ZOONOTIC DISEASES OF PUBLIC HEALTH IMPORTANCE ZOONOSIS DIVISION NATIONAL INSTITUTE OF COMMUNICABLE DISEASES (DIRECTORATE GENERAL OF HEALTH SERVICES) 22 – SHAM NATH MARG, DELHI – 110 054 2005 List of contributors: Dr. Shiv Lal, Addl. DG & Director Dr. Veena Mittal, Joint Director & HOD, Zoonosis Division Dr. Dipesh Bhattacharya, Joint Director, Zoonosis Division Dr. U.V.S. Rana, Joint Director, Zoonosis Division Dr. Mala Chhabra, Deputy Director, Zoonosis Division FOREWORD Several zoonotic diseases are major public health problems not only in India but also in different parts of the world. Some of them have been plaguing mankind from time immemorial and some have emerged as major problems in recent times. Diseases like plague, Japanese encephalitis, leishmaniasis, rabies, leptospirosis and dengue fever etc. have been major public health concerns in India and are considered important because of large human morbidity and mortality from these diseases. During 1994 India had an outbreak of plague in man in Surat (Gujarat) and Beed (Maharashtra) after a lapse of around 3 decades. Again after 8 years in 2002, an outbreak of pneumonic plague occurred in Himachal Pradesh followed by outbreak of bubonic plague in 2004 in Uttaranchal. Japanese encephalitis has emerged as a major problem in several states and every year several outbreaks of Japanese encephalitis are reported from different parts of the country. Resurgence of Kala-azar in mid seventies in Bihar, West Bengal and Jharkhand still continues to be a major public health concern. Efforts are being made to initiate kala-azar elimination programme by the year 2010. Rabies continues to be an important killer in the country. The use of nervous tissue anti rabies vaccine has been discontinued since December, 2004. The Government has taken steps to make tissue culture derived vaccine available in public sector. Dengue fever & Dengue Haemorrhagic fever is one of the important mosquito borne viral disease of major international public health concern. India is endemic for dengue fever and every year cases of dengue fever and dengue haemorrhagic fever are reported. The first edition of the manual published in 2000 has been updated with the basic aim of providing details about zoonotic diseases of public health importance including laboratory techniques for medical and veterinary laboratories interested in undertaking work on zoonotic diseases. Each chapter deals briefly with various aspects of the disease to provide necessary background to the reader which shall help in better understanding of the subject. It contains details of techniques and procedures which have been used by the National Institute of Communicable Diseases, Delhi and also various other techniques employed elsewhere. References for further reading have been appended to make the task of enthusiastic workers much easier to try and develop other laboratory methods. In this edition chapters on anthrax and sterilization and disinfection procedure are added and chapter on arboviral diseases is thoroughly revised with detailed information on Japanese encephalitis, Dengue fever and Kyasanur Forest Disease. This manual has been printed with the financial assistance provided by the World Health Organization. It is hoped that the manual shall be useful in providing necessary technical information for control of zoonotic diseases. DR. SHIV LAL ADDL. DG & DIRECTOR Dated: CONTENTS Chapter 1 Zoonoses – General Aspects 1.1 Definition 1.2 Zoonoses – An international problem 1.3 Zoonoses – An emerging problem 1.4 Classification 1.4.1 According to etiological agents 1.4.2 According to the mode of transmission 1.4.2.1 Direct zoonoses 1.4.2.2 Cyclozoonoses 1.4.2.3 Metazoonoses 1.4.2.4 Saprozoonoses 1.4.3 According to the reservoir host 1.4.3.1 Anthrapozoonoses 1.4.3.2 Zooanthraponoses 1.4.3.3 Amphixenoses 1.5 Factors influencing prevalence of zoonoses 1.5.1 Ecological changes in man’s environment 1.5.2 Handling animal by products and wastes (occupational hazards) 1.5.3 Increased movements of man 1.5.4 Increased trade in animal products 1.5.5 Increased density of animal population 1.5.6 Transportation of virus infected mosquitoes 1.5.7 Cultural anthropological norms 1.6 Zoonoses as a public health problem Chapter 2 Safety precautions in the laboratory Chapter 3 Rabies 3.1 Introduction 3.2 Causative agent 3.2.1 Susceptibility to physical and chemical agents 3.2.2 Excretion of rabies virus 3.3 Epidemiology 3.3.1 Global status 3.3.2 Rabies in India 3.3.3 Mode of transmission 3.4 Pathogenesis 3.4.1 Incubation period 3.5 Clinical features in man 3.5.1 Hydrophobia 3.5.2 Differential diagnosis 3.6 Rabies in animals 3.6.1 Clinical features in dogs 3.6.2 Clinical features in cats and cattle 3.7 Post Exposure treatment in humans 3.7.1 Management of animal bite wound 3.7.2 Passive immunization by rabies immunoglobulins 3.7.3 Active Immunization by Anti rabies vaccine 3.7.3.1 Nervous tissue derived vaccine 3.7.3.2 Tissue Culture Vaccine 3.7.3.3 Purified duck embryo vaccine (PDEV) 3.7.4 Intradermal regimen 3.7.5 Post exposure therapy in previously vaccinated person 3.8 Pre-exposure immunisation 3.9 Control of rabies 3.10 Laboratory diagnosis 3.10.1 Collection, preservation, packing and transporation of sample 3.10.1.1 Specimen from human being 3.10.1.2 Collection of specimen from suspected rabid animal 3.10.1.3 Preservation 3.10.1.4 Labelling 3.10.1.5 Information to be enclosed 3.10.1.6 Packing 3.10.1.7 Transportation 3.10.2 Laboratory tests 3.10.2.1 Negri body examination 3.10.2.2 Fluorescent antibody Test (FAT) 3.10.2.3 Mouse inoculation 3.10.2.4 Serum virus neutralisation test 3.10.2.5 Complement fixation Test (CFT) 3.10.2.6 Counter – immuno electrophoresis (CIE) 3.10.2.7 Enzyme – linked immunosorbent assay 3.10.2.8 Immunoperoxidase test 3.10.2.9 Haemagglutination and haemagglutination inhibition test 3.10.2.10 Passive haemagglutination (PHA) 3.10.2.11 Gel diffusion 3.10.2.12 Electron microscopy 3.10.2.13 Tissue culture techniques 3.10.2.14 Polymerase Chain Reaction 3.10.3 Principles and procedure of commonly used techniques 3.10.3.1 Seller’s staining for detection of Negri body 3.10.3.2 Fluorescent antibody test 3.10.3.3 Biological test Chapter 4 Leishmaniasis 4.1 Epidemiology 4.1.1 Geographical distribution 4.1.2 Etiologial agent 4.1.3 Reservoir host 4.2 Clinical features 4.3 Treatment 4.4 Surveillance and control 4.5 Laboratory diagnosis 4.5.1 Collection, storage and transportation of specimen 4.5.2 Specimen 4.5.2.1 Blood 4.5.2.2 Bone marrow aspirate 4.5.2.3 Spleen puncture 4.5.3 Demonstration of parasite 4.5.3.1 Direct examination 4.5.3.2 Culture techniques 4.5.4 Serological techniques 4.5.4.1 Counter current immuno electrophoresis (CIE) 4.5.4.2 Indirect fluorescent antibody test (IFAT) 4.5.4.3 Enzyme linked immuno sorbent assay (ELISA) 4.5.4.4 DOT Enzyme linked immunosorbent assay 4.5.5 Other indirect evidences 4.5.5.1 Changes in blood picture 4.5.5.2 Non – specific serological tests 4.5.6 Other diagnostic tests 4.5.6.1 Leishmanin or Montenegro test 4.5.6.2 Direct agglutination test 4.5.6.3 Indirect haemagglutination test 4.5.7 Recent molecular techniques 4.6 Laboratory diagnosis of cutaenous leishmaniasis Chapter 5 Plague 5.1 Epidemiology 5.1.1 Sylvatic plague 5.1.2 Domestic plague 5.1.3 Causative agent 5.1.4 Vectors of plague 5.1.5 Reservoirs 5.2 Clinical features in man 5.2.1 Bubonic plague 5.2.2 Pneumonic plague 5.2.3 Septicemic plague 5.2.4 Pestis minor 5.3 Signs in rodents 5.3.1 Plague in other animals 5.4 Differential diagnosis 5.5 Diagnosis of plague 5.5.1 For suspected plague 5.5.2 For presumptive plague 5.5.3 For confirmed plague 5.6 Laboratory diagnosis of plague 5.6.1 Specimens for diagnosis of plague 5.6.1.1 Collection of material from patients 5.6.1.2 Collection of autopsy material 5.6.1.3 Collection of material from rodents and flea 5.6.2 Transporation of specimen 5.6.2.1 Specimen from human being 5.6.2.2 Gross tissue specimen 5.6.2.3 Flea specimens 5.6.3 Processing of specimen 5.6.3.1 Clinical specimen 5.6.3.2 Post mortem specimen 5.6.3.3 Specimen of rodent tissue 5.6.3.4 Flea specimen 5.6.3.5 Soil specimen 5.6.4 Direct demonstration of plague bacilli 5.6.4.1 Smears 5.6.4.2 Fluorescent antibody (FA) staining 5.6.5 Culture 5.6.5.1 Test with bacteriophage 5.6.5.2 Biochemical tests 5.6.5.3 Animal pathogenicity test 5.6.6 Newer tests for detection of antigen 5.6.7 Serological tests 5.7 Treatment, prevention and control 5.7.1 Treatment 5.7.2 Prevention and control 5.7.2.1 Management of patient 5.7.2.2 Case contact management 5.7.2.3 Environmental control measures 5.7.2.4 Vaccination Chapter 6 Leptospirosis 6.1 Etiological agent 6.2 Epidemiology 6.2.1 Reservoir host 6.2.2 Climatic factors 6.2.2.1 Transmission 6.3 Prevalence in India 6.3.1 Man 6.3.2 Animals 6.3.2.1 Sheep and goat 6.3.2.2 Swine 6.3.2.3 Horse 6.3.2.4 Dogs 6.3.2.5 Wild animals 6.4 Clinical features 6.4.1 Animals 6.4.2 Man 6.5 Laboratory diagnosis 6.5.1 Microscopic demonstation 6.5.2 Isolation of bacterium 6.5.3 Serological examination 6.5.3.1 Microscopic agglutination test 6.5.3.2 Macroscopic agglutination test 6.5.3.3 Enzyme linked immunosorbent assay (ELISA) 6.5.4 Other molecular techniques 6.6 Control measures 6.6.1 Control of infection in animals 6.6.1.1 Isolation 6.6.1.2 Chemotherapy 6.6.1.3 Slaughter 6.6.1.4 Use of protective clothing 6.6.2 Control of source of infection 6.6.2.1 Rodent control 6.6.2.3 Carrier 6.6.3 Control of transmission 6.6.3.1 Disinfection of water 6.6.3.2 Hygienic measures 6.6.4 Education of the professional groups 6.6.5 Immunization