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  • for today, Ms. Ria Ghai.

  • Ms. Ghai, you may begin.

  • >> Thanks so much, Brad.

  • Good afternoon everyone.

  • My name's Ria Ghai, and I work at the One Health office

  • of the National Center of Emerging

  • and Zoonotic Infectious Diseases at the Center

  • for Disease Control and Prevention.

  • On behalf of the One Health office,

  • I'm pleased to welcome you to the monthly Zoonoses

  • and One Health Update call for today, February 5th, 2020.

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  • Before we begin today's presentation, Colin Basler,

  • a veterinarian epidemiologist with CDC's National Center

  • for Emerging and Zoonotic Infectious Diseases will share

  • some news and updates.

  • Colin, please go ahead.

  • >> Thanks, Ria.

  • Hi everyone.

  • Thanks for joining us for today's ZOHU call,

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  • To begin today's call, I'd like to share some highlights

  • from the One Health News from CDC included

  • in today's ZOHU call email newsletter.

  • CDC's latest antibiotic resistance investments map is

  • now available.

  • And the United Nations has declared 2020 the international

  • year of plant health.

  • Some upcoming conferences include two here in Atlanta.

  • The 2020 Inform Conference will be from March 9th

  • through the 12th, and the 2020 Epidemic Intelligence Service

  • (EIS) Conference will be from May 4th through 7th.

  • Applications are being accepted

  • for the David J. Sencer Scholarship

  • to attend the EIS conference.

  • We've shared links to recent publications

  • on several topics including: pool code updates and use

  • of the model aquatic health code in the local jurisdictions;

  • rabies outbreak in captive big brown bats used

  • in white-nose syndrome vaccine trials; and the AVMA guidelines

  • for the euthanasia of animals, the 2020 edition,

  • has just been published.

  • Recent publications in the Morbidity

  • and Mortality Weekly Report

  • of interest include Candida auris isolates resistant

  • to three classes of antifungal medications, New York, 2019.

  • Notes from the field about the 2019 multistate outbreak

  • of Eastern equine encephalitis virus.

  • And a third publication

  • that just went live a few minutes ago,

  • the MMWR on the initial public health response

  • and interim guidance for the 2019 novel coronavirus outbreak,

  • United States, December 31st, 2019 to February 4th, 2020.

  • Regarding outbreaks, CDC is closely monitoring an outbreak

  • of respiratory illness called

  • by a novel coronavirus first identified in Wuhan,

  • Hubei Province, China.

  • Please see CDC's website for more information,

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  • A new outbreak of salmonella infections list

  • to small pet turtles has been posted.

  • And updates for outbreaks of E. coli infections linked

  • to romaine lettuce and Fresh Express Sunflower Crips Chopped

  • Salad Kits have also been posted.

  • A selected list of ongoing and past U.S. outbreaks

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  • Again, thank you for supporting the ZOHU call

  • and for joining us today.

  • We've got an exciting lineup of speakers and topics,

  • and I'll now turn the call back over to Ria.

  • >> Thanks so much, Colin.

  • Today's presentations will address one or more

  • of the following objectives.

  • Describe two key points from each presentation.

  • To describe how a multisectoral One Health approach can be

  • applied to the presentation topics.

  • To identify an implication for animal and human health.

  • To identify a One Health approach strategy

  • for prevention, detection or response

  • to public health threats.

  • Or finally, to identify two new resources from CDC partners.

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  • You'll find resources and links for all presentations

  • on our website an in today's ZOHU call email.

  • I'm now excited to announce our first presentation

  • which is called Ticks, Tortoises and Tick-borne Relapsing Fever

  • in the Mojave Desert which will be given by Molly June Bechtel.

  • Molly, please go ahead and begin when you're ready.

  • >> Thank you.

  • So, today I'm going to talk

  • about a very understudied relationship between a vector

  • and its host, the desert tortoise, in the Mojave Desert.

  • I'm going to start by giving some background

  • on the Mojave Desert tortoise.

  • The Mojave Desert tortoises are keystone species.

  • They create a lot of habitat with their burrows for a myriad

  • of species from rodents to birds to even insects.

  • Unfortunately, their populations have been declining

  • since the 80s, and they were listed as threatened

  • by the U.S. Fish and Wildlife Services in 1990.

  • Tortoise populations are monitored because in order

  • to keep tabs on the populations, per government regulation,

  • and we look for things like clinical signs of disease

  • as well as other morphometrics just like size

  • of the tortoise and weight.

  • Ticks are also often noted

  • on these tortoise health assessments.

  • In fact, ticks are known

  • to commonly parasitize desert tortoises,

  • and the two species we know

  • that do commonly parasitize tortoises are ornithodoros

  • parkeri and ornithodoros turicatae.

  • They're often called tortoise ticks,

  • especially in the tortoise literature.

  • Mostly because they're difficult to identify.

  • You have to count the number of bumps on the back,

  • on their backs to be able

  • to distinguish the two species apart.

  • Or they're also just listed as ornithodoros species

  • when they're found on tortoises.

  • So, these are soft ticks,

  • and their biology is a little bit different than hard ticks.

  • They are nidicolous, meaning that they like to be

  • in dark burrows and dark places.

  • Tortoises really create excellent habitat

  • for these guys and their burrows.

  • They're generalists, which means they're not specific

  • to one particular species for the blood meal.

  • They'll feed on anything, any animal that comes their way.

  • And they commonly parasitize other tortoises.

  • They're also vectors of the causative agent

  • of tick-borne relapsing fever.

  • Tick-borne relapsing fever is caused by a wide variety

  • of species in the genus Borrelia.

  • It's a familiar genus because Lyme disease is also caused

  • by a species of Borrelia.

  • But I'm going to be focusing on the relapsing fever Borrelia

  • that occur in the new world.

  • And you can see the new world clade include three species

  • of Borrelia, two of which are specialized

  • with their tick factor, ornithodoros parkeri

  • and ornithodoros turicatae, that occur in the Mojave Desert

  • and parasitize desert tortoises.

  • Both species of Borrelia cause tick-borne relapsing fever

  • or TBRF in people.

  • TBRF is characterized by high fever,

  • around 103 to 105 degrees.

  • Headache, muscle and joint aches, symptoms very similar

  • to the flu, except these symptoms will reoccur.

  • So usually with a fever and other symptoms lasting

  • for about three days followed

  • by a febrile period for about a week.

  • And then those symptoms will return for another three days.

  • This cycle can occur several times without treatment.

  • Sometimes symptoms will resolve on their own, but it's treated

  • with antibiotics like doxycycline.

  • And this could also occur and passed if they get bit

  • by a tick carrying relapsing fever group Borrelia,

  • which is dogs.

  • These relapses are due to the ability of a Borrelia

  • to undergo multiple cyclic anagenic variations.

  • So, what happens is Borrelia invades our antibodies

  • by switching the surface proteins they express

  • and become unrecognizable to the immune system.

  • These relapses can make TBRF difficult to diagnose, but also,

  • people will go into the doctor, complain of symptoms

  • that are very similar to the flu,

  • and they'll be prescribed antibiotics and get better.

  • And then they're never tested for TBRF.

  • So, it's thought that TBRF is underreported.

  • Regardless, ticks are common in desert tortoise habitat

  • and do come in contact with people, which suggests

  • that they are a transmission risk.

  • But very little is known about the ticks in the Mojave,

  • and even less is known about the relationship

  • to their host, the desert tortoise.

  • We do know, though, that about 10%

  • of wild desert tortoises are sampled are parasitized

  • by ticks, and almost half

  • of all active tortoise burrows are invested,

  • particular with ornithodoros parkeri.

  • So, we also know that tortoises create habitats for rodents,

  • which are documented as reservoirs

  • of TBRF Borrelia group in other parts of the country.

  • So tortoises may not even be a part

  • of this transmission cycle other than serving as a source

  • of nutrition and creating habitat for these ticks.

  • But the fact remains that tortoise biologists do come

  • in contact with these tick species as well as hundreds

  • of pet owners in Las Vegas who have adopted desert tortoises.

  • And these ticks are competent vectors of a pathogen

  • that is harmful to people.

  • So there is a to be addressed of transmission,

  • and doctors should consider tick-borne relapsing fever.

  • In fact, we do have two cases to illustrate

  • that it is a transmission risk.

  • So the first case study I'm going to talk

  • about happened in 2017.

  • This happened to a tortoise biologist that was working

  • at a study site about two hours north of Las Vegas.

  • She was out sampling wild tortoise burrows.

  • She did notice that there were ticks around the burrow,

  • and about a week after she got home from her field trip,

  • she became ill with a high fever.

  • Then the high fever went away after a few days only to return.

  • So we actually took a blood sample,

  • and she did test positive for TBRF Borrelia by QPCR.

  • The second case happened a bit more recently.

  • Again, this is the tortoise biologist,

  • except she was working at a captive site near Las Vegas,

  • and that captive site is pictured

  • in the middle picture there to the right.

  • After working in this captive site digging up burrows,

  • about a week later she did notice that she had been bit

  • by a tick, and she became ill with a very high fever

  • and other flu-like symptoms.

  • And this cycle repeated

  • until the third cycle actually prompted her to go to the ER.

  • And because she was aware of the case that occurred in 2017,

  • she asked the emergency room doctors to test her

  • for Borrelia, and she did test positive for Borrelia,

  • and was treated with Doxycycline,

  • and her symptoms subsided.

  • So we do have two confirmed cases

  • of tick-borne relapsing fever occurring in the Mojave Desert

  • after exposure to these tortoise ticks.

  • So we want to learn more about the relationship

  • between this vector and the host, the desert tortoise.

  • Because these ticks are a risk factor

  • for not only biologists but, like I mentioned,

  • desert tortoise pet owners that live throughout Las Vegas.

  • To shed some light on this relationship,

  • I analyzed the tortoise health assessments that are required

  • by the government,

  • and I analyzed health assessments from 2007 to 2017.

  • I looked at presence in relation, tick presence,

  • in relation to tortoise morphometrics, location

  • and clinical signs of disease.

  • So I used the GLM and I binned my ticks into categories based

  • on the range they're given on the health assessment datasheet,

  • because I'm not asked for an exact number.

  • So I use a median number for each range.

  • And in instances where ticks are recorded as greater than ten,

  • I just use the number ten.

  • And in rare cases when the technician actually counted the

  • exact number of ticks that were observed on the tortoise,

  • I used that exact number.

  • I also binned clinical signs

  • into total number of clinical signs.

  • My initial analysis, I found

  • that about 8,341 ticks were noted on tortoises

  • over this ten-year period.

  • 494 of these ticks occurred on tortoises

  • at the study site Coyote Springs,

  • which is where case one was exposed to ticks.

  • But most of them, almost 7,000 ticks,

  • were noted on tortoises at captive sites.

  • And this is where case two was exposed to tortoise ticks.

  • So, from my model, I found that ticks were more likely

  • to be found on females than males,

  • and they were statistically significantly more likely

  • to be found on captive sites

  • than wild sites, which makes sense.

  • And as far as my clinical signs go,

  • I found that ticks were associated more with a tortoise

  • that has a very low body condition score of three or one

  • that has a very high body condition of seven,

  • as well as weak posture and a higher number

  • of total observed clinical signs.

  • While fewer ticks were observed

  • on tortoises with forage evidence.

  • But what can we glean from this analysis

  • about tick and tortoise biology?

  • Well, ornithodoros ticks could be described as lazy,

  • although they are just really well adapted

  • for harsh environments like the Mojave Desert.

  • These ticks stay in their burrows and nests,

  • and they don't quest like hard ticks do for blood meal.

  • They're happy to just wait in their dark burrow

  • for something to come along.

  • In fact, some ticks have been documented to go for a year

  • or more without a blood meal.

  • So it makes sense then that tortoises

  • that have a higher site fidelity, like females

  • that don't go from burrow to burrow looking for males

  • for mates, would have a higher likelihood of getting ticks.

  • Same goes for captive tortoises and tortoises

  • that have more cynical signs of disease,

  • which they just may not be feeling so hot

  • so they're choosing to stay in their burrows.

  • But captive tortoises don't have a choice.

  • So it would seem that if tortoises are

  • in their normal natural healthy desert environment,

  • they can scrape off ticks

  • and choose different burrows, which is good.

  • Especially because captive tortoises are also more likely

  • to come in contact with people.

  • So, to add to this story, oh, and tortoises

  • with forage evidence, then it makes sense

  • that they wouldn't have as many ticks observed on them

  • because they can scrape the ticks off

  • because they are walking along through the desert looking

  • for forage, things to eat, so ticks can either be scraped off

  • as early as in the burrow, or they can decide

  • to jump ship just because that intense sun is something they

  • want to hide from.

  • And they can hide under a rock or a dark piece of vegetation

  • as the tortoise is wondering about the desert.

  • To add to the story, we tested ticks collected from tortoises

  • for Borrelia, and interestingly, we found only 7 out of the

  • over 900 ticks that were tested positive for Borrelia,

  • which is less than a 1% prevalence.

  • It's pretty low, especially considering the density of ticks

  • that are found in tortoise burrows.

  • So TBRF is endemic in the West, but very little is known

  • about the strains that occur in the Mojave Desert.

  • In fact, this map on the top right corner from Forrester,

  • et al, includes cases of tick-borne relapsing fever

  • that were caused by ornithodoros hermsi.

  • Nothing is known about the prevalence of Borrelia parkeri

  • and Borrelia turicatae.

  • So going back to that low prevalence rate

  • in the tortoise ticks, there is an interesting relationship

  • that exists between reptiles and ticks in Northern California,

  • where we see ixodes pacificus, the hard tick,

  • that carries the Lyme group Borrelia

  • and causes Lyme's disease and sceloporus occidentalis

  • of this lizard that occurs in the same habitat.

  • So what happens is that it's been found

  • that this lizard has a component in its blood,

  • and you'll notice it's a Borreliacidal factor

  • or a Borrelia killing factor.

  • So when these ticks come up and take a blood meal

  • from this lizard, the Borreliacidal factor

  • in the lizard's blood actually kills any pathogen, any Borrelia

  • that that tick may be carrying.

  • So it leaves that tick incapable of transmitting disease

  • because the Borrelia has been killed.

  • So, what's really cool about this is in areas

  • in Northern California where we see more lizards,

  • we actually see fewer infected ticks.

  • And this Borreliacidal factor is related

  • to a thermal lay bioprotein that does occur

  • in reptiles such as tortoises.

  • But no research on resistance or susceptibility

  • to tick-borne disease in desert tortoises exist.

  • So this research is really just scratching the surface of ticks

  • and tick-borne relapsing fever in the Mojave Desert,

  • but we'd like to learn more about the relationships

  • between tortoises and ticks.

  • Rodents also share burrows, as I mentioned, with tortoises.

  • So we don't know if they are helping to maintain the pathogen

  • and tortoises are creating this perfect habitat

  • for a potential reservoir hosts as well as the ticks.

  • Which would help maintain Borrelia in the system

  • or if they do have a Borreliacidal factor

  • in their blood, like the lizards in Northern California,

  • and are helping to keep Borrelia at a very low prevalence.

  • Regardless, we know

  • that tick-borne relapsing fever cases may increase

  • as people continue to encroach on the Mojave Desert,

  • and research to better understand the somatic disease

  • dynamic is important to maintaining public health

  • and potentially to help conserve populations

  • of the threatened desert tortoise.

  • So with that, I'd like to thank all of my collaborators

  • and funders as well as the Zoonoses

  • and One Health Updates call for giving me the opportunity

  • to talk about this cool research.

  • >> Thanks so much, Molly.

  • That is indeed very cool research.

  • So our next presentation is 2019 AAFP Feline Zoonoses Guidelines.

  • And this will be given by Michael Lappin.

  • Michael, when you're ready, please begin.

  • >> Thank you very much.

  • That was a great first talk, and I'm quite honored

  • to be on the call today.

  • This is my first experience, even though I've gotten to work

  • with the CDC in a number of different ways over the years,

  • including with our WSAVA One Health committee,

  • which I'll talk about in a few minutes.

  • But certainly, anyone has follow up calls,

  • I believe Helen has made the email address available already.

  • Please follow up as indicated.

  • I direct the Center for Companion Animal Studies

  • at Colorado State, which is a nonprofit that's really our

  • mission is to promote research by young people.

  • We fund a number of seed money grants

  • to help people do clinical.

  • Usually non-fatal research.

  • But today I'm serving as a representative

  • of the American Association of Feline Practitioners.

  • As you can see, I'm a DVM.

  • My PhD is in parasitology, and I'm board certified

  • in small animal internal medicine.

  • This particular call does not have any direct competition

  • or any conflicts to report,

  • but I do always thank all the different sponsors

  • of our student granting projects,

  • the Young Investigator Awards for giving gift money

  • to help promote research

  • by the next generation of veterinarians.

  • So for today I'd like to introduce you

  • to our WSAVA One Health committee.

  • Michal Day from Bristol was our founder.

  • It was his dream to have this small animal group be more

  • active on the world stage for One Health issues.

  • If you're not familiar with our group,

  • we now have over 120 member countries or delegations

  • around the world, and because of the AVMA being part

  • of our group, that puts us over 200,000 veterinarians

  • that we contact, hopefully, with our work.

  • Casey's been our representative for the CDC since the inception

  • of this particular endeavor, and as you can see,

  • we currently have two medical doctors that serve

  • with William working mainly with comparative oncology and Chand,

  • who's a DVM, is the other part of comparative oncology.

  • Peter is an MD in Rhode Island that just happens to be married

  • to a feline specialist,

  • so he does recognize the health benefits of pet ownership.

  • So this particular group has been involved

  • with the AAFP zoonoses committee, which we'll talk

  • about today indirectly as well as directly.

  • So, for example, Peter co-serves on our AAFP zoonoses guidelines,

  • as well as our One Health committee.

  • And as we develop these guidelines,

  • which are the second edition.

  • The first edition was over ten years of age,

  • so we felt that it was time to refresh these.

  • What we've done with our guidelines,

  • if you're not familiar with the AAFP,

  • which by the way is catvets.org.

  • If you're not familiar with our guidelines,

  • we tend to find topics that we believe are important.

  • We often co-sponsor with the International Society

  • of Feline Medicine, or we will co-certify each

  • other's guidelines.

  • This particular document, Carol Glasser from Pediatric AIDS

  • in San Francisco in the old days,

  • Carol was a repeat medical doctor that's also a doctor

  • of veterinarian medicine on this particular document.

  • Bottom line is then a group of these feline specialists

  • or feline-interested individuals.

  • Then we interact with attempting to come up with a document

  • that we feel is probably most commonly read by veterinarians.

  • But we are attempting to advance our One Health mission

  • by interacting more closely

  • with our especially primary care physicians.

  • This particular page is just to point out that this document

  • when we had finished

  • at the committee level had approval from our board.

  • We also then asked the Companion Animal Parasite Council,

  • which is one of the parasite groups in the United States,

  • WSAVA, and the International Society of Medicine,

  • to evaluate the document for accuracy for one thing

  • and then also to whether or not they wanted

  • to state an endorsement.

  • The messages that I wanted to get across to the group today,

  • which I know has a great mix of different types of scientists,

  • is that practicing veterinarians,

  • they have to know many different things, multiple species,

  • infectious diseases, and One Health issues is obviously not

  • or only thing that we need to focus on in our practices.

  • So it's great that we have such excellent resources

  • like the capcvet.org for the American parasite guidelines.

  • The ESCCAP group has had theirs translated

  • into several different languages, very similar

  • to the American guidelines, and all the great work

  • that the CDC has done with healthy pets, healthy people,

  • and that's been great to interact

  • with that team, including Casey.

  • So that's one of my most important go-to sites

  • when I'm working with my lay people owners of cats.

  • And then, of course, Bayer has done a nice job

  • with their CVBD site.

  • If nothing else are world occurrence maps

  • for when animals come into the United States

  • and we don't actually know,

  • a practicing vet might not know what vector borne diseases were

  • endemic in that country.

  • Those worldwide occurrence maps are quite helpful.

  • We also work with the other publications from the NIH,

  • other federal agencies.

  • AIDS info has been used, you know, quite frequently

  • by our group and others over the years trying to really educate

  • that variance for the most part.

  • And then make sure that our veterinarians and physicians

  • that are helping these family units, folks that own cats are

  • on the same wavelength.

  • Some of the graphics that have been developed are just

  • fantastic and really, I think, is very helpful

  • in helping people understand

  • that they can potentially enjoy the health benefits

  • of pet ownership but still trying

  • to avoid those real potential zoonotic issues.

  • So again, from the cat side of things being an AAFP member,

  • I've got to admit our side is that pets are good,

  • cats are good for you.

  • And we certainly encourage and applaud those

  • that have been studying, you know,

  • the benefits of pet ownership.

  • My wife's a veterinarian as well,

  • and we both have agreed well,

  • we're in our 20th season together, to own four dogs

  • and four cats at any one time.

  • And we've kept that pact for a long time.

  • But we also realize that there are health risks

  • from those kitties, and we have to be careful as, you know,

  • our lives change and perhaps health issues develop.

  • But what we believe from the AAFP side of things,

  • and I hope this is the message that you'll get if you read

  • that document that should be posted as well with the slides.

  • We really would like to strengthen that interaction

  • between physicians, veterinarians and the family.

  • I think we all are familiar with some of the misperceptions

  • of risk of individual cats for say acquiring say toxoplasma.

  • Gosh, in the early days of HIV and certainly for a long time

  • with pregnant people, a lot of folks, you know,

  • assumed that you could increase your safety level

  • by not owning cats, but not concurrently, reminding people

  • to wash their hands after gardening

  • or to wash their produce well.

  • So I think our goal from AAFP and this document

  • in particular is to at least try to have accurate information

  • to the readers of the document to help people at least start

  • on this even playing field when giving owners advice.

  • What I personally said myself many times is I don't tell

  • people to own cats or dogs.

  • I don't tell them to get rid of their cat or their dog.

  • But if there is a health issue that might relate

  • to pet ownership, I believe

  • that we should give them accurate information

  • so the family unit can make their decisions.

  • And of course doing that,

  • working with the physician directly would give us the

  • most strength.

  • So our goals from the feline internal medicine

  • or feline practitioner side of things is really to make sure

  • that our lay persons realize that animals that are sick,

  • if their cat has clinical signs of disease of any flavor,

  • they could potentially have something

  • that would be a little bit more likely

  • to be shed to a family member.

  • And so our goals are just to make sure that our folks realize

  • in the sick animal arena to allow us

  • to do the appropriate test diagnostics consultations.

  • And in the wellness side of things, we certainly would

  • like our owners to allow us to provide our strategic deworming,

  • our flea and tick control that could help

  • with potential shared vector zoonoses.

  • And then, of course, our goals with the vets are to make sure

  • that veterinarians realize that if animals are sick,

  • they're a little bit more likely

  • to be potentially a zoonotic health risk but also realize

  • that there is benefit to flea tick preventative measures.

  • Obviously, rabies is our biggest worldwide problem, that we want

  • to make sure that countries

  • that don't have current prevention programs get

  • that stepped up over time.

  • And then again, as I've emphasized

  • on the previous slide, I think one of our biggest messages both

  • from AAFP as well as WSAVA is that the veterinarian half

  • of the family medical support would certainly love

  • to work more closely with the physicians

  • in a One Health arena.

  • What we did with our document, both versions,

  • including the 2019, which by the way just came out in December,

  • so a fairly new document for us.

  • We've gone ahead and talked

  • about the animal contact zoonoses.

  • Again, we believe that veterinarians are interested

  • in what they might catch at work.

  • And then of course, pet owners are very interested

  • in what they might acquire from touching their cat.

  • But we do spend time talking about contaminated vehicles.

  • Shared vectors, of course, are emphasized a lot,

  • especially with the bartonella issues.

  • And then shared environments, we make sure that we have

  • at least some discussion about many

  • of these zoonotic diseases are not acquired

  • from touching the pet directly but acquired

  • from that shared environment.

  • So just to give you a couple of examples,

  • if you haven't had a chance to review the document yet,

  • we then have a specific table for each

  • of those major direct zoonoses routes of transmission

  • and then have just a few words to remind people

  • of the most common agents, what you might suspect

  • in an animal infected with that particular agent

  • and then the concurrent illness in people.

  • And then what we've done, again, because this is

  • for primary care feline practitioners as well

  • as veterinarians in general, we did attempt

  • to make some callouts for some of our more important things

  • like the example I shared on this slide.

  • All of our panelists were quite keen on feeding processed foods,

  • especially if there's family members

  • with immune deficiencies.

  • This particular table is just one of the examples

  • of the starting of the list of the bite, scratch

  • and exudate associated organisms.

  • Certainly, since we touch more cats than most,

  • we certainly have to be cognizant as veterinarians

  • that bite wounds be managed appropriately.

  • In fact, one of my research technicians today just got a

  • nice kitten bite earlier this morning.

  • So she has already returned from urgent care, thankfully.

  • But we also try to get other points

  • across that have been generated by the CDC and others like that.

  • Kind of a rumor amongst veterinarians that's kind

  • of driven by one laboratory that perhaps we should be testing

  • and treating all kittens for bartonella.

  • And that, of course, goes against our judicious use

  • of antimicrobial guideline statements.

  • So we certainly pulled that one out as a callout

  • for that particular organism.

  • So as you read through the document,

  • we certainly look forward to input, especially from CDC

  • and folks that would be on some type of call.

  • We've then tried to summarize some of the general guidelines

  • and one table for veterinary staff members

  • and then a second table for owners.

  • And then the AAFP, we do like to make brochures and things

  • that are available for distribution to clinics and also

  • to owners to supplement what we might see on healthy pets,

  • healthy people at the CDC.

  • We consider you guys to be the gold standard

  • and appreciate the opportunity to work

  • with Dr. Behravesh on those things.

  • So bottom line is we try to get that message

  • across that clinically ill cats should be seen.

  • Healthy cats are relatively safe,

  • especially if you wash your hands a lot,

  • feed processed foods, clean the litter box daily, etcetera.

  • And continue to try to interact more

  • with our physician colleagues to spread the word.

  • So, so far I think we've gotten the point across hopefully

  • that we believe at the AAFP level that most pets are safe,

  • in the cat world especially, specifically with AAFP.

  • However, there are things that are shared, so we are attempting

  • to continue to partner with groups like WSAVA.

  • And Michael headed this up.

  • He was the chair of the committee

  • at the time we published this paper.

  • And I always lovingly call this the other AAFP being the

  • American Family Physician group rather than the cat group.

  • And we were quite pleased to have one

  • of our dual publications in that particular journal.

  • And we'll continue to try to spread that word.

  • One way that we're doing that is

  • with the One Health certificate course for veterinarians,

  • and we do allow animal technicians

  • to take this course as well.

  • In the United States, the groups of lecturers are RACE certified

  • so that veterinarians can get CPD credit.

  • I certainly would love any interactions

  • from those on the call today.

  • If you'd like to visit the website, we're hosting

  • that at CSU just because we actually have a system

  • to do that, but it is a WSAVA endeavor.

  • We have a number of One Health modules that still need

  • to be recorded, and we look forward

  • to having all 20 of these online.

  • And what we're doing with the veterinarians

  • that are interested, they can earn a certificate

  • by completing all the modules, and that can be displayed

  • in their veterinary clinics showing

  • that they have an interest in expertise in One Health.

  • So thank you very much for listening today.

  • I look forward to the next talk and then questions

  • at the end or follow up emails.

  • Thank you.

  • >> Thank you so much, Michael.

  • Our final presentation is Community-Based Prevention

  • of Epidemic Rocky Mountain Spotted Fever Among Minority

  • Populations in Sonora, Mexico, using a One Health approach,

  • and it's going to be presented by Anne Straily.

  • Anne, please begin when you're ready.

  • >> All right, thank you for that introduction.

  • So this is a project that I was fortunate enough to work

  • on as an EIS officer with [inaudible] zoonoses branch.

  • I've since moved on from the [inaudible] zoonoses branch,

  • so I'm giving this presentation on behalf of my colleagues

  • in RSV and also in Sonora, Mexico who are unable

  • to make today's ZOHU call.

  • So rocky mountain spotted fever or RMSF for short is caused

  • by the obligate intracellular bacteria rickettsia rickettsii,

  • which likes to infect endothelial cells lining the

  • blood vessels which when damaged become leaky and results

  • in a widespread vasculitis.

  • So the picture at the bottom right-hand corner there

  • demonstrates the endothelial cells of a blood vessel

  • which is cut in crossed section containing the rickettsia

  • rickettsia bacteria, which is stained red.

  • RMSF is a tick borne illness, and it is treatable

  • with doxycycline, but treatment really needs

  • to be initiated early in the course of illness

  • to obtain the best outcome.

  • Early symptoms, unfortunately, are fairly nonspecific,

  • things like fever, headache, muscle pain,

  • all of which can be easily confused with other diseases.

  • So on the next slide I'm going to show you some pictures

  • of what advanced severe RMSF looks like.

  • I should warn you that some of these pictures can be graphic.

  • Without timely treatment with doxycycline,

  • RMSF progresses rapidly.

  • Extensive vasculopathy results in necrosis and gangrene,

  • which often requires amputation of digits or limbs.

  • Other long-term sequelae can include neurologic complications

  • such as cognitive impairment or hearing loss,

  • peripheral neuropathies, cerebellar

  • or vestibular motor dysfunction, just to name a few.

  • Death occurs due to multiorgan failure

  • and disseminated intravascular coagulation,

  • and case fatality rates without timely treatment are around 25%.

  • Epidemic RMSF is associated with massive infestations

  • of the brown dog tick, Rhipicephalus sanguineus,

  • which is pictured here.

  • The brown dog tick has actually been recognized as a vector

  • of RMSF in Mexico and the American southwest

  • since the 1940s.

  • The dog is the preferred host for all life stages

  • of the brown dog tick, but the tick will also readily invest

  • human dwellings and kennels when it's not on the dog,

  • and the red arrow here is pointing to a tick

  • that was spotted on the wall of a house

  • in our intervention area.

  • So dogs can be heavily infested with ticks,

  • like in the photos here.

  • And actually, each one of the little black spots

  • on the brown puppy in the picture

  • on the right there is a tick.

  • And again, another picture of a dog heavily infested with tick.

  • Each one of those little gray blubs

  • on that dog's ear is a tick.

  • So these heavily infested dogs support large populations

  • of ticks in very close proximity to humans.

  • And the warm climate in Mexico provides a suitable environment

  • for ticks to be active year-round.

  • So this isn't a seasonal problem.

  • As a result, the ticks are everywhere.

  • They're in the houses.

  • They're in the yards.

  • They're on the dogs.

  • They're almost impossible to escape.

  • And humans are bitten as a result of contact

  • with tick-infested dogs or tick-infested environments.

  • And kids are especially at risk of exposure

  • because they have increased contact with dogs

  • and spend more time playing in spaces

  • where ticks live, like in the yard.

  • So in case you're unfamiliar with where Sonora is,

  • Sonora is a state in Northwest Mexico which is outlined here

  • in red, and it borders the U.S. states of Arizona

  • and New Mexico to the north.

  • During the time period from 2004 to 2016, there were almost 1,400

  • of RMSF cases reported in the state of Sonora

  • with 250 deaths almost.

  • Seventy-five percent of those cases corresponded

  • to people living in disadvantaged neighborhoods.

  • Between 2009 to 2015, there was one small impoverished community

  • in particular that was severely affected by RMSF.

  • They had median accumulative incidence rates

  • of 29 cases per 100,000 people,

  • which is around six times the median accumulative incidence

  • rates for the rest of the state.

  • Three-quarters of those cases occurred

  • within just a ten-block area

  • that consisted of 703 households.

  • So quite a focal occurrence there.

  • In 2015, the Mexican Administrative Health actually

  • declared RMSF an epidemiologic emergency.

  • So this is a picture of community A. The community A is

  • that severely affected ten-block section that we talked

  • about on the previous slide.

  • It's part of a larger but still impoverished rural community

  • that's located about 50 miles from Hermosillo.

  • Community A is inhabited predominantly

  • by agricultural laborers with a majority

  • of migrant families coming from Oaxaca and other states

  • in the south of Mexico.

  • So community A was selected as our intervention community.

  • Community B which was selected

  • as the control community is an impoverished suburban community

  • of about 730 households that located

  • on the outskirts of Hermosillo.

  • It was selected because it was geographically isolated

  • from community A, which was important

  • to limit the possibility of intervention bleed over but also

  • because it was highly impacted by RMSF,

  • although not necessarily to the degree that community A was.

  • In fact, no other community was hit quite as hard by RMSF

  • as community A. So community B experienced six cases

  • of RMSF during 2009 to 2016, three of which were fatal

  • and one of which occurred in a child.

  • So now we're going to take a closer look at the intervention.

  • The goal of which was to reduce the number of human RMSF cases.

  • The intervention was designed using a One Health approach

  • with components targeting animals,

  • the environment and people.

  • We sought to control ticks on dogs, control ticks

  • in the environment and educate people

  • in the community about RMSF.

  • So if this sounds familiar,

  • it's because this approach was modeled off a very successful

  • intervention that was previously used in Arizona.

  • So component number 1, control ticks on dogs.

  • Each dog received two collars, like you see in the photo here.

  • The gray collar is the tick collar.

  • This is a collar that contains flumethrin and imidacloprid.

  • It provides tick control for up to eight months,

  • and it actually holds up pretty well in a desert environment.

  • Dogs have to be at least eight weeks old,

  • and it has to be fitted and worn correctly

  • for maximum effectiveness.

  • The red collar is just a simple nylon collar.

  • It was provided so that people would not attempt to handle

  • or restrain dogs using the gray collar, because the gray collar,

  • the tick collar, is actually designed to break off

  • if the dog struggles against it.

  • The red collars are also a fairly handy and visible marker

  • that dogs are participating in the intervention.

  • So puppies less than eight weeks of age and therefore too young

  • to receive a collar were instead treated with fipronil spray,

  • and they were aged based on their dentition.

  • Component number 2, control ticks in the environment.

  • Participating homes received pesticide applications

  • with deltamethrin on a bimonthly basis.

  • The deltamethrin was applied by vector control operators

  • with the Sonora Department of Health,

  • and homes were sprayed inside and outside,

  • and the adjacent yard areas were also treated.

  • Component number 3 was to educate the community.

  • So here we developed a pictorial bifold pamphlet

  • to use in this area.

  • Literacy is quite variable in this community, and Trique,

  • which is the indigenous language which is spoken

  • by many residents in community A is actually not a

  • written language.

  • So we had community health workers that spoke Trique

  • that were available to translate for households

  • that did not speak Spanish.

  • These pictorial pamphlets covered how RMSF is translated,

  • the signs and symptoms of the disease, when to seek care

  • from the health clinic and how to prevent it.

  • So it wasn't ethical to just do nothing for community B,

  • our control community, given how serious RMSF is.

  • So community B continued

  • to receive the standard RMSF prevention activities used

  • by the Ministry of Health, which includes community education

  • and environmental acaricide treatment of home.

  • I should also mention that the larger town outside

  • of the ten-block area that made up community A also continue

  • to receive the MOH standard of prevention

  • for RMSF during the stay period.

  • So the real difference here between the intervention

  • and control communities is the provision

  • of tick collars on the dogs.

  • There were a number of different measures

  • that we collected during the study.

  • We did a pre and post knowledge, attitudes and practices

  • or KAP survey that collected information on a number

  • of different things, including dog ownership practices,

  • tick contact and awareness of RMSF.

  • We also visually inspected a systematically selected random

  • sample of dogs for ticks.

  • And these tick counts were categorized as no ticks seen,

  • one to ten, 10 to 100 and over 100 ticks.

  • The study took place during March to November of 2016.

  • So beginning in March, we registered homes

  • and collected the pre-KAP survey data.

  • We did the first environmental acaricide treatment,

  • and in community A we enrolled dogs

  • and applied the tick collars.

  • We went back to both communities in May, July and September

  • where we did the tick burden, the monitoring

  • of the tick burdens on dogs,

  • and the participating homes received another round

  • of acaricide treatments.

  • In community A specifically, we also replaced lost tick collars

  • and gave new dogs new collars during each of those visits.

  • And finally, in November,

  • we collected the post-KAP survey data

  • and did a final tick count on the dogs.

  • So we don't have time to go over all the results,

  • so for today's presentation I'm just going to focus

  • on the measures of tick contact

  • and the visual burden of ticks on dogs.

  • The first result that I want to highlight is the number

  • of households of dogs with dogs with ticks.

  • So both community A and B saw a decrease

  • in visible tick infestations on the dogs.

  • But it was only in community A which is the purple line here

  • where that decrease was statistically significant.

  • So in community A at the beginning of the study,

  • a full one-third of households had a dog with ticks,

  • and that number decreased to only 9% of households

  • by the end of the study.

  • The second result that I want to highlight is the report

  • of tick activity by homeowners.

  • So we asked participants if they saw ticks in their house,

  • which is denoted by the orange line, or in the yard,

  • which is denoted by the green line.

  • And in community a, which is the solid line,

  • both of those measures actually decreased significantly while

  • in community B, which is the dashed lines,

  • both of those measures actually increased during the study.

  • So there were far fewer households in community A

  • that reported seeing ticks in their house or in their yards

  • at the end of the study compared to the beginning

  • and also compared to community B. So we'll finish

  • up with perhaps the most important result of all,

  • which is the number of human RMSF cases.

  • So in community B, there were two confirmed cases

  • of Rocky Mountain Spotted Fever

  • and one death reported during the study period.

  • While in community A, there were actually no cases

  • of human RMSF reported during the study period.

  • And in fact, there were no human cases of RMSF reported

  • in this area until April of 2018 which is a full 18 months

  • after the study ended.

  • So in conclusion, we were able to demonstrate

  • that this One Health approach successfully prevented RMSF

  • cases in a high-risk, heavily impacted

  • and impoverished area of Sonora, Mexico.

  • So each element in this strategy really contributed

  • to a decreased number of dogs with ticks, decrease the number

  • of ticks that people saw in their house or in their yard

  • and also contributed to an increased awareness

  • of RMSF in the community.

  • And all of these different components together resulted

  • in a decreased number of human RMSF cases and deaths.

  • So that's all I have for you today.

  • Thank you so much for your time and attention.

  • >> Thanks so much, Anne.

  • It's always great to see those types

  • of One Health approaches occurring in the field.

  • At this time, we'd like to take questions

  • from any of our presenters.

  • If anyone in the audience has a question,

  • please call 1-800-857-9665

  • and enter participant passcode 6236326.

  • Press star one and give the operator your name

  • and affiliation.

  • Please name the presenter or topic

  • at the beginning of your question.

  • So Brad, do we have any questions yet?

  • >> And once again, that is star one.

  • If you are already on the phone, please press star

  • and then one at this time.

  • One moment, Miss, while we gather questions.

  • We have Christina Nelson from the CDC.

  • Miss Nelson, please go ahead with your question.

  • >> Hi everyone.

  • First of all, I just want

  • to say the ZOHU call always has good speakers,

  • but the speakers today were particularly excellent.

  • I really enjoyed all of these presentations,

  • so thank you to everyone.

  • My question is specifically for Mike Lappin.

  • I know you mentioned that for cats for owners

  • who are immunocompetent it is not recommended

  • that veterinarians test or treat for bartonella

  • if the cats are asymptomatic.

  • For immunocompromised owners, my understanding was

  • that the recommendation is still the same.

  • That, you know, if the cats are asymptomatic

  • and the owners were doing okay, asymptomatic in terms

  • of no evidence of cat scratch disease or other things,

  • then the cat still should not be tested or treated

  • from bartonella because, you know,

  • it's hard to give antibiotics to the cats.

  • And sometimes the owners get scratched when they're trying

  • to give the antibiotics.

  • So I was just wondering your comments on that,

  • have any recommendations changed and any other thoughts.

  • >> Yeah, so thank you for the kind comment about the lecture.

  • I certainly enjoyed the other two a lot.

  • And to directly answer this question, we follow the lead

  • for the CDC of course and aid them though in pet ownership

  • by immunocompromised people.

  • And I support those recommendations.

  • Honestly, doing something like soft claws

  • and bleed control is probably going to control the majority

  • of zoonotic transmission of bartonella by flea

  • or dander or scratches.

  • And so our group the AAFP, a group of veterinarians,

  • we don't support testing and treating cats

  • of immune suppressed families in general.

  • However, the caveat always does come up is what if they walk in

  • and they say they've heard about bartonella,

  • and my cat has had fleas.

  • I'm going to relinquish the cat unless I know.

  • And in that case, you now,

  • I believe that most veterinarians would go ahead

  • and test, even, hoping for negative [inaudible]

  • and negative PCR so that we can then just put that to bed.

  • Because, gosh, my clients, well I practiced in Georgia,

  • Oklahoma, California and 30 years in Colorado.

  • You know, one thing though, even though they know there's,

  • even though we tell them there's probably little risk,

  • once they know they're having antibody positive or whatever,

  • they do want to treat.

  • So again, I think our overall recommendation would follow

  • exactly the CDC's which is there's probably no indication

  • that test healthy cats of any family,

  • but all families should do flea control

  • and avoid bites and scratches.

  • >> All right, okay.

  • Thanks Mike.

  • That's very helpful.

  • >> Once again, if you have a question and would

  • like to ask it over the phone, please press star

  • and the one at this time.

  • Please stand by for any further questions from the phone.

  • And once again, that is star one for questions over the phone.

  • One moment please.

  • Next, we have Dr. Pat Kline from the USDA Forest Service.

  • Please go ahead.

  • >> Yeah, hi, good afternoon.

  • This is Dr. Pat Kline from USDA Forest Service.

  • My question is actually for Dr. Lappin as well.

  • I've actually had an opportunity

  • to read the new zoonotic guideline,

  • and it's very well done.

  • I had one quick question if I could get some feedback

  • from you regarding cats and toxoplasmosis.

  • We do recognize that the litter

  • of the cat is the definitive host, and as you were explaining

  • in your guide, yes, oftentimes the exposure to humans is

  • through environmental exposure route.

  • So, how does AAFP stand, or what's your position

  • on advocating to keep your cats indoors,

  • I mean all of your pet cats for all the right reasons in a way.

  • But also to not add to that environmental burden

  • if they're going to be shedding toxoplasmosis

  • in the environment?

  • Would you make any comments on that please?

  • >> Yes thank you for that great question.

  • Now, I did not serve on any

  • of the cat wellness committee work from AAFP.

  • I've just been with the zoonoses and vaccine guidelines.

  • But you may know some of the listeners today.

  • There's kind of a large push from some feline practitioners

  • and that, you know, cats should be allowed to go outside.

  • And so that particular, you know, discussion,

  • is kind of a hot button amongst our team.

  • And, you know, with the tradeoffs of, you know,

  • cats behaviorally want to be outdoors,

  • whereas indoor cats live longer.

  • Don't pass toxoplasma environment, don't eat,

  • you know, hundreds of birds per year.

  • You know, there's lots of great discussion on both sides.

  • So our committee stayed a little bit out of that fray.

  • But certainly, it's well established

  • that it's not just domestic cats.

  • They can complete the lifecycle of the organism as well.

  • So confining all cats indoors, you know, in theory,

  • would hopefully lessen the world's outdoor burden

  • of toxo OSS, but it probably wouldn't eliminate it

  • because of other, you know, competent felids.

  • >> Thank you for that.

  • And by the way, I've owned cats for 30 years, and I adore them

  • as much since I'm a veterinarian as well.

  • But none of my cats go outdoors.

  • And I'm lucky because they've lived to be 18 and,

  • you know, 20 plus years.

  • So, I really love cats.

  • I'm just looking out for their best interests as well.

  • Thank you.

  • >> Yeah, great comment for that.

  • We love ours as well.

  • And we kind of have the compromised position

  • that we actually have an outdoor cat run.

  • But they do ingest birds, bunnies and rodents

  • and one snake in their outdoor cat run.

  • So they weren't eaten by the coyotes,

  • but they've certain eaten their share of other creatures.

  • So I should probably test the soil there in their cat run

  • to see if there's [inaudible] OSS.

  • >> Thanks for your questions.

  • We're going to wrap up now.

  • But if you do have additional questions,

  • you can also email the presenters.

  • You'll be able to find their email addresses

  • on the ZOHU call webpage for today's call.

  • So I just wanted to say thanks again for all

  • of today's speakers, for their excellent presentations

  • and give you a few instructions on continuing education.

  • So, you can receive free continuing education,

  • and that's available

  • at CDC.gov/onehealth/ ZOHU/continuingeducation.

  • And the course access code is onehalt2020, all lowercase.

  • To receive free CE for today's webcast, complete the evaluation

  • at CDC.gov/PCEonline by March 9th, 2020.

  • Our web on demand recording

  • of today's call will also be posted online

  • at CDC.gov/onehealth/ZOHU/2020/ February.html

  • by March 10th, 2020.

  • Our next call will take place on Wednesday, March 4th,

  • at 2 p.m. Eastern Standard Time.

  • Please feel free to send suggestions

  • and questions to ZOHUcall@CDC.gov.

  • And for more information and to subscribe

  • to our email newsletter, please visit CDC.gov/onehealth/ZOHU.

  • Thanks again to everyone for your participation,

  • and we will now end today's call.

  • Thank you.

  • >> Thank you all for your participation

  • on today's conference call.

  • At this time, all parties --

>> Welcome and thank you for standing by.

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中國疾病預防控制中心ZOHU呼叫2020年2月5日 (CDC ZOHU Call February 5, 2020)

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