Objectives · Urbanization Biomedical manipulation Technology and Industry Agricultural...

09/14/2012

Tennessee Public Health Association_2012 1

One Health: Moving from Concept to Practice

Carina Blackmore, DVM, PhD, Dipl. ACVPMFlorida Department of Health

Objectives

What is Florida Who is Florida Department of Health How One Health

09/14/2012


Florida facts

19,057,542 (4th) 22.9% Hispanics; 16.5% African-Americans 67 counties (7,700-2.5 million) 1,800 miles of coast line 1,200 miles of sand beaches 19 commercial airports 14 deepwater ports 370,000 hotel rooms 1,000,000 cattle

Central AmericaOutlaws

Crackers

Red Necks

Mickey

South Georgia

Yankees

Yankees

Bureaucrats

RNC country

Oldest European City in US

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Wildlife EID

DomesticAnimal EID

Human EID

Translocation

Human encroachmentEx situ contactEcological manipulation

Global travelUrbanizationBiomedicalmanipulation

Technology andIndustry

AgriculturalIntensification

EncroachmentIntroduction“Spill over” &“Spill back”

Emerging InfectiousDiseases

Dasazak P. et.al.Science 2000 287:443

The linked image cannot be displayed. The file may have been moved, renamed, or deleted. Verify that the link points to the correct file and location.

09/14/2012


Friendly ecology

Wild macaques Giant pouched rats Prairie dogs Iguanas Pythons Red-eared sliders Lionfish

Fresh squeezed Giant African Land Snail Juice

Giant African Land Snail

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“One Health” diseases reportable to FDOH Anthrax Brucellosis CJD CO poisoning Dengue Ehrlichiosis Enteric diseases Influenza Lead poisoning Lyme Malaria

Mosquito-borne encephalitis

Mercury Poisoning Pesticide Poisoning Plague Psittacosis Q fever Rabies Rocky Mountain Spotted

Fever Toxoplasmosis Tuberculosis Tularemia

09/14/2012


Rabies Advisory Committee

Representing:

Dept. of Health

Dept. of Agriculture and Consumer Services

Fl. Animal Control Association

University of Florida

• Fl. Fish and Wildlife Conservation Commission

• Fl. Veterinary Medical Association

• Dept. of Environmental Protection

• Humane Society of US

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Purpose

Policies and procedures for rabies prevention and control

For use by CHDs, AC staff, HCPs, DVMs, others

Updated annually

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Animal Rabies in Florida 2010 2011 20-Year Total

1991-2010 20-Year Average

Raccoon 75 79 2427 121

Bat 15 18 350 18

Fox 15 6 476 24

Cat 15 11 280 14

Dog 0 1 56 3

Skunk 3 1 24 1

Bobcat 4 2 44 2

Horse 0 1 21 1

Otter 1 0 26 1

Cow 0 0 2 0

Total 128 119 3710 185

Rabies Epidemiologic DataLimitations

Animals are tested if they expose a person or pet

Underestimates the prevalence of disease

09/14/2012


TABLE –Animal Rabies Cases and State PEP Statistics

YEAR Animal Rabies PEP – Statistics

2011 119 2359

2010 128 2114

2009 154 1793

2008 144 1618

2007 131 1474

2006 176 1244

2005 201 1215

Rabies Still Lacks One Health Systems thinking

Public Health

Health Care

AnimalControl

Veterinarians

Laboratories

CDC

$

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FERAL CAT PROBLEMOverpopulation of roaming cats

– Animal welfare concern– Wildlife conservation concern– Public health concern– Animal control

ineffective

Florida Ecology Supports Mosquito Borne Disease

Warm Climate Regular Rainfall Vectors Identified Suitable Hosts for

Amplification Historical Data

09/14/2012


Agents of concern

EEEV WNV SLEV DENV Plasmodium spp.

SLEV, EEEV, WNV Transmission Cycle

Virus

Mosquito vector

Bird reservoir hosts

Incidental infections

EEEV, WNV

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Purpose of Surveillance

Human cases

Veterinary cases

Mosquitoes,

Dead bird

Time

Dis

ease

Act

ivit

y

Sentinel hosts

Human Cases of WNV illness in Florida, 2001-2011

0102030405060708090

100

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

year

nu

mb

er

of

case

s

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Animal surveillance, WNV, 2011

EEE Horse Cases, Florida, 2001-2011

0

50

100

150

200

250

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

year

nu

mb

er o

f ca

ses

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Human EEE Cases, Florida 2001 - 2011

0

1

2

3

4

5

6

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Nu

mb

er o

f C

ases

EEE Cases by Age-Florida, 1957-2011

0

5

10

15

20

25

30

0-9 10-19 20-29 30-39 40-49 50-59 60-69 70 +

Cas

es

Age Categories

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227 2

1

1

Dengue Virus

Flavivirus– Same family as the viruses that cause West

Nile fever, St. Louis encephalitis, and yellow fever

– Four serotypes – DEN-1, 2, 3, 4

Causes dengue and dengue hemorrhagic fever

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Imported Dengue in FloridaImported dengue cases

0

2

4

6

8

10

12

14

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Weeks

Nu

mb

er o

f d

eng

ue

case

s

2011

2010

2009

Local 2011-MD Local 2011-MD

Local 2010-MD

Local 2011-MD

Local 2011-M

Local 2011-H

Local 2011-PB

Local 2011-PB Local 2010-B

B - BrowardH - HillsboroughM - MartinMD - Miami DadePB - Palm Beach

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Malaria

0

20

40

60

80

100

120

140

2006 2007* 2008 2009 2010 2011

Year

Nu

mb

er o

f ca

ses

Total

Haiti

*Country of origin data not assessed for 2007.

P. falciparum- 64%

P. vivax- 32%

P. ovale - 2%

P. Malariae -1%

Unknown – 1%

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Arbovirus surveillance and response taskforce

Florida Department of Health Florida Department of Agriculture and Consumer

Services Florida Department of Environmental Protection Florida Wildlife Conservation Commission Florida Association of County Health Officers Florida Environmental Health Association Florida Mosquito Control Association University of Florida University of South Florida Florida State University

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Brucellosis

Brucella suis Brucella melitensis Brucella abortus

Brucella in Florida

10 human cases/year– 70-80% locally acquired

Brucella suis– 20-30% immigrants and

travelers (primarily B. melitensis)

2,000 licensed feral swine transporters/trappers

recreational hunters

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Brucellosis is a serious disease! Hospitalization required for

most identified cases Heart disease complications

Fatal myocarditis Fatal endocarditis Paralysis

Joint and bone infections Relapses 20-22% Lab exposures are common

IHC demonstrating Brucella myocarditis (fatal) in a 48 yr male C. Paddock / CDC Path Lab

Florida Elephants with TB

Mycobacterium tuberculosis Mycobacterium bovis Silent disease No

– TST– Gamma interferon testing– X ray

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Testing and treatment imperfect Trunk wash (naso-pharyngeal

specimen) Antibodies

– STAT PAK (Screen)– MAPIA (Secondary test)

Treatment challenging and expensive

One Health concerns

Animal welfare 11 circus handlers/ 4 elephants Illinois,

1996 2 elephants, 1 rhinoceros, 3 goats CA 1997 9/46 TST conversions of staff with or

without close contact with TB-positive quarantined elephants, TN 2009

Business

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Transmission unclear

Not all TB is contagious Aerosol (respiratory) Aerosol transmission during cleaning?

– Organisms shed in feces and vaginal discharge

Few tools to assess status– Human sentinels?

Leprosy/ Hansen’s disease

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Salmonella

Affects mammals, birds and reptiles Gastro-intestinal disease

– Fever and diarrhea (can be bloody)– 2% extra-intestinal infections– Mortality rare

+150,000 cases per year in Florida– 5,000-6,000 are reported

Carriers

Salmonellosis, by age

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Reptiles carry Salmonella sp

Salmonella Sandiego, S. Poona and S. Pomona associated with small turtles.

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Epi curve posted August 2, 2012

FDA CFR Title 21

Sec. 1240.62 (b)Viable turtle eggs and live turtles

with a carapace length of less than 4 inches shall not be sold, held for sale, or offered for any other type of commercial or public distribution.

Punishment: fine ($1,000) or prison (1 yr) or both

09/14/2012


The sale, holding for sale, and distribution of live turtles and viable turtle eggs for bona fide scientific, educational, or exhibitional purposes, other than use as pets.

Salmonella Sandiego, S. Poona and S. Pomona associated with small turtles.

09/14/2012


FL12118b8/10/12

Dice (Opt:1.50%) (Tol 1.5%-2.5%) (H>0.0% S>0.0%) [0.0%-100.0%]PFGE-Xba

100

PFGE-XbaI

Key

LAC__F27745

TX___TXAML1103204

FL0564-12

FL0556-12

FL0561-12

FL0562-12

FL0563-12

FL0565-12

LAC__T4564

KY___12-22365846-0162

MS___12MS00293

LA___20120625

TN___N12E001503

FL0433-12

FL0540-12

FL0537-12

M11030667001A

FL0539-12

FL0551-12

FL0552-12

FL0553-12

FL0566-12

FL0555-12

FL0554-12

NVLV_76952

FL0558-12

FL0560-12

FL0557-12

FL0216-12

FL0559-12

FL0543-12

FL0544-12

FL0545-12

FL0546-12

FL0549-12

FL0550-12

FL0547-12

FL0548-12

ID___C120501689

FL0541-12

FL0542-12

FL0538-12

name

LAC_F27745

TX_TXAML1103204

MAUI W AVES SL MW, UNKNOWN

SNAPPY TURTLE #2, UNKNOWN




MAUI WAVES SL MW, UNKNOW N

RAMIREZAVILA, KATHIA

SUNSATIONS #43, UNKNOWN


SUNSATIONS#43, UNKNOWN







NVLV_76952




BOBROW, MASEN


SURF STYLES#113, UNKNOW N








ID_C120501689




DOB

L2

S1

MW S1

S2 (1)

S2 (2)

RP

2010-02-12

L2

S1 (BG)

S2

S1 (1)

S1 (2)

L2 (1)

He S1

RP

L2 (2)

S2

RP

L1

2012-04-12

L2

S1

L1 (1)

L1 (2)

S2

RP (1)

RP (2)

L2 (1)

L2 (2)

RP (1)

RP (2)

L1

SourceCity

AUSTIN

Rosemary Beach area

Rosemary Beach area

Rosemary Beach area

Rosemary Beach area

Rosemary Beach area

Rosemary Beach area

Lawrenceburg

Olive Branch

F rench Settlement

Orlando

Dest in

Dest in

Dest in

Dest in

Dest in

Dest in

Dest in

Dest in

Dest in

Rosemary Beach area

Rosemary Beach area

Rosemary Beach area

Boca Raton

Rosemary Beach area

Dest in

Dest in

Dest in

Dest in

Dest in

Dest in

Dest in

Dest in

Caldwell

Dest in

Dest in

Dest in

OGroup

B

G

G

G

G

G

G (O 13)

B

B

N

B

B

B

B

B

B

B

X

X

X

X

X

X

X

X

X

X

X

X

X

0:61

0:61

C1

Serotype

Pomona

Pomona

Typhimurium

Poona

Poona

Poona

Poona

Poona

Poona

Poona

Poona

Poona

Poona

Paratyphi B var. L(+) tartrate + (Java)

Urbana

Sandiego

Sandiego

Sandiego

Sandiego

Sandiego

Sandiego

Sandiego

Sandiego

IIIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

I IIb 47 :k:*

Poona

IIIb 61:i:z53

IIIb 61:i:z53

PFGE-XbaI-pattern

POMX01.0004

POMX01.0002

JPXX01.3212

JL6X01.0104

JL6X01.0104

JL6X01.0104

JL6X01.0104

JL6X01.0104

JL6X01.0104

JL6X01.0104

JL6X01.0104

JL6X01.0104

JL6X01.0104

JKXX01.0014

JKXX01.0015

JLXX01.0053

JLXX01.0002

JLXX01.0002

JLXX01.0002

JLXX01.0002

JLXX01.0002

JLXX01.0051

JLXX01.0051

JL6X01.0576

Merlin Case #

559340

545385

Fingerprints from out of state clients

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Red-eared slider

09/14/2012


Chicks can carry Salmonella too

2012 Salmonella Newport/ Lille outbreak

09/14/2012


Salmonella infantis

in dog food

RESPONSIBLE HUMAN-ANIMAL INTERACTION

09/14/2012


Cycles of the Asian H5N1 Virus in Animals and Humans

Waterfowl

Domestic birds

Mammals(primarily

swine)

Waterfowl

Humans

09/14/2012


Swine influenza

Common respiratory illness in swine

Usually mild 1-2 human cases/

year Swine infected by

human influenza viruses

Swine flu vaccines

Swine Influenza in North America

1930

09/14/2012


Influenza A H3N2v

12 human cases from 5 states in 2011 296 cases from 10 states in 2012 16 hospitalizations 1 death 80-90% in swine exhibitors+families

Clinical presentation

Similar to signs of seasonal influenza Duration 3-5 days < 10 year-olds Exacerbation of underlying conditions ILI+pig exposure=treatment Seasonal influenza vaccine does not

protect

09/14/2012


2009 H1N1 influenza in critters May 2, commercial swine herd, Alberta July, show pig Minnesota August, turkey farm Chile October, ferret Oregon November, commercial swine herd, Indiana November, cat, Iowa November, cat, Oregon (fatal case) November, dogs, China November, turkey farm, Virginia December, cheetah, California

09/14/2012


Canine flu

Oysters or drinking water?

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Apalachicola watershed

AtlantaLake Lanier

Apalachicola

Tennessee

South-east US water war

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The ocean is not a septic tank

Marine sentinels

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Cyanobacteria

Puffer Fish Poisoning

Surveillance

Research

Education

Public Health Strategies

Harmful algal blooms

One Health toxins

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Talk One Health economics

Ecological health impacts human health

Coordinated responsemore efficient

Partnerships acrossboundaries generates synergism

Future One Health practice

09/14/2012


The Human-AnimalBond

57% US homes have pets More households with pets than children

(46%) 93% of pet owners would risk their life for

their pet 50% of pet owners would choose their pet

as their single companion if stranded on a deserted island

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One Health Disaster

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One weighty health issue

Questions?

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