what are the three major global factors which lead to emergence?
(1) Adaptation of infectious agent to new spp (spillover and accidental hosts. Also, Crossing of the Species-barrier) (2) Environmental factors (3) Host related factors
explain what Spillover and Accidental hosts are, and how it is a factor contributing to emergence. (examples?)
There is 1 reservoir host for the agent, but other spp. become infected but do not ‘maintain’ the agent. Examples of this are Hendra and SARS, where in the case of SARS it is bats spilling over to civets-->civets infect humans. (civets are not res. hosts though)
explain what crossing of a species barrier is, and contributes to emergence, and what is an example?
This is where an infectious agent establishes a complete cycle of transmission in a new species. An example is how avian influenza was in birds, but then mutated to be maintained and transmitted between people
what does Partial Crossing of the Species-barrier mean? (example?)
this is where the initial reservoir host is still needed for the intermediate host to transmit to humans. An example would be how hendra and nipah can't be maintained in horses/pigs effectively enough to sustain transmission independently of bats. (concern is if Complete crossing of spp. Barrier may occur if mutations or other factors > emergence occur)
what are environmental factors which can contribute to emergence?
Climate change affected by Host factors....such as global warming leading to more mosquito vecotrs
host factors--> what are some examples of how globilization and travel affect emergence?
Intercontinental transport, The impact of trade and transport, Land use, Failure of public health systems, Climate change and global warming
Worldwide Failure of Public health systems can lead to things like..
Inadequate surveillance, reporting, implementation of control measures, as well as Iatrogenic transmission of infectious diseases, through transfusions, transplants
what is the Role of the Veterinarian relating to emerging zoonoses?
Education, as well as Early detection and response. Report to the relevant authorities in YOUR COUNTRY
If you suspect you have a infectious and zoonotic emerging dz, what should you do FIRST?
In all cases of infectious particularly zoonotic diseases, it is imperative that before collecting animal samples you report your suspicions to the relevant State or Federal authority.
Group Discussion readings AVMA and the Law and Vet Std (kinda just read over, common sense)
Legal duties of vets are determined by who?
State veterinary medical boards
Legal duties--> (3)
Standard of care to avoid malpractice, State laws and regulation, Additionally all employers (vets/non-vets) obligation to employees to provide worker safety & public safety
what are some ethical duties of vets?
Ethical duty to promote public health and to educate clients on risks associated with Zoonoses in their pets, and minimizing the transmission of zoonotic diseases (as stated in the vet oath).
if a vet does not adhere to their ethical duties, what can happen?
State Veterinary medical board can take action to suspend a vet’s license if ethical duties not adhered to
The following 4 elements must be present to sustain a claim of malpractice.... (4)
duty, a breach of the applicable professional standard of care, causation, and damages
Malpractice--> duty. Explain how duty must be present to sustain a claim of malpractice
Establishment of a vet-client relationship establishes a duty for the vet to provide a standard of care, if there is no relationship, the vet owes no duty to the patient. (so the vet must actually be the vet for the client)
Malpractice--> standard of care. Explain how standard of care must be present to sustain a claim of malpractice
a breach of the applicable professional standard of care where the vet fails to diagnose, recommend preventive measures for zoonoses, refer to a specialist for a spp/condition not within the treating vets’ expertise & advise clients on this and seeking MD care [INCLUDES educating VETERINARY STAFF on risks also].
malpractice--> causation and damages. Explain how causation/damages must be present to sustain a claim of malpractice
Determine if the vet’s conduct was negligent & caused the injury / disease in which case the owner can be awarded damages [financial compensation] ( What the vet must remember is new & advanced diagnostics are available to confirm animals as the source of human infections & these diagnostic tools must be utilised)
if employee contracts a zoonoses during employment, who might be helf liable?
What's OSHA and and what does it mean for the vet?
Occupational Safety and Hazards Act- Vets’ responsibility to implement an infection control plan to protect employees from exposure to zoonoses. Protect by implementing infection control practices (PPE) , handwashing, disinfection of premises/…..
*To negate initial elements required for a negligence claim, Vets should..
Record any advice they give to clients and keep accurate records
*if there is an owner who refuses recommended diagnostics and treatment, what should the vet do?
Obtain disclaimers, and seek advice from an attorney on how to best to design and implement these disclaimers
*when should you treat owners/people?
Infection control planning includes what 4 things?
(1) Exposure avoidance (e.g., refusal to provide care for species for which a practice is not equipped) (2) Engineering controls (e.g., convenient placement of sharps containers or providing an employee break room) (3) Administrative controls (e.g., employee training)) (4) Educate owners and staff on risks
Zoonotic agent transmission involves what three factos?
(1) Source Of Infection (2) Host Susceptibility (Age, i/suppression, preg) (3) Route Of Transmission (contact, aerosol, vector-borne transmission)
what are thee major Veterinary Standard precautions vet should be doing?
(1) Personal protection action and equipment (2) Protective Actions during procedures (3) Environmental Infection Control
examples of Personal protection action and equipment? (7)
(1) Hand hygiene < risk of disease transmission (2) Gloves & sleeves to < risk of pathogen transmission ( like from Necropsies, Handling faeces, body fluids, Dental procedures, NOT a substitute for handwashing). (3) Facial protection to prevent exposure of mucous membranes of eyes, mouth, nose to pathogens..use of face shields, goggles (when lancing abscesses, Flushing wounds, suction, Dental & obstetrical procedures) (4) Respiratory tract protection: NIOSH CERTIFIED N95 Respirators [ filter 95% of airborne particles] & protect airways from inhalation of aerosols /infectious agents (when working with Ill psittacines, Q fever-abortion storms, Respiratory- M. bovis) (5) Disposeable Protective outerwear, footwear to prevent exposure to infectious material and prevent spread (6) Head covers (7) Bite- resistant equipment to protect animal handlers from injury
what are some examples of Protective Actions during procedures? (6)
(1) Isolate animals with infectious diseases in a separate examination room (2) Ensure room has a source of running water and vets and personnel wash hands between examinations of individual animals or litters; alcohol based hand rubs, properly cleaned and disinfected between batches (3) Protective outerwear/gloves for vet +personnel, facial protection..if suspect zoonoses (4) Engineering controls-provide appropriate sharp containers to avoid needlestick injuries and discourage removal of needle caps by mouth (5) Use gloves for venipuncture if animal >infectious disease (6) Appropriate use of outerwear, and disposal of gloves, use of facial masks, respirators.. during dental, diagnostic specimen handling, wound care, handling lab specimens, obstetrical, necropsy procedures.Resuscitate using endotracheal tubes & a manual resuscitator or anaesthetic machine not your mouth!
Implement Vaccination policy for staff, such as
rabies, tetanus, influenza and educate staff and encourage compliance with policies and procedures. Keep records.
what should you be ESPECIALLY stringent out with record keeping?
record-keeping especially documentation of exposure incidents (autoinoculation with vaccines, bites, needlestick injuries [euthatal] , zoonotic pathogen exposures & reporting where appropriate to local or State health departments)
A state in which the immune system is suppressed. Can be... (1) Artifically (by steroids/drugs during the treatment of: Autoimmune diseases, Organ transplantation) (2) Naturally: Age, pregnancy
clinical definition of AIDS?
2 things required for this dx: (1) HIV + (2) Has one of the following AIDS-defining zoonoses: Cerebral Toxoplasmosis or Chronic Cryptosporidiosis (both parasites-- they are toxic for the HIV pts crypts of the body)
three common modes of pet-human transmission?
Bites, scratches, aerosol, Exposure to Saliva and secretions: urine, faeces
what are some BACTERIAL zoonoses which I/suppressed or I/compromised people are esp. at risk to?
where is pasturella multocida usually found? how is it usually transmitted?
Normal microflora of oral cavity of domestic carnivores. Transmission via: bites or scratches, aerosol, saliva and other animal secretions (pasture in the mouth of carnivores...lol)
how does pasturella often affect IC pts?
Systemic infections in IC patients often > deep cellulitis (remember- in mouth of carnivores, so bites, so get into the cellulite, so cellulitis)
capnocytophagia canimorsus is usually found where? how is it transmitted?
Component of oral microflora of domestic carnivores. Transmitted via bites or aerosol from animal >humans
how does capnocytophagia canimorsus affect IC pts?
In IC patients, septicemia >mortality rates up to 33%.
mycobacteria marinum is usually found where/what is the reservoir? how is it transmitted?
Lives in aquatic environments. Both fresh and salt water are the reservoir. Humans usually become infected after areas of minor trauma are exposed to contaminated water
how does mycobacteria marinum affect IC patients?
They develop cutaneous lesions> "swimming-pool granuloma" or "fishtank granuloma”. Can be disseminated infections which may be unresponsive to treatment
how can IC patents avoid mycobacterium marinum?
all cases with AIDS parents was from an aquarium. Tell them to wear gloves when cleaning aquarium, or have someone else clean it
rhodocococcus equi--> where is this found? how can IC pts get infected?
No vertebrate reservoir required!! People AND horses can get it from the environment. Pathogenic to foals when inhaled in dust and they get pneumonia, BUT HORSES NOT ESSENTIAL FOR HUMAN INFECTION. Usually IC pts infected via inhalation/areosol
how does rhodococcus equi affect IC pts?
they develop pneumonia from inhaling in from the enviro
How can IC patents avoid rhodococcus equi?
Ubiquitous bacteria, especially in equine environment where herbivore manure and warm temperatures appear to provide ideal conditions for multiplication, and Infected foals may shed larger numbers in feces. So, Avoid farms with cases in foals. These farms will have high numbers of organism in the environment
what are the two mos common strains of salmonella in AIDS pts?
Salmonella typhimurium, Salmonella enteritidis (typhoid sally with diarrhea is a AIDS patient's worst nightmare)
how is almonella usually transmitted?
Transmission via Faeco–oral, contaminated food, environment or fomites.
how can animals infected with salmonella present?
can be asymptomatic or diarrhea
what is a known source of salmonella in children?
Contact with reptiles in particular pet turtles, are known source of infection to children thus FDA ban on the interstate shipment of pet turtles. can Also come from Other pet reptiles, cats, birds, rodents
how does salmonella present in an IC patient?
In HIV infected patients, salmonellosis is characterized by a recurrent diarrhoea, frequently associated with septicaemia /more severe disease with systemic involvement
which two campylobacter sp are the leading cause of human enteritis?
C. jejuni, C. coli (camping with intestines)
which campylobacter is most frequently associated with systemic dissemination, especially in I/C patients?
C. fetus (them babies all up inside of you...AHHH)
how are campylobacter species usually spread to humans? (2)
Contaminated or undercooked meat, Young, diarrhoeic pets, shedit and pose a risk to owners
what is disease caused by campylobacter like?
Localized to GIT or further systemic involvement…Guillain-Barre( rare disorder in which your body's immune system attacks your nerves) (I camped with a chick that had guillain-barre once)
how do humans acquire bordetella bronchiseptica, and what is the disease like in people?
It may cause respiratory infections in IC humans, mostly following direct exposure to infected animals