The National Companion Animal Surveillance System (NCASP) A Supercourse Lecture Larry Glickman, VMD, DrPH Nita Glickman, MPH, PhD Department of Comparative Pathobiology Purdue University School of Veterinary Medicine West Lafayette, IN

Banfield Pet Hospital-Purdue University The National Companion Animal Surveillance System (NCASP)

Objectives of Lecture Learning Objectives Learning Objectives understand the principles of syndromic surveillance understand the principles of syndromic surveillance appreciate why animals may be good sentinels for human health appreciate why animals may be good sentinels for human health Performance Objectives Performance Objectives graph and interpret changes in frequency of health events over time graph and interpret changes in frequency of health events over time design a surveillance program using either syndromic events or diseases design a surveillance program using either syndromic events or diseases

What is the National Companion Animal Surveillance Program (NCASP) NCASP is a national, near real-time, surveillance system that uses the electronic medical records of pet animals seen at >560 veterinary hospitals in the U.S. to detect events that signal the threat of an emerging infection, a terrorist threat, or a natural disaster, for people living in the same geographic area NCASP is a national, near real-time, surveillance system that uses the electronic medical records of pet animals seen at >560 veterinary hospitals in the U.S. to detect events that signal the threat of an emerging infection, a terrorist threat, or a natural disaster, for people living in the same geographic area Supported by a grant from the CDC Supported by a grant from the CDC

Mission of the National Companion Animal Surveillance Program Provide real-time and near-real-time information on syndromic and disease events that occur among species of pet animals in the United States Provide real-time and near-real-time information on syndromic and disease events that occur among species of pet animals in the United States Conduct detailed statistical analyses to identify space-time clusters of events and characterize host and environmental risk factors Conduct detailed statistical analyses to identify space-time clusters of events and characterize host and environmental risk factors Alert to the occurrence of potential acts of bioterrorism, emerging zoonoses, and toxic chemical exposures Alert to the occurrence of potential acts of bioterrorism, emerging zoonoses, and toxic chemical exposures Serve as a sentinel for the occurrence of environmentally related diseases (e.g.., cancer) Serve as a sentinel for the occurrence of environmentally related diseases (e.g.., cancer)

Surveillance – CDC Definition Ongoing systematic collection, analysis, and interpretation of health data Ongoing systematic collection, analysis, and interpretation of health data Essential to the planning, implementation, and evaluation of public health practice Essential to the planning, implementation, and evaluation of public health practice Closely integrated with the timely dissemination of these data to those who need to know Closely integrated with the timely dissemination of these data to those who need to know

AgentSigns & Symptoms (I & W) Diagnostic Tests Specific Diagnosis or Agent Outcome Recovery Death Syndromic Surveillance Traditional Surveillance Exposure Surveillance Temporal Sequence of Surveillance Disease Specific or Syndromic Events I & W = Indications & Warnings

Why are Animals Good Sentinels for Emerging & Human Infections? Why are Animals Good Sentinels for Emerging & Human Infections? 1,407 pathogens affect humans; of these 58% are zoonotic 1,407 pathogens affect humans; of these 58% are zoonotic 177 of these pathogens are considered ‘emerging’ or ‘reemerging’ 177 of these pathogens are considered ‘emerging’ or ‘reemerging’ 38 animal diseases have affected humans over the past 25 years 38 animal diseases have affected humans over the past 25 years SARS SARS Monkey pox Monkey pox Avian Influenza Avian Influenza West Nile virus West Nile virus

Biothreat A Agents in Dogs & Cats Diseases/Agents* Occurs naturally in Category A companion animals** Anthrax (Bacillus anthracis) Anthrax (Bacillus anthracis) Dogs and cats Botulism (Clostridium botulinum toxin) Botulism (Clostridium botulinum toxin) Dogs and cats Plague (Yersinia pestis) Plague (Yersinia pestis) Cats and dogs Smallpox (variola major) Smallpox (variola major) Not reported Tularemia (Francisella tularensis) Tularemia (Francisella tularensis) Cats and dogs Viral hemorrhagic fevers (filoviruses & arenaviruses) Viral hemorrhagic fevers (filoviruses & arenaviruses) Not reported * - CDC 2003: ** - reported with species of greatest (or equal) susceptibility first

Advantages of Using Companion Animals as Sentinels 62% of American households own a pet 62% of American households own a pet ■ 39% dogs ■ 34% cats ■ 58% any Pets less mobile than people Pets less mobile than people Less confounding (smoking, alcohol) Less confounding (smoking, alcohol) Explore environment (smelling, licking) Explore environment (smelling, licking) Shorter latency time (exposure to disease) Shorter latency time (exposure to disease) More sensitive to fixed pathogen dose? More sensitive to fixed pathogen dose?

Data Warehouse Data Mining >550 hospitals18,000 hospitals Purdue University National Companion Animal Surveillance Program (NCASP)

Banfield The Pet Hospital Banfield The Pet Hospital Currently >560 full service hospitals Currently >560 full service hospitals Add 2 new hospitals per week Add 2 new hospitals per week Located in 44 states, Mexico, UK Located in 44 states, Mexico, UK >3.0 million patient visits yearly >3.0 million patient visits yearly ~ 10,000 patient visits daily ~ 10,000 patient visits daily ~ 1-2% of U.S. pet population ~ 1-2% of U.S. pet population Addresses of pets geocoded Addresses of pets geocoded Web addresss: Banfield The Pet Hospital Web addresss: Banfield The Pet HospitalBanfield The Pet HospitalBanfield The Pet Hospital

Banfield The Pet Hospital Banfield The Pet Hospital Paperless practices Paperless practices Standardized medical records Standardized medical records Computerized records sent nightly to central data warehouse Computerized records sent nightly to central data warehouse Subjected to quality control Subjected to quality control Corporate HQ in Portland, OR Corporate HQ in Portland, OR

Banfield PetWare Proprietary Software Office Visits Pet Demographics Exam findings Diagnoses Laboratory Results Medical Notes Treatments

Banfield Hospital Locations in Major Metropolitan Areas as of June 13, 2006 Atlanta Los Angeles Chicago PhoenixDallas Washington DC

Number of Dogs & Cats Visiting Banfield The Pet Hospital in 2005

Number of Other Animal Species Visiting Banfield The Pet Hospital in 2005

Medical Records Vector ID Pathogen ID Ticks: Anaplasma sp, Babesia sp, Bartonella sp, Borrelia lonestari, Erlichia sp, Francisella tularensis, Rickettsia sp Fleas: Bartonella sp, Dipylidium caninum, Mycoplasma sp, Rickettsia sp, Yersinia pestis Web Portal National Flea/Tick Pathogen Surveillance

Relationship between Canine Tick Activity & Human Lyme Disease

Change in frequency of respiratory syndrome in pets following hurricane Katrina

Alert!!! Fayette County-GA’s Own “Silent Summer” Fayette County-GA’s Own “Silent Summer Fayette County-GA’s Own “Silent Summer Philips Services, Corp. plant emits noxious chemical Philips Services, Corp. plant emits noxious chemical 600 residents sickened by onion-like chemical odor 600 residents sickened by onion-like chemical odor Like their owners, many dogs and cats are sick, nearly all within 2-mile radius of PSC plant Like their owners, many dogs and cats are sick, nearly all within 2-mile radius of PSC plant Pets dying from June-Aug. with signs of vomiting, diarrhea, skin irritation, dyspnea Pets dying from June-Aug. with signs of vomiting, diarrhea, skin irritation, dyspnea Chemical pesticide identified as Ethoprop Chemical pesticide identified as Ethoprop Purdue contacted Sept. 2 for help regarding the acute & long-term health of animals and residents in community Purdue contacted Sept. 2 for help regarding the acute & long-term health of animals and residents in community

Banfield Hospitals Near Fairburn, GA Georgia Dept of Health Chemical Hazards

Banfield Dogs and Cats Living Within 15-miles of Chemical Plant in Fairburn, GA Banfield Dogs n = 15,753 Banfield Cats n = 3,065 Fairburn Chemical Plant

Fairburn Georgia ♦ Respiratory syndrome in pet dogs following possible exposure to a hazardous chemical released during week 26 ♦ Dogs living miles from Fairburn, GA were thought to have had the greatest exposure

Data Warehouse Data Mining >550 hospitals18,000 hospitals Purdue University National Companion Animal Surveillance Program

Leptospirosis World-wide zoonotic disease World-wide zoonotic disease Gram negative bacteria Gram negative bacteria Spirochetes Spirochetes Genus Leptospira Genus Leptospira Over 250 serovars Over 250 serovars

Transmission Direct (hospital) Direct (hospital) Infected urine Infected urine Bite wounds Bite wounds Ingestion Ingestion Indirect (community) Indirect (community) Contact with stagnant or slow moving water contaminated by urine Contact with stagnant or slow moving water contaminated by urine Leptospirosis at triathlon in Illinois Leptospirosis at triathlon in Illinois Leptospirosis at triathlon in Illinois Leptospirosis at triathlon in Illinois

Positive >= 1: Canine Leptospirosis, US,

Highest Percent Positive Leptospira Serovar by State 2004

Summary The National Companion Animal Surveillance System provides complementary syndromic surveillance capability to the more traditional use of human hospital records to detect acts of bioterrorism, emerging infections, and to study health effects resulting from natural and man made disasters such as floods, hurricanes, and accidental chemical releases into the environment The National Companion Animal Surveillance System provides complementary syndromic surveillance capability to the more traditional use of human hospital records to detect acts of bioterrorism, emerging infections, and to study health effects resulting from natural and man made disasters such as floods, hurricanes, and accidental chemical releases into the environment

Summary-con’t The success of parallel animal and human syndromic surveillance ultimately depends on development of better statistical and visual methods to identify correlations between temporal and spatial changes in syndrome frequency in humans and animals and better communication between ALL health care providers The success of parallel animal and human syndromic surveillance ultimately depends on development of better statistical and visual methods to identify correlations between temporal and spatial changes in syndrome frequency in humans and animals and better communication between ALL health care providers

The New Yorker, June 16 & 23, 2003