One Health News

Massey University (New Zealand) Updated One Health Program

Provided August 2, 2013 to One Health Initiative website by:

“Most importantly they are providing a working model for collaboration between the public, animal health and wildlife sectors, through which all participants [human and animal health and other science professionals] gain experience in the One Health approach to epidemiology and zoonotic disease control. …”

The successful collaboration between the Massey University teaching and research groups, EpiCentre and the Centre for Public Health Research has expanded the One Health Masters degree training in epidemiology and public health to a new cohort of 19 human and animal health professionals from China and Mongolia.

The cohort includes people working at the operational, laboratory and policy-making levels in both the veterinary and human health sectors.

In addition to the educational outcomes, the program results in strengthening of relationships between the human and animal health sectors, and at the peer-to-peer level between countries.

This second cohort of students builds on the previously successful training of 67 veterinarians and physicians from seven countries in South Asia during 2010-2011 as a part of the Regional Training in Human and Animal Health Epidemiology in South Asia Program, which we reported in *July 2012.

Following the Masters degree training, the second phase of the South Asia program has expanded capacity-building activities to approximately 200 human and animal health professionals who are directly involved in the design, management, data analysis and reporting of 11 Collaborative Investigation Projects (CIPs) across the 7 countries, with a wider group of over 2000 people participating in the collection and processing of biological samples and data for the projects.

Delivery of this phase is supported by an international network of human and animal health epidemiologists, disease experts and diagnosticians who are mentoring the CIP teams and running the associated epidemiology workshops. The network includes professionals from London School of Hygiene and Tropical Medicine, University of Otago (New Zealand), University of Prince Edward Island (Canada), Centre for Animal Health Research in Barcelona (CReSA), Mahidol University (Thailand), Indian Council for Medical Research, Public Health Foundation of India, Tufts Medical Centre, Investigation and Diagnostic Centre - Ministry of Primary Industries (New Zealand), Chittagong Veterinary and Animal Sciences University (Bangladesh), regional offices for WHO, FAO and OIE and Massey University (New Zealand).

Participation in the CIPs is providing hands-on experience with epidemiological investigations of major zoonoses whilst at the same time building and strengthening relationships between the human and animal health sectors from field through to national and regional levels.

At the institutional level, the CIPs have also provided a catalyst for the establishment of formal agreements between government organisations to work together on the implementation of collaborative projects.

Most importantly they are providing a working model for collaboration between the public, domestic animal and wildlife health sectors, through which all participants gain experience in the One Health approach to epidemiology and zoonotic disease control.

*See Dr. McKenzie's previous submission on One Health Initiative website www.onehealthinitiative.com scroll down to NEWS item “Outstanding One Health Program Established at Massey University” – New Zealand – Posted Sunday, June 17, 2012.

Footnote: Drs. McIntyre and McKenzie are veterinarians with extensive training and expertise in public health/epidemiology.  Dr. Borman http://publichealth.massey.ac.nz/home/people/show/4 is also an epidemiologist and public health authority.

American College of Preventive Medicine (ACPM) Physicians Endorse One Health

One Health endorsement statement provided to One Health Initiative website by ACPM President, Dr. Halley S. Faust August 18, 2013 http://www.onehealthinitiative.com/publications/American%20College%20of%20Preventive%20Medicine%20One%20Health%20Endorsement%20August%2018%202013.doc.pdf

“The American College of Preventive Medicine http://www.acpm.org/ has had a long-standing commitment in support of activities that advance the One Health Initiative; indeed, we spearheaded the successful passage of the One Health AMA resolution in 2007. As preventive medicine physicians with unique training in clinical medicine and public health, we recognize that human and animal medicine are inextricably linked. We are pleased to offer our strong endorsement of the One Health initiative, fostering greater collaboration between human and animal medicine to improve population health. We look forward to our continued engagement in this effort.”

Halley S. Faust, MD, MPH, MA

President

American College of Preventive Medicine

1260 Vallecita Drive
Santa Fe, NM 87501
Voice: 505-501-8181

hfaust@jeromecapital.com

@OnHealthPolicy

blog: www.halleycomments.com

__________________________________

Footnote: About ACPM http://www.acpm.org/?WhoWeAre

Founded in 1954, the American College of Preventive Medicine (ACPM) is a professional, medical society of more than 2,700 members employed in research, academia, government, clinical settings, and other entities worldwide. ACPM provides a dynamic forum for the exchange of knowledge among preventive medicine specialists, and offers high-quality educational programs for continuing medical education (CME) and maintenance of certification (MOC), information and resources for ongoing professional development, and networking opportunities.

ACPM's Mission

As the leader for the specialty of Preventive Medicine and physicians dedicated to prevention, ACPM improves the health of individuals and populations through evidence-based health promotion, disease prevention, and systems-based approaches to improving health and health care.

Strategic Goals and Organizational Objectives (in brief)

1. Promote the specialty of Preventive Medicine and Preventive Medicine physicians to assure an appropriate supply and demand of properly trained physicians to deliver effective and efficient health and health care.

2. Promote the advancement of scientific knowledge in preventive medicine and establish ACPM as the recognized leader for professional, multi-disciplinary, and public education, collaboration and communication in the areas of preventive medicine and public health.

3. Enhance member value by serving as the primary source for members to meet their professional needs, including but not limited to CME, MOC, MOL, career development and practice tools.

4. Maintain and enhance the institutional stature and credibility of ACPM, professionally, financially, and politically, in order to maximally achieve its mission and goals.

National Academies of Practice (NAP) Elects First Veterinarian as President

Press Release submitted to One Health Initiative website August 17, 2013

For more information, please contact:

Alice Villalobos, DVM, FNAP

dralicev@aol.com   cell 310-261-1015

Note: Dr. Villalobos is Chair, Veterinary Academy, National Academies of Practice (NAP)

and

Kimberly Korbel, Executive Director

National Academies of Practice (NAP)

801 N Fairfax Street
Suite 211
Alexandria, VA 22314
Tel: 703-299-0105
Fax: 703-299-9233

kkorbel@napractice.org  
Email: info@napractice.org

Dr. John Herbold https://sph.uth.edu/cv/herbold.pdf, a notable One Health supporter/advocate known for his leadership and outstanding work in epidemiology, public health and animal welfare, is the first veterinarian to serve as President of the National Academies of Practice (NAP) https://www.napractice.org/eweb/startpage.aspx, founded in 1981. 

NAP is a non-profit organization with the goal of multidisciplinary health care experts jointly advising governmental agencies on matters concerning the structure and function of the nation’s health care system and delivery.  Dr. Herbold’s term is focused on the aging of the baby boomer generation and related health care issues.  

NAP works collectively via the well-established scientific paradigm of multiple partnerships to generate successful white papers that are multidisciplinary in understanding problems as they interact within society and the environment from a broader and more collaborative outlook such as the One Health philosophy.  There are 12 professional Academies that include: medicine, nursing, dentistry, optometry, osteopathic medicine, pharmacy, podiatric medicine, psychology, social work, speech pathology, audiology and veterinary medicine. NAP will embrace new Academies as they arise.

The 12 professional Academies collectively create information about interdisciplinary topics in health care for the U.S. Congress, health care planners, and other public agencies.  Ongoing dialogues reach consensus during interprofessional health care policy forums, which generate white papers on various health topics aspiring to the One Health model. The National Academies of Practice’s belief and action system revolves around the premises that all Americans should have affordable quality health care, beginning with preventive medicine and extending through all of the physical, behavioral, and social aspects of human health. 

The Journal of Interprofessional Health Care https://www.napractice.org/eweb/DynamicPage.aspx?Site=nap2&WebCode=JIHMAIN is the official publication of the NAP, and is another source of communication to the health care community and the general public.  The Journal Editor-in-Chief is Anthony E. Puente, PhD, University of North Carolina at Wilmingon.  Dr. Puente is joined by Associate Editors Mary E. Costanza, MA, MD, University of Massachusetts Medical School and the current NAP president, Dr. Herbold, San Antonio, Texas (USA).

As President of NAP, Dr. Herbold and the Veterinary Academy have helped firmly establish the valuable role that veterinary medicine has played and continues to play in the advancement of human health endeavors. The expertise available via veterinary medicine includes: research and discovery, bioterrorism, disaster preparedness, zoonoses, community health, food animal production, agriculture, the human-animal bond in society (which encompasses the impact and benefit of companion animal ownership and related issues), wildlife and the innate importance of water conservation and the environment.

NEWS item submitted to One Health Initiative website August 6, 2013

Hospital personnel need greater awareness of animal-to-human disease threats

Clifford Warwick, PGDipMedSci, CBiol, CSci, EurProBiol, FOCAE, FSB

Consultant Biologist & Medical Scientist

Riverside House, River Lawn Road, Tonbridge, Kent TN9 1EP, UK

mail@emergentdisease.org

cliffordwarwick@yahoo.com

Susan Corning, BA, MSc, BVSc, MRCVS, FRSPH

Director, Collaborating for Global Health

Bologna, Italy

www.collab4globalhealth.com

dr.susan.corning@collab4globalhealth.com

The Royal Society of Medicine - Managing patients for zoonotic disease in hospitals, Warwick, C. & Corning, S. (2013).  J R Soc Med Sh Rep., 4: 1–9. DOI: 10.1177/2042533313490287

“Noscomial disease transmission is a true “One Health” issue, and there is an urgent need for the medical and veterinary professions to collaboratively plan to ensure that hospital staff can implement simple and effective measures to prevent and control this transmission.”

A new paper published this week in the Journal Royal Society of Medicine (Short Reports) warns that zoonotic diseases from pets, foreign travel, petting zoos and other sources warrant greater attention by hospital staff in order to minimise their spread within the hospital environment.  The paper entitled ‘Managing patients for zoonotic disease in the hospital environment’ identifies a need for greater awareness and better management of zoonoses in hospitals. 

Noting that zoonotic pandemics could pose a major global threat to human health, the paper states that: ‘Hospitals are often an early portal for infection cases and must be equipped to promptly and effectively diagnose and control the spread of zoonotic disease.’  Secondary care  staff who are not aware of, or have not implemented appropriate disease prevention and control measures may incidentally facilitate the spread of pathogens in hospitals, known as “noscomial disease transmission”. 

The paper cites an example of a hospital in Mauritania that in 2003 admitted a patient who had contracted Crimean-Congo hemorrhagic fever from a goat. This disease was transmitted within the hospital to 15 people and resulted in the infection and death of five hospital workers.  It was also noted that hospitals themselves may even unknowingly facilitate the transfer zoonotic pathogens to patients, as was evidenced during a donor transplantation in 2005.  Following organ transplants from a single donor to four patients in Massachusetts and Rhode Island, all four recipients were found to have been infected with lymphocytic choriomeningitis virus (LCMV). This rodent-borne arenavirus had apparently been contracted by the donor from an infected pet hamster.  The paper particularly warns against the ownership of exotic as pets such as amphibians, reptiles, birds, and primates which may pose involve special health risks to their keepers and others.

Under-ascertainment is believed to be common because numerous zoonoses superficially resemble common illnesses such as gastrointestinal, respiratory and dermal disease and thus may go undiagnosed.  Guidance for hospital staff is therefore critical, and the paper includes a protocol for managing patients, and also information leaflets that can be readily distributed to patients to help prevent animal-linked disease.

Noscomial disease transmission is a true “One Health” issue, and there is an urgent need for the medical and veterinary professions to collaboratively plan to ensure that hospital staff can implement simple and effective measures to prevent and control this transmission.

SEE: Full text HTML version: http://shr.sagepub.com/content/4/8/2042533313490287.full

PDF version: http://shr.sagepub.com/content/4/8/2042533313490287.full.pdf+html

[open access]

Clifford Warwick is a Consultant Biologist & Medical Scientist and Dr. Corning, a veterinarinan, is a One Health consultant for international organisations and global development projects, as well as corporate and non-for-profit business initiatives.

PRESS RELEASE (provided Thursday, 1 Aug 2013 15:18:49 +0100 by Clifford Warwick):

 New guidance to help hospitals fight exotic bugs

A new paper published today in the Journal of the Royal Society of Medicine (Short Reports) warns that animal-to-human (zoonotic) diseases from pets, foreign travel, petting zoos and other sources warrant greater attention by hospital staff.

The article entitled ‘Managing patients for zoonotic disease in the hospital environment’, says that animal-related pandemics have been identified as a major global threat to human health. People are exposed to disease risks through keeping exotic pets, foreign travel and visiting zoos among other things. The article states that: ‘Hospitals are often an early portal for infection cases and must be equipped to promptly and effectively diagnose and control the spread of zoonotic disease.’

The paper includes a protocol for managing patients, and also information leaflets that can be readily distributed to patients to help prevent animal-linked disease. ‘Under-ascertainment is believed to be common because numerous zoonoses superficially resemble common illnesses such as gastrointestinal, respiratory and dermal disease and thus may go undiagnosed’, the article says.

Exotic pets are highlighted as a particularly significant disease risk. The guidance provided emphasises the difficulty of guarding against exotic pet infections in the home and goes further to warn against keeping exotic pets at all:

‘Ownership of exotic pets such as fishes, amphibians, reptiles, birds, and mammals such as raccoons and primates involve special risks to the health of animal keepers and to the health of those around them. It is not advisable to keep exotic animals as pets. Many people, however, already have exotic pets, and this most likely causes thousands of cases of human illness annually and occasional deaths.’

Says lead author, Clifford Warwick, DipMedSci CBiol CSci EurProBiol FOCAE FSB Consultant Biologist & Medical Scientist, Emergent Disease Foundation

“Whether through keeping exotic pets in the home, visiting roadside zoos abroad or other issues, exposure to atypical bugs is a matter of increasing concern to both the medical profession and governments. Hospital personnel are frequently on the front line when dealing with these ‘zoonotic’ infections and infestations. This article sets out general protocols for healthcare workers when assessing possible zoonoses in patients, as well as equipping them with guidance to help patients avoid unnecessary animal-linked disease.”

Says co-author, Susan Corning, BA BVSc MSc MRCVS FRSPH Director, Collaborating for Global Health

“Given that many human diseases are of animal origin, our article highlights the importance of the early recognition of zoonoses by medical personnel in order to minimize their spread, including within the hospital environment. This is a true “One Health” issue, and there is an urgent need for the medical and veterinary professions to collaboratively plan to ensure that hospital staff can implement simple and effective measures to prevent and control zoonoses generally as well as nosocomial disease.”

The paper’s guidance also states:

‘Hygiene measures, such as hand-washing, where performed thoroughly and with correct chemicals, can significantly reduce the amount of germs on your hands but does not guarantee protection against becoming sick or remove the possibility of passing germs directly or indirectly to others.’

The guidance emphasises the difficulty of guarding against exotic pet infections in the home:

‘It is important to note that because exotic pets occupy the home, and that germs are easily spread around surfaces, walls, door-handles, clothes and other items, even thoroughly cleaned hands can quickly become contaminated again by simple contact with any of these items. Pet stores and the people who work there should also be regarded as sources of contamination. Thorough cleaning of exotic pet-related germs from the home may be practically impossible.’

And further the guidance concludes:

‘Local authorities, [physicians], [veterinarinans], and facility managers should advise their patients and customers of the health risks associated with having an exotic animal as a family pet and should provide appropriate health protection advice.’

The article is open access and available here:

http://shr.sagepub.com/content/4/8/2042533313490287.full.pdf+html

Issued: 1/8/13

Article: Managing patients for zoonotic disease in hospitals, Warwick, C. & Corning, S. (2013).  J R Soc Med Sh Rep., 4: 1–9. DOI: 10.1177/2042533313490287

 Rabies in Taiwan after 50 years -- in wildlife

By Jack Woodall, PhD

Three ferret-badgers were found dead on the island in 2012, between May and December, but rabies tests were only carried out in June 2013.  The delay was presumably due to the extremely low index of suspicion, because Taiwan had been rabies-free since 1959.  Since June, 41 more animals of that species have been found dead from rabies, plus a dead infected house shrew that had probably been bitten by one of them.  The Animal Health Research Institute (National Laboratory) of Taiwan confirmed the infections by direct fluorescent antibody tests on the 2013 cases.

About 1000 Taiwanese are receiving rabies vaccinations; it may be supposed that these were hunters and others who had handled the carcasses.  Ferret-badgers are hunted for their fur in the south of mainland China, where many human cases have been found in hunters.  There was a rabies epizootic in ferret-badgers on the mainland in 2007-2008.

According to Tsai Hsiang-jung, Director-general of Taiwan’s Council of Agriculture Animal Health Research Institute, analysis of the virus isolates from the ferret-badgers showed that they are about 90 percent similar to those found in mainland China and can be classified into 3 types.  The findings suggest the virus has been lurking in Taiwan's mountainous areas for years before it was discovered, but he declined to speculate on how long the virus has existed here.  A virology moderator commented in a ProMED post that the heterogeneity of the isolates of rabies virus obtained from the Taiwan ferret-badger population suggests that the virus has been present there for a considerable period, and is not a recent introduction [1].

Asked if the disease could have been caused by smuggled animals from China, Tsai said health officials were not certain of this, but that there was a "very high possibility" this might have happened.  This writer suggests that a search of old records might show that the ferret-badger population was once almost hunted out, and then replenished from the mainland [2].  

No practical rabies vaccine has been developed for wildlife in China.  Taiwan’s official report to the OIE states that intensified vaccination of dogs and cats is being carried out in the areas where infected ferret-badgers have been found and that monitoring is ongoing.  So far no dogs or cats have been found to be rabid. 

Chinese authors publishing in 2009 cited lack of communication and cooperation among mainland China’s Center for Disease Control and Prevention, Ministry of Agriculture and wildlife services from the Bureau of Forestry which make the situation there more complicated than canine rabies control.  This is a clear case of an outbreak that demands a One Health approach, with close inter-agency collaboration.

[1] ProMED-mail (2013). Rabies - Taiwan (08): ferret badger, more cases, isolate characterization, OIE.   ProMED-mail; 6 Aug: 20130806.1866372. http://www.promedmail.org. Accessed 6 Aug 2013.

[2] Zhang S, Tang Q Wu X, et al (2009): Rabies in Ferret Badgers, Southeastern China. Emerging Infectious Disease 15(6): 946-9; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727325/. Accessed 6 Aug 2013.

Footnote: Dr. Woodall http://www.onehealthinitiative.com/publications/Jack%20Woodall%20Biography%20June%202013.pdf is a member of the One Health Initiative Autonomous pro bono team and contents manager of the One Health Initiative website’s ProMED-mail page http://www.onehealthinitiative.com/promed.php.

Important Annual Rabies in the Americas (RITA) XXIV meeting: Toronto, Ontario, Canada, October 27-31, 2013

“The Rabies in the Americas (RITA) meeting is an annual event that has been held since 1990. It has been hosted in many countries across the Americas. For many years, RITA has grown in popularity and prominence with delegates now coming from more than 20 countries across five continents. 

 The meeting provides an opportunity for researchers, health professionals, international, national and local managers of rabies programs, wildlife biologists, laboratory personnel and other people interested in advancing knowledge of rabies surveillance, prevention and control, to meet each other, to share their successes and also to discuss the challenges to be met.” ...

 Please read more at http://www.rabiesintheamericas.org/home

Also note the following salient comment:

“Rabies is the epitome of a One Health issue based upon theory and practice. Based upon World Organization for Animal Health (OIE) guidelines, the disease should be reportable in all countries. As such, proper surveillance at the human, domestic animal, and wildlife interface sets the standard for the detection of emerging infectious diseases. From a laboratory perspective, this is the only example of a routine diagnostic test applied in real time on a suspect animal that results in direct life saving medical intervention in Homo sapiens. Moreover, the disease is global in distribution. All mammals are susceptible. Additionally, as a vaccine preventable disease, ideal application of herd immunity targeting reservoir species is the most cost-effective method of intervention from a health economics approach.”  

Charles E. Rupprecht, VMD, PhD

Director of Research, Global Alliance for Rabies Control (GARC)

Note: Dr. Rupprecht is a leading internationally recognized Rabies expert and formerly Head, OIE Reference Laboratory at CDC, Chief, Rabies Program at Centers for Disease Control and Prevention and Director, World Health Organization (WHO) Collaborating Centre for Reference & Research at U.S. Centers for Disease Control and Prevention (CDC).

Submitted to One Health Initiative website July 19, 2013 by Professor Anna Meredith, MA, VetMB, PhD, MRCVS, Chair, Zoological and Conservation Medicine Head of Exotic Animal and Wildlife Service, Royal (Dick) School of Veterinary Studies, University of Edinburgh Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin Midlothia EH25 9RT www.ed.ac.uk/vet/conservation-medicine  Posted July 31, 2013

The University of Edinburgh (UK) and Kerala Veterinary and Animal Sciences University (India) -- “…various aspects of teaching and research in One Health, particularly in wildlife health, livestock health and animal welfare…” 

The University of Edinburgh has recently signed a Memorandum of Understanding with the Kerala Veterinary and Animal Sciences University (KVASU), in which both institutions have made a commitment to collaborate on various aspects of teaching and research in One Health, particularly in wildlife health, livestock health and animal welfare.  During a recent visit (July 14^th to 19^th 2013) to KVASU in south west India I endeavoured to teach students there about the One Health concept and Conservation Medicine. The two Universities have also recently submitted an ambitious joint funding bid to the British Council’s UKIERI fund (UK-India Educational Research Initiative) for a collaborative project in One Health to be carried out in Kerala, entitled “A multidisciplinary 'One Health' approach for predicting disease emergence in Wayanad district of Kerala, India”, focusing on surveillance of diseases found in the local livestock, wildlife and humans in Kerala. I am hopeful that this bid will be successful as the University of Edinburgh is committed to working with KVASU to raise awareness of the One Health concept in India. Obviously, veterinarians, physicians and public health officials in India will greatly benefit from increased understanding of and research into the complex relationships between animal, human and ecosystem health.

A recent case of Lyme disease in a Kerala woman, a disease transmitted from wild deer ticks and a wild rodent reservoir, and ongoing human cases in the area of Kyasannur Forest Disease (KFD), a virus transmitted from wild monkeys, have highlighted the need for increased understanding and surveillance of the disease risks at the interface of wildlife, livestock and humans in this area of India. Kerala is particularly rich in biodiversity, but is facing rising threats due to habitat destruction and an increasing human/wildlife interface.

I taught a four day intensive module—the first of its kind in India—on One Health and Conservation Medicine principles, to a group of KVASU Masters degree students in Wildlife Studies, and also Masters degree veterinary students in Public Health and Parasitology. Using a combination of seminars and interactive sessions, I focused on the risk of emerging infectious disease in endangered wildlife populations and the risk to livestock and human health, but also on ecosystem health and biodiversity. We now understand that loss of biodiversity invariably leads to an increased risk of emerging infectious disease.  Therefore it is vital that we promote a greater understanding of the importance of ecosystem health in a holistic way, because animal and human health ultimately depends on a healthy ecosystem.

These Indian students are used to a rigid, formal style of teaching which doesn’t tend to encourage interaction, or problem-based learning, and although they were rather shy at first, they soon embraced the more informal learning style and we had some very lively discussions. Importantly, I also learnt a lot from them about the complex local issues in the area, and these exchanges are vital in fostering understanding, respect and trust between our two organisations. As part of the Memorandum of Understanding the University of Edinburgh will be hosting the KVASU students and staff when they visit Edinburgh University and the Zoological Society of London in the UK later this year.

While at KVASU, I performed the inaugural ceremony to open a new Molecular Wildlife Forensic and Disease Laboratory at KVASU which will be a key resource in disease surveillance and wildlife crime in the region.  In addition I met with Dr. Naveen Pandey [BVSc & AH, CCAW(TANUVAS), LCBC(BNHS), MBA], Veterinary Consultant from India’s Corbett Foundation who travelled to Kerala to participate in the course and learn about One Health.  We made plans for future strategy and collaboration for working with wildlife and livestock health around Indian National Parks in Corbett, Kanha, Bandhavgarh and Kaziranga and the grasslands of Kutch. The Corbett Foundation works for wildlife, ecology, conservation, human livelihood and animal health and is already jointly organising a workshop on rural ‘Farm Animal Care’ later this year with Prof Neil Sargison, BVMS, PhD, DSHP,FRCVS, Professor of Farm Animal Practice  and Head of Farm Animal Section, one of my colleagues from the Royal (Dick) School of Veterinary Studies  in Edinburgh.

This is a really exciting time for promotion and development of the One Heath concept in India and I am delighted that Edinburgh University is playing a key role in assisting our Indian colleagues in this mutual endeavour.

Footnote: During Dr. Meredith’s visit to India, she was interviewed by The Hindu newspaper http://www.thehindu.com/todays-paper/tp-national/tp-kerala/the-whole-new-world-of-one-health/article4926586.ece

Submitted exclusively to One Health Initiative website June 28. 2013

*Aspergillus felis – One-health & Public Health Implications

**Vanessa R Barrs, BVSc(hons), MVetClinStud, FANCVSc(Feline Medicine), Faculty of Veterinary Science, The University of Sydney

Malcolm Richardson, PhD, FSB, FRCPath, FInstSSE, University Hospital of South Manchester (Wythenshawe Hospital), Manchester, UK

Tineke van Doorn, BSc, CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands

Jos Houbraken, PhD, CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands

Sarah E Kidd, PhD, SA Pathology at Women’s and Children’s Hospital, Adelaide, SA, Australia.

Patricia Martin, BVSc(hons) MVSc, Faculty of Veterinary Science, The University of Sydney

Dolores Pinheiro, MD, Hospital S. João EPE, Porto, Portugal

Janos Varga, PhD, DSc, University of Szeged, Szeged, Hungary

Robert A Samson, PhD, CBS-KNAW Fungal Biodiversity Centre, Utrecht, the Netherlands

http://www.onehealthinitiative.com/publications/A.felis%20ProMED%20FINAL%20June%2028%202013.pdf

Invasive aspergillosis is a global health concern because of high mortality rates and treatment costs. The aetiological agents of aspergillosis are ubiquitous in the environment and the likelihood that infection will occur following inhalation or implantation of spores largely depends on host factors.  As the number of immunosuppressed patients worldwide rises, invasive aspergillosis has emerged as a major problem in several groups of these patients. Those at greatest risk include persons with hematological malignancies, hematopoietic stem cell transplant recipients, solid organ transplant recipients, individuals receiving high-dose corticosteroid treatment and persons with neutrophil deficiencies or dysfunction. Emerging at-risk populations include persons with acquired immunodeficiency syndrome, patients receiving intensive care and patients with chronic obstructive pulmonary disease.

Invasive aspergillosis primarily affects the respiratory tract. Although there are over 260 species of Aspergillus, fewer than 40 have been documented to cause disease in humans or animals, and some of these have been reported only once.  Aspergillus fumigatus accounts for most human cases of aspergillosis.  However in recent years, A. fumigatus-like or “cryptic” species such as A. udagawae and A. viridinutans have been identified to cause disease. These infections are more refractory to treatment due to innate antifungal resistance and propensity to spread across adjacent anatomical planes. We describe an emerging agent of invasive aspergillosis, Aspergillus felis, in humans and companion animals, namely domestic cats and dogs. Further, we present evidence that triazole antifungal drug resistance is common amongst A. felis isolates.

A. felis is a novel A. fumigatus-like species in the Aspergillus section Fumigati. In characterizing A. felis we applied a polyphasic taxonomical approach incorporating a combination of multilocus sequence data, morphological, physiological characteristics and ecologic data. Our data satisfy biological, morphological and phylogenetic species concept definitions. Our discovery of a novel heterothallic fungus with a fully functional reproductive cycle in the Aspergillus section Fumigati is significant and will provide unique opportunities for future translational research.

A. felis was isolated from two individuals in our study that were both receiving immunosuppressive therapy – a male adult human and a dog. Infections in both cases were fatal. The human patient had type II diabetes mellitus and was being treated for rheumatoid arthritis with prednisolone, etarnecept and methotrexate, while the dog received prednisolone and cyclosporine for immune-mediated haemolytic anemia. In the human patient, fungal infection was protracted over 18 months and extended from a solitary lung nodule across anatomic planes to involve cervical lymph nodes and pleural space. The dog had a more acute course of disease and developed disseminated invasive aspergillosis. More curiously, the pet cats in our study, from which A. felis was isolated in 17 cases, did not have evidence of systemic immunosuppression. Disease in these cats was typically confined to the upper respiratory tract, with involvement of the sinonasal cavity and orbit, as well as contiguous anatomic structures such as the oral cavity and paranasal subcutaneous tissues.

Feline upper respiratory aspergillosis (URTA), is a relatively new disease in cats and of the 55 or so cases now described, more than two-thirds were reported in the last five years. Interestingly, cats of brachycephalic conformation, especially Persian and Himalayan breeds, make up more than a third of all documented cases. To date no studies have been performed to investigate innate or immune-responses in cats with URTA. A number of single nucleotide polymorphisms (SNPs) in pattern recognition receptors expressed by phagocytic cells, that increase susceptibility to invasive aspergillosis have been described in humans including SNPs in toll-like receptors 1, 3, 4 and 6, and in the C-type lectin receptors Dectin-1 and DC-SIGN. Whether similar genetic mutations could be associated with increased susceptibility to URTA in Persian/Himalayan cats has not been investigated.

Alternatively, the increased risk of URTA observed in brachycephalic cats could reflect reduced mucociliary clearance from abnormal sino-nasal cavity conformation. A decrease in sinus aeration and drainage of respiratory secretions secondary to infection, polyps and allergic rhinosinusitis is a risk factor for invasive fungal rhinosinusitis in humans. Mucosal edema and impaired drainage of upper respiratory tract secretions due to turbulent airflow and abnormal facial conformation has been proposed as a risk factor for fungal colonization in brachycephalic cats. Additional risk factors such as previous viral upper respiratory infection or recurrent antimicrobial therapy may also be involved.  In particular, chronic feline herpes virus-1 infection can severely alter sino-nasal cavity architecture because of turbinate lysis secondary to intense inflammation, resulting in altered local mucosal defence mechanisms.

Sino-orbital aspergillosis in cats due to A .felis is strikingly similar in presentation to another form of aspergillosis that occurs in immunocompetent humans, known as granulomatous fungal rhinosinusitis (FRS). This disease predominantly occurs in the Sudan, Middle-East and Indian subcontinent. Risk factors for infection include hot, dry environmental conditions, poor hygiene and low socioeconomic status. In contrast to other forms of FRS in humans that are mostly caused by A. fumigatus, chronic granulomatous FRS is predominantly caused by A. flavus, which has a propensity to colonise the nasal and paranasal sinuses in hot, dry climates. 

Importantly, companion animals with aspergillosis due to A. felis are unlikely to be a source of transmission of infection to humans. Aspergillus species are amongst the most common molds on earth encountered by humans and animals. Their environmental niche is decaying vegetation in soil, where they have an important role in recycling carbon and nitrogen. The abundant spores of Aspergillus species are aerosolised and disseminated widely in wind currents, as demonstrated by isolation of A. felis from an indoor air sample in Germany, in our study.

Director World Health Organization’s Global Smallpox Eradication Campaign Joins One Health Initiative Honorary Advisory Board

The One Health Initiative Autonomous pro bono team is delighted to announce that Dr. D. A. Henderson, a physician, has accepted becoming a member of the team’s Honorary Advisory Board http://www.onehealthinitiative.com/advBoard.php on July 17, 2013.  He said, “I am delighted to be asked to join the Honorary Advisory Board.  It is a distinguished group and a worthy cause.”  The Advisory Board was established in 2010 and now has 29 distinguished members from within the U.S. and worldwide.

Donald A. Henderson, MD, MPH is presently a Resident Scholar at the Center for Biosecurity of the University of Pittsburgh Medical Center. The Center for Biosecurity was originally founded in 1998 as the Center for Civilian Biodefense Studies at the Johns Hopkins Medical Institutions. The Center was established to increase national and international awareness of the medical and public health threats posed by biological weapons. Immediately after the 9/11 terrorist attack, Dr. Henderson was appointed as the government's first Director of the Office of Public Health Emergency Preparedness. He continues to serve as senior science advisor to the Office of Public Health Emergency Preparedness of the Department of Health and Human Services.

Dr. Henderson is a Johns Hopkins University Distinguished Service Professor and Dean Emeritus of the School, with a joint appointment in the department of Epidemiology. He is also Professor of Medicine and Public Health of the University of Pittsburgh School of Medicine. He rejoined the Hopkins faculty in June 1995 after five years of federal government service in which he served initially as Associate Director, Office of Science and Technology Policy, Executive Office of the President (1991-1993), and later as deputy assistant secretary and senior science advisor in the Department of Health and Human Services.

From 1977 through August 1990, Dr. Henderson was dean of the Johns Hopkins School of Public Health. He came to Hopkins after directing the World Health Organization's (WHO) global smallpox eradication campaign (1966-1977). Dr. Henderson was instrumental in initiating WHO's global program of immunization, which has vaccinated 80 percent of the world's children against six major diseases and has as a goal the eradication of poliomyelitis.

Dr. Henderson is a longstanding One Health supporter/advocate.  See http://www.onehealthinitiative.com/supporters.php and http://www.onehealthinitiative.com/endorsements.php.

Submitted exclusively to One Health Initiative website June 21, 2013

...“Without the consistent and adequate support of the university and the college leaders, such an innovative interdisciplinary approach to education would not succeed,” Dr. Cates noted.  “We are very fortunate here to have some leaders who are willing to fund non-traditional approaches in a field where multidisciplinary methods really make the most sense. Prevention is the best way to health, and collaboration is key.  Together, we must set a ‘one health’ example among all stakeholders, for improved community health throughout our state and beyond.”   

http://www.onehealthinitiative.com/publications/Kansas%20State%20University%20One%20Health%20MPH%20Program%20June%202013%20FINAL%20PUB.doc.pdf

Kansas State University:  An Interdisciplinary Approach to Graduate Public Health Education (USA)

Michael B. Cates, DVM, MPH, DACVPM

The Master of Public Health Program at Kansas State University in Manhattan Kansas (USA) continues its innovative, interdisciplinary approach to graduate public health education.  While a few other Master of Public Health programs in the United States are partially aligned with a College of Veterinary Medicine, K-State’s program is housed in one.  And, three other colleges on the campus, along with the Graduate School, are partners in the program, making it truly interdisciplinary. 

Started in the fall semester of 2003, the Kansas State MPH Program was initiated as a collaboration of the Graduate School and the Colleges of Agriculture, Arts & Sciences, Human Ecology, and Veterinary Medicine, with the first interim director from Human Ecology, Carol Ann Holcomb, PhD.  This innovative approach was both cost effective and efficient with its use of existing infrastructure, faculty and courses.  Today, the college partners are still the same, and the program has its first full-time Director, *Michael B. Cates, DVM, MPH, DACVPM, also a Professor in the College of Veterinary Medicine.  Brigadier General (Retired) Cates is the former Chief of the Army Veterinary Corps and the first veterinarian to serve as the Commanding General of the Army’s main public health organization, the Center for Health Promotion and Preventive Medicine as well as the Surgeon General’s primary senior executive on Preventive Medicine and Public Health. 

The partnership, crossing traditional college boundaries at Kansas State University, has a definite advantage for students.   There are over 55 different faculty members affiliated with the MPH Program, from 12 departments in five academic colleges.  This variety of disciplines and research interests opens a wealth of possibilities for students, who can choose between four distinct areas of emphasis—Infectious Diseases and Zoonoses; Food Safety and Biosecurity; Public Health Nutrition; and Public Health Physical Activity.  Dr. Cates noted “The faculty members here are extraordinary experts in many different areas which impact on animal, human and/or environmental health.  You will probably not find such a unique blend anywhere else.”

That uniqueness and breadth has led to significant growth in enrollment.  When Dr. Cates arrived in January 2009, the program had an enrollment of 26 students; today, there are over 90.  One noticeable trait of the program is the high interest level of veterinarians, veterinary students and even pre-professional students to pursue the MPH degree or the Graduate Certificate in Public Health Core Concepts.  Right now, over 40% of the program’s students fit into one of those veterinary-related categories.  Overall, the program has attracted outstanding domestic and international students from over 20 disciplines, including medicine, nursing, dentistry, human nutrition, kinesiology, animal science, food science and several others, from 23 states and territories and 13 other countries.  Already, the 91 total Kansas State University MPH graduates are contributing to global health improvements around the world, in local, state, federal and international organizations, public and private.  

The future looks bright for even more opportunities for students and graduates of this program, with the arrival of two major federal laboratories—the National Bio and Agro-Defense Facility and the Arthropod Borne Animal Disease Research Unit / Center for Grain and Animal Health Research—and a continuing and growing culture of teamwork across the state.  The program is exploring ways to collaborate with the University of Kansas’ more traditional public health program and medical school, and the two universities already play active roles in the state’s Public Health Systems Group, involving local and state governmental agencies along with foundations and other health-related stakeholders, and the Public Health Workforce Development Coordinating Council.  In another example, Kansas State MPH faculty and students help in public health outreach, education and research with the university’s One Health Kansas and Pathways to Public Health initiatives, aiming to raise awareness and interest in public health, starting with children in kindergarten, and ultimately to improve the numbers and quality of educated professionals in the public health workforce. 

A crucial component of the tremendous growth of the K-State MPH Program is the interest, advocacy and support from the university’s administrative leadership, particularly the college deans and the past and present university provosts and presidents.  “Without the consistent and adequate support of the university and the college leaders, such an innovative interdisciplinary approach to education would not succeed,” Dr. Cates noted.  “We are very fortunate here to have some leaders who are willing to fund non-traditional approaches in a field where multidisciplinary methods really make the most sense. Prevention is the best way to health, and collaboration is key.  Together, we must set a ‘one health’ example among all stakeholders, for improved community health throughout our state and beyond.”    

*Dr. Cates is a recognized One Health leader and longstanding One Health supporter/advocate http://www.onehealthinitiative.com/supporters.php.

Note: In addition, The Dean of Kansas State University’s College of Veterinary Medicine, Ralph C. Richardson, DVM, Dipl ACVIM (Oncology, Internal Med) is a recognized One Health leader and longstanding One Health supporter/advocate.  Dr. Richardson also serves on the One Health Initiative Autonomous pro bono team’s Honorary Advisory Board http://www.onehealthinitiative.com/advBoard.php.