2016-2017

University

of Athens, B. Ed. Greek

Literature
University of Paisley, Scotland, MSc. Quality
Management and Control
University of Athens, Medical School, MSc.
Health Crisis Management and Global Health

edousia@gmail.com

Advancing Global Health with

One Health Concept

http://www.globalchange.umich.edu/globalchange2/current/lectures/human_pop/human_pop.html

Global Health

Morens et al., 2004, Nature 430, 242-49

Human
Animal
Ecologic
al

Cohen et al., 2000. Nature ; Cutler et al., 2010 Emerg Infect Dis.

Global Collaborative Multidisciplinary Effort

Promote humans, animals and environment health

 Enhance integration, cooperation and

collaboration between Human Medicine,
Veterinary Medicine and Environmental Science
Expand the scientific knowledge base
Accelerate biomedical research discoveries
Improve human/animal medical education and
clinical care
Enhance public health efficacy

World Health organization (WHO)

World organization for Animal Health (OIE)
American Medical Association (AMA)
American Veterinary Medical Association (AVMA)
American Society of Tropical Medicine and Hygiene
(ASTMH)
The Centers for Disease Control and Prevention (CDC)
The United States Department of Agriculture (USDA)
U.S National Environmental Health Association (NEHA)

 1821-1902: Rudolph Virchow- the link between

human and animal health
1947: James Steele- The Veterinary Public Health
Division at CDC
1927-2006: Calvin Schwabe- coined "One Medicine

 2004: The Wildlife Conservation Society published the Manhattan

principles.
2009: The one health office at CDC
Key recommendations for one health developed
2011: The 1st One health congress held in Melbourne, Australia
The 1st One Health Conference held in Africa
2012: The Global Risk Forum sponsors the first one Health Summit.
in Switzerland.
2013: The 2nd International One Health Congress in Thailand; 1000
attendees from 70 countries.

Rabies

Escherichia coli O157:H7

Mad cow disease

Lead poisoning

Bacterial antibiotic resistance

 The oldest known zoonosis and may

be the oldest known infectious
disease
Annually, kills 55,000 people in the
world, 30,000 in India (60% total)
60% victims - Children under 16
Dog bite - 95% human cases
100% case fatality rate

(Pasteur

Institute)

 Rabies is a vaccine preventable disease. The MOST COST

EFFECTIVE STRATEGY for preventing rabies in people is to
eliminate rabies in dogs through vaccination (World Health
Organization, 2010)
Vaccinating 70% of dog population prevents 99% human
infections

 Island wide mass vaccination program:

March 2011- first phase of mass vaccination program
completed
210,000 dogs vaccinated (70% dog population)
Outcome:
84 human cases in 2011
Only 8 reported cases in 2012

 Community mobilization
15,000 persons
involved in
the program
Vaccination, CDC training in
field level diagnostic tests,
Rabies education in school
curriculum
Outcome:
No rabies reported since 2008
Program strategy to be selfsustainable when outside
funding is no longer available

 Surveillance
Community education and outreach
Mass vaccination program:
1977- 2011
99% decrease in both human and canine cases

In India:
Rabies control is generally confined to small urban pockets, with
minimal interdisciplinary co-ordination
Animal birth control and vaccination programs have limited success
on an all India basis
National Rabies control program in 12th plan of Gov. of India Need of intensive 'One Health' program

Key Components
Recognize the importance of human-animal- environment
interface
Develop an Integrated, Multidisciplinary, and Multiagency
approach toward Rabies management
Investment in risk-based rabies surveillance, intervention, outbreak
prevention, control and elimination programs in primary host
species
Increased investment in rabies virus research, vaccine research,
and development of prioritized targeted programs through
research
Public health education and awareness
(USDA 2012)

Major foodborne pathogen in the United States

Causes about 63,000 cases annually in the United States

Cost the US economy ~ $1 billion per year

Causes hemorrhagic colitis, Hemolytic Uremic Syndrome, kidney
damage and brain damage

(Scallan et al., 2011)

22

Principal reservoir host: cattle

Recto anal
junction
Terminal
rectum
Rumen

Colon
(Naylor et al., 2003)
23

 Food-borne transmission
Contamination of environment/water from cattle and other
animal reservoirs
Cattle-to-cattle transmission
Cattle-to-human transmission
Human-to-human transmission

 Major virulence factor

Binds with globotriaosylceramide (Gb3) receptor
Treatment
- Supportive therapy
- Antibiotics are contraindicated
- No vaccines are available

 Farm level: Surveillance, Intervention strategies,

Vaccines
Slaughter house and meat hygiene
Environmental hygiene: Considering animal- ecosystem
dynamics of water systems
Agriculture: pre- and post-harvest interventions
Community education: Adequate cooking and hygienic
practices
Medical Professionals: Scrutiny of suspected cases for
E. coli O157:H7 and restrict antibiotic usage that
potentially predisposes to HUS

 Infectious neurogenerative diseases

Misfolded protein
Transmissible particles devoid of nucleic acid
Humans (Creutzfeldt-Jakob disease (CJD), variant CJD
Cattle (BSE, mad cow disease)
Sheep and goats (scrapie)

Deer and elk (chronic wasting disease)

 The first case: United Kingdom in

the mid 1980s
~ 200,000 documented total cases
in the UK
Detected all over Europe, Japan
and North America
Meat and bone meal as a feed
supplement

 Linked to consumption of BSE-infected beef

Fewer than 200 vCJD cases worldwide
Long periods of asymptomatic infection (years to decades in
humans)
Destruction of brain cells 100% fatal

Charlene Singh, first human form of

mad cow disease (vCJD) victim in the
U.S.

 Co-ordinated control and research effort of veterinary,

medical and environmental professionals for surveillance
of BSE incidents in humans, animals and food chain
180,000 cattle have been infected and 4.4 million
slaughtered during the eradication program in the UK
Ruminant to ruminant feed ban
Complete ban of specified risk materials in animal feed
Intensive surveillance for the disease

Lead poisoning investigation in

Zamfara, Northern Nigeria

Early 2010, Ducks began to disappear in

Zamfara district.
May 2010, Hundreds of children sick with
vomiting, abdominal pain, headaches,
seizures and death.
Dr. Lora Davis, CDC animal-human
interface officer
Investigation found unsafe, high levels of
lead in homes, community wells, and
blood samples.
Warning signs were missed: Ducks
sentinels of environmental hazard

Judicious use of antibiotics in animals

Preventing infections and the spread of resistance

Tracking of infections due to resistant pathogens

Improving antibiotic prescription/stewardship

Developing new drugs and diagnostic tests

The Veterinary profession: Strong advocate and leader of One

Health.
Advantages: Holistic understanding and occupational interaction with
a multitude of animal species

Human Health

Animal Health
Disease surveillance and control
Animal Welfare
Increase Domestic Animal Production

Control Zoonotic Diseases

Biomedical Research
Food Quality and Safety

Ecological Health
Protect Biodiversity
Natural Resource Conservation
Wildlife Management

Gibbs and Gibbs, 201

 Multidisciplinary and core public

health coursework including
Epidemiology and Biostatistics
Public health and Zoonotic diseases
Wildlife diseases and management
Environmental Health
Supervised teaching and research
Collaborative programs connecting
the three disciplines.
Internships in research laboratories

Veterinary
medicine

Human
Medicine

Environmental
Sciences

http://egh.phhp.ufl.edu/academic-programs/doctoral-programs/phd-in-one-health/

 One

world-one health concept for a healthier

planet
Be prepared for future challenges in global
health
Addressing connections between health and
environment

 Since

the first use of antibiotics in the 1930s

and 1940s, bacteria quickly adapted and
developed mechanisms to escape their effects
Over the following decades, new antibiotics
were developed to overcome resistance
Since the 1990s, new antibiotic development
has fallen sharply while bacterial resistance
continues to increase
Antibiotic resistance is responsible for
countless human deaths and billions of dollars
in healthcare expenses

Introduction
Resistance Beyond Typical Bacteria
Imidazole-resistant Candida spp.

Multidrug-resistant tuberculosis
Multidrug-resistant malaria

Anti-viral resistant influenza

 Antibiotic

= A drug that kills or inhibits the growth

of microorganisms

Resistant

= Somewhat arbitrary designation that

implies that an antimicrobial will not inhibit
bacterial growth at clinically achievable
concentrations

Susceptible

= Somewhat arbitrary designation that

implies that an antimicrobial will inhibit bacterial
growth at clinically achievable concentrations

 MIC

= Minimal inhibitory concentration. Lowest

concentration of antimicrobial that inhibits growth
of bacteria. Commonly used in clinical lab

MBC

= Minimal bactericidal concentration.

Concentration of an antimicrobial that kills
bacteria. Used clinically only in special
circumstances

Breakpoint

= The MIC that is used to designate

between susceptible and resistant. Arbitrarily set
by a committee

MIC = 6.25 mcg/mL

Automated Methods

Many Labs Use

Automated Testing

E-test

Kirby-Bauer
Disk Diffusion
Agar dilution

Antibiotic Use Leads to

Antibiotic Resistance
Inpatient

Agriculture
Outpatient

Patient Concerns
Want clear explanation
Green nasal discharge
Need to return to work

Physician Concerns
Patient expects antibiotic
Diagnostic uncertainty
Time pressure

Antibiotic Prescription
Barden L.S. Clin Pediatr 1998;37:665

 Resistant

bacteria or their
genetic determinates are
selected when colonizing or
infecting bacteria are exposed
to antibiotics
Resistant bacteria can then be
transmitted between patients
Highest risk patients:
Immunocompromised
Hospitalized
Invasive devices
(central venous catheters)

Cycle of Antibiotic
Resistance Acquisition:
Bacterial Selection
Under increasing
antibiotic selection
pressure:
1. Bacteria resistant to a
particular drug are
selected and replicate
2. Different antibiotics
select different
bacteria but can
select resistant
phenotypes to other
drugs as well
3. This results in
multidrug-resistant
(MDR) organisms and
increases their total
number

Selection by Drug X

Replication

Selection by Drug Y

Replication

Resistance to:Drug X

Drug Y

Drug Z

Antibiotic Mechanism of Action

Linezolid

Daptomycin
Daptomycin
Linezolid
Daptomycin

 Bacteria

are capable of
becoming resistant through
several mechanisms
One or many mechanisms
may exist in an organism
Multidrug-resistant bacteria
often have multiple
mechanisms
Genes encoding resistance
may exist on plasmid or
chromosome

Decreased
Permeability

Alteratio
n in
Target
Molecule

Wenzel et. al. ICHE 2008;29;1012

MSSA
(N=165)

MRSA
(N=121)

P Value

6.7%

20.7%

P<.001

After surgery

14 (7-25)

23 (12-38)

P<.001

After infection

10 (4-17)

15 (7-30)

P=.001

Unadjusted
Mortality, 90-day
Length of stay:
median days

Adjusted* mortality for MRSA (P=0.003)

*Adjusted for other predictors of mortality: age, physical status, duration of surgery.
Engemann JJ, et al. Clin Infect Dis. 2003;36:592-598.

Invasive Isolates
(Meningitis, bact
etc.)

http://www.cdc.gov/abcs/reports-findings/survreports/spneu09.pdf

Jenkins S. et al Emerg Infect Dis. 2009;5:1260

Hicks L et. Al. Emerg Infect Dis. 2010;16:896

15 - 64 y.o

> 64 y.o
# of Rx/100 persons

5
4
3
2
1

# of Prescriptions / 100 Persons

S. pneumo. with Reduced

Susceptibility to Fluoroquinolones (%)

5
4,5
4
3,5
3
2,5
2
1,5
1
0,5
0

0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

Chen et. al., NEJM 1999;341:233-9

 Mostly

UTIs
Young healthy women in
addition to the elderly
10-20% now resistant to
fluoroquinolones
30-50% resistant to
trimethoprim-sulfamethoxazole
CTX-M -lactamases becoming
more common

Cause cephalosporin resistance

 Inappropriate

and excessive use of antibiotics

is a major factor contributing to emerging
antibiotic resistance
Determinants of resistance are selected for by
antibiotic use
Multiple mechanisms exist for bacteria to
become resistant to antibiotics
Antibiotic resistance is a problem in outpatient
and inpatient settings and is a factor in a wide
variety of infections
Antibiotic resistance continues to emerge as a
serious threat to public health

Epidemiology

Cynthia L. Johnson, DVM, MS USDA:

APHIS
Veterinary Services
Centers for Epidemiology and Animal Health

Relatively new science emerged in 19th

century
In strictest terms study of epidemics

Today:
Concerned with epidemic disease and all other
forms of illness and health-related event

Cancer, heart disease

Reproduction
Mastitis
Animal movement

Epi = Upon
Demos = Population
Logy = study

Study of something that afflicts a population OR

The study of why some get sick and some dont

The study of patterns and

determinants of disease in a
population in order to identify
prevention and control strategies

 Disease

does not occur randomly in populations!

Disease has causal and

preventive factors

Epidemiology uses a systematic

approach to study the differences in
disease distribution in subgroups
Q Allows for study of causal and
preventive factors
Q

Population focused
Includes a broad definition of disease
Involves describing disease in relation to
individual/population, place and time
Involves an understanding of change, and the
ability to evaluate whether chance played a
role
Provides tools for studies

Look for patterns

Describe
Q
Q
Q

Population
Place
Time

Make comparisons
Establish cause(s)
Communicate recommendations

Epidemiology

Descriptive Epidemiology
Analytical Epidemiology

Describes population, place,

time
Surveys
Case reports and case studies

Population

Species
Breed
Age
Sex
Use

Place

Location of event(s)
Geographic distribution: one location, many?
Environment
Climate

Time
When

did it occur?
How quickly are new cases occurring?
Is there a seasonality to the disease event?
If fatalities, how long between first clinical
signs and death?
Is it vector season?

First step in identifying a problem

Very often the prelude to further studies

Analytical processes
Hypothesis testing

Descriptive: ask who, where, when

Analytical: ask how?? why???
Identification of causal and preventive factors

Infectious
Q

Chemical
Q

Toxins, allergens

Physical
Q

Virus, bacteria, fungi, prion

Radiation, trauma

Nutritional
Q

Deficiencies, imbalances

Disease

Infectivity
Pathogenicity
Virulence
Host Range
Lifecycle
Reservoir
Genetic Stability
Vector

Disease

Genetics
Age
Species
Immune function
Herd Immunity
Use
Diet
Gender

50% immune
Infectious
agent

80% immune

susceptible

immune

Associated with Disease

Climate
Geography
Housing
Plants and other animals
Stressors such as noise, light,
pollution
Feed
Use of the animals

2004/5 AI Epidemics
300

no. outbreaks

250
200
150
100
50
0

Source: Dirk Pfeiffer

Tet holiday
Feb 9-11, 2004

Tet holiday
Feb 11-13, 2005

John Snow (1854) Father of modern

epidemiology

Established modern epidemiologic methods

Q Cholera epidemic in London
Q

Plotted geographical location of all cases deaths from

cholera

From The Visual Display of Quantitative Data, Edward R. Tufte

Johns Snow went door to door, collecting

information on daily habits
Suspected water supply as source of epidemic

Broad street pump closed, epidemic stopped

Shoe leather epidemiology

Practical application use epidemiological
investigation to impact a health problem

Problem
investigation
Data collection

Analysis and
interpretation

Analysis and
interpretation

Assessment and
report

Strategy
application

Strategic
planning

Data

Data

Data
Data

Data

Data

Data
Data

Data

Data

Data
Data

Data

Data

Data
Data

Data
Data

Data

Data
Data

Data

Data

Data
Data

Characteristics
Inquisitive,

curious
Have investigation skills
Open minded
Creative
Interest in working with the public
Ability to use qualitative as well as quantitative data
to approach and solve problems

Veterinary epidemiologists need to ask:

Who?
Q Where?
Q

When?

To determine:
Q Why/How?

What?

Respond to outbreaks
Prevent disease
Decrease impacts of disease
Provide science for policy formation
Q
Q
Q
Q
Q

Health
Food Safety
Security
Trade
Environment

Veterinary epidemiologists have the ability to

impact many different areas
The skills needed are diverse
All animal health professionals are
epidemiologists on some level

Introduction to Veterinary Medical Terminology

)Prefix: word part found at the

beginning of a word
(
)Root: word part that gives the essential
meaning of the word
(
) Suffix: word part
found at the end of a word
(

 Learning

prefixes may be easier when

they are presented in pairs or in
similar groups:
A- and an- both mean without or no

Ab- means away from; ad- means

towards

Insert Figure 1-2

Example: ovariohysterectomy (
)
Divide the term:

ovari/o/hyster/ectomy

Start at the end:

-ectomy is surgical removal (

ovari/o means ovary
hysteri/o means uterus

Anatomic order: body parts are in order

Ovariohysterectomy means surgical removal of the
ovaries and uterus =

Changing one or two letters may completely change the meaning of a word:

hepatoma versus hematoma ( )

urethra versus ureters

Some words sound alike, but are spelled

differently and have very different
meanings:

ileum versus ilium (

Where, Why, and What?

Understanding Body Planes, Positional Terms, Directional Terms, and
Body Cavities

 Positional

terms are important for accurately

and concisely describing body locations and
relationships of one body structure to
another
Terms like forward and backward, up and
down, in and out, and side to side may not
be clear enough descriptions for universal
understanding

Relative location of
the whole body or an
organ is described
through the use of
pairs of contrasting
body direction terms
Medial versus lateral:

Medial is toward
midline(
)
Lateral is away from
midline (
)

ventral versus dorsal

(C and D)(
cranial versus caudal
(A and B) (
rostral versus caudal
(E and B) (

)
)
-

cephalic also means pertaining to

the head

proximal versus distal

)
(F and G) (
palmar versus plantar
(H and I) (
)
anterior versus posterior (
)
superior versus inferior ( )
superficial versus deep
(

Planes are imaginary lines used descriptively to

divide the body into sections
Planes of the body include

midsagittal plane: plane that divides the body into

equal right and left halves

sagittal plane: plane that divides the body into right and
left parts
dorsal plane: plane that divides the body into dorsal
(back) and ventral (belly) parts

also called the median plane and midline

also known as the frontal plane or coronal plane

transverse plane: plane that divides the body into

cranial and caudal parts

also known as the horizontal plane or cross-sectional plane

Anatomy

The suffix -logy means

the study of
Terms with -logy
are used to describe
specific branches of
study

Physiology

study of body function

Pathology

study of body structure

study of the nature, causes,

and development of
abnormal conditions

Etiology

study of disease

Dental arcade
arrangement of teeth in
mouth
Lingual surface
aspect of the tooth facing
tongue
Buccal surface
aspect of the tooth facing
cheek
Occlusal surface
aspect of the teeth that
meet when you chew
Labial surface
tooth surface facing the
lips
Contact surface
aspects of the tooth that
touch other teeth

mesial contact
distal contact

A body cavity is a hole or

hollow space within the body
that contains and protects
internal organs
There are many body cavities
within an animal

contains the spinal cord within the

spinal column

contains the heart and

lungs within the ribs and
between the neck and
diaphragm

Pelvic cavity

contains the brain in the skull

Spinal cavity

Thoracic cavity/chest
cavity

Cranial cavity

contains the reproductive

and some excretory organs
formed by the pelvic bones

Abdominal cavity

contains the major organs

of digestion between the
diaphragm and pelvic cavity

also known as the

t vty

 The

medical term for lying down is

recumbent
Recumbent positions are then described
by the body part that is being laid upon

dorsal recumbency: lying on the back

ventral recumbency: lying on the belly

left lateral recumbency: lying on the left side

right lateral recumbency: lying on the right side

 Adduction

to move toward
midline
t

Abduction

to move away from

midline
think child
abduction means to
take the child away

 Flexion

bending a joint or
reducing the angle
between two bones

Extension

straightening a joint
or increasing the
angle between
two bones

Cells are the basic

structural units of the
body
Cyt/o means cell
Cytology is the study of
cells

Protoplasm consists of the

cell membrane, cytoplasm
and nucleus

-plasm means formative

material of cells
Prot/o means first

 Genetic

means something that pertains to

genes or heredity
Genetic disorder is any disease or
condition caused by defective genes

also known as hereditary disorders

Congenital

denotes something that is

present at birth

a genetic defect may be congenital

Anomaly

is a deviation from what is

regarded as normal

tissue is a group of specialized cells that

join together to perform a certain
function
Histology is the study of tissues

Hist/o means tissue; -logy means the study of

There

are four main tissue types

Epithelial
connective
Muscle
Nervous

Tissue can form normally

or abnormally
-plasia (
) describes
formation, development,
and growth of tissue and
cell numbers
-trophy describes
formation, development,
and increased size of
tissue and cells

Prefixes used to describe

tissue growth:

a- means without
hypo- means less than
normal
hyper- means more than
normal
dys- means bad
ana- means without (
neo- means new

 Neoplasia

= any abnormal growth of tissue in

which multiplication of cells is uncontrolled,
more rapid than normal, and progressive

tumor: a distinct mass of tissue formed from a

neoplasm (-oma means tumor or neoplasm)

benign: not recurring

malignant: tending to spread and become lifethreatening

 Glands

are groups of specialized cells that

secrete material used elsewhere in the
body

aden/o means gland

Exocrine glands are glands that secrete material into

ducts

Exo- means out, crine means to secrete

Endocrine glands are glands that secrete chemicals

into the bloodstream for transportation to organs and
other structures throughout the body

Endo- means within, crine means to secrete

Anal sacs

pairs of pouches that

store an oily, foulsmelling fluid
secreted by the anal
glands

Anal glands

secretory tissues
that are composed
of aprocine and
sebaceous glands

 Carnassial

tooth

large, shearing
cheek tooth

the upper fourth

premolar and lower
first molar in dogs
the upper third
premolar and lower
first molar in cats

 Elizabethan

collar

device placed around

neck and head of
dogs to prevent them
from traumatizing an
area

commonly called an Ecollar

 Polydactyly

more than the

normal amount of
digits

 Points

color of nose
(mask), ears, tail,
and feet of an
animal

Drugs, Disease, and Dissection

Pharmacology, Pathology, and Surgical

Terms

 Pharmacology

is the study of the nature,

uses, and effects of drugs
Pharmacology terms

prescription drug
=
medication that may be purchased by
prescription or from a licensed professional
over-the-counter drug

= medication that may be purchased

without a prescription

Oral = po

Parenteral = route other than the GI tract

Nonparenteral = route via the GI tract

Intradermal = ID
Intramuscular = IM

Intravenous = IV

Subcutaneous = SQ, SC, SubC, or SubQ

Inhalation

 Look

at the following drug categories and by

defining the terms determine what these
drugs do:

Analgesic
Antipyretic
emetic versus antiemetic
mydriatic agent versus miotic agent
antipruritic agent

Ventral midline

Paramedian

cut lateral and parallel

to the ventral midline

Flank

cut along the

midsagittal plane of
the abdomen

cut perpendicular to the

long axis of the body

Paracostal

cut oriented parallel

to the last rib

 Biopsy

means removing living tissue to

examine

excisional biopsy

incisional biopsy

removing entire mass

removing part of the mass, tissue, or organ

needle biopsy

insertion of a needle into a tissue for extraction of

tissue to be examined

 Vital

signs are parameters taken from the

animal to assess its health

temperature

febrile versus afebrile

pyrexia

pulse
respiration
blood pressure

 Auscultation

listening to body sounds

Palpation

examination by feeling

Percussion

examination by tapping the surface to determine

density of a body area

ADR = vu yt tt vt yt
solidified into a diagnosis

BID = bis in die

are used with
prescriptions and mean that the medication
should be given twice daily. You might also see
TID (three times daily) or QID (four times daily).

BUN= The blood urea nitrogen test measures

t ut u t yu t ,
which helps us know how well the kidneys and
liver are performing

CBC= complete blood count

Dx: Rx, t, t Lt recipere,

recipe. Dx = diagnosis. Tx (treatment or therapy)
Sx (surgery or symptom).
HBC: Short for "hit by car.

IgA: Immunoglobulin A is a type of antibody that

protects the skin, respiratory tract, digestive tract,
and some parts of the reproductive and urinary
systems from bacterial, fungal and viral invaders.
Low levels of IgA can predispose pets to allergies or
infections.
O.S.: =oculus sinister, or left eye.
The term O.D. stands for oculus dexter, or right
eye.
SSRI: =selective serotonin reuptake inhibitor. This
class of drugs may be prescribed for pets with
general anxiety problems.