The Centers for Disease Control and Prevention (CDC), the Department of the Interior (DOI), and the US Department of Agriculture (USDA) released a report listing the zoonotic diseases of most concern in the United States.1 The agencies developed the report after hosting a workshop that aimed to “further joint efforts to address zoonotic disease challenges.”2

The diseases were selected based on 5 criteria: the potential to cause a pandemic or epidemic; the severity in humans, domestic animals, and wildlife; the economic burden; the potential for introduction or increased transmission; and the potential to be used for bioterrorism.1

According to the report, the top 8 infectious diseases spread from animals to humans include:

1. Zoonotic Influenza

Occasional outbreaks of avian influenza have been reported in the United States, such as the 2017 outbreak of avian influenza A(H7N9) in Tennessee.3 Certain avian viruses (H5, H7, and H9), as well as swine influenza H3N2v, H1N1v, and H1N2v are mentioned in the report.1

Advise your patients to adhere to the following longstanding CDC guidelines for domestic highly pathogenic avian influenza outbreaks3:

  • Avoid wild birds.
  • Avoid contact with domestic birds that appear ill or have died.
  • Avoid touching surfaces that may be contaminated with feces from wild or domestic birds.

2. Salmonellosis

Salmonella infection (salmonellosis) causes approximately 1.2 million illnesses and 450 deaths each year in the United States.4 In 2018, there were 18 reported outbreaks, 15 of which were linked to food.5

Encourage your patients to take safety precautions when handling, preparing, and ingesting food by advising the following6:

  • Avoid high-risk foods such as raw eggs, undercooked poultry or ground beef, and unpasteurized milk.
  • Wash hands and clean surfaces before preparing food.
  • Don’t use utensils on cooked foods that have been used on raw foods.

3. West Nile Virus

First detected in North America in 1999,7 West Nile virus is the leading mosquito-borne disease in the United States. Approximately 1 in 5 people who are infected with West Nile virus experience symptoms including headaches, body aches, and fever. Less than 1% develop a serious or fatal illness.8

During mosquito season, remind your patients to use insect repellant, wear long pants and long-sleeved shirts, and put screens on doors and windows to prevent mosquito bites.9

4. Plague

Pneumonic plague maintains a presence today in the rural western United States. From 2000 to 2017, an average of 7 human cases were reported annually.10 “Although the endemic burden is small, pneumonic plague has epidemic potential,” the report cautions.1

Point your patients to the CDC guidelines for plague prevention, summarized as follows11:

  • Reduce rodent habitat around your home and place of work.
  • Wear gloves when handling animals that might be infected.
  • Use repellent when camping, hiking, and working outdoors.
  • Apply flea-control products to pets.
  • Don’t allow pets that roam free in endemic areas to sleep on your bed.

5. Coronaviruses

Although coronaviruses are common worldwide and can cause mild to moderate illness,12 2 emerging coronaviruses — severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) — have been associated with severe illness. A global outbreak of SARS-CoV reached North America in the early 2000s, but no known cases have been reported anywhere in the world since 2004.13 Only 2 cases of MERS-CoV have been identified in the United States, both of which were imported by healthcare providers who had lived and worked in Saudi Arabia, where they were believed to have been infected.14

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6. Rabies

Rabies causes approximately 60,000 deaths annually worldwide. However, cases in the United States are rare, with an average of 8 per year.1

Your patients can reduce their chance of infection by taking these precautions15:

  • Don’t approach wild animals.
  • Vaccinate pets against rabies.
  • Monitor pets when outside to avoid contact with wild animals.
  • Report stray animals to local authorities.

7. Brucellosis

Every year, approximately 100 cases of brucellosis are reported in the United States, predominantly in California, Texas, Arizona, and Florida.1 Initial symptoms include fever, sweats, fatigue, and joint pain. Longer-term symptoms include recurrent fevers, arthritis, chronic fatigue, and endocarditis.16

Inform your patients that the best way to prevent brucellosis infection is to avoid consuming undercooked meat and unpasteurized dairy products including milk, cheese, and ice cream.17

8. Lyme Disease

Every year, approximately 300,000 Americans are diagnosed with Lyme disease.18 Although the tick-borne illness is often associated with erythema migrans (EM), a rash that sometimes appears in a bull’s-eye shape, not all patients present with this signature symptom. The disease is notoriously difficult to diagnose even for the most seasoned clinicians.

There are many myths surrounding Lyme disease, such as that no rash means no Lyme. Be sure to set the record straight with your patients and advise them to take precautions by wearing long-sleeved shirts and tucking in pant legs when outdoors in areas that may harbor ticks.

References

  1. Prioritizing zoonotic diseases for multisectoral, One Health collaboration in the United States. Centers for Disease Control and Prevention. Accessed May 30, 2019.
  2. US One Health zoonotic disease prioritization. Centers for Disease Control and Prevention. Reviewed May 14, 2019. Accessed May 30, 2019.
  3. CDC: outbreak of North American avian influenza A(H7N9) in poultry poses low risk to people. Centers for Disease Control and Prevention. March 8, 2017. Accessed May 30, 2019.
  4. Salmonella. Centers for Disease Control and Prevention. Reviewed May 17, 2019. Accessed May 30, 2019.
  5. Reports of Salmonella outbreak investigations from 2018. Centers for Disease Control and Prevention. Reviewed November 28, 2018. Accessed May 30, 2019.
  6. Salmonella. Foodsafety.gov. Accessed May 30, 2019.
  7. Sejvar JJ. West Nile virus: an historical overview. Ochsner J. 2003;5(3):6-10.
  8. West Nile virus. Centers for Disease Control and Prevention. Reviewed December 10, 2018. Accessed May 30, 2019.
  9. West Nile virus: prevention. Centers for Disease Control and Prevention. Reviewed December 10, 2018. Accessed May 30, 2019.
  10. Maps and statistics: plague in the United States. Centers for Disease Control and Prevention. Reviewed November 27, 2018. Accessed May 30, 2019.
  11. Plague: prevention. Centers for Disease Control and Prevention. Reviewed November 27, 2018. Accessed May 30, 2019.
  12. Coronavirus. Centers for Disease Control and Prevention. Reviewed November 9, 2017. Accessed May 30, 2019.
  13. Severe acute respiratory syndrome (SARS). Centers for Disease Control and Prevention. Reviewed December 6, 2017. Accessed May 30, 2019.
  14. MERS in the US. Centers for Disease Control and Prevention. Reviewed September 14, 2017. Accessed May 30, 2019.
  15. Rabies. Mayo Clinic. November 4, 2016. Accessed May 30, 2019.
  16. Brucellosis: signs and symptoms. Centers for Disease Control and Prevention. Reviewed November 12, 2012. Accessed May 30, 2019.
  17. Brucellosis: prevention. Centers for Disease Control and Prevention. Reviewed March 8, 2019. Accessed May 30, 2019.
  18. How many people get Lyme disease? Centers for Disease Control and Prevention. Reviewed December 21, 2018. Accessed May 30, 2019.