Incorporating one health into medical education.

One Health is an emerging concept that stresses the linkages between human, animal, and environmental health, as well as the need for interdisciplinary communication and collaboration to address health issues including emerging zoonotic diseases, climate change impacts, and the human-animal bond. It promotes complex problem solving using a systems framework that considers interactions between humans, animals, and their shared environment. While many medical educators may not yet be familiar with the concept, the One Health approach has been endorsed by a number of major medical and public health organizations and is beginning to be implemented in a number of medical schools. In the research setting, One Health opens up new avenues to understand, detect, and prevent emerging infectious diseases, and also to conduct translational studies across species. In the clinical setting, One Health provides practical ways to incorporate environmental and animal contact considerations into patient care. This paper reviews clinical and research aspects of the One Health approach through an illustrative case updating the biopsychosocial model and proposes a basic set of One Health competencies for training and education of human health care providers.

Association of American Veterinary Medical Colleges (AAVMC): 50 Years of History and Service.

The mission of the Association of American Veterinary Medical Colleges (AAVMC) is to advance the quality of academic veterinary medicine. Founded in 1966 by the 18 US colleges of veterinary medicine and 3 Canadian colleges of veterinary medicine then in existence, the AAVMC is celebrating 50 years of public service. Initially, the AAVMC comprised the Council of Deans, the Council of Educators, and the Council of Chairs. In 1984, the tri-cameral structure was abandoned and a new governing structure with a board of directors was created. In 1997, the AAVMC was incorporated in Washington, DC and a common application service was created. Matters such as workforce issues and the cost of veterinary medical education have persisted for decades. The AAVMC is a champion of diversity in the veterinary profession and a strong advocate for One Health. The AAVMC has adopted a global perspective as more international colleges of veterinary medicine have earned COE accreditation and become members.

Reported rabies pre-exposure immunization of students at US Colleges of Veterinary Medicine.

In 2008, the US experienced a disruption in human rabies vaccine supplies, leading public health authorities to prioritize vaccine release for post-exposure prophylaxis (PEP) and limit vaccine supplies for pre-exposure prophylaxis (PreEP) in high-risk groups. In 2008, the Association of American Veterinary Medical Colleges (AAVMC) surveyed its member institutions on rabies vaccination policies and practices. Senior administrators at Colleges of Veterinary Medicine (CVMs) and departments of veterinary science and comparative medicine were asked to identify the person most knowledgeable about their institution's student rabies vaccination program. Respondents were asked to describe their policies and procedures for administering PreEP to veterinary medical students and staff and to estimate the annual demand for student and staff PreEP vaccine. Twenty-one CVMs responded. Twenty (95%) reported requiring PreEP of veterinary medical students and 16 (80%) of those 20 required vaccination upon matriculation. An estimated 7,309 doses of vaccine were required for PreEP of an estimated 2,436 first-year US veterinary medical students. Seventy-two percent of respondents administered PreEP in August, September, and October, coinciding with the highest public demand for PEP. CVMs should consider altering the timing of rabies vaccine administration to veterinary medical students and staff to other months, thereby helping to ensure that PEP rabies vaccine will be available to people with validated rabies exposures and to ensure that supplies will be available for PreEP of students and staff. AAVMC may wish to identify and support a point of coordination to facilitate the purchase and distribution of human rabies vaccine among its US member CVMs.

Addressing the urgent health challenges of climate change and ecosystem degradation from a One Health perspective: what can veterinarians contribute?

Since the field of One Health was introduced in the early 2000s, veterinary medicine has provided leadership in working with other disciplines and sectors to identify effective, sustainable solutions to complex health problems that are shared by humans, animals, and the environment. Human-induced climate change has accelerated since the Industrial Age, resulting in serious adverse human, animal, and environmental health consequences. We summarize several drivers of climate change and ecosystem degradation connected to veterinary medicine. Building on previous studies and observations of others, we propose a set of urgent and actionable recommendations for individual veterinarians and the veterinary profession to mitigate and adapt to the health risks posed by climate change and ecosystem degradation at community, local, state, national, and international levels. In addition, we call for emphasizing the foundational relationship between climate change and ecosystem health to human, animal, and environmental health; integrating environmental health, climate change, and the diagnosis and treatment of climate-related adverse health outcomes into veterinary medical education and research; and providing ever-greater national and global leadership and participation by the veterinary medical profession to confront the causes and health consequences of human-induced climate change and ecosystem degradation, working in collaboration with other health professions, disciplines, and sectors.

Occupational Injuries of Aquaculture Workers: Washington State.

OBJECTIVE: To characterize occupational injuries of aquaculture workers in Washington State. METHODS: We reviewed accepted Washington State workers' compensation claims from January 1, 2006 to December 31, 2014. Trends in employment, worker demographics (including age, sex, and body mass index), claim rate, and injury characteristics were summarized for accepted claims in the Washington State risk classes that include aquaculture workers. RESULTS: During the nine-year study period, there were 1,180 accepted claims, 836 (65.1%) were medical-aid only and 344 (26.8%) were compensable. Most commonly reported injury types included being struck by/against an object (n = 420) and work-related musculoskeletal disorders (n = 310). Over the study period, there was no statistically significant change in claim rates in aquaculture (p = 0.77), though they were elevated compared to claim rates for all WA industries combined. A significant upward trend (p = 0.003) in aquaculture employment was observed during our study period. CONCLUSIONS: Given the growth in aquaculture production, and that aquaculture workers in Washington are experiencing higher occupational injury rates compared to other workers in the state, our study suggests that the industry should devote greater attention to prevention of work-related injuries, especially those resulting in being struck by/against objects or work-related musculoskeletal disorders. Enhanced occupational safety and health programs for this industry could help reduce injuries, as well as the cost of workers' compensation claims.

The global veterinarian: the why? The what? The how?

Globalization has created an entirely new landscape for veterinarians. Opportunities abound to meet the formidable challenges presented as animals, people, and microbes travel at a previously unimagined speed, fueled by the engine of commerce, resulting in a plethora of new diseases, issues, and partnerships. Re-tooling our profession to ensure that we can continue to fulfill our veterinary oath in the face of these changes will require both short- and long-term changes. It is essential that a single overarching, non-affiliated organization be formed to tie together all entities, providing the structure to create needed synergy to enhance our currently fragmented professional responses and to solicit funds to effect necessary changes.

Strengthening capacity in developing countries for evidence-based public health: the data for decision-making project.

Public health officials and the communities they serve need to: identify priority health problems; formulate effective health policies; respond to public health emergencies; select, implement, and evaluate cost-effective interventions to prevent and control disease and injury; and allocate human and financial resources. Despite agreement that rational, data-based decisions will lead to improved health outcomes, many public health decisions appear to be made intuitively or politically. During 1991-1996, the US Centers for Disease Control and Prevention implemented the US Agency for International Development funded Data for Decision-Making (DDM) Project. DDM goals were to: (a) strengthen the capacity of decision makers to identify data needs for solving problems and to interpret and use data appropriately for public health decisions; (b) enhance the capacity of technical advisors to provide valid, essential, and timely data to decision makers clearly and effectively; and (c) strengthen health information systems (HISs) to facilitate the collection, analysis, reporting, presentation, and use of data at local, district, regional, and national levels. Assessments were conducted to identify important health problems, problem-driven implementation plans with data-based solutions as objectives were developed, interdisciplinary, in-service training programs for mid-level policy makers, program managers, and technical advisors in applied epidemiology, management and leadership, communications, economic evaluation, and HISs were designed and implemented, national staff were trained in the refinement of HISs to improve access to essential data from multiple sources, and the effectiveness of the strategy was evaluated. This strategy was tested in Bolivia, Cameroon, Mexico, and the Philippines, where decentralization of health services led to a need to strengthen the capacity of policy makers and health officers at sub-national levels to use information more effectively. Results showed that the DDM strategy improved evidence-based public health. Subsequently, DDM concepts and practices have been institutionalized in participating countries and at CDC.

Veterinary medicine protecting and promoting the public's health and well-being.

Dr. Calvin Schwabe's vision of "One Medicine" has long inspired many in the public health community to strive toward bringing human and veterinary medicine together to improve the public's health and well-being around the world. In an increasingly human-dominated world, as Dr. Schwabe suggested many years ago, human health provides the most-logical unifying or apical cause in veterinary medicine's hierarchy of values. Veterinarians in all aspects of the profession-have opportunity and responsibility to protect the health and well-being of people in all that they do, including protecting food security and safety; addressing threats to antibiotic sensitivity; preventing and controlling zoonotic emerging infectious diseases; protecting environments and ecosystems; participating in bio- and agro-terrorism preparedness and response; using their skills to confront non-zoonotic diseases (such as malaria, HIV/AIDS, vaccine preventable diseases, chronic diseases and injuries); strengthening the public-health infrastructure; and advancing medical science through research. This article provides an overview of contributions made by veterinarians in each of these areas, and discusses the challenges to be overcome and the need for strategic thinking and action to achieve the vision of "one medicine".

Veterinarians and public health: the Epidemic Intelligence Service of the Centers for Disease Control and Prevention, 1951-2002.

Public health affords important and exciting career opportunities for veterinarians. The Epidemic Intelligence Service Program (EIS) of the Centers for Disease Prevention and Control (CDC) is a two-year post-graduate program of service and on-the-job training for health professionals, including veterinarians, who are interested in careers in epidemiology and public health. EIS serves as a major point of entry into the public health arena. Veterinarians applying to the program must have a Master of Public Health or equivalent degree, or demonstrated public health experience or course work. EIS officers are assigned to positions at CDC headquarters or in state and local health departments. During two-year assignments, they are trained in applied epidemiology, biostatistics, conducting outbreak investigations, emergency preparedness and response, and scientific communications. They conduct epidemiologic outbreak and other investigations, perform applied research and public health surveillance, serve the epidemiologic needs of state health departments, present at scientific and medical conferences, publish in the scientific literature, and disseminate vital public health information to the media and the public. EIS officers apply their training and skills to actual public health problems and issues, establish mentorships with recognized experts from CDC and other national and international health agencies, and travel domestically and internationally. Since 1951, 195 veterinarians have graduated from the program and gone on to make substantial contributions to public health in positions with federal, state, or local governments, academia, industry, and non-governmental organizations.

Strategies for educational action to meet veterinary medicine's role in biodefense and public health.

It is clear that the profession is not well prepared to respond to society's needs in bio-defense and public health. The imperatives that face the veterinary profession, as emphasized by the agenda for action conference deliberations that are reported in this issue of the journal, require action on many fronts, but possibly none more essential than to address how veterinary education needs to change to meet these challenges. Addressing these needs, participants at the agenda for action conference met in groups of 30 to 50 to shape approaches that would address these key questions. The 161 participants were broadly representative of government, private practice, corporate practice, organized veterinary medicine, and academia (Appendix A). Reported here are the results of those deliberations, with each of the seven sections written up by the discussion leader. Included in the participants were 20 students, representative of eight different veterinary colleges, who both participated in the group discussions and have presented their own report.

Lessons from pandemic H1N1 2009 to improve prevention, detection, and response to influenza pandemics from a One Health perspective.

In April 2009, a novel influenza A subtype H1N1 triple reassortant virus (novel H1N1 2009), composed of genes from swine, avian, and human influenza A viruses, emerged in humans in the United States and Mexico and spread person-to-person around the world to become the first influenza pandemic of the 21st century. The virus is believed to have emerged from a reassortment event involving a swine virus some time in the past 10 to 20 years, but pigs, pork, and pork products have not been involved with infection or spread of the virus to or among people. Because countries quickly implemented recently developed pandemic influenza plans, the disease was detected and reported and public health authorities instituted control measures in a timely fashion. But the news media's unfortunate and inappropriate naming of the disease as the "swine flu" led to a drop in the demand for pork and several countries banned pork imports from affected countries, resulting in serious negative economic impacts on the pork industry. With the continual circulation and interspecies transmission of human, swine, and avian influenza viruses in countries around the world, there are calls for strengthening influenza surveillance in pigs, birds, and other animals to aid in monitoring and assessing the risk of future pandemic virus emergence involving different species. We identify and discuss several lessons to be learned from pandemic H1N1 2009 from a One Health perspective, as stronger collaboration among human, animal, and environmental health sectors is necessary to more effectively prevent or detect and respond to influenza pandemics and thus improve human, animal, and environmental health and well-being.

Highly pathogenic H5N1 avian influenza virus: cause of the next pandemic?

Since 1997, when human infections with a highly pathogenic (HP) avian influenza A virus (AIV) subtype H5N1 - previously infecting only birds - were identified in a Hong Kong outbreak, global attention has focused on the potential for this virus to cause the next pandemic. From December 2003, an unprecedented H5N1 epizootic in poultry and migrating wild birds has spread across Asia and into Europe, the Middle East, and Africa. Humans in close contact with sick poultry and on rare occasion with other infected humans, have become infected. As of early March 2007, 12 countries have reported 167 deaths among 277 laboratory-confirmed human infections to WHO. WHO has declared the world to be in Phase 3 of a Pandemic Alert Period. This paper reviews the evolution of HP AIV H5N1, molecular changes that enable AIVs to infect and replicate in human cells and spread efficiently from person-to-person, and strategies to prevent the emergence of a pandemic virus.

Impact of globalization and animal trade on infectious disease ecology.

The articles on rabies and Marburg virus featured in this month's Emerging Infectious Diseases (EID) zoonoses issue illustrate common themes. Both discuss zoonotic diseases with serious health implications for humans, and both have a common reservoir, the bat. These articles, and the excitement generated by this year's recognition of World Rabies Day on September 8, also described in this issue, remind us how globalization has had an impact on the worldwide animal trade. This worldwide movement of animals has increased the potential for the translocation of zoonotic diseases, which pose serious risks to human and animal health.