The Interface Between Human and

Veterinary Public Health

Dr.Kedar Karki
 Historical Epidemiological Transitions

 Paleolithic Age
 Hunters and gatherers

 Nomadic
 Small populations
 Parasitic infections
Historical Epidemiologic Transitions –
1st Transition

• 10,000 years ago

• New social order due to
agriculture
• Zoonoses through animal
domestication
• Increases in infectious diseases
• Epidemics in non-immune
populations
Deadly Gifts
Human Diseases Animal Origin

Measles Rinderpest of
cattle
TB M. bovis of cattle
Smallpox Cowpox
I nfluenza Pigs and Ducks
Pertussis Pigs and Dogs
Malaria Birds

Guns, Germs and Steel − J. Diamond

 Historical Epidemiologic Transitions –
2nd Transition
• Coincided with mid-19th
century Industrial Revolution
• Decreases in infectious
disease mortality
• Increasing life expectancy
• Improved nutrition
• Antibiotics
• “Diseases of Civilization” – cancer,
diabetes, cardiovascular diseases
• Environmental problems
• Chronic diseases
 Historical Epidemiologic Transitions –
3rd Transition

• Last 25 years
• Emerging infectious diseases globally
• New diseases and increases in mortality; first since 19th
century
• Re-emergence
• Antimicrobial resistance
• 75 percent of diseases are zoonotic
• Anthropogenic factors of emergence;
the microbial “perfect storm”
“The Perfect Storm”
− Sebastian Junger

 an ocean tempest due to a rare combination of

factors and circumstances that might occur every
century
 MICROBIAL
EATS

O HEALTH
EMERGENCE,
CTION,

RESPONSE
The “Microbial” Perfect Storm
 Due to special combinations and circumstances
 Relatively common occurrence
 Doesn’t dissipate, but may perpetuate or
accelerate
 Convergence model
WHO Map on World –
Emerging Diseases
Convergence Model
Physical
Genetic and Environmental
Biological Factors
Factors Microbe

Human
Social, Political Ecological
and Economic Factors
Factors

Convergence Model (Microbial Threats to Health 2003)

Factors in Emergence
 Microbial adaptation and change
 Host susceptibility to infection
 Climate and weather
 Changing ecosystems
 Economic development and land use
 Human demographics and behavior
Technology and industry
Factors in Emergence
continued

 International travel and commerce

 Breakdown of public health measures
 Poverty and social inequality
 War and famine
 Lack of political will
 Intent to harm
Multi host Pathogens
 60% of all human pathogens are zoonotic
 80% of animal pathogens
 Ecological generalists
New Dynamic
 Emerging diseases – 70% zoonotic
 New zoonoses
 Food safety
 Antimicrobial resistance
 Agents of bio- and agro-terrorism – 80% zoonotic
 Global trade and movements
 Rapidly Increasing Human Population
• 6.1 Billion people
in 2000

• ~9.4 to 11.2 Billion in 2050

Source: United Nations, World Population Prospects,

The 1998 Revision; and estimates by the Population
Reference Bureau.
Rapidly Increasing Urbanization
• 2000
- 47% world population
living in urban areas
• 2030
- 60% world population
living in urban areas
 The Divided World of 2025 –
8.4 Billion People

 World 1 Advanced nations

(Advances in medicine and food)
 World 2 Middle class
(Livestock Revolution)
 World 3 People in destitution and poverty
(Sources of traditional pathogens)
El Nino

 Leptospirosis
 Hantavirus
 Rift Valley fever
Vectors of Disease
Global Warming
 Shifting and enlarging the incidence and
distribution of disease
 Malaria zone 45% of population to 60%
 Habitat change and disruption via weather
changes
Global Warming Effects on Malaria
Ecosystem
Waterborne Zoonoses

Animals Humans

Waterborne
Disease

Microbial
Pathogens

Water Environment
Waterborne Zoonoses –
Global Threat
 4 billion cases of diarrhea per year
 2-3 million deaths
 Poorly reported
 Zoonotic portion is significant
 Endemic and epidemic
 1.1 billion people with unreliable water supply
Waterborne Zoonoses Pathogens
 Cryptosporidium
 Giardia
 E. Coli 0157:H7
 Salmonella
 Leptospiria
 Toxoplasma
 Campylobacter
 Entamoeba
 Ascarsis
 Viruses and Prions? SARS?
Concentrated Animal Feeding
Operations (CAFOs)

Their Impact on Food Safety and

Healthy Environments
 Foodborne Infections
• Worldwide
 > 2 million people die from diarrhea caused by
contaminated food and water each year
• U.S.
 ~ 76 million persons experience foodborne illnesses (1
in 4 people)
- ~325,000 hospitalizations
- ~5,000 deaths
Most Common Food borne Pathogens
 Campylobacter
 Salmonella
 E. coli 0157:H7
 Yersinia
 Listeria
 Cryptosporidium
 Cyclospora
 Norwalk-like viruses
Livestock 2020 –
The Next Food Revolution
 Global increase and demand for protein and food
of animal origin
 Shift from poverty of 1-2 billion people to middle
class
 “Westernization” of Asia and Latin America
 Concerns with sustainability
 Increases in emerging zoonoses through the
concentration of people and animals
By 2020, There will be 1 Billion
People Over the Age of 60
 30% of US population are baby boomers
 Immuno-compromised population
Movement and Interactions
of People and Commerce
 Distance and speed of travel increased 1000 fold
since 1800
 1.4 billion air travelers/year
 50 million foreign visitors, to US year through,
102 sites
 Antibiotic resistance
 Global trade of food, animals and plants
The Coming Plague
Today’s mingling of people, animals and microbes in
new environments has no historical precedent.
-”We await the coming plague”

- Laurie Garrett
Remote Sites
Pathogen Pollution
 Human and domestic animal populations
 Free-living wild animals
 Example: global decline in amphibian populations
due to chytridiomycosis
 Concern with adverse effects on biodiversity
Chytridiomycosis
Virus Carriers

Fruit bats
Flying Foxes
Nipah Virus
Malaysian Pig Farms
Emerging Infectious
Diseases Translocation

Human
Encroachmen
encroachment
t
Wildlife EID Ex situ contact
Introduction
Ecological
“Spill over”
manipulation
&
“Spill back”

Domestic Human EID

Animal EID Global travel
Agricultural Urbanization
Intensification Biomedical
manipulation
Technology and
Dasazak P. et.al. Industry
Science 2000 287:443
Spill Over and Spill Back
What’s Next?
 Human Monkey pox Cases

Marshfield Clinic and MCW

Matt Kuehnert
Exotic Pets
SARS
Maintenance Host
SARS Airport Screening
 The Lessons of SARS

 The need for multinational collaboration

 Public alarm can lead to huge economic impact -
$80 billion
 Weaknesses in public health infrastructures
 Consequences of poor reporting –disincentives
 A true zoonosis: more to come
 Constant threat due to Emerging Infectious Diseases
in less developed countries
H5N1 Avian Influenza
Pandemic Influenza
The Next Influenza
Pandemic
 Not if, but when
 1918-1919 Experience:
20 million deaths
 150 – 450% increase in patient and hospital
visits
 In 2001 (Asia only), 160
million workdays lost,
and for a pandemic,
6 billion workdays lost worldwide
Bioterrorism
Biodefense
Agroterrorism
 Agents of Bioterrorism

Bacteria, Rickettisia, Total

Category Toxins Viruses (%
Zoonotic)
Anthrax; Botulism; Smallpox 6 (83%)
A Plague; Tularemia Viral Hemorrhagic
Fevers
Brucellosis; Epsilon 5 (80%)
B toxin of C.
perfringens;
Glanders;
Staphylococcus,
enterotoxin B; Q Fever

Multidrug-resistant Hantaviruses; Nipah 4 (80%)

C tuberculosis virus; Tickborne
encephalitis viruses;
Yellow Fever
Most Significant Global Epidemics
Over the Last Decade
 1993 – Hanta virus
 1994 – Plague (India)
 Ebola virus (Zaire)
 1996 – New Variant of CJD
(UK)
 H5N1 influenza (Hong
Kong)
 1998 – Nipah virus
(Malaysia)
 1999 – West Nile
 2000 – Rift Valley Fever
 2001 – Anthrax
 2002 – Norwalk-like
viruses
 2003 - SARS
Implications of Emerging Diseases

 Political
 Social
 Economic
 Psychological
 Environmental
Animal-borne Epidemics
Out of Control: Threatening
the Nation’s Health – 2003

− A report from the Trust

for America’s Health
Findings from the Report
 lack of national program to prevent and control diseases
that impact humans, animals and our food
 There is no coordinated effort or single agency with a
“command and control” responsibility
 There is a lack of effective communications with the public
about these diseases and their impact
 Disease surveillance systems are not linked
 Findings from the Report
(continued)

 Funding for bioterrorism has not adequately

supported efforts to counter zoonotic disease
threats, especially from the animal health
perspective and infrastructure
 There is a fragmentation of jurisdictions,
authorities, statutes and research; e.g. 200
different government offices and programs
responding to 5 zoonotic diseases
 Animal and public health are separated by culture
and organization
Microbial Threats to Health
Conclusions & Recommendations

1. Enhancing the global response capability

2. Improving global infectious disease surveillance
3. Rebuilding domestic public health capacity
4. Improving domestic surveillance through better
disease reporting (this includes both human
health and veterinary health)
5. Exploring innovative systems of surveillance
6. Developing and using diagnostics
Microbial Threats to Health
Conclusions & Recommendations (continued)

7. Educating and training the microbial threat

workforce
8. Developing and producing vaccines
9. Developing and producing antimicrobial drugs
10. Controlling the use of antimicrobials
11. Controlling vectorborne and zoonotic diseases
12. Establishing a comprehensive infectious disease research
13. Creating interdisciplinary infectious disease centers
Preventing Emerging Infectious Diseases: A
Strategy for the 21st Century.

Goal 1: Surveillance and Response

Goal 2: Applied Research
Goal 3: Prevention and Control
Goal 4: Infrastructure and Training
Public Health at the Crossroad
 New, inclusive vision of public health
 Shift to focusing on causes of population health
 Ensuring that population health is a central concern of
policymakers
 Globalization of causes and issues
 Socioeconomic disparities
 Emerging threats due to interdependence
 New team – expanded, integrated and transdisciplinary
 Public Health at the Crossroad
 Population health is a shift from an emphasis on
individual health to understanding the multiple
determinants of health.
 Public Health at the Crossroad
 Health is an outcome shaped by a wide range of
social, economic, natural, built, and political
environments that form a complex and ever-
changing dynamic. Because of this broad
perspective, public health teams themselves also
need to reflect this reality.