One health

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One World One Health
Silvia Pessah-Eljay. MD., MPh., MSc.
Epidemiology Division. Health Services. Ministry of Health.
Feb, 2016

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Chinese Zhou dynasty
(11th century BC)
Concept of One Health
Germ theory (19th -
20th century)
Greek comparative
medicine (3th century BC)
C. Schwabe (20th century) J. Zinsstag (21th century)
Torah
(30th century BC)

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✓ Cooperation between human and
veterinary medicine in selected
endeavors
What is One Health
Goal of building common knowledge
✓ Increase the knowledge of emerging
diseases
✓ Understand and manage the complex
relationships between humans, animals,
wildlife and environment
✓ Integrate surveillance to reduce time for
detection and on time interventions
✓ Develop new approaches to integrate
human and veterinary fields on zoonosis
✓ Simultaneous study of zoonotic
diseases in people, domestic and
wild animals
✓ Building on common pool of
knowledge in physiology, pathology,
epidemiology and other fields

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Animal
Zoonotic diseases
Animal
Humans
Animal

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Humans
Wild animals
Companion and Domestic
animals

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Animal
Animal
Animal
Complexity on building common knowledge
Vector
Food
Water
Human
Human

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Prevalence in reservoir
- Reservoir species (1 or more)
- Host population dynamics
- Density dependence of transmission
- Transmission mechanism
- Environmental influences
Probability of infection
DIRECT: - Human immune defense
- Dose
- Pathogen genotype
DIRECT AND VECTOR: - Duration and proximity of contact
VECTOR: - Vector competence
FOOD BORNE: - Butchering
- Food safety and cooking practices
Reservoir-human contact rate
DIRECT: - transmission mechanism
DIRECT AND VECTOR: - Reservoir population abundance
- Spatial overlap
- Human risk behavior
VECTOR: - Vector abundance
- Vector community
- Biting rates and preferences
FOOD BORNE: - Harvest rate
- Human consumption rate
- Species preference
Spillover forcé
of infection
Sustained transmission
and humans outbreak
.
Stuttering transmission
among humans
Jane Mary Doe
.
Reservoir dynamics –
zoonotic or epizootic
WestNileDisease,Brucellaabortus
Pandemicinfluenza,Y.pestis
Ro

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✓ According to the National Health Directive – 1940,
paragraph 11A, some infectious diseases have a
mandatory report
✓ The list includes more tan 70 infectious diseases, divided
in 4 sections:
✓Individual and immediate report - International
✓Individual and immediate report – National
✓Individual report
✓Collective report
Mandatory diseases report
(Israel)

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Disease -
Group 1
Main reservoirs
Usual mode of
transmission to
humans
Pandemic influenza poultry, ducks, pigs direct contact
Hantavirus syndromes rodents aerosol
Yellow fever monkeys mosquito bite
Ebola, Crimean-Congo
HF, Lassa and Marburg
viruses
variously: rodents,
ticks, livestock,
primates, bats
direct contact,
inoculation, ticks
Rift Valley fever cattle, goats, sheep
direct contact,
mosquito bite
Disease -
Group 2
Main reservoirs
Usual mode of
transmission to
humans
Plague no respiratory rats and their fleas flea bite
Tularemia
rabbits, wild animals,
environment, ticks
direct contact, aerosol,
ticks, inoculation
Anthrax
livestock, wild
animals, environment
direct contact,
ingestion
West Nile fever
wild birds,
mosquitoes
mosquito bite
Some mandatory zoonotic diseases

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Disease –
Group 3
Main reservoirs
Usual mode of
transmission to
humans
Tickborne encephalitis
rodents, small
mammals, livestock
tickbite, unpasteurised
milk products
Giardiasis humans, wildlife
waterborne, person to
person
Bovine tuberculosis cattle milk
Hydatid disease dogs, sheep
ingestion of eggs
excreted by dog
Campylobacter poultry, farm animals raw meat, milk
Brucellosis
cattle, goats, sheep,
pigs
dairy products, milk
Avian influenza poultry, ducks direct contact
Some mandatory zoonotic diseases
Disease –
Group 3
Main reservoirs
Usual mode of
transmission to
humans
Leptospirosis rodents, ruminants infected urine, water
Listeriosis cattle, sheep, soil
dairy produce, meat
products
Lyme disease
ticks, rodents, sheep,
deer, small mammals
tick bite
Leishmaniosis Rodents, dogs Sand-fly bite
Q fever
cattle, sheep, goats,
cats
aerosol, direct contact,
milk, fomites
Rabies
dogs, foxes, bats, cats
animal
bite
Salmonella
poultry, cattle, sheep,
pigs
foodborne

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One health: From the theory to the practice
What we re doing
in the national
level?
✓Cooperation between human
and veterinary medicine in
selected endeavors
✓Building on common pool of
knowledge in epidemiology
✓Integrate surveillance to
reduce time for detection and on
time interventions
✓Simultaneous study of
zoonotic diseases in people,
domestic and wild animals

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West Nile Disease (WND)
Agent: Flavivirus.
▪ Transmission
▪ Mosquito - borne
▪ Amplifying host: Birds
▪ End host: Human, Horses
▪ Other (transfusion, transplants, breastfeeding )
Transmission cycle
Incidental host
Primary
transmission
cycle
Incubation: 3 to 14 days
Classification according to the disease
manifestations
➢ Asymptomatic or subclinical (80%)
➢ Symptomatic (20%)
➢ Acute systemic febrile
illness (20%)
➢ Neuroinvasive disease (<1%)

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West Nile Disease (WND)
Case definition. Epidemiology Division

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West Nile Disease (WND) Surveillance
▪ Surveillance reports:
▪ Human cases
▪ Mosquitos
▪ Analysis and exchange
information
▪ Human cases
▪ Mosquitos
▪ Equine encephalitis

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Rabies Agent and transmission
Agent: RNA virus
()Genus Lyssavirus
Lagos bat
Rabies virus
Mokola virus
Australian bat virus
Duvenhage virus
European bat virus 1 & 2
Transmission: Only by infected mammals
In the period 2010-2013 the main rabies transmitters' in Israel were: domestic dogs
(58%), cows (27%) and wild animals (10%)
Contact with the rabid animal secretions
▪ Infected saliva usually from a rabid animal bite
▪ Other (unusual): Gastrointestinal, wounded skin, respiratory
or other (transplants)

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Rabies Clinical manifestations and National data
Incubation period:
➢ No symptoms
➢ Virus transfers from periphery to CNS
➢ No antibody detectable response
Acute neurological stage: 2 to 7 days
➢ Furious rabies (80%):
➢ Paralytic rabies (20%)
Prodromal stage:
➢ Virus enters to the CNS
➢ Duration between 2 and 10 days to
months
➢ No specific symptoms:
✓ Paraesthesia at inoculation site
✓ Malaise, nauseas, fever
✓ Anorexia, insomnia, depression
✓ Anxiety and agitation
National data. Ministry of Health – Ministry of
Agriculture.
▪ Report is mandatory
▪ Passive surveillance
▪ From 1958 to 2013 were only 9 cases of human cases.
▪ Main health activity against rabies is the post exposure
prophylaxis following by the pre exposure prophylaxis
in selected cases
▪ Rabies prevention is a join work between the Ministry
of Health, the Ministry of Agriculture and the local
authorities

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Rabies
National data of human cases. Data belongs to the Epidemiology Division. Ministry of Health
(63%)
(67%)
(60%)
(37%) (37%) (40%)
0
1000
2000
3000
4000
5000
6000
2011 2012 2013
Vaccine + Serum Vaccine only
13806 13911 14394
15604
3978 4160 4471 4929
0
5000
10000
15000
20000
2010 2011 2012 2013
Advised PEP treatment
Number of persons requested advise versus
persons that received treatment Treatment (PEP) received
3609
3925 4206
4613
(7.9%) (5.6%) (5.9%) (6.4%)
0
1000
2000
3000
4000
5000
2010 2011 2012 2013
Finished PEP Drop out PEP
Number of persons that finished versus people
that drop out the PEP

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Rabies Treatment & Prevention
 Treatment
 Preventive therapy for rabies is highly
efficacious. It includes:
 Wound cleansing
 Active and passive immunisation
after a recognised exposure
 Post-exposure prophylaxis is nearly 100%
effective at preventing rabies
▪ Active and passive immunization
▪ Active vaccination:
▪ Currently cell-culture derived vaccines
are used
▪ Post-exposure vaccination has been very
effective since introduction
▪ Passive immunization:
▪ Human rabies-specific immunoglobulin
(HRIG) at the start of all primary post-
exposure courses of rabies vaccine
▪ The schedule used depends on:
▪ Level of risk (low, medium or high) in
the country
▪ Type of exposure (history of the
animal/stray, likelihood of infection,
etc.)
▪ The individual's immunity (details of
previous vaccinations, if any)
Eliminating rabies in the reservoir animal
species is not possible without an
intersectoral approach including
collaboration between animal and
human health experts.

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▪ Human treatment
▪ Rabid animals
Rabies Surveillance
Eliminating rabies in the reservoir
animal species is not possible without
an intersectoral approach including
collaboration between animal and
human health experts.
▪ Update guidelines and
information exchange:
▪ Human treatment
▪ Rabid animals

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Brucellosis Agent and transmission
Agent: Brucella
Transmission: different ways
Other (transfusion,
transplants)
B. canis
B. pinnipediae
B. suis
B. mellitensis
B. abortus Wounded skinRespiratoryGastrointestinal
Contact with the infected animals and its
secretions
▪ Direct contact with infected animals or its
secretions
▪ Ingestion of unpasteurized dairy products

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Brucellosis Clinical manifestations and National data
Incubation period: 5 days to months
Clinical manifestations:
➢ Generalized:
➢ Fever, malaise, hepatomegaly,
articular diffuse pain,
depression
➢ Focalized:
➢ Osteomyelitis, arthritis
focalized, orchitis, epididymitis,
neurobrucellosis, endocartitis,
etc.
Duration of the disease:
➢ Acute: 1 – 8 weeks
➢ Sub-acute: 9 52 weeks
➢ Chronic: > 52 weeks
National data. Ministry of Health
➢ Report is mandatory since 1951
➢ Passive surveillance
➢ In the past years there are non changes in the case
definition
➢ Incidence cases reported in the last years seams to be
close to the real cases (?)
Mortality rate: <2%
EPIDEMIOLOGICAL CASE
Probable case: Clinical symptoms and
one of the following:
Confirmed case: Clinical symptoms
and one of the following:
✓ Epidemiological link with
confirmed human or animal case
✓ IgM by SAT or BMAT 160 or higher
✓ PCR positive for Brucella in clinical
sample
✓ Rose Bengal positive
✓ Positive culture of Brucella
(generally from bone marrow or
blood)
✓ Increase of 4 fold IgM in two
different blood samples within at
least 2 weeks

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Brucellosis
Number of cases and incidence of Brucellosis. 2004 - 2014 Brucellosis incidence (x100,000) according to health districts. 2000-2014
0
2
4
6
8
0
100
200
300
400
500
600
700
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Case number Incidence
0
5
10
15
20
25
30
2009 2010 2011 2012 2013 2014
Arabs 7 6.4 6.4 9.1 15.7 28.9
Jews&Others 0.2 0.2 0.3 0.1 0.2 0.1
0
5
10
15
20
25
30
35Incidencex-100,000
Brucellosis and nationality. 2009 - 2014
0
10
20
30
40
50
60
2009 2010 2011 2012 2013 2014
Incidencex-100,000
‫דרום‬
‫עכו‬
‫נצרת‬
Incidence (x100,000) in 3 health districts. 2009-2014
National data of human cases. Data belongs to the Epidemiology Division. Ministry of Health

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▪ Human cases
▪ Animal cases
▪ Analysis and exchange
information
▪ Human cases
▪ Animal cases
Brucellosis Surveillance
 Treatment
 Curative: antibiotics
 Preventive:
 Education to avoid consuming
unpasteurized milk and milk derivatives
 Barrier precautions for hunters and
professionals at risk (butchers, farmers,
slaughterers, veterinarians)
 Careful handling and disposal of
afterbirths, especially in cases of animal
abortion
 Serological or other testing of animals;
immunization of herds/flocks may be
envisaged; eliminate infected
herds/flocks.

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Avian influenza
Other zoonotic diseases with collaborative work
Tularaemia (??)
Leishmaniosis Salmonellosis
Leptospirosis (??) Q fever (??)

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Consensus
among
stakeholders
Commitment
by regional
organizations
Collaboration
among
professionals
Coordination
among
partner
agenciesCreate a road map
for implementation
and sustainable
changer.
Meet and understand
new global challenges
Gain scientific
knowledge to
create innovative
programs to
improve health
Cooperation
among
interdisciplinary
groups,
Consolidate into a
broad coalition
Commitment
by national
government
Complexity on building common knowledge

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Programs
implementation
.
Integrative surveillance
Inter-ministerial
coordination
.
Opportunities for One Health partnerships

One health

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