Zoonoses in Mammalsmmal_Zoonoses_Final_Report-2.pdf Human Diseases from Wildlife. By Michael R. Conover and Rosanna M. Vail (eds.). CRC Press. Boca Raton, FL USA. 2014. 549 pp. Infectious

ZOONOSES IN MAMMALS

Lecture

Bonnie E. Gulas-Wroblewski

National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital

Texas A&M University

IMPORTANCE OF ZOONOSES61% of all known human infections = zoonotic (WHO)

75%+ of all emerging diseases (in past decade) = zoonotic (WHO)

Outbreaks in the news: COVID-19 (Wuhan coronavirus), Ebola, SARS, H5N1 (avian influenza)

©Sarah A. Carter

OVERVIEWI. Introduction to Zoonoses

II. One Health

III. Transmission of Zoonotic Diseases

IV. Preventing/Mitigating Disease Transmission

V. Decontamination

VI. Resources for Additional Information on Zoonotic Diseases

VII. Introduction to lab topics

©Roy Hernández

ZOONOSIS

Any disease or infection that is naturally transmissible from non-human animals to humans and vice versa

ZOONOSES

Caused by pathogenic agents

Bacteria

Yersinia pestis

Fungi

Parasites

Viruses

Prions

ZOONOSES

Caused by pathogenic agents

Bacteria

Yersinia pestis : Plague

Fungi

Parasites

Viruses

Prions

ZOONOSES

Caused by pathogenic agents

Bacteria

Yersinia pestis

Fungi

Aspergillosis

Parasites

Viruses

Prions

From: http://www.lifescript.com

ZOONOSES

Caused by pathogenic agents

Bacteria

Yersinia pestis

Fungi

Aspergillosis

Parasites

Ancylostoma duodenale, Necator americanus

Viruses

ZOONOSES

Caused by pathogenic agents

Bacteria

Yersinia pestis

Fungi

Aspergillosis

Parasites

Hookworm

Viruses

©American University of Science & Technology

ZOONOSES

Caused by pathogenic agents

Bacteria

Yersinia pestis

Fungi

Aspergillosis

Parasites

Ancylostoma duodenale, Necator americanus

Viruses

Hantavirus ©Medicalrealm

ZOONOSES

Caused by pathogenic agents

Bacteria

Yersinia pestis

Fungi

Aspergillosis

Parasites

Ancylostoma duodenale, Necator americanus

Viruses

Hantavirus

Prions

“Proteinaceous infectious particle”

Cause transmissible spongiform encephalopathies

Creutzfeldt-Jakob disease in humans

From: http://www.vet.uga.edu

CHAIN OF INFECTIONTransmission occurs when the agent leaves its reservoir or host

through a portal of exit, is conveyed by some mode of transmission,

and enters through an appropriate portal of entry to infect a

susceptible host. (CDC)

DEFINITIONS: RESERVOIRReservoir: animate or inanimate sources which naturally harbor disease-causing organisms and thus serve as potential sources of disease outbreaks (NIH)

Ex. Ticks for Rocky Mountain spotted fever (Rickettsia ricketsii)

Ex. Hay for Aspergillosis (Aspergillus spp.)

Aspergillus spp. on alfalfa.

©Gerald Holmes

DEFINITIONS: VECTORS

Vectors: living organisms that can transmit infectious diseases between humans, animals, and/or humans and animals (WHO)

Vector-borne diseases = ~17% of all infectious diseases

Ex. Triatomine insect (carrying Trypanosoma cruzi) and Chagas disease

DEFINITIONS: CARRIERCarrier: a person or animal that harbors a specific infectious agent without discernible clinical disease and serves as a potential source of infection (UCLA School of Public Health)

Aka. Asymptomatic carrier

Ex. Armadillo and Chagas disease

DEFINITIONS: HOSTHost - an organism that harbors a pathogen, usually providing habitat and/or food for the pathogen

Parasite host: Definitive host (aka primary host) - a host in which a parasite reaches sexual maturity and

reproduces

Intermediate host (aka secondary host) - a host in which a parasite lives only for a limited transition period during which time the parasite usually completes a stage in its development

Paratenic host - a host in which a parasite lives only for a limited transition period and does not complete a stage in its development

Dead-end host (aka incidental host) - an intermediate host that does not allow transmission of parasite to the definitive host

Baylisascaris procyonis transmission cycle

DEFINITIONS:INCUBATION PERIOD VS. LATENT PERIOD

Incubation period – time interval between exposure and start of the first symptom

Infectious agent multiplying to #s needed to cause symptoms

If lifespan of patient < incubation period → no symptoms

Latent period – time interval between exposure and period of infectiousness

Incubation period and latent period may or may not overlap

ONE HEALTH

Recognizes the interconnection of health of humans, domestic animals, wildlife, plants, and the environment in which they live

Collaborative, transdisciplinary

Multiple scales: local, national, global

University of Alaska, Fairbanks

HUMAN-ANIMAL-ECOSYSTEM INTERFACEEncompasses all direct and indirect human exposure to animals and animal products

and to the various environments and ecosystems we all share

HUMAN-ANIMAL-ECOSYSTEM INTERFACE

HUMAN-ANIMAL-ECOSYSTEM INTERFACESkunk with ringworm → You with ringworm

HUMAN-ANIMAL-ECOSYSTEM INTERFACEYou → Dog

Dog → Dogs in dog park

Dogs in dog park → All their owners

All the dog owners → All their friends, family, co-workers, pets, etc.

On and on…

From: http://www.behbg.com

HUMAN-ANIMAL-ECOSYSTEM INTERFACEYou → Other wildlife in rehabilitation

Other wildlife in rehabilitation → All wildlife in rehabilitation at facility

Wildlife in rehabilitation → Volunteers/staff On and on….

Wildlife in rehabilitation → Free-ranging wildlife touch through outside caging Free-ranging wildlife → Wild population

Wildlife in rehabilitation → Free-ranging wildlife/population when released

White-tailed deer with ringworm infection

HUMAN-ANIMAL-ECOSYSTEM INTERFACEYou → Education animal ambassador

Education animal ambassador → All animal ambassadors

Education animal ambassadors → Volunteers/staff

On and on…

Education animal ambassadors → public

Public → Friends, family, co-workers, pets, etc.

On and on…

HUMAN-ANIMAL-ECOSYSTEM INTERFACESix Degrees of Kevin Bacon

HUMAN-ANIMAL-ECOSYSTEM INTERFACE AND ONE HEALTH

Wildlife rehabilitators = right at interface

Middle(wo)men to either prevent or spread zoonoses

ENORMOUS RESPONSIBILITY

Direct Actions

PPE, Quarantine, Disinfection protocols, etc.

Education

Through public education programs, RESPONSIBLE depictions in media, reporting infectious disease to state health services/CDC, etc.

DISEASE TRANSMISSION

Infected May Be Asymptomatic

Young, Old, Pregnant, Immune deficient (YOPI) = more

susceptible to infection

TRANSMISSION TO WILDLIFE REHABILITATORS

Direct transmission

Direct contact

Unprotected contact with infected area

Unprotected contact with infected feces, urine, other bodily excretion

Bite/scratch or skin-to-skin contact from infected animal

Droplet spread

Spray with relatively large, short-range aerosols produced by sneezing, coughing, or even talking.

Indirect transmission

Airborne transmission (e.g. dust or suspended droplets)

Transmission via inanimate object

Infection via animate vector

©DMCA

PREVENTING INFECTIONPersonal Protective Equipment (PPE) at ALL times

Barrier between you and patient (direct/indirect contact)

Prevents zoonotic infection both ways

GLOVES!!!!

Disposable latex, vinyl, nitrile gloves

Leather, kevlar gloves

Protective eye and face wear

Mucous membrane protection: goggles, face shields, welding masks

Aerosol-transmission: surgical masks, respirators

Protective clothing

Disposable overalls, gowns, aprons, head coverings

Reduce/prevent active transport of contagions: disposable booties, sanitize-able boots

Proper disposal of PPE = as important as proper wearing of PPE!

More PPE info.:

http://www.cdc.gov/HAI/ppt/ppe/PPEslides6-29-04.ppt

PREVENTING INFECTIONMinimize contact with patients as much as possible

Hand-washing

“PullClean”

Footbaths

Door-knob/light-switch cleaning

Air filtration systems

HEPA filter air purifiers

UV airflow sanitizers

Contamination-resistant surfaces

Ex. Sharklet micropattern and Staphylococcus aureus

Ex. Copper = antimicrobial

Non-toxic

http://www.gadgetify.com

http://www.americanfloormats.com

ARTHROPOD PARASITE CONTROLTransmit disease directly

Ex. Ticks: rickettsial bacteria, Borrelia burgdorferi (Lyme disease), Babesiaspp.

Ex. Mosquitoes: Zika virus, West Nile Virus, Saint Louis encephalitis, Eastern Equine Encephalitis, etc.

Ex. Fleas: rickettsial bacteria, Yersinia pestis (plague), Bartonella spp., etc.

Mechanical transmission of disease

Fleas, ticks, cockroaches, mosquitoes, flies, lice, mites

Ex. LCM

QUARANTINEStrict isolation imposed to prevent the spread of disease

Duration Relation of latent and incubation periods

DKRWR Skunk Quarantine Ex. Healthy presentation on admission exam: quarantine for 14 days

Questionable presentation on admission exam: quarantine for 30 days minimum

Whole litter will be quarantined even if only one or few individuals exhibit symptoms

Diagnosed parasitism, illness, or other health issue on admission exam: quarantine for 14 days post-confirmation of resolution of health problem

Whole litter will be quarantined even if only one or few individuals exhibit symptoms

Multiple clear/negative fecals (potential false negatives) before released from quarantine

Timing is not ideal, but realistic

Canine distemper, incubation = 9-14 days, but may be as long as 6 weeks

QUARANTINEIdeal

Handling

Minimize handling and handlers

Each litter/individual has appointed quarantine protective wear

When finished with care of one litter/individual, carefully disrobe (dispose of PPE when appropriate), disinfect self, dress in next group/individual’s PPE before giving care to next group/individual

Housing

Separate facility

Separate cleaning and food prep. area

Separate air circulation system

Air filtration system separate in quarantine, other in main facility – be sure air circulation is not drawing quarantine air into main facility

Sanitation

Within quarantine, EACH litter/individual has own enclosure, cleaning materials, feeding bowls/devices, enrichment items, etc.

When available, use autoclave or dish sanitizer for bowls, tools, and feeding devices

Laundry – separate load for quarantine

Wash with detergent and bleach at “sanitation level,” if available

Dry on high heat, can post-dry hang outside for further UV disinfection

Clean and disinfect handles at least twice a day

Foot bathes with appropriate disinfectant

QUARANTINE

If do have outbreak:

NO admissions

NO transfers

NO releases

Avoid transport

Minimize caretaker interaction with animals

Treat whole facility like quarantine

Isolate sick patients in “quarantine within quarantine”

VACCINATIONSDecision is based on risk of exposure

Number of animals admitted to facility

Quarantine capabilities/protocols of facility

Outbreaks of the disease in wild habitat

Risk of negative side effects of the vaccine

Immunosuppression, allergic reactions, vaccine-induced disease, etc.

Other factors

Known effectiveness of vaccine, duration of effective titer levels inferred by vaccine, ability to vaccinate prior to exposure to the disease

Rabies vaccination program for raccoons in Brooklyn ©USDA

PREVENTING INFECTION

Proper handling of contaminated items

Decontamination: bedding, enrichment items, food bowls, etc.

Waste disposal: carcasses, feces, dirty bedding, etc. in sealed garbage bags

Specific recommendations: http://www.cdc.gov

PREVENTING INFECTIONOther considerations to minimize infection

Stress

Carcass feeding

Asymptomatic infections of feeder animals

Enrichment gathering

Substrate origination

Exposure to wild populations while in outdoor enclosures

DECONTAMINATIONDisinfection vs. Sterilization

Disinfection: process of eliminating most microorganisms from inanimate objects and surfaces

Sterilization: process of eliminating all microorganisms and biological agents from inanimate objects and surfaces

Specific to disease and route of transmission

Wide variety of products and procedures

Specific recommendations: http://www.cdc.gov

OVERVIEW OF LAB TOPICS

Viral infections Lymphocytic choriomeningitis

Rabies

Bacterial infections Lyme disease

Fungal infections Dermatophytosis

Parasitic infections Baylisascaris spp.

Cestodes

Prions

Chronic Wasting Disease

From: http://www.fairfaxcounty.gov

RESOURCES

Centers for Disease Control and Prevention: http://www.cdc.gov

USGS Wildlife Health Center: http://www.nwhc.usgs.gov

World Health Organisation http://www.who.int

World Organisation for Animal Health http://www.oie.int

Journal of Wildlife Diseases: http://www.jwildlifedis.org

The Center for Food Security & Public Health, Iowa State University: http://www.cfsph.iastate.edu

SE Cooperative Wildlife Disease Study: http://www.vet.uga.edu

Purdue University: Indiana Animal Disease Diagnostic Laboratory Forum Newsletters: http://www.addl.purdue.edu/Links/Newsletters/current.aspx

Marine Mammals: https://swfsc.noaa.gov/uploadedFiles/Divisions/PRD/Programs/Photogrammetry/Marine_Mammal_Zoonoses_Final_Report-2.pdf

Human Diseases from Wildlife. By Michael R. Conover and Rosanna M. Vail (eds.). CRC Press. Boca Raton, FL USA. 2014. 549 pp.

Infectious Diseases of the Dog and Cat, 4th ed. By Craig E. Greene (ed.). Elsevier Saunders. St. Louis, MI USA. 2012. 1354 pp.

ACKNOWLEDGEMENTSThank You!!!!

NWRA for hosting

All of you for attending

My creative husband, Anton Wroblewski, for providing artwork for this presentation and listening to me babble non-stop about zoonoses

Dr. Kristy Murray and EVERYONE in her lab at BCM/TCH