1. Bioterrorism Agents – Plague Lesson 7 Information for Veterinarians

2. Objectives Symptoms of plague in animalsSymptoms of plague in animals Public health significance of plague in animalsPublic health significance of plague in animals Medication optionsMedication options

3. Overview Plague – acute, bacterial infection that affects both human and animals. Caused by Y. pestisPlague – acute, bacterial infection that affects both human and animals. Caused by Y. pestis Affects both domestics and peri-domesticsAffects both domestics and peri-domestics Natural transmission in western USNatural transmission in western US Occasional outbreaks in rodentsOccasional outbreaks in rodents Some species do not have clinical signsSome species do not have clinical signs

4. Domestic Cats Highly susceptibleHighly susceptible Transmission to humansTransmission to humans –Bites or scratches –Infectious exudates –Inhalation of respiratory droplets –Transport infected fleas 25 cat-to-human cases since 197725 cat-to-human cases since 1977 –7 in veterinarians or assistants –5 primary pneumonic

5. Dogs and Ungulates DogsDogs –Can become infected –Sometimes clinical signs –Greatest threat – transport of fleas UngulatesUngulates –Rarely identified in US –Relatively little risk to humans –Examine if after known plague in area

6. Rodents, Rabbits and Others Likely susceptibleLikely susceptible Bioterror exposure depends on where kept in relation to releaseBioterror exposure depends on where kept in relation to release Domestic ferrets – relatively resistantDomestic ferrets – relatively resistant Birds, reptiles, fish – completely resistantBirds, reptiles, fish – completely resistant

7. The Domestic Feline A Detailed Look Eidson, 1991Eidson, 1991 –53% - bubonic –8% - septicemic –10% - plague pneumonia –29% - unknown, septicemic? Airborne release would result in primary pneumonic plague among exposed catsAirborne release would result in primary pneumonic plague among exposed cats

8. The Domestic Feline Bubonic Plague Incubation – 2 to 3 daysIncubation – 2 to 3 days SymptomsSymptoms –75% submandibular lymphadenitis –Fever, lethargy, anorexia common –Oral lesions can be present ProgressionProgression –DIC –Multi-organ failure –38% of untreated cases fatal

9. The Domestic Feline Pneumonic Plague Incubation – 3 to 4 daysIncubation – 3 to 4 days SymptomsSymptoms –Serious, rapidly progressing –Fever –Cough –Bloody sputum Significant risk toSignificant risk to owners and veterinarians!

10. Plague Management – Animals Public Health Issues Important to collect samplesImportant to collect samples Keep chilled, not frozenKeep chilled, not frozen Notify public health veterinary surveillance team immediatelyNotify public health veterinary surveillance team immediately –Assist with follow-up investigations –Preventive measures

11. Laboratory Specimen Collection Antemortem Available TestsAvailable Tests –Fluorescent antibody –Culture Specimens to CollectSpecimens to Collect –Lesions –Serology – acute and convalescent –Pharyngeal swabs – use culturettes Obtain prior to antibioticsObtain prior to antibiotics

12. Laboratory Specimen Collection Postmortem Available TestsAvailable Tests –Fluorescent antibody –Culture Specimens to CollectSpecimens to Collect –Lymph node aspirate –Tissue Samples – lymph node, liver, spleen, lung, long bones from decaying caracasses –Whole blood Place in clean container and keep chilledPlace in clean container and keep chilled Do NOT use formalin or alcoholDo NOT use formalin or alcohol

13. Laboratory Specimen Collection Procedures Lymph node aspiratesLymph node aspirates –Be sure bubo itself is aspirated –If little or no fluid, 1cc non-bacteriostatic saline SerologySerology –Acute and convalescent –0.5ml at least 14 days apart –Retrospective confirmation only Pharyngeal swab – use culturettesPharyngeal swab – use culturettes

14. Laboratory Specimen Collection Handling Keep chilled, not frozenKeep chilled, not frozen Submit as quickly as possibleSubmit as quickly as possible Request instructions from public healthRequest instructions from public health Leave aspirates in syringe or transfer to culturetteLeave aspirates in syringe or transfer to culturette

15. Plague Treatment Animals Radiographs to check for pneumoniaRadiographs to check for pneumonia Start antibiotics immediatelyStart antibiotics immediately Preferred – StreptomycinPreferred – Streptomycin Sulfonamides can be tried if other drugs not availableSulfonamides can be tried if other drugs not available Gentamicin 2-3mg/kg TID, IM or SQ Doxycycline 5mg/kg BID, PO Tetracycline 22mg/kg TID, PO Chloramphenicol 50mg/kg BID PO

16. Infection Control Veterinary Clinic Maintain in isolation until improvementMaintain in isolation until improvement Thought to be noninfectious after 48 hrsThought to be noninfectious after 48 hrs Apply flea control to cat and premisesApply flea control to cat and premises Potential risk for humansPotential risk for humans –Pneumonic – respiratory spread –Bubonic – contact with infectious tissues, exudates or fleas Cat fleas poor vectors of plagueCat fleas poor vectors of plague

17. Infection Control Veterinary Clinic Exudates and oral cavity infectiousExudates and oral cavity infectious Disinfect any material used for treatmentDisinfect any material used for treatment Pneumonic plague – close patient contactPneumonic plague – close patient contact Wear mask and glovesWear mask and gloves Well-fitted N95 rated mask preferred, but surgical mask might offer some protectionWell-fitted N95 rated mask preferred, but surgical mask might offer some protection

18. Infection Control Veterinary Clinic Consult public health after exposure to infected catConsult public health after exposure to infected cat Get to doctor immediately if febrile illness after exposureGet to doctor immediately if febrile illness after exposure Incubation in Humans – 2 to 6Incubation in Humans – 2 to 6 days, but can be as short as one day Early treatment is criticalEarly treatment is critical

19. Infection Control Animal Owners Refer owners to public healthRefer owners to public health Use following precautionsUse following precautions –Confine pets as much as possible –Apply flea control –Do not share sleeping area with animals –Get any ill animals to veterinarian Intentional plague release – keep all animals indoorsIntentional plague release – keep all animals indoors

20. Plague Review Questions Lesson 7 Information for Veterinarians

21. Plague Review Question Lesson 7, Question 1 Domestic feline patientDomestic feline patient Sick for several daysSick for several days Suspicion of plagueSuspicion of plague What do you base your initial findings on?

22. Plague Review Question Lesson 7, Question 1 What do you base your initial findings on? A.Anorexia, oral lesions, fever B.History of roaming, submandibular lymphadenitis C.Clinic in western US D.All of the above

23. Plague Review Question Lesson 7, Question 1 What do you base your initial findings on? D.All of the above –Anorexia, oral lesions, fever –Roaming, submandibular lymphadenitis –Clinic in western US

24. Plague Review Question Lesson 7, Question 2 Domestic feline patientDomestic feline patient Thorough physical examThorough physical exam Radiographs to look for pneumoniaRadiographs to look for pneumonia Collection of lab samplesCollection of lab samples What do you start your patient on?

25. Plague Review Question Lesson 7, Question 2 What do you start your patient on? A.Streptomycin B.Ampicillin C.Amoxicillin D.Clavamox

26. Plague Review Question Lesson 7, Question 2 What do you start your patient on? A. Streptomycin

27. Plague Review Question Lesson 7, Question 3 Domestic feline patientDomestic feline patient Suspected plagueSuspected plague Clinic is located in New JerseyClinic is located in New Jersey What is the significance of this finding?

28. Plague Review Questions Lesson 7, Question 3 What is the significance of this finding? A.It’s just an anomaly B.One expects plague in New Jersey C.Could indicate a bioterrorist event D.Animals get sick after humans do

29. Plague Review Questions Lesson 7, Question 3 What is the significance of this finding? C. Could indicate a bioterrorist event