When Neglected Tropical Diseases Knock on...

WhenNeglectedTropicalDiseasesKnockonCalifornia’sDoor

AnneKjemtrup,DVM,MPVM,PhDCaliforniaDepartmentofPublicHealth

Vector-BorneDiseaseSecFon

OverviewofToday’sTopics•  Neglectedtropicaldiseases:seLngthestageforimpactonCalifornia

•  CaliforniaPublicHealthOverview–  Surveillance/responsestructure– Vector-BorneDiseaseprogramareas

•  Twoexamples:– ArbovirusintroducFon(dengue,chikungunya,zika)–  Re-emergenceofRockyMountainspoSedfever(notreallyNTDbutsimilarprincipals)

THEMONSTERRETURNSPeterMcCarty

NeglectedTropicalDiseases

•  BuruliUlcer•  Chagasdisease•  DengueandChikungunya•  Dracunculiasis(guinea

wormdisease)•  Echinococcosis•  Endemictreponematoses

(Yaws)•  Foodbornetrematodiases•  HumanAfrican

trypanosomiasis(sleepingsickness)

•  Leishmaniasis•  Leprosy(Hansendisease)•  LymphaEcfilariasis•  Onchocerciasis(river

blindness)•  Rabies•  Schistosomiasis•  Soil-transmiLed

helminthiases•  Taeniasis/CysEcercosis•  Trachoma

NeglectedTropicalDiseases•  BuruliUlcer•  Chagasdisease•  DengueandChikungunya•  Dracunculiasis(guinea

wormdisease)•  Echinococcosis•  Endemictreponematoses

(Yaws)•  Foodbornetrematodiases•  HumanAfrican

trypanosomiasis(sleepingsickness)

•  Leishmaniasis•  Leprosy(Hansendisease)•  LymphaEcfilariasis•  Onchocerciasis(river

blindness)•  Rabies•  Schistosomiasis•  Soil-transmiLed

helminthiases•  Taeniasis/CysEcercosis•  Trachoma

Californiahasvectorand/ordiseaseagent

StateReportableDiseasesCaliforniaDepartmentofPublicHealth!81humandiseasesorcondiEons(includingallthe

naEonaldiseases),2animaldiseases(rabiesandplague)•  Vector-Bornediseasesinclude:

•  Anaplasma/Ehrlichiosis•  Babesiosis•  ColoradoTickFever(toberemovednextyear)•  Dengue•  Hantaviruscardiopulmonarysyndrome•  LymeDisease•  Malaria•  Plague(humanoranimal)•  Relapsingfever•  RockyMountainspoLedfever•  Tularemia•  WestNilevirus•  YellowFever

7

Notifiable/reportable

Vector control

pathogen control

Vaccination, prophylaxis

Vector-surveillance

pathogen-surveillance

Dise

ase

burd

enIntervention/Response Surveillance

Ri

sk

Reservoir hosts: presence/absence/abundance/distribution

Vector: presence/absence/abundance/distribution

General population: exposure

General pop.: (A)symptomatic infected

General pop.:Symptomatic

Health care provider

hospital

Sero-surveillance, surveys

Public education

(Improved) diagnosis, treatment(s) recommendations

Adapted from Braks et al, Parasites and Vectors 2011, 4: 192

NoEfiableDiseaseSurveillance:RouteofInformaEon

ReporEngmandatedbystatelaw(Title17CCR)

Health care providers, laboratories, others, report to local health department (LHD)

LHD submits reports to CDPH

Reports transmitted to Centers for Disease Control and Prevention (CDC)

NoEfiableDiseaseSurveillance:RouteofInformaEonReporting mandated by state law (Title 17 CCR) Reportable TBD include: anaplasmosis, babesiosis, Lyme disease, relapsing fever (B.

hermsii), spotted fever and non-spotted fever group rickettsia

Local health department (LHD) receives, follows-up, reviews reports

LHD submits reports to CDPH

Reports transmitted to Centers for Disease Control and Prevention (CDC)

Vector-BorneDiseaseSecFon

PrimaryVectorPrograms•  Mosquito•  Flea•  Tick•  Rodent

Somevector-bornediseasesrequirecomplexsurveillanceeffortstomonitor,intervene,anEcipate,detect,andstudytheirepidemiology(justafewofsurveillancefuncEons)

Urban cycle Rural cycles

??

?? Bird/Mosquito Movement? Aedes, Culiseta Aedes, Culiseta

Culex tarsalis Culex tarsalis

Culex Culex pipiens pipiens stigmat stigmat . . ? ? erythro erythro . .

Dead end hosts

??

Rural cycles

??

?? Bird/Mosquito Movement?

West Nile virus transmission cycles in California

Aedes, Culiseta

Culex tarsalis Culex tarsalis

Culex Culex pipiens pipiens stigmat stigmat . . ? ? erythro erythro . .

Dead end hosts

??

•  ExposurepotenEaltohumansfromvectorfleasassessed

•  PasthistoryofepizooEcsand/orhumanplaguecasesintheregionreviewed

•  RecommendaEonsandacEonstakentoreducevectorsandpublicexposure

Plague Surveillance •  CDPH has expanded and refined the

statewide plague surveillance program to include: •  investigations of human and domestic

felid plague cases •  serologic monitoring of wild carnivores •  evaluation of epizootic activity in

rodents

TickSurveillance

HumanDengue,ChikungunyaandZikaSurveillanceinCalifornia

LookingBeyondtheUnfortunateTravelSouvenir

VirusesandTransmission

•  ChikungunyaisanalphavirussimilartoWEEandRossRivervirus

•  DengueandZikavirusesarebothflavivirusessimilartoyellowfeverandJapaneseencephaliFsvirus

•  AllarearbovirusesandtransmiSedprimarilyhumantohumanbyAedesaegyp*andAe.albopictus

Dengue,Chikungunya,Zikamosquitotransmissioncycles

GeographicspreadSpreadofChikungunyavirus

Denguevirusareaofrisk

ArbovirusesEaseofIntroducFon

AedesmodesofintroducFonintoU.S.

ImportedusedFres(SoutheasternU.S.)

LuckyBamboo(California)

AedesalbopictusandAedesaegyp*havearrivedandbecomeestablishedinCA

Aedesalbopictus

AsianFgermosquito2008:Firstintroducedthen

eradicated2011:LosAngelesCounty

Aedesaegyp*Yellowfevermosquito2013:Madera,Fresno,SanMateoCounFes

ImpactofinvasiveAedesintroducEontoCalifornia

•  Vector:Dengue,chikungunya,andseveralencephaliFsviruses

•  IncreasedriskofintroducFonofexoFcmosquito-borneviruses

•  Aggressiveday-biFngmosquitoes•  Prefertobitepeople(ratherthanbirdsorotheranimals)

•  Difficulttocontrol:Breedincontainers

InvasiveAedesMosquitoesDetecFonSitesinCalifornia,2011-2015

Exeter

Arvin

ClovisFresno

MaderaMaderaRanchosParkwood

MenloParkAtherton

ElMonteArcadiaIrwindaleDuarteMonroviaTempleCityBaldwinParkRosemeadMontereyParkCityofIndustryBradburySouthElMonteAvocadoHeightsWhi_erSanGabrielLaPuente

Aedesaegyp@Aedesalbopictus

EscondidoSanDiegoChulaVista

CommercePicoRivera

CalexicoAndradeAnaheim

Hayward

ClimateChangeandInvasiveAedesMosquitoesinCA

•  Tropicalspecies– Warmweatherenhancessurvival,reproducFon,andspread

•  Drought:unintendedconsequence– Residentsstorewaterinbackyardbuckets,containers,andrainbarrels

– Donotmaintainswimmingpools

•  AedesestablishmentandspaFaldistribuFonmayserveasindictorsofclimatechange

Localmosquitoresponse

SurveillanceforChikungunya,DengueandZikainCalifornia

•  CDPHisworkingcloselywithlocalhealthdepartmentsandvectorcontrolagencies–  IdenFfyingviremiccases–  Mappingco-locaFonofviremic

casesandinvasiveAedes–  PrompFngmosquitosurveillance

nearcaseresidents

•  CommunicaFonbetweenlocalVectorControlAgenciesandHealthDepartmentsiscriFcaltoensurerapidresponsetoreduceriskoflocaltransmission

•  In2015:561,501confirmedand2,326,829probablecases

•  Including10,276deaths

•  Highestincidencerate(820/100,000)wasinBrazilwithover1.5millioncases

•  Caseswerereportedfrom49countriesorterritoriesintheAmericas

DengueintheAmericas

2015

Confirmed Dengue Cases in Mexico by State January 1, 2015 – December 31, 2015

Sonora

Chihuahua

Coahuila

DurangoNuevoLeón

Tamaulipas

Yucatán

Campeche

OaxacaGuerrero

Chiapas

Colima

Jalisco

TabascoPuebla

Morelos

0confirmedcases

1–100confirmedcases



Morethan1000confirmedcases

Ag.

Tl.

Ag.=AguascalientesQuer.=QuerétaroDF=DistritoFederalTl.=Tlaxcala

DataformapavailablefromhSp://www.epidemiologia.salud.gob.mx/dgae/panodengue/intd_dengue.html

DengueOutbreakinHawaii260CasestoDate

260

ChikungunyaintheAmericas

Confirmed Chikungunya Cases in Mexico by State January 1, 2015 – December 31, 2015

Sonora

Chihuahua

Coahuila

DurangoNuevoLeón

Tamaulipas

Yucatán

OaxacaGuerrero

Chiapas

Colima

Jalisco

Nayarit

TabascoPuebla

Morelos

0confirmedcases






Ag.

Tl.

DataformapavailablefromhSp://www.epidemiologia.salud.gob.mx/doctos/avisos/2016/chik/DGE_CHIK_CASOSYDEF_SEM05_2016.pdf

Countries,TerritoriesandAreaswithAutochthonousZikaVirusCirculaFon(2007-2016)

Confirmed Zika Cases in Mexico by State January 1, 2016 – February 19, 2016

Sonora

Chihuahua

Coahuila

DurangoNuevoLeón

Tamaulipas

Yucatán

OaxacaGuerrero

Chiapas

Colima

Jalisco

Nayarit

TabascoPuebla

Morelos

0confirmedcases






Ag.

Tl.

DataprovidedbytheMexicanMinistryofHealthhSp://www.epidemiologia.salud.gob.mx/doctos/avisos/2016/zika/DGE_ZIKA_CASOS_SEM06_2016.pdf

ImportedDengueintheUnitedStates,2015

N=540

75

42

76

119109

89

1

1

10

823

25

0

20

40

60

80

100

120

140

2010 2011 2012 2013 2014 2015

Num

bero

frep

ortedden

guecases

Year

ImportedHumanDengueCasesinCalifornia2010-2015*

*AsofFebruary17,2016

n=581

ConfirmedProbable

ImportedDengueinCalifornia,2015•  114casesreportedin2015*

– From22counFes,10withinvasiveAedes– 62casesreturnedtocounFeswithinvasiveAedes

•  Ofthose76%werelikelyviremicwhileinCalifornia

•  54%ofcaseswerefemale•  32%ofcasesrequiredhospitalizaFon•  45%ofcaseshadtraveltoLaFnAmerica

– Mexico17%,ElSalvador12%

*EsFmatedFebruary2016

ChikungunyaintheUnitedStates2014

2015

2014:2,811importedcasesreportedinUS,12locallyacquiredcasesinFlorida2015:679importedcasesreportedinUS,nolocallyacquiredcases

ImportedChikungunyaCasesinCalifornia,2015

•  233casesreportedin2015*(140casesin2014)– From30counFes,10withinvasiveAedes– 152casesreturnedtocounFeswithinvasiveAedes

•  Ofthose53%werelikelyviremicwhileinCalifornia

•  67%ofcaseswerefemale•  Only8%ofcasesrequiredhospitalizaFon•  91%ofcaseshadtraveltoLaFnAmerica

– Mexico40%,ElSalvador16%,Guatemala13%*EsFmatedasofFebruary2016

2015 Human dengue and/or chikungunya cases

Aedes aegypti

Aedes albopictus

San Diego

Los Angeles

Kern

Tulare

Fresno Madera

San Mateo

Imperial

California, USA

No reported cases 1-10 reported cases 11-20 reported cases >21 reported cases

Orange

Alameda

San Bernardino

Riverside

DengueandChikungunyaCasesinCaliforniaandLocaFonofInvasiveAedes

ImportedZikaintheUnitedStates,2015-2016

Noreportedcases

1-4reportedcases

5-9reportedcases

10-15reportedcases

>15reportedcases

DistrictofColumbia

N=107

ImportedZikainCalifornia2013-2016Year CDCFinal

ConfirmedCases*CDCPreliminaryPosiEveCases*

2013 1 NA

2014 3 NA

2015 4 0

2016 6 0

•  All14ZikacasesreportedtodatehavetraveledtoaregionwithaknownZikaoutbreakatFmeoftravel

•  Travelcountriesinclude:FrenchPolynesia,CookIslands,EasterIsland,KiribaF,ElSalvador,HaiF,Colombia,MexicoandHonduras

•  Ofthe10casesin2015-2016,5wereresidentsofcounFeswithinvasiveAedes

•  8werepotenFallyviremicwhileinCalifornia

*CDPHhasreceivedthefinalwriSenlabreportfromCDC**CDPHhasreceivedpreliminarynoFficaFonofaposiFvecasefromCDC

FactorsMiFgaFngDengue,ChikungunyaandZikaTransmissioninCalifornia

•  RelaFvelyshortviremia(average5-7days)•  HousingcondiFonsandlifestylesminimizevector-humancontact•  VectordistribuFonandlongevityisvariableanduneven•  Vectordensityneededfortransmissionmaynotbehighenough•  ComprehensivemosquitocontrolprogramsinCalifornia

•  Riskoflocaldengue,chikungunyaorZikatransmissionislow

•  NolocallyacquiredinfecFonshavebeendocumentedinCalifornia

•  ThedetecFonofAedesaegyp*andAedesalbopictusandviremictravelersinthesameareaisapublichealthconcern

–  Climatechange/DroughtmayimpactdistribuFon/abundanceofvectorbasedonhumanresponse

•  EnhancedsurveillanceofbothmosquitoesandcasepaFentsisnecessarytoreduceriskofautochthonoustransmission

Conclusion

CaliforniaDepartmentofPublicHealth(CDPH)hSps://www.cdph.ca.gov/HealthInfo/discond/Pages/Zika.aspx

CentersforDiseaseControlandPrevenFon(CDC)hSp://www.cdc.gov/zika/index.html

PanAmericanHealthOrganizaFon(PAHO)hSp://www.paho.org/hq/index.php?opFon=com_topics&view=arFcle&id=427&Itemid=41484&lang=en#

CharseyColePorse,PhD,MPHCaliforniaDepartmentofPublicHealth,Vector-BorneDiseaseSecFon

[email protected]

MoreInformaFon

RockyMountainSpoLedFever:aRe-EmergingDisease

CaliforniahasseveralendemicFck-bornepathogensinRickeSsialesorder

RickeSsialdiseasescalled,“spoSedfevergroup”becauserashesaretypicallyseenwithinfecFonswiththesebacteria

•  Clinical:–  Nonspecific(canbedifficulttodiagnose)–  Fever,headache,nausea,muscleaches2-14daysa}erFckbite–  Rashdevelops3-5daysa}erfever–  DecreasedcloLngcellsleadingtoseverecomplicaFons:Acute

respiratorydistresssyndrome(ARDS),abdominalpain(leadingtosurgery),neurologicorbleedingdisorders,lossofcirculaFon(gangrene)

–  Casefatalityreportsrangingfrom5-90%

48

RMSFinHumans

•  Diagnosis:–  Serology:RisinganFbodyFters(4Xchangeinacuteandconvalescent

samples).IFAorELISAtests.–  PCR,immunohistochemicalstainingofFssue,culture:(Fssuesdifficultto

obtain)

•  Treatment:Doxycycline–  adultsandchildren–  Cannotwaitfordiagnosis–musttreatonsuspicion

49

RMSFinHumans

LifecycleofRickeCsiarickeCsii

RockyMountainwoodEckDermacentorandersoni

AmericanDogTickDermacentorvariabilis

•  Mammalreservoirbut…

•  Tickmaybebothreservoirandvector

•  RarelyfindagentintheFck

RockyMountainSpoSedFeverNaFonally

Source:CDChSp://www.cdc.gov/rmsf/stats/

RockyMountainSpoSedFever,Arizona

•  2002-2004:11confirmedcasesofRMSFidenFfiedinclosegeographicareainArizona

•  NoDermacentorsppFcksfoundinarea•  HomesandareasaroundhomesinfestedwithbrowndogFcks;many

free-roamingdogsinarea•  R.ricke9siadetectedmolecularlyandculturedfromareaFcks•  FirstEmebrowndogEckimplicatedasvectorforRMSFinN.

America

RMSFResponse:2004-2005SHORTTERM

•  EducaFonforresidents&clinicians•  Tickcontrolondogs•  Pestcontrolaroundhomes•  Communityclean-upLONGTERM

•  Animalcontrolprogram•  Sustainedvectorcontrol•  Structuralchangestohomes–skirFng•  Clean-upcampaign:TribalMembersandothersTeam:CDC,HIS,Tribes,ADHS,ORKIN®,WATSONIANS,USDA,Army–Ft.Huachuca

53

TickControlforDogs:AnimalServicesAgencyCoordinaFon

•  USDA,Army,CDC,IHS&ADHS

•  Zodiak®Eckcollars–(propoxur–3monthresidual)wereplacedon1,000’sofdogs(est.70%+coverage)

•  Also,spot-ontreatments&sprays

54

Notalldogswereapproachable

55

RockyMountainSpoSedFever,Mexico

•  UrbanoutbreakofRMSFinMexicali,Mexico,2009

•  BrowndogFck-associated•  >1200suspectcases,217confirmed

•  6deaths(2.3%)amongconfirmedcases

56

BrowndogFckhabitat,Mexico

hSps://www.epa.gov/sites/producFon/files/2016-02/documents/rmsf_on_the_border_where_children_contagion_and_climate_converge.pdf

AredogsinCaliforniaAffected?

•  DogsareacommonFckhostforR.ricke9siiFck-vectors.Theycangetill-evendie-frominfecFonswithR.ricke9sii.

•  ReportsintheliteratureofconcomitantinfecFonofownersandtheirdogs,suggesFngacommonexposure

•  AnecdotalreportsofRMSFinCAdogs

TheInfestaEonofRhipicephalussanguineusinaResidenEalArea,Riverside,2005

DogMansion

Findings•  OnJuly26,2005,morethan200Rh.sanguineusFckswerecollectedatthesiteinRiverside

•  R.ricke9siiDNAwasdetectedin1of62(1.6%)adultRh.sanguineusFcksbyCDC(differentfromthoseisolatedfromMontanaandArizona.)

DoesSpotgetSpots?SurveyforCanineCasesofRockyMountainSpoSed

FeverinCalifornia.

Results

•  338completedresponses•  PredominatelysmallanimalpracFcesthoughafewmixedandexoFc-mixedpracFcesalsoresponded.

•  PracFcesizerangedfrom5-50,000dogvisitsperyear(median2500dogvisits).

1

2-10

11-20 21-41

Number of responses (n=338)

County # Reported RMSF Cases

Orange 6

San Diego 5

Contra Costa 3

San Mateo 3

Alameda 2

Calaveras 1

Kern 1

Los Angeles 1

Riverside 1

Sacramento 1

Santa Barbara 1

Total 25

64

RMSF diagnosed in Californian dogs, CDPH Survey, 2007

ClinicalPresentaFon

Clinical Sign Number (percentage) n=25

Fever 17 (68%)

Other* 11 (44%)

Multiple painful joints 11 (44%)

tiny hemorrhages on gums, mucous membranes

4 (16%)

Abdominal Pain 3 (12%)

Edema (swelling) 2 (8%)

*Tiredness most common “other” sign

Small number of clinical cases precludes statistical comparison, however, note that a large percentage of clinics with RMSF dogs reported high exposure in their general practice to the brown dog tick, followed by the American dog tick and the western black-legged tick when compared to all practices.

Comparison of reported tick species between veterinary practices with and without RMSF K9 cases

0

10

20

30

40

50

60

70

80

90

Brow n dogtick

Unknow nspp.

Americandog tick

None torare tick

Westernblack-

legged tick

Pacif icCoast tick

Rocky MtnWood tick

Lone Startick

Winter tick

Tick Species

Perc

enta

ge o

f pra

ctic

es Practices with NO RMSF (n=321)

Practices with RMSF (n=17)

“DoesSpotgetSpots?”Conclusions

•  RMSFisrareindogsinCalifornia•  Largenumberofcasesreportedfromurbanareasandwithno

travelhistorysupportsideathatRMSFecologyhaschangedoverthepast50years.

•  Spotdoesgetspots,thoughrarityofdiseasebothinhumansanddogsandcomplexityofsurveillanceprecludesusingcaninesasregular“senFnel”forhumandisease.

CoulddogsinSouthernCaliforniabeinfectedwithR.rickeCsiiand/orinfestedwithinfectedbrowndogEcks?(CDC,CDPHandImperialCo.DOHstudy)EstablishedTwoSitesforDogSurveillance

•  CityAnimalShelterinCalexico

•  CountyAnimalShelterinEl

Centro

TrainingAnimalShelterStaff

Results

•  116dogsexamined(45inCalexicoand71inElCentro)March-April2009

•  Ticksfoundon35(30%)dogs(16inCalexicoand19inElCentro)

•  Overall,200Fckswerecollected(111females,87males,and2nymphs)andallwereidenFfiedasRh.sanguineus

•  PCRtesFngresultsshowedthatonefemaleFckwaspresumpFvelyposiFveforrickeSsialDNAbutspecies(orstrain)wasnotconfirmed

Conclusions

•  Rh.sanguineusinfestaFonondogsinImperialCo.ismoreheavierthaniniFallythoughtandtheFckscanbepotenFallyrelocatedintoneighboringareas

•  LackofR.ricke9siidetecFoninFckssuggestedthattheriskofRMSFintheareaisminimalattheFme

•  AcFveFcksurveillanceandcontroloffree-roamingdogsareimportantaspectsforkeepingtheriskofRMSFbelowepidemicthresholds

2013•  Resident,Fresnocounty•  PresentedlateDecember2012tolocalEDwithfever,headache,muscleaches,rashonwrist,leg,andtorso.

•  PaFentsuccumbedtoillness•  OrganFssuestestedposiFvebyimmuno-histochemistryandPCRatCDC

•  PaFenthadhistoryofvisiFnglocalruralCaliforniaareasoneweekprecedingdiseaseonset

•  36Dermacentorspp.FcksrecoveredfromoneareapaFentvisited;alltestednegaFve

2014•  Resident,ImperialCounty•  PresentedMaytolocalEDwithfever,nausea,vomiFng

•  Duringcourseofillness,RMSFserologictestsshowedrisingFter(confirmedcase)

•  PaFentcouldnotrecoveranddiedlateJune•  PaFent’smothertraveledwithdogsacrossMexicanborder

•  BrowndogFckspresentinandaroundhome;1/95posiFveforR.ricke9sii

•  NewsreleaseissuedbyImperialCountya}erpaFent’sdeathtoincreaseawarenessofdisease,importanceoftreaFngFckinfestaFons

LifecycleofRickeCsiarickeCsiiTickVectorsinCalifornia

RockyMountainwoodEckDermacentorandersoni

NaturalareasnortheasternCalifornia

PacificCoastEck,CADermacentoroccidentalis

Humid,naturalareasthroughoutCalifornia

BrownDogTickRipicephalussanguineus

UrbanareasandnaturalareasthroughoutCalifornia

AmericanDogTickDermacentorvariabilis

NaturalareasthroughoutCalifornia

•  Mammalreservoirbut…

•  Tickmaybebothreservoirandvector

•  RarelyfindagentintheFck

AnotherTicktoA

ddto

theStory…….

RockyMountainSpoLedFeverinHumansin

California2002-2014

CountyofresidenceofconfirmedRMSFhumancases

aTravelhistoryoutofcountybFatality

Since2002therehavebeen13confirmedcasesofRMSFreportedinCalifornia

2002,2014a,b

2004

2003

2002

2010

2011

2012a

2013a,b

2014a2014b

2012a

2011

NumberConfirmedandProbableRMSFCases,1997-2014

RMSFSeasonality

NaFonwide,1993-2010 California,1997-2014

Demographics,RMSFConfirmedandProbableReportedCases,1997–2014

Frequency Percent 95%CILower 95%CIUpper

Female 24 43.6% 30.3% 57.7%

Male 31 56.3% 42.3% 69.7%

TOTAL 55

North/SouthDistribuFonCountyofResidence,RMSFCasePaFents

ProporEonofcase-paEents(confirmedandprobable)whosecountyofresidenceisinNorth/SouthCA,byyearofsymptomonset,p<0.05.

Southern California Northern California

FrequencyofHispanic/LaEnoethnicityselfreported,byyear

-Trend(notsignificant)towardgreaterfrequencyofHispanic/LaFnoethnicity,(N=39)ChiSquared(MxN)p>0.05

NonHispanic/NonLatino Hispanic/Latino

TypicalDermacentorsppLifeCycle

BrownDogTick(Rhipicephalussanguineus)typicallifecycle

ImpactonMessagingForbothFckvectors:

•  AwarenessofDisease•  AvoidFckbites

– RemoveFckspromptlyandcorrectly–  InspectpetsandremoveFcks

•  Seephysicianifdevelopfever,headacheorrasha}erFckbite

•  Takepettoveterinarianifitdevelopsfever,lethargya}erFck-bite

ImpactonMessaging:Dermacentorspp

•  AwarenessofRMSFDisease–  Moregeneralapproach–  Targetaudience(California):outdoor

enthusiasts,ruralresidents•  AvoidFckbites

–  Stayinmiddleoftrails–  WheninFckhabitat:wearrepellents

containingDEETorclothingtreatedwithpermethrin

–  RemoveFckspromptlyandcorrectly•  Seephysicianifdevelopfever,headache

orrasha}erFckbite•  Takepettoveterinarianifitdevelops

fever,lethargya}erFck-bite

ImpactonMessagingBrownDogTick(Rhipicephalussanguineus)

•  AwarenessofDisease–  Mayneedcommunityapproach

•  Localresident/physicianawareness•  AvoidFckbites

–  Hostandenvironmentalissue•  KeepdogsonFckprevenFon(collars,vet-

approvedproduct)•  Environmentaltreatmentmayberequired

bylicensedpest-controloperator(mulFpletreatmentssomeFmesnecessary)

•  CleanupyardtoremovedebriswhereFckscanhide

–  RemoveFckspromptlyandsafely–  InspectpetsandremoveFcks

•  Seephysicianifdevelopfever,headacheorrasha}erFckbite

•  Takepettoveterinarianifitdevelopsfever,lethargya}erFck-bite

Source:Az.Dept.ofHealthServices

TreaFngBrownDogTickInfestaFons

Conclusions:re-emergingRicke9sia

•  NewlyidenFfiedFckvectorforCaliforniademonstrated

•  PotenFalsouthtonorthintroducFon•  ImpactshealtheducaFonmessaging•  Onehealthapproach(canine/human)usefulforsurveillanceandcontrol–  Sustainedsurveillance/controleffortneededforbrowndogFck-transmiSedRMSF

FinalThoughtsonDiseasesatCalifornia’sDoor

THEMONSTERRETURNSPeterMcCarty

•  Morepandemicslikelytobeseen“knocking”atthedoor

•  Airtravel/massiverapidmovementofpeople•  Increasedincomedisparitywillcontributetoemergence

•  ClimatechangemayinfluencevectorsaswellassocialstructurethatwillencouragemoremigraFon

•  PublichealthinfrastructureallowsforearlydetecFonandplanningforintroduceddisease

•  Ongoing,systemaFcsurveillance•  Buildonpreviousexperience(e.g.WestNilevirus)andmulF-agency(One-Health)collaboraFon

QuesEons?

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