Public Health and Human-Animal Medicine

13 Public Health and Human-Animal Medicine

Peter M. Rabinowitz, Lisa A. Conti, Hugh M. Mainzer

Both the human and veterinary medical oaths address the need for the promotion of public health. This chapter deals with human-animal health situations in which population health duties take primacy and where human and veterinary clinicians perform many functions that place them together on the front line of public health practice (Color Plate 13-1).

In ancient Greece, Asclepius, Apollo’s son, was charged by the gods with caring for the mortals of Greece (the classic symbol of medicine is Asclepius’ staff, around which is wound one snake).* His two daughters were Hygeia (Figure 13-1), the guardian of health and champion of common sense practices as the basis of wellness (“cleanliness is next to godliness”), and Panacea, whose occupation was to cure individuals already sick, one at a time. Mortals remained healthier when they followed Hygeian principles, creating a healthy environment and preventing disease. Individuals who lost their health sought Panacea.

Figure 13-1 The bust of the Greek muse of health, Hygeia, on the CDC’s Roybal campus in Atlanta, Ga.

(From Centers for Disease Control and Prevention Public Health Image Library. Photo courtesy John P. Anderton.)

Although in today’s culture, human and veterinary clinicians are more likely to practice solely as the hand of Panacea, the “one health” concept—drawing human, veterinary, and population health practices together—is focused on providing a comprehensive approach to disease control and prevention and wellness promotion.

Key Points for Clinicians and Public Health Professionals

Human Health Clinicians

• At a minimum, clinicians are required to report “notifiable diseases” to the state or local health department. It is critical to contact the health department if an issue of public health importance is even suspected.

• Practice preventive medicine.

Veterinary Clinicians

• All veterinary clinicians must recognize that they are essential parts of the public health system, with responsibility to protect and improve the health of human as well as animal populations. What the veterinarian observes, diagnoses, and treats in the clinical setting can have a far-reaching population health impact.

• It is important to contact the health department (in addition to requirements for reporting to agriculture officials) if an issue of public health importance is suspected to discuss the situation. For example, if leptospirosis is diagnosed in an animal, the public health department can provide guidance for preventing human cases and be on the watch for human cases. Contacting the health department regarding a communicable disease or other environmental health hazard can also increase communication between veterinarians and human health clinicians in the community.

• Practice preventive medicine.

THE 10 ESSENTIAL PUBLIC HEALTH SERVICES

In 1994, the U.S. Public Health Service assembled and tasked the Public Health Functions Steering Committee to develop a working definition of public health and a guiding framework for the responsibilities of local public health systems.¹ The resulting 10 Essential Public Health Services are the following:

1. Monitor health status to identify and solve community health problems.

2. Diagnose and investigate health problems and health hazards in the community.

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships and action to identify and solve health problems.

5. Develop policies and plans that support individual and community health efforts.

6. Enforce laws and regulations that protect health and ensure safety.

7. Link people to needed personal health services and ensure the provision of health care when otherwise unavailable.

8. Ensure a competent public and personal health care workforce.

9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.

10. Research for new insights and innovative solutions to health problems.

The actions of public health professionals as well as human and veterinary clinicians that are mentioned in many sections of this book encompass these 10 core responsibilities.

DISEASE SURVEILLANCE AND INFORMATION FLOW BETWEEN HUMAN AND ANIMAL HEALTH PROFESSIONALS

Much of this book discusses the need for enhanced communication between animal health and human health professionals. Not always evident is the key role that public health professionals and the public health system play in such communication.

The first three core functions of public health systems are to monitor the status of the health of the community; to diagnose and investigate health problems and health hazards affecting communities; and inform, educate, and empower communities to improve health. To accomplish these functions, accurate information is required on the prevalence and incidence of disease events and risk factors as well as the extent of environmental health hazards. A major method of obtaining this information is from surveillance data gathered through mandated reporting systems. These data, reported by clinicians, laboratories, and others, are used to identify emerging diseases, plan for disasters, track trends, and evaluate progress of intervention strategies. Reportable disease events in animals could be sentinel events for human health hazards, and vice versa.

In the United States each state can set its own priorities for disease reporting. The Council of State and Territorial Epidemiologists (CSTE; http://www.cste.org) and National Association of State Public Health Veterinarians (NASPHV; http://www.nasphv.org) provide guidance for such reportable condition criteria and for both communicable and noncommunicable conditions. State and local health departments then provide selected data to the Centers for Disease Control and Prevention (CDC).² Most states have required animal disease reporting of agricultural importance to agricultural agencies as well (see state requirements at http://www.biosecuritycenter.org/reportDisease.php). Box 13-1 lists the human infectious diseases that are nationally notifiable to the public health system. One animal disease, rabies, is also required to be reported. For a complete listing of nationally notifiable diseases and other conditions of public health importance (including injury and lead), see http://www.cdc.gov/ncphi/disss/nndss/phs/files/NNDSS_event_code_list_January_2008.doc.

BOX 13-1 Nationally Notifiable Infectious Diseases, United States, 2009

From Centers for Disease Control and Prevention: National notifiable infectious diseases. Available at http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm. Accessed April 8, 2009. AIDS, Acquired immunodeficiency syndrome; HIV, human immunodeficiency virus.

Arboviral neuroinvasive and nonneuroinvasive diseases

• California serogroup virus disease

• Eastern equine encephalitis virus disease

• Powassan virus disease

• St. Louis encephalitis virus disease

• West Nile virus disease

• Western equine encephalitis virus disease

• Other (wound and unspecified)

Chlamydia trachomatis, genital infections

Coccidioidomycosis

Cryptosporidiosis

Ehrlichiosis/anaplasmosis

• Ehrlichia chaffeensis

• Ehrlichia ewingii

• Anaplasma phagocytophilum

• Undetermined

Haemophilus influenzae, invasive disease

Hansen disease (leprosy)

Hantavirus pulmonary syndrome

Hemolytic uremic syndrome, postdiarrheal

Hepatitis, viral, acute

• Hepatitis A, acute

• Hepatitis B, acute

• Hepatitis B virus, perinatal infection

• Hepatitis, C, acute

Hepatitis, viral, chronic

• Chronic hepatitis B

• Hepatitis C virus infection (past or present)

• Adult/adolescent (age ≥13 years)

• Child (age ≥18 months and <13 years)

• Pediatric (age <18 months)

Influenza-associated pediatric death

Meningococcal disease

Novel influenza A virus infections

Poliomyelitis, paralytic

Poliovirus infection, nonparalytic

Rocky Mountain spotted fever

Rubella, congenital syndrome

Severe acute respiratory syndrome–associated coronavirus (SARS-CoV) disease

Shiga toxin–producing Escherichia coli

Streptococcal disease, invasive, group A

Streptococcal toxic-shock syndrome

Streptococcus pneumoniae, drug resistant, invasive disease

Streptococcus pneumoniae, invasive disease, non–drug resistant, in children <5 years

• Early latent

• Late latent

• Latent, unknown duration

• Neurosyphilis

• Late, nonneurologic

• Syphilitic stillbirth

Syphilis, congenital

Toxic-shock syndrome (other than streptococcal)

Trichinellosis (trichinosis)

Vancomycin-intermediate Staphylococcus aureus

Vancomycin-resistant Staphylococcus aureus

Varicella (morbidity)

Varicella (deaths only)

In individual states, additional diseases may also be reportable to state health and/or agriculture departments.

In the United States veterinarians may be required to report selected clinical conditions to either public health authorities, who may perform further disease investigations to protect human health, or to their state veterinarian at the state department of agriculture for the protection of animal and human health. Ideally, the public health and agriculture authorities then communicate. State veterinarians provide selected data to the U.S. Department of Agriculture (USDA). Every 6 months the USDA reports to the World Organization for Animal Health (OIE) regarding the presence or absence of reportable animal diseases in the United States.³ Box 13-2 lists reportable diseases tracked by the OIE.

BOX 13-2 Animal Diseases Reportable to the World Organization for Animal Health

As of January 21, 2008. From World Organisation for Animal Health: OIE listed diseases. http://www.oie.int/eng/maladies/en_classification2008.htm?e1d7. Accessed March 3, 2008.

Only gold members can continue reading. Log In or Register to continue

Related

Stay updated, free articles. Join our Telegram channel

Tags: Human-Animal Medicine

Aug 6, 2016 | Posted by admin in INTERNAL MEDICINE | Comments Off

Full access? Get Clinical Tree

Get Clinical Tree app for offline access

Get Clinical Tree app for offline access