1

Selected Zoonotic Diseases Conference Call

November 4, 2009

Carol Rubin, DVM, MPH, National Center for Zoonotic, Vector-borne, and Enteric Diseases, CDC404-639-7378crubin@cdc.gov

Selected Zoonotic Diseases Conference Call

November 4, 2009

Update on H1N1

Kendra E. Stauffer, DVM; Bacterial Zoonoses Branch, CDC404-639-3435 kstauffer@cdc.gov

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 batys@azdhs.gov

Andrea McCollum, PhD, Poxvirus and Rabies Branch, CDC404-639-4164 amccollum@cdc.gov

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 wunner@wistar.org

Deborah J. Briggs, PhD, Adjunct Professor, College of Veterinary Medicine, Kansas State University briggs@vet.k-state.edu

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 Richard.B.Chipman@aphis.usda.gov

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 smoore@vet.ksu.edu

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