Nina Marano DVM MPH Dipl ACVPM

1

One Medicine, Actually
Nina Marano DVM MPH Dipl ACVPM Division of
Global Migration and Quarantine
2
Zoonotic Vectorborne Diseases

• Zoonoses Those diseases and infections which
  are naturally transmitted between vertebrate
  animals and man.
• Emerging zoonoses may include
• Old diseases, new hosts
• Old diseases, new areas
• New diseases

Ref The Emergence of Zoonotic Diseases, Workshop
Summary. Institute of Medicine report, National
Academy Press, 2002
3
Risk Factors for Human Disease Emergence

• 1415 species of infectious agents reported to
  cause disease in humans
• Viruses, prions, bacteria, rickettsia, fungi,
  protozoa, helminths
• 868/1415 (61) zoonotic
• 175 emerging infectious diseases
• 132/175 (75) emerging zoonoses
• 37/132 (28) emerging vectorborne diseases

Taylor et al. Risk factors for disease
emergence. 2001, Philosophical Transactions, The
Royal Society, London
4
A wide variety of animal species carry microbes
that infect humans

• Carnivores 43
• Domestic Livestock 39
• Rodents 23
• Other primates 13
• Birds 10
• Marine Mammals 5
• Bats 2

5
Humans as Hunters and Gatherers

• Paleolithic Age
• Nomadic, small populations
• Shift from herbivorous diet
• Parasitic infections

Adapted from Beasts of the Earth Animals Humans
and Disease E. Fuller Torrey MD and Robert
Yolken MD
6
Humans as Farmers

• 10,000 years ago
• New social order due to agriculture
• Zoonoses through animal domestication
• Increases in infectious diseases
• Epidemics in non-immune populations

Adapted from Beasts of the Earth Animals Humans
and Disease E. Fuller Torrey MD and Robert
Yolken MD
7
Humans as Traders Microbes Get Passports

• Increasing trade and travel by shipping
• Warfare and resettlement
• Unprecedented human movement led to pathogen
  dispersal and spread of
• Yellow Fever, smallpox, tuberculosis
• Rodent-borne diseases - plague

Adapted from Beasts of the Earth Animals Humans
and Disease E. Fuller Torrey MD and Robert
Yolken MD
8
Humans as Warriors Animal Origins of
Bioterrorism

• Brucellosis
• Q Fever
• Tularemia
• Glanders
• Anthrax
• Plague

Aerosolizable, hardy, capable of infecting
humans and a wide variety of animals
Adapted from Beasts of the Earth Animals Humans
and Disease E. Fuller Torrey MD and Robert
Yolken MD
9
History of Biological Warfare

• 1346 Tartars lob cadavers of bubonic plague
  victims into the Crimean city of Kaffa

10
Humans as Pet Owners
Adapted from Beasts of the Earth Animals Humans
and Disease E. Fuller Torrey MD and Robert
Yolken MD
11
Pet Ownership and Utilization of Veterinary
Services in the US

• Owners using services of veterinarian in previous
  two years
• Dog 88.7
• Cat 72.9
• Horse 66.3
• Bird 15.8

• Owning dogs 36
• Owning cats 31
• Owning horses 2.9
• Owning birds 4.6

Source AVMA, U.S. Pet Ownership Demographics
Sourcebook, 2002
12
(No Transcript)
13
Vectorborne Infections Public
Health Implications April 2007 EID Theme
Issue
14
Zoonotic Diseases of Concern in the Americas

• Current West Nile fever, bat and wildlife
  rabies, equine encephalitis, hantavirus,
  monkeypox, avian influenza, q-fever, plague,
  anthrax, lyme, leptospirosis, bartonellosis,
  leishmaniasis, echinococcus, BSE, coccidiomycosis
• Future Yellow fever, SARS, hepatitis E,
  poxviruses, Rift Valley Fever, meliodosis,
  potential for tranmission of Chronic Wasting
  Disease

As identified by Regional Surveillance Working
Group from WHO/FAO/OIE Consultation on
Emerging Zoonoses
15
Emerging Zoonotic Diseases The Role of Commerce

• Exhibition at zoos
• Education and research
• Scientific conservation programs
• Incidental/Accidental
• Use as food and products
• Tourism and Immigration
• Commercial pet trade

16
Emerging Zoonotic Diseases and Commercial Pet
Trade
Live Animal Importation - 2005

• 87,991 mammals
• including 29 species of rodents
• 259,000 birds
• 1.3 million reptiles
• 5.1 million amphibians
• 203 million fish

U.S. Fish Wildlife Service Data
17
Emerging Zoonotic Diseases The Role of Humans

• Humans are ultimately responsible for most
  patterns of zoonotic disease emergence
• Human population growth
• land use, habitat destruction
• Human interactions with wildlife
• food, sport, pet trade
• Global transportation increases speed with which
  pathogens are disseminated
• High speed air travel
• Movement of animals and arthropod vectors

18
Speed of Global Travel in Relation to World
Population Growth
From Murphy and Nathanson. Semin. Virol. 5, 87,
1994
19
A World in Motion
International Passenger Arrivals 49,401,528
Wild Mammals Imported 88,000 (Photo Delta
Sky Mag.)
Immigrant and Refugee Arrivals 437,864
Traveler Visits Abroad gt 1 night 63,502,000
20
Emerging Infectious Diseases
Translocation
Encroachment Introduction Spill over Spill
back
Human encroachment Ex situ contact Ecological
manipulation
Wildlife EID
Domestic Animal EID
Human EID
Global travel Urbanization Biomedical manipulation
Agricultural Intensification
Technology and Industry
Daszak P. et.al. Science 2000 287443
21
Early Detection--Front Line Response Expecting
the Unexpected

22
West Nile Virus, 1999 Undetected entry of
infected human, bird, mosquito
23
Time Line to Confirmation of WNV, 1999
Veterinary pathologist suspects human and bird
epidemics linked
human sera tested positive for SLE
1st patient admitted to hospital, Queens
CDC confirms WNV
Introduction
24
Early Detection

• There is a history of people serving as sentinels
  for disease in animal populations
• There is a desire to reverse this situation

25
Infectious Disease Outbreak
Source Minnesota Dept of Health
Symptoms
Seek Care
No. Affected
Time (days)
26
Emerging Zoonotic Diseases The Role of Diagnosis
and Surveillance

• Diseases may appear different in humans than
  animals
• - Nipah respiratory disease in pigs,
  encephalitis
• in humans
• - Time delay in association may result in more
  cases or
• outbreak
• Human and animal surveillance systems often not
• linked
• - West Nile virus emergence
• Rare diseases may not be high on differential
• Bat-associated rabies virus infection in humans
• May lead to further spread (such as transplant-
  
• associated cases)

27
(No Transcript)
28
Global Warming Impact on Malaria
29
The Worlds Most Dangerous Animal
30
Vectorborne Disease Precautions
Advice to Travelers

• Avoid exposure
• Appropriate clothing
• Bed nets
• Fans/screens
• Tick removal
• Insect repellents
• Antimalarials
• Vaccines

31
CDC in 1946
Communicable Disease Center opens in the
Office of Malaria Control in War Areas
32
We are making progress

• Raise awareness of emerging and reemerging
  diseases at home and abroad
• International Meeting on Emerging Diseases Feb
  07
• World Rabies Day Sept 8 2007
• Train the future vectorborne disease workforce
• Skills needed Medical entomologists, vector
  biologists, mammologists, ornithologists
• Engage academia - American Schools of Public
  Health/American Association of Veterinary Medical
  Schools Symposium April 07
• CDC Veterinary Student Day 06 08

33
We are making progress

• Train the US veterinary/medical workforce to
  recognize emerging diseases
• Travelers health incorporate travel medicine
  into medical school curricula and into primary
  care practice
• Plum Island foreign animal disease training
• Animals in commerce - Partner with industry
• Pet Zoonoses Coalition
• Pets in the home - Improve veterinary-medical
  clinical collaborations teamwork
• Kids, Docs, Pets, Vets Campaigns
• Invest in veterinary public health infrastructure
  abroad
• Stipends for veterinarians for Field Epi Training
  Programs
• USAID, USDA HHS funding for avian influenza
  response
• Look for opportunities to engage in collaborative
  research
• Southeastern Center for Emerging Biologic Threats

34
Major American Epidemics of Yellow Fever,
1793-1905
From The Great Fever www.pbs.org
35
(No Transcript)
36
CDC in 2007
The National Center for Zoonotic,
Vectorborne and Enteric Diseases
There is a blurring of boundaries,
disciplines, and biological systems found in
our environment and animal and human populations
that hold great promise and need for our future
understanding, control, and prevention of
infectious diseases. Dr. Lonnie King, Director
NCZVED
37
Acknowledgements

• CDC
• Jennifer McQuiston DVM MS
• Paul Arguin MD MPH
• Lonnie King DVM PhD
• Tracee Treadwell DVM
• Heather Bair-Brake DVM
• Richard Meyer PhD
• Emory University
• Jim Hughes MD
• University of Minnesota
• Marguerite Pappiaoanou DVM PhD

The findings and conclusions in this presentation
are those of the author and do not necessarily
represent the views of the Centers for Disease
Control and Prevention.