The National Companion Animal Surveillance Program A Partnership of Banfield Pet Hospitals & Purdue University

1. The National Companion Animal Surveillance ProgramA Partnership of Banfield Pet Hospitals & Purdue University AAVMC/ASPH Joint Symposium Atlanta, GA April 22-24, 2007 Larry Glickman, VMD, MPH, DrPH Professor Epidemiology & Environmental Medicine Purdue University School of Veterinary Medicine Supported by a $1.2 million dollar grant from the CDC in 2003

2. Surveillance – CDC Definition • Ongoing systematic collection, analysis, and interpretation of health data • Essential to the planning, implementation, and evaluation of public health practice • Closely integrated with the timely dissemination of these data to those who need to know

3. Temporal Sequence of Surveillance Recovery Agent Signs & Symptoms (I & W) Diagnostic Tests Specific Diagnosis/Agent Outcome Death Syndromic Surveillance Exposure Surveillance Traditional Surveillance I & W = Indications & Warnings

4. Biothreat A Agents in Dogs & Cats * - CDC 2003: http://www.bt.cdc.gov/agent/agentlist-category.asp ** - reported with species of greatest (or equal) susceptibility first

5. The National Companion Animal Surveillance Program (NCASP) Team • A joint effort of the Purdue University School of Veterinary Medicine with Banfield the Pet Hospital • Other participants at Purdue: • School Electrical & Computer Engineering • Cyber Center • Statistics Department • COMSYS (SAS Affiliate) • Antech Diagnostics

6. Objectives of NCASP • Provide surveillance for syndromic and disease events in pet animals in the United States • Federal • State • Conduct statistical analyses to identify space-time clusters of events and risk factors (host, environment) for disease • Alert to the occurrence of potential acts of bioterrorism and emerging zoonoses • Characterize safety & efficacy of veterinary drugs and vaccines (pharmacoepidemiology) • Serve as a sentinel for environmental hazards for human and animal health

7. Banfield The Pet Hospital • Currently 620+ full service hospitals • 2 additional hospitals per week • Located in 44 states, Mexico, UK • >3.0 million patient visits yearly • ~ 10,000 patient visits daily • ~ 2-4% of U.S. pet population • Addresses geocoded & records electronic

8. Purdue University Data Warehouse Data Mining National Companion Animal SurveillanceProgram

9. Number of Dogs & Cats Visiting Banfield The Pet Hospital in 2005

10. Number of Other Animal Species Visiting Banfield The Pet Hospital in 2005

11. Alert!!!Fayette County GA’s Own “Silent Summer” • Philips Services, Corp. emits noxious pesticide (Ethoprop) on May 29, 2006 • 600 residents affected with clinical illness and reports of an onion-like odor • Dogs and cats are sick or dying with signs of vomiting, diarrhea, skin irritation, dyspnea • Purdue contacted Sept. 2 for help regarding acute & long-term health • Animals as sentinels for human health • Animal health

12. Persons Reported with At Least 2 Specified Symptoms by Week of Onset, Fayette & Fulton Counties, GA, May 1 – Aug 31, 2006 Specified symptoms: headache, nausea/vomiting, nosebleed, difficulty breathing, cough/sore throat, burning eyes (N=233)

13. Location of Fairburn, GA Banfield Hospitals Near Fairburn, GA Banfield Hospitals within 20-mile radius of Fairburn, GA

14. Banfield Dogs and Cats within 15-mile Radius of Chemical Plant in Fairburn, GA Banfield Cats n = 3,065 Banfield Dogs n = 15,753 1129 288 Fairburn Chemical Plant 281 Includes Banfield dogs and cats successfully geocoded for year 2005

15. Dog Eye InflammationWithin 20 miles of FairburnNormalized by total # of Dogs

16. Eye Inflammation in Cats (top) and Dogs (bottom)Y Axis=Distance from Epicenter in Miles

17. Syndromic Spatial -Temporal Clusters in Fairburn, GA in Week Following Mercaptan Release Eye Inflammation - Dogs (p<0.05) Respiratory Syndrome - Dogs (p<0.05)

18. Other Published Studies Using NCASP • Pharmacoepidemiology • Safety and efficacy of heartworm preventives • Dog and cat vaccine adverse reactions • Animal diseases & infections • Parasitic infections of cats & risk factors • Prevalence of canine tick infestation & risk factors • Canine heartworm prevalence & risk factors • Leptospirosis epidemiology • Influenza illness in dogs and cats • Comparative medicine • Periodontal disease & chronic health conditions including renal and heart disease (in progress)

19. Proposed Flea/Tick Pathogen Surveillance Vector ID Pathogen ID Medical Records Ticks: Anaplasma sp, Babesia sp, Bartonella sp, Borrelia lonestari, Erlichia sp, Francisella tularensis, Rickettsia sp Fleas: Bartonella sp, Dipylidium caninum, Mycoplasma sp, Rickettsia sp, Yersinia pestis Web Portal

20. Tick Infestation in Dogs

21. Lyme Disease in Dogs

22. Canine Tick Activity Precedes Human Lyme Disease

23. Banfield, The Pet HospitalAtlanta, GA Metropolitan Area Canine Tick Rate by Month Canine Tick by Residence

25. Respiratory Syndrome: Hurricane Katrina

26. The New Yorker, June 16 & 23, 2003

27. Epidemiology Using Large Data Bases Can Produce the Evidence Required to Address Important Veterinary Clinical and Public Health Issues

28. Leptospirosis • World-wide zoonotic disease • Gram negative bacteria • Spirochetes • Genus Leptospira • Over 250 serovars

29. Percent Positive* Leptospirosis (MAT Tests) 2002 2003 2004 * Positive ≥ 1:400

30. Allergic events following administration of a 4-way leptospirosis vaccine (breeds >5000 dogs) JAVMA 2005;227:1102-1108.

31. Moore GE, et al. J Am Vet Med Assoc 2005;227:1102-1108.

32. 27.3% 11.5%

34. Evidence from epidemiological studies using large clinical and laboratory data bases allows veterinarians to determine the risk of infection for pets in their area and to perform individualized risk assessments for vaccination or therapy.

35. The Purdue-Banfield National CompanionNational Animal Surveillance Program • Moore, G., Ward M., Glickman N., Engler K., Lewis H., Glickman L.:  Incidence and risk factors for adverse events associated with distemper or rabies vaccine administration in pet ferrets, J. Amer Vet. Med. Assoc., 226:909-912, 2005. • Glickman, L., Glickman, N., Moore, G.: The safety profile of ProHeart 6 (moxidectin) and two oral heartworm preventives in dogs, Intl. J. Appl. Res. Vet. Med. 3:49-61, 2005. • Moore, G., Frana, T., Guptill, L., Ward, M., Lewis, H., Glickman, L.:  Postmarketing surveillance for dog and cat vaccines: new resources in changing times, J. Amer. Vet. Med. Assoc., 227:1066-1068, 2005. • Moore, E., Guptill, L., Ward, M., Glickman, N., Faunt, K., Lewis, L., Glickman, L.: Adverse events diagnosed within three days of vaccination in pet dogs, J. Amer. Vet. Med. Assoc., 227:1102-1108, 2005. • Moore, G., Ward, M., Kulldorff, M., Caldanaro, R., Guptill, L., Lewis, H., Glickman, L.: A space-time cluster of adverse events associated with canine rabies vaccine, Vaccine, 23:5557-5562, 2005. • Moore, G., Guptill, L., Glickman, N., Caldanaro, R., Aucoin, D., Glickman, L.: Serologic prevalence of canine leptospirosis in the US, 2003-2005, Emerging Infect. Dis., 12:501-503, 2006

36. The Purdue-Banfield National CompanionNational Animal Surveillance Program (con’t) • DeSantis-Kerr, A., Raghavan, M., Caldanaro, R., Glickman, N., Moore, G., Lewis, H., Glickman, L.: A national survey of nematode parasitism among pet cats in the United States, J. Amer. Vet. Med. Assoc., 228:885-892, 2006 • Glickman, L., Moore, G., Glickman, N., Caldanaro, R., Aucoin, D., Lewis, H.: Purdue University-Banfield National Companion Animal Surveillance Program for emerging and zoonotic diseases. Vector-born Zoonotic Dis., 6:14-23, 2006. • DeSantis, A., Raghavan, M., Caldanaro, R., Glickman, N., Moore, G., Lewis, H., Glickman, L.: Prevalence and risk factors for Giardia and coccidian species of pet cats in 2003-2004, J. Feline Med. Surg., 8, 292-301, 2006 • Glickman, L., Glickman, N., Moore, G., Lok, J., McCall, J., Lewis, H.: Comparative effectiveness of sustained-release moxidectin ((Proheart 6) and ivermectin (Heartgard Plus) for the prevention of heartworm infection in dogs in the United States, Intl. J. Appl. Res. Vet. Med., 4:339-354,2007. • Raghavan, M., Glickman, N., Moore, G., Caldanaro, R., Lewis, H., Glickman, L.: Prevalence and risk factors for canine tick infestation in the United States, 2002-2004, Vector-born Zoonotic Dis., 7:65-75, 2007. • Moore, G., DeSantis-Kerr, A., Guptill, L., Glickman, N., Lewis, H., Glickman, L.: Adverse events following vaccine administration in cats, J. Amer. Vet. Med. Assoc. (Accepted with revisions)