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“One Health” working group seminar25 August 2016 Cedar Shores, South Dakota
Lon Kightlinger, MSPH, Ph.D.State EpidemiologistSouth Dakota Department of Health
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Tularemia: rodents, rabbits, and hares.
Plague: wild rodents, fleas and predators.
Anthrax: cattle, deer, antelope, bison, moose.
Brucellosis: bison, elk, and other wild animals. --------------------------------------------------Q Fever: sheep, goats, cattle, rabbits and other wild animals.
Tuberculosis (TB): deer, elk, and bison.
Enterics: livestock, wildlife, birds, reptiles.
Rabies: wildlife especially skunks, and bats. Hantavirus Pulmonary Syndrome: wild mice.
Histoplasma Infection (histoplasmosis): bat guano.
Baylisascaris (roundworm): raccoons.
Giardia:
Francisella tularensis: small aerobic, pleomorphic gram-negative coccobacilli.
Animals: rabbits, rodents, zoo animals, pets and ticks.
Human disease, mild to fatal: fever, glandular, ocular, pneumonic, septicemic.
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4
Tularemia cases, 1990-2000
Tularemia cases, 2001-2010
CDC. MMWR March 8, 2002 / 51(09);182-4
CDC. MMWR Nov 29, 2013 / 62(47);963-966
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1,200
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CDC. MMWR. December 4, 2015 / 64(47);1317-8. www.cdc.gov/mmwr/preview/mmwrhtml/mm6447a4.htm
100 tularemia cases were among residents of Colorado (43), Nebraska (21), South Dakota (20), Wyoming (16). This represents a substantial increase in the annual mean number of 4 (975% increase), 7 (200%), 7 (186%) and 2 (70%) cases, respectively, reported in each state during 2004–2014.
100 tularemia cases were among residents of Colorado (43), Nebraska (21), South Dakota (20), and Wyoming (16). This represents a substantial increase in the annual mean number of four (975% increase), seven (200%), seven (186%) and two (70%) cases, respectively, reported in each state during 2004–2014
ORID
WA
NV
AZ
CA
MT
CO
ND
SD
UT
ME
VT
MA
NH
RI
CTIL
MI
WI
MN
OHIN
NJMD
MO
IANE
KS
NMOK AR
TX LA
DC
PA
MS
KY
TN
SC
FL
ALGA
NC
WA
ORID
ME
MD
DEWV
PA
VA
PA
OH
WV
WYNY
>50 cases
20-49 cases
10-19 cases
<10 cases
www.cdc.gov/tularemia/statistics/index.html
ORID
WA
NV
AZ
CA
MT
CO
ND
SD
UT
ME
VT
MA
NH
RI
CTIL
MI
WI
MN
OHIN
NJMD
MO
IANE
KS
NMOK AR
TX LA
DC
PA
MS
KY
TN
SC
FL
ALGA
NC
WA
ORID
ME
MD
DEWV
PA
VA
PA
OH
WV
>0.20 incidence
0.05-0.015 incidence
0.01-0.04 incidence
<0.01 incidence
WYNY
www.cdc.gov/tularemia/statistics/index.html
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4 43 3
01 1 1
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<1 yr 1-4yr 5-14yr 15-24yr 25-39yr 40-64yr 65+yr
2016
2015
2014
2013
2012
2011
2010
2009
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2005
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SerotypesSerotype A: 4 Serotype B: 7
Pneumonic23%
Typhoidal3%
Ulceroglandular
50%
Oropharyngeal1%
Other15%
Unspecified8%
1 death61% hospitalized
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21
12
10
6 65 5
43 3 3
2 2 2 2 2 2 2 2 2 21 1 1 1 1 1 1 1
0
5
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15
20
25
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23.9
15.2
12.2
10.0
8.17.1
6.0 6.0 5.64.9 4.7
3.6 3.63.1 3.0 2.8 2.4 2.1 2.0 2.0 1.7 1.6 1.6 1.5 1.5 1.0 0.8 0.8 0.5 0.1
0
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Provisional Data
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Regions Cases Rate†
Sioux Falls MSA 1 0.4Rapid City MSA 1 0.7
Northeast 0 0.0Southeast 0 0.0
Central 0 0.0West 9 9.7
South Dakota 11 1.3
†Rate: cases per 100,000 population.
MSA: Metropolitan Statistical Area.
Counties with cases: Fall River*,
Lawrence*, Minnehaha*, Oglala
Lakota*, Pennington*, Todd 6 (*counties with <5 cases).
South Dakota Department of Health20152013 20142012 2016
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1
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0 5 10 15 20 25 30
Cat
Dog
Rabbit
Tick
Mouse
Prairie dog
Other*
*Other:3 cow3 rodents2 voles1 fox1 raccoon1 coyote
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Insect repellents: 20% to 30% DEET.
Long pants and long socks to keep ticks and deer flies off your skin.
Remove attached ticks promptly.
Don’t mow over sick or dead animals.
Masking during mowing may reduce your risk.
Use gloves when handling animals, especially rabbits, muskrats, prairie dogs, and other rodents.
Cook game meat thoroughly before eating.Until recently, a vaccine had been available for laboratorians routinely working with Francisella tularensis. This vaccine is currently under FDA review and is not generally available in the United States.
21www.cdc.gov/tularemia/prevention/index.html
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Inhalational Anthrax
• Inhalation of spores.
• Incubation, 2-3 days (range up to 60 days).
• Spores engulfed by macrophages and transported to mediastinal and peribronchial lymph nodes.
• Insidious onset: malaise, low grade fever, nonproductive cough.
• Abrupt development of respiratory distress.
• Hemorrhagic mediastinitis.
• 85% fatal.
Day 2-4 Day 6
Day 10
Eschar formation
Cutaneous anthrax
Accounts for 80% of
naturally occurring
Anthrax cases.
Enters through
openings in skin from
abrasions, lacerations.
20% progress to
systemic form if
untreated: fatal.
Most cases recover.
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South Dakota n=1
United States n=487
2002 South
Dakota 1 case
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Tom Brokaw, Yankton
Tom Daschle, Aberdeen
Aug 1993: 13 bovine.
Aug 2001: 11 bison (herd of 90),
1 bovine (herd of 92),
1 equine (herd of 4),
Sept 2001: 1 bovine (herd of 68),
June 2002: 1 bison (herd of 35),
July 2002: 1 bovine (herd of 256).
TOTAL: 29 ungulate deaths
3 July:- Beef cow found dead by rancher,- No signs of anthrax,- Necropsy by vet and assistant, - Bloody knives washed and sharpened.
4 July: 3 mm circular, raised, itchy, flesh-colored lesion with small center depression noted on middle segment of middle finger of right hand. Resembled insect bite.
5 July: Lesion increased in size.
6 July: 1 cm, flesh colored lesion.
• 7 July: 1.5 cm purple-
colored lesion with
black center.
Anthrax suspected.
• Patient went to hospital
emergency department
54 miles away,
• Then patient went to
hospital emergency
department to another
ER 75 miles away.
Patient work up:Blood culture.
Lesion core culture,
CBC (normal),
Chest radiographs (normal),
TreatmentCipro 500 mg bid
Sent home
8 July:Finger swollen,Right axillary lymph node swelling,Fever and chills.
• Blood culture grew Gram + rods.
• Dept of Health notified.
• Cultures sent to SD Public Health Lab.
• Patient interviewed.
• CDC notified.
• Found other humans exposed.
9 July: Bacillus anthracis culture confirmed.
Photo: DFA cell wall stain. SD Public Health Laboratory
• DFA for capsule (SDPHL),
• DFA for cell wall
polysaccharide (SDPHL),
• RT-PCR (SDPHL),
• Gamma phage (SDPHL),
• Immuno-
histochemistry (CDC),
9 July: Patient admitted to hospital, treated with oral cipro and IV Penicillin.
Reported to CDC.
Bioterrorism alert (≈ 1 hour).
Area health care providers alerted.
Active surveillance for suspect anthrax patients for 3 weeks.
Quarantine of cattle herds.
Media release asking area humans to look for lesions on themselves and illness in their livestock.
Public told this was not a BT attack.
Community meeting to address livestock health,
human medical and public health concerns.
Nobody panicked.
Cow burned in 2.5 m pit with tires and straw,
then buried.
All animals on pasture boosted and given
antibiotics (LA200): 15 cattle on a 60 acre
pasture on 1500 acre range.
No other livestock developed anthrax in Jerauld
County in 2002.
The patient recovered, went back to work, and
participated in CDC anthrax survivors cohort
study.
The medical/public health/veterinary system detected and responded to an anthrax case.
Naturally occurring human anthrax still happens in cattle county. Not all anthrax is Bioterrorism.
No definition of “natural exposure”.
No clear prophylaxis after a “natural exposure”.
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Plague reservoir: Wild rodents.
Vector: flea (insect that transmits a disease organism from the reservoir to the host, human).
Animal Plague:Sylvatic plague: rural forested area
Campestral plague: rural open area
Domestic plague: around human dwellings
Urban Plague: within city
Human Plague:Bubonic plague: lymph gland
Pneumonic plague: lungs
Septicemic plague: blood system
SDGF&P photo
41
Plague cycles
Wild rodent cycle
Domestic cycle
Human
bubonic
plague
Human
pneumonic
plague
www.promedmail.org
19 July: 77 year old man, New Mexico.
28 June: Squirrel, California.
16 July: 16 year old boy, New Mexico.
14 June: Cat and ground squirrel, Idaho.
6 June: Cat, Colorado.
21 April: Cats, Wyoming.
14 January: Dogs, New Mexico.
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2404
586
72 66 61 39 10 5 3
476
6712 7 7 5 4 2 2
0
500
1,000
1,500
2,000
2,500
Cases Deaths
44WHO. 2016 Weekly epidemiological record, No 8, 91. www.who.int/wer/2016/wer9108.pdf?ua=1
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NO human plague vaccine.
Avoid fleas.
Wear gloves while handing wildlife.
Stay out of prairie dog towns. If you must enter prairie dog towns:
Wear insect repellent,
Tuck pants into socks or tape pants bottoms.
Spray clothes with permethrin.
Do not touch, move, skin or butcher dead wild rodents.
48
INFECTED PETS CAN TRANSMIT PLAGUE TO HUMANS.
Keep pets away from prairie dog towns.
Use pet flea control measures.
Eliminate sources of rodent food/shelter around
you house:
Set traps,
Clear away plants/firewood/clutter from house,
Dust before killing rodents (DeltaDust: Delatamethrin 0.05%).
49
Fever and symptom watch for anyone working in epizootic plague areas.
If you develop symptoms within 7 days, seek medical attention. Let your doctor know that you have been in a plague area.
50
Investigation of contacts and sources of infection. Search for people who are close contact to patient.
Search for sick or dead animals and fleas.
Look for sick or dead cats.
History of recent travel.
Case finding for additional human cases. Alert medical community.
51
Case study: 37 year old wildlife biologist died of plague, November 2007, Arizona.Exposure: necropsy of a mountain lion without use of personal protective equipment (PPE).
Recommended PPE: vigilant hand hygiene, disposable gloves, long pants, long-sleeved shirts, N95 masks when conducting necropsies or handling dead animals.
Refs: D. Wong, et al., Primary pneumonic plague contracted from a mountain lion carcass. 2009. Clinical Infect Dis, e33-e38.
*S. Bevins et al., Wild felids as hosts for human plague, Western United States. 2009. Emerg Infect Dis, 15(12): 2021-4.
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Brucellosis in South Dakota
Colonial morphology ofBrucella suis on chocolate
agar at 48 hours, at 37°C (photo CDC Pete Seidel)
Reservoir: infected cattle, goats, sheep, elk, bison, swine, dogs.
Transmission: contact with infected animal tissue or fluids; inhalation; contaminated milk or food.
Incubation period: usually 5-60 days.
Disease: systemic bacterial disease of acute or insidious onset with continued or intermittent fever; headache, weakness, sweating, chills, arthralgia, depression, weight loss, generalized aching . . . . . .
Legal Reportable Disease: call 800-592-1861.
Select Agent notification: call 800-592-1861.
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183185173
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96 9582
104105
120119
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79 82 87
136125
104114
120121131
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55*2016 cases reported as of 30July2016
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56*2016 cases reported as of 15 August 2016
Most recent SD case: 2013 Adult male.
Puncture wound with systemic infection.
Agent: Brucella suis.
Exposure: Wild boar bow hunting out of state.
Brucellosis is the most commonly reported laboratory-associated bacterial infection.
A number of factors contribute to the risk of an accidental Brucella exposure, including:
lack of experience working with the organism.
unknown or unidentified samples that arrive for analysis.
work performed on a Brucella isolate on an open bench, not under BSL-3 conditions.
57
www.cdc.gov/brucellosis/laboratories/index.html
Characteristics of Brucella increase risk of infection in a laboratory:
low infectious dose,
ease of aerosolization.
Activities related to Brucella exposure:sniffing bacteriological cultures,
direct contact with cut or abraded skin,
mouth pipetting,
Inoculations,
sprays into eyes, nose, and mouth.
58www.cdc.gov/brucellosis/laboratories/index.html
Doxycycline 100mg twice daily and rifampin 600mg once daily for 3 weeks.
Sequential serologic testing at 0, 6, 12, 18 and 24 weeks post exposure (IgM and IgG).
Symptom watch and daily self fever check for 24 weeks.
59www.cdc.gov/brucellosis/laboratories/risk-level.html l
60
Call 1-800-592-1804 Voice Mail
Call 1-800-592-1861 or 773-3737
Secure website: sd.gov/diseasereport
FAX: 605-773-5509
Mail: “Confidential Medical Report”
Courier to DOH in Pierre
Off hours: call 280-4810 or 1-800-592-1861
61Photo: Grain almost ready for harvest, Lower Brule,
South Dakota (3 July 2016) by Andrew Kightlinger
63
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