# Presentation: 196865

## 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)

**Nipah Virus**

**Hendra virus**

**Multidrug resistant *****Salmonella***

**Lyme Borreliosis**

**West Nile**

**Cryptosporidiosis**

**Reston virus**

**Venezuelan**
** ****Equine Encephalitis**

**E.coli O157**

**E.coli O157**

**Lassa fever**

**Yellow fever**

**Ebola**

**Monkeypox**

**Influenza A(H5N1)**

**Rift valley Fever**

**NV-CJD**

**Ross River virus**

**Equine morbillivirus**

**Nv-CJD**

**E.coli non-O157**

**West Nile Virus**

**Reston Virus**

**Brucellosis**

**Hantavirus pulmonary**
** ****syndrome**

**Leptospirosis**

***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**

## Transmission of Emerging Infectious Diseases

- Wildlife EID

- Domestic
- Animal EID

- Human EID

- Translocation

- Human encroachment
- Ex situ contact
- Ecological manipulation
- Human behaviors

- Global travel
- Urbanization
- Biomedical
- manipulation

- Food processing/distribution
- Technology and
- Industry

- Agricultural
- Intensification

- Encroachment
- Introduction
- “Spill over” &
- “Spill back”

**Transmission of Emerging Infectious Diseases**

**Dasazak P. et.al.**
**Science 2000 287:443**

## Factors Promoting Transmission of Infectious Diseases from Animals to Humans

**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**

## Emerging Infectious Diseases 

**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**

**Public Health Detection, Prevention, Control**
**Emerging Infectious Diseases**** **

**Notes:**
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

**Notes:**
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 **

**Rapid Laboratory Diagnosis**

**Notes:**
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**

**Notes:**
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

**Additional information about WNV activity**
** ****is available from CDC at**** **** **_[http://www.cdc.gov/ncidod/dvbid/westnile/index.htm](http://www.cdc.gov/ncidod/dvbid/westnile/index.htm)_** ****and**
- _[http://](http://westnilemaps.usgs.gov/)__[westnilemaps.usgs.gov](http://westnilemaps.usgs.gov/)_** **

## Slide 21

## 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 

**Investigation **
**Of Human **
**Cases**

## Animal 

**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**