April to June 2021

Zoonoses and Veterinary Public Health

Quarterly report Q2 – April to June 2021

Project FZ2100

Published: August 2021

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Contents

1. General scanning surveillance ...... 1

1.1 Zoonoses VIDA data for Great Britain: April-June 2021 ...... 1

1.2 Highlights from APHA and SRUC disease surveillance centres ...... 4

2. Specific scanning and targeted surveillance and other studies ...... 4

2.1 Campylobacter...... 4

2.2 Leptospirosis ...... 5

2.3 Mycobacteria (excluding M. bovis) ...... 5

2.4 Q fever...... 6

2.5 Streptococcus suis ...... 7

2.6 Toxoplasmosis ...... 7

3. Investigations into zoonotic and potentially zoonotic incidents...... 8

3.1 Cryptosporidiosis ...... 8

3.2 STEC ...... 9

3.3 Corynebacterium ulcerans ...... 9

3.4 Coxiella burnetii ...... 10

Monitoring the occurrence of certain animal diseases can highlight the potential for zoonotic transmission and provide an indication of human, environmental and foodborne health risks. These FZ2100 project reports, which primarily relate to farmed animal species, summarise the surveillance activities of the Animal and Plant Health Agency (APHA) and the SRUC Veterinary Services (SRUC VS) in Scotland, for mainly non- statutory zoonoses and infections shared between man and animals in Great Britain, using data gathered by the network of Veterinary Investigation Centres. Quantitative diagnostic data for all of GB is provided by the Veterinary Investigation Diagnostic Analysis (VIDA) surveillance system. Summaries of joint veterinary/medical investigations into incidents and outbreaks of zoonotic disease and associated activities are also included. This report covers the three month period between April and June 2021.

The Zoonoses and Veterinary Public Health project (FZ2100) is funded by Defra, the Scottish Government and the Welsh Government through the APHA’s Bacterial Diseases and Food Safety portfolio and also uses returns from scanning surveillance projects. Non- statutory zoonoses are defined as any zoonoses for which no specific animal-health derived legislation exists, and so excludes Salmonella and those diseases which are compulsorily notifiable in certain animal species, e.g. brucellosis or TB. Information concerning notifiable or reportable zoonoses is recorded elsewhere, some under specific projects such as FZ2000 (Salmonella). Coxiella burnetii (Q fever) was made reportable under the Zoonoses Order in 2021 and is included in this report.

1. General scanning surveillance

1.1 Zoonoses VIDA data for Great Britain: April-June 2021

This table (collated 27/07/2021) summarises clinical diagnoses of zoonoses and infections shared between animals and humans from specimens submitted to APHA and SRUC veterinary investigation centres between April and June 2021 and compares the findings with the same quarter (Q2) in 2019 and 2020. It includes rare zoonotic infections and those for which zoonotic potential is confined predominantly to immuno-compromised individuals. Diagnoses use strict criteria and are recorded (once only per incident) using the Veterinary Investigation Diagnostic Analysis (VIDA) system. The list is subject to selection, submission and testing bias. It is not definitive and excludes notifiable or most reportable diseases (notably salmonellosis, which is recorded elsewhere). Coxiella burnetii (Q fever) was made reportable under the Zoonoses Order in 2021 and is included in this report. It is intended only as a general guide for veterinary and public health professionals to the diagnosed occurrence of animal-associated infections in predominantly farmed animal species in GB.

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1. General scanning surveillance: zoonotic VIDA data for Great Britain April - June 2021 – all species

VIDA codes Diagnosis 1

2019 2020 2021

attle

C Sheep Goats Pigs Birds Misc Wildlife

311 3 3 11 11 Babesiasis

258 & 659 21 12 8 8 0 Brachyspira pilosicoli /intestinal spirochaetosis

013 8 6 9 3 6 0 0 0 Campylobacter fetopathy

282 0 0 0 0 Chlamydiosis (C. psittaci)

014 49 21 29 0 27 2 0 0 Chlamydia abortus fetopathy

732 4 6 3 2 1 Corynebacterium pseudotuberculosis (CLA)

318 84 99 113 98 15 0 0 0 0 0 Cryptosporidiosis

362 0 0 1 1 Cysticercosis

193 0 1 0 0 0 0 0 0 Dermatophilus infection

022, 133 & 3 3 2 0 0 2 0 0 Erysipelas 615

371, 372 & 43 30 59 26 28 2 2 1 Fasciolosis 373

363 0 0 0 0 Hydatidosis

015, 136 & 3 1 0 0 0 0 0 0 0 Leptospirosis (all 139 categories)

016, 140, 24 28 50 11 34 5 0 0 0 0 Listeriosis (all categories) 150, 189 & 711

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VIDA codes 1

Diagnosis

2019 2020 2021

attle

C Sheep Goats Pigs Birds Misc Wildlife

217 11 3 7 1 5 1 Louping ill

225 7 4 10 10 0 0 Orf (parapox virus)

152,153, 80 58 66 35 21 0 10 0 0 0 Pasteurella multocida 157, 158 pneumonia /pasteurellosis

223 0 0 0 0 Pseudocowpox (parapox virus)

027 & 262 0 0 0 0 0 0 0 0 Q Fever/Coxiella burnetii

374 0 0 3 3 Red Mite (Dermanyssus gallinae)

195 1 0 0 0 0 0 0 0 0 0 Ringworm

379, & 392 1 1 1 0 0 0 1 Sarcoptes scabei infection

024, 171, 43 45 46 12 1 33 0 0 0 Streptococcal infection 172 & 644 (excluding bovine mastitis)

745 10 9 18 18 Swine influenza

026 & 315 24 26 21 21 0 0 0 Toxoplasmosis (incl. fetopathy)

142 8 3 4 0 0 4 0 0 Tuberculosis (excl. M. bovis)

034 & 154 8 1 4 1 1 0 0 0 2 Yersiniasis (incl. fetopathy)

NR – Not recorded Shaded boxes indicate a diagnosis is not available for that species

1 Includes both domestic and wild birds 2 Mammals only

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Common minor diseases of zoonotic importance, such as orf and ringworm, are grossly underestimated by the VIDA recording and reporting system, as it is unusual for practising veterinary surgeons to submit material for diagnosis.

More detailed specific information on scanning surveillance is available from: http://apha.defra.gov.uk/vet-gateway/surveillance/index.htm

1.2 Highlights from APHA and SRUC disease surveillance centres

This section provides a summary of main items of zoonotic interest from material submitted to the APHA (England and Wales) and SRUC Veterinary Services (Scotland) between April and June 2021.

Further information is provided in the quarterly reports by the APHA species groups and the monthly surveillance reports in the Veterinary Record derived from scanning surveillance, which can be found at: http://apha.defra.gov.uk/vet-gateway/surveillance/reports.htm

Quarter 2 in 2021 saw recovered levels of diagnostic submissions made to APHA and SRUC surveillance centres when compared to the reduced numbers of diagnostic submissions in Q2 2020. The reduced numbers in Q2 2020 were considered (in part) to be related to the COVID-19 pandemic. For Q2 2021: For sheep, goats, pigs and miscellaneous species the total number of diagnostic submissions was higher than those of Q2 2019 (12% increase for sheep and pigs; 38% increase for goats; 48% increase for miscellaneous species when compared to Q2 2019). Cattle submissions for Q2 2021 were higher than those of Q2 2020, however 13% less than Q2 2019. Avian submissions remained similar to Q2 2020, although there was a 16% reduction in chicken diagnostic submissions when compared to Q2 2019.

2. Specific scanning and targeted surveillance and other studies

2.1 Campylobacter

Human campylobacteriosis is usually caused by the thermophilic Campylobacter species C. jejuni and C. coli, which can be found in a wide range of livestock, poultry and wildlife species. Poultry and poultry meat products are the main sources for human infection, and campylobacteriosis is the most commonly reported bacterial cause of food poisoning in the UK, with over 65,000 cases reported in 2018. This report does not cover food-borne illness related to Campylobacter infection.

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Please note that only Campylobacter fetopathy numbers are detailed in Table 1 above.

England & Wales

A total of 10 Campylobacter isolates (mainly from ruminant abortion cases in England and Wales) were identified by the APHA Starcross laboratory during the period April to June 2021; of those, 4 originated from cattle and 6 originated from sheep.

The four bovine isolates were C. jejuni, C. hyointestinalis and two C. fetus venerealis intermedius

Of the ovine isolates, all six were C. fetus.

Scotland

SRUC VS isolated Campylobacter spp as detailed below:

Bovine – 2 reproductive C. fetus venerealis

Ovine – 7 foetal C. fetus

Canine – 63 all faecal (49 C. upsaliensis, 11 C. jejuni, 2 C. lari and 1 Campylobacter sp.)

Feline – no isolates

2.2 Leptospirosis

Targeted surveillance by APHA for leptospirosis is variously achieved by analysis of results from: (1) RT-PCR for pathogenic leptospires on appropriate diagnostic samples, sequencing and denaturing high pressure liquid chromatography (DHPLC); (2) Microscopic agglutination test (MAT) antibody testing on sera submitted for disease diagnosis, monitoring and export (mainly dogs). Diagnostic MAT titres are considered seropositive at 1/100 or above (1/50 for L. Hardjobovis in cattle) and; (3) Bulk milk tank antibody testing (by ELISA) of samples submitted from dairy herds for monitoring purposes. The latter two methods are influenced by vaccination (dogs and cattle); MAT results are also very dependent on the range of serology (pools or single serovars) undertaken.

1. Between April and June 2021, a total of 83 kidney specimens from 41 separate submissions (16 cattle; 63 pigs, an alpaca, a dog, a fox and a rabbit) were examined by real-time PCR for pathogenic leptospires, all with negative results. Seven of the kidney samples submitted were unsuitable for testing. Twenty-one vaginal swabs were also tested with negative results.

2. 666 serum samples from a range of species were examined during Q2, 2021. Of 159 canine sera examined for L. Canicola and 19 for L. Icterohaemorrhagiae for export

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purposes, 5% and 0% were positive respectively, compared to 8.3% and 0% for the same quarter last year. Of 80 canine sera tested for diagnostic purposes, 18.3% were positive for L. Canicola (5% in Q2 2020), 18.3% for L. Copenhagenii (44.4% in Q2 2020), 8.6% for L. Icterohaemorrhagiae (5.3% in Q2 2020), 10.9% for L. Bratislava (7.1% in Q2 2020), 2.7% for L. Pomona, 8.1% for L. Grippotyphosa, 50% for L. Australis, 0% for L. Autumnalis and L. Sejroe ; of 279 bovine samples examined for L. Hardjobovis, 13.3% were positive (18% in Q2 2020); from 78 samples received, there were 35.9% positive porcine samples tested for L. Bratislava (0% in Q2 2020).

3. Between April and June 2021, six (55%) of 11 bulk milk L. Hardjo antibody tests undertaken for monitoring purposes were negative, two (18%) were low positive, and three (27%) were high positive. Between April and June 2020, five (26%) of 19 bulk milk L. Hardjo antibody tests undertaken for monitoring purposes were negative, four (21%) were low-positive and 10 (53%) were high positive. The significance of these observations is heavily influenced by vaccination status and selection, although it is thought unlikely that fully vaccinated herds contributed many samples.

2.3 Mycobacteria (excluding M. bovis)

Since Mycobacterium bovis became notifiable in all species in 2006, the number of samples examined by APHA Weybridge has increased, particularly from pets and camelids. Samples from pigs are mainly submitted by meat inspectors. A summary of potentially zoonotic non-statutory mycobacteria identified during the calendar year will be provided in the annual (Q4) report.

2.4 Q fever

Coxiella burnetii was made reportable under the Zoonoses Order in 2021. Diagnosis of Q fever is undertaken using PCR to confirm the presence of Coxiella burnetii, typically following the identification of suspicious acid-fast bodies in MZN stained smears of foetal tissues. Confirmation of Q fever as a cause of fetopathy requires histopathology and immunohistochemistry of placental tissue, in addition to a positive PCR result. In each case where a clinical diagnosis is made, public health colleagues are informed of the incident and the zoonotic potential of this organism is highlighted to the farmer and private veterinary surgeon, with the provision of an advisory sheet:

Q fever: Information for farmers

There were six Q fever PCR positive submissions in Q2 2021. These comprised two bovine submissions, one ovine submission and three caprine submissions. The bovine and ovine submissions were from different farms; the three goat submissions were from two farms. None of these submissions were VIDA coded as causes of abortion or of disease caused by Coxiella burnetii as the isolate could not be confirmed as the direct cause of the abortion.

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The two bovine submissions comprised a placental sample from an aborted cow. The cows were from two different dairy herds in Southern England. Both herds had a history of bulk milk seropositive for Q fever antibodies.

The ovine submission comprised a placental sample from an ovine abortion case from a flock in Powys, Wales.

The three caprine submissions comprised one placental sample from a case of stillbirth on one farm; and one foetal fluid and one placental sample from a caprine abortion outbreak on the second farm. Both goat herds were in South West England. In the case of the abortion outbreak Chlamydia abortus was also detected in placental tissue by PCR. Histopathological examination revealed the pathology was consistent with C. abortus infection which was the recorded diagnosis. (See 3.4 below for further details).

2.5 Streptococcus suis

Streptococcus suis isolates from diagnostic material submitted to APHA and SRUC Veterinary Investigation Centres are typed further for disease surveillance purposes. The numbers and serotypes from porcine diagnostic material submitted during the period April to June 2021 are shown below, with data for the same quarter in previous years for comparison. UT = untypeable

YEAR 1 2 3 4 5 6 7 8 9 10 13 14 15 16 21 25 26 28 29 33 34 UT TOTAL

(Q2)

2018 8 10 4 2 1 4 1 4 3 5 1 7 50

2019 9 10 1 1 1 1 4 1 1 3 1 2 35

2020 3 16 1 2 8 3 3 1 3 2 1 1 1 1 5 51

2021 3 11 3 2 5 1 3 1 1 4 1 3 38

Streptococcus suis type 2 continues to be the most commonly isolated serotype. There continues to be a notable spread across serotypes.

2.6 Toxoplasmosis

The European Food Safety Authority (EFSA Journal 2007, 583, 1-64) highlighted the significance of toxoplasmosis as a foodborne zoonosis and the need to improve surveillance in this field. Serological examinations for Toxoplasma gondii using the latex agglutination test (LAT) are undertaken by the APHA on sera submitted to VICs. The findings presented below provide a summary of the serological status of samples submitted for diagnosis, monitoring and screening purposes during the period April to June

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2021, but do not constitute a structured survey. Positive samples, as defined here, have LAT titres of 1/64 or greater and indicate a history of exposure to this protozoan parasite. Toxoplasmosis as a cause of fetopathy in sheep and goats may also be diagnosed through antigen (PCR) testing of placental tissue, and in sheep through IFAT testing of fetal blood or body fluid.

In sheep, 13 samples originating from six premises were tested, of which 10 samples were positive for antibodies to T. gondii. In goats, there were two samples submitted, both of which were negative.

Please consult the Table in section 1 which includes results for fetopathy due to toxoplasmosis.

3. Investigations into zoonotic and potentially zoonotic incidents

Protocols for the investigation of zoonotic disease incidents in England and Wales are set out in the following document:

Guidelines for the Investigation of Zoonotic Disease (England and Wales)

There is similar guidance on the investigation and management of zoonotic disease in Scotland: http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=1190

Advice for members of the public planning a trip to animal-associated visitor attractions and other information can be found on the PHE Zoonoses Webpages.

3.1 Cryptosporidiosis

Investigations to assist in human outbreaks of Cryptosporidiosis linked to direct contact with animals are undertaken at the request of Consultants in Communicable Disease Control (CsCDC) of PHE/PHW (CsPHM in Scotland) and in collaboration with the National Cryptosporidium Reference Unit, Swansea, and follow jointly agreed guidelines.

This is usually the busiest quarter for outbreaks of Cryptosporidiosis. However, there were only three reported outbreaks of Cryptosporidiosis this quarter, which is most likely linked to open and petting farms being closed to members of the public during the spring, due to Covid-19.

In one incident, the CCDC for Yorkshire and the Humber contacted APHA on 27/04/2021 regarding an investigation into human cases of Cryptosporidiosis potentially linked to a nursery school which has farm animals on site. An advisory visit to support this PHE

August 2021 8 of 11 investigation into a human outbreak of Cryptosporidia was conducted at the nursery. The original human cases (one child and one adult of a different child) arose in March 2021, some two months earlier. On site at that time were a resident population of six adult herbivores, which comprised two sheep, two goats and two alpacas. All 12 samples collected from a range of different animals gave negative results by FAT for the presence of Cryptosporidium spp.

The remaining two incidents were potentially linked to the consumption of home- pasteurised milk sold through two separate, unrelated, on-farm vending machines selling milk and milkshakes to the public.

3.2 STEC

Shiga toxin-producing E. coli (STEC, formerly known as VTEC) outbreak investigations are undertaken, according to agreed guidelines, at the request of CsCDC of PHE/PHW (CsPHM in Scotland) where an animal-associated source is suspected. These investigations often also involve collaboration with other organisations, including the Environmental Health Departments of Local Authorities and the Health and Safety Executive. Determination of phage type (PT), shiga toxin (ST) type, and comparison of human and animal isolates by whole genome sequencing (WGS) analysis are performed by the Gastrointestinal Bacteria Reference Unit (GBRU), PHE Colindale. If isolates from animals circumstantially implicated in outbreaks have an indistinguishable WGS profile to those from human cases, this is taken as confirmatory evidence of a causal association. Other STEC (VTEC) PTs or WGS types may be detected incidentally during the investigation of animal premises.

No investigations into STEC outbreaks were conducted in the second quarter of 2021.

3.3 Corynebacterium ulcerans

Corynebacterium ulcerans was first isolated from cases of throat infection in humans in 1926, with zoonotic outbreaks initially associated with direct contact with farm animals or consumption of unpasteurised milk. The organism can produce diphtheria toxin which is capable of producing human disease with the same clinical signs as cutaneous or respiratory diphtheria caused by C. diphtheriae. More recently, C. ulcerans has been isolated from the oral cavity of domestic pets such as dogs and cats, and current zoonotic outbreaks are investigated by APHA and SRUC VS in Scotland by throat swabbing of in- contact companion animals.

There were a total of six Corynebacterium ulcerans cases recorded during the Quarter; for comparison there were only four cases recorded during the whole of 2020. Four of the six cases were human initial cases, i.e., toxigenic C. ulcerans infections detected by Public Health England (PHE) who then contacted APHA for veterinary input, with two cases where the infection was first identified in a pet animal and PHE were notified by the testing

August 2021 9 of 11 veterinary laboratory and the isolates sent to PHE Colindale for confirmation of toxigenicity.

Two of the human index cases were associated with clinical treatment of diabetic leg ulcers, one with a chronic fistula from a surgical procedure and one from an ear, nose and throat infection. In-contact domestic pets were swabbed by private veterinary surgeons and cultures were undertaken at APHA Starcross under the Project FZ2100 budget. Only one occasion did this result in the isolation of C. ulcerans, and even in that case it was only one animal from the six swabbed in–contact animals that tested positive for the organism. Antimicrobial treatment of all in-contact animals was undertaken regardless of the swab results.

Of the two animal index cases, one was a cat presenting with a chronic nasal discharge and, in the second case, a cat was presented to a private veterinary surgeon, having developed a swollen hind paw together with dullness and lethargy over a period of three weeks. The animal was originally unresponsive to anti-inflammatory treatment, however the swelling ulcerated, and a swab of the purulent exudate showed an infection of C. ulcerans upon laboratory examination, which was reported to PHE, who later confirmed this as a toxigenic strain by further testing. Another in-contact cat sharing the same household was swabbed with negative results, and the owners were advised through their GP according to the PHE programme; involving vaccination and prophylactic antibiotic treatment. The owners were advised to keep both cats in house isolation, until after the affected cat has provided a negative result on a re-sample taken at the end of a prolonged course of antibiotic treatment. Interestingly, in none of the animal index cases presented this Quarter or indeed in recent years has there been any evidence of spread of infection to human in-contacts, although prophylactic vaccination is always advised in these human contacts.

3.4 Coxiella burnetii

Coxiella burnetii (the cause of Q fever) has since April 2021 become a Reportable infection due to amendments to the Zoonosis Order 1989. Private, non-APHA laboratories are now required to report any isolations of C. burnetii to APHA and to submit suspicious tissues for government funded confirmatory PCR testing to APHA Penrith.

Tissue samples from a neonatal goat kid were submitted to APHA Starcross Laboratory from a community open city farm for testing. Three Pygmy goats were mated and became pregnant, one goat kidded a single foetus which was found dead two weeks previously, a second goat had twin kids in good health, and the third kidded a single kid which was then found dead. The samples submitted by the private veterinary surgeon were from this last case and included liver, spleen, foetal stomach content and both fixed and fresh placental tissues. Interestingly no organisms resembling Coxiella spp were seen on the initial MZN smears. However, given the history, placental tissue was submitted for PCR testing and gave a positive result for the presence of Coxiella burnetii DNA.

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A Q-fever farmer information leaflet was sent to the veterinary practice for forwarding to the owner. In May the Incident Management Team concluded that the farm should remain closed until further quantification of the risk to the public, volunteers and workers on site. Recommendations were also made including to cover the areas where soiled bedding from the births were being composted and limit the number of workers entering the goat pens.

Coxiella burnetii is shed in birth products and milk. Those handling the products of normal births or abortions in infected does, should take suitable personal hygiene precautions. Highly resistant spores remain viable in the environment for months. There is a potential zoonotic risk, especially to pregnant women, immunocompromised people and those with heart disease.

All those who live or work on the farm are well with no symptoms but they were advised to see their GP if they developed relevant symptoms over the next 2-3 weeks and to mention the Q-fever outbreak. The incubation period can be up to 6 weeks but most people will develop symptoms within 2-3 weeks.

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