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February 3, 2010 Selected Zoonotic Diseases  Conference Call *Proposed *
February 3, 2010 Selected Zoonotic Diseases  Conference Call   Update on Dengue in the United States  + Christopher J. Gre...
Christopher J. Gregory, MD, MPH EIS Officer, Dengue Branch Centers for Disease Control and Prevention San Juan, Puerto Ric...
Dengue <ul><li>Flavivirus – related to WNV, JE, Yellow Fever </li></ul><ul><li>Four serotypes: DENV-1, -2, -3, -4  </li></...
Dengue Infections <ul><li>Most common mosquito-borne viral disease </li></ul><ul><li>40% of world at risk of infection; at...
Dengue in the Continental US   <ul><li>Transmission in US after a 35 year absence  </li></ul><ul><ul><li>Texas:  7 outbrea...
Dengue Diagnosis and Reporting <ul><li>Clinical Diagnosis alone unreliable </li></ul><ul><li>PCR for diagnosis during vire...
Dengue as Public Health Issue <ul><li>Evidence of geographic spread and increased severity of disease </li></ul><ul><li>No...
<ul><li>Contact information: </li></ul><ul><ul><li>Dengue Branch </li></ul></ul><ul><ul><li>Division of Vector-Borne Infec...
Human Salmonella Associated with Aquatic Frogs  January 6, 2010 Selected Zoonotic Diseases  Conference Call Shauna L. Mett...
It’s Not Easy Being Green–A Multistate Outbreak of Human Salmonella Typhimurium Infections Associated with Aquatic Frogs–U...
Outline <ul><li>Outbreak detection </li></ul><ul><li>Outbreak investigation </li></ul><ul><li>Field investigation </li></u...
Outbreak Detection <ul><li>April 2009: Utah identified 5 cases of  Salmonella  Typhimurium in children </li></ul><ul><li>I...
Infections with the outbreak strain of  Salmonella  Typhimurium, by week of illness onset (n=83 for whom information was r...
Case Counts by States reporting  Salmonella  Typhimurium cases in cluster 0909MAJPX-1, as of Thursday, December 31, 2009 3...
Demographics for cases of  Salmonella  Typhimurium cases in cluster 0909MAJPX-1, as of Thursday, December 31, 2009
Hypothesis Generation Continues… <ul><li>April 2009: Utah identified 5 cases of Salmonella typhimurium in children </li></...
Matched Case-Control Study: Case Definition <ul><li>Salmonella  Typhimurium infection with illness onset on or after April...
Matched Case-Control Study: Control Selection <ul><li>Controls were persons with recent infection of  Salmonella  strains ...
Matched Case-Control Study: <ul><li>19 cases and 31 age- and geography- matched controls enrolled </li></ul><ul><li>Exposu...
Results of Matched  Case-Control Study <ul><li>Illness was significantly associated with exposure to frogs (63% cases vs 3...
Results of  Environmental Sampling <ul><li>Environmental samples from aquariums containing African Dwarf Frogs in 4 patien...
African Dwarf Frogs
Lots o’ Frogs
Lots o’ Frogs
Lots o’ Frogs
Lots o’ Frogs
Historical Case Investigation  <ul><li>Asking states to interview historical cases from Jan 1, 2008 - present with revised...
Public Health Interventions <ul><li>Conversations with veterinarians at large pet store chains </li></ul><ul><li>CDC Web u...
Advice to the Public: Consumers <ul><li>Aquatic frogs and all water in the habitat should be considered contaminated </li>...
Advice to the Public:  Pet Store Owners <ul><li>Provide consumers information about the risk of acquiring salmonellosis fr...
Advice to the Public: Health Care Providers & Veterinarians <ul><li>Provide information to pet owners about risks of acqui...
Acknowledgments <ul><li>CDC </li></ul><ul><ul><li>Samir Sodha, Casey Barton Behravesh, Linda Capewell, Gwen Ewald, Nancy G...
For more information <ul><li>CDC Podcasts </li></ul><ul><li>Salmonella Infection and Water Frogs: </li></ul><ul><li>http:/...
For more information <ul><li>CDC Web Update </li></ul><ul><li>http://www.cdc.gov/salmonella/typh1209/index.html </li></ul>...
Rabies Postexposure Prophylaxis for Animals  January 6, 2010 Selected Zoonotic Diseases  Conference Call Charles Rupprecht...
February 3, 2010 Selected Zoonotic Diseases  Conference Call *Proposed *
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  • Transcript of "February 2010 Selected Zoonotic Diseases Conference Call"

    1. 1. February 3, 2010 Selected Zoonotic Diseases Conference Call *Proposed *
    2. 2. February 3, 2010 Selected Zoonotic Diseases Conference Call   Update on Dengue in the United States + Christopher J. Gregory, MD, MPH; Epidemic Intelligence Service Officer Dengue Branch, CDC 787-706-2399 [email_address] Carina Blackmore, DVM, PhD, Dipl. ACVPM State Public Health Veterinarian Florida Department of Health 850-245-4732 carina_blackmore@doh.state.fl.us
    3. 3. Christopher J. Gregory, MD, MPH EIS Officer, Dengue Branch Centers for Disease Control and Prevention San Juan, Puerto Rico, USA Update on Dengue in the United States February 3, 2010
    4. 4. Dengue <ul><li>Flavivirus – related to WNV, JE, Yellow Fever </li></ul><ul><li>Four serotypes: DENV-1, -2, -3, -4 </li></ul><ul><ul><li>All cause full spectrum of disease </li></ul></ul><ul><ul><li>Infection confers lifelong serotype-specific immunity </li></ul></ul><ul><li>Dengue virus causes an acute febrile illness (called dengue ) that is transmitted by bite of infected Aedes mosquito </li></ul>
    5. 5. Dengue Infections <ul><li>Most common mosquito-borne viral disease </li></ul><ul><li>40% of world at risk of infection; at least 4 million U.S. citizens live in dengue-endemic areas </li></ul><ul><li>50 - 100 million cases of dengue occur annually </li></ul><ul><ul><li>Five fold increase in cases in Americas in 20 years </li></ul></ul><ul><ul><li>Leading cause of febrile illness in US travelers returning from Asia, South America, Caribbean </li></ul></ul>
    6. 6. Dengue in the Continental US <ul><li>Transmission in US after a 35 year absence </li></ul><ul><ul><li>Texas: 7 outbreaks since 1980 </li></ul></ul><ul><ul><li>Hawaii: outbreak in 2001 </li></ul></ul><ul><ul><li>Key West, FL: outbreak in 2009 </li></ul></ul><ul><li>Aedes aegypti present in AZ,LA,GA,TX,NM,FL </li></ul><ul><ul><li>A. albopictus widespread through south </li></ul></ul><ul><li>Increased international travel and immigrant population with ties to endemic country of origin </li></ul><ul><ul><li>2006-08: >1000 travel-associated cases </li></ul></ul>
    7. 7. Dengue Diagnosis and Reporting <ul><li>Clinical Diagnosis alone unreliable </li></ul><ul><li>PCR for diagnosis during viremic phase ( ~1 st 5 days of illness) </li></ul><ul><li>IgM antibodies reliably detectable after day 5 </li></ul><ul><ul><li>IgG remains elevated for life, not useful for diagnosis </li></ul></ul><ul><li>Dengue added as nationally notifiable condition in June 2009; 32 states currently mandate reporting </li></ul><ul><ul><li>Dengue is not reportable in 7 states that have competent mosquito vectors </li></ul></ul>
    8. 8. Dengue as Public Health Issue <ul><li>Evidence of geographic spread and increased severity of disease </li></ul><ul><li>No effective, sustainable way to eliminate mosquito and breeding sites </li></ul><ul><li>No vaccine; although 5 candidates in field studies </li></ul><ul><li>Evidence of dengue transmission via receipt of donor organs or tissue, blood transfusions, and occupational exposure in healthcare settings </li></ul><ul><ul><li>Blood donations not currently screened;1 in 600 donations in PR positive for dengue viral RNA in 2007 </li></ul></ul>
    9. 9. <ul><li>Contact information: </li></ul><ul><ul><li>Dengue Branch </li></ul></ul><ul><ul><li>Division of Vector-Borne Infectious Disease </li></ul></ul><ul><ul><li>Centers for Disease Control and Prevention </li></ul></ul><ul><ul><li>1324 Calle Cañada </li></ul></ul><ul><ul><li>San Juan, Puerto Rico   00920 </li></ul></ul><ul><ul><li>Tele:    787.706.2399 </li></ul></ul><ul><ul><li>Fax:     787.706.2496 </li></ul></ul><ul><ul><li>E-mail: hgk4@cdc.gov </li></ul></ul>
    10. 10. Human Salmonella Associated with Aquatic Frogs January 6, 2010 Selected Zoonotic Diseases Conference Call Shauna L. Mettee, MSN EIS Officer Enteric Diseases Epidemiology Branch, CDC 404-639-5277 [email_address]
    11. 11. It’s Not Easy Being Green–A Multistate Outbreak of Human Salmonella Typhimurium Infections Associated with Aquatic Frogs–United States, 2009 Outbreak Response and Prevention Branch Division of Foodborne, Bacterial and Mycotic Diseases National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Shauna L. Mettee, RN, MSN, MPH LTJG, United States Public Health Service Epidemic Intelligence Officer
    12. 12. Outline <ul><li>Outbreak detection </li></ul><ul><li>Outbreak investigation </li></ul><ul><li>Field investigation </li></ul><ul><li>Recommendations </li></ul><ul><li>Next steps </li></ul>
    13. 13. Outbreak Detection <ul><li>April 2009: Utah identified 5 cases of Salmonella Typhimurium in children </li></ul><ul><li>Indistinguishable PFGE pattern identified (outbreak strain) </li></ul>
    14. 14. Infections with the outbreak strain of Salmonella Typhimurium, by week of illness onset (n=83 for whom information was reported as of 12/31/09)* No. of cases Week of Illness Onset *Some illness onset dates have been estimated from other reported information (Estimated onset dates range 4/9 – 12/11; Reported onset dates (n=48) range 5/24 – 11/30) Illnesses that began during this time may not yet be reported
    15. 15. Case Counts by States reporting Salmonella Typhimurium cases in cluster 0909MAJPX-1, as of Thursday, December 31, 2009 3-4 Cases AZ 1 CA 5 FL 1 GA 1 ID 1 IL 5 MD 3 MA 3 MI 4 MO 4 NJ 2 NY 2 OH 2 PA 4 TN 2 TX 4 UT 14 WA 7 More than 4 Cases MN 1 LA 1 CO 4 KY 1 NM 1 MS 1 VA 3 WI 1 NE 1 SD 3 AL 1 IN 1 NV 1 1-2 Cases
    16. 16. Demographics for cases of Salmonella Typhimurium cases in cluster 0909MAJPX-1, as of Thursday, December 31, 2009
    17. 17. Hypothesis Generation Continues… <ul><li>April 2009: Utah identified 5 cases of Salmonella typhimurium in children </li></ul><ul><li>August: CDC identified multistate outbreak predominantly in children </li></ul><ul><li>CDC conducted hypothesis-generating interviews – 3/6 hypotheses identified </li></ul>
    18. 18. Matched Case-Control Study: Case Definition <ul><li>Salmonella Typhimurium infection with illness onset on or after April 1, 2009, with </li></ul><ul><ul><li>1) indistinguishable PFGE pattern, the outbreak strain </li></ul></ul><ul><ul><li>2) MLVA pattern either matching that of the main outbreak strain, or MLVA unknown </li></ul></ul>
    19. 19. Matched Case-Control Study: Control Selection <ul><li>Controls were persons with recent infection of Salmonella strains other than the outbreak strain </li></ul><ul><li>Matched to case-patients: </li></ul><ul><ul><li>by age </li></ul></ul><ul><ul><li>county of residence </li></ul></ul>
    20. 20. Matched Case-Control Study: <ul><li>19 cases and 31 age- and geography- matched controls enrolled </li></ul><ul><li>Exposure histories collected </li></ul><ul><ul><li>7 days before illness onset for case-patients </li></ul></ul><ul><ul><li>7 days before interview for controls </li></ul></ul>
    21. 21. Results of Matched Case-Control Study <ul><li>Illness was significantly associated with exposure to frogs (63% cases vs 3% controls, mOR=24.4, CI=4.0-infinity). </li></ul><ul><li>6 case-patients knew frog type </li></ul><ul><ul><li>All reported African Dwarf Frogs </li></ul></ul>
    22. 22. Results of Environmental Sampling <ul><li>Environmental samples from aquariums containing African Dwarf Frogs in 4 patient homes yielded Salmonella Typhimurium matching the outbreak strain </li></ul><ul><ul><li>CO, UT, OH, NM </li></ul></ul><ul><li>Common breeder in California identified </li></ul><ul><ul><li>Environmental samples from breeder’s facility yielded outbreak strain </li></ul></ul>
    23. 23. African Dwarf Frogs
    24. 24. Lots o’ Frogs
    25. 25. Lots o’ Frogs
    26. 26. Lots o’ Frogs
    27. 27. Lots o’ Frogs
    28. 28. Historical Case Investigation <ul><li>Asking states to interview historical cases from Jan 1, 2008 - present with revised case questionnaire </li></ul>
    29. 29. Public Health Interventions <ul><li>Conversations with veterinarians at large pet store chains </li></ul><ul><li>CDC Web updates and media releases </li></ul><ul><li>CDC Podcasts </li></ul><ul><li>MMWR – Jan 8, 2010 </li></ul><ul><li>Recommendations to frog breeder regarding animal husbandry, water system and general biosafety practices </li></ul>
    30. 30. Advice to the Public: Consumers <ul><li>Aquatic frogs and all water in the habitat should be considered contaminated </li></ul><ul><li>Hand-washing </li></ul><ul><li>Persons who should avoid contact </li></ul><ul><li>Placement of habitats </li></ul>
    31. 31. Advice to the Public: Pet Store Owners <ul><li>Provide consumers information about the risk of acquiring salmonellosis from amphibians and reptiles </li></ul><ul><li>2009 Compendium of Measures to Prevent Diseases Associated with Animals in Public Settings </li></ul><ul><li>http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5805a1.htm </li></ul>
    32. 32. Advice to the Public: Health Care Providers & Veterinarians <ul><li>Provide information to pet owners about risks of acquiring salmonellosis from amphibians and reptiles </li></ul><ul><li>Advise patients on proper hand washing practices </li></ul><ul><li>Veterinarians should teach pet owners how to properly clean the animal habitat </li></ul>
    33. 33. Acknowledgments <ul><li>CDC </li></ul><ul><ul><li>Samir Sodha, Casey Barton Behravesh, Linda Capewell, Gwen Ewald, Nancy Garrett, Brenda Le, Leslie Hausman, Ian Williams </li></ul></ul><ul><li>State and Local Health Departments: </li></ul><ul><ul><li>Alabama, Arizona, California, Colorado, Florida, Georgia, Idaho, Indiana, Illinois, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Mississippi, Nebraska, Nevada, New Jersey, New Mexico, New York, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, and Wisconsin </li></ul></ul>
    34. 34. For more information <ul><li>CDC Podcasts </li></ul><ul><li>Salmonella Infection and Water Frogs: </li></ul><ul><li>http://www2c.cdc.gov/podcasts/player.asp?f=641101 </li></ul><ul><li>Wash Away Salmonella: </li></ul><ul><li>http://www2c.cdc.gov/podcasts/player.asp?f=722515 </li></ul><ul><li>For Kids: </li></ul><ul><li>Water Frogs, Aquariums, and Salmonella -- Oh My! </li></ul><ul><li>http://www2c.cdc.gov/podcasts/player.asp?f=442708 </li></ul><ul><li>Contact: Shauna Mettee , smettee@cdc.gov </li></ul>
    35. 35. For more information <ul><li>CDC Web Update </li></ul><ul><li>http://www.cdc.gov/salmonella/typh1209/index.html </li></ul><ul><li>MMWR – Jan 8, 2009 </li></ul><ul><li>Multistate Outbreak of Human Salmonella Typhimurium Infections Associated with Aquatic Frogs — United States, 2009 </li></ul><ul><li>http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5851a1.htm </li></ul><ul><li>Contact: Shauna Mettee </li></ul><ul><li>[email_address] </li></ul>
    36. 36. Rabies Postexposure Prophylaxis for Animals January 6, 2010 Selected Zoonotic Diseases Conference Call Charles Rupprecht, VMD, PhD Poxvirus and Rabies Branch, CDC 404-639-1053 crupprecht@cdc.gov
    37. 37. February 3, 2010 Selected Zoonotic Diseases Conference Call *Proposed *
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