Clinical One Health: Collaborative Consultations for Zoonotic Diseases

In recent years, the emergence of zoonotic infectious diseases as a public health concern has received ample media attention. Though the role of health professionals dealing with both animal and human health has been underlined by the One Health approach, there remains an implementation gap when it comes to clinical One Health approaches in dealing with zoonoses affecting humans and animals. Recent research shows that there is growing recognition of the need to unify functionaries in clinical settings as well.

The Context

Zoonotic diseases present a unique clinical challenge, in that they are slightly different from other clinical conditions which can be managed without extensive need to collaborate with other sectors. Considering the recent emergence of spillover-spillback diseases, this already difficult terrain has become even more challenging to navigate in the absence of an integrated approach. Although only recently recognised, diseases that spillover from humans to animals, then become endemic in animals, and eventually circle back to infect humans, present with challenges which clinicians may not be able to deal with comprehensively without the assistance of veterinarians. For example, agents like methicillin resistant Staphylococcus aureus, and extended-spectrum beta lactamase producing Enterobacteriaceae, which used to be recognised as pathogens afflicting human beings exclusively, have now been seen to spill into animals, and then spill back into human beings.(1) Such emerging evidence points to a potentially dangerous trend where animal and human health issues, which have long been viewed as separate water-tight compartments, are getting merged together.

What about the user?

The most important question when it comes to issues of healthcare behaviour and access, is the willingness of the users to adopt the target behaviour. In this case, a group of investigators from Australia examined this issue and concluded that there is a substantial proportion of these users who would be willing to consult veterinarians based on a physician’s advice for zoonotic diseases. (2) The findings of Speare et al suggest that self-reported willingness to consult with a veterinarian at one’s own expense was almost 80%, whilst, if it were to be covered by the Australian public health insurance scheme, then over 90% of the respondents would be willing to see a veterinarian. This study indicates that there is a strong and growing tide of recognition of the role of veterinarians in the context of clinical management of zoonotic diseases even within the general population. The study indicates that there is a possibility of the emergence of clinical One Health as a paradigm within the existing norms of clinical medicine.

Where do we stand?

Although the Australian perspective seems very promising, things have been slower to take off in the Indian context. A previous study by PHFI/RCZI regarding veterinary public health capacity building in the Indian setting has reflected a grim reality. (3) Critical deficiencies in veterinary public health in the Indian context has hobbled the Indian response to the rising risks because of the rapid growth in the livestock sector.

Poverty alleviation and livelihood generation measures have encouraged the espousal of intensive animal rearing in the small holder setting, with mixed livestock rearing being endorsed through governmental mechanisms. However, the poor response in the development of veterinary public health capacity has failed to offset rising risks because of the espousal of such measures.

These deficiencies are not typical of the animal health sector alone as the human health and medical training sectors are also lagging behind when it comes to zoonoses knowledge and capacity. In a previous study conducted by RCZI, a validated tool was used to show that fewer than 3% of medical students could correctly define zoonoses. In general, they had very poor knowledge and awareness about zoonotic diseases overall. (4)

References:

  1. Wieler LH, Ewers C, Guenther S, Walther B, Lübke-Becker A. Methicillin-resistant staphylococci (MRS) and extended-spectrum beta-lactamases (ESBL)-producing Enterobacteriaceae in companion animals: nosocomial infections as one reason for the rising prevalence of these potential zoonotic pathogens in clinical samples. Int J Med Microbiol. 2011; 301: 635–641. doi: 10.1016/j.ijmm.2011.09.009
  2. Speare R, Mendez D, Judd J, Reid S, Tzipori S, Massey PD (2015) Willingness to Consult a Veterinarian on Physician’s Advice for Zoonotic Diseases: A Formal Role for Veterinarians in Medicine? PLoS ONE 10(8): e0131406. doi:10.1371/ journal.pone.0131406
  3. Kakkar M, Abbas SS, Kumar A, Hussain MA, Sharma K, Bhatt PM, Zodpey S. Veterinary public health capacity building in India: a grim reflection of the developing world’s underpreparedness to address zoonotic risks. WHO South-East Asia Journal of Public Health. 2013;2(3-4):187-191.
  4. Kakkar M, Ramani S, Menon G, Sankhe L, Gaidhane A, Krishnan S. 'Zoonoses? Not sure what that is...' An assessment of knowledge of zoonoses among medical students in India. Trans R Soc Trop Med Hyg. 2011 May;105(5):254-61. doi: 10.1016/j.trstmh.2011.02.002. Epub 2011 Mar 5. PubMed PMID: 21377707.