More info about rabies survival
A few more details are available about the apparent case of a person surviving rabies infection that I also wrote about in a post a few days ago. The affected individual is an eight-year-old girl from Willow Creek, California. She initially had non-specific signs of illness (which is not unusual for rabies) and at her first visit to a doctor, it was thought that she probably had the flu. However, her illness progressed quickly and she developed severe neurological signs shortly thereafter. She was sent to the University of California Davis Medical Center, where she was diagnosed with rabies a week later. I'm not sure if they suspected rabies before the diagnosis and started treatment, or whether they didn't initiate treatment until after the diagnosis was made. Presumably, they started treated based on a suspicion of rabies because she would have deteriorated greatly during that week otherwise.
Her current health status isn't reported so it's not clear whether she is truly out of the woods or whether there are any residual neurological abnormalities. If treatment is successful, this girl would be only the fifth person (as far as my count goes) known to have survived rabies infection. Presumably she was treated with a form of the Milwaukee protocol, which involves putting the patient in a medically-induced coma and administering a series of anti-rabies drugs. When it was first reported to be successful, this protocol was hailed as a remarkable breakthrough in the management of rabies (which is was). However, it still has a low success rate, which is a testament to the severity of rabies and the often late recognition and initiation of treatment. Hopefully more details about the treatment protocol and her clinical status will be made available soon.
On a happy related note, Jeanna Giese, the girl who in 2004 became the first known rabies survivor in the world, graduated from College a few weeks ago at the age of 21.
Aquatic frog Salmonella update
As I mentioned in an earlier post, there's been a large and ongoing outbreak of salmonellosis in people across the US associated with pet aquatic frogs (such as African dwarf frogs). A recent edition of Morbidity and Mortality Weekly Reports provides an update on this large and concerning outbreak. Here are the highlights regarding infections reported between April 1, 2009 and May 10, 2011.
- 224 infections with the unique outbreak strain of Salmonella Typhimurium have been identified in 42 US states. Since it is estimated that only ~3% of Salmonella infections are laboratory confirmed, this means that the number of true cases is probably much higher (e.g. >8000, if the 3% estimate is accurate).
- The median age of affected people was 5 years, with a range of <1-67 years. The young age bias may be because of increased susceptibility to infection, increased likelihood of severe infection (which would more likely result in testing) or more common exposure.
- 30% of affected individuals were hospitalized. There were no deaths.
- 65% of affected people reported contact with frogs in the week before illness. 18% of those occurred outside the home (which is why we need to make sure that even non-pet-owners are educated about zoonotic disease risks associated with pets).
- The median time from acquiring a frog to onset of disease was 15 days. This means people often got sick fairly soon after acquiring their new pet.
- One breeder in California has been implicated as a common source of infected African dwarf frogs. As with many kinds of small pets (e.g. rodents, reptiles), this is a large breeder that sells to distributors who then sell to pet stores and elsewhere. This type of mass production and distribution system means that a problem with a single breeder can result in widespread disease. This has been clearly shown previously in various other outbreaks, especially with pet rodents.
What should the average pet owner know?
- High-risk households - those including kids under the age of five, elderly individuals, pregnant women or individuals with a compromised immune system - should not have pet aquatic frogs.
- High-risk people (as describe above) should not have contact with aquatic frogs in other places.
- People with aquatic frogs should consider the frogs to be infected with Salmonella until proven otherwise. Since we don't know how to prove otherwise, that means treat all pet aquatic frogs as infectious.
- Frog owners should avoid direct contact with the frogs and their water. Hands should be washed thoroughly after contact with frogs or their environment.
- Frog owners should never dump aquarium water into kitchen or bathroom sinks.
- Any spills of water during aquarium cleaning should be promptly and thoroughly cleaned up.
- Other pets should be kept away from aquaria (I remember when I used to have aquatic turtles and a cat. The cat used to drink from the aquarium and occasionally bat at the turtles. Not something I'd endorse now, but that was in my pre-DVM era).
This outbreak doesn't mean that aquatic frogs can't be good pets. It means that they shouldn't be pets for certain people, that good routine infection control practices need to be used by frog owners and that consideration needs to be given to whether mass production of pet frogs (and other species) is appropriate.
Photo: An African dwarf frog (Hymenochirus boettgeri) (photo credit: James Gathany, CDC Public Health Image LIbrary #11831).
Rabies in person in California
Although limited on information, there's a recent report of a person with rabies in California, with some hope for survival. Rabies was apparently diagnosed in the person on May 6. Incredibly, not only is the woman alive, but she is reported to be in "stable condition" and improving at UC Davis Medical Center. That's remarkable because rabies is almost always fatal, and death usually occurs fairly quickly by the time rabies is suspected and diagnosed. Rabies survival has been reported but is extremely rare.
While it's far too early to talk about survival and cure of the woman's illness, there are many different factors that could be involved in this potentially successful treatment. These include very rapid administration of anti-rabies treatment, use of the "Milwaukee protocol" (which was the first successful treatment protocol for rabies in a person, which has also failed to be successful numerous times since), pre-existing partial immunity from previous vaccination, and/or the whims of biology and the immune system. Hopefully, this person will continue to improve and more information will be made available about why treatment has been successful so far.
The source of rabies is suspected to have been feral cats, although this is far from certain and it may be that this presumption is based on the lack of other more likely possibilities. While this is an encouraging report, it doesn't change the fact that rabies almost always kills, and it's almost 100% preventable with proper post-exposure treatment. People need to be aware of how to avoid rabies and that prompt treatment is needed anytime rabies might have been encountered.
Dog bite death
A 35-year-old UK man has died following a seemingly innocuous dog bite. He was nipped by the family's pet dog, not during an aggressive incident but just a playful, boisterous dog. Later, he developed a fever. He saw a doctor the next day and was told that he had influenza based on his clinical signs, but no testing was done. There's no mention about whether the doctor was notified about the dog bite or asked about animal bites or contact. (I wouldn't be surprised if that didn't happen.)
Unfortunately, the man's condition deteriorated and he was diagnosed with sepsis, which is an overwhelming infection of the bloodstream. A dog-associated bacterium, Capnocytophaga canimorsus, was identified as the cause. Both of the man's leg's were amputated because of the effects of the infection, after which he started to improve, but he later developed more complications and ultimately died.
A doctor explained, "These things are so unusual. It would have been like an unstoppable train – it just depends on how the body reacts." Infection with C. canimorsus is rare, and once it's underway, it can be difficult to control. However, this quote neglects the potential treatable aspect of the infection. For an aggressive infection like this, diagnosing it early is critical. If the doctor had asked about pet contact, asked about bites, noticed the bite, or if the person had mentioned the dog bite at the first visit, an astute physician may have thought about bite-associated infection and hopefully started proper treatment, before fulminant sepsis developed. This would be particularly true for certain high-risk individuals.
Capnocytophaga infections occur almost exclusively in high-risk people, particularly people without a spleen, but also in immunocompromised individuals or alcoholics. There's no mention of whether this person had any of these risk factors, but people who do should know that they are at high risk, see a physician if they are ever bitten by an animal (even if it seems like a very minor bite), and make sure their physician knows about pet contact.
Avoiding Capnocytophaga is essentially impossible if you have a dog. It's carried in the mouths of most (if not all) dogs, but it's typically not an issue. Human infections are rare but they are important because, like in this case, they tend to be very severe when they do occur. High-risk individuals need to know about this bug, make sure their physician knows about any animal contact they have, be proactive to avoid bites and other exposure to dog saliva, thoroughly wash any bites or wounds contaminated with dog saliva, and consult a physician after any bite, regardless of how mild it may seem. Pet owners shouldn't be afraid of Capnocytophaga, but they should be aware of it and various other bite-associated pathogens, do their best to reduce the risk of bites occurring (e.g. proper training of dogs (and kids)), and know how to take care of bites.
MRSP transmission between people and pets
Today (like most days) I answered questions about the potential for transmission of methicillin-resistant Staphylococcus pseudintermedius (MRSP) between people and pets. We have a long way to go before we fully understand the issues, but research continues to progress and we're learning more and more. A recent study by Dr. Engeline van Duijkeren and colleagues from Utrecht University published in Veterinary Microbiology (van Duijkeren et al. 2011) steps up our knowledge another notch.
In their study, the authors enrolled 20 households that owned pets with MRSP infections. They went into the households and collected samples from the index pet (the one with the MRSP infection), other pets, people and the household environment. At the time of sampling, 10 of the infected pets had gotten over their illness while the other 10 still had active infections.
Some highlights of the study:
- 4/14 (36%) of other dogs and 4/13 (31%) other cats in the households were MRSP carriers. In households where the pet still had an active infection, an astounding 86% of the other animals were carriers. All these numbers are much higher than the expected baseline rate of MRSP carriage by healthy pets in households, giving strong support to the notion that MRSP is being passed between pets in households with an infected pet. From an infection control standpoint, it's probably reasonable to assume that a pet living with an infected animal is a carrier.
- MRSP was isolated from 2/45 (4%) of nasal swabs from people. This is not too surprising, since we know that MRSP (and its susceptible counterpart, methicillin-susceptible S. pseudintermedius (MSSP)) can be transmitted between people and pets. This study shows us, however, that even when there is apparent MRSP transmission going on between pets in the household, it doesn't seem to commonly involve people.
- MRSP was found in the environment in 70% of houses (and 90% of household where the pet was still infected). These are pretty big numbers but are not really unexpected, since if MRSP is in and/or on animals, it's bound to be found in the environment. Whether the environment is a potential source of human or animal infection isn't known, but it's something to consider.
This research gives more evidence that MRSP can be spread readily between animals but less so between animals and people. It could be because animals have closer contact with each other in a household than with people, but a bigger factor is probably that S. pseudintermedius is more adapted to living on animals than on people.
MRSP info sheet update
The ever-popular methicilin-resistant Staphylococcus pseudintermedius (MRSP) owner information sheet has been updated and can be found, along with info sheets on many other topics, on the Worms & Germs Resources page.
Rare rabbit infection in Manitoba
Rabbit hemorrhagic disease (RHD), a rare and reportable disease, has been identified in a pet rabbit from Winnipeg, Manitoba. The affected adult male rabbit was taken to a veterinary clinic in March after being lethargic for a short period of time. It was diagnosed with liver failure and subsequently died. The rabbit's body was forwarded to the Manitoba Ministry of Agriculture, Food and Rural Initiatives animal health laboratory. Various tests were performed and rabbit hemorrhagic disease was identified.
Rabbit hemorrhagic disease is a viral disease caused by a calicivirus. It is a serious infection that has high death rates and spreads very rapidly between rabbits through direct contact and through contaminated items such as cages and bedding. It does not affect people. Caliciviruses are non-enveloped viruses - viruses of this kind are very hardy, and can survive in the environment for long periods of time. RHD is reportable in Canada, and has not, to my knowledge, been identified in the country before. It's endemic in wild rabbits in many countries, and is thought to have made its way to North America in 1988 in a shipment of frozen rabbits from China to a supermarket in Mexico City. It's been found in the US in sporadic outbreaks since 2000.
Finding RHD in a Canadian rabbit perhaps isn't too surprising, since it's been identified in the US periodically over the past decade. However, this is a strange situation. The affected Manitoba rabbit lived in an apartment with two other pet rabbits, and did not have any outdoor access or contact with any other rabbits (or any other wildlife). These other two rabbits were fine. They were quarantined initially but have since been released from quarantine since they stayed healthy and tests for the virus were negative.
So, where did the virus come from? That's a baffling question, because this virus is a rare and exotic disease that is not known to be elsewhere in Canada. It would have been a lot less surprising if this was in a rabbit with outdoor access or that had had contact with other rabbits (outside of a confined household group). No source has been reported, but I assume authorities have looked at aspects like the owner's contact with rabbits or wildlife, the owner's contact with areas where wild rabbits might live, when the other rabbits were obtained and from where, and whether the owner has brought rabbit meat into the house. Although mice and similar rodents aren't known to be susceptible to the virus, checking for a rodent infestation in the house would be another consideration at in a strange situation like this.
Why were the other rabbits unaffected? That's surprising as well, considering how easily the virus is normally transmitted.
Another thing this story highlights is the usefulness of diagnostic testing. I'm impressed that the owners and veterinarian submitted the rabbit's body for testing. Too often, an animal that dies of a strange disease is just buried or cremated. That's understandable from an emotional aspect, but often it occurs because testing is not even discussed after an animal has died, or because people don't think about why it might be useful. Cost is an issue, as testing is not typically subsidized for non-food-animals (in this case, even though it was a pet, I presume the rabbit was treated as a food animal, with a lot of testing done for free). While testing won't help the dead animal, it can provide useful information at times, beyond finding a rare foreign disease. It's not uncommon for me to get a call from someone saying "my dog recently died of some strange disease, is it safe for me to get a new puppy or do I have to do something first?" or less commonly "I'm sick and the doctors haven't figured it out. My dog died last month of something strange, do you think they could be linked?' With only a vague clinical description, there's often not much I can say.
Rare diseases are just that - rare. The odds of encountering one are quite low, but they do happen. Arriving at a diagnosis can help identify risks to other pets and people, and it is often money and time well spent.
Travel, pets and infectious disease risks
An important concept when dealing with infectious diseases is consideration of the risk that an animal has been, or will be, exposed to a particular microorganism. Some diseases vary greatly geographically, and something that's very important in one region may be rare or non-existent in another. Good veterinarians are aware of disease trends in their area and make informed decisions about vaccination and anti-parasitic treatments based on what's happening in the area. They also know which diseases are common and which are rare or non-existent.
But that only works if the pets stay in their "home" area. Traveling with pets can result in exposure to various infectious diseases they wouldn't normally encounter. If a veterinarian doesn't know a pet travels, they can't make proper recommendations for preventive medicine.
Additionally, travel history can be very important when evaluating a sick animal, since there may be diseases that need to be considered in a traveling pet that wouldn't be an issue with a local pet. However, it's easy to overlook or forget about travel history. Pet owners need to tell their veterinarians about "recent" travel with their pets. What does recent mean? It's hard to say. For some diseases, exposure within the past few days is all that's important. For others, it may be weeks or months. So, if you have a sick pet and have traveled any time in the past year with it, it's good to mention that to your veterinarian. It may have nothing to do with the current illness, but it never hurts to let them know anyway. In some situations, it may be the critical piece of information needed to trigger thinking about a specific disease.
Some examples of diseases that may be travel-related (at least to dogs in most parts of Ontario):
- Blastomycosis, a fungal disease, tends to occur predominantly in specific areas. It's not too common elsewhere, but travel to high-risk areas puts blasto on the list of possibilities in certain cases.
- Around here, there's no indication for heartworm preventive treatment during cold winter months, but that changes if the pet goes to areas where mosquitoes hang around all year.
- Some tickborne diseases have very specific ranges that correspond to their primary hosts and certain vector species (such as birds). In Ontario, ticks are currently quite geographically focused and many dogs have little risk of exposure. Travel to one of the tick hotbed areas changes that, and means that certain tickborne diseases need to be considered.
- Canine influenza currently seems like a non-entity in Ontario. We're still looking for it but haven't found it. It is present in some places in the US, and at times, is a big problem. Travel to a place experiencing a canine flu outbreak would be a good indication to consider canine flu vaccination.
What to do?
- If you travel with your pet, part of your pre-travel checklist should be an appointment with your veterinarian to go over anything that needs to be done, be it vaccination, deworming, flea control, heartworm preventive or anything else. (It's also a good time to make sure there's nothing else going on with your pet, because you don't want a pet health crisis en route.)
- If your pet gets sick and has traveled, make sure your veterinarian knows where you went and when.
- If you travel regularly, even if it's not long distances, it's good to discuss it with your veterinarian to see if anything is required for your pet. Even if you just go a couple of hours away to a cottage regularly during the summer, you may be exposing your pet to something different.
Illegal alligators attract women? Who knew?
I guess I'm lucky I'm married since I'm obviously out of touch with the best ways to attract women. Unlike Dewayne Yarborough of Ford Heights, Illinois, I didn't know that a 4-foot-long alligator is a "chick magnet."
His reason for keeping the reptile was that he claimed it attracted women (I kid you not). While it may have attracted a few dates, it ended up costing Mr. Yarborough, as he was charged with possession of an illegal animal. Investigators found the alligator in a fish tank in the man's kitchen. Apparently, he was keeping it in a small tank and feeding it minimally (aka starving it) to keep it from growing too big. (Apparently, the degree of attraction of women is not directly proportional to the size of the alligator.)
Besides being illegal in many jurisdictions, keeping alligators is rarely a good idea. They can grow very large and can be very aggressive. They need lots of space, a proper environment and a proper diet. Like all other reptiles, they are a potential source of Salmonella (and some other microorganisms), so keeping them in the kitchen is an even worse idea.
I wonder what other animal-associated dating trends I've missed over the past few years...
Animal first aid kit recall
Earlier this year, there was a large recall of pre-packaged alcohol wipes made by Triad Group because of bacterial contamination and implication of the wipes in a large number of human infections. While alcohol is used as an antiseptic, bacterial spores are inherently resistant to the effects of alcohol and contamination with spore-forming bacteria can turn wipes into disease vectors. In the latest outbreak, alcohol wipes were contaminated with Bacillus cereus and implicated in the deaths of 7 people.
As an extension of the earlier recall, Creative Pet Products and MAI/Genesis (Veterinary Concepts) have recalled first aid kits marketed for use in pets and horses. In addition to the potential for contaminated alcohol wipes there is concern that the "sterile" lubricant jelly may not be so sterile, and could also be contaminated with Bacillus cereus. Additionally there is mention that the iodine pads could be contaminated with another bacterium, Elizabethkingia meningoseptica. (It sounds like they have some pretty major quality control issues. Not surprisingly, production at the plant has been suspended pending an ongoing FDA investigation.)
Anyway, anyone with one of these first aid kits should check to see if their kit is involved in the recall:
Alcohol prep pads – Kits affected:
10140 Horse Aid™ Kit
10145 Sporting Dog Kit
10148 Sporting Dog II Kit
10151 K9 First Aid Police & Military Kit
Brands: Triad or NovaPlus
All Lot Numbers
Iodine prep pads – Kits affected:
10140 Horse Aid™ Kit
10145 Sporting Dog Kit
10148 Sporting Dog II Kit
Brands: Triad or H&P Industries
Lot Numbers starting with 8, 9, 0, 1
The kits were distributed in the United States, Australia, the United Kingdom, Taiwan and Costa Rica.
If you have one of these kits, you should get rid of the affected items. For further details (and presumably how to get a refund) click here.
This Worms & Germs blog entry was originally posted on equIDblog on 09-May-11.
New petting zoo guidelines
As petting zoo season approaches (along with petting zoo-associated disease outbreak season, unfortunately), it's important for people who run petting zoos and other animal contact events to think about what they do to reduce the risk of infecting visitors. No petting zoo will ever be 100% safe, because any person-animal contact (just like any person-person contact) carries some degree of risk. However, the risks can be greatly minimized by some basic measures, such that the benefits of animal contact can greatly outweigh the risks for most people.
One of the standard guideline documents for managing public person-animal contact is the National Association of State Public Health Veterinarians (NASPHV) Compendium of Measures to Prevent Disease Associated With Animals in Public Settings, which has just be updated again for 2011. Anyone planning a petting zoo or similar event should know this document well and ensure that their event fulfills all the recommendations within it.
Hopefully, petting zoo operators will pay attention to these guidelines out of a desire to safeguard the health of their visitors. If that's not enough motivation, the liability aspect should be considered. Since there are well established and readily available guidelines, failing to use them could certainly increase the legal liability risk.
Natural disasters and pet diseases
After the devastation caused by Hurricane Katrina, there were numerous efforts to rescue animals left homeless or ownerless. As part of this, some animals were shipped far away, including large numbers to the Northeastern US and Canada. It was a time-consuming and expensive endeavour by very well-meaning people, but was accompanied by much controversy. Beyond the concerns about resources spent importing animals into areas where there is no shortage of strays and limited resources to care for them, there were infectious disease concerns. These concerns were real because of the potentially high incidence of disease, high rate of carriage of certain infectious agents and movement of dogs to regions where these diseases are rare or absent. Anytime you get population migration (be it human or animal) in response to a natural disaster, you have the risk of those migrants spreading diseases.
A study published earlier this year in the Journal of the American Veterinary Medical Association (Levy et al 2011) characterized some of these concerns. The researchers tested blood samples from 414 dogs and 56 cats that were transferred from the Gulf Coast region within four months of Hurricane Katrina. They tested the samples for a variety of infectious agents.
Among the highlights in dogs:
- Overall, 74% of dogs had "evidence of previous or current vector-borne infections." That's a pretty high number. Current versus previous is important, since the animals are only an infectious disease risk if currently infected. At least some of the testing was aimed at detecting infectious organisms (indicative of active infection), not just antibodies (which may indicate active or previous infection), so there was clear evidence that many dogs had active and potentially transmissible infections.
- Bartonella, Borrelia (Lyme disease), Ehrlichia and Babesia spp DNA were found rarely, in less than 2% of dogs. These organisms are spread by certain types of insects, and a concern with moving infected dogs is that it might allow for introduction of the disease into a new population if there are insects capable of transmitting these infectious agents in the new area. Fortunately, these weren't common.
- Canine influenza antibodies were found in less than 2% of dogs. This is a more important finding since canine flu is quite transmissible. While the virus is present in various parts of the US, it's distribution is pretty patchy. A dog infected with canine flu that comes into contact with other dogs in a new area could easily be the source of a local or regional outbreak.
- Dirofilaria immitis (heartworm) antigen was detected in 49% of dogs. This is a major concern and was one of the big causes of controversy in some regions. Dogs that are infected with heartworm and untreated are sources of infection. If bitten by a mosquito, heartworm can be transmitted to the mosquito, and then to other dogs (and less commonly cats, and very rarely humans). Heartworm is quite uncommon in many regions, and there were concerns that the transfer of these dogs could result in local increases in disease. Recommendations were developed to reduce the risk of heartworm dissemination, but given the high rate reported here, it's likely they were not widely followed.
- 56% of dogs had antibodies against West Nile virus. This is an interesting finding but not really relevant from a disease transmission standpoint. It likely reflects heavy mosquito exposure. West Nile virus is pretty innocuous in dogs and cats, and infected dogs and cats cannot pass on the virus to mosquiotoes or other animals.
- Dogs infected with heartworm were more likely to be infected with West Nile virus compared to those not infected with heartworm - presumably an indication of mosquito exposure.
The concerns are summed up nicely in the paper's conclusions: "Cats and dogs rescued from the disaster region had evidence of multiple infectious diseases. The dispersal of potentially infectious animals to other regions of North America where some infections were not typically found could have contributed to new geographic ranges for these organisms or to underdiagnosis in affected animals because of a low index of suspicion in regions with low disease prevalence."
I'm not saying don't rescue dogs and cats during disasters. Personally, I have to question the wisdom of putting the time, effort and resources into shipping animals around the continent when pretty much every jurisdiction already has their fill of animals in need of care, but people have different opinions. What common sense and this study should tell us is that we need to think about the infectious disease implications of mass animal movement, particularly marginalized animals with questionable or unknown disease status. Any large scale movement of animals needs to be accompanied by careful assessment of possible risks, and measures to make sure animals are properly tested and treated so that they don't pose an undue risk to the regions where they end up.
Image: Hurricane Katrina on August 28, 2005 (NASA)(source: http://en.wikipedia.org)
Rabies in "petting zoo" animals
Rabies in a lamb and cow at a petting zoo (or more accurately, in a communal group of hobby animals) has been reported in Israel. This follows identification of rabies in another lamb from the same group last week. Little is reported about possible sources of infection of these animals, at Kibbutz Neve Eitan, or how widespread human exposure may have been. It's a concern given the serious nature of rabies and the possibility that there was largely uncontrolled contact with the public, which complicates tracing of potential exposures. Given the state of rabies in Israel, the canine rabies variant is most likely the cause.
Presumably, public health and Kibbutz personnel are contacting people in the area to determine who may have had contact with the animals. Casual contact is not a risk for rabies transmission - it is only transmitted through contact of an open wound or mucous membrane (e.g. nose, mouth, eyes) with saliva from an infected animal. The risk of transmission to humans from contact with species like sheep and cattle is pretty low, however the tendency of young animals to suck on things and the fact that people often let them suck on a fingers when playing with them raises the potential for exposure. Anyone identified as having high-risk contact needs post-exposure treatment, consisting of a shot of anti-rabies antibodies and a series of four vaccines over the course of a month (unless they have been previously vaccinated against rabies, in which case they just need two booster shots).
Any animals involved in public displays, petting zoos or other events where there may be contact with the public should be vaccinated against rabies. That's particularly true in areas such as Israel, where rabies is endemic.
Another "service dog" problem
Another recent incident highlights yet again problems with untrained or inadequately trained service dogs.
The incident in question occurred in March, when Ava, a 14-month-old German Shepherd "service animal," lunged at a six-year-old child who lived next door. It sounds like the dog was roaming free and attacked the girl on her property. There's some debate about whether or not the girl was playing with the dog (which doesn't really matter because a service dog shouldn't attack under circumstances like that, nor should it be roaming at large). Anyway, the girl suffered a serious bite to her face that required more than 100 stitches to close.
Ava was owned by a family whose nine-year-old daughter has cancer. The dog was "trained" to steady the girl when she's dizzy. That may certainly be a good role for a service dog, as there is a wide range of beneficial activities that proper service dogs can perform. However, real service dogs are highly trained and closely evaluated, with a significant effort dedicated to making sure the dog is properly behaved and does not pose a risk to others. That's the problem here. While Ava might have been good for this one particular child, it doesn't sound like there was any training to protect the public (and if there was, it was woefully inadequate).
Ava apparently also bit another child in the fall, compounding the concerns. A settlement between the neighbours has resulted in the dog being removed from the township, with no declaration that she's dangerous, but also nothing preventing the likely lawsuit to recover medical costs, if not more.
There's nothing good that comes from a situation like this. A young girl has lost her dog, another young girl has suffered a serious bite, and true service dogs - that play a critical role in the lives of many people - get lumped in with these untrained animals.
If someone wants and needs a service dog, it's important to facilitate that. At the same time, if someone is going to take advantage of the benefits of having a service dog (e.g. broader access) they need to have an adequately trained, true service animal. Too many "service animals" are just pets with basically no additional training, but serious training is required for the animal to both do a real job as well as to ensure that there is minimal risk to the public.
