Role of Veterinarians and One Health Professionals in Preventing Zoonoses
- Dr Sayan Bhattacharyya
Associate Professor, Microbiology, AIIH&PH, Kolkata, India.
Abstract: Zoonoses are often neglected but can be major killer diseases of animals and man. Veterinarians are the first responders in case of zoonoses. However, now with the advent of one health, people like Doctors, nurses and paramedical personnel are also working in tandem to prevent zoonosis for a better animal and human health. In this article the author has tried to surmise available information about this.
Keywords: Zoonoses, veterinarians, one health.
Introduction: Zoonoses are infections that are commonly transmitted from vertebrate animals to man. They can lead to economic losses and also add up to the costs of healthcare and increase healthcare admissions. Quite naturally, zoonoses should demand attention from public health stakeholders. Veterinarians generally detect and diagnose zoonoses and also investigate the cases for better public health (1). Veterinary public health(VPH) is a very important stream of public health but somewhat neglected in India. One health(OH) is also a new upcoming branch which needs to be recognized more. It treats human health, animal health and environment as part of the same spectrum and postulates that they are interdependent. Rabies, Bird flu, Brucellosis, Leptospirosis and Anthrax are important zoonotic diseases widely prevalent in India and other tropical countries. These infections highlight the need of a conjoined effort of Veterinarians and one health professionals to better the clinical outcome. COVID 19 is also a good example of how failure to control zoonoses by timely and apt one health and public health measures in one particular area can lead to a raging pandemic.
Role of veterinarians in one health to prevent zoonoses: Veterinarians definitely play a crucial role in generating awareness about emerging and existing zoonoses. They can work in tandem with Epidemiologists to monitor outbreak of zoonoses (1). They can also help manging the proper storage of biological products like animal drugs and vaccines and medical devices. State Veterinarians working in the Department of agriculture can help in protecting the livestock, poultry, and aquaculture industries directly, and also indirectly the public, via prevention, early detection, containment, and eradication of economically important livestock, poultry, and fish diseases. These diseases, in many cases can be transmissible to humans(1).
Especially in case of Rabies , both veterinarians and one health professionals like Doctors, Microbiologists , Laboratory scientists and nursing experts can help generate public awareness about prevention of Rabies along with Government who can formulate policies(2). They can guide people about the need of pre and post exposure prophylaxis for Rabies. Veterinarians can help in managing the biting canine/dog and help in its monitoring. They can also play a key role in Rabies prevention by vaccinating stray dogs in urban and peri-urban areas. Municipal corporations can also work hand in hand with veterinary service providers for registering the number of stray dogs in an area and their neutering or sterilization. Since there is no effective treatment in Rabies, post exposure prophylaxis by vaccination and Human Rabies Immunoglobulin have to be administered depending on the type of injury. Doctors, nurses and laboratory people can guide people in this aspect.
In case of Avian Influenza or bird flu caused by H5N1 Influenza virus, veterinarians should promptly demarcate the area of infected zone and start culling and burial activities along with municipality workers(3). These works should be done with utmost caution, preventing new movement within or outside the group actively involved in culling. One health professionals including Doctors and Nurses should generate awareness about bird flu in the local population and ensure their cooperation by telling them not to consume eggs and meat in the immediate vicinity.
In case of possible bioterrorism attack by Bacillus anthracis spores, similar concerted approach is needed between veterinarians and one health promulgators. Improved laboratory facilities are also needed for diagnosing Anthrax.
COVID-19 , caused by SARS-CoV2 or novel Coronavirus is also a zoonosis. It spread in December 2019 via bats and pangolins to man, in Hubei, China. Now it is spreading rapidly from man to man as a full fledged pandemic. Other Coronaviruses are also set to emerge, given the abundance of open wet animal markets in that area. Hence veterinarians along with clinicians should play a crucial role in managing these emerging zoonoses.
How to prevent zoonoses: Many zoonoses arise from illegal trade of animal and also improper handling and slaughter of diseased animals. Prion disease like Bovine spongiform encephalopathy, CJD and vCJD can be prevented by preventing slaughter of old diseased cows and segregating the meat and neural tissue, eye which are specific risk materials (SRM) (4). Strict laws and policies are needed to prevent unlawful slaughter of old or diseases animals. Government policies are needed also to manage zoonoses. The NCDC (National Centre for Disease Control), under ministry of Health, Government of India, is running different programmes like Inter-sectoral Coordination for Prevention and control of Zoonotic Diseases.(ISC), National rabies control programme(NRCP) and Programme for prevention and control of leptospirosis ( PPCL ) for managing various zoonoses in India(5).
Role of one health professionals in controlling zoonoses: Doctors, veterinarians, nurses and paramedics all can form a team and practice one health. About 75% of all emerging infections and 60% of existing infectious diseases worldwide are zoonoses(6). Hence zoonoses are the most important critical risk factor for human health; so one health naturally becomes very important here. One health is formally defined by the One Health Commission as the collaborative effort of multiple sectors or disciplines to obtain optimal health for people, animals, and our environment (7). The environment also plays a pivotal role in spreading zoonoses from animals to man. The community model health system needs to be strengthened in OH and more new tools need to be devised and implemented by one health practitioners for preventing zoonoses. Utilizing and mobilizing resources and more online courses are also needed in one health in order to prevent zoonoses.
One health concept is deemed to be very important for proper control of Rabies in countries like India and Nepal which still report a high number of cases and deaths due to the infection. A Multi-sectoral One Health Approach can ensure participation of people from all strata of society and help in generating awareness in the masses about Rabies, and also ensure proper vaccination and post exposure prophylaxis. It can also enhance laboratory facility to detect Rabies. The One Health concept, in this case requires close coordination between animal and human health sectors at the national, regional and continental levels for control of Rabies(2). A successfully executed one health approach can also take in its stride the various complex socio-economic, environmental, animal, and human factors to be considered for controlling Rabies(8). It also needs a robust surveillance system and strong and meticulous data collection, compilation and case reporting. Such an approach has been very successful in mitigating Rabies-related mortality in Bhutan and Bangladesh.
For preventing and controlling the COVID-19 Pandemic also, one health concept should have been important. Since the outbreak of closely related SARS Cov1 virus infection in 2003, one medicine or one health approach has evolved rapidly. The foundation of the OH approach is said to consist of 3 key elements: communication, coordination, and collaboration. Bodies like WHO, various health organizations and national governments are working together for formulation and implementation of stringent OH policies including laws and penalization for successful application of One Health idea in COVID-19. Measures like social distancing, frequent hand washing and wearing face masks while venturing outside are relevant and significant here(8). With more and more psychosocial problems surfacing in the wake of the current COVID-19 pandemic, psychiatrists and psychologists also need to be integrated in the one health set up for controlling COVID-19 and its aftermaths(9).
Recently, India has reported its first death due to Avian influenza. Obviously, one health concept is now very important in controlling Bird flu or Avian influenza also. By improving bio-security, active surveillance, poultry vaccination and by measures like segregating ducks and geese from poultry, emergence of new genetic reassortments can be prevented. New policies need to be formulated and updated regularly as well for keeping Bird flu in check(10). One health concept is important here.
Leptospirosis is another zoonotic disease caused by Leptospira spp., a spirochaete, which urgently needs a One health viewpoint. Rodents, rice fields and rainfall are epidemiologically very important for spread of the infection. It is very common in developing countries and its prevalence is grossly underestimated. Various sectors like Health sector, agriculture and others need to be integrated via One Health to diagnose cases accurately, properly control rodents and stop spread of the infection(11).
Coordinated approach: Coordination and cooperation are the pillars of OH. A positive mindset is earnestly needed among all stakeholders , with the zeal for doing new work and new research, which can boost coordination between Doctors, nurses, Microbiology professionals and veterinarians and improve management of zoonoses. These four groups of people need to understand the importance of one health in this aspect and need to coordinate with each other in surveillance and reporting..
Requirement of funds:
More funds need to be channelized for research and other activities related to prevention of zoonoses. This will help in devising new tests for diagnosis, new vaccines and also new therapeutic approaches. Advanced laboratory equipment like Biosafety level 4 facilities are sometimes needed for diagnosing zoonoses like Anthrax in laboratories and hence the need of ample funds. Also, sometimes ex-gratia payments need to be made to the traders and meat sellers to prevent and stop wet markets from operating in order to prevent Bird flu and emerging Coronaviruses, and Governments can play a significant role here(10).
Requirement of research: More research needs to be diverted towards detection of emerging zoonoses and also for finding out new effective diagnostic tests and vaccines for preventing these zoonoses. Hence new Research departments can be opened in Institute level and also ministry level for addressing this issue.
Development of one health concept in India: Countries like Ethiopia, Tanzania, Nigeria and India report the highest number of Zoonoses in the World. In India alone, 2.4 billion cases of human diseases and 2.2 million deaths per year are attributed to 13 types of zoonoses(12). Human health and medicine is given a lot of emphasis in India, but animal husbandry sector lacks monitoring and surveillance and hence zoonoses can often be missed(12). So, in India the One health idea is slowly gaining recognition from public health professionals, veterinarians, health-care providers, policymakers, and researchers. Avian flu, Rabies and Bovine Tuberculosis are the major zoonoses in India that require management by OH approach (13). However, viral zoonoses and vector-borne zoonoses like Scrub Typhus are also widely found in India(12). The Government is trying to devise a formal set up and Department of One Health for looking into this. However first the collaboration and coordination among the various stakeholders need to be improved for implementing a successful One Health programme. The Indian Council of Medical Research (ICMR) has held many symposia and workshops to promote OH in India and published special OH issue in its journal(14). The ICMR and ICAR (Indian Council of Agricultural Research) has decided to jointly set up a National Institute of One Health in Nagpur, Maharashtra for better practice of One Health in the country(15).
Conclusion: Zoonoses add to the disease burden in humans and can also lead to huge economic losses. Brucellosis, Bovine Tuberculosis, Leptospirosis, Rabies and Anthrax are important zoonoses widely prevalent in India and other developing countries. In India and in other countries, a large human and animal population leads to contact and conflicts between animals and man(12). Role of Veterinarians and One health practitioners hence assumes importance here. A concerted and coordinated approach is the need of the hour for management of zoonoses, and to prevent emergence of new zoonotic infections. This can be achieved by a well-planned OH approach in which Veterinarians, clinicians, Epidemiologists, laboratory scientists and nursing professionals have a very important role to play. A fruitful OH approach also needs robust public health facilities, trained frontline workers, IEC activities, early diagnosis, treatment, prevention, control and management of zoonotic diseases. New upcoming institutes can spread further this idea of OH involving animals, human, wild life and environment, by providing inter-sectoral and inter-disciplinary cooperation and coordination for better surveillance, response, research, capacity building and advocacy or communication(15). This is needed for timely prevention and control of zoonotic diseases.
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