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Environmental Health Biomed Central Environmental Health BioMed Central Research Open Access Risk behaviors in a rural community with a known point-source exposure to chronic wasting disease Ralph M Garruto*1,2, Chris Reiber2, Marta P Alfonso2, Heidi Gastrich2, Kelsey Needham2, Sarah Sunderman2, Sarah Walker2, Jennifer Weeks2,3, Nicholas DeRosa4, Eric Faisst3,4, John Dunn4, Kenneth Fanelli4 and Kenneth Shilkret4 Address: 1Laboratory of Biomedical Anthropology and Neurosciences, State University of New York at Binghamton, PO Box 6000, Binghamton, New York, 13902-6000, USA, 2Graduate Program in Biomedical Anthropology, State University of New York at Binghamton, PO Box 6000, Binghamton, New York, 13902-6000, USA, 3Madison County Health Department, Wampsville, New York, 13163, USA and 4Oneida County Health Department, Utica, New York, 13501, USA Email: Ralph M Garruto* - [email protected]; Chris Reiber - [email protected]; Marta P Alfonso - [email protected]; Heidi Gastrich - [email protected]; Kelsey Needham - [email protected]; Sarah Sunderman - [email protected]; Sarah Walker - [email protected]; Jennifer Weeks - [email protected]; Nicholas DeRosa - [email protected]; Eric Faisst - [email protected]; John Dunn - [email protected]; Kenneth Fanelli - [email protected]; Kenneth Shilkret - [email protected] * Corresponding author Published: 24 June 2008 Received: 17 March 2008 Accepted: 24 June 2008 Environmental Health 2008, 7:31 doi:10.1186/1476-069X-7-31 This article is available from: http://www.ehjournal.net/content/7/1/31 © 2008 Garruto et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: The emergence and continuing spread of Chronic Wasting Disease (CWD) in cervids has now reached 14 U.S. states, two Canadian provinces, and South Korea, producing a potential for transmission of CWD prions to humans and other animals globally. In 2005, CWD spread for the first time from the Midwest to more densely populated regions of the East Coast. As a result, a large cohort of individuals attending a wild game feast in upstate New York were exposed to a deer that was subsequently confirmed positive for CWD. Methods: Eighty-one participants who ingested or otherwise were exposed to a deer with chronic wasting disease at a local New York State sportsman's feast were recruited for this study. Participants were administered an exposure questionnaire and agreed to follow-up health evaluations longitudinally over the next six years. Results: Our results indicate two types of risks for those who attended the feast, a Feast Risk and a General Risk. The larger the number of risk factors, the greater the risk to human health if CWD is transmissible to humans. Long-term surveillance of feast participants exposed to CWD is ongoing. Conclusion: The risk data from this study provide a relative scale for cumulative exposure to CWD-infected tissues and surfaces, and those in the upper tiers of cumulative risk may be most at risk if CWD is transmissible to humans. Page 1 of 7 (page number not for citation purposes) Environmental Health 2008, 7:31 http://www.ehjournal.net/content/7/1/31 Background first positive samples (five in total) were confirmed in Chronic Wasting Disease (CWD) was first observed in the April 2005 from animals on two domestic deer farms in United States in the late 1960s, though its origins are still Oneida County, NY. The second deer farm, located very unclear [1,2]. The term "chronic wasting disease" was first near to the first, received two deer that tested positive used in 1967 to describe clinical symptoms in captive from the first deer farm. In response, the NYSDEC imple- Colorado mule deer [1,2]. In 1978, the disease was diag- mented an intensive mandatory surveillance of CWD, pri- nosed as a spongiform encephalopathy [1,3]. By 1980, marily in Oneida and Madison counties [4]. In order to CWD had been described in captive elk and mule deer monitor the wild deer herd, a CWD containment area was herds in both Colorado and Wyoming [1,2]. Subse- created encompassing approximately a 10 mile radius quently in 1985, CWD was found in free-ranging elk in around the location of the CWD positive domestic deer Wyoming, and recognized in free-ranging mule deer and farms in Oneida and Madison counties (Figure 1) [4]. whitetail deer in both states by 1990 [3]. CWD has since During the initial phase of intensive monitoring (through been described in 14 states across the US and in 2 prov- April 30, 2005), 317 wild deer were collected and tested inces in Canada (Figure 1). from this containment area as well as from the Town of Arietta in Hamilton County. Wild deer (two in total), in In April of 2002, the New York State Department of Envi- close proximity to the domestic deer farms, were found to ronmental Conservation (NYSDEC) began a statewide be positive for CWD. During the second phase of the surveillance program for CWD in whitetail deer [4]. The intensive monitoring program, all deer that died or were SpatialFigure distribution 1 of CWD in the United States and Canada Spatial distribution of CWD in the United States and Canada. The CWD map is overlaid on a demographic map of the U.S. population. The insert map of New York State shows the Department of Environmental Conservation CWD Contain- ment Area where the outbreak of CWD occurred. This depiction combines and updates information based on maps and data from the USGS National Wildlife Health Center [38], and census data from the US Census Bureau's interactive online mapping program for 2006 Population Estimates (US Census Bureau; 2006 Population Estimates; generated by Chris Reiber; using American FactFinder [39].). Page 2 of 7 (page number not for citation purposes) Environmental Health 2008, 7:31 http://www.ehjournal.net/content/7/1/31 one of the deer served was positive for CWD [27]. Since 2002, the New York State Department of Environmental Conservation has required the mandatory testing of deer for CWD harvested from a domestic deer farm. However, there is no requirement that the meat not be consumed before the results are made available and thus reaction to the finding that the deer tested positive ranged from unconcerned to anger. Feast attendees were exposed to the contaminated meat through a variety of activities, includ- ing butchering and processing, cooking, consumption of venison, and/or through contact with contaminated sur- faces. This incident represents the only known large scale ExaminationdeerFigure 2 of and specimen preparation from a whitetail point-source exposure of humans to an animal with con- Examination of and specimen preparation from a firmed CWD. whitetail deer. The check station where the deer are examined is located in the New York State Department of In response to this known point-source exposure, the Environmental Conservation CWD Containment Area in Oneida County Health Department and the State Univer- Oneida County. sity of New York at Binghamton (SUNY) proposed and launched the Oneida County Chronic Wasting Disease Surveillance Project, a cohort study designed to examine a killed within this area were subject to mandatory testing natural experimental model of human exposure to CWD. (Figure 2). Additionally, the NYSDEC expanded its testing The objective of the study are to determine the potential program statewide [4], and now the annual testing of deer human health risks associated with exposure to CWD- for CWD includes 800–1000 animals within the contain- contaminated cervids by following the events and health ment area (Figure 1) and approximately 5000 animals outcomes of attendees at the Sportsmen's Feast. Study par- statewide [4]. No additional positive deer, wild or domes- ticipants are being followed for a minimum period of six tic, have been found since April 2005. Details of the dis- years from the time of exposure. This is based on the min- tribution of the deer tested across New York State for imum incubation period and earliest age at onset for CWD can be found on the DEC website [4]. known human prion diseases including vCJD [11] and kuru [28-31]. The current report describes the initial Traditions of hunting deer, elk, moose, and other cervids, results of a risk analysis based on behaviors associated and management of domestic cervid preserves bring with the wild game feast in upstate New York. humans into contact with animals that could have CWD. Currently, it is unclear whether CWD prions can be natu- Methods rally transmitted from infected cervids to humans or to The exposed cohort, whose names are held confidentially non-cervids. The question of cross-species transmission of by the Oneida County Health Department, were con- CWD has been raised in the past [5-13]. In 2002 an unu- tacted by mail about an informational meeting held in sual cluster of Creutzfeldt-Jakob Disease (CJD) – a human Oneida County in November, 2005. The project was prion disease – developed in individuals who were avid approved by the Institutional Review Board at SUNY Bing- lifelong Idaho deer hunters [14]; however, this and other hamton. Questionnaires and informational packets were reports investigating clusters of CJD have failed to estab- distributed either by mail or in person to those who lish a link with exposure to cervids through hunting or expressed an interest in participating in the surveillance consuming the animals, or through other associated project. From January to June 2006, SUNY Binghamton behaviors [12,14-18]. Although still unclear for CWD, research assistants conducted additional follow-up mail- epidemiological and laboratory findings have established ings and telephone calls to those who indicated an inter- an unequivocal link between Bovine Spongiform Enceph- est in participating.
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