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Education and training needs to improve animal disease
surveillance systems
Cristóbal Zepeda MVZ, MSc, PhD – USDA-APHIS-VS Centers for Epidemiology and Animal Health / Animal Population Health Institute, Colorado State University
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Objectives
Identify problems affecting the efficiency of surveillance systems
Describe skills required at different levels within disease surveillance systems
Propose possible solutions
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Animal health surveillance
Collection, analysis and interpretation of data to determine:– Distribution of diseases in time and space – Presence or absence of disease
Tool for decision-making– Directed at the control and eradication of diseases
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The challenge
SPS measures under the spotlight
Increasing demands on the veterinary infrastructure
Need to demonstrate the animal health status
Effective surveillance systems central to the process
However... Reduction of public
spending Veterinary services often
not top priority Decreasing budgets for
veterinary services Weak infrastructures Difficulty to obtain funding
for surveillance
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Increased demands
Disease freedom– Initial declaration– Maintenance
Compartmentalization– Internal and external surveillance
Outbreak surveillance Large number of samples
– Increased loads on surveillance systems and Dx laboratories
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Why conduct surveillance?
Disease priorities should be based on:
Public health impact Impact on production Impact on international trade
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Surveillance and monitoring
Surveillance Transforms data into
information Implies an action Essential for diseases
under a program
Monitoring Overview of disease
occurrence Does not imply an
action Basis for the
development of a program
Both activities require the support of competent diagnostic laboratories
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Surveillance systems
Veterinary practitioners
Veterinary Para-
professionalsProducers General public
Sub-national level
surveillllance systems
Sub-national level
laboratories
National level surveillllance
systems
National level laboratories
OIEWorld
reference laboratories
Field Level
Laboratory networks
Data analysis
International reporting
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Approach
Informal survey of veterinarians working in
disease surveillance systems and academia
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Veterinary presence in the field
Many developed countries are experiencing a shortage of veterinarians working with production animals– Preference for small animal practice– Lifestyle choices
Gap in coverage– May become a critical problem in the near future
The same is true for some developing countries– But not all
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In some developing countries there are sufficient veterinarians in the field– Varying quality– Excessive number of veterinary schools
Coverage may vary by production system
Veterinary presence in the field
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Factors affecting the coverage of surveillance systems
Geographic coverage
Awareness of field veterinarians and farmers– What to report? To whom?
What happens if I do?
Economic incentives– Possible consequences of
disease reporting– Conflicts of interest
Compensation– Inadequate or inexistent
programs
Veterinary practitioners
Veterinary Para-
professionalsProducers General public
Sub-national level
surveillllance systems
Sub-national level
laboratories
National level surveillllance
systems
National level laboratories
OIEWorld
reference laboratories
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Factors affecting the coverage of surveillance systems
Inability to directly link the benefits of animal health surveillance with better production, market access and public health
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Skills
Do new graduates have adequate skills to understand the importance of surveillance and their role in surveillance systems?– In many countries training in epidemiology has increased in
veterinary schools
Not necessarily true in all countries– Emphasis is still on individual clinical cases
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Changes in veterinary curricula
Increased training in applied epidemiology at the undergraduate level– Practical applications
Emphasis on the human-livestock-wildlife interface
Increased awareness on the importance of surveillance at graduate programs in epidemiology– National and international obligations – Exposure to animal health officials
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Graduate level programs
Increased offer in graduate-level programs
Expensive– Funding sources are critical
Long term commitment
Problem to secure the current position when the trainee returns
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Possible approaches
Modular approaches– Diploma and MSc
Distance education Mixed delivery modes Possibility to
accumulate credits from multiple institutions– Across international
borders
Veterinary practitioners
Veterinary Para-
professionalsProducers General public
Sub-national level
surveillllance systems
Sub-national level
laboratories
National level surveillllance
systems
National level laboratories
OIEWorld
reference laboratories
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Role of international organizations
Veterinary education extends beyond university
Continuing education programs– Essential to hone and update skills
Role of OIE collaborating centers– Applied epidemiology courses
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Short courses
Very useful
Targeted to a specific objective(s)– e.g. surveillance, biosecurity, risk analysis
Allow participants to return to their work and apply new knowledge
Do not replace postgraduate training– There are no shortcuts!
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Diagnostic capabilities
Fewer veterinarians have an interest
What is the role of the veterinarian in the lab?– Provide the “big picture”
Increased dialogue between epidemiologists and the lab– Eliminate the “us and them”
mentality
Veterinary practitioners
Veterinary Para-
professionalsProducers General public
Sub-national level
surveillllance systems
Sub-national level
laboratories
National level surveillllance
systems
National level laboratories
OIEWorld
reference laboratories
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Veterinary practitioners
Veterinary Paraprofessionals Producers General public
Sub-national level surveillllance
systems
Sub-national level laboratories
National level surveillllance
systems
National level laboratories
OIEWorld reference
laboratories
Increased understanding of
Population based approaches
Estimation of population parameters
Interpretation of diagnostic tests
Understanding of surveillance objectives and approaches
Link to public health
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Population based approaches
Need to shift from individual clinical case emphasis to broader population-based thinking
Individuallevel
Herd levelMacro
Epidemiology
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Agent
Host
Environment
Health Disease
Population
Epidemiological triad
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Macro-epidemiology
Social, economic, politic and religious
factors
Agent Environment
Host
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Temporal Pattern of 2003/4 and 2004/5 AI Epidemics in Vietnam
0
50
100
150
200
250
300
10/1/
04
10/2/
04
10/3/
04
10/4/
04
10/5/
04
10/6/
04
10/7/
04
10/8/
04
10/9/
04
10/10
/04
10/11
/04
10/12
/04
10/1/
05
10/2/
05
10/3/
05
no
. o
utb
reak
s Tet holiday Feb 9-11, 2004 Tet holiday
Feb 11-13, 2005
Source: Dirk Pfeiffer
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Veterinarians in public service
Main objective is public health, through:– Prevention of zoonotic diseases
• Direct animal to human transmission– Food security
• Safe, sufficient and nutritious food supply
True for all veterinarians– Including small animal practitioners
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Data Data
Data
Data
Data
Data
Data
Data
Data
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Data Data
Data
Data
Data
Data
Data
Data
Data
Information
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Data Data
Data
Data
Data
Data
Data
Data
Data
Information
Decision-making
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Overall, there is a need to shift from a veterinarian with a syringe to a
veterinarian with a strategy
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Acknowledgements
Arnon Shimshony Ian East Christine Power Katharina Stärk Dirk Pfeiffer Jorge Hernández David Hird Mo Salman
Vitor Gonçalves Paulo Duarte Lachlan McIntyre Marc Stevenson Graeme Garner Katsuaki Sugiura Kachen
Wongsathapornchai