IVSA SCOH VPH Journal

OLA

TICKS AVIAN INFLUENZA

PANDEMIC

OUTBREAKS

VECTOR BORNE NEGLECTED TROPICAL DISEASES

L

ANIMA

INTERDISCIPLINARY

MICS ECONQO-FEVER H T L A E H S

RIFT VALLEY FEVER LEPTOSPIROSIS

H RA

X

GY

B IS E

ATN

ANTHRAX

ABI E

S

ENV SCHISTOS IRO OMIASIS NM TOXICO ENT LOGY R

ZIKA VIRUS

OLO EMI EPID

NOS

FOODBORNE DISEASES

LTH HEA ONE

Z OO

VETERINARY MEDICINE ENVIRONMENT HUMAN

Journal Journal

6th Veterinary Health Journal by the Veterinary StudentsStudents Association, IVSA 6th VeterinaryPublic Public Health Journal byInternational the International Veterinary Association, IVSA

IN THIS EDITION

IN THIS EDITION ZIKA VIRUS: the new bug around the block

Interview with Dr. Patricia Conrad

Professor of Parasitology, Associate Dean for Global Programs in the School of Veterinary Medicine...

Veterinarians, One Health and the nexus between disease and food se1 - Prof. Robyn Alders curity

Veterinarians, One Health and the nexus between disease and food security

UPDATE: Zika virus

VPH Journal 6th edition

VPH Journal 6th edition

INTERVIEW with Dr. Bernadette Abela-Ridder

Team Leader for Neglected Zoonotic Diseases in the Department for the Control of Neglected Topical Diseases, World Health Organization (WHO)

Interview with Dr. Bernadette Abela-Ridder - World Health Organization (WHO)

Caroline Bulstra

Lawal Temitope

Dear all, A couple of weeks ago I saw an article popping up on my LinkedIn titled “Zika virus – 7 FAQS about a new bug around the block”. It was posted in the AIM Infectious Disease Group by Dr. Amina Goodwin-Fernandez.

I clicked on the link out of curiosity and thought: is this another emerging or re-emerging disease?

There are many emerging and re-emerging diseases present on our globe, like Lassa Fever for example. This is a viral hemorrhagic zoonotic disease that is re-emerging in Nigeria. It was first reported in Lassa Town, Borno State, Nigeria in 1969. The recent outbreak of Lassa fever was around December 2015 and since then it has spread to about five states across Nigeria.

This edition of the IVSA Veterinary Public Health Journal covers vector borne and food borne diseases coming from an animal source and affecting animals and humans. Climate change has influence on the rate of survivability of vectors, which has increased greatly due to global travels and global changes in the use of land and this way they can bring diseases to new, susceptible populations. Like the influence of El Nino on the Aedes mosquito that transmits Zika, Chikungunya and Dengue and ticks being able to survive in more northern African countries and that way able to introduce Theileria parva in cattle in new regions.

A nice way of looking at diseases and their impact on public health is by looking at the five W’s: Who – the host, Where – the environment affected, When – pattern of occurrence; What – etiologic agents and Why – determine why a disease affects some people in the population and not others, which is the ultimate goal of public health.

I hope you enjoy this edition!

Best Regards, Lawal Temitope Publications Team member - Standing Committee on One Health (SCOH) 2015-2016

2

VPH Journal 6th edition

The VPH Journal is edited and published by the Standing Committee on One Health (SCOH), part of the International Veterinary Students Association (IVSA).

6th edition February 2016

SCOH 2015-2016 Chair Elizabeth Malcolm Official Member Taylor Calloway Publications Team Caroline Bulstra Lawal Temitope Regional Coordinator Sungil Kim Policy Statement Liaison Officer Giorgos Polyzois Project Managers Clara Buxbaum Claudine Girardo Webmaster/Social Media Director Mathijs Knipscheer

3

VPH Journal 6th edition

In this issue

6 7 9 12 16 19 4

STOP TB DAY 2016 - FLYER PREVENTION AND SCREENING OF TUBERCULOSIS

RE-EMERGING DISEASE UPDATE ZIKA VIRUS: “THE NEW BUG AROUND THE BLOCK” Claudine Girardo, IVSA Lyon, France Caroline Bulstra, IVSA Utrecht, The Netherlands

VECTOR BORNE DISEASES

By Bolajoko Muhammad-Bashir Epidemiology Unit, National Veterinary Research Institute, Vom, Plateau State, Nigeria

INTERVIEW with Dr. BERNADETTE ABELA-RIDDER Team Leader for Neglected Zoonotic Diseases in the Department of Control of Neglected Topical Diseases, World Health Organization (WHO)

INTERNSHIP at the WORLD HEALTH ORGANIZATION: TWO VET STUDENTS SHARE THEIR EXPERIENCES Joss Kessels & Gabriel Innes

INTERVIEW with Dr. PATRICIA CONRAD Professor of Parasitology, Associate Dean for Global Programs at the University of California, Davis, School of Veterinary Medicine

VPH Journal 6th edition

22 26 30

Veterinarians, One Health and the nexus between disease and food security Associate Prof. Robyn Alders, Faculty of Veterinary Science and Charles Perkins Centre, University of Sydney, Australia

TRAVELING AND ZOONOSIS Skrekas Chrysovalantis IVSA Thessaloniki, Greece

RMBDs: Raw meat diets and consequences Giorgos Polyzois, SCOH Liaison Officer IVSA Thessaloniki, 3rd Year, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Greece

33

INTERVIEW with

37

ONE HEALTH JOBS:

41

SCOVE WRITING CHALLENGE WINNER: Yuvraj Panth from Nepal

44

IVSA at the WHO 138th session of the Executive Board

5

Dr. Barbara Haesler - One Health lecturer and researcher at the Royal Veterinary College (RVC) Maria Garza - MSc One Health gratuate Royal Veterinary College

Epke le Rutte Veterinarian working in Human Public Health

Standing Committee on Veterinary Education, (SCOVE) IVSA As a veterinary student: How can you contribute to public education on improving the welfare of stray animals?

Caroline Bulstra, SCOH Student at the Faculty of Veterinary Medicine, Utrecht University, The Netherlands VPH Journal 6th edition

STOP TB DAY 2016 "Prevention & Screening of TB" Stop TB Day is coming up on March 24th This year, the international medical, pharmaceutical, and veterinary student associations are working together against Tuberculosis!

How can you get involved?

Join us in our campaign with your own local project to raise awareness and to fight together to stop tuberculosis!

Create a campaign with local members from IFMSA, IPSF & IVSA on the topic of Prevention and Screening of Tuberculosis

Want more information?

6

cIFMSA: Jozo Schmuch, scophd@ifmsa.org IPSF: Mac Ardy J. Gloria, healthadvocacy@ipsf.org VPH Journal 6th edition IVSA: Elizabeth Malcolm, publichealth@ivsa.org

RE-EMERGING DISEASE:

Zika virus Claudine Girardo, IVSA Lyon, France Project Manager, Standing Committee on One Health Caroline Bulstra, IVSA Utrecht, The Netherlands Publications Team, Standing Committee on One Health

2016 has started with a new worldwide health alert, about Zika virus. The issue has already been fully addressed in the media, but a brief presentation should refresh our memories.

Zika is a virus transmitted by the Aedes mosquito, which also transmits dengue and chikungunya. Only one in four people develop symptoms, including mild fever, conjunctivitis, headache, joint pain and skin rash. Complications are very rare. The main concern is that Zika virus can cause microcephaly in babies of mothers who got infected while pregnant. A major health concern can be feared, since the global population is poorly immunized against the virus, the geographical distribution of the vector is large and no vaccines or specific treatments are available. That is why the World Health Organization (WHO) is being particularly active on this matter.

Why is Zika important to us, as vet students and future veterinarians? It does not seem obvious at first sight, as Zika virus only seems to affect human health. When we have a closer look at the history of the virus, it gets even more relevant. Researchers accidentally isolated the virus in 1947 from monkeys living in the Zika forest in Uganda, while investigating mosquitoes for yellow fever. In the years after, it spread across Africa and then further to Asia. Nowadays, the infection is widespread among monkeys and humans.

The current outbreak started in May 2015, when physicians reported cases of skin rash and fever in Brazil. Less than a year later, there are 23 Latin American countries that have been reporting cases of Zika virus. To address this 7

VPH Journal 6th edition

disease the WHO aims at increasing surveillance and measurements for vector control, for instance by limiting open water sources. Environmental experts play their part in that task by assessing the impact of El NiĂąo in the development of mosquito populations. El NiĂąo is a meteorological phenomenon causing severe drought, flooding, rains and temperature rises, which can lead to an increase of the mosquito population.

Collaboration between veterinarians and environmental experts is also represented by the contribution of the Food and Agriculture Organization (FAO). With its veterinary and environmental background, the FAO already has great experience dealing with vector borne diseases. The organization knows how to lead a program including rational insecticides treatment, which takes into account human and environmental health.

The two organizations are on top of controlling the Zika virus outbreak and try to decrease the number of new Zika cases to a minimum.

From our perspective, it appears as a good illustration of using the One Health approach, strengthening interdisciplinary collaboration among human health, animal health and environmental health. In the case of Zika virus this collaboration is needed to create efficient prevention and control strategies and hopefully will show how applying the One Health approach can help addressing certain disease outbreaks.

Resources: Centers for Disease Control and Prevention (CDC), http://www.cdc.gov/ Food and Agriculture Organization (FAO), http://www.fao.org ProMED-mail, http://www.promedmail.org/ World Health Organization (WHO), http://who.int/en/

8

VPH Journal 6th edition

VECTOR BORNE DISEASES

By Bolajoko Muhammad-Bashir Epidemiology Unit, National Veterinary Research Institute, Vom, Plateau State, Nigeria

mosquitoes; others include some species of ticks, flies, sandflies, fleas, bugs and freshwater snails.

Essentially, vector-borne diseases have been the group of illnesses scourging man and animals since the beginning of time. Going back in time, these are the same illnesses that caused the 14th Century’s Black Death plague in Europe and the epidemics of yellow fever that scourged the development of the New World. And others, such as the “Nagana”, which was dubbed as the major factor that slowed the development in Africa for so many years. Yet, at the turn of the 20th Century, vector-borne diseases are still among the most threatening public and animal health problems in the world. Gubler (2009), concluded that the global trends in the changes in Alexander the Great, the well known and history acclaimed conqueror of many nations, was vanquished only by the bite of a tiny vector - mosquito bearing malaria parasites in the marshes of what is presently called Iraq.

and globalisation, are responsible for the present global re-emergence of epidemic vector-borne diseases affecting both humans and animals.

According to the WHO, presently, one sixth of the

Vectors are living organisms with capabilities to transmit infectious diseases between humans or from animals to humans. Most vectors are bloodsucking insects that ingest disease-producing micro-organisms during a blood meal from an infected host (whether human or animal) and later inject them into a new host during their next blood meal. The most popular disease vectors are the 9

animal husbandry, urbanisation, transportation

diseases suffered worldwide is due to vector-borne diseases and approximately half of the global population is at risk of these diseases especially the poorest members of the society and least-developed countries. This is because amongst these populations the living conditions are poor, with lack of access to adequate housing, safe drinking water and sanitation.

VPH Journal 6th edition

Vector-borne diseases amongst human populations can be caused by different kinds of pathogens.

The pathogens transmitted by vectors include viruses, rickettsia, bacteria, protozoa and helminths.

Among the viruses transmitted by vectors are yel-

“A sustainable and cost-effective longterm vector control and disease elimination requires strong and well-funded national or international control programmes�

low fever, dengue fever, rift valley fever and the encephalides. The transmitted protozoans include Babesia spp, Plasmodium spp, Leishmania spp, Try-

tats, flight range, feeding preferences and seasons;

panosoma spp and the helminths that are transmit-

the local epidemiology of the diseases; human ac-

ted are Wuchereria bancrofti, Onchocerca volvulus

tivities such as irrigation and animal farming; the

and Loa loa for example.

socioeconomic conditions and cultural context of the affected communities; feasibility of applying in-

Around the world, people are highly at risk of viral

terventions that will be acceptable to the populace

and bacterial transmission by mosquitoes, ticks,

in specific settings; and last but not the least is the

fleas and other vectors. The rate of increase in risk is

need for sustainable management of the environ-

now on the highest rate ever, partly because of the

mental by all and sundry in time and space.

increase of international travels and global changes in the use of land. Nowadays, we are witnessing an

A sustainable and cost-effective long-term vector

increasing risk of old and new vector-borne patho-

control and disease elimination requires strong

gens that are not stopped by national or internati-

and well-funded national or international control

onal boundaries. More so, it is particularly difficult

programmes as the situation demands. This can be

to predict, prevent or control vector-borne disea-

achieved by instituting and entrenching a compre-

ses; for example, mosquitoes and ticks are noto-

hensive national and regional strategies that will be

riously difficult to reach and often develop resistan-

supported by a close collaboration among partners

ce to available insecticides. In addition to these

in the global public health community. Further-

complexities, nearly all vector-borne pathogens are

more, a technical guideline for control should be

zoonotic.

set out with clearly delineated standard operating procedures, which are to be ethically and efficiently

Now more than ever, is the time to utilize the full

monitored and evaluated to ensure its success and

potential available for vector control for a sustaina-

sustainability.

ble and large-scale control of vector-borne disea-

10

ses. WHO recommends a couple of interventions

Essentially, environmental management such as

to prevent and control vector-borne diseases, some

modification or manipulation of the environment in

of which are more pertinent than others depending

addition to changes to human habitation and/

on the following factors: the local ecology and be-

or behaviour is needed. It will be a long way to-

haviour of the vector species - including its habi-

wards achieving a way for sustainable control

VPH Journal 6th edition

of vectors and in turn prevent the diseases they

Bibliography:

bear. Also, the government, legislatures, resear-

Lavelle, J.M., 2013. CDC Fact Sheet on Vector Bor-

chers and all stakeholders need to work hand in

ne

hand on their policies and laws respectively, in

of Vector-Borne Diseases.

order to improve on water supply, support incre-

Dickson Despommier, 2005. Vector Borne

ased expertise in vector control and surveillan-

Infectious Diseases.

ce, solid waste management to reduce vectors’

WHO, 2014. A global brief on vector borne -

breeding habitats and a sustainable use of chemi-

diseases. A publication of the world health

cals by both government and the general public.

organization; WHO/DCO/WHD/2014.1

Diseases. A publication of the CDC’s Division

Gubler, D.J., 2009. Vector - borne diseases. Rev. sci. tech. Off. int. Epiz., 28 (2), 583 - 588.

Mosquito Zone Corporation, 2009. Vector borne diseases.

Tel.: +2348038298072.

Email: mbbolajoko@gmail.com

11

VPH Journal 6th edition

INTERVIEW with Dr. Bernadette Abela-Ridder Team Leader for Neglected Zoonotic Diseases in the Department of Control of Neglected Topical Diseases, World Health Organization (WHO)

By Caroline Bulstra - Standing Committee on One Health

After Kenya we moved to Austria and I started studying Veterinary Medicine, in German, so that was a challen-

During the WHO 138th session of the Executive Board in Ja-

ge. As a student working behind the scene and following

nuary I had a chance to interview Dr. Bernadette Abela-Rid-

graduation I worked with one of the best veterinarians in

der. She is a veterinarian born in Malta and she lived and

Vienna. Slowly I realized, I would like to follow my dream

worked in many different countries worldwide. Currently,

and work beyond small animal clinical practice. I con-

she works for the World Health Organization as the team

tinued working in clinical practice to be able to finance

leader for Neglected Zoonotic Diseases in the Department

my advanced studies while I applied for other opportu-

for the Control of Neglected Topical Diseases, with respon-

nities. I then pursued a PhD at the University of Vienna

sibility for rabies control.

and a one-year master in University of Edinburgh at the Centre for Tropical Veterinary Medicine. That opened my

You studied Veterinary Medicine and worked in

path to international health development. For my thesis I

clinical practice at the start of your career. Can you tell

worked on the epidemiology and the brucellosis eradica-

us about your career path and where your affinity for

tion programme in Malta, where Brucella Melitensis was

veterinary public health (VPH) started?

first discovered by David Bruce. This work was my ticket

My passion for Veterinary Public Health started during

to the Food and Agriculture Organization in 1996 where I

my adolescence, growing up in Kenya. Seeing the won-

started on a short-term contract with the Animal Health

derful biodiversity, but also the poverty and people de-

Section. The next two and a half years I worked partly for

pending on their animals for livelihoods. At the age of 10

FAO and then moved to Gabon after getting married be-

years old I decided I wanted to become a vet. It was the

cause my husband was working there and we moved to

interest for development, animal and human health and

Cameroon together. Here I started working on a project

better lives that fascinated me and I think that has carried

of the Institute for Research for Development of France

me through till now.

(IRD), on simian immunodeficiency viruses and HIV. My

1.

main task was to map viruses coming out of the wild from Where I am now, as a team leader for the Zoonotic Ne-

non-human primates that complicate the HIV pandemic

glected Tropical Diseases, I work at the nexus of deve-

and carry out HIV awareness campaigns in these very re-

lopment, human and animal health and this is where

mote settings. So I was working in the bush, tracking pri-

I want to be. Of course it was a long way getting there.

mates, tracking bush meat and pet primates (the babies

12

VPH Journal 6th edition

of bush meat sold as pets), working alongside medical

different roles and responsibilities and together we can

staff within communities; it was a fascinating experience.

coordinate and organise ourselves to work efficiently to-

Next I moved to the US where I worked for the US Food

wards our vision of rabies elimination. So we can make a

and Drug Administration in Washington. My work was on

change.

AMR, which was a very different and new subject 15 years ago - compared to now. I knew I needed to go back to

WHO has convening power; it’s a way of bringing and

the international context eventually, but this became an

using the best evidence and expertise to tackle health

important stepping-stone for the next step in my career

problems; in the end leading to people with better health

Over the starting years I gathered experience in the clini-

and better lives, because that is our focus. What moti-

cal setting, in the field, in research and then in policy and

vates me is that my work is not all about writing the next

standard setting at a national government level, which

paper, but the aspiration that it is saving people’s lives

subsequently brought me to my current position at the

especially children from a terrible diseases like rabies or

World Health Organization.

other zoonotic diseases. There is still need for significant investment to catalyse more work to be considered at

2.

Why did you choose to join World Health Organi-

the human-animal-environmental interface.

zation (WHO) initially?

WHO is the lead technical UN agency in public health.

People share their environment with other people and

WHO is a member organisation and has the ability to im-

animals; they have many problems, many existential.

pact the health and well-being of people through techni-

Working in silos does not always achieve the best re-

cal, policy setting and political pathways. WHO can make

sults and it is of utmost importance to make the linkages

a difference through working with its member states and

across the different sectors to get the best impact on the

partners: we can see this for example of effort into rabies

ground. We need to have that collaboration to address

elimination, worked closely with the partners and we’-

the bigger picture. As we proceed in engaging different

re seeing the change. We are starting to see that some

groups to work together for better efficiencies, we need

countries are willing to start serious elimination pro-

to also document the results of applying the One Health

grams and this will attract/influence other countries to do

approach so that we build a solid evidence base.

the same when they see that it is feasible to stop humans

If you look at recent research on burden of foodborne di-

from dying from this dreadful disease. The partners have

seases, it shows you that the endemic diseases actually

13

VPH Journal 6th edition

cause the largest burden on human health and economic

know the behaviour of dogs and how to approach them. It

burden and so we should be putting more attention on

is very important to have that clinical exposure and I think

this. Food security is of major importance in our world.

that, as a vet, it is really important to gain that experience

Food security is access to enough and to safe food, so

before you jump into something where you are more or

it has a component of food safety in it. Again there is a

less at a desk job.

big role to be played on endemic diseases, because it is not always influenza or other emerging infectious disea-

4.

At the moment the WHO 138th session of the

ses that cause the largest losses in populations. We need

Executive Board (EB) takes place here in Geneva. Which

to put more emphasis on thinking about those endemic

agenda items are of most interest to you as the team

problems. If you have a system of surveillance and of

leader of the Neglected Zoonotic Diseases?

response to endemic diseases, that is building systems

There is nothing speaking directly to the zoonotic NTDs.

within communities and countries and those systems can

There are definitely members of the Executive Board who

actually be the alert systems for picking up something ab-

are here that are interested in this topic. Many discussi-

normal, even if they are set up for other diseases. These

ons occur outside the meeting room of the EB and this is

systems involve especially veterinary services and human

a great opportunity to meet the representatives of those

health services but also others like water and sanitation.

countries where work is ongoing or intended. A lot of the

So that is why we need to be always clear that system

reforms are translated into our daily work. We have six

strengthening is so important.

regions and HQ and often it is challenging to streamline coordination between them and countries. Discussions

3.

The WHO is a huge international organization

with many different work areas. What are your main

on reform have a direct impact on the way we work on an everyday basis.

activities at WHO and how does your background as a vet assist you in this?

The pest control part of the Zika epidemic response is un-

At WHO I started working on food safety and zoonoses

der the main responsibility of the NTD department. Other

and was the liaison between WHO, FAO and OIE on zoon-

departments are responsible for outbreak response and

otic outbreaks. I led the Global Early Warning System

surveillance of microcephaly. There is a lot of discussion

(GLEWS) at WHO, worked on food safety and coordina-

not only within EB, but also outside of the EB talking about

ted the Global Foodborne Infections Network (GFN) and

how to improve the evidence on Zika virus and what should

from there I moved to my current position 2,5 years ago.

be developed as tools to stop the disease from spreading

I think it is so important as a vet to do some hands-on

further. The Executive Board sets the agenda for the Wor-

work after graduating, before working for an organisati-

ld Health Assembly (WHA) in May and we were hoping to

on such as WHO. This provides a basic understanding, to

get a rabies resolution coming through in the next year or

know how to diagnose animals and how to approach them

two. There are some interested countries and they hope

and how to work with animal owners. Even in my current

to take it through their regional committees which are the

position working on endemic zoonoses it is so useful to

governing bodies of the WHO regions. So we really hope

have that experience, for example in rabies elimination to

there is going to be some movement on that.

14

VPH Journal 6th edition

Which accomplishments or actions in the field of

much we can learn from different sectors and so much to

VPH would you like to see being made in the foreseea-

do and it’s about translating this knowledge into practice.

ble future?

We have lots of research findings, but how do you imple-

At a training level students are speaking across the levels

ment them into the everyday routines. It is important that

and that is of major importance. It is about T-shaped ex-

students join forces and get out there as a community to

pertise: the long leg is for the depth of your knowledge

contribute to accumulating solid research data that can

and you specific expertise for example veterinary medici-

be the foundation of evidence that could motivate policy

ne, but you also need that horizontal part of the T, stan-

change. There is a role for everybody - from the students

ding for the importance of multidisciplinary collaboration

all the way up to the international organisations.

5.

and speaking to others, sharing knowledge. Improving that T-shaped expertise and taking that in to the work

6.

There are a lot of vet students out there that de-

environment and into practice is one of the main things

sire to work for WHO or for other interesting organiza-

we need to do. How can One Health be translated in day-

tions in the field of (veterinary) public health. Is there

to-day? One Health often remains something rather ne-

a last message you would like to give to them?

bulous, how do we get such a concept into structures and

Get some taste of what we do by doing internships or get

budgets and operational planning more efficiently? There

exposure to work at the field stations and with NGOs,

are nice examples coming out of food safety and animal

with pharmaceutical companies or foundations. It is pro-

human risk assessments based on human health, animal

bably best not to target a job at an international orga-

health, climate change and trade. The different parts co-

nization as your first station for work. Build a little bit of

ming together like in a puzzle. People will start to apply

experience so that when you come to an international or-

this concept on a day-to-day and it will become automa-

ganisation you have accumulated exposure, experience

tic rather than the exception.

and bring fresh, new ideas. It is not directly need to be in the field of veterinary public health at first. Look for op-

Where do we want to go with veterinary public health?

portunities that give you that exposure, through further

Not only focussing on epidemics, but also looking at whe-

education, through working in different jobs to get an un-

re the impact is on production and on people. Looking at

derstanding of the complexity of things. Don’t be shy and

development of practical and affordable tools that will

put your CV’s in. I also would suggest veterinary students

help us in disease control programs e.g. removing the

to think more with a business mind, because a lot of what

cold chain or the booster dose for vaccines, penside tests

drives the livestock communities is the business aspect.

for screening of disease. We need to try to look at things

What will farmers speak for? Understanding the dollar

holistically. We have an eradication program on Guinea

sign is really important.

worm and now we are at one of the last stages. There are only between 20 and 30 human cases left in Africa, but

That wider exposure is of great importance to get an un-

dogs are maintaining the cycle in some environments.

derstanding of the dynamics that have an influence on

Pre-empting these hurdles and preparing strategies at

VPH and the so many different ways to find solutions to

the onset will help reduce the risk of failure. There is so

problems from different angles.

15

VPH Journal 6th edition

Internship at the WHO: Two vet students share their experiences Interview with Joss Kessels School of Veterinary Science University of Queensland, Australia Why an internship at World Health Organization (WHO)?

I’ve always been interested in the big picture. My mum is a vet, and growing up I loved helping out at our clinic at home.

I was also interested in foreign cultures and international development, and spent a year on student exchange and another year travelling before starting international relations type study. It was interesting, but the talk didn’t feel tangible.

Towards the end of my first year, I was struck with the realisation that health is an absolutely essential and tangible way to improve people’s lives.

I changed to veterinary science, and went to South America for 3 months before starting. This really reinforced how important animals are to peoples health and livelihoods, especially in communities where they live close together, and are a major source of income or wealth. In 2nd year, I did a research project in the US in epidemiology, but with an economic bent. It was interesting to get a taste of the economic aspect of health, because it’s underacknowledged. The people that know a lot about health and are doing great research are not necessarily talking to the people that make decisions about health, or fund them, or implement them on the ground.

Bridging that gap is something I am passionate about. Rabies is the perfect example! It’s a disease that more than 59,000 people around the world die from every year, and one that’s preventable at multiple levels. We have the knowledge and every piece of technology that we need to tackle this disease and still so many people die from it every year, because they live in rural areas and do not have the financial resources or access to preventative measures. I want to bridge the gap between what we have the potential to do, the technology that we have and the science that we have, and how this is put into practice at a political level (like implementing national disease prevention programs), at an economic level (getting money to fund these actions) and on the ground (how these filter down to impact day to day life).

16

VPH Journal 6th edition

What are your main tasks at WHO? One of my main projects has been to draft what would constitute a stimulus package to kick-start rabies prevention programs in endemic regions. The WHO and OIE are collaborating to develop this. You could imagine it as a box that would be offered to a country or region where rabies is endemic, that gives them material tools to combat rabies: like vaccines for dogs, vaccines for humans, animal handling equipment and training and awareness materials. And technical support to help things along. The oustanding idea is to start a small project that will build gradually, be successful, and that could be expanded into neighbouring regions or sustained as a national program. Specifically what I am working on at the moment is a draft document that outlines why it would be necessary, what it would involve and that presents the different components the package should have in an attractive and compelling way. Actually though, our unit works incredibly hard on a whole range of things, and this is just one example of the work they do.

Did this internship changed the way you look at veterinary public health and WHO? I wasn’t expecting it, but I became fascinated by how policy is made and implemented. We need to present health issues (and solutions!) in a way that somebody who doesn’t work in health (like an economist or politician) can understand, recognise the importance of, and act upon. I need to get a better understanding of how those sectors work, to be able to work with them better in the future.

As for WHO, it was fantastic to gain insight into the multiple roles it performs. It’s a powerful advocate for health, and in our department especially for diseases affecting poor or rural populations (who may have little say, but often bear the greatest burden of disease). It’s a convenor of experts and stakeholders, bringing them together and channeling their cumulative knowledge and power towards strategic goals. It operates with integrity. It takes time to critically evaluate the available evidence and put together guidelines and strategies to confront complex problems, but when WHO says something, it carries weight, and this has the power to move mountains. And the word ‘organisation’ is so broad; at an operational level, at least in my experience, WHO is comprised of incredibly passionate, skilled and inspiring individuals, working tirelessly to improve health outcomes around the world. And that was wonderful to experience.

17

VPH Journal 6th edition

Interview with Gabriel Innes Penn Vet School University of Pennsylvania, United States I initially chose to become a veterinarian because, like so many of us in the profession, I had an innate feeling and affinity towards helping animals. That feeling was and is still intangible. At that point in my life, the capacity for which I felt this drive was incomprehensible. I started exploring the many facets of veterinary medicine. I started exposing myself to small animal medicine, and then eventually started becoming immersed in the dairy industry. This experience was fortified in China. I spent 2 months on a Chinese dairy in Beijing, learning about practices and methods that they use and compare it to the ones used back home in the USA. This experience also gave me insight into occupational health, and more broadly global public health. I wanted to understand how change was created and enforced, and found myself working at the Food and Agriculture Organization in Rome, Italy. Though I was not working in the field at FAO, I found myself making significant strides in gaining a complete picture of the effects of rabies, specifically in Latin America. My experience with rabies opened up doors to other organizations, namely the USDA and WHO. At WHO, I am currently committing myself to updating the Global Health Observatory for two diseases: rabies and leptospirosis. I am also fortunate enough to work in an environment that allows me to work on a number of other projects and allow me to meet people in a variety of other departments. This is truly a great experience.

From here I plan on working towards a PhD in the areas of environmental health and epidemiology. The PhD will give me insight into the environmental piece of the tripartite puzzle, which leaves me the last facet: human health, which I plan to acquire through epidemiological training. However, where I will end up remains a mystery. I am under the impression that there are "pillars of change" that I have categorized into four categories: government, advocacy, academia, and industry. Though most of my experience is in the government and industry pillars, I plan on gaining experience and perspective in the academia and advocacy sections, which I will hope to accomplish during my PhD candidacy and beyond.

18

VPH Journal 6th edition

INTERVIEW with Dr. PATRICIA CONRAD Professor of Parasitology, Associate Dean for Global Programs at the University of California, Davis, School of Veterinary Medicine When the room fills with friendly debate about the true de-

Therefore, it seemed highly beneficial to pose some key

finition of One Health, I always find myself thinking of the

questions to her concerning One Health.

people who inspired me to use the One Health approach, and I consider what contributions they would make to the conver-

1.

sation.

One Health is an approach to global health that takes into

What does the phrase “One Health” mean to you?

consideration the interconnectedness between animals, Dr. Patricia Conrad is one of the first people who comes to

humans and the environment that they share… to me it is

mind when the topic of One Health is discussed. She is a

that simple.

veterinarian, professor of parasitology, Associate Dean for Global Programs in the School of Veterinary Medicine and

2.

co-director of the University of California Global Health In-

career?

stitute’s One Health Center of Expertise at UC Davis. Her

I was taking a One Health approach to a lot of problems,

research is based on zoonotic transmission of protozoan

particularly in my research, long before One Health was a

parasites and emerging infectious diseases. Although, she

term applied to this approach. I believe a lot of people have

will laugh and tell you she never wanted to do research in

done the same. I do think the term or label is a very useful

the first place.

one to strike-up a conversation to explain what this rather

How have you incorporated One Health into your

complex system approach is about. One Health has been a After receiving her Doctorate of Veterinary Medicine from

part of my perspective since I was a veterinary student and

Colorado State University she earned a PhD in Proto-

is the major reason I fell in love with research.

zoology and Tropical Animal Health from the University of Edinburgh. She completed her post-doctoral research at

I actually did not want to complete a PhD after veterinary

the International Laboratory for Research on Animal Di-

school. Even though I had a desire to solve problems, I did

seases in Nairobi, Kenya studying the transmission of ru-

not find the lab-based focus with one person working on

minant parasites.

one parasite appealing. I said, not for me, not this research thing! I wanted to be an equine surgeon or mixed practice

Dr. Conrad, along with being a leader in her field, is some-

veterinarian and be around more people and animals.

one who has mentored and advised many individuals in-

However, I received an offer to go to Africa if I agreed to

terested in research, infectious disease and One Health.

19

VPH Journal 6th edition

take a research position. So after much contemplation, even more encouraging, there is an increased appreciation I thought I would give it a try for a couple of years. That

in many different sectors for people that have specific skills

is where I discovered this approach of bringing together

and abilities that can also work well with others and are able

people from different disciplines, perspectives and coun-

to fulfill multiple roles and responsibilities. I believe that over

tries to look at a problem as a team, and I loved it. This

time, more employers in private, public and academic orga-

love is why I stayed with research and found myself

nizations will be looking for employees who can understand

looking for other opportunities to continue to apply the

animal and human health issues in the context of environ-

One Health approach to hopefully make a contribution.

mental change.

I brought this approach to the University of California,

With that in mind, there are a wide variety of paths to pur-

Davis and over time have gained more confidence in

sue when you practice a One Health approach. Many people

looking at the ecology of disease, pathogen transmissi-

choose to look into zoonotic diseases. It is one of the first

on and how our animals and we, ourselves, impact the

ideas that captured peoples’ attention because that is where

environment.

the label or descriptor gained wide international acceptance. The avian influenza A (H5N1) outbreak in Hong Kong in

One Health is best, and certainly the most fun, for people

1997 may be credited with initially prompting global support

who like to work together and want to tackle complex for the application of a “One-Health" approach to emerging problems. It is important for a successful team to have a

infectious diseases because of the need for veterinary and

mix of personalities and perspectives. I shaped my own

public health experts to work together. Since then the World

career taking a One Health approach to parasite pro-

Bank, OIE, FAO, USAID and WHO have all come to support

blems and hope I’ve exposed others to these concepts so

this approach to pandemic infectious disease prevention and

they can also find ways to apply a One Health approach control. Therefore, the area of zoonotic diseases is certainly a big one to consider, but One Health is not limited to that.

to global health challenges.

Take a zoonotic virus transmitted by mosquitos. We have a 3.

What are the potential career paths for veteri-

vector interacting with a pathogen and multiple hosts. But,

nary students to pursue in the field of One Health?

when you have vectors you have environmental factors such

First, I want to clarify a part of your question. I do not

as water, humidity, and climate conditions that impact their

believe that One Health is a field or discipline; it is a per-

population. Any problem that is multifaceted can have as-

spective or approach. It is a more holistic way of viewing pects that most people might not think about initially. The a problem or global challenges with their many intercon-

One Health approach has applications for these complex is-

nected components. And we all have something special

sues and is breaking down communication barriers to impact

to contribute to that.

and solve issues.

When we call it a field, I think we are placing ourselves, As veterinary students, you have already begun to learn what as One Health practitioners, in a box. Advertisements you are passionate about but if you keep an open mind and for One Health positions are starting to appear. But heart there is even more to discover. I can give examples of

20

VPH Journal 6th edition

people who have been in your shoes and are now invested

To become involved locally people should build or participate

in working globally. Some of my former PhD students with

in organizations that that give you an opportunity to test your

DVM degrees have gone into epidemiology, bacteriology,

ideas and apply your skills, such as One Health clinics, rese-

parasitology and marine ecology. Others have done residen-

arch projects and seminars. Making connections in these clubs

cies or Masters degree programs to become pathologists,

with faculty, staff and students outside of your regular classes

microbiologists and public health practitioners. Having the

is also important. Sharing successes among your groups can

flexibility to move into different learning environments will

excite and promote the One Health approach.

help you discover more about your calling and apply the One Health approach.

One Health is an approach that anyone can use and be a part of. It is first about opening up to that possibility and then co-

The challenge goes back to the fact that One Health is not

ming together that makes One Health work.

a discipline. Having DVM training provides a solid foundation for tackling many problems. If you then do advanced training, you will come out with specific expertise that builds on that foundation, differentiates you and advances your career. Personally, I never wanted a PhD but I’m glad I got it!

My doctoral training and degree created opportunities for me to work in other countries and then come to UC Davis.

This changed my life in the best possible way! I love my job and the students I get to work with here!

4.

I understand you travel internationally frequently.

What do you believe travel has to do with One Health?

Traveling will let you observe and possibly participate in another culture. To me, this is the best learning experience. We

Picture taken in Sri Lanka during a One Health Intensive Field

are placing ourselves in an environment that is different and

Course. This is where the author learned about Dr. Conrad’s

causes us to be more vulnerable, open and observant. All of

views on One Health.

those are good characteristics in applying a One Health approach because they make you question what you already know.

5.

Health professional students are very busy, and we

are looking for a way to promote involvement as much as possible. What do you think is the best way for students to get involved in One Health locally?

21

VPH Journal 6th edition

Veterinarians, One Health and the nexus between disease and food security Robyn Alders1, Julia de Bruyn1, Kate Wingett1 and Johanna Wong1 Faculty of Veterinary Science and Charles Perkins Centre, University of Sydney, Australia

Introduction

Definitions One Health, Conservation Medicine, Eco-

Humanity is at a crossroads as we seek to deliver optimal

health and Planetary Health

and sustainable diets for 9 billion people by 2050 (Alders et

Interdisciplinary research focusing on the intersection of

al. 2016; FAO 2009). Despite increases in agricultural pro-

human and animal health and environmental conditions

duction during the past two decades, malnutrition rates

has risen to prominence during the past two decades. This

have not diminished significantly. Undernutrition remains

has been in response to complex health issues as varied as

a significant problem in many developing countries while

(i) highly pathogenic avian influenza, which connects hu-

over nutrition (obesity and its sequelae) has become a ma-

mans, poultry management, and wild birds; (ii) amphibian

jor global issue.

declines, which involve chytridiomycosis, an emerging fungal disease; (iii) poaching and consumption of ‘bush meat’,

Historically the domestication and production of animal

linked to population pressures, a lack of livelihood oppor-

species has been a major driving force behind the emer-

tunities, and infectious disease; and (iv) noncommunicable

gence of infectious disease (Alders et al. 2012). Diseases

diseases resulting from modern food systems that deliver

have tended to emerge and maintain themselves in cen-

food of poor nutritional value produced using technologies

tres where human and animal density is high or where hu-

that have a significant negative effect on ecosystems.

man activities encroach on naive environments. Intensive systems of animal production have grown rapidly since

These interdisciplinary endeavours have been given a range

the mid-1800s and dominate modern food systems, con-

of names over the years including:

tributing to the emergence, spread and maintenance of

·

new disease agents through the increased interaction and

ciplines working locally, nationally, and globally to attain

of animals and people. Concurrently, increased consump-

optimal health for people, animals, and the environment

tion of animal-source foods — in addition to nutrient-poor,

(AVMA 2008);

energy-rich processed foods — has been linked to the rise

·

in overnutrition and non-communicable diseases such as

with a strong focus on the integrity of ecosystems (Alders

obesity.

2009); ·

One Health – an integrative effort of multiple dis-

Conservation Medicine – an interdisciplinary field

EcoHealth – a movement that recognizesthat

The nexus between disease and food security is one cru-

‘health and well-being are the result of complex and dy-

cial issue being addressed by interdisciplinary research,

namic interactions between determinants, and between

with veterinarians playing a central role.

people, social and economic conditions, and ecosystems’ (Charron 2012); and most recently

22

VPH Journal 6th edition

¡

Planetary Health – which aims to safeguard

Vaccination programs against Newcastle disease (ND), a

human health and the natural systems that underpin it

major constraint to village poultry production (Alexander

(Rockefeller Foundation 2015).

et al. 2004), offer the potential to avoid significant seasonal mortalities. Our current research in Tanzania and Zam-

Chronic food and nutrition insecurity: a key driver of

bia is assessing the effect of ND control on chicken flocks

disease

and looking at opportunities to improve human nutrition

Given the relationship between human food production

through greater sale and consumption of poultry products

activities and disease emergence, it is essential that the

(Alders et al. 2014; de Bruyn et al. 2015). It is taking a mul-

drivers of chronic food insecurity be understood. The ma-

tidisciplinary One Health approach and is exploring how

nifestations of these drivers are often context-specific as

bush meat contributes to human diets and how promoting

they vary according to gender, cultural, socioeconomic and

the production of micronutrient-rich traditional vegeta-

agro-ecological frameworks. A lack of access to a balanced

bles in conjunction with increased consumption of chicken

diet can lead to both undernutrition and overnutrition re-

meat and eggs can help reduce malnutrition and improve

sulting in lifelong impacts on human health and inefficien-

maternal child health outcomes.

cies in food utilization.

Foods of animal-origin contain high-quality protein and Veterinarians working to reduce disease, improve

bioavailable micronutrients with the potential to greatly

food security and support sustainable development

improve the nutrient content of carbohydrate-based diets

In Tanzania and Zambia

(Neumann, Harris and Rogers 2002). Veterinary interven-

Recent evaluation of progress towards international tar-

tions that improve chicken health and production, and in-

gets for improving food and nutrition security has revea-

crease access to poultry products, can contribute to sustai-

led substantial geographical variation (FAO, IFAD and WFP

nable improvements in food security and human nutrition

2015). Sub-Saharan Africa has the highest prevalence of

(Alders et al. 2014).

undernutrition of any region, and population growth there has resulted in a marked increase in the number of under-

In Timor-Leste

nourished people in recent decades.

Timor-Leste, a near neighbour to Australia, has one of the highest rates of undernutrition in the world. Despite im-

Chickens are kept in small flocks by households in rural and

provements during recent years, 50.2% of children are still

urban communities throughout Africa and in many low

affected by chronic undernutrition, with low dietary diver-

income, food-deficit countries around the world. In villa-

sity being the limiting factor for children achieving an ade-

ge settings, chickens often rely largely on environmental

quate diet (SEAMEO RECFON 2014). Animal-source foods

food sources, roaming and scavenging during the day and

are one of the least frequently consumed food categories

roosting in trees or being kept in their owners’ houses over-

in Timor-Leste and there is great potential for increased

night. Infectious disease poses a significant threat in such

consumption to contribute to human nutrition.

systems, where birds move freely between households and through markets, and there are limited options for biosecu-

Although most households in rural Timor-Leste keep poul-

rity measures to be enforced.

try, production is hampered by a high burden of disease,

23

VPH Journal 6th edition

particularly ND, and predation (SerrĂŁo 2012). The Village

Climate change and weather variability, competition for

Poultry Health and Biosecurity Program, is implemented

land use,and the rising cost of inputs may all heighten the

jointly by the Australian Government Department of Agri-

vulnerability of farming systems in the near future (How-

culture and Water Resources and the Timorese Ministry of

den et al. Stokes 2008; FAO 2014). Novel approaches are

Agriculture and Fisheries, with technical support from the

required to ensure the longevity of agriculture in Australia

University of Sydney. The program aims to reduce mor-

and the health of our ecosystems and people.

tality of village chickens and improve production through community-based vaccination campaigns against ND and

We are researching ways to reduce the prevalence of die-

the use of other appropriate husbandry practices. Our rese-

trelated NCDs while simultaneously maximizing the pro-

arch in Timor-Leste is monitoring and assessing the effect

ductivity of merino sheep and reducing greenhouse gas

of this program on village chicken production and on hu-

emissions in Australia, including increasing domestic con-

man nutrition, and is also investigating factors that influen-

sumption of mutton and offal. These commodities are pro-

ce household food consumption, particularly of poultry

duced in parallel with fine wool from extensively grazed

products. These factors include seasonal changes in food

Merino sheep and are good source of protein, iron, zinc and

availability, wild food consumption, and socio-cultural be-

omega-3 fatty acids (Williams et al. 2007), but are rarely ea-

liefs and practices.

ten by Australians today (ABARES 2014).

In Australia

Conclusions

Being an island nation with vigilant biosecurity, Australia is

These examples show that veterinarians can provide a key

fortunate to be free of many of the infectious diseases that

link between primary producers, dietitians, food retailers

debilitate other regions of the world. However, noncom-

and environmental scientists, facilitating the sustainable

municable diseases (NCDs) related to poor dietary choices

production of animal source foods, in terms of nutrient

are having a major negative effect on the health of Aus-

content and diversity, biosecurity, animal welfare, environ-

tralians today. More than one-quarter of Australian adults

mental impact and food availability. Our veterinary training

are obese and there is widespread insufficient intake of

in comparative anatomy, physiology, medicine and animal

micronutrients, primarily due to the excessive consump-

management systems opens up many career pathways.

tion of energy-dense, nutrient-poor foods (ABS & FSANZ

Using our training in support of ecologically sustainable

2015; OECD 2014). It appears that the diet of a significant

food systems for people and non-human animals makes

proportion of Australians is of inadequate quality in terms

a major contribution to the health of all life on our incre-

of nutrient content, thus failing to meet the criteria set by

asingly resource-limited planet.

the FAO for being food and nutrient secure, despite the domestic production of sufficient fresh food to feed a popula-

Acknowledgements

tion more than double the country’s current size.

We would like to acknowledge funding provided by the Australian Government, especially the Australian Centre

The challenge ahead for the agricultural industries and the

for International Agricultural Research, in support of rese-

veterinary profession is to maintain the reliable supply of

arch on disease prevention and improved foodsecurity.

diverse and safe nutrient-dense animal-source foods.

24

VPH Journal 6th edition

References

Health. Edited by: Charron DF. Springer, New York.

ABARES. 2014. Agricultural commodity statistics 2014,

FAO. 2009. High Level Expert Forum - How to Feed the World in

Australian Bureau of Agricultural and Resource Economics and Sci-

2050. Available: http://www.fao.org/fileadmin/templates/wsfs/docs

ences, December, Canberra. Available: http://www.agriculture.gov.

Issues_papers/HLEF2050_Global_Agriculture.pdf

au/abares/publications/display?url=http://143.188.17.20/anrdl/DAFF-

FAO. 2014.Building a common vision for sustainable food and agri-

Service/display.php?fid=pb_agcstd9abcc0022014_11a.xml

culture: Principles and Approaches, Rome. Available: http://www.

Alders, R.G. 2009. Conservation Medicine. Environment: Science

fao.org/sustainability/en/

and Policy for Sustainable Development 51(4):7-8.

FAO, IFAD and WFP. 2015. The State of Food Insecurity in the World

Available: http://www.tandfonline.com/doi/pdf/10.3200/ENV.51.4.7-

2015. Meeting the 2015 international hunger targets: taking stock of

9

uneven progress. Rome, FAO.

Alders, R., Aongola, A., Bagnol, B., de Bruyn, J., Kimboka, S.,

Howden, S.M., Crimp S.J., and Stokes, C.J. 2008. Climate change

Kock, R., Li, M., Maulaga, W., McConchie, R., Mor, S., Msami, H.,

and Australian livestock systems: impacts, research and policy issues,

Mulenga, F., Mwala, M., Mwale, S., Rushton, J., Simpson, J., Vi-

Australian Journal of Experimental Agriculture, vol. 48:7, pp 780-788

ctor, R., Yongolo, C. and Young, M. 2014. Using a One Health ap-

Neumann, C., Harris, D.M., and Rogers, L.M. 2002. Contribution of

proach to promote food and nutrition security in Tanzania and Zam-

animal source foods in improving diet quality and function in children

bia. Planet@Risk (Special Issue on One Health) 2(3):187-190.

in the developing world. Nutrition Research 22:193-220

Alders, R.G., Bagnol, B., Farrell, P., Fornace, K., Gleeson, L.,

Organisation for Economic Cooperation and Development (OECD).

Kock, R., Rushton, J. and Rushton, R. 2012. The human dimensions

2014. Obesity Update 2014. 27/05/2014. Available: http://www.oecd.

of food safety and biosecurity with special emphasis on chronic food

org/health/obesityupdate.htm

and financial insecurity. Emerging Infectious Diseases Symposium

Rockefeller Foundation. 2015. Planetary Health. Available: https://

Abstract Booklet, CSIRO, Geelong, 22-23 October, 2012, p. 57.

www.rockefellerfoundation.org/planetary-health/

Alders, R., Nunn, M., Bagnol, B., Cribb, J., Kock, R. and

SEAMEO RECFON. 2014. Timor-Leste food and nutrition survey.

Rushton, J. 2016. Fixing Broken Food Systems. Good Nutrition in

Southeast Asian Ministers of Education Organization Regional Cent-

One World. Karger, Basel, Switzerland. [in press]

re of Food and Nutrition, UNICEF. Jakarta, Indonesia.

American Veterinary Medical Association (AVMA). 2008. One

Seppelt, R., Manceur, A.M., Liu, J., Fenichel, E.P. & Klotz, S. 2014.

Health: A new professional imperative. One Health Initiative Task

Synchronized peak-rate years of global resources use. Ecology and

Force: Final report. Available: https://www.avma.org/KB/Resources/

Society 19(4): 50

Reports/Pages/One-Health.aspx

SerrĂŁo, E. 2012. Constraints to production of village and

Australian Bureau of Statistics and Food Standards Austr lia New

commercial chickens in Timor-LestĂŠ, PhD thesis,

Zealand. 2015. Australian Health Survey: Usual

University of Queensland, Australia.

Nutrient Intakes, 2011-2012, cat no. 4364.0.55.008, Canberra, 2015.

Williams, P., Droulez, V., Levy, G. and Stobaus, T. 2007.

Available: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.0

Composition of Australian red meat 2002: 3. Nutrient

De Bruyn, J., Wong, J., Bagnol, B., Pengelly, B. and Alders, R.

profile. Food Australia 59(7): 331-341

2015. Family poultry and food and nutrition security. CAB Reviews 10(13):1-9.

Charron, D.F. 2012. Ecohealth Research in Practice: Innovative Applications of an Ecosystem Approach to

25

VPH Journal 6th edition

TRAVELING AND ZOONOSIS Skrekas Chrysovalantis IVSA Thessaloniki member Faculty of Veterinary Medicine AUTH, third year of school, Thessaloniki, Greece “There is nowhere in the world from which we are remote

developing. Also, travelers who constract infections can

and no one from whom we are disconnected.� – Joshua

serve to initiate epidemics.

Lederberg, 1992 Zoonotic infections are defined as infections transmitThis article focuses on travel as a risk factor in exposure

ted from animals to humans (and less frequently vice

to zoonoses and other factors potentially confounding

versa), either through direct contact, through contact

diagnoses. With the escalating speed of transportation,

with animal products or indirectly through intermedi-

people can travel to rural and remote areas with which

ate vectors such as arthropods. In recent years, zoon-

they had little contact before and where there are unique

oses and communicable diseases common to man and

and often concentrated collections of wildlife. So their ex-

animals have gained more attention worldwide. Human

posure to animals, and the infections they transmit, has

diseases that have their origins in infected animals, such

increased dramatically over the years. People can be ex-

as AIDS, have highlighted the need for a better under-

posed to pathogens not common in their home location.

standing of animal diseases in terms of their epidemio-

They are in excellent position to acquire zoonoses, trans-

logy, mechanism of transmission to man, diagnosis,

mit them, and act as sentinels for disease emergence. Ac-

prevention and control. Social and demographic chan-

curate diagnoses of the pathogens involved are often es-

ges have also contributed to the importance of gaining

sential to prevent life-threatening stages of disease from

and disseminating knowledge about zoonoses.

26

VPH Journal 6th edition

About 60% of pathogens that infect humans are zoon-

as tapeworms and flukes and other food-borne parasi-

otic and these pathogens are highly relevant in veteri-

tes. Biting vectors encountered by travelers can trans-

nary public health: Ebola virus is now a top priority on

mit Leishmania spp, or the monkey malaria Plasmodi-

many health and humanitarian agendas leading to tra-

um knowlesi, respiratory zoonotic viruses include highly

vel restrictions and call for a global medical emergency

pathogenic H5N1, avian influenza, H1N1 swine flu, and

situation. Rabies virus poses a major threat to travelers

emerging coronaviruses SARS-CoV and MERS-CoV.

in endemic areas, the exotic culinary delights that are

Some destinations have particular zoonotic risks.

enjoyed during travel may contain hidden dangers such

Common routes for potential transmission of infectious diseases between animals and humans.

Worldwide occurrence of infectious disease emergence and resurgence during recent years results in a need for increased vigilance, risk assessment and prediction of zoonotic diseases.

A special characteristic of zoonotic infections is that they

How do travelers het infected with zoonoses?

can re-emerge just when they are considered to be un-

•

Oral ingestion of food water

der control or eliminated, because they can go into hi-

•

Aerosol or droplet infection

ding in the animal reservoirs so there is no possibility for

•

Vector borne

complacency. Travelers will act as sentinels for infections

•

Direct contact with animal reservoirs

but also as disseminators.

•

Water borne (contact)

•

Food borne

27

VPH Journal 6th edition

Infections that travelers can obtain while far from home

ved may not exist in the geographic area where the visi-

can complicate timely diagnoses. The doctor may miss

ted hospital is located. In addition, an increasing number

the diagnosis, because of the similarity in clinical signs

of pathogens of animal origin have not historically been

and symptoms that are associated with multiple diseases,

human health concerns, yet may be emerging or resur-

especially during early stages of illness. However, some

ging causes of disease in immunocompromised people.

doctors may have little familiarity with the pathogen involved or little reason to consider that pathogen without

For references contact Skrekas Chrysovalantis

the patient offering clear information. Failure of the tra-

Email: valantisskrekas@gmail.com

veler to identify and disclose those situations can greatly complicate disease diagnoses when the pathogens invol-

28

VPH Journal 6th edition

RMBDs: Raw meat diets and consequences Giorgos Polyzois, SCOH Liaison Officer IVSA Thessaloniki, 3rd Year, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Greece Feeding of raw meat-based diets to pets has become an increasingly popular trend amongst pet owners2. Raw-meat based diets or BARF (Bones And Raw Food) or RMBDs (Raw Meat Based Diets) are those that include uncooked ingredients and that are fed to companion animals living in home environments, including bones, skeletal muscles, fish, poultry or sometimes uncooked eggs. It is also very common amongst breeders. Owners usually feed their pets like feeding their family, with products they believe that give a nutritional boost to them. Sometimes that is not exactly very accurate, because these diets could cause several problems; not only to animals, but also in humans. The problems with raw-food diets first appeared in ruminants. Specifically, with the use of meat and fishmeal in the diet of dairy cows. We had the mad cow disease as a result of the prion protein, which was included in these meals. These cows had neurological problems and humans couldn’t use this meat for consumption.

People believe that feeding raw meat to their pets has a lot of advantages. For example, some pet owners have abandoned the recommended commercial diets, in search of a more ‘natural’ and ‘home-made’ choice2. They also believe that these natural diets could give their pets increased energy, improved coat and skin condition and decreased body odor for the dogs that are on this diet4. As veterinarians, I think it is our task to inform the public about the risks involved in RMBDs.

29

VPH Journal 6th edition

Many scientists have been exploring the potential danger of feeding raw meat to dogs and cats. Specifically, they have been exploring the fecal prevalence of several enteric zoonotic pathogens3. Given the frequency with which raw meat products are contaminated with foodborne pathogens, many researchers determined that pets consuming food containing raw meat were at increased risk of carrying the three most common foodborne bacterial zoonotic pathogens occurring in humans: Salmonella enterica, Campylobacter jejuni, and Escherichia coli3. Consuming that kind of diets could also lead to infection with another major pathogen, Toxoplasma gondii.

First of all, Salmonella entericais a zoonotic, Gram-negative bacterium, intracellular pathogen, causing usually gastrointestinal diseases, such as diarrhea. Humans can be infected from contaminated food, which includes high concentration of this bacteria. Additionally, Campylobacter jejuni is a zoonotic, Gram-negative bacterium, commonly found in animal feces. It is one of the most common causes of human gastroenteritis. It is usually associated with poultry. Contaminated food is a major source of isolated infections, with incorrectly prepared meat and poultry as the primary source of the bacteria. Moreover, Escherichia coli (E. coli) is a zoonotic, Gram-negative bacterium, usually found in the lower intestine of warm-blooded organisms. Most E. coli strains do not cause disease, but some virulent strains, could cause gastrointestinal problems due to food contamination. Finally, Toxoplasma gondii (T. gondii) is a parasitic protozoan, that could cause the disease toxoplasmosis. The main source for T. gondii transmission is raw meat. This parasite could cause several neurological problems, such as tremors and lethargy, but mostly causes diarrhea, fever and other gastrointestinal problems to pets.

Studies have confirmed that RMBDs may be a theoretical risk nutritionally. Raw food poses also a substantial risk of infectious disease to the pet, the pet’s environment, and the humans in the household2. The previous pathogens have been isolated from the feed, feces, and vacuum contents. This could cause public health issues, especially for young people, elderly or pregnant women. For example, women newly infected with T. gondii during pregnancy

30

VPH Journal 6th edition

and anyone with a compromised immune system should be aware that toxoplasmosis can have several consequences especially abortion. Also, Salmonella could cause serious diarrhea to people, with several months of full recovery.

Raw food diets for companion animals are not intended for human consumption. However, it is likely that they are handled in kitchen where foods for human consumption are prepared. Thereby there is a possibility of cross-contamination and a subsequent exposure of humans to pathogens from the raw food diet products5.

In conclusion, there is a need for extensive studies, in order to clarify the benefits and risks of RMBDs. But, due to the knowledge we have from our faculties, we are aware that feeding raw meat to companion animals could lead to the spread of zoonotic diseases. To the pet owners that insist on using these diets to feed their pets, the observance of hygiene rules, and the feed with well heat and boiled meat could possibly prevent the development of this phenomenon.

References: 1.

Current knowledge about the risks and benefits of raw meat-based diets for dogs and cats.

Freeman LM, Chandler ML, Hamper BA, Weeth LP 2.

Raw food diets in companion animals: a critical review.

Schlesinger DP1, Joffe DJ. 3.

Perceptions, practices, and consequences associated with foodborne pathogens and the feeding of raw meat to dogs.

Lenz J1, Joffe D, Kauffman M, Zhang Y, LeJeune J 4.

Preliminary assessment of the risk of Salmonella infection in dogs fed raw chicken diets.xe

Daniel J. Joffe and Daniel P. Schlesinger 5.

Hygiene quality and presence of ESBL-producing Escherichia coli in raw food diets for dogs.

Oskar Nilsson, DVM, BSc, PhD

31

VPH Journal 6th edition

INTERVIEW with Dr. Barbara Haesler One Health lecturer and researcher at the Royal Veterinary College (RVC)

& Maria Garza MSc One Health gratuate Royal Veterinary College

1.

Can you tell us a little bit about yourself and

ledge about the control of infectious diseases and also

your career?

was very interested about international development

Maria: I graduated in Veterinary Medicine in Zarago-

and found out about the MSc One Health hosted by the

za, Spain. Soon, I was more interested in livestock

Royal Veterinary College (RVC) and the London School

health and its economic and public health impact

of Hygiene & Tropical Medicine (LSHTM). It was a very

than in pet’s medicine. Subsequently, I was lucky to be

fulfilling year, coming across extremely inspirational

able to do some training and working periods in Peru,

professionals and colleagues which broadened my in-

Ireland and Spain. During that time I gained some

terests even more. Since then I took part as a research

experience in animal health and production and in-

assistant in some projects led by Barbara.

sights into infectious diseases and its diagnostics and control. I realized that I wanted to improve my know-

32

Barbara: I did an undergraduate degree in veterinary

VPH Journal 6th edition

medicine at the University of Bern, Switzerland and then

timicrobial resistance, which requires shared efforts by

moved on to do a Swiss doctoral thesis at the Federal

multiple sectors – animal, human and environmental

Veterinary Office (now called Federal Food Safety and

health – on antimicrobial use and resistance develop-

Veterinary Office) on the epidemiology and economics

ment to gain knowledge on how resistance genes deve-

of neosporosis control. After working as a border vete-

lop and spread and what could be done in terms of miti-

rinary inspector at the border inspection post in Basel,

gation.

I joined the Royal Veterinary College as a research assistant in Veterinary Public Health. From 2008 to 2011 I

3.

Can you tell us something about the history of

undertook research for a PhD on the economics of ani-

One Health? Did we have it before or is it really some-

mal health surveillance while simultaneously studying

thing new?

for a Certificate of Higher Education in Economics, both

Maria: In my case, I had heard about the concept of

of London University. After that I worked as a Post-Doc-

“One Health - One World” thanks to one of my profes-

toral Fellow in the Leverhulme Centre for Integrative Re-

sors at University. I fully discovered about the multiple

search on Agriculture and Health (LCIRAH) and RVC de-

dimensions of it during my MSc One Health. However, it

veloping frameworks to assess the impact of foodborne

was never a revelation. Looking back at my training, se-

and zoonotic diseases and their mitigation. In 2013 I be-

veral professors and professionals instilled ideas in the

came a lecturer in Agrihealth at the same centre. I have

line of “one health”; observing and considering multiple

a strong interest in applying One Health or Ecohealth

factors to tackle problems, particularly when dealing

approaches to better understand food systems and how

with infectious diseases. Actually, the veterinary field is

changes in those impact on food safety and food secu-

itself a compendium of disciplines, as opposed to other

rity and to improve the wellbeing of people and animals

“niche” sciences. Not only do we learn about observati-

through better resource allocation.

onal, clinical knowledge and pathology, but also about basic sciences and technology, animal production, hus-

2.

According to you, what is One Health?

bandry, economics, the food systems and public health,

Both: We conceive it as an approach based on the in-

legislation... it really is broad. I think that veterinarians

tegration of different disciplines and sectors in order

have naturally always been open to interdisciplinary ap-

to solve multifactorial problems, particularly those of

proaches because of their role in linking animal and hu-

a complex nature. We believe that the concept is much

man health.

broader than referring to health issues. In fact, One Health endeavours should take a systems approach to

Barbara: In fact, the idea that the health and well-being

capture and address the interactions of ecological, so-

of people is closely linked to the animals they depend on

cial, economic and political factors. By doing this, we

and the environment they share, is nothing new. Some

can hopefully contribute to healthier, more equitable,

colleagues summarised it very nicely in a paper where

efficient and resilient systems that promote health for

they said “It is a basic condition of life on earth, repe-

people, animals and the environment. A very topical

atedly re-discovered and further explored throughout

challenge is the understanding and management of an-

human history”. I believe that the recent rise or re-acti-

33

VPH Journal 6th edition

vation of One Health was triggered by the occurrence of

food systems and how they are linked to food safety,

pandemics and epidemics of emerging problems – most

nutrition, food security, economic and health outco-

notably the emergence of highly pathogenic avian in-

mes. To do this work, we need to think about econo-

fluenza and more recently ecological disasters and eco-

mic, epidemiological, cultural, biological, policy and

nomic crises that made people realise that we need to

social factors. Because our food systems are under

collaborate to address the big challenges that we are fa-

enormous pressure, in the project Innovative Food

cing. This trend was most likely exacerbated by the role

System Teaching and Learning (IFSTAL, http://ifstal.

of the internet and media coverage of these topics.

ouce.ox.ac.uk/), which is cross-university post-graduate learning opportunity for students at Reading, Ox-

4.

How do you use the concept in your work or

ford, Warwick, London City University and LCIRAH,

everyday life?

we are discussing in an interdisciplinary, systems-ba-

Both: The Veterinary Epidemiology Economics and Pu-

sed way the challenge of providing food security un-

blic Health Group at the Royal Veterinary College and

der global population and economic growth. In these

the associated Leverhulme Centre for Integrative Re-

interdisciplinary projects, we often need to leave our

search on Agriculture and Health have many national

comfort zone to look at our research question from

and international projects that embrace the concept of

a new perspective taking into account ideas and me-

interdisciplinary and inter-sectoral work in One Health,

thods from other disciplines and deal with a wide ran-

Ecohealth or Agrihealth. Given the multi-factorial natu-

ge of information. It can sometimes be challenging to

re of many of the research questions we are addressing,

solve logistics and produce clear and concrete results,

our work often requires collaboration with experts from

but it is motivating as you learn and thrive with each

other fields and countries. For example in LCIRAH under

project. However, One Health is still not mainstream

the guidance of Jonathan Rushton, Professor in Animal

and we think that one of the reasons for this is that

Health Economics at the RVC, we are working on pro-

there is limited evidence on the added value of One

jects that aim to understand the dynamics of livestock

Health. Therefore, we are both part of the internatio-

34

VPH Journal 6th edition

nal Network for Evaluation of One Health (http://neoh.

tion and global trade networks. Often, the consequen-

onehealthglobal.net/) that Barbara is chairing, where a

ces of these events are felt most strongly in the most

network of international professionals collaborates to

vulnerable populations. Another major challenge we

capture the added value of One Health.

need to tackle is the big rise and global spread in antimicrobial resistance. Finally, the world is facing a huge

5.

What are the most striking/surprising/interes-

crisis in both over- and undernutrition with a minority of

ting research developments so far?

people globally having healthy and balanced diets. As a

Maria: In terms of developments, I would say that for

society, in collaboration with policy makers, producers,

me, the most interesting prospects will be to see effi-

consumers, the research community, retailers, NGOs

cient collaborations between different groups of peop-

and other stakeholders, we need to find ways to create

le and from different fields to show evidence that can

more resilient and sustainable food systems that allow

ultimately be translated into reality and policies. In ad-

feeding ever growing human populations in a healthy

dition, I think that in the last years there has been a lot

way. As vets, we have a great responsibility both as pro-

of advances in technology to identify and to be applied

fessionals and consumers, to contribute to the solution,

in the field to control infectious diseases: vector control,

as we are part of livestock value chains and know about

development of new and more efficient diagnostics test,

disease, animal welfare, public health and environmen-

better forecasting tools or effective vaccination pro-

tal repercussions. We must use this knowledge to allow

grams.

people to make informed consumption choices and increase the efficiency and sustainability of our livestock

Barbara: I concur with Maria, these are encouraging

systems.

developments. What is surprising for me to see is that despite very many calls for system-based, interdiscipli-

7. What do you hope for with a One Health approach?

nary approaches like Ecohealth, One Health, Agrihealth,

Maria: Given the current circumstances, I don’t think

Planetary Health, etc. there is still a very large group of

that we have other alternatives than fighting to use the-

professionals out there who continue to look for discipli-

se approaches that would alleviate and prevent more

nary solutions without considering system drivers, inter-

problems.

actions and effects.

Barbara: We now have a very enthusiastic group of stu6 What do you identify as the most important One

dents at RVC with a great interest in One Health and Glo-

Health movements/activities/topics at the moment?

bal Health. They actively communicate with other disci-

Both: One of the current hot topics in One Health are

plines, have innovative ideas and the vision to do things

emerging diseases (of which around two thirds are zoon-

differently. This gives me a lot of hope and I would like

otic) that pose a threat to humans. Emergence rates are

to encourage you all to keep an open mind, gain strong

influenced by climate change, human encroachment

disciplinary skills and use them in fruitful and respectful

and change in land use and other important factors such

collaboration with other sectors!

as the intensification of production systems, urbanisa-

35

VPH Journal 6th edition

Working in Human Public Health as a VETERINARIAN Epke Le Rutte, DVM

I was born in 1987, grew up in the Netherlands

(NL), finished high school in the UK and went to study Ve-

global public health challenges in the field of infectious diseases.

terinary Medicine to become a veterinarian just like my grandmother. I studied at Utrecht University (NL) and in

Back at the faculty in Utrecht I did my practical rotati-

between many fun social events I squeezed in the requi-

ons but also pursued my interest in One Health by ta-

red long days of vet school. Being more interested in the

king summer courses at Harvard School of Public Health

medical side than the fluffy animals, I was very excited

(HSPH) to learn more from a ‘human public health’ point

to write my bachelor thesis about disease transmission

of view, and increase my knowledge in epidemiology

between cattle and wild buffalo’s in sub-Saharan Africa.

and vector borne and zoonotic global infectious disea-

This was a real turning point, as I realized that there was

ses. I started to further appreciate the importance but

much more to veterinary medicine than curing one ani-

also the complexity and challenges of the One Health

mal at a time. Large programs that focused on interrup-

approach. Being the only vet student at HSPH among

ting transmission, benefitting both animals ánd humans

mostly doctors and health scientist led to many interes-

sounded much more interesting and important to me.

ting discussions and I was often shocked about how little was taught about zoonotic infections and public health

With this newly sparked enthusiasm I started my

in medical schools.

masters (Livestock and Veterinary Public Health) with my research project: 4 months at the Food and Agricul-

ture Organization (FAO) of the United Nations (UN) in

Q-fever in the Netherlands, which raised a lot of awa-

Rome, Italy. Which ended up being 9 months as part of

reness as many cases could have been prevented if GP’s

the minor ‘research’. Working on pathogen survival stra-

and vets would have worked closer together, by at least

tegies for 40 zoonotic infections made me understand

informing one another of the occurring cases. This out-

the importance of a multidisciplinary approach towards

break led to a political report that suggested a closer

36

At the time there was an ongoing outbreak of

VPH Journal 6th edition

collaboration between vets and human doctors. At that

To avert this neglect, the World Health Organizati-

same time the faculty was developing a new ‘major’

on (WHO) created the list of 10 NTDs that consist of

called ‘One Health’ which I was actively involved in as a

worm infections: lymphatic filariasis, onchocerciasis,

student-job and which aimed to promote collaboration

soil-transmitted helinths (ascariasis, trichuriasis, hook-

from early on between pharmacology, medical and ve-

worm) schistosomiasis and Guinnee worm, protozoa:

terinary students.

visceral leishmaniasis, Chagas’ disease and human African trypanosomiasis and bacteria causing blinding tra-

Currently I am working as a PhD-candidate at the

choma and leprosy, of which some are zoonotic.

Department of Public Health of the Erasmus Medical Center in Rotterdam, the Netherlands and my team is

NTDs can cause anemia and blindness, stunt child-

funded by the Bill and Melinda Gates Foundation. Eras-

ren’s growth, lead to cognitive impairments, complicate

mus MC is NLs largest university hospital and we are one

pregnancies and sometimes cause death. People living

of the partners of the newly formed Netherlands Center

in extreme poverty often suffer from more than one of

for One Health. My topic is the elimination and control

these diseases simultaneously, which affects their abili-

of Visceral Leishmaniasis, a Neglected Tropical Disease

ty to make a living and move out of poverty. As a major

that is zoonotic in certain parts of the world. I very much

public health burden in dozens of poor countries, NTDs

enjoy the international aspect of my job, with over 36

are a barrier to the achievement of the UN Millennium

flights in my first year, as well as the multidisciplinary

Development Goals.

partners I work with globally, such as WHO, PAHO, other universities and institutes, the pharmaceutical industry

In 2012, WHO developed the first NTD 2020 Road-

and many more. We all share the excitement and pas-

map that contains targets for the elimination and con-

sion in eliminating and controlling this disease as we

trol of NTDs. That same year, the London Declaration

speak. I look forward to pursue a career on the interface

was signed by several partners from the public and pri-

of Human and Veterinary Public Health.

vate sector, to support the 2020 WHO Roadmap targets through advocacy, pharmaceutical supplies and rese-

Neglected Tropical Diseases

arch funding from the Bill and Melinda Gates Foundati-

More than 1 billion people in developing countries suf-

on (BMGF), among others.

fer from neglected tropical diseases (NTDs). NTDs are considered a special category of infectious diseases, dis-

In the ideal situation that all WHO 2020 targets

tinct from the major tropical infections HIV, tuberculosis

are met it has been calculated to lead to about 600 mil-

and malaria, which have been the main focus of atten-

lion averted DALYs and 600 billion averted US Dollars in

tion and funding for developing countries over the past

the period 2011–2030. These health gains include about

decades. The NTDs have attracted little funding, largely

150 million averted irreversible disease manifestations

because they are rare in wealthier countries and often

(e.g. blindness) and 5 million averted deaths. Control of

not affect tourists.

soil-transmitted helminths accounts for one third of all averted DALYs. The projected health impact of reaching

37

VPH Journal 6th edition

the London Declaration is considered to justify the re-

quired efforts. (health impact paper) An overview of the

pant of the Modelling Consortium working on 5 NTDs,

health and economic impact of achieving the WHO tar-

Visceral Leishmaniasis (VL) being one of them. On the

gets for control and elimination of London Declaration

Indian subcontinent (ISC), VL is caused by the protozo-

NTDs has been beautifully illustrated here.

an Leishmania donovani, which is transmitted by the

Erasmus Medical Center in Rotterdam is a partici-

peri-domestic female sand- fly, Phlebotomus argenti

The question whether we are on track towards

pes. There are about 300 million people at risk globally,

achieving the goals is of high relevance with the 2020

mainly affecting the poorest of the poor in rural areas.

deadline approaching quickly. The current intervention

Two thirds of the estimated global 200,000 to 400,000

strategies vary per disease and per country, therefor a

new VL cases per year occur on the ISC. Furthermore,

Modeling Consortium has formed, funded by the BMGF,

over 20,000 deaths per year on the ISC are attributed to

to calculate per disease whether the current interventi-

VL, making it the deadliest parasitic infection in the wor-

on strategies are sufficient to reach the 2020 elimination

ld after malaria. On the ISC, the target is to eliminate

and control targets. Transmission modeling is an appro-

VL as a public health problem by or before the end of

priate tool to simulate the disease transmission dyna-

2017, where elimination is defined as an annual inciden-

mics and calculate the expected effect of interventions

ce of VL of <1 per 10,000 capita at sub-district-levels in

such as mass drug administration and vector control on

Bangladesh and India; and at district-level in Bhutan and

future disease prevalence.

Nepal. In the rest of the world, the WHO target is 100 %

38

VPH Journal 6th edition

detection and treatment of all VL cases.

Would you like to read more about this topic?

WHO: http://www.who.int/neglected_diseases/en/

The governments of the ISC-countries have com-

mitted themselves to achieving the elimination target by implementing different interventions. These are

London Declaration: http://www.who.int/neglected_di-

mainly focused on two approaches: (1) early diagnosis of

seases/London_Declaration_NTDs.pdf

symptomatic cases followed by effective case management, which prevents disability and death, and reduces

Gates Foundation on NTDs: http://www.gatesfounda-

the presence of infective individuals; and (2) vector con-

tion.org/What-We-Do/Global-Health/Neglected-Infec-

trol to reduce or interrupt transmission. Indoor residual

tious-Diseases

spraying (IRS) of human dwellings and cattle sheds with long lasting insecticides such as DDT is currently the

Uniting to Combat NTDs Progress Report: http://uni-

most important and widely implemented form of vector

tingtocombatntds.org/sites/default/files/document/UT-

control.

CNTD%20FULL%20REPORT.pdf

Or contact me! e.lerutte@erasmusmc.nl

According to recent predictions by the Erasmusâ&#x20AC;&#x2122;

VL transmission model, elimination of VL (incidence of

LinkedIN:

<1 per 10,000) by 2017 is only feasible in low and medi-

69b94953

um endemic settings with optimal IRS. In highly ende-

Instagram: Epke_Annelie

mic settings and settings with sub-optimal IRS, additional interventions will be required.

Current research focuses on what to do if current

interventions are predicted not sufficient to reach the targets, by exploring the impact of intensifying the effectiveness of interventions or by applying different interventions, such as a possible future vaccine.

39

VPH Journal 6th edition

https://www.linkedin.com/in/epke-le-rutte-

As a veterinary student: How can you contribute to public education on improving the welfare of stray animals?

SCOVE WRITING CHALLENGE WINNER: Yuvraj Panth from Nepal Standing Committee on Veterinary Education, (SCOVE) IVSA

Awareness on Rabies at Usha English Boarding School Animal Welfare dignifies the animal to be facilitated with 5Fâ&#x20AC;&#x2122;s viz. Freedom from thirst and hunger; discomfort; pain, injury and disease; fear and distress and Freedom to express most normal behaviour. Concern for animal welfare is often based on the belief that animals are sentient and so consideration should be given to their well-being or suffering. While animal welfare are limited only to animal right activists and veterinarians, the welfare may not be achieved although, so public awareness is a must.

Public awareness on animal welfare includes pamphlets distribution, artistic presentations, painting/ postering

40

VPH Journal 6th edition

on walls, street dances with themes, dramas, etc. The educated ones would be favoured by pamphlets and presentations while illiterate could be awared by TV shows, radio scripts, street dances and drama shows.

Organizing free community animal health camps for stray animals with the involvement of public could motivate them work on animal welfare (feeding, sheltering) and importance of human-animal bond as well as importance of those animals (eg. as pet). Say, catching dogs for neutering at the market throughout the day, where many people could see that veterinarians working proactively for the communityâ&#x20AC;&#x2122;s wellbeing, is important to gain the communityâ&#x20AC;&#x2122;s trust and to engage them in to the work. Engagement of local people, raising their awareness and making them value population and disease control and therefore increase the animal health within their community is the key to a sustainable health balance.

No matter wherever veterinarians work, private or shelter or community, they can make a huge impact in the lives of animals and humans alike by offering resources and knowledge to aid in the reduction of unnecessary relinquishment, abandonment and euthanasia of companion animals. One Health issues also put the importance of public awareness on diseases that could be spread by stray animals, so welfare is included in it.

Mass Awareness on Rabies at Ratnanagar Hospital

41

VPH Journal 6th edition

School Awareness at Valmiki School

As a vet, I can educate the importance of those cute animals when they are made a pet or a domestic and offer advice to owners on at-home care, grooming, nutrition, dental care, behaviour, and the benefits of pet sterilization. I can raise public awareness of issues pertaining to homeless animals and pet overpopulation. I can serve the community by getting involved with programs that offer veterinary care to those animals who are homeless and helping to control overpopulation of animals.

I have also been engaged frequently in public awareness and school awareness issues mainly in eradicating Rabies where the contents would include the stray dogs, that are more prone to be a reservoir of Rabies.

Awareing the public, school teachers and students on neutering (because large number of dog population will have to suffer more for hunger, shelter) the stray dogs as well as vaccinations are part of animal welfares.

Involving kids from the school and children is a great way of changing peopleâ&#x20AC;&#x2122;s minds towards animal health and welfare. Children are naturally open and curious, and they can take their experiences from our awareness topics to their families. Children are futureâ&#x20AC;&#x2122;s nation builders, so educating and awaring them is thus important and effective.

So, whatever might be the way or means of awareing public, the focus point is that, it should be of participatory approach. When people participate themselves in community field approaches, the awareness would be effective and welfare of such stray animals can be sustainable.

42

VPH Journal 6th edition

IVSA at the WHO 138th session of the Executive Board Caroline Bulstra Member of the IVSA Standing Committee on One Health (SCOH) Student at the Faculty of Veterinary Medicine, Utrecht University, the Netherlands

From 25-29 January 2016 the 138th session of the Executive Board of the World Health Organization (WHO) took place at their headquarters in Geneva, Switzerland. As a veterinary student and IVSA and SCOH member I represented our student association at this conference, a great honour!

So what is the EB exactly and what is the main purpose? The WHO 138th session of the Executive Board, the EB, is attended by delegations from the 194 UN member states, NGOs in official relation with WHO and other partners. The Executive Board is composed of 34 members technically qualified in the field of health; these members are elected for a three-year term. It is the meeting in which the priorities for the upcoming World Health Assembly (WHA) are defined, and thereby many of the pressuring global health topics are discussed. The International Pharmaceutical Students' Federation (IPSF) and the International Federation of Medical Studentsâ&#x20AC;&#x2122; Associations (IFMSA) are NGOs that are in official relation with WHO and that way are invited to the EB each year. Last year and this year the students from IPSF asked us (IVSA), together with the World Congress of Chiropractic Students (WCCS), to join them.

43

VPH Journal 6th edition

Our delegation was constituted as follows: Ana Catharina Duarte – IPSF Amber Liu – IPSF Renato Nolasco – IPSF Caroline Bulstra – IVSA Damiano Costa – WCCS The IFMSA delegation consisted of five medical students.

The WHO Director-General Dr. Margaret Chan opened the EB with a report, highlighting the last developments, events and achievements in the field of global public health. In her address, she provided an update on the Ebola situation in West Africa, ending with the words “no one will let this virus take off and run away again”. Moreover, she expressed her concerns regarding the explosive spread of Zika virus to new geographical areas with little population immunity. A new emergency programme that transforms the way WHO responds to outbreaks and humanitarian crises was described and also the implications for health of the United Nations Sustainable Development Goals (SDGs) were discussed. The current refugee crisis was given as an example for several major crises that recently threaten health worldwide.

According to the member states, the agenda was the most comprehensive one they had seen so far. The EB agenda consisted of 55 agenda items; subjects varied from disease preparedness, surveillance and response to communicable diseases to non-communicable diseases to health systems and the WHO reform.

How do the WHO official member states, non-member states and partners contribute to the session of the Executive Board? The Chair coordinates the session and every agenda item is discussed separately. The member states are the first ones invited to deliver statements, then the non-member states and then the partners (including IVSA together with

44

VPH Journal 6th edition

IPSF and IFMSA). By delivering a statement the relevant party can state their position and advise the WHO regarding the discussed topic.

The Chair, Malebona Precious Matsoso, was responsible for the smooth running of the session and had some creative ways to encouraged this. She handed out chocolates and sang famous songs in the states’ own language when member states ran out of time in delivering their statements. Dr. Margaret Chan appreciated it and said: “Chair, you may never know, even with a bracketed text and a comma, how much chairing an EB session can affect WHO’s capacity to improve world health”.

For us, as International Veterinary Student’ Association, interesting agenda items were the Ebola outbreak evaluation, climate change, the global vaccine action plan and the global action plan on antimicrobial resistance (AMR).

Our IVSA Working Group on Policy Statements and Position Papers, together with the Executive Committee (ExCo), worked hard on preparing statements for this conference and for the WHA in May. We were proud to be able to deliver a statement on AMR, together with IFMSA and IPSF. This statement stressed the importance of interdisciplinary collaboration and applying the One Health approach in addressing antimicrobial resistance. It also emphasized the importance of starting AMR control now in order to be able to cure the next generation by using antimicrobials when there is no other treatment alternative and that, as future healthcare workers, we are key in this.

As student delegation we served as a great example of how powerful it can be to join forces and use the diverse and unique knowledge from the different fields in creating solutions to currently existing global public health issues. We were a very enthusiastic and driven team and it was fantastic to be part of that team. The World Health Organizations’ mandate is “the attainment by all people of the highest possible level of health”. As future veterinarians we can contribute to this mandate by stressing the importance of involving human-animal-environmental health collaboration in addressing the (veterinary) public health threats we currently face. Of course there was also time for fun during this week! With the delegation we had some great Swiss cheese fondue, spent our lunch breaks at the beautiful WHO rooftop and went out for drinks with the students from IFMSA. I would like to thank IPSF for inviting IVSA to be part of their delegation and I would like to thank the IVSA ExCo and SCOH for giving me the opportunity to represent our association during the WHO EB, it was an unforgettable experience! The 69th World Health Assembly takes place 23-28 May 2016 and here the focus will be on the specific health agenda set by the EB.

45

VPH Journal 6th edition

46

VPH Journal 6th edition

For more IVSA Veterinary Public Health Journals go to: https://issuu.com/ivsaveterinarypublichealthjournal

6th Veterinary Public Health Journal by the International Veterinary Students Association, IVSA February 2016 47

VPH Journal 6th edition

/ivsapage

/thescoh

IVSA. Information Office DSR KU LIFE DyrlĂŚgevej 9, Kopenhag 1870 Fredriksberg C Website: www.ivsa.org Email: publichealth@ivsa.org 48

VPH Journal 6th edition

/ivsa_global