1 Pathogen Control and Public Health at Livestock InteractionsMegan Jacobs, Derek Foster, Ben Chapman North Carolina State University

2 Introduction Megan Jacob, MS, PhD Assistant Professor, Clinical Microbiology NC State

3 Prevalence of Foodborne Incidence at Livestock Interactions/BurdenBen Chapman Department of Agricultural and Human Sciences

4 2940 illnesses 60 outbreaks since 1994

5 Farm Fairs and Petting Zoos: A Review of Animal Contact as a Source of Zoonotic Enteric Disease

6 Investigation of animal contact burdenPathogens investigated Campylobacter species, Cryptosporidium species, Shiga toxin–producing Escherichia coli (STEC) O157, STEC non-O157, Listeria monocytogenes, nontyphoidal Salmonella species, Yersinia enterocolitica. 14% or 445,213 illnesses linked to animal interactions (Hale et al., 2012)

7 NW Washington fair 25 confirmed cases 35 others suspected (symptoms)6 Cases of HUS

8 Fall-out of NW Washington fairMilk Maker’s Fest cancelled in 2016 Lawsuit filed against: Whatcom County Dairy Women, Northwest Washington Fair Association and the Lynden School District Read more here:

9 NW Washington Fair Washing or sanitizing their hands before eating lunch were less likely to become ill. Children who reported always biting their nails were more likely to become ill. Leaving animal areas without washing hands might have contributed to an increased risk of transmission. Eating in animal areas might have contributed to an increased risk of transmission.

10 2003 study on prevalence Prevalence of E. coli O157: H7 in livestock at 29 county and three large state agricultural fairs: 13.8 percent of beef cattle 5.9 percent of dairy cattle 3.6 percent of pigs 5.2 percent of sheep 2.8 percent of goats. Over 7 per- cent of pest-fly pools also tested positive for E. coli O157:H7

11 Case Study on Incidence at Livestock InteractionsNicole Lee Foodborne Epidemiologist Division of Public Health, Communicable Disease Branch North Carolina Department of Health and Human Services

12 Handwashing –efficacy and limitationsBen Chapman

13 Sources of pathogens on handsToilet Salmonella, E. coli, Campylobacter, Vibrio Hepatitis A, norovirus, Shigella, Giardia, Salmonella The food surface has at most 20,000 pathogens per ml Source: Human feces has 10^7 pathogens per gram Food

14 Hand hygiene research 3 petting zoos in Kansas and Missouri, hand hygiene compliance of 574 visitors was observed Only 37% of visitors attempted any type of hand hygiene. Importantly, visitors were 4.8 × more likely to wash their hands when a staff member was present ( Hand hygiene compliance was also observed at 36 petting zoos in Ontario, Canada A compliance of 0–77% was observed (mean value 30.9%). Increased hand hygiene compliance was observed when hand-washing stations were located near the exit (Weese et al., 2007).

15 Rinse hands under clean, running waterStep 1: Rinse Rinse hands under clean, running water Wash off any large particles that could inhibit effectiveness of disinfection steps, if used Water temperature does not matter for pathogen removal Plays other roles (loosening soil, preference) Talk about how temperature doesn;’t matter, a study was done that found that different temperatures (ranging from 40 F to 120 F) had no discernable impact on the reduction of microbes or contaminants on hands (Boyce & Pittet, 2002; Michaels et al., 2002)

16 Step 2: Soap Apply hand soap Soap makes it easier to rinse off things, likes fats and oils, because it makes them more soluble in water Soap has better activity at warmer Regular soap versus antimicrobial soap is not important, antimicrobial soaps have been found to be only marginally more effective than regular soaps (and will talk about why in a second); liquid soap is preferable (Boyce & Pittet, 2002)

17 Step 3: Scrub Rub together for 10 to 15 seconds, pay particular attention to fingernails Mechanical removal of contaminants and microbes from hands is crucial in proper hand hygiene Scrubbing physically gets rid of these (and a nail brush helps) It is important to be thorough around fingernails, as it has been found that these harbor very high amounts of organisms (Lin et al., 2003; Price P., 1938)

18 Thoroughly rinse hands under clean, running waterStep 4: Rinse Thoroughly rinse hands under clean, running water This aids in the mechanical removal of microbes and contaminants from your hands (Boyce & Pittet, 2002; Michaels et al., 2002)

19 Rinse hands under clean, running waterStep 5: Dry Rinse hands under clean, running water Mechanical drying is the last step in physically removing microbes and contaminants from hands – 1 log reduction Disposable paper towels are desirable as they dry efficiently, remove bacteria effectively, and can cause less contamination in the washroom (Huang, Ma, & Stack, 2012)

20 Reduction of Microbes from Hand WashingProper hand washing has been found to reduce microbes on hands between 99 and 99.9% It is estimated that the microbial population on hands ranges from 40,000 and 4,600,000 This could leave anywhere between 100 to 5,000 microbes behind Not all of these microbes are going to be disease causing, but some diseases need as few as ten particles to infect. Take home message: wash your hands but also be cautious of what you touch with bare hands *Note: this is only if proper technique is followed, literature has found that glove use without hand washing is not effective (Boyce & Pittet, 2002; FDA, 2009; Green et al., 2007)

21 Handwashing complianceIt is known that hand washing compliance tends to be very poor, around 40% One study found that 73% of restaurant workers failed to use proper hand washing Other have found similar results, with about 30% of food handlers displaying correct hand washing practices (Green et al., 2007; Voss & Widmer, 1997)

22 Hand Sanitizers: Fact or Fiction?The composition matters Fact For most pathogens a hand sanitizer with an alcohol concentration of at least 60% is needed (Boyce & Pittet, 2002; FDA, 1994)

23 Hand Sanitizers: Fact or Fiction?Can prevent disease caused by all agents Fiction Most hand sanitizer is not effective for all agents of disease, especially Norovirus (Liu, Yuen, Hsiao, Jaykus, & Moe, 2010)

24 Why clean? Why sanitize? Reduce risk of biological contaminationReduce bacterial multiplication – food particles removed Protect food from contamination Avoid attracting pests Maintain safe environment

25 Establishing Effective Cleaning and Disinfection ProgramsBen Chapman

26 Locations for cleaning and sanitizingManure bunker Hay maze area Bleachers by east wall Bleachers by west wall

27 What is the Difference? Cleaning – the removal of soil (food) from surfaces of equipment and utensils. Sanitizing – reduces the number of disease-causing microorganisms on equipment and utensils to acceptable public health levels. It’s like brushing your teeth (clean), then using mouth wash (sanitize)

28 Five Steps Pre-flush and pre-scrape Wash Rinse Sanitize Air dry

29 When to Clean All surfaces need to be cleaned and rinsed at regular intervals Follow the master cleaning schedule Use clean as you go strategy maintain and safe and clean environment Minimize amount of cleaning when finished

30 Hand Contact Surfaces Rails/barriers Handlesdoors, refrigeration equipment, freezers, cupboards, drawers, etc Faucets, soap and paper towel dispensers

31 How Does Cleaning Work? Washing helps to loosen soils and detergent and scrubbing help break adhesion of soil and microorganisms Iowa State University Extension

32 How Does Cleaning Work? Rinsing removes loosened soil and detergent from the surface. This is important because they can make sanitizers less effective Iowa State University Extension

33 How Does Sanitizing Work?Applying sanitizer to a clean surface provides a “kill” step to reduce the number of microorganisms to a safe level. Note: We don’t sterilize in food service, it isn’t reasonable or necessary Iowa State University Extension

34 How does a sanitizer work?Disruption of the cell wall barrier by reactions of chlorine with target sites on the cell surface release of cell insides Doesn’t allow cell to function It blows it up Chlorine effectively kills a large variety of microbial waterborne pathogens, including those that can cause typhoid fever, dysentery, cholera and Legionnaires' disease. Chlorine is widely credited with virtually eliminating outbreaks of waterborne disease in the United States and other developed countries. And Life magazine recently cited the filtration of drinking water and use of chlorine as "probably the most significant public health Health officials began treating drinking water with chlorine in Previously, typhoid fever had killed about 25 out of 100,000 people in the U.S. annually, a death rate close to that now associated with automobile accidents. Today, typhoid fever has been virtually eliminated.

35 Chemical Sanitation Chlorine – effective against most microorganisms, in hard/soft water, relatively cheap, may corrode Quaternary Ammonium Compounds - odor free, non-corrosive, do not work well in hard water, not effective against all microorganisms. pH, temperature, concentration, contact time are important Iodine – works rapidly, may stain some metals

36 Chemical Sanitation Chlorine Quaternary Ammonium Compounds IodineUse ppm depending on pH and water temperature Contact time of seven seconds Quaternary Ammonium Compounds ppm, water at 75F-120F Contact time of 30 seconds Iodine ppm, water at 68F

37 Megan Jacob, MS, PhD Assistant Professor, Clinical MicrobiologyEnvironmental Control and Considerations for Human Pathogens in Animals Megan Jacob, MS, PhD Assistant Professor, Clinical Microbiology

38 What are zoonotic pathogens?Microorganisms from animals that can be shared and cause disease in people Viruses Bacteria Fungi Parasites Very common (6 of 10 infectious diseases in people) Animals do not necessarily appear sick when carrying zoonotic organisms

39 How are zoonotic pathogens shared?Direct contact with an animal Indirect contact Ingestion of contaminated food or water Raw milk Drinking water Ingestion after contact with environment Fence rails Door knobs Equipment Serving utensils Animal bedding Contaminated clothing or shoes

40 Role of environmental survival of pathogensOrganisms that persist in the environment extend the time that people may be at risk for acquiring a zoonotic pathogen Organisms that survive in the environment can be disseminated to new areas Insect vectors Rainwater runoff Physical movement Dust Some microorganisms remain stable in the environment, others proliferate

41 How well do zoonotic organisms survive in the environment?Highly variable between and even within different organisms Influenza virus – short - minutes Shiga toxin-producing E. coli (STEC) – reported > 300 days in sawdust Salmonella – months in manure or wooden fencing Cryptosporidium - stage dependent; oocyte can survive months in water environment

42 Factors that influence environmental survival of zoonotic pathogensPresence of biological material (manure) Temperature Humidity/Moisture Acidity Type of microorganism

43 Bacterial biofilms Biofilms are a group of microorganisms that stick to each other and usually to a surface. They are embedded in an extracellular matrix and behave differently then they would outside of the community

44 Examples of environmental persistence

45 Examples of environmental persistence

46

47 Current recommendations to control zoonotic pathogens in the environmentControl shedding of organisms from animals Control strategies? Testing strategies? Management strategies Stress, handling, transportation, season, age of animal Proper manure disposal Facility design Disinfect areas as possible Provide ventilation Limit animal use space for community events

48 Environmental persistenceCannot be predicted by organism Multi-factorial Can be controlled with management strategies

49 Questions? Megan Jacob Department of Population Health & Pathobiology 1060 William Moore Dr. Raleigh, NC (919)

50 Zoonotic Pathogens and Interactions with Animal HealthDerek Foster, DVM, PhD Assistant Professor of Ruminant Medicine

51 Zoonotic Pathogens Salmonella—cattle, poultry Cryptosporidium—calvesCan cause disease Also found in healthy animals Cryptosporidium—calves Campylobacter—cattle, poultry Rarely causes disease in animals E. coli O157—Cattle, sheep and goats Does not cause disease in animals

52 Risk Factors for Shedding in Healthy Animals“Stress” Weather changes Overcrowding Transportation Adding animals Nutrition Diet changes Underfeeding Giving birth Young animals

53 Interventions and current recommendationsMajor pathogens can be found in feces of healthy animals Shedding is not consistent Fecal cultures can accurately say an animal is positive Fecal cultures CANNOT say an animal is negative Routine cultures may be useful for some pathogens Salmonella, E. coli O157:H7 Prior to purchase Prior to exhibition Any animals with diarrhea Annually?

54 Interventions and current recommendationsAvoid stress that can increase shedding Raise replacement animals Only buy new animals from “clean farms” National Poultry Improvement Program Isolate animals with diarrhea

55 Interventions and current recommendationsAvoid high risk animals Animals that have recently given birth Very young (Cryptosporidium)

56 What’s being explored? Use of vaccination to control sheddingE. coli O157:H7 vaccine reduces odds of shedding by half in feedlot cattle Varela et al., 2012

57 What’s being explored? Swift et al, 2017.

58 What is being explored? Use of vaccination to control sheddingSalmonella vaccine does not reduce shedding in healthy adult animals Cannot be given to young calves Heider et al, 2008.

59 What is being explored? Smith, et al., 2014

60 Conclusions Pathogens can be shed by healthy animalsNo perfect testing or vaccination strategy Discuss options with your veterinarian Decrease likelihood of shedding by reducing stress Provide adequate barriers and handwashing

61 Questions? Derek Foster 1060 William Moore Drive NC State University College of Veterinary Medicine Raleigh, NC

62 Are Naïve Human Populations at Increased Risk for Zoonoses?Megan Jacob, MS, PhD Assistant Professor, Clinical Microbiology

63 Who’s at risk for zoonoses?Young children (< 5 years old) Adults > 65 years old Immunocompromised Infectious diseases Immune system dysfunction Cancer patients receiving chemotherapy Pregnant women

64 Who’s at risk for zoonoses?Young children (< 5 years old) Adults > 65 years old Immunocompromised Infectious diseases Immune system dysfunction Cancer patients receiving chemotherapy Pregnant women 15-20% of population in developed countries

65 Others? Malnutrition Use of antacids (proton pump inhibitors)Increased circulating iron Ingestion of fatty foods Ingestion of large volumes of water Transplant recipients

66 Reasons for decreased immunityGeneral immunosuppression Primary deficit in immune system, or using drugs that target immune system  reduction in the number of organisms needed to cause disease and increase the severity of illness

67 Is there more?

68 Hygiene Hypothesis

69 “Conclusions” Strong evidence ties the immune status with susceptibility to foodborne pathogens and zoonoses Evidence that immune system function differs between those exposed to farm environments often and at an early age Increasing amounts of immunocompromised people may be visiting livestock interaction facilities

70 Questions? Megan Jacob Department of Population Health & Pathobiology 1060 William Moore Dr. Raleigh, NC (919)

71 Round Table questions

72 Do you conduct any animal health testing or is testing something you have considered?

73 Do you have a relationship with a veterinarian and do you maintain vaccination protocols?

74 Have you considered adding additional barriers between the animals and the public?

75 Do you practice any kind of insect control and have you considered insect control as part of your biosafety plan?

76 Do you encourage visitors to touch the animalsDo you encourage visitors to touch the animals? How do you handle explaining risks of touching animals?

77 If feeding by visitors is allowed, how are animals fed?

78 Do you manage your exhibit/petting zoo/facility different when it rains? How do you handle run-off?