HOMELAND SECURITY PROGRAM SCIENCE AND SECURITY SERIES “Continued Gaps in Biosurveillance: Have the Lessons of West Nile Virus been Learned?” Dr. Tracey McNamara Veterinary Pathologist Tuesday, April 17, 2007 1:30 – 3:00 PM Center for Strategic and International Studies 1800 K St. NW, Room B1-B Lessons Learned from the WNV outbreak in 1999 West Nile virus presented a challenge to our detection and response capabilities because it crossed species boundaries - has this been addressed? “…this case demonstrates the near absence of interagency and contingency planning for zoonotic diseases.” Report to the Minority Staff, Senate Governmental Affairs Committee to Senator Lieberman, Ranking Member Given the fact that most of the known biological threat agents and emerging infectious diseases are zoonotic and may be detected in animals before man…and millions of $$$$ have been spent since 1999… The Role of Sentinel Species in the Early Detection of Zoonotic Events • 1999 - West Nile virus – significant crow mortality took place well in advance of any human morbidity/mortality but they were “just a bunch of crows” • 2003 - Monkeypox – the disease was not diagnosed until it spread to people in several states; would it not have been preferable to have tested the prairie dogs? Integrated Biosurveillance for Real-time Detection of Zoonotic Threats and Emerging Infectious Diseases • From the point of view of zoonoses, little has changed since WNV– Funding still targets detection in the human population, not in sentinel or reservoir animal species • Non-agricultural sentinel species continue to be ignored • Taxpayers continue to be used as urban biosentinels ZOONOTIC THREATS We are only looking at Many animal species are not the tip of the iceberg under the jurisdiction of the of federal agencies Who is responsible for surveillance and testing of •Pet prairie dogs? •Pet dogs and cats? •Zoo animals •Local wildlife? •Giant Gambian rats? Urban biosentinels are still left out We continue to take an “Agency-based” vs. “Agent-based” approach to disease surveillance Homeland Security focus is on getting existing federal agencies to work together • Does not address the fact that those species that have served as sentinels for EIDs still do not fall under the jurisdiction of a federal agency (pet prairie dogs, zoo species etc) – • No federal agency has responsibility for detection of zoonotic agents in dogs, cats, exotic pets, zoo animals, wildlife handled by non-state/non-federal personnel (rehabilitators), or local pest species in urban environments We still lack a mechanism for reporting that works across species • Unlike physicians, veterinarians have no mechanism through which they can report unusual cases, have them investigated, and have the cost of testing covered; • There is no equivalent of the “MD-Public Health Dept” system in veterinary medicine (unless a foreign animal disease of agricultural interest only is suspected) From a Biodefense point of view, we have a “species gap” • Lack of recognition of the double standard applied to non-agricultural species; little diagnostic testing actually being performed in wildlife; • that, coupled with a lack of uniform standards for those performing diagnostic work on wildlife, guarantees we will continue to miss early warnings Emerging Infectious Diseases Volume 12, Number 12–December 2006 Introduction International Attention for Zoonotic Infections Nina Marano,* Paul Arguin,* Marguerite Pappaioanou,† Bruno Chomel,‡ Esther Schelling,§ Vincent Martin,¶ Jay C. Butler,* C. Ben Beard,* and Lonnie King* *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †University of Minnesota, Minneapolis, Minnesota, USA; ‡University of California, Davis, Davis, California, USA; §Swiss Tropical Institute, Basel, Switzerland; and ¶Food and Agricultural Organization of the United Nations, Rome, Italy “Zoonosis surveillance systems are, however, still dangerously deficient in many places in the world, so that an emerging zoonotic problem may be undetected for a while until it has reached such a magnitude that control requires huge efforts.” Francois Meslin, World Health Organization, 1992 Reference: Meslin, F.X. Surveillance and Control of Emerging Zoonoses. Wld hlth statist quart, 45, 1992. “Global Pathogen Surveillance Act of 2003” “Developing countries could benefit from: • Better trained public health professionals and epidemiologists to recognize disease patterns • Appropriate laboratory equipment for diagnosis of pathogens • Disease reporting based on symptoms and signs (known as syndromic surveillance), enabling the earliest possible opportunity to conduct an effective response • Appropriate communications..including Internet based Geographic Information Systems(GIS)” When it comes to real-time detection of zoonoses across species lines, we are a “developing country”! False sense of security ? We still do not use a species neutral approach to surveillance for zoonotic threats SENTINEL SPECIES… BUT, WHO REALLY KNOWS WHO OR WHAT WILL PROVIDE EARLY WARNING FOR THE NEXT ZOONOTIC THREAT??? WNV as a Model of Response to an Unknown Zoonotic Threat • Question # 1 – What were the factors that contributed to delayed recognition of WNV? • Question # 2 – Have those factors been addressed? • Question # 3 – What did we need to make a diagnosis and respond with surveillance? • Question # 4 – If a similar situation arose tomorrow, would the response differ significantly from that of seven years ago? • Question # 5 - Are we even asking the right questions??? The Point of Biosurveillance Detect zoonotic threats in animal sentinels or reservoirs before people are in the emergency room! Goal is to detect health threats at the far left of the epidemic curve Logical Approach to Zoonoses Detect zoonotic disease threats prior to significant human morbidity and mortality Find the “index” case Human Agricultural Wildlife Species * Implies a “species neutral” approach to disease surveillance * Implies equity across the agencies responsible for them The Reality of Biosurveillance in the USA Human Health Agriculture $$$$$$$$ $$$$$$$$$$$ WL Pets Zoos With the exception of Rabies and WNV surveillance, there is little overlap between the human and animal sectors and a marked discrepancy in funding USDA Mission/ Species Bias • Agriculture - Food animals of economic importance • Cattle, swine, poultry, some equine • Primary concerns are foreign animal diseases, not zoonoses (plague/tularemia are not problems in cattle) • Crows? Raptors? Zoo species? Dogs? Cats? These are not the focus of the NAHLN • Which of the above might serve as URBAN sentinels? “Program” diseases vs. Pathogen Discovery Vulnerabilities from the perspective of Zoonotic Threats Zoonoses not emphasis Jurisdiction over WL only as it APHIS WL impacts on NAHLN agricultural species Zoos? Fed/State Pets? Wildlife NWRA Syndromics but no access No emphasis on pathology to diagnostics or real-time diagnoses TMcN Another way of looking at it … Human Health Agriculture Pets/Zoos WL If our Our Ability to Detect Zoonotic threats depends upon Non-Agricultural Species, our situation is precarious indeed The Reality of Biosurveillance in the USA “All animals are created equal but some animals are more equal than others” George Orwell “Just a bunch of crows” …. # 1 WNV Bird Deaths early June 1999 to mid- August <------------------------> Avian sentinels gave early warning well in advance of human morbidity and mortality but were ignored – Why? However, $$$ is not the only issue… Cultural differences between Agencies and emphasis on diagnostics Diagnostic Double (Triple) Standard across Species One for people, one for animals with owners, and one for free-ranging wildlife Free Ranging Wildlife and the ability to detect “index” cases • More than 400 crows had been submitted for testing since early June 1999 • Illustrates fact that wildlife disease surveillance is insensitive to individual losses • “Mother Nature” mentality – high threshold • The “culture” of free-ranging wildlife Details Report for: 19-1023.00 Zoologists and Wildlife Biologists Importance Category Task Core 78 78 Study animals in their natural habitats, assessing effects of environment and industry on animals, interpreting findings and recommending alternative operating conditions for industry. 74 Core Inventory or estimate plant and wildlife populations. 73 Core Analyze characteristics of animals to identify and classify them. 73 Core Make recommendations on management systems and planning for wildlife populations and habitat, consulting with stakeholders and the public at large to explore options. Source: Bureau of Labor Details Report for: 19-1023.00 Zoologists and Wildlife Biologists Importance Category Task 56 Supplemental Coordinate prevention programs to prevent disease outbreaks 53 534038 Prepare collections of preserved specimens or Supplemental microscopic slides for species identification and study of development or disease. 40 Supplemental Raise specimens for study and observation or for use in experiments. *** 38 Supplemental Collect and dissect animal specimens and examine specimens under microscope. Source: Bureau of Labor Wildlife Agency Survey – Dr.Milt Friend USGS Congressional briefing September 26, 2003 • Does your agency /institution currently commit internal resources in support of disease investigations? • What is the nature of that support? (personnel? laboratory?) • What species are dealt with by internal program activities? • What are the sources for your diagnostic cases? • Can non-agency/institutions