Järhult Josef D
Zoonosis Science Center, Department of Medical Sciences, Uppsala University, 75185, Uppsala, Sweden.
Acta Vet Scand. 2018 Jan 25;60(1):6. doi: 10.1186/s13028-018-0360-1.
A multidisciplinary approach is a prerequisite for One Health. Physicians are important players in the One Health team, yet they are often hard to convince of the benefits of the One Health approach. Here, the case for multidisciplinarity including physicians is made using the example of environmental resistance development to influenza antivirals. Neuraminidase inhibitors are the major class of anti-influenza pharmaceuticals, and extensively stockpiled globally as a cornerstone of pandemic preparedness, especially important in the first phase before vaccines can be mass-produced. The active metabolite of oseltamivir that is excreted from treated patients degrades poorly in conventional sewage treatment processes and has been found in river waters. Dabbling ducks constitute the natural influenza A virus reservoir and often reside near sewage treatment plant outlets, where they may be exposed to neuraminidase inhibitor residues. In vivo experiments using influenza-infected Mallards exposed to neuraminidase inhibitors present in their water have shown resistance development and persistence, demonstrating that resistance may be induced and become established in the influenza strains circulating in natural hosts. Neuraminidase inhibitor resistance genes may become part of a human-adapted influenza virus with pandemic potential through reassortment or direct transmission. A pandemic caused by a neuraminidase inhibitor-resistant influenza virus is a serious threat as the first line defense in pandemic preparedness would be disarmed. To assess the risk for environmental influenza resistance development, a broad multidisciplinary team containing chemists, social scientists, veterinarians, biologists, ecologists, virologists, epidemiologists, and physicians is needed. Information about One Health early in high school and undergraduate training, an active participation of One Health-engaged physicians in the debate, and more One Health-adapted funding and publication possibilities are suggested to increase the possibility to engage physicians.
多学科方法是“同一健康”理念的先决条件。医生是“同一健康”团队中的重要成员，但往往很难让他们相信“同一健康”方法的益处。在此，以环境中流感抗病毒药物耐药性的产生为例，阐述了包括医生在内的多学科合作的必要性。神经氨酸酶抑制剂是主要的抗流感药物类别，在全球范围内被大量储备，作为大流行防范的基石，在疫苗能够大规模生产之前的第一阶段尤为重要。经治疗患者排出的奥司他韦活性代谢物在传统污水处理过程中降解不佳，已在河水中被发现。绿头鸭是甲型流感病毒的天然宿主，常栖息在污水处理厂排放口附近，可能接触到神经氨酸酶抑制剂残留。对感染流感的绿头鸭进行的体内实验表明，当它们接触水中存在的神经氨酸酶抑制剂时，会产生耐药性并持续存在，这表明耐药性可能在自然宿主中传播的流感毒株中诱发并确立。神经氨酸酶抑制剂耐药基因可能通过基因重配或直接传播，成为具有大流行潜力的人源适应流感病毒的一部分。由神经氨酸酶抑制剂耐药流感病毒引起的大流行是一个严重威胁，因为大流行防范的一线防御将失效。为了评估环境中流感耐药性产生的风险，需要一个由化学家、社会科学家、兽医、生物学家、生态学家、病毒学家、流行病学家和医生组成的广泛多学科团队。建议在高中和本科早期培训中提供有关“同一健康”的信息，让参与“同一健康”的医生积极参与辩论，并提供更多适应“同一健康”的资金和发表机会，以增加吸引医生参与的可能性。
