Child+reptile zoo - (infection control+hand hygiene) = lawsuit
Gurnee's Serpent Safari is being sued by the family of a two-year-old boy who allege the child contracted salmonellosis from a snake at the zoo. The child became ill and was hospitalized three days after visiting the zoo and petting a snake. The boy's mother got sick shortly thereafter. It's unclear if the same Salmonella strain was found in the snake or what degree of proof is present that the zoo was the source, but contact with reptiles is a huge risk factor for salmonellosis.
Exposure to zoonotic infections like Salmonella is an inherent risk of animal contact. We accept some degree of risk in everything that we do. The question is "Did the zoo take reasonable precautions to reduce the risk of disease transmission?" Based on the information in the Chicago Tribune news report, the answer is pretty clearly no.
There are standard guidelines for animal contact events that should be followed. These include:
- Children less than five years of age should not have contact with reptiles.
- There should be good, convenient access to hand hygiene (handwashing stations or alcohol hand sanitizers).
- Signs should be present to encourage people to wash their hands after animal contact and discourage high risk people (e.g. two-year-olds) from having contact with high risk animals (e.g. snakes)
The family alleges that the zoo is negligent because it:
- Did not have notices regarding handwashing after contact with reptiles.
- Did not provide hand sanitizers for patrons.
- Did not provide warnings regarding the risk of Salmonella for high risk groups.
- Allowed and encouraged the child to touch the snake.
We live in a pretty litigious society, but people need to assume responsibility for their (and their childrens') health and safety. However, exhibits that allow people to have contact with animals have a moral and legal responsibility to provide as safe of an environment as reasonably possible. Risk will never be zero and people can get sick from the best run events, but there is no excuse for failing to implement basic measures to reduce the risks.
Rabies in a household but hopefully not in a nursing home
.A Texas couple is undergoing rabies post-exposure prophylaxis after an abandoned puppy they adopted was diagnosed with rabies. They found the puppy outside and brought it into their house. One of them was subsequently bitten and they found out about the rabies diagnosis on Christmas eve.
One of the couple is quoted as saying "The doctor said 'It was a good thing they didn't wait until Monday, because it would have been too late. We couldn't have given you the shot because it wouldn't have done any good. You would have been dead within 48 hours." I really hope they completely misinterpreted what the doctor said, otherwise the doc has no clue about rabies. Prompt treatment is the goal, and you certainly don't want to wait any longer than you have to, however rabies doesn't kill in 48 hours, and you can start post-exposure treatment any time (just the sooner the better).
The couple also have seven other pets, who may also have been bitten. There wasn't any comment about what's happening to those pets. Hopefully they are properly vaccinated so they can be given a rabies vaccine booster and only undergo a short-term "quarantine" at home with the owners. (The alternative is immediate euthanasia or strict, long-term quarantine for months).
This isn't a new scenario - adopting a stray animal then finding out it has rabies. The less you know about an animal at the time of adoption, the greater the risks. I'm certainly not saying don't adopt a stray animal. But, if you are going to do it, recognize the risk, make sure you are in a low-risk household (everyone's susceptible to rabies, but some people are at greater risk for other zoonotic diseases and stray adoptions should be avoided by them), get the animal examined by a veterinarian as soon as possible, and make sure that it gets examined by a veterinarian if it develops any signs of disease.
All this leads into another another story I read a few days ago. Basically, it was a feel-good story about someone who found some puppies, stopped by a nursing home (or similar facility) and the facility adopted one or more of the puppies. This demonstrates some good points (e.g. resident's presumably had a great time watching the pups) and bad points (e.g. disease exposure, unknown temperament, injury risks from rambunctious puppies...) of animals in long-term care facilities. What if the puppies that were adopted by the home had rabies? It's happened before, and you end up having to administer post-exposure prophylaxis to a large number of people that already have enough health issues and risks. Nursing homes and other facilities should never adopt stray animals. Hopefully we don't see a news release in the next few weeks about widespread rabies exposure in that facility.
Video from wfaa.com
Beaver attack, Part 2
Last week, I wrote about the uncommon situation where a child was attacked by a 60 pound beaver. Any bite from a wild mammal, especially one acting different than normal, needs to be considered a possible rabies exposure, and I was impressed that the family pushed for rabies testing. Unfortunately, it turns out that rabies testing was not possible. The beaver was killed with a crowbar and "The skull was crushed to the point where there wasn't enough brain material" for testing.
That creates a difficult situation. The likelihood that the beaver had rabies is probably very slim, but rabies is an almost invariably fatal disease. Post-exposure treatment consists of an injection of anti-rabies antibodies and then a series of 4-5 vaccines. It's not fun, but it's not typically that big of a deal (particularly compared to the old protocol from decades past). It's also expensive, which can be a problem if the government or insurance doesn't cover it. I'd certainly err on the side of caution and get my child vaccinated (been there, done that) but there's no word what was done in this situation.
Inadequate brain material for testing occurs occasionally based on how a potentially rabid animal is killed. If you are in such a situation and you can avoid destroying the head, try to do so. But, while keeping the head intact when beating off an attacking animal is the goal from a rabies diagnosis standpoint, you can see how it wouldn't be high on the priority list when actually confronted with an attacking animal.
More information about rabies can be found on the Worms & Germs Resources page.
Internet exotic pet dealer horrors
.A public health expert has recommended that an exotic animal dealer's facility be demolished or "completely gutted and sterilized" because it is so contaminated with animal feces and vomit, as well as roach infested and swarming with uncaged animals. No evidence of infection control was present in the facility that "reeked of death and decay on a mammoth and overwhelming scale."
26 000 (yes, twenty-six thousand) reptiles, rodents and mammals were removed from US Global Exotic's Texas facility last week, in a raid prompted by an undercover investigation by PETA. An employee working undercover in the facility for PETA documented various abuses. The company now stands accused by the city of inhumanely housing the animals as well as denying them proper food, water and medical care. Hundreds of dead animals were found, and some animals had started eating one another to survive. An SPCA spokesperson said she stopped counting at 200 dead iguanas.
Buying certain things on the internet is fine. Buying live animals over the internet is something that you shouldn't even consider. This is a multi-million dollar industry that feeds off the naivety of people, the willingness of people to ignore serious welfare issues in their desire to get a unique pet, and the suffering of animals. Exotic pets can be good pets in certain situations, but tremendous numbers of them suffer and die from inadequate care at distributors, pet stores and homes, with many (many) more dying during smuggling.
If you want an exotic pet:
- Read a lot about it first. Make sure you can properly manage the animal and that it's legal in your area.
- Learn about any infectious disease risks and whether it's appropriate for your household. In general, exotic pets should not be present in households with children under five years of age, pregnant women, elderly individuals and people with compromised immune systems.
- Find a small, local breeder. Buy the animal from a place where you can see how they are raised so you can have more confidence they are healthy and have been properly cared for.
- If you want to buy an exotic pet from a pet shop, ask clear questions about the origin of the animal and request supporting documentation. Only buy a pet that was bred locally. US Global Exotics apparently sold most of their animals through pet stores.
Don't support illegal and unethical activities by buying exotic pets - if you really want to have such a pet, remember that it requires a lot of forethought and investigation of the source.
Risk factors for MRSA in dogs
A recent study just published in the journal Emerging Infectious Diseases evaluated risk factors for dogs having an infection with methicillin-resistant Staphylococcus aureus (MRSA) versus methicillin-susceptible S. aureus (MSSA). This study, headed by Dr. Meredith Faires, compared dogs with MRSA versus MSSA infections from three different veterinary referral hospitals in Canada and the US. Among the more important findings were the following:
- Staying in a veterinary hospital was not a risk factor for MRSA infection, reinforcing the notion that this is predominantly a community-associated disease in dogs (meaning it typically develops in dogs in the general population).
- Most infections, in both the MRSA and MSSA groups, were skin infections. While serious deeper infections can and do occur, skin and ear infections are very common.
- Prior treatment with antibiotics was associated with development of MRSA versus MSSA infections. Dogs that received any antibiotic within 90 days were approximately 3.8 times as likely to have MRSA versus MSSA infection. Dogs treated with drugs from the fluoroquinolone class of antibiotics were 4.6 times as likely to have MRSA versus MSSA infection.
The association between prior antibiotic use and development of a resistant (i.e. MRSA) infection is not surprising, but it is important to document these events and to be aware of them. Antibiotics are critically important drugs in veterinary and human medicine. They save countless lives, but are also overused and misused frequently, and resistance is a critical problem. Studies such as this demonstrate the need for prudent antibiotic use - use them when needed, but use them properly. Don't use them when a bacterial infection is not present or unlikely to occur.
The study can be downloaded by clicking here. More information about MRSA in available on the Worms & Germs Resources page.
Image source: http://animalphotos.info/a/
Boy attacked by beaver
A five-year-old Oklahoma boy is recovering after being attacked by a beaver. Beaver and attack aren't two words that you usually put together, but in this case the boy went to pet a 60 lb beaver that he saw outside and it proceeded to attack him, taking a "chunk out of his calf" in the process. The beaver was killed with a crowbar.
This is a pretty unusual situation. Beavers aren't known for attacking people, which should raise some red flags right there. Rabies should be considered in any mammal that acts abnormally. An aggressive act by a species not known for unprovoked attacks would certainly count.
The boy's mother went to "great lengths" to get the beaver tested for rabies. I'm not sure why great lengths were required since this was a bite from an abnormally-behaving wild animal in a rabies endemic area, but it's great that she was aware of the problem and acted accordingly. While the outcome was unfortunate for the beaver, the family is lucky that the beaver was killed and available for testing. If it had gotten away, they would have had to assume that it was rabid, meaning the child would need rabies post-exposure treatment. That's expensive and somewhat unpleasant (two initial shots and 3-4 boosters) but virtually 100% effective at preventing rabies (and since rabies is almost always fatal, it's a necessary procedure).
This report highlights a two key points:
- Leave wildlife alone.
- If you are bitten by a wild animal, make sure rabies is considered. It's very rare but fatal when it occurs, so you don't want to take any chances.
Bali rabies vaccination plan
A rabies epidemic has been underway in Bali for some time. There have been 25 deaths, with 2 occurring in the past 2 weeks. There are several reasons for this ongoing problem: large numbers of dogs (especially feral dogs) with limited vaccination, rabies circulating in the feral dog population, inadequate post-exposure treatment of people, and poor education of the public regarding the risks of rabies and how to properly address dog bites.
An encouraging sign is the institution of a mass rabies vaccination program for dogs. Unfortunately it won't start until February, which is disappointing because some people may get infected and die in the interim, but there are likely considerable logistical challenges to overcome, making some delay unavoidable.
The goal of this program is vaccination of 70% of all dogs in each affected regency. According to the recommendations of the World Health Organization (WHO), 70% is the proportion of the canine population that needs to be vaccinated in order to have a chance of eradicating of canine rabies from a given area. It's a challenging goal given the number of feral dogs and the limited resources available in Bali, but it's critical to vaccinate as many dogs as possible. It is estimated that there are approximately 500 000 dogs on the island. Approximately 137 000 dogs have already been vaccinated and another 39 000 have been culled (destroyed). Vaccination will not be performed in two regions because rabies cases have not been identified there. (Hopefully they have good enough surveillance to be very sure that rabies truly isn't in the dogs in those areas. It's a bit of a gamble otherwise.)
One thing that has not been specified is how they intend to handle vaccination of feral dogs. It's not clear whether the numbers mentioned here include feral dogs and whether efforts are being directed at pet dogs only or both pets and feral dogs. Poor compliance with booster vaccinations was cited as a concern, implying this was only focused on pets. Achieving 70% vaccination of the pet population is an important step, but if there is still uncontrolled circulation of rabies in the large pool of feral dogs, eradication will not be possible. Hopefully, trap-vaccinate-and-release programs or oral rabies bating will be used to address the feral dogs.
Image: Mt. Agung, southern Bali
Over-indulgence: Canine-style
As we approach the holidays, a lot of people are going to eat and/or drink too much, and suffer the consequences. The same can happen with dogs, and sometimes both the dog and their owner pay the price. Dogs get into things they shouldn't all the time... too much food, garbage, dead critters and various other "dietary indiscretions" can easily lead to diarrhea (and sometimes more serious problems). During the holidays, there's often a greater opportunity for dogs to steal food or to be fed too many treats or leftovers. Sometimes it's dramatic - like a 60 pound Lab eating a 15 pound turkey - but often the first sign of a problem is the pile of diarrhea on the floor (usually at 3 AM, in the case of my dog).
So, after yelling at the dog, blaming someone else for leaving food out, and perhaps cleaning off your foot (depending on where you stepped), how do you clean up this mess without getting sick yourself?
The good news is diarrhea from dietary indiscretions is not usually associated with zoonotic microorganisms like Salmonella or Campylobacter. However, those and other potentially harmful bacteria can be found in any dog feces, and you have to assume that diarrhea is infectious. The risk of infection of people is probably low, but you don't want to take unnecessary chances (especially over the holidays).
First things first: Clean up as much of the diarrhea as possible. Ideally wear gloves, and clean up the diarrhea using paper towels or something else disposable. Don't wander around the house with the diarrhea-soaked items - bring a garbage bag with you to the scene of the "accident".
After the bulk of the mess has been removed, your next step depends on a few things, including the surface, what you have available, and whether any high risk people are in the house (i.e. infants, elderly, people with compromised immune systems).
- Smooth, sealed surfaces (e.g. tile, laminate, sealed wood) are easy to clean and disinfect. A general cleaner can be used to remove traces of diarrhea. If you want to disinfect the area, use a general household disinfectant or dilute bleach solution (1 part bleach to 50 parts water). While general household disinfectants may not kill everything, I'm not sure aggressive disinfection is needed in most households. Thorough cleaning does a very good job, and we aren't trying to make the house sterile. I'd be more concerned about disinfection in a household with high-risk people (particularly infants who may crawl over that part of the floor). If you are concerned about bleach damaging the surface, use something else or test it on an out-of-the-way area.
- Carpet is problematic because it's pretty much impossible to disinfect. After removing as much diarrhea as possible, use of a carpet cleaning spray might be helpful (but it's more effective for removing stains, not pathogens). A few disinfectants can be used on carpets safely. Bleach isn't a good idea unless the carpet is already (or was originally) white. Even with a good disinfectant, you're very unlikely to kill all of the bacteria present, because of the ability of microbes to hide in fabric. Steam cleaning is another option.
Once that's done, don't forget the most important step: wash your hands thoroughly. (The second-most important step might be to cordon the dog off in a more easily cleanable area for the rest of the night in case further accidents occur).
Overall, the risk of getting sick from overindulgence-associated dog diarrhea is pretty low. I focus on cleaning up the mess and don't worry about thorough disinfection. That's probably reasonable in a low risk household, but I'd be more wary around high-risk individuals.
Bulk bin rawhides
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My daughter's kindergarten class is having a gingerbread cookie decorating event tomorrow. They're supposed to bring a guest (in Amy's case, me) and some items (e.g. candy sprinkles, gummies) to put on the cookies. I was surprised (but impressed) to see a statement asking people to avoid bringing items from bulk bins because of the potential for cross contamination. The concern is that bulk bin items could be contaminated with items such as nuts, which are banned from schools because of allergies.
Cross contamination can also involve bacteria, and can extend into the realm of pet treats. Salmonella contamination of rawhide treats is a problem, and rawhides and other raw pet treats have been the cause of multiple outbreaks of salmonellosis in people. Salmonella (and E. coli, and other bacteria) contamination is a concern with any raw animal-origin product, and while there have been improvements in some areas in manufacturing practices, some risk will always be present. That's why rawhides, pigs' ears and similar treats shouldn't be present in households with young children, elderly individuals or people with compromised immune systems, and why good attention to hand hygiene is needed when these products are handled. Buying individually-packaged rawhides (instead of bulk bin items) is also recommended. Bulk bins may offer some cost savings, but you are at the mercy of cross-contamination and potential accumulation of Salmonella and other bacteria. If one rawhide is contaminated, it can cross-contaminate all the other rawhides in the bin. If bins are just topped up as they get low, this can lead to contamination of a large number of rawhides. There's also the risk of exposure when you reach into the bin and grab one (and it's unlikely that you'd wash your hands afterwards).
Rabies post-exposure prophylaxis for dogs
If an unvaccinated person is exposed to rabies (usually by a bite), they undergo post-exposure prophylaxis (PEP), consisting of an injection of anti-rabies antibodies and a series of 4 or 5 vaccines. (It used to be 5, but it was recently recommended to drop this to 4). This is a highly effective protocol which basically guarantees that the person won't get rabies IF the person is treated promptly.
If an unvaccinated pet is exposed to rabies, the situation is much different. The two options are euthanasia or a strict six month quarantine and a single dose of rabies vaccine either immediately or after 5 (of 6) months of quarantine.
So, if there is a post-exposure treatment for people that is basically 100% effective, why don't we do the same thing in dogs and cats?
There are a few possible explanations for this:
1) Rabies is almost invariably fatal. The significant public health risks take precedence over animal health and pet owner inconvenience, stress and pet loss.
2) There is limited information about PEP in dogs, and results have been mixed.
- In one study (Hanlon et al 2002), experimentally-infected dogs were treated with various protocols. Treatment with rabies antibodies on day 0, followed by vaccination on days 0, 3, 7, 14 and 35 was effective at preventing rabies in 5/5 dogs - a good result, but the small number of dogs tested (5) prevents us from drawing any broader definitive conclusions. Rabies antibodies alone protected 4/5 dogs. All dogs that did not receive the antibodies but were vaccinated on days 0, 3, 7, 14 and 35 died of rabies.
- In another study (Manickam et al 2008), all exposed dogs were protected by rabies vaccination on days 0, 3, 7, 14 and 28. A 3-dose regimen (days 0, 5 and 28) was protective with one vaccine but not another.
Clearly, based on the limited number and small size of these studies, and the differing results, we cannot recommend a canine PEP protocol with confidence. However, these studies strongly suggest that PEP can be effective in dogs, and I think we need to consider when and how to use it. I wouldn't necessarily use PEP to replace quarantine without more evidence (i.e. field studies). I think the use of PEP to help protect the dogs while maintaining quarantine to protect the public is a good start. If canine PEP can be shown to be as effective as PEP in people, then some day quarantine might not be needed.
Regardless, this situation highlights the need for current vaccination of all dogs and cats in rabies-endemic areas. If a vaccinated animal is exposed to rabies, there is no requirement for euthanasia or long, strict quarantine. Rather, standard guidelines recommend giving the pet a rabies vaccine (booster) and having the animal observed by their owner for a period of 45 days. Developing better PEP protocols for unvaccinated animals is useful, but I'd prefer to see it become a moot point as a result of high vaccination rates.
Salmonella from frogs
The CDC is investigating an apparent multistate outbreak of salmonellosis associated with contact with frogs. As of December 7, 48 infected people had been identified from 25 states - a pretty remarkable distribution. People got sick between June 24 and November 14, 2009. As is normal for Salmonella outbreaks linked to animals, young children have been more commonly affected, with kids under 10 accounting for 77% of cases. Fortunately, no one has died.
As part of the investigation, contact with animals was investigated and their preliminary analysis indicates contact with water frogs like African Dwarf frogs is the likely source of infection.
Amphibians often get ignored when it comes to zoonotic diseases. The risk of salmonellosis associated with reptiles is fairly well known, but not too many people think about the risk associated with amphibians. The same general guidelines for keeping and handling reptiles should be used for amphibians:
- Children under the age of five should not have contact with amphibians, nor should people with compromised immune systems.
- Hands should be thoroughly washed after handling frogs or having contact with their environment (terrarium/aquarium).
- Frogs should not be allowed to roam freely in the house.
- Aquarium/terrarium water should not be dumped out in the kitchen sink. Ideally, amphibian habitats should be cleaned outside. Care should be taken to prevent contamination of the household environment.
- Amphibians should not be kept in childcare facilities or kindergarten classrooms.
Hepatitis C and cat scrathes
I had an advice call recently about the risk of hepatitis C transmission by cat scratches. Hepatitis C is a human virus that can cause serious liver disease. It is most commonly transmitted via the blood of infected individuals. The concern with cats in this case was whether there is a risk of transmission if a cat were to scratch someone with hepatitis C and then scratch someone else.
There are no reported cases of hepatitis C transmission via a cat scratch. For transmission to occur, the following must happen:
- The cat must scratch an infected person who has hepatitis C virus circulating in their bloodstream.
- The scratch must draw blood, which then contaminates the cat's claws.
- The virus must survive on the cat's claws.
- The cat must scratch someone else deep enough to draw blood.
- Hepatitis C virus must go from the cat's claws into the person's bloodstream and survive.
The odds of this sequence happening are very low. It's similar to the concerns about HIV transmission from dog bites - theoretically possible, never proven, and probably of very little concern.
This could be seen as similar to the situation with needlestick injuries in people: someone draws blood from an infected person, and then promptly sticks his or her finger with the needle by accident. Hepatitis C is not efficiently transmitted by needlesticks; only about 1.8% of people that get stuck in this manner (with a needle contaminated with blood from a hepatitis C-positive individual) develop antibodies against the virus. The risk is highest with hollow-bore needles (such as those used for injections and blood sampling) compared to needles used for sutures, because of the greater volume of blood that could be transferred via a hollow-bore needle. Cat scratches are presumably more like surgical needle punctures - there can only be contaminated blood on the outside of the claw, not inside it.
The only time I might have any concern would be if I suffered a significant scratch injury from a cat that had immediately before that caused a major injury in a hepatitis C-positive individual, such as in a situation that might be encountered when two people were breaking up a cat fight, or when someone was trying to pry an attacking cat off another person. It's a very unlikely scenario, and the associated risk would still be extremely low.
Bottom line: Don't worry about hepatitis C when around cats and infected people. Use common sense measures to avoid being scratched at all times.
Image source: www.gooddog.co.uk
Snakes and cakes
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My oldest daughter's latest favourite TV show is Cake Boss, a TLC show about life in a bakery (don't ask why... I guess it's better than John and Kate Plus 8). On a recent episode, they were making a cake for a circus sideshow and one of the performers appeared in the bakery's kitchen with a large albino snake. It makes for good entertainment but it's a break with common sense and presumably health codes.
Reptiles should never be allowed in a kitchen, let alone a commercial kitchen (especially one that presumably prepares items often eaten by children). Contact with reptiles is a significant risk factor for salmonellosis, and cross contamination is a concern in kitchens. All pets should be kept out of food preparation areas, but particular care should be taken around high risk species like reptiles, and every reptile should be assumed to be carrying Salmonella.
Another fatal strep outbreak at a shelter
A very poorly-written and confusing report suggests that another Streptococcus zooepidemicus outbreak is underway in dogs in a shelter in Ohio. Five of 175 dogs on the premises died suddenly of hemorrhagic pneumonia. The report variably mentioned a "virus that mutated from horses," that it's thought to be "not contagious" despite multiple dogs being affected, and that it's a "rare form of streptococcus" (a bacterium). Presumably, they are dealing with a group of dogs with Streptococcus zooepidemicus pneumonia (technically, Streptococcus equi var. zooepidemicus). This bacterium predominantly lives in horses but periodically causes infections in other species. Outbreaks in dogs are uncommon but have been reported in other shelters. I assume that cultures from the dead dogs identified the bacterium, otherwise other possible causes such as canine influenza would also have to be considered.
The statement about it not being contagious is bizzare. Obviously, it is contagious between dogs. It may have been referring to dog-to-human transmission, but while that's rare it has been reported.
The shelter is apparently treating all dogs with penicillin prophylactically (i.e. to prevent any more dogs from getting sick). There's no clear guidelines regarding management of S. zooepidemicus outbreaks in kennels. It's now known whether mass antibiotic treatment does anything helpful, but it has been used in other outbreaks. I think it's likely that these outbreaks stop on their own, rather than penicillin having a major impact, and that there's probably another underlying cause such as a viral infection to account for outbreaks of this rare disease. However, that's just speculation for now. Hopefully this outbreak will cease with whatever treatment and infection control measures they put in place (or on it's own). Hopefully a good review of routine infection control practices will be performed at the same time, as routine practices (or lack thereof) are often a major problem in shelters.
Rabies quarantine in (and of) Santa Cruz County, Arizona
A large number of rabies cases in Santa Cruz County, Arizona has lead to the rare practice of implementing a county-wide rabies quarantine. Fifty-four cases of rabies have been diagnosed so far this year, mainly in skunks. That's about twice as many as normal.
Quarantine is probably not the best description of what they are doing, but they are taking measures to improve vaccination of pets, reduce roaming pets and discourage human-wildlife interaction.
For the next 60 days, the following rules are in place:
- Dogs and cats must be vaccinated against rabies.
- Dogs must be confined to the property or on a leash.
- People are not allowed to feed wild animals.
- Pet food must not be left outdoors after sundown.
Those are all pretty standard measures that should be used anytime. It sounds like these rules already exist in Santa Cruz County but their "quarantine" means that they will be aggressive in enforcing them. Increasing enforcement is a good idea, but ongoing efforts after this quarantine period are also needed because rabies will continue to be a risk in that area.
Image source: www.acmeanimalremoval.com
Bordetella pneumonia in a person from dog vaccine
An article in an upcoming edition of Transplant Infectious Disease (Gisel et al) describes a case of Bordetella bronchiseptica pneumonia in a person who had received a kidney and pancreas transplant. This person had to board her dogs at a veterinary clinic while she was hospitalized for a bowel obstruction that occurred after surgery. The clinic required her dogs to be vaccinated against Bordetella bronchiseptica, a cause of canine "kennel cough." They were vaccinated intranasally (i.e. up the nose) with a modified live vaccine comprised of live B. bronchiseptica that is modified so it is unlikely to cause disease but can still induce a good immune response. The owner developed pneumonia after returning home and B. bronchiseptica was isolated. Specific testing was not performed to confirm that the vaccine strain caused disease, so it's possible that she was infected by the normal (i.e. "wild type") B. bronchiseptica (which still would have presumably come from the dogs).
Immunosuppressed individuals are at high risk for infection by microorganisms that usually don't cause disease in otherwise healthy people. Bordetella bronchiseptica is a good example of this. Care should be taken around pets by anyone whose immune system is compromised. Here are some recommendations pertaining to kennel cough vaccination:
- Immunosuppressed individuals should not receive modified live vaccines themselves, and it is probably prudent to extend this recommendation to avoid modified live vaccination of their pets with vaccines like the Bordetella (kennel cough) vaccine.
- If vaccination for kennel cough is required for entering a kennel or vet clinic, an exemption should be sought because of the potential risk to the immunocompromised person.
- If vaccination must be performed, injectable vaccination is preferred. It doesn't produce as good immunity in the dog compared with intranasal vaccination but the risks to the immunocompromised owner would be much less.
- If intranasal vaccination with modified live kennel cough vaccine is used, immunocompromised owners should not be in the same room during vaccination. They should avoid contact with the dog's mouth, nose and face for at least a few days after vaccination and should wash their hands (or use a hand sanitizer) regularly after contact with the dog.
- If respiratory disease develops in someone exposed to a dog recently vaccinated against kennel cough, the potential for vaccine-associated disease should be mentioned to the physician.
