Occupational Health Occupational Health for Wildlife Handlersfor Wildlife Handlers

M. A. Stevenson, DVM, PhD, M. A. Stevenson, DVM, PhD, DACVSDACVS

Director and Attending Director and Attending VeterinarianVeterinarian

The University of Montana-The University of Montana-MissoulaMissoula

Occupational HealthOccupational Health Why now?Why now?

– Mandatory for UM Mandatory for UM to maintain animal to maintain animal research program research program accreditationaccreditation

Why us?Why us?– Everyone listed on Everyone listed on

an AUP an AUP mustmust and and any one else any one else interested interested maymay participateparticipate

Staying SafeStaying Safe

TrainingTraining KnowledgeKnowledge AwarenessAwareness Co-workersCo-workers

Basic Safety PrinciplesBasic Safety Principles Use appropriate PPEUse appropriate PPE

– Gloves, coveralls, washable boots, Gloves, coveralls, washable boots, eye protection, mask or respiratoreye protection, mask or respirator

Good hygiene Good hygiene especially hands especially hands Protect human food and waterProtect human food and water Proper use of sharps containersProper use of sharps containers Communicate with your teamCommunicate with your team Please do not kiss the animals!Please do not kiss the animals!

Early Reporting of Early Reporting of InjuryInjury

Absolutely imperativeAbsolutely imperative to informto inform– Direct SupervisorDirect Supervisor– Principal InvestigatorPrincipal Investigator– Co-workers when in remote field areasCo-workers when in remote field areas

Any unusual symptoms Any unusual symptoms seek seek medical help immediately medical help immediately

Best defense is a good offense Best defense is a good offense Provide a Provide a completecomplete history to history to assist physiciansassist physicians

RabiesRabies

RhabdovirusRhabdovirus Fatal if no treatment Fatal if no treatment

or vaccine or vaccine protectionprotection

Infects all warm-Infects all warm-blooded mammalsblooded mammals

Sylvatic rabies Sylvatic rabies wildlife in life cyclewildlife in life cycle

Ole YellerOle Yeller Photo credits - CDCPhoto credits - CDC “Mad”

Rabies

RabiesRabies

““Dumb” rabiesDumb” rabies WildlifeWildlife

– Lose fear of humansLose fear of humans– Unusually “friendly” Unusually “friendly” – Uncharacteristic Uncharacteristic

places places – Uncharacteristic Uncharacteristic

times of daytimes of day– Neurological signsNeurological signs

– Photo credits - CDCPhoto credits - CDCRabid fox

RabiesRabies

Wildlife Wildlife reservoirs in reservoirs in US in 2001US in 2001

– Raccoons (38%)Raccoons (38%)– Skunks (30%)Skunks (30%)– Bats (17%)Bats (17%)– Foxes (6%)Foxes (6%)

– Photo credits - CDCPhoto credits - CDC

Silver-haired bat

Rabies Incidence in Rabies Incidence in U.S.U.S.

Rabies TransmissionRabies Transmission

Animal bites (virus in saliva)Animal bites (virus in saliva) Contamination of broken skinContamination of broken skin Aerosol in bat cavesAerosol in bat caves Corneal, liver, kidney Corneal, liver, kidney

transplant from infected donortransplant from infected donor 1-2 human cases/year in U.S. 1-2 human cases/year in U.S.

most often bat-associatedmost often bat-associated

Rabies Rabies Clinical Clinical SignsSigns

75% humans ill 75% humans ill << 90 days 90 days after bite woundafter bite wound

Nausea, vomiting, Nausea, vomiting, headacheheadache

Tingling and pain on side Tingling and pain on side of body where bite locatedof body where bite located

Furious and paralytic Furious and paralytic formsforms

Cause of death usually Cause of death usually respiratory failure during respiratory failure during paralytic phaseparalytic phase

CDC

Negri bodies – large pink inclusions in cytoplasm of

brain cells – diagnose Rabies

Rabies PreventionRabies Prevention

Avoid close contact with wild Avoid close contact with wild animals exhibiting unusual behavioranimals exhibiting unusual behavior

Consider pre-exposure Consider pre-exposure immunization if work is high-riskimmunization if work is high-risk

Report animal bites immediately: Report animal bites immediately: post-exposure treatment should post-exposure treatment should start within 24 hoursstart within 24 hours

HantavirusHantavirus Hemorrhagic Hemorrhagic

fever with renal fever with renal syndrome (HFRS)syndrome (HFRS)

1993 - Hantavirus 1993 - Hantavirus pulmonary pulmonary syndrome (HPS)syndrome (HPS)

Sin Nombre virusSin Nombre virus Wildlife reservoir Wildlife reservoir

- - Peromyscus Peromyscus maniculatusmaniculatus

CDC

CDC

Sin Nombre Incidence in Sin Nombre Incidence in U.S.U.S.

Sin Nombre Sin Nombre TransmissionTransmission Aerosol of deer mouse Aerosol of deer mouse urineurine

or fecesor feces Contaminated hands Contaminated hands

mucous membranesmucous membranes Contaminated foodContaminated food Bite transmission rareBite transmission rare 30-35% fatality rate30-35% fatality rate

Incubation 9 to 33 Incubation 9 to 33 daysdays

High fever, High fever, malaise, muscle or malaise, muscle or joint aches, joint aches, nausea, vomiting, nausea, vomiting, diarrhea, diarrhea, headaches, headaches, respiratory respiratory distress, coughdistress, cough

Sin Nombre Sin Nombre Clinical Clinical SignsSigns

Early stage of disease

Middle stage of disease

CDC

CDC

Sin Nombre PreventionSin Nombre Prevention

Personal protective equipmentPersonal protective equipment– Gloves, coveralls, bootsGloves, coveralls, boots

Work upwind of animalsWork upwind of animals Work in the sun, if possibleWork in the sun, if possible Wear a respiratorWear a respirator

– Fit-test through Environmental Fit-test through Environmental Health & Risk ManagementHealth & Risk Management

PlaguePlague

Yersinia pestisYersinia pestis Nonmotile, Gram – Nonmotile, Gram –

rodrod ““Black Death”Black Death” 3 forms 3 forms

(mortality):(mortality):– Bubonic Bubonic – Septicemic (5-50%)Septicemic (5-50%)– Pneumonic (20%)Pneumonic (20%) Gangrene of fingers – a

complication of plague

CDC

PlaguePlague > 200 species rodent > 200 species rodent

reservoirs: prairie reservoirs: prairie dogs, rats, marmots, dogs, rats, marmots, hares, chipmunks, hares, chipmunks, ground squirrelsground squirrels

Xenopsylla cheopis Xenopsylla cheopis rat flea – rat flea – regurgitates up to regurgitates up to 20,000 plague 20,000 plague bacteria from bacteria from “blocked” gut“blocked” gut

Prairie Dog

CDC

CDC

Plague in Plague in AnimalsAnimals Pin-point Pin-point

hemorrhage hemorrhage petechiae petechiae

Swollen Swollen lymph nodeslymph nodes

Respiratory Respiratory diseasedisease

Photo credits - CDCPhoto credits - CDC

Plague TransmissionPlague Transmission Bites of infected rodent fleasBites of infected rodent fleas Entry into breaks in skin when Entry into breaks in skin when

handling infected rodents or handling infected rodents or rabbits; wild carnivores that eat rabbits; wild carnivores that eat infected preyinfected prey

Domestic cats highly susceptible Domestic cats highly susceptible – aerosol or handling– aerosol or handling

Dogs and cats can carry rat fleasDogs and cats can carry rat fleas

Plague Plague Clinical Clinical SignsSigns

Illness 2-6 days Illness 2-6 days after infectionafter infection

Swollen lymph Swollen lymph gland, fever, gland, fever, chills, headache, chills, headache, extreme extreme exhaustionexhaustion

Photo credits - CDCPhoto credits - CDC

Plague Clinical SignsPlague Clinical Signs

Cough, bloody Cough, bloody sputum, sputum, increased increased heart rate, heart rate, shock, DICshock, DIC

Gangrene of Gangrene of fingers and fingers and toestoes

1 month after finger amputation for gangrene

CDC

Plague PreventionPlague Prevention

Prevent flea infestationPrevent flea infestation Handle wild rodents with Handle wild rodents with

appropriate PPEappropriate PPE Do not handle wild rodents Do not handle wild rodents

with petechial hemorrhageswith petechial hemorrhages Four Corners area of the US Four Corners area of the US

high incidencehigh incidence

TularemiaTularemia Francisella Francisella

tularensistularensis Aerobic, gram - Aerobic, gram -

coccobacilluscoccobacillus >> 10 organisms 10 organisms 1.4% fatality 1.4% fatality

raterate Arthropods in Arthropods in

life cyclelife cycle Rhipicephalus sanguineus

“Brown dog tick”

CDC

Tularemia Tularemia TransmissionTransmission Bites by infected arthropodsBites by infected arthropods

– TicksTicks Handling infectious tissuesHandling infectious tissues Contaminated food, water, soilContaminated food, water, soil Inhalation of infective aerosolsInhalation of infective aerosols No human to human No human to human

transmissiontransmission

Tularemia Clinical Tularemia Clinical SignsSigns Fever, headache, Fever, headache,

chills, body chills, body aches (low aches (low back), nasal back), nasal discharge, sore discharge, sore throatthroat

Substernal pain, Substernal pain, cough, anorexia, cough, anorexia, weight loss, weight loss, weaknessweakness

CDC

CDC

Tularemia PreventionTularemia Prevention Personal Personal

protective protective equipment when equipment when skinning hares skinning hares or rodentsor rodents

Check for ticks Check for ticks daily & removedaily & remove

Use repellants if Use repellants if possiblepossible

Wild hare – common culprit for disease transmission to hunters from bare-handed field skinning

CDC

West Nile VirusWest Nile Virus Flavivirus Flavivirus 1999 - in US1999 - in US Horses & Horses &

humans humans encephalitisencephalitis

Bird Bird reservoirs: reservoirs: corvidscorvids

Spread by Spread by mosquitoesmosquitoes

Ochlerotatus japonicusCDC

CDC

WNV Clinical SignsWNV Clinical Signs Incubation 3-14 days Incubation 3-14 days 80% infected humans show no 80% infected humans show no

symptomssymptoms 20% mild symptoms: fever, 20% mild symptoms: fever,

headache, body aches, headache, body aches, nausea, rashnausea, rash

1 in 150 infected 1 in 150 infected severe severe disease (e.g., stupor, coma, disease (e.g., stupor, coma, convulsions, paralysis)convulsions, paralysis)

West Nile Virus in the West Nile Virus in the U.S.U.S.

West Nile Virus West Nile Virus PreventionPrevention Long-sleeved shirts and long Long-sleeved shirts and long

pants, when possiblepants, when possible Bug TamerBug Tamer™™ apparel (Shannon apparel (Shannon

Outdoors, Inc)Outdoors, Inc) Mosquito repellant – DEET for skinMosquito repellant – DEET for skin Avoid dusk to dawn hours outsideAvoid dusk to dawn hours outside Avoid areas of standing waterAvoid areas of standing water http://www.cdc.gov/niosh/topics/westnihttp://www.cdc.gov/niosh/topics/westni

le/recout.html le/recout.html

Q FeverQ Fever Coxiella burnettiCoxiella burnetti Sheep, goats, Sheep, goats,

cattlecattle 1 organism can 1 organism can

cause diseasecause disease Placental Placental

tissuestissues Spread by Spread by

– AerosolAerosol– HandsHands

CDC

CDC

Q Fever Clinical SignsQ Fever Clinical Signs 50% infected get ill in 2-3 weeks50% infected get ill in 2-3 weeks 30-50% infected get pneumonia30-50% infected get pneumonia Headache, malaise, muscle Headache, malaise, muscle

aches, confusion, GI signs, aches, confusion, GI signs, weight loss, hepatitisweight loss, hepatitis

1-2% fatality rate1-2% fatality rate Chronic infection Chronic infection endocarditis endocarditis 65% chronic cases end in death65% chronic cases end in death

LCMLCM Lymphocytic Lymphocytic

choriomeningitis choriomeningitis virusvirus

5% 5% Mus musculusMus musculus in in US; wild mice; pet US; wild mice; pet hamstershamsters

Saliva, urine, feces of Saliva, urine, feces of infected rodentsinfected rodents

Mucous membranes, Mucous membranes, broken skin, bitesbroken skin, bites

Hamster

Peromyscus sp.

LCM Clinical SignsLCM Clinical Signs Humans showing illness Humans showing illness signs 8-13 signs 8-13

days post-infectiondays post-infection Early: biphasic fever, malaise, muscle Early: biphasic fever, malaise, muscle

aches, headache, nausea, vomitingaches, headache, nausea, vomiting Later: headache, stiff neck, Later: headache, stiff neck,

confusion, neurological signsconfusion, neurological signs Early pregnancy: abortion or fetal Early pregnancy: abortion or fetal

birth defectsbirth defects Fatality rate < 1%Fatality rate < 1%

The University of Montana-MissoulaOccupational Health and Safety Program Participant Capture

Employee/Animal User

IACUC reviews AUP

Visitor

Annual Training Sessions

“Right to Know”

Risk Assessment by OH&S Physician (questionnaire review, facility assessment, novel project assessment, feedback to IACUC)

RSC

IACUC Coordinator

IBC

Medical surveillance warranted

Procedures/policies to minimize risk

Annual Policy Reminder to Dept.

Chairs & PIs

IACUCNo medical surveillance warranted

Annual Medical Surveillance

IACUCOH&S PhysicianCapture Mechanisms

Flow of participants

Administrative flow

IACUCOH&S PhysicianUM Administration

Flow of participants

Administrative flow

Individual risk assessment reviewed by OH&S Physician

IACUC Coordinator

Medical surveillance not warranted

(E-mail notification)

Medical surveillance warranted

OH&S Physician Further Evaluation

Cleared without Restrictions (E-mail notification)

Annual Medical Surveillance

Serious health problem or direct threat

(Letter notification)

HR Director consultation if employment impacted

Respirator necessary

Fit-test UM EH&RM Dept.

Cleared with Restrictions

(Letter notification)

Occupational Health and Safety Program Participant Medical Review