One Health: An opportunity for an interprofessional approach to healthcare

One Health: An opportunity for an interprofessional approach to healthcare

One Health: An opportunity for an interprofessional approach to healthcare

ReportReport:

Courtenaya M., Sweeneyb, J., Zielinskab, P., Blakec, S.B. and  La Ragioned, R. (2015):One Health: An opportunity for an interprofessional approach to healthcare. Journal of Interprofessional Care. Volume 29, Issue 6, 2015. doi: htp://10.3109/13561820.2015.1041584

Summary

One Health has been viewed as the collaborative effort between professions and disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment.

For One Health principles to be operationalised, interprofessional education and interprofessional collaborative practice are essential. However, interprofessional initiatives between the human health professions and veterinary medicine focus primarily on patient care in the human health setting. The purpose of this report was to describe two models of collaboration between human and veterinary medicine that have been designed to address human and animal health challenges in practice. Initiatives that involve this cooperation are providing access to affordable and clean drinking water. Implications linked to these initiatives are explored in relation to the need for an interprofessional approach to attain optimal health for people, animals, and the environment.

Article appeared on the Taylor & Francis online platform at: http://www.tandfonline.com/doi/abs/10.3109/13561820.2015.1041584?journalCode=ijic20

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‘One Health, One Medicine’ Using research to assist both man and beast

‘One Health, One Medicine’ Using research to assist both man and beast

‘One Health, One Medicine’ Using research to assist both man and beast

“Research funded by the Wellcome Trust and implemented jointly by UK and Kenyan-based institutions investigates epidemiology of zoonotic diseases-these are diseases transmitted between animals and people”

PAZ ProjectDrive into a shamba, a Kenyan small-holding, and you can observe first hand the close relationship rural Kenyans hold with their animals: Men ploughing the fields with teams of cattle; women milking cows and goats or using fresh dung to floor their houses; poultry, cats, dogs and children playing together. Pigs, goats and sheep wander in and out of houses, latrines and kitchens, picking at anything remotely edible, all categories of household wastes included.

All the while you are also made aware of the trappings of poverty: pot-holed tracks, no running water or electricity and children bearing the tell-tale pot bellies of parasitic worm infection. Livestock often show overt signs of disease, ill thrift and anaemia being particularly common.

A stereotypical view of Africa, maybe, but a view that is none-the-less a reality and that, when you stop to look, can give an insight into the diseases encountered by those living in such communities. In these marginalised communities, zoonotic diseases – pathogens transmitted between animals and people – exert a heavy burden.

The PAZ (People, Animals & their Zoonoses) project, funded by the Wellcome Trust, brings together a multidisciplinary team of scientists from the School of Biological Sciences at the University of Edinburgh, the International Livestock Research Institute in Kenya and the Kenya Medical Research Institute. Under the project human and animal health teams will visit more than 450 homesteads in Western Kenya over 3 years, collecting data and samples from people, cattle and pigs, while offering health checks and advice or referral to those who require it.

Bringing basic health care facilities directly to the people and livestock of Western Kenya is one of the outcomes of the project, although it is the future outcomes of this research on which the greatest value is placed. Following a ‘One Health’ paradigm, the project will address both human and animal health, and its research agenda includes an effort to assess the true burden of zoonotic diseases in both humans and livestock. The project is the first to focus on quantifying the importance of zoonotic diseases in the context of other infectious diseases, understanding in detail the factors that put livestock and people at risk. It will trial new field-appropriate diagnostic tests and work on designing livestock-targeted interventions that are reasonably cheap and easy to implement and that may have an impact on human public health.

The PAZ project brings together epidemiologists, veterinarians, medical health professionals and laboratory technologists working as a single team in a study area covering a large proportion of the Western Province of Kenya, stretching from Lake Victoria in the south along the Ugandan Border towards Mount Elgon in the North.

The important zoonotic diseases which will be studied by the project include Brucellosis, Bovine TB, Q-fever, endemic Rift Valley Fever, Cysticercosis and zoonotic Trypanosomiasis. The possibility of acquiring these diseases within most shambas is high, due to the abundance of risk factors, both observable to the naked eye and those of a more hidden nature. A natural environment conducive to transmission, regular close contact between people and their animals, access of those animals to human waste, little preventative health provision for domestic stock, inconsistent meat inspection, and poor quality food and forage for both humans and animals all contribute to a high risk of acquiring infections. In addition, the presence in these same populations of humans and livestock of other, non-zoonotic diseases, such as HIV/AIDS may increase the chance of individuals acquiring a zoonotic disease in the first place.

For many people in rural Kenya today, zoonotic disease will remain undiagnosed or misdiagnosed. The same is true for their livestock. A multitude of factors are involved in this under-diagnosis: a lack of health seeking behaviour, the prohibitive cost of medical services, lack of veterinary service delivery, poor diagnostic test availability and lack of awareness amongst the population, or even the local medical and veterinary services. This is well demonstrated by the ubiquitous diagnosis of malaria for anyone suffering a fever – while malaria is undoubtedly a very serious health issue, its over-diagnosis hides many other problems.

To compound this, people living in Kenya and similar countries may easily fall under the health policy radar – many are born, live and die without official record being made of them, they have a weak, or non-existent, political voice and the causes of their deaths are never recorded. Thus, while these zoonotic diseases are grouped as ‘neglected zoonotic diseases,’ it would be equally correct to identify them as ‘diseases of neglected populations’. Two tenants at the core of the PAZ project’s ‘One Health’ paradigm are the belief that human and animal health are irrevocably entwined and that the improvement of both requires close collaboration between the medical and veterinary professions with support from allied disciplines. The greater understanding of the link between human and animal health which the project aims to develop will mark the first step in addressing the problem of neglected zoonotic diseases internationally. (Eric M. Fevre – Lian F. Doble, University of Edinburgh,  www.atomiumculture.eu) – derstandard.at/1308680366514/One-Health-one-Medicine-Using-research-to-assist-both-man-and-beast

Article originally appeared at: http://derstandard.at/1308680366514/One-Health-one-Medicine-Using-research-to-assist-both-man-and-beast

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Deforestation linked to rise in cases of emerging zoonotic malaria

Deforestation linked to rise in cases of emerging zoonotic malaria

Deforestation linked to rise in cases of emerging zoonotic malaria

Research suggests environmental changes are driving increase in Plasmodium knowlesi malaria – an infection usually found only in monkeys – among people in Malaysia.

MacaqueA steep rise in human cases of P. knowlesi malaria in Malaysia is likely to be linked to deforestation and associated environmental changes, according to new research published in Emerging Infectious Diseases. The study, led by the London School of Hygiene & Tropical Medicine, is the first to explore how changes in land use are impacting the emergence of the disease.

Plasmodium knowlesi is a zoonotic malaria parasite, transmitted between hosts by mosquitoes, which is common in forest-dwelling macaque monkeys. Although only recently reported in humans, it is now the most common form of human malaria in many areas of Malaysia, and has been reported across southeast Asia. In recent years, Malaysia has seen widespread deforestation alongside rapid oil palm and other agricultural expansion. It is thought changes in the way land is used could be a key driver in the emergence of P. knowlesi, but until now this has not been investigated in detail.

The study focused on the Kudat and Kota Marudu districts in Sabah, Malaysia, covering an area of more than 3,000km² with a population of approximately 120,000 people. Researchers used hospital records for 2008-2012 to collect data on the number of P. knowlesi malaria cases from villages in the districts. Information collected from satellite data helped the team to map the local forest, land use, and environmental changes around 450 villages, in order to correlate how these changes might affect human infection.

They found that the number of P. knowlesi cases was strongly linked to deforestation in areas surrounding the villages.  This could be explained by a number of factors, including humans coming into closer contact with the forest inhabited by the macaques and the mosquito vectors, due to employment in tree clearance and expanding agriculture. Another factor could be that as land use changes in this way, macaque populations are becoming more densely concentrated in areas of forest where humans are present.

Lead author Kimberly Fornace, Research Fellow at the London School of Hygiene & Tropical Medicine, said: “The dramatic rise in the number of P. knowlesi malaria cases in humans in Malaysia in the past ten years has been most common in areas with deforestation, as well as areas that are close to patches of forest where humans, macaques and mosquitoes are coming into closer and more frequent contact. This suggests that there is a higher risk of P. knowlesi transmission in areas where land use is changing, and this knowledge will help focus efforts on these areas and also predict and respond to future outbreaks. Given our findings, we view deforestation as having distinct public health consequences which need to be urgently addressed.”

The findings show the study region had undergone significant environmental changes, with many villages substantially affected by deforestation. During the five-year study alone, 39% of the region’s villages lost more than 10% of the forest cover in their surrounding 1km radius, and half of villages lost more than 10% within a 5km radius. Overall, forest cover in Kudat and Kota Marudu declined by 4.8% during the study period.

The findings also confirmed that P. knowlesi is the most common cause of human malaria cases in the region.

The authors note that some cases of malaria may have been unreported as they were asymptomatic or resolved without treatment. P. knowlesi can be mistaken for other forms of human malaria in microscope diagnosis, however the authors adjusted for this uncertainty in the study. They also highlight that the environmental data were limited as they could not discriminate between types of forest or crops, meaning further work is needed to investigate whether vegetation type is a risk factor for P. knowlesi.

This study was funded by the Biotechnology and Biosciences Research Council, Economic and Social Research Council, Medical Research Council, and Natural Environment Research Council, through the Environmental and Social Ecology of Human Infectious Diseases Initiative (ESEI).

The research was carried out in collaboration with the Infectious Disease Society Kota Kinabalu Sabah, Malaysia; Hospital Queen Elizabeth Clinical Research Centre, Malaysia; Menzies School of Health Research, Australia; Sabah Department of Health, Malaysia; and the University of Glasgow, UK.

Publication:

Article originally appeared on the London School of Hygiene and Tropical Medicine website on 18th December, 2015 at: http://www.lshtm.ac.uk/newsevents/news/2015/deforestation_malaria_link.html

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Bats, People and a complex web of disease transmission

Bats, People and a complex web of disease transmission

Bats, People and a complex web of disease transmission

It might seem strange that after millennia of human history, outbreaks of new, ’emerging’ diseases that we’ve never seen before still regularly occur around the world, some of which go on to become pandemic. However, this may not be so surprising considering how quickly and how intensively the world is changing – expansion of populations, industries, and travel and trade networks are all thought to play a role.

BatsMany current strategies to deal with emerging diseases are reactive, rather than proactive, i.e. the response is focused on dealing with outbreaks after they happen. But what if we could improve our response by projecting where the next outbreak will be and how it will occur? Or better yet, prevent it altogether?

This is the aim of the PREDICT programme, a consortium of worldwide disease biologists. Working with several PREDICT members from the EcoHealth Alliance, our team at University College London, in collaboration too with the STEPS-led Dynamic Drivers of Disease in Africa Consortium, aimed to quantify how these global changes affect the risk of emerging bat-borne viruses.

Bats and disease

The majority of human diseases are zoonoses, that is, they originate via transmission from animals, and bats are no exception. Many devastating viral outbreaks of the last 15 years are suspected to have their origins in bats, from Nipah virus disease in 1999 and SARS in 2002 to the recent outbreaks of Ebola disease and Middle East respiratory syndrome (MERS) in the last several years.

We started by mapping out the potential distribution of each of the 33 viruses shared between bats and humans, collaborating with the Vonhof group at Western Michigan University who have been collecting together data on all viruses known in bats, and which species they infect.

Next, we collected together spatial data on global changes and the wider environment, as well as human density and agriculture. This also included data on domestic animals as bat viruses can sometimes reach people through our livestock, and bushmeat hunting, as bats are hunted and consumed in many parts of the world. It’s critical to understand not just whether these factors affect disease emergence, but also through what means.

Virus risk hotspots

We grouped factors together depending on whether they were likely to increase risk through either increasing richness of viruses (the total number of viruses present) or increasing transmission potential from contact between bats and humans.

Using spatial statistical modelling, we then combined all of this into a single risk map. What we see from this is that, overall, there is a large hotspot of risk in sub-Saharan Africa, including West Africa, where the most recent Ebola virus outbreaks have occurred.

Global map of risk of bat-human shared viruses from statistical model based on ecological and human drivers.

However, when we break down the model into whether the risks occur through richness of viruses or bat-human contact, the resulting maps look very different. Central and South America seem to be a risk hotspot because a naturally high diversity of viruses occurs there, and associations in our model suggest this is a result of a high diversity of bat hosts. Contrastingly, South and East Asia seem to a be a risk hotspot because of high bat-human contact potential, a reflection of high densities of humans and domestic animals, as well as bushmeat practices in some areas.

This tells us something critical – that those places where wild bat populations host many viruses do not seem to be the same as those places where people frequently come into contact with bats, and that both contribute to risk in a different way.  Our risk maps take that first step in untangling the complex, multi-step process behind the emergence of a new bat-borne virus in humans.

One Health

In the last decade, there has been a real shift in the way public health is viewed to a much more modern, holistic – or ‘One Health‘ – approach. This acknowledges that animal health and human health are fundamentally connected through our wider ecology, and has guided much of our thinking in the Dynamic Drivers of Disease in Africa Consortium.

Future work will be able to delve deeper into the specific connections between bats and people that could help prevent future disease outbreaks. Although there is much we have yet to understand, what is clear is that bats should not be vilified for their association with emerging diseases. They can be key contributors to environmental stability and ecosystem services, and – admittedly, more sentimentally – they’re fascinating animals, whose world we’ve only just ventured into.

Kate Jones is Professor of Ecology and Biodiversity at University College London and a partner in the STEPS-led Dynamic Drivers of Disease in Africa Consortium. She will be speaking at the One Health for the Real World: zoonoses, ecosystems and wellbeing symposium, being held at the Zoological Society of London, 17-18 March 2016.

Quantifying Global Drivers of Zoonotic Bat Viruses: A Process-Based Perspective’, authored by Liam Brierley, Maarten J. Vonhof , Kevin J. Olival, Peter Daszak and Kate E. Jones, is published in The American Naturalist.

Article originally appeared on the Steps Centre website at: http://steps-centre.org/2016/blog/bats-people/ authored by Kate Jones and Liam Brierley on 5th January 2016

Kate Jones and Liam Brierley
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One Health: An opportunity for an interprofessional approach to healthcare

Fifteen Years After To Err is Human: A Success Story to Learn From

Fifteen Years After To Err is Human: A Success Story to Learn From

In late 1999, the Institute of Medicine released To Err is Human, a report that grabbed the world’s attention. It stated that up to 98,000 patients die each year in the United States from medical errors.  But little was done to reduce infections and other harms at that time.

In the article, Fifteen Years After To Err is Human, Dr. Peter J. Pronovost, Sr. Vice President for Patient Safety and Quality, Director of the Armstrong Institute for Patient Safety and Quality Johns Hopkins Medicine joined co-authors from HHS, CDC and ARHQ to highlight a key success story in protecting patients. Combined and coordinated efforts to reduce central line associated bloodstream infections (CLABSI) infections turned the tide in thinking that healthcare-associated infections were inevitable, instead showing clinicians and policymakers that these infections can be prevented by great numbers and patient mortality can be decreased.

The authors detail how a change in attitude, driven by five essential elements has led to national success in reducing CLABSI rates. These essential elements include:

  • Reliable and valid measurement systems
  • Evidence-based care practices
  • Investment in implementation science
  • Local ownership and peer learning communities
  • Align and synergize efforts around common goals and measures

In 2009, a national five year CLABSI prevention goal was set at 50% following this approach. By 2013, infections were reduced by 46% in intensive care units.

For more on this success story and insights into the components which led to the dramatic reductions in CLABSI, please visit: BMJ Quality & Safety website.

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Global Disease Detection Stories: Tracking and Taming Zoonotic Diseases in South Africa

Global Disease Detection Stories: Tracking and Taming Zoonotic Diseases in South Africa

Global Disease Detection Stories: Tracking and Taming Zoonotic Diseases in South Africa

A One Health program in South Africa connects physicians and veterinarians to better understand causes of human disease by looking at animals in a new light.

How do you tonsil swab a wild African buffalo? More importantly, why? The answer is that buffaloes are reservoirs for certain “zoonotic” diseases, or diseases that can be passed from animals to humans. Many infectious diseases (such as rabies and Rift Valley Fever) are transmitted through animals, which is why tracking animal diseases that could potentially jump to humans is a crucial aspect of public health. Early detection means spotting these diseases in animals before they make people sick.

Tracking disease in a national park

Dr. Marietjie Venter of the Global Disease Detection program in South Africa, visited Kruger National Park along with Jumari Steyn, a PhD student from the University of Pretoria. As part of a wildlife surveillance program, a skilled group of veterinarians sampled 30 buffalo in three hours. They swabbed tonsils and collected blood, fecal, and stomach content to investigate foot and mouth disease (FMD), which can cause major outbreaks in cattle if they come into contact with infected buffalo.

“Early detection means spotting diseases in animals before they make people sick.”

While buffalo are natural reservoirs for FMD, they are also thought to carry Rift Valley Fever, bovine tuberculosis, and other bacteria and viruses that could potentially spread to humans. The University’s research unit will use the collected samples to investigate for these zoonotic diseases which have been detected in wildlife, farm animals and humans.

An expanded partnership between the Centers for Disease Control and Prevention (CDC) South Africa and the University’s research unit improves surveillance capacity to include priority zoonotic diseases in the region: anthrax, brucellosis, rodent- and bat-borne pathogens, and many others. It also adds additional data collection sites and enhances reporting.

Bridging animal health and human health

Tracking diseases in domestic animals and wildlife has been happening for a long time, but linking that information to humans who are sick or could become sick has not. South Africa has strong surveillance systems; CDC’s role has been to support and expand them through its One Health program.

Buffalo are natural reservoirs for foot and mouth disease.

Buffalo are natural reservoirs for foot and mouth disease.

While it makes sense to get human and animal experts together, this is not an easy task. The One Health initiative has programs all over the world and builds bridges between people who may not otherwise work together. The success of the program lies in the regularity of the exchanges. One Health programs explores connections between human health, animal health, and the environment, bringing together experts in fields as diverse as climate change, farming practices, and wildlife management. According to Dr. Wanda Markotter, the Principal Investigator for CDC’s original agreement with the University of Pretoria, “This new project will significantly enhance the collaboration between the Health and Veterinary faculties to develop joint surveillance and diagnostic programs on zoonotic disease in South Africa and provide feedback to the Ministries of Health and Agriculture in South Africa.”

So back to that buffalo. Are you curious about how those specimens are collected?

       Step 1: Tranquilizer dart.
Step 2: Apply blindfold.
Step 3: Drag with tractor to recovery area.
Step 4: Collect sample.
Step 5: Provide tranquilizer antidote.
Step 6: Run! Doctors treating humans may want to count their blessings.

Originally posted at the CDC website under the Global Health Protection and Security at: http://www.cdc.gov/globalhealth/healthprotection/gdd/stories/south_africa_zoonotic_diseases.html

 

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