Education and training needs to improve animal disease

surveillance systems

Cristóbal Zepeda MVZ, MSc, PhD – USDA-APHIS-VS Centers for Epidemiology and Animal Health / Animal Population Health Institute, Colorado State University

Objectives

Identify problems affecting the efficiency of surveillance systems

Describe skills required at different levels within disease surveillance systems

Propose possible solutions

Animal health surveillance

Collection, analysis and interpretation of data to determine:– Distribution of diseases in time and space – Presence or absence of disease

Tool for decision-making– Directed at the control and eradication of diseases

The challenge

SPS measures under the spotlight

Increasing demands on the veterinary infrastructure

Need to demonstrate the animal health status

Effective surveillance systems central to the process

However... Reduction of public

spending Veterinary services often

not top priority Decreasing budgets for

veterinary services Weak infrastructures Difficulty to obtain funding

for surveillance

Increased demands

Disease freedom– Initial declaration– Maintenance

Compartmentalization– Internal and external surveillance

Outbreak surveillance Large number of samples

– Increased loads on surveillance systems and Dx laboratories

Why conduct surveillance?

Disease priorities should be based on:

Public health impact Impact on production Impact on international trade

Surveillance and monitoring

Surveillance Transforms data into

information Implies an action Essential for diseases

under a program

Monitoring Overview of disease

occurrence Does not imply an

action Basis for the

development of a program

Both activities require the support of competent diagnostic laboratories

Surveillance systems

Veterinary practitioners

Veterinary Para-

professionalsProducers General public

Sub-national level

surveillllance systems

Sub-national level

laboratories

National level surveillllance

systems

National level laboratories

OIEWorld

reference laboratories

Field Level

Laboratory networks

Data analysis

International reporting

Approach

Informal survey of veterinarians working in

disease surveillance systems and academia

Veterinary presence in the field

Many developed countries are experiencing a shortage of veterinarians working with production animals– Preference for small animal practice– Lifestyle choices

Gap in coverage– May become a critical problem in the near future

The same is true for some developing countries– But not all

In some developing countries there are sufficient veterinarians in the field– Varying quality– Excessive number of veterinary schools

Coverage may vary by production system

Veterinary presence in the field

Factors affecting the coverage of surveillance systems

Geographic coverage

Awareness of field veterinarians and farmers– What to report? To whom?

What happens if I do?

Economic incentives– Possible consequences of

disease reporting– Conflicts of interest

Compensation– Inadequate or inexistent

programs

Veterinary practitioners

Veterinary Para-

professionalsProducers General public

Sub-national level

surveillllance systems

Sub-national level

laboratories

National level surveillllance

systems

National level laboratories

OIEWorld

reference laboratories

Factors affecting the coverage of surveillance systems

Inability to directly link the benefits of animal health surveillance with better production, market access and public health

Skills

Do new graduates have adequate skills to understand the importance of surveillance and their role in surveillance systems?– In many countries training in epidemiology has increased in

veterinary schools

Not necessarily true in all countries– Emphasis is still on individual clinical cases

Changes in veterinary curricula

Increased training in applied epidemiology at the undergraduate level– Practical applications

Emphasis on the human-livestock-wildlife interface

Increased awareness on the importance of surveillance at graduate programs in epidemiology– National and international obligations – Exposure to animal health officials

Graduate level programs

Increased offer in graduate-level programs

Expensive– Funding sources are critical

Long term commitment

Problem to secure the current position when the trainee returns

Possible approaches

Modular approaches– Diploma and MSc

Distance education Mixed delivery modes Possibility to

accumulate credits from multiple institutions– Across international

borders

Veterinary practitioners

Veterinary Para-

professionalsProducers General public

Sub-national level

surveillllance systems

Sub-national level

laboratories

National level surveillllance

systems

National level laboratories

OIEWorld

reference laboratories

Role of international organizations

Veterinary education extends beyond university

Continuing education programs– Essential to hone and update skills

Role of OIE collaborating centers– Applied epidemiology courses

Short courses

Very useful

Targeted to a specific objective(s)– e.g. surveillance, biosecurity, risk analysis

Allow participants to return to their work and apply new knowledge

Do not replace postgraduate training– There are no shortcuts!

Diagnostic capabilities

Fewer veterinarians have an interest

What is the role of the veterinarian in the lab?– Provide the “big picture”

Increased dialogue between epidemiologists and the lab– Eliminate the “us and them”

mentality

Veterinary practitioners

Veterinary Para-

professionalsProducers General public

Sub-national level

surveillllance systems

Sub-national level

laboratories

National level surveillllance

systems

National level laboratories

OIEWorld

reference laboratories

Veterinary practitioners

Veterinary Paraprofessionals Producers General public

Sub-national level surveillllance

systems

Sub-national level laboratories

National level surveillllance

systems

National level laboratories

OIEWorld reference

laboratories

Increased understanding of

Population based approaches

Estimation of population parameters

Interpretation of diagnostic tests

Understanding of surveillance objectives and approaches

Link to public health

Population based approaches

Need to shift from individual clinical case emphasis to broader population-based thinking

Individuallevel

Herd levelMacro

Epidemiology

Agent

Host

Environment

Health Disease

Population

Epidemiological triad

Macro-epidemiology

Social, economic, politic and religious

factors

Agent Environment

Host

Temporal Pattern of 2003/4 and 2004/5 AI Epidemics in Vietnam

0

50

100

150

200

250

300

10/1/

04

10/2/

04

10/3/

04

10/4/

04

10/5/

04

10/6/

04

10/7/

04

10/8/

04

10/9/

04

10/10

/04

10/11

/04

10/12

/04

10/1/

05

10/2/

05

10/3/

05

no

. o

utb

reak

s Tet holiday Feb 9-11, 2004 Tet holiday

Feb 11-13, 2005

Source: Dirk Pfeiffer

Veterinarians in public service

Main objective is public health, through:– Prevention of zoonotic diseases

• Direct animal to human transmission– Food security

• Safe, sufficient and nutritious food supply

True for all veterinarians– Including small animal practitioners

Data Data

Data

Data

Data

Data

Data

Data

Data

Data Data

Data

Data

Data

Data

Data

Data

Data

Information

Data Data

Data

Data

Data

Data

Data

Data

Data

Information

Decision-making

Overall, there is a need to shift from a veterinarian with a syringe to a

veterinarian with a strategy

Acknowledgements

Arnon Shimshony Ian East Christine Power Katharina Stärk Dirk Pfeiffer Jorge Hernández David Hird Mo Salman

Vitor Gonçalves Paulo Duarte Lachlan McIntyre Marc Stevenson Graeme Garner Katsuaki Sugiura Kachen

Wongsathapornchai