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ADED Zoonoses RoundsADED Zoonoses Rounds
February 19, 2008February 19, 2008
Canine Leptospirosis Surveillance in Washington
February 19, 2008ADED Zoonoses Rounds
Liz Dykstra, PhDZoonotic Disease ProgramWashington Dept. of Health
The Washington State Situation
• Leptospirosis Overview
• History
• Findings
• Outbreaks
• Ongoing & Future Work
Leptospirosis Overview
• Leptospira interrogans• Aerobic, gram-negative bacteria• Spirochete
• >200 Known pathogenic Serovars• Autumnalis• Bratislava• Canicola• Grippotyphosa• Hardjo• Icterohaemorrhagiae• Pomona
Clinical Signs & Lab Test Results
• Vomiting• Anorexia • Abdominal discomfort• Febrile• Weight Loss• Depression/Lethargy
• Leukocytosis• Thrombocytopenia• Azotemia• Increased liver
enzymes• Hyperbilirubinemia• Decreased urine
specific gravity• Mild proteinuria
Ecology
• Mammalian Reservoirs – Settle into kidneys; shed in urine– Reservoir infected for life
• Also found in fresh water, soil, & mud
Janice Carr, CDC 1998
How are people and dogs getting leptospirosis?
Recreational exposures ie. swimming, bathing or wading in contaminated water, mud
Human Cases of Leptospirosis in Washington State
http://www.doh.wa.gov/EHSPHL/epitrends/08-epitrends/2008_trend.htm
Notifiable conditions and the veterinarian
Purpose– Integrate veterinarians into the public health
system.– Enhance surveillance for zoonotic diseases,
which indirectly enhances human surveillance– Enhance recognition and capacity to investigate
emerging pathogens in animal reservoirs– Detect agents used intentionally in biowarfare.
Flowchart for Veterinary Notifiable Conditions
•Veterinarian reports condition to LHJVeterinarian reports condition to LHJ•Completes Lepto Report FormCompletes Lepto Report Form
•Counsels Patient’s OwnersCounsels Patient’s Owners
•LHJ asks veterinarian to counsel client LHJ asks veterinarian to counsel client about zoonotic disease potential and about zoonotic disease potential and
prevention/control measures. prevention/control measures. •Completes report formCompletes report form•Faxes report to DOH. Faxes report to DOH.
LHJ reports LHJ reports condition to condition to
DOHDOH
LHJ CD LHJ CD Epi/EH is Epi/EH is informed about informed about the reportthe report
Clients know to visit their Clients know to visit their health care provider if they health care provider if they experience any symptoms experience any symptoms
and to mention their ill petand to mention their ill pet..
Health care Health care provider may call provider may call LHJ nurses for LHJ nurses for
informationinformation
Vet Clinic Faxes Report
to DOH
LHJ = Local Health Jurisdiction
History of DOH Surveillance Program
• Vets first required to report notifiable conditions around 2000
• Increased concern of bioterrorism potential of zoonotic diseases
• Increased number of lepto cases showing up vet clinics
• DOH Lepto reporting program begun in July 2004
To be completed by veterinarian
To be completed by LHJ
Case Definition*
• Acute onset of clinical signs including at least one of the following: fever, inappetance, abdominal pain, vomiting, jaundice, or polydipsia/polyuria, or oliguria.
AND
• Laboratory findings of azotemia or elevated liver enzymes OR• Histopathological diagnosis consistent with leptospirosis
AND
• MAT titer >1:800 for Leptospira OR • FA+ urine OR • Histological staining of tissues positive for Leptospira
*Margaret Davis, DVM, WADDL; 2/27/06
0
50
100
150
Num
ber
of C
ases
Leptospirosis Confirmed by Titer >1:800 (n=183)
Morbidity & Mortality (n=183)
0
50
100
150
Recov
ered
Died /
Eutha
nized
Unkno
wn
Num
ber
of C
ases
~27% Case Mortality
Average Monthly Reported Cases of Canine Leptospirosis in Washington
July 2004 – January 2008 (n=183)
0
2
4
6
8
10
Jan
Feb
Mar Apr
May Jun Ju
lAu
gSe
pOct No
vDec
Num
ber
of C
ases
Canine Leptospirosis Cases by CountyJuly 2004 – January 2008
San Juan
Island
Clallam
Jefferson
GraysHarbor
Kitsap
Lewis
Skamania
Pacific
Mason
Ferry
Stevens
Lincoln
Kittitas
Klickitat
Columbia
Garfield
Asotin
Okanogan
Snohomish
Douglas
Chelan
SpokaneKing
Yakima
Skagit
Whatcom
Pierce
Franklin
Benton
Whitman
Walla Walla
Clark
Cowlitz
Thurston
Wahkiakum
31+
10-15
6-9
1-5 16-30
Figure 1
PendOreille
Grant
Adams
Counties reporting human Leptospirosis cases
Age
0
2
4
6
8
10
Mea
n
Med
ian
Yea
rs
Gender
0
25
50
75
100
Per
cent
Leptospirosis Cases by Age & Gender (n=183)
0
20
40
60
Num
ber
of
Case
sLeptospirosis Cases by Breed Group (n=183)
Exposures
Wildlife
• Raccoons
• Rats
• Opossums
• Squirrels
Access to standing or slow moving water
Leptospira Serovars Detected
0
50
100
150
Num
ber o
f Cas
es
1:100+ >1:800
Outbreaks
• Bainbridge Island, King County– December 2006
• Vashon Island, King County– Dec 2005–Feb 2006
Ongoing and Future Work
• Vet and Owner Fact Sheets
• Canine Leptospirosis web site
• Brochures
• Downloadable Tools
Special Acknowledgements
• Dr. Jane Koehler – Seattle-King County PH• Dr. Sharon Hopkins – Seattle-King County PH
• Rebecca Baer – CD-Epi, WA DOH • Dr. Mira Leslie – Ministry of Agriculture & Lands, BC
• Dr. Margaret Davis – CVM, WSU• Dr. Jim Evermann – WADDL, WSU
• Dr. Ron Wohrle – ZD Program, WA DOH
• All of the LHJs and Veterinarians who have provided case reports to this program.
