Please cite this presentation as:

• Speare R. The role of veterinary education on zoonotic diseases and emerging diseases. Agriculture Fisheries and Conservation Department Annual Animal Health Workshop: Veterinary Education; Hong Kong. 23-24 January, 2013.

The role of veterinary education on zoonotic diseases and emerging diseases

Emeritus Professor Rick Speare

Tropical Health Solutions

&

James Cook UniversityTownsville

23 January 2013

rickspeare@gmail.com

My perspective

• Vet, doctor, public health physician• Researching control of communicable diseases in

animals and humans for over 30 years• Teaching postgraduate public health (Anton Breinl

Centre for Public Health & Tropical Medicine) – zoonoses and EIDs – to doctors, nurses, allied health, veterinarians – 1991-2012

• Highlighting need for human and animal health professionals to work together

• Realising that the current training for both keeps them apart

When is a new vet school / college needed?

• Australia agonised over this question in the late 1990s

• 4 veterinary schools since the 1970s• Finally decided in early 2000s to add 2 more in

non-capital cities (Rural vet schools)– James Cook University (Townsville)– Charles Sturt University (Wagga Wagga)

Residents per veterinary school: Australia

• Population = 22,015,600• Veterinary schools = 6• Residents/vet school = 3,669,263

• Canada = 8,575,021 • New Zealand = 4,327,944• UK = 9,006,737• USA = 11,208,838

Global statistics

• 5.5% of world’s population do not have a veterinary college / school in their country

Distribution of residents/ vet school by country

Statistics at www.tropicalhealthsolutions.com/veterinaryeducation

China = 74,624,44018 vet schools

Australia = 3,669,2636 vet schools

India = 41,554,26229 vet schools

Hong Kong = 7,153,5191 vet school?

Taiwan = 5,808,7345 vet schools

Proportion of countries by “continent” that have a vet school

Establishing new professional degrees: Learnings from James Cook Uni (JCU)

• We started 11 professional UG degrees • 1980s – Bachelor of Nursing Science• 1990s – B. Occupational Therapy; B. Speech Pathology; B.

Sports & Exercise Science; B. Biomedical Science; B. Medical Laboratory Science; B. Pharmacy; B. Physiotherapy; B. Medicine B. Surgery

• 2000s – B. Veterinary Science; B. Dentistry Although meeting the original needs was important, the

major benefits came from massive increases in professional capacity in the local area: specialists, new people, new ideas, higher quality, research answering local questions, new activities

Accreditation of degrees

• Universities are free to establish degrees in any discipline• If a degree is recognised (accredited) by a professional

body, the successful student is granted admission to that profession

• If the degree is not recognised, the student may not be granted entry to the profession, or only granted entry after doing additional training, and/or sitting a professional exam

• Accreditation saves effort by the student and gives status to the degree offered

Are zoonotic diseases and emerging infectious diseases a criteria for

accreditation of veterinary schools?

Are they a core content for accreditation?

Are they a “must have” rather than a “should have”?

The Australian & New Zealand requirements

• Accreditation is granted by the Australasian Veterinary Boards Council Inc (AVBC)

• Veterinary Schools Accreditation Advisory Committee (VSAAC) deals with accreditation of veterinary schools

• They use 12 standards for accreditation• Key document is the VSAAC Policies,

Procedures and Standards

12 standards of AVBC• Standard 1: Organisation• Standard 2: Finances• Standard 3: Facilities and equipment• Standard 4: Library and learning resources• Standard 5: Animals and related resources• Standard 6: Admission and students• Standard 7: Curriculum• Standard 8: Clinical resources and clinical learning and teaching• Standard 9: Academic and support staff• Standard 10: Postgraduate training and continuing education• Standard 11: Research• Standard 12: Outcomes assessment

Search of the VSAAC document

• Searched for “zoonoses”, “emerging infectious diseases”, “biosecurity”, “one health”, “one medicine”

• Hits:– “zoonoses” = 5– “emerging infectious diseases” = 0– “biosecurity” = 5– “one health” = 0– “one medicine” = 0

Standard 7. Curriculum

AVBC recognizes that curricula need to be flexible but the following areas must be covered:

• “- Instruction in the theory and practice of medicine and surgery applicable to a broad range of species. The instruction must include principles and hands-on experiences in physical and laboratory diagnostic techniques and interpretation (including clinical pathology, diagnostic imaging and necropsy), disease prevention, biosecurity, therapy (including surgery), patient management and care (including intensive care, emergency medicine and isolation procedures) involving clinical diseases of individual animals and populations.

• - Instruction in the principles of preventive medicine/epidemiology, zoonoses, food safety, the interrelationship of animals and the environment.”

Standard 8: Clinical resources and clinical learning and teaching

Expectations and Outcomes• “- Provides instruction on the principles and

practices of biosecurity within a clinical setting, including the students’ active participation in the use of isolation facilities.”

Essential Competences Required of the Veterinary Surgeon

Essential Competences Required of the Veterinary SurgeonAttributes relating to knowledge and understanding“Graduates will be able to demonstrate knowledge and understanding of:• The principles of epidemiology and zoonoses of disease and their

impact on the environment;” (p28)

Attributes relating to attitudes as they affect professional behavior“Graduates should have developed the following skills:• Recognition of the critical role of the veterinarian in biosecurity and in

the management of veterinary issues that have national and international implications.” (p28)

Annex 8 VSAAC requirements for Universities Implementing a ‘Distributed’ or ‘Off-campus’ Veterinary Clinical Education Model

Facilities• “15. The facilities and equipment at off-campus veterinary

clinics, practices and hospitals used for distributed teaching must meet the applicable state or national standards or codes, including compliance with all relevant legislation. The requirements for such facilities is that they meet “best practice” standards for veterinary hospitals and meet relevant standards for occupational health and safety, animal welfare and biosecurity. Ongoing compliance must be regularly reviewed (at least 12 monthly) by suitably qualified university staff or others.” (p102)

Accreditation requirements for other developed countries were similar

• American Veterinary Medical Association

• Royal College of Veterinary Surgeons

Importance of the Topics• Zoonoses and biosecurity are core content required

for accreditation of veterinary schools. Very important.

• The newer concepts of emerging infectious diseases (EIDs) and One World / One Health are not listed as core content.

• However, EIDs are rapidly increasing in importance.

• One Health is arguably an approach that will lead to improved control of zoonotic diseases. Important, but not yet critically so.

Important Definitions

• Zoonoses• Emerging infectious diseases (EIDs)• Zoonotic EIDs• Biosecurity• One Health• Veterinary Education

Zoonosis

A disease or agent transmitted from non-human vertebrate animals to humans

• 816 zoonotic pathogens• 1,407 human pathogens overall • Zoonoses = 58%

(Woolhouse & Gowtage-Sequeria EID 2005;11(12):1842)

What animal hosts carry zoonotic pathogens?

Woolhouse & Gowtage-Sequeria EID 2005;11(12):1842

A scheme for classifying zoonoses

• Zoonoses are complex• Most zoonoses have R0<1; so do not cause outbreaks• Can be classified in many ways• Agent, route of transmission, occupation, pathology• One approach classifies them into types by the

persistence of the zoonotic pathogen in humans and the ongoing relationship with an animal source

Zoonoses: type 1• Vertebrate animal reservoir, spillover to

humans; humans are a dead-end host• Animal hosts may be single species or multiple

Animal HumanAnimal

• This interaction occurs in an environment

Add climate change!

Example of type 1: leptospirosis• Small animal vet in Washington State

(USA) examined a pet rat• Rat urinated on his hands• Washed hands routinely• Developed leptospirosis 10 days

later• Diagnosis delayed until day 16 since

leptospirosis was not considered

Baer et al. Zoonoses and Public Health 2010;57:281

Role for vets

• Protect themselves – good infection control; recognise risky situations

• Protect staff – as above• Protect clients – as above; advise them in prevention• Remind doctors to think of zoonoses for any febrile

illness• Conduct hazard analysis - risk reduction• When reducing infection risks start with higher order

controls (elimination, substitution, isolation, redesign and engineering)

Higher order controls are more effective

• Work health and safety approach

HIGHER ORDER CONTROLS CONTROL THE PROCESS

Elimination

Substitution

Isolation

Redesign and engineering

LOWER ORDER CONTROLSCONTROL THE PERSON

Administrative controls

Personal protective equipment (PPE)

Thanks to Tricia Coward QWHS

Biosecurity

• Safeguarding of resources from biological threats• Encompasses the full spectrum of biological risk

whether naturally occurring harmful organisms, or introduced by accidents and/or negligence through to their deliberate use as biological weapons

• Term “biosecurity” is used in many different ways and often tailored for the particular situation

• Infection control is one component of biosecurity

Zoonoses: type 2

• Vertebrate animal reservoir, spillover to humans; limited human to human transmission

• About 25% of zoonoses

Animal HumanAnimal Human

Example of type 2:Salmonellosis• 1999; Salmonella

Typhimurium (multi-drug resistant) killed 9 cats in an animal shelter

• People who adopted kittens from the shelter became infected (primary human cases)

• One infected child passed their infection onto 2 children at a day care centre (secondary human cases)

Wright et al EID 2005;12(8):1235 Figure 1. Date of death among cats and week of illness onset among human case-patients, Minnesota, 1999.

Role for vets

• Protect themselves – good infection control; recognise risky situations

• Protect staff – as above• Protect clients – as above; advise them in prevention• Remind doctors to think of zoonoses for any febrile

illness• Assist/initiate epidemiological investigations• Conduct hazard analysis - risk reduction• If higher order strategies (elimination, substitution,

isolation) are an option, initiate these

Zoonoses: type 3

• Vertebrate animal reservoir, spillover to humans; well adapted human to human transmission; spillback to animals

Animal HumanAnimal Human

Two way transmission = anthropozoonosisHuman to vertebrate animal transmission = humanosis

Example of type 3:Influenza A• Influenza A infects humans, birds, pigs and variably

other mammals• Strains tend to associate with host groups, but can

spillover to other hosts• If dual infection occurs in an individual host, RNA strands

can mix (reassort), and a new strain can be excreted• For humans if i) the new strain transmits readily person

to person, ii) the antigens are novel (no widespread immunity) and iii) the virus is pathogenic, a pandemic can occur

• In 2009 a new strain of Influenza A H1N1 with genes from human, bird and pig influenzas caused a pandemic

Reassortment

• During this pandemic there were several instances of humans transmitting H1N1p2009 to pigs and poultry

• Viral genetics showed that human to pig transmission was frequent during and after the pandemic

(Nelson et al. J Gen Vir 2012;93:2195)

Mixing vessel host

Role for vets

• Protect themselves, staff & clients – infection control against droplet infection

• Encourage influenza vaccination of staff and clients to decrease risk of reassortment

• Advise clients to protect their pigs and poultry against risk of transmission from wild birds and human workers

• Assist with surveillance in animals• Assist in outbreak investigation and control

How to tell if an arriving flight has bird flu…

Escaped Zoonoses!

• Many human diseases started as zoonoses, adapted 100% to humans, and animals are no longer needed (eg, measles)

• Most recent example is HIV

Animal HumanAnimal Human

Human Immunodeficiency Viruses

Example of a group of viruses that made a cross-species transmission (zoonosis)

and Then became a “natural” human pathogen

Simian Immunodeficiency Viruses: Origin of HIV

Wertheim & Worobey (2009)

Simian Immunodeficiency Viruses: Origin of HIV

HIV-1 = from SIVcpz from chimpanzee (Central Africa: Cameroon)

HIV-2 = from SIVsm from sooty mangabey (West Africa: Côte d'Ivoire)

11 instances of non-human primate to human transmission of SIV to HIV

Non-Human Primate to Human Transmission Outcomes

• SIVcpz HIV-1 gp M • SIVcpz HIV-1 gp N• SIVcpz HIV 1 gp O• SIVsm HIV-2 gp A• SIVsm HIV-2 gp B• SIVsm HIV-2 gp C• SIVsm HIV-2 gp D• SIVsm HIV-2 gp E• SIVsm HIV-2 gp F• SIVsm HIV-2 gp G• SIVsm HIV-2 gp H

Wertheim & Worobey (2009)

Non-Human Primate to Human Transmission Outcomes

• SIVcpz HIV-1 gp M Human to human transmission• SIVcpz HIV-1 gp N Human to human transmission• SIVcpz HIV 1 GP O Human to human transmission• SIVsm HIV-2 gp A Human to human transmission• SIVsm HIV-2 gp B Human to human transmission• SIVsm HIV-2 gp C• SIVsm HIV-2 gp D• SIVsm HIV-2 gp E• SIVsm HIV-2 gp F• SIVsm HIV-2 gp G• SIVsm HIV-2 gp H

Group M then caused pandemic AIDS

Oldest date for the cross-species jump?

• HIV-1 gp M – 1900s• HIV-1 gp N - 1963• HIV-1 gp O – 1920• HIV-2 A – 1932• HIV-2 B - 1935

Wertheim & Worobey (2009)

Why did HIV become a pandemic?

• All about probabilities• Spillovers = many opportunities

• Bushmeat hypothesis

• Going global• Urbanisation hypothesis• Unsafe sex more frequent• Rapid transport of infected people long distances

A butchered monkey at a market in the Congo has been partially cooked. Nat. Geographic

Any role for vets in HIV/AIDS?

• Physicians do not talk to HIV/AIDS patients about zoonotic diseases (7% in USA Hill et al 2012)

• Vets do talk to HIV/AIDS clients about zoonoses (69% in USA)

• Physicians should refer patients to vets for advice….. But they don’t!• Vets and physicians don’t talk to one another• Vets have an important role in informing HIV/AIDS

patients and doctors about zoonotic risks• But their knowledge about specific risks for HIV/AIDS

patients is low (in USA)Hill et al. JAVMA 2012; 240(12):1432

Zoonoses: type 4

• Vertebrate animal reservoir; human reservoir; pathogen strains adapted to both; two way transmission

Animal HumanAnimal Human

Example of type 4:Methicillin resistant Staphylococcus aureus

MRSA: a humanosis becomes a zoonosis

Hospital

Community acquired MRSA

ICU

Human cases: Is there an animal MRSA source?

• Recurrent clinical episodes in a patient– Pet or livestock contact?

• Recurrent MRSA carriage in health care staff– Live on a farm?– Pets?

J Hosp Inf 2008;700186

MRSA: an occupational zoonosis for veterinarians

• Vets have an increased prevalence of community acquired-MRSA carriage

• Shown in several developed countries• Australian vets:• Industry & Govt vets (desk jockeys) 0.9%• Equine-only vets 21%• Vets who treat horses 12%• Small animal vets 4.9%

Jordan et al. Aust Vet J 2011;89(5):152Carriage of MRSA increases likelihood of invasive disease

Role for vets

• Protect themselves – good infection control; hand washing is critical

• Protect staff – as above; swabs to detect carriage of MRSA

• Protect clients – as above; advise them in prevention

• Conduct hazard analysis - risk reduction• Remind doctors to think of animal hosts for MRSA• Work with doctors in controlling any animal

reservoirs of recurrent human infections

Emerging Infectious Disease

Emerging Infectious Diseases (EIDs) are infections that have newly appeared in a population, or have existed but are rapidly increasing in incidence or geographic range, or threaten to increase

Origin of EID concept

• Federation of American Scientists 1992 report Emerging Infections: Microbial Threats to Health in the United States

• To protect USA by controlling diseases in country of origin

• Proactively implement communicable disease control in other countries in which outbreaks occur

• Particularly concerned by viral haemorrhagic fevers in Africa

EIDs

• Newly appeared; or• Previously recognised, but expanding in

incidence or geographic range; or• Threaten to increase• Total human EIDs = 177 (Woolhouse & Gowtage-

Sequeria 2005)

Trend to use terms:EMERGING and RE-EMERGING

INFECTIOUS DISEASES

EIDs

Relationship of EIDs to zoonoses

• 73% of Human EIDs are zoonoses (Woolhouse & Gowtage-Sequeria 2005)

Zoonoses

Risk factor for zoonotic EIDs: pathogen found in multiple animal host species

Figure 2. Relationship between breadth of host range and the fraction of pathogen species regarded as emerging or reemerging. (Woolhouse & Gowtage-Sequeria 2005)

Severe Acute Respiratory Syndrome (SARS)

• 8,422 cases globally• 916 deaths (Case Fatality Rate 11%)• 30 countries on 5 continents• Epidemic started Nov 2002 in Guandong Province• Lasted 8 months• Officially over 5 July 2003• Due to a coronavirus (SARS-CoV)• Four subsequent contained outbreaks due to escape of

SARS-CoV from labs

Metropole Hotel

Escape of SARS!China to the world

via the medical profession and jet planes

Animal Hosts for SARS CoV• Palm civet cat• Racoon dog• Domestic cat• Fox• Macaque• Original host appears

to be Chinese rufous horseshoe bat (Rhinolophus sinicus)

• Closest SLCoV (Yuan et al. J Gen Virol 2010;91(4):1058)

Spillover of SARS CoV

• Probabilities are important• Need many spillover events to get the “right”

virus

Wild Animal Markets

Bat HumanCivet cat Human

For SARS the driver of spillover was the wild animal markets that bought humans and animals close together

Who got infected?

• Muller et al (2004) Fig 1.

30% were Health Care

Workers!

An extremely dangerous disease … particularly to health professionals

Role of vets

• Assist in immediate epidemic control– Identifying agent– Identifying source– Completing the epidemiological picture– Coordinating animal aspects

• Assist in long term control– Developing vaccines– Source reduction– Reducing probability of spillovers

• Work collaboratively with health personnel, zoologists, ecologists, research laboratory scientists

• Vets have a very important role in zoonotic EIDs since they are more familiar than human health personnel with multi-species pathogens and investigations

Non-zoonotic EIDs: Affects animals only

Example: Wildlife EIDs that decrease biodiversity• Enter wildlife populations and cause massive

mortality• May be a host species jump or escape of a

pathogen from a restricted location• Can drive species to extinction– Highly Pathogenic Avian Influenza H5N1– Amphibian chytridiomycosis

Amphibian chytridiomycosis• Global epidemic in amphibians • High death rates in some species, causing

severe population crashes and some extinctions

• Most severe threat to amphibian biodiversity• Caused by a chytrid fungus, Batrachochytrium

dendrobatidis (Bd)• Skin fungus that kills frogs through causing

serum electrolyte imbalances (low K+) resulting in cardiac arrest

• James Cook University has been a leader in research and assisting in management strategies

Epidermis with Bd discharge tubes

Bd growing on agar plate

Frog dying from chytridiomycosis

Hong Kong research: Is chytridiomycosis present in Hong Kong?

• Hong Kong imports 4.3 million amphibians annually• Has chytridiomycosis been imported and escaped to

the wild?• Wild populations of 4 native species surveyed 2005-

2006 by Hong Kong-JCU team which was led by AFCD (Rowley et al. Dis Aquat Org 2007;78(2):87)

• No B. dendrobatidis found by PCR in 274 frogs

Is chytridiomycosis present in frog trade in Hong Kong?

• 137 imported amphibians negative (Rowley et al. 2007)

• Amphibians imported into USA from Hong Kong have tested positive in 2012 (Jon Kolby pers com)

• Result indicates need for:– More extensive surveillance in Hong Kong in trade

and wild frogs (monitoring program?)– Review of risk of B. dendrobatidis infected imported

frog escaping into wild

Role of vets in wildlife EIDs

• Absolutely essential!• Zoologists and ecologists have very poor knowledge of

disease• Typically keen to learn, but their basic training is

inadequate• Vets can contribute greatly to all aspects from

pathogen discovery, epidemiology, to control strategies• Major role in devising action based on deficient

evidence• To be effective vets have to understand perspectives of

the scientistsMutual respect!

Non zoonotic EIDs: Human only– Drug Resistant TB

• Mycobacterium tuberculosis is a human pathogen• Multi-drug resistant M. tuberculosis (MDR-TB) is

increasing– 310,000 cases (2011) – India, China (6% prev), Russia

• Extensively drug resistant M. tuberculosis (EDR-TB) is increasing– 27,900 cases (2011)

• Totally drug resistant M. tuberculosis (TDR-TB) has now appeared; Middle East, India

Hot spots in MDR-TB

Muller et al. Trends in Genetics 2013 epub

Pathogen Polution

• Pathogenic micro-organism that contaminates the environment resulting in human and/or animal disease

• Becomes an EID when the problem is increasing• Melioidosis (due to bacterium Burkholderia

pseudomallei in soil and water): EID? Tropical disease possibly moving into temperate areas with climate change

• Cryptococcosis (due to fungus Cryptococcus gattei)

Cryptococcus gatti: Aussie pathogen moves to Canada

• Environmental fungus that lives on Eucalyptus trees in Australia

• Causes meningitis and pneumonia in immunosuppressed people and animals

• C. gatti arrived in Vancouver Is, British Columbia (Canada) in 1999

Cryptococcosis: chronic disease

• Pulmonary granulomas• Asymptomatic• Fever• Cough

• CNS • Meningitis – slow• Meningoencephalitis

• Diagnosis• Demonstrate fungus• Antigen detection

Canadian outbreak

• 38 human cases (as at 2004)• Incidence Vancouver Is 3.7/100000• 72% lung (granulomas), 26% CNS• 35 animals

• Dogs• Cats• Ferrets• Dall’s porpoises

• C. gattii serotype B – two closely genetically related strains.

• VGIIa is the more virulent strain • Found in trees (5 native spp), soil, water, air

Kidd et al. PNAS 2004;101:17258-63

• Humans and many animal species infected• Even porpoises!

Virulent strain produced by same sex mating

Fraser et al. Nature 2005;437:1360-1364.

C. gattii expands

• Fungus spread to mainland Canada• Cases have occurred on Canadian mainland• Found now in Pacific Northwest (Oregon and

Washington, USA)• Spores on trees, woodchips, air, soil, cars,

footwear sea water

Why has Cryptococcus gattii spread?

• C. gattii is an endemic Australian fungus found on Eucalyptus trees

• Eucalyptus have been exported widely as woodchips, mulch and timber

• C. gattii discovered in Brazil and some tropical areas• In Canada global warming may have allowed the

fungus to become established once introduced• Now widespread in environment and using multiple

routes of spread• Example of “pathogen pollution”

Control of pathogen pollution?

• More difficult than controlling pathogens in wildlife reservoirs

• With cryptococcosis, veterinarians must be alert to diagnose disease early

• Vets can assist with research• Horses – surveillance (Duncan et al 2011)

• Cats & dogs – clinical management (Duncan et al 2006; Trivedi et al 2011)

• Pet birds, ferrets – clinical (Malik et al 2002; Lester et al 2004)

• Wildlife – epidemiology (Duncan et al 2005)

Managing zoonotic EIDs needs well-functioning multi-disciplinary teams

• Health personnel• Veterinarians• Laboratory scientists• Epidemiologists & disease control experts• Environmental experts• Social scientists• Industries• Policy makers

Same is true of many zoonoses

One Health: unification of the medical and veterinary professions with the

establishment of collaborative ventures in clinical care, surveillance and control of

cross-species disease, education, and research into disease pathogenesis, diagnosis, therapy and vaccination

• One World, One Health• Ecosystem and Public Health

“Between animal and human medicine there is no dividing line – nor should there be.” Rudolph Virchow

“The spirit behind One Health is mutual respect and communication across professions. We look for added value and synergy through surveillance, outbreak response and data sharing. This is an important step toward improving health outcomes incorporating human and animal health policies in all relevant sectors.”

AFCD "One Health: Past, Present and Future" workshop 2011

Professional silos

• For One Health to work, the professions have to understand each other, know their strengths (and weaknesses), what each can contribute, and how to maximize this to effectively manage complex problems to get a synergistic outcome

• Involves a cultural shift in veterinary and human medicine from disease care to health promotion and prevention

• Unfortunately, animal health, human health and environmental health professionals seem to be isolated

• The understanding of the other professions should be established during the undergraduate years

Differences between professional cultures:veterinarians and doctors

• Both are healing professions• Different values; different approaches• Different jargons; not exactly the same

languages (eg, biosecurity)• Vets deal with multiple animal species; docs

with only one

Vets and Docs: marked differences• Vets don’t have to deal with symptoms (how the patients say

they experience their illness); this is very important in human medicine (especially pain)

• Animals do not follow therapeutic instructions (so have therapy administered to them); docs expect their human patients to do so (but they often don’t)

• Legislation around disease can control an animal’s life and death, movements, behaviour and treatment given; not for humans

• Herd animals are usually managed as a group with few rights for the individual animal; not the case in human medicine

• For vets quality of life of their patient is more important than life itself; for docs life is paramount

Vets and Docs: marked differences• Economic issues are a very important factor in veterinary

decisions (life and death at times); costs modify management for docs, but killing a patient on economic grounds is not considered

• Consent of patient or guardian is very important for docs; consent of owner not so critical for vets

• Consent can often be overruled by legislation for vets; very difficult to overrule for docs

• Animals can be killed because they are ill, suspected of being ill, or close to another ill animal; not so for humans

• Vets have more power to enforce their decisions; docs have to convince patients and populations to do what is bestFor both professions to work together effectively

each must understand the other’s culture

Veterinary education

Three stages• Undergraduate (UG)– First degree (5-6 years)– Following pre-vet UG degree (4 years)

• Postgraduate (PG)• Continuing Professional Education (CPE)

UG curricula: Are zoonoses and EIDs taught?

• James Cook University BVSc as an example• Typical of Australian BVSc• Zoonoses – yes, but not as a specific subject• Biosecurity - yes• EIDs – no• One Health – no• Human population health – no• Working with other UG health professions - no

Zoonoses & Biosecurity Curricula: JCU• Pathogen and disease is the focus• Risk to veterinarians highlighted• 2nd Year

– TV2001 Integrated Animal Structure and Function 1: focus on pathogens: zoonotic risk highlighted

• 3rd year– TV3001 Transitions from Health to Disease 1: Vet Public Health is emphasised;

Biosecurity; Infection control, taught as a risk reduction approach• 4th year

– TV4001 Veterinary Clinical Sciences 1 & 2: zoonoses as part of clinical theory & practice

• 5th year– TV5005 Veterinary Clinical and Professional Practice: Practice rotations. One

week of lectures at start of year only: During this week 1 lecture on infection control.

The emphasis on teaching good infection control is a significant advance!

Hendra virus (HeV): a zoonotic EID

HeV is a threat to equine veterinarians, but a stark reminder to all the vet profession of the

importance of infection control

HeV: Stimulus for better infection control

• Importance of infection control in Australia now emphasised due to death of vets from HeV

• HeV is a Henipavirus similar to Nipah virus• Spillover from flying foxes to horses; horses to humans• 7 human cases, 4 deaths• 2 vets and 1 vet assistant have died; 1 vet nurse severe

sequelae• Vets left equine practice (Mendez et al EID 2012;18(1):83)

• HeV vaccine for horses now commercially available• Equine vets will maintain their infection control protocols

& HeV management plans (Mendez et al in press)

Are there better models for teaching zoonoses and EIDs?

• Unsure. Where is the evidence?• “Dearth of peer-reviewed research on factors

impacting veterinary medical education” (NAVMEC Board of Directors JAVMA 2011;38(4):320)

• North American Veterinary Medical Education Consortium (NAVMEC) proposed a new direction for veterinary schools (NAVMEC Board of Directors 2011)

– “Responsive, Collaborative, Flexible”– Core competency: One Health knowledge: animal,

human, and environmental health– Highlighted need for a research agenda for VME

NAVMEC Roadmap

• Broad areas only; hence a “Roadmap”

• Comparative biomedical approach, BUT focus on one or a few species or a discipline (eg, public health)

• One Health a core competency

Interdisciplinary Learning at UG Level

• One interesting strategy - have vet students learning with health professionals

• Uni of Florida Interdisciplinary Family Health subject (Waddell et al JAVMA 2010;37:126)

• 1st year vet students work with medical and allied health students in community visits to disadvantaged families

• Goal is learning interdisciplinary collaborative practice – highly successful

• Also learn about – Challenges of poverty to pet health– Zoonoses risk from neglected ill animals

One World, One Health: Veterinary Medicine, Uni of Calgary, Canada

• 4 year DVM (follows pre-vet)• Integrated core-elective curriculum• Fundamental core veterinary knowledge across all

years• One Health taught across all years (as is Global Health)• Electives in years 2 and 3• Areas of Emphasis in final year

– Production animal health– Ecosystem and public health– Equine health– Investigative medicine Cribb & Buntan Rev Sci Tech OIE 2009;28(2):753

Impact? Too early to know!1st class graduated

2012

PG Education and CPE

• More opportunities to gain specialised skills• Masters coursework (MPH, MVPH, etc)• Research degrees• Specialist training (eg, ANZCVS, Diplomats)• CPE– Business as usual (trend to prefer short seminars)– Innovative - Cornell Uni & Texas A&M have

combined with Pfizer Animal Health

Future• Suspect that the core

competencies in the NAVMEC Roadmap will eventually become accreditation requirements for veterinary schools / colleges in USA

• Strong emphasis on One Health• Shift from knowing about all

common domesticated species to few species or disciplines

• Can a new veterinary school meet the current competencies as well as the new NAVMEC ones? Thank you!

Source of images (if not original)

• Pet rat - http://en.allexperts.com/q/Pet-Rats-3537/2010/2/tumor-removal-extend-life.htm• Sooty Mangabey - http://pin.primate.wisc.edu/factsheets/image/440• Butchered monkey (DRC) -

http://www.nationalgeographicstock.com/ngsimages/explore/explorecomp.jsf?xsys=SF&id=1090012

• 3 silos - http://superiorrotary.areavoices.com/2010/11/25/silos/• Intensive care - http://www.corporeality.net/museion/category/medical-scientific-

instruments/• Home - http://www.webwombat.com.au/finance_/articles/first-time-home-owners-

grant.htm• Vet with dog cartoon - http://www.clipartof.com/portfolio/ctsankov/illustration/hispanic-

cartoon-dog-veterinarian-man-78904.html• Family cartoon - http://www.robertdstrong.com/reviews/family-iq-service-review/• Horse cartoon - http://www.balddog.com.au/illustration.html• Reassortment of influenza A - Nicholson (2003)• Rhinolophus sinicus - http://zmmu.msu.ru/bats/science/fauna/exfauna/rhsin.html