Worms & Germs Blog

Personal pet visitation in a Hamilton hospital

Posted in Cats, Dogs

Dog on blanketI’ve had a lot of emails about some news reports describing a program at Juravinski Hospital in Hamilton (Ontario) that allows personal pets to visit. Zachary’s Paws for Healing is touted as the first of its kind in Canada (which is far from true, but perhaps it’s the most formal).

Animals in healthcare facilities are nothing new. In a study we did a few years ago, the vast majority of Ontario hospitals had some type of animal visitation program (albeit usually poorly designed and operated). Things have improved, in part because of increased awareness and in part because of better guidelines.

There are some advantages and disadvantages of using personal pets vs formal pet visitation programs:


  • The person probably gets a much greater benefit from visiting with his or her own animal.


  • These animals and their handlers are not trained and screened like dogs in visitation programs.

The cost-benefit for the facility as a whole really depends on the program and how it’s run. If there is a formal mechanism to approve pet visitation, there are guidelines about which pets can and cannot visit, and there are clear visitation rules in place, the risks can typically be minimized. One very important rule is making sure that the pet only interacts with its owner. That’s easier said than done, since it’s not easy to walk a dog through a hospital without someone coming up to it wanting to pet it (or the dog trying to walk up to other people to get attention, depending on the dog’s personality).

There are some guidelines to help these programs. The most recent is an “Expert Guidance” document prepared by the Society for Healthcare Epidemiology of America (SHEA). This was an evolution of the international guidelines that we published in 2008 (Lefebvre et al, Am J Infect Control 2008). In the 2008 guidelines, we just addressed visitation programs, not personal pets. In the 2015 SHEA document, we covered more than just visitation program, including personal pets. The information about the program on the Zachary’s Paws for Healing website is pretty basic, but they’ve covered some of the important aspects of the current guidelines.

More and more evidence supports the health (physical and mental) benefits of animal contact in healthcare facilities. That’s balanced by zoonotic disease risks. Good programs (and good adherence to policies) can help make sure that the benefits outweigh the risks. I suspect we’ll see more of these programs in the future.

Get Smart About Antibiotics Week

Posted in Cats, Dogs, Horses, Miscellaneous, Other animals

AVMA_Antibiotics_Flyer_110315_Cats_ColorSince their discovery in the mid-1900s (which really wasn’t that long ago in the grand scheme of things), antibiotics have revolutionized human medicine, veterinary medicine and even food production.  They save lives and prevent illness, helping to make both people and animals healthier, happier and more efficient at what they do.  But if we want our antibiotics to work and continue to provide these amazing benefits for another century (or more!) then we all need to Get Smart About Antibiotics and how and when we use them.

This week (November 16-22)  is the 2015 Get Smart About Antibiotics Week, as promoted by the US Centers for Disease Control and Prevention (CDC).  The goal is to raise awareness about the threat of antibiotic resistance and the importance of proper antibiotic prescribing and use.  It’s part of the CDC’s ongoing “Get Smart: Know When Antibiotics Work” program, which has components targeting both the public and healthcare professionals.  The CDC also has a sister program called “Get Smart: Know When Antibiotics Work on the Farm” (sometimes just called Get Smart on the Farm”) which they launched over ten years ago in 2004. This program focuses on promoting appropriate antibiotic use in animals and educating veterinarians and veterinary students about how to be good stewards of antibiotics.

The American Veterinary Medical Association (AVMA) has also been working hard on this issue to provide additional guidance and resources to pet owners and veterinarians.  They convened a Task Force for Antimicrobial Stewardship in Companion Animal Practice to help develop practice guidelines for small animal vets.  They have put together a resources page that includes some new quick-reference materials on antimicrobial do’s and don’ts for dogs and cats, client education posters (like the one pictured), as well as links to use guidelines from the International Society for Companion Animal Infections Diseases (ISCAID) for urinary tract infections and canine superficial bacterial folliculitis, and recommendations from the Federation of European Companion Animal Veterinary Associations (FECAVA).

We ALL have a role to play in preserving the effectiveness of these very important drugs, from patients to pet owners, from physicians to veterinarians, from backyard hobby farmers to large-scale food animal producers.  Antibiotic use is changing, so let’s all get smarter about it!

Leptospirosis vaccination risks

Posted in Dogs, Vaccination

Syringe w needleVaccination discussions can get pretty heated. It’s not as bad with animals as with humans (thanks in part to the discredited (and formerly Dr.) Andrew Wakefield). Yet, there is still a reasonable number of people who are opposed to vaccination of pets, and probably a bigger number who are wary. There are various reasons for this, but a big one is the fear of adverse effects or reactions.

No, vaccines aren’t completely innocuous. Any vaccine can cause an adverse event. It’s rare, but it’s a fact of life that when we try to stimulate the immune system for good reasons, sometimes it doesn’t do what we want. Some vaccines may pose a greater risk of causing problems, and one that frequently gets discussed is leptospirosis vaccines. The concern is based on some reasonable history, since older lepto vaccines did seem to be associated with higher rates of adverse effects (especially among small breed dogs). However, the newer vaccines are both much more effective and seem to pose a much more limited risk of adverse effects. Data now provide more support to this last statement.

A paper in the latest edition of the Journal of the American Veterinary Medical Association (Yao et al 2015) looked at records from 130,557 (yes, over 130 thousand dogs!) that did or did not have a history of lepto vaccination. Retrospective studies using medical records are always a bit dodgy because of the (sometimes poor) quality  of medical record data, but a large and well-designed study helps limit those problems. The authors looked at records from dogs that were vaccinated during their veterinary visit. They then evaluated adverse events that developed within the 5-day period after vaccination. Not all those adverse events would have been caused by vaccination. However, it’s assumed that adverse events not associated with vaccination (e.g. diarrhea caused by some other issue) would be evenly distributed among the groups. It’s likely that this approach underestimates adverse events, but realistically, it probably only missed some mild ones. If the dog developed an adverse event of any consequence, odds are greater that this would be recorded in the medical record.

The results of the study showed:

  • The rate of adverse events in all dogs was 26.3/10,000 (just over 23 dogs out of every 10 thousand had some issues in the five day period after vaccination).
  • The rate in the dogs vaccinated against lepto was 53/10,000. The most common adverse event recorded was “nonspecific vaccine reaction.”
  • The rate in dogs vaccinated against anything else was 22.1/10,000, with “non-specific reaction” again being the main adverse event recorded.
  • Some breeds had higher rates of adverse events. The “winner” was American Eskimo Dogs, with a rate of 110.5/10,000

So, at first glance, this might raise some concern, with a rate of adverse events in lepto-vaccinated dogs that’s double the non-lepto-vaccinated dogs. Even when the analysis controled for other differences between groups, such as unequal distribution of breeds, age and weight, lepto-vaccinated dogs still had adverse events at a rate of 2.13 times that of other dogs.

But, let’s make sure this is put in perspective. This would indicate that vaccination increased the risk by ~26 events/10,000 dogs. So, if you lived long enough to own 400 dogs (or if your dog lived long enough to get 400 lepto vaccinations), you’d eventually get one that developed a complication. Further, most of those were ‘nonspecific’ and presumably mild. There was no significant difference in the incidence of hypersensitivity reactions (which is the more severe and concerning type of vaccine reaction).

The authors’ conclusion is reasonable: “These data suggest that vaccination against leptospirosis should be performed for all dogs at risk of the disease except those that have had hypersensitivity reactions previously.

Lepto vaccination isn’t needed for all dogs, but if you live in an area where lepto is present, vaccination should be considered. It’s a nasty disease, and a quite safe and effective vaccine. Don’t let internet hype lead to an increased risk of disease.

More information about leptospirosis can be found on the Worms & Germs Resources – Pets page.

Equine anaplasmosis: Ontario

Posted in Horses

pinto-horse-in-pastureAnother Ontario issue to report: this one is in a horse.

Recently, a case of anaplasmosis was identified in a horse in Eastern Ontario.

People in some places may say “so what?”

The reason it’s noteworthy is that anaplasmosis has historically been a very rare disease in Ontario. It’s a infection caused by the bacterium Anaplasma phagocytophilum, which is primarily transmitted by the tick Ixodes scapularis – the same tick that spreads Borrelia burgdorferi (the cause of Lyme disease).  Anaplasmosis is therefore something that we expect to see more of in areas where this tick (and Lyme disease) is becoming established. In Ontario, that’s the eastern part of the province, particularly along the north shore of Lake Ontario and the St. Lawrence River. The expansion of tick ranges over the last decade or more has been pretty impressive, and it’s likely to continue. So, as ticks spread, and pathogens spread with them, anaplasmosis is something that equine veterinarians and horse owners may need to be more aware of in coming years.

More information on the recent Ontario case can be found in a report by the Ontario Animal Health Network.

Ontario canine respiratory disease update

Posted in Dogs

Disease status

  • Collie soccerThings seem to be slowing down. Whether that’s because of a true decrease in disease or “reporting fatigue” is a good question. However, I’m pretty certain that the outbreak is burning itself out in the areas that were most affected.
  • Sporadic reports of sick dogs are still coming in from a few areas, but no major clusters are being reported to me, unlike a week ago.
  • Fortunately, very few severe infections seem to be occurring. Most cases are fairly mild and dogs recover with simply time or basic treatment. Complications such as bacterial pneumonia have occurred, but at a rate that is similar to or lower than what I’d expect for typical canine respiratory disease cases.

Diagnosis status

  • No definitive cause has been found so far, but that doesn’t mean no progress has been made. Given the number of tests that have been performed, I think we are at the point where we can say that the “usual suspects” such as canine parainfluenza, canine influenza and Bordetella bronchiseptica are not the cause.
  • Work is ongoing in a few different places to figure out what the cause might be.


Ontario canine respiratory disease update

Posted in Dogs

Here’s a quick update about what we know… which really isn’t a lot more than yesterday.

  • Case reports continue to roll in from different areas. I suspect the outbreak is burning itself out in Orangeville, but a few new cases are still being reported there.
  • A few other clusters seem to be ongoing in different towns such as Cobourg.

Boxer runningI’m still getting a reasonable number of reports of sick dogs from Ottawa too. I hesitate to write this, because people sometimes overreact, but a few of the Ottawa cases were reportedly at the Bruce Pitt dog park before becoming ill. The reason I hesitate is because it’s not a huge number of dogs, and if it’s a busy dog park, odds are some affected dogs will have gone there, irrespective of whether they were infected at the park or somewhere else. However, I figure it’s worth mentioning, not to make people stay away from that park or panic if they’ve been there, but to remind people to use some common sense precautions. These practices are particularly important in any high-dog-density area, and if we know sick dogs have been to a park, it’s even more important.

Sporadic reports are still coming in from other towns, and many of these are probably just part of the baseline level of disease that is always there, but we never hear about. That being said, keeping information coming in from other areas can help us identify new trends.

A cause of the respiratory illness still hasn’t been identified. Only a small percentage of affected dogs have been tested, but more results will be available soon. Beyond the small number of dogs that have been tested, an additional challenge is that some of the pathogens that cause canine infectious respiratory disease complex (CIRDC) tend to be shed for only a short period of time after the dog becomes ill. So, if it takes a couple of days before the dog is taken to a veterinarian (a common scenario), test results may be negative. We’re therefore trying to get samples from very early disease whenever possible. Hopefully we’ll find the cause. Often, we don’t, and that can be because of testing issues or the presence of something (new) for which we weren’t able to test.

More to come, hopefully including a diagnosis!

Canine respiratory disease outbreak update

Posted in Dogs

Dog nose2As I’ve written about a couple times over the past few days, we seem to have increased canine respiratory disease activity in a few areas of Ontario. The first reports came from Orangeville (incidentally, the town where I worked as a veterinarian in general practice when I first graduated), based on information provided by an astute veterinarian. As we started collecting data, it was pretty clear that a large number of affected dogs were present in the community. In some ways that’s not too surprising, since we occasionally see local outbreaks of canine infectious respiratory disease complex (CIRDC, also commonly called “kennel cough”).

However, reports have since been coming in from veterinarians and dog owners across the province, and my line-listing is getting quite long. The critical question is how many of these cases are simply “normal” disease activity that just isn’t usually reported. CIRDC is an endemic (ever-present) problem, so we expect to see sporadic cases all over the place. I suspect that many of the cases I’m hearing about from lots of different cities are just that, and we are only hearing about them now because we’ve asked for information. Nonetheless, while it’s hard to say anything definitive based on the loose surveillance we are doing (and which is the only type of surveillance that we can really do in situations like this), it seems like there may be genuine outbreaks going on in a few other areas as well.

In addition to Orangeville, areas that I’m particularly concerned about at the moment include:

  • Ottawa
  • Cobourg
  • Port Elgin

I don’t say this to cause panic, but to raise awareness so that people follow some basic precautions (a good idea no matter where you are, but particularly if there might be a local problem).

The particular cause of the disease in dogs in any of these areas is still unclear, and the clusters that have been detected aren’t all necessarily even being caused by the same thing. There are a lot of different viruses and bacteria that cause CIRDC, and testing has been pretty limited to date. We’re concerned about introduction of canine flu into Ontario, so we’re trying to figure out if it might be involved, but there’s no evidence so far that any of the dogs are infected with influenza virus.

This situation shows the importance of surveillance and communication, both during outbreaks and on a regular basis. That’s one of the reasons we developed WormsAndGermsMap. We don’t have CIRDC on their (at least not yet), but the map will hopefully help us understand the normal occurrence of various diseases, which will help us identify and track abnormal situations.

Canine respiratory disease precautions

Posted in Dogs, Vaccination

WhippetIf you’re one of the many (many) people asking about what to do in the midst of a canine respiratory disease outbreak, or someone who just wants to know what to do to reduce everyday risk of CIRDC, here are some basic pointers:

The microbes that cause respiratory disease in dogs are primarily spread by direct contact between dogs, especially nose-to-nose contact and licking. People can play a minor role as vectors, e.g. if you get contaminated by dog saliva or respiratory secretions (especially on your hands!) and then have contact with another dog. The role of the environment isn’t clear, but there’s some potential risk as many of the microbes in question can survive for a little while outside the dog. “Mouth contact” items such as food bowls and toys presumably pose the greatest risk.

As ever, infection control isn’t rocket science. The keys are some basic practices and common sense, and our approach to canine infectious respiratory disease is similar to messaging directed at influenza control in people:

  • If your dog is sick, keep it at home, ideally for 1-2 weeks after recovery.  Don’t visit the dog park or go to any “doggie socials”.
  • If your dog has been exposed to a sick dog, keep it at home (same idea).
  • Limit contact of your dog with other dogs. That doesn’t mean never let your dog see another dog, but ideally limit the number of different dogs with which it has close interactions. Playing with the same group of dogs every day is lower risk than playing with different groups every day.
  • Consider limiting access to dog-heavy areas such as off-leash parks if there is an apparent outbreak in your area.
  • Talk to your veterinarian about vaccination. We can’t vaccinate against all of the causes of CIRDC, but vaccines can help reduce the risk of some of the main players.
  • If your dog is at higher risk of complications (e.g. chronic respiratory or heart disease, immunocompromised), be particularly careful and more restrictive.

Above all, relax. There’s always some risk of exposure, just like there’s always some risk that you will encounter someone shedding influenza. You (hopefully) don’t lock yourself away in your house all winter to avoid flu season. Similarly, you shouldn’t lock your (healthy) dog up and stress about it.

Increased canine infectious respiratory disease: Ontario

Posted in Dogs

OESDInfectious respiratory disease isn’t exactly rare in dogs. A variety of viruses, bacteria and Mycoplasma can cause what we generically call canine infectious respiratory disease complex (CIRDC, formerly and still commonly called “kennel cough”). We see clusters of disease periodically and hear rumours of larger outbreaks, but usually there’s not a lot of additional information available.

It’s clear that something has been going on in Orangeville, Ontario. A relatively large number of dogs have been taken to local vets with respiratory disease, and reports of other sick dogs have been coming in. The story’s been reported on the local CTV new, and in a few news articles, some of which have pointed people in my direction. In some ways, that’s good, since we need to understand what’s going on and self-reporting is one way to get data. The hard part is figuring out how to use the information.

As is common, the information has made its way around the internet, and I’ve been inundated with emails… some from the Orangeville outbreak, and some completely unrelated messages from across the country. Data from informal, unstructured collection like this can be pretty unreliable. All we’re getting are reports from owners, with no standard case definitions and no idea what percentage of sick animals are being identified. However, I don’t think there’s any such thing as bad surveillance data, as long as the limitations are recognized. In this case, while any information gathering from outside of Orangeville was unintended, some interesting things have turned up. Specifically, a large number of reports of sick dogs have come from Ottawa. Reports from Halifax also seem high.

Putting these data into context is difficult. Just like I need to know what a healthy dog looks like to know what an abnormal dog looks like, I need to know what normal disease patterns are to pick up abnormal ones. The problem is, we don’t know much about the “normal” level of canine respiratory disease in any area. So, since we don’t know the endemic (baseline) disease rates and we have no formal surveillance, I can’t say with confidence that there are increased respiratory disease cases in Ottawa (and maybe Halifax). However, I think there’s enough information to raise a flag and try to get more information. That means directing efforts at letting dog owners and veterinarians know something might be up, and trying to get more data.

In terms of disease surveillance, keep the reports coming (just remember that we’re collecting data to look at trends and not to give out medical advice).

Oddball infections or concerns?

Posted in Cats, Dogs

Orange White KittenAnytime you see a case report in the medical literature, you know it must be something rare or new. Otherwise, no one would publish the occurrence of a single case. That can skew people’s perceptions because weird things get more attention.

So, it’s always hard to say what we should think about one-off reports of zoonotic infections. Is it the tip of the iceberg, with a lot of cases being missed? Is it an emerging threat? Is it a one-in-a-million fluke?  Often, it’s hard to say which of those might be true.

With those disclaimers in mind, here are a couple reports.

First reported human case of native mitral infective endocarditits caused by Streptococcus canis (Amsallem et al, Can J Cardiol 2014)

Streptococcus canis is somewhat of the dog equivalent to human Group A strep. It’s found in a lot of healthy dogs and usually doesn’t cause a problem, but can cause severe disease. It can also cause disease in people, but that is quite rare.

This case report is about a 65-year-old woman who developed infection of a heart valve. She needed an emergency valve replacement but recovered. The source was assumed to be her dog, but no unusual contacts such as a bite were reported. As is common, there appeared to have been little further investigation, and the dog was not tested to see if it was the source. Testing of the dog isn’t something I’d recommend as a routine measure in response to a human infection, but when it’s being published, a little more investigation would be nice.

Pasteurella multocida infection after solid organ transplantation (Christenson et al, Lancet Infect Dis 2015).

This one’s maybe less of an oddball case in that Pasteurella multocida, a bacterium commonly found in the mouths of healthy dogs and cats, is well recognized as a cause of infection in situations where it can get past the body’s normal protective barriers. Often, that’s because of bites or licking of broken skin. In this case, the infection probably occurred because of a combination of that and a profoundly weakened immune system because of the transplant.

The affected person was a 66-year-old man who had a kidney transplant. He had two dogs and a cat “with which he was very close.” He developed sepsis (a severe bloodstream infection) and subsequently died. It was suspected that the cat licking some ulcers on his leg was the source of the bacterium, but there was no subsequent investigation.

Low but ever-present risk

Both of these reports involve infections caused by bacteria that are commonly found in healthy dogs and cats. Human infections are rare, despite presumably very frequent exposure. This highlights the low but ever-present risk, and the need for basic infection control and hygiene practices to reduce the risk of infection. A few basic steps such as hand washing and keeping animals away from compromised body sites go a long way.