PulseNet OutbreakNet East Coast Regional Meeting Wednesday Sunrise Session Agenda Introduction to One Health Cryptosporidium and Goats Rhode Island Campylobacter and Puppies F ID: 819958
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One Health and Enteric DiseasePulseNet
One Health and Enteric DiseasePulseNet/OutbreakNetEast Coast Regional MeetingWednesday Sunrise SessionAgendaâ¢Introduction to One Healthâ¢Cryptosporidium and Goats âRhode Islandâ
¢Campylobacter and Puppies âFlorid
¢Campylobacter and Puppies âFloridaâ¢Salmonella and Turtles âPennsylvaniaâ¢Cryptosporidium and Cows âNew Hampshireâ¢DiscussionOne Health OfficeNational Center for Emerging
and Zoonotic Infectious DiseasesCenter
and Zoonotic Infectious DiseasesCenters for Disease Control and PreventionOneHealthThe health of humans is connected to the health of animals and the environment. Endemic and Emerging Zoon
otic Diseasesare spread between animal
otic Diseasesare spread between animals and people Zoonotic Diseases are a Threat to Health Securityï§60% of existing human infectious diseases are zoonoticï§At least 70% of emerging i
nfectious diseases of humans (including
nfectious diseases of humans (including Ebola, HIV, and influenza) have an animal originï§5 new human diseases appear every year. Three are of animal origin.ï§80% of agents with potenti
al bioterrorist use are zoonotic pathog
al bioterrorist use are zoonotic pathogenswww.oie.int/onehealthOne Health: The Way ForwardOne Health is the collaborative effort of multiple disciplines and sectorsâworkinglocally, na
tionally, regionally, and globallyâ
tionally, regionally, and globallyâwith the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and our shared environmentDomestic
One Health Priorities ï§AddressIHR
One Health Priorities ï§AddressIHR core capacities from US Joint External Evaluationï§Partnerwith industry, professional organizations, and others on zoonosespreventionâ¢NASPHV,
Youth in Agriculture, PIJAC, Zoonoses
Youth in Agriculture, PIJAC, Zoonoses Education Coalitionï§Distribute zoonoses prevention messaging and One Health updates to stakeholders â¢ZOHU Callsâ¢Healthy Pets, Healthy Peopl
e websiteGoat Cuddling and Cryptosporid
e websiteGoat Cuddling and Cryptosporidium: Rhode Island, April 2018Initial Investigationâ¢04/09/18-04/11/18ï 4 reports of crypto received.â¢04/11/18-04/13/18ï Investigated clus
ter. Learned 3/4 reported attending â
ter. Learned 3/4 reported attending âpet and cuddleâ event at same farm. Baby goats identified as common exposure.â¢04/13/18ï Notified DEM; farm cancelled âpet and cuddleâ schedul
ed for weekend.â¢4/16/18ï Order of
ed for weekend.â¢4/16/18ï Order of quarantine issued by DEM. Provider advisory issued.Continuing Investigation â¢4/16/18 & 4/17/18ï Additional illness reports received; stool culture
s obtained. MADPHnotified. â¢4/18/
s obtained. MADPHnotified. â¢4/18/18ï DEM inspected farm. CDC and other states consulted for advice and recommendations.â¢4/18/18 & 4/23/18ï 10 clinical specimens sent to CDC for s
ubtyping. â¢4/24/18ï Farm animals
ubtyping. â¢4/24/18ï Farm animals tested for parasites.â¢5/02/18ï Subtyping results received from CDC.â¢5/09/18ï Animal testing results received. â¢5/16/18ï Follow-up jo
int inspection; order of quarantine lift
int inspection; order of quarantine lifted.Epi Summaryâ¢55 probable and confirmed cases of cryptosporidiosis (21 laboratory confirmed, 2 MA residents)â¢All reported visiting farm over the
3 weekends beginning on 3/24/18, 3/30/18
3 weekends beginning on 3/24/18, 3/30/18 and 4/6/18â¢100% reported contact with baby goatsâ¢Median age: 29 yearsâ¢64% femaleâ¢Symptoms began a median of 7 days after visiting farmâ¢
Symptoms lasted median of 9.5 days (n=1
Symptoms lasted median of 9.5 days (n=12)â¢61.5% visited health care provider, 5.8% visited ER, 1 case hospitalized (n=52)Baby Goat Contact Outbreak, RI, 2018Handwashing information â¢Ha
ndwashing information available for 46 i
ndwashing information available for 46 individuals:â¢7 reported washing hands with soap and waterâ¢8 reported washing hands with soap and water & hand sanitizerâ¢22 reported washing hands
with hand sanitizer onlyâ¢9 reported
with hand sanitizer onlyâ¢9 reported not washing hands at all67.4% not effective32.6% effectiveClinical Testing Summaryâ¢All clinical specimens sent to CDC for genotyping were positive
for the same subtype of Cryptosporidi
for the same subtype of Cryptosporidium parvum (IIaA19G2R1)â¢Rare subtype; /400 submissions received by CDC in 2017 were positive for this subtype.â¢Subtype identified in goats previous
ly, but not known if itâs a dominant
ly, but not known if itâs a dominant subtype.Farm Investigation Summaryâ¢Barnyard where goats kept described as wet and unsanitary; DEM noted drier and more sanitary areas available.â¢G
oats observed to have access to indoor h
oats observed to have access to indoor housing that had excessive manure buildup.â¢Lack of routine veterinary care.â¢2 goats positive for Cryptosporidium, 2 goats suspect for Cryptosporid
ium. 1 goat and 1 calf positive for Gi
ium. 1 goat and 1 calf positive for Giardia.â¢Subtyping results not available for animals.Post Outbreak Recommendationsâ¢Separation of ill animals from well animalsâ¢Animals that test
ed negative moved to clean area of farm
ed negative moved to clean area of farmâ¢Submit plan for goat yogaâ¢Better signage for handwashingâ¢Ensure soap and water available; do not rely solely on hand sanitizerâ¢Instruct gues
ts on proper cleaning of soiled shoes, c
ts on proper cleaning of soiled shoes, clothes, etc.Conclusionsâ¢Animal contact outbreak associated with baby goats.â¢Epi and lab evidence supported cases becoming ill from a common source.
â¢Environmental evidence also linked
â¢Environmental evidence also linked cases to farm.â¢Improper hygiene contributing factor.â¢Need for outreach to other farms that may allow public to interact with animals.FloridaPenns
ylvaniaRecent history2017 âTwo out
ylvaniaRecent history2017 âTwo outbreaks of Crytposporidiumlinked to contact with ill calvesJanuary 2018 âLarge outbreak of Cryptosporidiumat a university dairy barnSpring 2018
âTwo outbreaks of Crytposporidiumli
âTwo outbreaks of Crytposporidiumlinked to contact with ill calvesFall 2018 âSmaller outbreak of Cryptosporidiumat a university dairy barnLetâs talk about this university dairy ba
rnFull dairy operation, run by students
rnFull dairy operation, run by students90 milking-age cows, 70 growing cowsFacility open to the publicUniversity dairy barn investigationReceived notification from Maine about lab-confirm
ed Cryptosporidiumcase who was visitin
ed Cryptosporidiumcase who was visiting the barnCase reported others with similar symptomsBarn manager confirmed others illProposed conducting a site visit at the dairy barn, talking with stu
dent workers, providing education at th
dent workers, providing education at the barnUniversity dairy barn investigationThrough interviews with students, identified 10 cases of Crypto-like illnessIdentified several issues with b
arnLack of hand washing sinks and signs
arnLack of hand washing sinks and signsFood and drinks in the barnDifficulties in boot washing and cleaningReported findings to State Veterinarian, who agreed with our recommendationsUnivers
ity dairy barn investigationSent barn m
ity dairy barn investigationSent barn manager and student team advisors a list of our findings and recommendationsCompendium of Measures to Prevent Disease Associated with Animals in Public Se
ttings, 2017No illnesses or issues repo
ttings, 2017No illnesses or issues reported during the remainder of the school yearAdditional cases identified in the Fall of 2018State Veterinarian site visitSigns EVERYWHERE!Sinks and clean
ing supplies in abundanceInterviews sho
ing supplies in abundanceInterviews showed increase in knowledge about Cryptosporidiumand how to prevent itStudents who were ill were the ones who were not following the barn rulesUsing the
One Health approach to prevent addition
One Health approach to prevent additional illnesses at this dairy barnEducate students about Cryptosporidiumin animalsInstitute environmental controls to limit or prevent the spread of dise
ase from animal to humanEducate student
ase from animal to humanEducate students about Cryptosporidiumin humansWhat worked for us:Good working relationship with State Veterinarians (Agriculture, Public Health, etc.)Compendium of
Measures to Prevent Disease Associated w
Measures to Prevent Disease Associated with Animals in Public Settings, 2017Visibility on-site during investigationsCDC One Health Fact Sheet Available at: https://www.cdc.gov/onehealth/pd
fs/OneHealth-FactSheet-FINAL.pdfHea
fs/OneHealth-FactSheet-FINAL.pdfHealthy Pets, Healthy People Websitewww.cdc.gov/healthypetsâ¢1stWednesday of month, 2pm ETâ¢NEW: Free Continuing Educationâ¢9,000 invite
es from local, state, & federal human an
es from local, state, & federal human and animal health departments, organizations, academics, and many other partnersâ¢Call topics include timely updates onâ¢Companion animals, livestock,
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and wildlife zoonosesâ¢Emerging infectious diseasesâ¢Vector-borne, foodborne, and waterborne diseasesâ¢Updates on recent outbreak investigationsâ¢Environmental health issuesâ¢Prev
ention programs, guidance, and resources
ention programs, guidance, and resourcesâ¢Upcoming public health events and activitiesâ¢To subscribe visit, https://www.cdc.gov/onehealth/zohu/â¢To suggest topics, contact ZOHUCall@
cdc.govDet the latest news from CDCâs
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