The 'One Health' paradigm: Time for infectious diseases clinicians to take note?

Genomic Characterization of Fecal Escherichia coli Isolates with Reduced Susceptibility to Beta-Lactam Antimicrobials from Wild Hogs and Coyotes

This study was carried out to determine the antimicrobial resistance (AMR) genes and mobile genetic elements of 16 Escherichia coli isolates-with reduced susceptibility to ceftazidime and imipenem-that were recovered from the fecal samples of coyotes and wild hogs from West Texas, USA. Whole-genome sequencing data analyses revealed distinct isolates with a unique sequence type and serotype designation. Among 16 isolates, 4 isolates were multidrug resistant, and 5 isolates harbored at least 1 beta-lactamase gene (bla_CMY-2, bla_CTX-M-55, or bla_CTX-M-27) that confers resistance to beta-lactam antimicrobials. Several isolates carried genes conferring resistance to tetracyclines (tet(A), tet(B), and tet(C)), aminoglycosides (aac(3)-IId, ant(3″)-Ia, aph(3')-Ia, aph(3″)-lb, aadA5, and aph(6)-ld), sulfonamides (sul1, sul2, and sul3), amphenicol (floR), trimethoprim (dfrA1 and dfrA17), and macrolide, lincosamide, and streptogramin B (MLSB) agents (Inu(F), erm(B), and mph(A)). Nine isolates showed chromosomal mutations in the promoter region G of ampC beta-lactamase gene, while three isolates showed mutations in gyrA, parC, and parE quinolone resistance-determining regions, which confer resistance to quinolones. We also detected seven incompatibility plasmid groups, with incF being the most common. Different types of virulence genes were detected, including those that enhance bacterial fitness and pathogenicity. One bla_CMY-2 positive isolate (O8:H28) from a wild hog was also a Shiga toxin-producing E. coli and was a carrier of the stx2A virulence toxin subtype. We report the detection of bla_CMY-2, bla_CTX-M-55, and bla_CTX-M-27 beta-lactamase genes in E. coli from coyotes for the first time. This study demonstrates the importance of wildlife as reservoirs of important multi-drug-resistant bacteria and provides information for future comparative genomic analysis with the limited literature on antimicrobial resistance dynamics in wildlife such as coyotes.

Antimicrobial resistance in Galapagos tortoises as an indicator of the growing human footprint

Antimicrobial resistance has become one of the main public health threats worldwide with anthropogenic activities driving the spread of resistance. Understanding and combatting the spread of resistant bacteria is a top priority for global health institutions, and it is included as one of the main goals of the One Health initiative. Giant tortoises (Chelonoidis spp.), some of the most iconic species on Earth, are widely distributed across the Galapagos archipelago and are thus perfect candidates to test the hypothesis that wildlife species in the Galapagos carry antimicrobial resistant genes (ARGs) associated with human activities. We sampled a total of 200 free-living Galapagos tortoises from western Santa Cruz Island (C. porteri), the most human-populated island of the archipelago, and 70 tortoises (C. vandenburghi) from the isolated Alcedo Volcano on Isabela Island, a natural area with minimal human presence. Fecal samples were analyzed by quantitative PCR for a panel of 21 ARGs conferring resistance for eight antimicrobial classes. We found ARGs in both Santa Cruz and Alcedo Volcano giant tortoises; however, both qualitative and quantitative results showed higher loads of ARGs in tortoises inhabiting the human modified environments of Santa Cruz. Moreover, Santa Cruz tortoises sampled in higher human-modified landscapes (i.e., farmlands and urban areas) presented a higher number of ARGs, antimicrobial classes, and multi-resistant microbiomes than those from less anthropized areas within the same island. Our findings suggest that human activities in Galapagos have a negative impact on ecosystem health through ARG dispersal. This research highlights a new threat for the health and conservation of the unique wildlife of the Galapagos, their ecosystems, and the humans inhabiting this World Heritage Site. Our recommendation to local policy makers is to control and reduce the use of antibiotics in both human and animal health, thus helping enforce antimicrobial regulations.

Efficacy of combination products containing sarolaner, moxidectin and pyrantel (Simparica Trio™) or afoxolaner and milbemycin (NexGard Spectra®) against induced infestations of Ixodes holocyclus in dogs

BACKGROUND

The Australian paralysis tick, Ixodes holocyclus, causes tick paralysis in dogs and cats in the eastern coastal regions of Australia. Prevention is the best option to protect dogs against this potentially fatal disease and sarolaner provides rapid and sustained efficacy against I. holocyclus. In this laboratory study, the efficacy of two combination endectocides containing sarolaner + moxidectin + pyrantel (Simparica Trio™) and afoxolaner + milbemycin (NexGard Spectra^®) was evaluated against an artificial infestation of I. holocyclus.

METHODS

Twenty-four (n =24) foxhounds were randomly allocated to three treatment groups and artificially infested with 30 adult female viable ticks on Days - 1, 7, 14, 21, 28 and 35. On Day 0, dogs in each treatment group were treated with either Drontal^® (control group), Simparica Trio™ at the label dose to provide minimum doses of sarolaner (1.2 mg/kg), moxidectin (24 µg/kg) and pyrantel (5 mg/kg) or NexGard Spectra^® to provide minimum doses of afoxolaner (2.5 mg/kg) and milbemycin (0.5 mg/kg). Live tick counts were performed at 48 and 72 hours after treatment and after each re-infestation on Days 7, 14, 21, 28 and 35. Efficacy was determined at each time point relative to counts for control dogs based on geometric means.

RESULTS

Against an existing infestation, efficacy of both Simparica Trio™ and NexGard Spectra^® was 99.6% and 100% at 48 and 72 h time points, respectively (P = 1.000). Against subsequent weekly infestations, treatment with Simparica Trio™ and NexGard Spectra^® resulted in efficacy of ≥ 97.7% and ≥ 95.5% (P ≥ 0.0911), respectively at the 48 h time point and at the 72 h time point, Simparica Trio™ and NexGard Spectra^® resulted in efficacy of ≥ 99.0% and ≥ 98.4% (P ≥ 0.0511), respectively. There were no treatment-related adverse events in the study.

CONCLUSIONS

Single doses of Simparica Trio™ and NexGard Spectra^® were highly efficacious and provided comparable efficacy against the Australian paralysis tick, I. holocyclus for up to 35 days.

Development, implementation, and evaluation of a novel multidisciplinary one health course for university undergraduates

Today's collaborations across fields of health and wellness are insufficient to meet societies' challenges in combating disease and maintaining the ecosystem and public health. In this article, we present a One Health curriculum model designed to encourage undergraduate students of varying disciplines to value the connectedness of animals, humans, and the environment and to think innovatively about solutions to priority global health issues. We present the design and implementation of a course that brought together multiple faculty from different fields of study, including the dental, medical, nutrition, and veterinary schools, in a curriculum designed for undergraduates primarily from Arts & Sciences fields. The curriculum was collaboratively designed around four key One Health categories: 1) Infectious zoonotic diseases and global health, 2) Naturally occurring shared disease in companion animals that can serve as models for human disease, 3) Human-animal interactions, and 4) Impact of environmental health on human and animal health. We show this course successfully deepened students' understandings of One Health, its role in addressing high priority health issues and the overall benefits of a One Health approach to tackling societal problems. We also report a positive experience by the faculty working in collaboration to implement the curriculum model and the overall enthusiasm of students for the course, all of whom would recommend it to their peers. We conclude by proposing the potential of the curriculum model underlying this course to fill the need for One Health Curricula in programs preparing future health professionals.

One Health and Streptococcus Canis in the Emergency Department: A Case of Cellulitis and Bacteremia in an Immunocompromised Patient Treated With Etanercept

BACKGROUND

One Health is a biomedical approach that aims to optimize the health of humans, animals, and the environment through interdisciplinary collaboration. Cellulitis is an infection of the dermis and subcutaneous fat that may be caused by zoonotic streptococci species.

CASE REPORT

We report a case of cellulitis caused by Streptococcus canis in a woman who was taking Etanercept. We frame the presentation within a One Health approach and urge emergency physicians to collaborate with veterinarians in the management of patients with zoonotic diseases who are discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pets are a source for zoonotic diseases, including resistant bacteria, that pose particular risk to immunocompromised patients. Emergency physicians often discharge patients with potential zoonotic infections such as cellulitis home without a long-term, holistic care plan, according to a One Health approach. Physicians should then collaborate with veterinarians in caring for humans and animals.

What makes an effective One Health clinical practitioner? Opinions of Australian One Health experts

Despite agreement that One Health practices facilitate effective management of zoonoses, the pathways to a coordinated and collaborative approach by general medical practitioners (GPs) and veterinarians are hampered by limited understanding of how this can be practically incorporated in routine clinical settings. Data collected during a Delphi survey of Australian One Health ‘experts’ was used to explore opinions and insights into desired knowledge, attitudes and practices of effective One Health clinical practitioners. Five categories were identified as essential for GPs and veterinarians, namely: accurate baseline knowledge of specific zoonoses; a ‘big picture’ understanding of zoonoses; understanding of professional roles within the One Health paradigm; understanding one's own professional limitations; and collaboration and referral improve outcomes. An outline of the roles and responsibilities of GPs and veterinarians as effective One Health clinicians was determined based on the opinions of the expert panel. Educational interventions that foster interprofessional communication and collaboration will be necessary to successfully bring about the cultural change required to achieve effective One Health practice in Australia, and thus expedite improved human, animal and environmental health outcomes.

•

Experts identified five essential categories required by general medical practitioners and veterinarians.

•

Cross professional collaboration was seen as a hallmark of effective One Health practice.

•

Specific roles were identified for GPs and veterinarians with regard to zoonoses management

•

Significant cultural change is required to successfully facilitate effective One Health practice at a clinical level

Member Perceptions of the One Health Initiative at a Zoological Institution

Zoological institutions play an important role in promoting the goals of the One Health movement. We launched the Institute for Conservation Medicine (ICM) at the Saint Louis Zoo in 2011 to advance the goals of One Health. In 2016, we distributed a survey to Zoo members to evaluate member awareness and understanding of One Health and to provide direction for future communication and actions from the ICM. We hypothesized that Zoo members would be aware of One Health and care about infectious disease issues. Survey results showed Zoo members primarily cared about chronic, non-infectious diseases and their associated economic costs, with participants ranking their top three health issues of concern for humans as nutrition/obesity/diet (49%), costs of health care (48%), and cancer (37%). Zoo members were interested in the roles of zoos in One Health and found them important, but were less aware of the Saint Louis Zoo's actions that did not directly relate to animal welfare. Only 6% of members had awareness of the term "One Health" and 16% were aware of the term "Conservation Medicine." These results suggest that zoos may do better to tailor One Health messaging to align with member interests. Messaging and programming from the Saint Louis Zoo will now include the direct benefits to human health that zoos offer, in addition to the ICM's more ecologically focused activities. This study offered valuable insight into how Zoo members view One Health and may serve as a template to help zoological institutions develop and promote One Health.

A Platform for Monitoring Regional Antimicrobial Resistance, Using Online Data Sources: ResistanceOpen

Background

Our understanding of the global burden of antimicrobial resistance is limited. Complementary approaches to antimicrobial resistance surveillance are needed.

Methods

We developed a Web-based/mobile platform for aggregating, analyzing, and disseminating regional antimicrobial resistance information. Antimicrobial resistance indices from existing but disparate online sources were identified and abstracted. To validate antimicrobial resistance data, in the absence of regional comparators, US and Canadian indices were aggregated and compared to existing national and state estimates. Measures of variability of antimicrobial susceptibility were determined for the United States and Canada to evaluate magnitudes of differences within countries.

Results

Over 850 resistance indices globally were identified and abstracted, totaling >5 million isolates, from 340 unique locations. Resistance index coverage spanned 41 countries, 6 continents, 43 of 50 US states, and 8 of 10 Canadian provinces. When compared to reported values, aggregated resistance values for the United States and Canada during 2013 and 2014 demonstrated agreements ranging from 94% to 97%. For the United States, state-specific resistance estimates demonstrated an agreement of 92%. Large differences in antimicrobial susceptibility were seen within countries.

Conclusions

Using existing nontraditional data sources, we have developed a Web-based platform for aggregating antimicrobial resistance indices to support monitoring of regional antimicrobial resistance patterns.

Stimulating collaboration between human and veterinary health care professionals

Background

Despite the need to control outbreaks of (emerging) zoonotic diseases and the need for added value in comparative/translational medicine, jointly addressed in the One Health approach [One health Initiative (n.d.a). About the One Health Initiative.http://www.onehealthinitiative.com/about.php. Accessed 13 September 2016], collaboration between human and veterinary health care professionals is limited. This study focuses on the social dilemma experienced by health care professionals and ways in which an interdisciplinary approach could be developed.

Results

Based on Gaertner and Dovidio’s Common Ingroup Identity Model, a number of questionnaires were designed and tested; with PROGRESS, the relation between collaboration and common goal was assessed, mediated by decategorization, recategorization, mutual differentiation and knowledge sharing. This study confirms the Common Ingroup Identity Model stating that common goals stimulate collaboration. Decategorization and mutual differentiation proved to be significant in this relationship; recategorization and knowledge sharing mediate this relation.

Conclusions

It can be concluded that the Common Ingroup Identity Model theory helps us to understand how health care professionals perceive the One Health initiative and how they can intervene in this process. In the One Health approach, professional associations could adopt a facilitating role.

'Global health' and 'global nursing': proposed definitions from The Global Advisory Panel on the Future of Nursing

AIMS

To propose definitions of global health and global nursing that reflect the new paradigm that integrates domestic and international health.

BACKGROUND

Increased globalization has led to expanded awareness of the importance of global health and global nursing among students and faculty in the health professions and among policymakers and practitioners.

DESIGN

Discussion paper that includes a discussion and review of the literature related to global health and global nursing.

DATA SOURCES

A task force searched for and reviewed articles published in English, Spanish or Portuguese between 2005-2015, developed summaries, listed key elements, identified prevalent themes and developed consensus definitions.

IMPLICATIONS FOR NURSING

The definitions will be used by the Global Advisory Panel on the Future of Nursing to guide promoting a voice and vision for nursing that will contribute to the advancement of the profession's contribution to global health.

CONCLUSIONS

Definitions of global health and global nursing were developed based on main themes and concepts identified in the literature review to guide contributions of nursing to global health.

Assessing health in agriculture--towards a common research framework for soils, plants, animals, humans and ecosystems

In agriculture and food systems, health-related research includes a vast diversity of topics. Nutritional, toxicological, pharmacological, epidemiological, behavioural, sociological, economic and political methods are used to study health in the five domains of soils, plants, livestock, humans and ecosystems. An idea developed in the early founding days of organic agriculture stated that the health of all domains is one and indivisible. Here we show that recent research reveals the existence and complex nature of such health links among domains. However, studies of health aspects in agriculture are often separated by disciplinary boundaries. This restrains the understanding of health in agricultural systems. Therefore we explore the opportunities and limitations of bringing perspectives together from the different domains. We review current approaches to define and assess health in agricultural contexts, comparing the state of the art of commonly used approaches and bringing together the presently disconnected debates in soil science, plant science, veterinary science and human medicine. Based on a qualitative literature analysis, we suggest that many health criteria fall into two paradigms: (1) the Growth Paradigm, where terms are primarily oriented towards continued growth; (2) the Boundary Paradigm, where terms focus on maintaining or coming back to a status quo, recognising system boundaries. Scientific health assessments in agricultural and food systems need to be explicit in terms of their position on the continuum between Growth Paradigm and Boundary Paradigm. Finally, we identify areas and concepts for a future direction of health assessment and research in agricultural and food systems.

Cattle scourge no more. The eradication of rinderpest and its lessons for global health campaigns

In 2011, the Food and Agriculture Organization of the United Nations (FAO) officially declared rinderpest eradicated. This cattle virus, which has historically had significant political, economic, and social consequences, is only the second infectious disease to disappear from the face of the planet due to concerted human actions. This paper explores the effects that rinderpest has had historically, chronicles the actions of the Global Rinderpest Eradication Campaign (GREP), and discusses the lessons that GREP can offer for combating other infectious diseases. I argue that rinderpest's unique viral characteristics made eradication particularly feasible, but that GREP's activities offer important lessons for fostering international cooperation on controlling infectious disease outbreaks.

Control and prevention of canine rabies: the need for building laboratory-based surveillance capacity

Dogs are the source of more than 99% of human rabies virus infections in endemic regions. Without postexposure prophylaxis, almost all cases are fatal, making rabies the most lethal infectious disease. Tens of thousands of deaths are reported annually, but the official figures are believed to be gross underestimates. Controlling canine rabies, especially in free-ranging dogs, is the first priority to reduce the burden of human disease. Because of their limited medical infrastructure, most endemic countries lack the laboratory facilities needed to diagnose human cases of viral encephalitis. Moreover, the veterinary sectors are often unable to undertake systematic surveillance and reporting of rabies in animals. Without an adequate and functioning risk assessment system that is primed for use, rabies will remain a 'neglected' and omnipresent disease, especially in poverty-stricken regions of the world. Fortunately, experience with the elimination of canine rabies from many industrialized countries has shown that these barriers are not insurmountable. Successful rabies prevention and control strategies that prove the absence of the disease depend on laboratory-based surveillance, rapid data reporting and an adequate system of risk assessment. Future control and prevention programmes should therefore coordinate the development of these key factors, creating synergies to eliminate rabies at its animal source. This article forms part of a symposium in Antiviral Research on the global elimination of canine rabies.