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Zoonotic Diseases and

One Health

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ContentsContents

OH Concept Zoonotic Diseases

Introduction1

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ZD

and

OH

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INTRODUCTIONINTRODUCTION

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ZOONOSISZOONOSIS

BiodiversiBiodiversity ty IndonesiaIndonesia

Zoonotic Zoonotic DiseasesDiseases

One One HealthHealth

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ProblemsProblems

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Zoonotic DiseasesZoonotic Diseases

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Morens, D., Folkers, G., & Fauci, A. (2004) The challenge of emerging and re-emerging infectious diseases. Nature, 430: 242-249.

805/03/23WPPKHT, WTA 8

Global distribution of Relative Risk for an EID Global distribution of Relative Risk for an EID Event caused by Zoonotic Pathogens from Event caused by Zoonotic Pathogens from

Wildlife*Wildlife*

Jones KE, Patel NG, Levy MA et al. Nature 2008; 451:990-993.

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OH – Public health as part of the ecosystem

Human Cases

Wild Animal

Domestic Animal

CASES

TIME

Animal Amplification

Human Amplification

SPILL OVER

SPILL OVER

SPILL OVER

One health program

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WHAT IS AN OUTBREAK?WHAT IS AN OUTBREAK?OutbreakOutbreak

EpidemicEpidemicClusterCluster

Increase in number of cases over expected in a given time period

Cases grouped in time or space

May or may NOT be an outbreak(may not represent a real increaseover the expected number in a given time period)

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““10 STEPS OF OUTBREAK 10 STEPS OF OUTBREAK INVESTIGATIONINVESTIGATION””

1.1. Determine the existence of the outbreakDetermine the existence of the outbreak2.2. Confirm the diagnosisConfirm the diagnosis3.3. Define a case and count casesDefine a case and count cases4.4. Orient the data in terms of time, place and Orient the data in terms of time, place and

individualindividual5.5. Determine who is at risk of becoming illDetermine who is at risk of becoming ill6.6. Develop hypothesis and statistically test itDevelop hypothesis and statistically test it7.7. Compare the hypothesis with established factsCompare the hypothesis with established facts8.8. Plan a more systematic studyPlan a more systematic study9.9. Prepare written reportPrepare written report10.10. Execute control and prevention measuresExecute control and prevention measures

From: “Field Epidemiology”, edited by Michael Gregg, 3rd ed. 11

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IDENTIFYING ADDITIONAL IDENTIFYING ADDITIONAL CASECASE

Buffer Zone

Surveillance Zone

Affected Zone

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DESCRIPTIVE EPIDEMIOLOGYDESCRIPTIVE EPIDEMIOLOGY

Who is at risk?Who is at risk?

Where are cases occurring?Where are cases occurring?

When did the cases happen? When did the cases happen?

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Rabies in BaliRabies in BaliPopulation • 3.9M in 2010; Hindu culture • Implications for rabies control Rural livelihoods • Agrarian society • Poultry, rice, tourism Acceptance of dogs • Guard dogs, pets Devolution of authority • Funding and control are your problem

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Jumlah Kasus Rabies Pada Manusia Jumlah Kasus Rabies Pada Manusia Per Kabupaten/Kota Tahun 2008 s/d 23 November Per Kabupaten/Kota Tahun 2008 s/d 23 November 20102010

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18

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330 2

36

Total : 107

2008 : 4

2009 : 28

2010 : 75

Kr.Assem

Buleleng BangliJembrana

Badung

Gianyar

DenpasarKlungkung

Tabanan

Lab Positif : 46 Kasus

Sumber: Subrata K. (2010)

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Rabies Cases in Bali !Rabies Cases in Bali !

Sumber: Dinas Kesehatan Badung 2010

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One HealthOne Health

Ecosystem healthAnimal healthHuman health

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OH ApproachOH Approach

One Health does not One Health does not change what we do, but change what we do, but rather how we do itrather how we do it

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3 Key Messages3 Key Messages1.1. Learning One Health has been a Learning One Health has been a

strugglestruggle

2.2. The link between One Health The link between One Health concept and practice is toolsconcept and practice is tools

3.3. Scenario planning is one tool help Scenario planning is one tool help us deal with complexityus deal with complexity

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Complexity at the local Complexity at the local level leads to more level leads to more

questionsquestions““You canYou can’’t change that river. Itt change that river. It ’’s been a problem for 30 yearss been a problem for 30 years””..

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Human-Animal-Ecosystem (Rural Ecosystem)

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How is knowledge integrated?How is knowledge integrated?Lots of awareness/ behavioral change – health & environment

Little pollution of water resources

Lots of pollution of water resources

Little awareness/ behavioral change – health & environment

Best case scenario

- Have a group of waste collectors

- Contributions from government & the people

- Have a landfill site, women`s union will implement

Worst case scenario

- Lots of diseases

- Income affected by decreased ability to work

-Individual health care spending is high

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One One HealthHealth

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No idea is born perfect, give it a chance to grow and explore OH

Thank YouThank You