Lizards on a plane (or greedy idiot on a plane)

Michael Plank, a California resident, was caught at the Los Angeles airport smuggling 15 lizards from Australia. Two geckos, two monitors and 11 skinks were found worth over $8500 and confiscated. The reptiles were strapped to his body inside money belts.  It's not explained how the smuggling was identified, but I imagine wriggling clothes might be a tip-off to an astute customs agent. The smell that would have almost certainly been generated from reptiles defecating during the trans-Pacific flight also could have played a role.

Importation of reptiles is regulated by the international Convention on International Trade of Endangers Species (CITES), and Mr. Plank faces some pretty severe financial penalties and jail time, although typically people charged with animal smuggling or abuse get off with a slap on the wrist at best. The problem is that people can make substantial amounts of money from smuggling reptiles, and the downside of being caught is often limited, thus making it a lucrative business. However, illegal importation of animals creates risks for disease importation, which can be a major problem for both the human population and native animal populations. Importation of animals is also associated with very high mortality rates - the percentage of smuggled animals that survives transportation is pretty low.

This isn't the first time this guy has been caught illegally importing reptiles, so it's safe to assume that he's done this many times before. Hopefully someone will get serious about the associated human health, animal health and animal welfare problems and start using some of the stiff penalty options that are available. People that buy reptiles should be conscious about the sources of the animals (and their forefathers), and ensure that they are not contributing to illegal activities.

H1N1 in a dog

H1N1 influenza was diagnosed in two dogs in China, bringing increased calls to pay attention to other animal species when it comes to this disease.

I'm more surprised by this than finding H1N1 in a cat or ferret. Dogs are susceptible to influenza and have their own circulating influenza strain (H3N8, originally from horses) but they rarely get other types of influenza. It's just an example of "rare things happen rarely, but they do happen." As with cats, it is now apparent that dogs are susceptible to this virus, although presumably minimally susceptible given the very low incidence of reported canine infections. This doesn't change our basic recommendations for dealing with H1N1: infected people should reduce contact with all individuals in the household, human or otherwise. People should be aware but not worried about the potential for pets to acquire H1N1. The risk of animals transmitting H1N1 back to people is unclear. It's theoretically possible but in practicality, a pet that gets H1N1 most likely got it from its owner, who's already exposed the rest of the household members as well.

Vaccination against canine influenza will not provide any protection against H1N1.

Feline leprosy

Leprosy usually evokes images of deformed faces and hands and leper colonies. This disease, caused by Mycobacterium leprae, has been recognized for at least 4000 years, and is thought to have been one of the biblical plagues. While now treatable with proper access to healthcare, leprosy is still a problem in some regions.

Feline leprosy is a disease that is present in cats in certain areas of the world, especially British Columbia Canada, northern New Zealand and eastern Australia. It typically causes granulomas (firm fleshy, tumour-like masses) in the skin and tissues directly under the skin, These can become ulcerated and secondary bacterial infections can develop. Feline leprosy has some similarities to human leprosy, however it's not the same thing. It is caused by a related but distinct bacterium Mycobacterium lepraemurium. (It's also suspected that one or more other related bacteria can also cause this disease.) Mycobacterium lepraemurium also causes disease in rodents and can survive in the environment. Cats most likely become infected after being bitten by infected rodents. While the name may be concerning and the disease can be serious in cats, fortunately there is no risk to humans. There is no evidence that this uncommon disease in cats can be transmitted to people.

Image: A photomicrograph of Mycobacterium leprae taken from a leprosy skin lesion. (source: CDC Public Health Image Library ID#2123).

Things not to do for Thanksgiving

I heard this on the radio yesterday morning, I kid you not: Butterball has a "Turkey Talk" toll-free helpline, which naturally gets busy around turkey holidays like Thanksgiving and Christmas.  Like many helplines, they get stories of every kind, and this year apparently one person called in and asked if it was alright that she thawed her frozen turkey in the bathtub - while her kids were in it taking a bath!

Anyone who has read anything about food safety hopefully knows that raw meat can potentially be (and usually is) contaminated with many different pathogens - that's the biggest reason why observing proper cooking times and temperatures is so important.  Raw poultry in particular should basically be treated like it's contaminated with Salmonella and/or Campylobacter until proven otherwise.  You can just imagine the field day that these bacteria could have in a nice warm, wet bathtub - it's just the way they like it, and it's exactly what we try to avoid in the kitchen, where food is ideally kept either nice and cold or nice and hot in order to prevent (or at least minimize) bacterial growth.  Then of all things to put young children in this veritable cesspool of bacteria - turkey and all - it's just a gastrointestinal disaster waiting to happen.  You also needs to consider what the turkey could become contaminated with sitting in bathwater.  Even children who don't have diarrhea can be shedding intestinal pathogens - human pathogens which are obviously transmissible to other people.  If you really cooked that bird well (maybe deep-fried it) I suppose that should ultimatley eliminate any surface contamination anyway, but I don't think I'd be able to get past the "ick" factor.  Don't throw the baby out with the bathwater, but of there's a turkey in there (as far as I'm concerned) that can go.

I realize this is primarily a food safety issue, but it made me think about what else this person (or others) may put in a bathtub.  In previous posts in which we've talked about reptiles kept as pets (all of which should be treated as Salmonella carriers), we've mentioned that ideally (if they need a bath) they should be bathed in their own designated container (like a big rubbermaid) and not in the bathtub.  If there is no other option and the bathtub must be used, it should be thoroughly cleaned and properly disinfected (keeping contact-time with the disinfectant in mind) before it is used again by a person (especially children). 

Ideally the same precautions should be taken if you bathe a dog in the bathtub, but the risks are not as high as with reptiles (unless the dog is very dirty, has skin lesions, or has (or recently had) diarrhea).  We've talked about the limited risks of allowing dogs in backyard swimming pools (but of course there is even less chlorine in bath water).  I hope no one ever bathes their dog with their kids - we could debate the risks, which likely aren't high anyway, but in the end the risk is simply unnecessary.  The pool is one thing, but there's no reason for a dog to be in the tub at the same time as the kids (and really, how clean are the kids going to get with a dirty dog in the tub?).  If you're trying to save water you can always throw the dog in after the kids are out.

If you're attempting to bathe a cat in the tub... well, based on most feline behaviour I'd say your primary risks are bites and scratches more than enteric bacteria and parasites.  Proceed at your own risk!

A happy (and hopefully healthy) American Thanksgiving to all of our US readers!

Lyme disease from a dog: Don't believe everything you read published an article entitled "Unsuspecting resident contracts Lyme disease from pet dog". However, Lyme disease cannot be transmitted from dogs to people.

Lyme disease is a tickborne disease caused by the bacterium Borrellia burgdorferi. This bacterium is transmitted from wildlife reservoirs to people and pets by ticks that have fed on an infected animal, and then latch onto a person or pet.

The article reports that a woman and her son from Scarborough, Ontario, were diagnosed with Lyme disease after there dog was infected. The owner frequently walked her dog in the Rouge Valley and Morningside Park. After finding a tick on her dog, the owner took the dog to the vet, and it was diagnosed with Lyme disease. She and her son were later diagnosed. The fact that people and pets in the same house got the same disease does not mean that the dog was the source of infection. Lyme disease cannot be transmitted directly between people and animals; ticks must be involved. Additionally, ticks must be attached for approximately 24 hours to efficiently transfer the bacterium. So, if multiple people and a pet in the house got Lyme disease, they were all bitten by ticks, presumably while walking in the woods. (It's also possible that a tick could have been brought into the house by a dog, and then it jumped onto a person). Identification of Lyme disease in a dog does not mean that there is a risk to people from the infected dog, but it does indicate that people may have been exposed in the same manner as the dog, and they should pay attention.

The dog owner in this case is upset that her veterinarian did not warn her about Lyme disease. She wants the College of Veterinarians of Ontario (the provincial licensing body for veterinarians) to "require members to tell people when they may have been exposed to Lyme disease through a pet, as well as what the symptoms are." That's reasonable, to a point. Veterinarians should engage their clients with discussions about zoonotic diseases. If they identify a pet with a zoonotic infection, they should talk about the implications. Similarly, if they identify a pet with an infection to which the owner may have also been exposed (such as Lyme disease), they should mention the risk. However, requiring vets to talk about signs of disease in people starts to cross the line between veterinary and human medicine. Vets should introduce the issue and let physicians take over from there.

People in the Toronto area should not panic based on this report. Lyme disease is quite rare in Ontario, especially in the Toronto area, as the ticks that transmit Lyme disease are not commonly found there.Toronto Public Health reports that an average of nine cases of Lyme disease a year have been diagnosed in people between 1998 and 2007, and that most of these cases were acquired in the US.

Probiotics and obesity

A recent editorial in Nature Microbiology Reviews by Dr. Didier Raoult raised questions about the potential role of probiotics in obesity.  It is based both on studies indicating weight gain in humans and farm animals in probiotic trials as well as some laboratory animal data. The conclusions based on clinical trials for treatment of disease are pretty weak, since while animals or people may have gained weight, that does not mean they gained fat (if you get better because of a probiotic, you gain weight, but that is probably a healthy response and not obesity). There is some interesting lab animal work that shows changes in fat deposition in response to some probiotics, but it's rather preliminary.

It's way too early to declare that consuming probiotics is a risk factor for obesity. Several letters to the Editor were submited by leading probiotic researchers in response to Dr. Raoult's editorial, contradicting some of the statements that were made. Personally, I don't see convincing evidence of a risk but Dr. Raoult's comments should serve as a reminder that probiotics can have broad and poorly understood effects on the intestinal bacterial population, and correspondingly broad and poorly understood effects on the body. That's why probiotics should be scrutinized like drugs, in terms of safety, effectiveness and quality control. If someone is using a probiotic for themselves or their pet for a defined reason and it seems to be working, I wouldn't recommend stopping because of these largely theoretical concerns about obesity. However, we should perhaps think about why we are using probiotics and the potential costs versus benefits. I doubt this is really going to be a major issue but it's a good one to think about.

The good and bad of pet therapy

.An article about a therapy dog demonstrates some good points of these programs and places to improve. The story is about "Taco", a Chihuahua involved in pet therapy at the Livingston Regional Hospital (Tennessee). The obvious benefit of the program is highlighted by the owner's comment "She creates smiles when there were none." There are definite social and emotional benefits of pet therapy. There are also some potential health benefits, although the research on that isn't the strongest. On the downside, there are disease transmission concerns. These can be greatly reduced through attention to some simple procedures, but this article describes a number of concerning yet common problems:

"(Taco) greets each patient (ones who are comfortable enough to have her in their lap) with kisses on the nose."

  • Being allowed to lick patients has been shown to be a risk factor for visitation dogs acquiring MRSA. Being allowed to like the nose is about as good of a model of MRSA transmission as you can develop, because the nose is the number-one site where this important bacterium lives. This type of licking can also transmit various other infectious agents to this compromised hospital population. Licking is an unnecessary behaviour that should not be permitted because it can be associated with infectious agent transmission.  Not permitting licking does little to decrease the value of visitation.

"(Owner Gerry) Cotnoir has had Taco since she was 9 weeks old.  She worked at Bethesda [Health Care Center) in Cookeville then and brought Taco with her to work every day. "She got used to people at an early age,""

  • Socialization of dogs is important, but a hospital is not the place to do this. Only dogs older than 1 (and ideally older than 2) years of age should be in hospitals. Young animals are more likely to bite or scratch; not necessarily from aggression but also from playful or excited behaviour. Young animals also have much higher rates of shedding of various infectious agents such as Campyobacter.
  • People in hospitals should not be bringing pets to work. Animals that are in hospitals should be there for formal, structured, short-term, properly observed and properly scrutinized visitation activities. That's not the case when someone brings a pet to work. A hospital is not a doggie day-care, although some people use them as such, with the occasional visit of a patient to explain why they are there.

The hospital's infection control personnel have approved the use of Taco in the Livingston facility, but you have to wonder how much they investigated the issues. There are clear guidelines for hospital therapy programs which aren't being followed here. Hopefully other important aspects of the guidelines, especially hand hygiene, are being followed. It's likely this is a situation where people don't understand the issues and don't realize that there are both concerns and resources to help them out.  Any facility that has, or is thinking of having, a visitation program, should be aware of these guidelines, plus other information from reputable groups such as Delta Society.

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Campylobacter upsaliensis: an overlooked problem?

Campylobacter bacteria are important causes of disease in people. Many Campylobacter species exist, and these different species vary quite a bit in their ability to cause disease in people and animals. Campylobacter jejuni is one of the most common causes of diarrhea in people worldwide, and is most commonly associated with contaminated food.  However, a few studies have reported that having pets (especially pets with diarrhea) is also a risk factor for Campylobacter jejuni infection.

Another Campylobacter species that may be of concern is Campylobacter upsaliensis. This species is primarily associated with dogs and cats, and a large percentage of healthy dogs and cats may be shedding this bacterium in their stool at any time. It doesn't seem to be a cause of disease in dogs and cats, but it may be an important and overlooked cause of disease in people. One study from the US reported that C. upsaliensis was the 2nd most common Campylobacter strain found in people with diarrhea (after C. jejuni). However, the true role of this species is unclear, partly because of common laboratory testing methods. Culture is the main method used to diagnose infection with Campylobacter, but this bacterium can be difficult to grow in the lab. Usually, culture media for Campylobacter contain antibiotics to inhibit other better/faster growing bacteria. Unfortunately, C. upsaliensis is often inhibited by these antibiotics, so it's likely to be missed in these cases even if it is there. Therefore, we might be underestimating the role of this Campylobacter species in diarrhea. This is an critical issue to investigate because C. upsaliensis is so common in dogs and cats, and it's important to determine what role pets play in human disease.

Avoiding Campylobacter infection involves some basic steps: avoid contact with feces, take care when handling diarrhea from pets, wash your hands regularly after handling pets and always wash your hands thoroughly after any contact with feces. Make sure your physician knows you have pets. In particular, if you have a pet with diarrhea or have recently acquired a new pet (especially a puppy or kitten), make sure Campylobacter infection is considered if you get diarrhea. Most infections are mild and go away on their own but some require specific treatment.

More information about Campylobacter can be found on the Worms & Germs Resources page.

Image credit: CDC/ Dr. Patricia Fields, Dr. Collette Fitzgerald

More H1N1 cat cases

Perhaps not too surprisingly, more cats have been diagnosed with H1N1. Following the first reported case in Iowa, two more cases have been reported: one in Utah and one in Oregon. The Utah case apparently had typical flu-like disease. The cat from Oregon died of severe respiratory disease.

This doesn't really change anything. We know cats are susceptible, although not highly so considering the small number of cases despite large numbers of cats being exposed by their owners. H1N1 in cats is a human-associated disease, with cats getting infected from infected people. We still have no evidence that pets are a source of human infection. Even so, good general hygiene practices should be used around infected pets and people to reduce the risk of transmission in both directions.

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Antibiotic Awareness Day

European Antibiotic Awareness Day is an initiative of the European Centre for Disease Prevention and Control.  This year it falls on November 18.  The aim of the Day is to provide an annual opportunity for raising awareness about the threat to public health of antibiotic resistance and how to use antibiotics responsibly.

Responsible use of antibiotics can help stop resistant bacteria from developing and help keep antibiotics effective for the use of future generations.  Successful national public awareness campaigns are already resulting in more rational use of antibiotics and a reduction in levels of antibiotic resistance in Europe.

Responsible use of antibiotics includes use in people and in animals.  Here are some of the things you can do to help with regard to antibiotic use in your pets:

  • Only give your pet antibiotics if directed to do so by your veterinarian.
  • Make sure your pet gets the full dose of medication at the correct time(s) of day.  If you are having problems getting your pet to swallow pills or take medication, contact your veterinarian as soon as possible.  Your veterinarian may be able to give you advice on some "tricks" for getting your pet to take the medication, or sometimes the medication can be provided in a different form (e.g. a liquid instead of a pill).
  • Always ensure your pet finishes the entire prescription.  There should be no leftover pills or medication.  Do not stop giving your pet the antibiotics just because it looks/acts like its feeling better.  This is a common mistake that can have disasterous consequences!  You should NEVER "save a few pills for the next time."
  • Never give your pet antibiotics that were prescribed for you or any other person, whether they are expired or not.

Stray cats and H1N1 influenza

The topic of the potential for feral (stray) animals, particularly cats, to be sources of human influenza infection came up today. For feral animals to be a public health problem, the following sequence has to happen:

Feral animals need to be exposed to H1N1

  • This is pretty unlikely. Influenza is spread through close contact, mainly through aerosols generated by an infectious person coughing, sneezing or breathing. Influenza only travels short distances in this manner. The likelihood of a feral animal being exposed to the H1N1 influenza virus is very low because it is rare for a feral animal to get that close to people. If there is close contact, it's probably very short term, and not high risk for exposure.

They need to become infected AND shed appreciable levels of virus

  • Considering the number of infected people, how common pet cats are, and the fact that only one cat has been diagnosed with H1N1, the risk of actually transmitting the virus to a cat is very low even with close contact with an infected person. If tens of thousands of household pet cats have had close and prolonged exposure and only one infection has been diagnosed, this virus is pretty poorly transmissible to cats.

They need to be exposed to susceptible people

  • As discussed above, there's not too much contact between stray cats and people. Close and prolonged contact is extremely rare. Influenza is only shed by infected individuals for a short period of time, unlike some other infections. So, the chance of an infected cat having close contact with a person during the relatively short infectious period is very low.

Each one of these events independently is very unlikely. When you combine them, it should be clear that the risks posed by feral cats are extremely low (probably about as close to zero as we get with infectious diseases).

A bigger concern might be someone infecting their indoor/outdoor cat, who would then infect a stray cat, which would then infect another indoor/outdoor cat, which could infect a family member. That's still a VERY unlikely situation - really it's nothing to worry about.

There are certainly public health issues with feral cats. H1N1 is not one of them.

How to remove a skunk from a pool

This morning, as my dog Meg and I went out to get the newspaper, she ran towards our pool fence, barking (pretty unusual for a dog that is afraid of chipmunks). I wondered what the issue was until I saw a black and white tail sticking out. The pool has been closed for the season and there was a skunk standing on the cover. The cover's about 1.5 feet below the deck and the skunk couldn't get out.

After going over various options, like putting things in for the skunk to climb out on (unsuccessful), getting a live trap (too lazy to go find one), scooping it up with the pool skimmer net (a matter of how badly I'd be sprayed, not whether I'd be sprayed), getting a wildlife removal person in (too cheap to get someone else to do it) or lacing food with a sedative, I came up with the following plan:

  1. Find a large garbage pail with a handle. Tie a long rope to one handle.
  2. Place the garbage pail on its side in the pool, with the handle tied to the rope on top.
  3. Lure the skunk into the pail (e.g. with food) or, as I did, herd it in using a LONG pole.
  4. When the skunk is inside, pull on the rope to tip the garbage pail back up.
  5. Cover the garbage pail. A plastic kiddie pool works well.
  6. Carefully but quickly lift the covered garbage pail out of the pool.
  7. RUN... upwind.

It worked for me... no guarantees however.

Family Salmonella outbreak from school reptile

Three Louisville, Kentucky children and their father recently contracted Salmonella from two lizards (green anoles) that the kids brought home from school. Two weeks after the lizards were brought home, the youngest child got sick. Then the other kids and the father got sick.

This outbreak highlights numerous problems:

Schools are not pet stores: Why is an exotic (and difficult to care for) pet that is a known Salmonella vector being sent home with students? Apparently, the school sent home a standard letter they use when students take home pets. (I assume sending animals home must be a very common event if the school has a standard form for it.) The letter provides "caretaking tips" but apparently mentions nothing about Salmonella and reptiles. The school has now modified the letter to include a "reminder to parents that good hygiene is imperative when dealing with any kind of living organism as a pet, so they need to make sure their kids wash their hands well after handling them or cleaning them out." That's better, but if they are sending home reptiles, they need a clear statement about the risk of Salmonella exposure. They need to be direct and highlight the greater risk associated with reptiles.

Lack of education before getting a pet: Too many pets die and too many people get sick because people don't take the responsible step of finding out about the animal before they adopt it as a pet. This is particularly true with exotic pets, and death of the pet is a common outcome. It doesn't take a lot of effort to find out basic information about reptile care, and information about the risk of salmonellosis should be easy to find.

Poor knowledge (or a poor attempt at damage control) by the school: The teacher "noted that other common pets, such as dogs, can also carry salmonella. Like lizards, they're perfectly safe as long as you practice proper handwashing when you handle them." Except for the fact that 0-1% of healthy dogs carry Salmonella while very high percentages of reptiles do, that tens of thousands of cases of reptile-associated salmonellosis occur every year, that contact with reptiles is a major risk factor for salmonellosis, and that the CDC (among other groups) recommends that children less than five years of age and other high-risk groups not have contact with reptiles.  This type of statement is misleading. It's unfortunately either an indication of ignorance of the issues or an attempt to cover their butts and not take their share of the responsibility for what happened.  Certain reptiles can be good pets in certain situations, but are clearly inappropriate in others.

The "it's never happened before so it must be safe" fallacy: The school's disappointing response was that they've been using lizards in classrooms for years and no one has gotten sick. Well, their luck just ran out. Just because I could drive around without a seatbelt and not get hurt doesn't mean not using a seatbelt is a perfectly safe plan. Risky behaviours tend to catch up with you eventually.

The "it didn't happen here so it's not our fault" excuse: School officials said teachers are well-trained on the proper way to prevent students from getting Salmonella, but that's pretty debatable since three kids got sick because of their actions (i.e. sending the reptiles to the children's home). The infections may not have originated in the school but the school was still the source of the problem.

Poor hygiene associated with reptile contact: The father admitted that they didn't wash their hands regularly after handling the lizards.

There's little excuse for sending reptiles home with kids. Reptiles require specialized care and commitment, and many (many!) die each year from inappropriate care. The last thing we need is to make it easier for people to obtain them without much forethought. Reptile-associated salmonellosis is a serious problem, especially in kids. Serious, including fatal, infections can occur. Schools need to realize the liability they might assume by sending these animals into households, especially with inadequate scrutiny and education. Reptiles should not be kept in  households with kids less than five years of age, pregnant women, elderly individuals or immunocompromised individuals. I doubt they asked whether any such people lived in the household before sending the reptiles home.

H1N1, cats and the potential for mutation

I've spent a lot of time talking to the press this week about H1N1 and pets. One question that has come up repeatedly involves concern about the potential for this virus to mutate because of its presence in pets. This largely relates to the general knowledge that pigs are potentially important "mixing vessels" for influenza viruses.

H1N1 infection of cats carries almost no risk of a significant mutation. For this to happen, the animal must be infected with two different influenza viruses, and those viruses must recombine so that a new virus containing parts of each of the parent viruses is produced. This virus must then be able to infect a new host and be transmitted. Pigs are a concern because they can be infected by various influenza viruses (from humans and birds, as well as swine-origin viruses), and they tend to live with many other pigs so that the transmission cycle can be started. This isn't the case with cats.

Cats don't have their own influenza virus that is in circulation. Therefore, it's very unlikely that a cat exposed to H1N1 already has a different influenza virus in its system. Even if a cat was infected with a different flu virus (which is exceedingly unlikely) and this virus recombined with H1N1 (which is unlikely even if the two viruses were present), your average cat doesn't have much contact with different individuals, human or animal, and it's quite possible that the virus would just die-out in that animal.

While we don't want to ignore some of the issues regarding H1N1 in pets, such as the potential for pet illness and the unproven possibility that they could transmit H1N1 to other people, we need to keep the concerns in perspective. The risk that pets pose to people is much lower than the already very low risk that people pose to pets, in terms of H1N1 influenza.

Human vaccinia infection from rabies bait exposure

Rabies baiting is a highly effective way to reduce rabies in wildlife populations. As we've discussed before, in Ontario this involves air-dropping edible rabies vaccine. These baits are dropped in key rural areas, but there is the potential for curious people to come into contact with the vaccine if they handle baits that they come across. It is recommended that people avoid contact with the baits and wash their hands if they do come into contact with one, because the baits contain a live virus. They do NOT contain live rabies virus. Rather, they contain a vaccinia virus that has been manufactured to produce immunity to rabies virus. The risk of human infection is low, but as we constantly get reminded with infectious diseases, low doesn't mean zero.

Today's MMWR reported a case of human vaccinia infection associated with a rabies bait.  In August, a 35-year-old Pennsylvania woman was picking berries and her dog and found a rabies bait. The dog punctured the bait packaging and the woman subsequently handled the bait. It took around 30 minutes for the woman to reach somewhere she could wash her hands, which she then did. This person had a few factors that put her at higher risk of developing an infection, including some skin lesions on her hands from berry thorns, and she was on multiple immunosuppressive drugs.

The day after exposure, her doctor took blood samples for rabies and vaccinia virus antibodies and examined her hands. Skin lesions (papules, i.e. little bumps) developed three days later. These lesions were tested and vaccinia virus was found in them. The skin lesions progressed and she was hospitalized a couple of days later. She was treated with antibodies against vaccinia virus because of the progression of disease and her compromised immune system. She went on to develop muscle aches, headache and a swollen lymph node.  She was treated with more antibodies and an experimental antiviral drug. She ultimately responded to treatment and was discharged from the hospital on day 19.

This is the second reported human infection associated with a rabies bait. Considering the millions of baits that have been dropped and the presumably relatively large number of people that have had some contact with the baits, the overall risk of disease is still very low. This person was at high risk because of her immunocompromised status, and it's likely that an otherwise healthy person would not have developed an infection like she did. The big problem here was her contact with the bait. She did everything right after that: washed her hands as soon as she could, called the Department of Health, went to her physician and ensured that testing was done, but she still got sick.

Avoid rabies baits. The risks are low but why take any risk? People that have compromised immune systems or skin diseases should take particular care. If you've been exposed to a rabies bait, wash your hands ASAP and contact the local health authorities to determine if anything else should be done.

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How to diagnosis influenza in pets

One of the common questions accompanying the onslaught of calls I've taken today is "How do you diagnose influenza in pets?"

Clinical signs, such as sneezing, coughing, fever and lethargy, are not useful for diagnosis. Influenza can produce highly variable disease, ranging from almost none to very severe - so you can't look at an animal and say it has influenza just based on the clinical signs. We don't know much about H1N1 influenza in different animal species (including pets), but this type of influenza can probably cause a wide range of disease in animals as well (at least in those it can infect).

The presence of someone in the household with influenza should get you thinking about flu in a sick pet, but it is far from diagnostic. Many, many people have influenza, but very few pets do. There are many other diseases that can produce signs similar to influenza in pets. The health of people in the household is an important thing to know, but we can't jump to conclusions based on the household history alone.

Laboratory testing is required for the diagnosis of influenza, and there are a few options:

  • PCR testing of nasopharyngeal (throat) or nasal swabs, or fluid collected from the trachea: This molecular test detects influenza virus RNA. This is the fastest test and it is most sensitive when samples are taken early in disease. This is the main option for diagnosis at this time.
  • Serology: This involves testing blood for antibodies against influenza. Two samples are taken 10-14 days apart. If the antibody level rises 4-fold or greater, that is indicative of influenza infection. This is considered the most reliable method of diagnosis of influenza in many species but takes time. It is not currently a viable option for pets because tests for pets are not available.
  • Virus isolation from nasopharyngeal or nasal swabs, or tracheal fluid: Samples are inoculated into eggs to try to grow the virus. This can take quite a while and isolation of the virus can be difficult. This is a method used by specialized labs with laboratory containment conditions appropriate for this virus and may not be readily available.

H1N1 in a cat

H1N1 influenza has been confirmed in a cat in Iowa. The cat had "influenza-like illness" and was tested, with H1N1 being confirmed today. Two of three people in the house were also sick, but they became ill before the cat, and were presumably the source of infection for the cat. There's no evidence that the cat has infected anyone.

This doesn't really change anything that we've been recommending regarding H1N1 and pets. H1N1 infection is pets is rare but has been diagnosed in ferrets, and now in a cat. Considering the large number of infected people and the presumably large number of exposed pets, the risk of transmission to pets appears to be extremely low. Low doesn't mean no, however, and taking basic precautions is still wise.

Basically, remember that your pets are part of the household - microbiologically as well as socially. If you are doing something to reduce the risk of transmission of infection to people in the household, act the same way around your pets. Reduce contact with pets if you are sick. Avoid being around them when you are coughing. Wash your hands frequently. Avoid contact with their faces. If your pet gets sick after you've had H1N1 (or any other infection) make sure your veterinarian is aware of it.

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'Registered' service dog scam

I've written a few times in the past about the need for better definitions and guidelines for service dogs. Service animals are incredibly beneficial for some people, but there is great potential for abuse of the "service animal" designation by people who don't really need a service animal and/or are using completely untrained and sometimes inappropriate animals.

An example of such unscrupulous behaviour is At this site, you can enter your pet's name and your information, and get a form for your physician to sign requesting the dog be authorized as a service animal - but there is no such process, and this company has absolutely no authorizing power! Additionally, there's a place for a vet to sign affirming  that the dog being "registered" has had all shots required by the state and that, to the best of the vet's knowledge, it will not be a threat to the general public. There is no mention about whether the dog is healthy, is well-trained, is specially trained as a service animal, has undergone any real scrutiny to determine whether it could be a "threat to the general public", or anything else that should be a requirement for a true service animal. In other words, this company does absolutely nothing to ensure that the animal is an appropriate service animal. For their overwhelming effort of providing you with a form to fill out, they charge $49.95 to send you a worthless card saying your dog is a "registered service animal".

Anyone who has a real service animal has no use for a card such as this. If they run into someone who inappropriately tries to restrict their access, they're better off with information from the agency that trained the animal or, in the US, a copy of highlights of the ADA, since restriction of service animals is illegal.

If this company was really in it to help the cause of service dogs, it would have some standard criteria to ensure that the animals it certifies as service dogs are really service dogs. Otherwise, it's a money-grab to provide a useless card to people with true service animals, and a way to help people who just want to take their pets with them to places where they are banned. None of this helps the cause of true service dogs.  It is a disgrace.

Anyone with a service dog that has questions or concerns about access should contact the agency that trained their dog or another reputable (non-profit) source of information such as Delta Society.

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Another ferret flu case

A second ferret in the US has been diagnosed with H1N1 influenza. The latest case involves a fatal infection in a ferret from Nebraska that was presumably infected by its owner. Three other ferrets in the household were also sick, and it's fair to assume that they had H1N1as well.

It's important to keep things in perspective. We have two confirmed pet cases among thousands and thousands of human cases. Thousands of pets have presumably been exposed to owners infected with H1N1, with few apparent problems. (You can never rule out additional cases completely, because pets tend to get ignored in outbreak investigations, but there's no indication that this is a major problem.)

This is yet another good reminder of the potential for diseases to move between species in households. If you are sick with a potential infectious disease, you should restrict contact with household members - all household members: human and animal. Ferrets are likely the greatest risk when it comes to H1N1, followed by pigs and pet birds. Dogs and cats are presumably low risk, but we can't say there's absolutely no risk.

If you might have H1N1, reduce close contact with your pets. Don't hide from them, but avoid close face-to-face contact and coughing around them. Wash your hands regularly. More details about household infection control precautions are available from the CDC. Take the same precautions around pets as you would around people. If your pet subsequently gets sick, make sure your veterinarian knows about the possible H1N1 exposure.

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