ONE  HEALTH:    TALES  ACROSS  THE  DISCIPLINES  Prof  Lucille  Blumberg  

Deputy-­‐Director:    Na8onal  Ins8tute  for  Communicable  Diseases  Head:  Division  of  Public  Health  Surveillance  and  Response  

Presented  by  Dr.  Clara  Bocchino  AHEAD-­‐GLTFCA  Network  Coordinator  

•  Underdiagnosed    

•  Passive  surveillance  

•  Non-­‐  specific    signs  and  

symptoms    

•  Limited  laboratory    

diagnos8cs    

Zoonosis at the human/animal interface!

Background  of  TB  -­‐  HIV    -­‐  MALARIA  ,    Water  –borne  and  respiratory  infec8ons      

Ebola Virus Disease !•  First  iden8fied  in  1976,  DRC  •  12  outbreaks  to  date    •  Major  outbreak:  2013/14  

(Sierra  Leone;  Guinea;  Liberia)-­‐  >  10,000  cases  

with  60%  mortality  •  Bats  likely    reservoir    •  Bush  meat  important  in  

transmission  to  humans  •  Human  to  human  

transmission  –  exposure  to  pa8ent  blood,  body  fluids      

•  Community  living  on  border  of  Greater  Kruger  Na8onal  Park  

•  Majority  are  agro-­‐pastoralists    •  Weekly  dip  tank  for  cadle  for  8ck  control  •  Zoonoses  are  an  important  cause  of  acute  

febrile  illness:  •  Tick  bite  fever    •  Q  fever    •  Bartonellosis  •  Leptospirosis  

Zoonoses: human and domestic/wild life interface – Limpopo Transfrontier National Park!

ISID  2014    Quan  Blumberg    Simpson  Knobel  Frean  Rossouw  Weyer          

RABIES OUTBREAK: LIMPOPO, SOUTH AFRICA 2005!

•  No  previous  human  cases  in  area  •  Major  increase  in  dog  rabies  in  preceding  year  •  Spill  over  from  Zimbabwe  into  local  dog  popula8on  

(poor  vaccine  coverage)  •  Poor  communica8on  between    veterinary  and  

human  health      •  Limited  rabies  preven8on  programme  for  exposed  

humans  •  Fatal  encephaliAs-­‐  iniAally  unrecognised  by  

physicians  as  rabies  (total  31  cases  over  9  months)    

Response:  •  Dog  vaccina8on  campaign  intensified    •  Community  awareness  raised    •  Health  care  worker  educa8on  •  Provision  of  rabies  vaccine  and  immunoglobulin    EID 2007

Outbreak of Highly Pathogenic Avian influenza (H5N2) Eastern Cape 2004 !

Animal  response  •  Farms  within  30km  radius  of  

affected  farms  quaran8ned  •  All  ostriches  and  poultry  in  infected  

zone  culled  •  Voluntary  ban  on  the  export  of  

poultry  ins8tuted    

Human  health  response  Sero-­‐epidemiological  study  •  HPAI  (H5N2)  is  transmissible  to  highly  

exposed  humans    but  no  severe  illness      

Outbreak  of  RiJ  Valley  fever    South  Africa  2008  

•  Outbreak  affec8ng  disease-­‐free  

buffalo  on  border  of  Kruger  

Na8onal  Park  

•  18  human  cases  in  veterinary  

and  farm  workers  

•  Predominantly  mild  disease    

•  Combined  human  and  veterinary  

response    

‘BETWEEN  ANIMALS  AND  HUMANS  THERE  IS  NO  DIVIDING  LINE’  Virchow  19th  century    

• Good  communica8on  is  cri8cal  

• Combined  resources  for  outbreak  response,  preven8on  and  control    is  

advantageous  

• Veterinary  alert  to  human  health  prac88oners  is  cri8cal  for  recogni8on  of  

clinical  cases  

 

 

 

 

 

 

 

What makes it work? !