Implementation of an Animal Sporotrichosis Surveillance and Control Program, Southeastern Brazil

We report the implementation of an animal sporotrichosis surveillance and control program that evaluates strategies to identify suspected and infected cats in a municipality in southeastern Brazil. All adopted measures reinforced the program, although strategies had different abilities to detect the presence of infection.

We report the implementation of an animal sporotrichosis surveillance and control program that evaluates strategies to identify suspected and infected cats in a municipality in southeastern Brazil. All adopted measures reinforced the program, although strategies had different abilities to detect the presence of infection.  Euthanasia at CZC Cats that had serious injuries suggestive of sporotrichosis were brought by owners for veterinary evaluation at CZC and euthanized because of illness or lack of financial resources for treatment. Sample collection for diagnosis confirmation was conducted at CZC after euthanasia. 2 Active surveillance Cats that had suspicious skin lesions were identified by endemic control agents during routine home visits for control of arboviruses. Sample collection for diagnosis confirmation was conducted in households. 3 Passive surveillance Cats with suspicious skin injuries were brought by owners to CZC for veterinary evaluation. Sample collection for diagnosis confirmation was conducted at CZC. 4

Ethics in
Public desexing service Cats with suspicious skin injuries were identified during a clinical examination before the public desexing service at CZC requested by owners. Sample collection for diagnosis confirmation was conducted at CZC before desexing.  city´s estimated feline population, 103 (62.4%) were considered positive. All health districts (administrative division) had positive cases, demonstrating the spread of the disease throughout the studied territory ( Figure 1). Among the positive samples sent for molecular identification (34.3%), all were confirmed as containing S. brasiliensis, a species often found in different regions of Brazil (2,7,8) and in parts of Latin America (9,10). The percentage of positive animals in this region was higher than that seen in other locations in Brazil that had epidemics (1,11).
The euthanasia service provided 36.9% (38/103) of positive cats. Passive surveillance provide 31.0% (32/103), active surveillance provided 26.2% (27/103) and the public desexing service provided 5.8% (6/103). The ability to detect the infection among the total number of suspected animals identified by each strategy varied ( Figure 2). Active surveillance proved to be efficient for identification of infected cats because 84.4% (27/32) with cutaneous lesions suggestive of sporotrichosis obtained by this approach were laboratory positive. In this category, the role of ECA stands out because this group was able to identify animals that had suggestive lesions. This finding demonstrates that awareness and training of these professionals are essential for the early detection of cases in a surveillance program in the cities affected by this zoonosis.
During the study, 50 animals that had suggestive cutaneous lesions were taken to the CZC by inhabitants of Contagem. This action was characterized as passive surveillance. Of these 50 cats, 32 (64.0%) had laboratory confirmed infections. This finding might reflect the awareness of the program among the population, which was promoted mainly by ECA.
Of the 40 cats identified that had lesions suspected of being sporotrichosis by the public desexing service, 6 (15%) were laboratory positive. Among the strategies for obtaining cats suspected of having sporotrichosis, this strategy identified the lowest percentage of positive animals. However, this practice represents an additional form of passive surveillance, which is relevant because of the potential for early identification of the disease resulting from felines submitted for neutering that are clinically evaluated before the surgical procedure.
Conversely, the category of cats that had cutaneous lesions suggestive of sporotrichosis referred for euthanasia at CZC showed the highest positivity (38/43, 88.4%). Animals in this condition were in an advanced stage of the disease. However, the diagnosis made at the time of euthanasia is ineffective in blocking transmission of sporotrichosis because it is most likely that until they died, these animals disseminated the etiologic agent.

Conclusions
Identifying cats that had cutaneous lesions suggestive of sporotrichosis or that were identified as positive for sporotrichosis contributes to reduction of inappropriate disposal of corpses, which in Contagem are incinerated by an outsourced company. This measure helped reduce environmental contamination and should be part of an animal sporotrichosis control program. Decomposing abandoned dead cats or cats being buried in the domestic environment could represent a risk for increased fungal load in the soil (12).
If one considers the health program implemented in the municipality, access to free diagnosis associated with multiple strategies for identifying infected cats (active surveillance, passive surveillance, public desexing service, and euthanasia service) proved to be a useful tool for surveillance and control of feline sporotrichosis. It was possible to identify the disease distributed throughout the territory, and surveillance strategies can, if maintained continuously in the service routine, offer a better situational diagnosis of the disease over time. In our view, the current challenges to the sporotrichosis detection system consist of enhancing training programs and awareness of public health professionals regarding early diagnosis.
We showed relevant advances in the surveillance of feline sporotrichosis. This program is a useful instrument to ensure standardization and efficiency of field actions. Active and passive surveillance were necessary means for initial actions related to completion of the implemented program. Training public health professionals, providing free laboratory diagnosis for animals, and disposing of positive corpses appropriately represent the minimum requirements for support of surveillance and control in municipalities that have their first sporotrichosis cases.