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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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