N°1 • OCTOBER 2015 1

SARS CHANGED INTERNATIONAL COOPERATION AS WE KNEW IT

BLAME THE SOOTEY Expert warns of MANGABEY disaster if lessons are not learned from Ebola outbreak

The Ebola outbreak that has that are necessary to develop a “ THE BIGGEST swept across West Africa is the preventive medicine or a treatment SURPRISE ABOUT More stories inside biggest ever reported, with more for Ebola. But we didn’t. Because than 25,000 cases and more the threat was thought to be of PANDEMICS IS IN than 10,000 deaths in Liberia, minor importance”, says Ab Os- FACT THAT WE ARE Sierra Leone and Guinea. Failure terhaus, who heads the Center for STILL SURPRISED to learn the lessons of this Infection Medicine and Zoonoses THEY HAPPEN.” HEALTH outbreak will have unthinkable Research in Hannover, Germany. ANTIMICROBIAL consequences when the next This statement holds an important POLICY global health emergency erupts, message for public health profes- RESISTANCE the director of the Center for sionals: the preparation for a public REVIEWS Infection Medicine and Zoonoses health threat must start well in ad- were not prepared. And are we pre- Research in Hannover warns. vance, in “times of peace”. pared for the next virus outbreak? There is Rift Valley Fever, MERS “7 or 8 years ago, we could have “By now, thousands of people have CoV... The biggest surprise about done the extensive clinical trials died from Ebola infection. The so- pandemics is in fact that we are still cial and economic costs already surprised they happen. We really amount to several billion Euros. If should invest in candidate vaccines NEGLECTED FROM we had spent not more than €20 and therapies. We need to convince PROF. AB OSTERHAUS: million some seven years ago, we’d the donors that this is money very INFECTIOUS INFLUENZA “WE NEED TO have had a vaccine available at the well spent, that it is cost-effective DISEASES TO MERS INVEST IN VACCINE start of the Ebola virus outbreak, in the end. We’ve had Ebola and we which would have saved so many should not make the same mistake DEVELOPMENT IN lives and expenses. However, we twice.” ■ PEACE TIME.” The ONE HEALTH PLATFORM Communicator

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ABOUT ONE HEALTH One Health recognizes that the health of humans, animals and ecosystems are interconnected. About 75% of new emerging human infections have their origin in zoonotic agents, meaning that they are naturally transmitted from animals to humans. Other infectious agents rely upon vectors, such as mosquitoes, ticks or sandflies to transmit from one host to the other. In addition, environmental and Creating a healthy future for ecosystem health negatively influence human and humans, animals and their animal health through issues like contamination, pollution and poor conditions that may lead to new environments. infectious agents.

ONE HEALTH PLATFORM An independent network organization that promotes an integrated approach to combat (re-) emerging neglected viruses, antiviral and antibiotic resistance, and bacterial and parasitic infections. à www.onehealthplatform.com

Erl Creer Reserchers MESSAGE FROM THE EDITOR Circle Interntionl One Helth Colition

One Helth One Helth Pltform Supportin Dear Reader, Supervisor Prtners Action Bord Group

elcome to the first edi- event, the Platform brought togeth- Editoril Bord One Helth tion of The One Health er public health professionals, policy Journl Platform Communica- makers and academics in a parallel tor, a brand new pe- 1-day Science Policy Interface (SPI) riodical issued by the programme. This track was specifical- Current One Health Coalition partners One Health Platform ly designed to bridge the gap between W Foundation. science and health policy. In a series of eleven lectures, the world’s leading

+7.@ The foundation builds on the belief that experts evaluated recent health crises governments, health science profes- like the outbreaks of Ebola, Q-Fever, sionals, key opinion leaders and public BSE, pandemic swine flu and SARS. health officials need to work together They also covered the most imminent to attain optimal health for people, public health challenges, unmasking domestic animals, wildlife, and our en- potential killers like avian influenza, vironment. After all, the emergence of the henipavirus and Rift Valley Fever. MERS CoV, the continuous outbreaks Special attention was given to the an- of avian influenza strains like H5N1 timicrobial resistance and the ques- and H7N9, the re-emergence of Ebo- tion how to avoid a post-antibiotic la in West Africa and the antimicrobial era, in which common infections and resistance of an ever-increasing range minor injuries can once again kill. of infections, have demonstrated that the health risks of our interconnect- The Science Policy Interface has prov- ed and fast-paced world continue to en a successful concept to integrate grow, especially in developing coun- science and health policy. It is a unique tries. The One Health Platform there- format for public health professionals fore creates a multidisciplinary net- to exchange information and ideas work of leading experts, offering a with their colleagues, academics and framework for information-sharing, other members of the One Health cooperation and awareness raising Community. This first issue of the One activities between the many parties Health Platform Communicator brings involved in One Health. you the conference highlights in short lecture reports. The One Health Platform was official- ly inaugurated during the 3rd Inter- Prof. A.D.M.E. Osterhaus, national One Health Congress, held Chair of the One Health Platform GloPID-R in Amsterdam in March 2015. At that GLOBAL RESEARCH COLLABORATION FOR INFECTIOUS DISEASE PREPAREDNESS The ONE HEALTH PLATFORM Communicator

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ZOONOSES LOOMING RESPIRATORY INFECTIONS THREAT HIV: Blame the sooty From influenza mangabey By Prof. Jean-Jacques Muyembe, to MERS Kinshasa University in DR Congo The first research project on HIV/AIDS in Africa was established in So for an avian influenza virus to the DRC in 1980. The major finding of the study was that HIV/AIDS become a pandemic virus, it has was an heterosexual epidemic, in contrast to what was seen in the Confirmed human cases of H5N1 disease to switch its binding position in West. The study’s main achievements included the prevention of the human respiratory tract. The HIV infection in high-risk women, the prevention of transmission of binding pattern of H7N9 is hence HIV from mother to child as well as the prevention of transmission of concern, since these viruses through blood transfusion. The latter is quite important because bind to both the upper and the blood transfusion is necessary in cases of anaemia caused by ma- lower human respiratory tract. laria. In addition, we were the first to show that prevalence of AIDS SOURCES OF INFECTION is high in tuberculosis patients and vice versa. The greatest risk of infection comes from live poultry markets. Three months Restrictions to trade, however, are ECDC risk assessment very difficult to implement since a http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List p 2015:=4f55ad51 already-4aed-4d32-b960 large-af70113dbb90&ID=1277 numbers of human H5N1 cases considerable part of the Chinese

in Egypt, although no change on molecular level population (both in Hong Kong + and mainland China) is dedicated 95%! HIV-1 (groups M,N,O,P) ! H5N1 AVIAN to two basic parameters for risk to having freshly killed chicken, INFLUENZA assessment: in spite of all the risks. To contain H5N6 viruses have infected hu- 1. probability of virus becoming virus spread, Hong Kong has in- HIV-2 ! mans in China, while H5N8 viruses pandemic (Is it easily transmis- stalled rest days in live poultry - have the potential to get estab- sible or not?) markets and a ban on keeping live 5%! poultry over night. lished in poultry and thus also to 2. impact/severity 2010; >30M infected people 3 infect humans. Research and ex- periments in ferret systems have H7N9 is of concern, because it MERS COV p HIV/AIDS is caused by two different virus strains demonstrated the pandemic ca- combines high probability and MERS CoV is a new coronavirus pacity of H5 viruses. Close mon- high impact, as opposed to H5N1. that had emerged in Saudi-Arabia HIV is a zoonotic disease from non-human primates, more specif- itoring and surveillance is hence in 2012. The number of human in- ically HIV-2 comes from sooty mangabeys in West Africa, whereas key. TRANSMISSIBILITY VS SEVERITY fections with MERS coronavirus is HIV-1 originates from chimpanzees and gorillas in Central Africa. Transmissibility of influenza vi- increasing still because of on-go- RESEARCHBoth| RESEARCH strainsEMBARGOED ARTICLE haveUNTIL 2:00 transmitted PM US ET THURSDAY, 2to OCTOBER humans 2014 due to hunting activities, H7N9 AVIAN ruses is closely related to the ing transmission of the virus from 1920 i.e. hunters butchering primate bush meat. From epidemiological Kinshasa Lubumbashi INFLUENZA position in the human respirato- animals to humans. Brazzavillestudies,Mbuyi-Mayi we have derived that HIV/AIDS was introduced in the hu- Bwamanda Pointe-Noire A virus of even greater concern Kisangani Americas B1 ry tract where the viruses bind. 1940 man population in Cameroon around 1920 and subsequently1.00 spread Likasi SE Africa C2 1.00 than H5N1is the H7N9 bird flu vi- Normal seasonal influenza vi- The important search for the via sexual transmission. The spread of HIV accelerated dramatically rus, which was first recognized in source of infection is still going 1.00 ruses bind in the upper respira- after the DRC gained independence,ZR.59 sparking an exodus from rural 1960 China in 2013. The concern relates tory tract, basically in the throat on. Camels are indicated as one areas to the country’s capital, leading to increased spread via sex- and nose. This makes it is easy animal source, but it is not exactly ual contacts. A Haitian professor subsequently exported HIV1 from Wave 1 to get the virus out of the body clear how the virus is getting from 1980 Africa to his homeland, marking the start of the global HIV/AIDS and spread. In comparison, avian camels to humans. Or, put differ- pandemic. influenza viruses predominantly ently, the virus is so common in 2000 1 2 camels, so why aren’t more hu- DRCongo (Kinshasa) as theSubtype amplification B siteSubtype ofC bind in the lower respiratory tract, Fig. 1. Time-scaled phylogeographic history of pandemic HIV-1. Branch colors represent the most probable location of the parental node of each branch.The respective colors for each location are shown in the upperHIV/AIDS left. U.S./Haiti/Trinidad subtypeepidemic B and southeast African subtype C lineages are highlighted by boxes deep in the lungs and that makes mans getting infected? ■ with a gradient shading, along with the posterior probabilities for their ancestral nodes. The tip for the ZR59 sequence is highlighted with a black circle. be around 1920 [95% credible interval (CI): F3 1909–1930] (Figs. 1 and 3A). Although we focus the transmission process difficult. on estimates under the best-fitting demographic • : SIV endemic in model for data set A, which1920 reduces by 39% the CIs of previous estimatesCameroon (16, 25–27 was), the epi- demic time scale we inferintroduced is robust tointo the human evo- lutionary models chosenpopulation(hunters) (fig. S8) and the data and sets analyzed (fig. S9). Because sequence frag- ments for the earliestbecame HIV-1 sample HIV [ZR59, with sam- sexual Acknowledgment BJ Cowling pled in 1959 in Kinshasatransmission. (17)] partly overlap with the C2V3 region• analyzed1960: here, DRCongo we included ZR59 as an internal controlindependance and estimated with both important the age and location ofrural this exodus strain. The to estimate Leopoldville of the age of ZR59 is centered on 1958 (95% CI: (Kinshasa): prostitution and Wave 2 1946–1970) (Fig. 3A), with little variation across data sets (fig. S9). In Fig.HIV/AIDS 3A, the posterior explosion. prob- ability distribution• of1960-70: this age estimate UN teaching is strati- fied according to the estimatedmission locationto DRC of by ZR59; Haitian crucially, Kinshasa receivesprofessors: the highest exportation support of Nuno et al., 2014 as the estimated locationHIV1 (PP to =Haiti 0.81).….USA..Global The de- cisive support for Kinshasapandemic as the epicenter of pandemic group M is robust to differences in spatial model specification and sampling heter- ogeneity (30) (tables S2 to S5 and fig. S4). To further test robustness,Adapted from we Sharp deliberately P M and excludedHahn B, 2011 Kinshasa sequences sampled at the earliest time Fig. 2. Spatial dynamics of HIV-1 group M spread. Circles represent sampled locations and are colored point (1985, representing 51% of strains for this according to the estimated time of introduction of HIV-1 group M from Kinshasa. Strongly supported rates location), which resulted in a root location at of virus spatial movement (table S6) are projected along the transportation network for the DRC (railways Brazzaville (PP = 0.97), located just 6 km from and waterways), which was fully operational until 1960 (38). Gradient colors depict the time scale of spatial Kinshasa across the Congo River. movements (bottom left). Our estimatedp locationSpread of pandemic originof ex-HIV/AIDS via railways and waterways plains the observation that Kinshasa exhibits city (16, 17) and why several early cases indicative occurred in southeast Cameroon, where the chim- more contemporary HIV-1 genetic diversity than of AIDS are linked to Kinshasa (35). The cross- panzees with SIVcpz strains most similar to group anywhere else (12, 13). It clarifies why the oldest species transmission of SIV to humans predates M have been identified (7, 8). After localized trans- known HIV-1Simian sequences were sourced Foamy from this the Virus group M common ancestor (36) and probably mission, presumably resulting from the hunting Acknowledgment BJ Cowling 2 00 MONTHLittle 2014 • VOL 000is ISSUE known, 0000 however, about HIV diversitysciencemag.org andSCIENCE prevalence in Afri- MS no: RA1256739/LK/MEDICINE Wave 3 can animals. For example, more than 30 species of non-human pri- mates have not been studied yet. We are now trying to monitor the history of HIV/AIDS in chimpanzees and gorillas, using non-invasive methods like stool sampling. This is an extremely important effort in light of the continued risk for transmission from non-human pri- mates to humans. After all, more than 70% of the populations in Central and West Africa rely on bush meat as a source of animal proteins. The risk of transmission therefore continues to exist, not

Acknowledgment BJ Cowling only for HIV/AIDS but also for new viruses, like Simian Foamy Vi- rus. We urgently need international cooperation to provide African p H7N9 spreading over multiple countries with well-equipped laboratories and well-trained staff. Chinese provinces in three After all, we are at the frontline. distinct waves The ONE HEALTH PLATFORM Communicator

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NEGLECTED INFECTIOUS DISEASES

Learn from 1999 HIV/AIDS to stop the RIFT VALLEY 2000

FEVER threat 2001 Disease transmitted by u Rift Valley Fever Virus outbreaks laid heavy burdens on people and livestock mosquito can spread in Africa and the Middle East. What can we learn from our HIV/AIDS outbreak very fast: West Nile management to minimize the impact of Rift Valley Fever? virus as an example RFV is a mosquito borne disease and such disease can spread 2002 Rift Valley Fever can cause severe disease in domestic very fast as is shown animals and humans. In adult animals (such as buffalo, by the example of camels, cattle, goats and sheep) disease causes fever, se- another well-known vere illness and abortions. Young lambs and calves devel- mosquito borne op a fever, become weak and may die. While most human infectious agent: West cases are relatively mild, a small percentage of patients Nile virus. develop a much more severe form of the disease. IMPORTANT OUTBREAKS 2003 • Senegal, Africa, 1987 • Kenya, 1997-1998 “ WE URGENTLY NEED • Est. 89,000 humans cases • 478 deaths INTERNATIONAL • Saudi Arabia, 2000 COOPERATION TO • First outbreak outside of Africa • Egypt, 2003 2004 PROVIDE AFRICAN • 45 cases, 17 deaths

COUNTRIES WITH RVF outbreaks typically occur when areas that are normal- WELL-EQUIPPED ly dry experience a period of heavy rainfall and/or flooding. In these warm, moist conditions mosquitoes breed in stag- LABORATORIES AND nant water and can then become carriers of the disease. WELL-TRAINED STAFF.” 2005

ONE HEALTH SYMPOSIUM 9 March 2016 Chatham House London, UK Scientific symposium for decision makers and public health officials CO-ORGANIZED BY THE ONE HEALTH PLATFORM AND THE CHATHAM HOUSE CENTRE ON GLOBAL HEALTH SECURITY

Renowned scientific experts will bring a series of tailor-made lectures, translating One Health science to policy practice on four major topics: Neglected infectious diseases (re-)emerging infectious diseases Antimicrobial resistance Scientific and societal intervention strategies

More information soon available at www.onehealthplatform.com The ONE HEALTH PLATFORM Communicator

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HENIPAVIRUS Family: Paramyxoviridae Genus: Henipavirus Species: • Hendra virus (HeV) • Nipah virus (NiV) • Cedar virus (CedPV) • Several other Bats may hold henipa-like viruses henipavirus Henipaviruses have been emerging quietly over the past 15 years. And they definitely have the potential to cause more widespread outbreaks. “They deserve threat our full attention given their broad host range, capacity to repeatedly spill over to the human population, their high mortality rate in people, and their ability to be transmitted from human to human”, says Jon Epstein of EcoHealth Alliance.

NIPAH VIRUS SURVEILLANCE AND CONTROL STRATEGIES IN BANGLADESH HENDRA VIRUS NIPAH VIRUS “THE MAIN STRATEGY • One Health approach: Integration of Human & Animal IS TO VACCINATE Surveillance Hendra virus was the first henipa- The second member of the Heni- HORSES.” • Active hospital surveillance (early detection of cases) virus to be discovered in Australia pavirus group is Nipah virus, • Integrated outbreak response in 1994, when it spilled over to a which was discovered in Malaysia • Anthropological studies to learn about modes of exposure group of race horses and even- in 1997 during a large outbreak in “In contrast to the single Nipah and incentives to adopt a different behaviour tually also infected a trainer and a pig farm. Scientists could rely virus outbreak in Malaysia, there • Prevent contamination of sap (f.i. bamboo cover of sap a veterinarian. The source of in- on the knowledge gained from have been more than 20 out- flow) fection was soon traced back to Hendra virus research and soon breaks in India and Bangladesh • Public outreach/educatio fruit bats. Jon Epstein elaborates: identified bats as the main source since 2001. In Bangladesh, these • Discussion of experimental vaccine and therapeutics use “Since 1994, we have seen seven of infection. The virus causes se- outbreaks mainly occur in the during outbreaks cases of human henipavirus in- vere respiratory and neurologi- western part of the country, most fection, four of which were fatal, cal disease in pigs, but does not often between November and including the horse trainer who have high mortality rates in these April. Case fatality rates have Known Henipavirus Distribution was among the first humans to be animals. Whereas most pigs re- been extremely high, varying infected. In horses, we have seen cover, about half of the farmers from 75 to 100%. And here we about 50 different outbreaks who contracted Nipah virus infec- do see bat-to-human and hu- along the east coast of Australia, tion from sick pigs have actually man-to-human transmission.” with a fairly high mortality rate of died. “In total, we have seen 265 75%.” human cases, about 40% of them “The most frequent route of were fatal due to encephalitis,” ac- transmission from bats to hu- “Hendra virus does not spread cording to Jon Epstein. “There was mans appears to be the con- directly from bats to humans or no evidence of bat-to-human or sumption of raw date palm sap. from humans to humans. So all human-to-human transmission, This sap is harvested by shaving human patients contracted the so all human cases contracted the bark of palm trees allowing virus via sick horses. This is crucial the infection from pigs. Normally, the sap to flow along the trunk of Henipavirus exposure/infection in bats knowledge to determine effec- pigs and bats do not interact, but the tree into pots. The Indian fly- Henipavirus exposure/infection in people tive management strategies, as due to the fact that fruit orchards ing fox (Pteropus giganteus) has we now know it is key to limit vi- were grown next to the pig enclo- learned to exploit this sweet juice rus spread in paddocks and horse sures (fruit production was a sup- as a food resource, contaminat- farms. The good news is that plemental form of income), pigs ing the sap with its saliva, or other p Known henipavirus distribution there is an effective equine vac- got exposed to this bat virus.” excreta, and occasionally Nipah cine available and hence the main virus while drinking from the sap strategy is to vaccinate horses. flow. Another potential pathway An additional important measure is through livestock, like goats, is to protect horses from grazing NIPAH VIRUS cows and pigs.” ■ SUMMARY under fruit trees and thus to limit CONTROL • Henipaviruses are omnipresent in Southeast exposure to bat excreta.” STRATEGIES IN Asia and the Pacific. The number of reported MALAYSIA human cases is probably a small portion of the • Depopulate farms during actual number of infections. Better surveillance outbreak is therefore urgently needed. After all, • Ban on fruit orchards near pig enclosures in henipaviruses have pandemic potential and high order to adjust the man- case fatality rates. "THERE HAVE BEEN made interface between • Human activities drive henipavirus spillover MORE THAN 20 NIPAH pigs and bats • Education, public outreach, surveillance and VIRUS OUTBREAKS • Advice not to feed further development of vaccine/therapeutics dropped fruit to animals IN INDIA AND can mitigate risk BANGLADESH SINCE 2001." The ONE HEALTH PLATFORM Communicator

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ANTIMICROBIAL RESISTANCE “ We are losing the battle for powerful and effective antibiotics.”

by Dik Mevius, Professor in Antimicrobial Resistance at Utrecht University, The Netherlands

The discovery of penicillin in 1928 initiated a period of antibiotics innovation and use. No less than 14 classes of antibiotics have been introduced for human use between 1935 and 1968. However, since than only five have been introduced, and new antibiotics have selected for resistance quite rapidly. We are losing the battle for powerful and effective antibiotics.

TWO EXAMPLES: The Netherlands. It was soon MRSA AND ESBL demonstrated that pigs carried Prevalence of ESBLs in other sources a specific MRSA variant, desig- The class of beta-lactams, which nated ST398, and the prevalence > 50% in (herds) of animals Environment includes penicillin, is the most of ST398 could soon be linked n Broilers n Soil effective and most widely used with carriership of MRSA in hu- n Layers n Surface water group of antibiotic in humans and mans with an occupational risk n Veal calves to a lesser extend also in animals. (e.g. farmers). It was also soon n Pigs Surveillance and control of or- demonstrated that livestock n Turkeys 13% birds (waders) ganisms that are resistant to this MRSA was not a Dutch problem n Dogs ESBL-positive n Dairy cows 41% group of antibiotic drugs is there- but rather a European and glob- Knapp, Dolfing et al. 2009 n Humans 4 – 10%?? fore of utmost importance. MRSA al one. We now know that it also Is poultry the source or part is an organism that is resistant to occurs in veal calves, poultry, of the problem?? EARSS-net 2013 report (ECDC)

MRSA ESBLs Globalisation of animal trade and Studies have shown that up to

Staphylococcus aureus. Total number of invasive isolates tested (N) and percentage resistant to meticillin (MRSA) including 95% confidence intervals (95% CI), EU/EEA Escherichia coli. Total number of invasive isolates tested (N) and percentage resistant to third-­‐generation the extensive use of antibiotics 90% of broilers in The Nether- cephalosporins (%R), including 95% confidence intervals (95% C I), EU/EEA countries, 2010-­‐2013

Country Comment** Iceland are risk factors for the emergence lands (and we produce about 450 Norway Sweden >* Country Comment** Netherlands Iceland and spread of those antimicrobial million broilers per year) were Sweden > Denmark Norway > Finland Netherlands Estonia >* Finland > Latvia < resistant agents. ESBL positive. This is a large res- Estonia Luxembourg < Lithuania Slovenia Belgium > Austria >* Denmark ESBLs are enzymes that inacti- ervoir that goes into the food Lithuania Slovenia Germany < Croatia Czech Republic Malta United Kingdom < France > vate the class of beta-lactam an- chain and into the environment. Austria > Poland Ireland > Belgium <* Luxembourg France < Germany > tibiotics and the genes involved Genetic associations have been EU/EEA mean percentage Poland > (population weighted) < EU/EEA (population Bulgaria weighted mean) > Ireland < Czech Republic > are transferrable via plasmids, demonstrated between plasmids Spain Spain > Hungary < Latvia Croatia United Kingdom > Portugal > which renders limitless possibil- and genes in poultry products Slovakia Greece > Cyprus Hungary Italy Romania Greece ities for transmission. Food and and human infections, suggestion Italy >* Portugal <* Slovakia Malta Cyprus > Romania >* Bulgaria > the environment are hence also transmission from poultry to hu- sources of transmission to hu- mans. mans. This means that, in con- methicillin, which first appeared horses and companion animals. trast to MRSA, these ESBLs cause in hospitals and after adaptation On the positive side, there is no a food safety issue. was able to spread to the com- human-to-human spread of this munity and to livestock. ESBLs MRSA variant and food products show a similar type of evolution. are not considered to be an im- Initially, they were typically seen portant source. “ESBLS ARE A in hospitals, and as of 2000, Challenges TRUE ONE HEALTH we’ve seen a pandemic spread in the community, in animals and PROBLEM” For scientists even in the food chain. • Understand the complex epidemiology of strains, mobile genetic elements, resistance and virulence determinants MRSA are well controlled in North- • Relation with antibiotic use and change in use practices ern European countries in hospi- • New antimicrobial active agents tals and a decrease in prevalence is seen in most EU countries due For policy makers to implementation of effective • Humans (Bottom-up: professionals conduct policy) control measures in hospitals. • Antibiotic prudent use policy and benchmarking of ESBLs emerged at the turn of the hospitals century and in all EU countries • Infection control measures there is an increase in ESBL pro- • Identification of persons/populations at risk ducing organisms. • Animals (Top-Down: risk-manager needed to implement Livestock associated MRSA was policy) first discovered in a pig farm in • Definition of targets • Law changes • Antibiotic prudent use policy and benchmarking of farms/vets • Routes of transmission: food, faeces and transports “LIVESTOCK MRSA IS NOT A DUTCH Public health challenge: PROBLEM BUT RATHER • Are we prepared to cope with the spread of carbapenemases in animals? A EUROPEAN AND GLOBAL ONE.” The ONE HEALTH PLATFORM Communicator

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ANTIMICROBIAL RESISTANCE

Many viral families exist and they all have different genomes, replication strategies and proteins. Consequently, a wide variety of antiviral drugs is needed. In this article, Prof. Johan Neyts of the ANTIVIRAL DRUG REGA Institute at Leuven University sheds light on the challenges RESISTANCE: and possible solutions to overcome antiviral drug resistance. ROOM FOR OPTIMISM HERPESVIRUS HIV COMMON COLD

Herpesvirus is a good example to demonstrate the chal- Today, 25 compounds Common colds are unpleasant, but the main problem is that lenges in developing new antiviral strategies. One of the first exist against HIV infec- they can cause exacerbations of asthma and COPD. Potent antiviral compounds that had been discovered and that is tion and they are all drugs with a high barrier to resistance are therefore need- still widely used to treat herpesvirus infection is acyclovir, used in fixed combina- “ONE OF THE ed. The first generation of antivirals, the picornavirus capsid while cidofovir is a second generation drug that can be used tions. Whereas some 20 CORNERSTONES OF binders, have a low barrier and are hence inappropriate for to treat infection with acyclovir-resistant strains. years ago, patients had HIV TREATMENT IS use against rhino and enterovirus infection. A new, promis- to take a handful of pills THE COMPOUND ing class of replication inhibitors with a high resistance bar- at specific time points CALLED TENOFOVIR, rier, however, is now under development. each day, the infection HOW ANTIVIRAL DRUGS WORK A MOLECULE WITH A and also drug resistance VERY HIGH BARRIER STEP 1 can now be kept under The antiviral compound is taken up and activated control with just one pill TO RESISTANCE.” by an enzyme (thymidine kinase) in the infected a day. One of the cor- DENGUE cell. nerstones of HIV treatment is the compound called tenofo- vir, a molecule discovered at Leuven University. Studies have Antiviral drugs have been developed against a wide range STEP 2 shown that tenofovir has a very high barrier to resistance. of virus families, but definitely not against all of them. Den- The activated compound starts building up metab- gue virus is a good example of an infectious agent for which olites that actually block the viral DNA polymerase, i.e. the replication machinery of the virus. we lack therapeutic drugs. Dengue infects about 100 mil- lion people every year and vaccine development has proven Novel compounds, like cidofivir, are designed to to be rather complex, so antivirals are dearly needed. We bypass the first step and hence do not need kinase HEPATITIS B activation. are therefore currently working on dengue inhibitors in our Hepatitis B, a virus that can cause cirrhosis and liver cancer, lab at Leuven University and a promising compound is now has again another replication mechanism. The first molecule under development in cooperation with Johnson&Johnson. Herpesvirus drug resistance mainly occurs in immunocom- used to treat hepatitis B infection, called lamivudine, had a Of course, we need to select compounds with a high resis- promised patients, transplant recipients and HIV patients. low barrier to resistance. New generation compounds, like tance barrier and an efficient selection procedure is put in It is therefore important to develop new sorts of antiviral entecavir, are more potent and resistance is very rare. How- place: we incubate in- medicines that have a different type of action. Pretilivir and ever, viruses that have developed resistance against lamivu- fected cells with subop- letermovir are two examples of such new compounds that dine do develop resistance against entecavir rather easily, timal concentrations of use completely different mechanisms to block virus replica- and the new compound should therefore not be used in pa- the tested compound to “DENGUE INFECTS tion. They therefore have non-overlapping resistance pro- tients with lamivudine-resistant virus infection. Fortunately, monitor the development ABOUT 100 MILLION files and can both be used to treat resistant infections. tenofovir – used, as mentioned, also against HIV infection of resistance. In the case - can provide a solution here as it acts effectively against of our new dengue inhib- PEOPLE EVERY YEAR hepatitis B virus replication, while resistance is non-existent. itor, it took almost half a AND THERAPEUTIC First generationINFLUENZA INFLUENZA drugs year for the virus to de- DRUGS ARE DEARLY velop resistance. ■ NEEDED.” Select The first generation ofrapidly antivirals for against flu were amanta- dine and rimantadine. Both drugs were only active against Maximising the barrier to resistance

influenza A, and influenzaresistance strains rapidly develop resistance Lamivudine Wild-type virus LAM-resistant virus against these channel blockers. Rimantadine rtM204V/I ± rtL180M Amantadine ETV-resistant virus IN A NUTSHELL

Entecavir rtT184 or rtS202 or rtM250 • Many viral families exist and they all differ rtM204V/I +/- rtL180M in terms of genomes, replication strategies and proteins. A plethora of antiviral drugs is Lamivudine rtT184 or rtS202 or rtM250 needed. then entecavir rtM204V/I +/- rtL180M • It is key to select drugs that have a high Tenofovir ? barrier to resistance • For long treatments, we need to use drugs with non-overlapping resistance profiles • Focus on the rational design of combinations largely reduces or prevents resistance development • Antiviral agents should not be used to treat Trend of amantadine resistant H3N2 influenza viruses “ SOME CHRONIC VIRAL infections in animals if the same virus can INFECTIONS CAN ALREADY BE also infect humans (cfr amantadine resistant The barrier for antiviral resistance is higher in the second KEPT UNDER CONTROL OR EVEN influenza viruses emerged due to the use of generation of flu drugs, the neuraminidase inhibitors. How- CURED, WHILE AVOIDING THE amantadine in chickens) ever, resistance still occurs, and in light of influenza virus- • There is room for optimism as some chronic es’ pandemic potential, new antivirals are urgently needed. DEVELOPMENT OF RESISTANCE. viral infections can already be kept under The third generation, the so-called polymerase inhibitors, THIS SHOULD BE POSSIBLE control or even cured, while avoiding the are very promising in this respect as their resistance profile FOR ALMOST EVERY VIRAL development of resistance. does not overlap with the neuraminidase inhibitors and the INFECTION.” channel blockers. The ONE HEALTH PLATFORM Communicator

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HEALTH POLICY

BEYOND THE BEEF WARNING:

THE BSE PROF. MARTIN GROSCHUP: “UNTIL 1996, INFECTED ANIMALS WERE STILL PROCESSED IN THE STORY FOOD CHAIN.” by Prof. Martin Groschup, director of the institute for novel and emerging infectious diseases at the Friedrich Loeffler Institute, Germany

When the first cases of Bovine Spongiform Encephalopathy (BSE) occurred in the UK almost 30 years ago, nobody expected this infection to grow into a major epidemic in Europe. And yet, in 20 years time, 190,000 animal cases of BSE and 229 human fatalities have occurred, mainly in Europe. In this sense, BSE is also a zoonotic disease: people contracted the human variant of BSE by consuming contaminated food.

It was only in 1996 that a com- of health crises had not been re- with the public at large. After all, plete ban of feeding animal pro- garded as separate responsibil- the infection had long incubation teins to livestock was installed. ities. The BSE outbreak has led times (so you could be infected Until then, infected animals were to a fundamental change in this without even knowing it) and in- still processed in the food chain. area with the establishment of fection was always fatal. There the European Food Safety Agency was hence a strong urge for public This and other important mea- (EFSA), the Food Standard Agency health authorities to show leader- sures were taken as soon as the (FSA) and several national enti- ship and to manage the crisis de- crisis gained political impetus. For ties. In part, these political actions cisively. instance, until 2001, the risk as- were an attempt to counter the sessment and risk management perception of insecurity that lived

STRONG MEASURES, STRONG RESULTS EXIT Today, BSE is virtually eradicated in the EU and most parts of the world. To achieve this, several important measures had been taken: STRATEGIES 1) BSE RAPID TESTING 2) PROHIBITION OF MEAT AND 3) REMOVAL OF SPECIFIED RISK Effective but costly measures (as taken to counter the BSE crisis) call The rapid testing of all risk an- BONE MEAL FEEDING TO MATERIAL (SRM) for exit strategies. To that end, the EU and the World Organization imals and slaughter animals MAMMALS SRM are the organs and sites with for Animal Health (OIE) jointly developed a BSE risk categorisation above 13 months of age. Over A very important measure is the assumed or shown BSE prion rep- of countries, with three levels: negligible, controlled and unknown time this age limit was increased ban on the feeding of animal pro- lication. SRM from all slaughter BSE risk. In negligible risk countries, specified risk material no lon- in order to test only those ani- teins to ruminants and other live- animals must be burnt or buried ger needs to be removed and animal products are more qualified as mals that had been exposed to stock. As a result of the BSE crisis, to avoid inclusion in the human source material for pharmaceutical products. BSE. In total, some 100 million the EU countries have installed and animal food/feed chain. This animals have been tested. Today, strict procedures to avoid in- is a rather drastic measure in- BSE testing is no longer obligato- tra-species recycling. This implies deed. ry in the EU. that cattle cannot be fed bovine SUCCESS FACTORS AND material ever again. LESSONS LEARNED • EU-wide and global approach with BSE Estimation of the BSE associated costs measures receiving support from all political incurred in Germany ! 1.847-2.094 M€ levels “ THERE WAS 1% 2 M€ 11% 225 M€ • Veterinarians and medical doctors cooperated A STRONG 13% 249 M€ in a true One Health spirit 21% 405 M€ URGE FOR 54% 1.000 M€ • Long lasting strategy resulted in disease PUBLIC HEALTH eradication and safeguarded public health • BSE rapid testing of risk animals should AUTHORITIES remain obligatory for a very long time TO SHOW • Feed bans must be maintained as to avoid‚ LEADERSHIP AND cannibalism‘ • SRM definition can be amended according to For Germany alone, estimatedProbst et directal. (2013) costs Zoonoses amount and Public to Health 2 billion doi: 10.1111/zph.12032 TO MANAGE THE Euros. This estimation does not include the economic cost of epidemiological situation and state-of-the-art CRISIS DECISIVELY.” reduced beef consumption. BSE pathogenesis knowledge The ONE HEALTH PLATFORM Communicator

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HEALTH POLICY Balancing public health “PATIENT ORGANIZATIONS and economic interests ARE INSTRUMENTAL TO HIGHLIGHT THE MEDICAL URGENCY OF during Q fever outbreak AN EPIDEMIC.”

In 2007, healthcare professionals saw a sudden and unusual rise in adult isters were involved in this crisis, was long considered a local prob- the decision-making process was lem in a rural area of the country pneumonia cases in a rural area in the south of The Netherlands. It was soon suboptimal.” and hence did not make it into the clear that Q fever infection laid at the basis of this increase. The source of news headlines.” infection was traced back to a relatively new and fast growing type of farming THE IMPORTANCE OF PATIENT ORGANIZATIONS HUMAN VS ANIMAL in this part of the country: goat farms. “We had to balance public health and “The third barrier was a scientif- VACCINATION economic interests”, said Roel Coutinho, the former Director of the Netherlands ic one. Epidemiological evidence “Finally, and this is a general chal- Center for Infectious Disease control. clearly pointed at goats as the lenge that goes with any zoonotic source of the Q fever outbreak. outbreak that affects farmers and People living within a two km their livestock, we had to balance range from infected farms had a public health and economic in- THE EARLY MONTHS ed to monitor bulk milk produce limited knowledge of the medical 30 times higher risk of contract- terests. A crucial issue since this As a first set of measures, the to detect infected farms instead consequences of this bacterial ing Q fever than people living crisis involved intensive farming Dutch Outbreak Management of relying on farmers’ reports infection. Should we screen preg- more than 5 km away from these in one of the most densely pop- Team recommended an improved and at the end of 2009 all preg- nant women for Q fever infection, farms. And yet, the Ministry of Ag- ulated countries in the world. The hygienic regulation and the vol- nant goats at infected farms were and how could we prevent trans- riculture was not convinced and latter also explains why we made untary immunisation of goats culled. As a result of these mea- mission via blood and blood prod- demanded biological evidence. very little use of the human vac- with a new - as yet non-regis- sures the number of infections de- ucts? These questions were diffi- Which we could not provide at cine, as 100,000 to 150,000 peo- tered - vaccine. “It soon became clined strongly in 2010 and there cult to answer for us, experts in short notice.” The lack of patient ple should have received the shot clear, however, that this level of have been practically none since human medicine. Which brings us organizations played an import- and the human Q fever vaccine is intervention was not enough. In 2011.” to the second challenge: the co- ant role in managing the crisis non-registered in Europe. Animal 2009 the number of reported Q operation with veterinary experts. too. “Patient organizations are in- vaccination was hence the better fever cases rose to nearly 2,500”, Q FEVER REMAINS POORLY We had very limited experience in strumental to highlight the medi- option.” ■ Prof. Coutinho elaborated. “We UNDERSTOOD this area and we had to invent and cal urgency of an epidemic, as we then imposed a mandatory vacci- “A first important hurdle for a build new cooperation structures. have seen at the start of the HIV/ nation programme and very strict prompt and adequate response This distinction also translated on AIDS outbreak. The same goes for hygienic measures. We also start- to the Q fever outbreak was our the political level: since two min- press attention. The Q fever crisis

Q FEVER IN A NUTSHELL IMPACT ON THE MANAGEMENT OF • Zoonosis with a wide animal reservoir: wildlife, pets, ticks, cattle, ZOONOTIC CRISES IN THE NETHERLANDS sheep, goats AND LESSONS LEARNED • Transmission to humans occurs mainly through inhalation of contaminated aerosols (abortions, amnion fluid, placenta, manure) • The Dutch government has installed monthly meetings of • Disease is caused by Coxiella burnetti: a very infectious intracellular veterinarians and human medical specialists to discuss potential bacterium that is highly resistant (spore-like structures) zoonotic disease threats. • Clinical course in humans: mostly asymptomatic or flu-like, 20% of infected patients develop pneumonia (or hepatitis), 1-2% becomes • The crisis structure for zoonoses has been adapted. Human medical chronically ill (pregnant women and persons with valve abnormalities specialists do now also provide scientific advice to the agricultural are specifically vulnerable), death may occur in patients with co- authorities. morbidity • Improved collaboration between veterinarians and medical doctors • Q fever responds well to treatment with doxycycline (2 weeks) (yet there is still a large gap between both professions). • Clinical course in animals: generally asymptomatic. May lead to • Open and transparent communication during crises is essential to abortion and stillbirth in small ruminants (goats/sheep) gain the public’s trust. The ONE HEALTH PLATFORM Communicator

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HEALTH POLICY

TThe UK government had given high priority to preparedness for a pandemic outbreak of influenza. That explains why the country had a comprehensive plan in place when the 2009/10 H1N1 pandemic broke out. “But there has also been a backlash against antivirals and pandemic preparedness after the swine flu pandemic,” warns Peter Openshaw, professor at Imperial College London and a member of the UK Pandemic Influenza Committee. Billions spent on pandemic flu vaccines and antivirals! Was it worth the while?

tamivir and some zanamivir. We swers, you were given an elec- The UK applied an exceptional THE UK INFLUENZA PANDEMIC yet successful pandemic were giving prophylaxis to house- tronic voucher that entitled you hold contacts, again in the aim to to obtain antivirals directly from PREPAREDNESS PLAN: THREE DISTINCT strategy. In what way was it PHASES different from most European blunt the peak. To take the strain pharmacies without a prescrip- pandemic response plans? of the general practitioners, we tion. About a million courses of set up the National Pandemic Flu antivirals were distributed in this 1. Preparation: getting ready by stockpiling PROF. OPENSHAW: “The UK went for a Service, a novel telephone access way. But the proportion of peo- antivirals and vaccines, by making advance purchase widespread prophylaxis. We had system. If you contacted the call ple who developed flu wasn’t very agreements with pandemic vaccine manufacturers, an extensive stockpile of osel- centre and gave the right an- high, probably around 8%.” and by very extensive modelling. The UK government relied on mathematical modelling to try to anticipate Well-coordinated what sort of measures would be useful. communication is key during ” OSELTAMIVIR GIVEN a pandemic outbreak of any 2. Containment to slow the speed, blunt the peak infectious disease. How did the and buy time. The idea was to reduce the impact EARLY DURING UK handle this? on national service, health service, transport etc. PROF. OPENSHAW: “In terms of commu- The UK was unusual in investing heavily in contact THE COURSE OF nication, I think Liam Donaldson, prophylaxis, self-isolation and school closures. England’s chief medical officer, did DISEASE CAN BE VERY a marvellous job. He went before 3. Treatment, based on clinical diagnosis. Intention to the press every week, and he told treat everyone who developed influenza. BENEFICIAL.” it as we saw it. He was very sensi- ble and very measured in what he said. And generally, the press was very reasonable in the way they swinging back again. It had a against antivirals. Most notably interpreted his statements. With front-page feature accusing our from the Cochrane Collabora- some exceptions though. In Feb- health authorities of irresponsi- tion. The authors attack the use ruary 2010, The Daily Mail wrote: bility in not having acted more of oseltamivir, saying that there ‘Billions of pounds have been strongly.” is not a very significant shorten- wasted on swine flu vaccines that ing of symptoms. They are even will never be used’. The newspaper The use of influenza antivirals suggesting that the drug’s mode said that we’d vaccinated millions has long been in the centre of of action is as a central nervous of people, spent £13.5 million on the public health debate. Yet, system depressant, implying the flu phone service and issued antivirals are a cornerstone of that it reduces symptoms be- approximately 1 million cours- pandemic response planning. cause it makes you feel drowsy es of oseltamivir. While ‘only’ 411 PROF. OPENSHAW: “My absolute be- and lie down. Interestingly, the people died. By the time the third lief is that early administration of same data that was assessed by (post-pandemic) wave hit the UK antivirals is crucial. Studies show the Cochrane Collaboration was in November 2010, we had already that if you give antivirals at six or re-analysed by a group of experts moved back to the regular, sea- twelve hours after onset of symp- under the umbrella of the MU- sonal guidelines. We had reverted toms, they are much more effec- GAS Foundation. They used more to the policy that antivirals should tive in terms of reducing the dura- sophisticated and more detailed only be used under very strict tion of illness than if you give them methods and have come up with conditions. As a result, the use of later. Hence consensus is that the conclusion that there is a re- antivirals in the third wave had antivirals should be given within duction of about 50% in mortal- dropped dramatically and we saw the first 48 hours of the course of ity if oseltamivir is administered a high increase in the number of disease. Obviously, problems will within 48 hours and 20% overall. inpatients with confirmed influen- arise if everyone is going to their So using the very same data you za, outnumbering those admitted general practitioners and ask can come to quite different con- in the first and second wave put them for antivirals. So we need to clusions.” together. As a matter of fact, the find a solution that allows early number of confirmed deaths in treatment without overwhelming • Cochrane report in BMJ: http://www. bmj.com/content/348/bmj.g2630 the third wave is thought to be at primary care.” • MUGAS meta-analysis in The Lancet: least 602, probably much more. http://www.thelancet.com/journals/ And then the Daily Mail came “There has also been a backlash lancet/article/PIIS0140-6736(14)62449- 1/abstract The ONE HEALTH PLATFORM Communicator Quarantine: 11 action at borders to prevent local outbreaks INTERNATIONAL PUBLIC HEALTH COOPERATION

New diseases have been emerging at the unprecedented rate of one a year for the last two decades. The sudden and deadly arrival of SARS early in 2003 was in some ways the most dramatic of all. Its rapid containment is one of the biggest success stories in public health in recent years. But how much of that success was a result of good fortune as well as good science? How narrow was the escape from an international health disaster? “The international response to SARS will shape future strategies against infectious epidemics”, David Heymann, the former executive director of communicable diseases at the World Health Organization (WHO), explains. PREPARING FOR THE NEXT DISEASE OUTBREAK: March 2014 lessons from3 SARS

FORTY DAYS OF ISOLATION REVISING THE INTERNATIONAL GRO HARLEM BRUNDTLAND “In order to understand SARS, and HEALTH REGULATIONS “Around the turn of the century, the changes to international ef- “The original IHR were revised in the new director general of WHO, forts to stop the spread of infec- 2005 based on the following vi- Dr. Gro Harlem Brundtland, took tious diseases that occurred af- sion: 1. to be able to detect and some bold yet necessary policy terwards, we need to go back to collectively respond to interna- decisions that led to the revision the Middle Ages in history”, says tional infectious disease threats of the IHR. For instance, WHO was David Heymann. “In those days, within 24 hours using the most now allowed to accept and act on a measure to control the interna- up-to-date means of global com- information about disease out- tional spread of infectious diseas- munication and collaboration; 2. es like plague, cholera, yellow fe- to change the international norm ver and smallpox was being used for reporting infectious disease with limited impact: quarantine outbreaks so that countries were “THE SARS – an attempt to stop disease at not only expected to report out- OUTBREAK WAS A borders.” breaks, but also respected for TURNING POINT IN doing so. Until then, countries INTERNATIONAL “This required international agree- had been hesitant to report the COLLABORATION ON ments on public health measures outbreak of infectious disease INFECTIOUS DISEASE during the following centuries to WHO as required by the IHR, WORLDWIDE COOPERATION TO structive discussion, China began that carried through, in a series primarily because of potential CONTROL.” STOP SARS to work with the rest of the world of international treaties and con- damage to national economies. In “The SARS outbreak was a turning to stop the outbreak.” ferences, from the fourteenth the early 1990s, for example, the breaks from sources other than point in international collabora- “The disease spread around century until 1969, when WHO es- spread of cholera in Peru cost the countries. This led to the creation tion on infectious disease control. the globe over a period of eight tablished its International Health country more than $770 million in of the Global Public Health Infor- Virus experts from around the months, with the outbreak peak- Regulations (IHR). These IHR and lost trade and tourism. That same mation Network (GPHIN), and the world worked together virtually ing in April and May. By July 2003, the accompanying sanitation decade, India reported a loss of Global Outbreak Alert and Re- — by phone, videoconference and the outbreak had been contained. guidelines for seaports and air- over $1 billion in travel, trade and sponse Network (GOARN). GPHIN through the Internet — to share By then, an estimated 774 people ports attempted to achieve a bal- tourism revenues after plague is an early warning system that information and report progress. had died of SARS infection.” ance between ensuring maximum struck a small area of the coun- searches open sites on the Inter- Within weeks, they identified the public health security against the try. A few years later, a cholera net for key words associated with virus responsible for SARS. Epide- AFTER THE SARS miologists soon confirmed that international spread of the four outbreak in Tanzania came with infectious diseases, performs a OUTBREAK, IT WAS health workers were at great- infectious diseases with minimum an estimated loss of $36 million in preliminary analysis of the infor- CLEARLY UNDERSTOOD interference in global commerce revenue.” mation collected and provides est risk and that air travel was THAT INTERNATIONAL and trade. Measures in the IHR this information every 24 hours to spreading the disease. Doctors were aimed at stopping disease WHO, where it is verified as rapid- shared their knowledge about BORDERS COULD NOT at international borders. Coun- ly as possible.” what treatments worked and STOP THE SPREAD OF tries in which one of the four re- what did not via standardized pa- INFECTIOUS DISEASES, tient management forms.” portable diseases was occurring, “Early 2003, GPHIN reported AND THE IHR REVISION IN were required to notify WHO, and cases of an atypical pneumo- 2005 INCLUDED A MAJOR other countries were then permit- nia with high mortality in China. “Most countries cooperated in re- REQUIREMENT THAT ted to take specified measures at WHO feared that these cases sig- porting incidents of SARS. With the airports and seaports to attempt naled the beginning of an influen- exception of China, whose cooper- COUNTRIES DEVELOP to prevent the entry of disease. za pandemic because H5N1 was ation was key to tracing how the 8 CORE CAPACITIES For instance, during the period known to be present in that region disease emerged. The WHO direc- IN PUBLIC HEALTH TO “THE DIRECTOR tor general then took another bold between reporting and certifying of the country. WHO hence issued BE BETTER ABLE TO GENERAL OF WHO, decision and she spoke openly that the outbreak was contained, precautionary policy measures DETECT AND RESPOND countries could require vaccina- DR. GRO HARLEM and recommendations on patient about China’s reluctance to col- TO INFECTIOUS DISEASE tion certificates from passengers BRUNDTLAND, TOOK management and eventually is- laborate. Shortly afterwards, Chi- nese vice-premier, Madame Wu Yi, OUTBREAKS BEFORE THEY arriving from an affected coun- SOME BOLD YET sued travel recommendations in arrived in Geneva to meet with the SPREAD NATIONALLY, try.” NECESSARY POLICY an attempt to counter the inter- national spread of this new virus.” director general, and after a con- AND INTERNATIONALLY. DECISIONS.” The ONE HEALTH PLATFORM Communicator

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OPINION

by Prof. John MacKenzie, Curtin University, Australia

ONE HEALTH: from concept to practice

The 4th International One Health Congress & 6th Biennial Congress of the International Association for Ecology and Health In the past decades, we have seen the emergence of BREAK DOWN THE BARRIERS many new pathogens and the resurgence of others. But To achieve the goals of One Health, we will need to break the most important thing is that they may cost the gov- down the silos between human health and veterinary ernments of countries huge amounts of money, as we medicine and to ensure effective stakeholder engage- have seen during the outbreaks of SARS and avian in- ment. In other words, we need to enhance collaboration fluenza. The majority of these pathogens are zoonoses, and cooperation between all parties through the devel- and an understanding of the interplay of factors at the opment of an integrated approach to human, animal interface between humans and animals is absolutely cru- and ecosystem health. To break down the silos, howev- cial for their detection, response and control. And this is er, we need One Health training and education. Only by exactly what One Health is about: an integrated, holistic including the concept in academic curricula will we ever FORUM approach. Indeed, the role of the wildlife-livestock- hu- achieve integration of human health and veterinary med- man-ecosystem interfaces has been fundamental to the icine. In the mean time, several studies and cases sup- development of the One Health paradigm. port the added value of the One Health concept and have demonstrated that an integrated surveillance approach ONE HEALTH DRIVERS is more effective at predicting outbreaks of diseases that There are many different drivers for the One Health con- affect both man and animals, and that a One Health World cept. The 2003 SARS outbreak has been a real wake-up approach to control is more sustainable than that with call, as it demonstrated that a previously unknown patho- a human-centric approach. But obviously, more studies gen could emerge from a wildlife source at any time and are needed still, particularly those involving cost-benefit Veterinary in any place and, without warning, threaten the health, analysis. well-being and economies of all societies. Secondly, the Some four years ago, we had great hopes that the WHO- “Manhattan Principles”, a series of strategic goals issued OIE-FAO Tripartite Memorandum would provide the lead- Association by the Wildlife Conservation Society, nicely encapsulate ership that we needed. But it hasn’t, there is still need for the aims of One Health. And of course, concerns about global leadership. On the other hand, the World Bank, the novel zoonotic diseases were heightened by the spread of European Union, ASEAN, and other multi-national orga- joins the H5N1 avian influenza and its potential to become the next nizations have assisted the successful development of worldwide pandemic. So, it is fair to say that the SARS regional One Health networks and national and region- and H5N1 outbreaks have highlighted the urgent need of al activities. And on a national level, we see an increas- International effective alert and response systems, data-sharing plat- ing number of excellent One Health activities, notably in forms and global leadership. South-East Asian countries like Thailand, Laos, Cambodia, Mongolia and Bhutan, as well as in African countries. One Health ONE HEALTH PLATFORM Our important principles, taken In the absence of global leadership it is good to see that Coalition from The Manhattan Principles on new One Health initiatives are still taken, and in this con- ‘One World, One Health’ (2004), text I’m very proud to present the newly founded One describe the fundaments of One Health Platform. This international Foundation brings to- Health: gether key opinion leaders of the One Health topic and The World Veterinary Association (WVA) is a feder- provides them with a framework for information-sharing, ation of over 80 veterinary medical associations • To recognize the link between human, domestic cooperation and awareness raising activities. representing over 500,000 veterinarians across animal, and wildlife health, and the threat the world on six continents. The association works disease poses to people, their food supplies to promote animal health, animal welfare, and and economies, and the biodiversity essential public health globally with the understanding that to maintaining the healthy environments and “THERE IS they are intricately interconnected. In alignment functioning ecosystems we all require with the Zoonosis strategic priority, the WVA now URGENT NEED joins the International One Health Coalition as part • To recognise that decisions regarding land and of the newly established One Health Platform. water use have real implications for health. FOR GLOBAL Alterations in the resilience of ecosystems and The One Health Coalition is a collaborative part- shifts in patterns of disease emergence and ONE HEALTH nership with existing international governmental spread manifest themselves when we fail to and non-governmental organizations and insti- recognize this relationship LEADERSHIP. tutions with the aim to reinforce the One Health concept. The main objectives of the One Health • To include wildlife health science as an essential Platform include the promotion of a cross-sectoral component of global disease prevention, and collaborative approach to improve the health surveillance, monitoring, control, and mitigation. and well-being of humans, animals and their envi- • To devise adaptive, holistic, and forward-looking For more information, contact ronments, to advocate a scientific research agen- approaches to the prevention, surveillance, Mr. David De Pooter da into zoonoses, neglected emerging infectious monitoring, control, and mitigation of emerging One Health Platform management diseases and antimicrobial resistance, and to dis- and resurging diseases that fully account for the e-mail: [email protected] seminate novel scientific findings to anyone who complex interconnections among species might benefit from them. mobile: +32 479 45 74 46 www.onehealthplatform.com