Zoonoses final

1. ZOONOSES Dr. manoj vedpathak

2. • Scope  Definition  Epidemiology  Factors influencing prevalence  Stages of zoonotic diseases  Modes of transmission  Persons at risk  Classification  Viral zoonoses – classification, general clinical features, diseases in brief  Laboratory diagnosis  Treatment  Prevention

4. •The word 'Zoonosis' (Pleural: Zoonoses) was introduced by Rudolf Virchow in 1880 to include collectively the diseases shared in nature by man and animals. • Later WHO in 1959 defined that Zoonoses are "those diseases and infections which are naturally transmitted between vertebrate animals and man". (http://www.who.int/topics/zoonoses/en/) • Zoonoses include only those infections where there is either a proof or a strong circumstantial evidence for transmission between animals and man. • Zoonotic Diseases (also known as zoonoses) are caused by infections that are shared between animals and people. (https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html)

5. Change of Idea in Zoonosis

8. FACTORS INFLUENCING PREVALENCE OF ZOONOSES • Ecological changes in man's environment • Handling animal by-products and wastes (occupational hazards) • Increased movements of man • Increased trade in animal products • Increased density of animal population • Transportation of virus infected mosquitoes • Cultural anthropological norms

12. Who are at Risk? I. Farmers, livestock and animal processing workers II. Outdoor recreational activities or vocational activities in wild or underdeveloped regions III. Persons in contact with pets, other animals in urban areas IV. Health care and laboratory personnel (human and veterinary) V. Fishers and others working in aquatic envirnment VI. Immunocompromised hosts; Public, anyone, any place

13. Classification *Etiological - Bacterial - Viral - Rickettsial - Fungal - Parasitic - Ectoparasites *Mode of transmission - Direct zoonoses - Cyclozoonoses - Metazoonoses - Saprozoonoses *Reservoir host - Anthropozoonoses - Zooanthroponoses - Amphixenoses

14. • When an insect vector is involved, the disease is also known as an arboviral disease. • However, not all arboviral diseases are zoonosis: where the transmission cycle takes place exclusively between insect vector and human e.g. dengue and yellow fever.

15. Mode of transmission Directly from lower vertebrate Bite/Scratch • Rabies • Herpes B encephalom ylitis Direct contact/ contact with product • Foot & mouth ds • Orf • Vesicular stomatitis • monkeypox • Marburg & Ebola • Nipah & Hindra Respiratory • Lymphocytic choriomenin gitis virus • Influenza virus • Hantavirus Ingestion • Lassa fever

16. Through the Arthropod vector Arboviral Infections *Fever with arthrits - Chikungunya - Mayaro - Ross river - Sindbis - Semiliki *Encephalitis - Japanese enceph. - West nile enceph. - Colorado tick fever - California enceph. - St. Louis enceph. - Estern equine - Western equine - Venezuelan equine *Hemorrhagic - Yellow fever - Kyasanur forest disease - Dengue - Crimean congo HF - Omsk HF

17. • According to Zoonotic Diseases of Public Health Importance (manual) published by Zoonosis Division of National Centre for Disease Control, Delhi.(20th July 2016) • Following viral zoonotic diseases seen in India are:  Rabies  Arboviral Infections  Zika Virus Disease  Crimean-Congo Haemorrhagic Fever  Ebola Virus

18. General Clinical features of Viral Diseases • Fever • Headache • Bodyache • Myalgia • Nausea

19. Zoonoses transmitted by animal bite Disease Organism Animal Host Person at risk Rabies (Rhabdoviridae) Rabies virus Dogs, fox, bats, cattles Human (Accident al) II, IV, Public Herpes B encephal omylitis (Herpesviridae) Herpes simiae Monkey Human (rare) II, III, IV

20. Disease World distribution India disribution Clinical features Rabies Worlswide, rural areas of Africa and Asia, (Except Australia, New Zealand, UK, Ireland, Scandinavia, Japan and Taiwan Except andaman and Nicobar Islands, Lakshadweep headache, malaise, sore throat and mild fever, pain and tingling, Aerophobia, Hydrophobia Herpes B encephalomyli tis ---- ---- Acute ascending myelitis

21. Zoonoses transmitted by Direct contact/skin penetration Disease Organism Animal Host Person at risk Foot & Mouth ds Aphthovir us Cattle Cattle, Human I, III, IV Orf (contagio us erythema ) Parapox virus Sheep, goat Sheep, goat human (rare) I

22. Disease Organism Animal Host Person at risk Vesicular stomatitis (Rhabdoviridae) Vesicular stomatitis virus Cattle, horses Cattle, horses, human(rar e) III, IV Monkey pox (Orthopox) Monkey pox virus Rodents/ Monkey Human II, III Ebola Filovirus ?Fruit bat ? Primates (apes/mo nkeys) Human I, II, IV Marburg Filovirus Monkey Human I, II, IV

23. Disease Organism Animal Host Person at risk Nipah virus Paramyxo virus Fruit bat Pigs Human (close contact) I, II Hindra virus Paramyxo virus Fruit bat Horses Human (body fluid &secreti ons) I, II

24. Disease World distribution India disribution Clinical features Foot & Mouth ds Worldwide Southern & western part (2006) - Sore throat - Ulcers in the throat, mouth and tongue - Rash with vesicles on hands, feet and diaper area. - Loss of appetite Orf (contagious erythema) Worldwide ---- Localised skin lesions, mouth sore (contagious pustula dermatitis)

25. Disease World distribution India disribution Clinical features Vesicular stomatitis Worldwide ---- Oral mucosal vesicles, ulcers Monkeypo x Worldwide, Africa (First outbreak in USA 2003) ---- Vesicular rash, fever, lymphadenop athy

26. Disease World distribution India disribution Clinical features Ebola African countries Not in India Fever, headache, myalgia, sore throat, abdomial pain, vomoting, diarrhea, rash with hemorrhage Marburg African countries Not in India Hemorrhagic fever

27. Disease World distribution India disribution Clinical features Nipah virus Malaysia Siliguri (WB 2001) Encephalitis Hindra virus Australia Siliguri (WB 2001) Encephalitis

28. Zoonoses transmitted by Inhalation Disease Organism Animal Host Person at risk Lymphocyti c choriomeni ngitis Lymphocyti c choriomeni ngitis (Arenavirus) Mice, hamster, rodents Human I, III, IV, Public Influenza (Avian/ Pandemic) Influenza virus (Orthomyxo) Pigs, Birds Human I, II, Public Hanta virus HF Hantavirus (Bunyaviridae) Rodents Human I, II, IV

29. Disease World distribution India disribution Clinical features Lymphocytic choriomeningi tis Worldwide (Europe & America) ---- Aseptic meningitis, Influenza like illness, severe in immunocompro mised Vertical transmission in early pregnancy

30. Disease World distribution India disribution Clinical features Influenza Worldwide India Uncomplicated: mild URTI & diarrohea. Complicated/ Severe: Secondary bacterial pneumonia, dehydration, CNS involvement, multi-organ failure

31. Disease World distribution India disribution Clinical features Hanta virus HF Worldwide ---- Hemorrhagic fever with renal syndrome, Hanta virus pulmonary syndrome.

32. Zoonoses transmitted by Ingestion Disease Organism Animal Host Person at risk Lassa fever Arenavirus Mouse (food contaminat ed with rodent excreta) Human I, II

33. Disease World distribution India disribution Clinical features Lassa fever West Africa Outbreaks have occurred in the Central African Republic, Guinea,Liberia Nigeria, and Sierra ---- -Hemorrhagic fever - Pneumonia - Cardiac & renal damage

34. Zoonoses transmitted by Arthropod vector Disease Organis m Vector Animal Host Person at risk Yellow fever Flavivir us Mosqui to (Aedes aegypti) Primate s Monkey Human II Japanes e enceph alitis Flavivir us Mosqui to ( Culex tritaeniorhynch us) Pigs Animal Birds Human (dead end) II, Children <15 yr Adults Infants not affected

35. Disease Organis m Vector Animal Host Person at risk Kyasanu r forest disease Flavivir us Tick Monkey rodent, squirrel Monkey rodent, squirrel Man (incident al & dead end) II Dengue Flavivir us Mosqui to(Aedes aegypti) ?Monke y Human II, Public Chikung unya Flavivir us Mosqui to(Aedes aegypti) ?Monke y Monkey Rodents II, Public

36. Disease Organis m Vector Animal Host Person at risk Zika virus Flavivirus Mosquito (Aedes aegypti) Monkey -Human (Mother to child transmission; Sexual transmission) II, Public Crimean- congo HF Bunyaviru s Tick Domestic mammals , rodents Human I, IV

37. Disease World distributio n India disributi on Clinical features Yellow fever Worlwide Africa Not in India Fever, headache, myalgia, nausea, vomiting, hemorrhagic Japanese encephalitis Japan, India, south east Asia Assam, UP, Bihar, Haryana, Goa, Maharasht ra, South India signs of increased intracranial pressure, difficulty of speech, ocular palsies, hemiplegia, quadriplegia, tremors, altered sensorium, convulsions, coma

38. Disease World distributi on India disribution Clinical features Kyasanur forest disease India Karnataka Fever, headache conjunctivitis, myalgia, prostration, gastrointestinal disturbances. Dengue India, far east, Caribbean islands Whole of India Saddle back fever, headache, retro bulbar pain, break bone fever, conjuctival injection, lymphadenopathy, maculopapular rash

39. Disease World distributi on India disribution Clinical features Chikungu nya Sub- Saharan Africa, India, many areas of Asia Tamil Nadu, Kerala, Karnataka, Maharashtra, Madhya Pradesh, Gujarat, Rajasthan, Pondicherry, Goa, Orissa, West Bengal, UP and Andaman. Fever, chills, vomiting, epistaxis, petechiae, arthropathy, pain, swelling, stiffness of the metacarpophalange a l, wrist, elbow, shoulder, knee, ankle and metatarsal joints

40. Disease World distribution India disribution Clinical features Zika virus Brazil, South & Central America, Caribbean, Europe, Australia. Not present -Asymptomatic: Symptomatic (5:1) - Minor: fever, rash - Congenital transmission- microcephaly - GBS (very few cases)

41. Disease World distribution India disribution Clinical features Crimean-congo HF Africa, Europe Middle East and Central Asia, Pakistan (50-60 cases annually) Gujrat (2011) Sore eyes, photophobia, sore throat, diarrhoea, abdominal pain, hepatomegaly, mood swings Hemorrhagic manifestations (hematemisis, petechiae, malena etc.)

42. Disease Organism Vector Animal Person at risk Encephalitis (Eastern equine, western equine, venezuelan equine) Alphavirus Mosquito (Aades, culex) Birds, horses II, III, IV, Public California Bunyavirus Mosquito (Aades) Mammals, wild rodents I, II, Public St. Louis Encephalitis Flavivirus Mosquito (Culex) Birds I, Public West nile encephalitis Flavivirus Mosquito (Aades, culex) Birds II, Public

43. Disease Organism Vector Animal Person at risk Murray valley encephalitis Flavivirus Mosquito (Culex) Birds II Rift valley fever Bunyavirus Mosquito (Aades) Sheep, goat, cattle I, II, IV, Public Colorado tick fever Orbovirus Tick Rodents I, II Sandfly fever Bunyavirus Sandfly Small mammals I, II

44. • Egg innoculation  Yolk sac – JE virus, St. Louis virus, West nile virus.  Amniotic sac – Influenza virus  Allantoic sac – larger cavity hence used to derive viral vaccines. Influenza vaccine Yellow fever (17D) vaccine Rabies (Flury strain) vaccine.

45. Laboratory Diagnosis & Prevention

46. Disease Laboratory Diagnosis Prevention Rabies 1. Specimen :  Human –  Antemortem : corneal smear, skin biopsy (face/neck), saliva, hair follicles, blood, cerebrospinal fluid  Postmortem : brain (hippocampus, cerebellum)or spinal cord  suspected rabid animals –  Postmortem : brain and salivary glands  Antemortem : saliva and corneal smears 1. Prophylaxis :  Pre-exposure –  Pre-exposure immunization should be three full IM dose of vaccine given on day 0, 7 and 28 or 0, 28 and 56 followed by booster at one year and then a booster every three years.  Laboratory staff and others at high continuing risk of exposure should have their neutralizing antibody titres checked every 6 months. If it is less than 0.5 i.u./ml a booster dose of vaccine should be given

47. Disease Laboratory Diagnosis Prevention Rabies 2. Direct microscopy :  Demonstration of rabies virus antigen by Direct FAT  Demonstration of Negri bodies by Seller’s stain. (other Giemsa or Mann’s stain) 3. Isolation :  Animal inoculation : Intracerebral in mice from brain, CSF and saliva. Inoculated mice are examined for signs of illness and their brains are examined at death or at 28 days post-inoculation for Negri bodies. Post – exposure :  Management of wound: - Wound toilet - Antiseptic - Local infiltration of rabies Ig  Passive immunization : - Antirabies serun/ERIG (Equine Rabies immunoglobulin) 40 IU/kg body wt. - HRIG (Human Rabies immunoglobulin) 20 IU/kg body wt.

49. Disease Laboratory Diagnosis Prevention Rabies  Tissue culture :  WI 38, BHK 21, CER  Cytopathic effect is minimal  Virus isolation is identified by IF as early as 2-4 days after inoculation. 4. Antibody demonstration :  By ELISA  Diagnostic role is limited in antemortem diagnosis as the disease is largely fatal. 5. Electron Microscopy :  Shows bullet shaped virus 6. Molecular method :  Detection of rabies virus RNA by RT-PCR  Active immunization : -Antirabies vaccines (Day 0,3,7,14 & 28) 2. Control :  Rabies is primarily a disease of animals and control measures have to be directed towards the natural reservoir of the disease  Vaccines for animals

51. Name of the vaccine Fixed virus strain Substrate Available 1. Neural tissue vaccine BPL inactivated sheep brain vaccine (Semple type) PV – 11 Sheep brain Production stopped since December 2004 Cell Culture vaccines i) Human Diploid Cell Vaccine (HDCV) ii) Purified Chick Embryo Cell Vaccine (PCEC) iii) Purified Vero Cell Rabies Vaccine (PVRV) Pitman Moore (PM) LEP-Flury Pitman Moore (PM) MRC-5 Primary SPF chick embryo cells Vero Cells Imported Produced locally in pvt. Sector Imported + produced locally in public sector Purified Duck Embryo Vaccine Pitman Moore (PM) Duck Embryo Imported

52. Disease Laboratory Diagnosis Prevention Ebola - Specimen : Blood/serum/plasma - ELISA for Ag & Ab detection - RT-PCR - Electron microscopy - Vero cell line for virus isolation - Rodent control - Avoid contacts with rodents & their products Marburg - Specimen : Blood/serum/plasma - ELISA for Ag & Ab detection - RT-PCR - Electron microscopy - Vero cell line for virus isolation - Rodent control - Avoid contacts with rodents & their products

53. Disease Laboratory Diagnosis Prevention Nipah virus - Specimen : Blood/Serum/Plasma - ELISA (IgM/IgG) - PCR (RNA) - Avoid contacts with infected animals. Hindra virus - Specimen : Blood/Serum/Plasma - ELISA (IgM/IgG) - PCR (RNA) - Avoid contacts with infected animals.

54. Disease Laboratory Diagnosis Prevention Influenza 1. Specimen :  Nasopharyngeal swab  Throat gargling  Serum and plasma 2. Demonstration of viral antigen: By IF 3. Isolation of the virus :  During first 2-3 days  Throat gargling using broth saline or buffered salt solution.  Isolation may be made in amniotic cavity of hen’s egg or in monkey kidney cell culture. 1. Immunoprophy- laxis :  Inactivated vaccine:  Subunit vaccines  Recombinant vaccines  Live attenuated vaccines: intranasal instillation  Recombinant live vaccine

55. Disease Laboratory Diagnosis Prevention Influenza  Virus growth identified by hemadsorption with human O group, fowl/guinea pig erythrocytes. 4. Serology :  Hemagglutination inhibition : detection of antibodies  Complement fixation :  RNP antigen  Very useful as antibodies formed during infection only  Now used rarely 2. chemoprophylaxis:  Amantadine  Rimantadine

56. Disease Laboratory Diagnosis Prevention Influenza  Radial immunodiffusion : Identification of antibodies to RNP antigen, hemagglutinin, neuroaminidase 5. Molecular method :  Multiplex PCR 3. General measures:  Avoid contact with infected people  Stay at home if sick.  Use mask (N95)  Wash your hand thoroughly and frequently.

57. Disease Laboratory Diagnosis Prevention Lymphocytic choriomening itis 1. Specimen : Blood/Serum/Plasma, CSF, Brain tissue 2. Serum IgM/IgG dection 3. Viral RNA detection by RT-PCR 4. Viral culture – vero cell line - Rodent control - Avoid contact with contaminated material.

58. Disease Laboratory Diagnosis Prevention Hanta virus HF -Specimen : Blood/serum/plasma, urine, tissue (renal, liver, lung) - IgM Antibody detection by ELISA - Isolation of viruses - RT-PCR - Rodent control - Protection from exposure to rodent droppings and contaminated material.

59. Disease Laboratory Diagnosis Prevention Lassa fever 1. Specimen : Blood/serum/plasma, tissue (renal, cardiac,lung) 2. Serum IgM/IgG dection 3. Viral RNA detection by RT-PCR 4. Viral culture – vero cell line Rodent control - Protection from exposure to rodent droppings and contaminated material.

60. Disease Laboratory Diagnosis Prevention Yellow fever 1. Specimen : 2. Virus Isolation by culture 3. IgM antibody/ antigen detection by ELISA 4. Neutralisation test (more specific) 5. Molecular: Real time-PCR 1. Vaccine:  17D vaccine  CRI Kasoli  Single dose- s/c  Certification for 10 years. 2. Control measures: mosquito control

62. Disease Laboratory Diagnosis Prevention Japanese encephalitis 1. Specimen :  Serum  CSF  Brain tissue (postmortem) 2. Detection of antigen: from autopsied brain tissue by fluorescent antibody test. 3. Isolation of virus: mosquito cell line from CSF or brain tissure 4. Detection of antibody: HAI , IgM capture ELISA 5. Molecular: PCR Control measures: 1. Interruption of transmission: Mosquito control 2. Vaccine:  Live attenuated :SA14-14-2,  Inactivate vaccine: nakayama, beijing vaccine 3. Health education

64. Disease Laboratory Diagnosis Prevention Kyasanur forest disease 1. Specimen: serum / blood 2. Detection of antibody:IgM ELISA 3. Isolation of virus from blood 4. Molecular : nested PCR and Real Time -PCR for viral RNA 1. Protection of man:  Vaccine:  Killed KFD vaccine- 2 doses at interval of 2 months , boster at 6 to 9 month then every 5 year  Prevention of tick bite. 2. Protective measures against ticks: lindane effective for 6 weeks

65. Disease Laboratory Diagnosis Prevention Dengue 1. Specimen: serum/ plasma/ tissue (liver, renal) 2. Detection of antigen: Direct IF NS1 antigen detection by immunochromatograpy (flow through assay)or ELISA 3. Serological diagnosis: Detection of IgM antibody by capture ELISA and rapid IgM test . Detection of IgG antibodies by IgG ELISA ,rapid IgG and HAI 4. Isolation of virus: suckling mice tissue culture or mosquitoe cell line 5.Molecular method: real time PCR 1. Vaccine:  No effective vaccine available  Dengvaxia vaccine 2. Vector control measures 3. Protection from mosquito bite

67. Disease Laboratory Diagnosis Prevention Chikungunya virus 1. Specimen: blood/ serum 2. Detection of antibody: IgM ELISA 3. Isolation of virus: mosquitoe cell lines, suckling mice inoculation 4. Molecular method: Real Time-PCR 1. Vector control measures 2. Protection from mosquito bite 3. No vaccine is available.

69. Disease Laboratory Diagnosis Prevention Zika virus 1. Specimen: blood/ serum 2. Detection of antibody: IgM ELISA 3. Molecular method: RT- PCR 1. Vector control measure 2. Protection from mosquito bite 3. No vaccine available

70. Disease Laboratory Diagnosis Prevention Crimean- congo HF (CCHF) 1. Specimen :  Antemorterm: serum/plasma  Postmorterm : tissue (liver, spleen, Bone Marrow, kidney, lung ,brain) 2. Serology:  IgG/IgM antibodies by ELISA. 3. Isolation if virus from blood or tissue : vero cell line 4. Molecular detection : RT- PCR 1. No vaccine available 2. Tick control 3. Health education

73. References • www.who.int/topics/zoonoses/en/ • www.ncdc.gov.in • www.cdc.gov.in • Ghasemzadeh I, Namazi SH,Review of bacterial and viral zoonotic infections transmitted by dogs, J Med Life;2015; 8(Spec Iss 4): 1–5 • Shanson DC, Microbiology in clinical practice, Indian ed; Wrights & Sons pvt ltd; London, England, 1983, pp 400-11 • Text book of Microbiology, Ananthnarayan, Panikar R; 9 th edition,2014 • Sastry AS, Sandhya BK; Essentials of Medical Microbiology; Jaypee brothers Medical Publishers Pvt Ltd, 1 st edition,2016 • Park’s textbook of Preventive and social medicine; Park K; Bhanot Publication, Jabalpur, India;24 th Ed, 2017 • Gandham Pavani, Review Article ZOONOTIC DISEASES WITH SPECIAL REFERENCE TO INDIA, International Journal of Basic and Applied Medical Sciences ISSN:2014 Vol. 4 (1) January-April, pp. 73-87. • J Kay Richmond, Deborah J Baglole, Lassa fever: epidemiology, clinical features, and social consequences, BMJ 2003;327:1271–5

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