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Stephen M. Apatow
Director of Research and Development 
Humanitarian Resource Institute Biodefense Reference Library
Foreign Animal and Zoonotic Disease Center
Eastern USA: (203) 668-0282   Western USA: (775) 884-4680
Internet: http://www.humanitarian.net/biodefense/fazdc/
Email: s.m.apatow@humanitarian.net

VETERINARY MEDICINE: BIOTERRORISM AND EMERGING INFECTIOUS DISEASES

80% of "emerging" infections are animal based (Martin Hugh Jones, Director, WHO Collaborating Center for Remote Sensing and Geographic Information Systems for Public Health), outlining the significance of the veterinary profession as a key player in collaborative research associated with the international threat of bioterrorism and emerging infectious diseases.

As outlined in the CDC resource Influenza Pandemics: How They Start, How They Spread, and Their Potential Impact:

"The reservoir for Type A influenza viruses is wild birds, but influenza A viruses also infect animals such as pigs and horses, as well as people. The last two pandemic viruses were combinations of bird and human influenza viruses. Many persons believe that these new viruses emerged when an intermediate host, such as a pig, was infected by both human and bird influenza A viruses at the same time. A new virus was created. Events in Hong Kong in 1997, however, showed that this is not the only way that humans can become infected with a novel virus. Sometimes, an avian influenza virus can "jump the species barrier" and move directly from chickens to humans and cause disease."

According to Heinen, Swine influenza and public health implications:

"Around 1970, following the human 'Hong Kong' flu pandemic, the human H3N2 virus was transmitted to pigs. This human-like swine H3N2 virus continued to circulate, particularly in Europe and Asia, but only sporadically caused clinical signs. It has only started causing clinical disease since 1984, probably as a result of a reassortment with the avian-like swine H1N1 virus. The new virus was a reassortment human-like swine H3N2 virus with the HA and NA of the human virus and all the internal proteins of the avian virus. It has since replaced the original H3N2 virus in Europe. It was only recently that H3N2 started to circulate in the US, where it has caused serious illness and reproductive losses in sows. The viruses evolved from reassortments involving classical H1N1 and human H3N2 viruses and are antigenically and genetically distinct from the European human-like H3N2 viruses."

This discussion has redirected attention to the importance of veterinary profession in all phases of preparedness, planning and response to bioterrorism/emerging infectious disease initiatives.  International dialogue regarding the omission of the veterinary profession as a lead agency, exposes one of the most serious gaps associated with current unmet needs in the reassessment of recommendations first presented in the 1998 training workshop (ASM/CDC/NIH Training in Emerging and Reemerging Infectious Diseases), which coincided with the International Conference on Emerging Infectious Diseases.  These included:

1) Current CDC, NIH, and Department of Defense training programs should receive additional funding and be expanded through increased U.S. government resources and through innovative cooperative efforts with the private sector.

2) U.S. Agency for International Development (USAID), World Health Organization (WHO), and other international organizations should join forces with domestic agencies to provide for training of foreign nationals.

3) Increased communication and coordination between the clinical, public health, and research communities are needed. The veterinary educational model, which looks at populations rather than individual patients, might serve as a model for the medical community.

4) An intersectorial emerging infectious diseases group composed of U.S. members from government agencies (CDC, NIH) and state health departments, universities, industry, schools of public health, professional organizations (e.g., ASM, Infectious Disease Society of America, American Society of Tropical Medicine and Hygiene, and international organizations (USAID, WHO) should be organized to identify training needs.

5) ASM and other professional organizations should work with academic institutions to promote curriculum changes at the professional student, clinical training, and research training levels to increase awareness of and capacity to recognize and treat or prevent emerging infections.

6) Continuing medical education courses, audiovisual programs, and interactive educational materials should be developed to address these training needs and should provide opportunities for cooperation with industry and the private sector.

7) Intersectorial efforts should be undertaken to train personnel and support work plans for training and research that will help anticipate and control emerging diseases other than influenza.
 

Stephen M. Apatow, is the Director of Research and Development of the Humanitarian Resource Institute Foreign Animal and Zoonotic Disease Center as well as administrator/presentor of the Foreign Animal Disease Online Course and Zoonotic Disease Online Review for medical and veterinary professionals worldwide.