November 2009 Selected Zoonotic Diseases Conference Call

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November 2009 Selected Zoonotic Diseases Conference Call

  1. 1. Selected Zoonotic Diseases Conference Call November 4, 2009
  2. 2. Carol Rubin, DVM, MPH , National Center for Zoonotic, Vector-borne, and Enteric Diseases, CDC 404-639-7378 [email_address] Selected Zoonotic Diseases Conference Call November 4, 2009 Update on H1N1
  3. 4. Kendra E. Stauffer, DVM ; Bacterial Zoonoses Branch, CDC 404-639-3435 kstauffer@cdc.gov Selected Zoonotic Diseases Conference Call November 4, 2009 The Changing Face of Brucellosis in the United States  http ://www.cdc.gov/Features/HuntingSafety/Brucellosis_and_HogHunters_508.pdf   Additional zoonotic resources for hunters from the AVMA include: http://www.avma.org/public_health/zoonotic_risks/hunters.asp http://www.avma.org/public_health/zoonotic_risks/hunters_precautions.asp
  4. 5. Steven Baty, DVM, MPH,  Arizona Department of Health Services 602-364-3875 batys@azdhs.gov Andrea McCollum, PhD, Poxvirus and Rabies Branch, CDC 404-639-4164 amccollum@cdc.gov Selected Zoonotic Diseases Conference Call November 4, 2009 Bat-associated Rabies Virus in Skunks and Foxes, Flagstaff, Arizona 2009
  5. 6. Bat-associated Rabies Virus Variant Arizona, 2009 Steven Baty, DVM, MPH Arizona Department of Health Services EIS Field Assignments Branch, CDD, OWCD Andrea McCollum, PhD Division of Viral and Rickettsial Diseases, CDC
  6. 7. Situation <ul><li>October 2008 </li></ul><ul><li>Coconino County, Arizona </li></ul><ul><li>Rabies epizootic </li></ul><ul><ul><li>Big brown bat (Eptesicus fuscus) rabies virus variant </li></ul></ul><ul><li>Public health significance </li></ul>
  7. 8. Epi-Aid <ul><li>Summer 2009 Epi-Aid </li></ul><ul><li>Team Members </li></ul><ul><ul><li>Epidemic Intelligence Service Officers(2) </li></ul></ul><ul><ul><li>CDC, Rabies Team (3) </li></ul></ul><ul><li>Objectives </li></ul>
  8. 10. Big Brown Bat Variant Grey Fox Variant South-Central Skunk Variant
  9. 11. Number of cases Wildlife Rabies Cases Arizona 1999 – 2009 Year
  10. 12. Flagstaff
  11. 14. Wildlife Rabies Cases Coconino County 1999 – 2009 Number of cases Year
  12. 15. Wildlife Rabies Cases Coconino County November 2008 –October 2009 Oral Rabies Vaccine (ORV) Trap Vaccinate Release (TVR) Quarantine Number of cases Month
  13. 16. Public Health Impact Coconino County 2009 <ul><li>Domestic animal rabid animal exposures requiring quarantine (7) </li></ul><ul><li>Human rabid animal exposures requiring post-exposure prophylaxis (12) </li></ul><ul><li>Domestic animal or human exposure to ORV </li></ul>
  14. 17. Surveillance <ul><li>Passive Surveillance </li></ul><ul><ul><li>Companion animal or human exposure </li></ul></ul><ul><li>Enhanced Surveillance </li></ul><ul><ul><li>Direct Rapid Immunohistochemical Test (DRIT) </li></ul></ul><ul><ul><li>Capacity development </li></ul></ul>
  15. 18. Coconino County ORV Bait Campaign <ul><li>July 21-24 aerial ORV bait drop </li></ul><ul><li>July 22 ground teams distributed baits </li></ul><ul><li>>110,000 baits distributed over 91 square mile area </li></ul>
  16. 20. Trap Vaccinate and Release <ul><li>Location </li></ul><ul><li>Targeted animal </li></ul><ul><li>Results </li></ul>
  17. 23. Community Outreach <ul><li>Health Care Provider update </li></ul><ul><li>Community knowledge, practices, and attitudes survey </li></ul><ul><li>Rabies post-exposure prophylaxis case review </li></ul>
  18. 24. Conclusion <ul><li>Public Health Significance </li></ul><ul><ul><li>Human and companion animal exposure </li></ul></ul><ul><ul><li>Rabies post-exposure prophylaxis administration </li></ul></ul><ul><li>Wildlife/Domestic/Human emerging infectious disease interface </li></ul>
  19. 25. Acknowledgments <ul><li>Arizona Department of Health Services </li></ul><ul><ul><li>Rebecca Sunnenshine </li></ul></ul><ul><ul><li>Craig Levy </li></ul></ul><ul><li>CDC, Rabies Team </li></ul><ul><ul><li>Jesse Blanton </li></ul></ul><ul><ul><li>Douglas Green </li></ul></ul><ul><ul><li>Michael Niezgoda </li></ul></ul><ul><ul><li>Charles Rupprecht </li></ul></ul><ul><li>USDA Wildlife Services </li></ul><ul><ul><li>David Bergman </li></ul></ul><ul><ul><li>Stephanie Johnston </li></ul></ul><ul><ul><li>Krista Wenning </li></ul></ul><ul><li>Coconino County </li></ul><ul><ul><li>Michael Callahan </li></ul></ul><ul><ul><li>Sabrina Ferrat </li></ul></ul><ul><ul><li>Randy Phillips </li></ul></ul>The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
  20. 26. William H. Wunner, PhD, Professor and Director of Outreach Education and Technology Training; The Wistar Institute; 215-898-3854 wunner@wistar.org Deborah J. Briggs, PhD, Adjunct Professor, College of Veterinary Medicine, Kansas State University briggs@vet.k-state.edu Selected Zoonotic Diseases Conference Call November 4, 2009 Overview of special collections on papers on rabies appearing in the journals Vaccine and PLoS NTD
  21. 27. Richard B. Chipman, National Rabies Management Program, USDA, APHIS, Wildlife Services 518-477-5628 Richard.B.Chipman@ aphis.usda.gov Selected Zoonotic Diseases Conference Call November 4, 2009 Oral vaccination opportunities, complexities and challenges in North America
  22. 28. Rich Chipman Asst. Rabies Management Coordinator USDA, APHIS, WS-National Rabies Management Program
  23. 29. 10 Minute Paper Summary “ Oral Rabies Vaccination in North America: Opportunities, Complexities and Challenges” (In Press) Public Library of Science Neglected Tropical Diseases Dennis Slate, Timothy P. Algeo, Kathleen M. Nelson, Richard B. Chipman, Dennis Donovan, Jesse D. Blanton, Michael Niezgoda, and Charles E. Rupprecht
  24. 30. Background
  25. 31. Diverse meso-carnivore community…
  26. 32. U.S. Rabies Virus Variants 2008
  27. 33. North American borders and key meso-carnivore ranges Coyote Red fox Gray fox Raccoon Striped skunk Bobcat
  28. 34. In 1969, Dr. George Baer, then at CDC, and associates prove oral rabies vaccination feasible in foxes… Baer, G.M., M.K. Abelseth, and J.G. Debbie. (1971). Oral vaccination of foxes against rabies. Am. J. of Epidemiol. 93:487-490. Oral Rabies Vaccination from proof of concept To control reality
  29. 35. Oral Rabies Vaccination <ul><li>Oral rabies vaccination (ORV) represents a socially acceptable methodology that has helped eliminate canine rabies from the USA, and restricted the distribution of raccoon, arctic fox, and gray fox variants of rabies in North America. </li></ul>
  30. 36. Wildlife Management Agencies Public Health Agencies Agriculture Agencies Universities Oral Rabies Vaccination Wildlife Health Agriculture
  31. 37. Collaboration & Strategic Planning
  32. 38. Collaboration & Strategic Planning <ul><li>An international rabies management team composed of experts from the public health-agriculture-wildlife management interface has been vital to the establishment of viable rabies control programs in North America.  </li></ul>
  33. 39. Cooperative Annual Planning Rabies Management Team <ul><li>2009: ATLANTA, GA </li></ul><ul><li>2008: MOBILE, AL </li></ul><ul><li>2007: SAN ANTONIO, TX </li></ul><ul><li>2006: JACKSONVILLE, FL </li></ul><ul><li>2005: RIVERDALE, MD </li></ul><ul><li>2004: ATLANTA, GA (CDC) </li></ul><ul><li>2003: FT. COLLINS, CO </li></ul><ul><li>2002: RIVERDALE, MD </li></ul><ul><li>2001: RIVERDALE, MD </li></ul><ul><li>2000: FT. COLLINS, CO </li></ul><ul><li>1999: FT. COLLINS, CO </li></ul>2009 11 th Anniversary!
  34. 40. … areas for collaboration North American Rabies Management Plan Information transfer Research Surveillance and monitoring Rabies prevention and control Wildlife Public Health Agriculture
  35. 41. <ul><li>Enhance coordination of wildlife rabies surveillance, management, research and communication….. </li></ul><ul><li>Prevent the spread of specific rabies virus variants in carnivores in the United States. </li></ul><ul><li>Eliminate specific rabies virus variants in carnivores at the local, regional, and national level. </li></ul>Goals of the U.S. National Plan for Wildlife Rabies Management
  36. 42. Enhanced Surveillance
  37. 43. Enhanced Surveillance <ul><li>Advances in enhanced rabies surveillance that relies largely on a direct rapid immunohistochemistry test have led to improved real-time management decisions for meso-carnivore rabies reservoir species in the USA. </li></ul>RabID Mapping
  38. 44. <ul><li>Sampling Emphasis </li></ul><ul><li>Strange behaving animals </li></ul><ul><li>(no human or pet exposure history) </li></ul><ul><li>Animals with lesions indicating aggression </li></ul><ul><li>Road kill surveys/other dead animals </li></ul><ul><li>Animals removed-- “hot” rabies focus </li></ul><ul><li>Nuisance removed animals </li></ul><ul><li>2005-2009 = >27,000 animals dRIT tested </li></ul>Enhanced Rabies Surveillance dRIT Analysis rabies negative rabies positive
  39. 45. Enhanced Surveillance WS Trap & Euthanize WS Firearms WS Road Kill Non-WS Collection 2009 Source Types
  40. 46. Trap-Vaccinate-Release Raccoon Variant Rabies
  41. 47. Oral Rabies Vaccination
  42. 48. ORV <ul><li>ORV in the USA remains focused on the raccoon variant of rabies, while work continues to contain and eliminate the gray fox rabies variant in west Texas, and prevent canine rabies from re-emerging into the USA from Mexico. </li></ul>
  43. 49. ORV Zones 2009 gray fox coyote raccoon
  44. 50. ORV in the U.S. (2009)
  45. 51. Oral Rabies Vaccination <ul><li>ORV has been successfully employed to prevent raccoon rabies from gaining a much broader foot print beyond the eastern U.S. </li></ul>
  46. 53. Oral Rabies Vaccination <ul><li>ORV was integrated into conventional rabies prevention and control reliant on parenteral rabies vaccination in dogs to free the U.S, of canine rabies that emerged in Texas from Mexico in the late 1980's and spilled-over into and spread among coyotes. </li></ul><ul><li>An ORV zone is currently maintained along the south Texas-Mexico border to try to prevent re-emergence of canine rabies from Mexico. </li></ul>
  47. 54. Year Rabies Cases ORV zone 1995 2000- 2007 Rabies case in 2001 and 2004 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 166 58 21 6 5 10 0 1 0 0 1 0 0 0 0 0 Canine Rabies in Coyote, South Texas W e b b D u v a l F r i o S t a r r B e e U v a l d e B e x a r H i d a l g o K i n n e y Z a v a l a D i m m i t M e d i n a L a S a l l e K e n e d y Z a p a t a M a v e r i c k B r o o k s G o l i a d L a v a c a A t a s c o s a D e W i t t V i c t o r i a W i l s o n L i v e O a k M c M u l l e n J i m H o g g G o n z a l e s N u e c e s K a r n e s K l e b e r g J a c k s o n R e f u g i o C a m e r o n J i m W e l l s W i l l a c y G u a d a l u p e S a n P a t r i c i o C a l h o u n A r a n s a s W e b b D u v a l F r i o S t a r r B e e U v a l d e B e x a r H i d a l g o K i n n e y Z a v a l a D i m m i t M e d i n a L a S a l l e K e n e d y Z a p a t a M a v e r i c k B r o o k s G o l i a d L a v a c a A t a s c o s a D e W i t t V i c t o r i a W i l s o n L i v e O a k M c M u l l e n J i m H o g g G o n z a l e s N u e c e s K a r n e s K l e b e r g J a c k s o n R e f u g i o C a m e r o n J i m W e l l s W i l l a c y G u a d a l u p e S a n P a t r i c i o C a l h o u n A r a n s a s ORV begins W e b b D u v a l F r i o S t a r r B e e U v a l d e B e x a r H i d a l g o K i n n e y Z a v a l a D i m m i t M e d i n a L a S a l l e K e n e d y Z a p a t a M a v e r i c k B r o o k s G o l i a d L a v a c a A t a s c o s a D e W i t t V i c t o r i a W i l s o n L i v e O a k M c M u l l e n J i m H o g g G o n z a l e s N u e c e s K a r n e s K l e b e r g J a c k s o n R e f u g i o C a m e r o n J i m W e l l s W i l l a c y G u a d a l u p e S a n P a t r i c i o C a l h o u n A r a n s a s
  48. 55. Oral Rabies Vaccination <ul><li>ORV has been used to shrink the area occupied by a unique variant of rabies virus in gray foxes in west Texas. </li></ul>
  49. 56. ??Gray fox var. TX
  50. 57. 125,278 by baits air 4,322 by baits ground ORV targeting gray fox TVR targeting skunks Big brown bat clades
  51. 58. Complexities, and other Considerations
  52. 59. Complexities <ul><li>Raccoon rabies has not spread appreciably since ORV intervention has expanded in the eastern USA, yet rabies virus neutralizing antibody levels in raccoon populations as an index to immune buffers in existing ORV zones point to the need for improved or new bait-oral vaccines and strategy refinements. </li></ul><ul><li>Achieving advances that lead to improved field performance should allow for a more aggressive movement of ORV zones into raccoon enzootic areas. </li></ul>
  53. 60. Seroconversion Post-ORV
  54. 61. Skunks infected with raccoon rabies Skunks
  55. 62. Raccoon Rabies Contingency Actions in FY 2009
  56. 63. <ul><li>Enhanced rabies surveillance </li></ul><ul><li>Oral rabies vaccination (75/150 baits/km 2 ) </li></ul><ul><li>Trap-vaccinate-release </li></ul>Contingency Action Strategy
  57. 64. WS ORV (75 baits/km 2 ) WS ORV (150 baits/km 2 ) NYSDOH ORV (75 baits/km 2 ) TVR area Border Contingency Action areas 2009
  58. 65. <ul><li>Goal : Restore target areas to raccoon variant rabies free status. </li></ul>New York OHIO 2007 -2009 Contingency Action
  59. 66. <ul><li>OH </li></ul><ul><ul><li>21/km 2 (2-50) </li></ul></ul><ul><li>NY </li></ul><ul><ul><li>16/km 2 (2-46) </li></ul></ul><ul><li>VT </li></ul><ul><ul><li>8/km 2 (2-18) </li></ul></ul><ul><li>ME </li></ul><ul><ul><li>4/km 2 (1-17) </li></ul></ul>Raccoon Densities in Contingency Zones
  60. 67. Trap-Vaccinate-Release Raccoon Variant Rabies in ORV Zone
  61. 68. Final Thoughts <ul><li>Coalition of diverse expertise from the public health-agriculture-wildlife management interface has been critical to facilitate coordination. </li></ul><ul><li>The NARMP has established a continental framework that extends collaboration and coordination, capacity for rabies communications, surveillance, control, and research among Canada, Mexico and the USA. </li></ul><ul><li>Enhanced surveillance as a complement to public health surveillance has improved decision making capability regarding allocation of rabies control resources, including contingency actions to address emergencies. </li></ul>
  62. 69. Final Thoughts <ul><li>Raccoon rabies has not spread appreciably since ORV intervention has expanded in the eastern USA, yet there is a need for improved or new bait-oral vaccines and strategy refinements. </li></ul><ul><li>Measureable successes beyond containment would be expected to enhance program sustainability toward the goal of broader scale elimination of raccoon rabies. </li></ul><ul><li>Continued economic analyses will remain integral to ORV planning and as a means to characterize successes in costs and benefits. </li></ul>
  63. 70. Susan Moore, Rabies Laboratory Manager, K-State Rabies Laboratory 785-532-4472 smoore@vet.ksu.edu Selected Zoonotic Diseases Conference Call November 4, 2009 Rabies specific antibodies: measuring surrogates of protection against a fatal disease
  64. 71. Rabies Specific Antibodies: Measuring Surrogates of Protection Against a Fatal Disease Susan M. Moore and Cathleen A. Hanlon
  65. 72. Learning Points <ul><li>Rabies virus neutralizing antibodies (RVNA) have been demonstrated to be critical for protection against rabies. Even so, in vitro measurements are only a partial determination of the degree of protection provided in vivo . Not all methods that measure rabies specific antibodies will determine the neutralizing function of the antibodies. </li></ul><ul><li>In the selection of the most appropriate assay for rabies antibody detection, consideration of the purpose and use of the results is as important as the established performance characteristic of the assay. </li></ul><ul><li>Standardization of assays includes both assay components and test conditions. Alterations will cause variation in results; therefore use of a particular assay (i.e. ELISA or serum neutralization) does not guarantee comparable results if the assays have not been standardized. </li></ul><ul><li>Because rabies is a fatal disease where development of a sufficient RVNA response is paramount for protection, verification of assay specificity, sensitivity, and accuracy must be defined for meaningful clinical decisions to be made based on the results. </li></ul><ul><li>Steps toward better understanding and use of rabies serology assays will include collaboration of national laboratories, regulatory agencies, as well as commercial and research laboratories. Greater cooperation and standardization of rabies serology assays will lead to increased understanding of the relationship between in vitro measurement and in vivo protection . </li></ul>
  66. 73. Serum Neutralization test ELISA test
  67. 74. Adequate response to rabies vaccination <ul><li>ACIP 2008 </li></ul><ul><li>“ minimum acceptable antibody level of complete neutralization at a serum dilution of 1:5” </li></ul><ul><li>“ the reported values of rabies virus neutralizing antibody titer (most properly reported according to a standard as IU/mL)” </li></ul><ul><li>WHO – Expert Committee 1992 </li></ul><ul><li>Does not define by endpoint titer or equate endpoint titer to IU/mL </li></ul><ul><li>“ All persons who work with live rabies virus in a diagnostic, research or vaccine production laboratory should have a serum sample tested for rabies virus-neutralizing antibodies and a booster administered when the titre falls below 0.5 IU/mL.” </li></ul>
  68. 75. Complete neutralization at 1:5 may or may not equal 0.5 IU/mL <ul><li>Example 1 </li></ul><ul><li>titer of patient sample is 1:10 </li></ul><ul><li>titer of reference serum (2.0 IU/mL) is 1:200 </li></ul><ul><li>IU/mL calculation: </li></ul><ul><ul><li>(10/200) X 2.0 IU/mL = 0.1 IU/mL </li></ul></ul><ul><li>Example 2 </li></ul><ul><li>titer of patient sample is 1:10 </li></ul><ul><li>titer of reference serum (2.0 IU/mL) is 1:20 </li></ul><ul><li>IU/mL calculation: </li></ul><ul><ul><li>(10/20) X 2.0 IU/mL = 1.0 IU/mL </li></ul></ul>
  69. 76. Method standardization and validation Why? <ul><li>Standardization of methods and use of methods enable direct comparison of results and consistent comparison over time </li></ul><ul><li>Validation gives assurance of accurate and precise results and understanding of method characteristics (good and bad) </li></ul><ul><li>Continued quality assurance programs identify problems and allow for timely corrective actions </li></ul>
  70. 77. Selected Zoonotic Diseases Conference Call November 4, 2009

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