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ADED Zoonoses Rounds February 19, 2008. Canine Leptospirosis Surveillance in Washington. February 19, 2008 ADED Zoonoses Rounds Liz Dykstra, PhD Zoonotic Disease Program Washington Dept. of Health. The Washington State Situation. Leptospirosis Overview History Findings Outbreaks
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ADED Zoonoses Rounds February 19, 2008
Canine Leptospirosis Surveillance in Washington February 19, 2008 ADED Zoonoses Rounds Liz Dykstra, PhD Zoonotic Disease Program Washington Dept. of Health
The Washington State Situation • Leptospirosis Overview • History • Findings • Outbreaks • Ongoing & Future Work
Leptospirosis Overview • Leptospira interrogans • Aerobic, gram-negative bacteria • Spirochete • >200 Known pathogenic Serovars • Autumnalis • Bratislava • Canicola • Grippotyphosa • Hardjo • Icterohaemorrhagiae • Pomona
Vomiting Anorexia Abdominal discomfort Febrile Weight Loss Depression/Lethargy Leukocytosis Thrombocytopenia Azotemia Increased liver enzymes Hyperbilirubinemia Decreased urine specific gravity Mild proteinuria Clinical Signs & Lab Test Results
Ecology • Mammalian Reservoirs • Settle into kidneys; shed in urine • Reservoir infected for life • Also found in fresh water, soil, & mud Janice Carr, CDC 1998
How are people and dogs getting leptospirosis? Recreational exposures ie. swimming, bathing or wading in contaminated water, mud
Human Cases of Leptospirosis in Washington State http://www.doh.wa.gov/EHSPHL/epitrends/08-epitrends/2008_trend.htm
Notifiable conditions and the veterinarian Purpose • Integrate veterinarians into the public health system. • Enhance surveillance for zoonotic diseases, which indirectly enhances human surveillance • Enhance recognition and capacity to investigate emerging pathogens in animal reservoirs • Detect agents used intentionally in biowarfare.
Flowchart for Veterinary Notifiable Conditions • Veterinarian reports condition to LHJ • Completes Lepto Report Form • Counsels Patient’s Owners Vet Clinic Faxes Report to DOH LHJ CD Epi/EH is informed about the report • LHJ asks veterinarian to counsel client about zoonotic disease potential and prevention/control measures. • Completes report form • Faxes report to DOH. LHJ reports condition to DOH Health care provider may call LHJ nurses for information Clients know to visit their health care provider if they experience any symptoms and to mention their ill pet. LHJ = Local Health Jurisdiction
History of DOH Surveillance Program • Vets first required to report notifiable conditions around 2000 • Increased concern of bioterrorism potential of zoonotic diseases • Increased number of lepto cases showing up vet clinics • DOH Lepto reporting program begun in July 2004
To be completed by veterinarian To be completed by LHJ
Case Definition* • Acute onset of clinical signs including at least one of the following: fever, inappetance, abdominal pain, vomiting, jaundice, or polydipsia/polyuria, or oliguria. AND • Laboratory findings of azotemia or elevated liver enzymes OR • Histopathological diagnosis consistent with leptospirosis AND • MAT titer >1:800 for LeptospiraOR • FA+ urine OR • Histological staining of tissues positive for Leptospira *Margaret Davis, DVM, WADDL; 2/27/06
Morbidity & Mortality (n=183) ~27% Case Mortality
Average Monthly Reported Cases of Canine Leptospirosis in WashingtonJuly 2004 – January 2008 (n=183)
Island San Juan Whatcom Okanogan Pend Oreille Ferry Skagit Stevens Clallam Snohomish Chelan Jefferson Douglas Spokane Kitsap Lincoln King Mason Grays Harbor Grant Kittitas Pierce Adams Whitman Counties reporting human Leptospirosis cases Thurston Pacific Lewis Garfield Franklin Yakima Columbia Asotin Cowlitz Benton Skamania Walla Walla Wahkiakum Klickitat Clark 1-5 16-30 6-9 31+ 10-15 Figure 1 Canine Leptospirosis Cases by CountyJuly 2004 – January 2008
Exposures Wildlife • Raccoons • Rats • Opossums • Squirrels Access to standing or slow moving water
Outbreaks • Bainbridge Island, King County • December 2006 • Vashon Island, King County • Dec 2005–Feb 2006
Ongoing and Future Work • Vet and Owner Fact Sheets • Canine Leptospirosis web site • Brochures • Downloadable Tools
Special Acknowledgements • Dr. Jane Koehler – Seattle-King County PH • Dr. Sharon Hopkins – Seattle-King County PH • Rebecca Baer – CD-Epi, WA DOH • Dr. Mira Leslie – Ministry of Agriculture & Lands, BC • Dr. Margaret Davis – CVM, WSU • Dr. Jim Evermann – WADDL, WSU • Dr. Ron Wohrle – ZD Program, WA DOH • All of the LHJs and Veterinarians who have provided case reports to this program.
Questions? Liz Dykstra Phone: 360.236.3388 Email: elizabeth.dykstra@doh.wa.gov http://www.doh.wa.gov/ehp/ts/zoo.htm