Zoonoses

1. Zoonoses Epidemiology of diseases transmitted from animals to humans

2. What are zoonoses? Diseases that are transmitted from animals to humans

3. Bacillus anthracis • Brucellosis • Crimean-Congo hemorrhagic fever • Rabies • Hanta Virus • Toxoplasmosis • Campylobacter

4. Farm Animals Cattle Swine Goats Cats & dogs Poultry Wild Animals Ticks Squirrels Raccoons Mice/rodents others What kind of animals transmit zoonoses?

5. Farmers more susceptible to contracting zoonoses • More likely to share air and space with animals • More contact with domestic and wild animals

6. How are disease transmitted? • Every day contact with animals • Transporting • By-products (feces/urine) • Scratches or bites • From milk and milking • Contaminated soils • Contaminated meats

7. Common Zoonoses

8. Campylobacter Common Carriers Cattle Sheep Pigs Dogs Rodents Poultry

9. Transmission Contaminated food or animals Clinical presentation Stomach ache Nausea Headache Diarrhea Campylobacter

10. Cat-Scratch Disease Common carriers Cats Dogs

11. Transmission Scratches and puncture wounds from infected animals Clinical presentation Fever Skin papule Swollen lymph nodes Cat-Scratch DiseaseBartonella henselae

12. Salmonella Common carriers Cattle Cats Dogs Horses Poultry

13. Transmission Direct contact with animal or feces Contaminated food Clinical Presentation Chills Fever Headache Diarrhea Vomiting Salmonella

14. Encephalitis Common carriers Horses Rodents

15. Transmission Mosquito bites Tick bites Clinical presentation Lethargy Fever Headache Disorientation Encephalitis

16. Rabies Common Carriers Cats Dogs Raccoons Skunks Bats Foxes

17. Transmission Animal Bite Contact with infected tissue, fluids or feces Clinical presentation Fever Headache Agitation Confusion Seizures Excessive salivation Rabies

18. Toxoplasmosis Common carriers Cats Sheep

19. Transmission Ingestion of infected meats Fecal contaminated soil Clinical Presentation Fever Swollen nodes Abortion Still-birth Mental retardation Toxoplasmosis

20. Scabies Common Carriers Dogs Raccoons

21. Transmission Direct contact with infected animals Clinical presentation Itching skin lesions Scabies

22. Prevention and Control

23. Assure an uncontaminated water supply • Add chlorination to water • Connect to water supply • Appropriate disposal of wastes

24. Prevent food contamination • Avoid unpasturized milk • Wash hands • Disinfect kitchen surfaces • Wash raw fruits and vegetables • Don’t defrost meats on the counter • Use separate utensils for raw/cooked meat

25. Always drink pasteurized milk!

26. Protect pets from getting & transmitting diseases • Vaccinate cats and dogs against rabies • Do not keep wild animals as pets • Do not allow pets to drink from toilet • Clean pet’s living area 1x/week • Clean litter box daily

27. Pregnant women should not clean litter boxes

28. Prevent tick bites • Wear repellent • Wear appropriate clothing • Long-sleeved shirt • Tuck pant legs into socks • Check yourself and pets after being in a tick-infested area

29. Treat animal scratches and bites seriously • Wash area with soap and water • Apply anti-bacterial medication • Bandage wound • Consider medical attention

30. Most Zoonoses are preventable if cautionary measures are taken!!

31. Food-borne and Water-borne Diseases Epidemiology of diseases spread by food and water

32. Definition • Food-borne illness – two or more cases of a similar illness resulting from the ingestion of a common food • Water-borne illness – an illness that occurs after consumption or use of water intended for drinking or as illness associated with recreational water such as swimming pools, whirlpools, hot tubs, spas, water parks, and naturally occurring fresh and marine surface waters

33. Epidemiology - Food-borne • In the U.S. per year 76 million illness 325,000 hospitalizations 5000 deaths - most unknown pathogens • Three known pathogens cause 1500 deaths Salmonella Listeria Toxoplasma

34. Epidemiology - Food-borne • Cholera only bacterial food-borne illness that must be reported internationally • Hepatitis A only viral food-borne illness that is reported • Globally only 1-10% of food-borne illness incidences are reported.

35. Epidemiology - Food-borne • List of most common bacterial food-borne illness, listed in order of occurrence 1) Campylobacter 2) Salmonella 3) Shigella 4) E. Coli

36. Epidemiology - Food-borne • List of most common viral food-borne illness 1) Norwalk virus 2) Astroviruses 3) Rotaviruses 4) Enteric adenoviruses • 23,000,000 incidences per year in the U.S • Spread person to person via fecal-oral route • Infectious at low doses; foods act as transfer media only

37. Diagnosis Important to the history is the exact time of exposure which can help narrow down the causative agent

38. History History of two or more people within a household becoming ill at the same time more likely food-borne vs. two people becoming ill within 24-36h.

39. History • Identify food handling practices a) length of preparation before consumption b) cooking time and reheating c) possible cross contamination d) people with poor hygiene

40. History • Identify activities that increase risk of exposure restaurants day care centers street-vended food or raw seafood overseas travel camping-ingestion of lake/stream water • Check to see if patient is on antibiotics or medications that reduce gastric acidity

41. Physical Examination • Determine hydration status • Presence of blood in the stool • Exclude other diarrheal illness

42. Diagnostic Tests • Blood cultures – suspect bateremia • Gram stain - identifies campylobacter with 66-99% sensitivity • Fecal leukocytes - if positive = higher culture yield • Ova and parasites - done in the ER

43. Diagnostic Tests • Stool cultures only if pt 1) febrile 2) bloody diarrhea 3) severe abdominal pain 4) clinically severe or persistent 5) significant historical risk factors for food-borne illness

44. Bacillus anthracis • Incubation period – 2d-weeks • Signs and symptoms – nausea, vomiting, bloody diarrhea, abdominal pain • Duration – weeks • Food Source – contaminated meat • Lab testing – blood

45. Bacillus cereus • Enterotoxin • Incubation period – 1-6h • Signs and symptoms – sudden fever, nausea, vomiting, may have diarrhea • Duration – 24h • Food Source – rice, meat • Lab testing – none • Treatment – supportive only

46. Brucella spp. • Incubation period – 7-21d • Signs and symptoms – fever, chills, headache, myalgias, arthralgias, bloody diarrhea • Duration – weeks • Food Source – raw milk, goat cheese, meats • Lab testing – blood, serology

47. Clostridium botulinum • Adults, children • Incubation period – 12-72h • Signs and symptoms – vomiting, diarrhea, diplopia, dysphagia, descending muscle weakness • Duration – variable, can end in death • Food Source – improperly canned foods, fermented fish, garlic, herb-infused oils, baked potato in foil, foods kept in a warm oven for hours • Lab testing – stool, serum, and food assayed for toxin at CDC or state labs • Treatment – botulinum antitoxin

48. Clostridium botulinum • Infants • Incubation period – 3-30d • Signs and symptoms – lethargy, poor feeding, hypotonia • Duration – variable • Food Source – honey, home-canned foods • Lab testing – stool, serum, and food assayed for toxin at CDC or state lab • Treatment – botulinum immune globulin

49. Campylobacter • Incubation period – 2-5d • Signs and symptoms – bloody or watery diarrhea, cramps, fever • Duration – 2-10d • Food Source – Poultry, milk, water • Lab testing – special stool culture

50. Clostridium perfringens • Incubation period – 8-16h • Signs and symptoms – watery diarrhea, nausea, cramps • Duration – 24-48h • Food Source – meat, poultry, gravy, dried or precooked foods • Lab testing – quantitative culture of stool • Treatment – supportive only