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.

Questions?

Liz DykstraPhone: 360.236.3388

Email: elizabeth.dykstra@doh.wa.govhttp://www.doh.wa.gov/ehp/ts/zoo.htm