Zoonosis Prevention and Infection Control in Zoos

1. Zoonosis Prevention and Infection Control in Zoos Donald L. Janssen, DVM, Dip. ACZM Corporate Director, Animal Health San Diego Zoo and San Diego Zoo’s Wild Animal Park

2. Topics for Today General Biosecurity in Zoos Handling Zoonotic Disease Cases Zoonosis Training for Zoo staff

3. Organization-wide approach to infection control 1. General Biosecurity Guidelines

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7. Biosecurity - Definition Those precautions taken to minimize the risk of introducing an infectious disease into an animal population. All programs of infection control within our facilities

8. General Biosecurity Highlights Facilities Animal Care Staff Collection Animals Animal Feed Wild and Feral Animals Surveillance Education and Communications Occupational Health Care Enhanced Biosecurity Measures

9. BiosecuritySpecific Policies and Procedures Primate Safety Policy Reptile Handling Guidelines Bat Handling Guidelines Placenta and Newborn Animal Handling Guidelines Highy-Pathogenic Avian Influenza Exotic Newcastle Disease

10. Facility Biosecurity • Design and manage with biosecurity in mind • Facility “control points” • Back of house • Entrance and exit procedures

11. Animal Care Staff Biosecurity Includes employees, volunteers, contractors, etc. Hand hygiene Uniforms and outerwear, footwear Animal products from outside

12. Collection Animals Biosecurity Quarantine incoming animals Cleaning and disinfection of transport carriers, nets, gloves,

13. Animal Feeds Biosecurity All food will be procured through the Nutritional Services department Do not feed uncooked poultry products General food safety principles will be followed in food storage and preparation areas.

14. Feeder crickets

15. Wild and Feral Animals Biosecurity Minimize access by wildlife around animal enclosures Follow protocols for handling sick and injured native wildlife Prevent standing water accumulation in accordance with West Nile virus prevention program.

16. Surveillance • Passive Surveillance • Post-mortem Examinations • Morbidity and Mortality Investigations • Active Surveillance • Preventive Medicine Examinations

17. Communication and EducationBiosecurity Highlights Public Communications Regulatory Communications Employee and Volunteer Training

19. Occupational Health Occupation Safety and Health Administration Employee occupational medicine provider

20. Enhanced Biosecurity Foreign Animal Diseases Exotic Newcastle Disease Highly Pathogenic Avian Influenza (e.g. H5N1) Foot and Mouth Disease

21. Disinfection Guidelines

22. Disinfection - Priniciples Clean before disinfection Contact time Proper dilution – label directions Frequency Disinfectant classes and spectrum of action

23. Disinfectants - Specific Uses Foot baths Hand washing Non-porous surfaces Porous surfaces Animal handling equipment Footwear

24. Disinfectant Approval Process

25. 2. Managing Cases Diagnosed With a Zoonotic Disease Agent

26. What should we do when we diagnose a zoonotic disease in our zoo?

27. Definition: Zoonotic Disease Any infectious disease that can be readily transmitted between animals and humans

28. Zoonotic Disease OccurrenceQuestions to Ask Ourselves What do we do? • Who is in charge and making decisions? • Who should we notify and what do we say? • What do the caretakers need to know? • Do we need to isolate the animal? How? • How do we handle animal waste? • Do we need to report to government regulators? • How do we manage the medical care of the infected animal?

29. Zoonotic Disease OccurrenceConsequences What are the consequences of mishandling this? • Animal well-being • Public health • Institutional reputation • Professional reputation • Unnecessary human and animal illness

30. Zoonotic Disease OccurrenceSolution • Zoo clinicians are well-suited to handle this • Decide what to do before the occurrence • Develop a pre-determined process • Decide what will trigger the process

31. Zoonotic Disease OccurrenceTrigger A zoonotic agent is diagnosed or highly suspected in an animal or human contact

32. Zoonotic Disease OccurrenceSuggested Steps • Notify • Infection Control • Isolate • Handle waste • Report • Treat/manage animal

33. #1 - NotifyKey Stakeholders • Animal care supervisors • Occupational health provider • Provide disease fact sheet to keepers • Remind all to report signs and symptoms of disease in themselves

34. #2a - IsolateAnimal from others • 1st Infection Control step • Consider feasibility and risk • Required if guest contact • Reinforce personal hygiene • Institute PPEs as indicated • Footbath • Use of separate tools and equipment

35. #2b - Waste handling • 2nd Infection Control step • Use sewer disposal if possible • Contaminated bedding • Prevent spreading contamination • Disinfection • Follow local regulations for biomedical wastes

36. #3 - ReportTo authorities if required • Know what diseases are reportable (federal, state, county) • Develop rapport with local health departments • Consider internal tracking document

37. #4 – Medical Care • Appropriate treatment, if indicated • Follow up diagnostics as appropriate • Establish an end point for the isolation and precautions

38. Resources Available CDC Zoonotic Disease Fact Sheets

39. Resources Available Reportable Diseases

40. Resources Available EPA Waste Management

41. Gorilla shigellosis Elephant MRSA Aviary Psittacosis Case Examples

42. Trigger Notify Isolate Waste Handling Report Medical Care Gorilla - Shigellosis

43. Trigger Notify Isolate Waste Handling Report Medical Care Elephant Calf - MRSA

44. Trigger Notify Isolate Waste Handling Report Medical Care Aviary - Psittacosis

45. Summary • The consequences of mishandling a zoonotic disease occurrence are enormous • A systematic process will help avoid mistakes and failures to act • Set up a process ahead of time

46. 3. Zoonosis Training Program for Zoo Staff Adapted from materials supplied by: Carol Roach, RN, PHN San Diego Health and Human Service Agency Community Epidemiology Branch

47. Basic infection control principles for all employees Course 1 Advanced training for animal care staff Course 2

48. Basic infection control principles for all employees Course 1 • Choices and Responsibilities • Definitions • Factors for Disease Transmission • Transmission Pathways • Simple Rules of Infection Control • Hand washing 101

49. Three Definitions You Need To Know ZOONOSES PATHOGEN INFECTION CONTROL • Infectious diseases that move easily between animals and humans Any disease-producing agent (especially a virus, bacterium, fungi or parasite) A systemofpreventive measures to reducethe risk of infectious disease transmission

50. The How, When & Where of Disease Transmission THERE ARE 3 FACTORS NECESSARY FOR DISEASE TRANSMISSION • 1. A Source of Pathogens 2. A Susceptible Host 3. A Means of Transmission