The National Companion Animal Surveillance System (NCASP) A

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					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
   Learning Objectives
       understand the principles of syndromic
        surveillance
       appreciate why animals may be good
        sentinels for human health
   Performance Objectives
       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)
   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

   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
   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 &       Diagnostic       Specific     Outcome
             Symptoms          Tests        Diagnosis
               (I & W)                      or Agent

                                                              Death
 Exposure     Syndromic
Surveillance Surveillance          Traditional Surveillance


 I & W = Indications & Warnings
    Why are Animals Good Sentinels for
     Emerging & Human Infections?
   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*                                       Occurs naturally
                                                               in
 Category A                                                 companion
                                                            animals**
  Anthrax (Bacillus anthracis)                            Dogs and cats
  Botulism (Clostridium botulinum                         Dogs and cats
 toxin)
  Plague (Yersinia pestis)                                Cats and dogs
  Smallpox (variola major)                                 Not reported
  Tularemia (Francisella tularensis)                      Cats and dogs
  Viral hemorrhagic fevers (filoviruses                    Not reported
 & arenaviruses)
  * - 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

   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
   Currently >560 full service hospitals
       Add 2 new hospitals per week
   Located in 44 states, Mexico, UK
   >3.0 million patient visits yearly
   ~ 10,000 patient visits daily
   ~ 1-2% of U.S. pet population
   Addresses of pets geocoded
   Web addresss: Banfield The Pet Hospital
                      Banfield
                  The Pet Hospital
   Paperless practices
   Standardized medical records
   Computerized records sent nightly to
    central data warehouse
   Subjected to quality control
   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
                          Office Visits
                          Number of Pets
1,500,000
1,000,000
  500,000
        0
            Dogs   Cats
Number of Other Animal Species
             Visiting
Banfield The Pet Hospital in 2005
20,000
18,000                                               Office Visits
16,000
                                                     Number of Pets
14,000
12,000
10,000
 8,000
 6,000
 4,000
 2,000
    0
         Rodent   Guinea   Avian   Rabbit   Ferret    Reptile   Other
                   Pig
               National Flea/Tick Pathogen Surveillance




      Vector ID
                                                   Medical Records
     Pathogen ID




Ticks: Anaplasma sp, Babesia sp, Bartonella sp, Borrelia         Web
lonestari, Erlichia sp, Francisella tularensis, Rickettsia sp   Portal
Fleas: Bartonella sp, Dipylidium caninum, Mycoplasma sp,
Rickettsia sp, Yersinia pestis
Relationship between Canine Tick Activity &
           Human Lyme Disease
                      10                                Tick infestation per 1,000 dog visits                                                                                                2.0
                                                        Human Lyme disease incidence per 100,000 persons
                      9

                      8
                                                                                                                                                                                             1.5
                      7




                                                                                                                                                                                                   Lyme Incidence
    Tick Prevalence




                      6

                      5                                                                                                                                                                      1.0

                      4

                      3
                                                                                                                                                                                             0.5
                      2

                      1

                      0                                                                                                                                                                      0.0
                                                                        Nov-02




                                                                                                                              Nov-03




                                                                                                                                                                                    Nov-04
                           Jan-02




                                                                                 Jan-03




                                                                                                                                       Jan-04
                                                      Jul-02




                                                                                                            Jul-03




                                                                                                                                                                  Jul-04
                                    Mar-02




                                                                                          Mar-03




                                                                                                                                                Mar-04
                                             May-02




                                                                                                   May-03




                                                                                                                                                         May-04
                                                               Sep-02




                                                                                                                     Sep-03




                                                                                                                                                                           Sep-04
                                                                                          Month and Year
    Change in frequency of respiratory
syndrome in pets following hurricane Katrina
                          Frequency of coughing & difficulty breathing
                       Banfield Hospitals in Louisiana (N=5) and Mississippi
                                               (N=3)

                   4
 Percent of Pets




                   3

                   2                                                           Canine
                                                                               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”
      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         Banfield Cats
            n = 15,753             n = 3,065



                                         1129




Fairburn                                         288

Chemical
                                          281
 Plant
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

           0.5
           0.4                                                           >20 miles
 Percent




           0.3                                                           10-20 miles
           0.2                                                           <=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
   World-wide zoonotic
    disease
   Gram negative
    bacteria
   Spirochetes
   Genus Leptospira
   Over 250 serovars
                     Transmission

   Direct (hospital)
       Infected urine
       Bite wounds
       Ingestion
   Indirect (community)
       Contact with stagnant or slow moving
        water contaminated by urine
       Leptospirosis at triathlon in Illinois
               2002                                                2003




                                         2004



    <5%
    5 - 10 %
    > 10 %
    No Data
                                                              Positive >= 1:800
0   750   1,500 Kilometers   Canine Leptospirosis, US, 2002-2004
    Highest Percent Positive
Leptospira Serovar by State 2004
                  Summary
   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

   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