december 2009 selected zoonotic diseases conference call
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Selected Zoonotic Diseases Conference Call
December 2, 2009
Adam Macneil, PhD Special Pathogens Branch (SPB), CDC 404-639-4651 [email protected]
Barbara Knust, DVM, MPH SPB, CDC404-639-1104 [email protected]
Selected Zoonotic Diseases Conference Call
December 2 ,2009
Hantavirus in the United States
Update: Epidemiology of Hantavirus Pulmonary Syndrome in the United
States
Adam MacNeil, PhD, MPH
Barbara Knust, DVM, MPH
Special Pathogens Branch, CDC
The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the views of the
Centers for Disease Control and Prevention.
Hantavirus Pulmonary Syndrome (HPS)
• Severe respiratory infection, high fatality– Febrile illness, acute thrombocytopenia– Rapid onset: Bilateral pulmonary edema / Acute
respiratory distress syndrome
• Caused by new world hantaviruses• Rodent reservoir
– Multiple hantavirus species, reservoirs– US: mostly Sin Nombre virus, associated the deer
mouse (Peromyscus maniculatus)
HPS in the United States
• Discovered in 1993: Outbreak in Four Corners region of US
• ‘Retrospective’ diagnosis of prior cases (serologic evidence back to 1959)
• HPS Registry– Maintained by Special Pathogens Branch, CDC– Systematically collect data on all confirmed HPS
cases in the US– Additional data fields (clinical, outcome,
laboratory testing) to National Notifiable Diseases Surveillance System
HPS registry data sources
1. Diagnostic samples submitted to CDC, case report form included
2. Case report forms submitted by states (diagnosis made at state or private lab)
3. National Notifiable Diseases Surveillance System– Recently attempted to acquire forms for all cases
from 2006 onward– Contact state HD, acquire case report form– Thank you to state HD personnel who assisted
HPS Registry
• 534 cases• 36.5% case fatality• Infections occurred in 31 states
– Majority of cases in southwestern US
• 63% cases male• 78% white, 19% N. America / American Indian• Pediatric (16 years or less) cases rare: 7%
Annual HPS Counts and Case Fatality
0
10
20
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60
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Count
% Fatality
Cumulative HPS cases by month of onset
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Janu
ary
Febru
ary
Mar
chApr
ilM
ayJu
ne July
Augus
t
Septe
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r
Octo
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Novem
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Decem
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f ca
ses
HPS cases by age-group
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20
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10 or less 11-20 years 21-30 years 31-40 years 41-50 years 51-60 years 61 or older
Nu
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er o
f ca
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A. Deer mouse (Sin Nombre virus)B. White-footed mouse (New York virus)C. Hispid cotton rat (Black Creek Canal virus)D. Rice rat (Bayou virus)
Distribution of hantavirus reservoirs
From: Mills et al, Vector-Borne and Zoonotic Diseases 2009: Epub ahead of print
Summary
• Over 500 HPS cases documented– >35% case fatality– HPS continues to occur
• Majority of cases in southwestern US– Cases and reservoirs do exist across entire US
• Special Pathogens in the process of rolling out new website and maps
http://www.cdc.gov/ncidod/diseases/hanta/hps/noframes/epislides/episls.htm
• Please contact with questions, data clarification, consultations
Pediatric Hantavirus Pulmonary Syndrome, 2009
• Case 1 (CO)– 6 year old male– Presented to hospital: 5/16/09
• Case 2 (WA)– 14 year old male– Presented to hospital: 6/8/09
• Case 3 (CO)– 6 year old male– Presented to hospital: 7/12/09
• Case 4 (AZ)– 9 year old female– Presented to hospital: 7/12/09
Case 1 Case 2 Case 3 Case 4
Days from onset to hospitalization
2 5 5 6
Days in Hospital 1 6 11 25Maximum WBC count 56.9 (↑) 25 (↑) 14.8 (↑) 37.5 (↑)Maximum Hematocrit 55 (↑) increased 33 52 (↑)Minimum Platelets 40 (↓) 19 (↓) 56 (↓) 24 (↓)Chest X-Ray with
infiltrates+ + + +
Outcome Died Survived Survived Survived
Clinical Findings
Environmental Assessment– Rodent Exposures
• Case 1: Rodent feces in child’s room and play areas• Case 2: Hand-grinding corn contaminated with
rodent feces 8 days prior to illness• Case 3: Bitten by mouse 10 days prior to illness• Case 4: Rodent feces and nesting materials in home
and play areas
Acknowledgements
• Craig Levy, Arizona DHS• Dr. Elisabeth Lawaczek & Bill Ray, Colorado
DPHE• Nicola Marsden-Haug, Washington State DPH
• State & Territorial Epidemiologists• NNDSS • SPB staff: Pierre Rollin, Jim Mills, Andy
Comer, Craig Manning, Arie Manangan, Julie Pierzchala
Brian F. Allan, PhD Postdoctoral Fellow,Tyson Research Center,Washington University in Saint Louis314-935-8443 [email protected]
Selected Zoonotic Diseases Conference Call
December 2, 2009
Research on integrated pest management approaches to preventing lone star tick bites and ehrlichiosis
William H. Wunner, PhD Professor and Director of Outreach Educationand Technology TrainingThe Wistar Institute215-898-3854 [email protected]
Deborah J. Briggs, PhD Adjunct Professor, College of Veterinary Medicine, Kansas State University [email protected]
Selected Zoonotic Diseases Conference Call
December 2, 2009
Overview of special collections on papers on rabies appearing in the journals Vaccine and PLoS NTD
Heather Henderson, DVM, MPH Georgia Department of Community Health706-845-4035 ext. 235 [email protected]
Selected Zoonotic Diseases Conference Call
December 2, 2009
Oral immunization of raccoons and skunks with a canine adenovirus recombinant rabies vaccine
Oral immunization of raccoons and skunks with a canine
adenovirus recombinant rabies vaccine
Heather Henderson, DVM, MPHEpidemiologist II, District 4 Public Health
Georgia Department of Community Health
Background
• Oral vaccination of wildlife is an important part of rabies control
• Attenuated (ERA/SAD/SAG) and recombinant vaccinia (V-RG) vaccines have been used successfully in raccoons, foxes, coyotes
• Concerns about residual pathogenicity and human contact with baits
• No licensed oral vaccine effective in skunks• Need for oral vaccine with efficacy in majority of
terrestrial reservoir species
Background• VNA produced against rabies virus glycoprotein (RVG)• RVG gene can be inserted into a viral vector to produce
recombinant vaccine• Vector must be able to replicate on mucosal surfaces,
have minimal safety concerns• Canine adenovirus serotype 2 (CAV2) is associated with
mild upper respiratory infections in dogs• Modified-live CAV2 vaccines used to prevent disease from
CAV1 and CAV2 with excellent safety and efficacy• Human and canine-derived adenovirus vectors induce
potent cellular, humoral, and mucosal immunity• CAV2-RVG previously constructed, effective against lethal
challenge in mice when administered IM or IN
Methods
• 14 raccoons– 7 experimental group (CAV2-RVG)– 7 control group (placebo), 1 animal died on day 21– Challenge with rabies virus day 28 post-vaccination
• 23 skunks– 6 negative control (CAV2 parent virus)– 5 experimental group 1 (CAV2-RVG, 1x108 TCID)– 6 experimental group 2 (CAV2-RVG, 10-fold dilution)– 6 positive control (recombinant virus SPBNGAS-GAS)– Challenge with rabies virus day 35 post-vaccination
• All treatments administered PO• Animals euthanized at first clinical signs of rabies, brain
tissue tested by DFA to confirm rabies
Results
• All animals seronegative at start of study• No adverse effects noted in animals
receiving CAV2-RVG after >500 animal-days observation
Results
• Raccoons– Control group
• 6 / 6 seronegative 7 days after challenge• All succumbed to rabies
– Experimental group• 6 / 7 seroconverted by day 21 after vaccination; 1
seroconverted within 7 days after challenge (day 35)
• All survived challenge
Results
• Skunks– Negative control group
• 6 / 6 seronegative 7 days after challenge• 4 / 6 succumbed to rabies
– Experimental groups 1 and 2• 10 / 11 seroconverted by day 21; 1 seroconverted by day 35• All survived challenge
– Positive control group• 5 / 6 seroconverted and survived challenge• 1 remained seronegative and succumbed to rabies
Discussion• CAV2 virus meets many criteria for an ideal recombinant
rabies vaccine vector• Concerns include potential for inhibition by naturally
occurring antibodies in target population and induced pathology in target or non-target species
• More work needed to assess importance of excretion of live recombinant virus in feces; establish safety and efficacy in other species; determine optimal effective dose
• Safe, effective, and affordable oral vaccine for free-roaming dogs in canine rabies-endemic countries will be essential for elimination of canine rabies—responsible for >99% of human rabies
Co-authors
Felix Jackson (CDC)Kayla Bean (CDC)Brian Panasuk (CDC)Michael Niezgoda (CDC)Dennis Slate (USDA/APHIS/WS)Jianwei Li (Thomas Jefferson Univ.)Bernard Dietzschold (Thomas Jefferson Univ.)Jeff Mattis (CDC)Charles E. Rupprecht (CDC)
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Selected Zoonotic Diseases Conference Call
December 2, 2009