For thousands of years, Native Americans, Alaskan Natives, and First Nation peoples in the rest of the Americas have understood innately, and honored consistently, the concepts of One Health that many people today are just coming to grasp and apply. According to the Centers for Disease Control and Prevention: “One Health is an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment. One Health is not new, but it has become more important in recent years. This is because many factors have changed interactions between people, animals, plants, and our environment.”

Past issues of the Journal have touched on aspects linked to One Health, including Climate and Health, Nutrition, Creating Healthy Communities, Cancer, and Communicable Disease. In reality, virtually every issue of the Journal has some component with linkage to One Health. For this issue, we engaged Karen Lopez, D.V.M., M.P.H., Delaware’s Deputy State Veterinarian as our guest editor, and we thank her for her connections and hard work that led to this issue’s culmination. For many readers, One Health will initially conjure up thoughts of rescue animals, such as those (both canine and feline) who will soon be in the White House with President-Elect Joe Biden and Dr. Jill Biden. For those of us old enough, we might recall the massive mosquito spraying efforts of our childhood when we chased after the mist from the planes (clearly not an advisable practice). Still others will think of our poultry industry, or the periodic scare from a potential rabies-carrying animal. And it goes much deeper than all of those combined. As a side note, we are very pleased to announce that the Delaware Journal of Public Health is now included, at an article level, in CrossRef; we’ll have more exciting news to share with you in our spring issue. As always, we hope that you enjoy this issue of the Journal, and we welcome your feedback.

Omar A. Khan, M.D., M.H.S. President Timothy E. Gibbs, M.P.H. Executive Director

Karen M. Lopez, D.V.M., M.P.H.

Diplomat – American College of Veterinary Preventive Medicine;

Deputy State Veterinarian, Delaware Department of Agriculture

I first learned of Conservation through Public Health (CTPH), a non-profit, non-governmental organization based in Uganda, during my second year of veterinary school, while attending a presentation made by an upperclassman on her experience doing a research project with the center over the summer. That was my first introduction to Dr. Gladys Kalema-Zikusoka. She is the veterinarian that made the connection that cases of scabies in the mountain gorillas living in Bwindi Impenetrable National Park were associated with scabies illnesses in the human communities surrounding the forest. The first outbreak occurred in 1996 with a subsequent outbreak in 2001-2002. Fortunately for this endangered species, treatment with Ivermectin led to successful resolution of illness in the gorillas, aside from one fatal case in a gorilla infant. CTPH was founded upon this realization that the health of the gorillas was dependent on the health of humans – and vice-versa – as the species encroached on each other’s habitats.1 For the reader of this journal issue, it also serves as a textbook example of the One Health concept. The Centers for Disease Control and Prevention (CDC) define One Health as “a collaborative, multi-sectoral, and transdisciplinary approach – working at the local, regional, national, and global levels – with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.”2 Classically, zoonotic diseases have served to exemplify the One Health concept, and indeed, several of these diseases and their collaborators will be highlighted in this issue. But the interrelationships between human, animal, and environmental health extend beyond hosts, pathogens, and their environments to issues concerning occupational health, mental health, chronic disease, and food security.2

The 2018 fatal case of rabies in a Delaware woman served as an impetus for the launch of a small One Health project here in the First State. A multi-agency educational committee consisting of representation from Delaware Departments of Agriculture, Natural Resources and Environmental Conservation/Division of Fish & Wildlife, Health and Social Services/Division of Public Health and the Public Health Laboratory was formed to address a perceived lack of public knowledge on the risk of rabies. The educational project debuted at the 2019 Delaware State Fair, where simple public messaging encouraging rabies vaccination of pets and keeping a safe distance from wildlife was shared through games, prizes, and informational materials.3 We believe that education such as this could have prevented the tragic death of the Delaware citizen the year prior, where neither interactions with domestic nor wild animals could be ruled out as routes of exposure for rabies. This was the first confirmed case of human rabies in Delaware since 1941. Plans to continue outreach at future Delaware State Fairs and other events in the state have been postponed at this time due to lack of personnel and financial resources for the endeavor due to COVID-19, but our intention is to resume activities once feasible.

How did I come to have the opportunity to meet my hero over dinner back in 2016? Well, I was coming to the end of my own One Health expedition as a volunteer with Veterinarians Without Borders during the last few months of my veterinary public health and preventive medicine residency. I had spent the last four weeks traveling throughout the West Nile region of Uganda with several other American veterinarians, educating local veterinarians, animal health technicians, cattle traders, butchers, and farmers on high consequence animal diseases and zoonotic disease prevention. I found myself in Kampala preparing to depart for my next destination, emailing with one of my mentors who was a personal friend of Dr. Kalema-Zikusoka. Knowing how exciting it would be for me to meet her while I was in country, phone calls were made, emails were sent, and the next thing I knew, Gladys was my dinner guest that evening. I giddily listened to her discuss CTPH projects: testing of gorilla fecal samples from night nests to evaluate for the presence of pathogens of concern to the gorillas and humans, family planning education and intervention with collaboration from local religious leaders, transport of human sputum samples by volunteers to regional hospitals to test for tuberculosis followed by initiation of treatment of case patients, and group livestock income-generating projects to support the Village Health and Conservation Team volunteers working in the community.4,5

Kristin Jankowski, V.M.D., C.C.R.P.

Assistant Clinical Professor, Small Animal Community Practice, UC Davis Veterinary Medical Teaching Hospital; Affiliated Faculty, One Health Institute, School of

Veterinary Medicine, UC Davis

Delaware Humane Association’s (DHA) One Health Delaware is a free, once monthly clinic that provides both veterinary and human healthcare to an underserved community in Wilmington, Delaware. The CDC states that, “Differences in social determinants of health contribute to the stark and persistent chronic disease disparities in the United States among racial, ethnic, and socioeconomic groups,1 systematically limiting opportunities for members of some groups to be healthy.”2 The goal of One Health Delaware is to utilize the human-animal bond to help bring preventive healthcare to families no matter their income, ethnicity, or immigration status. An additional benefit is to provide clinical experience to health professional students while modeling compassionate care without racial bias and enhancing One Health thinking across professions in a time of great global need. One Health Delaware is led by DHA, but is run with the volunteer help of veterinarians and technicians who join student volunteers from University of Pennsylvania School of Veterinary Medicine, University of Delaware, and Wilmington University Nurse Practitioner Program. The clinic runs in the community room of the Henrietta Johnson Medical Center, which is a Federally Qualified Health Center (FQHC) in the Southbridge section of Wilmington, Delaware. The team provides services for both the pets and people, side by side. The pets receive wellness exams, vaccinations, and health screenings. The families attending the clinic can access a variety of health and social services including blood pressure screenings, flu vaccines, or help enrolling for health insurance. All services are provided free of charge. They also have opportunities to schedule future health appointments, enroll in SNAP benefits, or sign up for healthy eating classes. Nurses and nursing students provide wellness information and opportunities to discuss any concerns. Spanish interpretation is provided by University of Delaware undergraduate students. According to the American Veterinary Medical Association, the human-animal bond is “a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors essential to the health and wellbeing of both.” One Health Delaware supports these relationships by providing an opportunity for clients to present their concerns and ask questions about themselves and their pets. Meanwhile, the medical professionals and student volunteers provide them with support, educational materials, and their time. This open platform encourages further development of the emotional and physical wellbeing of both pet and owner by creating a welcoming environment free of judgement or financial barriers. We aspire to give our clients the power to take an active role in their pet’s healthcare with the hope that this translates to empowerment in their own healthcare decisions. With the creation of this pop-up, open-door, One Health clinic in their neighborhood, we offer a unique opportunity to use the human-animal bond for the benefit of the community as a whole. This inclusive healthcare model shows promise to provide access to services in both rural and urban areas for people and pets and could become an impactful way to reach populations that have been previously underserved. Pilot data collection during the first year of the clinic showed a profound interest in families coming back to Henrietta Johnson Medical Center for both veterinary and human healthcare. Researchers from the University of Pennsylvania School of Veterinary Medicine are currently measuring the clinic’s impact on the clients, veterinary students, and volunteers of the clinic. It is my sincere hope that this small One Health project in the First State of Delaware could serve as a model for One Health clinic opportunities across the country. Correspondence: Kristin Jankowski, kkjankowski@ucdavis.edu REFERENCES 1. Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: Coming of age. Annual Review of

Public Health, 32, 381–398. https://doi.org/10.1146/annurev-publhealth-031210-101218 2. Braveman, P. & Gottlieb, L. (2014, Jan-Feb). The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep, 129 Suppl 2(Suppl 2), 19-31. https://doi.org/10.1177/00333549141291S206 PMID: 24385661;

PMCID: PMC3863696.

Halle Fitzgerald, Mugdha Parulekar, Eliana Schach, Gloria Bachmann, M.D., M.M.S.

Rutgers Robert Wood Johnson Medical School-Women’s Health Institute and members of the NJ One Health Committee

Introduction: Although it has been well-established that animal health and environmental health impact human health, there is a lack of inclusion of One Health in the education of medical and undergraduate students1. Most students, in fact, are not aware of the One Health initiative. Rationale: Due to the fundamental lack of One Health knowledge across all involved disciplines but particularly healthcare fields, educating students at the institutional level is desirable to provide early exposure. Education should influence more integrated practice for future citizens, including those in the health professions. Methods: A framework for commencing a successful One Health student club is outlined, with steps that include distinguishing the club, writing a Constitution, advertising to students, holding elections, formally establishing the University recognized club and expanding its presence on campus. Results: An undergraduate student One Health group at Rutgers University was established, and another one is currently being established at Rutgers Robert Wood Johnson Medical School. Despite the fact that One Health is an established, global initiative, there was a great deal of education necessary to alert students as to what One Health is. Although there also were multiple operational issues that had to be addressed, once commenced at the undergraduate level, it has been a very successful campus initiative. Discussion: From the experience at Rutgers University, One Health student groups can be established that further the message of One Health. Public health implications: Having a One Health presence at educational institutions via student groups will raise awareness of One Health principles, especially as they relate to public health.

Four states commenced and now have an ongoing One Health Regional Consortium (Delaware, Maryland, New Jersey and Pennsylvania). One of the initiatives that has been stressed is the education of students about One Health principles. Traditional health care fields have minimized the study of other animals and the environment in the training of future public health professionals and providers; for example, currently, there are only five medical schools that address One Health through student groups or teaching1. One of the outcomes from the last One Health Regional Consortium meeting was that the New Jersey Steering Committee took on the initiative for learners to establish a template for creating One Health student groups on campus. Due to the fundamental lack of One Health knowledge across all involved disciplines, educating students at the institutional level is desirable to provide early exposure to One Health ideals and thus inform practice and public health guidelines for future professionals. Therefore, the goals of these student groups are to increase awareness of One Health and instill the idea that people from different areas of study can and should collaborate to improve the environment, overall wellness of all humans and animals and public health outcomes. In addition to educating about One Health, another goal is to bring together students of different professions to promote collaboration on interdisciplinary projects and to possible set up a non-credit elective, especially as it relates to medical students. METHODS Undergraduate Club Framework The following steps were used to establish a One Health Club at the undergraduate level: Distinguishing the Club The main challenge of establishing an undergraduate level One Health Club is distinguishing the club from the hundreds of other organizations on campus Health and environmental organizations are both popular categories. A search of existing organizations was first performed to ensure there was not one already that was too similar in mission. In our research, we found that there were 21 health-related organizations, 13 organizations related to environmental science or conservation efforts, and 3 organizations related to animal science. However, none of them combined these three aspects of One Health into one mission. Writing a Constitution Next, a Constitution was written in order to outline the pillars that the One Health Club would be based on. The Constitution includes the club’s statement of purpose, types of initiatives, membership requirements, voting and running eligibility for executive board. We included the following goals for the club: 1. Raise awareness in the local community about the interconnectedness of human, animal, and environmental health. Many infectious human diseases have an animal

Andrew Bell

Shellfish Standardization Officer, Shellfish & Recreational Water Program, Delaware Department of Natural Resources and Environmental Control Michael Bott

Program Lead, Shellfish & Recreational Water Program, Delaware Department of Natural Resources and Environmental Control

The rapid progression, limited treatment options, and high fatality rate of vibriosis in high-risk individuals, coupled with the apparent increasing incidence of vibriosis, underscore the need for prevention by patients as well as quick diagnosis and treatment by healthcare providers. Yet, vibriosis is an under-recognized and under-reported illness,1 and awareness of the potential for infection is low among high-risk patients.2 Prompt diagnosis and treatment of vibriosis in high-risk patients is necessary to prevent death, and educating high-risk patients on how to avoid infection will save lives.2

Vibriosis is the human illness caused by pathogenic strains of the Vibrio genus of bacteria (excluding Vibrio cholerae strains O1 and O139, which cause the separate illness of cholera and which are not the focus of this article). Vibrio bacteria are a natural part of the estuarine ecosystem,2–7 with higher levels present in warm water of moderate salinity.2,5–10 There are two common modes of infection: wound contact and seafood consumption, particularly consumption of bivalve shellfish (oysters, clams, mussels, and scallops).1–3,6,7

While healthy individuals are unlikely to develop illness from the opportunistic Vibrio pathogen, individuals with certain underlying health conditions or with weakened immune systems may develop life-threatening illness. For this reason, high-risk individuals should never eat raw or partially cooked seafood. Additionally, all individuals should prevent contact between an open wound and salt or brackish water. Healthcare providers are the frontline of educating high-risk individuals on these lifesaving prevention measures. There are over 80 species of Vibrio bacteria, over 20 of which can cause vibriosis.3 The species which most frequently cause vibriosis in the US are Vibrio parahaemolyticus (Vp) and Vibrio vulnificus (Vv, see Figure 1).3 Though Vp is more common, especially in Delaware and the surrounding region, Vv is the most lethal of the Vibrios. 5,9 In fact, Vv has the highest fatality rate of any foodborne pathogen,6,7 and causes over 95% of seafood-related deaths in the US.7 About 1 in 5 people with serious Vv illnesses die, sometimes within only several days of illness onset, and many others require intensive care or limb amputations.3 Overall, an estimated 80,000 cases of vibriosis, with 500 hospitalizations and 100 deaths, occur each year in the United States.3

These statistics emphasize the critical need for patient education and prompt treatment by healthcare providers.

Christopher R. Main, Ph.D.

Environmental Laboratory Section, Division of Water, Delaware Department of Natural Resources and Environmental Control Robin Tyler, Ph.D.

Environmental Laboratory Section, Division of Water, Delaware Department of Natural Resources and Environmental Control Sergio Huerta, M.D.

Laboratory Director, Public Health and Environmental Laboratories, State of Delaware

ABSTRACT Fecal contamination of waterways in Delaware pose an ongoing problem for environmental and public health. For monitoring efforts, Enterococcus has been widely adopted by the state to indicate the presence of fecal matter from warm-blooded animals and to establish Primary and Secondary Contact Recreation criteria. In this study, we examined sites within the Love Creek watershed, a tributary of the Rehoboth bay, using next-generation sequencing and SourceTracker to determine sources of potential fecal contamination and compared to bacterial communities to chemical and nutrient concentrations. Microbial community from fecal samples of ten different types of animals and one human sample were used to generate a fecal library for community-based microbial source tracking. Orthophosphate and total dissolved solids were among the major factors associated with community composition. SourceTracker analysis of the monthly samples from the Love Creek watershed indicated the majority of the microbial community were attributed to “unknown” sources, i.e. wildlife. Those that attribute to known sources were primarily domestic animals, i.e. cat and dog. These results suggest that at the state level these methods are capable of giving the start for source tracking as a means to understanding bacterial contamination.

The Department of Natural Resources and Environmental Control (DNREC) Environmental Laboratory Section (ELS) has been monitoring the waters of Delaware for several decades as a requirement of the Clean Water Act (CWA) (USEPA 1987 - Sections 106, 303, 304 and 305). Section 303(d) identifies “impaired” waters as those that do not meet the Water Quality Standards laid out in Section 304(a). It includes processes for determining the degree of pollution reduction from human related sources likely to result in attainment of the Total Maximum Daily Load (TMDL) and recommending and informing land and water management practices necessary to achieve the targeted pollution reduction. Routine long-term monitoring at established stations tracks water quality status and documents how State waters are responding to environmental stewardship efforts. One measurable type of potential human-related water pollution is fecal bacteria. These bacteria may derive from humans, various domesticated animals (i.e. dogs, cats, cows, etc.) or from wild animals. Bacteria within the genus Enterococcus has been widely adopted to indicate the presence of fecal matter from warm-blooded animals in 305(b) monitoring efforts. Delaware has risk-based numeric criteria for Primary Contact Recreation (PCR) and Secondary Contact Recreation (SCR) in freshwater and saltwater “determined by the Department (DNREC) to be of non-wildlife origin based on best scientific judgment using available information.”1 Important among the limitations of the Enterococcus test is that it does not differentiate as to what type of animal the detected bacteria are from. It could be any mix of warm-blooded animal types that might be in the watershed – i.e. mammals and birds, domestic and wildlife. While these Enterococcus criteria are generally recognized to be protective of human health and the continuation of routine monitoring of waters is necessary to track status and trends, this test does not help in locating sources of bacterial contamination, which may be abatable. A supplemental, complimentary addition to the existing monitoring format is needed to facilitate where to apply pollution control practices and maximize the frugal utilization of the increasingly scarce resources available to bring about the environmental improvements intended under the CWA, such that waters meet standards criteria and attain designated uses,1 for example, PCR, SCR, fish, aquatic life and wildlife and harvestable shellfish waters.

Delaware’s inland coastal bays (DIB) consist of three interconnected water bodies, Rehoboth, Indian River and Little Assawoman bays that drain approximately 300 square miles of mixed land use. Eutrophication of the DIB has increased over the last several decades with inputs from agricultural and urban sources.2,3 The Love Creek watershed (Figure 1) is a tributary of the Rehoboth bay and part of the National Estuary Program for over 20 years. The watershed has undergone extensive human development of various types in its tidal and non-tidal segments with the inevitability of substantially more, making for an ideal study site. Its environmental condition, aquatic and terrestrial, could benefit substantially from improved precision in identifying human-related pollution sources. Additionally, considerable periodic seabird activity in the tidal segment and relatively wide forested stream corridors in the non-tidal segment are evidence of a robust complement of indigenous wildlife (e.g. deer, raccoons). Microbial source tracking (MST) methods use specific bacterial profiles associated with hosts, e.g. human, farm animal, bird, to

G. Donald Ritter, D.V.M., A.C.P.V.

Poultry Business Solutions LLC, Salisbury, Maryland

ABSTRACT Consumers are increasingly confused by the numerous meat labels confronting them in the meat case. Most meat labels do not provide actionable information and many labels only add to consumer confusion. While many consumers are willing to pay a premium for products with specific attributes, the trade-offs and unintended consequences associated with various animal raising programs are not transparent and often poorly understood. Adding to this confusion is a tendency toward the use of “absence labels” on meat products that can create a negative perception of unlabeled conventional products that may or may not include the attribute in question. Communicating with consumers about the complex issue of antimicrobial resistance (AMR) is challenging. A more balanced approach to raising food animals is a new consumer choice label program based on principles of One Health that provides transparent information to consumers with mandated antibiotic stewardship practices to reduce risk of AMR originating from food animals. This holistic program strives to provide optimal health outcomes for animals, people, and the environment and avoid the negative consequences sometimes associated with more narrowly focused programs.

The removal of all antibiotic use when raising food animals, a practice known as “no antibiotics ever” (NAE), has become a valuable marketing tool for many meat producers. A major concern of the use of antibiotics in food animals is that it may increase the risk of antibiotic-resistant bacterial infections in humans through several pathways.1 For antimicrobial resistance (AMR) to spread from farms to consumers via handling or consuming foods of animal origin, numerous sequential events must occur, and for many of these events the risk is uncertain. Non-foodborne spread of AMR from animal agriculture may also occur via other mechanisms such as direct contact with food animals, environmental spread of antibiotic-resistant bacteria from the farm or from secondary human-to-human transfer of farm acquired resistant bacteria in the community. Government mandated labels only address safe food handling, while voluntary labels target actual or perceived quality attributes related to specific animal raising practices. All voluntary label claims on meat and poultry products require prior approval from the United States Department of Agriculture, Food Safety Inspection Service (USDA-FSIS), while similar claims on milk and egg products are regulated by the Food and Drug Administration (FDA). One popular voluntary label claim, “no antibiotics ever,” is primarily marketed on chicken products and indicates the total absence of antibiotics used in raising the animals. Research suggests that there is widespread confusion and frustration among consumers surrounding such negative “absence labeling,” a practice that implies that similar unlabeled products may include the attribute or practice in question, which may or may not be true. A survey completed by ORC International found that 73% of consumers believe that antibiotics are present in most chicken meat despite federal regulations prohibiting unsafe levels of antibiotic residues from being present in any meat sold in the United States.2,3 Removing all antibiotics from animal production may at times put the health and welfare of animals at unnecessary risk and has negative environmental impacts. A more enlightened approach to raising food animals is to follow a balanced and holistic program based on the principles of One Health that seeks to minimize these negative tradeoffs. Such a program provides guidelines outlining best responsible animal care practices for animal producers to follow with uniform labeling to provide a new consumer choice label on meat packages. This brief article will describe the risk of AMR infection from antibiotic use in food animals and new steps that are being taken to provide more transparency in voluntary meat labels regarding this important topic.

RISK OF AMR INFECTIONS FROM FOODS OF ANIMAL ORIGIN Assessing the risk to consumers of acquiring an AMR infection to on farm use of antibiotics is dependent on the occurrence of a specific series of events. First, AMR bacteria or resistance genes emerge on the farm as a direct result of antibiotic use. Secondly, farm-origin AMR bacteria or resistance genes contact humans. Thirdly, a person acquires infection with the AMR bacteria or associated bacteria carrying the resistance genes and lastly, additional public health costs due to antibiotic treatment failures of the affected person may be incurred. To perform an informative risk assessment of AMR infections for

Christopher Brosch, M.Sc.

Administrator, Nutrient Management Program, Delaware Department of Agriculture Georgie Cartanza

Poultry Extension Agent, University of Delaware

Early community spread of COVID-19 presented a public health crisis and Delmarva’s essential workforce at the poultry processing plants. Plant workers in May 2020 were struggling to adapt to exposure risk and illness in the workforce. Furthermore, pressures of an unfamiliar marketplace strained the supply and demand linkages in poultry processing. By utilizing strategies to meaningfully slow the supply of chicken at the processing plant, farm and hatchery, supply was slowed without stopping. This ensured security in the food supply, but jeopardized farmers raising these livestock. After weeks of processing adjustments, some chicken farms were depopulated as a last resort to protect their welfare. The remains of the depopulated flocks presented a risk to public health from environmental externalities. Across the Delmarva peninsula, carcasses were composted in the housing in which they were raised along with feed, bedding and manure, and high-carbon material, and were carefully monitored to reduce environmental impacts. Compost is recycled into a resource and can be utilized safely on farms for soil conditioning, like organic fertilizer, rather than presenting an environmental disaster.

In April and May of 2020, while grocery stores in the United States were being wiped of foodstuffs, public testing for COVID-19 was ramping up. This was in part because of illnesses and calls to action from workers in meat processing plants across the country who were becoming infected with and fearful of the COVID-19 illness. Industry and the Government sprang to action with additional protective equipment, paid sick leave, mandatory health screening, and implementation of the Defense Production Act to ensure American food security. Nearly all citizens were impacted by the disruption in the supply chain of food, such as milk and chicken in the grocery stores, but agribusinesses, farmers, and the environment fell under threat as well. In many places, food shortages hit before travel restrictions. It was not the inability to move food to consumers globally that impacted grocery store stocks, but the supply itself. At that time, meat processing facilities were still running at a relatively normal rate. The first disruption was the almost immediate and total decline in purchasing of food service-packaged (bulk) meat, like 40-pound boxes of fresh and frozen boneless skinless chicken breast, which would have normally been bought by restaurants for dishes such as chicken tenders, sandwiches and Alfredo. Processing plants across the region preparing nearly 1.7 million chickens per day for distribution suffered decreased speeds as factory lines were accommodating larger than intended birds.1 The companies also shifted to direct-to-consumer packaging and hosted drive-through chicken sales at large outdoor venues on Delmarva where food service packages were put on clearance to lines of eager people. Soon also, scores of workers in each shift could not or would not come to work because of the virus’ spread, further limiting the supply chain. As supply issues quickly stacked up against solutions, plants and chicken farmers utilized other means of slowing the supply of chickens without a marketplace. At the plant, rendering operations that breakdown by-products like feathers, scraps and blood were maximized to recover fat and protein for animal feed from entire birds that could not be sold. Fewer eggs were hatched and chicks delivered to be raised by poultry farmers and those farmers with growing birds implemented strategies to slow down their chickens’ growth and draw out the supply of chickens to be processed at the plant. By the end of May 2020, these strategies had helped relieve some pressure in the system, but there were too many large chickens on farms and too few resources to bring them to any market. Compounding the crisis was the sheer scale of the issue; every chicken processing facility was strained, so cooperation of competitors (which historically solves acute issues) was not available. The final option available, like was done to millions of gallons of milk, was disposal (see Figure 1). The decision to cull birds on a farm is never an easy one, and it is even more difficult to destroy an entire 20 to 50 thousand head flock, but the alternatives are worse. As chickens are fed and grow, they have a higher demand for feed. At market age, a chicken farm only has capacity to store a few days of feed before it needs to be restocked. This increases the risk that chickens’ welfare will suffer, as feed demand across the peninsula will exceed the logistical capacity of delivery.2 Furthermore, at a certain weight, chickens become lethargic and may suffer from an unwillingness to eat or drink enough to maintain their health. Nursing large healthy chickens through a backlog in processing also strains the infrastructure and the housing is stocked for efficient use of space and heat, so delays can also lead to crowding and stress. Ultimately, if the life of a marketable chicken is extended beyond a few weeks, the welfare will quickly decline to a point where it is more humane to cull them on the farm.

The implications of in-field culling of flocks, or using the industries’ term “depopulation,” are also dire for human health and the environment. Decades ago, and in other extreme cases today, pits were dug to bury mass mortalities on farms to control the decomposition and eliminate disease vectors like flies and scavengers. This disposal method will still contribute to groundwater contamination by nitrogen causing eutrophication of down-stream surface waters and perhaps drinking water well contamination.3 The preferred alternative is in-house composting,

www.fic.nih.gov FOGARTY INTERNATIONAL CENTER • NATIONAL INSTITUTES OF HEALTH • DEPARTMENT OF HEALTH AND HUMAN SERVICES Inside this issue NOV/DEC 2020 GLOBAL HEALTH MATTERS Former Fogarty trainee examines nanomedicines for TB treatment . . . p. 5www.fic.nih.gov Inside this issue NOV/DEC 2020 GLOBAL HEALTH MATTERS Former Fogarty trainee examines nanomedicines for TB treatment . . . p. 5www.fic.nih.gov Inside this issue NOV/DEC 2020 GLOBAL HEALTH MATTERS Former Fogarty trainee examines nanomedicines for TB treatment . . . p. 544

FOGARTY INTERNATIONAL CENTER • NATIONAL INSTITUTES OF HEALTH • DEPARTMENT OF HEALTH AND HUMAN SERVICES Women advocate for leadership roles in global health FOGARTY INTERNATIONAL CENTER • NATIONAL INSTITUTES OF HEALTH • DEPARTMENT OF HEALTH AND HUMAN SERVICES By Susan Scutti Three days in the company of scientific trailblazers at the annual Women Leaders in Global Health Conference demonstrated, once again, that the personal is political. Her early 30s marked the moment when Dr. Soumya Swaminathan, the WHO’s chief scientist, said she entered “the culture of the male-dominated committee room” where older, male scientists patronized her and belittled her ideas. She faced this challenge with support from a male mentor who advised her to speak up: “They will grow to respect you and listen to you.” Now that Swaminathan’s voice is Photo by PointImages/iStock/Thinkstock Women advocate for leadership roles in global health By Susan Scutti Three days in the company of scientific trailblazers at the annual Women Leaders in Global Health Conference demonstrated, once again, that the personal is political. Her early 30s marked the moment when Dr. Soumya Swaminathan, the WHO’s chief scientist, said she entered “the culture of the male-dominated committee room” where older, male scientists patronized her and belittled her ideas. She faced this challenge with support from a male mentor Photo by PointImages/iStock/Thinkstock Women advocate for leadership roles in global health By Susan Scutti Three days in the company of scientific trailblazers at the annual Women Leaders in Global Health Conference demonstrated, once again, that the personal is political. Her early 30s marked the moment when Dr. Soumya Swaminathan, the WHO’s chief scientist, said she entered “the culture of the male-dominated committee room” where older, male scientists patronized her and belittled her ideas. Photo by PointImages/iStock/Thinkstock heard around the world, she remains committed to exposing who advised her to speak up: “They will grow to respect She faced this challenge with support from a male mentor lingering biases of previous generations. “It’s still more you and listen to you.” Now that Swaminathan’s voice is who advised her to speak up: “They will grow to respect difficult for women to get their grants approved than men, heard around the world, she remains committed to exposing you and listen to you.” Now that Swaminathan’s voice is everything else being equal,” said the former Fogarty trainee, lingering biases of previous generations. “It’s still more heard around the world, she remains committed to exposing citing a recent study. “Women also have more difficulty getting their research published.” . . . continued on p. 2 difficult for women to get their grants approved than men, everything else being equal,” said the former Fogarty trainee, lingering biases of previous generations. “It’s still more difficult for women to get their grants approved than men, Women scientists gathered recently for a virtual conference to discuss ways to nurture female leaders and achieve gender equity in global health research.citing a recent study. “Women also have more difficulty everything else being equal,” said the former Fogarty trainee, Women scientists gathered recently for a virtual conference to discuss ways to getting their research published.” . . . continued on p. 2citing a recent study. “Women also have more difficulty . . . continued on next page nurture female leaders and achieve gender equity in global health research. Women scientists gathered recently for a virtual conference to discuss ways to NIH helps LMIC institutions combat sexual harassment getting their research published.” nurture female leaders and achieve gender equity in global health research.. . . continued on p. 2 In an ongoing effort to reduce sexual harassment in science, Fogarty has awarded funds to 10 low- and middle-income the problem and shared strategies on how to make improvements. Although grantees reported most organizations have NIH helps LMIC institutions combat sexual harassment NIH helps LMIC institutions combat sexual harassment country (LMIC) institutions to shore up relevant policies, conduct training sessions and create awareness of the processes to report sexual harassment. The NIH Office of AIDS Research provided funds for the one-year awards. “We realize sexual harassment is a widespread and pervasive In an ongoing effort to reduce sexual harassment in science, Fogarty has awarded funds to 10 low- and middle-income country (LMIC) institutions to shore up relevant policies, conduct training sessions and create awareness of the processes to report sexual harassment. The NIH Office of AIDS Research provided funds for the one-year awards. In an ongoing effort to reduce sexual harassment in science, Fogarty has awarded funds to 10 low- and middle-income country (LMIC) institutions to shore up relevant policies, conduct training sessions and create awareness of the processes to report sexual harassment. The NIH Office of anti-harassment policies in place, many said they were not well publicized, and reporting processes and follow up pro- cedures were not clearly defined. The conversation was intended to encourage collaboration in developing models to combat harassment that can be shared broadly. the problem and shared strategies on how to make improvements. Although grantees reported most organizations have anti-harassment policies in place, many said they were not well publicized, and reporting processes and follow up pro- cedures were not clearly defined. The conversation was intended to encourage collaboration in developing models the problem and shared strategies on how to make improvements. Although grantees reported most organizations have anti-harassment policies in place, many said they were not well publicized, and reporting processes and follow up pro- cedures were not clearly defined. The conversation was problem,” said Fogarty Director Dr. Roger I. Glass. “We’ve AIDS Research provided funds for the one-year awards. NIH grantees are all required to provide a harassment-free to combat harassment that can be shared broadly. intended to encourage collaboration in developing models seen that many women enter the research pipeline but don’t reach leadership positions. A number have reported having to change their careers due to harassment, which is a devastating experience for them and a loss for science.” During a recent virtual network meeting hosted by Fogarty, awardees discussed how their institutions are dealing with “We realize sexual harassment is a widespread and pervasive problem,” said Fogarty Director Dr. Roger I. Glass. “We’ve seen that many women enter the research pipeline but don’t reach leadership positions. A number have reported having to change their careers due to harassment, which is a devastating experience for them and a loss for science.” “We realize sexual harassment is a widespread and pervasive problem,” said Fogarty Director Dr. Roger I. Glass. “We’ve seen that many women enter the research pipeline but don’t reach leadership positions. A number have reported having to change their careers due to harassment, which is a devastating experience for them and a loss for science.” work environment and are subject to the same terms and conditions wherever they are located, said NIH Associate Director for Science Policy Dr. Carrie Wolinetz. She cautioned the group that “policies can only take you so far,” and suggested they must be combined with communication, training and rigorous reporting—which require a firm commitment at all levels of an organization. NIH grantees are all required to provide a harassment-free work environment and are subject to the same terms and conditions wherever they are located, said NIH Associate Director for Science Policy Dr. Carrie Wolinetz. She cautioned the group that “policies can only take you so far,” and suggested they must be combined with communication, to combat harassment that can be shared broadly. NIH grantees are all required to provide a harassment-free work environment and are subject to the same terms and conditions wherever they are located, said NIH Associate Director for Science Policy Dr. Carrie Wolinetz. She cautioned the group that “policies can only take you so far,” and During a recent virtual network meeting hosted by Fogarty, training and rigorous reporting—which require a firm suggested they must be combined with communication, awardees discussed how their institutions are dealing with During a recent virtual network meeting hosted by Fogarty, commitment at all levels of an organization. training and rigorous reporting—which require a firm awardees discussed how their institutions are dealing with commitment at all levels of an organization. One Health research: a holistic approach to improving health

• Researchers study zoonotic diseases among Mongolian herders One Health research: a holistic approach to improving health • Livestock contact poses danger of human illness in Tanzania • Efforts to boost agriculture increase risk of parasites in Senegal • Researchers study zoonotic diseases among Mongolian herders • Livestock contact poses danger of human illness in Tanzania One Health research: a holistic approach to improving health • Researchers study zoonotic diseases among Mongolian herders Read more on pages 6 – 9• Efforts to boost agriculture increase risk of parasites in Senegal • Livestock contact poses danger of human illness in Tanzania Read More on pages 45-48 Read more on pages 6 – 9 • Efforts to boost agriculture increase risk of parasites in Senegal Read more on pages 6 – 9

Jarra F. Jagne, D.V.M.

New York State Animal Health and Diagnostic Center, Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine Joy Bennett, D.V.M., M.P.H., D.A.C.V.P.M.

New York State Department of Agriculture and Markets Division of Animal Industry Eireann Collins, D.V.M.

New York State Department of Agriculture and Markets Division of Animal Industry

ABSTRACT The live bird marketing system (LBMS) in the Northeastern United States (US) consists of a complex system of production flocks, dealers/haulers and live bird markets (LBMs). The States of New York (NY), Pennsylvania (PA) and New Jersey (NJ) have the most active systems with New York State having the most markets presently at 87. The states of Massachusetts, Maine and Connecticut have very few markets. Live bird markets serve mainly ethnic immigrant populations in large urban centers of Northeastern states. The markets are important in the epidemiology of avian influenza viruses (AIV) especially H5 and H7 strains that have zoonotic potential and an effect on trade with United States trading partners. Massive surveillance efforts are carried out to detect and control the spread of these virus strains in the markets under a state/federal/industry program. The program, named the “Prevention and Control of H5 and H7 Avian Influenza in the Live Bird Marketing System: Uniform Standards for a State-Federal-Industry Cooperative Program” is managed mainly by the states, with the federal government assisting in the lab detection and characterization of viruses isolated from the markets. This paper will describe the Northeastern market systems with emphasis on the largest system in NY State and will give a glimpse into its structure, clientele, general regulations, risk factors and avian influenza surveillance.

The Northeastern United States has the largest number of live bird markets (LBMs) in the United States.1 These markets are located in the States of New York (NY), Pennsylvania (PA), New Jersey (NJ), Connecticut (CT), Maine (ME), Massachusetts (MA) and Rhode Island (RI). In the past two decades, the live bird markets in CT, ME, RI and MA have decreased in number and importance, while those in the metropolitan areas of NY, NJ and PA thrive with the influx of new immigrants arriving from Asia, Africa and the Middle East. The only other region in the US that has a significant amount of live bird markets is in California (CA) on the West Coast.2 Despite the fact that each state has its own unique way of running the LBMs, there are many similarities in the way the markets are structured. There is also similarity in the way poultry flows from production sites all over the Northeast, the Mid-West, Mid-Atlantic and Canada into the urban markets.3 The poultry value chain for the LBMS in the Northeast is very simple compared to what has been observed in other countries. Poultry are raised on special production farms or commercial farms (spent layers) that sell wholesale to dealers and haulers who in turn sell to LBM owners who sell retail to consumers. Depending on customer preferences, birds brought into the markets are broilers (white or brown), spent hens, game fowl, ducks, geese, pigeons, guinea fowl, quail, and specialty chickens such as Silkies. Many come from large farms but an increasing number also come from smaller farms and backyard flocks. Many markets also sell turkeys and other animals such as sheep, goats and rabbits.4

Apart from the obvious economic benefits the states get from the presence of LBMs in the form of taxes and income for owners, dealers, haulers, farmers and jobs for many people, the LBMs are also noted for having AIV isolated frequently from birds and in the environment. Avian influenza viruses of the H7 and H5 types can become highly pathogenic and change into potentially zoonotic viruses.3 To decrease circulating AIV, the whole market system revolves around surveillance, sanitation and regulatory measures through a state/federal/industry program managed by the United States Department of Agriculture’s (USDA) Animal and Plant Health Inspection Services (APHIS). The program is the aptly named “Prevention and Control of H5 and H7 Avian Influenza in the Live Bird Marketing System: Uniform Standards for a State-Federal-Industry Cooperative Program”. It is used by all states in the US, and is the standard regulatory guide. The USDA also set up an LBM advisory group, “The Live Bird Market Working Group” which meets annually with all state stakeholders, federal personnel, federal and state laboratories to provide updates on state LBMs and AIV testing of markets and flocks.5

Production Farms and Regulations Producers from Pennsylvania provide the majority of the birds going into the LBMS for all the Northeastern States (Table 1). The Northeast LBMs provide about 500,000 birds weekly for LBMs in NY, NJ and PA, and the numbers increase during high demand periods such as holidays. The LBMs also receive poultry from other Northeastern states, the Midwest, the Mid-Atlantic region, and Canada. All Northeastern states require LBM source birds to be from an established, healthy, AI negative flock. Registration of supply flocks with departments of agriculture is required annually. Each farm is given a unique premises ID that is used for interstate movement of birds and all business conducted at LBMs. Producers also have to keep meticulous records of the farm operations and to keep them for at least a year. Animal health officers working for the state can go to farms at any time for inspection of the farm and records.5

Read Healthy You in English and Spanish

The Nation's Health

Vol. 50, Issue 10 January 2021 Table of Contents Table of Contents (PDF) Index by author Complete Issue (PDF)

APHA 2020: Virtual meeting provides vital connections for workforce – About 9,400 public health professionals come together for APHA Annual Meeting APHA’s 2020 Annual Meeting and Expo provided an anchor of support for workers fighting the COVID-19 pandemic.

Climate change worsens COVID-19, other illnesses, Lancet report says Climate change worsens health outcomes for people with COVID-19 and adds to health inequity and systemic racism in the U.S.

Study: Expanding Medicaid can boost preconception health Low-income women in states that expand Medicaid are more likely to receive preconception health counseling and take folic acid before pregnancy.

Report: OSHA dismissing most worker complaints of COVID-19 retaliation OSHA is failing to protect workers who report retaliation for speaking up about COVID-19 risks in the workplace.

U.S. poverty rising, despite historic CARES Act stimulus While federal relief funds reduced poverty in the early months of COVID-19, their expiration pushed millions of people below the poverty line.

Keep your health on course by tracking your progress Tracking measures such as activity, calories or your blood pressure can help improve your health and well-being.

Sheri L. Wood, D.V.M.

Medical Director, Brandywine Valley SPCA

The human-animal bond has existed for much longer than most people realize. There is archeological evidence of domesticated wolves found in human settlements dating back at least 14,000 years ago. It is thought that as humans and animals both sought food, shelter, and safety, they found comfort in each other and cohabitated.1

That bond has only gotten stronger over the years, and pets have played increasingly more prominent roles in contemporary households. The intense daily stressors that our society has placed on individuals has led to more recognized cases of depression and anxiety, and people are turning to domestic animals for relief. Studies have actually proven that owning a pet can actually reduce blood pressure and lower cholesterol levels.2 Some pets are even being classified as “emotional support” animals. Never has there been a greater need for emotional support in recent years than the present, during the pandemic of COVID-19. Since March of 2020, people have retreated into their homes, having much less human-to-human interaction and spending most of their days alone and in confinement. As many are now working, teaching, and learning remotely, their lives are revolving around their homes and immediate family. Those who didn’t have time enough for pets before COVID-19 are now finding that they not only have the time, but also a need for some companionship from a pet. As the Medical Director of Brandywine Valley SPCA (https:// bvspca.org/), one of the largest shelter organizations in the Delaware Valley, I’ve experienced first-hand this intense shift toward increases in pet ownership in this area. The BVSPCA was founded in 1929 in Chester County, Pennsylvania and expanded to all three counties in Delaware in 2016. For the past several months, there has been an incredible increase in the number of adoptions occurring at all of Brandywine Valley’s shelters, more than we’ve historically ever seen. For example, since July, the adoption numbers have increased by an average of 381 per month- that’s a 63% increase! It is now a normal occurrence to see lines forming outside of the shelters waiting for the doors to open each day. People who were too busy prior to the pandemic are now finding the time they need to acclimate a pet to their home. Those who anticipate not having time once returning to a regular routine have signed up to foster. I believe that this huge increase in adoption and fostering has a direct correlation to the COVID-19 pandemic. Because of the large numbers of adoptions, the Brandywine Valley shelters are emptier than they’ve ever been. This has given us the opportunity to save even more animals’ lives, by transporting in animals from areas with high euthanasia rates, such as Texas, Louisiana, and Georgia. Now, dogs and cats that were destined for euthanasia are getting a second chance at a good life in a loving home. Not only that, but there is now more room in the shelters to bring in animals from areas where hurricanes or natural disasters have recently hit. The BVSPCA aids these areas by transporting in animals who were currently in the shelters where the disaster occurred. This allows those shelters to be able to provide room for the animals found during the disaster- so that they may be able to again be reunited with their families in that area. This is a win-win situation for all of the pets and people involved. Not only have we been able to place many animals into homes in our area, but we’ve also been able to assist local families who have been affected by the pandemic. By offering discounted medical care and free vaccines and pet food, many have been able to keep their current pets in their homes. Despite the trying times we’ve all been experiencing during the COVID-19 pandemic, the human-animal bond seemingly remains stronger than ever, and both the humans and the animals are benefiting. So, if you find yourself feeling as if you need some emotional support, a hobby, or just some companionship during this time, feel free to stop by a local shelter and find a new best friend! REFERENCES 1. Serpell, J. A. (2008). In the company of animals: A study of human-animal relationships. Cambridge: Cambridge

University Press 2. Allen, K., Blascovich, J., & Mendes, W. B. (2002, September-

October). Cardiovascular reactivity and the presence of pets, friends, and spouses: The truth about cats and dogs.

Psychosomatic Medicine, 64(5), 727–739. https://www.ncbi.nlm.nih.gov/entrez/query. fcgi?cmd=Retrieve&db=PubMed&list_uids=12271103&dopt=Abstract

Douglas D Riley D.V.M.

Delaware Public Health Veterinarian

THE PARTNERSHIP What is One Health? One Health is a collaborative, multisectoral, and trans-disciplinary approach – working at local, regional, national, and global levels – to achieve optimal health and well-being outcomes recognizing the interconnectedness between people, animals, plants and their shared environment. Why is this important in Delaware? Planetary environmental health may affect human and animal health through contamination, pollution and changing climate conditions that may lead to increases in both non-infectious diseases (e.g. food deprivation) and infectious disease (e.g. COVID-19). Worldwide, nearly 75 percent of all emerging human infectious diseases in the past three decades originated in animals. As we push into the wild and the habitats of animals, these chance events will increase. We must remember that the global population in 2011 was 7 billion, and is expected to be 11 billion by 2050. In order to provide adequate healthcare, food and water for the growing global population, the health professions, and related disciplines and institutions, must work together. Remember, human-animal interactions/bonds can beneficially impact the health of both people and animals (Figure 1). This is One Health, One World, One Medicine and quite possibly our Last Chance.

A NEW BEGINNING COUPLED WITH AN AWAKENING TO THE TRUTH Initially conceived during the 2014 Ebola Outbreak in Africa, and formalized during the Avian Influenza outbreak and increases in Zika Virus cases, the One Health Partnership takes time to look at the issues in a new way. Instead of a decision based on a single siloed profession, we seek the input from multiple professionals in order to avoid unintended outcomes from a lack of a complete picture and understanding of potential bad outcomes to overall health. While there is no formal process for the development of a One Health movement, task force, coalition or partnership, the end results are very similar: the preservation of life and the mitigation of harm. Over the last few years, Delaware has spearheaded a coalition with our neighboring states in order to better share vital information and best practices. This is the first step in breaking down the walls that separate us, and learning what issues there are outside our own borders. We need to be able to better understand one another, and to use shared information as a tool to better inform the people and the leaders so that appropriate actions can be taken to secure a more fruitful tomorrow. Today, as we press on with our “new normal” lives, we are living in and around a One Health issue: COVID-19, a novel Coronavirus suspected to have originated in wildlife due to a chance encounter from a human being. This encounter led to the establishment of a new human pathogen and, unfortunately, the start of a pandemic. This should not have come as a surprise, as we have been preparing for such an event for many years. What did come as a surprise was just how elegant the enemy - SARS-CoV-2 – is, and how readily it is able to mutate and adapt.

HOW CAN THE ONE HEALTH MODEL WORK NOW? Fortunately, the One Health model is working right now. Medical fields have shared information, therapies and best practices. Animals are being monitored for potential infection, disease and establishment of reservoirs. Both active and passive monitoring is now happening in many areas of the United States and across the globe, and this information is being shared with global partners. FINAL THOUGHTS At one time, I advocated One Health as a New Beginning, here and throughout Asia. Now it is time for an Awakening. We can revert to the old normal (siloed discussions, unshared information, and a selfish demeanor) or we can shed the old ways and emerge from the COVID-19 Pandemic anew. Humanity will determine its path, and hopefully there will be an awakening where we are more apt to come alongside our neighbors and provide a hand up, and not a handout, or a gesture that is less than genuine. COVID should be a lesson that we can be defeated. As depicted in Orson Welles War of the Worlds, the aliens are killed by earthly pathogens, “slain after all man’s devices had failed, by the humblest things that God, in His wisdom, has put on the earth.”

Figure 1. Emotional support animals can bring joy and happiness to patients in long-term care facilities (source: unknown, licensed under CC BY-NC-ND).

Ashley C. Kennedy, Ph.D., M.S., B.C.E.

Tick Biologist, Mosquito Control Section, Division of Fish & Wildlife, Delaware Department of Natural Resources and Environmental Control Emily Marshall, M.S.

Enteric Disease Epidemiologist, Division of Public Health, Delaware Department of Health and Social Services

Public health messaging in the eastern United States has historically underemphasized the risks posed by lone star ticks (Amblyomma americanum), focusing instead on blacklegged ticks (Ixodes scapularis). This gap persists despite mounting evidence that lone star ticks also play an important role in disease ecology as confirmed vectors for a wide variety of tick-borne pathogens. These pathogens include several distinct bacterial agents that cause ehrlichiosis and tularensis in humans and dogs, a protozoal agent that causes cytauxzoonosis in cats, and emerging viruses such as Heartland, Bourbon, and Tacaribe. Lone star ticks are additionally linked to Rocky Mountain spotted fever, southern tick-associated rash illness, and alpha-gal syndrome, a condition marked by immune reactions to ingestion of mammalian meat. Moreover, their distribution in North America is expanding due to changing climatic factors and land use patterns. Lone star ticks are the most commonly encountered tick in Delaware, especially in Sussex and Kent Counties, and make up the vast majority of ticks collected in the first two years of the state’s tick surveillance program. Given the magnitude of lone star ticks’ medical and veterinary import, it is vital for healthcare professionals and health educators to devote more attention to this emerging threat.

Lone star ticks (Amblyomma americanum) have long been noted as aggressive human biters whose bites leave irritating, itchy wounds, but their greater importance in public health has been historically under-recognized. They are the most common human-biting ticks in Delaware and in the United States as a whole.1 Lone star ticks are associated with bacterial, viral, and protozoal pathogens as well as a newly recognized allergy to mammalian products (alpha-gal syndrome). Nonetheless, they are often overshadowed by blacklegged or “deer” ticks (Ixodes scapularis) in the public health sphere. This dearth of attention has resulted in a shortage of effective control methods for this species and may contribute to incorrect diagnoses and/or substandard treatment for associated diseases.

In contrast to ticks that use an ambush strategy (i.e., lying in wait for a host to move by), lone star ticks actively seek hosts, attracted by carbon dioxide and vibrations from host movement.2 To complete their life cycle, lone star ticks must take three blood meals, each from a different individual host; all three motile stages (larvae, nymphs, and adults) will readily feed on humans in addition to other vertebrate hosts. Each blood meal represents a possible exposure to pathogenic agents. Generally, the bite of a larval tick is considered less dangerous than the bite of a nymphal or adult tick because the larvae are feeding for the first time and thus have not had prior exposure to infected hosts. There is an increasingly recognized possibility, however, that some larvae may be infected by transovarial transmission of pathogens from the mother tick, irrespective of fed versus unfed status1,3; thus, all stages of lone star ticks should be considered possible threats to humans and other hosts. The first lone star tick specimen collected in Delaware was reported 75 years ago.4 At that time, it was not considered established in the state (i.e., there was no documentation of populations surviving year-round), and Virginia was considered the northernmost extent of its normal range. In the intervening decades, however, they have invaded, established, and supplanted blacklegged ticks and American dog ticks (Dermacentor variabilis) as the most commonly encountered tick species in the state. This range expansion is attributed to changing climatic factors such as shorter, milder winters, as well as the increasing abundance of preferred hosts like the whitetailed deer (Odocoileus virgianus), which in turn is facilitated by reduced predation pressure and changing land use patterns (e.g., forest fragmentation, suburbanization, and increased availability of edge habitat).2

Lone star ticks are abundant in the southeastern and southcentral United States, and within Delaware they are more common in the southern counties than in New Castle County. Despite their widespread presence, they are under appreciated as a threat to human and veterinary health. Much of our public health messaging (e.g., signage at state parks and other public lands, as well as in clinics and veterinary clinics) pertains to blacklegged ticks and specifically the risk of acquiring Lyme disease. This focus on blacklegged ticks has heretofore been justified by the fact that Lyme disease is the most common tick-borne infection in the country, and lone star ticks are unable to vector the Lyme diseasecausing spirochete and thus do not play an appreciable role in that disease cycle.5 Although Lyme disease remains the most common tick-associated disease in Delaware,6 this focus on one tick species and one disease suggests that other tick species and tick-borne pathogens are unimportant, when in fact they are associated with serious health outcomes.

Shaun McIntire, Matt Esposito, and John Badger

Environmental Scientists, Mosquito Control Section, Division of Fish and Wildlife, Delaware Department of Natural Resources and Environmental Control

The Delaware Mosquito Control Section (part of the Division of Fish and Wildlife in the Delaware Department of Natural Resources and Environmental Control) provides statewide services to maintain quality-of-life and protect public health by reducing mosquito population densities, and reducing the possibility of mosquito-borne illness to over 900,000 residents and nearly seven million annual visitors.1 With 90 miles of coastline and over 320,000 acres of wetland habitat, Delaware is home to approximately 57 species of mosquitoes, 19 of which are considered to be pestiferous towards humans and 17 of which are potential disease vectors.2 With an abundance of potential breeding habitat, Delaware also has the eighth-highest human population density in the United States.3 Whether it be from a nuisance standpoint (affecting quality of life, tourism, recreation, animal husbandry, property values) or the potential risk to public health, our staff focuses on controlling mosquito populations through an integrated pest management approach. Our integrated pest management includes mosquito population monitoring (both adult and larval), water management/source reduction, judicial insecticide use, and mosquito-borne virus surveillance. The Mosquito Control Section’s and the Delaware Division of Public Health’s mosquito-borne virus surveillance programs provide pertinent data to the medical and veterinary professionals throughout Delaware, alerting them to the active presence of Eastern Equine Encephalitis (EEE) and West Nile Virus (WNV) circulating in adult mosquito populations. The Mosquito Control Section conducts mosquito-borne virus surveillance and monitoring of EEE and WNV through its statewide sentinel chicken program. The transmission cycle of both WNV and EEE is maintained between vector mosquito species and susceptible avian hosts. Mosquitoes become infected when feeding on infected birds, and when taking their next blood meal, the now infected mosquito can then transmit virus to humans and horses (dead-end hosts).4 The amplification of virus occurs when the infected mosquito feeds again on another susceptible avian host. One of the more common ways around the country for conducting mosquito-borne virus surveillance is through the use of sentinel chicken flocks. Chicken flocks are placed in secured pens in mosquito prevalent areas where they are exposed to biting adult mosquitoes. Weekly blood samples are taken in the field from the chickens and are then processed by a qualified health lab. When a chicken tests positive for EEE or WNV, this means local active transmission is occurring and medical, veterinary, and mosquito control professionals can respond accordingly. Once a chicken tests positive, it is removed from further testing and replaced with another non-infected chicken (i.e., no virus antibodies present). Chickens serve as valuable sentinel animals since they are not effective amplifying hosts,5 and they develop a short and relatively low viremia compared to other bird species when infected by WNV or EEE.6 Through a working partnership with the University of Delaware, our sentinel chicken flock is raised in an indoor laboratory setting at the University’s College of Agriculture. Following the Centers for Disease Control and Prevention (CDC) guidelines, at 12 weeks old the chickens are banded and pretested to ensure each individual is not infected before deployment into the field.7 Four chickens are deployed at each of the 20 monitoring sites around the state in Figure 1. Beginning in the first week of July and continuing for an eighteen-week period through the end of October, blood samples are taken weekly from a pair of chickens from each monitoring site (and thus an individual chicken is tested bi-weekly). Sampling occurs in the field by a pair of trained staffers drawing blood from the wing vein of the chicken. Collected samples are then processed by the Delaware Division of Public Health’s Delaware Public Health Laboratory (DPHL). The DPHL tests the blood samples for WNV and EEE antibodies (seen as seroconversions) using an ELISA assay method.8 When a blood sample seroconverts for either WNV or EEE, the DPHL initiates a sequence of emails notifying the Department of Health and Social Services‘ (DHSS) Division of Public Health Office of Infectious Disease Epidemiology, the Delaware Department of Agriculture (DDA), and the Mosquito Control Section.