CDC Telebriefing Transcript

Outbreak of Tularemia in Commercially Sold Prairie Dogs in Texas

August 6, 2002

MR. SKINNER: I'd like to welcome all the reporters who have joined us on today's call, where we'll be providing an update to you all about an investigation that the Texas Department of Health and the Centers for Disease Control and Prevention have been collaborating on in regard to an outbreak of tularemia in some captive prairie dogs in a facility there in Texas.

On the phone with us today is Dr. Lisa [sic] Rawlings. She is the deputy state epidemiologist for the Texas Department of Health. As well as Dr. David Dennis, a medical epidemiologist for the Centers for Disease Control and Prevention, and a tularemia expert.

What we'll do is we'll turn the call over to Dr. Rawlings, who's going to provide a brief overview of the investigation there in Texas, and then we'll turn the call over to Dr. David Dennis, who will provide a brief overview of some of the activities that CDC's been involved in. And then we'll turn it over to reporters for Q&A.

So at this point I'd like Dr. Rawlings to take it away.

DR. RAWLINGS: Okay. Well, as you heard, the Texas Department of Health and CDC are investigating an outbreak of tularemia in wild--caught; they were caught in the wild--but captive prairie dogs. These prairie dogs were imported and exported from a commercial exotic animal distribution center in Denton County. Denton County is just north of Dallas.

Now, may of the prairie dogs which arrived at the Denton County facility in June began showing signs of illness in mid-July. The testing of the prairie dogs was done at CDC, and they were able to show that the outbreak was due to a bacterial disease called tularemia.

TDH received the report from CDC in late July, and then, with assistance from CDC, began an investigation. The goals of the investigation are to trace the prairie dogs, find out where they were sent to; determine whether there has been any human investigation; and to formulate control measures.

MR. SKINNER: Okay. Dr. Dennis?

DR. DENNIS: Yes, as Julie mentioned, CDC learned from the Texas state health authorities about one week ago of sick and dead prairie dogs at a commercial animal dealership. Animal specimens received by CDC the next day were tested and found to be positive for the bacterium causing tularemia, a serious infectious disease commonly known as rabbit fever.

Within 24 hours, scientists were dispatched to assist Texas health authorities with on-site investigations, with the tracing of prairie dogs in the pathways of distribution and with interstate and international notifications. Joint Texas-CDC investigations have revealed shipments of potentially infected animals to nine states and to seven countries in Europe and Asia. The Division of Quarantine, CDC Atlanta, has coordinated international notifications with the World Health Organization and with the European Disease Surveillance Networks.

To date, we have been notified of sick animals in one shipment to Europe and in several shipments in the United States. There have been no known human cases of tularemia associated with these prairie dogs shipments. We believe that the risk is very low to persons who have contact only with healthy prairie dogs, but there is concern about persons who have handled sick or dead animals.

The disease is treatable with the proper antibiotics. We are recommending that persons developing an illness with fever, chills, and other flu-like symptoms within three weeks of handling a prairie dog be seen by a physician without delay. Persons who have handled sick or dead animals should seek advice about possible preventive treatment with antibiotics.

MR. SKINNER: Thinks, Dr. Dennis. Jeanine, I think we're ready for some questions, please.

QUESTION: Anita Manning, USA Today.

Hi, thanks. Where do these prairie dogs come from? They were caught in the wild where? In Texas?

DR. RAWLINGS: We have prairie dogs that were collected in Texas and then in another state, and we're not sure where the origin of the disease occurred. That's why we're conducting investigations.

QUESTION: Can you say what the other state was?

MR. SKINNER: Dr. Dennis, I--you know, I mean, I think that's okay.

DR. DENNIS: Right. We still are in the early stages of investigation, but it appears that animals from the infect lot most likely came from a facility in South Dakota, and most likely were caught in the area--in South Dakota.

QUESTION: John Lauerman [sp], Bloomberg News.

Yeah, thank you. Do you know exactly how many prairie dogs were sent out?

MR. SKINNER: Dr. Dennis?

DR. DENNIS: There were in total hundreds of prairie dogs sent. I would say somewhere between 1,000 and 2,000 animals that may have come from that affected lot. Some of these shipments contained only one animal; some shipments contained as many as 500 animals.

QUESTION: And approximately how many pet stores were they sent to?

DR. DENNIS: That is something that is only being determined now. Because there is a network of distributors, and then the distributors send them out to individual pet shops.

As an example, there were--there was a considerable lot of animals sold to a dealer in a European country. He held these animals for a week, gave them antibiotics, actually, but then the next day sold them at an open market that we presume is a market of pet shops.

MR. SKINNER: Yeah, I think it's safe to say that this has continued to be a work in progress, and contact with the various distributors within the states continues to, you know, to go on. I think what is important for us having this call is what Dr. David Dennis alluded to in his brief introductory comment, that we really want people that have handled these, you know, dead animals within the last few weeks, if they develop illness, to, you know, seek medical attention. And that's really why we are having this call.

Next question?

QUESTION: Tina Hessman, St. Louis Post-Dispatch.

Can you tell me what states had shipments with prairie dogs that were known to be infected?

MR. SKINNER: Either one--Dr. Rawlings or Dr. Dennis.

DR. RAWLINGS: Sure. We can tell you that there were shipments to Florida, Illinois, Ohio, Virginia, West Virginia, Washington State, Mississippi, and Nevada. And, of course, Texas.

DR. DENNIS: Now, I'd like to qualify that in that we do not know that infected animals have been received by all those states. These are states that received shipments from a time period when there was a lot of animals at the Texas facility that became ill and died.

QUESTION: So you haven't seen the illness in animals that were sent in any of those shipments to those states?

DR. DENNIS: Yes, there--there was word that we received back, notification from one European country, of animals that had
actually been held in quarantine becoming sick and dying. And on testing, they determined that these animals were infected with the germ that causes tularemia. And we have been notified by several pet distributors in at least two states in the United States that have had animals that have been sick or dead. But those have not yet been tested in our laboratories.

MR. SKINNER: Dr. Dennis, do you think it's important to allude to the incubation period and, you know, stress that we continue to work with these states, though? So I--you know, this is--like I said, it's an investigation in progress, wouldn't you agree?

DR. DENNIS: I think the status of the investigation now--you know, we've done the ground work there with the Texas Health Department in Texas and we're--have been notifying the state and local health authorities that had received shipments from the lot that--or for the time period that we're concerned about. And they are now going out and doing the individual investigations to identify the pet shops and the sickness or health of the animals.

So that's where we are in this investigation. It will take some time before we identify animals that may have been sick or dead and then have a system to receive and test those for the illness.

MR. SKINNER: Next question, please.

QUESTION: Steve Mitchell, UPI.

Oh, yeah, hi. Can you give me some idea of how this disease is transmitted, in terms of what kind of contact a person would need, like with body fluids or airborne or whatever?

DR. DENNIS: The disease in nature is usually transmitted by the handling of infected animals, particularly infected carcasses and especially rabbits. Or a person can be infected by tick or fly bites. But in this concern with the prairie dogs, we think that the risk is very small to persons who are handling healthy animals. But persons who are handling sick or dead animals and come into contact with their secretions, or have been bitten or scratched by these animals when they are sick, is of concern to us about transmitting the disease.

MR. SKINNER: Next question, please.

QUESTION: Ann Carnes [sp], Wall Street Journal.

Hi. I joined the call a little late, so I apologize if I'm repeating a question here. But these prairie dogs were shipped for sale in pet shops for people to keep as pets in their homes as opposed to some sort of research purpose? Is that correct?

DR. RAWLINGS: Yes, prairie dogs are kept as pets. It's actually more common than you might think.

QUESTION: And have you identified the facility in Texas where the pets originated?

DR. RAWLINGS: Yeah, the distribution center was in Denton County, Texas. That county is just north of Dallas.

QUESTION: Does the facility have a name? I mean, is it a commercial enterprise?

DR. RAWLINGS: Yeah, it has a name. It's just that we generally don't give out the names of these facilities.

QUESTION: So you're not giving that out. I mean, has it been identified in press reports in Texas, for example? I mean...

DR. RAWLINGS: No, it hasn't.

QUESTION: Okay. Okay, thanks.

MR. SKINNER: Next question, please.

QUESTION: Regina McEnery [sp], Plain Dealer.

Yes, can you tell us which two states reported the sick or dead animals, reported having the sick or dead animals? And also, which of those states that you mentioned received the most dogs, and how many did those particular states receive?

MR. SKINNER: Dr. Dennis, I--you know, I don't know if you're prepared to go into that detailed information at this point, but--

DR. DENNIS: But Julie may have more information or more up-to-date information than I do. But we have heard about sick and dead animals in pet shops or dealers that--in Texas, other than the principal exporter; and as well in West Virginia. And then internationally, in the Czech Republic.

QUESTION: And the states that received most of the dogs, do you know what the breakdown...

DR. DENNIS: Let me see here.

MR. SKINNER: We might be--you know, if we don't have that readily available, we might be able to provide that to you after this call.

DR. DENNIS: I would say that most states received a hundred or fewer animals. It looks as if Texas received the most animals.

QUESTION: Okay.

MR. SKINNER: Next question, please?

QUESTION: John Lauerman, Bloomberg News.

Could you describe the circumstances under which--I understand that the disease takes different forms depending on how it is acquired. And can you describe the circumstances under which the most serious infections might take place? That is, I understand, like, a lung infection is most likely to cause serious disease.

DR. DENNIS: Yes, that's correct. Tularemia can take many forms depending upon where the germ was inoculated. If it's inoculated through the skin, it most typically results in an open sore and then in swollen, tender lymph nodes draining that sore--still accompanied by all the usual general systemic manifestations of illness--fever, chills, feeling of weakness.

If the organism is ingested, then it can cause--

QUESTION: In other words, if you eat it?

DR. DENNIS: Yeah, if you eat it or drink contaminated water, it can cause lesions in the mouth and throat and usually results in enlarged lymph glands in the neck region.

If you inhale it, you can get a primary pneumonia from tularemia, which is probably the most severe form.

Any form can result in what's called a typhoidal form of illness, in which the person has a general toxic reaction that people have when they have septicemia or [inaudible] of the organism in the blood stream. And that also can be very serious.

So it can result from inoculation through any means. As well, there can be secondary pneumonia that develops in persons who've been inoculated through the skin or mucous membranes.

QUESTION: So in other words, the serious consequences that could happen in an untreated person could happen no matter what the route of infection is? Or is the inhalation the most likely route, like, sort of, with anthrax, to cause a serious infection?

DR. DENNIS: No, I think you're right--the first. We take any infection as being potentially serious, because the organism often goes through the lungs or, if not treated early, can result in that systemic typhoidal type of disease.

MR. SKINNER: Next question, please.

QUESTION: Deborah Dennis [sp], Dallas Morning News.

Hi. Dr. Rawlings, I'm trying to find out where in Denton County specifically these prairie dogs may have been. And are there other towns in Texas?

DR. RAWLINGS: The facility in Denton County is in Lewisville. And the pet shops have been in Williamson County--I'm sorry, I don't--okay, it would be Belton, Houston, and Round Rock. And Arlington.

QUESTION: And Arlington. Okay, very good. Thank you.

QUESTION: Anita Manning, USA Today.

Oh, hi, I'm sorry. I had you on mute.

Just, finally, your--Tom, your mission here is to get people who have been handling animals that seem sick to call their own doctor or should they call a public health person? What are you telling them to do?

MR. SKINNER: I think--Dr. Dennis may allude to this, but I think we want people, if they've been handling, you know, a sick or dead prairie dog within the past three weeks or so to--if they--you know, they should contact their state and local health department or their health care provider right away. Is that correct, Dr. Dennis?

DR. DENNIS: Yes. And of course, if they have an illness with fever, chills, and other flu-like symptoms, they should be seen by a physician in the office without delay.

And I'd like to, sort of, emphasize the prevention methods that Tom was citing earlier. I mean, the investigation right now is to try to reach people who may have had contact with animals in the shipment of concern. And if they have been in contact with healthy animals, we think the risk is very small. If they've been in contact with sick or dead animals, then we have a concern and they should notify their health care provider and/or their health department about that situation. Because even though they may not be ill, it is possible to provide protection by giving preventive treatment with antibiotics.

MR. SKINNER: Okay, thanks, Jeanine, and thank you, everybody, for joining us on this conference call. I want to remind you that both the CDC and the Texas Department of Health have both put out press releases about this with featured website links with additional information on tularemia. Feel free to access those press releases, if necessary.

Thank you once again for joining us.

DR. DENNIS: Tom, just one last thing. I think you introduced Julie Rawlings as Lisa Rawlings.

MR. SKINNER: Oh, I'm sorry. Gee whiz, yes. I'm sorry. Yeah, Julie Rawlings. My apologies.

DR. DENNIS: All right. Thank you.

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