The Emergence of Zoonotic Diseases Understanding the Impact on Animal and Human Health: Workshop Summary (2002) / Chapter Skim
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5 Surveillance and Management of Zoonotic Disease Outbreaks
5 Surveillance and Management of Zoonotic Disease Outbreaks
Pages 79-112
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From page 79... ...
Director, University Hygienic Laboratory, University of Iowa Public health laboratories traditionally have conducted surveillance for critical infectious diseases, such as influenza, rabies in animals, and arboviruses. As new infectious diseases emerge and older ones alter their patterns of distribution, these laboratories may have to employ new strategies and tactics for disease surveillance.
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From page 80... ...
's Emerging Infections Program and its Epidemiology and Laboratory Capacity Program. In addition, examining some of the diseases that public health laboratories now face may help to illustrate some possible new approaches to designing surveillance strategies, as well as possible means to sustain them.
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From page 81... ...
(Information was not collected regarding the extent of the programs, so it is not known whether all of these states had sustained fully competent surveillance programs.) Although New York had sustained a modest surveillance program, New York City, where the West Nile virus was first detected in the United States, had no surveillance program.
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From page 82... ...
Our knowledge of the complex arbovirus ecosystem has grown greatly in recent clecacles, but our approach to surveillance has not been concomitantly acljustecl. The West Nile virus outbreak has reunited the public health community with partners in the wilcllife, veterinary, and entomology communities.
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From page 83... ...
In areas remote from the emerging margins of infection, human surveillance would be the focus, to identify disease in those individuals who had traveled to endemic areas or who were victims of unexpected introductions, as, for example, from ticks on hunting dogs brought into the area. As with arboviruses, the proposed surveillance strategy for tickborne diseases should be tailored to the cycle of emergence and the region of the country, and the strategy should be altered if there is a change in circumstances.
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From page 84... ...
The government also should require laboratories performing rabies tests on animals involved in human exposures to enroll in proficiency testing and quality assurance programs equivalent to those used to license laboratories that test human clinical specimens. The adverse consequences of poor testing are grave: false negative tests may produce fatal human disease because prophylaxis would not be administered, while false positive tests may lead to excessive use of expensive interventions and to a general loss of confidence in the tests.
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From page 85... ...
Recent attention to the potential for such activities in the United States has led the government to institute the Laboratory Response Network, sponsored by the CDC and managed by the Association of Public Health Laboratories, to enhance the detection of these agents in humans. As part of this nationwide program, personnel in laboratories that test clinical specimens from humans will receive training in the means to rule out these agents, as well as in how to forward the isolates to public health laboratories for specific identification and subsequent molecular fingerprinting.
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From page 86... ...
. Prior to the West Nile outbreak, the bureau's surveillance system for vectorborne and zoonotic diseases was primarily passive (with the exception of our active laboratory-based surveillance program for malaria that was instituted in response to the 1993 outbreak)
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From page 87... ...
At one time, we did have a mosquito surveillance and control program, but its funding was discontinued in 1988. We do conduct limited tick surveillance, focused primarily on areas of the city that are at high risk for Rocky Mountain spotted fever and Lyme disease.
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From page 88... ...
We broadcast a fax alert to several departments in all 70 city hospitals, asking the staff to report any similar cases, and we began calling physicians citywide who specialized in infectious diseases and neurology to determine if they were aware of additional cases. As the week unfolded, we learned of nearly 40 suspected cases throughout the city.
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From page 89... ...
Two independent investigations, by the veterinary pathologist at the Bronx Zoo and by the wildlife biologist at the New York State Department of Environmental Conservation, found pathologic evidence of widespread viral inflammation, including encephalitis, among dead birds found in the greater New York City area. Avian tissues were submitted for viral testing, and a flavivirus was isolated that was subsequently determined by CDC to be West Nile virus.
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From page 90... ...
We later learned, by reviewing newspaper reports, that crows had been dying at least 6 weeks before the first human cases were reported. Therefore, had the avian outbreak been recognized and investigated earlier, it is possible that the presence of West Nile virus may have been identified prior to the onset of illness among humans, and had mosquito control measures been implemented earlier, it is possible that this outbreak may have been averted.
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From page 91... ...
, as well as other agencies, also conducts veterinary surveillance for foodborne zoonotic pathogens, such programs will not be covered. Zoonoses Surveillance Systems West Nile Virus In September 1999, due primarily to the efforts of one veterinary pathologist at a local zoo, it was determined that an outbreak of encephalitis among humans in New York City was related to the deaths of wild birds in the area and of exotic birds at the zoo.
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From page 92... ...
This example demonstrates the primary veterinary surveillance system in place to detect exotic, unusual, or previously unknown livestock health problems, including zoonotic diseases. More than 40,000 federally accrecliteci private veterinary practitioners assist APHIS-VS and state animal health authorities in disease detection and control.
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From page 93... ...
APHIS-VS leads this interagency effort, which is targeted at adult animals most likely to be infected. Included among the animals tested are farm cattle with signs of neurologic disease, cattle condemned at slaughter for neurologic reasons, cattle submitted to VDLs and teaching hospitals because of neurologic abnormalities, rabies-negative cattle submitted to public health laboratories, and cattle that are nonambulatory at slaughter "downer cattle" )
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From page 94... ...
Detecting Risk Factors and Prevalence Trends To detect zoonotic agents that may cause little or no disease in livestock or poultry, as well as to identify risk factors or prevalence trends for a variety of agents, various agencies have developed additional surveillance and epidemiologic tools. These tools include: National Animal Health Monitoring System APHIS-VS's National Animal Health Monitoring System (NAHMS)
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From page 95... ...
colt, and eight health departments submit Campylobacter isolates. Issues of Concern Important issues of concern related to veterinary surveillance for zoonotic diseases include: Trade impact of finding an agent or disease.
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From page 96... ...
This may decrease or delay the submission of diagnostic specimens and thus delay the recognition of potential zoonotic diseases. Data sharing by and among laboratories is a problem.
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From page 97... ...
In the case of detecting West Nile virus in horses, we may have been near the sensitivity limits of the passive reporting system by which it became known. Had 21 of the 25 total cases detected not occurred within the observation of a single veterinarian, we might not have identified the equine component of the outbreak.
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From page 98... ...
One of the few positive aspects of the West Nile virus outbreak may be that it is illuminating this issue and will hopefully carry over to the detection of and response to future zoonotic disease outbreaks. NARMS is a good example of cross-community collaboration in surveillance.
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From page 99... ...
(While they may have been given appropriate information, the patient's perspective was reported.) This misinformation included such notions as "fleas can give you rabies" and "cats can give you AIDS." Two percent felt that they had been infected with diseases from their pets; such putative infections included such things as "parasites," "something from the litter box," and "cat scratch fever." The participants' medical records did not reveal any indication of additional zoonotic diseases.
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From page 100... ...
To help improve zoonotic disease surveillance in Florida, the Department of Health has developed a draft program to encourage veterinarians, especially small-animal practitioners, to report selected diseases to their county health departments. Diseases to be reported include those requiring an emergency response (for example, a possible bioterrorism situation)
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From page 101... ...
IDENTIFICATION AND CONTAINMENT OF UNKNOWN AND RARE PATHOGENS C.~.Peters,M.D. Chief, Special Pathogens Branch National Center for Infectious Diseases Centers for Disease Control and Prevention One major objective of the Special Pathogens Branch at the CDC is to identify previously unknown pathogens and keep them as rare as possible.
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From page 102... ...
. This cross-species traffic could form the basis for "new" human diseases that might be particularly difficult to control because they have cut the zoonotic link; in such cases, we will have to deal with a human-adapted virus.
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From page 103... ...
We know that some viruses already have proved themselves to be bad actors with major human disease potential, and we also know that at some point they are likely to return to center stage. This list includes Venezuelan equine encephalitis virus, West Nile virus, yellow fever virus, Rift Valley fever virus, and Nipah virus, among many others.
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From page 104... ...
This inability to produce new human vaccines and diagnostics on a practical level may become a serious deficiency in our ability to respond to emerging infectious diseases. There also are problems in supporting expensive longitudinal studies and innovative high-risk research.
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From page 105... ...
Deputy Administrator, Office of Public Health and Science Food Safety and Inspection Service, U.S. Department of Agriculture In the United States the most common foodborne bacterial pathogen is Campylobacter, which causes almost 2 million cases of infection per year, according to a 1999 report from the CDC.
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From page 106... ...
Ultimately, the mode! predicts the probability of human illness of varying severity (that is, risk)
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From page 107... ...
Among the efforts to validate both the individual modules and their combined performance, we compared their projections with various field observations. For example, we compared outputs from the public health module with the number of illnesses estimated from national disease surveillance systems.
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From page 108... ...
USDA's FSIS is responsible for establishing and enforcing standards for egg packers and processors. CDC is responsible for surveillance programs to monitor human health and will ultimately document whether the new egg-safety program is meet.
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From page 109... ...
Kennedy and Bill Frist (R-TN) have grown increasingly concerned that the United States is inadequately prepared for dangerous outbreaks of infectious disease.
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From page 110... ...
Now, because of widespread awareness of disease outbreaks, such as the emergence of West Nile virus in New York and the "mad cow" epidemic in Britain, the American public has become increasingly attuned to the need to improve our nation's defenses against disease outbreaks. Extensive consultation with the medical community revealed that the nation's local, state, and national public health agencies are poorly equipped to detect, monitor, and respond to outbreaks of infectious disease.
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From page 111... ...
Authorizes grants for public health agencies to combat antimicrobial resistance. · Establishes demonstration grants for hospitals and clinics to promote more responsible use of antibiotics and to control the spread of resistant infections.
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From page 112... ...
112 THE EMER GENCE OF ZO ONOTIC DISEASES Through these measures the Public Health Threats and Emergencies Act can lay the foundation for a strong public health response to the danger of infectious disease outbreaks. With the passage of this legislation, the sustained involvement of the medical and scientific communities will now be essential in ensuring that the programs authorized by the act are properly funded and implemented.
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