Perceptions of state public health officers and state veterinarians regarding risks of bioterrorism in the United States

OBJECTIVE:To assess perceptions of state public health officers and state veterinarians in the United States regarding the risks of bioterrorism and determine the degree of support provided for activities related to bioterrorism. DESIGN: Cross-sectional survey. SAMPLE POPULATION: State public health officers and state veterinarians. PROCEDURE: A questionnaire was sent between April and June 2001 to the state public health officer and state veterinarian in each of the 50 states and the District of Columbia. RESULTS: Perceptions of the risk of bioterrorism attacks were similar for state public health officers and state veterinarians. Veterinarians perceived the risks associated with foot-and-mouth disease and Newcastle disease to be higher than did physicians. State veterinarians perceived the risks associated with an anthrax hoax, brucellosis, and ricin toxicosis to be lower than did state public health officers. Risk posed by agents that affected animals exclusively was perceived to be higher than risk posed by agents that affected humans exclusively and zoonotic agents. Number of full-time-equivalent positions devoted to bioterrorism surveillance and percentage of the budget devoted to bioterrorism activities were significantly lower for offices run by state veterinarians than for offices run by state public health officers. State veterinarians were significantly less likely to have knowledge of bioterrorism incidents within their state or district than were state public health officers. CONCLUSIONS AND CLINICAL RELEVANCE: Provision of additional resources to state veterinarians and explicit integration of their expertise and surveillance capabilities may be important to effectively mitigate the risk of bioterrorism.     

The cooperative University of Iowa / Iowa State University MPH program

Public health is an important component of veterinary medicine. In the last 10 years, there has been growing recognition of the need to increase the number of veterinarians trained in public health. The Center for Food Security and Public Health (CFSPH) at Iowa State University (ISU), College of Veterinary Medicine, received a grant from the Centers for Disease Control and Prevention (CDC) to support veterinarians working at CFSPH while pursuing the Master of Public Health degree. CFSPH and ISU administrators worked with the University of Iowa (UI) College of Public Health to establish three cooperative programs for veterinarians to earn the MPH degree. This article describes how these programs were developed and how they operate. (1) Between 2002 and 2005, CFSPH used funds provided by the CDC to support 15 veterinarians as they worked for CFSPH and toward the MPH degree. As the program grew, distance-education methods such as the Internet, Polycom videoconferencing, and the Iowa Communications Network (ICN) were incorporated. (2) A concurrent DVM/MPH degree is now offered; students can complete both degrees in four years. As of January 2008, three students have received their DVM and MPH degrees and 16 students are enrolled in the program. (3) In June 2007, the UI and ISU launched a distance MPH program for veterinarians working in private practice, industry, and government. Eight veterinarians are participating in the program, which includes two two-week, in-person summer sessions, with the remainder of the coursework taken at a distance via the Internet.     

Field Epidemiology and Laboratory Training Programs in West Africa as a model for sustainable partnerships in animal and human health

The concept of animal and human health experts working together toward a healthier world has been endorsed, but challenges remain in identifying concrete actions to move this one health concept from vision to action. In 2008, as a result of avian influenza outbreaks in West Africa, international donor support led to a unique opportunity to invest in Field Epidemiology and Laboratory Training Programs (FELTPs) in the region that engaged the animal and human health sectors to strengthen the capacity for prevention and control of zoonotic diseases. The FELTPs mixed 25% to 35% classroom and 65% to 75% field-based training and service for cohorts of physicians, veterinarians, and laboratory scientists. They typically consisted of a 2-year course leading to a master's degree in field epidemiology and public health laboratory management for midlevel public health leaders and competency-based short courses for frontline public health surveillance workers. Trainees and graduates work in multidisciplinary teams to conduct surveillance, outbreak investigations, and epidemiological studies for disease control locally and across borders. Critical outcomes of these programs include development of a cadre of public health leaders with core skills in integrated disease surveillance, outbreak investigation, vaccination campaigns, laboratory diagnostic testing, and epidemiological studies that address priority public health problems. A key challenge exists in identifying ways to successfully scale up and transform this innovative donor-driven program into a sustainable multisectoral one health workforce capacity development model.     

The need for public-health veterinarians as seen by future employers

Future employers of veterinarians working in public health see a fast-growing demand. Emerging zoonotic diseases, bio-security threats, and food-safety problems all require the expertise of veterinarians with a focus on complex, global problems that span both human and animal health. The Public Health Task Force of the Association of American Veterinary Medical Colleges convened a group of stakeholders representing various branches of the US federal government, state and local governments, and professional societies to discuss their needs for public-health veterinarians. This article discusses those needs, the broader societal needs that require veterinarians with public-health expertise, and the implications of these for educational programs to train DVMs in public-health issues.     

A new approach to teaching veterinary public health at the Ohio State University

Public-health practitioners with expertise in the area of veterinary public health are expected to understand the prevention and control of zoonotic infectious diseases in both human and animal populations. This focus on multiple species is what makes the veterinary public health (VPH) official unique. The development of a new VPH specialization within the existing Master of Public Health (MPH) degree program at the Ohio State University represents a significant new collaboration between the College of Veterinary Medicine and the College of Public Health. The main objective of the VPH specialization is to educate and train professionals to provide them with the skills, knowledge, and resources necessary to protect and improve human health using a One Medicine approach. The program targets a population of students who will likely enter the professional veterinary medicine curriculum but have one year available to enhance their preparatory training in health sciences before beginning the program. A core series of VPH courses was initiated to complement the existing MPH course requirements. The program has been successful in attracting students from the primary target population, but it has also attracted students wanting the MPH as a terminal degree and veterinarians returning to school to expand their career options.     

Training the veterinary public health workforce: a review of educational opportunities in US veterinary schools

This article presents the results of an Internet-based review conducted in January and February 2003 to assess the educational opportunities available in veterinary public health, epidemiology, and preventive medicine at the 27 veterinary schools in the United States. Most professional veterinary curricula are designed to train students for careers as highly qualified private practitioners, although there is an increased need for veterinary perspectives and contributions in the public health sector. The future of veterinary public health relies on the opportunities available in education to teach and encourage students to pursue a career of public service. The results of this review indicate the availability of a wide variety of required courses, electives, and post-graduate training programs to veterinary students in the United States. Veterinary students are exposed to a median of 60 hours of public health, epidemiology, and preventive medicine in required stand-alone courses in these areas. Four veterinary schools also have required rotations for senior students in public health, preventive medicine, or population medicine. Contact time for required public health, epidemiology, and preventive medicine courses ranges from 30 to 150 contact hours. Advanced training was available in these subjects at 79% of the 27 schools. Greater collaboration between veterinary schools, schools of public health, and the professional public health community will increase exposure to and opportunities in public health to all future veterinarians.     

The dual DVM/MPH degree at the University of Wisconsin--Madison: a uniquely interdisciplinary collaboration

The University of Wisconsin-Madison (UWM) launched a new Master of Public Health (MPH) degree program in 2005. This 42-credit MPH degree consists of 18 core and 14 elective course credits, two seminar credits, and eight field project/culminating experience credits. Unique strengths of the program include its strongly interdisciplinary philosophy, encompassing both health science (human medicine, veterinary medicine, pharmacy, nursing) and social science units on campus, and its emphasis on service learning through instructional and field project ties to the public-health community of the state and beyond. To date, the program has admitted 87 students, including full-time students as well as part-time students who continue to work in the health care and/or public-health sectors. The program is currently proceeding with the process for accreditation through the Council for Education in Public Health. In 2007, a formal dual DVM/MPH program was approved to allow students to integrate DVM and MPH training and complete both degrees in a total of five years. Nine MPH students over the first three years of admissions have been individuals affiliated with veterinary medicine (five DVM students and four post-graduate veterinarians).     

Linking veterinary and human public-health education: collaborations at the University Of Tennessee

The increasing demand for veterinarians in public health has created an environment for innovative educational approaches, providing opportunities for veterinary students to gain additional education in public health. At the University of Tennessee, this environment has enabled a collaboration between the College of Veterinary Medicine and the College of Education, Health, and Human Sciences to establish a veterinary concentration in an existing Master of Public Health degree program. The veterinary public-health concentration was approved in 2004. In addition, other courses and initiatives have been developed at the College of Veterinary Medicine, creating stronger collaborations with academic units and public-health professionals.     

Joint degree programs in public health

Public health and veterinary medicine share a focus on population health and primary prevention, along with a commitment to preparedness, response, and recovery in the event of disease outbreaks. Public-health and veterinary professional degree programs share commonalities in their educational accreditation requirements related to epidemiology and public-health practice. The initiation of a number of joint professional degree programs over the last five years, including the joint Doctor of Veterinary Medicine and Master of Public Health (DVM/MPH), represents an exciting development for inter-professional education for veterinarians interested in public health. Various models for joint DVM/MPH educational programs are discussed, including pre-veterinary public-health credentialing, integrated programs, and post-DVM executive programs. Collaborations between colleges of veterinary medicine and schools of public health show great promise in both educational and research innovation.     

Public-health instruction necessary to supplement the veterinary professional curriculum: the DVM/MPH coordinated-degree program at Auburn University

To meet long-term needs, many veterinary colleges and schools are participating in dual-degree DVM/MPH programs. Auburn University's College of Veterinary Medicine and the School of Public Health at the University of Alabama at Birmingham have developed a coordinated-degree curriculum in which the DVM and the MPH are not necessarily awarded simultaneously. Other opportunities at Auburn include Public Health Careers Day, trips to the Centers for Disease Control and Prevention, several elective courses related to veterinary epidemiology, and online access to the Emerging and Exotic Diseases of Animals course available from the Veterinary Information Network. We have been able to increase our students' exposure to the role of the veterinarian in public health and to develop a program to augment their training in public practice.     

Science,politics and animal health policy: epidemiology in action

Public policy decisions underlie society's response to current animal health issues ranging from emerging diseases and public health threats to food safety concerns and sustainable animal agriculture strategies. Despite strong calls for "science-based" decisions, animal health policy most commonly emerges at the interface of science and politics. Too often scientists' disdain for politics limits their involvement in formulating policy. By contrast, epidemiologists are ideally qualified to bring scientific skills to complex policy issues through analytical, macro-epidemiological approaches that consider the economic, legal, and cultural context of policy issues as well as the biological and medical aspects. Risk analysis provides a systematic approach to evaluating animal health issues and comparing policy options. Capturing these opportunities for applied epidemiology requires an understanding of the policy-making process as well as the basic principles of epidemiology. Furthermore, epidemiology training programs must incorporate communications skill building and experiential learning opportunities in a team environment.     

Four multistate outbreaks of human Salmonella infections associated with live poultry contact, United States, 2009

Outbreaks of human salmonellosis associated with live poultry contact have been reported since 1955. Multiple Salmonella serotypes have been associated with these outbreaks, and specific outbreak strains have been repeatedly linked to single hatcheries over multiple years. During 2009, four multistate outbreaks of human Salmonella infections associated with direct and indirect exposure to live poultry purchased from mail-order hatcheries and agricultural feed stores were identified, resulting in 165 culture-confirmed cases in 30 states. This report describes the epidemiologic, environmental and laboratory investigations conducted by state and local health departments, state departments of agriculture, the U.S. Department of Agriculture (USDA), Animal and Plant Health Inspection Service (APHIS), National Poultry Improvement Plan (NPIP) and National Veterinary Services Laboratories (NVSL), and the Centers for Disease Control and Prevention (CDC). Case-patients were identified through PulseNet, the national molecular subtyping network for foodborne disease surveillance, and interviewed using the CDC standard live poultry contact questionnaire that asks about poultry-related exposures during the 7 days before illness onset. These outbreaks highlight the need to focus efforts on strategies to decrease and prevent human illness associated with live poultry contact through comprehensive interventions at the mail-order hatchery, agricultural feed store and consumer levels. Additional consumer education and interventions at mail-order hatcheries and venues where live poultry are sold, including agricultural feed stores, are necessary to prevent transmission of Salmonella from poultry to humans.     

Assessing bioterrorism preparedness and response of rural veterinarians: experiences and training needs

Veterinarians play a unique role in emergency preparedness and response, and federal agencies and academic institutions therefore allocate considerable resources to provide training to enhance their readiness. However, the level of preparedness of veterinarians in many rural regions is yet to be improved. This article reports an assessment of the bioterrorism preparedness, specifically the experience and training needs, of rural veterinarians in North Texas. The study employed a cross-sectional design with a study population that included all veterinarians (N = 352) in the 37 counties within Texas Department of State Health Services Regions 2 and 3. Data on veterinarians practicing or residing in the target region were obtained from the Texas State Board of Veterinary Medical Examiners. The response rate was 35% (n = 121). Results indicate that chemical exposure was the condition most frequently seen and treated, followed by botulism and anthrax. The majority (80%) of respondents indicated that they had not previously participated in training related to bioterrorism preparedness, and many (41%) also indicated a willingness to participate in a state health department-initiated bioterrorism response plan. However, only 18% were confident in their ability to diagnose and treat bioterrorism cases. These results suggest that many North Texas veterinarians practicing in rural regions could benefit from additional training in bioterrorism preparedness and response. An area in particular need of further training is the diagnosis and treatment of Category A agents. Federal, state, and local health agencies are urged to increase training opportunities and to make additional efforts to involve veterinarians in bioterrorism preparedness and response.     

Evaluation of veterinary public practice education programs

OBJECTIVE: To describe the number and types of veterinary professional degree and certificate programs providing education in the area of public practice to veterinarians and determine the availability of these programs via distance learning. PROCEDURES: Web-based internet searches were performed for programs for veterinary public practice or public health, population medicine, or Master's degree in Epidemiology. The information reviewed was derived from individual school and program Web sites and from personal e-mail correspondence with school administrators. RESULTS: 17 professional degree and 4 certificate programs were available to provide education and training in the areas of public practice and population medicine to veterinarians. Twelve of these programs have begun since 1998. Of the 17 professional degree programs, 7 are located in the United States and 10 are located in other countries. Nine of the professional degree programs provide education through traditional teaching methods, and 8 provide education and training through distance learning. CONCLUSIONS: During the preceding 5 years, the number of programs available to educate and train veterinarians in the areas of public practice and population medicine has increased. Distance learning is being used to increase capacity and reach a broader audience of veterinarians. With the increase in programs has come an increase in capacity to educate and train veterinarians in the fields of population medicine and public practice. The impact and sustainability of this increased capacity have not been evaluated.     

Zoological medicine and public health

Public-health issues regarding zoological collections and free-ranging wildlife have historically been linked to the risk of transmission of zoonotic diseases and accidents relating to bites or injection of venom or toxins by venomous animals. It is only recently that major consideration has been given worldwide to the role of the veterinary profession in contributing to investigating zoonotic diseases in free-ranging wildlife and integrating the concept of public health into the management activities of game preserves and wildlife parks. At the veterinary undergraduate level, courses in basic epidemiology, which should include outbreak investigation and disease surveillance, but also in population medicine, in infectious and parasitic diseases (especially new and emerging or re-emerging zoonoses), and in ecology should be part of the core curriculum. Foreign diseases, especially dealing with zoonotic diseases that are major threats because of possible agro-terrorism or spread of zoonoses, need to be taught in veterinary college curricula. Furthermore, knowledge of the principles of ecology and ecosystems should be acquired either during pre-veterinary studies or, at least, at the beginning of the veterinary curriculum. At the post-graduate level, master's degrees in preventive veterinary medicine, ecology and environmental health, or public health with an emphasis on infectious diseases should be offered to veterinarians seeking job opportunities in public health and wildlife management.     

Disease outbreak investigation in food animal practice.

In addition to excellent observation skills and a good understanding of production medicine, veterinarians require the tools of epidemiology for the successful investigation of disease outbreaks. Food supply veterinary practitioners are often called upon to investigate various types of disease outbreaks. In this article, the authors outline the primary questions a practitioner should address and summarize a systematic approach to determining the causes of an outbreak and minimizing further losses. The investigation of disease outbreaks provides an opportunity for the herd veterinarian to show clients the advantages of a herd health program and the value of a good record-keeping system.     

Veterinary medicine educational requirements to meet the needs of the US Agency for International Development

The US Agency for International Development (USAID) works within the overall purpose of US foreign assistance to improve the lives of the citizens of the developing world. Through partnerships with other agencies, organizations, and governments, and using its field offices around the world, USAID strives to develop local capacity and thus build sustainable development. Two specific USAID programs pertinent to veterinary medicine are global health and agriculture. In the area of global health, veterinarians can aid USAID's work to improve the quality, availability, and use of essential health services that specifically target maternal and child health, HIV/AIDS, family planning and reproductive health, infectious diseases, environmental health, nutrition, and other life-saving areas. The challenge of making the agricultural sector in a developing country more productive is a critical one for USAID and a clear area for input from the veterinary profession. Animal agriculture is the largest single sector of agricultural economies in most developing countries, and livestock remains a critical component of poverty alleviation. There are educational requirements that benefit anyone working at USAID and can be met prior to admittance to a DVM program, as part of a DVM curriculum, or in post-graduate training/employment, such as proficiency in a foreign language; environmental sciences background; familiarity with accounting and management techniques; expertise in foreign animal diseases, zoonotic diseases, epidemiology, food safety, and nutrition, as well as the application to human health of those areas; an advanced degree such as an MPH; and management experience. Appropriately trained veterinarians can make enormous contributions to USAID's global efforts to improve the health and agriculture sectors of developing nations.     

The application of information technology in the teaching of veterinary epidemiology and public health

Information technology (IT) is an imprecise term currently used to describe computer-based techniques for data manipulation, storage, dissemination, publication, and retrieval. IT possesses several characteristics that promote meaningful learning, including (1) just-in-time, personalized; (2) student-centered versus teacher-centric; (3) self-paced; (4) anytime, anywhere; and (5) discovery (through bibliographic and other information searches). However, if done improperly, IT-based teaching can be counterproductive. Factors to consider when evaluating the effectiveness of IT-based teaching methods include (1) content, (2) learning, (3) delivery support, (4) usability, and (5) technological. IT has been used to support instruction in epidemiology and public health at many levels, ranging from basic computer literacy to hands-on training in epidemiological methods through computer-based problem sets, case workups, outbreak investigations, and tutorials. Online quizzes based on articles selected from practice-oriented journals have been used to promote evidence-based medicine skills, including the critical evaluation of medical claims. As online access and delivery improve, opportunities for substantive online education and lifelong learning through IT have expanded. One of the most novel and comprehensive implementations of collaborative online sharing of educational content in epidemiology and public health is the Epidemiology Supercourse (http://www.pitt.edu/~super1/). More than 9,000 faculty from 118 countries have contributed to an online library of more than 700 lectures with quality control and adherence to accepted pedagogic principles. The goal is to improve teaching and research in epidemiology and public health worldwide. Although the focus is on human medicine, the concepts, methods, and principles can easily be applied to veterinary medicine. The Association for Veterinary Epidemiology and Preventive Medicine (AVEPM) seeks to heighten awareness of issues in veterinary epidemiology and public health education among veterinary educators through various forums, symposia, and workshops. The AVEPM Web site (http://www.cvm.uiuc.edu/avepm/) includes a listing of educational software and Web sites supporting epidemiology and public health education.     

One medicine, one university: the DVM/MPH program at the University of Illinois

The University of Illinois at Urbana-Champaign College of Veterinary Medicine (UIUC-CVM) and the University of Illinois-Chicago School of Public Health (UIC-SPH) are in the fourth year of a collaborative Doctor of Veterinary Medicine and Master of Public Health dual-degree program. The two campuses, one urban and one rural, are 150 miles apart but are sister schools within the University of Illinois system. This article describes the origin of the program, how the program functions across two campuses, its academic focus, required coursework, and research projects designed to fulfill the program's capstone requirements. The article shows how two campuses can be linked through a combination of online and on-site didactic coursework, briefly describes innovative proposals for projects within the United States and abroad, and highlights faculty committed to educating cross-trained public-health professionals while addressing the national need for veterinarians trained in public health. The authors also discuss how the dual-degree program has led to the formation of the Illinois Center for One Medicine, One Health (ICOMOH), an intra-university collaboration focusing on the interface of human, animal, and ecosystem health.     

Epidemiology, public health and preventive medicine in veterinary medical education in Canada and the United States

A survey was conducted of teachers, faculty positions, curricula, and administrative structure of epidemiology, public health and preventive medicine in the professional curricula of 28 veterinary schools in Canada and the United States. All or nearly all schools allocated core curricular time to courses in epidemiology, public health, food, safety, and preventive medicine. Fewer schools allocated time to regulatory medicine (79%), economics (75%), biometry (61%) and environmental protection (54%). Of the 148 surveyed teachers of these disciplines, 92% had the DVM or equivalent degree, and 52% had both DVM and Ph.D. degree.

In the period 1987–1989, 33 faculty positions related to epidemiology and preventive medicine were filled, and in mid-1989 there were 41 vacant or anticipated positions. Of the 41 vacant or anticipated positions, the DVM (or equivalent) degree was required in 85%, and the DVM and Ph.D. degrees were required in 61%. Analytic epidemiology (quantitative methodology) and livestock/herd health management were the most common areas of emphasis required in the vacant or anticipated positions.