>> The webinar will begin
soon, please standby. The webinar will begin
soon, please standby. Good afternoon. I'm Laura Murrell and I
work in the National Center for Emerging Zoonotic Infectious
Diseases at the Centers for Disease Control
and Prevention. On behalf of CDC's
One Health Office, I'm pleased to welcome you
to the monthly Zoonoses and One Health Updates
Call on February 2, 2022. Although the content of
this webinar is directed to veterinarians,
physician, epidemiologists, and related public health
professionals in federal, state, and local positions,
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Links to resources from each
presentation are available on our website at
CDC.gov/onehealth/ZOHU/ 2022/February.html. Today's presentations
will address one or more of the following
five objectives. Describe two key points
from each presentation. Describe how a multisectoral One
health approach can be applied to the presentation topics. Identify an implication for
animal and human health. Identify a One Health approach
strategy for prevention, detection, or response
to public health threats. And identify two new
resources from CDC partners.
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complete the evaluation at cdc.gov/tceonline
by March 8, 2024. Before we begin today's
presentations, Dr.
Colin Basler, Deputy Director of the OneHealth
office will share some news and updates. >> Thanks, Laura. Hello, everyone. Welcome to the first ZOHU
Call webinar of 2022. We appreciate you
all joining us today. Before our presentations begin, I'd like to share some
updates with you all. You can find links
to these resources in today's ZOHU Call
email newsletter. If you aren't yet subscribed,
please use the link at the top of the main ZOHU Call webpage. Our response to the COVID-19
pandemic continues to evolve. Please check CDC's website
for the latest guidance and resources including
information about keeping people as well as animals safe at home. There is no evidence that animals are playing
a significant role in spreading COVID-19 to people. But we continue to see animals
reported with SARS CoV-2. In the United States,
346 companion and captive animals
have been reported. Including cats, dogs, ferrets,
hyenas, large cats in zoos and sanctuaries, a binturong,
a fishing cat, a coatimundi, otters, and gorillas, as well
as white-tailed deer, and mink.
Seventeen mink farms
have been effected by SARS CoV-2 in the US to date. The latest animal case
numbers are available on the USDA APHIS website. Guidance for pet owner,
mink farmers, veterinarians, and many others are
available on CDC's website. Based on the identification of
SARS CoV-2 in white tailed deer in multiple states, CDC recently
updated our recommendations for hunters and other
individuals who have regular
contact with wildlife. You'll find links in
today's newsletters to several recent publications
including an outbreak of multi drug resistant
Salmonella Heidelberg infections linked to dairy calf
exposure in the United States. And then evaluating a
public acceptability of a potential Lyme disease
vaccine using a population based cross sectional survey
in high incidence areas of the United States. We've also shared links to several recent
announcements including two of recent highly
pathogenic avian influenza, H5N1 infections in wild birds. And the interagency food
safety analytics collaboration or IFSAC 2022-2023
interim strategic plan. Some upcoming events of
interest include the One Health and Development for a World
Under Pressure Symposium in May. And the International
Conference on Emerging and Infectious Diseases or
ICEID which has been rescheduled to August 7-10 in Atlanta.
And finally there's a new
Salmonella outbreak linked to pet bearded dragons. An E.coli outbreak
linked to packaged salads. And two Listeria outbreaks
also linked to packaged salads. Please visit CDC's Healthy
Pets Healthy People website for a selected list of ongoing and past US outbreaks
of zoonotic diseases. We appreciate you sharing
the ZOHU Call website link with your colleagues from
the Human Animal Plant and Environmental Health
Centers and letting them know about the live webinars
video recordings and free continuing education. Our next Call will take
place on March 2, 2022. Please send presenter
and topic suggestions for future presentations as well
as news from your organization to ZOHU Call at CDC.gov. Now, I'll turn the Call
back over to Laura. >> Thank you. You may submit questions at any
time using Zoom's Q&A feature. Please include the
topic or presenters. The Q&A session will follow
the final presentation if time permits. You can also email questions
to today's presenters. We've included their email
addresses on this slide on the ZOHU Call webpage
for today's webinar and in today's email newsletter. Our first presentation,
Factors influencing distribution of Coccidioides immitis
in soil Washington State, 2016 is by Dr.
Nancy Chow. Please begin when you're ready. >> Thanks, Laura
appreciate that. Hi everyone, it's
good to be here. I think I only have 12 minutes. So I'm going to try
to be speedy. But first and foremost, thanks
for taking the time to hear about fungi and fungal diseases. This work that I'm about to talk about started way
back when in 2016. Has really spanned over
the last few years.
And only started to communicate
the findings this past year so excited to share. So first, Coccidio-what? Is often the sentiment we get. People asking how
do I pronounce this? What is this? So, Coccidioides, it's
a fungal pathogen. Its genus has two species, one
Called Coccidioides immitis and the other Coccidioides
posadasii. Now, clinically for disease, these two species
present the same. So disease presentation
is not different. But there is geographic
variability between these two species. In terms of disease,
what we're talking about here is
Coccidioidomycosis, sometimes called Valley fever.
So for those online who
have heard of this before, if you have, it's probably
by the name Valley fever. We know that infections
are primarily caused by environmental exposures. Coccidioides lives
and grows in the soil. And that soil, when
it's disrupted, it can become airborne. So the Coccidioides spores,
sometimes anthocyanidin, that can become aerosolized. And if you breathe that in you
can maybe get an infection, a pulmonary infection. And in terms of clinical
presentation, we see a wide variety. So about 60% of persons
infected will be asymptomatic. So they won't have symptoms.
They it won't know they're
infected most often. And go on to clear the infection
in a matter of weeks or months. The remainder, the other
40%, they are symptomatic and this often presents as a
community acquired pneumonia. So you can have a persistent
cough, difficulty breathing, extreme fatigue, fever. These are the common symptoms
that was hear being reported. At this particular point, we
often like to say that in terms of education and
communication efforts, a lot of work goes here. Because Cocci is
often misdiagnosed as a bacterial infection. And persons are sometimes
put on antibiotics. And really, it's
a fungal infection that needs antifungals. So that's something that we
really try to communicate out and really respond to with
robust education efforts. And then lastly, it is rare. But some go on, about 1%, to develop a disseminated
infection. And this is if the Coccidioides
spreads from the lungs, it can go to the bones,
maybe the meninges and this is often
life-threatening. So mapping Valley fever. Understanding where it
is in the environment. Understanding where
infections are having. So having surveillance. This is a lot of what
we do in public health.
So on the left, you're
looking at slides, thinking of its typical
endemicity. Where is Cocci in
the environment. We know that it's in parts
of northern and central and south America,
in the United States, primarily in the
southwestern part. We've seen it start
to go up further. That we've realized
that it's further. So as far up as northern Utah. That happened in the early 2000s
where there was an outbreak of Valley fever among workers
in an archaeological dig site. We went back, we sampled and
Cocci was identified there.
The most recent place,
so about 15 years later, it was identified
in Washington State. I'm going to tell you
a lot more about that. And then on the right,
you're looking at average incidence rates. And you can see that the
majority of the burden, or you know the most burdensome
places is Southern California and Arizona. So to get these maps, there's a
lot of data that feeds into it. But recently, we've
done a lot of modeling. A lot of people. And by we, I mean the
Valley fever community, in terms of predictive modeling. And really trying to understand where is the endemic
area of Cocci. And what is the geographic
distribution of Cocci in the United States. And what's going to be the
impact of climate change, in terms of thinking of
intensified dust storms or other sort of
extreme weather events.
Or mean annual temperature
rises when thinking 100 years out from now, what is
it going to look like. And we've made a lot of
progress in this area. But thinking about where
we have left to go. This gets to the what is
the public health gap. And how are we addressing
that gap. So in terms of the gap,
what we've noticed is that there's limited
environmental data. We're talking about
deep, comprehensive data at local sites that can be
used to inform the parameters of these types of models. And because of the
limitations and the lack, it can sometimes lead
to overfit models and inaccurate conclusions. So for this work, what
really our main objective was to pick a site and really
try to collect some deep, comprehensive environmental
data.
Including the metadata. Really look at some
particular questions in mind. And have that data be able
to inform the types of models that we want to do more of. So methods. What did we do? We took a study site, and
we focused on Washington, particularly in ATV parks. So all-terrain vehicle. I've never ridden one of these. So I'm not going to be
pretend to be familiar.
But this is an ATV park
where we knew Coccidioides was documented. The story behind this is a
15-year-old male case riding their ATV fell off,
injured their leg. A few weeks later Coccidioides
is growing from the leg wound. And because he knew
exactly where he fell off, officials could go back
to sample that area and Coccidioides was identified. And so, what we wanted to do
by taking this study site, we wanted to think
about certain variables. And we wanted to see whether
or not there was a correlation between Cocci colonization
and certain things like being on the trail. Being near a wash. So that would be a proxy for
some sort of water activity. There's a wash in this area. We wanted to look
at rodent activity. There is a big theory in
the Valley fever community about whether or not Cocci
requires a mammalian host to propagate and really
spreading the environment. So we wanted to look
at that if we could. We wanted to look at vegetation. And very importantly soil
composition so thinking that chemical and
microbial signatures.
And then to do that, how
do we actually capture all these variables? How do we get enough
sample size? We had to think of
our sampling design. And I could go on
a lot about this. But we thought of
every different shape. You know, circles,
ovals, squares. We thought of grids. We learned so much
about transects and how you can sample along
the gradient of interest. We read a lot of
interesting studies. But this what we sort of
decided on, taking all of kind of the lit reviews and talking
to experts in the field. So we thought of
a radial design, where the center
would be where we knew that ATV accident happened. And we knew it to
be Cocci positive. And it started to
radiate outwards. For the first time ten meters
it would radiate out each meter. And then after in
increments of ten meters until you got out to 100 meters. In this design we
had nine transects. And so we would sample through
that transects every ten meters. So where you see a white
square, that's where we sampled.
We took a one-square
meter plot, and we sampled to the left and to the right. For each square meter
plot we dug three holes, about 10 to 15 centimeters
below the surface. Took that soil and then
we composited all three of those digs into one sample. And then whenever we
hit a rodent hole, that lied within that
one-square meter plot, we would sample that
rodent hole. So that was an additional
sample. And this, you know, this
goes without saying. This was a lot of
work, a lot of effort from the Washington
State Department of health, CDC colleagues. We collected 281 samples. You can see us here in
our intense PPE equipment. Trying to avoid infection. Trying to get out there and measure the different
angles to get the transects. For the spatulas that we
used, we would rinse bleach, rinse each time we dug.
We did pH measurements,
altitude measurements. We were recording
all these things. So a lot of work went into this. A lot of kudos to
a lot of people. And then, oh yeah. So the fun really began when
we got the samples back to CDC and it was processing time. So first we did the
molecular route. So we extracted DNA
from all samples. We developed a single tube
nested qPCR assay to really sort of increase the sensitivity
for environmental detection. And that way we could say, okay,
this soil sample is positive. This soil sample is negative. The next thing we did in
collaboration with USGS, US Geological Survey is
we did leaching soil. And this was to look
at chemical analyses. And leaching really what it was that we did was we
took the soil, added it to distilled
water, shake that up and then you let the soil
and the sediment settle down. That water that remains,
that's your leaching now. And you can go on to do
all sorts of analyses.
Ion, chromatography,
plasma mass spectrometry. We looked at organic carbon. All of these things to look
at ions, trace elements. And all of that was in
collaboration with USGS. SO, what did we find? What were the results? First, we found that there
was a wide distribution of Coccidioides immitis. That was the species
here at this site. So everything that you see
in red was qPCR positive. And you might notice
the addition of circles. Those were actually, when we
got to that square meter plot, if there was a rodent
hold in the circle, then that's what the
circle represents.
We notice that the highest
positivity rates were about you know within 30
meters from the center with the highest concentration
in the gully/wash area. And then I think this is kind
of getting cut off a little bit. But what we did was we took
the samples that were positive for Cocci by qPCR
and we cultured them. And we tried to culture
them for Cocci. That can be really hard. So not all samples got an islet. But for some we did. And we were able to
perform genome sequencing.
And we look to see whether or not they were
phylogenetically similar, whether genetically,
in terms of diversity, whether they were
similar to clinical and environmental islets
elsewhere in Washington. And they were. You can see that they kind
of have their own clade here. And they're very genetically,
distinct from islets in the environment and
clinically from California and the other sort of
clusters that you're seeing. And so this kind of spoke the
fact that this introduction of Cocci into Washington,
it's not recent. Cocci had been there
for a while. That's what this supports.
And then in terms of the
factors that we were interested in in terms of the transect,
distance, pH, rodent vegetation, this is kind of what we saw. Again, the closer you were to
the center, the more likely that sample was to be Cocci
positive or colonized by Cocci. We saw an inverse
correlation with vegetation. So less vegetation, more
likely Cocci positive. And this really complimented
with the ATV track. Where that correlated
with Cocci positivity.
And that kind of makes sense. Because you would imagine
that being along the ATV track and that's what we saw,
we saw less vegetation. And we did want to highlight,
this was a little bit of a surprise to
us because again, in the community
there's this be theory about rodent activity,
rodents being needed. But we didn't see a correlation. Now, this was one data point. You know, so just
something to consider. But this was a bit
of a surprise to us. In terms of chemical signatures. We looked at over
60 trace elements. Lots of ions, dissolved
organic carbon. But just highlighting
a few here. What we saw is that elevated
levels of boron, calcium, magnesium, sodium, and
silicon they were correlated with Cocci colonization. Probably the least surprising
was sodium, just because we know that Cocci likes high
salinity environments. And we actually used salt while
trying to culture it in the lab. So that was maybe
the least surprising. And then the most
surprising was silicon. That had not been
seen, really before when you look in the literature.
And then in terms of
microbial differences. I forgot to mention that
when we extracted that DNA and we were doing qPCRs. We also used that genomic DNA to do metagenomic specifically
amplicon sequencing, looking at ITS. And what we found were
significant differences in terms of the microbial profile. And I guess I'll just note
that for certain genera like Curvularia that's known
to associate with plant and plant material, that
was inversely correlated with Cocci positivity. And that kind of again
made sense what we saw with the inverse correlation with vegetation and
the ATV track. So it's nice when
things make sense. And then you know just
to get into limitations. I guess, the beauty
of this study in some ways is its limitation. You know, we picked one site and
we really wanted to do it well. And really collected a
lot of data from that. But at the end of the
day, it's one site and so when thinking back to that
map of where Cocci is fund and thinking of other
geographic areas where this type of work could be done,
that would be helpful.
This is only one
species just C. immitis. Would it have been
different if we'd been looking at a C. posadasii site? Maybe. And then there's
no temporal data here. So we can't think about the
effects of precipitation or temperature changes
throughout the course of the year and how that
affected colonization. And then you know, I won't go
into all of the conclusions, but just to say that given
the objective of this work, this is what we're trying to do
now where we're taking this data and we're really talking to a
lot of subject matter experts who do predictive models, who
can build these maps and try to bring in this data to help
inform some of those parameters. So that's what we're
actively doing right now. And then I think the next
slide is acknowledgments. Just giving big thanks to
Washington State Department of Health, especially
Dave Kangiser. He was definitely the
implementer in terms of the actual sample
collection and figuring out how to do these transects. Suzette Morman and
Geoff Plumlee at USGS.
And then many folks at CDC. Special thanks to Lalitha
Gade, and Ana Litvintseva. And then I think the last
slide is just what we often say to say thank you. And you can go to the
last slide if it's there. But it's just saying
think fungus, save lives. And then I will end. I think Q&A is afterwards. >> Thank you, Dr. Chow. Our next presentation. Melioidosis a potential zoonotic
disease is by Dr. William Bower. Please begin when you're ready.
>> Yes, thank you. And I just want to
thank everyone for joining us this afternoon. And we'll go over Melioidosis as it may be a potential
zoonotic disease. So just a quick overview. So I will go over the
Melioidosis background since it's not normally
known as a zoonotic disease. I'll just give a little
background to people who may not be familiar with it. Then I will go over the
case that we investigated that may suggest that it
has a zoonotic component. And actually I have Q&A
here, but as has been said, we will do Q&A after all
of the presentations. So Melioidosis is
caused by the organism, Bulkholderia pseudomallei. And it is a gram-negative
bacillus. And it is in the environment. It's usually found
in water and soil. And we talk about it as an
opportunistic infection. Because most people who get it
have some underlying condition. And it can last in host
cells for a period of time such that you can have
a subclinical infection. And then many years
later it can recur and some people may have heard of it called a Vietnam
time bomb.
Where US soldiers had
been in Southeast Asia where it is endemic
and would come back and years later develop
Melioidosis. And it does cause disease
in both human and animals. But there's not a lot of
evidence of transmission from animals to humans. And just one other
significant thing about it is that it is considered
a select agent because it does cause
severe disease. The inoculum for causing
disease is fairly low and it had been developed
as a bioweapon by some countries before
the ban on development of bioweapons was
instituted in the mid-1970s. So Melioidosis also known
as Whitmore's disease. It can have several
clinical presentations and it also given the
name the great mimicker because it can present as
several different forms. It oftentimes develops
as a cutaneous lesion. Pneumonia. It's often confused with TB. You can present with just
bacteremia and sepsis. It tends to cause
organ abscesses or micro abscesses in organs.
And there's a neurological
component to specific strains of Bulkholderia pseudomallei
have a propensity to cross the blood-brain barrier and cause [inaudible]
encephalitis. Risk factors as you
can see there. A lot of the cases are in people
who have pre-existing conditions such as diabetes,
excessive alcohol use, chronic lung disease,
liver, renal disease. And also other things that cause
immunosuppressing condition. However, it is not
necessarily related to HIV. But then abut 20-30% of people who are acutely infected have
none of these risk factors. So transmission occurs basically on how the organism
enters the body. If it's in water and soil.
It can come through the
skin, through wounds, or just by abrasions
in the skin. It can be ingested. And then one of the more
concerning ways of getting it is through inhalation where it
causes a severe pneumonia. And this is often
associated with weather events that the organism is blown
by driving winds or waters that are aerosolized
and inhaled. There is very limited history
of human to human transmission. Like just a handful
of case reports.
And it's not thought to
be infected born disease. But it is an occupational
hazard in people who work in micro labs. It is known to be a
lab-acquired infection. Just because as I previously
said, it has a low inoculum to cause disease and it can be
aerosolized off of a plate just by the normal handling of a plate growing the
organism in the lab.
And just a clinical form, we don't necessarily
need to go over this. I think I covered
this previously that acute pneumonia is one of
the most common presentations within the localized skin
infections it can disseminate and cause a fulminant
septicemia. And then I did talk a little
bit about a particular strain that does have a propensity
to cause neurological disease. So here is just sort of a map of where we believe
Melioidosis is endemic.
It is sort of know as a tropical/subtropical
disease particularly in Southeast Asia. You can see that Northern
Australia and Southeast Asia and South Asia/India is
particularly hot spots for Melioidosis. And then in South
America and Brazil. And as you'll note that in
the US it is not thought that it is endemic in the
continental United States. However, there have been
some psora islets found in Puerto Rico. So, now I'm going to talk about a potential zoonotic
case that we investigated. So the case was a
56-year-old Maryland resident who had a history of
diabetes, rheumatoid arthritis and had a history of
using tobacco products. So she did definitely
have some risk factors for acquiring Melioidosis. So she had a two-day history
of respiratory symptoms. Went to a health care facility. Was diagnosed with
community acquired pneumonia and discharged. And returned being sicker. And was hospitalized,
and treated, and eventually recovered. And as part of her workup,
they drew blood cultures and the CDC was notified by the
Maryland Department of Health that there was a presumptive
Bulkholderius pseudomallei isolet from the blood.
And our Zoonotic and Select
Agent Laboratory confirmed the identification of
Bulkholderius psudomallei. And the whole genome sequencing
suggested that it originated from Southeast Asia, which
is you know often what we see in people who are infected
in the United States when we do the whole genome
sequencing, it sort of points to a region in the world where
that organism likely was from. And then you do an
investigation and talk to them and then they say, oh yeah. I was in that area of the world at some period of
time in the past. So, interestingly when
the Maryland Department of Health interviewed
the patient, she had no international
travel history. Basically you can see there
that she had been in Florida, South Carolina, Pennsylvania,
Massachusetts. And that was the extent of
her travel from Maryland. She had several pets that
she had had over the years.
But none of those were current. She worked as a beautician
but was disabled because of her rheumatoid
arthritis. And you can see that people
in her household had jobs as landscapers and fisherman. So the goal of our
investigation was you know, find the source of
this infection. So, we knew that she didn't
have any travel history. And it looked like this
organism had originated from Southeast Asia.
So we wanted to collect items
in her home that could be tested to see if it had
been contaminated with Bulkholderius psudomallei. It's often thought
that that was the case, that some cases could
be occurring in the United States
were exposed to a product that had been imported from
an endemic country, but we had yet to definitively show that. So we worked with the
Maryland Department of Health to guide them on home sampling.
And during the investigation, it turned out that she
had two fish tanks. And we said, yes please
collect some samples from those fish tanks. And those samples were
sent to our Zoonotic and Select Agent
Laboratory for testing. So, we got 23 samples
and we put them in special incubation enrichment
broth to enhance the recovery of Bulkholderius
psudomallei, was there. You can see the samples
there that we collected. And you know there
were two water samples. And some of those 11
environmental samples were from the fish tank. But at the time we didn't
know so we collected samples from vaping products
and oils that look like they may have
originated from Southeast Asia. And also some soil samples
from around the property. And we did find a culture and
DNA positive results from water from the fish tank in two swabs
from one of the fish tanks. And this is just a deprogram
to show that the swabs and the water from the
fish tank and the isolet from the patient
were an exact match.
Suggesting strongly
that she was infected from interaction
with the aquarium. So after we got this piece
of information we went back and talked to the
patient some more and fund out that she had purchased two
fancy guppies in July 2019. They died four weeks
prior to onset. And she had cleaned the tank out with bare hands
when the fish died. And no one else in that house
really had contact with this. And it's not on the
slide, but she did note that she had two fish tanks. Fish tank one and two. Fish tank one had
no positive samples. But she did say that fish tank
number two tended to be cloudy. and require more cleaning
than tank one prior to the death of the guppies. And there's a timeline there
that you can sort of see where they go the
fish, the fish died, she cleaned it out
and became sick. So we worked with Maryland
Department of Health and identified a
national pet retailer where she had purchased
the guppies.
And the national pet retailer where she had purchased
the guppies. And the national retailer
was very cooperative in investigation and allowed us
to take samples from aquariums and talk to staff members. And 8 of 12 staff
members who had high risk. Essentially, they were
the ones who worked with the fish gave
us serum samples. And all the samples taken from
the aquariums were negative. And all the serum samples
from the employees indicated that they had not been exposed
to Bulkholderius psudomallei. And since we don't
believe that it's endemic in the United States, that
you would not expect someone to have a serological response
to Bulkholderius psudomallei. So, in talking with
the pet store, we fund where they got
the fish and the plants that were in these aquariums. And they said about 99% of their
guppies came from one supplier in Los Angeles County. And 100% of the plants
came from another supplier in Los Angeles County. And these suppliers all source
their fish from Southeast Asia. Which would match where the
islet in the patient came from. Okay. So then we worked with
Los Angeles County Department of Health. And actually had an epi-aid to
investigate the two vendors.
So as I said we found out that
supplier A supplied like 99% of the guppies and other
species to this national chain. And supplier B majority
of the aquatic plants. So we took 214 samples that
included transport water from 31 different farms
in Southeast Asia. The aquarium water, swabs
from transport water trays and from the facility drains and transport media
including plant material. And we also took fish
carcasses that arrived dead as they were brought into
the vendor in Los Angeles. So we did find that
the transport water from one location in Sri
Lanka was positive by PCR for Bulkholderius psudomallei. That was the only
thing that we had from that one farm was transport
water because there were no fish that arrived dead
from that farm. So we didn't have the ability
to do a work on the fish. And there were no swabs taken
from any of the transport trays or anything that came
from that particular farm.
But we did have PCR
evidence that it was positive for Bulkholderius psudomallei. However, despite our
using of enrichment broth and all the techniques
that our lab has to try to grow Bulkholderius
psudomallei, we were not able to grow it from there. So, just in summary. From the case investigation,
this is the first documentation of transmission of
Bulkholderius psudomallei from freshwater home
aquarium to human. There had been prior reports
though that have shown that it was in aquarium
transport water. And we also know that
there have been infections in marine animals. And it has been identified
in tropical fish, previously. The good news is that for the
local store investigation, it did not appear that
it had colonized any of the tanks in the pet store. And there was no
evidence of transmission to the staff in the store.
And from the vendor
investigation, it did appear that ornamental fish supply
chain could be a possible mode of dissemination of
Bulkholderius psudomallei into the United States. And that you know, we don't
know if it was the fish that brought it in or if
it was the transport water. But you know that's
why we're saying that it could potentially
be a zoonotic infection. And then, in the spirit of One
Health, this just importance of you know the epi in the lab. And looking at humans, and
animals, and the environment to piece together this
potential transmission. I thought there was
another slide so I could say acknowledgement. But I wanted to very much
thank the Maryland Department of Health for their
assistance on the ground with the investigation.
And the Los Angeles County
Department of Health. I wanted to thank the
Acute Communicable Disease Environmental Health and
Public Health Laboratory. And the Veterinary
Public Health units. Thank you. That ends the presentation. >> Thank you, Dr. Bower. Our final presentation,
Chicken Chats: Focus Groups with Flocks Owners is
by Lauren Gollarza. Please being when you're ready. >> Thanks, Laura. Hi, everyone. Today we'll be discussing
some focus groups conducted with backyard flock owners. So first I'd like to tell
you a little more background about why we did focus
groups with this population. So every year since the early
2000's we've seen multistate Salmonella outbreaks linked to
contact with backyard poultry. So over the years, these
numbers of illnesses and outbreaks have
been increasing. With the last few years
having around 1,000 cases. And notably in 2020,
almost 2,000 illnesses. So these outbreaks really
require One Health collaboration efforts in order
to make an impact. So we work to include animal
health, public health, sellers at all different levels
of the backyard poultry industry as well as consumers
when we're trying to share outbreak information
across these groups as well as prevention efforts.
So everyone can really work
together both during the acute outbreak phase as well as prevention phases
to make an impact. So you know, in response to
this public health problem, CDC along with partners over
the years have developed a suite of communication
materials for flock owners. And up until recently, those
materials have never been able to be formally tested
to assess appeal and whether they meet
flock owner's needs. When we look at literature, there's also relatively
limited qualitative data on backyard poultry owners.
And then when we look
at our outbreak data, which is you know limited
to people who are ill and becoming part
of the outbreak, but as well as looking
at social media. Some of the images
there on the right. We do see that people tend
to engage in behaviors that could lead to infection. And for anyone who may not know, backyard poultry can carry
Salmonella while they look healthy and clean. So you might end up with some
cross contamination occurring depending on how people
are interacting with them. So over the past year or
so, we were able to work with a contract company to actually conduct
some focus groups with backyard flock owners
to look at their knowledge, attitudes, and behaviors around safe handling
of backyard poultry.
As well as actually
getting some feedback and testing our existing
communication materials. We were not able to test all of
them, but we did select a few of them to show to participants. And we were able to actually
implement ten 90-minute virtual focus groups with about 56
participants with around four to six people per group. So I did want to note that
I'm giving a very high level overview of what
we did and results. And also wanted to note that focus groups are a
relatively small sample size. And not necessarily
generalizable to the entire population. But they do provide
really valuable feedback. So we used an online survey
and recruited via websites, social media, and some
partner listservs. And then we decided to segment
our groups by risk level, flock size, and experience. As we had hypothesized
there could be differences in handling practices,
reasons for ownership, or other conversational
differences.
But ultimately, we did not find
significant differences among participants with
their responses. In response to the survey,
we did have a wide range of people owning
backyard poultry. We had you know some as few
as ownership for five months. Some having owned backyard
poultry for more than 25 years. Some people had very
small flocks. Others had you know,
over 200 birds. Among these participants the
primary reasons or benefits for why they owned
backyard poultry that were sited most often
was fresh, better tasting, responsibly sourced eggs. Educational purposes,
such as teaching children. As well as companionship. And their interactions
with poultry, they are noted as very pet like. Most of them had names. Most people were very
physically affectionate, as were their children.
And very few parents noted
limiting any interactions with poultry. Most people kept them outdoors. But some did bring them indoors when the poultry were very
young, or during bad weather. Very few downsides were noted,
but when there were downsides, it was mostly bird
lost due to predation. Sometimes some cost
barriers, or other burdens such as finding someone to take
care of poultry in the event that they couldn't
or were out of town. When we looked at where people
were looking for information, we had asked if they knew
about health topics related to backyard poultry and
very few people reported that they sought information
on human health topics. They were mostly
looking for information about caring for their birds. There was a heavy reliance
on online resources. So things like owner discussion
groups on social media. They did note a healthy
degree of skepticism, and some have even started their
own online discussion groups or seek out groups where
there is more expert advice. Such as veterinarians
being the one to answer question
in those groups.
Although it was not used
by many, the majority of participants did trust
local and state agriculture and extension programs
as a resource for backyard poultry materials. Again, most people
trusted veterinarians as a reliable resource, but very
few noted that they had access to a veterinarian who
could treat poultry. And then while most
did not know CDC of health departments
have backyard resources, they were still a
trustworthy resource for health information overall. When we looked at knowledge
and awareness about Salmonella, the most frequently cited health
risk associated with poultry that people could
recall was Salmonella. And most were aware of the
importance of handwashing and risks associated
with kissing poultry. But most had more awareness about foodborne Salmonella
infections and not as much about how the transmission
dynamics work with poultry and people.
And then most people tended
to believe that their flocks and eggs were healthier
and viewed commercial farms and larger businesses as the you
know potential greater threat or source for infection as
it related to Salmonella. So in general risk perceptions
in Salmonella infection, participants overwhelmingly
did not consider themselves or their children at risk
for infection for a variant of reasons, and some of those
are listed here on the slide. Most of them, not really
know either themselves or someone else who had been
personally affected by this. They didn't really think that
they posed any greater risk than any other animal. Some had believed that
exposure might build immunity. And a lot of them did not
find information on risks or outbreaks super
relevant or compelling. However, most people did
engage in certain behaviors that could help to
prevent infection.
Such as handwashing,
keeping coops clean, avoiding overcrowding,
and cleaning eggs. So looking at some of the
materials we were able to show participants, some of the well-received materials
are there on the right. They were seen as positive,
supportive, and playful. They were easy to understand. And there was overall
general agreement with the messaging
and the content. Except there was less agreement
around some of the messaging for small children
and people over 65 when it related to
handling birds.
People also especially
really liked photos of baby poultry more
so than the animations. Another well-received material
was actually our advice section on the CDC website for
an outbreak notice. It was seen as informative
and helpful. Especially the Salmonella
symptom information for people. And again, there was
overall agreement with some of the messages, but
there was less agreement and a little bit more
confusion around the advice to not wash eggs in water. No one really was willing to
cook their eggs until firm. And no one really limited
physical interactions with birds. Some of the less well received
materials were the materials that included outbreak
statistics or data. Those were seen as a bit
scary or fear mongering. Some thought the outbreak
information was a little bit more harmful than helpful. And some people actually
wanted more information on who exactly was
affected by these outbreaks. And most preferred
prevention methods as a more supportive
or positive tone. Throughout the focus
groups participant were able to ask questions and some
of the remaining questions that they had at the end,
even after having seen some of the preventative materials
really seemed to center around how Salmonella happens
in birds in the first place.
Is there anything that can be
done to prevent or treat it. And there was still some
lingering questions around, you know, how many illnesses and outbreaks are actually
attributable to poultry, or was it just Salmonella
overall. So some of the things that
we've learned and some of the next steps that
we're going to take, here at CDC are really
thinking more about a holistic strategic
approach to our communications. Really trying to be
more audience-centric, message driven and
digital first. Since most people are
looking at things online. Try to position ourselves as
a partner to flock owners.
Provide that positive
reinforcement, consider the harm
reduction perspective. Also, add some more
poultry information online about how you can reduce
Salmonella in poultry as well as enhancing some of our
existing partnerships and creating new ones. So one thing that the contract
company provided us was this really helpful table that I
thought others might appreciate to really think about
your planning when you're doing material
and message development. And really trying to answer
these questions will have the biggest impact with
your materials. That has our team's
contact information if you have any questions
or want to reach out about partnering.
But with that, back to
the host of the call. >> Thank you,. Thanks to all of
today's speakers for their informative
presentations. Links to resources for each
presentation are available on our website at
CDC.gov/onehealth/ZOHU/ 2022/February/html. We do have time for maybe
just one or two questions. We're approaching
the top of the hour. So, I'll start with a
question for Dr. Chow. Do you have plans and
funding to sample other sites. >> Thanks. Right now we don't
have current plans. >> Dr. Chow, you're
a little bit quiet. >> Oh, thanks. Got my microphone
now, can you hear me? Yes.
Right now we don't
have current plans. But what we'd like to do
is work with other partners in state departments,
academic groups to accomplish things like that. And so our group, the mycotic
disease branch at CDC is trying to actively think through how
we can promote those types of activities. But we ourselves
don't have plans to go and do sampling quite like
that in the next year. Thanks. >> Thank you. And for Dr. Bower. Can you answer this question? Can infected people or
animals contaminate soil with Bulkholderius
spreading it to new areas? >> Yes. That is actually,
it is endemic in the soil in several countries
in the world. And mostly in the middle
latitudes in Southeast Asia and Northern Australia. It is something that
we are concerned with because the soil conditions
and the climate are appropriate in the United States for Bulkholderia pseudomallei
to live in the soil.
We just have not found
it in the soil yet here. However, there have been cases
of patients in the United States that have never traveled
to endemic country, and when you look
at their islet, it matches other North
American strains. Meaning that they are from
Mexico or the Caribbean, since we haven't actually
found one in the US. So that makes us think that
it may actually be in the soil in the US, we just
haven't found it yet. But yes, potentially it
could become established in the soil and water in the US. >> Thank you. And I apologize, we're at the
top of the hour, so we can't get to any other questions. But if you do have
other questions for today's presenters, we've
included their email addresses on this slide, on the ZOHU Call
webpage for today's webinar and into today's
email newsletter. A video of today's webinar
will be posted within 30 days. So please join us for the
next ZOHU Call on March 2. Thank you Call for
your participation and this ends today's webinar.
