Overview. Global Health: It s a Small World 7/2/15. Emerging Threats in Global One Health: Role of the Small Animal Clinician

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1 Emerging Threats in Global One Health: Role of the Small Animal Clinician Carrie McNeil DVM MPH Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy s National Nuclear Security Administration under contract DE-AC04-94AL SAND NO. SAND C Overview ü Emerging Threats in Global One Health ü Role of Small Animal PracIIoner If you hear meowing from the exam room, expect but are you ready for this? Global Health: It s a Small World Biological incidents, public and animal health emergencies do not recognize or stop at interna=onal borders hpp:// 3 1

2 7/2/15 Global One Health Global One Health Includes US Los Angeles Interna=onal Airport (LAX) 6th busiest airport in the world >900 weekly flights to 34 countries Port of Los Angeles #1 in the US (by container volume) NE Asia (74%), SE Asia (15%) trade by volume Borders interstate and transna=onal 2006 study: ~287,000 dogs, 25% unvaccinated 5 hpp:// Emerging ZoonoIc Threats Newly recognized - or- Newly evolved - or- hpp:// Increased incidence or geographic, host, vector- range expansion of previously- occurring disease (2004, WHO/FAO/OIE) 2

3 Recent Emerging Threats MERS (Coronavirus) Camel possible reservoir Healthcare workers impacted Latest outbreak in S. Korea/China 179 confirmed cases 29 deaths EBOLA (Filovirus) Infected fruit bats, primates possible reservoir Pigs may be infected, shed virus No evidence pets becoming ill or transmiang Healthcare workers impacted Largest known outbreak total in Guinea, Sierra Leone, Liberia deaths INFLUENZA, SARS, NIPAH, BSE an=- microbial resistance, rabies, brucellosis, tularemia Emerging Concerns Months before outbreak detected Panic grows & we don t have answers Healthcare workers at risk Zoono=c likely (though who would ve predicted camels?) Emerging Successes Early case detec=on saves lives Effec=ve risk communica=on is cri=cal Infec=on control saves (healthcare worker) lives Decrease in Ebola cases among healthcare workers may be due to concurrent implementa8on of infec8on control. cdc.gov/mmwr 3

4 First Line of Defense = You Even if your prac=ce is limited to dogs & cats And does not include bats chickens camels pigs Case Study the Companion Animal Vet 4

5 the Companion Animal Vet Prepare: Plan, Train, Equip, Exercise Infec=on Control Plan Not just for emerging outbreaks Improve occupaional health Reduce hospital- acquired infecions Reduce animicrobial resistance Assess risks in your prac=ce Plan Evaluate Organize, Train, Equip Exercise U=lize exis=ng templates (eg. NASPHV) Adapt to fit your pracice needs Make it sustainable * Add in communicaion plan & reporing schemaic Prepare: Plan, Train, Equip, Exercise Train Roles for all staff RecepIon, kennel, techs, vets Possibly ID infecion control lead Include in new staff orientaion Equip & Organize Sustainable, maintainable What do you need stockpiled? Adapt to fit your pracice needs Make it sustainable 5

6 Prepare: Plan, Train, Equip, Exercise Exercise & Evaluate Drills & Exercises Does your plan work? Does anyone follow the plan? Update plan and protocols Can be simple, crea=ve, and quick Handwashing contest RouIne checks for contaminaion Companion Animal Vet cross- sector Detect: Be the Astute Veterinarian Importance of Early Detec=on in One Health West Nile 1999 Local vet treaing sick, neurologic birds (June) Vet pathologist at Bronx zoo & CDC ID WNV (September) SARS 2003 Dr. Urbani alerts WHO about atypical pneumonia, dies month later Detec=on Methodology Complete history Clinical exam Laboratory test 6

7 Companion Animal Vet cross- sector Report: Whom do you call? 2006 Study For unusual symptoms in companion animals, vets might contact: 30% state agriculture agency 23% state public health agency 19% local public health agency 10% CDC/USDA/FDA Only 3% said they did not know Report: Whom do you call Disease surveillance in One Health Agriculture: CDFA, USDA, OIE Human Health: CDPH, Local PH, CDC Environmental Health: CalEPA, EPA, Water Board Companion Animal?? County of Los Angeles, Veterinary Public Health New Mexico DOH plague, tularemia surveillance Laboratory coordinaion for sample collecion Our experience Great opportunity for cross- sector collabora8on 7

8 Report: When do you call? Reportable Diseases & Syndromes Agriculture: CDFA, USDA, OIE Human Health: CDPH, Local PH, CDC, WHO Environmental Health: CalEPA, EPA, SWRCB Companion Animal?? Rabies Plague, tularemia Repor=ng Unknowns, Emerging call even if not on the list Companion Animal Vet cross- sector InvesIgate & MiIgate Cross- sector agency collabora=on Sample handling, storage, disposal Know case defini=on Pa=ent treatment, isola=on Records, records, records Clinical data Epidemiology data 8

9 Companion Animal Vet cross- sector Communicate Client Prepare zoonoic disease talking points Train in risk communicaion I don t know is okay Staff Clear explanaion of risk & miigaion WriPen policies & procedures Community AssociaIon spokesperson Coordinate messaging with agencies Summary Problems Emerging diseases are open zoonoic Booming global travel, trade increase likelihood We, our staff & clients may be at risk Solu=ons ü Develop & PracIce InfecIon Control Plan ü Know who, when & how to report ü Prepare for role as a risk communicator ü Work together to bridge human- animal health sectors 9

10 And remember You are the first line of defense for emerging zoonoic threats from companion animals When you hear meowing, don t be afraid to think Acknowledgements Liz Glenn, UNM Jen Gaudioso PhD, SNL Jason Bolles, SNL Halley Smith MS, SNL Meghan BreP MD hpp://terriermandotcom.blogspot.com/2008/05/rabies- cases- close- to- home.html Photos Halley Smith MS, SNL Jessica Vogelsang DVM Paula Thomas DVM Monear Makvandi MPH, SNL Author QuesIons? Feeling ready for the next (out)break? 10

11 References Gyles C. (2009) InfecIon in Veterinary Clinics. Canadian Vet. Journal. 50(4): Hufnagel et al. (2004) Forecast and control of epidemics in a globalized world. Proc Natl Acad Sci USA. 101 (42): Kahn, L. (2006) ConfronIng Zoonoses, Linking Human and Veterinary Medicine. Emerging InfecIous Diseases. 12(4): Kilmarx PH et al. (2014). Ebola Virus Disease in Health Care Workers Sierra Leone, MMWR. hpp:// preview/mmwrhtml/mm6349a6.htm. McQuiston JH et al. (2008) ImportaIon of dogs into the United States: risks form rabies and other zoonoic diseases. Zoonoses and Public Health, 1-6. NaIonal AssociaIon of State Public Health Veterinarians. (2010) Compendium of Veterinary Standard PrecauIons for ZoonoIc Disease PrevenIon in Veterinary Personnel. Veterinary InfecIon Control CommiPee US General AccounIng Office. West Nile Virus Outbreak. Lessons for Public Helath Preparedness. Washington, The Office, hpp:// Wohl JS. (2007) Public Health Roles for small animal praciioners. JAVMA. 230(4). Wright J et al. (2008) InfecIon control pracices and zoonoic disease risks among veterinarians in the United States. JAVMA. 232: ). Travel and importabon stats portoflosangeles.org, lawa.org Graphics World Outbreak Map: OnehealthiniIaIve.com Health cer8ficate: Ebola Photo: CDC PresentaIon Ebola Outbreak 2014, ScoP Rice OPHPR/CDC Dr.Urbani: hpp:// 11