One Health

Arbovirus infections are causing enormous global burden, while their geographic distribution expands and affects new regions and areas. West Nile virus (WNV), one of the most important pathogens among arboviruses, was historically associated with causing mild febrile illness, however, after the outbreak occurred in the North America, which caused more severe illness, it has received wider recognition. It is believed that the disease can reemerge after a hiatus of several years, and affect new territories, which has happened in 2018 in Greece, with 31 dead among 271 infections by the end of September. In Georgia, there is a lack of clinical suspicion on WNV because of the low awareness among medical society, and the existent passive surveillance system seems to be improved.

Objective: Identify cases of West Nile Virus in Black Sea region of Georgia through active surveillance.

Highly pathogenic avian influenza (HPAI) subtype H5N1 virus causes a highly contagious disease in poultry with up to 100% mortality and occasionally causes sporadic human infection. The first outbreak of HPAI H5N1 in Africa was reported in Nigeria in 2006 and has since been reported in seven other African countries with confirmed human cases and outbreaks in poultry. Since the emergence of Highly Pathogenic Avian Influenza (HPAI), virus subtype H5N1 in Ghana in 2007, outbreaks in poultry have led to dire economic consequences for the poultry sector, resulting from mass destruction of affected flocks. An economy heavily dependent on agriculture, the persistence of outbreaks threaten the livelihood of farmers who depend on poultry production for survival. Despite significant efforts made in HPAI-H5N1 control and prevention in Ghana, outbreaks persist and continue to spread to new areas. It is uncertain to what extent different pathways contribute to the introduction and the dissemination of the virus in Ghana. There is a need to understand the complex nature of the interactions between local and migratory fowl, the risk of transmission due to human endeavor and trade mechanisms that increase the likelihood of HPAI-H5N1 outbreaks in Ghana.

Objective: The purpose of the study was to characterize the spatial distribution and temporal patterns of laboratory confirmed H5N1 outbreaks from January 2007 to December 2017 in Ghana.

West Nile virus (WNV) is the leading cause of autochthonous arboviral disease in the United States. The virus is primarily spread to people through the bite of infected Culex species of mosquitos. WNV was first identified in Harris County, Texas, in 20022. Since then, the mosquito-borne virus has become endemic in the region, with surges in 2012 and 2014. Although majority of individuals infected are asymptomatic, WNV induced neuroinvasive infections often result in hospitalizations and adverse outcomes3-7, thus may pose a significant concern in public health and healthcare. The Harris County Public Health (HCPH) Surveillance and Epidemiology Unit (SEU) conducts surveillance of WNV in humans, in collaboration with Mosquito and Vector Control Division (MVCD) that monitors the virus in mosquito populations and birds. Mosquito abatement activities are implemented in areas where positive mosquitoes and human cases are identified. In this integrated model, clusters of WNV positive mosquito pools in relation with human cases provide comprehensive surveillance data to guide targeted efforts of mosquito control, disease prevention, and community education.

Objective: This abstract aims to: 1) describe human WNV infections in Harris County excluding the City of Houston, Texas, 2003 to 2018; 2) explore geographical distributions of WNV positive mosquito pools in relation to human cases; 3) provide a brief overview of the county's rigorous multidisciplinary WNV surveillance and control in mosquitoes and humans.

The 2014-2016 Ebola outbreak in Guinea revealed systematic weaknesses in the existing disease surveillance system. The lack of public health workers adequately trained in Integrated Disease Surveillance and Response (IDSR) contributed to underreporting of cases and problems with data completeness, accuracy, and reliability. These data quality issues resulted in difficulty assessing the epidemic's scale and distribution and hindered the control effort (McNamara, 2016; Bell, 2016). In 2015, the Guinean Ministry of Health (MoH) recognized the importance of the IDSR framework as a tool for improving disease surveillance and emphasized IDSR strengthening as a priority activity in the post-Ebola transition (MoH, 2015). To support this strategic objective, we engaged with the MoH, CDC, and key surveillance partners to strengthen surveillance capacity through a national initiative to improve IDSR tools, including assistance with developing Guinea-specific IDSR technical guidelines, simplified and standardized case notification forms, and supportive job aids to facilitate appropriate IDSR implementation by health workers at all levels of the system.

Objective: The objective is to discuss capacity building for Integrated Disease Surveillance and Response in Guinea and synthesize lessons learned for implementing the Global Health Security Agenda in similar settings.

After the 2009 H1N1 pandemic, the Assistant Secretary of Defense for Nuclear, Chemical and Biological Defense indicated œbiodefense would include emerging infectious disease. In response, DTRA launched an initiative for an innovative, rapidly emerging capability to enable real-time biosurveillance for early warning and course of action analysis. Through competitive prototyping, DTRA selected Digital Infuzion to develop the platform and next generation analytics. This work was extended to enhance collaboration capabilities and to harness data science and advanced analytics for multi-disciplinary surveillance including climate, crop, and animal as well as human data. New analysis tools ensure the BSVE supports a One Health paradigm to best inform public health action. Digital Infuzion and DTRA first introduced the BSVE to the ISDS community at the 2013 annual conference SWAP Meet. Digital Infuzion is pleased to present the mature platform to this community again as it is now a fully developed capability undergoing FedRAMP certification with the Department of Homeland Security's National Biosurveillance Integration Center and Is the basis for Digital Infuzion's HARBINGER ecosystem for biosurveillance.

Objective: While there is a growing torrent of data that disease surveillance could leverage, few effective tools exist to help public health professionals make sense of this data or that provide secure work-sharing and communication. Meanwhile, our ever more-connected world provides an increasingly receptive environment for diseases to emerge and spread rapidly making early warning and collaborative decision-making essential to saving lives and reducing the impact of outbreaks. Digital Infuzion's previous work on the Defense Threat Reduction Agency (DTRA)'s Biosurveillance Ecosystem (BSVE) built a cloud-based platform to ingest big data with analytics to provide users a robust surveillance environment. We next enhanced the BSVE data sources and analytics to support an integrated One Health paradigm. The resulting BSVE and Digital Infuzion's HARBINGER platform include: 1) identifying and ingesting data sources that span global human, animal and crop health; 2) inclusion of non-health data such as travel, weather, and infrastructure; 3) the data science tools, analytics and visualizations to make these data useful and 4) a fully-featured Collaboration Center for secure work-sharing and communication across agencies.

Antibiotic resistance is a mounting public health threat calling for action on global, national and local levels. Antibiotic use has been a major driver of increasing rates of antibiotic resistance. This has given rise to the practice of antibiotic stewardship, which seeks to reduce unnecessary antibiotic use across different care settings. Antibiotic stewardship has been increasingly applied in hospital settings, but adoption has been slow in many ambulatory care settings including primary care of humans. Uptake of antibiotic stewardship in veterinary care has been similarly limited. Audit and feedback systems of antibiotic use coupled with patterns of antibiotic use and best practice guidelines have proven useful in outpatient settings, but scale-up is limited by heterogeneous systems of care and limited resources.

Objective: To develop, evaluate, and implement a universal online platform - termed OPEN Stewardship - to promote responsible antimicrobial prescribing (antimicrobial stewardship).

The recent focus on the 'One Medicine' concept has resulted in an increased awareness that the control of diseases in animal populations, whether zoonotic or not, can be of great public health importance. Zoonotic and foodborne diseases represent an immediate threat to the health of human populations, while rapid spreading diseases in animals can compromise the food-supply and the economy of a country or region. On the other hand, animal populations can serve as sentinels, and continued surveillance can prevent the emergence and/or rapid spread of pathogens potentially harmful to humans. However, awareness of the activities developed in the field of animal health is still low among public health workers. To date, the cooperation between public health and animal health epidemiologists has mainly involved the control of outbreaks of foodborne diseases. Greater cooperation between the two fields, however, could improve prevention and reduce the number of such outbreaks.

Objective

To discuss opportunities to improve the synergy between animal and public health and increase awareness, among public health workers, of the concept of animal health.

Brucellosis is one of the world'•s most widespread zoonosis. It is caused by gram-negative bacilli of the genus Brucella.It is a risk to those occupationally exposed to animals such as farmers, veterinarians, laboratorians and butchers and to the public through the consumption of contaminated unprocessed milk, milk products and meats.The epidemiology of Brucella infections involves complex mechanisms which vary according to the disease determinants. Previous studies in Kenya have reported a prevalence range of between 5% - 45% in livestock as well as over 20% in humans in selected regions1. Therefore, risk factors observed in a particular agro-ecological region cannot easily be extrapolated to another area with different ecological settings and husbandry practices. A strategy for brucellosis control would greatly benefit from detailed knowledge of local epidemiology. The available data on brucellosis is not adequate enough to inform an effective control process. Decision makers frequently apply different strategies according to the prevalence and epidemiology of the disease. People who interact with livestock on a regular basis are thought to be at an increased risk of contracting zoonoses including Brucellosis. Previous studies on Brucellosis have focused either on human or animal disease. The current study simultaneously investigated the linkage in sero-prevalence between humans and their animals within the same household at the same time.

Objective

We determined the sero-prevalence and risk factors for brucellosis in humans and their animals in Kajiado and Kiambu Counties of Kenya. We also examined the linkage between the sero-status of humans and that of their livestock.

The illegal wildlife trade is a multi-faceted, clandestine industry that has led to the disruption of fragile ecosystems, facilitated the spread of pathogens, and has led to the emergence of novel infectious diseases in humans, domestic animals, and native wildlife(1, 2). The trade is as diverse as it is large, with live and dead wildlife representing multiple species sold to satisfy human demands for food, medicine, pets and trophies. Wildlife are harvested at astonishing numbers and used for such things as exotic pets, ornamental jewelry and clothing, and traditional Chinese medicine(3). An estimated 75% of recently emerging infectious diseases originated from animals(4), which can include both live animals and animal products.

Objective

We aim to develop an automated, real-time, comprehensive, global system for monitoring official and unofficial reports of illegal wildlife trade activity, and to determine potential hot-spot regions for emerging zoonotic pathogens along commonly utilized illegal wildlife trade routes.