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Preparing for the Next Disease:

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    Slide 1:Preparing for the Next Disease: The Human-Wildlife Connection

    Marguerite Pappaioanou, DVM, PhD Centers for Disease Control and Prevention

    Slide 2: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

    Slide 3:Emerging and re-emerging Zoonoses, 19962003 (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

    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

    Slide 5: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

    Slide 6: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

    Slide 7:Factors Promoting Transmission of Infectious Diseases from Animals to Humans

    Changing climates and ecosystems Increases in arthropod vector populations and their resistance to insecticides

    Slide 8: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

    Slide 9:Factors Promoting Transmission of Infectious Diseases from Animals to Humans

    Globalization of the food supply Centralized processing of food

    Slide 10: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

    Early disease detection; rapid, timely reporting 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

    Slide 11: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.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 DetectionBegins on the Front Line at the Local Level

    Slide 12: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? 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?

    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

    Slide 13:Rapid Laboratory Diagnosis

    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 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

    Slide 14: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 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 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

    Slide 15: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

    Slide 16:West Nile Virus, 1999

    Slide 17: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

    Slide 18:CDC ArboNET (9/8/03)

    Slide 19: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 is available from CDC at http://www.cdc.gov/ncidod/dvbid/westnile/index.htm and http://westnilemaps.usgs.gov

    Slide 22:USGS/CDC Wild Birds (9/3/03)

    Slide 23:USGS/CDC Mosquitoes (9/3/03)

    Slide 24:USGS/CDC- Veterinary (9/3/03)

    Slide 25:USGS/CDC Humans (9/3/03)

    Slide 26:Rapid Epidemiologic Investigation

    Investigation Of Human Cases Animal Trace back and Trace forward

    Slide 29: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

    Slide 30: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

    Slide 31: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