do humans get foot-and-mouth disease? suzanne burnham, dvm strategic preparedness branch texas...

Do humans get Do humans get foot-and-mouth foot-and-mouth

disease?disease?Suzanne Burnham, DVMSuzanne Burnham, DVMStrategic Preparedness BranchStrategic Preparedness Branch

Texas Department of State Health ServicesTexas Department of State Health Services

Foot-and-Mouth DiseaseFoot-and-Mouth Disease Foot-and-mouth disease Foot-and-mouth disease

(FMD) is a highly contagious, (FMD) is a highly contagious, viral disease of domestic viral disease of domestic cloven-hoofed and many wild cloven-hoofed and many wild animals.animals.

Emergency Responders will Emergency Responders will face very difficult issues in face very difficult issues in controlling the spread of this controlling the spread of this diseasedisease

Foot-and-Mouth DiseaseFoot-and-Mouth Disease

This devastating disease is This devastating disease is considered to be the most important considered to be the most important livestock disease in the world.livestock disease in the world.

Archives of VirologyArchives of Virology1997 (Suppl) 13: 95-97.1997 (Suppl) 13: 95-97.

Man’s susceptibility to the virus of foot-and-Man’s susceptibility to the virus of foot-and-mouth disease (FMD) was debated for many mouth disease (FMD) was debated for many years. Today the virus has been isolated and years. Today the virus has been isolated and typed (type O, followed by type C and rarely typed (type O, followed by type C and rarely A) in A) in more thanmore than 4040 human caseshuman cases. So no . So no doubt remains that FMD is a zoonosis. doubt remains that FMD is a zoonosis. Considering the high incidence of the disease Considering the high incidence of the disease (in animals) in the past and in some areas up to (in animals) in the past and in some areas up to date, occurrence in man is quite rare.”date, occurrence in man is quite rare.”

Konrad Bauer Konrad Bauer Landesuntersuchungsamt fLandesuntersuchungsamt für das Gesundheitswesen Nordbayern, Nürnberg, ür das Gesundheitswesen Nordbayern, Nürnberg,

Federal Republic of GermanyFederal Republic of Germany

““The virus of foot and mouth disease causes The virus of foot and mouth disease causes severe epizootics in animals and infrequently severe epizootics in animals and infrequently evokes painful, but transient clinical signs in evokes painful, but transient clinical signs in man. man.

Adults in certain occupational groups and Adults in certain occupational groups and children are particularly exposed to risk.”children are particularly exposed to risk.”

““Predisposing factors play an important role in Predisposing factors play an important role in the development of overt foot and mouth the development of overt foot and mouth disease in man. Subclinical infection occursdisease in man. Subclinical infection occurs” ”

N. ST. G. HYSLOP N. ST. G. HYSLOP Principal Scientific Officer, Animal Virus Research Institute, PirbrightPrincipal Scientific Officer, Animal Virus Research Institute, Pirbright

Transmission of the virus of FMD between animals and man. Transmission of the virus of FMD between animals and man. Bulletin of the World Health Organization. 1973;49:577-585.Bulletin of the World Health Organization. 1973;49:577-585.

Literature SearchLiterature Search

Limitations of our search:Limitations of our search:

1834 – present with concurrent FMD 1834 – present with concurrent FMD outbreak in animalsoutbreak in animals

Articles in English and 7 foreign languagesArticles in English and 7 foreign languages

Does not include articles from FMD Does not include articles from FMD endemic areas of China, Asia, Africa, the endemic areas of China, Asia, Africa, the

Middle EastMiddle East

FMD World DistributionFMD World DistributionJuly – Dec 2007July – Dec 2007

OIE World Animal Health Information Database (WAHID)

Search for articles Search for articles published in U.S.published in U.S.

1915 USDA Farm Bulletin 666 – 1915 USDA Farm Bulletin 666 – subchapter on FMD in humanssubchapter on FMD in humans

1915 Clough – medical student at 1915 Clough – medical student at Johns Hopkins UniversityJohns Hopkins University

1916 Sutton and O’Donnell – stockman 1916 Sutton and O’Donnell – stockman from Kansasfrom Kansas

Search resultsSearch results

468 References 468 References – 5 Bibliographies 5 Bibliographies

– 11 Dissertations 11 Dissertations

– 119 Reports of 381 Case Descriptions119 Reports of 381 Case Descriptions

Ministry of Agriculture Prussia 1880s Ministry of Agriculture Prussia 1880s (16 epidemics 1600 humans(16 epidemics 1600 humans BUSSENIUS AND SIEGELBUSSENIUS AND SIEGEL))

1834 Story1834 Story

Drs. Hertwig, Mann, Villain veterinary surgeons of Prussia

Drank 1 quart of fresh raw, warm milk from a cow severely infected with FMD

Day 1, 2 and 4 Article charts the symptoms of all 3

Repeated by Krajewski in 1901

Summary of findingsSummary of findings

Reported mostly by physicians Reported mostly by physicians In all ages from infants to adults In all ages from infants to adults Only when remarkable in severityOnly when remarkable in severity Often no epidemiology reported Often no epidemiology reported Photographs of lesions in many articles Photographs of lesions in many articles Case definitions by symptoms and then Case definitions by symptoms and then

by diagnosis by diagnosis

Mild Case SymptomsMild Case Symptoms

Headache, malaise, chills, thirst, dry Headache, malaise, chills, thirst, dry mouthmouth

Primary vesiclePrimary vesicle Itchiness; pharyngitis; GI symptomsItchiness; pharyngitis; GI symptoms Fever (38 Fever (38 ˚C – 39.5 ˚C) ˚C – 39.5 ˚C)

Multiple vesicles, some coalesceMultiple vesicles, some coalesce Vesicles rupture, erosions heal rapidlyVesicles rupture, erosions heal rapidly

More serious symptomsMore serious symptoms

Excessive salivation, inflammation of tongueExcessive salivation, inflammation of tongue Vesicles in mouth, tongue, lipsVesicles in mouth, tongue, lips Vesicles on hands, between fingersVesicles on hands, between fingers Fingernails, bed of nails damagedFingernails, bed of nails damaged Vesicles on feet, soles, between toesVesicles on feet, soles, between toes Large coalesced blisters sloughedLarge coalesced blisters sloughed Erosions caused painful swallowing, walkingErosions caused painful swallowing, walking Gastro-enteritis reported especially in Gastro-enteritis reported especially in

children who drank raw milkchildren who drank raw milk

Less frequently reported Less frequently reported symptomssymptoms

Conjunctivitis (from hand contact?)Conjunctivitis (from hand contact?) Change in voice qualityChange in voice quality Typical odor of necrosis, halitosisTypical odor of necrosis, halitosis GI complications from ulcerationsGI complications from ulcerations Temporary bilateral facial paresisTemporary bilateral facial paresis

October 28, 2008, USAHA MUSSER, BURNHAM


FMD virus Types reported in FMD virus Types reported in humanshumans

Type OType O Type CType C Type AType A Russia A22

Russia B

1960’s 38 28 9 3 1

1950’s 5 65 1

1940’s 18

1930’s 40

1920’s 1

For Descriptions that For Descriptions that included Virus Type in the included Virus Type in the

ReportReport

Type OType O: : 49%49%

Type CType C: : 45%45%

Type AType A: : 9%9%

““Clinical diagnosis”Clinical diagnosis”– Clinical signs Clinical signs – FMD in local livestockFMD in local livestock

““Presumptive diagnosis”Presumptive diagnosis”– Clinical signs Clinical signs – FMD in local livestockFMD in local livestock– Single test of guinea pig or calf passage, suckling mouse Single test of guinea pig or calf passage, suckling mouse

passagepassage– Language barrier Language barrier

““Confirmed diagnosis” Confirmed diagnosis” – Clinical signs Clinical signs – FMD in local livestockFMD in local livestock– Confirmatory laboratory diagnosis from serum neutralization, Confirmatory laboratory diagnosis from serum neutralization,

complement fixation or virus isolation testingcomplement fixation or virus isolation testing

Sero-positive onlySero-positive only– Serological identificationSerological identification– No clinical signs reported or investigatedNo clinical signs reported or investigated



DiagnosisDiagnosis

TotalTotal ClinicalClinical PresumPresum ConfirmedConfirmed A/S-PA/S-P

1970’s 44 4

1960’s 9494 6 3 23 62

1950’s 8484 11 2 13 58

1940’s 3333 8 7 18

1930’s 6767 20 6 19 22

1920’s 1414 7 6 1



1960’s Summary1960’s SummaryConfirmed by lab + clinical

signs

Sero-positive only

Employed at FMD research lab or vaccine production facility

8 Type O8 Type O

2 Type C 2 Type C

62 62 52% Type O52% Type O

31% Type C31% Type C

17% Type A17% Type A

No association with research or vaccine production

2 Type O2 Type O

9 Type C9 Type C

2 Type A2 Type A22Russia22Russia

? ? ?? ? ?

No report No report

Risk factorsRisk factors emergedemerged

1.1. Ingesting high quantity of FMD virus Ingesting high quantity of FMD virus in raw milkin raw milk

2.2. Daily direct contact and broken skinDaily direct contact and broken skin

3.3. Inoculation / lab accident Inoculation / lab accident

PLUSPLUS

Pre-existing disease (resulting in Pre-existing disease (resulting in dermatitis or immune suppression)dermatitis or immune suppression)

Most at-risk population Most at-risk population groups noted in the groups noted in the

literature searchliterature search ChildrenChildren Animal caretakersAnimal caretakers Dairy employeesDairy employees VeterinariansVeterinarians FarmersFarmers ButchersButchers Lab techniciansLab technicians


BBC News HEALTH: Monday, 23 April, 2001, 21:25 GMT 22:25 UK 'A mild and transient disease'

Bobby Brewis suffered from adverse publicityWhen Bobby Brewis was found to have the last confirmed case of human foot-and-mouth disease in the UK he became a minor celebrity.

http://news.bbc.co.uk/2/hi/health/1293311.stm

A Zoonosis A Zoonosis but generally not a but generally not a

Public Health ConcernPublic Health Concern

Public Health ConsiderationsPublic Health Considerations

Human cases occur singlyHuman cases occur singly Symptoms often not reported, Symptoms often not reported, Pasteurization eliminates 95% of FMD Pasteurization eliminates 95% of FMD

virus in milk. virus in milk. BiosecurityBiosecurity

Why it mattersWhy it matters

Questions?

Bobby Brewis

do humans get foot-and-mouth disease? suzanne burnham, dvm strategic preparedness branch texas...

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