Transcript The National Companion Animal Surveillance System (NCASP) A Supercourse Lecture Larry Glickman, VMD, DrPH Nita Glickman, MPH, PhD Department of Comparative Pathobiology Purdue University School of Veterinary.

The National Companion Animal
Surveillance System (NCASP)
A Supercourse Lecture
Larry Glickman, VMD, DrPH
Nita Glickman, MPH, PhD
Department of Comparative Pathobiology
Purdue University
School of Veterinary Medicine
West Lafayette, IN 47907-2027
Banfield Pet Hospital-Purdue University
The National Companion Animal
Surveillance System (NCASP)
Objectives of Lecture
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Learning Objectives
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understand the principles of syndromic
surveillance
appreciate why animals may be good
sentinels for human health
Performance Objectives
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graph and interpret changes in frequency of
health events over time
design a surveillance program using either
syndromic events or diseases
What is the National Companion Animal
Surveillance Program (NCASP)
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NCASP is a national, near real-time,
surveillance system that uses the
electronic medical records of pet animals
seen at >560 veterinary hospitals in the
U.S. to detect events that signal the threat
of an emerging infection, a terrorist
threat, or a natural disaster, for people
living in the same geographic area
Supported by a grant from the CDC
Mission of the National Companion Animal
Surveillance Program
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Provide real-time and near-real-time information
on syndromic and disease events that occur
among species of pet animals in the United
States
Conduct detailed statistical analyses to identify
space-time clusters of events and characterize
host and environmental risk factors
Alert to the occurrence of potential acts of
bioterrorism, emerging zoonoses, and toxic
chemical exposures
Serve as a sentinel for the occurrence of
environmentally related diseases (e.g.., cancer)
Surveillance – CDC Definition
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Ongoing systematic collection, analysis,
and interpretation of health data
Essential to the planning,
implementation, and evaluation of
public health practice
Closely integrated with the timely
dissemination of these data to those
who need to know
Temporal Sequence of Surveillance
Disease Specific or Syndromic Events
Recovery
Agent
Signs &
Symptoms
(I & W)
Diagnostic
Tests
Specific
Diagnosis
or Agent
Outcome
Death
Syndromic
Exposure
Surveillance Surveillance
Traditional Surveillance
I & W = Indications & Warnings
Why are Animals Good Sentinels for
Emerging & Human Infections?
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1,407 pathogens affect humans; of these 58%
are zoonotic
177 of these pathogens are considered
‘emerging’ or ‘reemerging’
38 animal diseases have affected humans over
the past 25 years
 SARS
 Monkey pox
 Avian Influenza
 West Nile virus
Biothreat A Agents in Dogs & Cats
Diseases/Agents*
Category A
Anthrax (Bacillus anthracis)
Botulism (Clostridium botulinum
toxin)
Occurs naturally
in
companion
animals**
Dogs and cats
Dogs and cats
Plague (Yersinia pestis)
Cats and dogs
Smallpox (variola major)
Not reported
Tularemia (Francisella tularensis)
Cats and dogs
Viral hemorrhagic fevers (filoviruses
& arenaviruses)
Not reported
* - CDC 2003: http://www.bt.cdc.gov/agent/agentlist-category.asp
** - reported with species of greatest (or equal) susceptibility first
Advantages of Using Companion
Animals as Sentinels
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62% of American households own a pet
■39% dogs ■34% cats ■58% any
Pets less mobile than people
Less confounding (smoking, alcohol)
Explore environment (smelling, licking)
Shorter latency time (exposure to
disease)
More sensitive to fixed pathogen dose?
>550 hospitals
18,000 hospitals
Purdue
University
Data Warehouse
Data Mining
National Companion Animal Surveillance Program (NCASP)
Banfield
The Pet Hospital
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Currently >560 full service hospitals
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Add 2 new hospitals per week
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Located in 44 states, Mexico, UK
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>3.0 million patient visits yearly
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~ 10,000 patient visits daily
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~ 1-2% of U.S. pet population
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Addresses of pets geocoded
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Web addresss: Banfield The Pet Hospital
Banfield
The Pet Hospital
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Paperless practices
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Standardized medical records
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Computerized records sent nightly to
central data warehouse
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Subjected to quality control
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Corporate HQ in Portland, OR
Banfield PetWare
Proprietary Software
Pet
Demographics
Exam findings
Diagnoses
Office Visits
Laboratory
Results
Treatments
Medical Notes
Banfield Hospital Locations in Major
Metropolitan Areas
Los Angeles
Phoenix
Dallas
Chicago
Atlanta
Washington DC
as of June 13, 2006
Number of Dogs & Cats Visiting
Banfield The Pet Hospital in 2005
4,000,000
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
Office Visits
Number of Pets
Dogs
Cats
Number of Other Animal Species
Visiting
Banfield The Pet Hospital in 2005
20,000
Office Visits
18,000
16,000
Number of Pets
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
Rodent
Guinea
Pig
Avian
Rabbit
Ferret
Reptile
Other
National Flea/Tick Pathogen Surveillance
Vector ID
Pathogen ID
Medical Records
Ticks: Anaplasma sp, Babesia sp, Bartonella sp, Borrelia
lonestari, Erlichia sp, Francisella tularensis, Rickettsia sp
Fleas: Bartonella sp, Dipylidium caninum, Mycoplasma sp,
Rickettsia sp, Yersinia pestis
Web
Portal
Relationship between Canine Tick Activity &
Human Lyme Disease
10
2.0
Tick infestation per 1,000 dog visits
Human Lyme disease incidence per 100,000 persons
9
8
1.5
1.0
5
4
3
0.5
2
1
Month and Year
Nov-04
Sep-04
Jul-04
May-04
Mar-04
Jan-04
Nov-03
Sep-03
Jul-03
May-03
Mar-03
Jan-03
Nov-02
Sep-02
Jul-02
May-02
Mar-02
0
0.0
Lyme Incidence
6
Jan-02
Tick Prevalence
7
Change in frequency of respiratory
syndrome in pets following hurricane Katrina
Percent of Pets
Frequency of coughing & difficulty breathing
Banfield Hospitals in Louisiana (N=5) and Mississippi
(N=3)
4
3
Canine
2
Feline
1
0
8/01 8/08 8/15 8/22 8/29 9/05 9/12 9/19 9/26
Hurricane Katrina
Alert!!!
Fayette County-GA’s Own “Silent Summer”
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Philips Services, Corp. plant emits noxious
chemical
600 residents sickened by onion-like chemical
odor
Like their owners, many dogs and cats are
sick, nearly all within 2-mile radius of PSC
plant
Pets dying from June-Aug. with signs of
vomiting, diarrhea, skin irritation, dyspnea
Chemical pesticide identified as Ethoprop
Purdue contacted Sept. 2 for help regarding
the acute & long-term health of animals
and residents in community
Banfield Hospitals Near Fairburn, GA
Georgia Dept of Health Chemical Hazards
Banfield Dogs and Cats Living Within 15-miles of
Chemical Plant in Fairburn, GA
Banfield Dogs
n = 15,753
Banfield Cats
n = 3,065
1129
288
Fairburn
Chemical
Plant
281
Fairburn Georgia
♦ Respiratory syndrome in pet dogs following
possible exposure to a hazardous chemical
released during week 26
♦ Dogs living 10-20 miles from Fairburn, GA were
thought to have had the greatest exposure
Respiratory
Percent
0.5
0.4
>20 miles
0.3
0.2
10-20 miles
<=10 miles
0.1
0
20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37
Week of 2006
coughing or trouble breathing
>550 hospitals
18,000 hospitals
Purdue
University
Data Warehouse
Data Mining
National Companion Animal Surveillance Program
Leptospirosis
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World-wide zoonotic
disease
Gram negative
bacteria
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Spirochetes
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Genus Leptospira
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Over 250 serovars
Transmission
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Direct (hospital)
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Infected urine
Bite wounds
Ingestion
Indirect (community)
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Contact with stagnant or slow moving
water contaminated by urine
Leptospirosis at triathlon in Illinois
2003
2002
2004
<5%
5 - 10 %
> 10 %
No Data
0
750
1,500 Kilometers
Positive >= 1:800
Canine Leptospirosis, US, 2002-2004
Highest Percent Positive
Leptospira Serovar by State 2004
Summary
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The National Companion Animal
Surveillance System provides
complementary syndromic surveillance
capability to the more traditional use of
human hospital records to detect acts of
bioterrorism, emerging infections, and to
study health effects resulting from natural
and man made disasters such as floods,
hurricanes, and accidental chemical
releases into the environment
Summary-con’t
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The success of parallel animal and human
syndromic surveillance ultimately depends
on development of better statistical and
visual methods to identify correlations
between temporal and spatial changes in
syndrome frequency in humans and
animals and better communication
between ALL health care providers
The New Yorker, June 16 & 23, 2003