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Multidisciplinary Collaboration in Veterinary Public Health Exper I Ence

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Multidisciplinary Collaboration in Veterinary Public Health Exper I Ence ANN IST SUPER SANITÀ 2006 | VOL. 42, NO. 4: 397-400 397 Multidisciplinary collaboration ENCE in veterinary public health I EXPER L (a) (a) (a,b) A Lucabusani , Alfredocaprioli , Agostinomacrì , C (c) (a) (c) I N Adrianomantovani ,Gaiascavia and Aristarcoseimenis I (a) CL Dipartimento di Sanità Alimentare ed Animale, Istituto Superiore di Sanità, Rome, Italy (b) WHO/FAO Collaborating Centre for Veterinary Public Health, TO Dipartimento di Sanità Alimentare e Animale, Istituto Superiore di Sanità, Rome, Italy NG (c)WHO Mediterranean Zoonoses Control Centre, Athens, Greece I TEST L A M Summary. Multidisciplinary collaboration has been recognised necessary for centuries and has a long I N A tradition. It is supported by solid bases, and is required to control a number of risk factors. Its practice encounters difficulties in various critical points. At present, the models of collaboration provided by the activities of the WHO/Mediterranean Zoonoses Control Centre and by the Med-Vet-Net network of the FROM European Community represent relevant examples. RCH Key words: inter-professional collaboration, zoonoses, food safety, Europe, Mediterranean. A ESE Riassunto (La collaborazione multidisciplinare in sanità pubblica veterinaria). La collaborazione mul- R tidisciplinare è riconosciuta necessaria da secoli ed ha una lunga tradizione. Ha solide fondamenta e si rivela indispensabile per il controllo di molti fattori di rischio. La sua attuazione pratica incontra difficoltà in molti punti critici. Significativi esempi di modelli di collaborazione multidisciplinare sono attualmente offerti dalle attività del Centro Mediterraneo per il Controllo delle Zoonosi e dalla rete Med-Vet-Net della Comunità Europea. Parole chiave: collaborazione interprofessionale, zoonosi, sicurezza alimentare, Europa, Mediterraneo. INTRODUCTION The necessity of collaboration has been surveyed by Human medicine and animal medicine have devel- many publications, courses, conferences etc. A funda- oped as “one medicine” starting from the times in mental document is the declaration of Alma Ata [1] which their bases were laid until the mid 18th century stating that “primary health care involves, in addition when specialisation proved necessary and led to the to the health sector, all related sectors and aspects of establishment of modern veterinary schools. Mention national and community development, in particular must be made of outstanding physicians (Hippocrates, agriculture, animal husbandry, food industry and other Redi, Galen, Fracastorius, Lancisi, Ramazzini) who sectors”. The need for collaboration was also examined faced human and animal epidemics. The founders of and recommended in two recent meetings of WHO [2] microbiology (Pasteur, Koch, and so on) investigated and FAO [3]. the aetiological agents of both human and animal dis- This paper will discuss some problems nowadays eases. Also in the earliest texts on communicable dis- facing the practice of collaboration as well as special eases the two fields are not dealt with separately. issues concerning the Mediterranean area and Europe. The separation has been the logical consequence of the construction of different fields of action, made nec- essary by the evolution of the disciplines and of the THEPRACTICEOF social and economic context, but common areas have MULTIDISCIPLINARYCOLLABORATION remained relevant and are required by modern devel- The risk factors requiring inter-professional collabo- opments. In veterinary medicine two separate branches ration are: have developed: the first (prevailingly public) dealing - zoonoses (all); with communicable diseases (zoonoses included), food - human diseases connected with food of animal origin; safety, management of animal populations, animal - animal population control; welfare and environmental problems connected with - animal-connected occupational diseases; animals; the second (prevailingly private, devoted to - arthropods common to man and animals (disease vec- the tradition of “one medicine”) practicing the care of tors included); animals (farm, companion, sports), and continuing the - pests and vector vertebrates; tradition of farriery. - detection of drug-resistant agents; Indirizzo per la corrispondenza (Address for correspondence): Alfredo Caprioli, Dipartimento di Sanità Alimentare ed Animale, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. E-mail: [email protected]. 398 Luca Busani, Alfredo Caprioli, Agostino Macrì, et al. - environmental pathogenic agents; result is that services, professions and mass media pay - substances used to protect animal health; attention to “fashionable” infections, while the control - substances used to increase animal production; of classical endemics (brucellosis, bovine tuberculo- - products able to induce resistance in pathogenic agents; sis, rabies and others) is neglected although being of - environmental contamination; greater social importance. - emergencies involving humans and animals; A serious emerging problem (and an instructive mod- - use of animals for human welfare and therapy; el) is the epidemic of avian influenza which requires - co-existence of animals with persons exposed to spe- the collaboration of public and private physicians and cial risk. veterinarians, as well as of wildlife specialists. These The bases for inter-professional collaboration are: should co-operate also with administrators (politicians) - physicians should know the zoonoses reported in and economists to face the social and financial issues animals in the area (e.g. brucellosis, anthrax, rabies, involved in the control of the infection. emerging zoonoses); All too often there are scarce knowledge of and - veterinarians should know which zoonoses are re- consideration for the welfare of animals and their ported in humans in the region; role in human wellbeing. For example, the co-exist- - the same applies for other animal-connected problems; ence of animals with immunodepressed persons or of - legislation should provide for compulsory informa- cats with pregnant women is not always accepted: a tion on common problems; consultation with a well informed veterinarian could - cases of zoonoses and other animal-connected prob- solve the problem. lems in humans should be reported to veterinary Food safety is a field of “passive cooperation”. The services that will perform epidemiological investi- fact that food of animal origin is safe because it has gation and take the necessary measures; undergone veterinary inspection is often ignored. - cases of zoonoses and other related problems should Food-associated infection outbreaks cause sometimes be reported to medical services to identify persons inter-professional conflicts and public alarm. at risk and take appropriate measures; Often the inter-service report of zoonoses (brucel- - planning of common action (e.g. in epidemics or losis, anthrax, taeniasis/cysticercosis, cystic echino- emergencies) should be organised; coccosis) in humans or animals is omitted even if - common information and training should be organ- required by law. The same applies to the detection of ised; contaminants (estrogens, antibiotics, dioxins) in food - health education and public information should be of animal origin. These omissions result in increased worked out jointly. difficulties in identifying possible consequences in The main critical points [4] are: humans. - competitiveness between sectors, services, profes- A modern emerging concept is that “public health sions, persons, etc.; operators” are all the workers involved in the con- - different administrative locations; trol of zoonoses, food safety, management of animal - conflicting competences; populations and related fields. Collaboration with - professional weakness; medical and veterinary practitioners is also important. - different availability of personnel and resources; Another relevant prerequisite is the contribution by - different access to the attention of public adminis- professionals not directly operating in public health, trators and mass media; such as administrators, city planners, educators, etc. - different cultural backgrounds; - different evaluation of priorities; - different languages; VETERINARYANDMEDICALINTEGRATED - difficulties in recognising common objectives; APPROACHTOFOODBORNEZOONOSES - lack of knowledge of legislation; SURVEILLANCEINTHEeUROPEANuNION - lack of knowledge of productive structures (food It is self-evident that integrated surveillance will re- production, processing chain included); quire a strong multidisciplinary approach. Medical, vet- - lack of knowledge of the real needs of consumers; erinary, and food microbiologists should be involved - lack of knowledge of other service(s). as well as medical and veterinary epidemiologists. While it is generally recognised that most of the The EU has recently reconsidered its strategy for the emerging and re-emerging infections are of zoonotic control of foodborne zoonoses, both in human and vet- origin, on the other hand there is insufficient consid- erinary health sectors. eration for endemic classical zoonoses. While “new Rules on surveillance of zoonotic infections, through zoonoses” such as BSE, West Nile fever and oth- community surveillance networks, are included in the ers are attracting great attention and resources, “old legislation on human communicable infectious dis- zoonoses” are often overlooked and considered of eases (Decision 2119/98/EC). A relevant contribution scarce interest. Zoonotic leishmaniasis re-emerging
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