Lisa Conti

Compendium of Animal Rabies Prevention and Control, 2011

the disease, and for purposes of this document, use of the term animal refers to mammals. The disease is an acute, progressive encephalitis caused by a lyssavirus. Rabies virus is the most important lyssavirus globally. In the United States, multiple rabies virus variants are maintained in wild mammalian reservoir populations, such as raccoons, skunks, foxes, and bats. Although the United States has been declared free from transmission of canine rabies virus variants, there is always a risk of reintroduction of these variants. 2–6 The virus is usually transmitted from animal to animal through bites. The incubation period is highly variable. In domestic animals, it is generally 3 to 12 weeks but can range from several days to months, rarely exceeding 6 months. 7 Rabies is communicable during the period of salivary shedding of rabies virus. Experimental and historic evidence document that dogs, cats, and ferrets shed virus a few days prior to clinical onset and during illness. Clinical signs of rabies are variable and include inappetence, dysphagia, cranial nerve deficits, abnormal behavior, ataxia, paralysis, altered vocalization, and seizures. Progression to death is rapid. There are currently no known effective rabies antiviral drugs.

Sociodemographics and HIV risk behaviors of bisexual men with AIDS : results from a multistate interview project

Objective:To describe the sociodemographic characteristics and sexual and drug use behaviors of men with AIDS who engage in bisexual activity. Methods:We interviewed 2120 men aged ≥ 18 years who were reported with AIDS in 11 states and cities. Men were considered bisexual if they reported having had sex with a man and a woman in the previous 5 years. Results:Of the 2020 men with AIDS who reported being sexually active in the previous 5 years, 1150 (57%) had had male partners only, 522 (26%) had had female partners only and 348 (17%) had had both. White men were least likely to report bisexual behavior (15%; 161 out of 1071). Men of Latin American descent were most likely to report bisexual behavior (24%; 37 out of 155), especially those born outside the United States who had lived there for ≤ 10 years (38%; 11 out of 29). Bisexual Latin American men, regardless of birthplace, were more likely to be currently married than all other bisexual men (22 versus 7%; P< 0.05). HIV risk behaviors differed between men reporting bisexual and those reporting exclusively homosexual or heterosexual activity. Injecting drug use in the previous 5 years was more common among bisexual than homosexual men (12 versus 6%; P< 0.05). Bisexual men were more likely (P< 0.05) to have received money for sex (11%) than homosexual (4%) or heterosexual men (4%). This difference was even greater among injecting drug users receiving money for sex: bisexual (29%), homosexual (13%), heterosexual (3%). Conclusions:Demographics and HIV risk behaviors of bisexual men with AIDS differ from those of homosexual and heterosexual men with AIDS. These findings indicate that special efforts are needed to prevent sexual transmission of HIV among bisexual men.

Differences in Participation in Experimental Drug Trials Among Persons With AIDS

To measure participation in experimental drug trials among persons with acquired immunodeficiency syndrome (AIDS), we interviewed 4,604 persons at least 18 years of age who were reported to have AIDS to 11 state and city health departments in the United States. Ten percent reported that they were currently in a trial. Current enrollment differed significantly (p < 0.05) by race/ethnicity (blacks, 5%; whites, 14%; Hispanics, 15%), gender (women, 7%; men, 11%), exposure mode (injection drug use, 5%, men who have sex with men, 14%), annual household income (<

Links Among Human Health, Animal Health, and Ecosystem Health

10,000, 8%, > or =

Checklist for One Health Epidemiological Reporting of Evidence (COHERE)

10,000, 14%), education (< 12 years, 6%; > or = 12 years, 12%), health care (no regular care, 1%, public care, 8%; private care, 17%), and time since AIDS diagnosis (< or = 6 months, 9%; > 6 months, 12%). Adjusting for all factors and time since AIDS diagnosis, blacks (adjusted odds ratio [AOR] = 0.35, 95% confidence interval [CI] 0.26, 0.47), persons with less than 12 years of education (AOR = 0.71, CI 0.53, 0.96), and those without regular health care (AOR = 0.24, CI 0.10, 0.61) remained less likely to be in a trial. Blacks, those with less than 12 years of education, and persons without regular health care were less likely than other persons with AIDS to be currently enrolled in AIDS trials. To increase enrollment of these persons, researchers must address barriers to participation for these groups.

Reported health conditions in animals residing near natural gas wells in southwestern Pennsylvania

In the face of growing world human and animal populations and rapid environmental change, the linkages between human, animal, and environmental health are becoming more evident. Because animals and humans have shared risk to health from changing environments, it seems logical to expand the perspective of public health beyond a single species to detect and manage emerging public health threats. Mitigating the effects of climate change, emerging pathogens, toxicant releases, and changes in the built environment requires a retooling of global public health resources and capabilities across multiple species. Furthermore, human and animal health professionals must overcome specific barriers to interprofessional collaboration to implement needed health strategies. This review outlines the relationships between human, animal, and ecosystem health and the public health challenges and opportunities that these links present.

One Health and Emerging Infectious Diseases: Clinical Perspectives

One Health is defined as the intersection and integration of knowledge regarding humans, animals, and the environment, yet as the One Health scientific literature expands, there is considerable heterogeneity of approach and quality of reporting in One Health studies. In addition, many researchers who publish such studies do not include or integrate data from all three domains of human, animal, and environmental health. This points to a critical need to unify guidelines for One Health studies. This report details the Checklist for One Health Epidemiological Reporting of Evidence (COHERE) to guide the design and publication format of future One Health studies. COHERE was developed by a core writing team and international expert review group that represents multiple disciplines, including human medicine, veterinary medicine, public health, allied professionals, clinical laboratory science, epidemiology, the social sciences, ecohealth and environmental health. The twin aims of the COHERE standards are to 1) improve the quality of reporting of observational or interventional epidemiological studies that collect and integrate data from humans, animals and/or vectors, and their environments; and 2) promote the concept that One Health studies should integrate knowledge from these three domains. The 19 standards in the COHERE checklist address descriptions of human populations, animal populations, environmental assessment, spatial and temporal relationships of data from the three domains, integration of analyses and interpretation, and inclusion of expertise in the research team from disciplines related to human health, animal health, and environmental health.

A manifesto for planetary health

Natural gas extraction activities, including the use of horizontal drilling and hydraulic fracturing, may pose potential health risks to both human and animal populations in close proximity to sites of extraction activity. Because animals may have increased exposure to contaminated water and air as well as increased susceptibility to contaminant exposures compared to nearby humans, animal disease events in communities living near natural gas extraction may provide “sentinel” information useful for human health risk assessment. Community health evaluations as well as health impact assessments (HIAs) of natural gas exploration should therefore consider the inclusion of animal health metrics in their assessment process. We report on a community environmental health survey conducted in an area of active natural gas drilling, which included the collection of health data on 2452 companion and backyard animals residing in 157 randomly-selected households of Washington County, Pennsylvania (USA). There were a total of 127 reported health conditions, most commonly among dogs. When reports from all animals were considered, there were no significant associations between reported health condition and household proximity to natural gas wells. When dogs were analyzed separately, we found an elevated risk of ‘any’ reported health condition in households less than 1km from the nearest gas well (OR = 3.2, 95% CI 1.07–9.7), with dermal conditions being the most common of canine disorders. While these results should be considered hypothesis generating and preliminary, they suggest value in ongoing assessments of pet dogs as well as other animals to better elucidate the health impacts of natural gas extraction on nearby communities.

One Health and emergency preparedness.

To date, there has been little articulation of specific One Health clinical activities for veterinary and human health care providers regarding emerging infectious diseases, yet they could play a critical role. Under current clinical paradigms, both human and animal health professionals routinely diagnose and treat zoonotic infectious diseases in their patients, but tend to work in parallel with little cross-professional communication or coordination of care. For this to evolve toward a One Health model, both types of clinicians need to see how individual cases can be “sentinel events” indicating environmental risk for disease emergence, and develop mechanisms of rapid communication about these risks. Human and animal clinicians also need to take a more proactive and preventive approach to zoonotic diseases that includes the occupational health of animal workers in farms, laboratories, veterinary clinics, and other settings, as well as the recognition of increased risk among immunocompromised individuals in contact with animals. This requires training in One Health clinical competencies including the ability to diagnose and treat zoonotic diseases, implement preventive care interventions for individual patients, provide occupational health services for animal workers, recognize sentinel cases, report cases to public heath and clinical colleagues, and assess and help to intervene with environmental factors driving infectious disease risk in humans and animals. To provide an evidence base for such competency training, there is a need for development and testing of innovative protocols for One Health clinical collaborations.

Confronting Emerging Zoonoses

www.thelancet.com Vol 383 April 26, 2014 1459 Richard Horton and colleagues’ manifesto is in the tradition of The Lancet’s founding Editor Thomas Wakley. It champions social medicine, as does The Lancet’s current Editor. We—as members of the People’s Health Movement also aiming to strengthen community and planetary health informed by public health principles—agree with and endorse the general analysis of The Lancet’s manifesto. However, the manifesto makes no mention of existing social movements, many of which have much the same aims as those being proposed, including: exposing political and economic systems that jeopardise public health, emphasising the provision of universal primary health care, insisting that public health institutions and facilities be protected, empowering the people most immediately aff ected and defending their rights, calling for renewed social values and a vision that puts the public interest fi rst, and pressing governments to protect public goods. For more than a decade, the disorder created by reckless capitalism has been authoritatively discredited, including by existing social movements. Nevertheless, sustainable development initiatives designed especially for Asia and Africa still almost invariably involve the private sector, as lead partners of UN agencies and governments. But, in reality, the private sector comprises the very transnational corporations whose actions are in conflict with public health. They must be excluded from policy formulations to improve public health. Instead, partnerships need to include genuinely independent public interest civil society organisations and social movements. The manifesto calls for the creation of a powerful social movement to deliver planetary health and support sustainable human development. But, there is no reference to the work already being done for example by the World Social Forum, Greenpeace, the International Baby A manifesto for planetary health