IVSA VPH Journal 5th edition

5th Veterinary Public Health Journal by the International Veterinary Students Association, IVSA

IN THIS EDITION

The fight against rabies in both humans and animals

VPH Journal 5th edition

Interview with Prof. Dr. Jakob Zinsstag, author of the book ‘One Health‘ 1

Caroline Bulstra

Lawal Temitope

Dear all, Some weeks ago I walked across two bill boards at the Central Station in Utrecht, The Netherlands and I stopped myself for a few seconds to have a closer look. One of the bill boards was a commercial by our national Health Centre saying ‘Can you recognize a malaria mosquito?’ The other one was by the Food Safety Centre and it was showing two delicious looking meals while stating ‘you don’t see the pathogens’. Public health and food safety are in our everyday lifes and I once more realized how big of a role vets can play in tackling these human health risks, since 70% of pathogens arise from an animal source. We can do this following the One Health spirit and applying a coordinated, collaborative, multidisciplinary and cross-sector approach to address potential or existing risks that originate at the animal-human-ecosystems interface.

Known and unknown disease pathogens pop up everywhere on our planet, on top of that globalization and increased traveling have made it easier for pathogens to spread faster and further. The ebola crisis is still fresh in our minds and there is always a significant risk of new emerging infectious disease outbreaks. The IVSA brings together veterinary students from over 50 countries worldwide. I feel that together we build a powerful network that is able to fight public health issues, both locally and globally.

The Veterinary Public Health Journal is compromised by students and brings up some of the latest trends and events in the field of Public Health. In this issue the main focus is on rabies, the zoonotic disease with the highest fatality rate after the onset of clinical signs. Also various other veterinary public health related topics will be covered in this edition of the journal.

Enjoy!

Best regards, Caroline Publications Team member - Standing Committee on One Health 2015-2016

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VPH Journal 5th edition

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

5th edition December 2015

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

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In this issue

6 10 12 15 17 4

iNTERVIEW WITH KATINKA DE BALOGH FROM THE FOOD AND AGRICULTURE ORGANIZATION (UNFAO)

RABIES IN SHORT LECTURE BY PROFESSOR A.B. OGUNKOYA

LATEST NEWS NEW RABIES CASES REPORTED IN MALAYSIA

STUDENTS INVOLVED IN THE FIGHT AGAINST RABIES REPORT FROM THE VET STUDENTS OF IBADAN, NIGERIA

MILK, THE PUBLIC AND ECONOMIC DISASTER OF SRI LANKA SRI LANKA DAIRY FARMING INDUSTRY VS. MILK POWDER PRODUCTION VPH Journal 5th edition

20 22 26 30 32 34

AMR DAY ANTIMICROBIAL RESISTANCE DAY, THE IMPORTANCE OF RAISING AWARENESS

BRUCELLOSIS AND INFERTILITY IN HUMANS PROF. CADMUS (DVM, MVPH, PhD)

JOBS IN THE FIELD OF VETERINARY PUBLIC HEALTH INTERVIEW WITH BARBARA JONES, FOUNDER OF THE COMPANY ONE HEALTH CONSULTING

INTERVIEW PROF. DR. JAKOB ZINSSTAG ONE OF THE AUTHORS OF THE BOOK ‘ONE HEALTH‘

SENT IN BY OUR MEMBERS CHIKUNGUNYA FEVER OUTBREAKS IN INDONESIA

IVSA POLICY STATEMENTS ANTIMICROBIAL RESISTANCE WEEK AND INTERNATIONAL STUDENTS DAY

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Interview with Dr Katinka de Balogh, UNFAO

By Aqil Jeenah, IVSA ExCo menber and previous Chair of the Standing Committee on One Health

From the December 10 to December 11, the world leading

loping countries was something I always wanted to do,

experts in rabies gathered in a joint conference held by

and before taking up my first job in Africa as a District

the WHO, OIE with support of the FAO and GARC. The

Veterinary Officer in rural Zambia I had spent one and a

outcomes of the meeting was a 5 pillar framework in wor-

half years working in a zoo in Utrecht, the Netherlands.

king towards total elimination of human dog-mediated rabies by the year 2030. IVSA were proud to have been

2.

You have been at the FAO for many years,

invited and was the voice of not just veterinary students,

and you just finished your last day at the Rome

but students of all fields.

head office of the FAO and are moving off to South East Asia. What drew you to joining FAO

1.

You are a veterinarian by training. Where

initially?

did you study, and why were you drawn into be-

Well, I actually also worked at the WHO-HQ in Geneva,

coming a veterinarian?

doing work on rabies prevention and control. My post

I started my studies in (West) Berlin, in the part that

as a district veterinary surgeon in rural Zambia, I was

belonged to West Germany, I then moved to Munich

confronted with rabies cases in dogs and livestock. This

for my clinical years. For my doctorate I conducted re-

is where my passion for rabies started. I also noticed

search in Jamaica to study ticks and blood parasites of

that the dog population in Africa was different to that

goats before moving to do a specialization in tropical

in Asia and Latin America where most of the research

diseases and animal production at the L’Institut d’Ele-

was being done. When I moved back to Zambia to work

vage et de Medecine Veterinaire des pays Tropicaux in

at the University of Lusaka we conducted dog ecology

Maisons Alfort, France and later specialized in veteri-

studies which provided us with valuable insights about

nary public health in the Netherlands. I have wanted to

dog-human linkages and accessibility of dogs for vacci-

be a veterinarian since I was 5 years old. I had grown up

nations and I also was part of the 1st SARC meeting in

in South America, and used to go out in the field with

1991 in Lusaka. It was during this time that I connected

my father who worked with the FAO as a marketing ex-

with people who have remained in contact over time

pert. He used to go into the indigenous communities

and was able to meet again during the (ongoing) Global

and try to find markets for them to sell their fruits and

Rabies Conference in Geneva.

vegetables in cities. Working with communities in deve6

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3.

The FAO is a large organization with many tion between panels, speakers and the participants. It

different sections. What are your tasks at FAO has certainly moved the rabies agenda (fast) forward. and how does your training as a veterinarian assist you in this?

5.

There was an interesting fact that was

So I have been working in the Animal Health Service pointed out by the FAO about Rabies: that its at FAO-HQ in Rome since 2002. The last seven years I socio-economic impact, especially in the poorer have been leading the veterinary public health activi- countries, that is often forgotten. What do you ties of the organization and have become very enga- think about this? Do you think this is an issue ged in One Health and in closely collaborating with the that should be addressed in the roadmap that OIE and WHO. I am able to use my veterinary know- comes out of the meeting? ledge on a daily basis for my job, but the most impor- I think this is a vital piece of the puzzle that is missing tant element that helps me is the field experience that and is extremely important. Rabies also has an imporI have had. In reality I don’t just have an average desk tant effect on livestock and on the livelihood of people. job, and having been able to see various realities and Unfortunately there is insufficient data on rabies and my practical experience helps me a lot. It also assists especially in livestock due to very large under-reporme when writing up policies as I can relate to what this ting. It was very interesting to note the data from North could mean for countries and their communities. I have Africa and Middle East indicating over 50% of rabies in also been very privileged to travel to over 100 coun- livestock. I have come across cases of farmers seeing tries, which has been an invaluable experience to me.

cows bellowing, and believing they were in heat. Only when the bulls did the same rabies was suspected. Of-

4.

We are having this interview at the side- ten animals had already been eaten before the sam-

lines of the Rabies conference which highlights ples could actually be taken. There have been cases the tripartite alliance of the WHO, OIE and of multiple children bitten by a rabid dog, but someFAO. What are your thoughts on the meeting times families are only able to afford treatment for one so far?

child. The grief of the parents is something that can’t

The meeting was great and it has created a lot of mo- be measured. These diverse aspects make it difficult to mentum for the elimination of rabies. There is renewed clearly assess the impact of rabies. energy and hopefully this will translate in long-lasting commitment to the fight. I liked the dynamic interac- 6.

We both know you are an avid supporter

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of student involvement within projects. What do or going to new places. It’s always an experience, good you think the role of students, no matter their or bad, and you can always learn from it. Many univerprofessions; play in the fight against the disease? sities push clinical work, but there is a lot more out the-

Students play a major role in creating awareness about re to do as a veterinarian. Last, don’t be afraid of taking the disease; they can be important advocates for the di- that big decision and jumping into the cold water as the sease. Students can be involved and provide vital man world is a fascinating place. power to especially punctual massive campaigns as longer-lasting campaigns would need their involvement over longer periods of time. Veterinary students normally should have received rabies pre-exposure prophylaxis and therefore can be involved in the actual injecting and handling of animals while other students could be more involved in (organizational) aspects of a vaccination campaigns. I worked with students during my time in both Zambia and Mozambique where we held big rabies drives. We mixed teams of older and younger students to allow the exchange of knowledge within the student group. The students were vital by going on radio and speaking the local language to explain rabies, but also by making and helping connect with the local communities during the actual vaccination days. I also advocate for not sticking to the health care profession of students but look beyond the border to business students who can help with the cost benefit or students involved in mass-media and communication.

7.

Any words to a student that has a desire of

joining FAO and following in your footsteps?

Never be afraid of taking a risk on trying something new 8

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Rabies in short

Lecture by Professor A.B. Ogunkoya Transmission

Two forms of the disease can follow. People with

Rabies is a disease transmitted from animals to all

furious rabies exhibit signs of hyperactivity, excited

warm-blooded species, especially the dead-end

behaviour, hydrophobia and sometimes aerophobia.

hosts. It induces an acute encephalitis and neurolo-

After a few days, death occurs by cardiorespiratory

gical disorder/irritability disease. The illness rapidly

arrest.

progresses to coma and death in victims. The disease is primarily transmitted from the rabid animal saliva

Paralytic rabies accounts for about 30% of the to-

through biting or scratching, but transmission is also

tal number of human cases. This form of rabies runs

possible through wound licking, aerosol and organ

a less dramatic and usually longer course than the

transplants.

furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma

Hosts

slowly develops, and eventually death occurs. The

Rabies affects all warm-blooded species, both do-

paralytic form of rabies is often misdiagnosed, contri-

mestic and wild animals. In 96-99% of human cases,

buting to the under-reporting of the disease� (WHO).

the rabies virus is transmitted by domestic dogs.

Rabies is also present in cattle and buffaloes which

History

serve as a dead end host.

As far as known, five human patients survived rabies.

These patients were vaccinated prior to exposure and

Geographical distribution

the onset of clinical signs. They were supported by

Rabies is present on all continents with the excepti-

the utility of maximum medical intervention.

on of Antarctica, but more than 95% of human deaths occur in Asia and Africa.

Rabies prevention in human

Nearly all human rabies cases are related directly to Symptoms

animal bite incidents and thus, primary disease pre-

“The incubation period for rabies is typically 1–3

vention requires minimization of suspected exposu-

months, but may vary from <1 week to >1 year. The

res.

initial symptoms of rabies are fever and often pain or

a. by eliminating the virus within animal species

an unusual or unexplained tingling, pricking or burn-

b. by giving adequate post exposure treatment after

ing sensation (paraesthesia) at the wound site. As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and

an unavoidable suspected real exposure c. by maintaining good dog management and main taining a rabies free status on the long run

spinal cord develops.

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Local treatment of the wound

atment soon after exposure to rabies can prevent

Wounds from animal bites or scratches should be was-

the onset of symptoms and death (WHO). Recent

hed and flushed immediately with soap and water for

evidence has shown that in communities where time

10-15 minutes. If soap is not available, flush with water

has been spent on rabies education and vaccinatio the

alone. This is the most effective first-aid treatment

cases of PEP has actually gone up. This is due to peo-

against rabies. Ideally wounds should be cleaned tho-

ple bitten now seeking medical attention the moment

roughly with 70% alcohol/ethanol or povidone-iodine

they are bitten.

if available. Victims should be taken to a health care facility as soon as possible. Do not cover the wound

Dog population management

with dressings or bandages.

“Rabies is a vaccine-preventable disease. Vaccinating dogs is the most cost-effective strategy for preven-

Suturing when possible. When necessary the infiltrati-

ting rabies in people. Dog vaccination will drive down

on of wounds with rabies immunoglobulin (RIG) is re-

not only the deaths attributable to rabies but also

quired. The equine origin (ERIG) or the human (HRIG)

the need for PEP as a part of dogbite patient care”

can be used.

(WHO). Mass vaccination up to at list 70% of the dog

Indications for post-exposure rabies prophylaxes (PEP)

population is needed to development the required “herd immunity” within the dog population.

Post-exposure prophylaxis (PEP) means the treat-

Benefits to rabies prevention in dog populations are:

ment of a bite victim that is started immediately after

•

Improvement of animal welfare

exposure to rabies in order to prevent rabies infecti-

•

Human health will be improved and protected

on. This treatment consists of local treatment of the

•

Socio-economic benefits due to reduced sick-

wound, initiated as soon as possible after exposure;

ness and death of human and livestock

effective rabies vaccination; and the administration of rabies immunoglobulin, if indicated. Effective tre-

References: World Health Organization (2013). WHO Expert Con

sultation on Rabies. WHO TECHNIC

AL Report Series 982. Second Rep-

ort. Geneva.

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New rabies cases reported in Malaysia Yee Nin, November 2015

Malaysia had been declared free from rabies by the

came into play. Within a public health emergency,

World Organization for Animal Health (OIE) since

what is the balance between animal welfare and pu-

2012. However, a dog bite incident in a small town in

blic health? It must be noted, that multiple studies

Perlis was evoking a nationwide panic and resulting

and experts agree that the killing of animals has no

in 3 states in the Northern of Malaysia gazetted as ra-

significant effect on the spread of the diseases.

bies area. The drama came to its climax after an announcement made by the Chief Minister of Penang

Within this context, we needed to consider the

Mr. Lim Guan Eng, advising culling all stray dogs in

amount of resources available in the country. Accor-

the state to prevent the disease from spreading.

ding to the veterinary department, Malaysia has a shortage of vaccines against Rabies. There was only

On 15 September, around 2000 strays had been cap-

a very limited stock of dog vaccines available to ma-

tured and put down by the veterinary authorities.

nage vaccination in the set â&#x20AC;&#x2DC;immune belt areaâ&#x20AC;&#x2122;. The

The mass cull was widely protested by NGOs, who

belt is bordered by Thailand where rabies is ende-

together submitted a memorandum to urge the sta-

mic after Malaysia was declared free of the disease

te goverment to put an end to the killing of stray ani-

in 1999. As the episode reccured, Malaysia was re-

mals. Within the memomrandum, alternative solu-

quired to purchase batches of vaccine from OIE to

tions were given to deal with the crisis. Mr. Lim, the

control the outbreak. In the meantime, the push by

Chief Minister insisted that the decision was made

NGOs for mass vaccination of strays instead of mass

after taking into account public health and other re-

culling was having no effect as there was an inade-

levant interests.

quate supply of dog vaccines within the country.

NGOs came up with other alternatives, such as qua-

At this point of the crists, a heavily debated point 12

rantine of infected animals.

VPH Journal 5th edition

This method was meant to be more humane as ani-

Vaccination only offers effective cure before mani-

mals are allowed to die due to progression of disease

festation of clinical signs, therefore it is pointless to

instead of being put down straight away, as Rabies is

offer vaccination to rabid animals. In terms of the

usually fatal in 3 to 10 days after presentation of cli-

five freedoms for animals (freedom from hunger

nical signs. One can doubt if this would be an ethical

and thirst, from discomfort, from pain, injury or di-

solution.

sease, freedom to express normal behaviour and the freedom from fear and distress), quarantined

There were several challenges to overcome when

rabid dogs had gone against at least the freedom

we were talking about putting a batch of animals in

from pain, discomfort and disease. In addition, this

quarantine. Holding a group of strays in a confined

is an expensive solution. The process needed con-

space increased the likelihood of disease transmissi-

sistent human resources and funding for mainte-

on via fighting behavior due to stress (by apparently

nance, as well as achieving optimum welfare.

healthy individuals), unless the animals were quarantined separately. Note that stress in confinement

State government and veterinary authorities had

also exaggerated other underlying complications.

been placed to lead the steps in resolving the out-

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break. It was undeniable that funds allocated, human

Cruelty to Animals president Ricky Soong and Dr. Ran-

power and available resources were always the limi-

jit Kaur Mendhir, founder of the no-kill Noahâ&#x20AC;&#x2122;s Ark Ipoh

ting factors in the decision making processes on how

animal sanctuary, lacking of correct information and ir-

to deal with the disease. To compensate for the scare

responsible ownership had lead many people to act of

resources, mass culling of stray and free roaming dogs

dumping their pet dogs, instead of vaccinating them.

was the â&#x20AC;&#x2DC;cheapest last minutes measureâ&#x20AC;&#x2122;, and the im-

This was mainly the case in Ipoh, the closest town to the

mediate action to remove the etiological agent out

immune belt. Pet owners in other states, such as Kuala

of the human population, with the human population

Lumpur and Johor, created a panic wave by rushing to

being the main concern of the goverment. However,

get their pets vaccinated. Thus, responsible ownership

this incident should serve as a good lesson for not only

should be educated to the Malaysian citizens, especial-

the government, but the citizens themselves to incre-

ly the management of animals in certain endemic out-

ase awareness on rabies and other potential zoonosis

breaks. Apart from proper vaccination, owners should

and always be well prepared for an outbreak. Going

restrict the movement of animals instead of leaving

forward, primary goals are aimed towards reducing

them roaming as usual, in order to reduce contact with

the stray population and revamping the public educa-

rabid animals. Correct information regarding rabies vi-

tion drastically.

rus transmissions and precaution steps upon bite incidents should be spread more effectively.

Public awareness and education were major issues to be tackled in this situation. The panic among citizens

In short, the chaos that resulted from the outbreak of

seemed to adversely affect the outbreak since animal

rabies in Malaysia happened due to the lack of public

dumping increased. Also people outside of the immu-

awareness on the zoonotic disease, lack of correct and

ne belt started buying rabies vaccines due to overall

reliable information on the disease agent and transmis-

panic and the lack of correct information on the di-

sion and the lack of general knowledge on crisis ma-

sease. This led to an increased lack of vaccines in the

nagement. Meanwhile, this provides a clear example

areas where the were needed.

for the younger generations on how the control of disease outbreaks can fail. Hopefully their roles get clea-

The risk of disease transmission in human and animals

rer when a outbreak occurs in the near future so that we

can be elimated by having a well managed control and

can effectively address new rabies outbreaks together.

maintaince program in a country. The Department of Veterinary Services had established a series of pro-

Resources:

tocols for vaccination of pet dogs. These protocols

WHO, ProMED-mail, The Malaysian Insider, Asia One,

should be disseminated and explained to the general

The Straits Times

public in coherence with the execution to avoid misunderstandings and unnecessary circumstances.

According to the Ipoh Society for the Prevention of 14

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Students involved in the fight against rabies Report from the vet students of Ibadan, Nigeria

By Mogbojuri Oluwatobi A (Local Chairman Organizing Committee, World Rabies Day 2015)

The International Veterinary Students Association (IVSA) Ibadan Chapter organised a 3-day event on the occasion of World Rabies Day on the 29, 30 September and 10 October 2015. The events were focussed on creating awareness, spreading information on rabies and fighting the disease by vaccinating dogs and cats.

On the first day we had organized a public seminar on rabies at our own university (University of Iba-

dan, Nigeria). Students and all other inhabitants of Ibadan who were interested in joining the seminar were invited. Around 600 people attented the seminar.

On the second day seminars for three secondary schools in the area were given on â&#x20AC;&#x2DC;the zoonotic impli-

cations of rabiesâ&#x20AC;&#x2122;. The main goal was to educate the public on rabies transmission and possible prevention and control measures to be taken. Another important goal was to make the communities aware of the free VPH Journal 5th edition

15

vaccination programme being offered by the IVSA Ibadan Chapter. A lot of secondary school students attended this day. During the evening session of day 2 an awareness rally took place at a rural area, Egbeda Local Government, Ibadan, Oyo State, Nigeria.

On day three there was the awareness rally in Egbeda Local Government (Bankesa, Erunmu, and Oree),

which is a typical rural community. The awareness rally was aimed to sensitize the community and educate them on the importance of rabies prevention and control and so why their dogs should be vaccinated. We communicated with them one on one. We tried to answer as many questions as possible, because the majority of the population does not understand what rabies is exactly and how to prevent the disease from spreading further.

We were able to talk to them in their own language, which ofcourse was a really great advantage.

Rabies is known as “aja digbolugi” in the Yoruba Language which means “mad dog”, literally it means “dog

that bites trees or that hits a tree with his head”. This is similar to the furious form of rabies and the name is based on the clinical manifestations in dogs affected with the rabies virus.

Finally, the vaccination activities took place on the 10th of October in the same rural area. Twohundred lo-

cal strain anti-rabies vaccines were offered by the Nigerian Veterinary Research Institute (NVRI). Dogs and cats of various species ranging from our indigenous breeds to exotic breeds were vaccinated. Additional veterinary services such as deworming, treatment for ectoparasites and advice on pet management and health care practices were carried out as well. It was a great event an hopefully we have more to follow!

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Milk, the public and economic disaster of Sri Lanka SRI LANKA DAIRY FARMING INDUSTRY VS. MILK POWDER PRODUCTION

Taylor Calloway, US Davis University of Carlifornia, School of Veterinary Medicine, IVSA SCOH Official Member Sri Lanka is an island nation located south of India. The country is known for its rich farming culture of tea and rice plantations. These practices are a vital part of family income and food consumption throughout the nation. Livestock farming is also a practice among the people and provides the main intake of multiple protein sources such as chicken, fish and cattle meat or products.

Unfortunately, Sri Lanka is not self-sufficient in its dairy industry, requiring a supplementation of imported powdered and condensed milk products. Local demand of milk requires 70% of outsourced products from other countries (Perera et al, 2008). Most recent statistic studies report the cost of imported products to be Rs 27 billion annually (Ministry of Social Services, Welfare and Livestock Development, 2012).

The amount tops the list of one of the largest country expenditures.

The Department of Census and Statistics in Sri Lanka reported in the 2012/2013-year, the average household expenditure was Rs. 41,444 monthly. Over a third (Rs. 15,651) of the monthly expenditures were spent on food consumption. The Sri Lankan residents consume rice, wheat flour and bread in the largest VPH Journal 5th edition

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quantities. This aspect places them at the top of the greater food expenditure list. However the largest expenditure on a protein source is powdered milk by the national household expenditure decile of 2012/2013year.

Figure 1: Milk powder imports Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Quantity (MT) 52525.8 49068.6 60768.5 58461.2 52701.8 52788.1 65840.3 61241.8 65376.1 63873.6 75482.6 87381.6 83817.7

Value (Rs./Mn) 7779.89 9080.06 9587.25 10106.1 11289.2 12591.4 16254 19306.2 30849 18608.7 29029.4 37882.9 39023

Figure 2: Milk production and collection Year 2005 2006 2007 2008 2009 2010 2011 2012

Milk production (million liters) 192.74 196.62 202 208 233.32 247.5 258.3 299.25

Milk collection (million liters) 100.18 113.37 120.76 117.08 125.12 137.66 143.70 183.58

There are various explanations for the countries need of imported powdered milk products. The reasons include but are not limited to political, technical and socio-economic factors, and a low farm gate price (Perera et al, 2008). The Ministry of Social Services, Welfare and Livestock Development had plans in 2009 to increase the country’s milk production (240 million) 300 times by the end of 2015. The plans included improvement in policy support, developmental programs, research, disease control, and strategies to improve breeding, production, marketing, industrial development and social aspects. In the past ten years, there has been an increase in the country’s own milk production and consumption. Although there is improvement in the years, there is still a high demand for more planning, implementation of new strategies, and sustainability of these ideas for the dairy industry in Sri Lanka to succeed.

One Health is a multidisciplinary topic that covers many aspects in the communication between human, en vironmental and animal health. There are many opportunities to use One Health strategies in issues involving local or global health. The example of Sri Lanka’s dairy industry is multifaceted with disease issues, cul-

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tural necessities, nutritional implications within both animal and human sides and economical problems.

These all require a team of diverse specialists to work together and organized large, detailed policies to set Sri Lanka up for success. So when you think of One Health, remember that it is to solve problems to promote the health of all.

References: Cow and Buffalo Milk Production (2014). Retrieved November 19, 2015, from http://www.statistics.gov.lk/agriculture/Livestock/ MilkProduction.html Gardew, L., Berhanu, A., Mengesha, D., and Tsegay, G. (2012). Identification of gram-negative bacteria from critical control points of raw and pasteurized cow milk consumed at Gondar town and its suburbs, Ethiopia. BMC Public Health, 12:950 Income and Expenditure (2013). Retrieved November 19, 2015, from http://www.statistics.gov.lk/page.asp?page=Income and Expenditure Milk Collection, Production and Milk Powder Imports. (2013). Retrieved November 19, 2015, from http://www.livestock.gov.lk/site/ en/statistics Perera, B., & Jayasuriya, M. (2008). The dairy industry in Sri Lanka. Retrieved November 19, 2015, from https://www.academia. edu/11428439/The_dairy_industry_in_Sri_Lanka Ranaweera N F C. (2007). Improved Market Access and Smallholder Dairy Farmer Participation for Sustainable Dairy Development.

Central Bank of Sri Lanka, Colombo, Sri Lanka Ranaweera, N. F C. (2007). Sri Lanka: Opportunities for dairy sector growth. Retrieved November 19, 2015, from http://www.fao.org/ docrep/011/i0588e/I0588E08.htm

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In 2013, just taking into account the USA, antibiotic resistance was estimated to be responsible for

How can antimicrobial resistance happen?

This is a worldwide issue

In the world, E. coli is significantly resistant to third generation cephalosporins and fluoroquinolones, two important and commonly used types of antibacterial medicine. In the world, according to the regions, from 25% to 90% of Staphyloccocus aureus infections are methicillin-resistant.

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WHAT CAN WE DO TO TACKLE ANTIMICROBIAL RESISTANCE?

•

•

Preventing infections by regularly washing hands

•

Practicing good food hygiene

•

Avoiding close contact with sick people

•

Keeping vaccinations up to date

•

Using only antibiotics when prescribed

•

Taking the full prescription

•

Never using left-over antibiotics

Preventing infections by ensuring hands, instruments and environment are

clean •

Keeping patients’ vaccinations up to date

•

Only prescribing and dispensing antibiotics when they are truly needed

•

Choosing the right antibiotic, at the right dose, for the right duration

•

Developping a robust national plan, including surveillance of antibio-

tic resistant infections, strengthening infection prevention and control

measures •

Making information on the impact of antibiotic resistance available

•

Rewarding the development of new treatments, vaccines or diagnostics

•

Ensure that antibiotics given to animals are only used to treat infectious disea-

ses and under veterinary supervision

•

Vaccinate animals to reduce the need for antibiotics

•

Develop alternatives to the use of antibiotics in plants

•

Promote and apply good practices at all steps of production and processing of

foods from animal and plant sources.

•

Adopt sustainable systems with improved hygiene, biosecurity and stress-free

handling of animals

•

Implement international standards for the responsible use of antibiotics, set

out by OIE, FAO and WHO

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Brucellosis and infertility in humans Prof. S.I.B. Cadmus (DVM, MVPH, PhD) Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria Brucellosis is a contagious systemic bacterial disease

but is rare route of infection. Brucella (the causative

of wild and domestic animals. The disease has been

agent) have been recovered from banked spermato-

eradicated in developed countries like Europe, USA,

zoa and vaginal discharges (Corbel, 2006) hence sexu-

and Japan as a result of strict control and eradication

al transmission is common especially in B. melitensis

programmes. However, it is still enzootic in developing

infections. The disease therefore commonly affects

economies of South America, Africa, Middle East and

herdsmen, abattoir workers, laboratory workers, ve-

The Mediterranean due to lack or non adherence to

terinarians, hides and skin workers and members of

control measures. The disease is present in Nigeria

the general public that drink unpasteurized milk.

and has been recorded in livestock and human populations. The presence of brucellosis in the livestock

In animals, the bacteria localize and multiply in

population translates to human population infection

the reproductive organs; hence, it is primarily a repro-

because brucellosis is zoonotic. The different Brucel-

ductive disease. The clinical signs of brucellosis the-

la species and the animals they commonly infect are,

refore are usually visible during pregnancy and they

Brucella melitensis: sheep and goats; B. abortus: cat-

include abortion (usually in third trimester), still birth,

tle; B. suis: pigs; B. canis: dog; B ovis: ram and marine

retained placenta, birth to weak calves and reduced

mammal Brucella species. Of these, B. melitensis, B.

milk yield. Retained placenta results in sterility but

abortus and B. suis commonly infect humans.

death is not common except in neonates. The clinical signs of brucellosis are not obvious in non pregnant

In animal populations, brucellosis is transmitted

animals and males except sterility, hygroma and or-

through contact with infected uterine discharges, suc-

chitis which sometimes lead to self-inflicted trauma.

kling of infected milk or in-utero maternal transfer. In

Symptoms of brucellosis in humans most times are

humans, the common routes of infection include direct

similar to those of endemic diseases like malaria and

contact with infected animals and uterine discharges,

typhoid (Muchaal, 2001) and they include recurrent

direct and accidental inoculation through cuts and

high fever (hence the name Undulant fever), chills,

abrasions in the skin, inhalation of infectious aerosols,

drenching sweats, insomnia, anorexia, headache,

and consumption of unpasteurized milk or other dairy

constipation, nervousness, encephalitis, spondylitis,

products, consumption of uncooked offals from infec-

arthritis, endocarditis, depression. Brucella melitensis

ted animals. Human-to-human transmission by blood

is the aetiological agent most frequently reported as a

transfusion, tissue transplantation, obstetrical ma-

cause of human disease and the most frequently isola-

nipulation, maternal transfer during birth is possible

ted. Brucella abortus on the other hand, is the most wi-

22

VPH Journal 5th edition

despread cause of infection but associated with much

in the ovaries and fallopian tubes leading to formati-

less human disease.

on of abscess. Infertility is a common sequel of animal brucellosis (Addis, 2015). The genitourinary system is

In contrast to animals, abortion due to brucello-

affected in 2-20% of cases having brucellosis (Hizli and

sis is not common in pregnant women (Oâ&#x20AC;&#x2122;Callaghan.,

Uygur, 2006). Genitourinary involvement of brucello-

2013), however when it occurs, spontaneous abortion

sis includes prostatitis (in which there is formation of

is observed mostly in the first and second trimesters

granuloma in the prostate gland), epididymo-orchitis,

of pregnancy (Teshager et al., 2014; Addis, 2015). The

cystitis, pyelonephritis, interstitial nephritis, exudative

first large series about correlation between abortion

glomerulonephritis and renal abscess. Epididymoor-

and brucellosis was reported in 1954 by Criscuolo and

chitis is the most frequent genitourinary complicati-

di Carlo with a total abortion rate of 10% reported in

on of brucellosis (Akinci et al., 2006). Brucella epidi-

200 cases of B. melitensis infection in pregnant women

dymoorchitis (BEO) occurs usually in the early stage

(Kurdoglu, 2015). Spontaneous abortion has been as-

of active brucellosis and may be the only presenting

sociated, by different schools of thought, with bacte-

symptom. It is mostly a condition of adults, seen less

remia or vaginal bleeding at presentation (Memish,

frequently in children and more commonly observed

2011). Rare cases of pelvic abscesses and salpingitis

in immuno-suppressed individuals such as persons

(inflammation of the fallopian tube) due to brucellosis

with HIV/AIDS. Resultant effects include aspermia or

have also been reported. Brucella may also be localized

oligospermia.

VPH Journal 5th edition

23

In nomadic societies however, the acute stage of

on of doxycycline and netilmycin for a month followed

the disease is not manifested among adults; although,

by doxycycline and rifampicin for another month or

there may be many chronic cases due to continuous

two. Abscess can be aspirated and drained although

exposure to the pathogen and long duration of the di-

in most cases, orchiectomy is usually performed on

sease in the affected person. In such societies there-

suspicion of a testicular cancer or tuberculosis.

fore, the acute disease is commonly observed among

It is therefore recommended that the following should

children and the disease becomes a pediatric problem

be observed in order to avoid human infection with

(Corbel, 2006). While BEO can occur as a separate di-

brucellosis:

sease with no symptoms of systemic disease, it can

i.

also be seen in relapses of cases that were inadequa-

gloves but in the absence of gloves, should co-

tely treated. Clinical features are not specific of the di-

ver their hands with polythene bags

sease and may simulate other conditions. There could

ii.

be development of a granulomatous mass (usually

the uterus and mammary glands of animals must

unilateral) in the testis which can mimic a testicular

not be touched with ordinary hands.

tumour or tuberculosis (this growth is however notice-

iii.

able upon orchiectomy). Bilateral epididymo-orchitis

properly disposed of by deep burial or burning.

occurs in up to 59% of affected patients (Papatsoris et

iv.

al., 2002). Testicular pain and swelling may start sud-

typhoid and waist pain, should be tested for brucel-

denly or gradually with variable degrees of pain inten-

losis especially those with history of regular contact

sity. Testicular swelling is associated with tenderness

with livestock and livestock products as well as those

and the testicle may be two to three times the normal

drinking unpasteurized milk.

size. Infection may progress in severity; particularly

v.

if the condition is not suspected, appropriate tests

avor to boil it properly before consumption.

Individuals assisting during calving should wear

Abortion materials, fetuses from the abattoir,

All abortion materials from animals must be Individuals that persistently suffer from malaria,

Individuals who drink fresh milk should ende-

are not performed and infection managed inappropriately. It may result in serious complications such as testicular abscess, atrophy and male infertility. There is increased evidence of decreased testosterone production, decreased libido and decreased sexual activity due to BEO ( Kassur and Dziubek, 1980).

In the suspicion of the condition, Brucella ag-

glutination tests and blood culture can be used as diagnostic methods for the differential diagnosis of epididymo-orchitis in endemic regions of brucellosis.

In endemic areas, the suspicion should be enough to initiate therapy for brucellosis while awaiting the confirmatory laboratory tests. Treatment is by combinati24

VPH Journal 5th edition

References:

C.Y. (2002). Endemic brucellar epididymo-orchitis: a 10-year expe-

Corbel, M. J. (2006). Brucellosis in humans and animals (pp. 1–102).

rience. Int J Infect Dis. 6: 309-13.

World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Swit-

Memish ZA. (2011). Brucellosis and pregnancy. International confe-

zerland. Retrieved from http://www.who.int/csr/resources/publica-

rence on brucellosis, Buenos Aires, Argentina.

tions/Brucellosis.pdf May, 2014 Muchaal, P. (2001). Zoonoses of dairy cattle with reference to Africa. Ottawa: Cities Feeding People International Development Research Centre (IDRC), Canada, 17–19. Retrieved from www.ruaf.org, May, 2014 Akinci, E., Bodur, H., Cevik ,M.A., Erbay,A., Eren, S.S., Ziraman, I., Balaban, N., Atan, A., Ergü, G. (2006). A complication of brucellosis: epididymoorchitis. Int J Infect Dis.10(2):171-7 Jequier, Anne.M. (2011). Male Infertility; A Clinical Guide. Cambridge University Press.

Teshager, Dubie., Mulie, Adugna., Tesfaye, Sisay and Yimer, Mukitar. (2014). The economic and public health significance of brucellosis. Global Research Journal of Public Health and Epidemiology:ISSN-2360-7920: Vol. 1(7): pp 054-064 Corbel, M.J. (2006). Brucellosis in humans and animals. World Health Organization /Food and Agriculture Organization of the United Nations / World Organisation for Animal Health Hizli, F., Uygur, M.C. (2006). Brucella orchitis: a rare cause of testicular mass: report of a case. Int Urol Nephrol 38: 637-639.

O’Callaghan, David. (2013). Novel Replication Profiles of Brucella in Human Trophoblasts Give Insights Into the Pathogenesis of Infectious Abortion. J Infect Dis.doi: 10.1093/infdis/jit010 Kassur, B. and Dziubek, S. (1980). Andrologic studies and sexual potency in chronic human brucellosis. Infection 8, 599-602 Addis, Mekonnen. (2015). Public Health and Economic Importance of Brucellosis: A Review Public Policy and Administration Research .www.iiste.org ISSN 2224-5731(Paper) ISSN 2225-0972(Online) Vol.5, No.7 Kurdoglu, Mertihan., Cetin, Orkun., Kurdoglu, Zehra., Akdeniz, Hayrettin. (2015). The Effect of Brucellosis on Women’s Health and Reproduction. International Journal of Women’s Health and Reproduction Sciences Vol 3 No 4, 176-183 Papatsoris, A.G., Mpadra, F.A., Karamouzis, M.V., Frangides,

VPH Journal 5th edition

25

Interview Barbara Jones One Health Consulting 1.

Can you tell us a little bit about yourself

diseases, or endure natural disasters.

and your career?

Currently, I provide consulting services to veterinary

I began my career as an equine general practitioner

hospitals, equine facilities, petting zoos, and canine

but was always interested in preventive medicine. I

facilities as well as pet owners with animals with an-

was particularly interested in the impact of environ-

tibiotic resistant infections. In addition, I continue

mental changes on health as well as management of

to practice veterinary medicine, with a focus on Tra-

disease outbreaks – involving intra-species as well as

ditional Chinese Veterinary Medicine (acupuncture,

zoonotic or cross-species transmission. I was able to

herbal therapy and food therapy) for performance

pursue that interest through the University of Iowa

animals, convalescent care for geriatric animals, and

Masters of Public Health program; they offer a pro-

convalescent care in post-op/ill animals. I also serve

gram designed for practicing veterinarians. I obtain-

as a Public Health Officer in the Air National Guard,

ed my Masters in Public Health from the University

which has broadened my experience to the human

of Iowa and then become a board-certified specialist

medicine side of One Health.

with the American College of Veterinary Preventive Medicine (ACVPM) in 2012. The ACVPM’s five main

2.

According to you, what is One Health?

core areas of practice include infectious disease, en-

I agree with the general One Health definition; an

vironmental health, epidemiology, food safety, and

integrative effort of multiple disciplines to attain

policy/education. I currently serve on the ACVP-

optimal health for people, animals and the environ-

M’s Continuing Education committee. We organize

ment; and that the optimal health of each of those

webinars not only for ACVPM diplomates, but also

is dependent on the others. This is contrary to the

DVMs and MDs/nurses/etc. in collaboration with the

hyper-specialization veterinary and human medicine

Centers for Disease Control (CDC) and Prevention.

has experienced in the last decade; in order to practice One Health, one needs to possess the mind-set

I formed One Health Consulting LLC to fill a need that

of Leonardo Da Vinci (artist, scientist, anatomist, ar-

is not currently being met in preventive medicine.

chitect, engineer) rather than Stephen Hawking. Da

Most veterinary clinics/hospitals, farmers, equine

Vinci’s philosophy is particularly adept at describing

facilities, petting zoos, etc. do not have the time or

One Health: “saper vedere,” “knowing how to see.”

expertise to develop standardized protocols to ma-

One Health is being able to see the connections bet-

nage outbreaks, prevent transmission of contagious

ween humans, animals and environment and under-

26

VPH Journal 5th edition

standing that we cannot exist in a vacuum, but must

future outbreak from occurring. Outbreak investiga-

learn to co-exist in a healthy way without manipula-

tion is not restricted to highly contagious diseases,

ting or destroying the other two.

but involves any increase in disease prevalence above baseline: for example, an increase in surgical site

While the definition for One Health is generally agreed

infections. Unless an infectious disease surveillance

upon, implementation of One Health principles and

system is in place, subtle increases in disease preva-

determining which fields fall under the umbrella of

lence can go undetected. Preventive medicine pro-

One Health are still occasionally cause for debate.

grams require constant monitoring and should conti-

This is probably because One Health encompasses

nue to evolve with new research.

so many different professions, disciplines, theories, conflicting interests and fields of study. How to im-

Infection control and prevention protocols are a vital

plement One Health is where most conferences and

part of outbreak investigation. Protocols allow us to

scientific discussions are currently focused.

standardize the steps of infection control and isolate

3.

Can you tell us something about your

company One Health Consulting?

the failure in preventive medicine when an outbreak occurs. Infection control and outbreak management protocols are also essential for data collection, which

My company can be described most simply by our

will help us to determine what role, if any, veterinary

company slogan: Identify-Prepare-Prevent.

medicine plays in global antibiotic resistance.

One

Health Consulting, LLC was started to provide outbreak investigation, disaster preparedness, and in-

Finally, disaster preparedness is one more layer es-

fection prevention and control services to veterinary

sential to total prevention. This component not only

clinics and hospitals, equestrian facilities, shows, re-

helps save animal and human lives, but also protects

hab centers, hobby farms/backyard poultry, petting

the environment during disasters. Goals of disaster

zoos, and multi-pet households. Outbreak investi-

preparedness include: minimizing the risk of medical

gation is not just for large scale outbreaks like avian

waste or manure being released into the environment

or canine influenza, it is also for individual clinics or

and preventing disease transmission in the event that

farms dealing with a contagious disease they either

humans and animals are forced into densely popula-

want to PREVENT from spreading to other animals/

ted areas, to name a few.

people/environment or want to learn how to prevent VPH Journal 5th edition

27

4.

What do you identify as the most impor-

general, plasmids can transfer between multiple bac-

tant One Health movements/activities/topics

terial species within the environment, and therefore

at the moment?

antibiotic resistance can spread among a wide range

This is the colloquial million-dollar question; but I

of bacteria very quickly. The NDM-1 enzyme gene

think the concern about antibiotic resistance is very

also provides an example of how environment plays a

real. Veterinarians are frequently blamed for antibi-

critical role: when NDM-1 genes are transferred, it oc-

otic resistance, which is shortsighted and potentially

curs at 1 to a million times more at 30 degrees Celsius

unfounded. Without evidence to refute these claims,

(ambient temperature) than 37 degrees Celsius. (body

antibiotics may eventually be eliminated from the re-

temperature). (Walsh, 2011) This demonstrates the

pertoire of pharmaceuticals that veterinarians are al-

huge impact environment can have on human and

lowed to prescribe. The veterinary profession needs

animal health.

to demonstrate a proactive approach to monitoring and preventing antibiotic resistance and minimizing

Liu, Yi-Yun et al. Emergence of plasmid-mediated

transmission of antibiotic resistant strains between

colistin resistance mechanism MCR-1 in animals and

animals and from animals to people and the environ-

human beings in China: a microbiological and mole-

ment. As the efficacy of antibiotic therapy becomes

cular biological study. The Lancet Infectious Disea-

in jeopardy, other forms of disease prevention are

ses. Published Online: Nov 18, 2015.

going to become a progressively more important aspect of veterinary medicine.

Walsh, Timothy R et al. Dissemination of NDM-1 positive bacteria in the New Delhi environment and

While not at the forefront now, transmission of antibi-

its implications for human health: an environmental

otic resistant strains of bacteria from animals into the

point prevalence study. The Lancet Infectious Disea-

environment is one of the areas that I think is going

ses. 2011. Volume 11 , Issue 5 , 355 â&#x20AC;&#x201C; 362.

to quickly become a very important movement/topic.

Just recently, a research paper was published that showed horizontal gene transfer (plasmid-mediated) of polymyxin resistance (MCR-1) in Escherichia coli in animals (pigs) and humans in China. (Liu Y-Y, 2015) This is concerning because research has shown, in 28

5.

According to you, what can we reach/ac-

complish by using the One Health approach?

And how does the company add to this?

Using the One Health approach is the only way human and veterinary medicine is going to be successful in a

VPH Journal 5th edition

world where everything from economy to health care is trending towards globalization. However, we need to develop a better understanding of how the environmental component impacts animal and human health. By using the One Health approach, all three areas, human, animal, and environmental health, will be improved and stabilized.

In addition, concerns about antibiotic resistance, zoonotic pandemics, and anti-helminthic resistance (which has a huge environmental component) will likely have a significant impact on the ability of general veterinary practitioners to prescribe drugs that we currently take for granted â&#x20AC;&#x201C; either because the drugs are no longer effective or because of legal restrictions.

One Health Consulting hopes to implement protocols to demonstrate that veterinary professionals and animal industries are being proactive in preventing not only antibiotic resistance, but also transmission of contagious disease agents between people, animals and the environment.

VPH Journal 5th edition

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Interview Jakob Zinsstag 1.

Can you tell us a little bit about your-

3.

Can you tell us something about the his-

self and your career?

tory of One Health? Did we have it before or

I trained as a veterinarian in Bern, Switzerland. After

is it really something new?

a short time in clinical practice I started working in

One Health is not new, we have a whole chapter on

Trypanosomiasis research at the Swiss Tropical and

its history in our new book. The interaction of human

Public Health Institute (Swiss TPH). From there we

and animal health has a very dynamic and changing

lived eight years in West Africa, four in the Gambia

history. But, there is still a growing need for the two

working on helminth disease of livestock and four

medicines and other sciences to collaborate in the

in CĂ´te dâ&#x20AC;&#x2122;Ivoire as director of the Centre Suisse de

face of emerging diseases or growing resistance to

Recherches Scientifiques. Since 1998 I lead a rese-

antimicrobials. Hence One Health is still of high ac-

arch group again at Swiss TPH on the health of mo-

tuality.

bile pastoralists and zoonoses control in developing countries. Today we are 30 people working in almost

4.

How do you use the concept in your

ten countries.

work or every day life?

We try to engage with civil society by organizing 2.

According to you, what is One Health?

participatory stakeholder workshops with commu-

Recognizing the inextricable interconnection of hu-

nities and authorities to identify the perceived pro-

mans, animals and the environment is a necessary

blems and problem solving strategies. We call this

but not a sufficient component of One Health. We

transdisciplinary strategies engaging academic and

consider a sufficient condition for a One Health ap-

non-academic knowledge (www.transdisciplinarity.

proach if we can show an added value of closer in-

ch). Then we create mixed research teams of doc-

teraction of human and animal health in terms of

tors, veterinarians, nutritionists and ecologists. We

better health of humans and animals and in terms

also design integrated studies that measure human

of financial savings and other benefits.

and animal health simultaneously. We develop ma-

Doctors and Veterinarians can make the patients

thematical models that simulate the transmission

healthy but if they work collaborate they can achie-

between humans and animals and finally we per-

ve better human and animal health then what they

form economic analyses to show the added value of

could achieve on their owns.

this closer cooperation. More and more we include

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VPH Journal 5th edition

ecosystem considerations under a paradigm of eco-

integrated approaches to health for humans and

systemic approaches to health (ecohealth.net). You

animals. In the industrialized countries we should

could also become student members of the Interna-

moderate our lifestyles to reduce our resource use.

tional Association for Ecology and Health.

This is a further challenge of One Health on how to provide health care not using more than 2000 Watts.

5.

What do you identify as the most im-

portant One Health movements, activities or

6.

topics at the moment?

complish by using the One Health approach?

Developing truly integrated surveillance systems

Better health for humans and animals while pre-

and build respective capacity for emerging diseases

serving ecosystem services for the generations to

and antimicrobial resistance surveillance. Team up in

come.

According to you, what can we reach/ac-

global partnership between industrialized countries and low and middle income countries to develop

VPH Journal 5th edition

31

Chikungunya fever Afdi Pratama Veterinary student Bogor Agricultural University (Bogor, Idonesia)

World veterinary day is an event to remind peo-

ple about contribution of veterinary profession to the many aspects of life, an important one being the health of both human and animals. This year, world veterinary day appointed an emerging issue as a theme: Vector Borne Diseases.

Vector borne diseases are becoming a major

public health issue worldwide. In the past time, vector borne diseases were known as infections in tropi-

“Rise of earth temperature is one of the reasons mosquitoes can impenetrate subtropical areas”

cal areas, but today the infections may spread into subtropical areas. There are many contributing factors driving this emergence. These factors include but are not limited to the destruction of habitat, changing ways in farming primarily in developing countries, and human invasion and encroachment and climate

change. All of these things caused an imbalance among host, agent and environment. A destroyed environment can lead to a number of other issues including global warming. Rising of the earth’s temperature is one of the reasons why mosquitoes can impenetrate subtropical areas. Mosquitoes usually cannot sustain their life in low temperature zones, but as the temperature rise mosquitoes can adapt and prolong life.

One very important vector borne disease is Chikungunya. Chikungunya is a viral zoonotic di-

sease caused by Chikungunya virus infection. Chikungunya was first isolated in Tanzania in 1952 from a patient. The word “Chikungunya” comes from the Kimakonde language (an ethic language of Tanzania), and means to become contorted. Before 2000, Chikungunya outbreaks were very rare.

Since 2000, Chikungunya outbreaks have emerged frequently. In 2000, there was a large outbreak happened in Democratic Republic of Congo, while another outbreak happened in Indonesia in 2001 to 2003. In addition, Kenya suffered Chikungunya outbreak in 2004. Comoros Island and India suf32

VPH Journal 5th edition

“Chikungunya is not treatable but preventable” fered Chikungunya outbreak in 2005 and 2007 respectively. Until 2015, Chikungunya fever has been identified in 60 countries in Asia, Europe, Africa, and America.

As was mentioned earlier, the cause of Chikungunya Fever is Chikungunya Virus. Chikungunya

is an RNA virus, genus Alphavirus, Family Togaviridae. Chikungunya is transmitted through Aedes, mosquito bites. Two species of Aedes, A. aegepty and A. albopictus, were known to be able to transmit the virus to vulnerable hosts. The mosquitoes are active primarily during the day, and humans are one of Chikungunya virus’ hosts. In Africa, Chikungunya virus was found in Bats and Non-human primates.

When an infected mosquito bites, the virus penetrates the body and enters blood stream, the

virus will start to infect cells and replicate rapidly. After 3 - 7 days after mosquito bite, symptoms most likely will start to emerge. In humans, some common symptoms of Chikungunya include fever and severe joint pain, and sometimes other symptoms can appear like headache, muscle pain, joint swelling and rash. The symptoms will emerge after 3 to 7 days after being bitten by infected mosquitoes.

At this stage, the virus can be found in the victim’s blood and the infected individual may transmit the disease to other people through a mosquito bite. When a human is infected, transmission of other vector borne diseases may occur (for instance dengue), so if you are infected by Chikungunya, you must protect yourself from mosquito bite because you’re the source of new infection. Usually sick people will get better within a week, painful joints may remain for months but death is rare.

Chikungunya is not treatable but preventable. So far there is neither vaccine nor medication ap-

proved for treating Chikungunya. We can prevent the infection by avoiding mosquitoes bite. Mosquitoes, especially Aedes, are active aggressively during daylight. It is highly recommended to use insect repellent before you go out during the day. If you stay in the room, make sure the door and window are always closed and use air conditioning if possible. You can also use insecticide spray to secure the room, wear long sleeved shirt and long pants. The other method to prevent the infection is by terminating life cycle of mosquitoes. In wet season or rain season, check items that may hold water around houses, if you find them you have to empty, throw out, bury or at least turn them over so they will not contain water any longer. Aedes have tendency to lay their eggs in fresh water so by doing this, it may help to cut their life-cycle.

We can prevent Chikungunya fever more further by spreading this information to your peers

and fellows to increase public awareness. Many diseases can be avoided by taking preventing actions, so make sure to take care of yourself and others.

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IVSA Policy Statement Antimicrobial Resistence Week

During the week of 17-22 November 2015, for the first time, the World Health Organization (WHO) held an Antimicrobial Resistance (AMR) week in recognition of this growing international problem. The WHO is making a massive step forward to highlight the immense global danger that AMR presents. Their campaign aims to increase worldwide awareness of antimicrobial resistance and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic-resistance (1).

Put eloquently by Dr. Margaret Chan, the Director-General of the WHO, “Antimicrobial Resistance is not a future threat looming on the horizon. It is here, right now, and the consequences are devastating.” To put this in perspective, there have been no newly developed classes of antimicrobial drugs for about the past 30 years. Bacterial virulence factors are continuously gaining advantage over our outdated antimicrobials, leading to more infection and disease paired with increased mortality.

The dramatic rise of AMR in recent times can be attributed to two main causes: •

The limitless and incorrect usage of antimicrobials by a variety of health professionals

•

The generalized lack of compliance by patients, owners and users of antimicrobials in regards to the

appropriate manner in which to use these medications.

The veterinary field has recently come under intense pressure to limit the use of antibiotics in multiple areas, especially concerning livestock. By enforcing regulations on the use of antimicrobials in food animals, there is an attempt to decrease residual levels of antibiotics found in meat for human consumption. There are copious amounts of scientific research showing that antibiotic use in livestock contributes to AMR spread in humans, due to these drug residues (2).

Thus, the IVSA calls that all veterinary students should be well informed about this issue of increasing AMR and should be actively involved in halting its progression. Students must have the ability to accurately inform animal owners about the risks of using antimicrobials, as well as to highlight the importance of following prescriber instructions. It is imperative that students clearly guide owners to follow directions and use the appropriate dosage and duration for their animals. Veterinary students must work to correctly diagnose patients and limit the use of antimicrobials for use only in those that genuinely benefit from them. As future veterinarian, students should avoid regarding antimicrobials as the panacea of all diseases.

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VPH Journal 5th edition

To achieve all of these goals, we need a change in the veterinary curriculum. The educational system must give students the opportunity to better educate consumers, allowing students to have the proper tools for guiding clients and educating owners on the importance of appropriate use of antimicrobials. The veterinary curriculum should also give future veterinarians the ability to correctly prescribe antimicrobials, and to stress the seriousness of limitless use. Proper usage of antimicrobials should be well understood and followed by veterinarians, and this usage should be based on clinical proof of active bacterial infection, as well as guided by antibiograms and susceptibility tests where possible.

References: 1.

â&#x20AC;&#x153;Antimicrobial Resistance.â&#x20AC;? World Health Organization. www.who.int/mediacentre/factsheets/fs194/en/

2.

Antibiotic Resistance Threats Report and Foodborne Germs. (2014, April 14). Retrieved from www.cdc.gov/narms/resources/thre-

ats.html

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IVSA Policy Statement International Students Day

On this day, November 17, the International Veterinary Studentsâ&#x20AC;&#x2122; Association (IVSA) congratulates the numerous people across history that have stood up for the rights of students: from Jan Opletal in 1939, to the strike in Athens in 1973, to the Velvet Revolution in Prague in 1989, to the recent shutdown of tertiary education in South Africa, to the hundreds of thousands of students in the Netherlands who stood up in the name of a free, fair education for all.

As veterinary students, we know and understand the pain and stress placed on students as they make their way through their veterinary education, and in particular the pressure they feel due to concurrent financial strain. In many countries, veterinary education is one of the most expensive degrees to pursue. This high cost of education not only places a great stress burden on students, but it can also prevent many students from achieving their dreams of becoming a veterinarian if they cannot afford to appropriately further their education or even afford it at all. There is an increasing demand for veterinarians due to a changing global perception of a veterinarianâ&#x20AC;&#x2122;s role in the betterment of human health following One Health principles, and the consequences of the financial burden of student education might soon result in the veterinary community not being able to cater to these demands.

However, the cost of education does not solely have a negative impact on academic pursuance and development.

Studies have shown that veterinary students experience depression more often than human medical students, with up to one third of first-year students showing symptoms of depression, in one US study (1) financial stress burden are less likely to be involved in campus life and instead, focus solely on their academic studies in fear of failing out (2) variety of problems, but perhaps, more importantly, does not foster adequate communication and social skills for a veterinary graduate to fit appropriately into society. Especially in a profession that requires a high level of social engagement and empathy with clients, this can have devastating effects in the work field, in turn, leading to a decrease in work satisfaction and an increase in work-related stress.

With the rising size and number of student loans required to achieve degrees, the financial burden does not end once a student has graduated. Veterinarians, who study on average for 6 years, earn much less money as compared to many other academic professions with a comparable degree. Many students find it impossible to combine the stress and lengthy hours of their education with a stable job during their veterinary studies, and are therefore left to start paying their debts as soon as they graduate and begin their working life. Although starting 36

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salaries have increased over the years, educational debt has proportionally increased at a much greater rate (3).

The veterinary degree has a very high debt-to-starting-salary ratio, which forces recently graduated veterinarians to face a very difficult first few years in their working lives as they struggle to pay off a loan that has accumulated over a considerable time. This adds much stress to veterinarians who are also dealing with being placed in highly emotional situations on a daily basis during the work day, and contributes to why the veterinary profession has one of the highest suicide rates across the world (4).

The IVSA, a global body representing over 30,000 veterinary students around the world, therefore calls on students and places of tertiary education to work together in decreasing the cost of veterinary education while maintaining high standards and excellent quality. We call on these institutions to work towards a model of free veterinary education to allow all students the ability and chance to achieve their goal of one day being high-quality and stress-free veterinarians. We therefore call on the global community of students to stand together to demand free, fair and quality education for all.

References: 1.

Hafen, M., Reisbig, A., White, M., & Rush, B. (n.d.). The First-Year Veterinary Student and Mental Health: The Role of Common Stres-

sors. Journal of Veterinary Medical Education, 102-109.

2.

Fosnacht, K. (2013). Financial Stress and Its Impact on First-Year Studentsâ&#x20AC;&#x2122; College Experiences. Indiana University, Bloomington, In-

diana.

3.

Chieffo, C., Kelly, A., & Ferguson, J. (2008). Trends in gender, employment, salary, and debt of graduates of US veterinary medical

schools and colleges. JAVMA, 233(6), 910-917. doi:10.2460/javma.233.6.910

4.

Bartram, D., & Baldwin, D. (2010). Veterinary surgeons and suicide: A structured review of possible influences on increased risk. Ve-

terinary Record, 166, 388-397. doi:10.1136/vr.b4794

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IVSA. Information Office DSR KU LIFE DyrlĂŚgevej 9, Kopenhag 1870 Fredriksberg C Website: www.ivsa.org Email: publichealth@ivsa.org 38

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