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Selected Zoonotic Diseases Conference Call
November 4, 2009
Carol Rubin, DVM, MPH, National Center for Zoonotic, Vector-borne, and Enteric Diseases, [email protected]
Selected Zoonotic Diseases Conference Call
November 4, 2009
Update on H1N1
Kendra E. Stauffer, DVM; Bacterial Zoonoses Branch, CDC404-639-3435 [email protected]
Selected Zoonotic Diseases Conference Call
November 4, 2009
The Changing Face of Brucellosis in the United States
http://www.cdc.gov/Features/HuntingSafety/Brucellosis_and_HogHunters_508.pdf Additional zoonotic resources for hunters from the AVMA include:http://www.avma.org/public_health/zoonotic_risks/hunters.asp http://www.avma.org/public_health/zoonotic_risks/hunters_precautions.asp
Steven Baty, DVM, MPH, Arizona Department of Health Services602-364-3875 [email protected]
Andrea McCollum, PhD, Poxvirus and Rabies Branch, CDC404-639-4164 [email protected]
Selected Zoonotic Diseases Conference Call
November 4, 2009
Bat-associated Rabies Virus in Skunks and Foxes, Flagstaff, Arizona 2009
Bat-associated Rabies Virus Variant Arizona, 2009
Steven Baty, DVM, MPHArizona Department of Health Services
EIS Field Assignments Branch, CDD, OWCD
Andrea McCollum, PhDDivision of Viral and Rickettsial Diseases, CDC
Situation
• October 2008
• Coconino County, Arizona
• Rabies epizootic– Big brown bat (Eptesicus fuscus) rabies virus
variant
• Public health significance
Epi-Aid
• Summer 2009 Epi-Aid
• Team Members– Epidemic Intelligence Service Officers(2)
– CDC, Rabies Team (3)
• Objectives
Big Brown Bat Variant
Grey Fox Variant
South-Central Skunk Variant
0
50
100
150
200
1999 2001 2003 2005 2007 2009
Nu
mb
er
of
cas
es
Wildlife Rabies Cases Arizona 1999–2009
Year
Flagstaff
Wildlife Rabies CasesFlagstaff, Arizona 2008-2009
Wildlife Rabies Cases Coconino County 1999–2009
05
101520253035
1999 2001 2003 2005 2007 2009
Nu
mb
er
of
cas
es
Year
Wildlife Rabies Cases Coconino County November 2008–October 2009
0
5
10
15
Nov Dec Jan Feb Mar April May June July Aug Sept Oct
Skunks
Other
Foxes
Oral Rabies Vaccine (ORV)
Trap Vaccinate Release (TVR)
Quarantine
Nu
mb
er
of
cas
es
Month
Public Health Impact Coconino County2009
• Domestic animal rabid animal exposures requiring quarantine (7)
• Human rabid animal exposures requiring post-exposure prophylaxis (12)
• Domestic animal or human exposure to ORV
Surveillance
• Passive Surveillance– Companion animal or human exposure
• Enhanced Surveillance– Direct Rapid Immunohistochemical Test (DRIT)
– Capacity development
Coconino County ORV Bait Campaign
• July 21-24 aerial ORV bait drop
• July 22 ground teams distributed baits
• >110,000 baits distributed over 91 square mile area
Trap Vaccinate and Release
• Location
• Targeted animal
• Results
Community Outreach
• Health Care Provider update
• Community knowledge, practices, and attitudes survey
• Rabies post-exposure prophylaxis case review
Conclusion
• Public Health Significance– Human and companion animal exposure
– Rabies post-exposure prophylaxis administration
• Wildlife/Domestic/Human emerging infectious disease interface
Acknowledgments
• Arizona Department of Health Services– Rebecca Sunnenshine
– Craig Levy
• CDC, Rabies Team– Jesse Blanton
– Douglas Green
– Michael Niezgoda
– Charles Rupprecht
• USDA Wildlife Services– David Bergman
– Stephanie Johnston
– Krista Wenning
• Coconino County– Michael Callahan
– Sabrina Ferrat
– Randy Phillips
The findings and conclusions in this report are those of the author(s) and do not necessarily
represent the official position of the Centers for Disease Control and Prevention.
William H. Wunner, PhD, Professor and Director of Outreach Educationand Technology Training; The Wistar Institute; 215-898-3854 [email protected]
Deborah J. Briggs, PhD, Adjunct Professor, College of Veterinary Medicine, Kansas State University [email protected]
Selected Zoonotic Diseases Conference Call
November 4, 2009
Overview of special collections on papers on rabies appearing in the journals Vaccine and PLoS NTD
Richard B. Chipman, National Rabies Management Program, USDA, APHIS, Wildlife Services518-477-5628 [email protected]
Selected Zoonotic Diseases Conference Call
November 4, 2009
Oral vaccination opportunities, complexities and challenges in North America
Rich ChipmanAsst. Rabies Management CoordinatorUSDA, APHIS, WS-National Rabies Management Program
10 Minute Paper Summary “Oral Rabies Vaccination in North America: Opportunities, Complexities and Challenges”(In Press) Public Library of Science Neglected Tropical Diseases
Dennis Slate, Timothy P. Algeo, Kathleen M. Nelson, Richard B. Chipman, Dennis Donovan, Jesse D. Blanton, Michael Niezgoda, and Charles E. Rupprecht
BackgroundBackground
Diverse meso-carnivore community…Diverse meso-carnivore community…
U.S. Rabies Virus Variants 2008
North American borders and key meso-carnivore rangesNorth American borders and key meso-carnivore ranges
Coyote Red fox Gray fox
Raccoon Striped skunk Bobcat
In 1969, Dr. George Baer, then at CDC, and associates prove oral rabies vaccination feasible in foxes… Baer, G.M., M.K. Abelseth, and J.G. Debbie. (1971). Oral vaccination of foxes against rabies. Am. J. of Epidemiol. 93:487-490.
In 1969, Dr. George Baer, then at CDC, and associates prove oral rabies vaccination feasible in foxes… Baer, G.M., M.K. Abelseth, and J.G. Debbie. (1971). Oral vaccination of foxes against rabies. Am. J. of Epidemiol. 93:487-490.
Oral Rabies Vaccination from proof of conceptOral Rabies Vaccination from proof of concept
To control realityTo control reality
Oral Rabies VaccinationOral Rabies Vaccination
• Oral rabies vaccination (ORV) represents a socially acceptable methodology that has helped eliminate canine rabies from the USA, and restricted the distribution of raccoon, arctic fox, and gray fox variants of rabies in North America.
• Oral rabies vaccination (ORV) represents a socially acceptable methodology that has helped eliminate canine rabies from the USA, and restricted the distribution of raccoon, arctic fox, and gray fox variants of rabies in North America.
Wildlife Management AgenciesWildlife Management Agencies
Public Health AgenciesPublic Health Agencies
Agriculture AgenciesAgriculture Agencies
UniversitiesUniversities
Oral Rabies VaccinationOral Rabies Vaccination
WildlifeWildlife
HealthHealthAgricultureAgriculture
Collaboration &
Strategic Planning
Collaboration &
Strategic Planning
Collaboration & Strategic PlanningCollaboration & Strategic Planning
• An international rabies management team composed of experts from the public health-agriculture-wildlife management interface has been vital to the establishment of viable rabies control programs in North America.
• An international rabies management team composed of experts from the public health-agriculture-wildlife management interface has been vital to the establishment of viable rabies control programs in North America.
Cooperative Annual PlanningRabies Management Team Cooperative Annual PlanningRabies Management Team
•2009: ATLANTA, GA•2008: MOBILE, AL•2007: SAN ANTONIO, TX•2006: JACKSONVILLE, FL•2005: RIVERDALE, MD •2004: ATLANTA, GA (CDC)•2003: FT. COLLINS, CO•2002: RIVERDALE, MD•2001: RIVERDALE, MD•2000: FT. COLLINS, CO•1999: FT. COLLINS, CO
•2009: ATLANTA, GA•2008: MOBILE, AL•2007: SAN ANTONIO, TX•2006: JACKSONVILLE, FL•2005: RIVERDALE, MD •2004: ATLANTA, GA (CDC)•2003: FT. COLLINS, CO•2002: RIVERDALE, MD•2001: RIVERDALE, MD•2000: FT. COLLINS, CO•1999: FT. COLLINS, CO
2009 11th Anniversary!2009 11th Anniversary!
Information transfer
Information transfer
Research Research Surveillance and monitoring Surveillance and monitoring Rabies prevention and control Rabies prevention and control Wildlife
PublicHealth Agriculture
…areas for collaboration…areas for collaboration
North American Rabies Management PlanNorth American Rabies Management Plan
• Enhance coordination of wildlife rabies surveillance, management, research and communication…..
• Prevent the spread of specific rabies virus variants in carnivores in the United States.
• Eliminate specific rabies virus variants in carnivores at the local, regional, and national level.
• Enhance coordination of wildlife rabies surveillance, management, research and communication…..
• Prevent the spread of specific rabies virus variants in carnivores in the United States.
• Eliminate specific rabies virus variants in carnivores at the local, regional, and national level.
Goals of the U.S. NationalPlan for Wildlife Rabies ManagementGoals of the U.S. NationalPlan for Wildlife Rabies Management
Enhanced
Surveillance
Enhanced
Surveillance
Enhanced SurveillanceEnhanced Surveillance• Advances in enhanced rabies surveillance
that relies largely on a direct rapid immunohistochemistry test have led to improved real-time management decisions for meso-carnivore rabies reservoir species in the USA.
• Advances in enhanced rabies surveillance that relies largely on a direct rapid immunohistochemistry test have led to improved real-time management decisions for meso-carnivore rabies reservoir species in the USA. RabID
Mapping
Sampling EmphasisStrange behaving animals (no human or pet exposure history)Animals with lesions indicating aggressionRoad kill surveys/other dead animalsAnimals removed-- “hot” rabies focusNuisance removed animals
2005-2009 = >27,000 animals dRIT tested
Sampling EmphasisStrange behaving animals (no human or pet exposure history)Animals with lesions indicating aggressionRoad kill surveys/other dead animalsAnimals removed-- “hot” rabies focusNuisance removed animals
2005-2009 = >27,000 animals dRIT tested
Enhanced Rabies SurveillanceEnhanced Rabies Surveillance
dRIT Analysis
rabiesnegative
rabiespositive
921681
797
0
200
400
600
800
1000
2007 2008 2009
Enhanced SurveillanceEnhanced Surveillance
22
345
235
195
WS Trap & Euthanize
WS Firearms
WS Road Kill
Non-WS Collection
2009 Source Types2009 Source Types
1,285
4,1963,451
0
1,000
2,000
3,000
4,000
5,000
2007 2008 2009
Trap-Vaccinate-ReleaseTrap-Vaccinate-Release
Raccoon Variant RabiesRaccoon Variant Rabies
4638
209 310
05
101520253035404550
2004 2005 2006 2007 2008 2009
Oral Rabies
Vaccination
Oral Rabies
Vaccination
ORVORV
• ORV in the USA remains focused on the raccoon variant of rabies, while work continues to contain and eliminate the gray fox rabies variant in west Texas, and prevent canine rabies from re-emerging into the USA from Mexico.
• ORV in the USA remains focused on the raccoon variant of rabies, while work continues to contain and eliminate the gray fox rabies variant in west Texas, and prevent canine rabies from re-emerging into the USA from Mexico.
ORV Zones 2009ORV Zones 2009
gray fox
coyote
raccoon
ORV in the U.S. (2009)ORV in the U.S. (2009)
Oral Rabies VaccinationOral Rabies Vaccination
• ORV has been successfully employed to prevent raccoon rabies from gaining a much broader foot print beyond the eastern U.S.
• ORV has been successfully employed to prevent raccoon rabies from gaining a much broader foot print beyond the eastern U.S.
Baits Distributions By State, FY 2005 – FY 2009
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
Alabama
Arizona
Florid
a
Georgi
aMain
e
Marylan
d
Massac
husetts
New Jerse
y
New York
North Caro
lina
Ohio
Pennsyl
vania
Tennes
seeTe
xas
Vermont/N
H
Virginia
Wes
t Virg
inia
State
Bait
s
2005 2006 2007 2008 2009
Oral Rabies VaccinationOral Rabies Vaccination
• ORV was integrated into conventional rabies prevention and control reliant on parenteral rabies vaccination in dogs to free the U.S, of canine rabies that emerged in Texas from Mexico in the late 1980's and spilled-over into and spread among coyotes.
• An ORV zone is currently maintained along the south Texas-Mexico border to try to prevent re-emergence of canine rabies from Mexico.
• ORV was integrated into conventional rabies prevention and control reliant on parenteral rabies vaccination in dogs to free the U.S, of canine rabies that emerged in Texas from Mexico in the late 1980's and spilled-over into and spread among coyotes.
• An ORV zone is currently maintained along the south Texas-Mexico border to try to prevent re-emergence of canine rabies from Mexico.
YearYear Rabies CasesRabies Cases
Webb Duval
Frio
Starr
Bee
Uvalde Bexar
Hidalgo
Kinney
Zavala
Dimmit
Medina
La Salle
KenedyZapata
Maverick
Brooks
Goliad
Lavaca
AtascosaDe Witt
Victoria
Wilson
Live OakMcMullen
Jim Hogg
Gonzales
Nueces
Karnes
Kleberg
Jackson
Refugio
Cameron
Jim Wells
Willacy
Guadalupe
San Patricio
CalhounAransas
ORV zoneORV zone
19951995
2000-2007
2000-2007
Webb Duval
Frio
Starr
Bee
Uvalde Bexar
Hidalgo
Kinney
Zavala
Dimmit
Medina
La Salle
KenedyZapata
Maverick
Brooks
Goliad
Lavaca
AtascosaDe Witt
Victoria
Wilson
Live OakMcMullen
Jim Hogg
Gonzales
Nueces
Karnes
Kleberg
Jackson
Refugio
Cameron
Jim Wells
Willacy
Guadalupe
San Patricio
CalhounAransas
Rabies case in2001 and 2004Rabies case in2001 and 2004
1994199519961997199819992000200120022003200420052006200720082009
166 58 21 6 5 10 0 1 0 0 1 0 0 0 0 0
ORV begins
Webb Duval
Frio
Starr
Bee
Uvalde Bexar
Hidalgo
Kinney
Zavala
Dimmit
Medina
La Salle
KenedyZapata
Maverick
Brooks
Goliad
Lavaca
AtascosaDe Witt
Victoria
Wilson
Live OakMcMullen
Jim Hogg
Gonzales
Nueces
Karnes
Kleberg
Jackson
Refugio
Cameron
Jim Wells
Willacy
Guadalupe
San Patricio
CalhounAransas
Canine Rabies in Coyote, South TexasCanine Rabies in Coyote, South Texas
Oral Rabies VaccinationOral Rabies Vaccination
• ORV has been used to shrink the area occupied by a unique variant of rabies virus in gray foxes in west Texas.
• ORV has been used to shrink the area occupied by a unique variant of rabies virus in gray foxes in west Texas.
??Gray fox var. TX
125,278 by baits air4,322 by baits ground125,278 by baits air4,322 by baits ground
Big brown bat cladesBig brown bat clades
ORV targeting gray foxTVR targeting skunksORV targeting gray foxTVR targeting skunks
Complexities,
and other
Considerations
Complexities,
and other
Considerations
ComplexitiesComplexities
• Raccoon rabies has not spread appreciably since ORV intervention has expanded in the eastern USA, yet rabies virus neutralizing antibody levels in raccoon populations as an index to immune buffers in existing ORV zones point to the need for improved or new bait-oral vaccines and strategy refinements.
• Achieving advances that lead to improved field performance should allow for a more aggressive movement of ORV zones into raccoon enzootic areas.
• Raccoon rabies has not spread appreciably since ORV intervention has expanded in the eastern USA, yet rabies virus neutralizing antibody levels in raccoon populations as an index to immune buffers in existing ORV zones point to the need for improved or new bait-oral vaccines and strategy refinements.
• Achieving advances that lead to improved field performance should allow for a more aggressive movement of ORV zones into raccoon enzootic areas.
Seroconversion Post-ORVSeroconversion Post-ORV
0
10
20
30
40
50
60
70
80
90
100
95 96 97 98 99 00 01 02 03 04 05 06 07 08
Year
Per
cen
t p
osi
tive
rab
ies
anti
bo
dy
resp
on
se
COYOTE GRAY FOX RACCOON
Skunksinfectedwith raccoonrabies
Skunksinfectedwith raccoonrabies
SkunksSkunks
Raccoon Rabies Contingency Actions in FY 2009Raccoon Rabies Contingency Actions in FY 2009
Ohio
New York
Pennsylvania
Vermont
New Hampshire
Massachusetts
Connecticut Rhode Island
Ontario
Quebec
Quebec
Enhanced rabies surveillanceOral rabies vaccination (75/150 baits/km2)
Trap-vaccinate-release
Enhanced rabies surveillanceOral rabies vaccination (75/150 baits/km2)
Trap-vaccinate-release
Contingency Action Strategy Contingency Action Strategy
WS ORV (75 baits/km2)WS ORV (150 baits/km2)NYSDOH ORV (75 baits/km2)TVR area
Border Contingency Action areas 2009Border Contingency Action areas 2009
• Goal: Restore target areas to raccoon variant rabies free status.
• Goal: Restore target areas to raccoon variant rabies free status.
2007 -2009 Contingency Action2007 -2009 Contingency Action
• OH– 21/km2 (2-50)
• NY– 16/km2 (2-46)
• VT– 8/km2 (2-18)
• ME– 4/km2 (1-17)
• OH– 21/km2 (2-50)
• NY– 16/km2 (2-46)
• VT– 8/km2 (2-18)
• ME– 4/km2 (1-17)
Raccoon Densities in Contingency ZonesRaccoon Densities in Contingency Zones
1,2261,463
1,733
0
500
1,000
1,500
2,000
2007 2008 2009
Trap-Vaccinate-ReleaseTrap-Vaccinate-Release
127
115
9
0
20
40
60
80
100
120
140
2006 2007 2008 2009
Raccoon Variant RabiesRaccoon Variant Rabiesin ORV Zonein ORV Zone
Final ThoughtsFinal Thoughts
• Coalition of diverse expertise from the public health-agriculture-wildlife management interface has been critical to facilitate coordination.
• The NARMP has established a continental framework that extends collaboration and coordination, capacity for rabies communications, surveillance, control, and research among Canada, Mexico and the USA.
• Enhanced surveillance as a complement to public health surveillance has improved decision making capability regarding allocation of rabies control resources, including contingency actions to address emergencies.
• Coalition of diverse expertise from the public health-agriculture-wildlife management interface has been critical to facilitate coordination.
• The NARMP has established a continental framework that extends collaboration and coordination, capacity for rabies communications, surveillance, control, and research among Canada, Mexico and the USA.
• Enhanced surveillance as a complement to public health surveillance has improved decision making capability regarding allocation of rabies control resources, including contingency actions to address emergencies.
Final ThoughtsFinal Thoughts
• Raccoon rabies has not spread appreciably since ORV intervention has expanded in the eastern USA, yet there is a need for improved or new bait-oral vaccines and strategy refinements.
• Measureable successes beyond containment would be expected to enhance program sustainability toward the goal of broader scale elimination of raccoon rabies.
• Continued economic analyses will remain integral to ORV planning and as a means to characterize successes in costs and benefits.
• Raccoon rabies has not spread appreciably since ORV intervention has expanded in the eastern USA, yet there is a need for improved or new bait-oral vaccines and strategy refinements.
• Measureable successes beyond containment would be expected to enhance program sustainability toward the goal of broader scale elimination of raccoon rabies.
• Continued economic analyses will remain integral to ORV planning and as a means to characterize successes in costs and benefits.
Susan Moore, Rabies Laboratory Manager, K-State Rabies Laboratory785-532-4472 [email protected]
Selected Zoonotic Diseases Conference Call
November 4, 2009
Rabies specific antibodies: measuring surrogates of protection against a fatal disease
Rabies Specific Antibodies: Measuring Surrogates of Protection
Against a Fatal Disease
Susan M. Moore and Cathleen A. Hanlon
Learning Points• Rabies virus neutralizing antibodies (RVNA) have been demonstrated to be critical for
protection against rabies. Even so, in vitro measurements are only a partial determination of the degree of protection provided in vivo. Not all methods that measure rabies specific antibodies will determine the neutralizing function of the antibodies.
• In the selection of the most appropriate assay for rabies antibody detection, consideration of the purpose and use of the results is as important as the established performance characteristic of the assay.
• Standardization of assays includes both assay components and test conditions. Alterations will cause variation in results; therefore use of a particular assay (i.e. ELISA or serum neutralization) does not guarantee comparable results if the assays have not been standardized.
• Because rabies is a fatal disease where development of a sufficient RVNA response is paramount for protection, verification of assay specificity, sensitivity, and accuracy must be defined for meaningful clinical decisions to be made based on the results.
• Steps toward better understanding and use of rabies serology assays will include collaboration of national laboratories, regulatory agencies, as well as commercial and research laboratories. Greater cooperation and standardization of rabies serology assays will lead to increased understanding of the relationship between in vitro measurement and in vivo protection.
Serum Neutralization test ELISA test
Adequate response to rabies vaccination
ACIP 2008• “minimum acceptable
antibody level of complete neutralization at a serum dilution of 1:5”
• “the reported values of rabies virus neutralizing antibody titer (most properly reported according to a standard as IU/mL)”
WHO – Expert Committee 1992• Does not define by endpoint
titer or equate endpoint titer to IU/mL
• “All persons who work with live rabies virus in a diagnostic, research or vaccine production laboratory should have a serum sample tested for rabies virus-neutralizing antibodies and a booster administered when the titre falls below 0.5 IU/mL.”
Complete neutralization at 1:5 may or may not equal 0.5 IU/mL
Example 1• titer of patient sample is 1:10• titer of reference serum (2.0 IU/mL) is 1:200• IU/mL calculation:
– (10/200) X 2.0 IU/mL = 0.1 IU/mL
Example 2• titer of patient sample is 1:10• titer of reference serum (2.0 IU/mL) is 1:20• IU/mL calculation:
– (10/20) X 2.0 IU/mL = 1.0 IU/mL
Method standardization and validation Why?
• Standardization of methods and use of methods enable direct comparison of results and consistent comparison over time
• Validation gives assurance of accurate and precise results and understanding of method characteristics (good and bad)
• Continued quality assurance programs identify problems and allow for timely corrective actions
77
Selected Zoonotic Diseases Conference Call
November 4, 2009
