Uploaded bySilvia Pessah
One health
1) The document discusses several zoonotic diseases including West Nile virus, rabies, and brucellosis. It describes the pathogens, transmission cycles between animals and humans, clinical manifestations in humans, and national surveillance efforts. 2) For diseases like rabies and brucellosis, the national surveillance involves mandatory reporting of human cases, monitoring of infected animals, and collaboration between human and veterinary agencies. 3) One health approaches discussed include integrating epidemiological data between human and veterinary fields to more rapidly detect and respond to zoonotic outbreaks.
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One health
- 1. 1 One World OneHealth Silvia Pessah-Eljay. MD., MPh., MSc. Epidemiology Division. Health Services. Ministry of Health. Feb, 2016
- 2. 2 Chinese Zhou dynasty (11thcentury BC) Concept of One Health Germ theory (19th - 20th century) Greek comparative medicine (3th century BC) C. Schwabe (20th century) J. Zinsstag (21th century) Torah (30th century BC)
- 3. 3 ✓ Cooperation betweenhuman and veterinary medicine in selected endeavors What is One Health Goal of building common knowledge ✓ Increase the knowledge of emerging diseases ✓ Understand and manage the complex relationships between humans, animals, wildlife and environment ✓ Integrate surveillance to reduce time for detection and on time interventions ✓ Develop new approaches to integrate human and veterinary fields on zoonosis ✓ Simultaneous study of zoonotic diseases in people, domestic and wild animals ✓ Building on common pool of knowledge in physiology, pathology, epidemiology and other fields
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- 5. 5 Humans Wild animals Companion andDomestic animals
- 6. 6 Animal Animal Animal Complexity on buildingcommon knowledge Vector Food Water Human Human
- 7. 7 Prevalence in reservoir -Reservoir species (1 or more) - Host population dynamics - Density dependence of transmission - Transmission mechanism - Environmental influences Probability of infection DIRECT: - Human immune defense - Dose - Pathogen genotype DIRECT AND VECTOR: - Duration and proximity of contact VECTOR: - Vector competence FOOD BORNE: - Butchering - Food safety and cooking practices Reservoir-human contact rate DIRECT: - transmission mechanism DIRECT AND VECTOR: - Reservoir population abundance - Spatial overlap - Human risk behavior VECTOR: - Vector abundance - Vector community - Biting rates and preferences FOOD BORNE: - Harvest rate - Human consumption rate - Species preference Spillover forcé of infection Sustained transmission and humans outbreak . Stuttering transmission among humans Jane Mary Doe . Reservoir dynamics – zoonotic or epizootic WestNileDisease,Brucellaabortus Pandemicinfluenza,Y.pestis Ro
- 8. 8 ✓ According tothe National Health Directive – 1940, paragraph 11A, some infectious diseases have a mandatory report ✓ The list includes more tan 70 infectious diseases, divided in 4 sections: ✓Individual and immediate report - International ✓Individual and immediate report – National ✓Individual report ✓Collective report Mandatory diseases report (Israel)
- 9. 9 Mandatory diseases report Disease- Group 1 Main reservoirs Usual mode of transmission to humans Pandemic influenza poultry, ducks, pigs direct contact Hantavirus syndromes rodents aerosol Yellow fever monkeys mosquito bite Ebola, Crimean-Congo HF, Lassa and Marburg viruses variously: rodents, ticks, livestock, primates, bats direct contact, inoculation, ticks Rift Valley fever cattle, goats, sheep direct contact, mosquito bite Disease - Group 2 Main reservoirs Usual mode of transmission to humans Plague no respiratory rats and their fleas flea bite Tularemia rabbits, wild animals, environment, ticks direct contact, aerosol, ticks, inoculation Anthrax livestock, wild animals, environment direct contact, ingestion West Nile fever wild birds, mosquitoes mosquito bite Some mandatory zoonotic diseases
- 10. 10 Mandatory diseases report Disease– Group 3 Main reservoirs Usual mode of transmission to humans Tickborne encephalitis rodents, small mammals, livestock tickbite, unpasteurised milk products Giardiasis humans, wildlife waterborne, person to person Bovine tuberculosis cattle milk Hydatid disease dogs, sheep ingestion of eggs excreted by dog Campylobacter poultry, farm animals raw meat, milk Brucellosis cattle, goats, sheep, pigs dairy products, milk Avian influenza poultry, ducks direct contact Some mandatory zoonotic diseases Disease – Group 3 Main reservoirs Usual mode of transmission to humans Leptospirosis rodents, ruminants infected urine, water Listeriosis cattle, sheep, soil dairy produce, meat products Lyme disease ticks, rodents, sheep, deer, small mammals tick bite Leishmaniosis Rodents, dogs Sand-fly bite Q fever cattle, sheep, goats, cats aerosol, direct contact, milk, fomites Rabies dogs, foxes, bats, cats animal bite Salmonella poultry, cattle, sheep, pigs foodborne
- 11. 11 One health: Fromthe theory to the practice What we re doing in the national level? ✓Cooperation between human and veterinary medicine in selected endeavors ✓Building on common pool of knowledge in epidemiology ✓Integrate surveillance to reduce time for detection and on time interventions ✓Simultaneous study of zoonotic diseases in people, domestic and wild animals
- 12. 12 West Nile Disease(WND) Agent: Flavivirus. ▪ Transmission ▪ Mosquito - borne ▪ Amplifying host: Birds ▪ End host: Human, Horses ▪ Other (transfusion, transplants, breastfeeding ) Transmission cycle Incidental host Primary transmission cycle Incubation: 3 to 14 days Classification according to the disease manifestations ➢ Asymptomatic or subclinical (80%) ➢ Symptomatic (20%) ➢ Acute systemic febrile illness (20%) ➢ Neuroinvasive disease (<1%)
- 13. 13 West Nile Disease(WND) Case definition. Epidemiology Division
- 14. 14 West Nile Disease(WND) Surveillance ▪ Surveillance reports: ▪ Human cases ▪ Mosquitos ▪ Analysis and exchange information ▪ Human cases ▪ Mosquitos ▪ Equine encephalitis
- 15. 15 Rabies Agent andtransmission Agent: RNA virus ()Genus Lyssavirus Lagos bat Rabies virus Mokola virus Australian bat virus Duvenhage virus European bat virus 1 & 2 Transmission: Only by infected mammals In the period 2010-2013 the main rabies transmitters' in Israel were: domestic dogs (58%), cows (27%) and wild animals (10%) Contact with the rabid animal secretions ▪ Infected saliva usually from a rabid animal bite ▪ Other (unusual): Gastrointestinal, wounded skin, respiratory or other (transplants)
- 16. 16 Rabies Clinical manifestationsand National data Incubation period: ➢ No symptoms ➢ Virus transfers from periphery to CNS ➢ No antibody detectable response Acute neurological stage: 2 to 7 days ➢ Furious rabies (80%): ➢ Paralytic rabies (20%) Prodromal stage: ➢ Virus enters to the CNS ➢ Duration between 2 and 10 days to months ➢ No specific symptoms: ✓ Paraesthesia at inoculation site ✓ Malaise, nauseas, fever ✓ Anorexia, insomnia, depression ✓ Anxiety and agitation National data. Ministry of Health – Ministry of Agriculture. ▪ Report is mandatory ▪ Passive surveillance ▪ From 1958 to 2013 were only 9 cases of human cases. ▪ Main health activity against rabies is the post exposure prophylaxis following by the pre exposure prophylaxis in selected cases ▪ Rabies prevention is a join work between the Ministry of Health, the Ministry of Agriculture and the local authorities
- 17. 17 Rabies National data ofhuman cases. Data belongs to the Epidemiology Division. Ministry of Health (63%) (67%) (60%) (37%) (37%) (40%) 0 1000 2000 3000 4000 5000 6000 2011 2012 2013 Vaccine + Serum Vaccine only 13806 13911 14394 15604 3978 4160 4471 4929 0 5000 10000 15000 20000 2010 2011 2012 2013 Advised PEP treatment Number of persons requested advise versus persons that received treatment Treatment (PEP) received 3609 3925 4206 4613 (7.9%) (5.6%) (5.9%) (6.4%) 0 1000 2000 3000 4000 5000 2010 2011 2012 2013 Finished PEP Drop out PEP Number of persons that finished versus people that drop out the PEP
- 18. 18 Rabies Treatment &Prevention Treatment Preventive therapy for rabies is highly efficacious. It includes: Wound cleansing Active and passive immunisation after a recognised exposure Post-exposure prophylaxis is nearly 100% effective at preventing rabies ▪ Active and passive immunization ▪ Active vaccination: ▪ Currently cell-culture derived vaccines are used ▪ Post-exposure vaccination has been very effective since introduction ▪ Passive immunization: ▪ Human rabies-specific immunoglobulin (HRIG) at the start of all primary post- exposure courses of rabies vaccine ▪ The schedule used depends on: ▪ Level of risk (low, medium or high) in the country ▪ Type of exposure (history of the animal/stray, likelihood of infection, etc.) ▪ The individual's immunity (details of previous vaccinations, if any) Eliminating rabies in the reservoir animal species is not possible without an intersectoral approach including collaboration between animal and human health experts.
- 19. 19 ▪ Surveillance reports: ▪Human treatment ▪ Rabid animals Rabies Surveillance Eliminating rabies in the reservoir animal species is not possible without an intersectoral approach including collaboration between animal and human health experts. ▪ Update guidelines and information exchange: ▪ Human treatment ▪ Rabid animals
- 20. 20 Brucellosis Agent andtransmission Agent: Brucella Transmission: different ways Other (transfusion, transplants) B. canis B. pinnipediae B. suis B. mellitensis B. abortus Wounded skinRespiratoryGastrointestinal Contact with the infected animals and its secretions ▪ Direct contact with infected animals or its secretions ▪ Ingestion of unpasteurized dairy products
- 21. 21 Brucellosis Clinical manifestationsand National data Incubation period: 5 days to months Clinical manifestations: ➢ Generalized: ➢ Fever, malaise, hepatomegaly, articular diffuse pain, depression ➢ Focalized: ➢ Osteomyelitis, arthritis focalized, orchitis, epididymitis, neurobrucellosis, endocartitis, etc. Duration of the disease: ➢ Acute: 1 – 8 weeks ➢ Sub-acute: 9 52 weeks ➢ Chronic: > 52 weeks National data. Ministry of Health ➢ Report is mandatory since 1951 ➢ Passive surveillance ➢ In the past years there are non changes in the case definition ➢ Incidence cases reported in the last years seams to be close to the real cases (?) Mortality rate: <2% EPIDEMIOLOGICAL CASE Probable case: Clinical symptoms and one of the following: Confirmed case: Clinical symptoms and one of the following: ✓ Epidemiological link with confirmed human or animal case ✓ IgM by SAT or BMAT 160 or higher ✓ PCR positive for Brucella in clinical sample ✓ Rose Bengal positive ✓ Positive culture of Brucella (generally from bone marrow or blood) ✓ Increase of 4 fold IgM in two different blood samples within at least 2 weeks
- 22. 22 Brucellosis Number of casesand incidence of Brucellosis. 2004 - 2014 Brucellosis incidence (x100,000) according to health districts. 2000-2014 0 2 4 6 8 0 100 200 300 400 500 600 700 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Case number Incidence 0 5 10 15 20 25 30 2009 2010 2011 2012 2013 2014 Arabs 7 6.4 6.4 9.1 15.7 28.9 Jews&Others 0.2 0.2 0.3 0.1 0.2 0.1 0 5 10 15 20 25 30 35Incidencex-100,000 Brucellosis and nationality. 2009 - 2014 0 10 20 30 40 50 60 2009 2010 2011 2012 2013 2014 Incidencex-100,000 דרום עכו נצרת Incidence (x100,000) in 3 health districts. 2009-2014 National data of human cases. Data belongs to the Epidemiology Division. Ministry of Health
- 23. 23 ▪ Surveillance reports: ▪Human cases ▪ Animal cases ▪ Analysis and exchange information ▪ Human cases ▪ Animal cases Brucellosis Surveillance Treatment Curative: antibiotics Preventive: Education to avoid consuming unpasteurized milk and milk derivatives Barrier precautions for hunters and professionals at risk (butchers, farmers, slaughterers, veterinarians) Careful handling and disposal of afterbirths, especially in cases of animal abortion Serological or other testing of animals; immunization of herds/flocks may be envisaged; eliminate infected herds/flocks.
- 24. 24 Avian influenza Other zoonoticdiseases with collaborative work Tularaemia (??) Leishmaniosis Salmonellosis Leptospirosis (??) Q fever (??)
- 25. 25 Consensus among stakeholders Commitment by regional organizations Collaboration among professionals Coordination among partner agenciesCreate aroad map for implementation and sustainable changer. Meet and understand new global challenges Gain scientific knowledge to create innovative programs to improve health Cooperation among interdisciplinary groups, Consolidate into a broad coalition Commitment by national government Complexity on building common knowledge
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