December 2001
Maryland's Emergency Preparedness Plan
Tracy S. DuVernoy, DVM, MPH
Maryland Department of Health and Mental Hygiene
Center for Veterinary Public Health
Presented to the DC Academy on December 6, 2001
Why the concern to develop a preparedness plan?
- CDC lists various agents as having greatest implication as BT agent (Table 1)
- Biological Diseases
- Chemical agents
- We've all learned from the anthrax experience
Some goals of a preparedness plan:
- Provide timely information to veterinarians
- Obtain appropriate information from veterinarians
- Early detection of unusual diseases
- Institute timely treatment to minimize losses
- Production
- Financial
- Animal and Human life
Why veterinarians are vital to this plan:
- Many suspected bioterrorism agents are zoonotic diseases
- Veterinarians are better educated than physicians regarding recognition of zoonotic diseases
- Veterinarians may be the first responders and be the first to report something unusual
- Continued vigilance is critical
Suspect an infectious agent as a BT threat when:
- Epidemiological clues suggestive of BT
- Suspected or confirmed zoonotic disease not endemic/enzootic in MD
- Sudden increase of illness within healthy animals
- Uncommon time of year for natural infection
- Uncommon species infected
- Disease resistant to conventional treatment
- Disease clustering
Selected diseases of concern:
- Anthrax
- Bacteria: Bacillus anthracis
- Gram-positive rod, spore-forming
- Non-motile
- Produces three toxins
- Can survive in soil for a long time
- Occurs worldwide
- African, South American, Central Asia
- In US: SD, NE, AR, TX, LA, CA and MS
- Species susceptibility
- Ruminants especially susceptible to natural infection
- Ratites also very susceptible
- Carnivores and swine less susceptible
- Typically animals are infected via ingestion
- Ruminants suffer peracute death
- Rapid death
- Profuse bleeding from all orifices
- Lack of rigor mortis
- Bloating
- Horses suffer acute death
- Listlessness, fever, anorexia
- Ventral subQ edema in horses
- Carnivores suffer from chronic form
- Pharyngeal edema due to localized infection in oropharynx
- May also see GI form
- Incubation time: 3-7 days
- Current bioterrorism agent
- Service dogs at risk
- Other pets in home/work setting
- Expect to see oropharyngeal/inhalational dz.
- Diagnosis in animals
- Culture
- Blood, pharyngeal swab or from lesion
- Organism may be seen in blood
- Methylene blue stain of fixed slide
- Treatment
- Antibiotics - enrofloxacin
- Vaccine available for cattle
- Animal disease
- In US
- Various areas enzootic
- Current outbreak in California
- In MD
- Last known case occurred in cattle in 1969
- REPORTABLE DISEASE
- Disease in humans
- Intestinal
- Ingestion of contaminated meat
- Cutaneous (malignant carbuncle)
- Small skin lesion progressing to black eschar
- Inhalational (pulmonary; Woolsorters' disease)
- Flu-like symptoms
- Generally no rhinitis with anthrax
- Dry cough with anthrax
- Rapidly fatal
- In US
- Prior to October 2001
- last case of inhalational anthrax occurred in 1976
- cutaneous case occurred in early 2001 (TX)
- Currently, 23 individuals infected with either inhalational or cutaneous form (18 confirmed, 5 suspect)
- 5 fatalities - all inhalational
- In MD
- 3 confirmed cases - inhalational
- 2 fatalities in Brentwood Postal workers
- Tularemia
- Bacteria: Francisella tularensis
- 2 different strains
- var tularensis (very pathogenic)
- var palaeartica
- Gram negative coccobacillus
- Occurs worldwide and throughout the United States
- Most cases from south-central and western states
- Mode of transmission
- Ingestion: food or water
- Direct contact with infected tissues
- Insects - deer fly and ticks
- Inhalation
- Considered a "classic zoonotic" disease
- Over 200 animal hosts
- Natural host
- Small mammals such as rabbits, voles, mice
- Incubation time
- Species susceptibility
- Rodents and lagomorphs - most
- Herbivores and birds - low mortality
- Carnivores - least
- Higher rate of disease in neonates and stressed animals
- Animals infected via
- Arthropod
- Direct contact
- Ingestion
- Inhalation
- Bioterrorism agent
- Via aerosol release
- Inhalational (Pneumonic) disease
- Clinical signs
- Causes bacterial septicemia
- Rodents and lagomorphs
- Usually found dead or moribund
- Other species
- Lethargy, pyrexia, lymphadenopathy, hepatosplenomegaly, icterus
- Diagnosis
- Bacterial isolation
- Serology
- Fluorescent antibody
- Treatment
- Antibiotics
- Streptomycin is drug of choice
- Animal disease
- In US
- 2000: Phoenix zoo - primates
- 2001: Colorado - rabbits
- In Maryland
- Feline disease in June 2001
- Recent outbreak in Assateague (presumptive) - rabbits
- REPORTABLE DISEASE
- Human disease
- 6 Different forms
- Ulceroglandular
- Glandular
- Typhoidal
- Oculoglandular
- Oropharyngeal
- Pneumonic
- Symptoms dependent on mode of transmission
- In the US
- Generally about 100 to 200 human cases annually
- 2000:
- Martha's Vineyard outbreak (15 cases; 1 fatality)
- Oklahoma outbreak (11 cases; 1 fatality)
- 2001:
- In Maryland
- Cases in 1989 (2), 1991 (2), 1998, 2001
- Probable case in 1994
- No fatalities
- No longer nationally reportable!
- Plague
- Bacteria: Yersinia pestis
- Gram negative coccobacillus
- Non-spore forming
- Non-motile
- Bipolar staining
- Occurs worldwide
- Except Australia
- No plague in Europe since WW II
- US: NM, AZ, CO, and UT
- Species susceptibility
- Small rodents (prairie dogs), rabbits, cats, humans
- Dogs susceptible but rarely develop clinical illness
- Reservoir
- Incubation time
- Clinical signs
- Cats:
- Bubonic
- Lymphadenopathy (head and neck)
- Fever
- Can progress to septicemic and pneumonic
- Pneumonic
- Potentially infectious to humans
- Bioterrorism agent
- Diagnosis
- Serology
- PCR
- Culture
- Radiography to assess if pneumonic form
- Treatment
- Treat ectoparasites
- Isolate!
- Antibiotics
- Animal disease
- In US
- Epizootic activity within prairie dog populations
- In MT and CO in 2000
- In CO and TX in 2001
- In 2001
- Chipmunk in CA
- Cats in NM and NV
- In MD
- REPORTABLE DISEASE
- Disease in humans
- Bubonic
- Septicemic
- Pneumonic - shorter incubation period
- Vaccine available
- Human disease
- Between 1977 - 1994, 15 human cases associated with feline exposure
- In US
- 9 cases in 1999 (CO, NM)
- 2 cases in 2000 (1 case in NM)
- 6 cases in 2001 (1 case each in UT, WY, NM)
- In MD
- REPORTABLE HUMAN DISEASE to WHO as well
- What to do if a BT agent is suspected:
- Collect appropriate specimens for diagnosis
- Notify laboratory of specimen submission
- Notify appropriate authorities
- Animal health and Animal public health (Figure 1)
- Human public health
- Law enforcement
- Local authorities
- FBI (see next page)
- Prevention:
- Use universal precautions when dealing with unknown animals or those exhibiting unusual signs
- Animal to human transmission can occur
- Pneumonic plague
- Tularemia
- Anthrax (via contaminated environment)
- Maryland's Plan
- Multi-agency Plan
- Database of all veterinarians
- Include FAX number and email
- Veterinarian's Hotline (24/7)
- Report suspicious disease occurrences to appropriate authorities!
- Bioterrorism Agents: Implications for Animals handbook
- Conclusion
- Continued vigilance by practitioners remains critical!
- When you hear hoof beats think horses but DO NOT forget about the zebras!
Web sites of interest
- http://www.bt.cdc.gov (CDC web site)
- http://www.edcp.org (MD Dept. of Health web site)
- http://www.afip.org (Pathology)
- http://www.avma.org (Zoonoses and VMAT)
- http://www.hopkins-biodefense.org
- http://www.fbi.gov/contact/fo/info.htm
Regional Federal Bureau of Investigation Offices:
- FBI
- Washington Metropolitan Field Office
- 601 4th Street, NW
- Washington, DC 20535-0002
- 202-278-2000
- FBI
- 7142 Ambassador Road
- Baltimore, MD 21244-2754
- 410-265-8080
- FBI
- 150 Corporate Blvd.
- Norfolk, VA 23502-4999
- 757-455-0100
- FBI
- 1970 E. Parkham Road
- Richmond, VA 23228
- 804-261-1044
Table 1: List of potential bioterrorism agents
| Category A (most likely to be used as BT agents) |
Category B (second most likely to be used as BT agents) |
Category C (third most likely to be used as BT agents) |
| Bacillus anthracis (anthrax) |
Coxiella burnetti (Q fever) |
Nipah virus |
| Clostridium botulinum toxin (botulism) |
Brucella species (brucellosis) |
Hantaviruses |
| Yersinia pestis (plague) |
Burkholderia mallei (glanders) |
Tickborne hemorrhagic fever viruses |
| Variola major (smallpox) |
Ricin toxin from Ricinus communis (castor beans) |
Tickborne encephalitis viruses |
| Francisella tularensis (tularemia) |
Epsilon toxin from Clostridium perfringens |
Yellow fever |
| Viral hemorrhagic fever |
Staphylococcus enterotoxin B (SEB) |
Multi-drug resistant tuberculosis |
Source: Centers for Disease Control and Prevention, 2001
Reporting Animals Exposed To Or Ill From
Biological Or Chemical Agents
To report diseases within livestock, contact:
- Dr. Roger Olson (State Veterinarian) at 410-841-5810.
To report foreign animal diseases in small or large animals, contact:
- Dr. David Vogt (USDA, Area Veterinarian in Charge)
- at 410-349-9708 or
410-279-3037 (cell phone).
To report disease within small animals, zoonotic diseases or for public health inquiries, contact:
- Dr. Clifford Johnson (State Public Health Veterinarian)
- at 410-767-6703 or
410-767-6700 (after hours);
- or
- Dr. Tracy DuVernoy (Assistant State Public Health Veterinarian)
- at 410-767-5779 or 410-767-6700 (after hours);
- or
- Ms. Karon Damewood (Chief, Zoonotic Diseases)
- at 410-767-5441 or
410-767-6700 (after hours).
To report disease within wildlife populations, contact:
- Dr. Cindy Driscoll (State Wildlife Veterinarian) at
- 410-226-5193 or
1-800-628-9944 (24 hour DNR hotline).
For diseases within fish populations contact:
- DNR Fish Health hotline at 1-888-584-6610.
Other Phone Numbers Of Importance
Coordinator of Disaster Services: MVMA Bioterrorism Coordinator:
Dr. Jack Casper, MDA, 443-394-1449 Dr. Larry Giebel, 301-258-0850
State Bio-Terrorism Coordinator:
Dr. Julie Casani, DHMH, 410-767-6682
Other State Emergency Coordinators:
Gail Wowk, DHMH, 410-767-6434
Sandi Malone, DHMH, 410-767-6659
Stephen C. Malan, MDA, 410-841-5920
Maryland State Animal Health Laboratories:
Oakland: 301-334-2185
Frederick: 301-663-9528
College Park: 301-314-1870
Centreville: 410-758-0846
Salisbury: 410-543-6610
Maryland Department of Health and Mental Hygiene, November 2001
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