Frequently asked questions concerning Chronic Wasting Disease (CWD)

• What is CWD?
  

  Chronic wasting disease (CWD) was first recognized in 1967 as a clinical syndrome of unknown etiology among captive mule deer Odocoileus hemionus at wildlife research facilities in Colorado (Williams and Young 1992). The disease was diagnosed in 1978 as a spongiform encephalopathy by histopathologic examination of CNS from affected animals. Shortly afterward CWD was recognized among captive deer in Wyoming (Williams and Young 1980). Diagnosis of CWD in Rocky Mountain elk from these same facilities quickly followed (Williams and Young 1982). Deer and elk in a few zoological gardens in the United States and Canada were identified with CWD in subsequent years (Williams and Young 1992). Apparently it did not persist in these locations. Chronic wasting disease has recently become a concern to the game farm industry following its diagnosis in elk in Saskatchewan, Canada, and in South Dakota, Nebraska, Montana, Colorado, and Oklahoma.

  In 1981, CWD was recognized in a free-ranging elk in Colorado (Spraker et al. 1997). Subsequently, it was found in free- ranging elk in Wyoming, and in free-ranging mule deer [1985 (M.W. Miller unpublished)] and white-tailed deer Odocoileus virginianus [1990 (E.S. Williams unpublished)] in both states. The known distribution of CWD currently includes captive and free-ranging cervids in southeast Wyoming and north-central and northeast Colorado (Miller et al. 2000) and several game farms in the United States and Canada.

  
  
• What causes CWD?
  

  The origin of CWD is not known. Spontaneous development of PrP^res might have occurred in deer, with subsequent transmission to other deer and elk. An alternate explanation is= that CWD is actually scrapie occurring in cervids. Chronic wasting disease could also have originated by infection with an as-yet-unrecognized prion.

  Characteristics of the agent causing CWD are poorly understood, but the agent is presumed to be a prion. Based on mouse strain typing, it appears to differ from the BSE agent (Bruce et al. 1997), many strains of scrapie, and the TME agent (M.E. Bruce personal communication). The marked similarity of CNS lesions and epidemiology strongly suggests CWD agent is the same in captive and free-ranging deer and elk.

  
  
• What is the epidemiology of CWD?
  

  The mode of transmission of CWD is unknown. There is no evidence that CWD is a food- borne disease associated with rendered ruminant meat and bonemeal as was the case in BSE (Wilesmith et al. 1988). Occurrence of the disease among captive deer and elk, many of which were acquired as neonates, fawns, or adults, provides strong evidence of lateral transmission (Williams and Young 1992; Miller et al. 1998; Miller et al. 2000). Maternal transmission may also occur; however, this has not been definitively determined. It is likely transmission occurred from mule deer to elk.

  The scrapie agent is found in many lymphoid tissues, including those of the digestive tract (Hadlow et al. 1980, 1982), suggesting the agent may be shed through the alimentary tract. Lymphoid tissues of affected deer and elk contain PrP^res; thus, alimentary tract shedding may also occur in CWD. The TSE agents are extremely resistant in the environment (Brown and Gajdusek 1991); pasture contamination has been suspected of being the source of scrapie agent in some outbreaks of sheep scrapie (Greig 1940; Pálsson 1979). Concentration of deer and elk in captivity or by artificial feeding may increase the likelihood of transmission between individuals.

  The youngest animal diagnosed with natural CWD was 17 months of age, suggesting this as an approximate minimum incubation period; however, without knowledge of when the animal was infected, it is impossible to accurately determine the incubation period. Maximum incubation periods are not known. Most cases of CWD among deer and elk residing in facilities with a long history of CWD are in 3 7-year-old animals. The age of onset of clinical signs is variable in animals brought into facilities as adults or among animals in herds newly recognized to have CWD. For example, one elk in a presumed newly infected herd was more than 15 years old. It is not known when during the course of infection an animal may be infectious. In one study, more than 90% of mule deer residing on a premises for more than 2 years died or were euthanized due to CWD) (Williams and Young 1980). Chronic wasting disease was the primary cause of adult mortality [5 (7 1%) of 7 and 4 (23%) of 23] in two captive elk herds (Miller et al. 1998).

  Relatively little is known about the epidemiology of CWD in free-ranging cervids. In addition to necropsy and examination of brains from animals showing clinical signs suggestive of CWD to determine its distribution (targeted surveillance), brains from deer and elk harvested by hunters in the CWD-endemic area have been used to estimate prevalence. Within endemic areas, prevalence of preclinical CWD, based on histopathology and/or immunohistochemistry for PrP^res, is estimated at less than 1%-8% (Miller et al. 2000). Chronic wasting disease has not been found in cervids outside the endemic areas.

  Preliminary modeling suggested lateral transmission is necessary to maintain CWD at the prevalence observed in surveillance programs. Maternal transmission may occur, but in the model this route of transmission alone was not adequate to maintain the disease at observed levels (Miller et al. 2000).

  
  
• What are the clinical signs of CWD?
  

  The most striking clinical features of CWD in deer and elk are loss of body condition and changes in behavior. Clinical signs of CWD may be more subtle and prolonged in elk than in mule deer. Affected animals may increase or decrease their interaction with handlers or other members of the herd. They may show repetitive behaviors, such as walking set patterns in their pens or pastures, show periods of somnolence or depression from which they are easily roused, and may carry their head and ears lowered. Affected animals continue to eat, but they consume reduced amounts of feed, leading to gradual loss of body condition. As the disease progresses, many affected animals display polydipsia and polyuria; increased salivation with resultant slobbering or drooling; and incoordination, particularly posterior ataxia, fine head tremors, and wide-based stance. Esophageal dilatation, hyperexcitability, and syncope are rarely seen. Death is inevitable.

  In captive herds newly experiencing CWD, sporadic cases of prime-aged animals losing condition, being unresponsive to symptomatic treatment, and death from pneumonia are common. Aspiration pneumonia, presumably from difficulty swallowing and hypersalivation, may lead to misdiagnosis of the condition if the brain is not examined.

  The clinical course of CWD varies from a few days to a year, with most animals surviving a few weeks to 3 4 months. Although a protracted clinical disease is typical, occasionally acute death may occur in white-tailed deer (M.W. Miller unpublished). Caretakers familiar with individual animals often recognize subtle changes in behavior well before those not familiar with the particular animal detect abnormalities or serious weight loss occurs. Also, those who have seen clinically affected animals are more astute at detecting early behavioral changes than naive observers.

  The clinical course of CWD in free-ranging deer and elk is probably shorter than in captivity. Wild cervids must forage, find water, and are susceptible to predation, all factors affecting longevity of sick animals in the wild.

  
  
• How is CWD diagnosed?
  

  Clinical signs of CWD are not specific, and currently diagnosis is based on examination of the brain for spongiform lesions and/or accumulation of PrP^res. The parasympathetic vagal nucleus in the dorsal portion of the medulla oblongata at the obex is the most important site to be examined for diagnosis of CWD (Williams and Young 1993) and should be submitted for histopathologic examination on every animal suspected of having CWD. The whole head or whole brain can be submitted to the diagnostic laboratory to ensure that the correct portion of the brain is examined. Supplemental tests include negative-stain electron microscopy for SAF or Western blotting for detection of PrP^res in brain (Williams and Young 1992; Spraker et al. 1997).

  Demonstration of PrP^res in lymph nodes, tonsil, and conjunctival lymphoid tissues is useful in antemortem diagnosis of sheep scrapie (Ikegami et al. 1991; Schreuder et al. 1996, 1998; O'Rourke et al. 1998a). These techniques are currently being tested in deer and elk to determine their sensitivity and specificity.

  
  
• Where has CWD been found?