1. CDC’s Role in the Importation and Transportation of Live Animals Gale Galland, DVM, MS, DACVPM Senior Veterinary Medical Officer Importations and Animal Contact Team Quarantine and Border Health Services Branch National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine

2. Objectives Discuss CDC’s role and authority to regulate the importation of live animals Overview CDC regulations that pertain to live animal imports Describe CDC’s Nonhuman Primate (NHP) Import Quarantine Program and discuss issues associated specifically with the importation, transport, and quarantine of NHPs

3. Importations and Animal Contact Team Mission To prevent and control the transmission of communicable diseases of public health importance through: Administration and enforcement of Foreign and Interstate Quarantine regulations governing – live animals and animal products – human remains, human tissues, and human products – infectious biological agents, infectious substances, and vectors of human disease Development of effective public- and private-sector partnerships Health promotion and risk communication regarding zoonotic diseases and the public health benefits and risks associated with human-animal contact

4. Organizational Structure CDC National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine Quarantine and Border Health Services Branch Importations and Animal Contact Team

5. Regulatory Authority Health and Human Services (HHS) The Secretary of HHS has statutory responsibility for preventing introduction, transmission, and spread of communicable diseases into and among the United States CDC’s Division of Global Migration and Quarantine administers interstate and foreign quarantine regulations (42 Code of Federal Regulations (CFR) part 70 and 71) – To govern the international and interstate movement of persons, animals, and cargo Legal foundation for these activities – Found in Titles 8 and 42 of the U.S. Code and relevant supporting regulations

6. CDC Regulatory Authority for the Importation of Animals and Animal Products 42 CFR 71 – Foreign Quarantine Subpart F – Importations 71.51 – Dogs and cats 71.52 – Turtles, tortoises, and terrapins 71.53 – Requirements for importers of nonhuman primates 71.54 – Import regulations for infectious biological agents, infectious substances, and vectors 71.56 – African rodents Subpart D – Health Measures at U.S. Ports: Communicable Diseases 71.32-Persons, carriers, things

7. Dogs and Cats 42 CFR 71.51 photo credit: cartoon drawings.net photo credit: publicdomainpictures.net Dogs and cats must be healthy on arrival at the port of entry into the United States Animals that are ill on arrival may be required to be taken for an examination by a licensed veterinarian at importer’s expense Photo credit: DGMQ staff

8. Dogs and Cats Rabies Vaccination Requirements Cats – CDC highly recommends rabies vaccination for cats – Currently no rabies vaccination required Dogs: Must have proof of current rabies vaccination – Puppies must have been at least 3 months of age when vaccinated – Vaccine must be given at least 30 days before entry – Certificates should list an expiration date – Rabies vaccines for dogs have expiration dates that range from 1 to 3 years from date of administration – Exceptions to this requirement limited – Rarely granted and only for extenuated circumstances and importers must agree to confine dog until it can be vaccinated against rabies when it reaches its final destination in the United States and for 30 days post vaccination – Granted in cases where rabies vaccination may interfere with research projects

9. Turtles, Tortoises, and Terrapins 42 CFR 71.52 Restrictions stem from concerns over Salmonella infection Turtles with a carapace less than 4 inches and viable turtle eggs may not be imported for commercial purposes Up to a total of six viable turtle eggs or turtles with a carapace less than 4 inches may be allowed as personal pets Greater than 6 small turtles or viable turtle eggs may be imported for science, education or exhibition with CDC permission Photo credit istock Photo credit: NY of\ Environmental Conservation Credit: iStockPhoto

10. Import Regulation for Infectious Biological Agents, Infectious Substances and Vectors: 42 CFR 71.54 Persons may not import an animal host or vector of human disease (or animal capable of being a host or vector) without a permit photo credit: echolocalizer.com Photo credit: scrapetv.com

11. Restrictions followed a 2003 monkeypox outbreak in the United States Linked to African rodents imported for the commercial pet trade First human monkeypox cases reported outside of Africa A total of 71 human cases were investigated Can only be imported for science, education or exhibition with CDC permission photo credit: flikr.com photo credit: Flikr.com African Rodents 42 CFR 71.56

12. Persons, Carriers, or Things 42 CFR 71.32 (b) When persons, carriers, or things on a carrier are suspected of being infected or contaminated, CDC may require detention, disinfection, disinfestation, fumigation, or other measures necessary to prevent the introduction, transmission, or spread of communicable diseases

13. Civets: 42 CFR 71.32(b) Civets are linked to transmission of severe acute respiratory syndrome (SARS) Civets can only be imported for science, education or exhibition with CDC permission Photo credit: Wickispaces.com Photo credit: University of Michigan.edu

14. Requirements for Importers of Nonhuman Primates (NHPs): 42 CFR 71.53 First implemented in 1975 Revised several times since then Importers currently required to: Register with CDC Quarantine imported NHPs for 31 days Screen for infectious zoonotic diseases photo credit: fotopedia.com Ensure imported NHPs have negative TB tests prior to release Complete filovirus testing for suspected infections Report any suspected zoonotic illness Maintain records for distribution

15. NHP Import Regulations History NHP import regulations strengthened in 1990 Response to 1989 Ebola Reston outbreak NHP regulations revised further in 2013 Photo Credit: fotopedia.com

16. NHP Infectious Disease Risks Tuberculosis Viral Hemorrhagic Fever Ebola, Marburg Herpes B virus Hepatitis A and B viruses Monkeypox Simian Immunodeficiency Virus (SIV) Yellow Fever reservoir Shigella, Salmonella, Campylobacter Credit: iStockPhoto

17. Hemorrhagic Fever Viruses 1967 Marburg outbreak Occurred in Marburg and Frankfurt, Germany Associated with tissues from African green monkeys 31 people infected, 7 deaths photo credit: fotopedia.com

18. Hemorrhagic Fever Viruses 1989 outbreak of Ebola Reston in a group of imported NHPs First thought to be Simian Hemorrhagic Fever Illness spread through the facility Facility was depopulated 500 animals euthanized Six individuals associated with this outbreak were seropositive but did not develop illness photo credit: DGMQ staff

19. Prior to 1990 Regulations: Baby Carriage on Cargo Belt Photo credit: DGMQ staff

20. Prior to 1990 Regulations: Minimal Personal Protective Equipment NHP Crates Stacked with Other Cargo Photo credit: DGMQ staff

21. Prior to 1990 Regulations: NHP Crates Stacked with Other Cargo Photo credit: DGMQ staff

22. Prior to 1990 Regulations: Close-up of NHP Crates Stacked with Other Cargo Photo credit: DGMQ staff

23. Current Best Practices for Meeting NHP Shipments Photo credit: DGMQ staff

24. Current Best Practices for NHP Shipments Photo credit: DGMQ staff

25. Most Recent NHP Regulation Update April 16, 2013 Consolidated all the MMWRs, Special Permit Requirements, Dear Interested Party letters, and best practices into a single regulation Added specific requirements for zoo-to-zoo and lab-to- lab transfer

26. Current Challenges Importation and Transportation of NHPs Currently only a limited number of airlines are routinely transporting NHPs imported into the United States More importers are moving to charter flights No domestic airline will carry NHPs Shipments must be transported by truck to final quarantine destination

27. Potential Consequences Charter flights typically have scheduling delays and flight interruptions Leads to more stress on animals Increased stress means increased potential for animal illness and death during CDC quarantine Illnesses and deaths during quarantine may require extension of quarantine at greater cost to importers Risk of an outbreak in a cohort is higher Outbreaks in larger cohorts can cause catastrophic losses

28. Potential Consequences Challenges with larger shipments at port of entry Additional staff needed to handle larger shipments Increased stress on staff (gov’t agencies, ground handlers) More difficult to find suitable holding facilities during delays Increased costs for all involved organizations  Large shipments of NHPs on charter flights pose an increased public health risk During transportation During off-loading

29. Potential Consequences Long truck rides increase transportation time More stress on animals Increase potential illness

30. Summary CDC’s authority to regulate animals is based on threats they may pose to human health Implementation has been species- and pathogen-specific CDC’s role in animal importation is to reduce the risk to public health New regulations are currently being developed Goal is to have comprehensive, proactive regulations that help protect public health

31. Acknowledgements Importations and Animal Contact Team Adam Langer, Team Lead Julie Sinclair, Deputy Team Lead Bob Mullan Heather Bair-Brake Sheryl Shapiro Nelva Bryant Quarantine Station Staff Disclaimer: The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent CDC’s official position.