This document discusses using a One Health approach and consensus PCR to develop a new diagnostic paradigm for detecting unknown illnesses. It summarizes work done through the PREDICT project, which used low-tech surveillance methods to safely sample over 56,000 animals across Asia and Africa. This led to the detection of 812 novel and 147 known viruses in animals, and 3 novel and 31 known viruses in humans. The approach aims to preempt disease emergence at its source in a cost-effective manner. It has enhanced field and lab capacities globally and built intersectoral cooperation between governments.

1. Shifting the Diagnostic Paradigm
for Undiagnosed Illnesses:
Low-tech Lessons Emerging
from the Wild
Woutrina Smith
One Health Institute
School of Veterinary Medicine
University of California, Davis
U.S.A.

2. One Health Approach

3. One Health Approach
Animals
Humans
Environment

4. The Challenge
Pre-empt or combat, at their source, the first stage
of emergence of zoonotic diseases that pose a
significant threat to public & animal health
(potentially pandemic infections)

5. One Health in Action

6. One Health in Action

8. High Risk Interfaces
Specific situations
enabling contact
between wild animal
hosts and people
Large-scale Ecological Drivers
Wildlife biodiversity
Human population density
Land use change
Agricultural industry change
Targeted, Risk-based
Surveillance

9. • Primates
• Bats
• Rodents
• Birds
• Suids
• Carnivores
• Ungulates
Targeted, Risk-based
Surveillance

10. Bat Guano Farms
Vietnam, Cambodia & Thailand

13. Safely Sampled More than 56,000 Anim

15. Developed & Operationalized Diagnostic Pla

16. Enhanced Field and
Laboratory Capacities

19. PCR: primers = key
Specific vs Consensus Primers
Traditional PCR
Exclusive
amplification and
detection of one
specific pathogen
Consensus = Degenerate
Broad amplification of multiple,
genetically related including
previously unidentified
pathogens
Diagnostic Approach

20. PCR: Consensus primer design
THE LIZARD LIKES TO LIVE IN THE DESERT
THE MONKEY LIKED TWO OLIVES IN THE DESSERT
THE WIZARD MIKE SAID TO LIVE IN THE DESERT
THE MONKEY BIKES FOR MILES IN THE DESERT
Sequence amplicon for
specific identification
Consensus PCR

21. Cost Savings
Routine diagnostic testing paradigm
• Rule out of 8 specific pathogens x $40 = $500/sample
• Shipping of sample to detect novel pathogens =
$10/sample
• Deep sequencing + interpretation = $3000/sample
• Total Cost: $3,510/sample
Diagnostic testing paradigm under PREDICT
• Sample extraction and first PCR test = $60/sample
• Screening for 10 viral families x $10 = $100/sample
• Total cost with sequence confirmation of positives:
$300/sample

22. Laboratory Capacity Building
• Trained 32
laboratories
globally
• 27 screening for
targeted viral
families

23. Viral Detection Success
Overall 984 known and new viruses:
• 812 novel and 147 known in animals
• 3 novel and 31 known in human pilot studies

24. Viruses Detected in 28 Viral Families

25. Li et al. (2005) Science; Ge et al. (2013) Nature

26. MERS-CoV, Saudi
Arabia
Wacharapluesadee et al. (2013) EID
Thailand bat CoV
Novel beta CoV from bat
guano

27. Mortalities caused
by Human Metapneumovirus &
Human Respiratory Syncytial Virus

28. Outbreak Investigations

30. CAPACITY BUILDING EFFORTS AND PRIORITIES FROM
A ONE HEALTH PERSPECTIVE
Aim: To evaluate the perspectives of public health
professionals, animal health professionals, and PREDICT’s
project scientists regarding current priority animal-human
interfaces

31. PREDICT Capacity Building
Successes
as reported by project scientists
0 2 4 6 8 10 12 14 16 18 20
Implemention of government programs/policies
Inclusion of wildlife in outbreak response
Outbreak response
Data management
Use of effective cold chain
Intersectoral cooperation
Trained laboratory personnel
Wildlife field surveillance protocols
Laboratory diagnostic protocols
Trained field surveillance personnel
Number of Countries
CoreCapacityAreas
Africa Asia Latin America

32. With Governments: Making Data Available to the

33. Towards a proactive paradigm
for early disease detection and
response
One Health approach to understanding the dynamics of
zoonotic virus evolution, spillover from animals to people,
amplification, and spread to inform prevention and control

34. The Ministries of Health, Agriculture & Environment and
Implementing University and NGO Partners in 31 Countries

35. One Health Institute
Mission
“Working at the interface of animals, people,
and the environment to solve complex
problems impacting health and
conservation.”