Zoonotic Diseases: More Common than You Think

1. Zoonotic Diseases: More Common than You Think Jason Stull, VMD, MPVM Public Health Veterinarian, NH DHHS Assistant Clinical Professor, UNH NH Department of Health and Human Services Division of Public Health Services

2. Zoonoses From the Greek: Zoon: Animal Noson: Disease Diseases and infections which are naturally transmitted between vertebrate animals and humans - WHO 1959 NH Department of Health and Human Services Division of Public Health Services

3. Zoonoses: Animal Species • Dogs & Cats • Rabies • Roundworm • Ringworm • Cat Scratch Disease • Food Animals • Salmonella • E.coli • Brucellosis NH Department of Health and Human Services Division of Public Health Services

4. Zoonoses: Animal Species • Birds: • Psittacosis • West Nile virus • Eastern Equine Encephalitis • Avian Influenza • Reptiles, Fish, & Amphibians • Salmonella • Mycobacterium • Wild Animals • Hantavirus • Plague • Tularemia • Lyme Disease NH Department of Health and Human Services Division of Public Health Services

5. Zoonoses • Common (of 1,407 human pathogens) • 58% are zoonotic • 70% of emerging diseases are zoonotic • Occur in numerous animal species • Very diverse • Severity • Transmission dynamics • Difficult to predict changes in incidence NH Department of Health and Human Services Division of Public Health Services

6. Zoonoses • Risk factors should be considered in ill patients • Animal ownership and contact • Activities bringing humans into contact with animals • Discuss appropriate pet species for appropriate individuals • Animals as sentinels of disease NH Department of Health and Human Services Division of Public Health Services

7. Common Zoonotic Disease Question Areas • Rabies • Lyme Disease • Mosquito-borne Disease • Animals in Public Settings • Food-borne Disease • Avian Influenza NH Department of Health and Human Services Division of Public Health Services

8. Common Zoonotic Disease Question Areas • Rabies • Lyme Disease • Mosquito-borne Disease • Animals in Public Settings • Food-borne Disease • Avian Influenza NH Department of Health and Human Services Division of Public Health Services

9. Common Zoonotic Disease Question Areas • Rabies • Lyme Disease • Mosquito-borne Disease • Animals in Public Settings • Food-borne Disease • Avian Influenza NH Department of Health and Human Services Division of Public Health Services

10. Common Zoonotic Disease Question Areas • Rabies • Lyme Disease • Mosquito-borne Disease • Animals in Public Settings • Food-borne Disease • Avian Influenza NH Department of Health and Human Services Division of Public Health Services

11. Common Zoonotic Disease Question Areas • Rabies • Lyme Disease • Mosquito-borne Disease • Animals in Public Settings • Food-borne Disease • Avian Influenza NH Department of Health and Human Services Division of Public Health Services

12. Common Zoonotic Disease Question Areas • Rabies • Lyme Disease • Mosquito-borne Disease • Animals in Public Settings • Food-borne Disease • Avian Influenza NH Department of Health and Human Services Division of Public Health Services

13. Common Zoonotic Disease Question Areas • Rabies • Lyme Disease • Mosquito-borne Disease • Animals in Public Settings • Food-borne Disease • Avian Influenza NH Department of Health and Human Services Division of Public Health Services

14. Psittacosis(Chlamydophila psittaci) NH Department of Health and Human Services Division of Public Health Services

15. August 2006 • Family boarded birds at pet store in August 06 • Birds became ill Aug 23 (~2 weeks after returned from pet store) • Lethargy, nasal d/c • Husband and wife ill Sept 6 • Fever, cough, headache NH Department of Health and Human Services Division of Public Health Services

16. September 2006 • MD visit (Sept 8) • Dx pneumonia (chest radiographs) • Abx started; illness quickly resolved • Titers positive for psittacosis (Chlamydophila psittaci) NH Department of Health and Human Services Division of Public Health Services

17. November 2006 • Patient reported by veterinarian! • Investigation: • Child in household ill since Nov 1 with cough • Birds still in house….. NH Department of Health and Human Services Division of Public Health Services

18. NH DHHS and Dept Ag Actions • Child • Acute and convalescent samples to CDC for testing - pending • Abx; illness resolved immediately • Education to family and possible contacts • No additional suspect cases identified • Birds • Placed in isolation • Testing for Chlamydophila psittaci • PCR (cloacal and oral swaps): negative • Abx NH Department of Health and Human Services Division of Public Health Services

19. Psittacosis - Background • Chlamydophila psittaci • Intracellular bacterium • Survive outside the host for days to weeks • Transmission: inhalation, vertical (birds) • Zoonotic • Reportable NH Department of Health and Human Services Division of Public Health Services

20. C. psittaci - Animals • Wide host spectrum among birds and mammals • Pet psittacine birds are most often implicated in human infection Macaw Parakeet NH Department of Health and Human Services Division of Public Health Services

21. C. psittaci - Birds • Not an unusual disease among pet birds • Shed in feces and nasal & ocular discharges • Incubation 3 days to several weeks • Latent infections - disease may appear years after exposure NH Department of Health and Human Services Division of Public Health Services

22. C. psittaci - Birds • Clinical signs variable • Intermittent & asymptomatic shedding possible • Shedding can be activated by stress - shipping, crowding, cold, breeding. • Birds with confirmed or probable psittacosis should be isolated and treated under the care of a veterinarian • Important consideration in any lethargic bird with nonspecific illness - especially in a recently acquired bird NH Department of Health and Human Services Division of Public Health Services

23. C. psittaci - Humans • Routes of infection • Inhalation (feather dust, resp. secretions, dried feces) • Mouth-to-beak contact • Handling of infected bird’s plumage and tissues • Even brief exposures can lead to infection NH Department of Health and Human Services Division of Public Health Services

24. Psittacosis: Humans • Incubation ~ 5-14 d • Inapparent to systemic illness (pneumonia) • Acute fever, chills, headache, nonproductive cough, dyspnea • Can affect other organ systems NH Department of Health and Human Services Division of Public Health Services

25. Psittacosis – Diagnosis & Treatment • Diagnosis • Antibodies: may cross-react, acute and convalescent samples (at least 2 weeks apart) • Culture - rarely performed (difficult/safety concerns) • PCR • Treatment • Tetracyclines • Symptoms improve in 48-72 hours, but relapse is common if inadequately treated • 15-20% fatality pre antibiotics, today <1% if properly treated NH Department of Health and Human Services Division of Public Health Services

26. Psittacosis: Public Health Reportable disease: • USA: 923 cases reported to CDC (1988 to 2002) • NH: 2 cases (1998, 2003) • True incidence likely much higher NH Department of Health and Human Services Division of Public Health Services

27. Psittacosis: Public Health • Occupational hazard to workers in bird industry • Pet birds • Turkey-processing plants • Sporadic cases associated with pet bird ownership NH Department of Health and Human Services Division of Public Health Services

28. Psittacosis: Controlling Infection • Prevent generation of aerosols and dust during cleanup • Practice good bird husbandry NH Department of Health and Human Services Division of Public Health Services

29. Resources http://www.nasphv.org/Documents/Psittacosis.pdf NH Department of Health and Human Services Division of Public Health Services

30. NH Department of Health and Human Services Division of Public Health Services