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NYS Response to Rodent Associated Monkeypox: 

NYS Response to Rodent Associated Monkeypox Bryan Cherry, VMD, PhD New York State Department of Health

Summary of the outbreak: 

Summary of the outbreak Index case: 3 y.o. child in Wisconsin Bitten by pet prairie dog Traceback of prairie dogs: TX  ILWI WI distributor received sick Gambian giant rat Giant rats and other African rodents arrived 4/9/03 in a shipment from Ghana (900+ rodents) Found virus in rope squirrels never housed in TX Set the stage for aggressive national guidelines for monkeypox control

Monkeypox and other orthopoxvirses: 

Monkeypox and other orthopoxvirses Or, “What the heck is Vaccinia, anyway?”

Poxviridae: 

Poxviridae

Orthopoxviruses, and the origin of Vaccinia: 

Orthopoxviruses, and the origin of Vaccinia All genetically very similar Antigenically related, all provide some cross-protection Vaccinia origin is unknown possible hybrid of smallpox and cowpox isolated from animals, after exposed by people has since been introduced as enzootic infection of buffalo, epizootic infection of rabbits immunity following infection for >5 years

Monkeypox epi and natural history: 

Monkeypox epi and natural history First recognized illness: Copenhagen, 1958 Fever, rash in lab monkeys Subsequent lab/zoo outbreaks in Europe, USA, linked to virus found in 1958 Had not been identified prior to 1958 Outbreaks in Africa in 1970’s No outbreaks outside Africa since 1966 Sporadic cases continue in Africa today

Monkeypox epi and natural history: 

Monkeypox epi and natural history Natural reservoir: rodents (tree squirrels) Incidental hosts: primates: clinical illness in apes (except chimp) humans, Asian monkeys many lab animal species can be infected, +/- clinical disease

Monkeypox epi and natural history: 

Monkeypox epi and natural history Clinical illness (humans) incubation avg. 12 days fever > rash > enanthem mortality highest in young children Human-human spread occurs rarely Endemic persistence in humans highly unlikely

Slide10: 

Richardson’s ground squirrel Prairie dog

Monkeypox fallout in NYS: 

Monkeypox fallout in NYS 2 wallabies in contact with infected animals in Midwest were purchased by a NYS resident, end of March Wallabies and family are healthy, beyond period of time where quarantine would be required One ill prairie dog in Onondaga County (June) tested at Cornell’s veterinary diagnostic laboratory by looking for orthopox viruses in heart blood; this is an insensitive test, and results were negative prairie dog recovered, did not meet case definitions (had intermittent skin lesions only) Prairie dogs from facilities that also had African rodents were delivered to 2 individuals, 3 pet stores in NYS 15 shipped, 6 others housed with “suspect” pdogs

Outreach to NYS Veterinarians: 

Outreach to NYS Veterinarians 2 Letters to veterinarians Providing general control guidelines Soliciting volunteers in each region for triage of suspect animals Working on availability of PPE N95 masks and kevlar bite-proof gloves for key veterinarians to handle suspect animal cases Exploring inclusion of veterinarians on smallpox response teams, offering smallpox vaccination

Monkeypox Control Efforts, NYS: 

Monkeypox Control Efforts, NYS Seizure order issued by NYSDOH (Thurs., PM) All prairie dogs that had prior contact with African rodents 3 counties affected Formal letter (Fri., PM) requesting seizure “by all means necessary, including court order” Procedures guidelines for NYS in final development

Response to Control Efforts: 

Response to Control Efforts Agriculture Dept. did not support seizure Provided little assistance collecting and destroying healthy animals Environmental Conservation did not support seizure “not wildlife” LHDs did not support their role in seizure “should be done by Ag or Environ. Cons. Difficult to get vets to provide euthanasia

Lessons learned, lessons still to be learned: 

Lessons learned, lessons still to be learned

Why an aggressive responsewas necessary: 

Why an aggressive response was necessary Monkeypox was new (?) to the U.S. “Up to 10% mortality in Africa” Potential introduction to indigenous wildlife Yet another smallpox mimic to complicate rapid detection of a BT event Impossible to know the potential for reservoir hosts, asymptomatic shed, latency

What was done well: 

What was done well Rapid identification of the etiology and animal sources of infection (vs. West Nile) Rapid traceback/traceout of animals, despite MANY obstacles Decisive moves to stop trafficking of potential carriers Collection of truly suspect rodents to reduce risk of wildlife

Where we need improvement: 

Where we need improvement Ambiguous message regarding use of smallpox vaccine post-exposure ideally within 4 days, can use up to 2 weeks(?) definition of exposure: 3 hours spent within 6 ft of a suspect rodent definition of suspect rodent (only sick pdogs? Pdogs in contact with sick animals?)

Where we need improvement: 

Where we need improvement Ambiguous guidelines regarding “suspect animals” African rodents from 4/9/03 shipment Pdogs with clinical illness, or housed with animals showing clinical illness Any pdogs housed with healthy African rodents at any time since 4/9/03? “no guarantees regarding how long they may be infectious” verbal advice to destroy, not clear in guidelines

Where we need improvement: 

Where we need improvement More realistic follow-up CDC/FDA ban still in place pet store owners frustrated, costing them $$ no indication of what will change, or when Seizure and destruction of healthy pets requires solid justification Virology, epi evidence: convince the public this is necessary Improve cooperation between HHS, USDA no message from USDA during monkeypox outbreak

Where we need improvement: 

Where we need improvement The role of veterinarians Continued lack of involvement of vets in local public health Smallpox vaccination and protective equipment Need to consider vets for smallpox response teams If we ask vets to put themselves at KNOWN risk for public health, we must be willing to provide them liability protection as we do for physicians The role of local health departments Many (in NYS) feel zoonotic disease response should be handled at the state level

When regulation meets human nature: 

When regulation meets human nature Index family (WI) refuses to give up pdog WI, IL: issued “lifetime quarantines” NY: seizure orders for 21 prairie dogs 12/21 collected, tested by NYSDOH (negative) 2/21 died and unavailable (1 buried in yard) 5/21 untraceable (sold with no records) 2/21 owners refused to surrender now presumed dead or released to wild!

“Fire Island Phil”: 

“Fire Island Phil” Prairie dog living wild on Long Island ~1yr State Park staff arranged for trapping and relocation to Texas Staff were unaware of federal embargo! Pdog now held at State Park building Awaiting decision from FDA TX rehab does not want pdog anymore Example of poor communication, lack of coordinated response among state agencies

Next steps, nationally: 

Next steps, nationally General BT planning Recognition that vets are needed to evaluate and diagnose animals with zoonotic diseases Promote inclusion of local vets in emergency planning (model: NYSCART) Promote animal disease surveillance (model: NYCDOH) Establish national system for diagnostic testing, inclusion of VDL’s in LRN (in progress) Establish protocol for joint investigations between CDC, USDA

Next steps, nationally: 

Next steps, nationally Smallpox planning Smallpox may not be zoonotic, but what about other orthopoxviruses? Who will diagnose potential infections? Vets can play an integral role in smallpox response: contact investigation vaccinators Promote inclusion of vets on smallpox response teams

Next Steps, NYS: 

Next Steps, NYS Clarify investigation of veterinary reports of ill animals DOH or State Ag responsible? Pet store interviews by local health What to do with the information Traceback of ill/dead suspect animals Ag or DOH? Continue to explore capacity/resources needed for animal testing within the State

Next steps, NYS: 

Next steps, NYS Establish formal response plans for zoonotic disease primary role for animal follow up: Ag & Markets primary role for human investigation: NYSDOH clear protocol for NYSDOH enlisting Ag assistance/enforcement when necessary Assist LHDs to incorporate animal investigation as part of zoonoses surveillance

What to do about exotic pets?: 

What to do about exotic pets? Wildlife can carry numerous zoonotic agents and vectors Importation of many species is virtually unregulated animals with no agricultural value animals not perceived to carry a risk to agriculture Some states, localities ban ownership, far from consensus in the U.S.