Summer 2024 One Health Newsletter one health Section Of The American Public Health Association

Beyond Bird Flu: Preventing Pandemics at the Source

By Charlotte Baylis

APHA One Health Supporter

Founded in 2020 in response to COVID-19, Preventing Pandemics at the Source (PPATS) aims to mobilize global action to stop pandemics at their origin—preventing the spillover of pathogens from animals to humans. The PPATS Coalition, comprising 20 leading organizations focused on public health, health justice, conservation, human rights, science, and Indigenous Rights, emphasizes that while current prevention efforts largely focus on post-spillover measures to contain, control, and (most importantly) mitigate outbreaks. This proactive approach is an equitable form of prevention and without it, we accept the illness and deaths of those in spillover-prone areas: Indigenous Peoples, local communities, and the underprivileged. These populations are often the last to benefit from vaccines, therapeutics, and other reactive interventions.

In October 2023, PPATS and The Lancet launched the Lancet-PPATS Commission on Prevention of Viral Spillover. The Commission aims to mobilize decision-makers and implementers to take transdisciplinary action to limit viral spillovers through research, policy, law, and practice—thereby reducing the risk of future pandemics while promoting a healthier, more sustainable, and more equitable future. With recent outbreaks of avian influenza, as well as outbreaks of COVID-19, Marburg virus, and Nipah virus occurring in 2023, we have a clear reminder of the urgency and necessity of this work. Together, we must bolster the evidence base on interventions, shift the prevention narrative towards spillover prevention, and develop recommendations and mechanisms influencing decision makers to act (1).

Taking a closer look at the highly pathogenic avian influenza A (H5N1), it was first identified in domestic waterfowl in 1996. Since then, the virus has been found in over 40 species of wild and domestic animals, across every continent except Oceania (2). The virus has ‘spilled over’ into humans, with over 900 people infected since 1997, and a case fatality rate of 52% (3). While the risk of infection remains low to the general public, people who work with infected birds or mammals are at higher risk (3). And, though human-to-human transmission of H5N1 is currently rare, the virus continues to evolve (2,3). The more ‘hosts’ like farmed poultry and dairy cattle that H5N1 can inhabit, the more opportunities there are for it to mutate into a pathogen capable of causing a pandemic. For H5N1, the number of potential hosts is extraordinary; there are approximately 34 billion chickens worldwide, many on densely-packed factory farms (4).

Recognizing that spillover is primarily driven by land use changes, inadequate biosecurity in animal husbandry, and wildlife trade and markets, the PPATS Coalition advocates for five key interventions: 1) stopping deforestation and forest degradation; 2) reducing human-wildlife contact in spillover hotspots by providing better healthcare and alternative livelihoods to communities living close to wildlife; 3) supporting improved livestock health and strengthening veterinary care and biosecurity in animal husbandry; 4) shutting down or strictly regulating wildlife markets and trade that pose public health risks; and 5) enhancing surveillance for zoonotic viruses at interfaces between humans, domestic animals, and wildlife, particularly in spillover hotspots (6,7). The estimated cost of implementing these solutions is US$10 billion per year globally, which carries massive return on investment when compared to the millions of lives and trillions of dollars lost from pandemics such as COVID-19 (7).

Human encroachment on the natural world is accelerating the spillover of viruses from animals, particularly wildlife, to humans. Intensive farming practices, resource extraction and environmental degradation, land use change, wildlife trade and consumption, climate change, and other activities that increase contact between humans and wild animals all increase opportunities for spillover to occur (3,5). Hence, a One Health approach is critical to address spillover risks at the human-animal-environmental interface and prevent pandemics at the source.

References

1. Vora NM, Hassan L, Plowright RK, et al. The Lancet–PPATS Commission on Prevention of Viral Spillover: reducing the risk of pandemics through primary prevention. The Lancet. 2024;403(10427):597-599.
2. The Lancet Infectious Diseases. What is the pandemic potential of avian influenza A(H5N1)? Lancet Infect Dis. 2024;24(5):437.
3. Centers for Disease Control and Prevention. Technical Report: June 2024 Highly Pathogenic Avian Influenza A(H5N1) Viruses. https://www.cdc.gov/bird-flu/php/technical-report/h5n1-06052024.html
4. Quammen D. Our desire for inexpensive food is putting us in danger. New York Times. https://www.nytimes.com/2024/06/12/opinion/bird-flu-factory-farming.html. Published June 12, 2024.
5. Vora NM, Hannah L, Walzer C, et al. Interventions to reduce risk for pathogen spillover and early disease spread to prevent outbreaks, epidemics, and pandemics. Emerg Infect Dis. 2023;29(3):1-9.
6. Alimi Y, Bernstein A, Epstein J, et al. Report of the Scientific Task Force on Preventing Pandemics. Harvard Global Health Institute; 2021. https://www.hsph.harvard.edu/wp-content/uploads/sites/2343/2021/08/PreventingPandemicsAug2021.pdf
7. Preventing Pandemics at the Source. Interventions to prevent pathogen spillover and curb early disease spread among domestic animals and humans: a summary of analysis prepared by the Coalition to Prevent Pandemics at the Source. n.d. https://518e5d64-0420-46bf-af00-ae9ccb35a974.usrfiles.com/ugd/518e5d_40b62fb5ff104a1a806276bc9bf54a2a.pdf

One Health Spotlight Featuring Catherine Machalaba, PhD, MPH

APHA One Health Section, Governing Councilor

Principal Scientist for Health and Policy, EcoHealth Alliance

1. How does One Health apply to your current roles, and why is it important?

One Health is fundamental to all of my work. As the Principal Scientist for Health and Policy at an NGO working at the intersection of local conservation, global health, and capacity strengthening, I have been able to apply a One Health approach to my research and work with partners at the World Bank, UN agencies, national governments, and local organizations and academic institutions to put One Health into policy and practice. In recent years, I have been working on the application of One Health to the conservation field, developing guidance and trainings for protected area and wildlife managers. It has been exciting to work with rangers in Liberia - frontline One Health workers who are the eyes and ears of the forest - seeing how they can contribute to monitoring the health of the environment and also benefit from One Health knowledge to keep themselves and their communities safe in their work and daily life.

At the global level, I am a member of the One Health High-Level Expert Panel (OHHLEP) formed in 2021, to advise the Food and Agriculture Organization of the United Nations (FAO), United Nations Environment Programme (UNEP), World Health Organization (WHO), and World Organisation for Animal Health (WOAH) in their collaborative work (“the Quadripartite for One Health”). The Quadripartite cooperation is focused on combating health risks at the animal-human-ecosystem interface, recognizing the increasing threat of endemic and epidemic zoonoses and antimicrobial resistance. The triple planetary crisis – climate change, biodiversity loss, and pollution – is rapidly shifting disease dynamics while also making us less resilient; collaboration across sectors at all scales is essential to reduce risks and mitigate impacts to human, animal, and ecosystem health. To learn more, please review information on the Quadripartite and OHHLEP’s work in Term I and the recently-started Term II.

2. How did you first become interested in One Health as a concept, and what was your career pathway like to lead you to your current work?

After first hearing about public health from a friend, I was intrigued and fortunate to be selected as a summer field agent with a local public health department. It was a great experience and introduction to what I realized later was One Health – an exciting summer of collecting dead birds to be tested for West Nile virus infection and outreach on Lyme disease prevention in senior centers and state parks! Between college and my master’s in public health, I pursued a few different avenues of research and practice – interning with the tobacco control program at the Vermont attorney general’s office, in a cancer biology lab, and conducting a health systems engineering fellowship at the Veterans Affairs Boston healthcare system. I quickly realized I yearned to work on environmental and animal dimensions of health and joined EcoHealth Alliance (where I have worked since 2010). In 2020, I completed my PhD in Environmental and Planetary Health Sciences at the CUNY Graduate School of Public Health and Health Policy.

3. What is your favorite part about working in One Health, and what is your favorite example (or fun fact) of One Health?

There are so many interesting facets of human, animal, and environmental health that can be appreciated through a One Health approach. Rabies is a compelling example because of the connections across species – in addition to being zoonotic, there have been documented infections in over 200 species – and mix of domestic dog-mediated and sylvatic cycles. The animal and environmental health and welfare implications of dog ownership practices and stray dog management reinforce the importance of context in designing and implementing rabies prevention and control programs. I also love examining ecosystem services that contribute to health directly and indirectly – for example, some species of bats can eat thousands of insects each night. Tiny salamanders also play an important role in nutrient cycling in such a way that they prevent the equivalent of 500 miles of car emissions over their lifetime!

4. What does global One Health in action look like in working on the OHHLEP and advising the Quadripartite? What is one of the major One Health issues you are working with this group on?

In our first term, a major output was an inclusive definition of One Health, accompanied by five underlying principles. The definition provides a harmonized understanding that guides the collaborative work of four agencies (the Quadripartite). It was particularly exciting to see the formal addition of UNEP in 2022, to what was formerly the Tripartite (FAO, WHO, WOAH), giving a more prominent role to the environment sector in One Health at the global level. OHHLEP is called on to support the Quadripartite, including the One Health Joint Plan of Action that is now being translated into regional plans and national One Health strategies. The Joint Plan of Action has six Action Tracks: workforce capacity strengthening, neglected (endemic) diseases, emerging diseases, food safety, antimicrobial resistance, and strengthening the environment sector role in One Health.

We have had several other outputs, including a Theory of Change for One Health and a white paper on spillover prevention at source. The terms of reference for Term II focuses more on implementation, and it is likely that part of our work will center on economic analyses to guide investments in One Health. The Panel was initially comprised of 26 members (it now has 29 members in its second term), bringing a unique mix of expertise, experience, and perspectives. It has been rewarding to work alongside the other members and the Quadripartite institutions – although we have achieved a lot, there is of course much more work to do!

5. Do you have any words of advice for readers wanting to become more active in One Health?

The first piece of advice is that all APHA members and public health allies can (and should) try to play a role in advancing One Health. Examine the key issues or role you are working on to consider direct and indirect connections with animals and environment – whether antimicrobial resistance, zoonotic diseases, chemical poisoning, ecosystem services, or other factors – likely all APHA Sections and Affiliates are tackling issues that can benefit from the more comprehensive understanding and multi-solutions that One Health can provide. Doing so can help to identify useful entry points for awareness, monitoring, and interventions, including their contributions to other sectors and technical, financial, and policy resources.

The second piece of advice is to get involved! After joining APHA in 2012, I received a positive welcome when I reached out to the group’s leaders, encouraging me to get involved. APHA has afforded me incredible leadership, mentoring, learning, and collaboration opportunities that I never expected, including as newsletter editor, policy chair, chair, and currently a governing councilor. I was able to lead the development of the Association’s first One Health policy statement (adopted in 2017), getting to appreciate APHA’s rigorous policy review process firsthand. These opportunities have helped me to grow in my career in ways that I sometimes could not in my organization and expand my public health network – gaining several great friends along the way! Don’t be afraid to jump in and learn as you go, while welcoming others to the table to contribute too. One Health needs all of us!

One Health Epidemiology Program of San Diego County – Linking Human and Animal Health

By Emily Trumbull, Sarah Stous, Julie Breher, Jeff Johnson, and Seema Shah

APHA One Health Supporters

One Health Epidemiology Program (OHEP), San Diego County

The One Health Epidemiology Program (OHEP) of San Diego County is dedicated to surveillance, investigation, response, and prevention of zoonotic disease outbreaks and spillover events. Established in 2023, as part of the Public Health Services Department, this multidisciplinary team is comprised of epidemiologists, veterinarians, physicians, nurses, and laboratorians who support zoonotic disease surveillance and response efforts (Photo 1). To ensure that this work is synergistic with other local, state, and federal groups and agencies, the OHEP collaborates with the California Department of Public Health (CDPH), California Department of Food and Agriculture (CDFA), and U.S. Department of Agriculture (USDA), on conducting case investigations involving livestock, implementing community outreach regarding safe animal interactions at fairs and animal exhibits, and coordinating personal protective equipment messaging for local farms to prevent avian influenza spillover events.

Following a strategic planning and priority setting phase, the OHEP has initiated surveillance and investigation efforts focused on identifying and confirming zoonotic transmission of reportable diseases between humans and animals within the county. The OHEP collects surveillance data on reported zoonotic diseases in humans and analyzes them on a weekly basis to identify trends across multiple diseases. Data sharing from veterinary reference diagnostic laboratories and through increased electronic reporting capacity has expanded county data collection from local veterinarians, including animal shelters and wildlife rehabilitators. Furthermore, the OHEP has conducted multiple field investigations and obtained animal samples, including for rabies, brucellosis, avian chlamydiosis, leptospirosis, salmonellosis, Shiga-toxin producing Escherichia coli, and Rocky Mountain spotted fever, for testing by the San Diego County’s Public Health Laboratory and affiliated laboratories (Photo 2).

Notably, the OHEP has developed multiple avenues for public outreach and education to become a local resource for animal health and zoonotic disease information. First, the team launched a website that includes educational resources, updates of local relevance, and public health messaging for the wider community of human and veterinary health professionals. Second, a newsletter was created for regional human and veterinary medical professionals for knowledge sharing on clinical and public health updates. Third, hybrid continuing education events for veterinarians were developed to increase knowledge and skills on a variety of public health topics (e.g. rabies, Rocky Mountain spotted fever). Fourth, local outreach activities have included briefing local healthcare professionals at monthly meetings, providing information on regulations and zoonotic diseases for animal importation and rescue groups, as well as enrolling local veterinarians into the OHEP listserv for public health updates. Educational resources (like laminated infection prevention and biosecurity signage) have been provided to groups interested in exploring engagement opportunities with the OHEP.

As wildlife is essential to maintain healthy ecosystems enjoyed by both people and animals, the OHEP is eager to partner with conservation groups to support wildlife health in San Diego County. Currently, the OHEP is collaborating with the California Department of Fish and Wildlife (CDFW) on building capacity for zoonotic disease investigations in wildlife, the National Oceanographic and Atmospheric Association (NOAA) on expanding response and disease investigation in stranded deceased marine mammals, and the San Diego Natural History Museum on increasing scientific understanding of local bat ecology. The OHEP continues to develop valuable partnerships to pursue grant opportunities that support and expand the scope of San Diego County’s work activities. If you are interested in learning more or working with the OHEP team, please contact us at phs.ohep.hhsa@sdcounty.ca.gov.

Alpha-Gal Syndrome (AGS) and Potential Public Health Implications in the United States

By Megan Sloan, Ayano Annis, and Dawn Ford

APHA One Health Supporters

Epidemiology Department, Hamilton County Health Department, Tennessee

Ticks are notorious vectors for serious illnesses such as babesiosis, ehrlichiosis, anaplasmosis, Rocky Mountain Spotted Fever, and Lyme disease. Bites from certain species of ticks, primarily the Lone Star tick (Amblyomma americanum, Photo 1), can pass on those diseases, and also prompt a specific type of reaction. Saliva transferred to the host at the site of attachment causes the development of IgE antibodies to the carbohydrate galactose-alpha-1,3-galactose, or α-gal, found in non-catarrhine mammalian products (1,2). Alpha-gal syndrome (AGS) was first identified in the 1980s, but the connection between AGS and tick bites was not identified until the cetuximab cancer drug trials in the early 2000s (3).

As the ticks induce an allergic sensitization to red meat-containing products in the human hosts (Figure 1), AGS can present as mild to severe immune responses in affected individuals after ingestion or exposure to red meat-containing products. The health concerns, however, extend beyond individual food sensitivities, as those with AGS may also experience allergic reactions to medications and medical devices that contain animal products, including (but not limited to) anti-venom, heparin, bovine- and porcine-derived hormones and heart valves, and vaccines containing gelatin, including measles, mumps, and rubella (MMR) and shingles (Zostavax) (4). Unlike reportable tick-borne illnesses, the distribution and prevalence of AGS is unclear and relies heavily on self-reported cases and syndromic surveillance. Based on these two surveillance methods and the geographic distribution of the Lone Star tick, researchers are finding that most AGS cases occur in the southeastern region of the United States. One study reported there were approximately 110,000 suspected cases of AGS in the years 2010 through 2022, but the true number is likely higher due to the statistical reliance on self-reporting (5).

In May 2024, the United States experienced the highest number of monthly tick-bite-related emergency department visits since 2019 (5). Climate change may factor into this increase in cases, as warmer temperatures throughout the year provide a more favorable environment for tick activity and a larger window of opportunity for human contact. According to the U.S. Centers for Disease Control and Prevention (CDC), prevention is the best method to tackle AGS and other tick-borne illnesses. Some recommendations include to avoid areas where ticks are usually found (e.g. brushy or heavily wooded areas, high grasses), treat clothing with 0.5% permethrin or a U.S. Environmental Protection Agency (EPA)-registered insect repellent, and find specific repellent products to reduce tick exposure (5).

An alarming and emerging effect of the increase in AGS allergies is now the potential for lowered childhood and adult vaccination rates (from vaccine hesitancy) around the country, due to the threat of adverse events caused by this syndrome. In fact, many communities across the United States are already dealing with below-goal vaccine rates, and further deterrences would leave swathes of the population vulnerable to disease outbreaks (6). There is already a large enough debate in the general population around vaccines stemming from the COVID-19 pandemic. Further challenges related to building public trust cannot be overlooked by the medical and public health communities.

References

1. Sharma SR, Karim S. Tick saliva and the alpha-gal syndrome: finding a needle in a haystack. Front Cell Infect Microbiol. 2021;11:680264.
2. Wolaver W, Thakrar S, Thomas K, et al. Demystifying α-gal syndrome: identification and risk management in the perioperative setting. Curr Opin Anaesthesiol. 2021;34(6):761-765.
3. Steinke JW, Platts-Mills TAE, Commins SP. The alpha-gal story: lessons learned from connecting the dots. J Allergy Clin Immunol. 2015;135(3):589-596; quiz 597.
4. Macdougall JD, Thomas KO, Iweala OI. The meat of the matter: understanding and managing alpha-gal syndrome. ImmunoTargets Ther. 2022;11:37-54.
5. Thompson JM, Carpenter A, Kersh GJ, Wachs T, Commins SP, Salzer JS. Geographic distribution of suspected alpha-gal syndrome cases — United States, January 2017–December 2022. MMWR Morb Mortal Wkly Rep 2023;72:815–820.
6. Seither R, Calhoun K, Yusuf OB, et al. Vaccination coverage with selected vaccines and exemption rates among children in kindergarten — United States, 2021–22 school year. Morb Mortal Wkly Rep. 2023;72(2):26-32.
7. Patel C, Iweala OI. “Doc, will I ever eat steak again?”: diagnosis and management of alpha-gal syndrome. Curr Opin Pediatr. 2020;32(6):816-824.

One Health Fellowship Opportunities & RESOURCES

By Anna Makaretz

One Health Newsletter Editor and Section Program Planner

A recurring section in our newsletter, One Health Fellowship Opportunities will feature professional development opportunities for early career professionals interested in One Health topics. Everyone has a unique career path, and below you will find a few launching points to get started. Click on the button below each description to visit the program's site for more details.

American Association for the Advancement of Science (AAAS) Science & Technology Policy Fellowship (STPF) - AAAS STPF provides opportunities to outstanding scientists and engineers to learn first-hand about policy making while contributing their knowledge and analytical skills to the federal policymaking process. Fellows serve yearlong assignments in the executive, legislative and judicial branches of the federal government in Washington, DC. Each year, the program adds to a growing corps of over 3,400 strong policy-savvy leaders working across academia, government, nonprofits and industry to serve the nation and the world. (Applications open on June 1, 2024 and close on November 1, 2024.)

Association of Schools and Programs of Public Health (ASPPH) - ASPPH offers a number of different fellowships and internships, some of which are in collaboration with other entities such as the CDC, EPA, and USDA, as well as with ASPPH itself. For more information, please visit their website. (Application deadlines specific to program.)

American Veterinary Medical Association (AVMA) Fellowship Program - The AVMA Fellowship Program is an unparalleled opportunity to shape public policy while enhancing your knowledge of the political process. AVMA fellows do serve for one year in Washington as scientific advisors to members of Congress or congressional committees and shape and influence key legislation on a variety of issues. (Applications open in November 2024.)

American Veterinary Medical Association (AVMA) Government Relations Student Externship - The AVMA Extern Program pairs talented veterinary students with the AVMA Government Relations Division for a four-week program that introduces the breadth of public policy issues facing our profession and provides hands-on lobbying experience with Capitol Hill legislators and staff. (Applications close on October 11, 2024.)

Association of Public Health Laboratories (APHL) and the US Centers for Disease Control and Prevention (CDC) - The APHL and CDC offer competitive fellowships available to degreed applicants interested in starting or furthering an exciting new career in laboratory science while working collaboratively with industry leaders and developing professional networks. Fellowships support public health laboratory program areas, such as: bioinformatics, biosafety and biosecurity, emergency preparedness and response, environmental health, infectious disease, informatics, food safety, newborn screening, and quality management. Each fellow will be trained in alignment with established public health laboratory core competencies and functions and will work on unique program-specific projects and other initiatives in host laboratories. (Applications accepted and reviewed on a rolling basis. There is no deadline to apply.)

CDC Epidemic Intelligence Service (EIS) - The EIS is a highly competitive, 2-year post-graduate fellowship in applied epidemiology. This CDC program, established in 1951, is a unique combination of on-the-job-learning and service. Investigating outbreaks in the field is integral to the EIS experience. As CDC’s disease detectives, EIS officers are among the agency’s first-line rapid responders. EIS officers help public health officials investigate and control infectious disease outbreaks and respond to natural disasters and other threats to the public’s health. (The application period for the July 2026-June 2028 cohort opens on March 3, 2025 and close on June 5, 2025.)

Oak Ridge Institute for Science and Education (ORISE) - ORISE connects talented and diverse college students, recent graduates, postdocs, and faculty to STEM internship and fellowship programs closely aligned with the interests of a variety of research facilities, including those managed for the U.S. Department of Energy and other federal agencies. These STEM internship and fellowship programs are key to the recruitment and preparation of the next generation of the scientific workforce. (Application deadlines specific to program.)

The Public Health Institute (PHI) - The Generation Next Humanitarian Fellowship Program is a PHI program, supported by the USAID Bureau for Humanitarian Assistance, and in partnership with our program host organizations. This is a two-year fellowship program open to recent Bachelor-level graduates. The fellowship aims to increase the diversity of professionals in the humanitarian sector by building a pathway for seniors and recent graduates of Historically Black Colleges and Universities, Hispanic-Serving Institutions, Asian American and Pacific Islander Institutions and Tribal Colleges and Universities. (The application period has closed for 2024, but you can subscribe to their listserv for info about 2025.)

Winston Health Policy Fellowship - This 12-month fellowship offers a postgraduate immersion experience in health policy development by working directly with policy-makers in both the public and private sectors. Current graduate students in their final year of study for a masters or doctoral degree are eligible to apply. The Winston Health Policy Fellowship is located in Washington, DC. (Applications open on June 1, 2024 and close on October 18, 2024.)

Resources Recommended by One Health Section Members

AMA Journal of Ethics February 2024 Issue: Health Ecology and Disease Transmission

CDC National Public Health Strategy for the Prevention and Control of Vector-Borne Diseases in People

GEO Health Community of Practice

NASA Applied Sciences Program - Health and Air Quality

One Health Joint Plan of Action (‎2022‒2026)‎: Working Together for the Health of Humans, Animals, Plants and the Environment

The Berlin Principles on One Health, 2019

US Global Change Research Program - Fifth National Climate Assessment