One Health: A Concept for

st
the 21 Century

Laura H Kahn, MD, MPH, MPP, FACP

Research Scholar
Program on Science and Global Security, Princeton University
Eighth Annual International Society for Disease Surveillance
Conference
December 3, 2009

Acknowledgments

Present Collaborators:

Bruce Kaplan DVM, Dipl. AVES (Hon)

Tom Monath MD
Jack Woodall, PhD

Past Leaders:

Calvin Schwabe DVM, DSc

19th century: Virchow, Osler

Many organizations and

individuals support the One
Health Initiative

American Veterinary Medical Association

American Medical Association
American Society for Microbiology
American Society of Tropical Medicine
and Hygiene
American Phytopathological Society
Association of Schools of Public Health

Outline

The One Health Initiative

A Brief History of One Health
The Challenge of Zoonotic Diseases
National and International Human and Animal Disease
Infrastructures and Surveillance Activities
A Tale of Three Outbreaks
Challenges Ahead

I. The One Health Initiative

Recognizing the inter-connectedness

between human, animal, and ecological
health, the OHI seeks to increase
communication, collaboration, and
cooperation across a wide variety of
disciplines including human medicine,
veterinary medicine, public health,
microbiology, ecology, and others.
http://www.onehealthinitiative.com

A Brief History of One Health:

Beginnings of Veterinary
Medicine

Pope Clement XI
instructed his
physician, Dr. Giovanni
Maria Lancisi, to do
something about
rinderpest
Rinderpest is a highly
lethal viral disease of
cattle that was
devastating the human
food supply

Animal Disease Control

Measures

Lancisi
recommended that
all ill and suspect
animals be
destroyed.
Principles were a
milestone in
controlling the
spread of
contagious
diseases in animals.

One Health in the 19th

Century

Rudolf Virchow
(1821-1902), a
German physician
and pathologist
said, between
animal and human
medicine there are
no dividing lines-nor should there
be.

Early Meat Inspection

Programs

Virchows father
was a butcher.
Animal
experiments on life
cycle of Trichinella
spiralis in porcine
muscular tissue.
Cysticercosis and
tuberculosis in
cattle.

The Challenge of Zoonotic

Diseases

Many Emerging Infectious

Diseases are Zoonotic

Pandemic Influenza A
HIV/AIDS
West Nile virus
SARS
Monkeypox virus
Bovine Spongiform Encephalopathy
Rift Valley Fever

Many of the Agents of

Bioterrorism are Zoonotic
CDC Category A Agents:
Anthrax (Bacillus anthracis)
Plague (Yersinia pestis)
Tularemia (Francisella tularensis)
Viral Hemorrhagic Fever Viruses
(Ebola,
Marburg, Lassa,
Machupo)

Reasons for the

Emergence of Zoonotic
Diseases
Better Reporting and Technology

Microbial Adaptation
Human Population Pressures
Poverty and Susceptibility to Infection
Economic Development and Land Use
Bush Meat Consumption
International Travel
Exotic Animal Trade
Intent to Cause Harm

Human and Animal

Disease Infrastructures

U.S. National
Comparison of Human and Animal
Health Infrastructures
Surveillance Activities
International
Comparison of Human and Animal
Health Infrastructures
Surveillance Activities

U.S. Federal Human Health

Infrastructure

U.S. Department of Health and Human

Services (DHHS) is lead agency at
federal level.
U.S. Department of Homeland Security
(DHS) is involved in human health.
U.S. Department of Defense (DoD) helps
in times of crisis.

U.S. Department of Health

and Human Services

U.S. Federal Animal Health

Infrastructure

U.S. Department of Agriculture (USDA) Animal Plant Health

Inspection Service (APHIS) is lead agency for livestock.
U.S. Department of Homeland Security (DHS) now has
parts of APHIS.
U.S. Department of Health and Human Services (HHS)
established National Center for Zoonotic, Vector-borne and
Enteric diseases at CDC.
U.S. Department of Interior (DOI) Fish and Wildlife Service
is responsible for wildlife, endangered species, and wildlife
imported into the U.S.
U.S. Department of Commerce (DOC) oversees fisheries
management.

U.S. federal agencies

addressing animal
diseases
Animal Health at the Crossroads, National Academies Press 2005, page 36

A Tale of Three Outbreaks:

West Nile Virus

1999 NYC West Nile Virus outbreak

Two simultaneous outbreaks: one in
animals and one in humans.
Outbreak highlighted the importance
of disease surveillance in wildlife
and zoo animals.
Animals were sentinels for human
health but were largely ignored.

U.S. Response to West Nile virus

Outbreak

In 1999, the CDC

established ArboNET.
A success story

Mosquito WNV Infections 2002

http://westnilemaps.usgs.gov/2002/usa_mosquito_apr_22.html

WNV Positive Wild Birds 2002

http://westnilemaps.usgs.gov/2002/usa_avian_apr_22.html

Human WNV Cases 2002

http://westnilemaps.usgs.gov/2002/usa_human_apr_22.html

Zoos as a public health

resource

Distributed throughout the U.S.

Located in urban and rural areas
Close to humans
Stationary population
Populated with variety of species with
different levels of susceptibility
Serial sampling
Highly trained veterinarians closely monitor
the animals health

Association of Zoos and

Aquariums

West Nile Surveillance

System for Zoological
Institutions
Initially funded by CDC and operational

from 2001 to 2006.

Collected data from > 13,000 animals
~13% (633/4711) confirmed positive
animals (virus isolated and PCR) to date
~17% (1716/9760) sero-positive
animals (serum neutralization)

Animals tested in 2001

Zoo animals tested in 2001: Preliminary Count
641

Preliminary count 641 for 2001

Animals tested in 2002

Zoo animals tested in 2002: Preliminary Count
6529

Preliminary count 6529 for 2002

Zoo animals tested in 2003: Preliminary count 3817

Preliminary count 3817 for 2003

Animals tested in 2004

Zoo animals tested in 2004: Preliminary count 2700

Preliminary count 2700 for 2004

Animals sampled in 2005

Zoo animals sampled in 2005: Preliminary count 1161

Preliminary count 1161 for 2005

Animals sampled in 2006

Zoo animals sampled in 2006: Preliminary count 814

Preliminary count 814 for 2006

Zoo Animal Health

Network (ZAHN)

USDA
American Zoological Association (AZA)
Lincoln Park Zoo
National Animal Health Laboratory
http://www.zooanimalhealthnetwork.co
m/

A Tale of Three Outbreaks:

Monkeypox

Monkeypox outbreak of 2003 in U.S. Midwest

started with the importation of giant Gambian rats
exposing prairie dogs in a pet distribution center.
Outbreak highlighted the problems of importing
millions of exotic animals into the U.S.
Little attention paid to the sick and dying prairie
dogs until after humans became sick.
A total of 71 human cases of monkeypox were
reported to CDC; 35 (41%) were lab confirmed.
18 people were hospitalized.
Minimal disease surveillance of companion animals.

U.S. Response to
Monkeypox Outbreak

CDC and FDA issued order

prohibiting importation of African
rodents
And prohibited sale, transfer, or
release of prairie dogs
Replaced by interim final rule
No surveillance system of pets
developed.

Disease Surveillance in
Companion Animals

Approximately 63% of all U.S.

households own at least one pet.
Most commonly owned animals include:

Cats (90.5 million)

Dogs (73.9 million)
Small mammals (18.2 million)
Birds (16.6 million)
Aquarium Fish (140 million freshwater/9
million saltwater)

http://www.nytimes.com/2009/09/22/health/22mrsa.html?_r=2

New York Times September 21, 2009

Tie to pets has germ jumping to and fro
Methicillin Resistant Staph aureus (MRSA) is
infecting both humans and animals.

Purdue University-Banfield National

Companion Animal Surveillance
Program

Established in 2004 at Purdue University

School of Veterinary Medicine
Banfield, the Pet Hospital, largest provider
of companion animal health care in U.S.
Serve approx. 2% of entire pet dog and cat
population in U.S.
Includes guinea pigs, other rodents, birds,
rabbits, ferrets, and reptiles.

Glickman LT, Moore GE, Blickman NW, et al. Purdue University-Banfield National Companion Animal
Surveillance Program for Emerging and Zoonotic Diseases, Vector-Borne and Zoonotic Diseases.
2006: 6: 14-23.

Purdue University-Banfield National

Companion Animal Surveillance
Program Study

Banfield hospital database searched for

influenza-like illness in cats using syndromic
surveillance (fever, cough, difficulty breathing)
in 18 hospitals within 50 miles of Washington
DC area.

Compared cat data to ILI in humans from

emergency room data.

Glickman LT, Moore GE, Glickman NW, et al. Purdue University-Banfield National Companion Animal
Surveillance Program for Emerging and Zoonotic Diseases. Vector-borne and Zoonotic Diseases.
2006; 6: 14-23.

Human and Cat Flu in

Washington DC, 2004 Findings

International Human
Health Infrastructure

World Health Organization

International Animal
Health Infrastructure

World Health Organization

World Animal Health Organization
(OIE: Office International des
Epizooties)
Food and Agriculture Organization

Global Surveillance
Systems

WHORevised 2005 IHR and Global

Outbreak Alert and Response
Network (GOARN)
OIETerrestrial Animal Health Code
FAOEmergency Prevention
System for Transboundary Animal
Diseases (EMPRES)

A Tale of Three Outbreaks:

HPAI Influenza A (H5N1)

1997 highly pathogenic avian influenza

A (H5N1) outbreak in Hong Kong.
Surveillance of wild water fowl and
domestic poultry facilitated early
recognition of virus in humans.
Resurgence of virus in SE Asia in 2003
prompted an international response
and global surveillance.

International Response to HPAI

Influenza A (H5N1)outbreak

In 2006, global surveillance of H5N1

avian influenza in wild birds, poultry,
and humans began.
Global Early Warning and Response
System for Major Animal Diseases
including Zoonoses (GLEWS)
Global Avian Influenza Network for
Surveillance (GAINS)

Cumulative Human Avian

Influenza (H5N1) Cases as of
Sept. 24, 2009

http://gamapserver.who.int/mapLibrary/Files/Maps/Global_H5N1inHumanCUMULATIVE_FIMS_20090
924.png

Nations with confirmed cases of

avian influenza H5N1 as of July 7,
2006

http://www.flu.gov/map.html

PREDICT

New project funded by USAID

Up to $75 million over 5 years
UC Davis School of Veterinary Medicine
will lead consortium of organizations
Wildlife Conservation Society
Wildlife Trust
Global Viral Forecasting, Inc.
Smithsonian Institution

Challenges Ahead

As the human population explodes, interactions

with new zoonotic agents (e.g. viruses) from
animal populations will continue to increase.
Can expect more emerging zoonotic diseases.
The One Health Initiative addresses the need for
greater collaboration on many levels (individual,
public health, and research) between human,
animal, and public health professionals.
Many organizations and individuals endorse the
One Health Initiative, but considerable effort
remains to implement the concept nationally and
globally.

Challenges Ahead

Legal
Logistical
Financial
Organizational
Philosophical

Time to Embrace One

Health
Thank you!