Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
A One Health Approach to Detecting and Reporting Non-Native Zoonotic Pathogens
How can a stray kitten spark an investigation that spans hundreds of miles and delves into the heart of zoonotic disease control? Join us as Dr. Anne Carpenter and Dr. Ryan Wallace unravel the surprising discovery of a raccoon rabies virus variant found far from its expected territory. Their expertise sheds light on the critical yet often unseen role veterinarians play in identifying and reporting zoonotic diseases, underscoring the need for vigilance and the diverse career opportunities within the profession. Through their stories, you'll gain insights into the complexities of rabies diagnostics and the vital need for maintaining rabies as a differential diagnosis in unexpected regions.
Dive deeper into the intricacies of rabies transmission and the pivotal role of vaccination, especially within the context of stray and domestic animals. Anne shares the invaluable lessons from her public health journey, emphasizing the importance of a One Health approach and the exciting potential of AI-driven models in assessing rabies risks. This episode offers a unique window into the rewarding and multifaceted world of veterinary medicine beyond the clinic doors.
JAVMA article: https://doi.org/10.2460/javma.24.08.0542
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You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about the identification of raccoon rabies virus variant in a stray kitten with our guests Anne Carpenter and Ryan Wallace.
Lisa Fortier:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today, we have Anne and Ryan joining us to talk about the ever-important and popular topic of rabies. Anne and Ryan, thank you so much for being here with us today.
Anne Carpenter:Thank you so much for the opportunity to join you.
Sarah Wright:All right, let's dive right in, Anne. Your JAVMA article discusses the identification of raccoon rabies virus variant in a stray kitten. Please share with our listeners the background on this article.
Anne Carpenter:Thanks so much, Sarah. This article describes an investigation that we collaborated with Nebraska and USDA on following the identification of rabies virus variant that was specific to raccoons in a stray kitten, and the unique aspect of this investigation wasn't that rabies virus variant that was specific to raccoons in a stray kitten, and the unique aspect of this investigation wasn't that rabies was identified in a kitten, but rather that it was the raccoon variant rabies which was found in an area around Omaha, Nebraska, about 850 miles from where the variant is known to exist. 850 miles from where the variant is known to exist and so when this case was identified and sequenced, a number of different questions came to light, and the first was where did this variant come from?
Anne Carpenter:Was it already circulating in the area, or was this kitten moved from an area endemic for the rabies virus variant specific to raccoons, and it just so happened that we caught it early? And the second question was this was a stray kitten, so exposure information was unknown, so we didn't know if the kitten had been exposed by a wild animal or if it had exposed any other animals or people. And this is relevant because multiple agencies, but most notably USDA Wildlife Services, have spent a great deal of time and resources keeping this variant east of the Appalachian Mountains. And this case was detected by a very astute veterinarian who, despite practicing in a part of Nebraska where rabies is rarely seen in domestic animals, still tested this kitten. And so our report describes the One Health approach that we took to answering these questions and the really critical role that veterinary practitioners play in detecting and reporting these unique instances of disease.
Sarah Wright:Kudos to that veterinarian. It's always so important to keep things on our list, even if we think that might not be possible, just always having an open mind. So, Anne, what are the important take-home messages from this JAVMA article?
Anne Carpenter:There are a couple of important take-home messages for the veterinary community in this article. The identification of the raccoon variant rabies in the kitten really serves as an important reminder about the role of veterinarians in testing and reporting zoonotic and, in this case, high-consequence diseases. In this instance, the veterinarian who examined the kitten noted that he had a potential wound on his head and it was unclear whether or not this was a bite or it was ringworm or it was something else, but either way, it was unclear whether or not this was a bite or it was ringworm or it was something else, but either way it was suspicious. Additionally, the kitten was estimated to be about six weeks old, so he was too young to have received a rabies vaccine and, being a stray, he had an unknown exposure history and, lastly, he had nondescript but progressive neurological signs. And, lastly, he had nondescript but progressive neurological signs. And so again, even though rabies hadn't been identified in this part of the state in domestic animals in quite some time, it was important that he was tested and the clinician who tested him was really instrumental in the case identification and the resulting investigation.
Anne Carpenter:And there are about 300 to 500 rabid domestic animals in the US every year, and so most practitioners are unlikely to ever encounter a situation like this, but it should be on the differential list in circumstances like this certainly, and I think on a separate note. This investigation really highlighted the diversity of roles that we as veterinarians can play outside of general practice. We had veterinarians who were working in public health, at the state level, in different federal agencies, at the local level, in shelter clinics, working as laboratorians at the state with wildlife and in a number of other capacities, and I think it really just goes to show our versatility as a profession.
Lisa Fortier:Yeah, that's awesome. I think that's one of the best things is like. Being a veterinarian is the coolest job on earth. Yes, I agree. More specifically, Anne, what sparked your interest in zoonotic diseases?
Anne Carpenter:You know, I think as soon as I realized it was a career option, I was interested in it. I was very fortunate in veterinary school to have lots of exposure to career pathways that were outside of the clinic, and working as an epidemiologist and with zoonotic diseases is always something that has appealed to me. Since that school I have been really fortunate to have wonderful mentors, like Ryan, who have taught me how rewarding and unique this area of work is. Every day is different, which I think we're very lucky to say, and the impact of the work that we do can be quite far reaching, and I think that that holds a lot of appeal to me.
Lisa Fortier:Sarah knows what I'm going to say. One of my favorite sayings is every day is a school day, and that's one of the best parts of our profession the ever changing and the one health approach that you and Ryan have so nicely outlined in this article.
Anne Carpenter:Every day is a surprise.
Lisa Fortier:A surprise and maybe I'll change it a surprising school day.
Anne Carpenter:Yeah, in a positive way you know?
Lisa Fortier:Oh for sure. Yeah, Sarah asked you a little bit earlier what some of the take home messages were, but every time you do an investigation like this, something surprises you. What did you and Ryan find that was surprising in this article?
Anne Carpenter:better expert more than me was that this variant wasn't where it was supposed to be. The raccoon variant is supposed to be 850 miles east, and so identifying it in Omaha was a surprise right off the bat. But I think that as we worked on the investigation, the thing that struck me most was how wonderful our collaborators were and how well these groups worked together. And this was a fairly complex and time-sensitive investigation and there was a lot of opportunity where folks could have gotten a little bit territorial and I said this is my jurisdiction, Not been interested in collaborating, but we were really really fortunate to work with the partners that we did, and you know we had incredible collaborators at the state, with USDA Wildlife Services, with the lab team at CDC and the county, and I think those relationships really helped us get the work done as efficiently and seamlessly as we could.
Ryan Wallace:I was surprised just how easy it is to move an animal with rabies across the United States.
Ryan Wallace:The lack of knowledge as we talk to people in other states about vaccination requirements and there are vaccination, rabies, vaccination requirements and health certificates moving between states. I think very few people do that. There were multiple college campuses in this area of Omaha and lots of students coming in and out and it was almost impossible for us to reach out and figure out. Well, did a college student bring a rabid cat from North Carolina? And we still don't know the answer to how this cat got there. So just how easy it is in our really connected systems here in the US to move animals, but they're going to bring their diseases with them.
Lisa Fortier:A little bit terrifying, Ryan, as a subject matter expert in rabies and a nicely shout out to a good mentor that you are. What do you see as the next steps? Research in this topic.
Ryan Wallace:Yeah, a lot of what we do at CDC is more on the operational research, especially for investigations like this. A lot of what we do at CDC is more on the operational research, especially for investigations like this, and I think this case demonstrated a couple of really important things we will take on to. Hopefully we won't have another event like this, but we almost certainly will. I think this set the stage for what how we will react in the next ones. First, like Anne said, we have three to five hundred rabid domestic animals every year, and there are three to five thousand rabid animals diagnosed in the US every year. The only reason this one sparked the investigation it did was because the lab did some additional testing to show what variant of the virus it was, and so we knew it was in the wrong place. We can't do that for 4,000 animals a year. They're relatively expensive tests and these are public health systems that you know. All of that funding is incredibly important to go somewhere. We can't test everything to say where did it come from?
Ryan Wallace:This case was kicked off because of a very small funding grant that CDC gives to the states. That allowed Nebraska to do this special test on a small subset. So one of the things moving forward, we have to figure out better algorithms for doing this, advanced testing on the right animals where a big response like this is gonna need to be enacted, and so those are lessons we'll take forward. One other great thing that came out of this there's this big response we described. There were sample size goals that were established based on some really loose on the fly models that we had to create to just define what this response would look like, and in July we met those goals, and so we've got now a response activity. We have data and surveillance and we have time, a time component where no more positive animals were found. That again a great lesson for how this can be done effectively in the future, because this certainly will happen again.
Lisa Fortier:And, given that and need for algorithm and sample size calculation and being quick, do you see a role for AI in this area of research?
Ryan Wallace:Yeah, I think AI is going to play a role hopefully a beneficial role for all of our jobs in the future. One of the problems we had early on was trying to understand what is the right size for this type of investigation. We did hear it's one rabid cat. Why should we be concerned? And we can explain the dangers of rabies, and most people are convinced when we talk about that. But a lot of questions came up of how long has it been here and how do we know? How far could it spread? What impact will that have on people and vaccine supplies and our animals and, especially in that part of the country, livestock?
Ryan Wallace:And we were able to, through some really intensive modeling and very fast modeling, answer some of this. But we've already advanced some of this into AI-driven models. We have a paper that was published just last month, more with our international work, but is utilizing machine learning to try to develop these models and understand rabies risk and transmission much faster. Like I said, I think this investigation created the ideal template of collaboration and science and response and now we need to take those lessons and utilize these new tools like AI to formalize them, make them easily reproducible and implementable.
Sarah Wright:That's fascinating, super cool and, for those of you just joining us, we're discussing the identification of raccoon rabies virus variant in a stray kitten with our guests Anne and Ryan. Anne, how did your training or previous work prepare you to write this special report?
Anne Carpenter:Thanks, Sarah. I worked on this investigation during my time as an epidemic intelligence service officer at CDC or EIS, and this is a two-year fellowship in applied epidemiology for veterinarians and other professionals, primarily MDs and PhDs, and so part of the EIS training involves surveillance, evaluations and field investigations and public communication training, which you know sometimes we're a little short of coming out of vet school, so having this more structured training program was extremely helpful, as well as you know all of the knowledge that our collaborators had and our mentors, and did a great job preparing us for this sort of field investigation and response.
Sarah Wright:Now, this next set of questions is going to be very important for our listeners, anne, what is one piece of information the veterinarian should know about the role of veterinary practitioners in the detection and reporting of a non-native zoonotic pathogen?
Anne Carpenter:We, as veterinarians, are in a fairly unique position where we all play a public health role, whether we are aware of it or not.
Anne Carpenter:And part of that is identifying and reporting zoonotic diseases that are reportable in your state, and this kitten was tested and confirmed. Because a savvy clinician suspected rabies, she alerted her local health department and this allowed multiple people to receive post-exposure prophylaxis following their rabies exposures. And the decisions that we make as veterinarians really have the potential to impact not only the animals that we're providing care for, but our veterinary staff who may have been exposed, our pet owners, other animals in the household and the public, and in most cases, there is also a legal requirement to report certain zoonotic diseases.
Sarah Wright:On the other side of the relationship. What's one thing the public should know about the identification of raccoon rabies virus variant in a stray kitten?
Anne Carpenter:The public should exercise good judgment when they're interacting with stray and free-roaming animals, and they should call their health department and seek health care if they are concerned that they may have been exposed to an animal with rabies.
Ryan Wallace:And I can just add to that rabies is found in wildlife in every state in the United States except Hawaii. So if the public is interacting with wildlife, especially stray animals and now stray cats are one of the highest risk for rabies in the United States amongst our domestic animals you do need to be thinking about the zoonotic diseases wildlife and stray animals might have that you're bringing into your home or maybe transporting across the United States. So a veterinary assessment if you're going to bring one of these animals in and getting it. It's vaccines For this kitten. It was too young to be vaccinated, so that is an unfortunate reality of some situations.
Ryan Wallace:But looking back at this case, it's probably likely it was actually the kitten's mother that was translocated. That's probably the most plausible scenario here. That kitten's mother probably died of rabies and was never found. We see very little of actual wildlife or stray animal rabies in the United States because of the way our surveillance systems operate. But there probably was an opportunity prior to transport of the original animal to Omaha to get it vaccinated and this never would have happened.
Lisa Fortier:Yeah, fascinating. I've learned so much from you guys and thank you for sharing also in the joy of our profession and alternate career paths. That's really important to get out there to other veterinarians as well. As we wind down a little bit, we like to ask a little bit of a personal question. So for Ryan, for you, if you could have a superpower, what would it be and why?
Ryan Wallace:It would be the power of flight and because I spent when I was also in the same training program and was just a little bit longer ago, and so my first 10 years at CDC I was traveling largely international, 25 to 40% of the year and through all that I now really am reluctant to get on an airplane. I spend too much time on them. It's gotten way more complicated. If I could just step outdoors, fly where I need to go to address rabies and fly back, that would make my day.
Lisa Fortier:HR will probably get me for this one, but you do look a lot like Clark Kent, so I don't know why you don't have that power already?
Ryan Wallace:Hang on, I can do this.
Lisa Fortier:There you go, and for you, what is the oldest or the most interesting item on your desk or in your desk drawer?
Anne Carpenter:The oldest item is a glass insulator cap that I collect as decorations and sometimes paperweights, and the one that is on my desk is teal, which are sometimes harder to find, but you know, it gives me something to look for and they're sort of pretty to look at and reminiscent of some other time.
Lisa Fortier:They're very cool.
Sarah Wright:Yeah, that's awesome. Also, my cat decided to join us. I think she's like oh hey, you're talking about cats, I'm here. Thank you so much, Anne and Ryan Really appreciate you being here today and for submitting your article to JAVMA.
Ryan Wallace:Thanks for having us.
Sarah Wright:Thanks so much, Sarah, For our listeners. You can read Anne and Ryan's article in Javma. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
