John Pape is an Epidemiologist with the Communicable Disease Epidemiology Program, Colorado Department of Public Health & Environment. This slide-show presents facts and images relating to Zoonoses: diseases of animals transmissible to humans under natural conditions. The characteristics of Zoonoses are: common in natural reservoir, uncommon in people; rural exposure; serious diseases with high fatality rates; complex cycles; prevention achieved via “The Weakest Link.” Zoonotic diseases comprise the majority of potential bioterrorist agents and emerging infections.  Specific sections include: Influenza, Avian Influenza,and Pandemic Influenza Projected Pandemic Scenarios COLORADO  H5N1 Surveillance Strategy in US  Baylisascaris and Racoons Q-fever Outbreak Associated with Goats  Hamsters & Tularemia  Sin Nombre Virus in Colorado: Deer Mice and Cotton Rats Hantavirus Pulmonary Syndrome  Human Plague Cases in Colorado  Animal Plague Surveillance West Nile Virus:  Outlook for 2006

Pape, W.  John

English

UNL | Libraries

University of Nebraska - Lincoln 
DigitalCommons@University of Nebraska - Lincoln 
Other Publications in Wildlife Management Wildlife Damage Management, Internet Center for 
May 2006 
Public Health Confronts the Chicken, the Hamster, and the Goat 
W. John Pape 
Colorado Department of Public Health and Environment, John.Pape@state.co.us 
Follow this and additional works at: https://digitalcommons.unl.edu/icwdmother 
 Part of the Environmental Sciences Commons 
Pape, W. John, "Public Health Confronts the Chicken, the Hamster, and the Goat" (2006). Other 
Publications in Wildlife Management. 20. 
https://digitalcommons.unl.edu/icwdmother/20 
This Article is brought to you for free and open access by the Wildlife Damage Management, Internet Center for at 
DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Other Publications in Wildlife 
Management by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. 
Public Health Confronts
The Chicken, The Hamster and 
The Goat
John Pape, Epidemiologist
Communicable Disease Epidemiology Program
Colorado Department of Public Health & Environment
Zoonoses: Diseases of animals transmissible to 
humans under natural conditions
Characteristics of Zoonoses
•common in natural reservior, uncommon in people
•rural exposure
•serious disease, high fatality rates
•complex cycles
•prevention via “The Weakest Link”
•zoonotic diseases comprise the majority of potential
bioterrorist agents and emerging infections


October 7

Influenza, Avian Influenza,
and Pandemic Influenza

Wild Bird Population
Avian Influenza 
A Viruses
H1 – H16
H1 – H3
Human Influenza 
A Viruses
Influenza A Virus
Type A Influenza Viruses
• Host range: [humans, pigs, birds, horses, marine mammals]
• Antigens/surface proteins:
– Hemaglutinin (HA) ? 16 distinct types (H1 - H16)
– Neuraminidase (NA) ? 9 distinct types (N1 – N9)
• Human infections primarily:
– H1, H2, H3
– N1, N2 (? N8)
– Since 1977, H1N1  &  H3N2 have co-circulated
How Influenza Viruses Change
• Drift:
– Minor changes in structure of (H) and (N)
– Result of cumulative point mutations in viral RNA
– Occurs frequently ? new “strain” (of A or B)
– Reason for updated vaccine formulation annually
• Shift:
– Major change thru reassortment (“swapping”) of RNA
– Result is new “virus subtype” (i.e. new “H” or “N”)
– Populations have no immunity to new subtype
– Occurs infrequently ? may result in pandemic
Human
virus
Reassortant
virus
Non-human
virus
Mechanisms of Influenza Virus Antigenic “Shift”
16 HAs
9 NAs
DIREC
T
Timeline of Emergence of 
Influenza Viruses in Humans
1918 1957 1968 1977 1997
1998/9
2003
H1
H1
B
H2
Spanish
Influenza
Asian
Influenza
Russian
Influenza
Hong Kong
Influenza
H7
H5H5
H9
Avian
Influenza
H3
P
a
n
d
e
m
i
c
v
a
c
c
i
n
e
s
R
e
g
u
l
a
r
 
v
a
c
c
i
n
e
s
1997 H5N1 Outbreak, 
Hong Kong
•First evidence that AI viruses 
can directly infect people 
•H5N1’s unusual lethality
–6 deaths among 18 
hospitalizations
Primary risk factor:
Exposure to poultry in week 
before illness 
Outbreak stopped by culling 
all wholesale & vendor 
domestic chickens

Countries Affected by H5N1: July - Oct. 2005
Countries Affected by H5N1
and Major Migratory Birds’ Flyways
H5N1 Positive Eagles Smuggled 
into Belguim from Thailand
Economic Impact
Why H5N1 is of Particular Concern
• Progressively more pathogenic for poultry
• Asymptomatically infected domestic ducks are shedding virus for longer 
duration compared with 2003
• Expanding mammalian host range (tigers, leopards, cats)
• Virus able to survive days longer in the environment compared to 2003
• Ability to cause severe disease in humans
• Increasing poultry infections = increased human exposures / infections
• Increasing humans infections = increased chances of reassortment
– (e.g. H5N1 & H3N2)
Human H5N1 cases, Asia, Dec. 2003-06*
• 148 confirmed  ? 79 deaths (53%)
• Vietnam:   93 cases ? 42 deaths (45%)
• Thailand:  22 cases ? 14 deaths (64%)
• Cambodia:  4 cases ? 4 deaths (100%) 
• Indonesia:  17 cases ? 12 deaths (71%)
• China:         8 cases ? 5 death (63%) 
• Turkey: 4 cases    2 deaths (50%)
*As of January 14, 2006 (cases officially reported by WHO)
Limited Person-Person Transmission
• 15 family clusters identified Jan. 2004 – July 2005
? Emerg Infect Dis 2005;11:1799-1801
• Incidence of family clusters does not appear to be increasing   
(as a proportion of total cases)
• Most clusters compatible with common (poultry) exposure 
• Thailand (September 2004) 
? 11-year old girl cared for by mother and aunt in hospital, died, not confirmed; 
both women confirmed with H5N1, mother died
? NEJM 2005;352:333-40. 
• Vietnam (Feb. 2005)
? 2 nurses who cared for H5N1 patient were hospitalized with severe pneumonia
? 1 confirmed as H5N1
Pandemic Response Challenges
• Healthcare system capacity - overwhelmed
• Antiviral supplies – insufficient / resistance
• Vaccine – manufacturing issues / supply /distribution
• Critical infrastructure - disruption 
• Economy - disruption
Projected Pandemic Scenarios - COLORADO
Moderate (1958/68) Severe (1918-like)
Illness 1,394,644 1,394,644
Outpt. medical care 697,322 697,322
Hospitalizations 13,404 153,411
ICU care 1,995 23,012
Mechanical 
ventilation
1,005 11,506
Deaths 3,239 29,489
Challenges for Physicians
• Distinguish H5N1 from “normal” flu
• Worried Well
– Concerned of exposure
– Want bird flu vaccine
– Want oseltamivir
• Should I stockpile oseltamivir?
H5N1 Surveillance Strategy in US
• Focus on severe resp. illness plus travel history
– Unexplained pneumonia or ARDS
– Travel w/in 10 days to area w/ H5N1 in poultry/humans
• Contact & Airborne precautions 
• Testing:
– PCR for influenza (type A & H5N1) @ State Lab
– If PCR+ ? Culture & subtyping @ CDC 






Baylisascaris procyonis
Procyon lotor

Baylisascaris Adult Worms
• Fully grown 15-20 cm
• 50-80% adult raccons carry worms
– 90% in juvenile animals 
• 2-3 months from infection to shedding eggs
• Asymptomatic infections
– Obstruction, malnutrition, intussusception
Baylisascais Eggs
• Infected raccoons shed in feces
– 20 – 100,000 eggs/gm (100 gm/defecation)
• Eggs infective in 30 days 
• Highly resistant
– Lab frig for 12 years
– 3-5 years in soil
– Resistant to most disinfectants
• Sticky
• Treat by flaming, boiling lye/lysol

Baylisascaris Larvae
• Raccoons
– Ingest eggs or encysted larvae
• Intermediate host
– Penetrate intestine & migrate throughout body
• Larvae in lung 12-18 hours after ingestion, brain by day 3
– Encyst in muscle, liver, lungs
– Affinity for nerve tissue – 5-15% reach brain
– Grow to 1.5-2mm during migration
• Impact depends on number of larvae, tissue 
involved and size of host






Baylisascaris Prevention
• No pet raccoons
• Assume infected until treated
– Negative stool culture   =   not infected
• Exclude from chimneys, attics, woodpiles
• Protect feed, hay, bedding 
• Special problems for rehabilitators
• Hand-washing, hand-washing, hand-washing
Q Fever
• Highly infectious by aerosol route
• Persists in resistant spore-like form
• Febrile illness – self-limited FUO
– Asymptomatic infections common
– Low mortality
• Common in sheep/goats
– Heavy shedding during birthing
• High infectivity and durability make 
it an ideal incapacitating biological 
warfare agent
Q Fever
• 25 cases reported
– 12 probable, 10 confirmed
– 3 clusters Weld (n=5), Rio Blanco (n=2), Pueblo
• From 2000-2004: 12 reported cases (2.4/year)
• Exposures
– owned livestock (n=9) or lived next to livestock (n=4) 
– contact with goats (n=9)
– large animal veterinarian, abattoir worker and exposure 
to a livestock barn
• Highly undiagnosed disease
Q-fever Outbreak Associated 
with Goats
• Report of case in September 2005
– Pt had assisted with birthing goats
• Ranch has recently purchased 360 head
– ~20% stillbirth rate June-August
• Horse boarders had assisted with birthing
• Conducted cohort study and environmental 
assessment

Q-fever Outbreak Associated 
with Goats
• Sixty-eight persons with potential exposure
– 66 interviewed; 37 (56%) provide blood
– 18 persons (49%) had serological evidence of 
infection; 9 ill / 9 asymptomatic
• 40 soil samples from pens/pasture
– 9 (23%) confirmed, 12 (30%) presumptive +
• 51 goats tested (vaginal and/or milk)
– 7 positive (2 vaginal, 3 milk, 2 both)

Q-fever Outbreak Associated 
with Goats
• Risk associated with goat contact
– Any goat contact RR 3.4 (0.9-12.3) p=0.02
– Contact with newborn RR 2.3 (1.7-2.6) p=0.01
– Pull goats RR 2.1 (1.3-3.6) p=0.04
• No risk from petting goats, time spent on 
the ranch or any activities associated with 
horses
Hamsters & Tularemia
• April 2004
– 3 yo boy reported with tularemia
• Isolate from excised axillary lymph node (3/31)
• January 2004 
– Family purchased 1st hamster 
– Bitten Feb 4; onset Feb 11
• Pet store noted hamster die-off
– No hamsters available for testing 
– 1 store cat + tularemia antibody titer
• No other cases in employees (n=2) or hamster 
purchasers (n=15)
Hamsters & Tularemia
• October 2005
– CDPHE notified of 2 shipments of hamsters 
possibly infected with tularemia
– Store indicated ½ of one shipment DOA
• 4/6 carcasses positive
• Doxycycline Rx
– 2 employees–negative
• No further cases ID
• CDPHE initiated routine tularemia testing
– What to do with this information?
• Six human cases
– 1 pneumonia – likely lawn mowing associated
– 1 rabbit contact, 2 arthropod bite, 2 unk
• 23/192 (12%) specimens tularemia positive
– 16 rabbits, 6 squirrels, 1 cat
• Tularemia cycles in patterns similar to plague
Year of the Rodent 
Tularemia Cases by Year,
Colorado, 1975-2005*
0
2
4
6
8
10
12
14
16
18
20
19
75
19
77
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
20
03
20
05
YEAR
#
 
o
f
 
C
a
s
e
s
* Provisional data for 2005








• Record year for HPS cases (n=11)
– Only 1 fatality
• First 28 cases – 14 fatal (50%)
• Last 20 cases – 3 fatal (15%)
• Cases reported statewide 
– 3 from SLV 
– SLV accounts for 11/48 (23%) of CO cases
• Two study sites (LaPlata/Mesa counties) showed increased 
deer mouse populations and rising infection rates in Fall 
’04 and Spring ’05
Year of the Rodent 
Sin Nombre Virus
John Pape, Epidemiologist
Communicable Disease Epidemiology Program
Colorado Department of Public Health & 
Environment
303-692-2628 john.pape@state.co.us
in Colorado
Deer mouse
Cotton rat


• Record year for HPS cases (n=11)
– Only 1 fatality
• First 28 cases – 14 fatal (50%)
• Last 20 cases – 3 fatal (15%)
• Cases reported statewide 
– 3 from SLV 
– SLV accounts for 12/49 (24%) of CO cases
• Two study sites (LaPlata/Mesa counties) showed increased 
deer mouse populations and rising infection rates in Fall 
’04 and Spring ’05
Year of the Rodent 
0
2
4
6
8
10
12
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
YEAR
#
 
o
f
 
c
a
s
e
s
Survived Fatal
Hantavirus Pulmonary Syndrome (N=48+) by 
Year and Outcome, Colorado, 1993-2005
+   fatal case from 1985 not shown

Sin Nombre Virus Antibody Prevelance of Deer 
Mice, LaPlata County, CO, 1994-2005
0
50
100
150
200
250
J
u
n
-
9
4
A
u
g
-
9
4
D
e
c
-
9
4
J
u
n
-
9
5
S
e
p
-
9
5
N
o
v
-
9
5
J
u
n
-
9
6
A
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g
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9
6
M
a
y
-
9
7
J
u
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-
9
7
O
c
t
-
9
7
M
a
y
-
9
8
A
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g
-
9
8
A
p
r
-
9
9
J
u
l
-
9
9
O
c
t
-
9
9
M
a
y
-
0
0
A
u
g
-
0
0
A
p
r
-
0
1
J
u
l
-
0
1
S
e
p
-
0
1
A
p
r
-
0
2
J
u
l
-
0
2
O
c
t
-
0
2
M
a
y
-
0
3
J
u
l
-
0
3
M
a
y
-
0
4
A
u
g
-
0
4
O
c
t
-
0
4
J
u
l
-
0
5
O
c
t
-
0
5
Trap Date
#
 
o
f
 
m
i
c
e
0
1000
2000
3000
4000
5000
6000
I
n
f
e
c
t
i
o
n
 
I
n
d
e
x
# mice # positive infection index
Sin Nombre Virus Antibody Prevelance of Deer Mice, Mesa County, CO
0
20
40
60
80
100
120
O
c
t
-
9
4
J
u
n
-
9
5
S
e
p
-
9
5
D
e
c
-
9
5
J
u
n
-
9
6
A
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9
6
M
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9
7
A
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g
-
9
7
O
c
t
-
9
7
J
u
l
-
9
8
O
c
t
-
9
8
J
u
l
-
9
9
O
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t
-
9
9
J
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n
-
0
0
A
u
g
-
0
0
M
a
y
-
0
1
A
u
g
-
0
1
N
o
v
-
0
1
M
a
y
-
0
2
A
u
g
-
0
2
J
u
n
-
0
3
S
e
p
-
0
3
M
a
y
-
0
4
A
u
g
-
0
4
J
u
n
-
0
5
S
e
p
-
0
5
Trap Date
#
 
o
f
 
m
i
c
e
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
I
n
f
e
c
t
i
o
n
 
I
n
d
e
x
# trapped # positive Infection Index (SNV prevelance rate x # of mice)
Case Demographics
• All Cases
– Median age: 33 (range 12 – 69) years
– 28 male (57%)
• Fatal Cases
– Median age: 30.5 (range 15 – 69) years
– 10 male (58%)
Hantavirus Pulmonary Syndrome Cases (n=49) by 
Month of Onset and Outcome, Colorado, 1985-2005
0
2
4
6
8
10
12
14
16
J
a
n
F
e
b
M
a
r
A
p
r
M
a
y
J
u
n
J
u
l
A
u
g
S
e
p
O
c
t
 
N
o
v
D
e
c
Month of Onset
N
u
m
b
e
r
 
o
f
 
C
a
s
e
s
Survived Fatal
Colorado Hantavirus Pulmonary Syndrome Cases,
By Residence, 1985-2005
• Flu syndrome without rhinorhea, otitis, sinusitis, congestion,             
sneezing
• Nausea, vomiting, abdominal pain are often severe if present
• Cough does not begin on the first day of symptoms; begins after 
two or more days, accompanied by progressive dyspnea and   
heralds the onset of pulmonary edema
• During the prodrome , thrombocytopenia is the only lab sign
• A rapidly falling platelet count helps differentiate HPS
Clinical Clues for HPS
How do you find rare HPS among thousands of flu syndromes?

Hantavirus Pulmonary Syndrome
Prevention Recommendations
• Rodent-proof  homes, barns and outbuildings
• Eliminate rodent harborage and food supplies
• Conduct ongoing rodent population reduction
• Use special precautions when working in or
cleaning rodent-infested environments
Year of the Rodent 
• First significant state-wide plague activity 
since 1992-94
– Six human cases (1 fatal) since August ’04
• 2 rabbit hunters, 4 flea bite
– 65 /265 (25%) plague specimens positive
• 16 cats, 1 dog, 20 flea pools, 21 rodents, 
2 rabbits, 7 coyotes
Human Plague Cases 
Colorado, 1974-2005 (n=48)*
0
1
2
3
4
5
1
9
8
0
1
9
9
0
2
0
0
0
YEAR
#
 
O
F
 
C
A
S
E
S
Recovered Fatal
* Not included are 5 cases (2 fatal) occurring between 1957-1973
















2003
2006  ?


Public Health Confronts the Chicken, the Hamster, and the Goat

DigitalCommons@University of Nebraska

University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Other Publications in Wildlife Management Wildlife Damage Management, Internet Center for May 2006 Public Health Confronts the Chicken, the Hamster, and the Goat W. John Pape Colorado Department of Public Health and Environment, John.Pape@state.co.us Follow this and additional works at: https://digitalcommons.unl.edu/icwdmother  Part of the Environmental Sciences Commons Pape, W. John, "Public Health Confronts the Chicken, the Hamster, and the Goat" (2006). Other Publications in Wildlife Management. 20. https://digitalcommons.unl.edu/icwdmother/20 This Article is brought to you for free and open access by the Wildlife Damage Management, Internet Center for at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Other Publications in Wildlife Management by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Public Health ConfrontsThe Chicken, The Hamster and The GoatJohn Pape, EpidemiologistCommunicable Disease Epidemiology ProgramColorado Department of Public Health & EnvironmentZoonoses: Diseases of animals transmissible to humans under natural conditionsCharacteristics of Zoonoses•common in natural reservior, uncommon in people•rural exposure•serious disease, high fatality rates•complex cycles•prevention via “The Weakest Link”•zoonotic diseases comprise the majority of potentialbioterrorist agents and emerging infectionsOctober 7Influenza, Avian Influenza,and Pandemic InfluenzaWild Bird PopulationAvian Influenza A VirusesH1 – H16H1 – H3Human Influenza A VirusesInfluenza A VirusType A Influenza Viruses• Host range: [humans, pigs, birds, horses, marine mammals]• Antigens/surface proteins:– Hemaglutinin (HA) Æ 16 distinct types (H1 - H16)– Neuraminidase (NA) Æ 9 distinct types (N1 – N9)• Human infections primarily:– H1, H2, H3– N1, N2 (? N8)– Since 1977, H1N1  &  H3N2 have co-circulatedHow Influenza Viruses Change• Drift:– Minor changes in structure of (H) and (N)– Result of cumulative point mutations in viral RNA– Occurs frequently Æ new “strain” (of A or B)– Reason for updated vaccine formulation annually• Shift:– Major change thru reassortment (“swapping”) of RNA– Result is new “virus subtype” (i.e. new “H” or “N”)– Populations have no immunity to new subtype– Occurs infrequently Æ may result in pandemicHumanvirusReassortantvirusNon-humanvirusMechanisms of Influenza Virus Antigenic “Shift”16 HAs9 NAsDIRECTTimeline of Emergence of Influenza Viruses in Humans1918 1957 1968 1977 19971998/92003H1H1BH2SpanishInfluenzaAsianInfluenzaRussianInfluenzaHong KongInfluenzaH7H5H5H9AvianInfluenzaH3PandemicvaccinesRegular vaccines1997 H5N1 Outbreak, Hong Kong•First evidence that AI viruses can directly infect people •H5N1’s unusual lethality–6 deaths among 18 hospitalizationsPrimary risk factor:Exposure to poultry in week before illness Outbreak stopped by culling all wholesale & vendor domestic chickensCountries Affected by H5N1: July - Oct. 2005Countries Affected by H5N1and Major Migratory Birds’ FlywaysH5N1 Positive Eagles Smuggled into Belguim from ThailandEconomic ImpactWhy H5N1 is of Particular Concern• Progressively more pathogenic for poultry• Asymptomatically infected domestic ducks are shedding virus for longer duration compared with 2003• Expanding mammalian host range (tigers, leopards, cats)• Virus able to survive days longer in the environment compared to 2003• Ability to cause severe disease in humans• Increasing poultry infections = increased human exposures / infections• Increasing humans infections = increased chances of reassortment– (e.g. H5N1 & H3N2)Human H5N1 cases, Asia, Dec. 2003-06*• 148 confirmed  Æ 79 deaths (53%)• Vietnam:   93 cases Æ 42 deaths (45%)• Thailand:  22 cases Æ 14 deaths (64%)• Cambodia:  4 cases Æ 4 deaths (100%) • Indonesia:  17 cases Æ 12 deaths (71%)• China:         8 cases Æ 5 death (63%) • Turkey: 4 cases    2 deaths (50%)*As of January 14, 2006 (cases officially reported by WHO)Limited Person-Person Transmission• 15 family clusters identified Jan. 2004 – July 2005¾ Emerg Infect Dis 2005;11:1799-1801• Incidence of family clusters does not appear to be increasing   (as a proportion of total cases)• Most clusters compatible with common (poultry) exposure • Thailand (September 2004) ¾ 11-year old girl cared for by mother and aunt in hospital, died, not confirmed; both women confirmed with H5N1, mother died¾ NEJM 2005;352:333-40. • Vietnam (Feb. 2005)¾ 2 nurses who cared for H5N1 patient were hospitalized with severe pneumonia¾ 1 confirmed as H5N1Pandemic Response Challenges• Healthcare system capacity - overwhelmed• Antiviral supplies – insufficient / resistance• Vaccine – manufacturing issues / supply /distribution• Critical infrastructure - disruption • Economy - disruptionProjected Pandemic Scenarios - COLORADOModerate (1958/68) Severe (1918-like)Illness 1,394,644 1,394,644Outpt. medical care 697,322 697,322Hospitalizations 13,404 153,411ICU care 1,995 23,012Mechanical ventilation1,005 11,506Deaths 3,239 29,489Challenges for Physicians• Distinguish H5N1 from “normal” flu• Worried Well– Concerned of exposure– Want bird flu vaccine– Want oseltamivir• Should I stockpile oseltamivir?H5N1 Surveillance Strategy in US• Focus on severe resp. illness plus travel history– Unexplained pneumonia or ARDS– Travel w/in 10 days to area w/ H5N1 in poultry/humans• Contact & Airborne precautions • Testing:– PCR for influenza (type A & H5N1) @ State Lab– If PCR+ Æ Culture & subtyping @ CDC Baylisascaris procyonisProcyon lotorBaylisascaris Adult Worms• Fully grown 15-20 cm• 50-80% adult raccons carry worms– 90% in juvenile animals • 2-3 months from infection to shedding eggs• Asymptomatic infections– Obstruction, malnutrition, intussusceptionBaylisascais Eggs• Infected raccoons shed in feces– 20 – 100,000 eggs/gm (100 gm/defecation)• Eggs infective in 30 days • Highly resistant– Lab frig for 12 years– 3-5 years in soil– Resistant to most disinfectants• Sticky• Treat by flaming, boiling lye/lysolBaylisascaris Larvae• Raccoons– Ingest eggs or encysted larvae• Intermediate host– Penetrate intestine & migrate throughout body• Larvae in lung 12-18 hours after ingestion, brain by day 3– Encyst in muscle, liver, lungs– Affinity for nerve tissue – 5-15% reach brain– Grow to 1.5-2mm during migration• Impact depends on number of larvae, tissue involved and size of hostBaylisascaris Prevention• No pet raccoons• Assume infected until treated– Negative stool culture   =   not infected• Exclude from chimneys, attics, woodpiles• Protect feed, hay, bedding • Special problems for rehabilitators• Hand-washing, hand-washing, hand-washingQ Fever• Highly infectious by aerosol route• Persists in resistant spore-like form• Febrile illness – self-limited FUO– Asymptomatic infections common– Low mortality• Common in sheep/goats– Heavy shedding during birthing• High infectivity and durability make it an ideal incapacitating biological warfare agentQ Fever• 25 cases reported– 12 probable, 10 confirmed– 3 clusters Weld (n=5), Rio Blanco (n=2), Pueblo• From 2000-2004: 12 reported cases (2.4/year)• Exposures– owned livestock (n=9) or lived next to livestock (n=4) – contact with goats (n=9)– large animal veterinarian, abattoir worker and exposure to a livestock barn• Highly undiagnosed diseaseQ-fever Outbreak Associated with Goats• Report of case in September 2005– Pt had assisted with birthing goats• Ranch has recently purchased 360 head– ~20% stillbirth rate June-August• Horse boarders had assisted with birthing• Conducted cohort study and environmental assessmentQ-fever Outbreak Associated with Goats• Sixty-eight persons with potential exposure– 66 interviewed; 37 (56%) provide blood– 18 persons (49%) had serological evidence of infection; 9 ill / 9 asymptomatic• 40 soil samples from pens/pasture– 9 (23%) confirmed, 12 (30%) presumptive +• 51 goats tested (vaginal and/or milk)– 7 positive (2 vaginal, 3 milk, 2 both)Q-fever Outbreak Associated with Goats• Risk associated with goat contact– Any goat contact RR 3.4 (0.9-12.3) p=0.02– Contact with newborn RR 2.3 (1.7-2.6) p=0.01– Pull goats RR 2.1 (1.3-3.6) p=0.04• No risk from petting goats, time spent on the ranch or any activities associated with horsesHamsters & Tularemia• April 2004– 3 yo boy reported with tularemia• Isolate from excised axillary lymph node (3/31)• January 2004 – Family purchased 1st hamster – Bitten Feb 4; onset Feb 11• Pet store noted hamster die-off– No hamsters available for testing – 1 store cat + tularemia antibody titer• No other cases in employees (n=2) or hamster purchasers (n=15)Hamsters & Tularemia• October 2005– CDPHE notified of 2 shipments of hamsters possibly infected with tularemia– Store indicated ½ of one shipment DOA• 4/6 carcasses positive• Doxycycline Rx– 2 employees–negative• No further cases ID• CDPHE initiated routine tularemia testing– What to do with this information?• Six human cases– 1 pneumonia – likely lawn mowing associated– 1 rabbit contact, 2 arthropod bite, 2 unk• 23/192 (12%) specimens tularemia positive– 16 rabbits, 6 squirrels, 1 cat• Tularemia cycles in patterns similar to plagueYear of the Rodent Tularemia Cases by Year,Colorado, 1975-2005*024681012141618201975197719791981198319851987198919911993199519971999200120032005YEAR# of Cases* Provisional data for 2005• Record year for HPS cases (n=11)– Only 1 fatality• First 28 cases – 14 fatal (50%)• Last 20 cases – 3 fatal (15%)• Cases reported statewide – 3 from SLV – SLV accounts for 11/48 (23%) of CO cases• Two study sites (LaPlata/Mesa counties) showed increased deer mouse populations and rising infection rates in Fall ’04 and Spring ’05Year of the Rodent Sin Nombre VirusJohn Pape, EpidemiologistCommunicable Disease Epidemiology ProgramColorado Department of Public Health & Environment303-692-2628 john.pape@state.co.usin ColoradoDeer mouseCotton rat• Record year for HPS cases (n=11)– Only 1 fatality• First 28 cases – 14 fatal (50%)• Last 20 cases – 3 fatal (15%)• Cases reported statewide – 3 from SLV – SLV accounts for 12/49 (24%) of CO cases• Two study sites (LaPlata/Mesa counties) showed increased deer mouse populations and rising infection rates in Fall ’04 and Spring ’05Year of the Rodent 0246810121993199419951996199719981999200020012002200320042005YEAR# of casesSurvived FatalHantavirus Pulmonary Syndrome (N=48+) by Year and Outcome, Colorado, 1993-2005+   fatal case from 1985 not shownSin Nombre Virus Antibody Prevelance of Deer Mice, LaPlata County, CO, 1994-2005050100150200250Jun-94Aug-94Dec-94Jun-95Sep-95Nov-95Jun-96Aug-96May-97Jul-97Oct-97May-98Aug-98Apr-99Jul-99Oct-99May-00Aug-00Apr-01Jul-01Sep-01Apr-02Jul-02Oct-02May-03Jul-03May-04Aug-04Oct-04Jul-05Oct-05Trap Date# of mice0100020003000400050006000Infection Index# mice # positive infection indexSin Nombre Virus Antibody Prevelance of Deer Mice, Mesa County, CO020406080100120Oct-94Jun-95Sep-95Dec-95Jun-96Aug-96May-97Aug-97Oct-97Jul-98Oct-98Jul-99Oct-99Jun-00Aug-00May-01Aug-01Nov-01May-02Aug-02Jun-03Sep-03May-04Aug-04Jun-05Sep-05Trap Date# of mice0.0200.0400.0600.0800.01000.01200.0Infection Index# trapped # positive Infection Index (SNV prevelance rate x # of mice)Case Demographics• All Cases– Median age: 33 (range 12 – 69) years– 28 male (57%)• Fatal Cases– Median age: 30.5 (range 15 – 69) years– 10 male (58%)Hantavirus Pulmonary Syndrome Cases (n=49) by Month of Onset and Outcome, Colorado, 1985-20050246810121416JanFebMarAprMayJunJulAugSepOct NovDecMonth of OnsetNumber of CasesSurvived FatalColorado Hantavirus Pulmonary Syndrome Cases,By Residence, 1985-2005• Flu syndrome without rhinorhea, otitis, sinusitis, congestion,             sneezing• Nausea, vomiting, abdominal pain are often severe if present• Cough does not begin on the first day of symptoms; begins after two or more days, accompanied by progressive dyspnea and   heralds the onset of pulmonary edema• During the prodrome , thrombocytopenia is the only lab sign• A rapidly falling platelet count helps differentiate HPSClinical Clues for HPSHow do you find rare HPS among thousands of flu syndromes?Hantavirus Pulmonary SyndromePrevention Recommendations• Rodent-proof  homes, barns and outbuildings• Eliminate rodent harborage and food supplies• Conduct ongoing rodent population reduction• Use special precautions when working in orcleaning rodent-infested environmentsYear of the Rodent • First significant state-wide plague activity since 1992-94– Six human cases (1 fatal) since August ’04• 2 rabbit hunters, 4 flea bite– 65 /265 (25%) plague specimens positive• 16 cats, 1 dog, 20 flea pools, 21 rodents, 2 rabbits, 7 coyotesHuman Plague Cases Colorado, 1974-2005 (n=48)*012345198019902000YEAR# OF CASESRecovered Fatal* Not included are 5 cases (2 fatal) occurring between 1957-197320032006  ?

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Public Health Confronts the Chicken, the Hamster, and the Goat

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