Preventing Disease: A Prescription for Global Health

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Preventing DiseaseA Prescription for Global
Health
The Innovators

• Terry McElwain, D.V.M., Ph.D.
• Diplomate, American College of Veterinary
  Pathologists
• Executive Director and Professor, Washington
  Animal Disease Diagnostic Laboratory
• Director, Animal Health Research Center
• College of Veterinary Medicine
• Thomas Besser, D.V.M., Ph.D.
• Diplomate, American College of Veterinary
  Microbiologists
• Professor, Zoonosis Research Unit, Microbiology
  and Pathology
• College of Veterinary Medicine
• Guy Palmer, D.V.M., Ph.D.
• Diplomate, American College of Veterinary
  Pathologists
• Professor, Microbiology and Pathology
• College of Veterinary Medicine

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Health Solutionsat the Animal-Human Interface
Jan Brueghel the Elder, 1613
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The Global Infectious Disease Challenge
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Direct Economic Impact of SelectedInfectious
Disease Outbreaks1990-2003
UK - BSE US 39 billion 1990-1998
Asia SARS US 30 billion 2003
USA E. coli O157H7 US 1.6 billion 1991-1999
India - Plague US 1.7 billion 1995
Tanzania - Cholera US 36 million 1998
Malaysia Nipah US 625 million 1999
Peru - Cholera US 770 million 1991
World Health Report 2007, WHO (Excludes economic
impact of human sickness and death)
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What Is the Animal-Human Interface?
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Emergence of Disease Agents from Animals to
Humans
Animal reservoirs are a source for
adaptationprior to species jumping.
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Emergence of Disease Agentsfrom Animals to Humans
Animal reservoirs are a continuous source for
adaptation before transmission to humans.
H5N1 Asian
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Transmission of Disease Agents from Animals or
Food to Humans
Many of the food and waterborne diseases are
maintainedin animal reservoirs or transmitted
from animals.
70 of human pathogens are zoonotic(transmitted
from animals to humans)
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Poverty Reduction through Global Animal Health
Healthy animals are essential to
healthy,economically secure people.
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Poverty Reduction through Global Animal Health
Animal disease burden is cripplingin poor
tropical countries.
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Disease Control at theAnimal-Human Interface

• Early detection and rapid response
• Understanding determinants of emergence
• Disease surveillance in animals
• Prevention of transmission
• Understanding dynamics of transmission
• Managing the disease in its reservoir
• Vaccination
• Development of novel vaccines
• New pathways for vaccine deployment

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Disease Control at theAnimal-Human Interface

• Early detection and rapid response
• Understanding determinants of emergence
• Disease surveillance in animals
• Prevention of transmission
• Understanding dynamics of transmission
• Managing the disease in its reservoir
• Vaccination
• Development of novel vaccines
• New pathways for vaccine deployment

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Early Detection and Rapid Response
Washington Animal Disease Diagnostic Lab
Disease Surveillance in Real Time
West Nile Virus
BSE (Mad Cow)
Avian Influenza
Foot Mouth Disease
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Early Detection and Rapid Response
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Why Such Rapid Spread?

• Transmission potential
• Adapted for spread among humans
• Completely susceptible population
• Movement of people
• WWI Troops
• Delay in diagnosis
• We didnt know what it was
• No treatment
• Antivirals unknown in 1918

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What Is the Cost of Delayed Identification?
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What Is the Cost of a Delay in Diagnosis?
Foot and Mouth Disease
One week delay estimated 1.7B loss(10M/hour!)
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Disease Control at theAnimal-Human Interface

• Early detection and rapid response
• Understanding determinants of emergence
• Disease surveillance in animals
• Prevention of transmission
• Understanding dynamics of transmission
• Managing the disease in its reservoir
• Vaccination
• Development of novel vaccines
• New pathways for vaccine deployment

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Prevention of Transmission

• What are the dynamics of transmission?
• Ecology- how and where does the agent persist?
• Epidemiology- what exactly is the reservoir?
• Managing the disease agent in its reservoir
• Management and husbandry conditions
• Dissemination
• Host-agent interaction

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Understand the Dynamics of Transmission Ecology

• Is it the cattle or is it the farmthat is the
  reservoir?

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Understand the Dynamics of Transmission Ecology

• Is it the cattle or is it the farmthat is the
  reservoir?

• 50,000 cattle in 100 pens, originating from gt100
  farms
• Average feeding period 120 days resultsin 3
  complete population turn-overs per year
• Four E. coli O157H7 strains predominated overa
  3 year period!

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Understand the Dynamics of Transmission Ecology

• Super-shedders
• RAJ / feces / flies

• Super-shedder
• 5 of infected cattle, 90 of E. coli O157H7!

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The ReservoirCattle Farm Management and
Husbandry
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Reported E. coli O157H7Cases in the U.S.
1994-1996
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Reported E. coli O157H7Cases in the U.S.
1994-1996
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Seasonality of E. coli O157H7 in Humans and
Cattle
Ostroff, MMWR- CDC Surv. Summaries, 1991
Hancock, Besser, et al, Epi Inf 1997
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Seasonality of E. coli O157H7 in Humans and
Cattle
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Disseminationof E. coli O157H7
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E. coli O157H7Host and Agent Factors
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E. coli O157H7Host and Agent factors
Human
Bovine
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E. coli O157H7Host and Agent Factors
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Disease Control at theAnimal-Human Interface

• Early detection and rapid response
• Understanding determinants of emergence
• Disease surveillance in animals
• Prevention of transmission
• Understanding dynamics of transmission
• Managing the disease in its reservoir
• Vaccination
• Development of novel vaccines
• New pathways for vaccine deployment

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Vaccine Development/Deploymentat the
Animal-Human Interface
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Blocking Zoonotic PathogenTransmission to Humans

• Prevention of animal infection (e.g. rabies)
• Brucellosis
• Avian influenza H5N1
• Leptospirosis

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Brucellosis as a Case Study

• Human brucellosis cases in the US lt100
• Human brucellosis cases worldwide 500,000
• 1956 124,000 infected cattle herds in the U.S.
• 2006 lt10 infected cattle herds in the U.S.

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Blocking Zoonotic PathogenTransmission to Humans

• Prevention of animal infection (e.g. rabies)
• Brucellosis
• Avian influenza H5N1
• Leptospirosis
• Reduction of pathogen shedding
• E. coli O157H7
• Salmonella
• Campylobacter

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E. coli O157H7 as a Case Study
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E. coli O157H7 as a Case Study

• Super-shedders drive pathogen prevalencein the
  cohort of animals
• Threshold is breached resultingin human
  infection
• Vaccine induced reduction of sheddingis the goal

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E. coli O157H7 as a Case Study
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E. coli O157H7 as a Case Study
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E. coli O157H7 as a Case Study
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Livestock Vaccination as aGlobal Delivery Pathway

• Food and economic security of 70 of the worlds
  poor is dependent on livestock
• Primary source of food, labor, fertilizer,and
  income
• Represents the economic capitalof the family

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Targeting Infectious Diseasesthat Constrain
Development

• Food and economic security is dependenton
  small-holder farms

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Targeting Infectious Diseasesthat Constrain
Development

• Similar to human malaria, animals in the tropics
  suffer from vector-borne diseases not found in
  the U.S. and Europe

Anaplasmosis Babesiosis East Coast
Fever Trypanosomiasis
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Livestock Vaccination as aGlobal Delivery Pathway

• 67 of children of sub-Saharan African children
  are fully immunized (DPT/polio)
• lt50 in Chad
• Significant role in polio spread WT1 2002-2004
• 9 full-immunization among children in nomadic
  pastoralist families

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Livestock Vaccination as aGlobal Delivery Pathway

• Vaccinated 149,255 cattle and small ruminants
  (anthrax, pasteurellosis, blackleg, CBPP)
• Vaccinated 4,653 children (DPT/polio)
• Significant increase in coverage as comparedto
  fixed location or mobile public health units
  (plt0.001)

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Vaccine Development/Deploymentat the
Animal-Human Interface

• Prevent human disease by low-cost, high coverage
  vaccination of animal reservoirs
• Common basic research goals and anexpedited
  translational pathway
• On a global scale, livestock vaccination is
  directly linked to human health and well-being

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• Washington Animal DiseaseDiagnostic Laboratory
• The Zoonoses Research Unit at WSU
• The Program in Vector-borneDiseases at WSU
• The Program in Immunology at WSU
• USDA-Animal Diseases ResearchUnit at WSU

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School of Global Animal Health
Global leadership in health solutionsat the
animal-human interface.
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Questions?

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• Coming Up
• The Innovators lecture series
• Fall 2007

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A Garden of HopePlants Key to Treatinga
Variety of Diseases
The InnovatorsOctober 26, Spokane

• Howard Grimes, Ph.D.
• Vice Provost and Dean, Graduate School
• Professor, Molecular Biosciences
• College of Sciences

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Organic ViticultureFrom Vine to Wine
The InnovatorsNovember 2, San Francisco

• Carolyn Ross, Ph.D.
• Assistant Professor, Food Science and Human
  Nutrition
• College of Agricultural, Human, and Natural
  Resource Sciences
• John Reganold, Ph.D.
• Regents Professor, Crop and Soil Sciences
• College of Agricultural, Human, and Natural
  Resource Sciences

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Its a Small World,After AllInternational
Outreach Stretches Around the Globe
The InnovatorsNovember 15, Seattle

• Christopher Pannkuk, Ph.D.
• Director, International Research and Development
• International Programs

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For more information www.wsu.edu/theinnovators To
ll free 877-978-3868

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