Emerging Infectious Diseases Volume 19 Issue 12

2013·12.9 MB·English

by  CDC

Peer-Reviewed Journal Tracking and Analyzing Disease Trends pages 1913-2080
EDITOR-IN-CHIEF
D. Peter Drotman
Managing Senior Editor EDITORIAL BOARD
Polyxeni Potter, Atlanta, Georgia, USA
Dennis Alexander, Addlestone, Surrey, UK
Associate Editors Timothy Barrett, Atlanta, Georgia, USA
Paul Arguin, Atlanta, Georgia, USA Barry J. Beaty, Ft. Collins, Colorado, USA
Charles Ben Beard, Ft. Collins, Colorado, USA Martin J. Blaser, New York, New York, USA
Ermias Belay, Atlanta, Georgia, USA Christopher Braden, Atlanta, Georgia, USA
David Bell, Atlanta, Georgia, USA Arturo Casadevall, New York, New York, USA
Sharon Bloom, Atlanta, GA, USA Kenneth C. Castro, Atlanta, Georgia, USA
Mary Brandt, Atlanta, Georgia, USA Louisa Chapman, Atlanta, Georgia, USA
Corrie Brown, Athens, Georgia, USA Thomas Cleary, Houston, Texas, USA
Charles H. Calisher, Ft. Collins, Colorado, USA Vincent Deubel, Shanghai, China
Michel Drancourt, Marseille, France Ed Eitzen, Washington, DC, USA
Paul V. Effler, Perth, Australia Daniel Feikin, Baltimore, Maryland, USA
David Freedman, Birmingham, Alabama, USA Anthony Fiore, Atlanta, Georgia, USA
Peter Gerner-Smidt, Atlanta, Georgia, USA Kathleen Gensheimer, Cambridge, Massachusetts, USA
Stephen Hadler, Atlanta, Georgia, USA Duane J. Gubler, Singapore
Nina Marano, Atlanta, Georgia, USA Richard L. Guerrant, Charlottesville, Virginia, USA
Martin I. Meltzer, Atlanta, Georgia, USA Scott Halstead, Arlington, Virginia, USA
David Morens, Bethesda, Maryland, USA Katrina Hedberg, Portland, Oregon, USA
J. Glenn Morris, Gainesville, Florida, USA David L. Heymann, London, UK
Patrice Nordmann, Fribourg, Switzerland Charles King, Cleveland, Ohio, USA
Tanja Popovic, Atlanta, Georgia, USA Keith Klugman, Seattle, Washington, USA
Didier Raoult, Marseille, France Takeshi Kurata, Tokyo, Japan
Pierre Rollin, Atlanta, Georgia, USA S.K. Lam, Kuala Lumpur, Malaysia
Ronald M. Rosenberg, Fort Collins, Colorado, USA Stuart Levy, Boston, Massachusetts, USA
Frank Sorvillo, Los Angeles, California, USA John S. MacKenzie, Perth, Australia
David Walker, Galveston, Texas, USA Marian McDonald, Atlanta, Georgia, USA
J. Todd Weber, Atlanta, Georgia, USA John E. McGowan, Jr., Atlanta, Georgia, USA
Tom Marrie, Halifax, Nova Scotia, Canada
Founding Editor
Philip P. Mortimer, London, UK
Joseph E. McDade, Rome, Georgia, USA
Fred A. Murphy, Galveston, Texas, USA
Senior Associate Editor, Emeritus Barbara E. Murray, Houston, Texas, USA
Brian W.J. Mahy, Bury St. Edmunds, Suffolk, UK P. Keith Murray, Geelong, Australia
Copy Editors Claudia Chesley, Karen Foster, Thomas Gryczan, Stephen M. Ostroff, Harrisburg, Pennsylvania, USA
Jean Michaels Jones, Shannon O’Connor, Carol Snarey, Richard Platt, Boston, Massachusetts, USA
P. Lynne Stockton Gabriel Rabinovich, Buenos Aires, Argentina
Mario Raviglione, Geneva, Switzerland
Production Alicia Scarborough, Barbara Segal, Reginald Tucker
David Relman, Palo Alto, California, USA
Editorial Assistant Tracey Hodges Connie Schmaljohn, Frederick, Maryland, USA
Tom Schwan, Hamilton, Montana, USA
Communications/Social Media Sarah Logan Gregory
Ira Schwartz, Valhalla, New York, USA
Emerging Infectious Diseases is published monthly by the Centers for Tom Shinnick, Atlanta, Georgia, USA
Disease Control and Prevention, 1600 Clifton Road, Mailstop D61, Atlan- Bonnie Smoak, Bethesda, Maryland, USA
ta, GA 30333, USA. Telephone [phone], fax [phone], email Rosemary Soave, New York, New York, USA
[email protected]. P. Frederick Sparling, Chapel Hill, North Carolina, USA
The opinions expressed by authors contributing to this journal do not neces- Robert Swanepoel, Pretoria, South Africa
sarily reflect the opinions of the Centers for Disease Control and Prevention or Phillip Tarr, St. Louis, Missouri, USA
the institutions with which the authors are affiliated.
Timothy Tucker, Cape Town, South Africa
All material published in Emerging Infectious Diseases is in the public do-
Elaine Tuomanen, Memphis, Tennessee, USA
main and may be used and reprinted without special permission; proper citation,
however, is required. John Ward, Atlanta, Georgia, USA
Use of trade names is for identification only and does not imply endorsement Mary E. Wilson, Cambridge, Massachusetts, USA
by the Public Health Service or by the U.S. Department of Health and Human
Services. ∞ Emerging Infectious Diseases is printed on acid-free paper that meets the requirements
of ANSI/NISO 239.48-1992 (Permanence of Paper)
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 12, December 2013
December 2013
On the Cover Twenty-Year Summary of Surveillance
for Human Hantavirus Infections,
Paul Gauguin (1848–1903)
United States.....................................1934
Black Pigs (1891) (detail)
B. Knust and P.E. Rollin
Oil on canvas (91 cm × 72 cm)
Museum of Fine Arts, Sin Nombre virus causes most cases, but other
Budapest, Hungary viruses must be considered in patients with
atypical exposures/clinical presentations.
About the Cover p. 2068
Research
Perspective
Spontaneous Generation of
Infectious Prion Disease in
Institute of Medicine and National
Transgenic Mice................................1938
Research Council Recommendations
J.-M. Torres et al.
for One Health Initiative ...................1913
One amino acid change in bovine prion induced
C. Rubin et al.
a new infectious prion.
Review of articles on One Health subjects
concludes that future studies and workshops
Zoonotic Chlamydiaceae
should consider progress made and address
Species Associated with Trachoma,
remaining gaps.
Nepal ..................................................1948
Synopses D. Dean et al.
Zoonotic transmission of species other than
Chlamydia trachomatis probably plays a role in
ocular trachomatous disease.
p. 1994
Epidemiological Investigations Guillain-Barré Syndrome
into Outbreaks of Rift Valley Surveillance during National
Fever in Humans, South Africa, Influenza Vaccination Campaign,
2008-2011 ...........................1918 New York, USA, 2009 ........................1956
B. Archer et al. G.P. Giambrone et al.
Rift Valley fever continues to pose a notable A Clinical Network provided timely data, but
public health threat to humans. such data were less complete than traditional
hospital discharge data.
p. 1997
Antiviral Susceptibility of Highly
Pathogenic Avian Influenza A(H5N1)
Potential Role of Deer Viruses Isolated from Poultry,
Tick Virus in Powassan Vietnam, 2009–2011 ..........................1963
Encephalitis Cases in Lyme H.T. Nguyen et al.
Disease–endemic Areas of Monitoring antiviral drug susceptibility of HPAI
New York, USA ..................1926 (H5N1) viruses in poultry is crucial to pandemic
M.Y.B. Khoury et al. preparedness.
The epidemiologic pattern and limited
laboratory testing indicate that this virus lineage
might account for most of these illnesses.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 12, December 2013
Dispatches
December 2013
1972 Novel Reassortant Influenza
2008 Cerebellar Cysticercosis Caused
A(H1N2) Virus Derived from
by Larval Taenia crassiceps
A(H1N1)pdm09 Virus Isolated
Tapeworm in Immunocompetent
from Swine, Japan, 2012
M. Kobayashi et al. Woman, Germany
V. Ntoukas et al.
1975 Myocarditis after Trimethoprim/
2012 Powassan Virus in Mammals,
Sulfamethoxazole Treatment
Alaska and New Mexico, USA,
for Ehrlichiosis
S.U. Nayak and G.L. Simon and Russia, 2004–2007
E.R. Deardorff et al.
1978 Distinct Lineage of Vesiculovirus
2017 Reemergence of Vaccinia Virus
from Big Brown Bats,
during Zoonotic Outbreak,
United States
T.F.F. Ng et al. p. 2001 Pará State, Brazil
F.L. de Assis et al.
1981 Acute Toxoplasma gondii
2021 Novel Variants of Clade 2.3.4
Infection among Family
Highly Pathogenic Avian
Members in the United States
D.G. Contopoulos-Ioannidis et al. Influenza A(H5N1) Viruses, China
M. Gu et al.
1985 Novel Orthoreovirus from Mink,
2025 Rift Valley Fever in Namibia,
China, 2011
H. Lian et al. 2010
F. Monaco et al.
1989 Outbreak of Human Infection
2028 Hepatitis E Virus Variant in
with Sarcocystis nesbitti,
p. 2010
Farmed Mink, Denmark
Malaysia, 2012
J.S. Krog et al.
S. AbuBakar et al.
2031 Historical Prevalence and
1992 Transmission of Brucellosis
Distribution of Avian Influenza
from Elk to Cattle and Bison,
Virus A(H7N9) among Wild Birds
Greater Yellowstone Area,
S.H. Olson et al.
USA, 2002–2012
J. C. Rhyan et al.
2034 Lack of MERS Coronavirus
Neutralizing Antibodies in
1996 Concomitant Human Infections
Humans, Eastern Province,
with 2 Cowpox Virus Strains in
Saudi Arabia
Related Cases, France, 2011
S. Gierer et al.
C. Ducournau et al.
2037 Peste des Petits Ruminants
2000 Zoonotic Onchocerca lupi
Infection among Cattle and
infection in Dogs, Greece
Wildlife in Northern Tanzania
and Portugal, 2011–2012
T. Lembo et al.
D. Otranto et al.
2041 Surveillance for Avian Influenza
2004 Novel Cause of Tuberculosis in
A(H7N9), Beijing, China, 2013
Meerkats, South Africa
P. Yang et al.
S.D.C. Parsons et al.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 12, December 2013
2058 Treponemal Infection in
Nonhuman Primates as
December 2013
Possible Reservoir for
Human Yaws
Letters
2060 Porcine Hokovirus in Domestic
2044 Concurrent Parasitic Infections Pigs, Cameroon
in a Renal Transplant Patient
2062 Evaluation of 3 Electronic
2045 Vaccinia Virus in Household Methods Used to Detect
Environment during Bovine Influenza Diagnoses during
Vaccinia Outbreak, Brazil 2009 Pandemic
2048 Porcine Epidemic Diarrhea 2064 Bicolored White-toothed
Virus Variants with High Shrews as Reservoir for
Pathogenicity, China Borna Disease Virus,
p. 2048 Bavaria, Germany
2049 New Delhi Metallo-β-
Lactamase-1 in Carbapenem- Book Review
Resistant Salmonella Strain,
China
2067 Foodborne Infections
and Intoxications
2051 Contagious Caprine
About the Cover
Pleuropneumonia in
Endangered Tibetan Antelope,
p. 2052 2068 Savage Nature and Ecologic
China, 2012
Exchange
2053 Unexpected Brucella suis
Biovar 2 Infection in a Dairy Etymologia
Cow, Belgium 1974 Sarcocystis nesbitti
Online Report
2054 Hepatitis E and Lymphocytic
Leukemia in Man, Italy Toward Proof of Concept of a
One Health Approach to Disease
2056 Q Fever Surveillance in Prediction and Control
Ruminants, Thailand, 2012 http://wwwnc.cdc.gov/eid/
article/19/12/13-0265_article.htm
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 12, December 2013
AvAIlAblE
NOvEMbER 14Th
Art in Science: Selections from
EMERGING INFECTIOUS DISEASES
[Hardcover]
The journal’s highly popular fine-art
covers are contextualized with essays that
address how the featured art relates to
science, and to us all.
Available at
http://bit.ly/16sJI6R
Use promo code 32327
for an additional
20% off
This collection of 92 excerpts and covers from
Emerging Infectious Diseases will be of interest
to readers of the journal or to anyone who wishes
to reach across the aisle between art and science.
Review of Institute of Medicine
and National Research Council
Recommendations for
One Health Initiative
Carol Rubin, Tanya Myers, William Stokes, Bernadette Dunham, Stic Harris,
Beth Lautner, and Joseph Annelli
Human health is inextricably linked to the health of Initiative Task Force defined One Health as the collabora-
animals and the viability of ecosystems; this is a concept tive effort of multiple disciplines—working locally, na-
commonly known as One Health. Over the last 2 decades, tionally, and globally—to attain optimal health for people,
the Institute of Medicine (IOM) and the National Research animals and our environment. The report included the rec-
Council (NRC) have published consensus reports and
ommendation that the AVMA, the American Medical As-
workshop summaries addressing a variety of threats to ani-
sociation, and other interested parties should “plan a study
mal, human, and ecosystem health. We reviewed a selec-
on One Health to be conducted by the National Academy
tion of these publications and identified recommendations
of Sciences and secure the necessary funding to underwrite
from NRC and IOM/NRC consensus reports and from opin-
this effort” (1). In 2009, the Institute of Medicine (IOM)
ions expressed in workshop summaries that are relevant
to implementation of the One Health paradigm shift. We and National Research Council (NRC) co-hosted the One
grouped these recommendations and opinions into themat- Health Commission Summit, described as “a forerunner to
ic categories to determine if sufficient attention has been an IOM study on One Health…[that will be] used to de-
given to various aspects of One Health. We conclude that velop a strategic roadmap for public and private policies
although One Health themes have been included through- and initiatives that will, in turn, be instrumental in shaping
out numerous IOM and NRC publications, identified gaps the implementation of the One Health vision, both domesti-
remain that may warrant targeted studies related to the One
cally and internationally” (2). The study was slated to begin
Health approach.
in 2010; however, funding required to initiate it has not yet
been committed.
Over the past decade, animal and human health leaders A review of existing IOM publications for One
have begun to consider the benefit of collaboration, Health–related consensus recommendations or individual
prompted by recognition that highly specialized practices opinions is a critical step in assessing whether to move
of veterinary and human medicine are missing inextricable forward with a general, or more refined, focus that will
links between human health, animal health, and the viabil- complement the existing body of IOM/NRC reports. We
ity of ecosystems. The 2008 Final Report of the Ameri- sought to complete such a review, and to fit the findings
can Veterinary Medical Association (AVMA) One Health into a framework that would facilitate a data-driven assess-
ment of how to move forward in possibly seeking an IOM/
Author affiliations: Centers for Disease Control and Prevention, NRC review of One Health.
Atlanta, Georgia, USA (C. Rubin, T. Myers), National Institutes of
Environmental Health Sciences, Research Triangle Park, North Methods
Carolina, USA (W. Stokes), US Food and Drug Administration,
Rockville, Maryland, USA (B. Dunham), Department of Homeland The National Academies and Their Reports
Security, Washington DC, USA (S. Harris) US Department of Agri- A primary function of the National Academies is to
culture, Des Moines, Iowa, USA (Lautner); and US Department of provide unbiased and timely expert advice to policy mak-
Agriculture, Riverdale, Maryland (J. Annelli) ers and the general public. The National Academies include
the National Academy of Sciences, the IOM, the NRC, and
DOI: http://dx.doi.org/10.3201/eid1912.121659
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 12, December 2013 1913
PERSPECTIVE
the National Academy of Engineering. Their operations were judged most likely to contain multiple recommenda-
are independent from the US federal government and not tions or opinions related to One Health concepts. Although
funded by direct appropriation, although studies are often it is likely that additional reports may contain One Health
mandated by Congress in the interest of seeking expert concepts, this review was constructed to provide a starting
counsel. Studies can be requested by federal agencies or by point to inform those considering how future studies of One
independent organizations. Health by the National Academies could be constructed.
At the National Academies there is a vast difference in
the weight ascribed to consensus committee recommenda- Defining One Health Concepts
tions, compared to the individual opinions that are collected For the purposes of this review, a consensus recom-
in a workshop summary. A consensus committee, typically mendation or workshop opinion was deemed related to
including 10–15 members, is carefully chosen to represent One Health concepts if it included any aspect of the re-
a range of specific disciplines and experiences. Consensus lationships between humans, animals, and the ecosystems
committees are carefully structured to ensure that all mem- in which they coexist and interact. Although this defini-
bers are independent of the sponsoring agencies (3–5). The tion may be viewed as broad, it was chosen intentionally
committees operate under a set of rigorous rules pertinent to prevent bias for or against any particular component of
to Section 15 of the Federal Advisory Committee Act. Each One Health.
committee member undergoes an extensive bias and con-
flict of interest review, and their names are posted online Grouping of Recommendations
for public comment. The committee collects information All consensus reports and some workshop summa-
from presentations, literature reviews, and other means; ries and workshop reports included summary or overview
the committee’s recommendations are then designed in a chapters containing an aggregated view of consensus report
very structured way. When a draft report is compiled, it recommendations or themes emerging from the workshop.
is submitted to a review committee with a similar mix of However, in cases in which reports lacked such an orga-
disciplinary expertise. The entire process is overseen by the nized set of recommendations, the full report was reviewed
overarching National Academies Report Review Commit- to determine whether any pertinent information was con-
tee (RRC). veyed within individual chapters. Recommendations or
In strict contrast, a workshop summary is not allowed opinions found to be related to One Health were compiled
to contain anything that could be interpreted as a consen- for each individual report; then the aggregated list was re-
sus conclusion or recommendation. It is not reflective of viewed to identify common themes. Finally, we sought to
a Federal Advisory Committee Act process and the RRC identify examples of completed or ongoing activities that
is minimally involved in most instances. To separate the address recommendations and opinions.
workshop summary from the report of the persons who
designed the workshop, the summary is always written Results
by an appointed reporter rather than a workshop plan- Of the 20 publications that were reviewed in depth for
ning committee member . The goal is to ensure that the this article, 8 were consensus reports. More than 50 recom-
workshop report is not seen as the product of a commit- mendations and opinions were extracted, covering a broad
tee process, but as a collection of opinions expressed by array of topics ranging from a specific disease, system, or
workshop participants. The standard of peer review for a policy improvement, to general statements encouraging
workshop is very different from that described above for expansions of partnerships and broad investments in infra-
a consensus study. A much smaller group of reviewers structure for surveillance systems. As expected, the stron-
is involved, and the objective of the review is to ensure gest and most specific recommendations were captured in
that the report is an accurate and clear description of what consensus reports.
happened, not what should have happened. Because there We grouped the recommendations and opinions into
is some overlap in content between the IOM/NRC con- 7 topical categories: Surveillance and Response, Gover-
sensus reports and IOM workshop summaries in terms of nance and Policy, Laboratory Networks, Training Needs,
coverage of health-related issues, we included both types Research Needs, Communication Needs, and Partnerships.
of reports in this review. Online Technical Appendix Table 1 (wwwnc.cdc.gov/
EID/article/19/12/12-1659-Techapp1.pdf) displays a para-
Selection of Reports for Review phrased listing of the recommendations by category. The
Titles and objectives of NRC/IOM reports during list of recommendations was circulated among the authors
1991–2013 were reviewed to identify content addressing and other subject matter experts in an attempt to identify
interactions among humans, animals, and the environ- ongoing activities or programs that appear to address gaps
ment. By using this process, 20 reports (Table) (6–25) identified in the IOM and NRC reports. Online Technical
1914 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 12, December 2013
Recommendations for One Health

Table. Listing of Institute of Medicine/National Research Council reports included in review, 1991–2013*
Date Title Type
1991 Animals as sentinels of environmental health Report
1992 Emerging infectious diseases: Microbial threats to health in the United States Report
1999 The use of drugs in food animals: Benefits and risks Report
2001 Emerging infectious diseases: From the global to the local perspective WS
2002 The emergence of zoonotic diseases: Understanding the impact on animal and human health WS
2003 Microbial threats to health: Emergence, detection and response Report
2005 Animal health at the crossroads: Preventing, detecting, and diagnosing animal diseases Report
2005 Critical needs for research in veterinary science Report
2006 Addressing foodborne threats to health: Policies, practices, and global coordination WS
2006 The impact of globalization on infectious disease emergence and control WS
2007 Global infectious disease surveillance and detection: Assessing the challenges – finding solutions WS
2008 Vector-borne diseases: Understanding the environment, human health and ecologic consequences WS
2009 Sustaining global surveillance and response to emerging zoonotic diseases Report
2010 Antibiotic resistance: Implications for global health and novel intervention strategies WS
2010 Infectious disease movement in a borderless world WS
2011 Climate change, the indoor environment, and health Report
2011 Critical needs and gaps in understanding prevention, amelioration, and resolution of Lyme and other tick-
borne diseases WS
2011 Fungal diseases: an emerging threat to animal, human and plant health WS
2011 The causes and impacts of neglected tropical and zoonotic diseases: Opportunities for integrated intervention
strategies WS
2012 Improving food safety through a One Health approach WS
* Report and bold text indicates recommendations from consensus reports, NRC committee reports, or IOM consensus reports; IOM, Institute of Medicine;
NRC, National Research Council; WS, IOM workshop summary or workshop report.

Appendix Table 2 lists all of the recommendations, the into sufficient consideration of all aspects of a One Health
exact references that support each recommendation, and approach, nor does it indicate adequate consideration of
examples of activities that appear to respond to specific current understandings of One Health concepts. Appor-
recommendations. tioning our findings into thematic categories let us create a
framework for evaluation of breadth of coverage. We found
Discussion that some categories have received more attention than oth-
On the basis of the list compiled from the 20 reviewed ers. For example, the Surveillance and Response category
reports, we found that the principles of One Health have, had 16 recommendations or opinions that originated from
to varying extents, been included in many of the NRC/ 14 individual reports; and the Governance and Policy cat-
IOM recommendations and IOM workshop summaries. egory had 10 recommendations or opinions from 8 reports.
All of the reviewed reports had at least 1 recommenda- By contrast, 4 recommendations or opinions were identi-
tion related to an aspect of One Health. This sample was, fied in the Partnership category, and 3 were identified in the
admittedly, skewed toward those reports most likely to in- category of Communication Needs.
clude recommendations, but we were impressed with the Most of the examples of implementation of One
quantity identified in this review. Although even the ear- Health concepts that are described in the Technical Ap-
liest (1991) consensus report reviewed contained recom- pendix are not directly associated with specific IOM or
mendations, a deeper review including reports from ear- NRC recommendation. In contrast, recommendations from
lier dates would likely find additional recommendations the United States Agency for International Development
linked to One Health concepts. As might be expected, One (USAID)-supported IOM report “Sustaining Global Sur-
Health (or a related term) was not used in all instances veillance and Response to Emerging Zoonotic Diseases”
as a descriptor for recommendations or opinions that fit (2009) were translated into One Health activities under
within the definition of One Health activities used for this USAID’s Emerging Pandemic Threats (EPT) Program.
review; in fact, many recommendations that by today’s Progress in One Health activities may be a result of ex-
understanding are clearly related to One Health were not plicit recommendations from IOM and NRC reports, or
tagged as such. simply be occurring because of increasing awareness of
The quantity of recommendations and workshop opin- One Health concepts.
ions related to One Health concepts suggests that a reason-
able level of attention has been given to the One Health Examples of Progress
movement in the past 2 decades of IOM/NRC publications. In the Surveillance and Response category, there is
However, level of coverage does not necessarily translate good evidence that progress has been made in addressing
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 12, December 2013 1915
PERSPECTIVE
some of the One Health–related recommendations generat- Rockefeller Foundation funding (34). These 3 groups
ed from IOM and NRC studies. Several recommendations work independently and also collaboratively to define One
in this category address the need for integrated surveillance Health Core Competencies for varying levels of practitio-
systems that capture information from multiple sectors. An ners. They also develop course catalogs that capture exist-
excellent example of such integrated surveillance is the Na- ing training opportunities and identify needed training ma-
tional Antimicrobial Resistance Monitoring System, which terials. In April 2012, the University of Florida announced
became operational in 1996 as a collaborative effort of the that it will offer 2 new One Health degree programs, in-
Centers for Disease Control and Prevention (CDC), the US cluding a PhD in Public Health with a One Health con-
Food and Drug Administration, and the US Department of centration. “The One Health concentration is a research-
Agriculture. The National Antimicrobial Resistance Moni- oriented health degree that emphasizes working across
toring System tracks antimicrobial susceptibility among public health, veterinary health, and environmental health
enteric bacteria from humans, retail meats, and food ani- disciplines to tackle difficult health problems” (35).
mals (26–28) and provides timely integrated surveillance Similar selected examples of programs and projects
information that has enhanced the effectiveness of response that address the IOM recommendations can be identi-
to outbreaks of enteric disease. Although many of the rec- fied for the categories of Research Needs (e.g., National
ommendations regarding surveillance and response have Institutes of Health [NIH] Centers of Excellence for In-
been addressed in part, this particular area may provide an fluenza Research and Surveillance program, EPT PRE-
opportunity for a more focused IOM study group to eval- DICT projects and the NIH-NSF Ecology and Evolution
uate how existing systems could be linked or merged to of Infectious Diseases Program: A Joint Program for
provide a sustainable, integrated surveillance system that Multidisciplinary Research [36]), Communication Needs
addresses the needs of multiple sectors. (e.g., formation of One Health Offices at USDA and
Recommendations in the Governance and Policy cat- CDC), and Partnerships (e.g., US Interagency One Health
egory appear not to have been specifically addressed and Working Group, inclusion of veterinarians in CDC Field
may represent a gap that needs to receive more attention. Epidemiology and Laboratory Training Programs). Al-
However, a One Health website, www.onehealthglobal. though these examples are excellent steps in the right
net, was released in mid-April 2012. The portal is intend- direction, they do not respond to the majority of the rec-
ed to be a network-of-networks that speaks to One Health ommendations. In particular, recommendations that point
governance and that may serve as a mechanism that fa- toward collaboration, resource sharing, coordinated re-
cilitates the recommendations within the Governance and search, and strengthened lines of communication deserve
Policy category (29). The portal, Operationalizing “One greater attention.
Health”: A Policy Perspective—Taking Stock and Shap-
ing an Implementation Roadmap is a product of the One Conclusions
Health Global Network Work Group that was formed as The quantity of recommendations found suggests that,
an outcome of the “Stone Mountain” meeting organized by on a relatively consistent basis, One Health concepts have
CDC in collaboration with the World Organisation for Ani- been considered to be part of working group deliberations,
mal Health (OIE), the United Nations Food and Agriculture and of IOM and NRC studies, although there is no single
Organization (FAO), and the World Health Organization entity or process for tracking progress on the recommen-
(WHO) (30). dations of the National Academies’ studies related to One
Laboratory network recommendations have been ad- Health. The examples we provide of completed, ongoing,
dressed on several national fronts, including planning for and planned activities that address the recommendations
a National Bio and Agro-Defense Facility (31) and the are not intended to be comprehensive; however, the ex-
flourishing National Animal Health Laboratory Network amples demonstrate that the One Health approach is mak-
(32). Internationally, OIE, FAO, and WHO have received ing inroads. If additional IOM or NRC studies address-
USAID EPT funds to improve networking among human ing One Health do go forward, we suggest that progress
and animal laboratories (33). As mentioned previously, to date be considered and that the questions posed by the
this EPT funding occurred after a 2009 Consensus Report, National Academies be carefully targeted to address re-
demonstrating direct actions to enhance laboratory capa- maining gaps.
bilities in response to recommendations made within an
IOM report (18) Acknowledgment
Within the Training category, some recommenda- We acknowledge the valuable input provided by Patrick Kel-
tions are being addressed by the Stone Mountain Meeting ley during all aspects of this project. His scientific insight and
Training Workgroup, grantees from 1 of 4 EPT projects expertise concerning the National Academies’ publications was
named RESPOND, and the University of Minnesota with essential to the completion of this review.
1916 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 19, No. 12, December 2013