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2 Making the Case for Zoonotic Disease Surveillance
Pages 27-76

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From page 27...
... David Nabarro Senior United Nations System Coordinator for Avian and Human Influenza Special Interview with the Committee (September , 00) Recent emerging zoonotic diseases have had significant impacts in industrialized countries, despite well-developed health systems and sanitary infrastructures (Vorou et al., 2007; Jones et al., 2008; Murphy, 2008)
From page 28...
... SOCIOECONOMIC FACTORS AFFECTING ZOONOTIC DISEASE EMERGENCE Humans and animals can serve as pathogen reservoirs and vectors, and pathogens that may have resided in one part of the world can be carried or spread across long distances to become established in another part of the world. Technological advances now allow humans, animals, animal products, and their disease vectors to circumnavigate the globe in the span of 24 hours.
From page 29...
... In 2008, total trade imports were valued at $16.1 trillion USD and total trade exports were valued at $16.4 trillion USD.
From page 30...
... However, even competitive market economies do not necessarily reward additional investments in animal health infrastructure or encourage disease surveillance to track changing risk factors that might signal the potential emergence of a new disease. This failure to build veterinary capacity is even more relevant in countries where the food-animal production sectors primarily serve the local economy.
From page 31...
... FIGURE 2-2 International agricultural trade (world imports + world exports) by commodity type, 1961–2006.
From page 32...
...  FIGURE 2-3 Trends in poultry production.
From page 33...
... Consumers benefit from the reduced risk of exposure to zoonotic pathogens. In many parts of the world, the public investment in national animal health infrastructure has not been commensurate with agricultural development.
From page 34...
... The global market economy can also amplify disease effects through market instability as characterized by price volatility, shifts in consumption patterns, and variability in supplies. International Wildlife Trade Globalization has also impacted the movement of live, wild animals.
From page 35...
... . Even so, most of the zoonotic diseases reported to be caused by wildlife trade involved imports of legal wildlife (see Appendix B on monkeypox)
From page 36...
... HEALTH AND ECONOMIC IMPACTS OF ZOONOTIC DISEASES Human Health Human mortality resulting from emerging zoonotic diseases has been relatively low compared to other leading causes of death from infectious diseases, with the exception of the 1918 influenza pandemic and HIV/AIDS, a zoonosis that now transmits readily among humans. Between 2003 and
From page 37...
... 450 30 0 425 40 0 Cumulative D eaths , 2 57 375 250 350 325 30 0 20 0 275 250 Cases 225 150 20 0 175 150 10 0 79 125 59 10 0 43 75 50 33 32 50 7 25 4 0 0 20 03 20 04 20 05 20 06 20 07 20 08 20 09 Total Year Vietnam Myanmar Djibouti Turkey Lao PDR China Thailand Cambodia Iraq Pakistan Indonesia Bangladesh Azerbaijan Nigeria Egypt FIGURE 2-4 Number of confirmed human cases and deaths of avian influenza A (H5N1) reported to the World Health Organization by country and year.
From page 38...
... 2003 East Asian economies: 2 percent of regional GDP or US$200 billionk Canada SARS November 1, Civets 251i 43i N/A 0.15 percent of GDP or 2002, to July 31, C$1.5 billionl 2003 Asia Highly pathogenic January 24, 2004, Poultry, wild 337m 222m Birds: Estimated Asia $10 billion avian influenza to January 7, fowl, and 250 million (December 2003 to (HPAI) 2009 mammals February 2006)
From page 39...
... q India Plague August–October Rodents 693r 52r N/A $600 million–$2 billions 1994 Kenya, Rift Valley fever November 30, Sheep, cattle, 1,062t 315t N/A N/A Somalia, and 2006, to May 3, goats, water Tanzania 2007 buffalo; mosquitoes (vector) NOTES: N/A = not available; total = total cases worldwide; vCJD = variant Creutzfeldt-Jakob disease.
From page 40...
... . sWorld Resources Institute, United Nations Environment Programme, United Nations Development Programme, and World Bank (1996)
From page 41...
... . Furthermore, zoonoses can impose a significant human and animal health burden locally and, in many cases, that burden is underestimated (see Box 2-1)
From page 42...
... Emerging zoonotic diseases can cause economic losses as a result of morbidity and mortality among food animals, losses related to public interventions, and market losses at household, national, and global levels. Foodanimal morbidity and mortality losses can be the result of the disease itself, or result from preventive actions such as culling of diseased, suspected, or at-risk animals.
From page 43...
... . Detailed breakdowns of economic losses as described above are generally not available, but as shown in Table 2-1, total losses from emerging zoonotic diseases over the past two decades exceed $200 billion.
From page 44...
...  GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES BOX 2-2 The Economic Impact of Bovine Spongiform Encephalopathy Outbreaks in the United Kingdom, the United States, and Canada In 1986, the United Kingdom (UK) had a major outbreak of a novel disease in cattle, bovine spongiform encephalopathy (BSE)
From page 45...
... . Although the economic impact estimates in the case of an influenza pandemic show a high mortality in humans, the largest impact might arise from the uncoordinated efforts of people to avoid infection and the economic losses resulting from the reduction in the size and productivity of the world labor force due to illness and death (Brahmbhatt, 2006)
From page 46...
... Through early detection, a timely and effective response to zoonotic diseases in animal populations can prevent or minimize the likelihood of transmission to human populations (see Figure 2-8)
From page 47...
... Effective prevention and control of emerging zoonotic diseases require both disease surveillance and emergency response capabilities that include disseminating and communicating actionable disease surveillance information to officials who have the authority, motivation, and capability to implement a response. The relationship between disease surveillance and emergency response is typically in the size and efficacy of the two efforts: The more effective and timely the disease surveillance, the more likely it is to avert a relatively large emergency response.
From page 48...
... Examples would include vaccination programs (rabies, avian influenza, 11-9-09 other) ; effective live animal market sanitation and other management policies to prevent mixing of species; sanitation including manure and rodent/ pest management on farms; biosecurity measures; testing and treatment programs of companion and stray animals for zoonotic diseases (e.g., Echinococcus granulosus)
From page 49...
... Other response measures would include vaccination of animal populations in the face of an outbreak, testing and slaughter of food-animal populations, mass depopulation programs, strengthening biosecurity programs, and treating and curing zoonotic disease infection in household animals. HD = Detection of zoonotic diseases in human populations: • HD1, detection in humans before symptoms occur.
From page 50...
... First, disease surveillance detected the disease in humans and poultry, but only after the Therefore, an effective global disease surveillance system can be expected to reduce the emergence of zoonotic diseases in humans and provide early detection of zoonotic diseases in livestock, thereby reducing billions in economic losses. In most emerging zoonoses, if the disease had been recognized much earlier (as would happen with well-functioning disease surveillance systems)
From page 51...
... This is unfortunate because a well-designed emerging zoonotic disease surveillance system is what will ultimately result in less human morbidity and mortality and fewer adverse economic impacts globally. It is widely recognized that emergency response is essential.
From page 52...
... This information allows decisionmakers to more confidently allocate resources to prevent outbreaks from occurring. If a zoonotic disease outbreak should arise, such data become even more critical for informing effective control and response measures.
From page 53...
... . Zoonotic disease emergence from nonhuman animals may be viewed as a series of steps from primarily animal diseases, such as rabies that occasionally are transmitted to humans, all the way to diseases originating in animals, such as HIV-1 that jumped species to humans and successfully transmitted from human to human without further involvement of the original animal host.
From page 54...
... That, coupled with a great deal of interest in pathogen discovery, makes it possible that the rate of discovery, particularly of viruses, will accelerate as new efforts are made through surveillance programs. The majority of newly discovered human pathogens are either zoonotic or have recent origins in nonhuman reservoirs.
From page 55...
... First, monitoring is subject to massive ascertainment biases. There are vast differences in the efforts invested in different places and at different times, leading to important gaps in information whether at the level of species discovery, emerging disease "events," or disease outbreaks in humans.
From page 56...
... . Domestic Animals and Wildlife Surveillance to Predict Zoonotic Disease Emergence Given the desire to more effectively predict where the next zoonotic disease will emerge, there are many gaps in knowledge of potential emerging pathogens amidst the evidence of continuing events, underscoring the need for active disease surveillance in animal reservoirs for known zoonoses including domestic animals and also wildlife wherever possible.
From page 57...
... . The use of such analyses and disease models can better inform decisionmakers on how to effectively respond to disease outbreaks early on.
From page 58...
... . There are several examples from recent emerging infectious disease investigations (including Hendra virus, Nipah virus, coral diseases, and avian influenza)
From page 59...
... To inform such a study, the pairing of complex mathematical models with remote sensing data could be useful to correlate environment with disease outbreaks and more accurately predict future disease events (Ford et al., 2009)
From page 60...
... Traditional statistical methods (most often time-series and regression) are sometimes used to provide short-term predictions of infectious disease incidence, quantifying past trends, and projecting them forward (see Box 2-5)
From page 61...
... Louis encephalitis hemagglutination inhibition antibodies in wild birds, a hydrology model and a logistic regression model were combined to predict the incidence of human cases of St. Louis encephalitis, and these predictions were found to perform well looking 2 to 4 months ahead (Shaman et al., 2003, 2006)
From page 62...
...  GLOBAL SURVEILLANCE AND RESPONSE TO zOONOTIC DISEASES BOX 2-5 Predicting an Outbreak Anyamba and colleagues (2006, 2007) observed that sea surface temperatures in the equatorial east Pacific ocean increased anomalously during July to October 2006, indicating El Niño conditions.
From page 63...
... Dynamical mathematical models of disease transmission, in contrast to statistical models of trend or association, are better suited to longer term predictions and predictions of new and emerging threats. They also
From page 64...
... Mathematical models are valuable tools for policymakers, but are best used as one component of the decisionmaking process, which should draw on all kinds of evidence available. INTERNATIONAL AND NATIONAL SUPPORT IS CRITICAL Zoonotic diseases can transcend boundaries and affect multiple countries, thus the support of both the national and international community is critical for effectively responding to them.
From page 65...
... There are now weekly conference calls, and there is a stronger cooperation in the preparation of the strategy updates. The institutions work together in the preparation of Integrated National Action Plans.
From page 66...
... This flexible tool, with much lighter administrative requirements than normally demanded in FAO, provided FAO with the flexibility to respond early to the disease outbreaks. The lack of funds, however, caused the initial support that FAO provided in the affected and at-risk countries to be limited and restricted to strengthening disease surveillance systems, providing protective gear, and supporting epidemiological studies.
From page 67...
... To avoid lack of funds to control an emerging disease at an early stage, sustainable funding is needed for highly infectious zoonotic diseases. To foster cooperation at the national level, governments need to establish special permanent, functional cross-sector coordination mechanisms, either through the exchange of memorandums of agreement between the different ministries and agencies involved, or a coordinating authority (e.g., special task force)
From page 68...
... Data from surveillance systems are necessary for more accurately predicting future disease outbreaks. Accurately predicting or anticipating a disease outbreak enables local human and animal health authorities to implement prevention and control efforts, averting the need for costly emergency responses.
From page 69...
... 2009. AusAID assistance to combat avian influenza and other emerging and resurging zoonotic diseases -- Total commitments since 00.
From page 70...
... 2006. Impacts of animal disease outbreaks on livestock markets.
From page 71...
... 2009b. RFI Avian and Pandemic Influenza and zoonotic Disease Program RESPOND.
From page 72...
... 2008. CDC's role in preventing introduction of zoonotic diseases via animal importation.
From page 73...
... 2007. Modeling the relationship between food animal health and human foodborne illness.
From page 74...
... 2008. Global beef trade: Effects of animal health, sanitary, food safety, and other measures on U.S.
From page 75...
... A review of expert opinion on economic and social drivers of the wildlife trade and trade control efforts in Cambodia, Indonesia, Lao PDR, and Vietnam. Washington, DC: The World Bank.


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