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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
Tennessee Public Health Association_2012 2
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
09/14/2012
Tennessee Public Health Association_2012 3
09/14/2012
Tennessee Public Health Association_2012 4
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
Tennessee Public Health Association_2012 5
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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Tennessee Public Health Association_2012 6
“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
Tennessee Public Health Association_2012 7
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
09/14/2012
Tennessee Public Health Association_2012 8
Purpose
Policies and procedures for rabies prevention and control
For use by CHDs, AC staff, HCPs, DVMs, others
Updated annually
09/14/2012
Tennessee Public Health Association_2012 9
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
Tennessee Public Health Association_2012 10
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
$
09/14/2012
Tennessee Public Health Association_2012 11
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Tennessee Public Health Association_2012 12
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
Tennessee Public Health Association_2012 13
Agents of concern
EEEV WNV SLEV DENV Plasmodium spp.
SLEV, EEEV, WNV Transmission Cycle
Virus
Mosquito vector
Bird reservoir hosts
Incidental infections
EEEV, WNV
09/14/2012
Tennessee Public Health Association_2012 14
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
09/14/2012
Tennessee Public Health Association_2012 15
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
09/14/2012
Tennessee Public Health Association_2012 16
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
09/14/2012
Tennessee Public Health Association_2012 17
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
09/14/2012
Tennessee Public Health Association_2012 18
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
09/14/2012
Tennessee Public Health Association_2012 19
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%
09/14/2012
Tennessee Public Health Association_2012 20
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
09/14/2012
Tennessee Public Health Association_2012 21
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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Tennessee Public Health Association_2012 22
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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Tennessee Public Health Association_2012 23
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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Tennessee Public Health Association_2012 24
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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Tennessee Public Health Association_2012 25
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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Tennessee Public Health Association_2012 26
Reptiles carry Salmonella sp
Salmonella Sandiego, S. Poona and S. Pomona associated with small turtles.
09/14/2012
Tennessee Public Health Association_2012 27
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
Tennessee Public Health Association_2012 28
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
Tennessee Public Health Association_2012 29
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 W AVES SL MW, UNKNOWN
MAUI W AVES SL MW, UNKNOWN
MAUI W AVES SL MW, UNKNOWN
MAUI WAVES SL MW, UNKNOW N
RAMIREZAVILA, KATHIA
SUNSATIONS #43, UNKNOWN
SUNSATIONS #43, UNKNOWN
SUNSATIONS#43, UNKNOWN
SUNSATIONS#47, UNKNOWN
SUNSATIONS#47, UNKNOWN
SUNSATIONS #47, UNKNOWN
SUNSATIONS #43, UNKNOWN
SUNSATIONS #47, UNKNOWN
SUNSATIONS #47, UNKNOWN
NVLV_76952
SNAPPY TURTLE #2, UNKNOWN
SNAPPY TURTLE #2, UNKNOWN
SNAPPY TURTLE #2, UNKNOWN
BOBROW, MASEN
SNAPPY TURTLE #2, UNKNOWN
SURF STYLES#113, UNKNOW N
SURF STYLES#113, UNKNOW N
SURF STYLES#113, UNKNOW N
SURF STYLES#113, UNKNOW N
SURF STYLES#113, UNKNOW N
SURF STYLES#113, UNKNOW N
SURF STYLES#113, UNKNOW N
SURF STYLES#113, UNKNOW N
ID_C120501689
SUNSATIONS #43, UNKNOWN
SUNSATIONS #43, UNKNOWN
SUNSATIONS #43, UNKNOWN
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
Tennessee Public Health Association_2012 30
Chicks can carry Salmonella too
2012 Salmonella Newport/ Lille outbreak
09/14/2012
Tennessee Public Health Association_2012 31
Salmonella infantis
in dog food
RESPONSIBLE HUMAN-ANIMAL INTERACTION
09/14/2012
Tennessee Public Health Association_2012 32
Cycles of the Asian H5N1 Virus in Animals and Humans
Waterfowl
Domestic birds
Mammals(primarily
swine)
Waterfowl
Humans
09/14/2012
Tennessee Public Health Association_2012 33
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
Tennessee Public Health Association_2012 34
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
Tennessee Public Health Association_2012 35
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
Tennessee Public Health Association_2012 36
Canine flu
Oysters or drinking water?
09/14/2012
Tennessee Public Health Association_2012 37
Apalachicola watershed
AtlantaLake Lanier
Apalachicola
Tennessee
South-east US water war
09/14/2012
Tennessee Public Health Association_2012 38
09/14/2012
Tennessee Public Health Association_2012 39
09/14/2012
Tennessee Public Health Association_2012 40
The ocean is not a septic tank
Marine sentinels
09/14/2012
Tennessee Public Health Association_2012 41
Cyanobacteria
Puffer Fish Poisoning
Surveillance
Research
Education
Public Health Strategies
Harmful algal blooms
One Health toxins
09/14/2012
Tennessee Public Health Association_2012 42
09/14/2012
Tennessee Public Health Association_2012 43
Talk One Health economics
Ecological health impacts human health
Coordinated responsemore efficient
Partnerships acrossboundaries generates synergism
Future One Health practice
09/14/2012
Tennessee Public Health Association_2012 44
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
09/14/2012
Tennessee Public Health Association_2012 45
One Health Disaster
09/14/2012
Tennessee Public Health Association_2012 46
09/14/2012
Tennessee Public Health Association_2012 47
One weighty health issue
Questions?