Case 12 : Prioritizing Emerging and Re-Emerging Non-enteric Zoonotic Infectious Diseases: What Should we be Afraid of Next?
As time progresses, new zoonoses make their way to the forefront in the media, in healthcare systems, in government projects, and in the daily lives of Canadians. Prioritization exercises carried out by public health experts can provide an indication for which zoonoses we should be most afraid of next, and ultimately most prepared for, especially in light of impeding changes in climate. Blake O’Neil and Brock Jansen have recently transitioned to new positions with the Health Professionals Guidance Unit at the Centre for Food-borne, Environmental, and Zoonotic Infectious Diseases. Together, they plan to develop health professional guidance documents and tools to aid in the prevention, early diagnosis, and clinical management of various emerging and re-emerging non-enteric zoonotic infectious diseases. To maintain efficiency when creating guidance documents and tools, Blake and Brock have commenced a prioritization exercise to determine which emerging and re-emerging non-enteric zoonotic infectious diseases are of the greatest threat to the health of Canadians as a result of climate change. To date, Blake and Brock have reviewed previously conducted internal and external prioritization exercises; received consultation from the National Microbiology Lab in Winnipeg, Manitoba; undertaken a literature review to explore zoonoses relevant to the Canadian context; and organized an advisory committee composed of external stakeholders from various healthrelated specialties. With the results from the literature review and the input from various stakeholder organizations, Blake and Brock have developed a list of zoonoses to be included in the prioritization exercise. The upcoming federal election tenders a very constrained timeframe for Blake and Brock, specifically for engaging with stakeholders external to the Public Health Agency of Canada. As public servants, Blake and Brock need to ensure government resources are not used for partisan advantage. Therefore, any stakeholder engagement would need to be paused when electoral campaigning begins until a Prime Minister is elected and the Senate and House of Commons resume.
Furthermore, prior to the federal election, Blake and Brock must produce a list of priority emerging and re-emerging non-enteric zoonotic infectious diseases so they can begin developing health professional guidance documents and tools. The pair has only been able to identify two prioritization criteria thus far: measuring the number of incident cases within Canada for each zoonosis and measuring the severity of illness associated with each zoonosis. However, because severity of illness is relatively challenging to define, the pair continues to search for a unit of analysis that adequately represents the criterion. In addition, they must tailor the incidence formula to sufficiently capture the status of the zoonoses in Canada. Blake and Brock are now at a standstill in terms of identifying three additional prioritization criteria, defining what each criterion entails, and how each criterion will be measured.
- Define, list, and explain basic epidemiology terms and concepts relevant to the case (i.e., case definition, risk and protective factors, prevalence, incidence, and health-related states and events).
- Define and apply epidemiological units of analysis relevant to the case (i.e., incidence, mortality rate, case fatality rate, life expectancy at birth, years of life lost, etc.).
- Recall the indications for a prioritization exercise and the process required to determine a list of priority zoonotic infectious diseases.
- Explain the current and predicted relationship between climate change and human health.
- Discuss the relevance of the social, cultural, political, and economic determinants of health with respect for the indirect effects of climate on emerging and re-emerging non-enteric zoonotic infectious diseases.
Case Study Questions
- Why did Blake and Brock choose disease incidence as a definite prioritization criterion?
- Is there something Blake and Brock should do before calculating the incidence rates for each retained zoonosis?
- How should Blake and Brock define severity of illness and what measures, or units of analysis, should be included for this?
- Drawing from your previous experiences or from other course material, describe different measures or variables that could be used as prioritization criteria in the exercise.
- How would changes in the current and projected climate impact endemic versus nonendemic zoonotic infectious diseases? Describe the relationship between climate change, disease transmission, and the risk to human health.
Climate change, current and emerging public health issues, infectious disease prioritization, measures of occurrence, severity of illness, emerging and re-emerging non-enteric zoonotic infectious diseases, units of analysis, stakeholder engagement
Schill, J., Deilgat, M. P., Thériault, J., Ahmad, R., & Terry, A. (2020). Prioritizing Emerging and Re-Emerging Non-enteric Zoonotic Infectious Diseases: What Should we be Afraid of Next? in: McKinley, G. & Speechley, M. [eds] Western Public Health Casebook 2020. London, ON: Public Health Casebook Publishing.