HEALTH - Global Pandemics: What Puts us at Risk?

(World Health Organization)

Although pandemics are not a new phenomenon even for modern humans, the risks are increasing.

SARS, Ebola, Swine and Avian Flu, Zika – global health challenges have been mounting, and the next crisis-level pandemic will likely come from an unexpected source, and will hit with unprecedented force.

Although vaccination and hygiene mitigate the risk, other factors exacerbate it.

Travel is one of the biggest issues, particularly air travel. Humans travel faster than they ever have before, and across greater distances.

Infections can be carried from one population to another population in a different part of the world before the carrier even knows that they’re sick.

However, travel is not inherently an issue – pre-colonial Africans travelled widely, but had precautions in place to prevent the spread of illnesses.

One of their most effective strategies is simply no longer an option - spreading people out, so that one group of infected people would not result in an entire population being exposed.

This changed with colonization, and today global urbanization and population density pose some of the greatest risks.

It is not feasible to quarantine people with enough time and enough distance to prevent the spread of infectious diseases, and becoming less feasible by the year.

The UN estimates that over half the global population will live in urban areas by 2050.

Global inequality is another major risk factor, in a few different ways.

Civil unrest leaves countries vulnerable to an outbreak by putting exceptional strain on their resources and infrastructure, and countries are more likely to experience conflict when they are struggling economically.

Civil unrest is also contagious itself, meaning that the spread of conflict and the spread of disease can go hand-in-hand.

Global inequality also means that the regions most likely to experience an outbreak are also least likely to attract and retain qualified medical staff.

There are better prospects elsewhere, and qualified medical staff are unlikely to stay in impoverished countries where there is neither the compensation nor the infrastructure to support their work.

Referred to as “brain drain,” this migration of health workers has been an issue since the early 20th century.

However, it is not only the behaviour of humans that contributes to this current escalated threat level.

Zoonotic diseases are also a significant source of threat, even more urgently than they have been in the past.

Both Zoobiquity and the One Health Initiative aim to take a holistic view of human and animal health, recognizing and responding to zoonotic threats – those diseases that can jump the species barrier.

Until now, most of the concerns around zoonotic diseases have been with those diseases that move from animals to humans, such as swine and avian flu, ringworm and other parasites (including rat lungworm disease), and rabies.

Recently, a vet contracted avian flu from a cat – demonstrating just how easily some diseases hop between species.

But the recent rise of reverse zoonotic diseases is a growing concern.

Not only are animals at risk from reverse zoonoses, but humans are also at increased risk of both reinfection from their infected pets, and also of mutated and potentially more harmful diseases that cross back into the human population.

A study in 2006 concluded that MRSA was able to transmit back and forth between pets and humans, making treatment difficult and lengthy.

Finally, when discussing global health, it’s impossible to ignore the state of the globe itself.

Climate change is a factor in the rising risk of a global pandemic.

Heat waves and flooding are providing more opportunities for waterborne and mosquito-transmitted diseases in new locations.

Climate change also exacerbates the risk of civil unrest, and the pressure on urban locales.

These escalating shifts will continue to open up new risk areas, and governments and other agencies will need to keep up.

About Tiffany Sostar

Tiffany is a published academic, an editor with the Editors Association of Canada, an independent scholar and researcher, and a self-care and narrative coach. She is particularly interested in the intersection of technology and identity - how our tools shape our selves and change our stories, and in how the nature of work is changing as we incorporate more technology into our daily lives. 

HEALTH - Globalization and Disease: It's Always the Rats on the Ship

Wherever humans travel, we bring diseases with us and then leave them behind as parting gifts, often carrying new diseases back home in trade.

European colonizers infamously brought smallpox and other deadly diseases around the world with them (sometimes even using germs intentionally during warfare).

Europe itself was ravaged by the bubonic plague when humans provided transport to rodents and fleas from Asia, and that disease had a long history of hitching a ride with human travelers.

Asia and the Middle East had suffered multiple outbreaks before it arrived in Europe.

The global spread of disease has not stopped, despite efforts to mitigate the risk.

Air travel has introduced a new method of disease transport and mosquitoes on international flights have brought malaria to previously uninfected countries.

But just because airplanes provide a new way for diseases to spread doesn’t mean ships have lost their relevance when it comes to the global migration of diseases.

Rat lungworm disease is caused by a parasitic worm that, when introduced to humans, invades the human brain.

It is spread primarily through rats that travel on cargo ships.

Once in the brain, the parasite causes bleeding, swelling, and even death. ­­­­The worm is carried by rats, and also found in slugs and snails.

The disease was first recorded in humans in Taiwan in 1944, and it has been present in Asia and the Caribbean since then.

Recently, though, it’s become endemic in the United States, showing up in Hawai’i, California, Alabama, Louisiana, Florida, and along the Gulf Coast.

A 2013 study found that the geographical distribution of the disease had changed significantly over the course of a few decades.

There have been nine confirmed cases of rat lungworm disease in Hawai’i in 2017, as of April 12. There are also four suspected cases being explored currently.

These numbers may be low, though, because in other parts of the United States where the disease is present but less common, doctors may not be watching for it.

And, even if they were watching, there is no simple blood test.

Rat lungworm disease is not an epidemic, and may not become one in the near future.

Humans are not ­the target of the parasite, and when a human is infected it is just as catastrophic for the worm as it is for the human – there is not currently a way for the worm to get back out of the brain once it crosses the blood-brain barrier, and the parasite dies inside the human.

However, rat lungworm disease has proven itself to be highly adaptable, and a 2015 study found that the parasite was able to find new viable hosts that allow it to spread to new geographical locations.

Although Hawai’i has seen a significant spike in infections among humans, the numbers remain low.

However, the fact that the disease is continuing to spread and is proving to be persistent even in areas thought to lack a suitable environment for the parasite, is concerning.

Even if rat lungworm disease isn’t the next catastrophic epidemic, something will be.

Climate change, deforestation, global travel, economic instability and the ensuing civil unrest, and changes to funding from wealthy countries for health initiatives in impoverished countries are all contributing to a perfect storm for a global health crisis.

The next article in this series will examine these factors in more detail.

 About Tiffany Sostar

Tiffany is a published academic, an editor with the Editors Association of Canada, an independent scholar and researcher, and a self-care and narrative coach. She is particularly interested in the intersection of technology and identity - how our tools shape our selves and change our stories, and in how the nature of work is changing as we incorporate more technology into our daily lives. 

HEALTH - Experts Predicting Risky Year for Lyme Disease in NE United States

With spring just around the corner, veterinarians and ecologists are beginning to warn about ticks and Lyme disease.

The Canadian Veterinary Medical Association (CVMA) has declared March National Tick Awareness Month.

According to their press release, many people don't know one very important fact about ticks: they don't mind cold weather.

In most parts of Canada, tick activity begins when the snow starts to melt and, depending on the tick species, can continue well into late fall.

For example, black-legged ticks that can transmit Lyme disease start looking for animals to feed on when it’s 4°C outside.

“National Tick Awareness Month is a rare opportunity for us to educate and empower pet owners, so we can work together to help prevent the spread of tick-borne diseases that can affect the health of pets and people,” said Dr. Troy Bourque, CVMA President.

Felicia Keesing, an ecologist at Bard College and Rick Ostfeld, an ecologist at the Cary Institute of Ecosystem Studies in New York, are predicting 2017 will be a particularly risky year for Lyme in the Northeast United States.

Why?

Because the Hudson River Valley experienced a mouse plague in 2016 with an overwhelming number of the critters.

Having studied Lyme disease for more than 20 years, Keesing and Ostfeld have developed a system to predict how many cases there will be a year in advance by counting the mice the year before.

They have found that mice are very good at transmitting Lyme and are responsible for infecting the majority of ticks carrying Lyme in the Northeast.

"An individual mouse might have 50, 60, even 100 ticks covering its ears and face," Ostfeld told NPR.

There was an increase in ticks and Lyme disease in 2016, and it appears that may be the case again this year.

Ticks and their carriers, like mice, live in wooded or bushy areas with high grass or leaf litter.

To reduce the chances that a tick will transmit disease to you or your pets the CDC recommends the following:

• Check your pets for ticks daily, especially after they spend time outdoors.
• If you find a tick on your dog, remove it right away.
• Ask your veterinarian to conduct a tick check at each exam.
• Talk to your veterinarian about tickborne diseases in your area.
• Reduce tick habitat in your yard.
• Talk with your veterinarian about using tick preventives on your pet.

You can find more information about preventing tick bites on the CDC website.

HEALTH - Second Rabid Cat Found in Ontario

On February 6th, a cat infected with rabies was reported in Ontario.

This is just the second reported case of rabies in a domesticated animal in the province in 20 years.

The city of Hamilton Public Health Services is asking anyone who may have lost, abandoned, fed, or came in contact with a male adult orange tabby cat in the area bounded by Rymal Road to the north, 5th Line to the south, Fletcher Road and Harrison Road to the east, and Pauline Johnson Road to the west between Sunday, January 22 and Monday, January 30, 2017 to contact their local health unit to determine whether or not they need rabies post-exposure vaccine.

The city believes the two feline rabies cases are likely related to the resurgence of raccoon rabies in the area.

The Canadian Food Inspection Agency is conducting tests to determine if this cat is related to the raccoon strain of rabies currently circulating in the wild animal population and results are expected next week.

To protect people and their pets the city is recommending:

• Avoid contact with live or dead animals including raccoons, skunks, bats, as well as unknown dogs and cats. Do not feed, help, or relocate any wildlife of keep them as pets.
• Vaccinate pets against rabies, and keep rabies vaccinations current for dogs and cats to protect them, and prevent any spread to people.
• Report animal bites and scratches to public health by calling 905-546-CITY (2489). Wash wounds with soap and water, and seek medical attention.
• Report sick, injured, or strange behaving wildlife to City of Hamilton Animal Services by calling 905-546-CITY (2489)

As at February 1st, the Ontario Ministry of Natural Resources and Forestry reported a total of 277 raccoon strain rabies cases and six fox strain since the outbreak began in December of 2015.

This is 14 new cases in 2017 and does not include the cat discovered this week.

The majority of incidents are raccoon strain rabies:

Raccoons: 187 cases

Skunks: 85 cases

Fox: 1 case

Cat: 1 case

Llama: 1 case

The province has tested over 4,800 animals for rabies and continues to rely on vaccine baits to help control the spread of the disease.

HEALTH - Two New Canine Flu Vaccines Developed

It’s flu season and not just for humans - dogs get the flu too.

To combat canine influenza, scientists at University of Rochester School of Medicine and Dentistry have developed the two new vaccines.

Currently veterinarians use vaccines that include inactivated or killed flu virus, but experts say they provide short-term, limited protection.

The new vaccines are “live-attenuated”  and work against H3N8 canine influenza virus, which is currently circulating in dogs in the US, along with the H3N2 virus.

Past research shows that live-attenuated vaccines, made from live flu virus that is dampened down so that it doesn’t cause the flu, provide better immune responses and longer periods of protection.

Scientists, led by Luis Martinez-Sobrido, Ph.D., used a genetic engineering technique called reserve genetics to create a live vaccine that replicates in the nose, but not in the lungs.

The nose is where the virus first enters a dog’s body, so generating an immune response there could stop the virus in its tracks.

The study found the vaccine was safe and able to induce better immune protection against H3N8 canine influenza virus in mice and dog tracheal cells than a commercially available inactivated vaccine.

To develop the second vaccine the team used reserve genetics to remove a protein called NS1 from H3N8 canine influenza virus.

Previous studies have shown that deleting the NS1 viral protein significantly weakens flu viruses so that they elicit an immune response but don’t cause illness, and this process has been successfully used for humans, horses and more.

The next step is clinical trials with dogs.

The team’s goal is to come up with new options to stem the spread of canine influenza in shelters and kennels, and to avoid the transmission of a dog flu virus to people.

According to the CDC there has been no evidence of transmission of canine influenza viruses from dogs to people and there has not been a single reported case of human infection with a canine influenza virus.

“However, influenza viruses are constantly changing and it is possible for a virus to change so that it could infect humans and spread easily between humans.”

This potential was recently illustrated when a veterinarian contracted avian flu (H7N2) through contact with a cat - the first time cats had gotten avian flu and first time it was passed to a human via a feline.  

By preventing dogs from getting the flu in the first place, the risk to humans in negated.

Canine influenza H3N8 virus originated in horses and has been known to exist in horses for more than 40 years.

The first canine infections were discovered in 2004 in greyhounds.

Symptoms include cough, runny nose and fever, but not all dogs will show signs of illness.

The severity of illness associated with canine flu in dogs can range from no signs to severe illness resulting in pneumonia and sometimes death.

HEALTH - More Rabies Cases in Ontario

The province of Ontario has been combating a rabies outbreak with the distribution of over 800,000 oral vaccines.

This week the Ministry of Natural Resources and Forestry reported three new rabies cases - two raccoons and one skunk, all with raccoon strain rabies.

This brings the total to 152 cases of raccoon strain rabies and 2 cases of fox strain rabies cases since December 2015.

Over 3,500 animals have been tested for the disease this year.

HEALTH - One Health Initiative: Uniting Human and Animal Medicine

With outbreaks of diseases such as avian flu, swine flu, and Ebola, there has been increased awareness of the risks associated with zoonotic diseases. (Zoonotic diseases are any diseases that can spread from animals to humans.)

 

Researchers are looking into how these diseases cross species barriers, spread through populations, and are impacted by environmental factors.

New research has made it clear that effective health management requires a holistic and integrated understanding of disease development and spread.

Each of the various disciplines involved – veterinarians, physicians, molecular biologists, ecologists, environmental chemists, and others – are better able to respond to existing and emerging concerns when they collaborate with each other.

The United States Department of Agriculture has taken a “One Health” approach for some time, meaning that they view human, animal, and environmental health as connected. In a recent blog post they state that health issues must “be solved through improved communication, cooperation, and collaboration across disciplines and institutions.”

As a step towards this communication, cooperation, and collaboration, they have recently launched a centralized web portal page to allow everyone, from stakeholders to the public, to access up to date information on programs, policies, and current issues.

Some of the topics that the USDA believes require a One Health approach are antimicrobial resistance, avian influenza, and influenza in swine.

Each specific topic is addressed in detail on the new site, with overviews, resources, and even links to information about research funding options.

The USDA partners with US Fish and Wildlife, US Food and Drug Administration, The Centers for Disease Control and Prevention, the National Institutes of Health, the Environmental Protection Agency, and tribal Nations, as well as working internally with each of its many branches.

The USDA’s One Health portal site is an important step for American integrative health management, and the concept of cross-discipline collaborative health management is gaining traction globally.

The One Health Initiative is a global initiative that also hopes to expand interdisciplinary collaboration for human, animal, and environmental health. Their website has been active since 2008, and although the One Health Initiative is separate from the USDA’s One Health portal, they also work with organizations such as the CDC and the USDA.

Other global initiatives include One Health Sweden, which works to integrate research about zoonotic infections from various disciplines, and the One Health Congress, which first met in February 2011 in Melbourne, Australia and has met every year since.

By Tiffany Sostar

Tiffany is a writer, editor, academic, and animal lover who came late to her appreciation of pets. At 18, a rescue pup named Tasha saved her from a depression and she hasn't looked back. She has worked as the canine behaviour program coordinator for the Calgary Humane Society, and was a dog trainer specializing in working with fearful and reactive dogs for many years. She doesn't have any pets right now, but makes up for it by giving her petsitting clients (and any dogs she comes across on her frequent coffee shop adventures) extra snuggles.

HEALTH - 6 Months in and Ontario Still Seeing Rabies Cases

Since the first rabies case was discovered in December 2015, 3,200 animals have been tested for the disease and over 800,000 oral vaccines have been distributed in Southern Ontario.

The Ministry of Natural Resources and Forestry has been aggressively fighting the outbreak and reports 134 cases of raccoon strain rabies and two fox strain to June 30th.

Of the raccoon strain cases, 122 have been discovered in Hamilton, five in Haldimand, four in Niagara and three in Brant.

The disease has infected 89 raccoons and 45 skunks.

Pet owners are encouraged to make sure their pets are up to date on their rabies vaccinations - which is required by law in the province.

In Canada the most common carriers of rabies are raccoons, skunks, foxes and bats.

Rabid animals may be extremely excited, attack objects or other animals, froth at the mouth, or bite at anything. 

HEALTH - Vaccine Debate Part Three: Herd Immunity and the Future

The concept of “herd immunity” - or community immunity when talking about human populations - describes the way widespread immunity from diseases protects the entire population.

Vaccination is currently the best way to achieve community immunity, because it is the safest and most effective way to immunize the greatest number of individuals.

Mass immunization works by reducing the number of available host bodies for the infection, and it can act as a shield for individuals who are not able to receive vaccination and are therefore vulnerable.

Among the human population, these vulnerable individuals may include people with severe allergies to a component of the vaccine, pregnant people, or people who are ill.

Among the pet population, older animals, sick animals, or animals with allergies might not be good candidates for vaccination.

Mass immunization can protect these vulnerable individuals by preventing outbreaks from finding a way into the population. This is called indirect protection, and in the case of pneumococcal and Haemophilus infections in humans, indirect protection reduced the diseases among people too old to be vaccinated, and dropped the total incidences of the disease by one- to two-thirds, according to Stanley Plotkin’s “Herd Immunity: A Rough Guide.”

I = Immunized

NI = Not Immunized

Orange boxes indicate the spread of the infection, and light green boxes indicate instances of indirect protection. This chart does not demonstrate the mathematical formula for determining herd immunity threshold, but it does demonstrate how community immunity works to protect the population.

What is the result of the increase in vaccine hesitancy among parents and pet owners?

It’s tough to say, but it doesn’t look good.

Research has found that where pertussis (whooping cough) vaccination rates have declined due to vaccine hesitancy and fears about vaccine safety, rates of infection have climbed by 10- to 100-times higher than in populations that still accept the vaccine. Recent outbreaks of measles also point to the risks of reduced community immunity.

The impacts of vaccine hesitancy among pet owners are much harder to track.

Pet owners are not required to vaccinate their pets, vaccine refusals are not tracked or monitored in pets like they are in children.

A study looking at the 1991 outbreak of canine distemper in Copenhagen found that the majority of infected dogs were not vaccinated. Distemper is a serious and highly contagious disease and widespread vaccination is one of the best ways to keep pets safe.

Vaccine hesitancy is not new, and likely not going away, as discussed in Part Two of this series.

Fortunately, vaccine science is developing in new and exciting directions.

New types of vaccines, such as live recombinant vaccines and DNA vaccines, are being developed. DNA vaccines are particularly revolutionary, have the potential to offer increased vaccine stability, and do not require the presence of an infectious agent (a concern that has contributed to vaccine hesitancy).

New vaccine delivery methods for humans include needle-free vaccines and Nanopatch technology that delivers vaccines to cells just below the skin surface.

With new outbreak prediction models available, new delivery methods, and new vaccine protocols being developed that take into account pet owner concerns about over-vaccination, hopefully levels of community immunity can remain high among people and pets.

By Tiffany Sostar

Tiffany is a writer, editor, academic, and animal lover who came late to her appreciation of pets. At 18, a rescue pup named Tasha saved her from a depression and she hasn't looked back. She has worked as the canine behaviour program coordinator for the Calgary Humane Society, and was a dog trainer specializing in working with fearful and reactive dogs for many years. She doesn't have any pets right now, but makes up for it by giving her petsitting clients (and any dogs she comes across on her frequent coffee shop adventures) extra snuggles.