and in , 2014-2015

Jennifer House, DVM, MPH, DACVPM State Veterinarian Colorado Department of Public Health and Environment

PLAGUE

2 Plague • pestis – Gram negative – Non-spore forming • in Western States only • Most cases occur in – Arizona – California – Colorado – New Mexico Reported Cases of Human Plague— United States, 1970-2012

http://www.cdc.gov/plague/maps/index.html Animals • Wildlife – such as Prairie dogs, Tree Squirrels, etc are highly susceptible • Companion Animals – Cats—highly susceptible – Dogs—more resistant but can still get sick – Pets can bring into the home • Livestock – Mostly resistant Exposures of human plague cases in Colorado (n=65), 1959 – 2014

Unknown Cat 12% 12%

Squirrel 3% 7%

Dog 7%

Woodrat 2% 57%

Forms of human plague in Colorado (n=65), 1959 – 2014

7%

23%

70%

Bubonic Septicemic Pneumonic Colorado Human Plague Cases (n=69) by Year and Disease Type

9

8

7

6

5

4

3

2

1

0 1959 1961 1963 1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015

Bubonic Disease Septicemic Disease Pneumonic Disease http://www.cdc.gov/mmwr/previ ew/mmwrhtml/mm6416a1.htm

10 Summer 2014

Tuesday, July 8 Epi notified of PCR +

June 25 July July 8 Summer 2014

Tuesday, July 8 Epi notified of PCR + Yersinia Pestis A B

25 27 30 July 4 6 8 10

DOG C D CSU diag. dog with Yersinia Pestis Human Case

Animal Case 1 1 Cat Animal Exposure 3 10 0 Hospital Exposure 5 Cat 2 Veterinary Clinic Staff Exposure

Veterinary Clinic Client Exposure 4 Hosp. C Cat Personal Contact Exposure 1 6 5 Animal Diagnostic Lab A (6) Dog D (10) Hosp. D 5 C Hosp. E Hosp. A 0 5 2 Hosp. A Hosp. E 37 Hosp. B 0 3 9* B

9

8 3

Hosp. E 0

Slide Provided by Tri-County Health Department, Colorado TULAREMIA

14 Tularemia-What is it? • Rare disease – Often referred to as “Rabbit ” • Caused by the tiny, Gram negative bacterium tularensis • Can be present and persist for long periods in water, mud, and animal carcasses • Can affect both people and animals

2

16 Animals • Wildlife – – Rodents—mice, voles, prairie dogs, squirrels, , muskrats, etc. • Companion Animals – Cats can become very ill (life-threatening) – Dogs normally have self-limiting illness • Some may become very ill • Other Animals – Several animal species are susceptible to (particularly sheep) including livestock and birds

3 Transmission to Humans

• Direct contact with infected animals • Inhalation of aerosols • Inoculation into wounds • Ingestion of contaminated food or water • -borne (, flies) • Laboratory exposures

4 Human Forms of Disease

• Ulceroglandular • Glandular • Oculoglandular • Oropharyngeal • Typhoidal • Pulmonary

5 Clinical presentations of Tularemia, Colorado 2014 (n=16) Pneumonic Glandular or 31% Ulceroglandular 50%

Typhoidal (septicemic