Mind map

Disease Surveillance

Jess Pope AD2 BVSc3 English

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International organisations involved
- World Health Organisation of the United Nations (WHO)
  - UN’s coordinating authority on health
  - Sets agenda/policy, defines standards & norms, provides advice, technical support...
  - World Health Assembly- decision making body
    - Meets in spring once a year – decide on what WHO should focus on. Comprised of representatives of member states
  - Many initiatives on zoonoses, emerging diseases
    - MZCP (Mediterranean Zoonoses Control Programme)
      - Working on leishmania (sandfly → dogs and people)
    - GLEWS (Global early warning system for major animal diseases (4 including zoonoses)
      - Run with OiE and FAO
      - Look at ‘rumours’ → allow investigation to investigate
  - Largely human health, but also heavily invested in animal health as well (esp. zoonoses)
- Food & Agriculture Organisation of the United Nations
  - Mandate: defeat hunger
  - Est. 1943 (prior to UN)
  - 1962. Codex Alimentarius
    - 'Food Bible'
    - The definitive guide to standards and codes on all aspects of food
- World Organisation for Animal Health
  - Purpose
    - Inform members of world animal health situation
      - World Animal Health Information System
      - Relies on member states relaying info on disease
      - List of notifiable diseases:
        A & B lists of notifiable diseases
        A → need to be controlled e.g. FMD, swine fever
        B → important for trade, bTB, Aujeszky’s
        May 2004: single list
        B list was becoming eradicated – no longer a principal difference in the approach to the two lists
  - Structure
    - Each member has delegate
      - UK: CVO
        Nigel Gobbons – Chief Veterinary Officer
    - International committee
      - All delegates
      - Annual meeting
    - Numerous working groups, ad hoc committees
  - Office International des Epizooties
    - Jan 24th 1924
      - 1920s – Rinderpest outbreak in Belgium
      - OiE formed off the back of it
    - Paris
  - Renamed in May 2003, still called OIE
  - 178 Member states/territories
  - Key international organisation for animal health
  - Zoonoses (incl. food safety)
  - Animal health codes – standards on all notifiable diseases
GLEWS (joint with FAO, WHO)
- Global Early Warning System for Major Animal Diseases, including zoonoses
- Non zoonotic
  - African Swine Fever (ASF)
  - Classical Swine Fever (CSF)
  - Contagious Bovine Pleuropneumonia (CBPP)*
  - Foot and Mouth Disease (FMD)*
  - Peste des Petits Ruminants (PPR)
  - Rinderpest – Stomatitis/Enteritis
    - Eradicated in 2011
- Zoonotic
  - Anthrax
  - Bovine Spongiform Encephalopathy (BSE)
  - Brucellosis (B. melitensis)
  - Crimean Congo Hemorrhagic Fever
  - Ebola virus
  - Foodborne diseases
  - Highly Pathogenic Avian Influenza (HPAI)
  - Japanese Encephalitis
  - Marburg Hemorrhagic Fever
  - New World Screwworm
  - Nipah Virus
  - Old World Screwworm
  - Q Fever
  - Rabies
  - Rift Valley Fever* (RVF)
  - Sheep Pox*/Goat Pox
  - Tularemia
  - Venezuelan Equine Encephalomyelitis
  - West Nile Virus
- *diseases for which trend analyses and forecasting will be emphasized
European Food Safety Authority
- Risk assessment regarding food and feed safety
- Provide independent scientific advice
  - 8 panels
  - Expert working groups
    - ~ 4,000 scientists across Europe
    - Meet in Parma, Italy to discuss issues
National Surveillance
- Monitoring Systems
  - Monitoring of disease causing agents in human and animal populations carried out through Statutory Notification
  - Doctors in clinical practice and vets:
    - Statutory duty to notify appropriate authority/officer of:
      - All notifiable diseases diagnosed
      - Any suspected notifiable diseases
  - Vets at all levels – on farm or in the laboratory running tests – all must inform if a notifiable disease is suspected or confirmed
  - Notified Cases: Human Population
    - False negative – issues with sensitivity
    - False positive – issues with specificity, GP unaware that they needed to be reported
    - e.g. Campylobacter – suspected there are 10x more cases than are notified
- Statutory Notification: Man
  - Notification introduced in 1889 as a means of identifying and preventing spread of infectious disease
    - Cholera, smallpox, scarlet fever, typhoid fever and diphtheria
      - Smallpox used to be fatal
      - Cholera was a large issue in the 19th century
  - Agents which cause food-borne disease notifiable since 1949
    - E.g. E. coli, campylobacter
- Notifiable Diseases, UK: Man
  - Public Health (Infectious Diseases) Regulation, 1988
    - Encephalitis, polio, anthrax, diptheria, dysentery, leprosy, leptospirosis, malaria, measles, meningitis, mumps, paratyphoid fever, rabies, rubella, scarlet fever, tetanus, tuberculosis, typhoid fever, viral haemorrhagic fever, viral hepatitis, whooping cough, yellow fever
      - Malaria – imported now, but used to have endemic malaria in the UK
      - Smallpox eradicated, and therefore no longer on here. Only have it in a few labs for research purposes
      - Measles can cause encephalitis, and in some countries it can kill
    - Some differences in Scotland
  - Public Health (Control of Diseases) Act, 1984 (as amended)
    - Food poisoning (any agent, food and water)
    - Cholera
    - Plague
      - Cholera and plague are still causing outbreaks in the world
    - Relapsing fever
      - Ticks
    - Smallpox
    - Typhus
    - Amendment requires notification of any condition that might pose threat to public health
      - Something new/unfamiliar that the government may need to take action on
    - Ireland
      - Bacillary dysentery, nvCJD, all food poisoning organisms
        nvCJD – new form of BSE
    - Spain
      - Botulism, Shigellosis, Trichinosis (trichinella)
    - France
      - Botulism, listeriosis
        Easily transmitted by eating soft cheeses – a lot of soft cheese in France
    - USA
      - Botulism, Giardia, Hepatitis, E. coli O157, Listeriosis, Salmonellosis, Shigellosis, Trichinosis
        E. coli - Hamburger disease
- Disease Monitoring: Man
  - Notifications from doctors – symptoms or lab reports
  - Consultant in Communicable Disease Control
    - Look at what needs to be done
  - Laboratory reports from clinical labs confirming agent
  - PHE- Centre for Infections (CfI), Colindale
  - Base for communicable disease surveillance
  - Advise Department of Health on action required to address emerging threat
  - Public Health England (PHE, formerly Health Protection Agency):
    - Will receive information on cases of disease caused by agents via food and water
    - Collate findings, publish trends on HPA website (http:www.hpa.org.uk) and in Health Protection Report (HPR) each week
    - Information also collated by Office of National Statistics
    - Information from surveillance of FBD outbreaks also sent to European Food Safety Authority (EFSA) annually
      - Annual reports produced on the basis of this information
- European coordination
  - Eur. Centre for Disease Prevention & Control (ECDC):
    - Based in stockholm
  - Programme on food and waterborne diseases and zoonoses:
    - Anthrax, botulism, brucellosis, campylobacteriosis, cholera, cryptosporidiosis, echinococcosis, giardiasis, hepatitis A, leptospirosis, listeriosis, salmonellosis, shigellosis, toxoplasmosis, trichinellosis, tularaemia, typhoid/paratyphoid fever, variant Creutzfeldt-Jakob disease (vCJD), VTEC/STEC (verotoxin/shigatoxin producing E. coli) infection, and yersiniosis.
  - Coordination of surveillance, prevention, knowledge etc
- Animal Health (DEFRA)
  - Key government department for surveillance of animal health
    - Run post mortem labs etc.
    - CVO is within DEFRA
  - 2003: 10 year UK Veterinary Surveillance Strategy
  - Coalition: merged with Veterinary Laboratories Agency → AHVLA
  - 2014: merged with plant health agency → Animal and Plant Health Agency (APHA)
- RADAR
  - Information from e.g.:
    - Agricultural holdings, land and livestock data from UK government databases;
    - Animal health data from private veterinary surgeons and animal owners;
      - Livestock industries
    - Companion animal data, including that collected by the PETS travel scheme, and horse passport registrations;
    - Information on carcass condemnations and throughputs from abattoirs;
      - This use of information could still be improved
    - Diagnostic data from veterinary laboratories;
    - Information on the number of fallen stock consigned for destruction
    - Meteorological information from the Met Office.
      - Very important for certain diseases e.g. FMD can be carried certain distances in the wind (+ classical swine fever) – enough to be blown to the UK from Europe
  - Rapid Analysis & Detection of Animal Associated Risks
  - IT tool for collation, management and analysis of the numerous and varied surveillance reports
  - Includes detailed info on number and location of animals in UK
    - Proved key failure during 2001 FMD outbreak
- DACTARI
  - Dog & Cat Travel and Risk Information:
  - Voluntary reporting scheme
    - Aimed at practicing vets
  - Focus on
    - Leishmaniasis (zoonotic, sand fly vector)
    - Babesiosis (tick borne)
      - Anaemia (related to malaria in humans)
      - Don’t know if we have it in the UK, but we have it in the database
    - Ehrlichosis (Rickettsia, tick borne)
      - Fever in small animals
    - Dirofilariasis (heartworm, mosquito vector)
      - Mostly tropical, quite regular in imported animals
      - Brought into/back into the country
  - Doesn’t seem to have been hugely successful as a scheme
  - PETS → under PETS scheme, legally travelled there
    - V. influential
  - Quarantine → pet scheme not allowed for animals from these countries
- Acarus Lab
  - Mostly focuses on tick/insect bourne diseases, run by the University of Bristol
  - To provide a rapid diagnostic service for a number of arthropod-borne microbial diseases in companion animals, specifically: Babesiosis, Bartonellosis, Borrelliosis, Ehrlichiosis and Leishmaniasis
  - To develop novel methodologies for the rapid identification of specific micro-parasites
    - e.g. PCR
  - To develop research projects addressing the prevalence, ecology and epidemiology of these disease in the UK
  - To raise awareness amongst veterinary practitioners on the subject of arthropod-borne diseases
    - Climate change – will see a rise in vector bourne diseases
  - To establish a focus for the dissemination of information on these diseases for the scientific community
  - Non-profit
  - PCR based
  - 24hr turn around
Animal-Human Disease Interface
- Major concern – novel/emerging diseases
  - Animals major reservoir/origin
- ONE HEALTH
- ‘Horizon scanning’ encompasses animal and human disease reports
- Human Animal Infection and Risks Surveillance Group (HAIRS)
  - Public Health England, DEFRA, APHA, DoH
  - Scans outputs from wide variety of sources to identify novel disease occurrences in animals and humans that may pose threat to public health
  - Produces monthly report, disseminated to various bodies
  - National Expert Panel on New and Emerging Infections
  - Putbreak – HAIRS come together to discuss whether it is of concern for the UK
Global trends in emerging infectious diseases (EID)
- Agents
  - Bacteria: 55%
    - Drug resistance prime factor
    - Tends to be known bacteria, resistant to drugs e.g. multidrug resistant TB from India
  - Virus, prion: 25%
  - Protozoa: 10%
  - Fungi: 6.6%
  - Helminths 3.3%
- Zoonoses
  - 60% of events
    - 72% of these - wildlife origin
      - E.g. Nipah virus, SARS
  - Increasing incidence over time (52% of events in 1990’s)
  - The proportion of zoonotic diseases is increasing, has risen to 75% from 60% in the 1940s
- Vector-bourne
  - 23% of events
    - ~29% 1994-2004
    - Increasing incidence
      - Appearing in areas they haven’t been before (looking for it?)
    - Climate change
- Temporal trends
  - Increasing incidence of emerging infections?
  - Taking into account reporting bias (temporal and geographical)
- Other patterns
  - EID concentrated in higher latitudes
    - Cf human pathogen species richness
  - Hotspots: NE USA, Japan, SE Australia, W Europe (↑ density of people and international travel)
    - Socio-economic drivers (pop density, drug use, agricultural practices)
    - Zoonoses from wildlife correlate with wildlife biodiversity
    - Drug resistant EIDs correlate with socioeconomic factors
    - Also political factors – ease of buying antimicrobial factors
      - Easy – rapid development of resistance
      - Hard - slower development
  - Zoonoses from wildlife & vector borne disease are concentrated in lower latitude, developing countries.
  - Most surveillance & research in rich, developed countries
  - Planet poorly equipped for early warning of emerging diseases?
- Emerging infectious disease events 1940-2004
  - Infections due to new strain of pathogen (e.g. multidrug resistant strains)
  - Appearance of pathogen in humans (e.g. HIV-1, SARS)
    - That have never been seen in humans before
    - SARS = Southern Avian Respiratory Syndrome
  - Increased incidence of disease (e.g. lyme disease)

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Description: BVSc3 AD2 (Public Health) Mind Map on Disease Surveillance, created by Jess Pope on 09/01/2017.
Created by: Jess Pope
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Disease Surveillance

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