September 2, 2009
Veterinarian dies after contracting Hendra virus
CDC concerned about infectious disease control in veterinary practices
By: Jennifer Fiala
For The VIN News Service
Australian veterinarian Dr. Alister Rodgers died last night after a weeklong battle with Hendra virus. Officials say he is the fourth person in the country to die from what scientists believe is a bat-borne disease.
Rodgers, 55, worked at Rockhampton Veterinary Clinic in Queensland. Authorities suspect that the equine practitioner contracted Hendra virus while treating a sick filly.
The death of the veterinarian and father of two has prompted calls from his Australian colleagues for more research into Hendra virus. Rodgers is the second veterinarian to die from Hendra virus. Last year, Dr. Ben Cunneen died after treating a horse with the disease.
Cunneen, of Brisbane, Australia, was a Veterinary Information Network (VIN) member.
“There’s a lot of concern here,” says Dr. Bob Doneley, a VIN consultant and practitioner in Queensland. “Personally, I’m not worried about it because I’m not a horse vet. But I’m quite disappointed that after having one vet die last year, that we weren’t able to prevent another death. It’s very sad.”
Doneley refers to the Australian Veterinary Association’s (AVA) infection control workshops, which have been held regionally since Cunneen’s death. “We thought we shouldn’t have another vet die again,” Doneley says.
AVA officials now are requesting that the government get involved by providing more resources to support research, training and education.
“Even the most stringent preventative measures are not foolproof, however, it’s vital that some progress is made immediately on treating the disease once a person has been exposed,” AVA President Dr. Mark Lawrie says in a news release. “We need a massive research effort into the source of the disease, vaccines and rapid on-site tests ... Unfortunately this problem is not going away.”
There is no known cure for Hendra virus (genus Henipavirus, family Paramyxoviridae). The disease gets its name from the Brisbane suburb where it was first isolated in 1994, from specimens obtained during an outbreak of respiratory and neurologic disease in horses and humans, reports the Centers for Disease Control and Prevention (CDC).
Humans become ill after exposure to the body fluids of horses infected with the virus. The natural reservoir for Hendra virus is suspected to be Australia’s flying foxes.
The disease is closely related to Nipah virus, a native of Asia that is known to infect pigs as well as dogs, cats and humans.
While there are no known U.S. cases of Hendra virus, American veterinarians should be more careful about protecting themselves and their staff members from the spread of diseases, says Dr. Jennifer McQuiston, epidemiology team lead for the Rickettsial Zoonoses Branch of CDC’s National Center for Zoonotic Vectorborne and Enteric Diseases.
According to McQuiston, 60 percent of all human pathogens are zoonotic in origin and all of the big outbreaks CDC has been involved in lately carry a zoonotic component.
Examples such as the 2003 SARS pandemic and H1N1 triple reassortment virus immediately come to mind. But it was the monkeypox outbreak of 2003, which infected more than 70 people in six states, that shed light on a cavalier attitude expressed by some in veterinary medicine concerning the spread of diseases and infection to humans.
“After we worked on the monkeypox outbreak, we became very concerned when almost a quarter of those who came down with it were veterinarians or veterinary technicians," McQuiston says. “These people were treated in human hospitals, but there wasn’t a lot of human-to-human transmission in that setting.
“As people who are on the front lines, veterinarians can either pose a risk to themselves or become a means of disease entry into the human population.”
McQuiston explains that human health care workers practice universally standardized precautions, such as wearing gloves and masks.
“Those sorts of things do not exist in veterinary medicine, and monkeypox highlighted that,” McQuiston adds.
With that, CDC acquired the American Veterinary Medical Association’s membership list and conducted a survey. Responses from more than 4,000 veterinarians showed what precautions they took in variety of clinical scenarios.
“What we found was that even though vets expressed being concerned about a lot of zoonotic diseases, having those concerns didn’t translate to better infection control practices,” McQuiston says.
Veterinarians might not be as rigorous about infection control measures such as glove wearing because non-primate animals carry almost no bloodborne pathogens that are dangerous to humans. That's not the case for those working in a human hospital setting, where advanced infection control largely has been propelled by the spread of diseases like HIV, explains Dr. Radford Davis, a VIN consultant and assistant professor of public health at the University of California, Davis School of Veterinary Medicine.
Davis and others state that core elements of veterinary medicine are much different than those in human medicine. For starters, veterinarians treat multiple species and often work in the field, outside of a clinic setting. What's more, veterinarians are trained to be on alert for reportable large-animal diseases such as foot and mouth, West Nile virus and tuberculosis as well as prevent the spread of common infectious diseases in pets, such as canine distemper. A growing list of diseases and precautionary measures to worry about will require more resources and education for an already stretched profession, proponents of veterinary medicine say.
Additionally, increased collaboration needs to exist among veterinary practices to standardize infection control measures, as is done in human medicine. While such changes in veterinary medicine are evolving, they are sure to drive up the cost of pet health care, insiders contend.
Davis adds that infection control practices in human medicine are overseen by the federal oversight bodies, whereas veterinarians largely are left to police themselves.
"There are a lot more checks and balances as well as liability issues (in human health care)," he says. "We're so diverse. There are so many species, so many types of practices. We just don't have that same regulation over us."
That might change to some degree, although there's been no attempt to develop any true mandates. Last year, the National Association of State Public Health Veterinarians authored recommendations for infection control practices in veterinary medicine.
The Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel
was published in the Aug. 1, 2008 Journal of the American Veterinary Medical Association
. The 18-page document gives guidance on everything from isolating animals with infectious diseases to cleaning and decontamination. Its appendixes address zoonotic diseases of importance in the United States as well as the characteristics of disinfectants.
The document ends with a model infection control plan for practices
“We work in very austere conditions,” McQuiston says of the veterinary profession. “We have sort of evolved from a cowboy type of mentality that we are tough and can handle these diseases.
“I don’t know that the Australia scenario was related to a lapse in infection control, but knowing Hendra virus, we would suspect it.”
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.
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