CHAPTER 12
Use of Wildlife Rehabilitation
Centers as Monitors of
Ecosystem Health
JONATHAN M. SLEEMAN
W
ildlife rehabilitation is defined as the tempo-
rary care of injured, diseased, and displaced
indigenous animals and the subsequent
release of healthy animals to appropriate habitat in the
wild.37 However, this definition does not include the
role of euthanasia as an appropriate disposition for
many wild animals brought to wildlife rehabilitators.
Few have doubted the important role of these activities
in improving the welfare of many wild animals that
are often injured as a result of human activities. How-
ever, it is unlikely that the rehabilitation of injured
individuals of a common species has any significant
effect at the population level.55 Therefore, legitimate
questions have been raised regarding the justification
for such activities and whether they could lead to the
interference in natural selective processes, increase
disease transmission among and between species, and
result in the inappropriate translocation of animals.
The limitations of wildlife rehabilitation as a conserva-
tion tool are discussed elsewhere.3,29
It is important that policies and practices are estab-
lished that eliminate or minimize the potential harm
that could result from wildlife rehabilitation, as well as
expand on the traditional role of the treatment and
release of wildlife to include many other educational,
research, conservation, and public policy initiatives.48
This chapter provides an overview of how wildlife
rehabilitation centers may contribute to the monitoring
of ecosystem health, which is defined as the maintenance
of biodiversity and ecosystem integrity. Specifically,
this discussion outlines the elements of a preventive
medicine program designed to minimize the potential
harm from wildlife rehabilitation. Furthermore, the con-
cept of conservation medicine as it relates to wildlife
rehabilitation is introduced, and two examples are used
to illustrate how data from a wildlife rehabilitation
center have been used to monitor ecosystem health.
PRIMUM NON NOCERE
(FIRST DO NO HARM)
One of the guiding principles of veterinary medicine is
“first, do no harm.” The welfare of wildlife popula-
tions is more important than the welfare of any indi-
vidual animal, and nothing done in the interest of an
individual animal should unnaturally jeopardize
healthy wildlife.52 In this context, it is important to
have a comprehensive preventive medicine program
designed for the specific geographic location and
circumstances to prevent harm to human health, indi-
vidual animals, the wildlife populations, and the envi-
ronment as a result of wildlife rehabilitation activities.
This program should consist of admittance and release
policies, animal identification and medical record
systems, feeding and nutrition protocols, appropriate
caging design and handling protocols to minimize
trauma, standard sanitary operating procedures,
wildlife health screening protocols, quarantine and
isolation, and a staff occupational health program.
The protection of public health is paramount to
all activities at a wildlife rehabilitation center. There-
fore, it must be determined whether acceptance of
any species represents an unacceptable risk to human
health. For example, the recovery and admission for
treatment of adult rabies-vector species, such as striped
skunks (Mephitis mephitis) and raccoons (Procyon lotor),
may present an unacceptable threat of exposure to
rabies virus both to the general public who may
encounter these animals and to the staff of the rehabil-
itation center.46 The risk of injury from venomous
species as well as physically dangerous animals, such
as adult white-tailed deer (Odocoileus virginianus),
should also be assessed before allowing the admission
of these species.
To prevent disease transmission within a wildlife
center (which has been documented on several
97
98 CHAPTER 12
occasions18,22), strict hygiene and sanitation should be
maintained that includes standard sanitary operating
procedures10 as well as pest and rodent control. In
addition, all animals that are admitted should undergo
a comprehensive health screening examination that
varies between species to reflect different disease risks.
The tests performed and prophylactic treatments
administered could be based, for example, on the
World Organization for Animal Health (OIE, Office
International des Epizooties) publication Quarantine
and Health Screening Protocols for Wildlife prior to
Translocation and Release into the Wild.56 Other examples
of a preventive medicine program include the isola-
tion of any sick animal with a communicable disease
from healthy animals, as well as the quarantine of
healthy animals suspected of carrying an infectious
disease before disease screening. These animals
should be housed in purpose-designed quarantine
rooms that include separate airflow and drainage and
separate caging and equipment from the rest of the
building. An occupational health program for the staff
could include annual rabies titers and vaccination if
necessary, policies on access to rabies-vector species
and dangerous animals, dissemination of information
on wildlife zoonoses, and annual educational programs
on health and safety, including classes on appropriate
restraint and handling techniques.
Finally, the release policies should be designed to
minimize the potential for disease introduction into
the wild and for harm to the wild populations and
the environment. The animal must not pose a risk to
the wild population, humans, or the environment and
should not be likely to spread pathogens or contribute
to disease processes in other ways. The animal must
not be carrying a potentially zoonotic infection and
should not be imprinted, tame, or habituated to humans.
In addition, animals must be released at, or near, the
original site of capture unless conservation efforts or
safety considerations dictate otherwise. The habitat
must be within carrying capacity for the species to be
released.
Prevention of interference in natural selection is
probably more difficult to achieve. However, few (if
any) wildlife populations in heavily altered ecosys-
tems, such as exist in many parts of North America,
escape anthropogenic effects on their health. In fact,
recent reviews of the morbidity and mortality of
wildlife presented to universities and wildlife centers
have identified that human activities account for the
majority of admissions.5,15,53 Even less obvious reasons
for admission, such as aural abscesses in box turtles
(Terrapene carolina) and Eustrongylides ignotus infection
in herons and egrets, may be the result of human activ-
ities, such as contamination of the environment with
organochlorine pesticides25 and eutrophication of wet-
land habitats,14 respectively. In contrast, wildlife from
more pristine ecosystems may be under less anthro-
pogenic influence, and consequently more considera-
tion must be given to the potential deleterious effects
of rehabilitation on the genetics of the population.
Although no systematic studies have been conducted,
some apparently pristine areas are also likely under
human pressures, although somewhat different from
those encountered in developed countries. For example,
the illegal wildlife trade accounts for the majority of
wildlife confiscations that are admitted to zoos and
wildlife rehabilitation centers in Central and South
America.40
Some species are afforded more legal protection,
that is, threatened and endangered species, whereas
others are classified as “nuisance” or “invasive”
species. Also, most wildlife rehabilitation centers have
limited resources. Thus, a triage policy should exist
such that more time and resources are allocated to the
animals from populations that would benefit most
from these efforts, such as threatened and endangered
species. It is also essential that wildlife rehabilitation
centers comply with all state and federal laws,
including those that may prohibit the release of certain
nuisance species, for example, coyotes (Canis latrans)
in Virginia.52 In addition, some introduced species,
such as starlings (Sturnus vulgaris) and mute swans
(Cygnus olor), are known to compete successfully with
native species for nesting sites.41 Consequently,
I believe that nonnative, invasive, and nuisance
species should not be rehabilitated or released into
the wild.
CONSERVATION MEDICINE
The importance of veterinary medicine and environ-
mental education as part of a multidisciplinary
approach to wildlife conservation and ecosystem
health has previously been identified.1 Conservation
medicine is a new discipline and has developed in
response to the emergence of new diseases and threats
to human and animal health from anthropogenic eco-
logic changes. Conservation medicine examines ecologic
health issues, including emerging diseases; the biologic
effects of pollutants; the health implications of ecologic
alterations such as habitat fragmentation, simplification,
and degradation; loss of biodiversity and ecosystem
services; and global climate change. Conservation
medicine is by definition transdisciplinary, involving
professionals from diverse disciplines, such as human
 Use of Wildlife Rehabilitation Centers as Monitors of Ecosystem Health
medicine, public health and epidemiology, veterinary
medicine, ecology, conservation biology, wildlife man-
agement, and the social and political sciences, as well
as educators and policy makers.
Wildlife rehabilitation centers are in a unique
position to observe these ecologic changes and anthro-
pogenic effects on wildlife health. Therefore, wildlife
species presented for treatment are potentially excel-
lent biomonitors for environmental problems. Many
species, especially raptors, amphibians, and marine
mammals, have provided information about environ-
mental pollution and emerging diseases.13,17,23,42,47
Reptiles may also be good indicators of ecosystem
health because of their reliance on the environment for
appropriate physiologic functions, such as immunity,
digestion, and thermoregulation.45 Data from wildlife
rehabilitation centers have been underutilized for this
purpose. However, the following studies demonstrate
how data collected at a wildlife rehabilitation center
may be used to monitor ecosystem integrity and the
maintenance of biodiversity. These studies also illus-
trate the usefulness of wildlife as sentinels for human
health threats.17
Aural Abscesses in Box Turtles as
an Indication of Environmental
Contamination
Aural abscess represented the second most common
diagnostic category in free-living eastern box turtles
(Terrapene carolina carolina) admitted to the Wildlife
Center of Virginia (WCV, Waynesboro) from 1991 to
20005 and has been reported in other states.54 Aural
abscesses are accumulations of caseous debris in the
tympanic cavity resulting from squamous metaplasia
of the epithelium that lines the middle ear.7,25 The lesion,
which may be unilateral or bilateral, varies in size from
subclinical accumulations of material to masses large
enough to impede the animal from drawing its head
back into the shell (Figure 12-1). Aural abscesses in
free-living eastern box turtles resemble lesions occur-
ring in captive box turtles that are vitamin A deficient.39
A similar relationship between hypovitaminosis A and
squamous metaplasia has been described in other
species, including ruminants and pigs.8,19
High body burdens of organochlorine (OC) com-
pounds were associated with aural abscesses and squa-
mous metaplasia of mucin-secreting epithelial tissues
of the upper and lower respiratory passages, eyes, and
the middle ear in free-living eastern box turtles.25 It
was hypothesized that increased levels of OC com-
pounds disrupted vitamin A metabolism, leading to
99
Fig 12-1 Bilateral aural abscesses in an eastern box turtle
(Terrapene carolina carolina).
hypovitaminosis A, squamous metaplasia, and accu-
mulation of caseous debris in the middle ear of these
turtles, visible grossly as aural abscesses. This is
consistent with previous studies on humans, rats, and
turtles that showed that increased exposure to OC
compounds led to a disturbance in vitamin A homeo-
stasis11,44 and to upper respiratory infections.51
A study of the epidemiologic determinants of aural
abscesses in free-living eastern box turtles in Virginia
found that affected turtles were geographically clus-
tered (Figure 12-2).6 In fact, geographic location was
the only risk factor associated with aural abscesses.
Thus the geographic location of this condition in
free-ranging eastern box turtles may be useful as an
indicator for the presence of OC compounds in the
environment, if a causal relationship between body
burdens of OC compounds and aural abscesses in box
turtles can be determined. Box turtles may serve as
good indicators of environmental contamination
because they are abundant, have a wide distribution
with a small home range, have an intricate relationship
with the environment, and are long lived.21,24,38,43,45
OC compounds are also hypothesized to be, or have
been, causally linked to a number of diseases in humans,
including but not limited to chloracne,11 neurologic
dysfunction,28 breast and other cancers,9,26 hypospa-
dias and other birth defects,4 and endometriosis.33 It
would be of particular interest to determine if these
OC-associated diseases in humans were clustered in
the same geographic regions as box turtles with ear
abscesses. This would illustrate the link between
human and wildlife health, as well as the sentinel
function of wildlife.
100 CHAPTER 12

Fig 12-2 Numbers of eastern box turtles (Terrapene carolina carolina) submitted to a
wildlife rehabilitation center from counties of Virginia, 1991–2000. Counties from which
eastern box turtles were received are shaded gray (dark gray for counties with aural abscess
cases, light gray for counties from which none of the submitted turtles had aural abscesses).
Pie charts in counties with aural abscess cases indicate county proportion of turtles with
aural abscesses in black, and turtles with no aural abscess in white. (From Brown JD, Sleeman
JM, Elnger F: J Wildl Dis 40:704-712, 2004.)

Impact of West Nile Virus
on Raptor Populations
West Nile virus (WNV) is a widely distributed
arbovirus of the family Flaviviridae. Birds are the prin-
cipal vertebrate host,31 and historically, clinical disease
is rare in birds.50 WNV was first detected in North
America during an outbreak of viral encephalitis in
New York in 1999.50 Since its initial detection in the
Western Hemisphere, this emerging infectious disease
has rapidly spread across North America, resulting in
morbidity and mortality of humans and a broad range
of vertebrate species.36 North American avian species
appear to be particularly susceptible to the disease,
and more than 230 avian species are listed in the
Centers for Disease Control and Prevention (CDC)
West Nile virus avian mortality database,* of which
15% (35/234) are native North American raptor
species. Several reports describe mortality of raptors
resulting from WNV infection.12,16,32,34 In addition,
recent authors have speculated that WNV has resulted
in regionally increased raptor mortality in the United
States.16,35 The impact of WNV on avian populations is
unknown, but some have predicted a likely negative
effect in the forthcoming years.2
A recent study investigated some epidemiologic
findings of a WNV outbreak in raptors from Virginia
*http://www.cdc.gov/ncidod/dvbid/westnile/birdspecies.
htm.
during 2003 by analyzing changes in trends of admis-
sions to a wildlife rehabilitation center for various
species of raptors.27 Annual juvenile raptor admissions
from 1993 to 2003 for all species, great horned owls (Bubo
virginianus), and red-tailed hawks (Buteo jamaicensis)
were calculated and graphically plotted. The mean
monthly number of admissions for all raptor species,
great horned owls, and red-tailed hawks admitted
between 1993 and 2002 was also plotted. Finally, the
monthly admissions for all raptors, great horned owls,
and red-tailed hawks during 2003 were plotted and com-
pared to previous 10-year mean monthly admissions.
The 2003 raptor admissions showed a decrease
during May and June, speculated to be caused by
nestling mortality from WNV infection, compared with
the mean of the previous 10 years. In addition, a similar
comparison with historical data showed increased
admissions during August and September in 2003
resulting from cases of WNV infection, followed by a
decrease from October to December, thought to result
from the decline in fledgling birds normally presented
at that time of year. Red-tailed hawk admissions also
showed a mild increase during June and August, with
a marked increase in September 2003 (Figure 12-3).
This was followed by a mild decrease in red-tailed
hawk admissions during October and November and
a marked decrease in December. In addition, there was
a marked decrease in the number of juvenile great
horned owl admissions during 2002 and 2003 com-
pared with the annual admissions from 1993 to 2001,
 Use of Wildlife Rehabilitation Centers as Monitors of Ecosystem Health 101

Fig 12-3 Comparison of monthly admissions of red-tailed hawks (Buteo jamaicensis) to

the Wildlife Center of Virginia during 2003 and the mean monthly admissions plus one
standard deviation (+1 SD) for red tailed hawks, 1993–2002. (From Joyner PH, Kelly S, Shreve
AA, et al: J Wildl Dis 42:335-344, 2006.)

Fig 12-4 Annual distribution of immature great horned owls (Bubo virginianus) admitted
to the Wildlife Center of Virginia, 1993–2003. (From Joyner PH, Kelly S, Shreve AA, et al:
J Wildl Dis 42:335-344, 2006.)

speculated to be caused by nestling mortality from
WNV infection (Figure 12-4).
The change in the trend of monthly distribution of
raptors admissions, as well as the decrease in annual
immature raptor admissions (especially great horned
owls), may indicate declines in local populations.
Although many environmental factors may be respon-
sible for potential population declines, the most plau-
sible hypothesis was WNV having a negative impact
on local raptor populations. This was supported by
that fact that the species showing the most dramatic
changes in admissions, red-tailed hawks and great
horned owls, accounted for the majority of WNV cases
(78% of all cases). Although WNV in raptors could not
be proved as the cause of these changes in trends, this
study illustrates the usefulness of monitoring trends
in admission data to generate hypotheses about the
impact of disease on wildlife populations. A decrease
in raptor populations would again have public health
implications. Raptors are ecologic keystone species
and important regulators of rodent populations. Loss
of this regulator would result in increased rodent
populations and possibly increased rodent-associated
zoonotic infections.
102 CHAPTER 12
EDUCATION, PUBLIC AWARENESS,
AND PUBLIC POLICY
Members of the public generally have a concern for
wildlife and the environment. Wildlife rehabilitation
centers may use clinical cases and experiences to
educate the public about the value of wildlife and the
importance of healthy ecosystems. Ultimately, con-
servation of wildlife and the environment requires the
support of the public, appropriate protective legisla-
tion, and adequate law enforcement. Clinical work
and research conducted at wildlife rehabilitation cen-
ters should help to influence conservation-related
public policy decisions.
Education of the general public is also important
to promote the prevention of many human-induced
diseases. For example, one study demonstrated sig-
nificant temporal changes in reptile morbidity and
mortality, especially road mortality, both in absolute
number and in proportion to the total caseload of
animals presented to a wildlife rehabilitation center5
(Figure 12-5). This study showed two peaks of mor-
tality: the first in May and June, indicative of the
natural period of breeding and nesting, and the second
in September, speculated to represent increased
activity before hibernation. There is also evidence that
the current prevalence of road mortality in the eastern
and central United States may jeopardize population
persistence of land turtles and large-bodied pond
turtles.20 Therefore, it is important to use these types of
data to educate people about wildlife health issues and
Fig 12-5 Monthly distribution of reptile cases presented to the Wildlife Center of Virginia,
1991–2000. (From Brown JD, Sleeman JM: J Wildl Dis 38:699-705, 2002.)
give advice about how to avoid injury to animals and,
in this example, prevent further road mortality. These
data are also important to help target education
campaigns at peak periods of mortality.
Many wildlife rehabilitation centers also have pro-
grams for veterinary students and recent graduates.
Ecosystem health should be incorporated into the
curriculum. The students should be encouraged to
consider the “bigger picture” and expand on the tradi-
tional physician-patient paradigm to look at regional
and global ecologic changes that may be influencing
diseases in their patients. This creates a more preven-
tive medicine–oriented approach in their thinking,
fosters an appreciation for biodiversity, enhances
social responsibility, and produces advocates for a
healthy environment.48
CONCLUSION
Wildlife rehabilitation centers may contribute to a
wide variety of important activities that may not only
enhance animal welfare, but also advance veterinary
science and veterinary education, biodiversity con-
servation and ecosystem health, wildlife health moni-
toring, public health, and biosecurity, as well as public
education and conservation-related public policy. For
these roles to be realized, more emphasis should be
placed on accurate and detailed medical record
keeping, standardized health screening, and more
thorough clinical examinations, ancillary diagnostic
 Use of Wildlife Rehabilitation Centers as Monitors of Ecosystem Health
tests, and postmortem examinations on animals that
die or are euthanized. In addition, it is important to
realize the limitations of the data as well as potential
biases, because admissions to wildlife rehabilitation
centers are also certainly biased toward human-
induced diseases.30,49
Acknowledgments
Figures and parts of this chapter are reproduced with
kind permission of the Journal of Avian Medicine
and Surgery and the Journal of Wildlife Diseases. The
views expressed are my own.
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