1. ADED Zoonoses Rounds February 19, 2008

2. Canine Leptospirosis Surveillance in Washington February 19, 2008 ADED Zoonoses Rounds Liz Dykstra, PhD Zoonotic Disease Program Washington Dept. of Health

3. The Washington State Situation Leptospirosis Overview History Findings Outbreaks Ongoing & Future Work

4. Leptospirosis Overview Leptospira interrogans Aerobic, gram-negative bacteria Spirochete >200 Known pathogenic Serovars Autumnalis Bratislava Canicola Grippotyphosa Hardjo Icterohaemorrhagiae Pomona

5. Clinical Signs & Lab Test Results Vomiting Anorexia Abdominal discomfort Febrile Weight Loss Depression/Lethargy Leukocytosis Thrombocytopenia Azotemia Increased liver enzymes Hyperbilirubinemia Decreased urine specific gravity Mild proteinuria

6. Ecology Mammalian Reservoirs –Settle into kidneys; shed in urine –Reservoir infected for life Also found in fresh water, soil, & mud Janice Carr, CDC 1998

7. How are people and dogs getting leptospirosis? Recreational exposures ie. swimming, bathing or wading in contaminated water, mud

8. Human Cases of Leptospirosis in Washington State http://www.doh.wa.gov/EHSPHL/epitrends/08-epitrends/2008_trend.htm

10. Notifiable conditions and the veterinarian Purpose –Integrate veterinarians into the public health system. –Enhance surveillance for zoonotic diseases, which indirectly enhances human surveillance – Enhance recognition and capacity to investigate emerging pathogens in animal reservoirs –Detect agents used intentionally in biowarfare.

12. Flowchart for Veterinary Notifiable Conditions Veterinarian reports condition to LHJVeterinarian reports condition to LHJ Completes Lepto Report FormCompletes Lepto Report Form Counsels Patient’s OwnersCounsels Patient’s Owners LHJ asks veterinarian to counsel client about zoonotic disease potential and prevention/control measures.LHJ asks veterinarian to counsel client about zoonotic disease potential and prevention/control measures. Completes report formCompletes report form Faxes report to DOH.Faxes report to DOH. LHJ reports condition to DOH LHJ CD Epi/EH is informed about the report Clients know to visit their health care provider if they experience any symptoms and to mention their ill pet. Health care provider may call LHJ nurses for information Vet Clinic Faxes Report to DOH LHJ = Local Health Jurisdiction

13. History of DOH Surveillance Program Vets first required to report notifiable conditions around 2000 Increased concern of bioterrorism potential of zoonotic diseases Increased number of lepto cases showing up vet clinics DOH Lepto reporting program begun in July 2004

14. To be completed by veterinarian To be completed by LHJ

16. Case Definition* Acute onset of clinical signs including at least one of the following: fever, inappetance, abdominal pain, vomiting, jaundice, or polydipsia/polyuria, or oliguria. AND Laboratory findings of azotemia or elevated liver enzymes OR Histopathological diagnosis consistent with leptospirosis AND MAT titer >1:800 for Leptospira OR FA+ urine OR Histological staining of tissues positive for Leptospira *Margaret Davis, DVM, WADDL; 2/27/06

17. Leptospirosis Confirmed by Titer >1:800 (n=183)

18. Morbidity & Mortality (n=183) ~27% Case Mortality

19. Average Monthly Reported Cases of Canine Leptospirosis in Washington July 2004 – January 2008 (n=183)

20. Canine Leptospirosis Cases by County July 2004 – January 2008 San Juan Island Clallam Jefferson Grays Harbor Kitsap Lewis Skamania Pacific Mason Ferry Stevens Lincoln Kittitas Klickitat Columbia Garfield Asotin Okanogan Snohomish Douglas Chelan Spokane King Yakima Skagit Whatcom Pierce Franklin Benton Whitman Walla Clark Cowlitz Thurston Wahkiakum 31+ 10-15 6-9 1-516-30 Figure 1 Pend Oreille Grant Adams Counties reporting human Leptospirosis cases

21. Leptospirosis Cases by Age & Gender (n=183)

22. Leptospirosis Cases by Breed Group (n=183)

23. Exposures Wildlife Raccoons Rats Opossums Squirrels Access to standing or slow moving water

24. Leptospira Serovars Detected

25. Outbreaks Bainbridge Island, King County –December 2006 Vashon Island, King County –Dec 2005–Feb 2006

26. Ongoing and Future Work Vet and Owner Fact Sheets Canine Leptospirosis web site Brochures Downloadable Tools

27. Special Acknowledgements Dr. Jane Koehler – Seattle-King County PH Dr. Sharon Hopkins – Seattle-King County PH Rebecca Baer – CD-Epi, WA DOH Dr. Mira Leslie – Ministry of Agriculture & Lands, BC Dr. Margaret Davis – CVM, WSU Dr. Jim Evermann – WADDL, WSU Dr. Ron Wohrle – ZD Program, WA DOH All of the LHJs and Veterinarians who have provided case reports to this program.

28. Questions? Liz Dykstra Phone: 360.236.3388 Email: elizabeth.dykstra@doh.wa.govelizabeth.dykstra@doh.wa.gov http://www.doh.wa.gov/ehp/ts/zoo.htm