Bovine Tuberculosis: Public Health Considerations Jen Brown, DVM, MPH, DACVPM State Public Health Veterinarian Updated in March 2017

Mycobacterium bovis (Mb) Gram positive, acid-fast bacterium in Mtb complex Host species: cattle, deer, bison, elk Many developed countries are Mb free Widespread in Africa, Asia, and the Middle East White-tailed deer. Photo: John White. Elk. Gerald and Buff Corsi, © California Academy of Sciences.

Zoonotic Mb transmission Consumption of unpasteurized milk/cheese Consumption of infected meat Introduction of body fluids into a wound Inhalation of respiratory aerosols Person-to-person transmission possible CDC/Minnesota Department of Health, 1929.

Zoonotic Mb infection Clinically similar to Mtb Extrapulmonary infection more likely Asymptomatic (LTBI) Constitutional symptoms Pulmonary symptoms GI symptoms Resistant to pyrazinamide Constitutional symptoms: fever, weight loss, night sweats Radiograph shows bilateral advanced TB with pulmonary infiltrates and cavitation Photo: CDC.

Zoonotic Mb epidemiology (US) Rare: 1.4% of TB disease cases Higher prevalence in US-Mexico border areas Risk factors: Foreign born Hispanic or Latino ethnicity Less than 15 years of age HIV infection Exposure to cattle, bison, or cervids Consumption of unpasteurized dairy products, especially Mexican origin Why is zoonotic M. bovis rare in the US? 1) M. bovis eradication programs in animals; 2) Pasteurization of milk.

Prevention of zoonotic Mb infection Do not consume unpasteurized dairy products Prevent infected meat/milk from entering the food supply Take precautions against contact with body fluids or tissue from wild bison or cervids People at risk of exposure should promptly seek medical attention for compatible illness

CDC/Minnesota Department of Health, 1925.

PPE for responders Testing: boots, coveralls, disposable gloves Necropsy: Disposable gloves Cut-resistant glove on non-dominant hand Goggles, safety glasses, or face shield Disposable apron Forearm protectors Cloth or Tyvek® coveralls Rubber boots Hairnet Fit-tested N95 respirator

Testing for responders Responders to bovine TB outbreaks are generally considered low-risk for Mb infection Higher-risk exposures: handling or necropsy of confirmed positive animals Recommendations: Baseline TB test at the time of hire Testing 8-10 weeks after high-risk exposure

Recommendations for hunters Wear disposable gloves when field-dressing deer Know the appearance of Mb pathology Do not eat meat from animals with TB lesions Contact DNR for testing of suspect animals

JEN BROWN, DVM, MPH, DACVPM State Public Health Veterinarian        JEN BROWN, DVM, MPH, DACVPM State Public Health Veterinarian Zoonotic and Vector-Borne Epidemiology Indiana State Department of Health 317.233.7272 office 317.771.2132 mobile 317.234.2812 fax jenbrown@isdh.in.gov www.StateHealth.in.gov The images, written excerpts, and videos included in this presentation are for educational purposes only and may be subject to copyright. Depiction of a specific product does not imply endorsement of said product by ISDH.