Lecture 11: State Public Health Veterinarian

Kentucky State Public Health Veterinarian

• kentucky department for public health

• cabinet for health and family resources

Kentucky state veterinarian

• kentucky department of agriculture

• deputy state veterinarian

• field veterinarians

kentucky fish and wildlife veterinarian

kentucky department of fish and wildlife resources

USDA/APHIS partners

federal partners

the state public health veterinarian is dedicated to address

zoonotic public health issues

what is the NASPHV?

national association of state public health veterinarians

what does the NASPHV do?

• communicate to share problems, ideas

• collaborate on the compendiums and guidance documents

what does the commissioner’s office do in the department for public health?

• administration and financial management

• epidemiology and health planning

• lab services

• maternal and child health

• prevention and quality improvement

• public health protection and safety

• women’s health

what do the 10 essential public health services do?

• falls under assurance, assessment, policy development, equity

• systemically identifies, investigates, and diagnoses health problems, hazards

• designed to monitor progress in each area

• epidemiology is mostly involved in assessment

why is epidemiology involved with assessment on the public health service wheel?

• monitor health

• investigate, diagnose, root causes

infectious disease surveillance at the state level

• state epidemiologist

• medical consultants

• public health veterinarian

• infectious disease epidemiologists

• nurse consultants

• other DPH staff

infectious disease surveillance at the local level

• regional epidemiologists

• local epidemiologist

• public health nurses

• environmental health specialists

chain of reporting for department of public health

1. lab

2. health care provider

3. kentucky department for public health or local health department

4. centers for disease control and prevention

5. multi-state outbreak investigations, recommendations, policy changes

surveillance for intervention and prevention

1. know your normal

2. alerts to problems

what does understanding the disease process help with?

• interventions to stop disease

• prevent future outbreaks

quick response to intervention and prevention

• K-PHAST training

• specialized trainings

• strike teams

rabies program

• maintain rabies data

• animal bite consults and follow up

• qualified persons for rabies vaccinations

• BATA: rabies tested bat identification program

zoonotic diseases

anthrax, brucellosis, hantavirus, lepto, psittacosis, tularemia, Q fever

what is the #1 disease?

rabies

CDC has never confirmed cases of rabies in

rodents, squirrels

rabies usually comes from

bats

animal bites (to humans)

• physicians are required to report LHD

• if not treated, parent or guardian are required to report

• LHD designates quarantine site

• pet owner responsible for cost of quarantine or test, damages, and/or prep

management of healthy dogs, cats, and ferrets for rabies

• quarantine 10 days

• observe 10 days

• any signs of rabies: euthanize and test

management of wildlife for rabies

• euthanize

• test for rabies

what does rabies PEP mean?

rabies post exposure prophylaxis

passive immunity for rabies

human immunoglobulin → immediate protective antibodies

rabies vaccine for active immunity

4 shots in deltoid on days 0, 3, 7, 14

rabies vaccine for immunosuppressed

5 doses, last one is day 28

if previously vaccinated for rabies, then

2 rabies vaccines only (no HRIG)

rabies PEP =

highly effective

how can rabies treatment go wrong?

• vaccinated patients given RIG

• RIG and vaccine given in same location

• RIG given too many times

• patients don’t come in on schedule

why was diagnosis delayed in the rabies case study?

there were red herrings:

• 7 month incubation period

• survival > 1 month after diagnosis

• rabies is rare in the area

• false positive drug screen caused confusion

• no known bite history

what is rabies PEP?

• no documented case of human-to-human transmission of rabies outside of tissue/organ donation but a theoretical risk exists

• virus spread: saliva and neural tissue

what is redcap?

rabies exposure risk assessment tool

what constitutes PEP recommendations

• exposure to saliva while wearing improper/no PPE

• multiple exposures to patient while symptomatic/infectious

• close contacts who cared for patient while symptomatic/infectious

• ensured inclusion of lab personnel

public communications for kentucky and ohio

• press release to media

• regional health alerts to medical providers

challenges and lessons learned for rabies case study

• multi-jurisdictional investigation

• importance of sequencing results

• sensitivities around immigrant community

• language and cultural barriers

• working with corporations

• timing during holidays