Preparing for the Next Disease: The Human-Wildlife Connection Marguerite Pappaioanou, DVM, PhD Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention Protects the health and safety of the people of the United States- at home and abroad Provides credible information to enhance health decisions Promotes health through strong partnerships Develops and applies disease prevention and control, environmental health, and health promotion and education activities

Emerging and re-emerging Zoonoses, 1996–2003 (Source: WHO and Pappaioanou) Recent outbreaks Influenza / Madagascar West Nile / USA, Canada Ebola / Gabon, Congo Monkeypox / DRC/ US CCHF / Afghanistan, Iran Tularemia / USA, Kosovo Yellow fever / Ivory Coast Brucellosis / Mongolia E. coli 0157 / Canada Hantavirus / US BSE-vCJD/ UK Nipah virus / Malaysia Avian Influenza / Hong Kong SARS / Global Multidrug resistant Salmonella Cryptosporidiosis E.coli O157 E.coli non-O157 Nv-CJD Brucellosis West Nile Virus West Nile E.coli O157 Hantavirus pulmonary syndrome NV-CJD Reston virus Influenza A(H5N1) Lyme Borreliosis Reston Virus Leptospirosis Lassa fever Nipah Virus Venezuelan Equine Encephalitis Rift valley Fever Yellow fever Ebola Monkeypox Ross River virus Equine morbillivirus Hendra virus

Transmission of Emerging Infectious Diseases Translocation Encroachment Introduction “Spill over” & “Spill back” Human encroachment Ex situ contact Ecological manipulation Human behaviors Wildlife EID Domestic Animal EID Human EID Global travel Urbanization Biomedical manipulation Agricultural Intensification Food processing/distribution Technology and Industry Dasazak P. et.al. Science 2000 287:443

Factors Promoting Transmission of Infectious Diseases from Animals to Humans Source: United Nations, World Population Prospects, The 1998 Revision; and estimates by the Population Reference Bureau. Rapidly Increasing Human Population 6.1 Billion people in 2000 ~9.4 to 11.2 Billion in 2050

Factors Promoting Transmission of Infectious Diseases from Animals to Humans Human population expanding into changing and overlapping wildlife habitat Increasing human interaction with domestic and wild/exotic animals

Factors Promoting Transmission of Infectious Diseases from Animals to Humans Changing climates and ecosystems Increases in arthropod vector populations and their resistance to insecticides

Factors Promoting Transmission of Infectious Diseases from Animals to Humans Increasing international travel and trade, civil wars, political unrest, famines, human-made and natural disasters Increasing movement of people and animals

Factors Promoting Transmission of Infectious Diseases from Animals to Humans Globalization of the food supply Centralized processing of food

Factors Promoting Transmission of Infectious Diseases from Animals to Humans Human behaviors Consumption of bushmeat/wildlife Wild animal game ranches Exotic wildlife as pets Feed stations to increase wildlife populations for hunting

Public Health Detection, Prevention, Control Emerging Infectious Diseases Early disease detection; rapid, timely reporting Ongoing disease surveillance Rapid laboratory diagnosis/confirmation Rapid epidemiologic investigations Timely and effective public health interventions Public health research Partnerships and communications Infrastructure/capacity building The public health system must be able to detect events in a timely fashion, rapidly identify the etiological agent initiate a rapid, yet scientifically sound investigation to determine the cause of the event, risk factors for illness, population that is most likely to be effected, implement control measures to stop the outbreak and prevent further illness.

Early Detection—Begins on the Front Line at the Local Level Preparedness activities start at the local level Surveillance efforts require local data “First responders” will probably be astute local healthcare providers Not the “lights and sirens” type of event---( police, fire, and EMS) “Local” therefore implies hospital readiness and healthcare provider readiness.. What can you do to be prepared?

Rapid Laboratory Diagnosis Clinical Labs, State & Local Public Health Labs, Military Labs, Veterinary Labs, Agricultural, Water & Food-Testing Labs, APHL & ASM, FDA, NIH, & International Labs, FBI, DoD, DOE, USDA, EPA Establish an integrated multilevel laboratory network to provide rapid & critical laboratory capacity for response to: bioterrorism emerging infectious diseases other public health threats & emergencies Includes both biological & chemical labs Food and veterinary diagnostic laboratories

Laboratory Response Network Agent-Specific Protocols Standardized Reagents & Controls Lab Referral Directory Secure Communications & Electronic Laboratory Reporting Training & Technology Transfer Proficiency Testing Appropriate Vaccinations for Lab Workers Talking points: The Electronic Laboratory Reporting (ELR) effort of the LRN will be NEDSS-compatible Have been working closely with John Loonsk & IRMO Regarding training, more than 100 individuals completed “train-the-trainer” courses w/ RRAT lab & NLTN Proficiency testing already occurring, plans to involve more agents Future goals Additional agents & testing methods FDA compliance & GMP Electronic specimen tracking & ELR Integration w/ Epi & EOC Response plans Expanded proficiency testing & training Registry of Level A labs GMP = Good Manufacturing Practices ELR = Electronic Laboratory Reporting Registry of LRN Level A labs will require defining additional criteria for select membership (to be determined) Registry best maintained at state level

LRN Partnership with Veterinary Diagnostic Laboratories 1999: National Veterinary Services Laboratory/USDA (Ames) and U. of Texas Veterinary Laboratories LRN members 2002: LRN state public health labs propose funding for 8 veterinary laboratories for membership 2002: CDC/NCID proposes phased collaboration to address concerns with zoonotic diseases, build LRN infrastructure capacity, link animal and human health 2003 - University of Minnesota Veterinary Diagnostic Laboratory joins LRN National Testing Site to screen for monekypox in animals

West Nile Virus, 1999

West Nile Virus leads to New Approaches for Disease Surveillance Epidemic/Epizootic West Nile Virus in the United States: Revised Guidelines for Surveillance, Prevention, and Control, 2003 Humans, birds, horses, mosquitoes Multidisciplinary ArboNET National Zoo Surveillance System

CDC – ArboNET (9/8/03)

Partnerships on West Nile Virus Activities in the United States State and Local Health Depts State and Local Veterinarians State and Local Wildlife Veterinarians and Biologists State and Local Mosquito Control CDC US Geological Survey USDA Department of Defense EPA

Additional information about WNV activity is available from CDC at http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and http://westnilemaps.usgs.gov

USGS/CDC – Wild Birds (9/3/03)

USGS/CDC – Mosquitoes (9/3/03)

USGS/CDC- Veterinary (9/3/03)

USGS/CDC – Humans (9/3/03)

Rapid Epidemiologic Investigation

Investigation Of Human Cases

Animal Trace back and Trace forward

Public Health Strategies to Control Epidemic FDA-CDC joint order banning importation and prohibiting movement of implicated exotic animals State enacted measures to further restrict intrastate animal shipment and trade Premise quarantine Animal euthanasia Pre- and post-exposure vaccination of potentially exposed persons with small pox vaccine

Preventing and Controlling Zoonoses – Wildlife Connection Vaccination of humans and animals Regulation of importation and movement of exotic animals Control of feral/stray populations Regulation of bush meat trade Testing and culling infected wildlife Other

Preparing for the Next Disease: The Human-Wildlife Connection Expect the unexpected Form and strengthen human-animal health partnerships Link human and animal surveillance Disease reporting; laboratory networks Communication Coordinate evidence-based public health action Develop multidisciplinary infectious disease centers Conduct research, e.g., ecology of diseases, risk factors for human exposure Develop, test, implement plans for integrated disease detection and response Roles, responsibilities, actions, coordination