Emerging infectious diseases in China: the One Health approach


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This report on the UN China One Health event (June 2011) is focusing on diseases at the human-animal-interface. ‘One Health’ and ‘Ecohealth’ are ways of thinking about, approaching and investigating diseases that go beyond the traditional pathogen-centric approach.

By examining the complex issues that result in disease emergence and transmission and this information can be used to implement better disease control and preventive measures.

One of the conclusions is that the rapid development in Asia means that the complex effects of changes to ecosystems not always have been discussed or examined in a way that takes account of the positive and negative effects of development.

For highly pathogenic avian influenza it has been important to understand how the disease emerged and spread so that appropriate measures could be implemented.

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Emerging infectious diseases in China: the One Health approach

  1. 1. An Eco-system Health Approach to AddressEmerging Infectious Diseases in China29-30 June 2011Beijing ChinaREPORT ON THE UN CHINA ONE HEALTH EVENTConvened by the UN Theme Group on HealthSub-working group on Diseases at the human-animal-interface
  2. 2. An Eco-system Health Approach to AddressEmerging Infectious Diseases in ChinaREPORT ON THE UN CHINA ONE HEALTH EVENTConvened by the UN Theme Group on HealthSub-working group on Diseases at the human-animal-interface29-30 June 2011Beijing China
  3. 3. CONTENTSExecu ve SummaryIntroduc onAn Integrated Approach to Agricultural Health: Linking Natural ResourceManagement, Wildlife, Livestock Produc on and Food Security(Summary of Presenta on and Discussion of Day 1)Disease Emergence at the Wildlife Livestock Interface(Summary of Presenta on and Discussion of Day 2)Possible Ways Forward to Ins tu onalizing One Health Principles in ChinaAnnexesAnnex 1: GlossaryAnnex 2: AgendaAnnex 3: List of Par cipantsAcknowledgement030406081013141621AuthorsLyle Fearnley, University of California, Berkeley, USABruce A. Wilcox, Mahidol University, ThailandLeslie David Sims, Asia Pacific Veterinary Informa on Service, AustraliaVincent Mar n, Food and Agriculture Organiza on of the United Na ons (FAO) China
  4. 4. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT03The H5N1 HPAI worldwide crisis makes evidentthe need for a broader perspective to addressthe challenges of Emerging Infectious Diseases(EIDs) and the root causes of disease emergencethrough a wide-angle, landscape lens that offersboth clinical and ecological perspectives (Leighton,2007). This perspective is not new and was firstraised by pioneers in applied ecology such asAldo Leopold (1887-1948), who believed that itis possible to restore the function and stability ofdamaged ecosystems if only we can “think like amountain”, that is, understand the full complexityof cause and effect in ecological processes andto plan and act on time scales of decades andcenturies. One health approaches also formed thebackbone of the ideas promoted by epidemiologistssuch as Calvin Schwabe in the late 1960s.Similarly, the Manhattan Principles that cameout of the ‘One World, One Health’ conferenceorganized by the Wildlife Conservation Societyin 2004, through a list of 12 recommendations,set the foundation for a more holistic approach topreventing epidemic disease and for maintainingecosystem integrity. The application of thisapproach aims to minimize the impact of epidemicsand pandemics due to EIDs. It sets out to providepreventive action on the root causes and drivers ofEIDs, build more robust public and animal healthsystems, better address the concerns of the poor,promote cross-sectoral and multi-disciplinaryapproaches, and conduct strategic research.More recently, the One Health concept wasendorsed by several international organizations(including the FAO, OIE, WHO, UNICEF and theWorld Bank, among others) seeking to followup on the achievements attained in the fightagainst the avian influenza panzootic. Today,there is an increasing demand for greatercollaboration between international and nationalagencies, encouraging a move towards the practicalimplementation of the One Health concept incountries where the ecological landscape favoursthe genesis of new pathogens. During the UnitedNations System Workshop on Animal andPandemic Influenza held in Bangkok Thailandin 3-4 February 2011, it was suggested that a‘road show’ be developed in order to promote theunderstanding and practical application of a OneHealth approach at the country level.China has over a decade of experience in thecontrol of H5N1 HPAI. The challenges andsuccesses of epidemic control efforts for HPAIstrongly demonstrate the potential benefits ofa One Health approach. The emergence andpersistence of HPAI is known to involve complexecological relationships among domestic chickens,free-ranging ducks, wild birds, and human marketsystems which can be best understood andmanaged through One Health principles. AlthoughHPAI is largely under control today (and despitethe fact infection remains entrenched in severalparts of the country), the recent emergence ofnew diseases in China (e.g. the Severe Feverwith Thrombocytopenia Syndrome (SFTS) virusresponsible for hemorrhagic fever in people as wellas a Tembusu-related Flavivirus causing egg-dropsyndrome in ducks) are reminders of the need tomove towards a holistic and preventive approachto disease emergence.On June 29, the first Chinese national meeting onOne Health was hosted in Beijing, with the supportof the United Nations Theme Group on Health,sub-working group on diseases at the human-animal interface coordinated by the FAO EmergencyCentre for Transboundary Animal Diseases (ECTAD)unit in China. Experts and officers from the Ministryof Health, Ministry of Agriculture, and StateForestry Administration participated in the meeting.The meeting took stock of the lessons learned inChina through the control of emerging infectiousdiseases, particularly HPAI H5N1; related theselessons to the concept of One Health; anddeveloped a roadmap for instituting One Healthconcepts in China.Execu ve Summary
  5. 5. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT04The experiences from the highly pathogenicavian influenza (HPAI) global crisis makes clearthat a broader perspective is needed to addressthe challenges of emerging infectious diseases(EIDs), a perspective examining the root causes ofdisease emergence, spread and persistence fromthe molecular to the ecological scale (Leighton,2007). Todays epidemics of infectious diseaseincreasingly emerge and spread at the interface ofhuman, domestic animal and wildlife populations.However, government institutions and scientificdisciplines divide up the responsibility andexpertise over these separate populations. Theconcept of One Health describes the need for aninstitutional and scientific approach to diseasesthat combines the expertise of many disciplines(including, but not limited to, veterinary, medical,wildlife specialists, social scientists, ecologists andmicrobiologists). Rather than dividing expertiseinto separate stovepipes of responsibility, a OneHealth approach aims to increase knowledge ofthe complete ecosystems-environment in whichpathogens emerge and persist according to aecological health paradigm.In response to the HPAI epizootic, the UnitedNations among which the FAO and WHO alongwith the OIE (World Organization for Animal Health)adopted the One Health concept as a guide forfuture joint activities by delivering a concept notethat among re-affirming their work together has thevision to building “A world capable of preventing,detecting, containing, eliminating and respondingto animal and public health risks attributable tozoonoses and animal diseases with an impact onfood security through multi-sectoral cooperationand strong partnerships”.On June 29 2011, FAO ECTAD China hosted the firstChinese national meeting on One Health, withthe support of the United Nations Theme Groupon Health, sub-working group on diseases at thehuman-animal interface coordinated by the FAOECTAD unit in China and the UNDP. Experts andofficers from the Ministry of Health, Ministry ofAgriculture, and State Forestry Administrationparticipated in the meeting. The meeting took stockof the lessons learned in China through the controlof emerging infectious diseases, particularly HPAIH5N1; related these lessons to the concept of OneHealth; and made some recommendations tofurther develop and apply this concept in China.The application of a One Health approach aimsnot only to minimize the local and global impactof epidemics and pandemics caused by emerginginfectious diseases but also to look at more holisticapproaches for solving health-related problems(in this regard, it also encompasses food safetyissues). By aiming to reduce the impact of diseaseon livestock populations, One Health is also anessential component of food security and foodsafety planning It aims to provide preventive actionon the root causes and drivers of EIDs, build morerobust public and animal health systems, betteraddress the concerns of the poor, promote cross-sectoral and multi-disciplinary approaches, andconduct strategic research.China has over a decade of experience in the controlof HPAI H5N1. The challenges and successesof epidemic control efforts for HPAI stronglydemonstrate the potential benefits of a One Healthapproach. The emergence of HPAI, as well asits persistence and transmission, is known torely on complex interactions between domesticIntroduc onOpening Ceremony of UN China One Health Event,Beijing, June 2011Representation of Ecological Health Approach, Source:Conservation Medicine, Oxford University Press, 2002
  6. 6. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT05Syndrome (SFTS) virus) responsible for hemorrhagicfever in people as well as a Tembusu-relatedFlavivirus recently discovered by Chinese scientistsand responsible for duck-egg drop syndrome.The ecology of these viruses is being exploredincluding the role of possible domestic animal hostsand competent vectors for the newly discoveredbunyavirus responsible for hemorrhagic fever anddeath in people or as yet unknown vectors for thenew Tembusu-related Flavivirus responsible forduck egg-drop syndrome.By looking forward towards the possible emergenceof new viruses, the importance of developing aOne Health approach to disease prevention andcontrol is clear. A strong capacity for sharing,integrating and understanding information aboutdomestic animals, wildlife, human biology andhuman societies is essential not only to minimizethe risk of emergence and spread of emerging andknown infectious diseases but also to answer topoultry (both ducks and chickens, from backyardto commercial to industrial), human social andeconomic systems; wild birds and animals alsoplaying a role in the initial introduction and in someplaces, in short and long distance transmission ofH5 viruses.A specific challenge faced during the control ofHPAI provides a useful example. One of the mainquestions throughout the epizootic has beenthe mechanism of transmission between flocks,particularly transmission over long distances andacross territorial borders as well as the questionof disease persistence in specific ecosystemconfigurations. However, to understand thedynamics impacting transmission required goingbeyond the traditional disciplinary boundaries ofveterinary or medical epidemiology. Among otherthings, experts debated the relative importanceof wild bird migrations, on the one hand, orcommercial trade in poultry, on the other. Touncover evidence on the transmission of HPAI,wildlife specialists conducted tests in wild birdsand studied the migratory pathways of various birdspecies; epidemiologists uncovered the ecologicalrisk factors associated with the emergence andspread of the disease while social scientistsinvestigated the networks and market chains ofcommercial poultry trade. Only by combining theexpertise of many disciplines could the true risks oftransmission be assessed and mitigated.During the past decade, Chinas disease controlefforts have successfully mitigated HPAI H5N1outbreaks, transforming HPAI from an urgent crisisto relative stability. However, the success of theseefforts should not lead to complacency, as risksstill remain. The persistence and, constant and fastevolution of the virus lead to remaining questionsabout its ecology and the need to adapt controlmeasures accordingly. Moreover, HPAI H5N1 isnot an exceptional event, but is exemplary of anemerging infection and transboundary animaldisease with a potentially high public health impact.Other viruses continue to emerge at the interface ofhuman, domestic animal, and wildlife populations,including a newly identified bunyavirus (now referredas the Severe Fever with ThrombocytopeniaLeft: Chinese researchers have identified a novel bunyavirus.Source: www.modernemedicine.comRight: SFTS Virus grown in Vero cells and detected onimmunofluorescence assay from a serum sample obtainedfrom a patient with SFTSV infection. Source: Fever withThrombocytopenia Associated with a Novel Bunyavirus in China,The New England Journal of Medicine, 2010Regions of BYDV infection outbreaks in China. The provinceor autonomous cities (regions) affected are indicated in gray.Regions from which viruses were isolated and confirmed by RT-PCR/sequencing are labeled with triangles. Source: PLoS ONE,March 2011, Volume 6, Issue 3.
  7. 7. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT06the challenge of reducing the burden of endemicdiseases. In addition, among the many aspects thatneed to be strengthened are disease surveillanceand investigations. As an example, at present thesource of virus in most H5N1 HPAI outbreaks is onlyrarely identified and surveillance systems do notprovide sufficient information on the level of threat.‘One Health’ and Ecohealth are ways of thinkingabout, approaching and investigating diseasethat go beyond the traditional pathogen-centricapproach. They examine the complex issues thatresult in disease emergence and transmission andthis information can be used to implement betterdisease control and preventive measures.Much has been written and discussed about OneHealth approaches by international agencies anddonor communities in the various internationalforums that have been held since 2007. Thediscipline of Ecohealth has been growing over thepast 20 years through the work done by a numberof academic groups and agencies, including thework presented by Professor Wilcox. A number ofgroups have been promoting Ecohealth approachesto disease and have been exploring and buildingthe discipline, including the new language ofecosystem health (see glossary in Annex 1), waysof viewing ecosystems and how diseases emergeand spread within ecosystems. In this regard,interplay that exists between urban, agriculturaland natural landscape largely explains diseaseemergence, especially:• Intensification of human and biological activity(mainly driven by human activity)• Mixing of living systems and biological agents• Transport of biological agentsEcohealth practitioners use a transdiciplinaryapproach to examine how changes to ecosystemscan drive or are driving disease emergence.Proponents recommend that it should be used indetermining issues such as land use planning. Therapid development in Asia means that the complexeffects of changes to ecosystems have not alwaysbeen discussed or examined in a way that takesaccount of the positive and negative effects ofdevelopment. More attention should be focused onthese issues.Examples were given of diseases where a OneHealth-type, multidisciplinary approach has beenadopted. In these examples the many elementsthat result in disease emergence and persistencehave been assessed and all actors in the processare involved in determining and implementingappropriate control and preventive measures.The examples included the improved live poultryretail market stalls in a few provinces in China andthe development of other control and preventivemeasures for highly pathogenic avian influenza.One Health approaches are not new, as shownby the work done in different areas including inthe field of food safety, which has for a long timelong crossed disciplines. However the crossing ofdisciplines also represents a potential problem in acountry like China where responsibility for health-related problems is spread over different agencies.The need for an integrated and transdisciplinaryapproach is therefore essential.For highly pathogenic avian influenza it has beenimportant to understand how the disease emergedand spread so that appropriate measures couldbe implemented. However, this knowledge wasonly gained once the motivations of the variousplayers in the poultry sector and the overallstructure of the industry and movements of poultrywere understood. In some areas we still have apoor understanding of the motivations of farmersand traders or do not have appropriate ways tomotivate behavioral change to prevent diseases.Better engagement of those affected is a crucialpart of One Health approaches.An Integrated Approach toAgricultural Health: Linking NaturalResource Management, Wildlife,Livestock Produc on and FoodSecurity(SummaryofPresenta onandDiscussionofDay1)Source: Bruce Wilcox’s Presentation, June 2011
  8. 8. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT07At the simplest level in government, One Healthstarts with the various Departments responsiblefor disease control and prevention in the areasof human, animal and ecological health havinggood cross departmental communication so thatinformation on new and emerging diseases isshared. Positive steps in this direction have beenmade recently. An example of how one healthapproaches are being applied was described in thetraining exercise on rabies control and preventionfor the FETPV program1.The two recently emerged diseases describedduring the meeting demonstrate the importance ofunderstanding the factors that drive the emergenceof disease. So far these factors are not known andthey represent ideal candidates for investigationsusing a One Health/Ecohealth approach.The animal health implications of the novelbunyavirus and the human health implications ofthe novel flavivirus are also not yet known. Theexperience with related viruses and the ecologicalpredictive modeling done for Rift Valley Fever – arelated bunyavirus may have potential for adoptionto assist in disease control and prevention.Already it is evident that there are aspects of thesediseases that warrant a strong cross disciplinary/transdisciplinary approach.Diseases today cross borders easily and quickly,as demonstrated by the rapid spread of theinfluenza A (H1N1) pandemic strain. It is thereforeessential that, even when the cause is unknown,information on these diseases is shared with theglobal community as soon as it is evident thata new syndrome is occurring. In this regard, weshould be strengthening our capacity to detectfactors or changes in ecosystems and productionmethods that might result in disease emergenceand undertake appropriate applied research andactive surveillance in these places using OneHealth approaches.The two new diseases discussed at the meetingare just examples of new diseases. Other diseasessuch as highly pathogenic strains of PRRS andFMD (diseases that are not considered zoonotic)also represent causes of concern for the swineand cattle industry. An Ecohealth approach shouldbe adopted to better understand the dynamics ofthese diseases and improve their controls.The meeting highlighted the many gaps existingin the knowledge about diseases at the human-animal-ecosystem interface as well as the needfor strengthening surveillance systems at global,regional and national levels. However, we also haveto recognize the costs of surveillance (ensuringwe ask the right questions and the objectives areclear) and have to understand the implications ofdoing surveillance so that farmers who allow theiranimals to be tested are not disadvantaged by theconsequences of doing so (e.g. when the herd hasto be slaughtered while no financial compensationsystem is in place).When outbreaks of zoonotic diseases occur(including when it can potentially involve wildlifespecies), forming transdiciplinary teams is essentialbut not just a matter of having members in a teamfrom different disciplines. They have to be working1The China FETPV (Field Epidemiology Training Programme for Veterinarians) was launched in November 2010 and aims toprovide government agencies with veterinary field epidemiologists who can meet critical needs including conduct effective andtimely outbreak investigation and surveillance for existing and emerging infectious diseases.Two Mongolian Farmers Visited by CMC-AH/FAOECTAD China Experts during FMD Evaluation Mission,December 2010Source: Bruce Wilcox’s Presentation, June 2011
  9. 9. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT08towards a common goal, led by a clear directionand allowing various partners to fully contribute.The introduction of control and preventive measuresfor diseases can have adverse consequencesand there are many real world examples and abody of academic work in this area. Leslie Simsused Livestock intensification as a case study ofthe positive and negative effects that can ariseas a result of changes to the way livestock arereared as a response to HPAI. These negativeeffects provide fertile ground for application of onehealth approaches so as to understand the likelyeffects of change before the changes are made. Ifthe potential problems are identified, appropriatemeasures can be implemented to minimize orprevent the risks. Studies can be done to monitoremergence of new problems such as increases inantimicrobial resistance or the emergence of newstrains of influenza virus.Ultimately One Health and Ecohealth approachesare tools that disease managers can and shoulduse to assist them in making decisions about thecontrol and prevention of disease. The tools arenot an end in themselves but a means to an end.These approaches are meant for decision makersto set the right questions and address them.The second day of the One Health event focusedon the importance of wildlife in emerging diseaseecologies, and the necessity of integrating wildlifescience into a One Health disease prevention andcontrol strategy.Investigation into the role of wild birds in the spreadof HPAI H5N1 is a central example of early effortsto undertake One Health approach to emergingdiseases. After the massive die-off of wild birdsin Qinghai Lake in China in 2005, wild birds werewidely blamed for the spread of H5N1 influenza.Yet very little was known about the actualmechanisms of transmission. Using migrationecology, we can learn about pathogens andpathogen movement through following migrationroutes. Studies aimed to compare wildlife migrationwith outbreak information, as well as with other riskfactors such as poultry density.Pivotal for the success of these studies is knowledgeof the molecular epidemiology, including thegeographic distribution of particular virusclades. The conclusions of a large number ofstudies support the hypothesis that wild birdsare an “intermittent transmission host.” Wildbird populations are unlikely to be long termreservoirs of H5N1 HPAI viruses (For instance,disappearance of Clade 2.2 viruses from wild birdssuggests that these viruses are not maintainedfor an extended period). Wild bird populations arenot needed to perpetuate transmission once virusis established in poultry and transmission occursthrough the poultry sector. Nevertheless molecularand epidemiological evidence also suggests wildbirds may play a significant role in spreading thevirus from one area to another (strong evidencehas accumulated during the last two years withDisease Emergence at the WildlifeLivestock Interface(SummaryofPresenta onandDiscussionofDay2)Spread of H5N1 HPAI 2.3.3 virus towards Europe in2010-2011, Source: EMPRES-iWild Birds at Qinghai Lake, May 2006, FAO ECTAD China
  10. 10. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT09the dissemination of the clade 2.3.2 and the likelyinvolvement of wild birds in its long-distance spreadtowards Europe).A number of new technologies are enablingenhanced understanding of wildlife movements.Bird banding, historically the primary techniquefor studying wild bird migrations, would onlyprovide the beginning and end points of migration;Additional and detailed information on e.g. whereor why a migratory bird dies can be provided bycontinuous global positioning, remote sensingtechnologies or recording of body indicators suchas heart rate and body temperature.An exemplary study investigating the migration andmovement of the African fruit bat discovered thatthey engaged in stereotypical foraging behavior,used predominantly urban areas and fed mainly oncultivated and introduced crops.The Scientific Task Force on Wildlife Disease is acollaboration between the FAO and the Conventionon Migratory Species (CMS), and was launched inJune 2011. The Convention on Migratory Speciesis a convention of the United Nations that governsconservation of migratory species across theirentire range. The convention calls on attention thatbeyond the often-cited statement that “diseasesknow no borders”; similarly migratory species donot recognize country borders. As these migratoryspecies may be hosts, carriers or vectors ofdisease, One Health approach must account forthe movement of wildlife populations, includingacross political borders.One Health approaches must also addressthe human-directed movement of animals e.g.wildlife trade. The global illegal trade in wildlife,including both live animals and animal derivatives,is enormous, with its annual value estimated atUS $10 billion dollars. Trade in wildlife can causeecological damage through species extinction orpopulation reduction, and can also cause damageto the destination ecosystem through introductionof invasive species.In addition, wildlife trade represents a key risk ofdisease emergence, potentially bringing diseasedanimals in contact with human populations,including distant and immunologically naïvepopulations. Bushmeat - defined as hunting of anywildlife as sources of food poses a particular riskbecause of the manner in which slaughter and foodpreparation take place. Finally, farming of wildlifepresents a risk of disease emergence through themixing of wildlife species with domestic species.Farming of wildlife can be a lucrative industry, andmay be a way of preventing exploitation of nativepopulations provided breeding occurs in farmsand animal welfare concerns are met. Much moreresearch into proper management of wildlife infarms is needed.The day ended with a presentation and discussionof a document outlining the way forward toinstitutionalizing One Health in China.Using GPS to Track Bats Movement, Martin Wikelski,Max-Plank InsituteMajor Shipping Routes of Wildlife Trade, Source: TRAFFIC
  11. 11. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT10Through a decade of implementing measures tocontrol HPAI, China has accumulated experiencethat forms an excellent foundation for buildingOne Health institutions. Following are concreteproposals that could help develop a One Healthapproach in China.Develop capacity for spa al epidemiologyand EID risk assessmentDevelopment in the form of acceleratingurbanization, agriculture intensification andexpansion/expansion/encroachment and habitatloss along with increasing human population andtrade/transport are known to be the main driversof disease emergence. All of these drivers involvesignificant transformations of human and naturalenvironments and ecosystems. Disciplines suchas landscape epidemiology, medical geographyand a range of related fields provide skills andtechnologies that enable the correlation of diseaseprevalence with environmental determinantsand spatial patterns. As a supplement to basicepidemiology, these spatial approaches provideenhanced capacity for EID risk analysis/assessmentapplied in the context of development.• Develop research capacity in the research areasof spatial epidemiology.• Conduct studies addressing emerging infectiousdisease and emerging pandemic threat riskassessment.• Conduct the above research with special attentionto policy development in relation to land use andland use change; associate social and ecologicalfactors as determinants of disease emergence.• Facilitate participation of researchers andstudents in training and skill-building activitiesin the region, including working groups currentlyorganized in association with the USAID EPTprogram.Develop capacity for integra ve researchFacilitate the development of the knowledgeand skills necessary to provide leadership inintegrative, One Health research at the national andinternational levels. This will include establishingthe necessary institutional arrangements to providetraining in transdisciplinary team-building andresearch design. Principles from systems theoryand practice, including an ecosystem-basedapproach to the problem of zoonotic diseaseemergence; problem-based rather than disciplinaryresearch; and incorporation of public or stakeholderparticipation will form the basis of this One Healthresearch. Specific foci include:• Disciplinary integration, cross-sectoral collaboration,and community participation.• Development of human resource capacity alignedwith the appropriate knowledge and skills requiredto build collaborative projects.• Achieve the above objectives at a level that meetsinternational standards of integrative, One Healthresearch on emerging infectious diseases.• Include biodiversity conservation in the approachand ensure that One Health research aims to enhancethe health of all human beings• Provide National as well as international leadershipin One Health research.• Conduct joint One Health Research Projects (e.g.zoonoses).• Develop collaborative research projects onparticular disease-causing pathogens, involvingPredicted Distribution of HPAI H5N1 Risk Based onVirological Surveillance Data (Using BootstrappedLogistic Regression Model), Vincent Martin,FAO ECTAD ChinaPossible Ways Forward toIns tu onalizing One HealthPrinciples in China
  12. 12. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT11experts from disciplines including veterinaryand medical epidemiology, wildlife conservation,and social science. Possible candidates includerecently discovered bunyavirus or flavivirus, forwhich numerous questions remain about theinteraction of wildlife hosts, reservoirs, vectors, andcommercially-raised domestic animals. Projectsshould also be developed on detection andanalysis of factors and systems that could lead tothe emergence of new pathogens, examining andrecommending practical and appropriate ways toreduce the risks.Further strengthen influenza virussurveillanceWhile influenza viruses should not be the onlyfocus of One Health initiatives in China, influenzasurveillance of poultry, pigs, horses and wildanimals/birds aimed at monitoring viral changesand emergence of new strains should still befurther strengthened. Studies should integratesurveillance of high-risk human populations incontact with farmed domestic and wild animals.The studies could focus on sites identified as highrisk of influenza virus emergence such as livepoultry markets, wildlife breeding sites, farmed wildbird production areas, trading centres and livestockslaughterhouses.The Poyang Lake Ecosystem located in Jiangxiprovince which combines all these dimensionswould be an excellent system to study in the spiritof the One Health approach. All disease outbreakswith signs suggestive of influenza should bethoroughly investigated and systems should bein place to detect sub-clinical infection in poultry.Given the global importance of the information allresults should be released internationally, includinggene sequences and geolocation of outbreaks, assoon as data are validated (including geolocationfor tracking purposes and analysis). Projectsin Egypt, Indonesia and Vietnam, coordinatedby the OFFLU network are already addressingthese issues of utmost importance for influenzamonitoring. In addition, access to data on ecologyand animal movement should be made available tofurther understand the epidemiological landscapeof influenza viruses.Coordina on across sectors and ins tu ons• Develop a mechanism for sharing disease informationbetween the Ministries of Health, Agriculture andForestry. Existing disease surveillance andreporting systems could be supplemented toinclude a function for sharing and integratingreports in order to perform joint analysis.• Find mechanisms to operationalize One Healthactivities through newly formed steering committeemeetings or existing coordination mechanisms.• Develop mechanisms for connecting One Healthresearch and practice with policymakers. Indeedpolicy makers represent one of the main usersof the results of research program that should betranslated into concrete actions and policies.One Health China in Action-Rabies Awareness Campaignin Yulin, Guangxi, September 2011, FAO ECTAD ChinaDucks at Poyang Lake, Jiangxi, January 2010,FAO ECTAD China
  13. 13. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT12ministries involved in the prevention and controlof emerging diseases. This steering committeemeeting would also interact extensively with theUN Theme Group on Health, making sure nationalpriorities are taken into consideration while guidingthe UNTGH in the implementation of its activities.Promote repor ng of disease in wildlife,livestock, and human popula ons by:• Employing social scientific approaches to betterunderstand the needs and demands of variouspopulations and stakeholders.• Providing incentives and remove disincentives fordisease reporting.Par cipate in regional One Health networksand develop leadershipSeveral regional networks are being establishedconsisting of university, government, and privatesector One Health researchers and practitioners,which already include Chinese researchers. Thesenetworks-a ‘One Health Network”, ‘EcohealthNetwork for Asia’, and ‘communities of practice’-associated with various international agencyprograms (WHO TDR, IDRC, USAID RESPONDand others) aim to facilitate regional collaborativeresearch and training for One Health research andpractice.• Identify researchers and students and facilitatetheir participating in these new regional activities,including developing leadership roles.• Ensure participation of researchers and studentsin regional and international meetings andconferences on One Health on an ongoing basis.• Participate in upcoming meetings in Chiang Rai,Thailand (Mae Fah Luang University, IntegrativeHealth Research Symposium-VulnerablePopulations, Vulnerable Ecosystems) andKunming (EcoHealth 2012). Participate in regionalshort courses and workshops currently beingdeveloped in association with the above programsand meetings.Develop One Health university curricula andprofessional trainings• Develop coursework on One Health for students inschools of medicine, animal health, and forestry/environment/wildlife. Integrate students fromvarious schools in common coursework, in orderto foster familiarity and personal connectionsbetween future experts in the various fields.• In the framework of existing training courses forprofessionals and administrators already employedby the Ministries, promote the concept of OneHealth and build bridges between disciplines. TheField Epidemiology Training Program (FETP) ofChina CDC and the Field Epidemiology TrainingProgram for Veterinarians (FETPV) of Ministry ofAgriculture provide examples of the feasibility andeffectiveness of such training courses.Establish a na onal technical One Healthsteering commi ee mee ngFood safety, like One Health, is the responsibilityof many ministries and bureaus, each with its ownarea of expertise and authority. In 2010, the CentralState Council created a special Committee onFood Safety. The objective of the Committee is tocoordinate and harmonize the many Ministries andbureaus involved in the successful administrationof food safety. Although not necessarily atthe same level, a similar steering committeemeeting focusing on the implementation of OneHealth would provide leadership and direct thecoordination and harmonization of the variousThe 3rd Training Module of China FETPV, Beijing, June2011, FAO ECTAD China
  14. 14. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT13Annex 1: Glossary• Ecotone – The boundary or transition zone between two adjacent ecological systems. They are knownto act as local ‘hotspots’ where biological activity is concentrated, including pathogen transmission eventssuch as infection of an “accidental host” that can lead to disease emergence. The extent and types ofecotones potentially contributing to disease emergence tend to increase exponentially with natural habitatloss and economic development in the absence of sound urban and regional planning.• Ecosystem Approach – The application of science of ecology to a conservation or public healthproblem including prevention and control of an emerging infectious disease. It includes using a holisticperspective and systems thinking, as well as specific principles and methods from systems ecology,landscape ecology, community ecology, and population ecology.• Landscape Epidemiology – A field of study that merges concepts and methods from classicalepidemiology and landscape ecology to attempt to determine the factors that influence the frequencyand distribution of disease. It employs geographic information systems, remote sensing, and statisticalmethods including spatial statistics and theories of landscape ecology. It has been applied analytically to avariety of emerging zoonotic diseases, including malaria, hantavirus, Lyme disease and Chagas disease.• Ecohealth – An emerging field of study that considers how changes in the Earth’s ecosystems affecthuman health. An interdisciplinary approach to research that brings together multiple disciplines (e.g.,physicians, veterinarians, ecologists, economists, social scientists, and policy analysts) to study andunderstand how changes in biological, physical, social, and economic systems impact human health. Aform of integrative science that includes participatory methods, often incorporating elements of communityparticipatory action research (COPAR).• One Health – A holistic approach to focused on the control of infectious disease. It requires collaborationamong professionals from across different disciplines have an understanding and appreciation of the linksamong human, animal, and ecosystem health, and the importance of and commitment to working togetherto address health challenges• Transdisciplinary – A form of integrative research that is integrative, employs a holistic and/or systemsand participatory approach, combines knowledge from outside as well as with academia to address a ‘realworld’ problem.Poyang Lake National Nature Reserve, Jiangxi, June 2008, FAO ECTAD China
  15. 15. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT14Annex 2: AgendaUN CHINA ONE HEALTH EVENTConvened by the UN Theme Group on HealthSub-working group on Diseases at the human-animal-interfaceAn Eco-system Health Approach to Address Emerging Infectious Diseases in China29-30 June 2011, Beijing ChinaDay 108:30 – 09:00 Registration09:00 – 09:45 Welcome and introductions- Opening remarks, UNTGH, DG VB China, DG MoH, SFA, EU, WHO, FAO, USAID- Introduction of the workshop process09:45 - 10:30 Keynote speech: Agriculture, Environment and Emerging infectious diseases of humans(speaker: Bruce Wilcox, University of Hawaii)10:30 – 10:40 Group photograph10:40 – 11:10 Coffee breakTheme 1: Lessons Learned from HPAI H5N1 and H1N1 Pandemic Influenza (Chair: China MoH)11:10 – 11:40 Taking Stock of experiences gained and lessons learned from H5N1 HPAI crisis in Asia(speaker: Leslie Sims, consultant, Australia)11:40 – 12:10 H1N1 pandemic influenza: lessons learned (Dr. Xu Zhen, Chief, Branch of RespiratoryDisease Prevention and Control Office for Disease Control and Emergency Response,China CDC)12:10 – 12:50 Lessons learned from H5N1 HPAI in China (Chen Guosheng, Division animal DiseaseControl and prevention, Veterinary Bureau, China MoA)12:50 – 13:10 The influenza gene pool: planning the next pandemic? (Leslie Sims)13:10 – 14:00 Light lunch14:00 – 14:30 DiscussionTheme 2: Integrated Approach to Agricultural Health: Linking Natural Resource Management, Wildlife,Livestock Production and Food Security (Chair: China MoA)14:30 – 15:00 The impact of EID on Food Security (S. Morzaria, FAO Regional Office)15:00 – 15:20 One Health approaches to natural resource management, species conservation andglobal challenges. (Kathryn Campbell, Convention on Biological Diversity)15:20 – 15:45 Dealing with Emerging Infectious Disease threats in China (Prof Zeng Guang, CFETP)15:45 – 16:00 Coffee break16:00 – 16:40 Severe Fever with Thrombocytopenia Syndrome (SFTS) and a new Bunyaviridae (Prof.Liang Mifang, China CDC)
  16. 16. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT1516:40 – 17:00 Discovery of a new Tembusu-Related Flavivirus in Ducks (Prof. Su Jingliang, Laboratoryof Zoonosis of MoA, China Agriculture University)17:00 – 17:15 OH through education – Presentation of FETPV Rabies Case Study (Jia Beibei, FAOECTAD China)17:15 – 17:40 A multidisciplinary approach to answer Food safety challenges in China (Peter BenEmbarek, WHO China)17:40 – 18:10 Discussion and closure of day 118:10 – 19:00 Dinner at the UN compoundDay 2Theme 3: Disease Emergence at the Wildlife Livestock Interface (Chair: SFA)09:00 – 09:20 Take home message from Day 109:20 – 10:00 The Role of Wild Birds in the Spread of Avian Influenza along the central Asian flyway-taking an eco-virological approach. Scott Newman (FAO)10:00 – 10:20 New technologies to understand wildlife migration - how this can be applied to diseasemanagement and conservation. Martin Wikelski (Max Planck Institute)10:20 – 10:45 Coffee Break10:45 – 11:15 The Scientific Task Force on Wildlife Disease and how CMS is addressing wildlifedisease as part of conservation management. Borja Heredia (UNEP-CMS)11:15 – 11:40 Wildlife trade: implication for conservation and disease transmission (LindseyMcCrickard, FAO)11:40 – 12:00 Key take-home messages from Day 1 and 212:00 – 12:45 A roadmap for One Health in China: Discussion12:45 – 13:00 Next steps and wrap up13:00 – 14:00 Light lunch
  17. 17. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT16Annex 3: List of Par cipantsNo Name Title Gender Organization Contact InformationOpening Speech1.ZhangZhongqiuDirector General MVeterinary Bureau, Ministry ofAgriculture (MoA), ChinaEmail: xmjwjch@agri.gov.cn2. Xu MinDeputy DivisionDirectorFHealth Emergency ResponseOffice, Ministry of Health(MOH), ChinaEmail: manage@moh.gov.cn3. Jia JianshengDeputy DirectorGeneralMState Forestry Administration(SFA),ChinaEmail: webmaster@forestry.gov.cn4. Percy Misika FAO Representative M FAO ChinaEmail: percy.misika@fao.org5.MichaelOLearyWHO Representative M WHO ChinaEmail: olearym@wpro.who.int6. Vincent MartinSenior TechnicalAdvisorMFAO ChinaEmergency Center forTransboundary AnimalDiseases (ECTAD) OfficeEmail: Vincent.Martin@fao.org7.Marie-PauleBENASSIFirst Counsellor F EU DelegationEmail: Marie-Paule.BENASSI@eeas.europa.eu8. Daniel ScharRegional EmergingInfectious DiseasesAdvisorMRegional DevelopmentMission Asia (RDMA),United States Agency forInternational Development(USAID), BangkokEmail: dschar@usaid.govSpeakers9. Bruce WilcoxProfessor of Ecologyand HealthMUniversity of HawaiiIntegrative GraduateEducation and ResearchTraineeship (IGERT)Integrating Ecology,Conservation and PathogenBiologyEmail: wilcox.bruce@gmail.com10.Leslie DavidSimsConsultant, DiseaseControl ManagerMAsia Pacific VeterinaryInformation ServiceEmail: vetpath00@yahoo.com.au11.ChenGuoshengDirector MDepartment of DiseaseControl, Veterinary Bureau,Ministry of Agriculture (MoA),ChinaEmail: xmjwjch@agri.gov.cn12. Xu Zhen Deputy Director FDepartment of DiseaseControl and EmergencyResponse, China CDCEmail: web@chinacdc.cn13.SubhashMorzariaRegional Manager MECTAD, FAO Regional Officefor Asia and the Pacific (RAP)Email: subhash.morzaria@fao.org
  18. 18. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT1714.KathrynCampbellProgramme Officerfor Scientific,Technical andTechnologicalMattersFConvention on BiologicalDiversity-CanadaEmail: kathryn.campbell@cbd.int15. Zeng GuangSenior EpidemiologyExpertMChina Field EpidemiologyTraining Program, China CDCEmail: zeng4605@vip.sina.com16. Liang MinfangDirector of ChinaCDCs Virus InstituteDirector of Institute forViral Disease Control andPrevention, China CDCEmail: office606@chinaaids.cn17. Su Jingliang ProfessorLaboratory of Zoonosisof MoA, China AgricultureUniversityEmail: sujl@cau.edu.cn18. Jia BeibeiNational VeterinaryEpidemiologistF FAO China/ECTAD OfficeEmail: Jia.Beibei@fao.org19.Peter BenEmbarekFood SafetyTechnical OfficerM WHO ChinaEmail: benembarekp@wpro.who.int20. Scott NewmanEMPRES WildlifeHealth and EcologyUnit CoordinatorMEMPRES Wildlife Health& Ecology Unit, FAOHeadquartersEmail: scott.newman@fao.org21.MartinWikelskiDirector M Max Planck Institute-GermanyEmail: martin.wikelski@uni-konstanz.de22. Borja HerediaScientific andTechnical Officer/Senior AdvisorMCMS Secretariat/ASCOBANSSenior AdvisorEmail: bheredia@cms.intParticipants23. Thomas PavieDeputy AgriculturalAttachéM French Embassy, ChinaEmail: Tomas.pavie@dgtresor.gouv.fr24.Amelie Martin-DarrasVeterinarian PublicHealth ConsultantF French Embassy, ChinaEmail: amelie.darras@ambafrance-cn.org25. Shi Jianzhou MHarbin Veterinary ResearchInstitute, Chinese Academy ofAgricultural Sciences (CAAS)Email: sjz@hvri.ac.cn26.JavierBurchardExpert in Agriculture,Agro-food andSanitary andPhytosanitary (SPS)M EU-China Trade ProjectEmail: javierburchard@euctp.org27. Yang Tingting Project Officer F EU-China Trade ProjectEmail: yangtingting@euctp.org28. Niu Xuejiao Project Officer F EU-China Trade ProjectEmail: niuxuejiao@euctp.org29. Dong JieNational ProgrammeAssistantF WHO ChinaEmail: dongji@wpro.who.int30.ZhangXiaodongProgramme Officer M WHO ChinaEmail: zhangxia@wpro.who.int
  19. 19. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT1831. Sirenda Vong Team Leader M WHO ChinaEmail: vongs@wpr.who.int32. Qian Yingjun Programme Officer F WHO ChinaEmail: qiany@wpro.who.int33. Yu HailunPublic InformationOfficerF WHO ChinaEmail: yuji@wpro.who.int34.SodnomdarjaaRuuragchAdvisor MState Central Veterinary Lab.,Ulaanbaatar, Mongolia35. Liang Yan F Netherland Embassy, ChinaEmail: Pek-vws@minbuza.nl36. Ma Shichun Senior Veterinarian MChina Animal Disease ControlCentreEmail: shichunma16@yahoo.com.cn37. Yang Lin Senior Veterinarian FChina Animal Disease ControlCentre38. Chi Lijuan Veterinarian FChina Animal Disease ControlCentre39. Wei Wei Veterinarian MChina Animal Disease ControlCentre40. Jia YoulingPresident of theCVMAMChinese Veterinary MedicalAssociation Institution(CVMA)mail: jiayl@agri.gov.cn41.HuangXangyangVice GeneralSecretaryF CVMAEmail: hxy823@126.com42. Wei Ying Coordinator F Liaison Department, CVMAEmail: cvma@cvma.org.cnwjibm@hotmail.com43. Feng Ye FChangchun VeterinaryResearch Institute, ChineseAcademy of AgriculturalSciences (CAAS)Email: ye722@yahoo.com.cn44. Lyle FearnleyMedicalAnthropologistMUniversity of California,Berkeley, USAEmail: lyle.fearnley@gmail.com45. Peng Daxin Professor MCollege of VeterinaryMedicine, YangzhouUniversity, ChinaEmail: pengdx@yzu.edu.cn46. Luo Shujin Professor F Peking University, ChinaEmail: luo.shujin@pku.edu.cn47. Zhang Tingting F Peking University, ChinaEmail: ztt1715113@yahoo.com.cn48. Mai TranExecutive VicePresidentFAsia, Health & Wellness,Ruder Finn Public RelationsEmail: mtran@ruderfinnasia.com49.GerdFleischerProgramme DirectorSino-German Projecton Food safetyMGerman Agency forInternational Cooperation(GIZ)Email: Gard.fleischer@giz.de
  20. 20. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT1950. Guo Nan Project Manager F GIZ Email: Nan.guo@giz.de51. Jin Lei Project Officer M GIZ Email: Lei.jin@giz.de52. Wang Zhiliang Director FNational Diagnostic Centerfor Exotic Animal Diseases,China Animal Health andEpidemiology Center(CAHEC)Email:zlwang222@yahoo.com.cn53. Teng XiangyanPrincipal ofInternationalVeterinary AffairsF CAHECEmail: rosesnowlinda@hotmail.com54. Fan WeixingHead of ZoonoticDisease surveillanceLaboratory CenterM CAHECEmail: naqi@epizoo.org55.BabaSoumareChief Animal HealthOfficerMAfrican Union Inter AfricanBureau for Animal Resources(AU-IBAR), KenyaEmail: Baba.soumare@au-ibar.com56.MeenakshiNagendranProgram Officer FAsian Elephant ConservationFund U.S. Fish and Wildlife(USFWS-USA)Email: meenakshi_nagendran@fws.gov57. Xun Lili Assistant Professor FChina Academy of SocialSciencesEmail: xunll@cass.org.cn58.RuanXiangdongDeputy Director ofWildlife ProtectionDivisionMState Forestry Administration(SFA), ChinaEmail: xdruan@163.com59. Luo YingDirector of WildlifeProtection DivisionM SFA Email: ly_sfa@yeah.net60. Sun Heting MWildlife Surveillance Station-ShenyangEmail: webmaster@forestry.gov.cn61. He HongxuanExecutive DeputyDirectorMChinese Academy ofSciences (CAS)Email: hehx@ioz.ac.cn62. Qian Fawen Deputy Director MNational Bird Banding Center,ChinaEmail: cranenw@caf.ac.cn63. Sun YanNational ProjectDirectorMVeterinary Bureau, Ministry ofAgriculture (MoA), ChinaEmail: xmjwjch@agri.gov.cn64. Xu Tiangang MVeterinary Bureau, Ministry ofAgriculture (MoA), ChinaEmail: xu_tiangang@hotmail.com65. Tang Qing Rabies Expert FCenters for Disease Control(CDC)66. Sun Hui M China CDCEmail: web@chinacdc.cn67. Ni Daxin M China CDCEmail: web@chinacdc.cn
  21. 21. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT2068. Pei Yingxin F China CDCEmail: web@chinacdc.cn69. Shen Jichuan F China CDCEmail: web@chinacdc.cn70.LindseyMcCirckardLivestock/veterinaryspecialistM FAO HeadquartersEmail: lindsey.mccrickard.fao.org71. Edgar KaeslinForestry OfficerWildlife andProtected AreaManagementMForestry Department,FAO HeadquartersEmail: edgar.kaeslin@fao.org72. Qin XinyanCoordinationOfficer of Influenzaand EmergencyManagementFInfluenza and EmergencyManagement, UNDP ChinaEmail: Xinyan.qin@undp.org73. Cai YingAssociateProgramme OfficerF UNDP ChinaEmail: Ying.cai@undp.org74. Xue Bo MMinistry of Health (MoH),ChinaEmail: manage@moh.gov.cn75. Guo FushengNational TechnicalAdvisorM FAO China/ECTAD OfficeEmail: Fusheng.Guo@fao.org76. Ma YuanyuanProgram/OperationAssistantF FAO China/ECTAD OfficeEmail: Yuanyuan.Ma@fao.org77. Tang Hao FETPV Coordinator M FAO China/ECTAD OfficeEmail: tang.hao@fao.org78. Lu Feng Project Assistant F FAO China/ECTAD OfficeEmail: Feng.Lu@fao.orgMedia79. Jane Qiu Freelance writer F Nature Publishing GroupEmail: jane@janeqiu.com80. Huang Jingling Correspondent F The Associated Press Email: gwong@ap.org81. Daryl Loo Correspondent M Bloomberg82. Li Yao Reporter News Center, China DailyEmail: liyao@chinadaily.com.cn83. Lv Nuo Correspondent M Xinhua News Agency84. Hu Hao Correspondent Xinhua News AgencyEmail: haohu@xinhuanet.com85. Zhang Yang Correspondent Xinhua News Agency86. Tong Lan Correspondent Xinhua News Agency87. Zhang Qiao Correspondent M Xinhua News Agency88. Wang Shen Photographer Xinhua News AgencyEmail: mrshenwang@gmail.com
  22. 22. AnEco-systemHealthApproachtoAddressEmergingInfectiousDiseasesinChinaREPORTONTHEUNCHINAONEHEALTHEVENT21AcknowledgementThe organizers of the meeting and authors of this report would like to express their gratitude to theMinistry of Health, Ministry of Agriculture and State Forestry Administration, as well as to the nationalresearch institutions and partners who delivered high level presentations and provided invaluable insightson the One Health topic.They would like to thank the international experts who participated in the meeting, including the membersof the scientific task force on wildlife diseases for their excellent presentations and contributions to thediscussion.A special thank also goes to the United States Agency for International Development (USAID) for itsfinancial contribution to this event and continued support to China in the fight against current as well asnew infectious diseases.The organizers also would like to acknowledge the United Nations Development Programme (UNDP) andits “Capacity Building for National Prevention and Preparedness for Avian and Human Influenza Pandemicin China” program for its contribution to the smooth organization of this event, including the provision ofsimultaneous translation, the translation and printing of this report.Finally, the authors of this report would like to thank Dr. Sirenda Vong, World Health Organization (WHOChina), for his thorough revision and suggestions to improve the final report, as well as Mr. Guo Fushengand Mr. Ning Haiqiang, the FAO Emergency Center for Transboundary Animal Diseases (ECTAD) Office,for their revision of the Chinese version.
  23. 23. An Eco-system Health Approach to AddressEmerging Infectious Diseases in China29-30 June 2011, Beijing ChinaREPORT ON THE UN CHINA ONE HEALTH EVENTConvened by the UN Theme Group on HealthSub-working group on Diseases at the human-animal-interface