Lindsey Shields-Outbreak Epidemics in a Connected World Training

Lindsey Shields-Outbreak Epidemics in a Connected World Training

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All. Right good afternoon how, are you guys all feeling anybody. Anybody. Exhausted. I've. Got, a lot of pictures to hopefully keep you engaged and. And, some stories that you'll maybe be able to use going forward I'm, also gonna time myself mostly. Because I have a bad, habit of just telling you crazy stories and losing track of time so. This will help me try to avoid this so, as mentioned, I'm Lindsay shields I'm a veterinarian, and, a preventative, medicine board-certified, veterinarian. Which, is just a fancy way of saying I like epidemiology. And diseases I. Work, with the Global Health Program which sits within the Smithsonian, conservation biology. Institute it's, a relatively, new program and, it is one of the implementing, partners for, the predict program that, Sarah just brought up a minute ago. Before. We go too much further who. Are we were at the Smithsonian, we're doing this crazy work. Our. Team is mostly veterinarians, who have been trained in epidemiology, or wildlife, work. We. Also have people on our staff who are public health specialists. Ecologists. Epidemiologists. But. At the end of the day we're all conservationists. We're all working together to try to figure out a way to safeguard human, and wildlife health, and. We do this within the one health concept which, you've heard a lot about already, the, health of the people is interconnected, with the health of the animals in the environment and it, requires collaborative, work across disciplines in, order to get the best health goals implemented. For all parties, so, our global health program was created to address animal, health for, direct conservation. Work and within, one health concern, so looking at emerging infectious, diseases, wildlife. Health research and capacity. Building and training for our international partners. I'm. Just gonna take a moment and kind of talk you guys through I really, like this. Image. Of one health because it's shown as a Venn diagram indicating. That no one's really doing anything all by, themselves you. Have people who work in the animal domain those range from veterinary medicine, to, biology, to, ecology, comparative. Medicine you. Also have people working on the human health side social, sciences and humanities medical, doctors, you. Have people working in environment, Earth Sciences, and engineering, now, when we're talking about emerging, in diseases, it's critical, that we kind of all work together and actually communicate, with each other about, the things that we're seeing in each of these different spheres for. Example if you have an outbreak of anthrax let's, say very. Scary sounding disease happens very frequently in, wildlife, populations, in Kenya and these, are often found where wildlife are just found dead on the ground and we don't have a lot of information about, what's going on with them perhaps.

At The same time there could be surveillance, in the clinics locally, that show that humans are coming in with with. Anthrax, related, sores, on their bodies so, there may be some interesting. Links there that are not really being identified, if you're working within that silo. So. You, guys have seen some of this before emerging. Infectious, diseases is what we're gonna focus on today zoonotic. Diseases again 75, percent cause for emerging infectious, diseases in humans and the majority, of those new zoonotic diseases, do you have a reservoir in wildlife, species there. Are cause for major pandemics, and they lead to major economic impact, now, what does that mean you guys toss out some ideas what, are what, are these costs, that we're worried about anybody, have any ideas just throw them out there tourism. Yeah huge, when, people in China for example during the SARS outbreak they. Had they saw a drastic, decrease in the tourist tourism, numbers. That year of people going to Hong Kong for tourism what else. Productivity. Agriculture. Yeah you've got for example you heard earlier today about avian influenza, when they identify low. Pathogenic avian, influenza in let's. Say chickens in Mexico they, do populate, the entire flock that's, a huge economic cost, to that farmer, and to that industry in that area, any other ideas. Okay. That's enough for now I'm gonna make you guys help me with this lecture that's that's, actually ordering okay so speaking, of emerging. Diseases versus, benefits, right because I'm ultimately. All about conservation. Even though I'm also all about preventing outbreaks. So, toss, them out what are some emerging diseases you've talked about a lot of them today, Zika. What else Ebola. What else MERS. What else, sorry. What else. NEPA. You guys heard about NEPA yet today yeah, not. Today okay so tons. Of diseases right, all. These things are emerging diseases you've got rabies you've got MERS SARS, Ebola hantavirus, you heard about earlier Hendra, virus okay. Why. Do we care if these are in our wildlife populations, do we have any benefits that we get from wildlife, what. Are some of those benefits oh. My. God you guys are really quiet right now do. You see this fascinating, thing it's so easy for us to talk about all of these really amazing, emerging, diseases it's a lot harder for us to advocate, for these wildlife species yes they're amazing, and they're important to our environment, do you guys have any ideas about benefits, what do you guys think toss. Diversity. Biodiversity. What else, yeah. Absolutely I think we set heard tourism, earlier today for a different aspect, right people do ecotourism so. There's a ton of different benefits what I haven't heard yet is pest. Control or pollination, I am, a big fan of bats I think, they're great and they actually prevent, us from having to use pesticides on, a lot of our crops here in the United States because, every night they'll go out and they'll eat up all of those locusts, and horrible, insects that would go and destroy your crops they're. Also critical for pollination, so, they're going out and by sampling, the fruits and then, traveling back to their roost they're, defecating, they're dropping seeds and new places and so they're helping us keep our environment safe and healthy we. Also care about them for conservation, ecotourism. Fertilizer. Do, you guys know this, yeah. People, collect things like bat guano and use it as fertilizers, on their agriculture, and, sometimes. For food security we heard earlier we're not gonna say bush meat we're gonna say meat, sometimes. People like to use wildlife, species for, their consumption, that can be in places where they maybe need it for food security but also is in places where, it's a preferred source of protein. Okay. Bonus points who knows what that is in the bottom right corner. Bottom. Right corner this little guy yeah, it's a palm civet do you guys know why these guys were kind of famous. Yes. Coffee do you guys owe extra, bonus points do you know the name of the coffee. Yes. It has a special name. Kopi. Luwak, it. Is the most expensive coffee in the world if you guys have not heard of this before they, feed the cherries. From coffee to civet, cats harvest. The feces. Yes. You heard that right they harvest, those feces, and they, make coffee out of the beans that have been processed through the civet cat and it's, the most expensive cup of coffee in the world now. The reason that I bring this up is because today we're talking all about emerging, infectious, diseases and no, matter what else we talk about for the rest of the day I want you to think about the interfaces, the, ways that we interact with wildlife, that you may not think about so.

When You go to vietnam and they're like oh this is the world's best coffee you have to try it you. Might be interacting with wildlife. You. Guys do you guys know what this little creature is, Pangolin. I love them I think they're great there's, been some rumors going around that they may have also been positive. For SARS. Back when there was the SARS outbreak. But. I just really thought he was adorable so he had to he had to stand all. Right so I'm gonna spend the rest of my time today focusing, on the predict program which you heard quite a lot about earlier, and the predict program as was mentioned has been going on for a number of years, it covers, 31, countries and. We're gonna get into some details about what we're doing in that program and how the Smithsonian, is actually participating. Before. We go too far I'm gonna walk you through this slide okay. Everybody calm down I know it looks really scary it's. Not a lot of information it just looks scary so, I really love this slide as a way of setting up when we look at emerging, infectious diseases and, spillover, from wildlife, or livestock to human populations, so, focus, with me at the very beginning you, see this nice green, sort, of cyclic, flow and that's, indicative of, what we're seeing in wild populations, sometimes. There will be outbreaks, of a particular emerging, disease lets, them let's. Just use an example one to make it a little easier to talk about let's say that this is what, do you guys want to use a bola, yeah. Okay we'll use Ebola so, you've got sort of this cyclic cycle in the, reservoir. Host right and for Ebola we think that it's probably bats, with. Spill over into primates, and then potentially, spill over into other types of animals so this, green thing is going on in the background and we don't even notice it. We. May notice it if it spills over into our domestic populations. And there's not been a ton of work on this from the Ebola side but let's just say you've got Ebola spilling, over into. Your goats and you're seeing these weird, weird. Clinical signs your goats are really sick you don't really know what's going on meanwhile. The Ebola is now amplifying, within that domestic host that means that more animals are getting sick more animals are getting exposed and you still haven't really figured out what's going on now. This is where we have spillover and spillover can occur in two places right we heard amplifying, hosts, and sometimes you need that middle host to go from a reservoir host to you and. So perhaps, that occurs because you're interacting with a wild population or, perhaps, that occurs because you're argh you're a goat herder and your goats have been exposed to something. Once that spillover, occurs, you, have this amplification. Within, human populations, and spread, within human populations, and so this is kind of what that would look like if you're looking at the whole ecosystem, and how the disease is spreading among all the susceptible, hosts and, this.

Is All fine and good but what, we want to do is figure out a way to minimize, the human amplification, perhaps. Prevent, our animals, our livestock, from getting ill in the first place and in order to do that we have to go all the way back to the beginning to understand. What's happening all the way on the ground in the wildlife species. So. I'm, gonna walk you through this one now this is what we're trying to get towards this is where we're striving for when we're looking at predicting, the next pandemic or predicting, what could be the next big disease, we, want to understand, what's going on earlier, in that lifecycle, so, the first thing is looking, at what's happening in those wild populations, and that's forecasting. And readiness and understanding, what potential pathogens are, there in those species, then. You've got early detection and, early, detection is basically your surveillance activities, that are identifying. When there's an ill animal, of a disease that you're concerned about earlier. Then. You're able to implement control, operations, that's shown in that sort of orange. Yellow so you can control it in your livestock if you identify it early you can implement control, measures and then. If you still have spillover into human populations, hopefully, you've identified it quickly and you understand what's going on so, you're putting that, your, you're doing a control measure during your rapid response here earlier and the. Takeaway message is here to compare these two graphs without. Any intervention, you're looking at this which is a lot of new cases, expanding. And exploding over time, if. We're able to intervene earlier and understand, what's going on in these populations earlier, we're, able to prevent those high number of cases to be to be occurring at the end of the day so, in you can see in the light blue that would be cases. That we aren't seeing in livestock and in the white area that's cases, we're not seeing in humans because we've been able to institute a control method or stun something, to intervene. This, is another way of representing. This and we'll just walk through this as well this is let's say a. Just. Human population, right so this is this is what you maybe would see at a health department if, this, if nothing was happening you would maybe see this outbreak at, your health department this is what the graphical, representation of the outbreak would look like if, we're able to implement control, measures and understand, what's going on earlier we're, able to do some things to prevent all of these cases from occurring so surveillance, observations, and monitoring that's gonna happen ongoing that's starting well before you even see the first case. Let's. Say the first case shows up but, you're ready you're prepared you know what you're looking for the people in the clinic know how to report what's going on so. They'll detect it they'll report it the, people who receive. That report. Will then seek out and confirm. It through laboratory confirmation, once. It's laboratory, confirmed, they'll, initiate, a response and again you'll, see an opportunity, for control preventing, all of these cases from occurring so. That's I think kind, of where we're trying to go with the predict program right so we're trying to get at that wild, life cycle, and understanding, the potential for spillover in, high-risk, countries throughout, the world. So. The predict countries, cover, 31, different countries, and they, are shown here on this map and if you remember back to the map that Sarah. Showed you before you, remember seeing where those I, think they were represented, in yellow, on her map yellow.

Zones Which were the high-risk zones and you'll note that most of the predict countries correlate. Very well to that map at, the. Smithsonian, we are the implementing, partner in two places in Kenya. And in Myanmar. So. Predict Kenya is in like hippy a County and as. Mentioned earlier it focuses, on the normal predict sort, of focus so capturing, and sampling, rodents. Primates, and bats also. Doing community-based surveillance, within human populations, and, working. With clinics to understand, sort of case based reporting, in. Addition, to that we're also looking at the potential, for camel. Camel. Interactions, between humans, as a, suspected. Reservoir. Host for the, MERS coronavirus. In Myanmar, were active in two sites and I'm actually gonna spend the rest of the time talking specifically. About Myanmar, so I'm not going to go into too much more detail here, all. Right what. Do you think these guys are doing. Bat, guano she nailed it exactly, I gave you guys too much of a hint earlier about it yes so this is in Myanmar. At a cave site where we do active. Surveillance there. Is a family that has been working in this location for about 50 years it's a family, business, they, regularly, go back there and every. Couple of months they go back into this cave and they collect bat guano and I'm not talking like a little bag of it look at the size of these bags look at the quantity. Of bat gonna that they're taking home and this, is being sold and used as fertilizers, in the local community, now, thinking, about that interface, again what are some things that you're thinking about already, from. What you've learned today. Getting. Disease from that so in what way. Yes. Absolutely direct, do you see these guys in like marshmallow, suits no. The local community, would not be going into that cave that they've done four generations with a marshmallow suit on they're, going in there with their bare hands they don't have anything covering their mouth they're, picking things up off the ground they're using tools that are getting them contaminated, and let's, be honest they're probably not washing their hands so.

The This group of people is a very interesting, group for us to understand, a little bit more about their risk about what's going on in their life how they're handling, the bat guano you, know understanding, a little bit more about what diseases they may have had in the past or the clinical signs that they may have they. Anecdotally. Shared with us that you know they're just kind of used to having respiratory. Distress, for, a couple of days after they go into the cave and collect, this bat guano. What. Else would you be thinking about when we're thinking about interphase anything, else. I told. You the bat guano's gonna be used as fertilizer right, so, that means they're gonna take it with them and they're gonna put it on crops and so there's also interesting, questions that you can ask about what's. Happening, with those crops how are they being used how, is it being put on the soil and. So there's a lot of interesting questions that come up when we're talking about this and if, it predicts me and my program is trying to understand, more. About the human, behaviors. That could impact the level of risk that we see in these communities, and targeting. People that are at higher risk such, as perhaps, guano farmers, in in, rural Myanmar, all. Right, so, we, focus on two sites in Myanmar and hapa, on and hewan got National Park in Yangon State you can see these marks here with the stars. We've picked these sites because there are clear, high, risk interfaces. That are demonstrated, at both of these sites and we coordinate with the Food and Agriculture, Organization at, both locations the, Food and Agricultural Organization is a UN agency that helps us bring in that livestock factor, that we at the Smithsonian, within the global health program don't have as much experience in, this. Particular project is supported by three government, ministries, in Myanmar that represent the Ministry of Health the, Ministry of Agriculture, and the Ministry of Environment which. If you're thinking, about that nice Venn diagram, I showed you earlier it's, a very clear link between this one health and a very clear strong message from the Myanmar government that, they support, and want to figure out how to do disease. Control activities, and surveillance, activities within, a one health approach. The. Main things that we do here are field capacity, laboratory. Capacity building and work with universities, to build their university, capacity, the idea being that we're going to identify potentially. New viruses, understand. The risk at the interface of human wildlife and human livestock interaction. And, support, me and Mar to be able to respond, to issues, at the interface on their own without outside help. So. Here is our first site and beyond this. Is a sacred, cave. Where, people regularly, go to worship and tourists. Regularly, go to visit. Any. Thoughts about what we might be thinking about in a cave like this that's. So many, bats at night we have these beautiful videos, of.

Thousands. And thousands of bats exiting, the cave all at once, and directly, outside the cave you've got lots of farmland too and so it's a very fascinating. Interface. That you're seeing. This is one of the bats that we sampled, isn't. He adorable. He's, actually really not I don't know if you can see his face he's got the weirdest little face. I love. These bats though they're they're great and. He was a good sport we put him right in front of that little secret site there so that you knew exactly where he was coming from. Speaking. Of interfaces, here's another example of interfaces, that we've seen please. Note I am not recommending that you go and interact with the monkeys this is not what we wanna see but. This is culturally, normal regularly. The monks will go out and feed this little group of monkeys that live near the live, near their their their, temple and so there's regular, sustained, interaction, there with the wildlife and. Then. Back to my favorite family this, is again the guano farming, family or guano harvesting, family the, other thing that they do here, and it's a little hard to see but can you guys see what's in those traps. Yes. Rats, and rodents and things that live in the cave besides, bats this. Particular family, when they go in and trap when, they go and collect the bat, guano from the caves will also trap rodents and use that for food and. So there's, another whole. Layer of complication, in how are they trapping, the rodents how are they interacting with them and as you heard earlier oftentimes, the biggest risk for disease transmission, is not in the consumption, of the wild meat but in the actual slaughtering, of the wild animal. So, just a quick summary of what I just showed you in our first surveillance, site again. We focused on the Buddhist temple cave sites where, there's also livestock, and produce production right outside some. High-risk interfaces, that we focused on include the bat guano extraction. The, rat and bat consumption, primate. Feeding and ecotourism. And I said we sampled so I feel like I had to show you that we were. Wearing lots of good gear and we. Were not going in and grabbing the bats without wearing proper protective. Equipment but. This is a picture of one of our colleagues at that site sampling, I believe one of those rats that you saw on an earlier slide. The. Second site that we chose the around, the National Park is actually very densely populated there's, a lot of villages that surround that National, Park that go into that National Park and regularly interact with the wildlife species found there this. Is a little boy who regularly, feeds the, the, monkeys in his neighborhood village. There. Are also interesting, types of wildlife there and. People that do regularly, interact with them whether they're using them as livestock or a sort. Of captive wild breeding and, finally. My favorite. So. Again we're seeing lots of high, density villages, surrounding, the zoos and sanctuaries, with free-roaming animals and, there are high-risk interfaces. Here with primate, feeding occurring like that little boy or that monk handing the food directly to the monkeys and. Then a lot of mixture, with free roaming wild life so boars and fowl and deer and I hope that when I'm saying these things you're already thinking about some of the other lectures, you've had today about the other types of emerging diseases that we're thinking about.

There. Are also restaurants, located in the area that were identified, to have severe rodent, infection, and that's an entirely other. Interface. That we want to learn more about and understand, more about and a very large small bat population. We. Also coordinate with FAO, in that region to look at slaughterhouse, pigs do. You guys remember this, is me going off on a tangent I think I have enough time do. You guys remember or have you learned about already Nipah, virus. Do. Okay, so some yes isn't some nose so Nipah virus is a fascinating, virus, and it's, a really interesting case, study for human, interface, in human, wildlife interaction. There, are two particular, outbreaks. That happened around the same time one in Malaysia and one in Bangladesh, and in Malaysia it was linked to actually pigs with bats that were roosting above the pigs eating some fruit. That they brought home from there you, know nightly for a to get to get their dinner and then dropping that fruit down into, the pen with the pigs and the pigs then eating it pigs, were serving as an amplifying, host and, then past that need for virus on to the handlers, of the pigs so that's the Malaysia story, in. Bangladesh, it was the same well, a very closely related virus, also Nipah virus and, a. Completely, different story. So in bong Bangladesh, there are, cultural. Practices, of palm. SAP have you guys heard of this already. Where. They consume raw palm SAP as part of their normal, diet and that meant that they would go out and find a a tree drill a hole and put something in it and hang, a jar at the end so that the SAP would come out and fall, into the jar and. That population has been changing, in Bangladesh it's a very populated, area and it's continuing, to expand into new parts of Bangladesh. And encroaching. Into places, where historically, mostly, wildlife has been present and, so. We had this emergence, of a NEPA virus also in Bangladesh with similar encephalitic. Clinical. Signs and. They actually took these amazing, pictures of the bats that were located in that area who had discovered that instead, of having to work hard for their meal they could fly to these treats, that had these these. Bamboo. Spouts, initially. Installed, in them and we, have amazing video of them hanging upside down from these trees and licking, the sap as it came out before, it was collected into that pot below and when they're doing that they're urinating and it's going into that jar collection, they're also licking, the SAP so saliva is interacting, with that I think. My favorite part. Of. This story is that they said okay let's put bat boxes, over top of these so they literally super. Easy super, cheap, put, a box overtop.

Of It to prevent the bat from being able to access that box and it, worked and they, you know did community messaging, about hey don't eat don't drink raw palm sap if you boil it first it'll be better and, so I think you know thinking about human, wildlife interaction. And the interventions, that we can have it doesn't always have to be some crazy, expensive. Scientifically. Savvy, new intervention, sometimes, it's just putting a bat box on a tree, and, so ok back to back. To our sites here so anyway that was why we wanted to look at slaughterhouse pigs was to think about also this potential, for Nipah virus. Again. We were doing sampling, here this is a primate, being sampled at the Halong. And National Park. And a. Bat being sampled there as well so in. Addition to the wildlife. Sampling, we are also doing human sampling, and human surveillance and, we do this through identifying. Occupational. Or communities, at risk so again thinking about the types of interactions that they're having with their wildlife and livestock the. Location, that they're sharing with those animals perhaps. Their work like going into the cave to go procure, some bat guano and we do. We. Implement a survey with them to understand more about that risk and how they interact with their livestock and wildlife species and we also collect, a blood sample and some. Other samples like swab. And things like that to look, for some of these novel pathogens, and identify, if there has been some early spillover. We. Also do syndrome, X surveillance at three clinics that means if they get something odd that is looks. Like malaria but it's not malaria, they they note it down so we have syndromic surveillance there, as well and. People who elect, to participate are, given a, gift in return for their samples, and their answers. To, our questions. So. Just to bring it back again to, this. One health concept in, Myanmar we've collected, over 2,500. Samples from wildlife species and over 400, samples from humans I can't. Give you a lot of the details of what the results have shown because they're still being processed but I can tell you that we did find coronaviruses, and and, other viruses that are interesting. And important for us to to, look at and understand better. Again. When we're talking about how we're going to manage. These emerging infectious diseases we. Want to try to find a way to develop. And prepare earlier.

In That cycle back at that early part where you've got wildlife. Back. In that graph at the earlier start of that graph but, again we can't do it alone, veterinarians. Like us we, can't do it alone we need to work with our human medical counterparts. And the environmental, specialists, who understand, how those disease. Dynamics will, be, altered, in the way that the location, is. Being, impacted so, I think, I've done pretty well and I've left a little bit of time for questions, so I will leave it there and thank you guys so much. You.

2018-09-11 12:31

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