Tag Archives: One Health


Glanders is in the news. Recently, the Texas Animal Health Commission confirmed the disease in a Mexican donkey which strayed across the southern US border.

Glanders is a nearly forgotten bacterial disease of equids (horses, donkeys, mules) that can also cause infections of other animals as well as humans. Identification of glanders in a donkey in the US is significant because this is the first naturally occurring case of equine glanders in the US since 1942.


Burkholderia mallei on blood & chocolate agar plates. CDC Public Health Image Library. Public Domain.

Burkholderia mallei on blood & chocolate agar plates.
CDC Public Health Image Library.
Public Domain.


Glanders is a disease of antiquity described by Hippocrates and the Romans. It is caused by a Gram negative rod, Burkholderia mallei, and is an obligate pathogen of mammals (ie, there is no environmental reservoir). I am always amazed to think of a disease that has survived millennia hopping from host to host in an unbroken chain. To think the bacteria infecting this Mexican donkey may be descended from bacteria that felled horses in the time of the Caesars – incredible!

The genus Burkholderia includes 3 significant pathogens: B. mallei, B. pseudomallei, and B. cepacia. (See separate text box.)

Table 1: Other Burkholderia species

Table 1: Other Burkholderia species

Because of the organism’s proclivity towards infection of draft animals, B. mallei became a potential weapon of war. At a time when horses were crucial to military campaigns, both for cartage and cavalry, an outbreak of glanders among horses could devastate military readiness and alter the course of battle. Glanders was widespread among the horses of both sides during the American Civil War (Sharrer, 1995).

US Army Veterinary Hospital No. 11, Gievres, France, WW 1. Testing horse for glanders. Source:  National Library of Medicine. Common Domain.

US Army Veterinary Hospital No. 11, Gievres, France, WW 1.
Testing horse for glanders.
Source: National Library of Medicine.
Common Domain.

The disease was suspected to have been used as a biological agent in both World Wars One and Two. The United States actively researched glanders as a biological warfare agent beginning in the 1940s. (Sidell, FR, ET Takafuji, and DR Franz, eds. 1997).  Despite accusations, and some evidence of use, the ultimate outcomes of the these wars were not affected by attempts at biological warfare.

Though the disease was eradicated from the United States in 1942, infections have occurred among laboratory workers since then. An illustrative (and relatively recent) case occurred in May, 2000, when a microbiologist working at the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) initially presented with a left axillary mass and fevers.  He was treated with an intra-muscular injection of ceftriaxone and a 10 day course of cephalexin, but he continued to be ill with fevers, fatigue, night sweats, malaise, and weight loss. He was prescribed a 10 day day course of clarithromycin, but his symptoms continued and he developed abdominal pain. A subsequent CT scan documented multiple hepatic and splenic abscesses and culture of a liver aspirate yielded B. mallei. (Anon. MMWR 49(24): 532- 5.)

Despite eradication of the disease in the United States, the disease continues to be enzootic in Central and South America, Asia, Africa, and the Middle East. Thus there is the risk in the US of imported animal and human cases. Infectious diseases thought to have been successfully eradicated may re-emerge from areas of endemnicity. In this case, a wayward infected donkey crossed from Mexico into Texas.

Diseases of low incidence (and even thought eradicated) should not be forgotten despite the low likelihood any particular clinician will see one of these diseases in clinic. Yes, if you hear hoofbeats, think of horses – but that does not mean you should forget that zebras are out there. As an example, in my clinical practice I have managed three cases of Hanson’s disease (leprosy) in the past five years. Yes, the disease is rare – especially in Minnesota – but leprosy continues to affect people worldwide. Healthcare workers (of the veterinary and human sort) should consider diseases in the differential that are rare – one may quickly eliminate them based on probabilities – but they need to be considered.

And finally, a number of rare to relatively rare zoonotic diseases are potential agents of bioterrorism. (See table below.)  Public health, veterinary, and human health care workers need to maintain vigilance for these infections because of this potential nefarious use. A human or animal case of glanders would be notifiable to public health authorities, including the OIE (World Organization for Animal Health).

CDC Bioterrorism Agents



Anonymous.  Laboratory acquired human glanders – Maryland, May 2000. MMWR 49(24): 532- 5. June 23, 2000.

CIDRAP: Glanders and melioidosis.

Khan, I, et al. 2013. Glanders in animals: A review on epidemiology, clinical presentation, diagnosis and countermeasures. Transboundary and Emerging Diseases 60: 204- 21.

Larsen, JC and NH Johnson. 2009. Pathogenesis of Burkholderia pseudomallei and Burkholderia mallei. Military Med 174: 647- 51.

OIE Technical Disease Card: Glanders.

Sharrer, GT. 1995. The great glanders epizootic, 1861-1866: A Civil War legacy. Agricultural History 69(1): 79-97.

Van Zandt, KE, MT Greer, and HC Gelhaus. 2013. Glanders: An overview of infection in humans. Orphanet J Rare Diseases 8: 131- 7.

Sidell, FR, ET Takafuji, and DR Franz, eds. 1997. Medical aspects of chemical and biological warfare. Office of the Surgeon General, Dept of the Army.

New York Dept of Health Glanders Page.

CDC Glanders page.

Merck Manual link on glanders

Equuus Magazine news article on glanders.

Calvin Schwabe

Today’s post is in honor of Calvin Schwabe who was born on March 15, 1927. He died June 24, 2006.

Calvin Schwabe, DVM Source: UC Davis Vet School, http://www.vetmed.ucdavis.edu/onehealth/about.cfm ?Original photo from CDC?

Calvin Schwabe, DVM
Source: UC Davis Vet School, http://www.vetmed.ucdavis.edu/onehealth/about.cfm
?Original photo from CDC?

Schwabe, as a veterinarian, is sadly unknown to most physicians. This should be rectified. He is considered the “father of modern epidemiology.” In a career that spanned 52 years, he made crucial and astute linkages between animal health, human health, and the environment. Current healthcare providers would benefit greatly from his perspective of these interrelationships.

For ten years (1956- 1966) he was on the faculty at the American University of Beirut. His research focused on parasitic zoonoses, including hydatid disease which was (and remains) endemic in the mideast. In 1966, Schwabe returned to the United States and was one of the founding members of the University of California Davis veterinary school. He established the Department of Epidemiology and Preventive Medicine – the first such department in a veterinary school in the world. The program offered the first graduate degree in preventive veterinary medicine and is a model replicated at numerous other veterinary schools.

Veterinary Medicine and Human Health, 3rd edition Calvin Schwabe, DVM

Veterinary Medicine and Human Health, 3rd edition
Calvin Schwabe, DVM

He first published his seminal work, Veterinary Medicine and Human Health, in 1969. Though animal and human medicine was historically seen as united until modern times, it was Schwabe and his textbook that revived the view that veterinarians, physicians (and public health workers) are all toiling at the same task.

I was introduced to Schwabe and Veterinary Medicine and Human Health, by Dr. Marguerite Pappaioanou when she was faculty at the University of Minnesota’s School of Public Health. Marguerite is one of many pupils of Schwabe who are now leaders in public health, epidemiology, and veterinary medicine. Some ~12 years ago, I met Marguerite to discuss my interest in conservation medicine. In a conversation that remains a pivotal point in my educational career, she told me about Schwabe and the history of One Health. She showed me her copy of Vet Med & Human Health. I was thrilled. I was subsequently able to buy a used copy of the 3rd and final edition of the book (published in 1984). It remains one of my most valued science/ medicine texts.

Schwabe’s influences can be seen in burgeoning global One Health efforts. It is not a coincidence that the 3rd International One Health Congress starts on the anniversary of his birth.  One Health teaching programs are flourishing at veterinary schools and the One Health approach is pursued by governmental and non-governmental agencies working to improve quality of life globally. Unfortunately, physicians and medical schools have been slow to understand the value of the One Health model. I would hope that this oversight will be rectified.



Calvin Schwabe One Health Project

Calvin W. Schwabe

In Memorium, University of California.

How vultures, cattle, and a minority religious sect are interconnected.

Work with me here.  I need to tell a circuitous story.

Gyps indicus vultures in the nest, Orchha, Madhya Pradesh. Source:  Yann (talk), Wikipedia.  Creative commons Attribution Share-alike.

Gyps indicus vultures in the nest, Orchha, Madhya Pradesh.
Source: Yann (talk), Wikipedia.
Creative commons Attribution Share-alike.

Gyps vultures belong to a genus of Old World vultures that, depending on species, range from south Asia across southern Europe and northern Africa.  Beginning in the 1990s, researchers noted a significant decline in Gyps species in India. And when I say significant, I am talking about a major loss in population: 95% or more of the birds disappeared over a decade. Ten million vultures were gone. Ecologically this was unprecedented.

I became aware of the loss of these vultures when the story was reported May 30, 2000 by ProMED. (See comment on ProMED in endnote.)  Andrew A. Cunningham, a veterinary pathologist with the Zoological Society of London, reported his findings:

I recently spent three weeks investigating vulture mortality in India at
the request of the Bombay Natural History Society (BNHS) and in
collaboration with, and funded by, the Royal Society for the Protection of
Birds (RSPB). Over the past ten years, populations of Gyps spp. vultures
have declined catastrophically – in at least some areas their numbers have
been reduced by about 96% – and the decline is still continuing.”

Ill vultures were noted to sit on tree branches with drooped necks. Deborah Pain of Britain’s Royal Society for the Protection of Birds, described, ”you see them slumped on tree branches everywhere. And then they just fall off, dead.”

The cause of the disease was unknown, but both a toxicologic cause (a pesticide?) and an infectious cause (a virus?), were theorized. A novel avian virus, perhaps introduced due to the expansion of the Indian poultry industry, was thought to be a possible cause. But no one knew, which was extremely frustrating given the consequential impacts the outbreak was having on the population.

Indian white-rumped vulture (Gyps bengalensis). Image: Goran Ekstrom, Gross L, PLoS Biology Vol. 4/3/2006, e61 http://dx.doi.org/10.1371/journal.pbio.0040061 Creative Commons.

Indian white-rumped vulture (Gyps bengalensis).
Image: Goran Ekstrom, Gross L, PLoS Biology Vol. 4/3/2006, e61 http://dx.doi.org/10.1371/journal.pbio.0040061
Creative Commons.

Birds affected included the Indian white-rumped vulture (Gyps bengalensis) which was previously the world’s most common bird of prey.

Indian Vulture (Gyps indicus) in flight, Ramanagara, Karnataka. Image:  Vaibhavcho.  Wikipedia.  Creative Commons.

Indian Vulture (Gyps indicus) in flight, Ramanagara, Karnataka.
Image: Vaibhavcho. Wikipedia.
Creative Commons.

Additional vulture species affected included the Indian Vulture (Gyps indicus) and the slender-billed vulture (Gyps tenuirostris).  Imagine birds as common as our American Crow suddenly disappearing from the skies. And disturbingly, ornithologists had no idea why.

Range map of three Gyps species in South Asia. Image:  Shyamal.  Wikipedia. Common domain.

Range map of three Gyps species in South Asia.
Image: Shyamal. Wikipedia.
Common domain.

Whatever the cause, the problem was spreading. Vulture population declines were soon noted in Pakistan and Nepal as well. The griffon vulture (Gyps fulvus) has a range that spans the Indian subcontinent across the mideast and into parts of southern Europe and west Africa. Would it be infected by the same presumed virus? Ecological implications of the epidemic spreading into Europe and Asia were horrifying.

Vulture declines triggered two sets of cascading ecological and cultural impacts.  Normally, vultures provide an essential ecological service, scavenging and disposing of animal remains.  Animal carcasses that would have been consumed by vultures now lay rotting in the sun. Loss of the major scavenger species led to a surplus of food (and I use the term loosely) for other scavenger animals. Of greatest concern was the potential for a population explosion of south Asia’s feral dogs, many of whom carry rabies.  More rabid dogs, ultimately, means more people being bitten and subsequently dying of rabies. Too few know that once a person has symptoms of rabies, the disease is essentially universally fatal.  Thanks to a robust veterinary and public health infrastructure, rabies is under good control in the United States.  However, rabies remains the 10th most common infectious disease cause of death worldwide. An estimated 50,000 to 60,000 people die of rabies annually, with 20,000 to 30,000 deaths in India alone. A 2008 study (Markandya, et al) estimated that excess rabies cases attributable to the vulture decline cost the Indian economy $34 billion over the 14 years 1993–2006.

The second set of cascading impacts was cultural. We should pause and discuss the religious and ethnic Parsee of India who practice Zoroastrianism.  This is a monotheistic faith that originated in Persia (now Iran) in the 6th century BCE. The faith influenced the beliefs of other monotheistic religions including Islam, Judaism and Christianity. Zoroastrians fled Iran after invasion by Islamic armies and the first Caliphs. In the 9th Century CE, a group of Persian Zoroastrians fled to India. Parsee means Persian in the Farsi language and thus Persian Zoroastrians became known as Parsee. They survive as a tiny minority in India, though this is the largest population in any country in the world. Within India, the Parsee population is centered in Mumbai.

Parsee Tower of Silence, Bombay (Mumbai), India.  Note vultures perched on the wall of the tower. Image:  Frederic Courtland Penfield, Wikipedia. Common domain.

Parsee Tower of Silence, Bombay (Mumbai), India.
Note vultures perched on the wall of the tower.
Image: Frederic Courtland Penfield, Wikipedia.
Common domain.

According to Zoroastrian beliefs, fire, water, earth, and air are sacred elements to be preserved. As a result, burial or cremation of the dead is considered unclean. The Zoroastrian funerary practices instead involve disposing of the dead in a dakhma or ossuary where the body is laid out to be cleaned of the flesh by vultures. The feeding of one’s body to birds is the final act of charity before leaving this world for the next. In India, these funeral sites were built as towers and came to be known as “Towers of Silence.”  A dakhma that serves the needs of India’s largest single Parsee population in Mumbai is located in Doongerwadi – 54 acres of forest surrounded by urban sprawl.

But what happens when the birds who facilitate one’s passage to the afterlife have disappeared? A three thousand year old burial tradition was upended in a decade.  In some dakhma, nonexistent vultures have been replaced by solar concentrators which desiccate the corpse consistent with the prohibition on defiling fire, water, earth, and air.  In other dakhma, the solar solution is reported not to have worked. The cultural impacts of this sudden change on a central rite of one’s faith are hard to overstate.

Meanwhile, in 2002, J. Lindsay Oaks, a veterinary pathologist at Washington State University- Pullman, investigated the population decline impacting Gyps bengalensis in Pakistan as part of a project supported by the Peregrine Fund and the Ornithology Society of Pakistan, with logistical support from Bahauddin Zakariya University and the Pakistani National Council for Conservation of Wildlife. He reported to ProMED grim findings from Pakistan troublingly similar to those in India:

“Field studies over the last 2 years in the Punjab Province indicate significant population declines (up to about 80 percent) associated with high adult mortality rates (11-27 percent).”

An intriguing pathologic finding noted in three-quarters of the examined vultures was the presence of urate crystals on the birds’ internal organs consistent with visceral gout. Either an infectious agent or a toxic chemical was killing the vultures.  Examining the kidneys, the birds had acute kidney failure with uric acid crystals in the tubules.  Inflammatory changes were not consistently present.  This suggested a toxic-metabolic rather than infectious cause.    Additionally, an infectious work-up did not identify pathogens associated with avian kidney disease.  Multiple chemical agents were ruled out based on testing.

The research team hypothesized veterinary drugs might be the cause.  Vultures ingested the meat from dead cattle – perhaps the birds were exposed to pharmaceuticals administered to cattle prior to their death.  The team surveyed local veterinarians regarding what drugs they used to treat cattle and identified a single drug commonly associated with kidney toxicity:  diclofenac.  Diclofenac belongs to the group of pharmaceutical drugs known as the nonsteroidal anti-inflammatory drugs or NSAIDs. This drug class includes common medications used by both medical and veterinary practitioners, such as ibuprofen.  Oaks and his colleagues tested 25 birds for diclofenac and all 25 had significant concentrations of the drug.  Furthermore, by testing Gyps bengalensis birds that had been injured and could not be returned to the wild, they confirmed a dose response of the exposure.

Diclofenac was identified as the principle cause of the vulture declines.  Oaks presented his group’s research findings at the World Conference on Birds of Prey and Owls, held on 18-23 May 2003 in Budapest, Hungary.  Eventually, in 2006, the governments of India, Pakistan and Nepal banned the manufacture of diclofenac.  Pharmaceutical firms are instead promoting an alternative NSAID, meloxicam, which is safe for vultures.  Unfortunately, decline in vulture populations continues, though at a slower rate.   Three species of Gyps vultures are critically endangered and may still go extinct in the wild.

Fortunately, North American vultures appear to suffer none of the toxicity that Gyps vultures experience.  (Ref: Dr. Pat Redig, Raptor Center, University of MN, per. comm.  2/11/2004.)


Screen Shot 2015-01-25 at 11.27.45 PM
Conclusion:  One Health
This story illustrates interconnections between human health, animal health, and ecological health. Introduction and widespread imprudent use of a veterinary NSAID for the treatment of cattle (a domesticated species) had cascading, interconnected ecological and cultural impacts. Feeding on cattle carcasses, Gyps vultures (a wildlife species) ingested diclofenac residues and suffered high rates of mortality due to visceral gout.  Loss of vultures represented a collapse of species diversity and the near loss of an entire trophic level in the south Asian ecosystem. Feral dogs filled the trophic gap with resulting population growth.  Incidence of dogbites increased and cases of humans exposed, infected, and killed by rabies increased.  Aside from the immeasurable human costs of suffering and death, the fiscal costs of responding to rabies is notable.  And 20 years of diclofenac use forced the Parsee to abandon funerary traditions practiced for 3,000 years.

What is the lesson here?
Development of new pharmaceuticals involves multiple research steps from the basic science laboratory to trials conducted in clinical settings. Even after FDA drug approval, post-marketing research will identify adverse reactions not seen in clinical trials. I have the utmost respect for researchers who navigate these labyrinthine protocols and regulations.  Such regulations protect healthcare consumers from adverse drug effects and they have been generally effective in this goal.

Yet pharmaceuticals may impact species aside from the intended human recipient.  In the case of diclofenac, the drug was being used for veterinary purposes, yet sickened vultures.  Drug manufacturing has been documented to lead to contamination of effluent waters with antibiotics (as one example).  And every day millions of people follow their doctor’s orders, ingest medications, and then urinate active drug and drug metabolites into our waterways.  The traditional research and regulatory regimes for pharmaceutical drug approval typical do not consider such downstream environmental impacts. I would argue it is time to change that myopic focus.



If you have not heard of ProMed or used the website, I invite you to take a look. ProMED, the Program for Monitoring Emerging Diseases, is a web based reporting system for disease outbreaks and not just for human diseases; ProMed also reports animal and plant disease outbreaks. The site was established in 1994 with the support of the Federation of American Scientists and SATELLIFE, but since 1999, has operated as a program of the International Society for Infectious Diseases.



Cunningham, AA, V Prakash, D Pain, et al. 2003. Indian vultures: victims of an infectious disease epidemic? Animal Conservation 6: 189– 97.

Green, RE, I Newton, S Schultz, et al. 2004. Diclofenac poisoning as a cause of vulture population declines across the Indian subcontinent. J Applied Ecology 41(5): 793- 800.

Gross, L. 2006. Switching drugs for livestock may help save critically endangered Asian vultures. PLoS Biology 4(3): e61. DOI: 10.1371/journal.pbio.0040061

Karkaria, B. 2015.  Death in the city: How a lack of vultures threatens Mumbai’s ‘Towers of Silence’ Guardian. (Link)

Markandya, A, T Taylor, A Longo, et al. 2008. Counting the cost of vulture decline- An appraisal of the human health and other benefits of vultures in India. Ecological Economics 67: 194- 204. (Link)

Oaks, JL, M Gilbert, M Virani, et al. 2004. Diclofenac residues as the cause of population decline of vultures in Pakistan. Nature 427: 630– 3.

Prakash, V. 1999. Status of vultures in Keoladeo National Park, Bharatpur,
Rajasthan, with special reference to population crash in Gyps species.
Journal Bombay Natural History Society 96(3): 365- 78.

Prakash, V, DJ Pain, AA Cunningham, et al. 2003. Catastrophic collapse of Indian white-backed Gyps bengalensis and long-billed Gyps indicus vulture populations. Biological Conservation 109: 381– 90.

Prakash V, MC Bishwakarma, A Chaudhary, et al. 2012. The population decline of Gyps vultures in India and Nepal has slowed since veterinary use of diclofenac was banned. PLoS ONE 7(11): e49118. doi:10.1371/journal.pone.0049118

ProMed. The Program for Monitoring Emerging Diseases. http://www.promedmail.org

Shultz, S, HS Baral, S Charman, et al. 2004. Diclofenac poisoning is widespread in declining vulture populations across the Indian subcontinent. Proceedings of the Royal Society of London B (Supplement), in press. DOI: 10.1098/rsbl.2004.0223

What Can Docs Learn about Measles from Veterinarians?

OK, quick sum-up for those living in a media-free cave: The US has a resurgence of measles related to falling vaccination rates, especially in specific demographic communities.  Ominously, 2015 is starting out with a large, multistate outbreak of measles centered on Disneyland theme parks in California – as of this writing at least 65 epidemiologically linked cases have been identified in 7 US states and Mexico.  And of local interest (and concern), a University of Minnesota student was diagnosed with measles this week.

Excellent commentary is available on the internet and in other media regarding measles and the need to improve the public’s acceptance of vaccination in general, and the MMR in particular, to prevent an ongoing spiral of worsening outbreaks of vaccine preventable disease.  Just to be clear, there is no epidemiological link between MMR and autism.  British gastroenterologist Andrew Wakefield published a fraudulent article in the Lancet in 1998 and then essentially pursued a media campaign to suggest a link between MMR and autism.  That article has been wholly discredited.   The other authors of the paper withdrew their support and it was retracted.  In January, 2010, the UK General Medical Council (essentially the United Kingdom’s medical licensing body), struck Wakefield from the medical register, meting out their harshest sanction available.  Unfortunately, Wakefield’s influence has continued to discourage some from vaccinating their children against measles.  I have little to add on the above sordid tale, though I encourage readers to know this history because of how significant Wakefield’s impact has been on adherence to recommended vaccinations.

For clinicians, I refer you to the CDC Measles page or the MDH Measles page.  I encourage providers who (like myself) have never seen a case of measles (yay! let’s hear it for vaccination!), to review the presenting signs and symptoms of measles as well as your clinic or hospital’s isolation procedures in the event you see a case. You don’t want to be the one contacting the family of someone who was inadvertantly exposed to measles in your healthcare setting.

And let’s get the legal boilerplate out of the way: Yes, I am a doc, but I don’t play one on the internet, so none of what I say should be construed as actual medical advice. Whew!

The topic for today, “What can docs learn about measles from veterinarians?” might seem incongruous as measles is a virus that only infects humans, but let’s talk.

Measles Virus

Measles virus belongs to the Paramyxoviridae family of viruses. You have to love virology because the name (Para-“beyond” and -myxo- “slime”) equates to the “beyond slime viruses” and conjures up (at least for me) an image of Bart Simpson working with Petri plates.  Viruses in this family have a genome composed of a non-segmented strand of RNA. This contrasts with influenza viruses where the genome is made up of 8 segments (or separate strands of RNA). This difference is important because reassortment of RNA segments between different strains of influenza leads to periodic genetic shifts allowing new pandemics of influenza for which people (and animals) have no immunity.  This is one reason why your healthcare provider brings up the flu vaccine every fall. So getting back to the Paramyxoviridae, they have one segment, which gives them genetic stability compared to influenza.  Which also means vaccination for measles can be more effective.

Below is a family tree of sorts for this family of viruses – think of it as something you’d find on Ancestry.com, but instead of aunts and uncles, you’ve got viruses that are related to differing degree. The figure here is from an article by Marsh, et al, (looking at a virus not actually that closely related to measles virus, but the image works for our discussion). Take a look at the cluster on the left labeled “Morbilivirus” (sic). Here is where we find measles virus. A number of closely related viruses are in this genus.  And except for measles, all the other viruses here are animal pathogens.  Very interesting.


This figure shows only the most important morbilliviruses (not all of them). In addition to measles, these include canine distemper (CDV, a pathogen primarily of dogs), peste-des-petits-ruminants (PPRV; I don’t speak French, but obviously it is a pathogen of petite ruminants, i.e., goats and sheep), and then there is rinderpest virus (RPV). Rinderpest virus, the one that strikes terror in animals and people alike. Wait, what?  You haven’t heard of rinderpest?  Astonishingly, if you are like most folks outside the veterinary or wildlife biology world you’ve probably never heard of it. It’s time to correct that oversight.

One reason for the anonymity of the virus (and the disease of the same name) is that it infects animals, specifically cattle and other members of the Artiodactyla. These are mammals that are even-toed ungulates, including antelope, gazelles, sheep, goats, pigs, and giraffes, among others. The disease has an ancient origin, likely in Asia.  As with many diseases, it spread with trade (via the Silk Road) and with human conflicts. The Fifth Plague of ancient Egypt (Exodus 9:1-3) was a cattle plague and may have been rinderpest.  The virus is thought to have spread into central Europe in the 13th century with the advancing armies of the Mongols.  Starting in the 1700s, multiple well-documented epizootics of rinderpest wracked Europe.

If there ever was an infectious disease candidate for the worst in the world, rinderpest would certainly be in the running.  The devastation wrought by the virus seems incomprehensible to us today.  Up to 95% of cattle were killed.  Famines followed quickly after epidemics of rinderpest because cattle were not only an important source of food (for dairy and meat) but also power (as draft animals used to plow fields).

Rinderpest outbreak in 18th Century Netherlands Source: Wikipedia  Public Domain

Rinderpest outbreak in 18th Century Netherlands
Source: Wikipedia
Public Domain

Africa was spared from the disease, until the 1800s.  Starting in 1887 the most devastating documented outbreak of rinderpest ensued, when the virus arrived on the continent, home to the world’s largest free ranging population of hooved animals.  All essentially susceptible to rinderpest.   And then enters the virus.  When the Italian military was waging a campaign in Eritrea, they imported cattle from India for food and draft power.  Some of the livestock were unfortunately infected with the virus (presumably unbeknownst to the Italians.)  The subsequent outbreak in Ethiopia was estimated by contemporary sources to have resulted in 90% mortality of the entire country’s cattle herd.   Famine resulted in 1888-1892. A third of the nomadic peoples of East Africa, dependent on hooved animals for milk and protein, are estimated to have died in the viral conflagration.  

By 1890, rinderpest had reached Tanzania.  In a very small illustration, in the region surrounding Unyanyembe the cattle population fell from a herd of ~40,000 to ~100.  Cattle deaths due to the ever-advancing rinderpest were reported in Rhodesia (now Zimbabwe) by 1896 and ultimately the scourge reached all the way to the Cape, killing an estimated 2.5 million head of cattle in southern Africa alone.  

And an equal devastation was meted out against wild hooved species.   The ecological impacts of rinderpest is a topic worthy of a separate post (and by a guest blogger who is an expert in ecology.)  It is hard to comprehend the devastation this plague left in its wake.

Cows dead from rinderpest in South Africa, 1896. Source: Wikipedia.  Public Domain.

Cows dead from rinderpest in South Africa, 1896. Source: Wikipedia. Public Domain.

Luckily, rinderpest was never imported into North America.  And now never will be.  A multi-decade effort by wildlife biologists and veterinarians to vaccinate against the plague was ultimately successful.   In the case of rinderpest, building herd immunity was both metaphorical and literal.  Rinderpest has been eradicated  as of May, 2011 – one of only two diseases that can claim the distinction, the other is smallpox.

I want to wrap up this discussion by connecting the rinderpest story back to measles.  It turns out measles is not only related to rinderpest – it’s basically it’s offspring.  (Imagine the B grade horror flick “Son of Rinderpest.”)  Measles appears to have evolved from rinderpest and “jumped” species  from cattle to humans around the 11th to 12th centuries.  A pandemic ensued that has persisted to this day – most recently impacting Mickey Mouse and his friends.

What can docs learn about measles from veterinarians?

First, this tale is a parable.  If rinderpest was eradicated, why not measles? In contrast to measles, rinderpest can infect a variety of host species.  Biologists and vets slayed rinderpest in extremely difficult circumstances, working in remote bush across multiple cultural boundaries, during peacetime and war.  But the tools used to contain and ultimate eradicate rinderpest were ultimately no different than the public health tools we use against measles.

Second, the story of rinderpest evolving from a virus solely infecting animals to one that infected humans is not unique.  In over half of human infectious diseases, the pathogens also infect animals.  Of emerging human diseases, the majority ‘jump species’ from an animal host.  These include ones that make the headlines:  Ebola, SARS, avian and swine influenza…  And diseases that don’t:  Nipah, Hendra, MERS…   Addressing the risks of the next pandemic requires interdisciplinary collaboration between docs and vets as well as ecologists, wildlife biologists, public health sanitarians, and anthropologists.  These collaborations have started, but we need to invigorate our approach at transdisciplinary thinking.



For those more interested in the clinical manifestations of rinderpest: A clinical description may be found here.

Rinderpest in cow Source:  CDC PHIL Public Domain

Rinderpest in cow
Source: CDC PHIL
Public Domain


Barrett, T, P Pastoret, & WP Taylor (eds).  2005.  Rinderpest and Peste des Petits Ruminants: Virus Plagues of Large and Small Ruminants.  Academic Press, Elsevier, London, UK.

Holdo, RM, et al.  2009. A disease-mediated trophic cascade in the Serengeti and its implications for ecosystem C.  PLoS Biol 7(9): e1000210. doi: 10.1371/journal.pbio.1000210.  (Link)

McNeil, Donald G, Jr.  June 28, 2011.  Rinderpest, Scourge of Cattle, is Vanquished.  New York Times.  p D1.

Pankhurst, R.  1966.  The great Ethiopian famine of 1888- 1892: A new assessment.  J Hist Med 21: 95-124, 271- 293.

Schwabe, Calvin W.  1984.  Veterinary Medicine and Human Health.  Third Edition. Williams & Wilkins; Baltimore, MD.  pp 17- 22.

Hello blogworld!

I decided to start a blog after enjoying Fall 2014 basically blogging on Facebook about my experiences and frustrations related to the Ebola Outbreak in West Africa.  (i.e., what happens when a developing world disease hits a developed world’s media during an election year and, to top it off, we all still have reptilian brains….)  I spent a fair amount of time sharing and commenting on content from the web, as well as making a few observations myself.  I realized this was all a bit overwhelming for my otherwise accommodating Facebook audience and so a Blog idea was born.  By moving commentary here I will give FB friends a needed respite from the blood, pus, and gore of infectious diseases while still satisfying my own morbid need to communicate about these topics.

Who is the intended audience of this blog?  That’s where you will help me out.  I am envisioning blog posts targeting a general (though scientifically literate) audience, with add-ons and downloads that will provide more details relevant for those in medicine generally or infectious diseases in particular.  Please post in the comments section (or email me) any infectious diseases topics that you are interested in hearing more about.

I need to emphasize my interest in all things One Health or Conservation Medicine. I am fascinated by the interactions shared between human health, animal (domesticated and wildlife) health, and ecosystem health.

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There is a rich literature that documents the impacts that climate change, land use change, environmental degradation (water and air quality), invasive species encroachment, and habitat degradation have on the health of animals and humans. Starting with the veterinarian Calvin Schwabe who coined the term “One Medicine” there has been a rich tradition of veterinarians understanding the connection between veterinary medicine and human medicine. Ecologists, conservation biologists, and wildlife biologists have shown the interconnections between wildlife and habitats and how the protection of these also serve a utilitarian function of protecting human health.

I became aware of the field with the 2002 publication of the book Conservation Medicine: Ecological Health in Practice, which was eye opening and exciting and posed to me the challenge – “What is the role for me as a physician in this transdisciplinary field?”

In 2003, I was awarded a grant by the University of Minnesota’s Consortium on Law and Values in Health, Environment, and the Life Sciences, “Building a Community of Scholars in Conservation Medicine.” These funds were used for a lecture series, bringing together Twin Cities researchers, educators, veterinarians, and clinicians from across the fields related to Conservation Medicine to discuss One Health topics. Out of that discussion series, rose new connections between practitioners in these respective fields.

I have continued to apply One Health precepts in my everyday practice of medicine, but have continued to look for a role that, I, as a physician, could more actively serve to enhance the connections between veterinarians, ecologists, and wildlife biologists, to the medical community.  This blog is a step in that direction.

Welcome to my blog, pull up a chair, have a cup of coffee and let’s chat about infectious diseases and Conservation Medicine.