Download Food Animal Veterinarian Presentation

Bioterrorism
Awareness:
Protection of
Human and Animal
Health
Food animal producers
Why Are We Here?
•
September 11, 2001
changed many things
− Worst
terrorist act in U.S.
history
− More than 3,000 presumed
dead
− Occurred on American soil
− Increased sense of
vulnerability
Center for Food Security and Public Health
Iowa State University 2005
Biological Attack
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Bioterrorism attacks of 2001
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Anthrax in postal system
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22 cases
5 deaths
U.S. public health realm changed
forever
Center for Food Security and Public Health
Iowa State University 2005
Overview
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Bioterrorism
Zoonoses and bioterrorism
Disease control and biosecurity
U.S. Government agencies involved
Bioterrorism agents/diseases
Your role and responsibility
Center for Food Security and Public Health
Iowa State University 2005
Terrorism
Agroterrorism
Biological,
chemical or
radiological
agents targeting
agriculture or its
components
•Livestock
•Food supply
•Crops
•Industry
•Workers
Bioterrorism
Biological agents
targeting humans,
animals, or plants
Other
Conventional,
radiological,
nuclear,
chemical,
cyber
•Typically
direct
human
targeting
Center for Food Security and Public Health
Iowa State University 2005
Characteristics of a
Biological Attack
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Difficult to detect release
Dissemination may cover large area
Possible secondary spread
Recognition of agent may be delayed
days to weeks
Difficulties in catching perpetrator
Center for Food Security and Public Health
Iowa State University 2005
Infectious Disease Outbreak
Exposure
Symptoms
No. Affected
Seek Care
Time (Days)
Center for Food Security and Public Health
Iowa State University 2005
Clues Suggesting Biological
Agent Release
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Clustering of morbidity or mortality
− Temporally
or geographically
− Large numbers of animals and/or people
− Atypical symptoms
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Normally healthy people affected
Unusual symptoms for area
Unusual age distribution
Disease occurring outside typical
season
Center for Food Security and Public Health
Iowa State University 2005
Many Agents are Zoonotic
Zoonotic means a disease transmitted
from animals to humans
• Disease may be seen in animals before
humans
• Animals are sentinels
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Pets, livestock,
wildlife
Center for Food Security and Public Health
Iowa State University 2005
Factors That Promote
Transmission of Zoonoses
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Frequent contact with
domestic or wild animals
Overlap with wildlife habitat
Intensive livestock production
Poor animal sanitation
Poor personal hygiene
Poor animal health
Center for Food Security and Public Health
Iowa State University 2005
Routes of Transmission
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Direct contact
Gel, liquid, powder
− Scratches
− Droplet spray onto mucous membranes
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Indirect: Ingestion, injection
Contaminated food, water
− Vector
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Aerosol
Center for Food Security and Public Health
Iowa State University 2005
Disease Control:
Client Education
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Disinfect/clean up areas
contaminated with animal waste
− Livestock,
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pets, wildlife, rodents
Basic hygiene
− Wash
hands
− Child supervision
Center for Food Security and Public Health
Iowa State University 2005
Zoonoses Control
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Proper pet selection
Use caution at petting zoos
Cook food properly
Control strays
Visit and communicate with physician
and veterinarian
Follow guidelines for
immunocompromised people
Center for Food Security and Public Health
Iowa State University 2005
Biosecurity Education
for the Producer
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Develop and implement
a biosecurity plan
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Train employees to help
maintain the plan
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Post signs restricting
access to areas of the
farm and control traffic
flow
Center for Food Security and Public Health
Iowa State University 2005
Biosecurity Education
for the Producer
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Regulate visitors
Keep visitors sanitary
− Clean
clothing, boots
− Disposable plastic
shoe/boot covers
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Implement insect,
bird and animal control
Secure water, feed, and nutrient
sources
Center for Food Security and Public Health
Iowa State University 2005
Biosecurity Education
for the Producer
Maintain healthy herd
− Vaccinations
− Proper hygiene for
animals and handlers
• Purchase from
reputable sources
• Quarantine newly
purchased animals
• Separate sick animals
•
Center for Food Security and Public Health
Iowa State University 2005
U.S. Agencies
Dealing with terrorism
Public Health Security and Bioterrorism
Preparedness Response Act of 2002
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June 12, 2002
Improve ability of the U.S. to
prevent, prepare for, and respond to
bioterrorism and other public health
emergencies
$4.3 billion to various federal, state
and local agencies
− Upgrade
facilities, enhance security, etc
Center for Food Security and Public Health
Iowa State University 2005
Department of Homeland
Security (DHS)
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Established January, 2003
Mission
− Prevent,
protect, and respond to acts of
terrorism on U.S. soil
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Established four policy directorates
− Responsibilities
for coordinating HHS and
USDA
− Guard borders and airports, coordinate
the response for future emergencies,
analyze threats and intelligence, protect
our critical infrastructure
Center for Food Security and Public Health
Iowa State University 2005
Centers for Disease Control
and Prevention (CDC)
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CDC's Mission
− Promote
health and quality
of life by preventing and
controlling disease, injury
and disability
• Preparing for bioterrorism since 1998
• One of first agencies to respond to anthrax
incidents of 2001
Center for Food Security and Public Health
Iowa State University 2005
Strategic National Stockpile
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12-hour Push Package
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Complete package of
medical materials
Vendor Managed Inventory
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Tailored to suspected agents
Center for Food Security and Public Health
Iowa State University 2005
Insert Your State’s Info Here
Center for Food Security and Public Health
Iowa State University 2005
Preparing Iowa
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Iowa’s Homeland
Security
− Administered
by
Iowa Emergency
Management
Division
− Works with public
and private
partners
www.iowahomeland
security.org
Center for Food Security and Public Health
Iowa State University 2005
Preparing Iowa
Iowa Department of Public Health
www.idph.state.ia.us/odedp
• Iowa Department of Agriculture and
Land Stewardship
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Highly infectious animal disease program
− IRVIN: Iowa Rapid Veterinary Information
Network
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CFSPH training veterinarians to educate
others
Center for Food Security and Public Health
Iowa State University 2005
Category ABC
Agent Overview
Classification
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Prepared by the CDC’s Bioterrorism
Preparedness and Response Office
Category A: Highest priority
Category B: Second highest priority
Category C: Third highest priority
Center for Food Security and Public Health
Iowa State University 2005
“Weaponization” of Agents
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Alter characteristics of an agent,
allowing it to cause a more serious
disease
− Enhance
transmission
− Increase virulence
− Resistant to antibiotics
− Evade vaccine protection
− Alter clinical signs

Harder to diagnose
Center for Food Security and Public Health
Iowa State University 2005
Note to presenter
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As time allows select diseases you would like
to review.
If you have limited time you should focus on
the Category A agents.
The disease coverage is brief. If you would
like more information on a disease, refer to
the fact sheet or to the disease specific
presentation.
Center for Food Security and Public Health
Iowa State University 2005
Category A : Agents/Diseases
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Anthrax
Botulism
Plague
Smallpox
Tularemia
Viral hemorrhagic fevers
Center for Food Security and Public Health
Iowa State University 2005
Anthrax: The Agent
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Bacteria: Bacillus anthracis
Forms spores
Human disease
− Skin
− Intestinal
− Inhalation
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Animal disease
− Spreads
through the body
− Rapid death
Center for Food Security and Public Health
Iowa State University 2005
Anthrax: The Response
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Vaccine
− Humans
− Animals
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Antibiotics
− Treatment
− Prevention
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Hardy in environment
− Difficult
to disinfect
Center for Food Security and Public Health
Iowa State University 2005
Botulism: The Agent
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Clostridium botulinum – Gram pos,
spore-forming bacteria
7 different neurotoxins
− Types
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A-G
Clinical signs
− Flaccid paralysis
− Pigs, dogs and cats
fairly resistant
Center for Food Security and Public Health
Iowa State University 2005
Botulism: The Response
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Toxoids for high risk people
Antitoxin available
− Case-by-case
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basis
Spores destroyed by moist
heat
Center for Food Security and Public Health
Iowa State University 2005
Plague: The Agent
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Yersinia pestis
− Gram
neg, transmitted by
fleabites, aerosol, direct contact
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Symptoms: Humans
− Bubonic,
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septicemic, pneumonic
Symptoms: Animals
− Cat:
Similar to human
− Dogs, livestock: Somewhat
resistant
Center for Food Security and Public Health
Iowa State University 2005
Plague: The Response
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Antibiotics generally effective if given
early
Killed vaccine available
Isolation of sick individuals
Susceptible to a number of common
disinfectants
Center for Food Security and Public Health
Iowa State University 2005
Smallpox: The Agent
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Variola virus
Eradicated from the world in 1977
Narrow host range: Humans only
Transmission: Person-to-person,
contaminated items
Clinical signs
− Flu-like,
progressive skin
eruptions
Center for Food Security and Public Health
Iowa State University 2005
Smallpox: The Response
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No specific treatment
Vaccine has side effects
Vaccination of health care personnel
Isolation of infected individuals
Disinfection of clothing etc. with
steam, fire or bleach
Center for Food Security and Public Health
Iowa State University 2005
Tularemia: The Agent
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Francisella tularensis
Transmitted by ingestion,
inhalation, vectors, direct
contact through skin
Six clinical forms in humans
Glandular
Ulceroglandular
Center for Food Security and Public Health
Iowa State University 2005
Tularemia: The Agent
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Sheep, young pigs, horses,
dogs, cats
• Sudden
fever, lethargy, stiffness,
prostration and death
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Wildlife
• Usually
find dead
• Rabbits behave strangely
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Cattle, older pigs resistant
Center for Food Security and Public Health
Iowa State University 2005
Tularemia: The Response
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Person-to-person transmission not
documented
Antibiotics effective if early or
preventative
Vaccine
− For
high risk individuals
− Unknown effectiveness
against inhalation
tularemia
Center for Food Security and Public Health
Iowa State University 2005
Viral Hemorrhagic Fevers:
The Agents
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Ebola, Marburg, Lassa, Machupo
Human clinical presentation
− Early:
Fever, fatigue
− Severe: Bleed from internal
organs, body orifices
− Progression to shock,
seizures
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Vincent Massey
Animals: Only non-human
primates susceptible
Center for Food Security and Public Health
Iowa State University 2005
VHF: The Response
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Intensive supportive care
Antiviral medications have shown
some efficacy
Susceptible to various disinfectants
Center for Food Security and Public Health
Iowa State University 2005
Category B: Agents/Diseases
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Brucellosis
Glanders
Melioidosis
Psittacosis
Q Fever
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Typhus fever
Viral encephalitis
Toxins
Food Safety Threats
Water Safety Threats
Center for Food Security and Public Health
Iowa State University 2005
Brucellosis: The Agent
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Bacteria: Brucella spp.
Transmission by
− Ingestion
− Inhalation
− Direct
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contact
Clinical signs
− Humans:
Cyclic fever
and flu-like symptoms
− Animals: Reproductive signs
Center for Food Security and Public Health
Iowa State University 2005
Brucellosis: The Response
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Long term antibiotics generally
effective
Vaccinate calves, no human vaccine
Eliminate reservoir
Standard precaution
to avoid exposure
Thorough disinfection
Center for Food Security and Public Health
Iowa State University 2005
Glanders: The Agent
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Bacteria: Burkholderia mallei
Transmission by
ingestion, inhalation or
direct contact
− Animal-to-human
transmission is inefficient
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Clinical signs
− Humans
& horses: Cutaneous &
pulmonary lesions, rapidly fatal illness
Center for Food Security and Public Health
Iowa State University 2005
Glanders: The Response
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No vaccine
Antibiotic therapy likely effective
Destroyed by various chemicals
Center for Food Security and Public Health
Iowa State University 2005
Melioidosis: The Agent
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Bacteria: Burkholderia
pseudomallei
Transmission: Contact,
ingestion, inhalation
Clinical signs: Humans,
sheep, goats and pigs
− No
symptoms to
pneumonia, lung and
wound abscesses
Center for Food Security and Public Health
Iowa State University 2005
Melioidosis: The Response
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Long-term, multiple
antibiotics effective
Vaccine not
available in U.S.
Easily destroyed by
disinfectants
Center for Food Security and Public Health
Iowa State University 2005
Psittacosis: The Agent
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Bacteria: Chlamydophila psittaci
Occurs worldwide
Reportable in U.S.
Clinical disease
− Humans
and birds:
Ranges from no symptoms to systemic
illness with severe pneumonia
Center for Food Security and Public Health
Iowa State University 2005
Psittacosis: The Response
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Antibiotics
generally effective
Decontamination
possible with most
disinfectants
Center for Food Security and Public Health
Iowa State University 2005
Q Fever: The Agent
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Bacteria: Coxiella burnetii
Transmission: inhalation,
contact, ingestion, ticks
Disease symptoms
direct
− Humans:
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Acute: Flu-like, pneumonia, liver disease
Chronic: Heart complications, bone
inflammation
− Animals:
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Most have no signs
Sheep, cattle and goats: Abortions
Center for Food Security and Public Health
Iowa State University 2005
Q Fever: The Response
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Antibiotic therapy may limit the
disease
Vaccine developed, not available in
U.S.
Some disinfectants are effective
Center for Food Security and Public Health
Iowa State University 2005
Typhus Fever: The Agent
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Bacteria: Rickettsia prowazekii
Endemic in Eastern Europe, Middle
East, and parts of Africa
Transmitted in feces
of human body louse
Clinical signs: Humans
J. Kalisch
− Fever,
headache, red blotches, and a
red-dot rash
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Not seen in domestic animals
Center for Food Security and Public Health
Iowa State University 2005
Typhus Fever: The Response
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Antibiotics are generally effective
Vaccine, not commercially available
Center for Food Security and Public Health
Iowa State University 2005
Viral Encephalitis: The Agent
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Viruses causing EEE, WEE, and VEE
Transmitted via mosquito
Clinical signs
− Humans,
horses, donkeys,
mules: Often no signs to
flu-like illness
− Brain inflammation in
some patients
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Birds do not become ill but are
carriers; act as sentinels
Center for Food Security and Public Health
Iowa State University 2005
Viral Encephalitis:
The Response
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Supportive care
Vaccine
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Virus cannot live
in environment
− Equine
− Human:
high risk
Center for Food Security and Public Health
Iowa State University 2005
Toxins: The Agents
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Staphylococcal
enterotoxin B (SEB)
Ricin toxin from
castor plant
Clostridium
perfringens epsilon
toxin
Center for Food Security and Public Health
Iowa State University 2005
SEB: The Agent
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Staphylococcal enterotoxin B (SEB)
A common cause of food poisoning
Clinical signs: Humans
− Fever,
chills, headache, aches
− Non-productive cough if inhaled
− GI signs if ingested
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Animals: Likely similar to human
Center for Food Security and Public Health
Iowa State University 2005
Ricin: The Agent
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Ricin toxin from bean of castor plant
Available worldwide
Clinical signs
− Acute
onset of fever,
chest tightness, cough,
dyspnea, nausea
Center for Food Security and Public Health
Iowa State University 2005
Epsilon Toxin: The Agent
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Clostridium perfringens type B and D
Increases intestinal and vascular
permeability, liver and neurological
damage
Clinical signs
− Calves:
Diarrhea, abdominal pain,
listlessness, neurologic
− Sheep, goats: Watery to bloody
diarrhea, neurologic
− Humans: Little information
Center for Food Security and Public Health
Iowa State University 2005
Toxins: The Response
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Supportive care
No vaccines currently available for
SEB or ricin
Vaccines for animals for clostridial
disease
Toxins are inactivated with common
disinfectants
Center for Food Security and Public Health
Iowa State University 2005
Food Safety Threats
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Campylobacter species
Salmonella species
E. coli 0157:H7
Viruses, parasites,
chemicals, toxins
Ingestion of
contaminated food
Gastrointestinal upset
Center for Food Security and Public Health
Iowa State University 2005
Food Safety Threats:
The Response
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Constant vigilance to
improve food safety
Food irradiation at
processing plants
Wash hands and
utensils frequently
Proper cooking
temperature and
storage
Center for Food Security and Public Health
Iowa State University 2005
Water Safety Threats
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53% of US drinking
water is from ground
water
Cryptosporidium
parvum- protozoa
Vibrio choleraebacteria
Center for Food Security and Public Health
Iowa State University 2005
Cryptosporidium: The Agent
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Cryptosporidium parvum- protozoa
Transmission: Inhalation, ingestion
Clinical signs: Humans, calves,
others
− Acute
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gastroenteritis
Dogs, cats, horses, pigs: Resistant
Center for Food Security and Public Health
Iowa State University 2005
Vibrio cholerae: The Agent
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Vibrio cholerae- bacteria
Transmission: fecal-oral,
contaminated shellfish
Clinical signs: humans
− Acute,
mild diarrhea
− 5% severe disease
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Animals are resistant to
disease
Center for Food Security and Public Health
Iowa State University 2005
Water Safety:
Public Health Significance
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Cryptosporidum parvum
− 1993:
Municipal water supply
contaminated in Milwaukee
− 40,000 ill
− 1997: Decorative water fountain at the
Minnesota Zoo
− 369 cases
− Mostly young children
Center for Food Security and Public Health
Iowa State University 2005
Water Safety Threats:
The Response
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Government has laws
to protect our water
supply
Treatment facilities
are equipped and will
likely inactivate most
organisms
− Chlorination,
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filtration, ozone
Dilution factor
Center for Food Security and Public Health
Iowa State University 2005
Category C
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Nipah virus
Hantavirus
Center for Food Security and Public Health
Iowa State University 2005
Nipah Virus: The Agent
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Fruit bats
Clinical signs
− Humans:
Brain inflammation
− Pigs: Respiratory; neurological
− Dogs and cats: “Distemper”
Center for Food Security and Public Health
Iowa State University 2005
Nipah Virus: The Response
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Avoid contact with all
infected animals and
fluids
Vaccine being researched
Call authorities
immediately
Center for Food Security and Public Health
Iowa State University 2005
Hantavirus: The Agent
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Bunyaviridae family
Asymptomatic reservoir: Rodents
Transmission: Inhalation,
ingestion, direct contact
Human clinical signs
− Fever,
myalgia, headache
− Hantavirus Pulmonary Syndrome
− Hemorrhagic Fever with Renal Syndrome
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Not seen in domestic animals
Center for Food Security and Public Health
Iowa State University 2005
Hantavirus: The Response
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Supportive care
Limit exposure to
rodent excrement
Virus is deactivated
with bleach
Center for Food Security and Public Health
Iowa State University 2005
Other Important
Diseases
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Transmissible Spongiform
Encephalopathy (TSE)
Rift Valley Fever
Hendra Virus
West Nile Virus
Foot and Mouth Disease
Monkeypox
Center for Food Security and Public Health
Iowa State University 2005
Transmissible Spongiform
Encephalopathy: The Agent
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Prions
− Proteinaceous
infectious particles
− Mutated proteins
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Very long incubation period
Neurological signs in all species
No treatment available
Center for Food Security and Public Health
Iowa State University 2005
Bovine Spongiform
Encephalopathy
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“Mad cow disease”
Incubation: 2 to 8 years
1995, United Kingdom
− vCJD
− People
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exposed to BSE
Before bovine offal ban in
1989
Active U.S. surveillance
since 1990
Center for Food Security and Public Health
Iowa State University 2005
TSE: The Response
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Very resistant
− Heat,
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sterilization and disinfectants
Early identification not possible
− Lack
of host immune response
− Long incubation period
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No effective treatment or vaccine
Surveillance program
Import restrictions
Center for Food Security and Public Health
Iowa State University 2005
Rift Valley Fever: The Agent
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Virus
Transmission: mosquito, inhalation,
contact with infected body fluids
Clinical signs
− Humans:
headache

Flu-like, fever,
Severe disease: Vision
complications, bleeding
with fever
− Animals:
Abortions, death in newborns
Center for Food Security and Public Health
Iowa State University 2005
Rift Valley Fever:
The Response
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Vaccinate ruminants in
endemic areas
Control mosquitoes
Avoid contact with
infected tissues & blood
− Wear
•
protective clothing
No person-to-person
transmission
Center for Food Security and Public Health
Iowa State University 2005
Hendra Virus: The Agent
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Newly discovered
−
Australia
Fruit bats
• Transmission: Urine, body fluids
• Incubation: 6-18 days
• Humans
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Flu-like illness, respiratory failure
Horses, cats
−
Acute respiratory signs, nasal discharge,
fever, encephalitis, sudden death
Center for Food Security and Public Health
Iowa State University 2005
Hendra Virus: The Response
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Little is known about disease
Potentially serious consequences
− High
death rate
− Lack of treatment
Center for Food Security and Public Health
Iowa State University 2005
West Nile Virus: The Agent
Flavivirus
• Transmission
•
Mosquitoes: Culex species
− Blood transfusion, organ
donation, breast feeding
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Animals: Horses, birds,
mammals and reptiles
• Humans
•
Duration: 3-6 days
− 80% have no signs
− 20% develop “West Nile Fever”
−
Center for Food Security and Public Health
Iowa State University 2005
West Nile Virus:
Public Health Significance
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Human illness in U.S. in 2003
− 9,100
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cases, 222 deaths
Horses illness in U.S. in 2003
− 4,554
cases
− 40% of ill result in death
•
Method of introduction to U.S.
unknown
*data current as of 1/30/04
Center for Food Security and Public Health
Iowa State University 2005
Spread of WNV in the U.S.:
1999-2002
Center for Food Security and Public Health
Iowa State University 2005
West Nile Virus:
The Response
Treatment: Supportive care
• Vaccine available for horses, not humans
• Source elimination
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Mosquito larval habitats
Personal protection
Reduce time outdoors
− Wear long pants and sleeves
− Use mosquito repellent
−
Center for Food Security and Public Health
Iowa State University 2005
Foot and Mouth Disease: FMD
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Picornavirus
Transmission: Direct contact,
aerosol, fomites
Species: Cloven-hooved
animals (not horses)
Signs: Fever, vesicles,
salivation, lameness
Extremely rare, mild
symptoms in people
Center for Food Security and Public Health
Iowa State University 2005
FMD: Agroterrorism Threat
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Most important livestock disease
in the world
U.S. agriculture as a target
− One
sixth of the U.S. domestic
product is tied to agriculture
− Immunologically naive population
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Vulnerabilities
− Increased
travel, poor biosecurity
Center for Food Security and Public Health
Iowa State University 2005
FMD: The Response
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USDA upgrading safeguarding
measures
Strict biosecurity
Notify authorities immediately
Response and
recovery plans
− Quarantine
− Depopulation
− Disinfection
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Vaccination – complex decision
Center for Food Security and Public Health
Iowa State University 2005
Monkeypox: The Agent
Orthopoxvirus, related to
smallpox
• Transmission
•
Reservoir may be African
squirrel
− Bites, aerosol, direct contact
− Zoonotic, animal-to-animal,
person-to-person
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Animals: Fever, rash,
pustules, red eyes
• Humans: Flu-like, rash,
pustules, swollen lymph nodes
•
Center for Food Security and Public Health
Iowa State University 2005
Monkeypox:
Public Health Significance
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2003 U.S. Outbreak
Zoonotic disease
− 6 Midwestern states
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Animal illness
Suspect cases: 93
− Confirmed cases: 10
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Human illness
Suspect cases: 72
− Confirmed cases: 37
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
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All had contact with infected prairie dogs
Potential bioweapon
Center for Food Security and Public Health
Iowa State University 2005
Monkeypox: The Response
Treatment: Supportive care
• Smallpox vaccination
•
Moderately protective (85% of cases)
− 30 individuals in 2003, no adverse events
−
•
Infection Control
EPA registered detergent disinfectant
− 0.5% sodium hypochlorite (bleach)
−
Embargo
• Euthanasia of animals
• Quarantine for 6 weeks
•
Center for Food Security and Public Health
Iowa State University 2005
Conclusion
What to do if bioterrorism
is suspected
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Stay informed and remain calm
Response is event specific
Response is everyone's responsibility
Follow the advice of public health
officials
Follow federal and state guidelines
Movement restrictions may be
necessary
Center for Food Security and Public Health
Iowa State University 2005
Contacts
•
Phone numbers to know
− Local
veterinarian
− Local physician
− Public health officials
Center for Food Security and Public Health
Iowa State University 2005
Summary
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•
•
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Bioterrorism is a real threat
Public health infrastructure is being
strengthened
Many bioterrorism agents are
zoonotic
Awareness education is an important
component of preparedness and
protection
Center for Food Security and Public Health
Iowa State University 2005
Summary
•
•
•
Prevention, recognition and
response involves everyone
Report any suspicious activity,
unexplained behavior or death loss
in your herd or flock
You play a critical role
Center for Food Security and Public Health
Iowa State University 2005
Conclusion
“The best prescription,
is knowledge.”
Dr. C. Everett Koop
Former U.S. Surgeon General
Center for Food Security and Public Health
Iowa State University 2005
Acknowledgments
Development of this
presentation was funded
by a grant from the
Centers for Disease Control
and Prevention to the
Center for Food Security
and Public Health at Iowa
State University.
Center for Food Security and Public Health
Iowa State University 2005
Acknowledgments
Authors:
Danelle Bickett-Weddle, DVM
Jamie Snow, DVM
Reviewers:
Radford G. Davis, DVM, MPH
Gayle B. Brown, DVM, PhD
Jean Gladon, BS
Center for Food Security and Public Health
Iowa State University 2005