SAPUVETNET

1. SAPUVETNET Case StudyVenezuelan Equine Encephalitis Outbreak • Animal and public health Adittional material: “Encefalitis equinas en salud pública” book

2. SAPUVETNET In memoriam To the valuable contribution of Dr. Jaime Cardenas (R.I.P.) PAHO/WHO Colombian veterinary Public health adviser

3. SAPUVETNET Antecedents • The events happen in Northern South American countries with coasts on the Caribbean Sea and a wide border zone. • In the border region of the neighboring country (A), the animal health services notified, during May an equids febrile disease event (equines, asnals and mules), with fast diffusion towards other localities. An indigenous group that inhabits that border zone, notified cases in its asses. • By those time this ethnic group makes an annual trip to the neighboring country (B), to make marine salt harvesting activities

4. SAPUVETNET Outbreak evolution • Towards the end of July, on the other side of the border (country B), the animal health authorities, notified the presence of an outbreak of febrile disease with nervous signs in equids. During that month a transition between the rains season and the dry station happened, flood zones persisted and strong vectorial activity: Ochlerotatus (Aedes) taeniorhynchus; entomological research were carried out, to evaluate the population density of several species of mosquitoes, revealing a high density of Ochlerotatus taeniorhynchus, Psorophora confinnis; Culex quinquefasciatus, Anopheles spp, Culex spp and Deinocerites pseude1 adults and larvae. • Between the 8 and the 16 of September, the health services notified an increase in the number of clinical consultations for febrile disease compatible with classic dengue. An attack rate greater than 60 % was found (febrile picture).

5. SAPUVETNET ¿Do you think there is any relation between the cases of humans and animals? According to your criteria what would be the basis to justify that relation. Consider the period of time, the subjects involved and the areas where the facts happened

6. SAPUVETNET Outbreak investigation About what diseases would you think? Make a list of them and indicate the most probable ones.

7. SAPUVETNET Outbreak investigation • About what diseases would you think? • Rabies, arbovirus encephalitis (Japanese encephalitis, EEE, WEE, West Nile encephalitis, Saint Luis encephalitis y Murray Valley encephalitis , among others), viral equine rhinoneumonitis, infectious equine anemia, pseudo rabies, African equine plague, maindrain virus, borna disease; • Tetanus, botulism, intoxication with heavy metals, hepatogenic encephalopathy because of toxic plants; • Equine Mielopathy; • Parasitary diseases because of nematodes, babesiosis, tripanosomiasis and toxoplasmosis.

8. SAPUVETNET With this information, How would you make the diagnosis? What samples would you take? ¿How would you send the samples? How would you interpret the results?

9. While you are waiting the results, what actions World you take? In humans, the report of the sanitary authorities was: 22.900 cases 1.200 hospitalizations Dissemination rate 5 km/Day Increase in the number of abortions/Month 3000 neurologically affected cases 300 associated deaths Isolation of EEV virus subtype 1C Most affected ethnic group: Wayuú Source: Reyes, M., Villamil, L., De la Hoz, F., 2006 The report in animals was: 137 affected farms 38 with diagnose of Venezuelan equine encephalitis (by laboratory) 12 with diagnose of east equine encephalitis (by laboratory) 87 with clinical diagnose Given the rapidity with which the epidemics and epizootics of VEE are scattered in the different geographic areas, an intervention of effective emergency is required; once a center of EEV is characterized in the zone, the actions of center control are made, by means of pre-established plans of contingency. SAPUVETNET Diagnosis

10. SAPUVETNET Which is your role as veterinarian in public health? What actions must be taken? Think on the intersectorial cooperation. Discuss it Give attention to the intersectorial cooperation, the comunicattion, the animal movement control, the vaccinations program, the epidemiologic surveillance systems, the vector control and the community participation..

11. SAPUVETNET BIBLIOGRAPHY • Brito, E. Encefalitis Equina - Relatoría. Simposio Internacional "Salud Pública Veterinaria, Protección Sanitaria y Desarrollo Agropecuario". Bogotá, Colombia. 2002. • Brito, E. Situación de la Encefalitis Equina Venezolana en Colombia. Simposio Internacional "Salud Pública Veterinaria, Protección Sanitaria y Desarrollo Agropecuario". Bogotá, Colombia. 2002. • Cárdenas, J. Las Encefalitis Equinas causadas por virus transmitidos por artrópodos, esfuerzos para su prevención y control. Simposio Internacional "Salud Pública Veterinaria, Protección Sanitaria y Desarrollo Agropecuario". Bogotá, Colombia. 2002. • Centres for disease Control and Prevention, Departamento de salud y servicios humanos, bioseguridad en laboratorios de microbiología y biomedicina, 4th Edition, Ver: http://www.cdc.gov/od/ohs/pdffiles/bmbl4_spanish.pdf • Dora, F. Encefalitis Equina en Venezuela. Simposio Internacional "Salud Pública Veterinaria, Protección Sanitaria y Desarrollo Agropecuario". Bogotá, Colombia 2002. • Ferro, C.; Boshell, J.; Weaver, S.; et al. Natural Enzootic Vectors of Venezuelan Equine Encephalitis Virus, Magdalena Valley, Colombia. Emerging Infectious Diseases, Vol 9, N° 1, Enero 2003. • López, E. Encefalitis Equinas en Centro América. Simposio Internacional "Salud Pública Veterinaria, Protección Sanitaria y Desarrollo Agropecuario". Bogotá, Colombia. 2002. • Mejía, F. Epidemiología de la Encefalitis Equina Venezolana en Colombia. Universidad Nacional de Colombia. Bogotá D.C. 2002. • Mesa FA., Cárdenas J., Villamil L.C. Las encefalitis equinas en la salud pública. Universidad nacional de Colombia. ISBN 958 701 598 3. 123pp. 2005 • OPS / OMS. Brote de Encefalitis Equina Venezolana 1995. Epidemiological Bulletin. Vol. 16, No. 4 . Diciembre 1995. • Rivas, F; De la Hoz, O.; Boshell, J.; Olano, V; Roselli, D; et al. Epidemic Venezuelan Equine Encephalitis in La Guajira, Colombia, 1995. The Journal of Infectious Diseases, 175: 828-32, 1997. • Ruiz, A.; Zúñiga, I.; Álvarez, E. Bases Para la Instrumentación de un Sistema de Información y Vigilancia Epidemiológica de la Encefalitis Equina Venezolana en la Región de las Américas. Organización Panamericana de la Salud. OPS/HCP/HCV/96.24 • SANINET. Encefalomielitis Equina Venezolana. www.iica.saninet.net

12. SAPUVETNET Acknowledgement To the valuable contribution of Dr. Jaime Cardenas (R.I.P.), PAHO/WHO Colombian veterinary Public health adviser and Dr. Fabio Mesa D from the ICA Colombian Risks Office. Case study developed by the members of RED SPVET, Universidad Nacional de Colombia y SAPUVETNET II – (contact: Luis Carlos Villamil J, E-mail: lcvillamilj@unal.edu.co, redspvet@yahoo.com.ar)