1. “One Health – One Medicine”
Design Proposal for a Distance Education Course:
Introduction to Zoonotic Diseases in Humans and Animals
Tracy L Middleton, DVM, BS
MPH-VPH Candidate
Veterinary Public Health Resident
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Project Objective
To create an introductory (online) course
on zoonotic diseases, focused on teaching
students foundational infectious disease
concepts and then using these to describe
common and important zoonoses
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Project Objective
• Undergraduate interest taking VPM 7721 Epidemiology of
Zoonotic Diseases demonstrated a need for a introductory
level course
– This course is not a replacement for VPM 7721
• The underlying goals in the development of this distance
education course are to:
– Raise awareness of the global impact of zoonoses on the
health of both humans an animals
– Encourage collaboration of medical, veterinary, and public
health professionals in research, prevention, and control of
zoonoses
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Definition of Zoonoses
• A zoonotic disease or zoonoses (pl.) is an infectious
disease transmissible between vertebrate animals and
humans under natural conditions
– Etymology: Greek. “zoion” animal + “nosos” disease
• Animal reservoirs maintain the disease agent in
nature
• Many zoonoses are multifactorial, with complex
cycles of infection
• Humans are often dead end hosts BUT zoonoses
have also originated great pandemics
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Zoonotic Disease Burden
• Zoonoses exist in the environment anywhere humans
and animals intersect
• Of the ~1400 infectious diseases recognized in
humans, 60% are zoonoses
• In the last 40+ years, 75% of the recently emerging
or re-emerging infectious diseases have been
zoonoses
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Salmonella
Zoonotic Disease Burden
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• Zoonotic diseases often seen as a veterinary issue
– Public Health Veterinarians are in short supply in
the United States (GAO, 2009)
• Physicians will not recognize or consider a disease
they do not know about
• Public Health is a diverse field with a population
health focus with the least amount of infectious or
zoonotic disease training
Zoonotic Disease Problem
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Benefits of an Undergraduate
Zoonoses Course
1. Physicians
Human Disease
General
Infectious
Disease
Individual Patient
focused Medicine
2. Veterinarians
Animal Disease
Zoonoses
Prevention and
Control
Population
Medicine
3. Public Health
Epidemiology
Biostatistics
Environmental
Health
Population Health
Principles
Undergraduate Education
IncreasingSpecialization
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• Target audience is 3rd/4th year undergraduates in Public Health
– 5 year BS/MPH degree program course elective
– Pre-Med, Pre-Vet, and other Pre-Professional students
– Prerequisite courses in Biology and Microbiology
• Instructional delivery –
– Traditional lecture-learn format
– Asynchronous and Synchronous Components
– Weekly virtual class discussion every Friday
Course Development
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Course Development
1. Identify
desired results.
• Educational
needs
• Create Goals
and Objectives
2. Determine
acceptable
evidence
• Plan student
exercises
• Create exams
and quizzes
3.Plan learning
experiences
and instruction
• Create lesson
plans
• Select course
materials
Backward Design is a method of designing education curriculum by setting
goals prior to choosing instructional methods and forms of assessment
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Course Development
• Representative zoonotic diseases were chosen using three
criteria:
1. Important human or animal morbidity/mortality
2. Economic impact upon society (i.e. agricultural,
productivity, or tourism)
3. Bioterrorism potential
• Course overlaid on a OSU Academic Calendar to determine
timing of modules and exam schedule
• Objective attainment will be measured by in unit quizzes,
news article analysis, and 3 proctored exams
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Academic Calendar
Each Wednesday, students will be required to submit discussion questions for the Friday
virtual class session
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Future Challenges
1. Development educational content suitable for
eLearning environment
– Accessibility is paramount!
– Copyright law and educational content
2. ODEE approval process plus Quality Matters
accreditation
3. Funding mechanism for teaching and further
course development
18. “One Health – One Medicine”
Human
Medicine
Public
Health
Veterinary
Medicine
Public Health Significance
• Approximately 75% of
emerging/reemerging
diseases are zoonotic
• Zoonoses are responsible
for 2.1B human illnesses
and 1.2M deaths annually
• Improvement needed in
collaboration of Physicians,
Veterinarians, and Public
Health
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Human
Medicine
Veterinary
Medicine
Public
Health
Conclusion
Animal reservoirs maintain growth of the disease agent in nature
Human morbidity and mortality - lasting chronic health effects (i.e. congenital toxoplasmosis, leptospirosis)
Animal morbidity and mortality - in livestock, exotic animals, and pets (i.e. human tuberculosis in elephants)
Zoonoses interfere with the production of animal products and create obstacles to international trade for agricultural economies (i.e. Avian Influenza, Q-fever)
Cost of starting vs. maintaining current disease control programs (i.e. Brucellosis, Rabies)
ILRI reported that endemic zoonoses are responsible for an estimated 99.9% of human illness and 96% of deaths.5 While epidemic zoonoses, like Ebola or WNV in the US, are much more sporadic in both their temporal or spatial distributions, and are much more feared because of their unpredictability and often severity (i.e. Ebola virus).5
The first Ebola case in the outbreak in west Africa dates back to December 2013 in Gueckedou, a forested region of Guinea near the border with Liberia and Sierra Leone. The origin of the virus is the consumption of bushmeat. (Image source: http://www.economist.com/blogs/graphicdetail/2014/12/ebola-graphics?fsrc=scn%2Ftw%2Fte%2Fbl%2Fed%2Fthetollofatragedy)
Image Source: http://wwwnc.cdc.gov/travel/page/infographic-mers-pictogram
As of 2 December 2014, the WHO has been notified of 927 laboratory-confirmed cases of infections with MERS-Cov, including at least 338 related deaths.
Multistate Outbreak of Human Salmonella Infections linked to live poultry in backyard flocks (363 cases, 43 States, 0 deaths, 33% required hospitalization) Trace back investigations identified Mt. Healthy Hatcheries in Ohio as source of chicks and ducklings. This same hatchery associated with multiple outbreaks linked to poultry in 2012 and 2013. Image Source: 2 ducklings public domain: http://www.publicdomainpictures.net/view-image.php?image=39159&picture=ducklings-d
Multistate Outbreak of Human Salmonellosis infectious linked to pet bearded dragons. (166 cases, 36 states, 0 deaths, 37% required hospitalization) Reptiles can be carriers of Salmonella bacteria but appear healthy. They are intermittent shedders of the bacteria.
Human infections with a new avian influenza A (H7N9) virus were first reported in China in March 2013. During the spring of 2013, WHO reported 132 human H7N9 infections with 44 deaths. While some mild illnesses in human H7N9 cases have been seen, most patients have had severe respiratory illness, with about one-third resulting in death. Cases decreased over the summer but picked back up in the fall/winter. Most cases reported had poultry exposure and lived in areas where H7N9 had been found previously. No evidence of sustained human-to-human transmission.
Chikungunya virus first introduced into the Americas in 2013. Since November 21, 2014 local transmission jas been identified in 40 countries and territories in the Caribbean, Central America, South America or North America. A total of 914, 960 suspected and 18,142 laboratory-confirmed cases of CHIKV have been reported. Since this virus is new to the Americas, most people in these regions are immunologically naïve.
Image Source: http://www.cdc.gov/flu/pdf/avianflu/h7n9-reassortment-diagram.pdf
The research clearly demonstrates that zoonotic diseases affect all aspects of our lives whether at home, work, or play.
Medical and Veterinary curriculums are already burgeoning with content. Veterinarians are taught population medicine as a rule while Physicians are taught to focus on a single patient at a time. Public Health Graduate students are training to be researchers, not Public Health Practitioners.
Public Health has recognized the need for a broadening of Public Health education and is now taking it to the undergraduate level.
Image: he Physician http://en.wikipedia.org/wiki/Physician#mediaviewer/File:The_Doctor_Luke_Fildes_crop.jpg
Image: The veterinarian http://www.nlm.nih.gov/exhibition/perez/images/vet.jpg
The destination is chosen first and then the road map is used to plan the trip to the desired destination. So you are teaching to an end point.
ADDIE Model of Design
Dick and Carey Model (Systems Approach Model)
Quality Matters –
ODEE Office of Distance Education and eLearning
Need to restate the objective but solved.
Introductory course not a replacement for VPM 7721
