Dr Elizabeth Mumford

Advocates for a One Health approach recognize that global health challenges require multidisciplinary collaborative efforts. While past publications have looked at interdisciplinary competency training for collaboration, few have identified the factors and conditions that enable operational One Health. Through a scoping review of the literature, a multidisciplinary team of researchers analyzed peer-reviewed publications describing multisectoral collaborations around infectious disease-related health events. The review identified 12 factors that support successful One Health collaborations and a coordinated response to health events across three levels: two individual factors (education & training and prior experience & existing relationships), four organizational factors (organizational structures, culture, human resources and, communication), and six network factors (network structures, relationships, leadership, management, available & accessible resources, political environment). The researchers also identified the stage of collaboration during which these factors were most critical, further organizing into starting condition or process-based factors. The research found that publications on multisectoral collaboration for health events do not uniformly report on successes or challenges of collaboration and rarely identify outputs or outcomes of the collaborative process. This paper proposes a common language and framework to enable more uniform reporting, implementation, and evaluation of future One Health collaborations.

One Health is a transdisciplinary approach used to address complex concerns related to human, animal, plant, and ecosystem health. One Health frameworks and operational tools are available to support countries and communities, particularly for the prevention and control of zoonotic diseases and antimicrobial resistance and the protection of food safety. However, One Health has yet to be implemented in a manner that fully considers the complexities and interconnectedness of the diverse influences that have impacts at a larger system level. This lack of consideration can undermine the sustainability of any positive outcomes. To ensure the One Health approach can function effectively within the new global context of converging and escalating health, social, economic, and ecological crises, it must evolve and expand in three overlapping dimensions: (1) Scope: the partners, knowledge, and knowledge systems included, (2) Approach: the techniques, methodologies, and scholarship considered, and (3) Worldview inclusivity: the interweaving of other worldviews together with the mainstream scientific worldview that currently predominates. Diverse partners and knowledge from outside the mainstream health and scientific sectors, including Indigenous peoples and representatives of local communities, and traditionally generated knowledge, must be included. These systems of knowledge can then be braided together with mainstream science to comprise a holistic framework for decision-making. Scholarship and methodologies being applied in other fields and contexts to solve complex challenges and manage uncertainty, such as collaborative governance, social-ecologic systems theory, and complexity science, must be recognized and incorporated. The spectrum of considered worldviews must also expand to authentically integrate the expanded scope and approach into action and sustainable impact. By increasing community and social engagement and by recognizing and entwining different worldviews, the plurality of disciplines, and traditional and scientific ways of knowing to address community concerns in the contexts in which they exist, we can ensure that One Health remains effective and true to its paradigm in our rapidly changing and complex world.

Alternatives to human chorionic gonadotropin (hCG) for inducing ovulation in cycling mares over several consecutive cycles were explored. Placebo, one, three or five short-term implants each containing 2.2 mg of gonadotropin-releasing hormone (GnRH) analogue (deslorelin) were administered to cycling mares after identification of a follicle over 30 mm. Mares were treated over three consecutive cycles, and artificially inseminated during the third cycle only. Serum was assayed for concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and progesterone during each cycle. All deslorelin doses decreased the interval to ovulation (4.0 days, 2.6 days, 2.4 days and 2.0 days), increased the proportion of mares ovulating within 48 h (20.0%, 83.3%, 73.3% and 85.7%), and decreased the diameter of the largest follicle at ovulation (45.8 mm, 38.0 mm, 41.0 mm and 37.2 mm) for the placebo, 2.2 mg, 6.6 mg and 11.0 mg groups, respectively ( P < 0.05). The interovulatory interval was lengthened in the 11.0 mg group compared with all other groups (21.2 days, 21.8 days, 26.4 days and 32.7 days for the placebo, 2.2 mg, 6.6 mg and 11.0 mg groups, respectively, P < 0.05). No differences ( P > 0.05) were detected in serum concentrations of progesterone or pregnancy rate among the groups. Cycle number had no effect ( P > 0.05) on the reproductive parameters or serum concentrations of progesterone. Concentrations of LH were higher in Cycle 3 in the 6.6 mg and 11.0 mg groups, and FSH concentrations were decreased in Cycles 2 and 3 in treated mares. Deslorelin was efficacious for inducing ovulation in cycling mares with no diminished activity over three consecutive cycles. However, ovarian suppression and changes in serum concentrations of gonadotropins were noted at higher doses.

P>Although the highly pathogenic avian influenza H5N1 virus continues to cause infections in both avian and human populations, the specific zoonotic risk factors remain poorly understood. This review summarizes available evidence regarding types of contact associated with transmission of H5N1 virus at the human-animal interface. A systematic search of the published literature revealed five analytical studies and 15 case reports describing avian influenza transmission from animals to humans for further review. Risk factors identified in analytical studies were compared, and World Health Organization-confirmed cases, identified in case reports, were classified according to type of contact reported using a standardized algorithm. Although cases were primarily associated with direct contact with sick/unexpectedly dead birds, some cases reported only indirect contact with birds or contaminated environments or contact with apparently healthy birds. Specific types of contacts or activities leading to exposure could not be determined from data available in the publications reviewed. These results support previous reports that direct contact with sick birds is not the only means of human exposure to avian influenza H5N1 virus. To target public health measures and disease awareness messaging for reducing the risk of zoonotic infection with avian influenza H5N1 virus, the specific types of contacts and activities leading to transmission need to be further understood. The role of environmental virus persistence, shedding of virus by asymptomatic poultry and disease pathophysiology in different avian species relative to human zoonotic risk, as well as specific modes of zoonotic transmission, should be determined.

Objective—To report clinical and serologic findings in horses with oral vesicular lesions that were consistent with vesicular stomatitis (VS) but apparently were not associated with VS virus (VSV) infection. Design—Serial case study. Animals—8 horses. Procedure—Horses were quarantined after appearance of oral lesions typical of VS. Severity of clinical signs was scored every 2 to 5 days for 3 months. Serum samples were tested for antibodies by use of competitive ELISA (cELISA), capture ELISA for IgM, serum neutralization, and complement fixation (CF). Virus isolation was attempted from swab specimens of active lesions. Results—2 horses with oral vesicular lesions on day 1 had antibodies (cELISA and CF) against VSV; however, results of CF were negative by day 19. Five of the 6 remaining horses were seronegative but developed oral lesions by day 23. Virus isolation was unsuccessful for all horses. Conclusion and Clinical Relevance—Horses were quarantined for 75 days in compliance with state and federal regulations. However, evidence suggests that oral lesions were apparently not associated with VSV infection. The occurrence in livestock of a vesicular disease that is not caused by VSV could confound efforts to improve control of VS in the United States and could impact foreign trade.Vesicular stomatitis is of substantial economic and regulatory concern. (J Am Vet Med Assoc 2000;216:1399–1404)

One hundred anestrous mares (early February) were injected s.c. with implants containing 0, .9, 1.8, 3.6, or 5.4 mg of a GnRH analogue (goserelin acetate) in an attempt to induce ovarian cyclicity. Follicular activity and concentrations of progesterone and LH were determined every 3 d, or daily during estrus. In treated mares that ovulated, the interval to the second ovulation of the season was compared to that for an additional group receiving 16 h/d of light beginning December 16 (positive controls). Of the mares that did not ovulate in 30 d, eight from each dose group were challenged on d 33 or 34 with an i.v. bolus of 950 micrograms of GnRH. Blood collected at -2, -1, and 0 h before GnRH and at 15, 30, 45, 60, and 90 min and 2, 3, and 4 h after injection was assayed for serum LH. More mares (P < .05) ovulated when given 3.6- (n = 7) or 5.4-mg (n = 6) implants than when given .9-mg implants (n = 0) or placebo (n = 0). Mares with initial follicles < or = 15 mm in diameter were less (P < .05) likely to ovulate (10 of 88) than were those with follicles 16 to 20 mm in diameter (5 of 12). Area under the curve (AUC) for LH was greater for mares receiving larger doses of GnRH. The AUC and peak LH were similar between ovulating and nonovulating mares. Luteinizing hormone peaked in all mares on approximately d 12. There was no difference (P > .05) in either peak LH or AUC among treatment groups in response to the GnRH challenge.

Pandemic, zoonotic and seasonal influenza viruses remain a threat to humans, and have major health and economic impacts globally. The pandemic threat due to Influenza A (H5N1) still exists since the virus is still endemic in poultry population in some countries. Sporadic cases of influenza A (H5N1) in humans are regularly reported. Efforts made by the animal sector to reduce circulation in poultry have contributed in reducing the risk of human H5N1 infection in many parts of the world. On 25 April 2009, Mexico, under the International Health Regulations (2005), notified the World Health Organization (WHO) about an outbreak of new influenza virus, which was characterized as a H1N1 virus previously not found in human. In less than nine weeks, the pandemic virus spread in the six WHO regions. On 11 June 2009, WHO announced a phase 6 pandemic alert. Thanks to the preparedness efforts carried out in a large number of countries in the world in response to influenza A (H5N1) threats, the international community has responded quite well to the pandemic. In particular, countries have been especially collaborative regarding the exchange of information and the global approach of access to supplies such as vaccine and antiviral drugs. The current pandemic presents significant differences to seasonal influenza epidemics and specific challenges are identified. (C) 2010 World Health Organization. All rights reserved.

BACKGROUND:Highly pathogenic avian influenza A (H5N1) virus has been of public health concern since 2003. Probable risk factors for A(H5N1) transmission to human have been demonstrated in several studies or epidemiological reports. However, transmission patterns may differ according to demographic characteristics of the population and local practices. This article aggregates these data from three studies with data collected in the previous surveys in 2006 and 2007 to further examine the risks factors associated with presence of anti-A(H5) antibodies among villagers residing within outbreak areas.METHODS:We aggregated 5-year data (2006-2010) from serology survey and matched case-control studies in Cambodia to further examine the risks factors associated with A(H5N1) infection among villagers in the outbreak areas.RESULTS:Serotesting among villagers detected 35 (1.5 % [0-2.6]) positive cases suggesting recent exposure to A(H5N1) virus. Practices associated with A(H5N1) infection among all ages were: having poultry cage or nesting area under or adjacent to the house (OR: 6.7 [1.6-28.3]; p = 0.010) and transporting poultry to market (OR: 17.6 [1.6-193.7]; p = 0.019). Practices found as risk factors for the infection among age under 20 years were swimming/bathing in ponds also accessed by domestic poultry (OR: 4.6 [1.1-19.1]; p = 0.038). Association with consuming wild birds reached borderline significance (p = 0.066).CONCLUSION:Our results suggest that swimming/bathing in contaminated pond water and close contact with poultry may present a risk of A(H5N1) transmission to human.

Introduction: Biodiversity is inextricably linked to human health. As an important area of research of the Convention on Biological Diversity and a key avenue for the dissemination of biodiversity and health knowledge, we investigated how well-embedded biodiversity and health interlinkages are in institutional higher education offerings. Methods: Using One Health education programs as a starting point, we collected a global list of institutions potentially carrying out education in the links between biodiversity and health through previously published research, academic partners of global conglomerates, and our own networks. We then analyzed the offerings from these institutions to determine the degree of integration of biodiversity and health interlinkages. Results: We found 105 educational offerings in biodiversity and health interlinkages from 89 institutions in 30 countries. These were primarily found in faculties of public health, veterinary sciences, and medicine, with varying degrees of coverage of the interlinkages. Conclusion: Education incorporating the links between biodiversity and health exists globally, but should be more widely integrated, particularly through inter-faculty and inter-institutional collaboration.

Background: The threat posed by highly pathogenic avian influenza A H5N1 viruses to humans remains significant, given the continued occurrence of sporadic human cases (499 human cases in 15 countries) with a high case fatality rate (approximately 60%), the endemicity in poultry populations in several countries, and the potential for reassortment with the newly emerging 2009 H1N1 pandemic strain. Therefore, we review risk factors for H5N1 infection in humans. Methods and Findings: Several epidemiologic studies have evaluated the risk factors associated with increased risk of H5N1 infection among humans who were exposed to H5N1 viruses. Our review shows that most H5N1 cases are attributed to exposure to sick poultry. Most cases are sporadic, while occasional limited human-to-human transmission occurs. The most commonly identified factors associated with H5N1 virus infection included exposure through contact with infected blood or bodily fluids of infected poultry via food preparation practices; touching and caring for infected poultry; consuming uncooked poultry products; exposure to H5N1 via swimming or bathing in potentially virus laden ponds; and exposure to H5N1 at live bird markets. Conclusions: Research has demonstrated that despite frequent and widespread contact with poultry, transmission of the H5N1 virus from poultry to humans is rare. Available research has identified several risk factors that may be associated with infection including close direct contact with poultry and transmission via the environment. However, several important data gaps remain that limit our understanding of the epidemiology of H5N1 in humans. Although infection in humans with H5N1 remains rare, human cases continue to be reported and H5N1 is now considered endemic among poultry in parts of Asia and in Egypt, providing opportunities for additional human infections and for the acquisition of virus mutations that may lead to more efficient spread among humans and other mammalian species. Collaboration between human and animal health sectors for surveillance, case investigation, virus sharing, and risk assessment is essential to monitor for potential changes in circulating H5N1 viruses and in the epidemiology of H5N1 in order to provide the best possible chance for effective mitigation of the impact of H5N1 in both poultry and humans. Disclaimer: The opinions expressed in this article are those of the authors and do not necessarily reflect those of the institutions or organizations with which they are affiliated.

The One Health paradigm for global health recognizes that most new human infectious diseases will emerge from animal reservoirs. Little consideration has been given to the known and potential zoonotic infectious diseases of small companion animals. Cats and dogs closely share the domestic environment with humans and have the potential to act as sources and sentinels of a wide spectrum of zoonotic infections. This report highlights the lack of a coordinated global surveillance scheme that monitors disease in these species and makes a case for the necessity of developing a strategy to implement such surveillance.

Although, the bovine spongiform encephalopathy (BSE) risk of most countries in Europe has been assessed and they have implemented both measures to control BSE and extensive surveillance systems, complete and valid data is still not consistently available. Globally, data is largely unavailable. Assessments based on incomplete or invalid information could lead to false conclusions. The BSE risk of countries throughout the world must continue to be assessed, and improvements in collection of surveillance data must be made, both in countries already reporting BSE cases and worldwide, in order to evaluate the global BSE picture and assure that cattle and products can be safely traded.

A lack of pituitary LH stores has been implicated as the cause of seasonal anestrus and failure to ovulate during the spring transition period in mares. In this experiment, 40 mares were used to study the effects of GnRH, estrogen, and an estrogen-GnRH combination on increasing releasable pituitary LH. Mares were stratified based on their ability to secrete LH in response to a 950-micrograms challenge of GnRH (n = 10 per group) and then assigned to one of four treatment groups: 1) controls, given no treatment; 2) 1 mg of estradiol-17 beta in oil i.m. daily for 8 d; 3) 200 micrograms of GnRH analogue des-Gly10, [D-ala6]-LHRH ethylamide in saline i.m. twice daily for 8 d; or 4) estradiol for 4 d then estradiol plus GnRH for four subsequent days. Blood was collected on d 1, 3, 5, and 7 of treatment, and serum was assayed for LH. On d 10 after initiation of treatment, mares were again challenged with GnRH (950 micrograms), and blood was collected for 4 h. Concentrations of serum LH did not vary significantly in control, estradiol-treated, or estradiol plus GnRH-treated mares among treatment days. In contrast, administration of GnRH alone increased (P < .05) concentrations of LH on d 5 and 7. Response to GnRH challenge, as measured by area under the LH curve (AUC) and peak LH, was greater (P < .05) for mares administered GnRH (7,307.1, 67.6 ng/mL, respectively) and GnRH plus estradiol (5,691.4, 60.3 ng/mL) than for mares given estradiol alone (1,519.4, 22.1 ng/mL) or no treatment (1,213.8, 19.4 ng/mL.

The control of bacteria in semen of stallions has been most effective with the use of seminal extenders containing suitable concentrations of antibiotics. However, the detrimental effect of antibiotics on sperm motility may be greater in stored, cooled semen due to the prolonged exposure to the antibiotic. Therefore, a study was conducted to determine the effect of various antibiotics on sperm motion characteristics following short term exposure and during cooled storage of semen. Reagent grade amikacin sulfate, ticarcillin disodium, gentamicin sulfate and polymixin B sulfate were added to a nonfat, dried, skim milk - glucose seminal extender at concentrations of 1000 or 2000 μg or IU/ml. Aliquots of raw semen were diluted with extender-antibiotic combinations to a concentration of 25 × 10 6 spermatozoa/ml. An aliquot was also diluted with extender without antibiotic. Aliquots were incubated at 23°C for 1 h. In addition, portions of the aliquots were cooled from 23 to 5°C and stored for 48 h. During 1 h of incubation of extended semen at 23°C, there was a significant (P

Objective - To determine potential risk factors for vesicular stomatitis (VS) in Colorado livestock in 1995 and evaluate VS virus (VSV) exposure of Colorado livestock in 1996. Design-Retrospective case-control study of VS risk factors and seroprevalence evaluation. Sample Population - Premises included 52 that had VS-positive animals and 33 that did not have VS-positive animals during the 1995 epidemic, and 8 in the vicinity of premises that had VS-positive animals during the 1995 epidemic. Procedure - Layout and management data for premises were collected during site visits in 1996. Signalment and management data were collected for animals from which samples were obtained, and samples were tested by serologic examination and virus isolation. The VSV seroprevalence rate was estimated for Colorado, using serum obtained for equine infectious anemia testing and from the Market Cattle identification program in Colorado. Results - At least 1 animal was seropositive for VSV on 35 of 52 (67%) premises, and 71 of 228 (31%) animals tested were seropositive for VSV. Seroprevalence was 63 of 170 (37%) for horses and 8 of 54 (15%) for cattle. Seroprevalence of VSV in animals from non-study premises in Colorado in 1996 was estimated to be 1.1% in cattle and 0.8% in horses. Clinical implications - Overall VSV seroprevalence in Colorado livestock was less than seroprevalence in epidemic areas, and seroprevalence rates in epidemic areas were greater for horses than cattle. Results may indicate that some animals had subclinical VSV infection during epidemics and that animals may be exposed to VSV between epidemics.

Physical trauma, dietary factors, certain toxins, immune mediated disorders, and vesicular stomatitis virus (VSV) infection are known causes of stomatitis in horses. There is evidence that some outbreaks of equine stomatitis are caused by as yet unidentified infectious agents. It remains to be determined whether stomatitis is an emerging equine infectious disease, or if the increase in reported cases is simply the result of greater public awareness as a consequence of widespread outbreaks of VSV in the southwestern United States in recent years. Focused laboratory and epidemiological studies are necessary to more adequately define non-VS related infectious and noninfectious causes of equine stomatitis.

Multisectoral, One Health collaboration is essential for addressing national and international health threats that arise at the human animal environment interface. Thanks to the efforts of multiple organisations, countries now have an array of One Health tools available to assess capacities within and between sectors, plan and prioritise activities, and strengthen multisectoral, One Health coordination, communication, and collaboration. By doing so, they are able to address health threats at the human animal environment interface, including emerging zoonotic and infectious diseases, more efficiently. However, to ensure optimal outcomes for the countries using these One Health tools, the partners responsible for implementation should regularly collaborate and share information such as implementation timelines, results and lessons learned, so that one process can inform the next. This paper presents a consensus framework on how commonly implemented One Health tools might align to best support countries in strengthening One Health systems. Twelve One Health tools were selected based on their high implementation rates, authors' experience with these tools and their focus on multisectoral, One Health coordination. Through a four-step process, the authors: a)jointlycarried outa landscape analysis of One Healthtools, using a Cloud based spreadsheet to share the unique characteristics and applications of each tool; b)performed an implementation analysis to identify and share implementation dynamics and identify respective outcomes and synergies; c) jointly created a consensus conceptual model of how the authors suggest the tools might logically work together; and d) extrapolated from steps 1-3 an agreed-upon overarching conceptual framework for how current and future One Health tools could be categorised to best support One Health system strengthening at the national level. Highlighted One Health tools include the States Parties Annual Reporting Tool under the International Health Regulations (IHR), the World Organisation for Animal Health Performance of Veterinary Services (PVS) Pathway, the Joint External Evaluation process, IHR/PVS National Bridging Workshops, the Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization Tool, the Food and Agriculture Organization (FAO) Laboratory Mapping Tool, the FAO Assessment Tool for Laboratories and Antimicrobial Resistance Surveillance Systems, the FAO Surveillance Evaluation Tool, the One Health Systems Mapping and Analysis Resource Toolkit, the National Action Plan for Health Security, and IHR Monitoring and Evaluation Framework tools for After Action Reviews and Simulation Exercises. A new guidance document entitled, Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries was also included as a framework that provides guidance to support the implementation of the outputs of the tools described.

Under the International Health Regulations (IHR, 2005), a legally binding document adopted by 196 States Parties, countries are required to develop their capacity to rapidly detect, assess, notify and respond to unusual health events of potential international concern. To support countries in monitoring and enhancing their capacities and complying with the IHR (2005), the World Health Organization (WHO) developed the IHR Monitoring and Evaluation Framework (IHR MEF). This framework comprises four complementary components: the State Party Annual Report, the Joint External Evaluation, after-action reviews and simulation exercises. The first two are used to review capacities and the second two to help to explore their functionality. The contribution of different disciplines, sectors, and areas of work, joining forces through a One Health approach, is essential for the implementation of the IHR (2005). Therefore, WHO, in partnership with the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and other international and national partners, has actively worked on facilitating the inclusion of the relevant sectors, in particular the animal health sector, in each of the four components of the IHR MEF. Other tools complement the IHR MEF, such as the WHO/OIE IHR PVS [Performance of Veterinary Services] National Bridging Workshops, which facilitate the optimal use of the results of the IHR MEF and the OIE Performance of Veterinary Services Pathway and create an opportunity for stakeholders from animal health and human health services to work on the coordination of their efforts. The results of these various tools are used in countries' planning processes and are incorporated in their National Action Plan for Health Security to accelerate the implementation of IHR core capacities. The present article describes how One Health is incorporated in all components of the IHR MEE

The national risk of bovine spongiform encephalopathy (BSE) has not been assessed by many countries, and many countries are conducting little or no BSE surveillance. National measures implemented, including import restrictions, surveillance systems, and sanitary controls, should be based on actual BSE risk. Thus, as a first step, the national BSE status must be determined, particularly through assessment of the national risk. The World Organisation for Animal Health (OIE) provides recommendations for surveillance and risk assessment of BSE, which are considered the international standard by the World Trade Organization (WTO). This document describes the variables for determination of BSE status and gives guidance on specific options and practical considerations for meeting the BSE surveillance and risk assessment recommendations of the OIE.

For the past 10 years, animal health experts and human health experts have been gaining experience in the technical aspects of avian influenza in mostly separate fora. More recently, in 2006, in a meeting of the small WHO Working Group on Influenza Research at the Human Animal Interface (Meeting report available from: http://www.who.int/csr/resources/publications/influenza/WHO_CDS_EPR_GIP_2006_3/en/index.html) in Geneva allowed influenza experts from the animal and public health sectors to discuss together the most recent avian influenza research. Ad hoc bilateral discussions on specific technical issues as well as formal meetings such as the Technical Meeting on HPAI and Human H5N1 Infection (Rome, June, 2007; information available from: http://www.fao.org/avianflu/en/conferences/june2007/index.html) have increasingly brought the sectors together and broadened the understanding of the topics of concern to each sector. The sectors have also recently come together at the broad global level, and have developed a joint strategy document for working together on zoonotic diseases (Joint strategy available from: ftp://ftp.fao.org/docrep/fao/011/ajl37e/ajl37e00.pdf). The 2008 FAO-OIE-WHO Joint Technical Consultation on Avian Influenza at the Human Animal Interface described here was the first opportunity for a large group of influenza experts from the animal and public health sectors to gather and discuss purely technical topics of joint interest that exist at the human-animal interface. During the consultation, three influenza-specific sessions aimed to (1) identify virological characteristics of avian influenza viruses (AIVs) important for zoonotic and pandemic disease, (2) evaluate the factors affecting evolution and emergence of a pandemic influenza strain and identify existing monitoring systems, and (3) identify modes of transmission and exposure sources for human zoonotic influenza infection (including discussion of specific exposure risks by affected countries). A final session was held to discuss broadening the use of tools and systems to other emerging zoonotic diseases. The meeting was structured as short technical presentations with substantial time available for facilitated discussion, to take advantage of the vast influenza knowledge and experience available from the invited expert participants. Particularly important was the identification of gaps in knowledge that have not yet been filled by either sector. Technical discussions focused on H5N1, but included other potentially zoonotic avian and animal influenza viruses whenever possible. During the consultation, the significant threat posed by subtypes other than H5N1 was continually emphasized in a variety of contexts. It was stressed that epidemiological and virological surveillance for these other viruses should be broadening and strengthened. The important role of live bird markets (LBMs) in amplifying and sustaining AIVs in some countries was also a recurring topic, and the need for better understanding of the role of LBMs in human zoonotic exposure and infection was noted. Much is understood about the contribution of various virus mutations and gene combinations to transmissibility, infectivity, and pathogenicity, although it was agreed that the specific constellation of gene types and mutations that would characterize a potentially pandemic virus remains unclear. The question of why only certain humans have become infected with H5N1 in the face of massive exposure in some communities was frequently raised during discussion of human exposure risks. It was suggested that individual-level factors may play a role. More research is needed to address this as well as questions of mode of transmission, behaviors associated with increased risk, virological and ecological aspects, and viral persistence in the environment in order to better elucidate specific human exposure risks. It became clear that great strides have been made in recent years in collaboration between the animal health and public health sectors, especially at the global level. In some countries outbreaks of H5N1 are being investigated jointly. Even greater transparency, cooperation, and information and materials exchange would allow more timely and effective responses in emergency situations, as well as in assessment and planning phases. Ensuring sustainability was also frequently emphasized, e.g. in infrastructure and capacity development and in development of tools and systems for surveillance, assessment and response. It was suggested that one way for tools and systems built or planned to address avian influenza to become more sustainable would be to make them applicable for a broader array of existing and emerging zoonotic diseases.

Mycobacterium tuberculosis is recognised as the primary cause of human tuberculosis worldwide. However, substantial evidence suggests that the burden of Mycobacterium bovis, the cause of bovine tuberculosis, might be underestimated in human beings as the cause of zoonotic tuberculosis. In 2013, results from a systematic review and meta-analysis of global zoonotic tuberculosis showed that the same challenges and concerns expressed 15 years ago remain valid. These challenges faced by people with zoonotic tuberculosis might not be proportional to the scientific attention and resources allocated in recent years to other diseases. The burden of zoonotic tuberculosis in people needs important reassessment, especially in areas where bovine tuberculosis is endemic and where people live in conditions that favour direct contact with infected animals or animal products. As countries move towards detecting the 3 million tuberculosis cases estimated to be missed annually, and in view of WHO's end TB strategy endorsed by the health authorities of WHO Member States in 2014 to achieve a world free of tuberculosis by 2035, we call on all tuberculosis stakeholders to act to accurately diagnose and treat tuberculosis caused by M bovis in human beings.

To identify environmental sites commonly contaminated by avian influenza virus A (H5N1) in live-bird markets in Indonesia we investigated 83 markets in 3 provinces in Indonesia At each market samples were collected from up to 27 poultry-related sites to assess the extent of contamination Samples were tested by using real-time reverse transcription PCR and virus isolation A questionnaire was used to ascertain types of birds in the market general infrastructure and work practices Thirty-nine (47%) markets showed contamination with avian influenza virus in >= 1 of the sites sampled Risk factors were slaughtering birds in the market and being located in West Java province Protective factors included daily removal of waste and zoning that segregated poultry-related work flow areas These results can aid in the design of evidence-based programs concerning environmental sanitation food safety and surveillance to reduce the risk for avian influenza virus A (H5N1) transmission in live-bird markets

Anestrous mares (n=99) were assigned randomly to 1 of 5 treatments. Treatments 1, 2, 3, 4, and 5 consisted of implants containing 0, 0.9, 1.8, 3.6 and 5.4 mg of a GnRH analogue, respectively, placed subcutaneously in the neck. Data were collected on body condition score, body weight, number and size of follicles and time of ovulation. After an initial 6 wk acclimation period, all treatment groups were fed a diet of mixed hay and grain to maintain or increase body weight. Reproductive parameters were collected twice weekly or daily when in estrus. Palpation and ultrasonography were used to determine number of follicles >30 mm and ovulation. Blood samples were collected and measured by radioimmunoassay for serum concentration of proges terone. Mares were weighed and body condition scored twice during the acclimation period, at the time of implantation and at the end of the study. There was an effect (P

Cross-sectoral assessment of health risks arising or existing at the human-animal interface is crucial to identifying and implementing effective national disease control measures. This requires availability of information from 4 functional information 'streams' - epidemiological, laboratory, animal, and human health. The Food and Agriculture Organization of the United Nations (FAO)/World Organisation for Animal Health (OIE)/World Health Organization (WHO) Four-Way Linking (4WL) project promotes the establishing of a national-level joint framework for data sharing, risk assessment, and risk communication, in order to both improve communications within and among governmental public health and animal health influenza laboratories, epidemiology offices, national partners, with the aim of strengthening the national capacity to detect, report and assess risks arising from emerging influenza viruses. The project is currently being implemented in countries where H5N1 avian influenza is endemic and where human cases have been reported. The project is comprised of two main activities at country level: a 'review mission', which is the project launch in the country and has the objective to assess the existing situation; and a 'scenario based workshop', with the scope to bring together key national partners and build relationships among people working in the 4 information streams and to improve understanding of national strengths and gaps. During the workshop the delegates engaged in interactive sessions on basic risk assessment and devoted to specify the needs and roles of the 4 different streams. The participants work through a mock influenza outbreak scenario, which practically illustrates how risk assessment and communication of an emergency at the animal-human interface is more effective when there is linking of the 4 streams, collaboration, communication, and coordinated action. In 2010, Egypt was the first country where the project was successfully implemented, followed by Vietnam and Indonesia.

Background: Multidisciplinary and multisectoral approaches such as One Health and related concepts (e.g.. Planetary Health, EcoHealth) offer opportunities for synergistic expertise to address complex health threats. The connections between humans, animals. and the environment necessitate collaboration among sectors to comprehensively understand and reduce risks and consequences on health and wellbeing. One Health approaches are increasingly emphasized for national and international plans and strategies related to zoonotic diseases. food safety, antimicrobial resistance, and climate change, but to date, the possible applications in clinical practice and benefits impacting human health are largely missing. Methods: In 2018 the "Application of the One Health Approach to Global Health Centers" conference held at the Albert Einstein College of Medicine convened experts involved in One Health policy and practice. The conference examined issues relevant to One Health approaches, sharing examples of challenges and successes to guide application to medical school curricula and clinical practice for human health. This paper presents a synthesis of conference proceedings, framed around objectives identified from presentations and audience feedback. Findings and Recommendations: The following objectives provide opportunities for One Health involvement and benefits for medical schools and global health centers by: 1) Improving One Health resource sharing in global health and medical education; 2) Creating pathways for information flow in clinical medicine and global health practice; 3) Developing innovative partnerships for improved health sector outcomes; and 4) Informing and empowering health through public outreach. These objectives can leverage existing resources to deliver value to additional settings and stakeholders through resource efficiency, more holistic and effective service delivery, and greater ability to manage determinants of poor health status. We encourage medical and global health educators, practitioners, and students to explore entry points where One Health can add value to their work from local to global scale.

Background  This study was conducted from 2006 to 2010 and investigated the seroprevalence of influenza A viruses in Cambodian pigs, including human H1N1, H3N2, 2009 pandemic H1N1 (A(H1N1)pdm09), and highly pathogenic avian H5N1 influenza A viruses. Methods  A total of 1147 sera obtained from pigs in Cambodia were tested by haemagglutination inhibition (HI) assays for antibody to human influenza A viruses along with both HI and microneutralization (MN) tests to assess immunological responses to H5N1 virus. The results were compared by year, age, and province. Results  Antibodies against a human influenza A virus were detected in 14·9% of samples. A(H1N1)pdm09 virus were dominant over the study period (23·1%), followed by those to human H1N1 (17·3%) and H3N2 subtypes (9·9%). No pigs were serologically positive for avian H5 influenza viruses. The seroprevalence of human H1N1 and H3N2 influenza viruses peaked in 2008, while that of A(H1N1)pdm09 reached a peak in 2010. No significant differences in seroprevalence to human influenza subtypes were observed in different age groups. Conclusions  Cambodian pigs were exposed to human strains of influenza A viruses either prior to or during this study. The implications of these high prevalence rates imply human‐to‐swine influenza virus transmission in Cambodia. Although pigs are mostly raised in small non‐commercial farms, our preliminary results provide evidence of sustained human influenza virus circulation in pig populations in Cambodia.

Pigs and humans have shared influenza A viruses (IAV) since at least 1918, and many interspecies transmission events have been documented since that time. However, despite this interplay, relatively little is known regarding IAV circulating in swine around the world compared with the avian and human knowledge base. This gap in knowledge impedes our understanding of how viruses adapted to swine or man impacts the ecology and evolution of IAV as a whole and the true impact of swine IAV on human health. The pandemic H1N1 that emerged in 2009 underscored the need for greater surveillance and sharing of data on IAV in swine. In this paper, we review the current state of IAV in swine around the world, highlight the collaboration between international organizations and a network of laboratories engaged in human and animal IAV surveillance and research, and emphasize the need to increase information in high-priority regions. The need for global integration and rapid sharing of data and resources to fight IAV in swine and other animal species is apparent, but this effort requires grassroots support from governments, practicing veterinarians and the swine industry and, ultimately, requires significant increases in funding and infrastructure.

Zoonotic diseases will maintain a high level of public policy attention in the coming decades. From the spectre of a global pandemic to anxieties over agricultural change, urbanization, social inequality and threats to natural ecosystems, effectively preparing and responding to endemic and emerging diseases will require technological, institutional and social innovation. Much current discussion emphasizes the need for a ‘One Health’ approach: bridging disciplines and sectors to tackle these complex dynamics. However, as attention has increased, so too has an appreciation of the practical challenges in linking multi-disciplinary, multi-sectoral research with policy, action and impact. In this commentary paper, we reflect on these issues with particular reference to the African sub-continent. We structure the themes of our analysis on the existing literature, expert opinion and 11 interviews with leading One Health scholars and practitioners, conducted at an international symposium in 2016. We highlight a variety of challenges in research and knowledge production, in the difficult terrain of implementation and outreach, and in the politicized nature of decision-making and priority setting. We then turn our attention to a number of strategies that might help reconfigure current pathways and accepted norms of practice. These include: (i) challenging scientific expertise; (ii) strengthening national multi-sectoral coordination; (iii) building on what works; and (iv) re-framing policy narratives. We argue that bridging the research-policy-action interface in Africa, and better connecting zoonoses, ecosystems and well-being in the twenty-first century, will ultimately require greater attention to the democratization of science and public policy. This article is part of the themed issue ‘One Health for a changing world: zoonoses, ecosystems and human well-being’.

Wild birds play a major role in the evolution, maintenance, and spread of avian influenza viruses. However, surveillance for these viruses in wild birds is sporadic, geographically biased, and often limited to the last outbreak virus. To identify opportunities to optimize wild bird surveillance for understanding viral diversity, we reviewed responses to a World Organisation for Animal Health–administered survey, government reports to this organization, articles on Web of Knowledge, and the Influenza Research Database. At least 119 countries conducted avian influenza virus surveillance in wild birds during 2008–2013, but coordination and standardization was lacking among surveillance efforts, and most focused on limited subsets of influenza viruses. Given high financial and public health burdens of recent avian influenza outbreaks, we call for sustained, cost-effective investments in locations with high avian influenza diversity in wild birds and efforts to promote standardized sampling, testing, and reporting methods, including full-genome sequencing and sharing of isolates with the scientific community.