Ear mites and the strange pursuit of knowledge
Ear mites are a common problem in dogs and cats, particularly in young animals, as well as in strays and animals in shelters. The species of mite typically involved is called Otodectes cynotis. It is transmitted between individuals by direct contact (basically hopping animal to animal, as it does not survive for long in the environment), and causes an extremely itchy ear infection (which can get even worse if there is secondary infection with bacteria or fungi).
There are a few reports of suspected infections with Otodectes in people. Considering how common ear mites are in cats and the small number of reported human infections, transmission between pets and people is probably rare, but it certainly can occur. Most of the reports are somewhat circumstantial, involving people with itchy skin lesions that developed after a pet was diagnosed with ear mites. However, one curious veterinarian took it a step further.
Dr. Robert Lopez, of Westport, New York, intentionally infested himself with ear mites from infected animals, and described the outcome in a 1993 edition of the Journal of the American Veterinary Medical Association. First, he took a sample from the ear of a cat with ear mites and placed it in his own ear. He described the scratching sounds and movement that he could feel as the mites explored his ear canal. Severe itching developed, to the point where "sleep was impossible." The intensity of the itching and mite movement decreased over time and the infection resolved by itself within a month.
Personally, I think I would have stopped there. (Actually, I wouldn't have made it to that point, but if I did, I certainly wouldn't have tried it again.) Yet, Dr. Lopez wanted to confirm his findings so, a few weeks later, he infected himself again with mites from another cat. The same type of disease developed, although it was less severe and only lasted two weeks.
Guess what he did next - he tried again, wanting to see if the reduction in severity might indicate development of immunity. So, he infected himself a third time, with the outcome being milder disease. This suggested to him (logically so) that immunity to the mites might develop, something that fits with the fact that ear mite infestations are more common in young animals.
Self-experimentation is generally frowned upon, but has been the source of remarkably scientific discoveries, even Nobel Prize winning discoveries (e.g. the role of Helicobacter pylori in gastric ulcers in people). I don't think Dr. Lopez is in line for any prizes, but it shows how a little academic curiosity along with minimal squeamishness can provide some interesting information.
What's the relevance of all this? If your pet has signs of ear mite infestation (e.g. scratching at the ears, dirty material inside the ears), get it examined and treated. If nothing else, this needs to be done because it's a very uncomfortable problem for the pet. There's also some risk of human infection, but it's probably minimal. The mites have to make it from the pet's ear to your body to cause problems. The quicker they are treated, the lower the likelihood of this occurring. Human ear mite infestations, be they in the ear or on the skin, seem to resolve by themselves, with treatment of the animal being the most important part of control. However, it can be a pretty uncomfortable condition and one most people (with the possible exception of Dr. Lopez) would certainly rather avoid.
Stray dog rabies vaccination debate
In response to an ongoing rabies outbreak, Thailand has launched a program to vaccinate stray dogs. A posting to ProMed questioned this approach.
"The authorities plan to catch stray dogs, to vaccinate them, and to release them. This is inadvisable, since rabies incubation in dogs may extend to a year, although it is mostly between 2-3 months. Catching an animal which might already be incubating an infection and then vaccinating it will not only not protect the animal but put at risk the lives of people led to believe that the animal is safe", wrote Maya Kimchi.
True, you could not guarantee that a dog that was caught was not incubating rabies, and in that case, vaccination of the dog would not be effective. However, the odds of this are very low, and it doesn't make sense to not vaccinate. The worst case scenario is you have a dog that develops rabies, that would have developed rabies anyway, but it is less likely to spread it to the other dogs you've vaccinated. There would be no risk to people vaccinating the dog since it wouldn't be infectious at that point.
"In an endemic country where there are many stray dogs and many cases of rabies in animals and humans, as in Thailand, the solution of [the problem] of stray dogs is to reduce their number and carry out mass vaccination to all owned dogs, cats, and ferrets."
The problem is the stray animals. Vaccination of pets is very much an important component, but vaccinating pets and ignoring the reservoir (stray dogs) doesn't help in the long run.
"If a country decides to avoid the elimination of stray dogs, it will be necessary to catch them, to vaccinate them, and to [quarantine] them for 6 months at a minimum, and only subsequently, together with birth control measures (castration/sterilization), release them for adoption, after registration in a database for further control."
Here's what the World Health Organization's Expert Consultation on Rabies says:
"Mass canine vaccination campaigns have been the most effective measure for controlling canine rabies."
"There is no evidence that removal of dogs alone has ever had a significant impact on dog population densities or the spread of rabies. The population turnover of dogs may be so high that even the highest recorded removal rates are easily compensated for by increased survival rates."
and
"Attempts to control dog populations through culling, without alteration o f habitat and resource availability, have generally been unsuccessful."
Culling is rarely the answer. Vaccination of stray and pet dogs, education of the public to avoid contact with stray dogs, controlling roaming of pet dogs to decrease control with strays, educating the public about the need for post-exposure prophylaxis if they have been bitten by a stray dog and ensuring that the healthcare system has the appropriate resources (e.g. available rabies antibody and vacccine) and knowledge to handle exposed individuals is the best approach.
Giardia outbreak closes shelter
A Fort McMurray (Alberta) SPCA shelter has been closed because of a Giardia outbreak. Giardia is an intestinal parasite that can cause diarrhea in dogs (and other species, including people) but can also be found in about 7% of healthy dogs. Giardia infection was confirmed in four dogs in the shelter, which led to the rather aggressive measure of closing the shelter. Shelter personnel suspect that the infection started with one dog, who spread the parasite to some other dogs that were in close contact with it. Giardia is passed in stool and animals get infected by ingesting Giardia oocysts from stool contamination in their environment or water sources.Giardia usually causes pretty mild disease that gets better on its own or with treatment. Shelter personnel stated "We are in desperate need for help from the public as far as raising funds for medical, because obviously it costs a lot of money to treat the dogs. It's a lot of money to treat an animal with giardia." It's actually pretty cheap to treat individual cases, but this makes me wonder whether they are treating all dogs in the shelter. That's not something I'd recommend because there's little evidence that treatment of non-diarrheic animals is needed or useful.
Presumably this outbreak (whether it was caused by Giardia or something else) will end soon, either because of or despite of what was done. You never know if you did something to control the outbreak or whether it just ran its natural course. If it truly was Giardia, I'd be surprised if there are more problems, but resolution of the outbreak won't change the fact that many dogs that they bring in will be shedding the organism.
Giardia is a cause of diarrhea in people, but we now know that dogs probably play only a minor role in human disease. The type of Giardia that is most often found in dogs is a dog-specific type (Assemblage D) that cannot infect people. Unless these dogs were infected with a strain that can infect people (uncommon but not impossible), there's no risk to people. Regardless, avoiding contact with stool, especially diarrhea, is still a good idea - for prevention of Giardia and other diseases.
Dog bites, the bad and the surprising
Dog bites are nothing new. They are extremely common and it's not unusual to see reports of serious, even fatal, dog bites, especially in children. There have been a few reports lately that are worth mentioning.
A Pennsylvania boy was seriously bitten on the face after being invited to pet a dog at a school function. The fact that the bite occurred during what we would consider an appropriate interaction, after being invited to pet the dog by the handler and under supervision, is notable. What's more concerning is the dog was at a booth set up by an organization that trains service dogs. Let's hope this group has reviewed their temperament testing and training protocols (the lawsuit might help spur that on).
A Custom's dog bit a young girl at Dulles Airport in Washington DC. The dog was in a training exercise in the baggage claim area and bit the child in the abdomen, requiring 20 stitches. This is very surprising for a dog that would presumably have been very highly trained and evaluated. Again, a review of their training program, the circumstances of the bite, the dog's history (whether it's shown any tendency to aggression before) and the handler's actions need careful review.
A 10-day old baby was bitten and killed by the family's husky. Little information is available but this reinforces the need to take care when introducing a new baby (or dog) into the household. This would have been an unprovoked attack, considering the age of the baby and the fact that it wouldn't have been moving around and potentially disturbing the dog.
A Hamilton, Ohio woman was attacked by a dog while locking her car, receiving injuries to her ankle and thigh. Neighbours needed to help get the dog off, indicating this was a real attack, not a nip from a startled dog. The dog is still at large.
Everyone needs to be aware of the risks of dog bites. That includes dog owners and people who never plan on having a dog, because you never know when you'll be in a situation where a bite is possible. Dog owners need to recognize the potential severity of bites, and ensure that their dogs are properly trained and controlled. Parents, in particular, need to ensure that their kids know how to act around dogs (whether or not they own a dog) and make sure they supervise their children closely when around dogs.
"Be A Tree" is part of the Doggone Safe Bite Prevention Program that teaches kids (primarily elementary school level) how to reduce the risk of being bitten by dogs in everyday situations. For more information, go to their website www.doggonesafe.com, or the Doggone Crazy website, www.doggonecrazy.ca.
Distemper in raccoons and dogs
The Toronto Star had a front page article today about an ongoing distemper outbreak in raccoons, and the potential effects on dogs. Toronto's not alone, as there are distemper outbreaks underway in many different municipal regions.
Distemper is an infection caused by a virus that is related to human measles virus. It mainly affects dogs, raccoons and ferrets. It can cause intestinal, respiratory and neurological disease, with neurological problems being the most severe. Vaccination of dogs against distemper is highly effective, and has greatly reduced the impact of this virus on the pet dog population.
Distemper cannot be transmitted to people, so the disease itself is only an animal health risk. However, there's an indirect effect of which people need to be aware. Rabies always needs to be considered in dogs and raccoons that have signs of neurological disease. If there is so much distemper in an area that people assume every sick (wild) animal they find has distemper, there is a risk that the odd (but important) case of rabies may be missed, leading to human exposure. It's easy to dismiss a neurological raccoon or unvaccinated dog as having distemper, and it usually is distemper (particular in light of the current outbreak), but the implications of missing a case of rabies can be severe since it can be transmitted to people and is almost invariably fatal.
If distemper is present in your area (or, really, even if it's not currently a problem):
- Make sure your dog is vaccinated.
- Keep your dog away from wild animals, especially ones that are acting strangely.
- Keep yourself away from wild animals, especially ones that are acting strangely.
- Don't do things that will encourage raccoons to move into your yard, like leaving out food.
- If you see a wild animal that is acting strangely, call your local animal control agency.
Photo credit: The Star - Toronto edition 18-Feb-10
Raccoon vaccination in New York
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In response to ongoing problems with rabies in raccoons in New York's Central Park, a vaccination program is now underway. Raccoons are being trapped, vaccinated, tagged and then released. This is a logical response to the outbreak and one that will hopefully have a significant impact.
Trap, vaccinate and release programs can help in a few different ways. Firstly, they protect the individual raccoons that are vaccinated. However, in the bigger picture, mass vaccination is designed to protect humans and animals beyond those that are vaccinated (this is referred to as "herd immunity" - click here for a good video about this concept from a previous post). As the number of vaccinated (and therefore immune) individuals in a population increases, there's less risk of ongoing transmission of the disease (in this case, rabies), since an infected animal is less likely to encounter a susceptible (unvaccinated) individual. If, on average, an infected individual does not have a chance to infect another individual, the outbreak will eventually die out. The key is getting a high enough percentage of the population vaccinated.
For eradication of dog rabies, the World Health Organization recommends vaccinating at least 70% of dogs in a population. I'm not sure what the critical number is for raccoons, but it's presumably a similar, and reasonably high, number. Since a high vaccination rate is needed, there needs to be a concerted effort to do more than just a token vaccination program. It also helps if there's good information about raccoon numbers and distribution in the area. As long as the Department of Health is serious about this program and puts the required time and resources into it, the odds are very good that it will be successful.
Raw food recall: Salmonella
Nature's Variety has recalled chicken-based raw meat products because of Salmonella contamination. After a customer complaint about "digestive problems," they tested the food and found Salmonella, prompting the recall. (For more details about the recall, click here.) In some ways, this doesn't make a lot of sense to me. If you think Salmonella contamination should be an uncommon event and a problem, you should test routinely, not wait until animals get sick. If you think that Salmonella contamination of raw meat is expected (which it is), then why test or recall? Just assume that every raw meat sample is positive for Salmonella (and Campylobacter, and E. coli). Recalling raw meat for Salmonella isn't logical. Presumably, a large percentage of the raw meat that they have sold and which they will sell in the future is contaminated, based on various studies of commercial raw meat. Handling and feeding raw meat carries an inherent risk of human and animal infections with Salmonella, Campylobacter, E. coli and other bacteria. People that feed raw meat need to understand that risk, and consider whether it's a reasonable risk for their pets and the people in the household. I don't think feeding raw meat is a good idea, but in some situations it's a particularly bad idea (e.g. when there are infants, elderly persons or immunocompromised people in the household, when the pet is very old or very young, when the pet visits high risk people).
More information about raw meat feeding can be found on the Worms & Germs Resources page.
Big gun antibiotics in pets
Antibiotic resistant bacteria are a huge problem in human medicine, and they're an increasing problem in veterinary medicine. In pets, we are seeing dramatic increases in multidrug-resistant bacteria, some as a result of transmission from humans and some that are developing in animals. Regardless of the source, infections caused by resistant bacteria are a major problem. As resistance increases and we have fewer and fewer treatment options for some infections, the potential need to use certain antibiotics that are important for serious infections in humans ("big-gun" antibiotics) increases. This is a very contentious issue because concerns have been raised over the use of these drugs in animals and the potential impact on humans.
There are two extremes to the argument:
- These are critically important drugs in human medicine and they should never be used in animals.
- These drugs are used thousands of times a day in people and very rarely in animals, so the impact of periodic use in animals should be minimal, and failure to use them would result in animal deaths from potentially treatable infections.
I take the middle ground here. I am very concerned about antibiotic resistance (in pets and people) and I want to make sure that what I do does not have a negative impact on public health. I also realize that very rare and appropriate use of these drugs will realistically be unlikely to have any negative impact on public health, and that withholding treatment could cause animal suffering, death and prolonged infections that could be transmitted to their owners. The key, to me, is ensuring that use of these drugs is truly very rare and appropriate. At the Ontario Veterinary College, we have strict guidelines for use of "big-gun" antibiotics to try to ensure that there are used rarely and properly. For example, vancomycin can be used, but only when:
- An infection is present and it is known that the bacterium is resistant to all other options and susceptible to vancomycin.
- Local antibiotic administration or other types of alternative treatment are not options.
- It's a serious infection that needs to be treated but it is treatable (i.e. no throwing a big gun drug at a patient that clearly has a terminal disease and does not have a realistic chance of surviving).
- Approval is obtained from the Chief of Infection Control (i.e. me).
With this approach, we've only had 1 case where vancomycin was used, and that was in 2001. That's a pretty good record for a busy referral centre with a tertiary care caseload that sees "the worst of the worst." There have been a few instances when vancomycin was requested but with discussion and review of the case, better alternatives were identified. I'm certain that these guidelines have reduced the use of vancomycin and increased awareness of the problem, but have had no negative impact on patient care.
Antimicrobial resistance isn't going away. We can control it but not eradicate it. Scrutiny of antibiotic use in veterinary medicine is also not going to go away, and in some ways, that's a good thing. It should provide impetus to make sure that we improve how we use drugs, from the big guns down to our day-to-day drugs. Realistically, it's the regular use (appropriate use, overuse and misuse) of less exotic antibiotics that is having a bigger impact on antimicrobial resistance, and we need to pay attention to that as much as to the high-profile drugs.
Tiger troubles in Ontario
February 14th marks the beginning of the Chinese New Year, and ushers in the year of the tiger. Coincidentally, there's been some publicity surrounding a tiger in Ontario that has nothing to do with a New Year or good fortune. On January 10, a 300 kilogram Siberian tiger killed its owner, 66-year-old Norman Buwalda, when he went into the tiger's cage to feed it. This tiger was one of many owned by private individuals or as part of dodgy roadside zoos in Ontario and across North America.
It is truly amazing how easy it is for people to obtain potentially lethal exotic animals like tigers, and how many (or most) jurisdictions have no rules against it. Tigers are beautiful and fascinating animals, but they shouldn't be pets. Exotic pets carry many risks, including injuries and infections, not to mention animal welfare issues from poor management and feeding practices. This is far from the first exotic cat to have killed its owner, and unfortunately, it's almost certainly not the last.
The latest concerns about this particular tiger involved its whereabouts. When the OSPCA (Ontario Society for Prevention of Cruelty to Animals) went to the property to investigate a complaint about the well-being of other animals, they discovered that the tiger was gone. The town's major was also unaware of the tiger's location.
Provincial police, at least, knew more, and stated that the tiger and two lions were moved to an "undisclosed location" on January 27th. I think people need to realize this isn't the witness protection program, and there's no justification for being secretive about the location of these animals. The fact that they are gone should be a comfort to neighbours in Southwold, Ontario, but what about the people that may now be living next to it? It's pretty unlikely that these animals have been moved to a proper zoo with adequate housing facilities and handlers experienced with big cats. More likely, they're in the same type of situation as before, just is a different locale.
In Ontario, you can be charged if you have a pit bull or even a dog that resembles a pit bull, but you can have a 300 kg carnivorous feline in your backyard. How does that make sense?
Rat bite fever leads to pet store lawsuit
A Phoenix, Arizona man is suing a pet store after he contracted rat bite fever from a rat he had purchased. It's not surprising to see a lawsuit following a serious illness, considering people in the US often try to sue for just about anything, but I'm not sure it won't get very far. I don't doubt that the man had rat bite fever, or that he got it from the rat he purchased - the question is, is the pet store really liable? Specifically, did they do anything inappropriate?
"Rats being sold to people should not have rat-bite fever," Heitzman's lawyer, M.E. "Buddy" Rake Jr., tells New Times.
Actually, the rats don't have rat bite fever... rats are healthy carriers of the bacteria that cause rat bite fever. There are two different bacteria that can cause the disease, Streptobacillus moniliformis and Spirillum minus. Streptobacillus moniliformis is presumably the cause here since it's the main cause of rat bite fever in the US. This bacterium is very commonly found in healthy rats, with upwards of 100% of healthy rats being carriers. You have to assume that every rat is carrying this bacterium.
"It wouldn't be any different if they sold someone a dog with rabies," he says. "I'm not in the nuisance-lawsuit business - he was in rough shape."
It would certainly be a different story if the store sold someone a dog that had signs of rabies. It's possible that someone could buy a dog that had been exposed to rabies but which was healthy at the time of sale, but that's pretty unlikely. However, a big difference is that there is a highly effective vaccine against rabies. There is no such thing for rat bite fever. If a pet store sells an unvaccinated dog of unknown origin that could have been exposed, despite knowing the need for rabies vaccination, there certainly could be liability issues. Selling a rat that is carrying a bacterium that we assume most or all rats carry anyway is different.
PetCo did not immediately return telephone calls this afternoon, but in its defense, there is an information pamphlet explaining exactly how to avoid contracting rat-bite fever available on the company's Web site. ...though it seems the pamphlet's best suggestion is to not get bitten in the first place.
It would be better if everyone who bought a rat was given the information sheet, but it's a start. The fact is, the best way to avoid rat bite fever IS to avoid getting bitten by a rat! Proper rat handling is a very important aspect of disease prevention, since you can never rule out the possibility that a rat is a carrier.
Our suggestion: Don't have a disgusting rat for a pet.
Whoa. Rats can make excellent pets. They can also carry infectious diseases. However, EVERY animal can carry infectious diseases, and rats are probably no more risky than most other domestic pets. The key is to take common sense precautions to reduce the risk of injury and infection (though the risk can never be completely eliminated). For rats, this includes selection of a rat that is not aggressive or fearful, knowing how to properly take care of a rat, knowing how to take care of a bite should it happen and being aware of some diseases for which you might be at increased risk because you own a rat.
Image source: http://commons.wikimedia.org
Cold weather + iguanas = botulism in dogs?
The Associated Press is reporting a concern about botulism in dogs in Florida that might be linked to dead iguanas. The facts are pretty sparse at the moment, and it sounds like both the diagnosis of botulism and the link with iguanas are hypothetical, but it's an interesting story.
Botulism is a very serious, hard to treat and rare disease in dogs. It's also very hard to definitively diagnose, which is one of the problems in a situation like this. It seems that a veterinary neurologist first raised concerns after seeing paralysed dogs (and no evidence of typical causes) and a common history of exposure to dead iguanas.
The recent and prolonged cold weather in south Florida has apparently resulted in widespread death of iguanas (who do not tolerate cold weather). The iguanas presumably didn't die of botulism, but if they had Clostridium botulinum, the bacterium that causes botulism, in their intestinal tract (something that can be common in some animal species), then theoretically dogs could ingest the bacterium or (more likely) botulinum toxin produced by the bacteria in the iguana carcasses after death. Botulinum toxin is extremely potent, and ingestion of even minuscule amounts is enough to cause serious or even fatal disease.
Testing is pending on some of the affected dogs. It would be nice if someone would test some dead iguanas as well, to see if there is really a link. This type of outbreak, however, often passes without a definitive diagnosis because of the difficulties diagnosing the disease. Regardless, keeping your pets away from dead iguanas (and other dead critters) is a good general rule.
Image source: www.cafepress.com
Watch out for rabbit pee
Urine from healthy animals is typically considered to be of little to no risk to people. This is generally true, at least for the otherwise healthy human population, but like with most things in infectious diseases, there are exceptions. An interesting one in rabbits is a bug called Encephalitozoon cuniculi. This microorganism (now classified as a fungus, but previously considered a protozoal parasite) is very common in healthy pet rabbits. In fact, the majority of rabbits have antibodies against E. cuniculi and may have it living in their bodies, particularly in the kidneys. It can cause infection of the brain, and is an important cause of neurological disease in rabbits, but more often than not it lives within the rabbit without causing any problems. Rabbits can shed spores of this organism is their urine, although they mainly do this only in the first few weeks after they've become infected, and shedding after that may be intermittent.
E. cuniculi is one of a group of microorganisms that became much more important when the HIV/AIDS epidemic hit. While rarely a cause of disease in people in the pre-HIV era, E. cuniculi is recognized as a potential cause of infection in people with compromised immune systems, particularly people with AIDS. Infections of people with normal immune systems are extremely rare.
It's always a challenge deciding what to do with a microorganism that can be shed by a large number of healthy animals. One reference "strongly advises" routine testing of rabbits, but that makes no sense to me. Here's why:
- Screening always comes down to a question of what you would do with the results. If you get a positive antibody test, it means that the rabbit has been exposed sometime in its life, but that does not mean that it is necessarily still infected or shedding spores - so it's not really convincing.
- Tests can be done to detect spore shedding but they are not particularly reliable. Since infected animals shed spores intermittently, a negative result here isn't convincing either.
- If the animal is positive, what would you do? If the household has no immunocompromised people, I'd say do what you've always done, and pay attention to good hygiene.
- If the animal was "negative," I'd say do what you've always done, and pay attention to good hygiene... same as for a positive rabbit.
- If there is an immunocompromised person in the house, I wouldn't say to get rid of the pet, since there's no evidence that's necessary. There is also no evidence that treatment is useful to eliminate E. cuniculi shedding rabbits. If the animal is positive, immunocompromised persons should avoid contact with urine and feces, and use good personal hygiene... just as they should do if the rabbit is negative!
More information about E. cuniculi in rabbits can be found in our archives.
Kissing a frog might get you more than a prince
The Hollywood effect is quite real when it comes to various trends, including pets (remember the glut of Dalmatians after 101 Dalmatians?). I can understand how seeing a cute puppy of some breed might lead to people wanting to get one. However, when Disney's The Princess and the Frog was released, I didn't really think a lot of people who watched this movie were going to start running around kissing frogs. I assumed that some degree of common sense would apply. Apparently, I was wrong.
Various news outlets are reporting that at least 50 children (mainly kids under the age of 10) have become sick in the US after copying the movie's Princess Tiana by kissing frogs. There's not a lot of information regarding what they contracted, whether the illnesses were all clearly linked to frogs, or whether these were truly associated with the movie, but there are certainly disease risks associated with kissing a frog. While we pay more attention to reptiles as a source of Salmonella, the risk is also present with frogs, and the best thing is to do is assume that all frogs are carrying this potentially harmful bacterium. Accordingly, high-risk people (e.g. kids less than 5 years of age, the elderly, people with compromised immune systems) should have no contact with frogs - they shouldn't even be in the same house. Hands should always be washed after touching a frog, and no one should ever kiss a frog. The chances of living happily ever after with a prince are much lower than the chances of a nasty bout of diarrhea (or worse)!
Autism/vaccine link study now fully retracted
The medical journal Lancet has fully retracted the flawed 1998 study that raised a link between MMR (measles, mumps, rubella) vaccination and autism in children. This study fueled incredible debate and was a driving force in the anti-vaccination movement, and subsequent declines in vaccination rates were a key reason for the resurgence of measles. It also fostered general anti-vaccination sentiment that has continued to affect decisions regarding vaccination of people and animals.
The study has come under fire for years and has been highly controversial, with strong opinions on both sides. In 2004, the journal issued a partial retraction based on a conflict of interest of Dr. Wakefield's (the lead researcher), since it was revealed that he was being paid by lawyers acting for parents who believed their children had been harmed by MMR vaccination. The new full retraction goes much beyond this, and is based on problems that have been revealed with the scientific method, reporting of what was done, plus ethical issues pertaining to ethical committee approval.
The UK's General Medical Council ruled last week that Dr. Wakefield had shown "callous disregard" for the children involved in the study and acted "dishonestly." He faces being stripped of the right to practice medicine in the UK. Accordingly, all of the findings of this study are considered invalid.
Image source: http://www.dailymail.co.uk
Reptiles and infants don't mix
A recent report in the Journal of Pediatrics (Tabarani et al 2010) describes a case of infection around the brain, at the site of a previous subdural hematoma, in a five-month-old child. Four reptiles (all bearded dragons) were present in the child's foster household, but the foster parent reported that the baby did not have any contact with them. Salmonella Houtenae was identified as the cause of the infection. The reptiles were an obvious potential source given what we know about Salmonella and reptiles, the unusual Salmonella strain that was isolated from the baby, and the lack of any other obvious risk factor. All previous human infections caused by this type of Salmonella have been associated with reptiles, and all occurred in young children. Unfortunately, the reptiles in this case were euthanized before they could be tested.
This report highlights a few important points.
- Direct contact with reptiles is not needed to cause an infection. There are many reports of people (especially infants) being infected by Salmonella from a pet reptile despite them having no direct contact with the animal. The common statement that 'there's no risk to my child because my child is never allowed to touch the animal' is completely false.
- Reptiles should not be in households with children less than five years of age. In this report, the child was in a foster home. In some jurisdictions, reptiles are banned from foster homes for this very reason.
- The majority of reptiles carry Salmonella. This is expected and impossible to prevent. That's why people at high risk of serious infection (e.g. young children) should not be around them. It's also why euthanasia of the reptiles in this case was highly questionable. Why kill the lizards for carrying a bug that we assume they (and most other reptiles) normally carry? Finding them a new home that doesn't have high risk people would be more appropriate.
Image: Central Bearded Dragon (Pogona vitticeps) (photo credit: Eigene Arbeit, 2007)
