Research

Latest Works in Global One Health, Zoonoses & Epidemiology at the Animal-Human Interface

2023

2023 – “Describing the Experience of Livestock Producers from Ohio, USA with ticks and associated diseases” published in One Health Outlook

Background

As tick ranges expand across North America, the risk of tick bites and tick-borne diseases (TBDs, i.e. diseases or syndromes associated with ticks) rises for humans and animals, making prevention critical. Several U.S. studies have examined knowledge, attitudes, and practices regarding ticks and TBDs for various cohorts of people. However, among occupational groups with high exposure risk from ticks and TBDs are livestock producers, of which we know little about. To help address this gap, an electronic questionnaire was distributed to livestock producers in Ohio, U.S, a state with a robust agricultural sector.

Methods

We generated descriptive statistics and conducted a multiple correspondence analysis followed by hierarchical clustering on principal components to identify producers with similar response profiles.

Results

Responses from 57 producers showed that most (52.6%) think the American dog tick (Dermacentor variabilis) is found in Ohio but are unsure about other species. Although several TBDs are present in Ohio, most (> 50%) producers were unsure or unaware of their presence. Interestingly, most (54.4%) thought ticks pose major health risks for their livestock but fewer (49.1%) thought the same for humans. Regardless, most producers did employ at least one prevention method for themselves (96.5%) and their animals (82.5%). Cluster analysis (n = 48) identified three groups: the largest (n = 21) was considered “aware and cautious” consisting primarily of farm owners. The others generally practiced less prevention and consisted primarily of farm employees.

Conclusions

Our findings indicate that producers in Ohio practice prevention for themselves and their livestock, but demonstrate gaps in knowledge (e.g., TBD occurrence) and attitudes (e.g., health risks) that could be addressed via educational formats we found producers preferred (e.g., extension materials), to encourage informed prevention. This is especially important for farm employees that may practice less prevention because of lower awareness. Our study can guide others in regions faced with similar tick and TBD risks to protect occupational and livestock health.

2023 – “A multisectoral approach to developing a state-level foreign animal disease response plan: the Ohio African Swine Fever Response Plan Workshop” published in Journal of the American Veterinary Medical Association

Foreign animal disease (FAD) preparedness is a high priority for state and federal governments to ensure the protection of the nation’s livestock industry. Highly contagious diseases such as African swine fever (ASF) have been the focus of recent advancements in FAD preparedness, including the development of disease-specific response plans. At the state level, FAD response plans provide a framework to help ensure a rapid and coordinated response that considers the resources and realities of that state; however, preparing a comprehensive plan requires collaboration across multiple agencies and sectors that can be difficult to operationalize. To initiate systematic state-level ASF response plan writing and identify gaps in preparedness, university and industry stakeholders partnered with the Ohio Department of Agriculture and USDA to develop the Ohio African Swine Fever Response Plan Workshop. A linear planning model was used to implement the workshop in May 2021. All planning and workshop activities were conducted fully virtually, prompted by public health restrictions in response to COVID-19. Sixty-four participants, representing multiple sectors and stakeholder groups including state/federal/industry animal health officials, emergency management, environmental protection, and academia, contributed to the workshop. Spanning 3 days, participants identified current response capabilities and areas requiring additional planning for an effective state-level response. The workshop generated recommendations from a multisectoral perspective for subcommittees tasked with developing standard operating procedures for the Ohio ASF Response Plan. The methodology and resources used to plan, implement, and evaluate the workshop are described to provide a model for state-level response planning.

2023 – “Gender and Zoonotic Pathogen Exposure Pathways in a Resource-Limited Community, Mpumalanga, South Africa: A Qualitative Analysis” published in PLOS Global Public Health

The Mnisi community is a livestock-dependent community neighboring the Great Limpopo Transfrontier Conservation Area in South Africa. Here, zoonotic pathogens contribute to as many as 77% of cases of acute febrile illness. Previous gender-disaggregated analysis in the community has shown that men and women have different risks of zoonotic illness, suggesting that exposure routes for zoonotic infections should be further explored to inform gender-sensitive risk mitigation strategies. Using a One Health approach and ethnographic methodology, we examined interactions between community residents, domestic animals, and the built and natural environment to investigate potential exposure pathways for zoonotic infections from a gendered perspective. We combined data from direct household observations and focus group discussions on previously identified gendered tasks such as domestic animal care, water collection, and food preparation, and how and by whom these tasks were performed. We noted gender differences for household tasks, animal care duties, and environmental exposure. Both men and women access grazing land but for different tasks (water collection—females, cattle grazing—males), and both men and women experience more time in the bush in recent years due to decreased water availability. From observations, it was noted that men wore covered protective work clothes (such as long trousers and closed-toe shoes) more commonly than women did; women did not often wear these for household duties including water collection in the bush. We recommend that these gender-typed roles serve as critical control points for zoonotic pathogen exposure. For example, tick-bite exposure prevention should be directed at both men and women based on their daily activities, but prevention in men should target exposure from cattle and prevention in women should focus on personal protective measures during water and firewood collection. These findings can contribute to a more detailed understanding of the role of human behavior and critical control points for zoonotic disease—a significant contributor to acute febrile illness in this rural, resource-limited setting.

2023 – “A Survey of Knowledge, Attitudes, and Practices of Veterinary Professionals Regarding Ticks and Tick-Borne Diseases: Insights from Ohio, USA” published in One Health

Globally, ticks are becoming more problematic as agricultural pests and vectors of tick-borne diseases (TBDs), many of which are shared between animals and people. Veterinary professionals, including veterinarians and non-veterinarians, are considered a vulnerable group through occupational exposure. To inform educational interventions at the intrapersonal level, a common approach is to first assess knowledge, attitudes, and practices (KAP) of target populations. Thus, our objective was to assess KAP of veterinary professionals in Ohio, a state faced with expanding and invading ticks of medical and veterinary concern. Using a convenience sample, we surveyed 178 veterinary professionals across Ohio with an electronic questionnaire that covered knowledge, attitudes, practices, exposures, demography, education, and surveillance regarding ticks and TBDs. We found that veterinary professionals had cautionary attitudes towards ticks and TBDs and practiced prevention for themselves and their patients, even when tick exposures were infrequently reported. However, veterinary professionals significantly lacked in knowledge regarding tick biology and local TBD epidemiology. Furthermore, we found that knowledge regarding tick biology and attitudes towards ticks and TBDs did not associate with practices. Instead, we found that veterinarian status and routine tick checks of patients were associated with frequent discussions of tick prevention with clients. Our findings emphasize that most tick exposures of veterinary professionals are occupational, and thus prevention should start at the workplace. Cultivating knowledge of veterinary professionals regarding tick biology and local TBD epidemiology may lead to greater motivation and confidence with identifying ticks and testing for TBDs, which may also increase the diagnostic capacity of veterinary professionals for tick and TBD surveillance. Because veterinary professionals typically interact with both animals and their owners, improving their KAP regarding ticks and TBDs, can in turn promote animal, human, and environmental health within a “One Health” context.

2022

2022 – “Disposable Diaper Waste Accumulation at the Human-Livestock-Wildlife Interface: a One Health Approach” published in Environmental Challenges

Improper management of disposable diaper waste is becoming a priority global health issue because it has resulted in environmental accumulation of fecal pathogens and non-biodegradable material. Concerns include drinking water safety, as well as chemical and physical contaminants that may harm human, animal (domestic and wildlife), and environmental health. In rural areas, especially those in low- and middle-income countries where municipal waste management infrastructure may be lacking, this issue is particularly challenging. Using a One Health approach, this study used spatial statistics to describe the location and proximity of disposable diaper waste sites to livestock grazing areas, human dwellings, rivers, and conservation areas in agro-pastoralist communities in South Africa. A total of 627 unique diaper waste sites were identified and plotted between May 2019 and March 2020. The mean distance of waste sites to rivers was 2,196 m (SD=1,799) and 5,523 m (SD=2,642) to protected areas. Most diaper waste sites were located along the perimeter of villages and dwellings, where livestock grazing areas are common. This description of waste sites is an important step in strategizing efficient and effective waste management programs and policies that prioritize those areas with greatest potential impact on human, animal, and environmental health for remediation.

2022 – “Association Between Pet Ownership and Utilization of Public Services Among People Experiencing Homelessness in Columbus, Ohio: a cross-sectional survey” published in Journal of Social Distress and Homelessness

Nearly 3.5 million Americans experience homelessness every year; between 5% and 25% own companion animals. Animal ownership can serve as a social determinant of health when it prevents accessing important public services like transportation, housing, medical and social services. In this study, we examine the relationship between homelessness, pet ownership, and public service utilization. A cross-sectional survey was administered at six homelessness services locations in Columbus, Ohio, 2018. We compared service utilization between homeless pet owners (n = 24) and non-pet owners (n = 33) using regression analyses. Pets provided emotional support to owners (n = 28;90%), yet prevented obtaining housing assistance (n = 10;32%). Housing concerns were the main reason for pet relinquishment (14/20;70%); 65% (20/31) who owned a pet prior to becoming homeless gave it up. Pet owners stayed six fewer nights per month in homeless shelters (β = −6.15; 95% CI: −12.0, −0.27); and were 84% less likely to be living alone (OR = 0.16, 95% CI: 0.05, 0.51) than non-pet owners. Our research highlights challenges that homeless pet owners face when accessing public services. Given the reported benefits of animal companionship, policies should be examined to consider social determinants and facilitate access and utilization of programs aimed to serve homeless populations.

2021

2021 – “Causes of Mortality of Northern Sea Otters (Enhydra lutris kenyoni) in Alaska from 2002 to 2012″ published in Frontiers in Marine Science

Most of the world’s sea otters reside in Alaska, but there has never been an assessment of long-term mortality patterns for this keystone predator. We examined data collected from 780 northern sea otter (Enhydra lutris kenyoni) carcasses recovered in Alaska from 2002 to 2012 to evaluate the causes of mortality and risk factors associated with death. A smaller group (n = 144, 18%) of fresh non-frozen carcasses were included in a more detailed mortality analysis. Forty-four percent of the fresh dead otters were determined to have died from infectious endocarditis, meningoencephalitis, and/or septicemia due to systemic streptococcosis (“Strep syndrome”). Streptococcus lutetiensis, a member of the Streptococcus bovis/equinus (SB/E) group was most commonly isolated, although other members of the SB/E group were identified. There were fewer cases where S. phocae and other streptococci were isolated. A regression analysis revealed age and location risk factors for Strep syndrome. Subadults were the highest risk age group, and otters recovered from the Kachemak Bay region were 3.6 times (95% CI: 2.2–5.9) more likely to die from Strep syndrome than otters recovered elsewhere. Diagnosis of this Strep syndrome had not been reported in other marine mammals in Alaska. Sporadic cases of septicemia and infectious endocarditis due to S. lutetiensis have been seen in the southern sea otter population in California. Other causes of death for the fresh otters included neurologic diseases (10%), trauma (8%), nutritional diseases (7%), cardiovascular diseases (7%), gastrointestinal diseases /parasites (6%), undetermined (5%), septicemia (3%), and neoplasia (3%). All other causes of death (oiling, hepatobiliary, fungal, marine biotoxins, pulmonary) were at or below 1%. Twenty percent of fresh animals were positive for phocine distemper virus (PDV) by polymerase chain reaction (PCR, 11/55), 18% seropositive for PDV (7/38), and paramyxovirus-like particles were demonstrated by electron microscopy within inclusion bodies from one animal. Low concentrations of the harmful algal bloom toxins domoic acid and saxitoxin were also detected in 26% and 22% of fresh animals, respectively. Protozoal disease was rare. These patterns of disease differ from sea otters in other regions and possible reasons are discussed.

2021 – “Delivering Modern Global Health Learning Requires New Obligations and Approaches” published in Annals of Global Health (part of Special Collection: Capacity Building for Global Health Leadership Training)

Introduction: The COVID-19 pandemic has forced a new look (or modernization) for both the obligations and approaches to achieve best-practices in global health learning. These best-practices have moved beyond traditional, face-to-face (F2F), classroom-based didactics to the use of innovative online, asynchronous and synchronous instructional design and the information and communication technology (ICT) tools to support it. But moving to this higher level of online in-service and pre-service training, key obligations (e.g., stopping neocolonialization, cultural humility, reversing brain drain, gender equity) must guide the modernization of instructional design and the supporting ICT. To positively impact global health training, educators must meet the needs of learners where they are.

Purpose: We describe a set of multi-communication methods, e-Learning principles, strategies, and ICT approaches for educators to pivot content delivery from traditional, F2F classroom didactics into the modern era. These best-practices in both the obligations and approaches utilize thoughtful, modern strategies of instructional design and ICT.

Approach: We harnessed our collective experiences in global health training to present thoughtful insights on the guiding principles, strategies, and ICT environment central to develop learning curricula that meet trainee needs and how they can be actualized. Specifically, we describe five strategies: 1. Individualized learning; 2. Provide experiential learning; 3. Mentor … Mentor … Mentor; 4. Reinforce learning through assessment; and 5. Information and communication technology and tools to support learning.

Discussion: We offer a vision, set of guiding principles, and five strategies for successful curricula delivery in the modern era so that global health training can be made available to a wider audience more efficiently and effectively.

2021 – “Applying a One Health Approach in Global Health and Medicine: Enhancing Involvement of Medical Schools and Global Health Centers” published in Annals of Global Health 

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.

2020

2020 –  “Developing a Global One Health Workforce: The ‘Rx One Health Summer Institute’ Approach” published in EcoHealth

2020 – “Gender and Zoonotic Pathogen Risk in a Resource-Limited Community at the Livestock-Wildlife Interface, Mpumalanga, South Africa: a qualitative analysis” published in Lancet Global Health

Background

The Mnisi community is a livestock-dependent community neighbouring the Great Limpopo Transfrontier Conservation Area in South Africa. Here, zoonotic pathogens contribute to as many as 77% of cases of acute febrile illness, including those associated with tick, domestic animal, rodent, and wildlife exposure. Previous gender-disaggregated analysis has shown that men and women have different risks of zoonotic illness, suggesting that exposure routes for zoonotic infections should be further explored to inform gender-sensitive risk mitigation strategies. Using a One Health approach, we focused on interactions between community residents, domestic animals, and the built and natural environment to investigate potential exposure pathways for zoonotic infections from a gendered perspective.

Methods

We used an ethnographic approach, combining data from direct household observations and focus group discussions, to examine behaviours that may be linked to zoonotic pathogen exposure. Participating households were randomly selected from three villages under the leadership of the Mnisi Traditional Authority in Mpumalanga, South Africa. We conducted four household observations in each village followed by one male and one female focus group per village. Observations and discussions focused on previously identified gendered tasks such as domestic animal care, water collection, and food preparation, and how and by whom these tasks were performed. Data were triangulated across methods, and analysis included translation, transcription, and thematic coding using fundamental grounded theory.

Findings

Observations and focus groups took place during July, 2019. The focus groups included 44 participants: 23 men and 21 women, mean age was 36 years. Mean household size was nine people. Observations were conducted in 12 households (four per village) for a total of 50 h. We noted gender differences for household tasks, animal care duties, and environmental exposure. Male gender-typed roles included cattle husbandry such as taking cattle to the bush daily for grazing (13 mentions) and slaughter of cattle (7 mentions). Female gender-typed tasks included household duties such as food preparation (13 mentions), household cleaning including sweeping the yard, taking out trash (10 mentions), water collection from boreholes or neighbourhood taps (7 mentions), and feeding and care of smaller livestock such as goats and chickens (4 mentions). Other emergent themes included decreased water and grazing land availability in the community, affecting both men and women, as water collection and cattle grazing now required more time spent in the bush and increased potential vector-borne disease exposure. From observations, it was noted that men wore covered protective work clothes (such as long trousers and closed-toe shoes) more commonly than women did, but women did not often wear these for household duties including water collection in the bush. Conflict with wild animals and domestic animals, such as wild animals killing domestic animals in the bush and domestic animals entering other households was also noted as a concern by men and women (13 mentions).

Interpretation

We recommend that these gender-typed roles serve as specific critical control points for zoonotic pathogen exposure. For example, tick-bite exposure prevention should be directed at both men and women based on their daily activities, such that prevention in men should target exposure from cattle and prevention in women should focus on personal protective measures during water collection. Exposure prevention strategies at the household level for water-borne zoonotic diseases like leptospirosis should be targeted towards women. These findings contribute to a more detailed understanding of risk behaviour and critical control points for zoonotic disease—a significant contributor to acute febrile illness in this rural, resource-limited setting.

2020 – “Development of an OIE Harmonized Day 1 Competency-Based Veterinary School Curriculum in Ethiopia: A Partnership Model for Curriculum Evaluation and Implementation” published in Journal of Veterinary Medical Education

The University of Gondar College of Veterinary Medicine and Animal Sciences (UoG-CVMASc) and the Ohio State University College of Veterinary Medicine (OSU-CVM) developed an objective methodology to assess the curriculum of veterinary institutions and implement changes to create a curriculum that is harmonized with OIE standards while also covering the needs and realities of Gondar and Ethiopia. The process, developed under the sponsorship of the World Organisation for Animal Health (OIE) Veterinary Education Twinning Programme, is outlined in this article with the hope that it can be applied by other countries wishing to improve national veterinary services (VS) through the improvement of their academic programs. The plan created by the UoG-OSU Twinning team consisted of an in-depth curriculum assessment and development process, which entailed three consecutive stages. Stage 1 (Curriculum Assessment) included the design and development of an Evaluation Tool for OIE Day 1 Graduating Veterinarian Competencies in recent graduates, and the mapping and evaluation of the current UoG-CVMASc curriculum based on the OIE Veterinary Education Core Curriculum. Stage 2 (Curriculum Development) consisted of the identification and prioritization of possible solutions to address identified curriculum gaps as well as the development of an action plan to revise and update the curriculum. Finally, Stage 3 (Curriculum Implementation) focused on the process to launch the new curriculum. In September 2017, 53 first-year students started the professional program at the UoG-CVMASc as the first cohort to be accepted into the newly developed OIE Harmonized Curriculum, the first of its kind in Africa.

2020 – “Gender Roles and One Health Risk Factors at the Human-Livestock-Wildlife Interface, Mpumalanga Province, South Africa” published in EcoHealth

Gender sensitivity in health promotion has been widely recommended, yet attention to gender roles and gender-disaggregated studies are often lacking in disease research and public health intervention planning. In the rural Mnisi community of Mpumalanga, South Africa, where zoonotic pathogens are known to contribute to acute febrile illness, community and household tasks may increase an individual’s risk of exposure, and these tasks are likely to be influenced by gender. This study described the roles and responsibilities of community residents, specifically those that have been identified as critical control points for infectious pathogen exposure, by gender. Male gender-typed tasks included those associated with livestock and poultry husbandry, hunting and slaughtering wildlife, and rodent control. Female gender-typed tasks included animal-source food preparation, domestic cleaning and maintenance, and caregiving to children and ill family members. Given the gender-specific nature of these tasks, potential pathogen exposure and transmission patterns of infectious diseases may be also be gender-specific. These data can inform the development and revision of health promotion strategies, such as the community-based One Health Training and Leadership program, prioritizing outcomes for male and female participants alike. Gender-disaggregated analysis is recommended for effective risk mitigation and community-wide health promotion using a One Health approach.

2020 – “Multimodal Integration of Active Learning in the Veterinary Classroom” published in Journal of Veterinary Medical Education

Historically, pre-clinical professional veterinary instruction has relied heavily on didactic methods. With the shift toward competency-based education in health professions teaching, instructors at The Ohio State University College of Veterinary Medicine are exploring alternative engagement strategies to focus on learner outcomes. In this article, we report on the integration of competency-based active learning techniques in a large-lecture setting, along with preliminary outcomes from the student perspective. A total of 110 students from Zoonotic Diseases, a two-credit core course offered in the second year of the 4-year professional curriculum, participated in the learning techniques and retrospective pre-/post-questionnaire. Results of the questionnaire indicated improvement in learners’ perceived competency. For practical skills (e.g., donning and doffing of personal protective equipment), students also reported improved self-efficacy. Students enjoyed the interactive and self-directed learning techniques and described an improvement in their ability to evaluate their own understanding of relevant course concepts. The active learning techniques described herein may be used to supplement, and even transform, primarily lecture-based courses to better achieve professional competency and develop practice-ready veterinarians.