Preparing for the Next Disease:The Human-Wildlife Connection

Marguerite Pappaioanou, DVM, PhDCenters for Disease Control and Prevention

The Centers for Disease Control and Prevention

Protects the health and safety of the people of the United States- at home and abroad

Provides credible information to enhance health decisions

Promotes health through strong partnerships

Develops and applies disease prevention and control, environmental health, and health promotion and education activities

Emerging and re-emerging Zoonoses, 1996–2003 (Source: WHO and Pappaioanou)

Nipah Virus

Hendra virus

Multidrug resistant Salmonella

Lyme Borreliosis

West Nile

Cryptosporidiosis

Reston virus

Venezuelan Equine Encephalitis

E.coli O157

E.coli O157

Lassa fever

Yellow fever Ebola

Monkeypox

Influenza A(H5N1)

Rift valley Fever

NV-CJD

Ross River virusEquine

morbillivirus

Nv-CJDE.coli non-O157

West Nile Virus

Reston Virus

Brucellosis

Hantavirus pulmonary syndrome

Leptospirosis

Recent outbreaksInfluenza / Madagascar

West Nile / USA, CanadaEbola / Gabon, CongoMonkeypox / DRC/ US

CCHF / Afghanistan, IranTularemia / USA, KosovoYellow fever / Ivory Coast

Brucellosis / MongoliaE. coli 0157 / Canada

Hantavirus / USBSE-vCJD/ UK

Nipah virus / MalaysiaAvian Influenza / Hong Kong

SARS / Global

Wildlife EID

DomesticAnimal EID Human EID

Translocation

Human encroachmentEx situ contactEcological manipulationHuman behaviors

Global travelUrbanizationBiomedicalmanipulation

Food processing/distributionTechnology andIndustry

AgriculturalIntensification

EncroachmentIntroduction“Spill over” &“Spill back”

Transmission of Emerging Infectious Diseases

Dasazak P. et.al.Science 2000 287:443

Factors Promoting Transmission of Infectious Diseases from Animals to Humans

• Rapidly Increasing Human Population 6.1 Billion people 6.1 Billion people

in 2000in 2000 ~9.4 to 11.2 Billion in 2050~9.4 to 11.2 Billion in 2050

Source: United Nations, World Population Prospects, The 1998 Revision; and estimates by the Population Reference Bureau.

Factors Promoting Transmission of Infectious Diseases from Animals to Humans

Human population expanding into changing and overlapping wildlife habitat

Increasing human interaction with domestic and wild/exotic animals

Factors Promoting Transmission of Infectious Diseases from Animals to Humans

• Changing climates and ecosystems• Increases in arthropod vector populations and

their resistance to insecticides

Factors Promoting Transmission of Infectious Diseases from Animals to Humans

• Increasing international travel and trade, civil wars, political unrest, famines, human-made and natural disasters

• Increasing movement of people and animals

Factors Promoting Transmission of Infectious Diseases from Animals to Humans

• Globalization of the food supply

• Centralized processing of food

Factors Promoting Transmission of Infectious Diseases from Animals to Humans

• Human behaviors Consumption of bushmeat/wildlife Wild animal game ranches Exotic wildlife as pets Feed stations to increase wildlife populations for hunting

Early disease detection; rapid, timely reporting

Ongoing disease surveillance

Rapid laboratory diagnosis/confirmationRapid laboratory diagnosis/confirmation

Rapid epidemiologic investigationsRapid epidemiologic investigations

Timely and effective public health interventions

Public health research

Partnerships and communications

Infrastructure/capacity building

Public Health Detection, Prevention, ControlEmerging Infectious Diseases

Early Detection—Begins on the Front Line at the Local Level

Clinical Labs, State & Local Public Health Labs, Military Labs, Veterinary Labs, Agricultural, Water & Food-Testing Labs, APHL & ASM, FDA, NIH, & International Labs, FBI, DoD, DOE, USDA, EPA

Rapid Laboratory Diagnosis

Laboratory Response Network

Agent-Specific ProtocolsStandardized Reagents & ControlsLab Referral DirectorySecure Communications & Electronic Laboratory ReportingTraining & Technology TransferProficiency TestingAppropriate Vaccinations for Lab Workers

LRN Partnership with Veterinary Diagnostic Laboratories

1999: National Veterinary Services Laboratory/USDA (Ames) and U. of Texas Veterinary Laboratories LRN members

2002: LRN state public health labs propose funding for 8 veterinary laboratories for membership

2002: CDC/NCID proposes phased collaboration to address concerns with zoonotic diseases, build LRN infrastructure capacity, link animal and human health

2003 - University of Minnesota Veterinary Diagnostic Laboratory joins LRN National Testing Site to screen for monekypox in animals

West Nile Virus, 1999

West Nile Virus leads to New Approaches for Disease Surveillance

Epidemic/Epizootic West Nile Virus in the United States: Revised Guidelines for Surveillance, Prevention, and Control, 2003 Humans, birds, horses, mosquitoes Multidisciplinary

ArboNET National Zoo Surveillance System

CDC – ArboNET (9/8/03)

Partnerships on West Nile Virus Activities in the United States

State and Local Health DeptsState and Local VeterinariansState and Local Wildlife Veterinarians and BiologistsState and Local Mosquito ControlCDCUS Geological SurveyUSDADepartment of DefenseEPA

Weekly

September 5, 2003 / 52(35);845-846

West Nile Virus Activity --- United States, August 28--September 3, 2003 This report summarizes West Nile virus (WNV) surveillance data reported to CDC through ArboNET as of 3 a.m., Mountain Daylight Time, September 3, 2003.

During the reporting week of August 28--September 3, a total of 414 human cases of WNV infection were reported from 22 states (Alabama, Georgia, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, Ohio, Oklahoma, Pennsylvania, South Dakota, Tennessee, Texas, Virginia, and Wyoming), including 16 fatal cases from eight states (Iowa, Missouri, Nebraska, New Mexico, New York, South Dakota, Texas, and Wyoming). During the same period, WNV infections were reported in 975 dead birds, 252 horses, one dog, one squirrel, two unidentified animal species, and 532 mosquito pools.

Additional information about WNV activity

is available from CDC at http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and

http://westnilemaps.usgs.gov

What Everyone Should Know

· Fight the Bite! · What You Need To Know · Questions & Answers · Case Count Specific Topics

· Maps & Human Cases · Clinical Guidance · Laboratory Guidance · Background · Ecology/Virology · Education/Training Resources

· Press and Media · Publications · Conferences · Links · State and Local

Government Sites

West Nile Virus Home > Statistics, Surveillance, and Control Current Case Count

Statistics, Surveillance, and Control Maps and Data | Surveillance Program | Guidelines | Case Definition | See Also

Maps and Data

Human case and virus activity data and maps are available from several sources:

2003 Human Case Count

U.S. Maps Updated

Maps & County-Level

Data* Click here to view the

2002 Case Count Table.

Click here to view U.S. Maps

representing the spread of WNV.

Click here to go to the U.S. Geological Survey to view weekly maps

and tables of data collected.

*The data reported by USGS reflect surveillance information reported and verified to CDC through the Arbonet surveillance.

USGS/CDC – Wild Birds (9/3/03)

USGS/CDC – Mosquitoes (9/3/03)

USGS/CDC- Veterinary (9/3/03)

USGS/CDC – Humans (9/3/03)

Rapid Epidemiologic Investigation

Weekly

June 13, 2003 / 52(23);537-540

Multistate Outbreak of Monkeypox --- Illinois, Indiana, and Wisconsin, 2003 CDC has received reports of patients with a febrile rash illness who had close contact with pet prairie dogs and other animals. The Marshfield Clinic, Marshfield, Wisconsin, identified a virus morphologically consistent with a poxvirus by electron microscopy of skin lesion tissue from a patient, lymph node tissue from the patient's pet prairie dog, and isolates of virus from culture of these tissues. Additional laboratory testing at CDC indicated that the causative agent is a monkeypox virus, a member of the orthopoxvirus group. This report summarizes initial descriptive epidemiologic, clinical, and laboratory data, interim infection-control guidance, and new animal import regulations.

Investigation

Of Human

Cases

Animal

Trace back

and

Trace forward

Public Health Strategies to Control Epidemic

FDA-CDC joint order banning importation and prohibiting movement of implicated exotic animalsState enacted measures to further restrict intrastate animal shipment and tradePremise quarantineAnimal euthanasiaPre- and post-exposure vaccination of potentially exposed persons with small pox vaccine

Preventing and Controlling Zoonoses – Wildlife Connection

Vaccination of humans and animalsRegulation of importation and movement of exotic animalsControl of feral/stray populationsRegulation of bush meat tradeTesting and culling infected wildlifeOther

Preparing for the Next Disease:The Human-Wildlife Connection

Expect the unexpectedForm and strengthen human-animal health partnershipsLink human and animal surveillance Disease reporting; laboratory networks Communication Coordinate evidence-based public health action

Develop multidisciplinary infectious disease centers Conduct research, e.g., ecology of diseases, risk factors for

human exposure

Develop, test, implement plans for integrated disease detection and response Roles, responsibilities, actions, coordination