Veterinary aspects of alveolar echinococcosis--a zoonosis of public health significance

Human alveolar echinococcosis (AE), caused by the metacestode stage of Echinococcus multilocularis, is a serious zoonosis which caused up to 100% lethality in untreated patients before the 1970s, when modern methods of treatment were not yet established. AE occurs in large areas of the northern hemisphere mostly with low country-wide prevalences, but high prevalences of up to 4% have been reported from small population groups in highly endemic foci, e.g. from China. AE includes many veterinary aspects which are the topic of this review. Recent studies have shown that E. multilocularis has a wider geographic range than previously anticipated. There is evidence for growing populations of red foxes (Vulpes vulpes) in some areas, for increasing invasion of cities by foxes and also for establishment of the parasite cycle in urban areas. These and other factors may lead to an increased infection risk for humans. Significant progress has been made in the development of sensitive and specific new techniques for the intra vitam and post mortem diagnosis of intestinal E. multilocularis infection in definitive hosts, notably the detection of coproantigen by enzyme-linked immunosorbent assay and of copro-DNA by PCR. Both tests can also be used for the identification of E. multilocularis in faecal samples collected in the environment. Recommendations are given for chemotherapy and chemoprophylaxis of the intestinal infection in definitive hosts. In recent years, infections with the metacestode stage of E. multilocularis have not only been diagnosed in humans in several regions, including at least eight countries in central Europe, but also in animal species which do not play a role in the transmission cycle (wild and domestic pigs, dogs etc.). From 1987 to 2000 our group in Zurich has diagnosed 10 cases of AE in dogs and 15 in captive monkeys. In 2 dogs, concurrent infections of the intestine and of the liver with adult and larval stages of E. multilocularis, respectively, were observed for the first time. Clinical data are presented, and methods of diagnosis and treatment (surgery, chemotherapy) are described. Furthermore, small liver lesions caused by E. multilocularis were diagnosed in 10% of 90 slaughter pigs, and 2.9% of 522 breeding sows had specific serum antibodies against parasite antigens. In view of the unpredictable epidemiological situation, all possible measures for preventing E. multilocularis infections in humans and in domestic animals should be initiated by the veterinary and health authorities.     

Veterinary and public health aspects of Toxocara spp

Pet dogs and cats can play an important role in the transmission of zoonotic nematodes such as Toxocara canis and Toxocara cati, by excreting eggs directly into the human environment, without the involvement of vectors or intermediate hosts. Human toxocarosis remains a hazard despite the availability of highly effective anthelmintics for dogs and cats. A good understanding of the biology and epidemiology of these parasites, and the risk factors that lead to their transmission to humans is required for effective prevention strategies. In this respect, the maintenance of high quality continuing education for veterinarians and the provision of suitably presented information to pet owners are of priority importance. A closer collaboration between veterinary and public health professionals within the ‘One Health’ concept is also required.     

Veterinary medicine is public health

The symposium Partnerships for Preparedness: Future Directions of Schools of Public Health and Colleges of Veterinary Medicine documents the importance of further integration between the fields of veterinary medicine and public health to protect our nation from public-health emergencies. Current areas targeted for improved collaboration include academic programs, public policy, workforce training, and research.     

Veterinary medicine and public health or better: veterinary public health

The development of veterinary medicine and its impact on public health are outlined in this overview. In relation to this, we speak of Veterinary Public Health. In 1865, the liberal J.R. Thorbecke initiated the institution of the later independent 'State Supervisory Public Health Inspectorate' was set up in 1920, as a consequence of the Meat Inspection Act of 1919, and became part of the State Supervisory Service. In 1925 the 'Veterinary Public Health Inspectorate', which was part of the Ministry of Public Health, and the 'Veterinary Service', which was part of the Ministry of Agriculture, formed together a so-called 'Personal Union'. This Union came to an end in 1984. During the nearly 60 years of its existence, and especially after the Second World War, the Union has contributed enormously to public health by controlling zoonoses and decreasing chemical contaminants in foodstuffs. In these achievements it has worked in collaboration with veterinary surgeons, meat inspection services, and research institutes such as the National Institute of Public Health and Environment (RIVM), the Institute for Animal Science and Health (ID-Lelystad), and the Faculty of Veterinary Medicine.     

Veterinary public health: past success, new opportunities

Animal diseases are known to be the origin of many human diseases, and there are many examples from ancient civilizations of plagues that arose from animals, domesticated and wild. Records of attempts to control zoonoses are almost as old. The early focus on food-borne illness evolved into veterinary medicine's support of public health efforts. Key historical events, disease outbreaks, and individuals responsible for their control are reviewed and serve as a foundation for understanding the current and future efforts in veterinary public health. Animal medicine and veterinary public health have been intertwined since humans first began ministrations to their families and animals. In the United States, the veterinary medical profession has effectively eliminated those major problems of animal health that had serious public health ramifications. These lessons and experiences can serve as a model for other countries. Our past must also be a reminder that the battle for human and animal health is ongoing. New agents emerge to threaten human and animal populations. With knowledge of the past, coupled with new technologies and techniques, we must be vigilant and carry on.