The Influence of Zoonotic Diseases on Human Health................... Richard Rusk, DVM, MD, MPH Medical Officer of Health Manitoba Health June 4, 2012
OBJECTIVES Brief history of zoonotic diseases and pandemics The present situation surveillance, technology, globalization, legislation One World One Health The future Conclusions www.cahln-rctlsa.com 2
THE PAST Religion has recognized the importance of zoonotic disease for centuries Prohibited foods shellfish (Vibrio), pork (Trichinella), scavengers (everything else) 1 The Poor Laws stemmed out of the plague (rodents) and cholera (sanitation) The Report from the Poor Law Commissioners Chadwick, et al. 1842 lead to the first Public Health Act 1848 2 www.cahln-rctlsa.com 3 Source: 1: Macht, Bull of Hist of Medicine, 1953; 2: Streiner, et al, PDQ Public Health, 2011
THE PAST www.cahln-rctlsa.com 4
THE PAST Factors involved in infectious disease emergence 1 International trade and commerce Human demographics and behaviour Human susceptibility to infection Poverty and social inequality War and famine Breakdown of public-health measures Changing ecosystems Climate and weather Intent to harm Lack of political will Microbial adaptation and change Economic development and land use Technology and industry www.cahln-rctlsa.com 5 Source: 1: Morens, et al. Lancet Inf Dis, 2008
Emerging disease 1 THE PAST Causal agent Estimated number of human deaths Zoonotic component 430 426 BCE Plague of Athens Unidentified 40 000 YES? 1340s Black Death Yersinia pestis 50 million YES 1494 99 French pox (syphilis) Treponema pallidum >50 000 NO 1520 21 Hueyzahuatl (smallpox) Variola major 3 5 million YES/NO 1700s European cattle epizootics Rinderpest virus, foot and mouth disease virus, Bacillus anthracis >15 000 YES 1793 98 The American plague Yellow fever virus 25 000 YES 1832 Second cholera pandemic, Vibrio cholerae 18 402 YES/NO Paris 1875 Fiji virgin soil epidemic Measles virus 40 000 NO 1918 19 Spanish influenza H1N1 influenza virus 50 million PROBABLY From 1981 AIDS pandemic HIV >25 million YES www.cahlnrctlsa.com Source: 1: Morens, et al. Lancet Inf Dis, 2008 6
THE PRESENT Globalization has changed the way we do business Public Health issues are interconnected and multi-systemic much more so than 50 years ago Outbreaks are not in someone else s backyard any more Animals still don t care what they lick www.cahln-rctlsa.com 7
FMD ORIGINS? www.cahln-rctlsa.com 8
THE PRESENT Emerging and re-emerging infectious diseases Species range shifts global warming Habitat encroachment and loss Multiple species mingling Species eradication Shifting virulence in agents www.cahln-rctlsa.com 9
THE PRESENT Food safety Complex system, widespread distribution Antimicrobial resistance Needs antimicrobial stewardship from all parties Bioterrorism Zooeyia the positive impact of pets on human health 1 www.cahln-rctlsa.com Source:Hodgson et al, CVJ, 2001 10
Pathogen THE PRESENT Emerging foodborne diseases estimated annually Cases No. of No. of Illnesses Deaths Economic losses from foodborne diseases estimated annualy $ billion Campylobacter spp. 1,963,141 10,539 99 1.2 Salmonella nontyphoidal 1,341,873 15,608 553 2.4 E. coli O157:H7 62,458 1,843 52.7 E. coli non-o157- STEC 31,229 921 26.3 L. monocytogenes 2,493 2,298 499 2.3 Total 3,401,194 31,209 1,229 6.9 www.cahln-rctlsa.com 11 Source: USDA s Economic Research Services & CDC
GLOBALIZATION www.cahln-rctlsa.com 12 Source: 1: Morens, et al. Lancet Inf Dis, 2008
GLOBALIZATION www.cahln-rctlsa.com 13
ONE WORLD ONE HEALTH Source: bio-era 14
ONE WORLD ONE HEALTH THE GLOBAL MEAT TRADE IS HIGHLY CONCENTRATED Source: Center for Global Food Issues 15
TECHNOLOGY www.cahln-rctlsa.com 16
TECHNOLOGY www.cahlnrctlsa.com 17
SURVEILLANCE www.cahln-rctlsa.com Source: PHAC NML ph1n1 Lab data, 2009 18
SURVEILLANCE ph1n1 Cases by Health Regions www.cahlnrctlsa.com Source Data: Health Regions 2006 Census Data from StatsCan and AgriCanada PHAC NML Lab Data Hotspot? Cluster analysis overlaid with cases and swine density 19
ONE WORLD ONE HEALTH PRIORITIES OF CHIEF VETERINARY OFFICE, MAFRI www.cahln-rctlsa.com 20 Source: MAFRI OWOH Project Concept Design, 2009
ONE WORLD ONE HEALTH HOLISTIC PERSPECTIVE Environmental Health Human Health Animal Health Shared Ecology An integrated holistic perspective which acknowledges the inter-relationships between the health of humans, animals and the environment 1. Ensures that investigative and processes and programmatic responses acknowledge the complex ways in which disease may move between humans, animals and the environment 2. Highlights the need to share policy domains between departments 3. Helps identify upstream preventative solutions which will maximize human health benefits and minimize impacts on industry and the environment www.cahln-rctlsa.com 21 Source: MAFRI OWOH Project Concept Design, 2009
THE FUTURE Financial support, a broader array of partners, and sufficient time contribute to partnership effectiveness 1 Public health infrastructure must include both human and veterinary medicine Aggregate data analyzed from diverse sources for early detection 2 Value of animal sentinels only realized with close integration and communication between human and animal health sectors 3 www.cahln-rctlsa.com 22 Source: 1: Zahner, Public health Rep, 2005; 2:Gubernot et al, Public Health Rep, 2008; 3: Halliday et al, J Roy Soc, 2007
THE FUTURE www.cahlnrctlsa.com 23
THE FUTURE Integration Collaboration Shared budgets Common health policy Social impact assessments Seamless information technology Supportive regulations and legislation www.cahln-rctlsa.com 24
CONCLUSIONS Zoonotic diseases have always been drivers of human health policy decisions The world has evolved to facilitate another zoonotic disaster Science and technology are capable of preventing and controlling zoonoses Political support needs to sustain the efforts in health and agriculture to create systems to predict, prevent and control emerging zoonotic diseases www.cahln-rctlsa.com 25
THANK YOU FOR YOUR ATTENTION................... QUESTIONS?