The year 2011 represents a significant milestone for the veterinary profession as it is the 250th anniversary of the first veterinary school in Lyon, France. To commemorate this important date, the 2nd World Conference on Veterinary Education was held at the veterinary university of Lyon, now known as Vet Agro Sup.

Claude Bourgelat, founder of the Veterinary Profession

The origins of veterinary education and the profession itself can be traced back to the initiative of French barrister Claude Bourgelat. Noticing discrepancies in knowledge of equine anatomy in previously published resources, he decided to collaborate with human surgeons in order to address the issue. It was after this cooperation that he recognized the similarities between the “human and animal machine” and considered the opportunity for an “animal doctor” profession. He later managed to secure an audience in front of the King Louis XV and argued that the creation of a school to publicly teach veterinary medicine would significantly benefit the country’s agriculture in combating cattle diseases such as Rinderpest. The King authorized his request and the first veterinary school was created in 1761 in Lyon, followed by Maison Alfort near Paris in 1766.

The World Conference on Veterinary Education, sponsored by various international organizations such as OIE or Merial, reunited some 250 delegates from educational entities worldwide and largely celebrated this history of veterinary education and Bourgelat’s initiative. However, much focus was also put on the future of veterinary education, in particular how to improve current veterinary curricula in developed countries as well as in the developing world. Notable attendees included representatives from the AVMA, OIEAAVMC and a multitude of international veterinary schools.

Commemorative statue of Claude Bourgelat at the veterinary school in Lyon.

A recurring topic throughout the conference was that of the OIE’s & AVMA’s Day One Competencies. These provide guidelines to veterinary universities on specific areas of focus to teach students in order form competent veterinarians at the time of graduation. There was some discussion on potential enforcement of such guidelines by the OIE as well as the idea of a global veterinary school accreditation system. The OIE, however, argued that their role is not to oversee global veterinary curricula and that the guidelines provided are voluntary.

There was also significant mention of the need to integrate One Health into veterinary curricula, however, only few presentations provided concrete examples. I offered Western University’s perspective as I talked about the school’s Inter-Professional Education (IPE) curriculum (see previous post for more info) through my presentation: Inter-Professional Education – Training Veterinary students in a One Health Context. Western’s IPE curriculum brings together students from 9 health colleges covering human and animal needs and teaches these students how to approach health issues with a teamwork perspective as opposed to have each health profession isolated. At the basis of One Health is inter-professional cooperation and programs such as Western’s IPE provides a framework for communication and cooperation between health professions. I believe that adding skills in inter-professional cooperation could be a beneficial addition to the OIE’s Day One Competencies.

Western University’s IPE curriculum is an example of applied One Health concepts to veterinary education.

Other points of focus included addressing animal welfare issues in veterinary education. This can mean training students to recognize and address such issues once they become graduates, but also to provide education that minimally harms animals. There were several interesting presentations touching on this, notably from the University of Nottingham in the UK.

This 250th anniversary of veterinary education reminds us that, while forgotten until recently, One Health was at the genesis of the veterinary profession. Claude Bourgelat himself recognized the inherent similarities between human and animal medicine and actively cooperated with human surgeons to expand veterinary knowledge. Also, it is important to recognize that Bourgelat’s efforts to create veterinary schools in 1761 came as a consequence of a significant outbreak of Rinderpest decimating Europe’s agriculture. The year 2011 is not only the anniversary of the veterinary profession but also the year that Rinderpest has officially been eradicated from the globe.

Thanks to the Dean of Vet Agro Sup, all the staff and students for their tremendous work organizing this conference.

Increases in resource consumption and waste production associated with booming human development in the past hundred years have profoundly altered our environment. However, the question remains: how can we measure these changes adequately? One tool at our disposal is the study of animals in the wild. Wildlife, especially top predators, provides a good marker of environmental health and an abundance of these predators often reflects a healthy ecosystem.

I recently had the opportunity to visit The Marine Mammal Center (TMMC) in Sausalito, CA , where I met with fellow Western University 2009 graduate, Dr. Vanessa Fravel. The center offers state of the art facilities for the study and rehabilitation of stranded marine mammals such as California sea lions, Northern elephant seals or harbor seals and thus provides us with a better understanding of the interactions between wildlife, environment and public health. Just as with other animals, marine mammals can share a wide variety of diseases with humans and diagnosis of such pathogens in these species can help identify an outbreak in the environment and thus lead to preventive actions to aprotect the human population.

Such zoonoses include bacterial diseases (leptospirosis, brucellosis) but also fungal (coccidiomycosis), viral (influenza A & B, rabies) and parasitic (Anisakis). A more comprehensive list of zoonotic diseases shared between people and marine mammals can be found on this UC Davis webpage. Many of these diseases are present in both marine and terrestrial environments and studying their prevalence in wild marine mammals can help identify if these pathogens are naturally present in these animals’ environments or if they represent runoff from a land-based outbreak.

Taking a urine sample on an anesthetized California sea lion to look for Leptospira

Centers like TMMC are also very well placed to assess maritime ecosystem health, through evaluation of predatory species numbers or prevalence of environmental toxins. One such toxin has gained much attention in the marine mammal field in the past. Domoic acid has been linked to several sea birds deaths as well as marine mammals strandings, including a recent event involving sea lions in Santa Monica, CA in the USA. The toxin is produced by algal diatom Pseudonitzschia sp. The algae are naturally present in the environment and can be found at every level of the oceanic food chain beginning by absorption of the toxin by filter feeders such as clams and small fishes. While non-toxic at low levels, predators such as sea lions eat a large amount of these fish, leading to very high domoic acid tissue levels.

Dr. Fravel closely monitoring anesthesia in a California sea lion. The animal recovered uneventfully

The toxin principally affects the hippocampus and the most recognized clinical appearance of affected animals is neurologic in nature, represented by bouts of seizures as well as altered behavior. The signs are irreversible and animals are gradually not able to hunt and feed properly leading to death. However, the toxin can affect several other organs and has been detected in cardiac tissues of subclinical animals. Antemortem diagnosis of domoic acid poisoning can be difficult but MRI scan of the brain can reveal lesions in the hippocampus, however most diagnoses are made during necropsy once the animal has died.

The amount of fish people eat compared to marine mammals is minimal and as such, domoic acid poisoning in people does not lead to such extreme symptoms as seizures. However, the toxin is recognized to be the etiology of Amnesic Shellfish Poisoning (ASP) in humans through ingestion of contaminated shellfish, especially in periods of diatom blooms. Symptoms in humans also reflect involvement of the hippocampus and include short-term temporary memory loss, which can be permanent in severe cases.

While naturally present in the environment, scientists agree that blooms of domoic acid-producing algae are increasing. Reasons for this trend are most likely multifactorial and it remains to be seen whether causes include natural algal life cycle, global weather changes or increased nitrogenous agricultural waste runoff into the ocean (a phenomenon often associated with blooming of various algal species).

The diatom Pseudonitzschia, responsible for domoic acid poisoning (image from: http://www.sbnature.org/crc/425.html)

Once again, a One Health perspective allows us to recognize the inter-dependence between human, animal and ecosystem health and it is only through careful analysis of all of these factors that we can improve public health through an efficient and long lasting approach.

Zoonotic disease warning sign at TMMC – Always a good reminder when working with animals

More information:

Dierauf LA & Gulland FMD. 2001. CRC Handbook of Marine Mammal Medicine. Second edition. CRC Press ed.

Washington State Department of Health – Domoic Acid

National Oceanic and Atmospheric Administration (NOAA) – Domoic Acid Factsheet

Posted by: glamielle | April 3, 2011

Animal Welfare and Public Health

The role of veterinarians in promoting animal welfare is evident and explicitly stated in the AVMA’s Veterinary Oath, along with their involvement in protecting public health.

Veterinarians are therefore at the perfect intersection of these two ideas that may seem somewhat unrelated. While it is part of my ethical beliefs that unnecessary suffering in animals should be prevented, it is important to recognize that promoting animal welfare goes beyond an ethical imperative, it is also a necessary step to improving public health.

The concept of promoting welfare in animals is often brought up in most industrialized countries, however, it is in the developing world that the majority of animals suffer neglect or mistreatment.

Treatment of animals in various countries is largely dependent on cultural context and is influenced by experiences, education, religion, community, among other factors. Many who live in developing countries don’t always view animal welfare as a priority. We must remain open-minded when we approach these communities as Westerners and try not to impose our values of ethical treatment of animals in these regions where the people themselves are struggling to survive and improve their own welfare.

However, One Health gives us the tools to improve treatment of animals by promoting public health. Indeed, developing communities need to see how promoting proper animal welfare can benefit them. This doesn’t so much stem from a feeling of selfishness but rather a need for self-preservation.

One of my patients in Morocco, presented plantigrade on the left rear leg and I suspected Achilles tendon rupture. The dog suffered a laceration injury on that leg from a knife wound during a fight. Left: suturing gastrocnemius tendon ends. Right: post-operatively, the patient should not use the affected leg for the next month to avoid tension on the tendon. Unfortunately, the dog never presented for re-check examination.

Working in a free veterinary clinic in Morocco, I was often exposed to cases of animal neglect or mistreatment (although to be fair, I must also recognize that many of my clients treated their animals very well). These usually included malnourished animals, as their owners often gave them scraps of their meal or a diet based on milk and bread. As a veterinarian, educating the owners on proper animal handling and nutrition was an important part of my work, along with deworming these patients, reducing intestinal parasite load and decreasing the chance of zoonotic transmission.

This dog presented with a laceration from unknown origin. Although the owners said it had just happened, it was evident during examination that laceration was several days old. The wound was flushed, debrided and closed. The patient recovered uneventfully.

Dog aggression was also a major issue, which often made it difficult to work with some patients. There was a belief among many owners that proper dog management was through violent repression of unwanted behavior. Naturally, some animals became very fearful of human contact, which translated into aggression. Aggressive dogs can become unpredictable and more prone to biting. This has a direct effect on public health as bite wounds can often lead to grave injuries, especially in children. Furthermore, a study from 2007 done by the Moroccan Ministry of Agriculture looked at rabies statistics in the country. Researchers saw that dogs were the main vector for transmission of rabies to humans and that cases of human rabies averaged 22/year. It is important to remember that rabies remains a largely incurable disease. The study also indicated that dog fighting was implicated in the transmission of the virus to people.

Large abdominal hernia in a mule. Lesions like this one can cause intestinal entrapment and torsion, often fatal without significant surgical intervention. A large number of patient presented with similar conditions, which may be related to excess pressure on abdominal wall from long-term carrying of heavy loads.

While the link between animal welfare and public health is clear looking at this previous example, it is even more direct when one looks at working animals. Many people in developing countries depend on animals such as livestock to survive, whether it is for consumption or transport of loads. The center of the Moroccan town of Fès, called the Medina, is a network of medieval streets only accessible to pedestrians. As such, merchants largely use animals such as donkeys and mules to transport goods. Thus, neglect or malnourishment of these animals can severely affect these merchants’ businesses if they are unable to reach parts of the city and it makes sense that keeping these animals healthy is essential for the wellbeing of the people depending on them.

Overgrown hoof in a mule. Conditions like these can lead to permanent damage to hooves and tendons, causing chronic pain and lameness.

From my experience in North Africa, animal mistreatment often originate from lack of education or proper understanding of what these animals need, weighed against the people’s own needs. Education always plays a pivotal role in development of populations and it is important that leaders in animal health such as veterinarians be good resources on proper animal management practices. However, when trying to promote animal welfare in culturally diverse environments, it is also important to recognize the local cultural or religious values that guide these communities. We must find ways to work within this framework if we want the changes to be well-received and integrated in the lifestyle of these communities. This is why cooperation with local leaders such as governmental but also religious is essential.

Lastly, I want to share an example in the United States where improving animal welfare led to a benefit to both the animals affected and the people depending on them. Dr. Temple Grandin, professor at Colorado State University, was concerned over the state of distress of various livestock species in agricultural settings. Drawing on experiences with dealing with her autism, she recognized similarities between prey species and autistic behaviors and used that insight to improve animal’s conditions in farms. Chronic stress in animals can lead to several adverse effects such as increased susceptibility to diseases, failure to thrive or physical trauma when panicking animals injure themselves. As farmers lost significant numbers of cows from stress and self-inflicted injuries, she approached them with plans for improved facilities that made use of the animals’ natural behaviors to reduce handling stress. Changes included curving corrals so that cows could only see few animals ahead of them but also avoiding use of objects prone to scare animals such as reflecting surfaces, smooth floors or chains. These improvements lead to reduced mortality rates in cows used for agriculture and thus increased production and benefits for farmers, a win-win situation. Of course, conditions of farmed animals can still improve but Dr. Grandin’s changes have largely become the norm when managing livestock in the USA.

Example of curving corral developed by Dr. Grandin. (image from: http://www.grandin.com/design/design.html)

It is important to realize that animal welfare should not just be the agenda of animal activist groups, but rather an important component of public health and animal production activities. This idea is spreading within international organizations such as the OIE, which include promotion of animal welfare on their list of objectives. As human population grows and human-animal contact increases, we must be proactive and determine how we can best serve both the health of populations and the animals they depend on.

For more information on animal welfare:

Gregory NG. 2004. Physiology and behaviour of animal suffering. UFAW Animal Welfare Series. Blackwell Publishing, Oxford.

American Veterinary Medical Association – Animal Welfare

OIE – Animal Welfare

The 1st congress dedicated to the One Health movement was just held in Melbourne,  from February 14th-16th, 2011 and attracted hundreds of health professionals from all over the world.

Skyline view of Melbourne

Melbourne amazed the attendees by its vibrant architecture, modern cityscape & lively citizens. The congress was held at the Melbourne Convention Centre and offered its state of the art facilities to presenters.

The opening ceremony acknowledged aboriginal culture and respect of nature through traditional welcoming dances, followed by a speech by Peter Doherty from University of Melbourne and first veterinarian recipient of the Nobel Prize for his works in microbiology. From there, the program was packed with lectures and talks representing the diversity of One Health, divided into plenary sessions and smaller box sessions addressing specific themes.

Martyn Jeggo, Co-chair of the Organizing Committee, welcomes the attendees

Attendees reflected the diversity of the One Health movement and included many veterinarians, some human medical professionals, students, researchers and environmentalists. International organizations were also present such as the CDC, WHO, FAO, UN, WCS and USDA. Finally, there was a significant representation from governmental bodies including the Governments of Australia, Canada, Thailand as well as the European Union. Western University was also very well-represented as they were 4 of us at the conference presenting on various topics.

Cystic echinococcosis, considered a neglected infectious disease by the WHO is overrepresented in developing countries

I presented on my work in Latin America (see previous post) entitled Cystic echinococcosis prevention in the Highlands of Peru – A multidisciplinary perspective, under the banner of Neglected Zoonotic Diseases. These diseases usually remain on the sidelines of international attention but still kill millions worldwide. They are often driven by social factors such as human practices, poverty or development and are the perfect example of how One Health can benefit communities afflicted by such illnesses.

Other speakers provided us with practical examples of how the multidisciplinary approach of One Health has been applied from research to other health-related programs locally and internationally.

An interesting discussion regarding the definition or scope of the One Health movement was initiated by Jørgen Schlundt of the Danish National Food Safety Institute, who pushed for a more restrictive definition of One Health to “reduction of human disease through prevention of animal disease in all ecosystems”. His arguments were valid in the sense that we need a clear and simple idea of how to describe One Health to others, including governments, media, sponsors or the public. He further developed that if we focus on a single theme and build credibility and acceptance of the One Health movement using this issue as a support or example, we may then branch out and include other perspectives, such as social and mental health or non-transmissible diseases. Others responded that definition of health varies across the geographical and cultural spectrum and that social components of health are inherently part of One Health.

On this issue, I must say that I agree with both perspectives. One Health is indeed a very broad philosophy that can help us bridge and combine all aspects of global health, as it should be. However, I do have to side with Dr. Schlundt, to a certain extent. One of the recurring conclusions of the conference is that we need to keep the One Health momentum going. I think we all know in our hearts that One Health encompasses social issues, mental well-being and other non-transmissible illnesses. However, I also think that if this movement is to survive, we must simplify its meaning in order for others to understand it, and eventually support it. We must build a sort curriculum vitae for One Health to show the world what it has done as a movement and that such approach works. If we try to fix all of the planet’s problems at once, we will end up doing nothing and I am afraid that for the 2nd planned One Health congress to be held in 2 years time, we will be at the same place as today. Once we manage to build proper networks and channels and once One Health has become an established and respected idea, we can (and should) then expand its definition to other health-related fields. I do disagree with Dr. Schlundt, however, on the fact that, while zoonotic diseases are important, diseases affecting food safety and security should be included in this narrower definition of One Health (in fact, both fields often overlap). Hunger is one of the most important issues in the world today and One Health is the perfect platform to address it.

Another idea that came through the congress is that One Health doesn’t belong to anyone and I urge those who feel that the One Health perspective applies to their work, even if it relates to non-communicable diseases or social issues, to go ahead and bring this philosophy to their projects. As a small animal veterinarian, I do feel that the human-animal bond does belong under the One Health banner and I will try to include it in my work whenever I can. I just don’t think that it should be in the priorities of the movement as a whole right now.

Michael Alpers presented the movie “Kuru – Science and Sorcery” about his pioneer work leading to the discovery of prion diseases

The needs for a One Health paradigm is clear looking at the following statistics:

– By 2020, 50 million people will be environmental refugees, fleeing change in weather affecting their livelihoods

– One billion of people suffer from hunger worldwide (1/7 people)

– About 60% of infectious diseases of humans come from animal origins

No single approach can solve these “wicked problems”, however in order to do things right, we cannot rush things. I would personally like to see a roadmap of what One Health should accomplish in the near future and maybe some objectives that the movement will try to attain as a whole before we hopefully meet again in Thailand in 2013. We need to progress step by step and build a strong base before we can expand.

This is the synthesis of my feelings towards One Health at the close of this first conference, and I am ever more motivated, especially now, to be part of it and see it progress and evolve over time.

I welcome people’s thoughts or comment and hope for a constructive discussion so that we can have a clearer picture of who we are as a movement and where we should be heading.

I also would like to thank the organizers of this congress Martyn Jeggo, John Mackenzie and their team for their tremendous work and for giving me the opportunity to meet and interact with so many others who are as passionate as I am about One Health.

Victoria’s Great Ocean Road offers truly breathtaking vistas such as the Twelve Apostles pictured here

For the past month, I have been working as a volunteer veterinarian at the American Fondouk, a mixed animal hospital in Fès, Morocco. The clinic offers free veterinary care to its patients and sees all sorts of animals from dogs and cats, to horses, donkeys, birds, sheep and goats. I chose this site to get more experience in promoting veterinary care in communities with limited resources as well as to see more public health-related cases.

The American Fondouk in Fès, Morocco offers free veterinary care to the community.

After a few weeks, I had the occasion to be exposed to such a case. The veterinary student externs were presented with an adult male German shepherd with recurrent epistaxis and crusting skin lesions on his face and ears. Upon closer examination, the lesions were distributed around the nose, eyes as well as the ear tips and were characterized by exfoliative dermatitis and ulceration. Ocular examination revealed bilateral anterior uveitis, keratitis and conjunctivitis.

Adult German shepherd with clinical appearance suspect of cutaneous leishmaniasis.

Due to the history and clinical presentation, leishmaniasis was suspected. I scraped the affected area around the right eye using a scalpel blade to clear the debris until bleeding was noticed. I then made an impression smear of the bleeding lesion which was stained with Diff Quick. During microscopic evaluation of the sample, I noticed macrophages with intracytoplasmic structures characteristic of infection with Leishmania. The dog had previously been treated with allopurinol, with unfortunately no improvement and euthanasia was elected due to the poor prognosis.

Macrophage from a direct smear of a periocular lesion. The intracytoplasmic inclusion bodies are consistent with Leishmania protozoans. (excuse the low quality of the picture…)

Leishmaniasis is a protozal disease seen in several different animal species as well as humans. It is distributed worldwide and affects millions of people each year. There are about 20 different species of Leishmania sp. and disease presentation can vary depending on the protozoan type.

Leishmania is present as a motile, flagellated protozoan in the vector, the sand fly (Phlebotomus & Lutzomyia), which feeds on mammalian hosts. As the parasite enters a host, it becomes non-motile and reproduces inside macrophages. The life cycle completes when another sand fly ingests a blood meal from an infected host. Wildlife reservoirs for the protozoan include rodents, hyaxes, dogs or foxes.

In North Africa, Phlebotomus sp. acts as the vector. However, in the United States, there have been reports of direct transmission, without the presence of an appropriate vector; direct transmission from a female dog to her pups has also been reported in the USA.

The Phlebotomus sand fly, vector of leishmaniasis in North Africa, is smaller than a mosquito and active throughout the night. (http://www.life-of-science.net/medicine/)

In animals, the disease is most commonly seen in dogs, although cats and horses can also show signs of infection. Canine leishmaniasis can have visceral, cutaneous and systemic component (although multiple forms can occur in a single animal). Clinical presentation is similar to the patient above and there is often cutaneous involvement. Other clinical signs present in dogs include anorexia, fever, lymphadenopathy and renal failure (the main cause of death in unmanaged cases). The disease in cats and horses is usually milder and is characterized by non-healing ulcers on the ear tips or muzzle.

Treatment in dogs is often unrewarding and no good protocol has been found yet. Common medications used include allopurinol or Pentostam (sodium stibogluconate). Even well-managed patients can show high rates of recurrence.

Human disease also varies in clinical appearance. Cutaneous manifestations can be simple or diffuse and are usually characterized by nodules on exposed areas of skin (most often face & hands), which can develop to ulcers. Simple cutaneous infection is often self-limiting while the diffuse form can be lifelong. Symptoms of visceral leishmaniasis in people (Kala-azar) include weight loss, fever, splenomegaly and hepatomegaly. Once again, the illness can resolve on its own, however, in immunocompromised or malnourished individuals, the disease can be fatal. Resolution of the visceral form can also be followed by the cutaneous form. Mucocutaneous leishmaniasis is a more aggressive form found primarily in Latin America and is characterized by erosion of the nose or oropharynx.

Treatment in people is often long and depends on the form of the disease, geographical location and species of Leishmania. Pentostam and meglumine are often used; guidelines from the World Health Organization (WHO) also include the use of amphotericin for visceral leishmaniasis.

From left to right: visceral, mucocutaneous & cutaneous leishmaniasis. (http://wiz2.pharm.wayne.edu/module/antiparasitic.html)

Infection rates in people and animals are increasing worldwide and it is important to look to environmental factors to explain this trend from a One Health perspective. Some of these factors include increased human-wildlife contact, such as in newly deforested areas where populations have increased contacts with sand flies. Another theory that has been put forth regarding many arthropod-transmitted diseases is global warming. As average summer temperatures rise, vectors find more suitable environments and establish persistent populations at higher latitudes.

For more information on Leishmaniasis:

Leishmaniasis – CDC

Leishmaniasis – Iwoa State Center for Food Security and Public Health

Rabinowitz PM & Conti LA. 2010. Human-Animal Medicine. Saunders Elseviers ed.

(Courtesy of Western University)

One Health promotes a multi-disciplinary approach to public health, in which professionals from different backgrounds must work together for a common goal, each adding their part to the puzzle that is public health.

At a basic level, it requires health professionals to be aware of responsibilities of other health-related fields.

Short-term strategies to establish a One Health approach include having current health professionals communicate and encourage multi-field cooperation. This is a conscious transition that these professional have to make. A more long-term solution is to expose professionals to One Health during their training and give them the tools for efficient inter-disciplinary cooperation as they become prepared to enter their respective professions.

Western University of Health Sciences, located in Pomona CA USA, started in January 2010 its first Inter-Professional Education (IPE) curriculum. The program reunites 1st and 2nd year students from the 9 colleges present on campus into groups of 8 or 9 as they are exposed to cases written by various professors. These cases may focus on one specific aspect of medicine or health, but are inter-disciplinary in nature (just like real life) and every team member adds their own perspective and experience to solve the problem presented to them with a multi-faceted approach. The Problem-Based Learning (PBL) curriculum promotes discussion and cooperation between the students and exposes them to the work of their peers. PBL requires that each group is facilitated by a faculty member, however, this person only monitors the discussion and this is overall a student-oriented process. The group members are responsible for steering the analysis of the case and its progression. The elect which strategy would be beneficial to follow and identify what issues or concept are important.

I had the occasion to participate to this IPE courses as a facilitator (faculty member) responsible for several different student groups. This was a unique experience, to sit in the facilitator’s chair, after having been taught veterinary medicine at Western myself through a PBL system. Group dynamics largely depended on individual student personalities, however, the most interesting aspect for me was to see how these students’ views on other health-related professions changed during the course. During my professional career, I have noticed that people do not always appreciate the range of work executed by veterinarians and IPE is a way to introduce these health professions to one another.

The hopes are that, after graduation, work in inter-disciplinary teams will be easier for these students as they will have been exposed to the challenges of such environment.

The course is mandatory for all students enrolled in 1st and 2nd years at Western University, regardless of their future professional interests and some may not see themselves working in the public health field. It is important, however, to remember that every health professional is a public health advocate and that a better understanding of One Health starts with a better understanding of health professions in general.

For more information on Western University’s IPE program, check out their website.

Note:
Western University is home to 9 colleges:

Osteopathic Medicine (COMP), Allied Health – PT, PA, MSHS (CAHP), Pharmacy (COP), Graduate Nursing (CGN), Veterinary Medicine (CVM), Dental Medicine (CDM), Podiatric Medicine (CPM), Optometry (CO) & Biomedical Sciences (GCBS)

(Courtesy of Western University)

Posted by: glamielle | August 21, 2010

Echinococcosis prevention in the highlands of Peru

The communities studied were often remote and had limited access to medical facilities

Zoonotic diseases most often affect populations of the developing world, as exampled by tuberculosis, an illness largely eradicated from developed countries but still present in poor communities. The relationship between poverty and such diseases are multifactorial in nature but heavily influenced by lack of education, inadequate funding or little international interest in these pathogens.

I was able to witness these relationships as a 4th year veterinary student at Western University. Our curriculum enabled us to set up rotations in specific areas of interest and I naturally focused on public health. During one of these rotations, I and two other classmates spent one month in Peru with the San Marcos Veterinary Faculty in Lima, Peru. We participated in various local research projects regarding zoonotic diseases such as Chagas disease, neurocystisercosis, equine infectious anemia and methicillin-resistant Staphylococcus aureus (MRSA) prevalence in neighboring farms.

Our main work, however was in the Peruvian Highlands as we were actively participating in a prevention program against tapeworm Echinococcus granulosus. This is a parasites that is distributed worldwide, however there are several hotspots such as Peru, where human prevalence is thought to be around 9% in some parts of the country (one of the highest worldwide). Other hotspots include Northern Africa and China.

Life cycle of Echinococcus granulosus (http://www.dpd.cdc.gov/dpdx/html/Echinococcosis.htm)

The parasite’s life cycle is closely related to several domestic species, which greatly facilitates human transmission. Dogs are the primary host and the pathogens are shed in the feces. From there, they are eaten by a secondary host, in our case sheep, and escape the gastrointestinal tract to internal organs where they form cystic structures. This life cycle completes when dogs eat these organs along with the cysts.

A human radiologist came along for part of the research to help us identify hepatic hydatid cysts in sheep

Dogs remain relatively asymptomatic for infection as the parasite stays in the intestines, however sheep can show clinical signs as these cysts grow and obliterate internal organs.

In the Andean context, this life cycle is favored by a sheep-based agriculture and a large canine population, mainly used as herders. Native practices of home slaughtering of the sheep and feeding viscera to the dogs also greatly facilitate this life cycle. Human cystic echinococcosis is similar to the sheep disease as people are considered a secondary dead-end host (fortunately because we seldom get eaten by dogs, the life cycle doesn’t complete itself after human infection). The pathology is also similar in the sense that the tapeworm disseminates to internal organs, mainly liver and lungs, and forms slowly growing cystic structures, eventually leading to failure of these organs. In the Andean context, children are often the primary caretakers of the dogs and thus are at higher risk of exposure.

People often get infected at an early age as they care for the family’s dog

Diagnostics in people and sheep is most efficiently done through diagnostic imaging such as abdominal ultrasounds or radiographs. Treatment is often difficult as medications can have difficulties reaching through the cysts and surgery is often necessary for complete removal. However, surgery itself is not without risks and rupture of the cyst during removal can cause dissemination of the parasites throughout the body and secondary cyst formation in the abdomen. Several methods have been developed to treat the infection such as the perforation aspiration injection and re-aspiration (PAIR) procedure, in which cystic fluid is aspirated and then replaced by medication. This procedure, however requires general anesthesia and advanced medical equipment, which is not always available in remote areas. In fact, in the some remote communities of the Andes, medical facilities can be virtually non-existent and infection in people can be undiagnosed until later stages.

Diagnostics in dogs can also be difficult since these animals are usually asymptomatic. Fecal floatation for egg identification can yield results, however, eggs are shed intermittently and it is impossible to distinguish them visually from other tapeworm eggs such as Taenia spp. Other methods include ELISA and PCR but these can be costly. The infection in dogs is efficiently resolved through the uses of praziquantel but, since the parasite is present in the environment, there are high rates of re-infection.

The culprit: Echinococcus granulosus, in a heavily infected canine fecal sample

Our work with the San Marcos Faculty included travelling to various Andean communities to promote knowledge of the

Fecal sampling in a dog. Samples will be analyzed for infection through fecal floatation and copro-ELISA

infection and its life cycle as well as testing alternate treatment protocols using more frequent praziquantel administration. We took blood and fecal samples from dogs presented to us by the villagers and gave them medication. Researchers would come at different time in the future to reproduce these steps and measure rates of re-infection in dogs. Along with that, I designed a knowledge, attitude, practices (KAP) survey to identify potential risk factors for human infection and administered the survey in a few of these communities. The fact that these were usually indigenous populations often made Quechua the favored language compared to Spanish and communications often required a translator. I found that knowledge of the disease was inconsistent and education is the first barrier for proper management and control of echinococcosis in these parts.

When considering zoonotic diseases, prevention is one of the most important aspects for eradication and control. These are often pathogens that are prevalent in parts of the world that do not have proper access to medical professionals, proper educational background or the economic power to implement ideal surveillance programs. In this context, there are specific practices that put people at higher risk of infection, namely feeding infected sheep offal to dogs or hygiene habits. If we want to be able to prevent human infection, we must educate the local population about the disease and implement proper slaughter protocols to break the life cycle of the parasite. A One Health approach is needed to recognize that reduction of disease in people is impossible without treating dogs and the environment in which they live and thus limit rates of re-infection.

While there is a lot of attention on emerging infectious diseases such as novel influenza strains or Ebola virus, we need to remember that there are countless chronic or re-emerging illnesses diseases that still affect millions of people worldwide, such as cystic echinoccocosis or leptospirosis.

Administering KAP surveys. Contact with the affected population was an essential part of the project.

More information:

Echinococcosis – Iwoa State Center for Food Security and Public Health

Posted by: glamielle | August 21, 2010

About One Health

In the traditional model for public health (left), there are minimal interactions between each field. A One Health approach (right) recognizes the inherent relationships between each field.

While not new, the principle of One Health has recently resurfaced. On its most basic level, it refers to the relationships between human, animal and environmental health. While the definition of global health may vary, my belief is that it is the application of One Health to a global scale.

The traditional view of public health is one that is often sheltered within its specific field. There is thus the belief that human health is only a matter of human health professionals, animal health a matter of veterinarians and environmental health a matter of environmentalists.

In such a situation, there is little communication between each field and in that sense they progress isolated, at a different pace and with little cooperation with each other.  Problems are viewed from one perspective and are managed in a unilateral fashion. This is, however, not a realistic representation of our world, where every system affects one another.

The advent of the Industrial Age has changed our world in dramatic ways. Science progressed to new exciting heights and human success has boomed. The other side of the coin is that the world has become overpopulated, leading to unequal development, rise in poverty and disease, decrease in food supply and environmental degradation. These are known as “wicked problems” and are multifactorial in nature. Unfortunately, there is rarely a simple answer to such complicated problems. It is only when looking at the world in a new way and appreciating its complexities that we come to realize that one-sided approaches cannot provide long-lasting solution to these problems.

There is thus the need to shift away from this traditional unilateral approach. One Health provides a more comprehensive perspective to public health, taking into account the intricate complexities of our world and using interdisciplinary tools to solve problems. In this model, humans and other animals live in a common environment. It is logical to assume that a change in one of these factors will affect the other two.

Veterinarians are lucky (well that’s how I see it at least…) in the sense that they find themselves at the center of these interactions. Indeed, they are on the frontlines of human health when it comes to zoonotic diseases, or diseases transmissible between animals and people. According to the World Health Organization, 70% of infectious diseases discovered in the past twenty years originated from animals. These include well-known illnesses such as HIV-AIDS, tuberculosis, plague, or influenza virus. If we are able to detect and identify outbreaks of such diseases in animals, we will be more likely to reduce their impact on the human population.

The bubonic plague, transmitted by the rat flea, is still largely present in the developing world (Photo from: http://medlibrary.org/medwiki/Bubo)

Public health is also strongly influenced by animal health. Indeed, many depend on animals for their subsistence and it is important to promote adequate animal health to ensure proper food safety and security.  Diseases such as rinderpest or foot and mouth disease are directly harmless to humans; however they can devastate agriculture and thus people’s livelihoods. Animal welfare is also an important part of promoting public health from this perspective and it is important to understand that, besides the obvious ethical issues, mistreated or stressed animals are more susceptible to illness.

While immune to the disease, people can be severely affected by Foot and Mouth Disease (FMD) through cattle and other animal losses (Photo from: http://www.topnews.in/another-foot-and-mouth-case-confirmed-surrey-cattle-farm-22335)

Perhaps the most complicated issue we are faced with is human impact on the environment and climate. It is difficult to project how environmental degradation will affect long-term public health. Losses in biodiversity have reached unprecedented levels through over-exploitation and habitat loss. Numbers are staggering, as illustrated by dwindling shark numbers worldwide (hundred million fished yearly) or bluefin tuna population in the Mediterranean. Wildlife species such as amphibians provide us with important bio-markers for environmental health and it is important to adequately study them if we are to better understand how environmental changes affect public health.

The chytrid fungus has been responsible for dramatic decreases in amphibian populations worldwide. Causes of this sudden spread of the disease are not well-known and some scientist implicate international travel and global weather changes. (Photo from: http://www.dpughphoto.com/frogs_and_toads.htm)

To conclude, One Health gives us a complex world and appreciating how each part affects another can be difficult. While I am positive that we can do it, the question is: can we act accordingly. To tackle these “wicked problems”, a comprehensive and multidisciplinary approach is essential.

For more information about One Health, check out the Links section.

Posted by: glamielle | August 20, 2010

Hello planet Earth!

Front page

Hello everyone!

My name is Gaël Lamielle and I am a veterinarian pursuing a career in public health.

Why public health you ask? (And I know you will ask, because I’ve been asked that many times). Well a lot of people think that being a

At the clinic with Effie, perhaps the strangest cat in the world

veterinarian and a public health professional are 2 distinct fields and they believe I have to leave my veterinary career behind to step into public health.

Public health is a very broad topic and there are many angles to which one can approach it. Veterinarians are in fact very intimately to public health, in virtually every aspect of their work. Even a local small animal practitioner is a public health advocate by vaccinating pets, or treating them against diseases such as parasite Toxacara for example, which is very common in cats and dogs, but can cause serious illness in people.

Veterinary public health promotes public health from the animal perspective. It recognizes the inherent interdependence between humans and animals. For more about this idea, check out the About One Health post.

A little bit about me, I was born and raised in Lyon, France and I later moved to the USA. I became a veterinarian in 2009 after attending Western University of Health Sciences in Pomona, California.

Throughout my studies, I was exposed to public and global health through projects in Latin America as well as wildlife medicine in South Africa.

Intramuscular antibiotics administration in an immobilized springbok in South Africa

I was also an active member of the International Veterinary Student Association (IVSA), probably the best association in the world (but maybe I’m biased…), where I made great friends and where I learned to recognize the different challenges in learning and practicing veterinary medicine throughout the world. Check out their website at: www.ivsa.org.

Since I graduated, I have been working part-time at a small animal clinic in Southern California as well as at Western University. I also recently completed a Masters in Public Health (MPH) with University of Minnesota . In the future, I hope to continue promoting global veterinary public health and I would like to work for global public health organizations such as the CDCOIE or WHO. We shall see…

With this website, I hope to promote the perspective of the veterinarian in addressing public health issues and share experiences on a local and international level. Let me know what you think.

Cheers,

Gaël Lamielle, DVM MPH

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