Reverse Zoonosis: A new way of thinking about pathogen flow

1. Reverse Zoonosis:A new way of thinking about pathogen flow Nancy P. Lung, VMD, MS Director of Veterinary Services Fort Worth Zoo

2. The Science of Zoonosis ControlOne-directional thinking

3. Pathogen Flow is Dynamic

4. This dynamic flow can result in many fascinating situations! Reverse Zoonosis Pass-through Zoonosis

5. Examples from the literature and from my experience • Animal Hospitals • Agriculture • Risks from Ecotourism • Zoos

6. Animal Hospital SettingMRSA in Horses • VMTH • 11 Cases of post-procedure infection over a 13-month period • Previously undiagnosed at this hospital • 3/5 people associated with equine surgery and recovery were positive by nasal culture • Likely that colonized staff transmitted the bacteria to the affected horses

7. Agriculture • Herd of 122 dairy cattle • Long standing TB negative status in herd • 14 of 122 developed clinical M. bovis • Source identified from the farmer • Asymptomatic renal M. bovis • Infected the cattle by urinating on the straw in the barn • Risk to the swine industry from H1N1

8. Risks from Ecotourism • Tourism is now the world’s largest industry---$476 billion! • 698 million international travelers per year • Ecotravel is rising by 30% per year and is growing fastest in developing countries.

9. EcotourismPathogen Flow Local People Domestic or Wild Animals Traveler Arthropod vectors

10. Endangered primate populations are particularly vulnerable.

11. Mountain Gorillas of the Virunga Mountains • Dian Fossey’s first field work in mid 1970’s • First tourists visited camp in 1979. • First gorilla group was officially “visited” by a handful of tourists in 1981. • 10,641 tourists visited in 2005!!

12. Pathogen Flow in the Zoo setting • Interaction between animal care staff and the collection animals • Interaction between the public and the collection animals

13. A fascinating pass-through, amplification situation 20/55 infected (36%) MRSA-colonized caretaker USA 300 1 nutritionist 1 vet 5 nursery staff 13 elephant keepers

15. Elephant calf MRSA Lesions

16. Elephant Keeper MRSA Lesion

17. Reducing Pathogen Flow Between the Public and Collection Animals Case Examples

18. “Jackie” the Lowland Gorilla • 10yr old female • Flu-like symptoms in family group • Rapid decline in Jackie—recumbent within 48 hrs • Confirmed Parainfluenza 3 • Placed on life support for 7 days • Eventually made a full recovery

20. Pneumococcal pneumonia Maintained in oxygen cage Outcome--recovered Influenza A Secondary pericarditis Outcome--died “Ramses”31 yr old gorilla “Kate” 39 yr old gorilla

21. 7 animals in a single family group All 7 had cold/flu-like symptoms 9 yr old male—status declined rapidly Outcome—young male died, others recovered Confirmed human metapneumoniavirus Upper and lower respiratory infection Confirmed Haemophilus influenzae Outcome--recovered Chimpanzee GroupLincoln Park ZooMarch, 2009 “Basan” 4yr old orangutan

24. Kimberly Clarke Chimpanzee Forest Dallas Zoo

25. FWZ Outdoor Chimpanzee and Bonobo exhibit

26. FWZ Bonobo Exhibit

27. How to protect the health of animals in captive settings • Exhibit design in zoos • Personnel health assessment protocols in captive animal settings • Personal protective equipment during animal interactions • Public Education

28. Zoonosis ControlPathogen Flow is Dynamic

29. Protection of People and Animals Goes Hand-in-Hand