, or
the animals are healthy carriers. When Rift Valley fever started to occur in 1977
in Egypt, the frequent abortion syndromes in small ruminants, and the high yearly
toll of enterotoxemia and brucellosis were blamed for the occurrence of the death
in these species. Similarly, Reston virus infection was not suspected in the
Philippines, as limited mortality could be associated to simian hemorrhagic fever
or other non-specic infections. In the tropics, a wide variety of infections often
mimics or hides the clinical and pathological signs. During the Mauritania out-
break of Rift Valley fever (RVF), a concomitant yellow fever outbreak slowed
down the identication of RVF in humans [26].
In many instances, veterinarians are confronted with the lack of clinical symp-
toms in domestic animal species, humans being the only aected ones, such as for
hantavirus infections. Furthermore, many of the emerging zoonoses have a wildlife
reservoir, which very few veterinarians are trained to recognize, identify or even
care for. The reservoir of Reston virus is still not identied, assuming that highly
susceptible monkeys cannot be the main reservoir, but only the amplier of infec-
tion. The mystery of the Ebola virus reservoir, despite several recent outbreaks,
has not been solved yet.
A major limitation in disease recognition is the lack of training in exotic dis-
eases and pathogens. In Egypt, Rift Valley fever was not initially suspected since
it was considered to be an exotic disease and therefore not likely to occur in that
part of the world. Such an approach by negative reasoning is very dangerous. The
entire concept of `exotic disease' is obsolete as any disease can emerge at anytime
anywhere on the planet.
Veterinarians are challenged when a new emerging zoonosis occurs, as they are
more likely to encounter it in domestic animals or pets. Are we set to properly
diagnose the new Salmonella typhimurium DT104 from any dairy cattle or from
bloody diarrhoea in a pet dog or cat?
In many countries, education of veterinarians is more and more oriented
towards clinical and surgical skills of animal diseases, but not enough emphasis is
given to public health-related issues. In the U.S.A., the teaching of food safety
and food-borne zoonoses to veterinary students has dramatically declined. Courses
on foreign animal diseases are mainly on the elective list. Training is therefore
essential for preventing major outbreaks.
3.2. How to contain before a big `epidemic'?
Surveillance of animal diseases needs to be emphasized as a major step in the
prevention of zoonosis outbreaks. It is the duty of all countries to not only have a
surveillance system for major economically impairing animal diseases (i.e. foot and
mouth disease, rinderpest), but to also have an extensive surveillance system of
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 9
zoonotic infections. Any disruption of the surveillance may lead to spread of the
infection, as illustrated by rabies outbreaks in urban centers in South America or
in many rural areas in Africa. The lack of an ecient data collection system has
been blamed in Egypt for the late recognition of the RVF outbreak in 1977.
Retrospective surveys showed that major death losses occurred in farm animals
before any clinical signs were yet identied in humans [8]. Permanent vigilance
and search for an etiology need to be pursued. If a physician had not questioned
and carefully investigated a cluster of acute respiratory distress syndrome (ARDS)
in a group of young and healthy Navajo indians, death caused by the Sin Nombre
virus would still be attributed to the numerous ARDS of unknown origin! When
death occurred among a small group of horses with a very peculiar respiratory dis-
tress syndrome, if no careful investigation had been conducted, the equine morbil-
livirus responsible would not have been identied [23]. Clinicians teamed with
epidemiologists, pathologists and public health specialists are the major players in
the identication of emerging zoonoses.
3.3. How to survey: role of veterinary epidemiology
Epidemiology has been identied as an important asset for investigation and the
identication of new emerging zoonoses. Case-control studies have allowed us to
pinpoint risk factors associated with specic diseases. For instance, in the recent
Congo-Crimean hemorrhagic fever outbreak in South Africa, it led to the
ostriches [11]. Similarly, a case control study was the main tool that allowed to
identify the role of the cat in bacillary angiomatosis and, further, to identify the
agent of cat scratch disease [27]. Epidemiology training of veterinary students is
still very limited in most countries, especially in the tropics, where disease emer-
gence is preeminent. The World Health Organization has strongly emphasized in
the recent years the need for a better curriculum in veterinary epidemiology.
Original solutions need to be brought up. Privatization of veterinary services can
create major disruption in disease surveillance, but can be a more responsible sys-
tem, if based on active participation of the various players. The use of computer
networks, such as Promed may be an important tool in reporting and identifying
new outbreaks. Communication technology costs are dropping and any place can
be connected to a surveillance network system at an aordable price.
3.4. Which tools are available?
Many new emerging pathogens are fastidious organisms or non-cultivable
agents that are challenging the scientic community. The revolution of molecular
biology, especially with the use of the nucleic acid sequence analysis and polymer-
ase chain reaction, has allowed us to move forward. As indicated by McDade and
Anderson [21], ``extremely sensitive and specic molecular techniques have recently
been developed to facilitate epidemiologic studies. Nucleic acid amplication and
analysis have emerged as particularly powerful analytic methodologies. These
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 10
methodologies have prompted scientists to modify Koch's postulates as the stan-
dard proof for a microbial etiology of a given disease.'' One of the limitations of
these techniques is the fact that they are not yet accessible to all diagnostic labora-
tories. Many are still used only in research laboratories. However, they are very
powerful tools that allow to pinpoint many outbreak sources and make outbreak
investigation more sensitive and more specic. DNA sequencing allowed the
identication of the various rabies variants when they were accidentally exported
from their original focus (Texas to Alabama or Florida). It also allowed to dis-
tinguish the European bat lyssaviruses from the initially suspected Duvenhagen
strain. Such technology was applied recently in Australia for identifying the new
equine morbillivirus or the Pteropid lyssavirus. We therefore have the tools that
allow us to identify new pathogens and to dierentiate them from other known
agents. When human monocytic ehrlichiosis was rst described in the United
States, E. canis was designated as the culprit [28]. Molecular analysis showed that
the agent of human monocytic erhlichiosis was closely related to Ehrlichia canis,
and was, however, a new and dierent organism, E. chaeensis. Recently, the
agent of human granulocytic ehrlichiosis was identied through a similar broad-
range PCR/sequencing approach.
4. An opportunity for the veterinary profession
Emerging zoonoses are not only a challenge to the veterinary profession, but
are also an opportunity.
4.1. Zoonoses knowledge leadership
Veterinarians have historically led the medical world in clinical knowledge of
zoonotic diseases and on their methods of prevention and control. The permanent
need to determine the etiology of a clinical case or a death must be on the mind
of any clinician or pathologist. Priority of exclusion of any zoonotic disease as
well as any exotic disease must be a systematic thinking process of the clinician.
Any abnormal situation or cluster of uncommon events must be systematically
investigated. The laboratory is often powerless without the input of the clinician,
but the clinician also needs the laboratory tools to perform his/her medical activi-
ties.
4.2. Wildlife medicine and surveillance
Training, usually dedicated to farm animals and companion animals, needs to
be expanded to the vast arena of wildlife medicine. With human encroachment on
wildlife habitat, the interface between domestic animals and wildlife needs to be
investigated and managed. Outbreaks of distemper in Serengeti's lions or spread
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 11
of rabies from domestic dogs to the endangered wild dogs are already reality that
needs veterinary knowledge to either prevent or control it.
4.3. Disease management and veterinary epidemiology skills
Veterinarians have both clinical and population medicine training, as well as an
education in disease control. These professional competencies are essential for
identication and management of new emerging zoonoses. Identication of risk
factors associated with a specic disease is becoming more and more common
practice to further identify the organism involved. Training programs in epide-
miology that are aimed at veterinary public health and food safety will have to be
major components of the veterinary curriculum in the coming decades to better
contribute to the new emerging zoonoses challenge.
Disease surveillance, using mapping software and data analysis software will be
an important component of the veterinarian activities in public health. Exchange
of information on the electronic mail will allow action to be taken very quickly in
any country around the world in order to prevent the spread of possible epidemics.
4.4. A come-back in the public health arena
The 1990s are characterized in the U.S.A. by a `come-back' of the veterinary
profession in the eld of public health. The number of veterinarians working in
Federal, State or local agencies has been increasing. In California, many public
health residents have both a Doctor of Veterinary Medicine and Master of
Preventive Veterinary Medicine degrees. In Atlanta, the number of Epidemic
Intelligence Service Ocers working at the Centers for Disease Control and
Prevention who are veterinarians has also increased in the 1990s, to represent
about 910% of the total. Trained professionals to investigate disease outbreaks
of new emerging zoonoses are an asset that need to be built. In many of the recent
major outbreaks of emerging zoonoses, at least one veterinarian was a member of
the team. It is essential that other countries in the world build up a group of veter-
inarians with such an expertise.
4.5. Molecular biology and veterinary research
Identication of new emerging zoonoses will require new tools that make the
clinician more and more dependant on team work, including laboratory support
with improved methods of diagnosis, epidemiological support to investigate var-
ious risk factors associated with the outbreak, and nancial support to conduct
the research necessary to identify the organism, its reservoir and its mode of
propagation. Lack of sustained monetary support has severe drawbacks, usually
associated with outbreak recurrence due to lack of identication of the reservoir,
such as for Reston or Ebola viruses, or by spread of the vector, such as for den-
gue.
B. B. Chomel / Comp. Immun., Microbiol. Infect. Dis. 21 (1998) 114 12
5. Conclusion
Surveillance, clinical curiosity and awareness, epidemiology and laboratory
training are the essential tools and competency that the veterinary profession must
use to meet the challenge of new emerging zoonoses.
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