1. Megin Nichols, DVM, MPH, DACVPM
Preventing Outbreaks of Illness linked to Animal Contact: It is Possible!
Megin Nichols, DVM, MPH, DACVPM
Enteric Zoonoses Activity Lead Outbreak Response and Prevention Branch
Agritourism: Protecting Public Health, Animal Health and your Farm
August 24, 2016
National Center for Emerging and Zoonotic Infectious Diseases
Division Name in this space

2. Prevention
Eliminating all risk from animal contact might not be achievable
Preventing and minimizing disease and injury is the goal

3. A One Health Approach to Prevention
Focuses on the intersection of health of humans, animals, and environments

4. Framework for the classification of drivers of human exposure to animal pathogens (interspecies barrier)
Gortazar C, Reperant LA, Kuiken T, de la Fuente J, Boadella M, et al. (2014) Crossing the Interspecies Barrier: Opening the Door to Zoonotic Pathogens. PLoS Pathog 10(6): e doi: /journal.ppat

5. Guidelines for Disease Prevention
Recommendations for:
Local, state and federal agencies
Venue operators and staff
Personnel involved in animal management/care
School and childcare settings
General public

6. Recommendations for Local, State and Federal Agencies
Foundation of cooperation and communication
Disseminate the compendium
Provide educational and training material
Oversight of animal contact venues
Conduct outbreak investigations
Survey affected individuals to determine source of infection
Collect samples and perform analysis
Work to implement control and prevention measures
Report outbreaks to state and local authorities

7. Regulation

8. Map of States with Hand Sanitation Laws for Animal Contact Exhibits

9. Recommendations for Venue Operators and Staff:
Education
Notify visitors of potential risks
Verbal and written hygiene reminders

10. Recommendations for Venue Operators and Staff:
Provide training and educational material for staff regarding the risks associated with zoonotic agents and animal-related injuries
Consult with veterinarians, state and local agencies to establish guidelines for safe animal contact
Age minimum for some exhibits
Species of animals that should not be handled by the general public
Eliminate animals as prizes
Provide information for schools planning field trips, prior to arrival, outlining safe animal contact practices
Ensure public compliance with posted and verbal recommendations

11. Recommendations for Venue Operators and Staff:
Facility design
Adequate hand-washing stations with
placards that outline proper protocols
for removing zoonotic pathogens
Maintain hand-washing stations
(i.e. clean water supply; soap; paper
towels)
Place staff near stations to encourage
compliance

12. Recommendations for Venue Operators and Staff:
Build exhibits to minimize cross-traffic
between animal, non-animal and food
service areas
Provide hand-washing stations at exit
transitions
Disinfect all surfaces to remove organic
matter (1:32 bleach dilution, quaternary
ammonium compound)
Maintain proper waste management
and disposal of manure

13. Recommendations for Venue Operators and Staff:
Animal Areas
Do not allow food, beverages, toys, pacifiers, strollers, baby bottles or spill-proof cups in animal exhibit areas
Advise staff and parents to watch children closely
Animal contact/feeding should only be allowed with barriers in place
Provide proper ventilation in the exhibit area
Remind visitors which individuals fall into high-risk populations (i.e. young children, elderly, immuno-compromised, pregnant)

14. Curran et al. An Outbreak of Escherichia coli O157:H7 Infections following a Dairy Education School Field Trip in Washington State,

15. Animal Health Check with state and local animal health authorities
Vaccination
Health certificates
Animal movement
Animals carrying the most common zoonotic agents often show no clinical signs
Animals shed organisms intermittently making detection difficult
Treatment of animals does not eliminate pathogens, can prolong shedding, and can result in antimicrobial resistance

16. Recommendations for Animal Care and Management Personnel
Monitor animals daily for signs of illness; isolate affected animals
Ensure up-to-date inspection by accredited veterinarian
Minimize contact between domestic and wild animals
Prohibit contact between the public and dangerous animal species (i.e. venomous snakes, nonhuman primates, lions, wolves, bears, tigers, bats, raccoons, foxes etc.)
Ensure the public has no contact with live animal births or newborn animals

17. Recommendations for School and Childcare Settings
Make sure teachers and staff are familiar with animal species that are inappropriate or present high zoonotic risk
Animals NOT recommended
Nonhuman primates
Dangerous and/or unpredictable animals (i.e. lions, bears, wild or aggressive domestic animals)
Mammals at high risk for transmitting rabies (i.e. bats, raccoons, skunks, foxes, coyotes)
Venomous or toxin-producing spiders, insects, reptiles or amphibians

18. Recommendations for School and Childcare Settings
Animals that present a high risk for zoonotic disease transmission
Reptiles or amphibians (i.e. turtles, snakes, lizards)
Live poultry
Ferrets
Farm animals (i.e. sheep, calves, goats)
Psittacine birds
Other animals that can transmit zoonotic diseases:
Rodents (i.e. mice, rats, guinea pigs, hamsters, gerbils)
Cats
Dogs
Rabbits
Nonpsittacine birds

19. Recommendations for School and Childcare Settings
Farm animals, turtles and ferrets are not recommended in facilities with children <5 years old
Close supervision and meticulous attention to hygiene must be observed when children >5 years of age engage in animal contact
Wear gloves when cleaning aquariums and do not keep fish near food preparation areas
Assume owl pellets and frozen rodents used to feed reptiles are contaminated with Salmonella organisms

20. Recommendations for School and Childcare Settings
Ensure everyone washes their hands thoroughly after direct and indirect animal contact
Supervise all human-animal contact
Do not allow animals to roam the classroom
Do not clean cages in sinks used to prepare, serve or consume food
Obtain a health certificate or proof of rabies vaccination for all animals being exhibited

21. 991 attendees observed at 6 petting zoos in Tennessee
Human Behavior
991 attendees observed at 6 petting zoos in Tennessee
74% direct animal contact
87% contacted contaminated surfaces
49% hand-to-face contact
22% ate/drank in animal areas

22. Recommendations for the General Public
High-risk individuals should take heightened precautions or avoid animal exhibits (i.e. children < 5yr, elderly, pregnant women, persons with HIV/AIDS or those receiving immunosuppressive treatments, those who are ill at the time of the exhibit/fair)
Wear protective equipment
Wash hands thoroughly and often
Avoid direct contact with animals
Avoid sitting on the ground, handling animal bedding and eating or drinking near animal exhibits

23. Recommendations for the General Public
Reduce potential transmission by decreasing exposure time (i.e. do not board with animals at agriculture fairs)
Ensure all animals transported for exhibition have been examined by an accredited veterinarian
Abide by all written and verbal recommendations
made by staff and personnel

24. Thank you
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA
Telephone: CDC-INFO ( )/TTY:
Visit: | Contact CDC at: CDC-INFO or
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious Diseases
Division Name in this space