NASAAEP Symposium 2016 Biosecurity Considerations for Equine Emergency Sheltering Rebecca S. McConnico, DVM, PhD Diplomate ACVIM (LA) Professor of Equine Medicine School of Veterinary Medicine Louisiana State University Equine Branch Director - Louisiana State Animal Response Team
Emergency Sheltering Perfect Storm for Disease Outbreak Comingling of horses of unknown health status Allowing for entry & movement of disease Stabling in close proximity Lack of Biosecurity Allowance of environmental spread of disease No isolation area Stressed & susceptible horse population
Biosecurity A set of preventative measures designed to reduce the risk of transmission of infectious diseases Biosecurity Principles - same veterinary hospital equine event boarding stable emergency sheltering Protecting the health of livestock & personnel by preventing the transmission of disease through physical barriers and hygiene practices. Slide courtesy of L. Pantaleon
Biosecurity
ANIMAL DISEASE ONE HEALTH HUMAN DISEASE ENVIRONMENT Slide courtesy of L. Pantaleon
Considerations Buy-in = Teamwork Every staff member needs to take responsibility for protecting: Animal evacuees All staff members (including self) Reducing the risk of zoonotic disease Veterinarian + public health officials work together on the plan Overall human safety issues associated with taking care of animals Consider having co-located shelters where owners care for their own animals Decreases injuries and work-load Need to coordinate feeding & animal exercise
Standard Operating Procedure (SOP) SOPs are required for sustainability If 1 person is in charge, with little buy-in or oversight of a program (biosecurity or other) there will be little opportunity for carry-over Important for continuity of biosecurity
Zoonotic Infections Infection of animals communicable to humans Deadly Rabies Hendravirus (AUS) Potentially deadly Salmonellosis Cryptosporidiosis Bacillus anthracis C. difficile Non-deadly Ringworm - Dermatophytosis Methicillin-resistant Staphylococcus aureus (MRSA) Brucellosis Giardiasis Leptospirosis
Zoonotic Rabies - Virus Signs Lameness Colic Incoordination Progressive neurologic signs Seizures Coma Death Transmitted Saliva or spinal fluid/neuro tissue with human mucous membrane PPE gloves, booties, coveralls, face protection
Zoonotic Hendra virus Australia Respiratory & Neurologic signs Fatal
Zoonotic Enteric Infections Causes Salmonellosis Clostridium difficile Cryptosporidiosis Giardia Equine corona virus Signs Enterocolitis Diarrhea Debilitation Can be deadly in immunocompromised people ~1% to 2% of healthy horses are shedding Salmonella organisms
Zoonotic Burkholderia mallei Glanders Can be transmitted to Humans Susceptibility to glanders has also been demonstrated in camels, felines living in the wild, bears, wolves and dogs
Zoonotic Brucellosis - bacteria Brucella abortus Can cause fistulous withers in horses Causes infectious lymphadenitis in people Transmitted by contact Can cause intermittent fever, flu-like symptoms Results in sterility in males Problem in laboratory workers
Anthrax High fever Agitation Severe colic Loss of appetite Depression Neurologic signs Labored breathing/suffocation Exercise intolerance Muscle weakness Bloody diarrhea may be observed Swelling of head/neck Chest and lower abdomen swelling Localized skin infection (human) Rapid deterioration/death
Zoonotic Dermatophytosis fungal organism Ringworm
Zoonotic MRSA Methicillin resistant Staph. aureus Cellulitis Pain Heat Swelling Redness Non-healing wound Horse case Human case
Foreign animal diseases Emerging disease or foreign animal disease Required to contact at least 1 of these: 1. State Veterinarian 2. APHIS-VS Area Veterinarian 3. Foreign animal disease diagnostician (Plum Island training) (call early to discuss rather than waiting until it s too late) Eg. Oral lesions Coronary band lesions Neuro-invasive diseases Diagnostic test results
Strep equi equi Clinical signs Most Common and Important Infectious Diseases of Horses Bacterial or Viral origin Bacterial and viral diseases Vague Mimic signs of other conditions Common signs Weakness, ataxia, vague neurologic deficits, fever, diarrhea, nasal discharge, enlarged lymph nodes, and coughing, with laboratory findings including anemia and leukopenia or leukocytosis Exceptions Ringworm infection fungal Endoparasites and ectoparasites can be problematic in certain circumstances WEE
The OIE Top 6 for HHP horses HHP - High Health High Performance OIE World Organization for Animal health 1. African Horse Sickness Not in US 2. Venezuelan Equine Encephalitis Not in the US - (can be Zoonotic) 3. Piroplasmosis 4. EIA (Coggins disease) Equine Infectious Anemia Eradicated from many parts of US 5. Glanders Not in US (Zoonotic) 6. Equine Influenza
Pathogens aren t picky
Vectors! Culicoides no see-ums African Horse Sickness Mosquitoes VEE Ticks Piroplasmosis Tabanids EIA Insect Management Fans/ventilation Insect repellants Manure management Overall shelter hygiene
Who is the official in charge of equine sheltering in a local community during disasters? State veterinarian or designee Coordination of local, regional, state, & national plan ICS Establishing a network of trained/credentialed personnel Emergency managers
Emergency Sheltering Issues -Lessons learned H. Katrina Must use ICS system 12 hr. shifts Span of control for leadership Mostly husbandry Veterinary input for triage, biosecurity, health maintenance Safety & security issues Communication
Biosecurity Plan for an Equine Response Shelter Resource Management Personnel Facility Layout Animal entry/exit Stabling Stall and environmental sanitation plan Manure/bedding disposal Water source & disposal Feed/Hay storage Horse to horse contact Traffic Record keeping
What needs to be considered for determining an appropriate equine shelter for emergency response? Overall Goal Keep/move animals out of harm s way without adding to the risk i.e. gridlock traffic in summer heat Shelter-in-place option Requires Appropriate pre-storm or pre-event planning Early evacuation Consider typical emergencies for different areas of the country Shelters to be far enough from harm if there is an impending disaster but in close enough proximity for practical purposes.
What needs to be considered for determining an appropriate equine shelter for emergency response? Identify potential facilities Involve these groups in planning & mitigation 1. State equine councils 2. Other state, regional, and local community equine stakeholders 3. Shelter resource options Compiled by state animal response teams Communicated with state veterinarian s office Should be updated yearly
Shelter Considerations Size of facility Large enough to provide for a separate area for sick animals Isolation Maintain sick animals at 35 feet from presumed healthy animals (ie. EHM, Strangles) Memoranda of understanding/agreement with facility owner Examples University livestock exhibit/handling facilities Stockyards Sale barns Feedlots Private/public-owned livestock arenas/expo centers Fairgrounds Horse activity centers Exhibition facilities Race tracks Private horse farm
Shelters Safe animal handling/holding areas Stalls, gates, and fences good working condition Water & other utilities available Safe & secure Enough space to separate groups isolation area stallion area
Equine Shelter Facilities Need to be cleanable Cleanable surfaces Cinderblock walls are used in construction Require painting with epoxy-type paints to maximize cleanability Most horse facilities Wood Concrete blocks Asphalt Metal Rubber mats Commercial flooring materials Floors made of sand, dirt, compacted clay or other organic materials cannot be adequately disinfected.
Animal Holding Areas Individual stalls Portable stalls Round pens/panels Rolled plastic webbing/fencing to segregate 2 layers of fencing separated Limits nose-to-nose contact Unfamiliar horses grouped together in paddocks or round pens 6-8 animals per 50 ft. round pen allow enough space so that pecking order activities can safely occur
Biosecurity planning Veterinarian s Role Work with public health veterinarian ICS/ESF structure Credentialed? Licensed? Accredited?
What should be done to ensure that shelter horses medical needs and health maintenance are managed appropriately? Veterinarian s responsibility Overall health management of an equine evacuation and/or response shelter Daily nutritional management Physical condition Medical care of all sheltered horses Shelter biosecurity Work with public health officials regarding the overall human safety issues associated with taking care of shelter horse protects the volunteers as well as well-intentioned but curious by-standers and others
Biosecurity/Isolation If isolation procedures cannot be followed for animals entering a shelter Increase surveillance and health checks at entry Use Separate Equipment Grooms/care takers can sometimes be restricted to working only in specific barn and barns equine population at an event can be partitioned
Veterinarian s Role with Emergency Sheltering All horses should be examined by a veterinarian as soon as possible upon admission Within at least within 12 hours Sick horses need to be separated as soon as possible Fever Nasal discharge Lethargy Diarrhea Maintain in individual stalls in a remote area (at least 35 feet) from the rest of the sheltered animals Handled by separate, dedicated, trained shelter personnel wearing appropriate barrier precautions (PPE)
Which patients need to be isolated? Require only mild barrier precautions & stall signage Minor barrier precautions - gloves or disposable boots Brucellosis Ringworm infection Leptospirosis Infection with methicillinresistant Staphylococcus aureus Staphylococcosis
Which patients need to be isolated? Higher Level Understanding a suspected disease is critical to ensuring effective control Understanding the route of transmission is important for determining the risk factor Route of transmission may not require patient isolation Venereal diseases (e.g., equine metritis) Some blood-contaminating and insect-borne diseases (e.g., equine piroplasmosis) Public perceptions EIA? Patients with GI diseases with zoonotic potential Clostridium spp, Escherichia coli Equine corona virus Salmonella spp. Common diseases that require isolation Salmonellosis Strangles Influenza Rotavirus infection Equine corona virus Herpesvirus EIA Rabies
Managing Disease Outbreak Have a biosecurity & Record diagnostic response plan testing results Maintain a log & Delegate tasks that do detailed medical not require execution record: by a licensed Case identification veterinarian which horse(s) got sick, Utilize licensed where, & when veterinary technicians Control measures Sample collection implemented Physical inspections, temperature recording Horse movement within facility, entering and exiting facility
Stopping movement Biosecurity kit Disinfectants, gloves, foot baths, signs Can be obtained quickly Can be improvised Protocols Hardest to control Improvised necessary Required to control spread and introduction of infection Veterinarian actions Authorization for movement of animals Stall and other environmental cleaning» specific and generic protocols
Horse Management Notify veterinarians responsibility to report Health requirements for access to shelter and make necessary notifications: Health Certificate +/- disease specific disclaimer Coggins Test Vaccinations (requirements vs. recommendations) Horse tracking system: Origin and date/time of arrival Location of horse while present at shelter Contact info for individual responsible for horse Contact info for attending veterinarian Destination and date/time of departure Mode of transport
Environmental Harboring of Organisms Organic Material Environmental presence can render some disinfectants useless Manure Urine Blood Discharges Dirt
Disinfectants Many bacteria can be killed using several disinfectants Enveloped viruses most easily killed detergent breaks apart the envelope Rotavirus is non-enveloped Can withstand freezing temperatures Can remain alive for > 9 months at room temperature Even when dried on a surface, rotavirus can be infective to foals for several hours Disinfectants which can kill rotavirus can kill the other known equine pathogens
Soap, Scrub, Rinse, Dry, Disinfect, Dry Organisms - organic Matter Manure Rotavirus, Salmonella spp. and R. equi Urine Leptospira spp. Nasal secretions Streptococcus equi var equi Influenza virus Herpesvirus The importance of disinfectant efficacy in the presence of organic matter cannot be overemphasized
Disinfectants Choice of disinfectants is critical, and many factors must be considered Ability of the chemical to be germicidal: on the surface germicidal - relevant pathogens Efficacy in the presence organic matter hard water Cost? Biodegradability? Safety for animals and humans
Disinfectants Quaternary ammoniums less expensive Peroxygen disinfectants and accelerated hydrogen peroxide Bleach One of the most common household & workplace disinfectants Oxidizers Quick kill & better than bleach in the presence of organic debris Phenolics Biguanides
PPE Personal Protective Equipment Barrier nursing precautions Sick or high-risk animals Barriers Disposable plastic gowns Gloves Plastic or rubber over boots Footbaths for each patient Smocks Laboratory coats or coveralls Closed-toe footwear - easily cleanable such as rubber over-boots
Decontamination Dawn dishwashing liquid Thorough rinsing Proper disposal of effluent Barrier precautions for bathers Water repellent Water resistant Requires medical monitoring of personnel for over-heating
Good Hygiene Is Critical Between animals in a high risk situation wash hands or use an alcohol-based hand sanitizer sanitizer works only if no gross debris or dirt is present Always wash your hands thoroughly with an antibacterial soap before eating or drinking Hand-washing stations the more the better! Many who work in equine health care have pets or other animals to care for Important to change clothing and shoes If possible, shower after working with ill animals to reduce the risk of disease spread.
Biosecurity Kit AAEP.org additional information Part of shelter supply list Examination gloves (1 pr/horse) Dedicated coveralls/animal examination (or group of like animals) Impervious to upper body toward secretions - nasal discharge Plastic shoe covers Head covering (for isolation cases) Spray container of disinfectant Soles of shoes or boots Hand sanitizer Hand soap with water source would be
thehorse.com HORSE (Colonize Infected) PEOPLE (Hands Feet) ENVIRONMENT horse-journal.com Slide courtesy of L. Pantaleon
Vaccinations Manure, soil & dust harbor many organisms Can t disinfect everything Appropriate vaccination and management can be used to control many of these disease agents
Vaccinating During Disaster Response Risk assessment Require tetanus toxoid booster Vaccinating extremely stressed horses with respiratory and encephalitis vaccines may not be necessary and may even contribute to adverse reactions If it is determined that the horses will remain in a shelter for a prolonged period of time, then mass vaccination for contagious equine respiratory viruses may be indicated (influenza & EHV 1 & 4).
Dealing with the Media Gulf Oil Spill 2010
What if something goes wrong Authority do you have it? What are your responsibilities? What are your options? Beware of being the default scapegoat if things go wrong A good scapegoat is just about as good as a solution to the problem
What kinds of supplies are needed for stocking an equine shelter? Water buckets Halters Lead ropes Louisiana State Animal Response Team Stockpiled 100 each water buckets, halters, lead ropes
Pre-planning Owners Responsibility
Medical Triage Done rapidly and involves examining individual animals One approach is to use the following four physiological criteria (RPPN): Respiration/minute Pulse rate/minute Pulse pressure (although subjective, pulse pressure has a linear relationship to stroke volume. Therefore, if the pulse pressure is decreased (as you might see in shock) the stroke volume is also likely decreased) mucous membrane color and character; limb temperature Neurological status
Triage Triage for suspected infectious disease Animals requiring hospital level care in an equine shelter should be transported to an equipped veterinary hospital MOU with local or regional veterinary hospitals
EIA Coggins testing Coggins test status should be determined prior to their admission Don t turn horses away without Coggins testing Plan to test A specific animal identification team headed by a veterinarian is helpful with organizing EIAV testing Animal data sheets can be created for individual horses Information stored secure location Animal release form may be used to document owner retrieval of the horse from the shelter
Resource Management Personnel Establish 'chain of command' Verify contact information for: State Department of Agriculture Veterinarian USDA Area-Veterinarian-In-Charge Area practicing veterinarians Assess personnel resources and skill level: Veterinarians Veterinary technicians Laypersons Assess communications needs and designate specific individuals for communications tasks
Shelter Workers Volunteers or Owners or Both Owners Horse owners (consider limiting the number per family) day-to-day care daily feeding watering hand walking for exercise Decreases risk of human injury associated with working with unfamiliar horses Limits the number of volunteers needed to run the shelter
Volunteers or Owners or Both Volunteers Credentialed ICS Trained Work within the system MOU with NGO Work with trained groups! NGO s Military Local livestock groups
Utilizing these resources on a local level Memoranda of Understanding (MOU or MOA) Outline a specific understanding of parameters of deployment, chain of command and the requests that will be made of the national organization As local capabilities mature, these MOA s should evolve Defining specific needs, eg ICS command team, shelter management expertise, financial organization Local planners need to be aware of all of the MOU s in place for each organization within their region
What the Big Humane Groups Can Do Highly trained Disaster Response Teams ICS training and special skills Global understanding of Disaster Response Maintain expertise in communications, safety, logistics, administration, finance, public relations Rapid mobilization of volunteers with training and experience Expertise on management of emergent volunteers Shelter set-up and management expertise.
What the Big Humane Groups Can Do Search and Rescue expertise required for coordination with human SAR. Training courses -- local and state-wide Resource development and willingness to commit financial resources; help with donations management Some maintain distributed disaster response mobile units, safety and support equipment Working with FEMA/USDA and each other toward national animal response plan. Formation of National Animal Rescue and Sheltering Coalition (NARSC) Working with governments and Red Cross to encourage set-up of Pet-Friendly Shelters
Pet Identification
Animal Identification Coggins database Identification of all horses testing negative for Equine Infectious Anemia (federally regulated disease) Required in Louisiana Brand Tattoo Microchip
Encourage owners to identify their pets Permanent Brand (large animal) Microchip Microchips require a chip reader Can t see from a distance Lip/ear tattoo Temporary Needs to have owner contact info if possible Luggage tag Metal collar tag Tab bands Ear tags Pictures Keep in folder with medical records/papers Face/front view Side view
Resources AAEP AVMA TAMU LSART ASPCA IFAW Code 3 TLAER American Humane Red Rover UC-Davis NARSC HSUS OSU UF USDA NASAAEP FEMA State Depts. Of Ag Animal Health Commissions OIE LDAF SDMI
Equine Team Formed sheltering teams for the northern and southern portions of the state aka. kicking team & receiving team Equine Response Sheltering - Leadership North LA Tech Central & South LSART Veterinarians/Vet Techs Shelter Volunteers La Tech Equine Science Program Student & staff LSU SVM students & LSU Pre-vet students LSART Volunteers
Building Community Resilience!
Director of LSART Dr. Renee Poirrier