MARKERS IN MILESTONES


MARKERS in MILESTONES in POPULATION HEALTH– ERADICATION OF DISEASE: “THE HOLY GRAIL OF DISEASE PREVENTION”

Rinderpest and the Context
Comments of Dr. James Steele, DVM MPH

The Washington Post headline of May 26, 2011 points to a landmark in Human and Animal Health “Rinderpest, or ‘cattle plague,’ becomes only second disease to be eradicated.” Second to Small Pox, this represents as the article goes on to recount, a disease that has hobbled herding, and food supply with all its implications since the first report in ancient Chinese manuscripts.

Through the millennium man, animals and plants have lived in a dynamic balance with marked swings of habitat, times of excess and times of deprivation. The clock inexorably ticks on, and our current discussions of sustainable societies has an urgency that only grows. The counterpoint is that humankind can exercise a deliberative hand – and as David Brown’s report writes “Eradication is the Holy Grail of Disease Prevention.” And though “only second,” the story of Rinderpest eradication is a testimonial to the power and necessity of collaboration bounding together by science, practice and sheer commitment. We know of a litany of diseases such as Polio, Malaria, and myriad preventable conditions that are ripe for eradication. The key to the end game of eradication is the commitment, continuity, collaboration and the cadre of institutions and people that are doggedly pursuing multiple crossing of thresholds in the eradication and control of diseases.

As an important “back story,” MPHI has been holding a series of interviews with Dr. James Steele, DVM, MPH, the founding member of the U.S. Centers for Disease Control Veterinary Public Health Program in 1946 pointed says, it is one condition at a time, but the key is the building of sustainable systems of population health as the basis for eradication and control. At 98 and as sharp and incisive as ever, Dr. Steele puts his “lessons learned” in his over 7 decades in public health this way.

“You cannot have good public health if you do not have good animal health, and the reverse is equally true.” And better yet, it makes good economic sense as well. I put it into an equation.

Public Health + Animal Health = the advancement of good health and economic wealth.

In future reports we will go on to highlight people, events and organizations that are putting the Steele Health and Wealth Equation into practice.

The Washington Post article follows:

Rinderpest, or ‘cattle plague,’ becomes only second disease to be eradicated

Cow Image

A cow licks its muzzle in Padukka, Sri Lanka, where the U.N. has worked to eradicate rinderpest.

By David Brown, published: May 26, 2011

Rinderpest, a cattle disease that for centuries felled herds in Europe, Africa and Asia and caused periodic human famine, has been eradicated, veterinary epidemiologists announced this week.

Eradication is the Holy Grail of disease prevention and has been successful only once before. Smallpox, an equally devastating human scourge, was eradicated in 1980, proving it is possible to stamp out a microbe across the entire planet. Attempts are underway to rid the world of polio and Guinea worm disease.

The bovine equivalent of measles, rinderpest is described in ancient Chinese writings and in documents from the Roman Empire. It hobbled Charlemagne when he moved herds to support his armies in the 8th century. When it entered Ethiopia in 1889, it caused starvation that killed one-third of the country’s human population, even though the microbe does not infect people.

Even in communities that do not depend on herding for their livelihood, rinderpest could be lethal because it killed draft animals and disrupted agriculture.

“This is quite a momentous occasion for humanity,” said Juan Lubroth, chief veterinary officer of the U.N. Food and Agriculture Organization (FAO), which next month at its headquarters in Rome will officially declare the disease eradicated.

William R. White, a rinderpest expert at the U.S. Department of Agriculture, said: “The suffering that this disease has caused through the millennia is incredible. This is probably the greatest achievement in veterinary medicine.”

Rinderpest, which means “cattle plague” in German, is highly contagious and has a fatality rate of about 80 percent. It is the only animal disease to have been eradicated; smallpox occurs only in human beings.

Clean Bill of Health

The World Organization for Animal Health, at its annual meeting in Paris, accepted documentation from the last 14 countries that they were now free of rinderpest. The organization, which goes by its French acronym, OIE, was started in 1924 in response to a rinderpest importation in Europe.

The most recent recorded outbreak occurred in Kenya in 2001. Much of the past decade has been spent looking for new cases, in domesticated animals and in the wild, wandering herds of ungulates, or hoofed animals, in East Africa. The last place of especially intense surveillance was Somalia, where the final outbreak of smallpox occurred in 1977.

“There are a huge number of unsung heroes in lots of countries that made this possible,” said Michael Baron, a rinderpest virologist at the Institute for Animal Health in Surrey, England. “In most places, they were ordinary veterinary workers who were doing the vaccination, the surveillance, the teaching.”

Ridding the world of other infectious diseases, however, has proved even more difficult.

Smallpox eradication took 11 years of intensive effort and was aided by a hard-to-miss rash that made finding cases easy. The effort to eradicate polio, launched in 1988, has proved far more arduous. It is now 11 years past its original deadline, with the virus — which in most cases causes no obvious symptoms — still circulating in eight countries. An effort to eradicate malaria failed spectacularly in the 1950s.

Guinea worm disease, a waterborne disease caused by a parasite, is the next likely eradication success. Last year about 1,800 cases were recorded in four African countries, down from 3.5 million cases worldwide in 1986.

Three things made rinderpest eradicable. Animals that survived infection became immune for life. A vaccine developed in the 1960s by Walter Plowright, an English scientist who died last year at 86, provided equally good immunity. And even though the virus could infect wild animals, it did not have a reservoir of host animals capable of carrying it for prolonged periods without becoming ill.

Eradication program

In 1994, the FAO launched an eradication program that was largely financed by European countries, although the United States, which never had rinderpest, also contributed money. The effort consisted of massive vaccination campaigns, which were made more practicable when two American researchers made a version of the Plowright vaccine that required no refrigeration.

Vaccination was accompanied by surveillance for the disease. One way that was done was with a technique called “participatory epidemiology” in which outside surveyors meet with herdsmen and ask open-ended questions about the health of their animals and when they last noticed certain symptoms.

“It was local knowledge that really helped us trace back the last places where transmission occurred — sitting down underneath a tree in the shade, listening to storytelling,” said Lubroth, of the FAO.

Blood samples were also routinely collected from herds to determine the extent of immunity. In some cases, wild animals were darted and tested to see whether they also had antibodies to the virus. No wild herds were vaccinated. However, it appears that the presence of the virus in wild animals required its presence in domesticated ones.

“If cattle are not a source of infection, then the virus in the other species naturally disappears,” said Bernard Vallat, a veterinarian who is director general of the OIE.

Rinderpest appears to have emerged in Asia. In Europe it was sometimes called “steppe murrain,” or cattle disease from the steppes. It was never endemic in the Americas. An importation to Brazil in 1921 was contained, as was one to Australia a few years later.

The vaccine consists of an extremely weakened form of the rinderpest virus. While it has never been known to cause disease, its use has been stopped to prevent the chance that it might “revert to pathogenicity” and cause the disease it is trying to prevent.

Baron, the English virologist and consultant to the OIE, said rinderpest eradication had one obvious thing that made it easier than eradication campaigns against human diseases.
“When it came to vaccination, the cows never had a choice,” he said. “But people have a choice.”