Emerging and reemerging zoonoses in the 21st century: an epidemiological approach in the scope of the One Health concept
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2022-11-25
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Zoonose(s) é o termo que designa as doenças e infeções naturalmente transmitidas entre os seres humanos e os animais. De acordo com a Organização Mundial de Saúde, existem mais de 200 zoonoses de origem viral, bacteriana, fúngica, parasitária, entre diversos agentes patogénicos. A emergência e reemergência de doenças zoonóticas corresponde a um processo multifatorial complexo que tem como força motriz a ação antropogénica. Para além do impacto negativo na saúde humana global e na economia de cada país, as zoonoses têm efeitos adversos na saúde animal e fragilizam os esforços de conservação para proteção da biodiversidade. De facto, as zoonoses constituem um dos principais desafios da abordagem “One Health”, cujo conceito se baseia na interdependência da saúde humana, animal e ambiental. A One Health desempenha um papel importante na vigilância, prevenção e controlo das zoonoses através de uma abordagem colaborativa, coordenada, multissetorial e transdisciplinar, a nível local, regional, nacional e global, envolvendo profissionais de saúde humana, animal e ambiental, bem como entidades de saúde pública, o poder político e a comunidade em geral. Dada a impossibilidade de abordar todas as zoonoses existentes, o principal objetivo deste trabalho consistiu em contribuir para a determinação da situação epidemiológica de duas zoonoses: a telaziose e a COVID-19. A presente tese está estruturada em oito capítulos: O capítulo I apresenta uma revisão geral dos fatores biológicos, sociais e ambientais associados à emergência de doenças infeciosas com caráter zoonótico, bem como o papel da abordagem One Health nesta temática. O capítulo II identifica os principais objetivos desta tese. O capítulo III consiste num estudo de revisão dos aspetos-chave do parasita Thelazia callipaeda, nomeadamente a sua morfologia, ciclo de vida, vetor – a mosca da fruta Phortica variegata, sinais clínicos, diagnóstico e tratamento. Também sumariza os casos de telaziose humana e animal na Europa. O capítulo IV corresponde a uma revisão sistemática desenvolvida para proceder à análise qualitativa e quantitativa das características epidemiológicas e clínicas dos casos de telaziose por T. callipaeda nos humanos e nos animais domésticos e selvagens. Verificou-se que nos cães, gatos e raposas vermelhas, os machos foram mais frequentemente infetados do que as fêmeas (cães: p = 0.0365; gatos: p = 0.0164; raposas vermelhas: p = 0.0082). Segundo os resultados obtidos, os cães adultos parecem ser mais propensos à infeção (p < 0. 0001), assim como, os cães de grande porte (p < 0. 0001) e animais de companhia que vivem exclusivamente ao ar livre (p < 0. 0001). Também se verificou que os cães e as raposas vermelhas albergavam significativamente mais nematodes femininos do que masculinos (p < 0. 0001). O capítulo V diz respeito a uma revisão desenvolvida com o intuito de providenciar a informação disponível sobre a provável origem animal do vírus SARS-CoV-2 e possíveis hospedeiros/reservatórios. De acordo com a informação reunida, os morcegos da espécie Rhinolophus affinis parecem ser um reservatório natural do vírus e os pangolins (Manis javanica) um possível hospedeiro intermediário. Os seres humanos continuam a ser a principal fonte de disseminação do vírus SARS-CoV-2 para outros humanos, mas também para animais domésticos (cães e gatos), animais em jardins zoológicos (tigres, leões, pumas) e animais de produção intensiva como os visons (Neovison vison). A transmissão do vírus de animais para os humanos não parece ser uma via sustentável, embora haja relatos de transmissão do vírus SARS-CoV-2 de visons para humanos em explorações intensivas. Através de infeções experimentais, outros animais parecem ser suscetíveis ao SARS-CoV-2, nomeadamente algumas espécies de primatas e os furões. O capítulo VI refere-se a uma breve revisão sobre a importância da implementação da abordagem One Health para a vigilância, prevenção e controlo da COVID-19 e de outras zoonoses. Enfatiza a necessidade de colaboração, coordenação e comunicação entre a medicina humana e a medicina veterinária para evitar futuros eventos pandémicos. No capítulo VII é apresentado um estudo, tendo por base um questionário desenvolvido com o intuito de averiguar o conhecimento e práticas dos tutores de animais de companhia sobre a detenção e convivência com esses animais, bem como sobre zoonoses. Este estudo contou com a participação de 424 tutores residentes no norte de Portugal. A maioria dos inquiridos (97,2%) considerou os animais de companhia uma importante parte da família; 41,3% negaram partilhar a cama com os animais enquanto 29% assumiram fazê-lo diariamente. De acordo com os resultados obtidos, 73,6% dos participantes consideraram os animais potenciais fontes de doença para os humanos, no entanto apenas 25,9% confirmaram ter conhecimento sobre a definição de zoonoses. Também ficou patente a importância dada aos médicos veterinários como profissionais responsáveis pela proteção da saúde pública (96,9%). Este trabalho permitiu concluir o reduzido conhecimento dos tutores sobre zoonoses e a ocorrência de comportamentos de risco indicam a necessidade de fortalecer a comunicação entre médicos veterinários, médicos, tutores e a comunidade em geral para reduzir o risco de aquisição e transmissão de zoonoses. O capítulo final (capítulo VIII – Considerações finais) inclui uma conclusão global da investigação, enfatizando os aspetos mais relevantes e significativos, bem como perspetivas e desafios futuros.
Zoonoses is the term that define diseases and infections naturally transmitted between humans and animals. According to the World Health Organization, there are more than 200 zoonoses of viral, bacterial, fungal, parasitic, among several pathogens. The emergence and reemergence of zoonotic infectious diseases correspond to a complex multifactorial process whose driving force is the anthropogenic action. In addition to the negative impact on global human health and the economy of each country, zoonoses have adverse effects on animal health and weaken conservation efforts to protect biodiversity. In fact, zoonoses constitute one of the main challenges of the One Health approach, whose concept is based on the interdependence of human, animal and environmental health. One Health plays an important role in the surveillance, prevention and control of zoonoses through a collaborative, coordinated, multisectoral and transdisciplinary approach, at local, regional, national and global levels, involving human, animal and environmental health professionals, as well as public health entities, the political power and the community in general. Given the impossibility of addressing all existing zoonoses, the main objective of this work was to contribute to the determination of the epidemiological situation of two zoonoses: thelaziosis and COVID-19. The present thesis is structured in eight chapters: Chapter I presents a general review of biological, social and environmental factors associated with the emergence of zoonotic infectious diseases, as well as the role of the One Health approach in this theme. Chapter II identifies the major objectives of this thesis. Chapter III consists of a review of the key aspects of the parasite Thelazia callipaeda, such as its morphology, life cycle, vector – the fruit fly Phortica variegata, clinical signs, diagnosis and treatment. This study also summarizes the cases of human and animal thelaziosis in Europe since the beginning of the 21st century. Chapter IV corresponds to a systematic review developed to carry out a qualitative and quantitative analysis of the epidemiological and clinical features of thelaziosis cases by T. callipaeda in humans, domestic animals and wildlife. It was found that in dogs, cats and red foxes, males were more frequently infected than females (dogs: p = 0.0365; cats: p = 0.0164; red foxes: p = 0.0082). According to the results obtained, adult dogs seem to be more prone to infection (p < 0.0001), as well as large dogs (p < 0.0001) and pet animals that live exclusively outdoors (p < 0.0001). Dogs and red foxes harbored significantly more female than male nematodes (p < 0.0001). Chapter V concerns a review developed in order to provide the available information on the likely animal origin of SARS-CoV-2 and its possible hosts/reservoirs. According to the information collected, bats of the species Rhinolophus affinis appear to be a natural reservoir of the virus and pangolins (Manis javanica) a possible intermediate host. Humans remain the most likely spreading source of SARS-CoV-2 to other humans, but also to domestic animals (dogs and cats), animals in zoos (tigers, lions, pumas) and farm animals, such as minks (Neovison vison). Animal-to-human transmission does not seem to be a sustainable pathway, although there are reports of SARS-CoV-2 transmission from farmed minks to humans. Through experimental infections, other animals appear to be susceptible to SARS-CoV-2, such as non-human primates and ferrets. Chapter VI refers to a brief review on the importance of implementing the One Health approach for the surveillance, prevention and control of COVID-19 and other zoonoses. It emphasizes the need for collaboration, coordination and communication between human medicine and veterinary medicine to prevent future pandemic events. In chapter VII, a study is presented, based on a questionnaire developed to ascertain the knowledge and practices of pet tutors on pet ownership and zoonoses. This study involved the participation of 424 pet owners residing in northern Portugal. Most respondents (97.2%) considered pet animals an important part of the family; 73.1% of participants allowed their animals to live an indoor/outdoor life; 41.3% denied sharing the bed with their pets while 29% reported that they do so daily. According to the results obtained, 73.6% of the participants considered animals to be potential sources of disease for humans, however only 25.9% known the definition of zoonoses. It was also evident the importance given to veterinarians as professionals responsible for protecting public health (96.9%). The reduced knowledge of tutors about zoonoses and the occurrence of risk behaviors indicate the need to strengthen communication between veterinarians, doctors, tutors and the community in general to reduce the risk of acquisition and transmission of zoonoses. The final chapter (chapter VIII – Final considerations) includes a general conclusion of the investigation, emphasizing the most relevant and significant aspects, as well as future perspectives and challenges.
Zoonoses is the term that define diseases and infections naturally transmitted between humans and animals. According to the World Health Organization, there are more than 200 zoonoses of viral, bacterial, fungal, parasitic, among several pathogens. The emergence and reemergence of zoonotic infectious diseases correspond to a complex multifactorial process whose driving force is the anthropogenic action. In addition to the negative impact on global human health and the economy of each country, zoonoses have adverse effects on animal health and weaken conservation efforts to protect biodiversity. In fact, zoonoses constitute one of the main challenges of the One Health approach, whose concept is based on the interdependence of human, animal and environmental health. One Health plays an important role in the surveillance, prevention and control of zoonoses through a collaborative, coordinated, multisectoral and transdisciplinary approach, at local, regional, national and global levels, involving human, animal and environmental health professionals, as well as public health entities, the political power and the community in general. Given the impossibility of addressing all existing zoonoses, the main objective of this work was to contribute to the determination of the epidemiological situation of two zoonoses: thelaziosis and COVID-19. The present thesis is structured in eight chapters: Chapter I presents a general review of biological, social and environmental factors associated with the emergence of zoonotic infectious diseases, as well as the role of the One Health approach in this theme. Chapter II identifies the major objectives of this thesis. Chapter III consists of a review of the key aspects of the parasite Thelazia callipaeda, such as its morphology, life cycle, vector – the fruit fly Phortica variegata, clinical signs, diagnosis and treatment. This study also summarizes the cases of human and animal thelaziosis in Europe since the beginning of the 21st century. Chapter IV corresponds to a systematic review developed to carry out a qualitative and quantitative analysis of the epidemiological and clinical features of thelaziosis cases by T. callipaeda in humans, domestic animals and wildlife. It was found that in dogs, cats and red foxes, males were more frequently infected than females (dogs: p = 0.0365; cats: p = 0.0164; red foxes: p = 0.0082). According to the results obtained, adult dogs seem to be more prone to infection (p < 0.0001), as well as large dogs (p < 0.0001) and pet animals that live exclusively outdoors (p < 0.0001). Dogs and red foxes harbored significantly more female than male nematodes (p < 0.0001). Chapter V concerns a review developed in order to provide the available information on the likely animal origin of SARS-CoV-2 and its possible hosts/reservoirs. According to the information collected, bats of the species Rhinolophus affinis appear to be a natural reservoir of the virus and pangolins (Manis javanica) a possible intermediate host. Humans remain the most likely spreading source of SARS-CoV-2 to other humans, but also to domestic animals (dogs and cats), animals in zoos (tigers, lions, pumas) and farm animals, such as minks (Neovison vison). Animal-to-human transmission does not seem to be a sustainable pathway, although there are reports of SARS-CoV-2 transmission from farmed minks to humans. Through experimental infections, other animals appear to be susceptible to SARS-CoV-2, such as non-human primates and ferrets. Chapter VI refers to a brief review on the importance of implementing the One Health approach for the surveillance, prevention and control of COVID-19 and other zoonoses. It emphasizes the need for collaboration, coordination and communication between human medicine and veterinary medicine to prevent future pandemic events. In chapter VII, a study is presented, based on a questionnaire developed to ascertain the knowledge and practices of pet tutors on pet ownership and zoonoses. This study involved the participation of 424 pet owners residing in northern Portugal. Most respondents (97.2%) considered pet animals an important part of the family; 73.1% of participants allowed their animals to live an indoor/outdoor life; 41.3% denied sharing the bed with their pets while 29% reported that they do so daily. According to the results obtained, 73.6% of the participants considered animals to be potential sources of disease for humans, however only 25.9% known the definition of zoonoses. It was also evident the importance given to veterinarians as professionals responsible for protecting public health (96.9%). The reduced knowledge of tutors about zoonoses and the occurrence of risk behaviors indicate the need to strengthen communication between veterinarians, doctors, tutors and the community in general to reduce the risk of acquisition and transmission of zoonoses. The final chapter (chapter VIII – Final considerations) includes a general conclusion of the investigation, emphasizing the most relevant and significant aspects, as well as future perspectives and challenges.
Descrição
I, Beatriz Maria Pinto do Vale, declare that the work presented in the thesis is my own. Where the information has been derived from other sources, there is an indication on the thesis.
Palavras-chave
Doenças infeciosas emergentes , Epidemiologia