OVERVIEW OF VETERINARY EPIDEMIOLOGY

The veterinary profession faces many challenges

Rapid movement of disease

Climate change

Todays challenges require population health approach to investigation and solving problems

WHAT DOES VETERINARY EPIDEMIOLOGY HAVE TO OFFER?

Veterinary Epidemiology is concerned with efforts to describe, explain, predict and prevent/control disease (& other healthrelated outcomes) in animal populations.

Description Identifying cases of diseases in order to calculate the relative frequencies of the diseases within population subgroups.

Explanation Identifying causal factors and modes of transmission

Prediction Estimating the likely number of cases that Identifying patterns of will develop in the disease occurrence future

Prevent/Control Applying epidemiological knowledge to prevent the occurrence of new cases of disease, eradicate existing cases, and prolong the lives of animals with disease

Taken together, epidemiology provides the data that will improve our understanding of how diseases develop over time and the factors that relate to disease distributions.

These in turn will lead to application of interventions to reduce disease impact.

- What it is

Epi - "upon demos - "the people logos - "study of".

Veterinary Epidemiology
"

The frequency, patterns and the factors that influence health, disease & other healthrelated states in animal populations

and its application and to disease prevention & control, promotion of health, optimizing
production, improving animal welfare & the quality & safety of animal-derived foods.

Epidemiology extends beyond the study of disease but also other health-related states

Examples of Health-related states

Injury Lowered animal productivity Animal welfare problems Food safety problems Suboptimal performance Accessibility & availability of veterinary services

WHAT ITS MAIN GOALS ARE

- as a science - in veterinary practice

- in veterinary service

As a science..

To understand the causes of disease

In veterinary practice

To prevent & control diseases in populations; promote health, improve production & welfare and the safety of foods of animal origin
Better veterinary services

To improve the effectiveness of animal health care; guide animal health planning & decisionmaking

Understand the causes of disease

We look at variations in the frequency of disease in groups of animals and determine why certain animals develop a particular disease whereas others do not. Knowing how animals are likely to develop a particular disease and under what situations would allow us to manipulate some of these factors and so reduce the frequency of the disease of interest.

From Epidemiology to Prevention or Control Epidemiology provides the information for directed actions against disease.

EXAMPLE. Designing strategic anthelmintic treatment against liver flukes Knowledge of the geographic distribution of Fasciola gigantica, its life cycle in the snail intermediate hosts, the concentration of metacercaria on the pasture and fluke egg production can be used in the design of strategic treatment for goats with anthelminthic drugs.

From Epidemiology to Better Veterinary Service

Investigation & evaluation of veterinary service Assessment of veterinary service Views of producers on - animal disease - what they see as priorities for our services . Why farmers make the decisions they do on animal health matters. Why there are discrepancies with what we see and what farmers do as priorities.

D E L I V E R Y

The next slide presents the ISSUES AND QUESTIONS IN THE PRACTICE OF VETERINARY MEDICINE which are most often addressed in epidemiologic studies.

Abnormality
Diagnosis

Is the patient sick or well?

How accurate are tests to diagnose disease? What factors are associated with an increased risk of disease? What is the case definition? How common is the disease? What is the host, temporal & spatial distribution? What are the consequences of having a disease? What are the factors associated with increase or decrease probability of recovery?

Risk
Frequency/ Occurrence

Prognosis

Treatment/ Control

How effective is the therapeutic intervention Did treatment change the course of disease? How can the rate or risk of disease spread be minimized? How useful are the tools for diagnosis, treatment, prevention and control?
What is the etiologic agent & its life cycle? What are the factors that contribute to its pathogenicity and virulence? What factors determine host susceptibility or resistance to disease? What conditions predispose populations to outbreaks

Cause

Prevention

Does an intervention on well animals keep disease from arising? Does early detection and treatment improve the course of disease
What are the sources and reservoirs of the causative agent? What are the periods of communicability? How is the agent spread from infected to susceptible individuals? What is the mode of infection?

Source/ Transmission

Cost

What is the impact of a disease in personal and economic terms?

KEY EPIDEMIOLOGIC CONCEPTS

Focus on Prevention

Counting

Subjects are animals & humans Disease does not occur at random

Populationbased

KEY CONCEPTS

Setting is the field

Group comparison Multiple determinants

Each of these epidemiologic concepts will be discussed.

1. The emphasis is prevention

Optimizing production Improving animal welfare Promoting animal health Improving quality & safety of animal-sourced foods
Healthy Animal Population

2. Subjects are animals and humans.

These diseases impact on both animals and humans. We will use the term Epidemiology throughout this course.
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3. Study disease in populations

since disease experiences differ between populations or population subgroups as a result of exposure of individuals in the population to the causes of disease.

Note
Although the focus is the population, individuals within a population are studied to obtain biologic knowledge and understanding about the overall animal health status. All epidemiological conclusions are drawn from and are directly applicable to a defined population but only indirectly to individuals.

4. Compare population groups

Cases Exposure? Non-cases No Exposure Exposure Disease?

Epidemiologists measures the determinants from both health and sick groups of animals in a population to seek to discover whether the distribution of disease occurrence varies from one population group to another.

5. Disease is studied in the environment in which it occurs.

Village, herd or flock disease results from complex interactions between the agent, animal host and environmental factors.

This means investigating disease in populations directly in their natural environment where disease occurs, i.e., on the farm and in the field rather than in a laboratory, university animal facility or research institutions.

Note
The challenge of epidemiology is that we must make comparisons of exposures and outcomes NOT in a highly controlled environment such as a laboratory but in a real-life situation, i.e., in the field. A laboratory environment may not accurately reflect the actual conditions of exposure in real populations. In addition, animals of different species may have different responses to experimental manipulations. We cannot assume that biologic effects observed experimental animals (e.g., rodents) will necessarily apply to domestic animals such as cattle, pigs and poultry.

Note
By studying disease in its natural habitat, we do not have to assume about similarity of effects either across species, across doses and routes of exposure. We observe patterns of exposure and disease development as they naturally occur within animal populations. Without such information, we could never reach a definitive conclusion about the frequency of disease related to a particular agent.

6. Disease does not occur at random but rather in patterns across populations, time and places.

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We search for patterns

Who is at greatest risk for disease? When does the disease occur most frequently?

Where is the disease most common?

What interventions or animal health programs might be most effective?

Note
By describing disease variations between & within population groups, their causes can be explored, i.e.,

Factors that are likely to produce (or prevent) disease can be identified. Consequently, preventive & control strategies can be planned & implemented against these identified risk factors.

7. Disease has multiple determinants.

Causal factors are often varied and selection of prevention/control strategies is complex.

EXAMPLE.Farmers behavior and economics as disease determinants Although a recommended intervention works, farmers may be reluctant to adopt such measure as it will entail much expense to their operations.

Note
Because disease and other health-related outcomes are due to multiple causes, epidemiology takes a multidisciplinary approach to understanding & solving disease since. The epidemiologist get inputs from, coordinate and integrate the use of different disciplines & techniques to obtain a comprehensive picture of how a particular disease maintains itself in nature and how disease can controlled and prevented most effectively and quickly.

Examples of Scientific Disciplines

Medicine Pathology Microbiology Parasitology Nutrition Biostatistics Psychology Agric Economics Sociology Biology Demography Chemistry Geography Physics Engineering Environmental science Policy analysis Bioinformatics Computer science

The epidemiologist integrates the data generated from several disciplines & techniques during an investigation of a disease.

8. Disease is quantified
Burden of disease? Who, Where and when it occurs most? What factors increase risk of disease?

OBJECTIVES of
Epidemiology

To identify the etiology or a cause of a disease and the factors that increase risk for a disease.
If we can identify the etiologic or causal factors for disease and reduce or eliminate exposure to those factors, we can develop a basis for disease prevention or control programs.

EXAMPLE. Investigation of risk factors for toxoplasmosis

A number of cross-sectional studies had been conducted in various countries to investigate the seroprevalence and risk factors associated with Toxoplasma gondii infection in pigs. The factors found to be associated with increased risk of T. gondi seroprevalence were the presence of cats, outdoor rearing and age. Cats are essential for the maintenance of T. gondii infection in pig farms through oocyst elimination and contamination of feed &water. Access to outdoor facilities favor contact with cats and rodents, increasing the probability of oocyst and tissue cysts ingestion, respectively. The high seroprevalence of T. gondii antibodies in 11- and 15-week old pigs may indicate horizontal transmission. These studies indicate the need for the farmers to control the presence of cats on their farms in order to decrease the risk of T. gondii infecting their pigs.

To determine the extent of disease found in particular place or populations or both.

What is the burden of disease in the area?

This question is critical for planning animal health services and facilities, and for training future veterinarians and other animal health professionals.

To study the natural history and prognosis of disease

The natural history of disease refers to its natural progression without intervention whereas prognosis refers to the outcome such as death or recovery. By defining the baseline natural history of a disease in quantitative terms, we can determine the effectiveness of new intervention modalities by comparing the results to that of the baseline data.

To develop both existing and new developed preventive and therapeutic measures and modes of animal health care delivery.

To provide the foundation for developing policies relating to animal health, animal welfare, improve animal productivity, food safety, environmental problems, genetic issues, and other considerations regarding disease prevention and risk management.

Epidemiologists may be involved in the following activities:

Identifying risk factors for disease & other healthrelated outcomes

Describing the natural history of disease Identifying individuals and populations at greatest risk of disease Identifying where the disease is greatest

Monitoring & surveillance of disease and other health related events over time
Evaluating the efficacy and effectiveness of prevention and treatment programs

Being a resource person

Assisting in carrying out animal health programs Communicating animal health information

Types of Epidemiologic information

useful for influencing animal health policy and planning and producers animal health decisions

ANIMAL HEALTH ASSESSMENT COMPLETING THE CLINICAL PICTURE

Identifying who is at greatest risk of a particular disease Identifying who is at greatest risk of a particular disease Identifying who is susceptible to disease Identifying the types of exposures capable of causing disease Describing the pathologic changes that occur, the stage of subclinical disease, and expected length of subclinical phase of the disease.

Identifying where the disease is greatest

Identifying when the disease is greatest Monitoring potential exposures over time Monitoring intervention-health related outcomes over time

Identifying the types of symptoms that characterize the disease

Identifying probable outcomes (recovery, disability, death) associated with different levels of the disease

EVALUATING THE PROGRAM Identifying the efficacy of the animal health program
Measuring the effectiveness of the animal health program

FINDING CAUSES OF A DISEASE Identifying who is susceptible to disease

Identifying the primary agents associated with disease, disorders, or conditions Identifying the transmission mode of

Combining lab evidence with epidemiologic findings