IVSA Standing Committee on One Health meets Spring! VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
May 2014
Table of Contents...
Editorial by Theofanis Liatis
Public Health within IPSF by Sheena Patel
Why donkey milk? by Nikoleta Makri
Anthrax: a potential threat of animals and human life by Arslan Mehboob Working and therapeutic animals as potential carriers of bacterial pathogens by Tina Zitnik Oitzl, Mateja Naralockik
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VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
May 2014
Editorial... Dear readers, We are very glad that you welcomed the 1st VPHJ of SCOH in February 2014. Our goal was achieved. Many articles from all over the world were published in order to give a taste of Public/One Health throughout the world and of course vet’s role in it. In this issue, you can find very interesting articles and a great article of Sheena Patel, the Chairperson of Public Health of IPSF (International Pharmaceutical Students’ Federation). IVSA/SCOH is going to collaborate formally with IPSF and our pharmaceutical colleagues in order to promote the interdisciplinary collaboration and the importance of many joint sectors and especially Antimicrobial Resistance. I also would like to thank Sheena, as I was invited to write an article for IPSF’s journal. Please guys, entertain yourselves! Friendly, Theofanis K. Liatis Chief Editor Veterinary Public Health Director of IVSA Chairman of Standing Committee on One Health 2013/2014
The VetPubHealth Journal (VPHJ) Edition Editors Team: Bastola Sirjan, Nakade Mangesh, Ntemka Katerina, Yablonovich Ilana Designer & Chief Editor: Liatis Theofanis A publication of the Standing Committee on One Health (SCOH) of International Veterinary Students’ Association (IVSA) https://www.facebook.com/thescoh publichealth@ivsa.org ©2014 VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
May 2014
IPSF Collaboration
PUBLIC HEALTH WITHIN IPSF International Pharmaceutical Students’ Federation
By Sheena Patel, IPSF Chairperson of Public Health 2013/2014 Hello everyone! My name is Sheena Patel and I am the current Chairperson of Public Health within International Pharmaceutical Students’ Federation (IPSF). I am currently a Pharmacy Student at Wilkes University in United States of America. I will be graduating school this May, so VERY excited for this!! IPSF now represents more than 350,000 pharmacy students and recent graduates in 70 countries worldwide. IPSF is the leading international advocacy organization of pharmacy students promoting improved public health through provision of information, education, networking, and a range of publication and professional activities. So my role is mostly focused on Public Health. I help our members educate patients all over the world on seven Public Health Campaigns. These seven Projects have been selected based on prevalence of each issue. The Public Health Campaigns IPSF focuses on are the Humanitarian Campaign, Medicine Awareness Campaign, Anti-Counterfeit Drug Campaign, Diabetes and Healthy Living Campaign, HIV/AIDS Campaign, Tobacco Awareness Campaign, and AntiTuberculosis Campaign.
World Health Organization. They have felt that this year anti-microbial resistance and non-medical use of prescription drugs are an issue. So we have asked our members through a ‘Mission Impossible’ concept to educate patients on how to prevent these two issues. The members will create a video of them carrying out this mission which we will be showcased during our World Congress held in Porto, Portugal this July/ August. Anti-Counterfeit Drugs Campaign is self-explanatory in the fact that we want to educate students and Pharmacists on counterfeit medications. This year we are asking our members to share a picture of themselves wearing yellow t-shirts and forming the letter ‘X.’ They will include a small summary of their activities with their picture. All of this will be posted on a map under the ACDC section of Public Health on the IPSF website. For each of our Awareness Campaigns we did a different project. For example for Diabetes and Healthy Living Campaign we had members share pictures from their Diabetes events on Facebook, while members wrote an essay on discrimination for our HIV/AIDS Campaign. In the Anti-Tuberculosis Campaign, we are having members create a poster on the importance of Tuberculosis to our patients and our members. Finally for IPSF’s Tobacco Awareness Campaign we are having members create a short video on our fight against Tobacco.
In the Humanitarian Campaign we chose three international projects to support, the Vampire Cup, PLAN, and Books for Africa. The Vampire Cup is a competition where countries all over the world compete to raise the most number of units of blood. The country within IPSF that raises the most number of units of blood will win the Vampire Cup. Books for Africa is where IPSF members can donate Pharmacy textbooks to stu- “I want to keep the memdents in Africa who may not have access bers active in Public to these resources. PLAN aims to improve the quality of life for deprived chil- Health…” dren in developing countries. IPSF memAs you can see we are very busy bers can support Plan’s efforts through within Public Health in IPSF. I want to one-time donations, sponsoring a child, keep the members active in Public or purchasing “gifts of hope.” Health not only to be involved in the This year for the Medicine organization, but also be involved in paAwareness Campaign we are focusing on tient care. A Pharmacists’ role is changissues that are important to one of our ing towards a more patient centered main external Public Health partners, the treatment. At the center of this change is VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
Public Health. In order to help treat patients with medications Public Health is needed. It provides the awareness aspect as well as the patient interaction of Pharmacist oriented care. This is just one aspect that helps unify and strengthen the role of the Pharmacist on a global scale. Thank you for taking the time to read my summary of my role as IPSF Chairperson of Public Health! I hope this inspires you to get involved in Public Health not only in IVSA, but also in your local association!
“Public Health Rocks!”
May 2014
TUBERCULOSIS IN INDIA
Zoonoses
By Kelvin Momanyi, IVSA India
Tuberculosis is a chronic disease of Human being as well as animal species caused by bacteria of the genus Mycobacterium. It is characterized by development of tubercles in the organs of most species. Bovine tuberculosis is caused by Mycobacterium bovis and in humans by Mycobacterium tuberculosis. Both the species have significant zoonotic Importance.
History Tuberculosis was first discovered by the Dr. Robert Koch in the year 1882. He announced in Berlin that cause of tuberculosis means the TB bacillus. He declared publically about this virulent human infectious disease and explained about the etiology of the tuberculosis through the presentation of many microscope slides. During his announcement in the Berlin, it was spreading very fastly in the Europe and the Americas of which the death ratio was one out of seven. His discovery about the tuberculosis had opened a big door in front of the people to get diagnosed and cured of tuberculosis. Types of tuberculosis The human type – M. tuberculosis The bovine type – M. bovis The avian type – M. avium There is a fourth type that affects fish Modes of infection The routes by which tubercle bacilli gain enVetPubHealth Journal ISSUE 2
trance to the body are: Respiration, Ingestion, Inoculation, Congenital, Genital – infection by way of genital tracts. Geographical Distribution in India: India accounts for 20% of the world’s TB cases and the disease infects 3 million people a year and kills over 3 lakh every year. In Jan 2012 things got even uglier as India played host to an extremely dangerous version of tuberculosis which experts termed Totally Drug Resistant Tuberculosis (TDR-TB) – a disease that afflicted 12 people in Mumbai. This new version of TB was resistant to all forms of anti-TB drugs and unlike earlier drug resistant versions like multidrug resistant (resistant to two drugs) and extensively-drug resistant (resistant to four drugs). Not only was it resistant to every known TB drug but it had afflicted people in a densely populated city like Mumbai where the potential for an outbreak was immense. Zoonotic Aspect M. bovis in India Till 1916 Tuberculosis in cattle was considered very rare because Indigenous cattle are naturally resistant Low virulent tubercle bacilli isolated from indigenous cattle Open air system where animals are housed During 1980s, Indian council of Agriculture Research (ICAR) started scheme they found prevalence of bovine TB in India varies from 1.6 to 16% in cattle and 3 to 25% in buffaloes. Proportion of human disease caused by M. bovis show regional variation depending on the presence and extent of disease in cattle population, the social and economic situation, standard of food hygiene besides application of preventive measures. Studies in United Kingdom and United States of America confirm that by 1937, upto 25% of TB cases in humans were due to M. bovis. The majority of these cases were non-pulmonary TB with only 2.5% pulmonary TB. A high rate of M. bovis infection is commonly associated wih occupational exposure. Veterinarians working with infected herds show high rate
IVSA Standing Committee on One Health
May 2014
of tuberculin positivity (45.4%) and overt T.B. animal species as disease reservoir. (4.1%) although it is not established that such infec- Creating awareness in the community especially tion and disease is only due to M. bovis. farmers and those involved in slaughtering and meat trading. Zoonotic Aspect of M. tuberculosis in India Public health precautions like pasteurization/ heat M. tuberculosis infects 3 million people a year and treatment of milk that can reduce the danger of kills over 3 lakh every year. But it is not distinguish- TB particularly to infants. able M. tuberculosis is alone responsible for this cas- Efficient surveillance system and co-ordination es. between medical and veterinary professionals through effective communication for contact tracVeterinary Public Health Measures for zoon- ing and joint epidemiological investigations otic TB Regular health check- up for occupational groups Routine testing and inspection of cattle even at at risk including examination for non-pulmonary slaughterhouses forms of TB such as lymphadenitis beside sputum Detecting infected herds and removing them to microscopy and chest radiology, if required. reduce the spread of TB within herds. A co-ordinated strategy for developing and testing Adopting control strategies to reduce transmisof new vaccines for tuberculosis in man and anision by: (i) Effective ventilation; (ii) Reduction of mal. group size; (iii) Minimizing contamination of feed, Funding agencies need to be encouraged to spongrazing and water with respiratory secretions or sor regular workshops to facilitate collaborations faeces by attention to hygienic practices, buildings and achieve scientific consensus on research priand equipments. orities besides developing an E-mal discussion Promoting research on accurate diagnostic tests groups and video conference. and the potential role of other domestic and wild
VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
May 2014
WHY DONKEY MILK?
Food Safety
By Nikoleta Makri, IVSA Thessaly
Eventually Greek consumers can drink Donkey milk, as the Ministry of Rural Development and Food published a new Decision on the requirements and conditions in order to be followed for the production, processing and disposal of equine milk, creating the framework for this new market. In order to understand the importance of this, not as much as we suggest “new product” ,we must have a look at the history of donkey milk. It is well known that some of the most beautiful women of ancient times, particularly appreciate the beneficial qualities of donkey milk. Cleopatra, the Queen of Ancient Egypt, known for her stunning beauty as well as the second wife of the Roman Emperor Nero, Poppea Sabina took their daily baths in Asse’s milk. Studies showed the presence of vitamins A1, B1, B2, C and E in large quantities as well as a great rate of immunoglobulins, magnesium, calcium, potassium, phosphorus, zinc and sodium in donkey’s milk. Furthermore, donkey’s milk proteins provide remarkable moisturizing and nourishing properties and it is generally believed that effaces facial wrinkles. Today, plenty products, like soaps and moisturizers, are made of this kind of milk.
it has a low-fat percentage, only 1%, while cow's milk has a fat percentage of 3.9%, goat’s 3.5% and sheep’s 6%. It is worthmentioning that donkey milk can be a solution for people intolerant to cow's milk. Studies have been carried out on children allergic to cow's milk; they have shown that Donkey's milk is tolerated by most of them. Furthermore it has sweeter taste which makes it more pleasant and well accepted, unlike -other formulas or products, whose use among children allergic to cow's milk is rightly compromised because of their bitter taste and after-taste.
In addition to its cosmetic use, Hippocrates (460 – 370 BC) the father of medicine- prescribed asses’ milk for numerous purposes, such as liver troubles, infectious diseases, fevers, edema, nose bleeds, poisonings, and wounds. Asse’s milk has found to be the closest in the human breast milk and exhibited unique nutritional characteristics because it contains more lactose and less fat than cow’s milk. As a result of this advantage, it is given in some cases to premature infants to ensure their proper growth. The high content of lactose increases the absorption rate of calcium, an important fact for the development and maintenance of the human body and thus it can be used by elderly people with osteoporosis problems. The high content in omega-3 makes it a functional food for human consumption, even more for adults, where the risk for cardiovascular disease increases. Compared with breast milk, donkey milk contains a higher amount of essential fatty acids for the body. In addition,
Eventually the donkey milk is not the super-product that will magically meet all our nutritional deficiencies. But it is a valuable food and a natural supplement, which within a relatively balanced diet offers us something “extra” we are all looking for.
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Therefore taking into account all the above, it could be said that donkey milk is more nutritious and beneficial for the body than the milk of a goat or cow. Is it however the same resistant in pathogens or is a food most vulnerable? Latest research data showed that it is a product with very low microbial load that can be eaten without having undergone any heat treatment, such as pasteurization. The lack of pasteurization constitutes the immediate freezing after milking, while the transfer process from the producer to the consumer, but also the storage require special attention to prevent contamination.
IVSA Standing Committee on One Health
May 2014
ANTHRAX: A POTENT TRHEAT OF ANIMALS & HUMAN LIFE
Zoonoses
By Arslan Mehboob, Undergraduate student of the Faculty of Veterinary & Animal Sciences of Lahore, Pakistan Introduction Anthrax is the most fatal and zoonotic disease caused by a gram positive bacterium bacillus anthracis. According to OIE (Office International des Epizootics). It is considered as A category notable disease. This should be reported to WHO (world health organization) and OIE within 24 hours of its occurrence. Etiology It is caused by bacteria known as Bacillus anthracis. Morphology of Causative Agent Bacillus anthracis is a gram positive rod shaped aerobic non motile capsulated spore forming bacteria having cell wall made up of peptidoglycan and a capsule around it. This bacteria has plasmid encoded virulence factors; a capsule which resist in the phagocytosis. It also has a plasmid named pXO2.The bacterium is characterized by having tripartite toxins having edema factor, lethal and protective antigens. Mostly genotyping is done to perform epidemiological studies. This organism has capable of producing toxins that survive in the environment for decades and remains active. The bacterium is capable of producing terminal endospores that are frequently called as spores but it may not be confused with the spores of fungi. These spores can be found everywhere in the earth including Antarctica. They can cause infection even when they come in contact with skin, inhaled or ingested. They rapidly activate and multiply rapidly. Spores of bacteria Spores are much resistant to the extreme climatic conditions included in salting phenomenon of hides, standard disinfections and temperature fluctuations. The spores are viable up to 60 years in the soil in the presence of organic matter. Soils acidic in nature reduce the chances of survival for Bacillus anthracis. As spores are soil bore. They may cause infection about 60 year later of their production .Disturbed grave sites are the major cause of spore transmission to the other areas. Anthrax spores can be produced artificially in vitro. It does not spread directly by the contact instead it spreads through the fatal spores. The spores can be transmitted either by clothes or contaminated shoes. The blood and secretions of affected animals also have spores that become activated. It is a potent disease which is used as a chemical source of war head used by most of the countries. Although the culturing of bacillus anthracis is banned worldwide, a number of countries are culturing it as a potent source of bio weapon. In powder form the culture of this organism is used as a biological weapon. Anthrax is considered as category A disease by CDC (centers of disease control and prevention). Eating meat of the affected animals act as a source of pathogen entry into the body. Epidemiology Until the twentieth century thousands of animals and humans died each year from anthrax. The disease has worldwide distribution and probably has origin from sub Saharan Africa. It is reported both in human as well as in veterinary sector. Prevalence areas vary from the type of soil, the climatic conditions and most importantly the efforts which are being made to suppress its occurrence. Anthrax Belts are the specific areas where anthrax is enzootic. Morbidity and mortality rates Most of its cases are sporadic and randomly occur in a population. Morbidity is about 1% but the mortality is 100%.Now a day's many sudden deaths occurs without showing any clear cut signs. In tropics the organism remains in the soils where mostly frequent outbreaks are reported. In some of the Saharan areas the disease mostly occurs in the summer months and attains its peak in heavy rain fall months having devastating effects. Mostly predators are an inert carrier of the infection so majority of deaths occur in those areas. In temperate areas sporadic infection usually occurs due to soil borne infections. Most common sources in the areas are the pastures affected from tannery wastes and the contaminated bone meal. In this case number of animals infected and incidence of outbreaks are small.
VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
May 2014
Use in Bioterrorism In United States in 2001, White House officials received a letter having a white powder. The letter was written to US President. Forensic experts later found that the envelope was full of spores of anthrax. It was used as a threat and active biological agent. In early 2010 in Cagayan province of Philippines, about 400 people got infection by consuming the meat which was previously infected with anthrax spores. The disease ended with great morbidity and two people died. Routes of transmission There are three major routes of its transmission, principal off which is inhalation. Other routes include are oral and cutaneous. Spores play most active role in transmission of disease and enter the body through inhalation. After getting entry into the body the organism is surrounded by macrophages. The organism is resistant to phagocytosis due to the availability of poly D glutamic acid capsule Forms of disease Inhalation anthrax Inhalation anthrax is also named as Woolsorter's disease or Ragpicker's disease. These professions were more associated with the disease occurrence. The use of animal skin and horns for production of different articles was a potential source of susceptibility. Gastrointestinal anthrax Gastrointestinal type of disease in human is caused when spores are ingested in the body. Initially there is GIT disturbance, bloody vomit and inflammation of whole tract. Lesions occur more on the intestine where necrosis also occur. The spores actively propagate and produce toxins that frequently go in the blood and condition becomes worse. The case fatality of this form is 25 % to 60%. It is treatable but rarest form of the disease. In United States only two cases were reported. The first one being reported in 1942 and the second case reported in 2010 in Philippines. Cutaneous Anthrax In human beings the cutaneous form of this infection is characterized by formation of boil like lesion that eventually converts into a black centered scar tissue. In general in 2 to 5 days a black colored eschar appears on the skin that resembles with black mold. In the beginning the eschar is painless with intense itching. Unlike bruises or other infections of skin, the typical lesion of anthrax has no pain. Cutaneous anthrax is caused when skin comes in contact with infective spores. Spores may enter in the body through cuts in the skin. This form is most commonly present in those people who are involved in animal skins and hides handling. It is not a lethal form as infection is only limited to a specific area. In cutaneous form there is no entry of edema factor, lethal factor and protective antigen form. If untreated about 20% of cases may die due to toxemia. Cutaneous anthrax can occur in the veterinarians dealing with the carcasses for the postmortem examinations. Major areas affected are neck and fore arm regions. Initially infection starts with the formation of a papule which swells and within 1-2 days it bursts that later converts into necrotic ulcer with a central scar of black colour. There is also swelling of regional lymph nodes. Vaccination and treatment protocol US CDC center of disease control and prevention department suggest that persons having exposed to bacillus anthracis as Bio Weapon must be vaccinated as early as possible. However vaccination prior to attack is not recommended in these groups. In human populations, post exposure vaccination is done by inactivated vaccine at 0, 2 and 4 week interval along with the combination of antibiotics for 3 doses. Doxycycline or ciprofloxacin may be an ideal choice in this case .the drugs of choice are Penicillin and doxycycline. These antibiotics are only effective to the germinated Bacillus and are inactive against the spores of disease. The safety and efficacy of vaccine is not been studied in pregnant women and children, therefore it is not recommended to use the vaccine in these groups. The duration of protection provided by the vaccine is also unknown. However it is believed that the protection remains for 12 months. If subsequent exposures occur, repeated vaccination is recommanded.immediate washing is recommended in case of cutaneous infections. In GIT and Cutaneous forms, there is no recommendation in postexposure prophylaxis. Because of the severity in GIT form maximum emphasis is put on post exposure vaccination along with regular antibiotic therapy to reduce the risk of spore formation and to subside the disease.
VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
May 2014
Zoonoses
WORKING AND THERAPEUTIC ANIMALS AS POTENTIAL CARRIERS OF BACTERIAL PATHOGENS By Tina Zitnik Oitzl, Mateja Naralockik IVSA Slovenia
Therapeutic and working animals have become very important in various human activities. However, certain requirements should be fulfilled. Besides having the adequate temperament, the animals must be completely healthy and must not carry infectious transmissible to humans. We have to pay attention to microorganisms which colonise skin, fur, apparent mucosa and digestive system. Animals that are colonised with microorganisms can be a potential threat to people, especially as mostly therapeutic and working animals come in contact with immune-compromised people. On the other hand, these patients are potential source for animal colonisation. The purpose of our study was to find out the state of colonisation of therapeutic and working animals with bacteria that cause hospital infections. We studied three bacterial species which are the most im-
portant agents of nosocomial infections and are difficult to treat with antibiotics: methicillin-resistant Staphylococcus aureus (MRSA), E. coli with extended-spectrum beta-lactamases (ESBLs) and Clostridium difficile (CD). We examined 84 animals: 14 therapeutic horses and 70 working dogs (48 therapeutic dogs, 17 rescue dogs and 5 dogs that live with therapeutic animals). Control group consisted of 28 animals (18 dogs and 10 horses). Our goal was to ensure safety of people that come in close contact with therapeutic and working animals, their owners and lastly these animals alone. In genus Staphylococcus are coagulase negative and positive species. The latter are clinically more important. S. aureus causes hospital and community associated infections which often gain resistance for antibiotics (HA-MRSA and CA-MRSA), and lately livestock associated MRSA (LA-MRSA). The S. intermedius group (S. intermedius, S. delphini, S. pseudintermedius) are isolated in animals, the latter in dogs and cats rather than S. aureus. Staphylococci colonise skin and mucosa and cause pyodermatitis, otits externa, inflammation of genitourinary tract, respiratory system and surgical wounds, often as a secondary infection. Escherichia coli is a part of intestinal micro flora. Strains are classified as enterotoxic, enteropathogenic, enteroinvasive, enteroaggregative and enterohaemorrhagic. Resistance is acquired horizontally from other intestinal micro flora species or caused by beta-lactamase enzymes. E. coli causes infections of genitourinary and respiratory system, sepsis, abscesses, peritonitis etc. Clostridium difficile is sporogenic bacteria and a part of intestinal micro flora. Enterotoxigenic strains cause infection when intestinal micro flora is altered. Clinical manifestation is diarrhoea, haemorrhagic colitis, pseudo membrane colitis or even gut perforation.
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IVSA Standing Committee on One Health
May 2014
We collected nasal swabs to determine the presence of coagulase-positive staphylococci and their resistance to methicillin. We examined rectal swabs or faeces to determine the presence of E. coli with extended-spectrum beta-lactamases (ESBLs) and the presence of anareobic bacterium C. difficile. MRSA was not isolated from any canine or equine sample. However, coagulase-positive staphylococci (S. pseudintermedius, S. aureus, S. intermedius and S. schleiferi subsp. coagulans) were isolated from 21 samples. Low resistance to beta-lactam antibiotics, aminoglycosides and macrolides was determined for these isolates. Three faecal samples of dogs were positive for E. coli ESBL/AmpC (4.3%) and one for C. difficile (1.4%). All equine faecal samples were negative for both bacteria. According to the available literature, no study on colonisation of therapeutic animals regarding zoonotic bacteria has been performed in Slovenia up to date. Therefore, the available data is insufficient. Taking into account results of this study and the literature data from other countries, we prepared basic guidelines for microbiological control of therapeutic animals in particular, as they are often exposed to and colonised with the agents of nosocomial infections and can therefore become the source of human infections. We do not require regularly testing on presence of zoonotic bacteria in working animals. However, we do recommend some general and specific guidelines to be taken in account. Hand hygiene of owners, hospital staff and patients is in first place for it can prevent many infections. Therapeutic animals should be well groomed, healthy, without wounds, injuries or skin diseases. They must be regularly vaccinated against rabies (vaccination against some other infectious diseases is also recommended) and receive antiparasitic treatment. In case of contact with person who is positive on potentially zoonotic bacteria should be tested. If the results are positive, that animal is not allowed to visit patients until two consecutive samples in one week interval are negative. Animals should not visit risky patients like the one with insufficient immune system, intensive care patients,
oncologic patients or those in quarantine. If those patients expressly want to be visited, it should be at the end of predicted visit time. Animals are not allowed to jump on patients’ bed or lick them and patients should not shake their paws. We strongly advise not to feed animals with raw meat, especially chicken and beef. Animals should be regularly veterinary examined, properly socialized and have good temperament. Cats are less appropriate because they are of higher risk for gastrointestinal diseases and dermatophitosis transmission and also their character is less predictable.
VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
May 2014
VetPubHealth Journal ISSUE 2
IVSA Standing Committee on One Health
May 2014