Download The Human Public Health Perspective

One Health:
The Human Public Health
Perspective
RADM Ali S. Khan, MD MPH
Assistant Surgeon General, USPHS
Acting Deputy Director, National Center for Emerging
and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
ASTHO One Health Webinar – April 15, 2010
Emergence of 2009 H1N1 Influenza
March – April 2009
• Human infections with a
novel H1N1 influenza virus of
swine origin reported in
California and Texas
• Patients had no known
contact with pigs, indicating
human-to-human
transmission
• Virus: Quadruple-reassorted
swine H1N1 virus
2009 H1N1 Flu: Current Global Situation
As of March 21, WHO reports at least 16,981 deaths due to 2009 H1N1
Human-Animal Cooperation
• Veterinary diagnostic labs are soliciting animal
samples from practicing veterinarians
• USDA-APHIS requesting expansion of SIV
surveillance funds to cover testing for influenza in
other animals, with a focus on companion animals
• 12 of 36 NAHLN labs requested and were granted a
waiver by NVSL allowing them to use NVSL swine
2009 H1N1 assays in non-swine animal species
• Renewed surveillance for novel influenza isolates in
swine
Influenza A Subtypes
H1
H2
H3
H4
H5
H6
H7
H8
H9
H10
H11
H12
H13
H14
H15, H16
N1
N2
N3
N4
N5
N6
N7
N8
N9
Emerging and Re-emerging Infectious Diseases
Rate per 100.000 Population
Death Rates for Typhoid Fever in the U.S
Year
Factors in Emergence
• Genetic and biological factors
• Microbial adaptation and change
• Human susceptibility to Infection
• Physical environmental factors
• Climate and weather
• Economic development and land use
• Ecological factors
• Changing ecosystems
• Human demographics and behavior
• Social, political, and economic factors
•
•
•
•
•
International travel and commerce
Poverty and social inequity
War and famine
Lack of political will
Intent to harm
SARS Clusters Linked
to Hotel M
Canada
Guangdong
Province,
China
F,G
A
18 HCW
F,G
A
Hotel M
Hong Kong
A
Hong Kong SAR
95 HCW
H,J
H,J
K
B
Ireland
K
0 HCW
I, L,M
C,D,E
I,L,M
>100 close contacts
B
C,D,E
Vietnam
Singapore
37 HCW
34 HCW
United
States
1 HCW
First Report of Illness,
October 2007
• MN Dept. of Health notified of cluster of
10 cases of unusual neurological
illness
• Numbness, tingling, weakness in arms
and legs
• Difficulty walking
• All workers at pork processing plant
• Number of ill workers far exceeded
expected background rate of peripheral
neuropathies
• Incidence: 830 cases/100,000 workers
MN Investigation: Clinical Diagnosis
• Illness suggestive of autoimmune
inflammatory neuropathy
• Guillain-Barré Syndrome (GBS)
• Chronic Inflammatory Demyelinating
Polyradiculopathy (CIDP)
• Test results showed something new
• Nerve root inflammation on spinal MRI
• Distinctive, abnormal electrodiagnostic testing
• “Progressive Inflammatory Neuropathy” (PIN)
 Progressive Inflammatory Neuropathy (PIN)
Minneapolis Star-Tribune
MN Plant Investigation: Findings
• Almost all cases worked at “head table”
• Compressed air used to remove pig brains (“blowing
brains”)
• Liquefied brain collected in bucket
• Led to brain splattering and a “brain mist”
•
Additional cases of PIN identified at plants in
Nebraska and Indiana
•
•
Cases were not identified through active investigation
Proverbial “astute clinician” heard about the MN
situation and remembered seeing similar cases
Actions Taken
• Plants discontinued brain blowing and increased
personal protection, including goggles and face
shields
• Notice sent out to state neurologists, other physicians
• Further investigation of PIN is in progress
17
Confirmed Cases of E. coli 0157:H7
By Date of Illness Onset
August-September 2006
Source: USDA
Need for a New Approach
Example – E. coli outbreak in spinach, 2006

Viewed through public health lens: focus on
morbidity, mortality, diagnosis, treatment

Viewed through animal health lens: organism
found in cattle and wild swine in spinachproducing region

Viewed through ecology/hydrology lens:
irrigation system strained due to weather
anomalies
Investigation succeeded only when
information was integrated.
Opportunities for One Health
Embracing One Health
• Recognizing and addressing disease emergence at the
interface of animal, humans, environmental health
• Looking beyond humans to expand opportunities for
disease detection, control, and prevention. Upstream
prevention
• Environmental stewardship
• Examples of human diseases we currently prevent by
concurrently protecting animals:
•
•
•
•
Rabies
Rift valley fever
Brucellosis
Variant spongiform encephalopathy
Putting One Health into Action
• Leadership
• Investment
• Integration
• Research
• Respectful partnerships
The Way Forward
• Insightful leaders have provided vision
• Sometimes the shelf life for vision can be short
• Crossroads between talking about One Health and
truly embracing the new paradigm
• Challenge to us as health professionals
Thinking is easy, acting is difficult,
and to put one's thoughts into action
is the most difficult thing in the world.
-Goethe
Thank You!
RADM Ali S. Khan
[email protected] 404.639.7377
http://blogs.cdc.gov/publichealthmatters/
The views and conclusions of this report are those of the
authors and do not necessarily represent the views of the CDC.
Acknowledgements
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Lonnie King
Carol Rubin
Alison Laing
Millie Trotter
Marguerite Pappaioanou
Brynn Berger