Polling Question. The One Health Approach to Public Health Challenges in the Pacific Northwest

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The One Health Approach to Public Health Challenges in the Pacific Northwest Peter M. Rabinowitz, MD, MPH UW Center for One Health Research www.

1 The One Health Approach to Public Health Challenges in the Pacific Northwest Peter M. Rabinowitz, MD, MPH UW Center for One Health Research Polling Question Which area of public health are you primarily engaged in? Human health Animal health Environmental health 1

2 Why Do We Need One Health? Sally Vegso, UW Center for One Health Research. Data source: FAO Polling Question What percent of emerging infections diseases do you believe are zoonotic? 0-25% 25-50% 50-75% % 2

3 Why Do We Need One Health? One Health Initiative Silos HUMAN HEALTH ANIMAL HEALTH ENVIRON MENT Photo by Chris Yunker (CC BY-SA 2.0) 3

One Health Framework Human activity causes agricultural intensification, habitat loss, climate change. New diseases emerge from wildlife and domestic animals: Ebola, MERS, SARS.

0) Photo courtesy of CDC Photo by Christopher Holden (CC BY-SA 2.

4 One Health Framework Human activity causes agricultural intensification, habitat loss, climate change. New diseases emerge from wildlife and domestic animals: Ebola, MERS, SARS. Animals can be the canary in the coal mine to provide early warning of environmental hazards. Photo by Paul Albertella (CC BY-SA 2.0) Photo courtesy of CDC Photo by Christopher Holden (CC BY-SA 2.0) WA One Health Steering Committee Washington State Medical Association (Vacant) WA Department of Health Department of Fish and Wildlife Washington State Veterinary Medical Association WA Department of Agriculture UW Dept. of Allergy & Infectious Diseases Office of the Governor WSU School for Global Animal Health UW Center for One Health Research Wayne Clifford, WA Dept. of Health 4

5 WA One Health Structure Strategic Steering Committee Tactical Administrative Support Team Antimicrobial Stewardship Workgroup Surveillance and Data Systems Workgroup Goals Across human, animal, and environmental health sectors: Develop a model for antimicrobial stewardship for Washington State Develop an integrated disease pathogen notification system Develop a One Health surveillance plan for antibiotic resistance Wayne Clifford, WA Dept. of Health Reportable Diseases in Humans and Animals: WA WA State Dept. of WA State Dept. of USDA National Veterinary WSU WADDL (Disease WA Department of Fish & Diseases of Importance Health Agriculture Services Laboratories Surveillance Testing) Wildlife (Wildlife Health) Amoebic meningitis X Anaplasmosis X X X Anthrax X X Atrophic rhinitis of swine X Mycoplasma X X Babesiosis X X Piroplasmosis X X Bovine spongiform encephalopathy X X X Bovine trichomoniasis X X Brucellosis X X X Campylobacteriosis X X Caseous lymphadenitis X X Chagas disease X Coccidioidomycosis X X Glanders X X Influenza X X X X Johne s disease (paratuberculosis) X X X Leptospirosis X X X Listeriosis X X Lyme disease X X Q fever X X Rabies X X X Salmonellosis X X Scrapie X X Severe acute respiratory syndrome X Tuberculosis (TB) X X Tularemia X X West Nile Virus X X X 5

Avian Influenza, Pacific Northwest Dec 1, 2014 Feb 6, 2015 Dec 8,

com Dec 1 2014 Dec 8 2014 Jan 3 2015 Feb 6 2015 Fraser Valley, BC

Washington Benton County, WA First domestic poultry HPAI positive

Surveillance Zone Established in Northern Whatcom County Washington

6 Avian Influenza, Pacific Northwest Dec 1, 2014 Feb 6, 2015 Dec 8, 2014 Jan 3, 2015 Free Vector Maps.com Dec Dec Jan Feb Fraser Valley, BC HPAI H5N2 reported Whatcom County, WA First documentation of HPAI in Washington Benton County, WA First domestic poultry HPAI positive Chilliwack, BC Backyard flock positive for HPA1 H5N1 High-Risk Surveillance Zone Established in Northern Whatcom County Washington Canada Surveillance Zone Whatcom Surveillance Zone Wiser Lake Area 10K Washington State Department of Agriculture 6

7 Potential Pathways of Avian Influenza Introduction to North America Novosibirsk Quinghai Lake Northern Pintail breeding area Bar-tailed Godwit breeding area Recent outbreaks in birds Hong Kong Northern Pintail migration corridors Documented Northern Pintail movement between Asia and North America Bar-tailed Godwit spring migration route Source: USGS Bar-tailed Godwit fall migration route Economic Impact of Avian Influenza Value of U.S. poultry exports in 2014 Over $6 billion Percentage of world poultry breeding stock produced in the U.S. Impact of mid-1980s outbreak on poultry stocks Cost to taxpayers of mid-1980s outbreak Number of nations that have restricted U.S. poultry imports due to 2015 cases 90% 17 million birds destroyed $65 million 30 Washington State Department of Agriculture 7

8 Role of Wild Waterfowl Wild bird surveillance continues and will be enhanced 1500 wild birds sampled in WA Visit the Washington Department of Fish and Wildlife website for more information about wild birds and Avian influenza health/avian_flu/index.htm Washington State Department of Agriculture UW DEOHS Water Sampling Photo courtesy of Christa Fagnant 8

Bird Flu One Health Challenges Relationship to bird abundance and

How to coordinate efforts in One Health approach?

9 Bird Flu One Health Challenges Relationship to bird abundance and climate change? Best way to perform ongoing monitoring and prediction? Best way to assess human risk? Tamiflu or Flu vaccine for workers? How to coordinate efforts in One Health approach? Photo by Christopher Holden (CC BY-SA 2.0) Coccidioidomycosis: a One Health Challenge for the PNW Image courtesy of CDC Image courtesy of CDC 9

10 Coccidioidomycosis Cases In Phoenix and Tucson, may account for 15-30% of community acquired pneumonias. Source: CDC 10

11 Cases of Locally Acquired Coccidioidomycosis, WA State, Onset date Report date Number of Cases Source: WA Dept. of Health Cocci Case Examples 12 Year Old Boy June 1, 2010 Chest pain, fever, difficulty breathing Regularly played and bicycled in a dirt canyon with native vegetation Only travel outside of WA was 2-day trip to CA in 2008 Animal Cases Two dogs and one horse Diagnosed culture-confirmed as coccidioidomycosis by Animal Disease Diagnostic Laboratory 11

4 C) Annual rainfall 18-20cm/year (5-50cm/year) Climate change will likely impact the dry summer

12 Environmental Factors Climate Soil Semi-arid environment Average temperature -3 C to 31 C (0.5 C to 24.4 C) Annual rainfall 18-20cm/year (5-50cm/year) Climate change will likely impact the dry summer season (July-October), creating a more favorable environment for the coccidioides fungus. Use soil variables to create risk map Wind Event in South Central WA Photo courtesy of Glen Clifford 12

Coccidioidomycosis: One Health Challenges Related to climate changes? Are cases being missed? Is there a rodent reservoir? Can dogs and other animals be sentinels for human risk?

13 Coccidioidomycosis: One Health Challenges Related to climate changes? Are cases being missed? Is there a rodent reservoir? Can dogs and other animals be sentinels for human risk? Image courtesy of CDC What type of surveillance and prevention? Polling Question What is the biggest factor leading to antibiotic resistance? Antibiotic use in human health care Antibiotic use in industrial agriculture Other 13

Antibiotic Resistance: One Health Challenges Question about role of animal agriculture Recent FDA directives about use of antibiotics for growth promotion and veterinary oversight Fall 2014 White

14 Antibiotic Resistance: One Health Challenges Question about role of animal agriculture Recent FDA directives about use of antibiotics for growth promotion and veterinary oversight Fall 2014 White House report calls for One Health approach to surveillance NIAA white paper 11/14 calls for shared antibiotic stewardship across human and animal health Stewardship and Surveillance (a sample) Sector Human Health Hospitals Human Health: Outpatient Human Public Health Veterinary Public Health Animal Health: Companion Animal Practice Animal Health: Agriculture Systems for Antibiotic Stewardship Designated stewards; formulary restrictions; case reviews Insurance restrictions; continuing education; CDC Get Smart Education of providers Education of providers Programs at some veterinary colleges Species-specific judicious use programs; therapeutic use; adherence to withdrawal times; Guidance 209, 213 and Vet Feed Directive Current Systems for Surveillance Laboratory antibiograms Laboratory reports on antibiotic sensitivities NARMS, public health laboratories NARMS, public health laboratories Diagnostic laboratories provide antibiograms on veterinary request USDA s Agriculture Research Service collects on-farm data to support NARMS Shared stewardship activities? Shared surveillance activities? Wayne Clifford, WA Dept. of Health 14

15 One Health Antimicrobial Stewardship Workgroup (Draft 1, 3/2/15) Identifies current work and gaps, and plans and coordinates future statewide activities, to promote AMS across the One Health spectrum Human Health Environmental Health Animal Health Acute Care Long Term Care Ambulatory Care Food Water Companion Animals Animal Agriculture Climate Change Wildlife Wayne Clifford, WA Dept. of Health Antibiotic Resistance Challenges Surveillance How to track usage across sectors Impact of FDA directives Shared Stewardship Sharing of best practices Integrated efforts 15

Future One Health Directions Look at real time prediction Look at toxic exposures Joint training and prevention Acknowledgments Wayne Clifford Ron Wohrle Mindy

16 Future One Health Directions Look at real time prediction Look at toxic exposures Joint training and prevention Acknowledgments Wayne Clifford Ron Wohrle Mindy Buswell Joe Baker Paul Kohrs Marisa D Angeli Michael Park Scott Meschke Alex Kossick Christa Fagnant Heather Fowler Gemina Garland-Lewis Vickie Ramirez Others! 16

17 Questions? 17

The One Health Approach to Public Health Challenges in the Pacific Northwest

The One Health Approach to Public Health Challenges in the Pacific Northwest Peter M. Rabinowitz, MD, MPH UW Center for One Health Research www.nwcphp.org/hot-topics Polling Question Which area of public