The Value of the One Health Approach: Shifting from Emergency Response to Prevention of Zoonotic Disease Threats at Their Source
The Value of the One Health Approach: Shifting from Emergency Response to Prevention of Zoonotic Disease Threats at Their Source
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DOI：
10.1128/microbiolspec.oh-0011-2012
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发表时间：
2013-10-01
影响因子：
3.7
通讯作者：
Dixon, Matthew
中科院分区：
文献类型：
--
作者：
Heymann, David L.;Dixon, Matthew
大多数新出现的传染病都起源于动物，当动物的感染突破物种屏障感染人类时，它们的出现发生在人与动物的接触面，而人类往往是最先发现这些疾病的人群。应对措施通常是一系列紧急活动，以控制和管理人群中的感染，同时确定自然界中的感染源。如果发现感染源自动物，并且动物对人类感染造成持续威胁，通常会建议扑杀，这会造成严重的经济影响。目前，动物和人类医学部门正在努力通过联合监测和风险评估，在动物与人类界面上进行更密切的互动，并且正在对过去出现过动物与人类界面的地理区域进行研究。这项研究的目标是识别热带和其他野生动物中的传染性生物体，对这些生物体进行基因测序，并试图预测哪些生物体有可能在人类群体中出现。然而，从过去的疫情事件中吸取教训，将人类疾病监测、检测和应对模式转变为通过了解和减轻影响动物感染的因素或决定因素，从源头预防疫情的发生，可能更具成本效益。通过对以往突发事件的研究可以清楚地了解这些决定因素，包括人类引起的自然环境、城市地区和农业系统的变化；动物性食品的饲养和加工；以及全球贸易、移民和气候变化的作用。通过对过去和现在的突发事件进行流行病学调查，更好地了解这些因素，并对可能缓解这些事件的干预措施的成本效益进行建模和研究，可以为更好地解决预防动物感染的政治和经济障碍提供必要的证据。需要这种在经济上令人信服的变革和缓解论据，因为动物健康（受利润需求驱动）和人类健康（受拯救生命需求驱动）存在根本差异。
The majority of emerging infectious diseases have their source in animals, and emergence occurs at the humananimal interface, when infections in animals breach the species barrier to infect humans, the population in which they are often first identified. The response is often a series of emergency activities to contain and manage the infection in human populations, and at the same time to identify the source of the infection in nature. If an infection is found to have a source in animals, and if animals cause a continuous threat of human infection, culling is often recommended, with severe economic impact. Currently the animal and human medicine sectors are working toward interacting more closely at the animal-human interface through joint surveillance and risk assessment, and research is under way in geographic areas where emergence at the animal-human interface has occurred in the past. The goal of this research is to identify infectious organisms in tropical and other wild animals, to genetically sequence these organisms, and to attempt to predict which organisms have the potential to emerge in human populations. It may be more cost-effective, however, to learn from past emergence events and to shift the paradigm from disease surveillance, detection, and response in humans to prevention of emergence at the source by understanding and mitigating the factors, or determinants, that influence animal infection. These determinants are clearly understood from the study of previous emergence events and include humaninduced changes in natural environments, urban areas, and agricultural systems; raising and processing of animal-based foods; and the roles of global trade, migration, and climate change. Better understanding of these factors gained from epidemiological investigation of past and present emergence events, and modeling and study of the cost-effectiveness of interventions that could result in their mitigation, could provide evidence necessary to better address the political and economic barriers to prevention of infections in animals. Such economically convincing arguments for change and mitigation are required because of the basic difference in animal health, driven by the need for profit, and human health, driven by the need to save lives.