Back in the 1980s, Vietnamese Pot-Bellied Pigs were a popular fad pet. These stout little oinkers are still out there, though they're not quite as popular as they once were. Potbellied pigs are cute (at least to some people... to each their own!), supposedly quite smart, and can even be house trained/litter trained. As with any new pet though, it's very important to do your research before going hog-wild and getting yourself a pot-bellied pig. Talk to your veterinarian about what your pig will need in terms of medical care - vaccines, deworming, spay/neuter, hoof trimming, tusk trimming... Because they are uncommon pets, some veterinarians may not be comfortable treating a pig. Make sure you ask ahead of time so you know to which veterinarian(s) in your area you can (and will!) take your pig.
We recently received a question about vaccination of pot-bellied pigs. Just like dogs, in some areas pigs need to be licensed by the city, and certain vaccines are required in order to obtain a license. In this particular case, pigs are required to be vaccinated against rabies, swine erysipelas and leptospirosis. Regular visitors to this site are no doubt familiar with the issues around rabies and why it's important to vaccinate for this deadly disease. (More information about rabies is available on the Worms & Germs Resources page and in our archives.) Swine erysipelas is a systemic bacterial infection caused by Erysipelothrix rhusiopathia, which can rarely cause a skin infection known as erysipeloid in humans. This is not to be confused with human erysipelas, which is a skin infection caused by various species of Streptococcus (particularly Streptococcus pyogenes).
But the question was about leptospirosis vaccination in pot-bellied pigs. Pigs are susceptible to infection by Leptospira interrogans, just like dogs and people, and if infected a pet pig would be equally capable of shedding the bacterium in its urine and potentially transmitting the disease. The issues around requiring vaccination of pigs for leptospirosis are very similar to those around making leptospirosis a "core" vaccine in dogs. More information about this is available in the Worms & Germs post entitled "Should all dogs in Ontario be vaccinated for leptospirosis?" A pet pig would likely be exposed to the same serovars of Leptospira as a dog kept in the same area, typically by coming in contact with urine from infected wild animals such as raccoons and skunks when they go outside. However, the risk of exposure for a pig that rarely or never leaves the house would be extremely low compared to a pig that has outdoor access. Another important consideration is whether or not the pig vaccine is against the same serovars that a pet pig, instead of a commercial pig, might encounter. This will also vary depending on in what area the pig lives. The Leptospira servoars pomona and bratislava are actually host-adapted to pigs.
It is also important to vaccinate an animal with vaccines that are labeled for use in its own species. Vaccinating a pig with a vaccine meant for dogs could have unpredictable results - it may increase the risk of an adverse reaction, or it may not adequately stimulate an immune response, thereby leaving the pig essentially unvaccinated. Your veterinarian can discuss the pros and cons of vaccination in your pet with the available vaccine products.
More information about leptospirosis is also available on the Worms & Germs Resources page.
Most of the infectious disease topics that we've covered on Worms & Germs involve bacteria or viruses. Fungal diseases (other than ringworm) are often overlooked because they are less common, and because they tend to be more of a concern in certain areas only. However, when fungal infections occur they can cause serious problems.
Blastomyces dermatitidis is a dimorphic fungus (meaning it can exist in the form of a mold or a yeast) that lives in the soil in some areas. It is more common in wet, sandy, acid soils that have a high organic content. Animals (and people) can become infected by exposure to the mold form of the fungus in the soil. If the fungal spores are inhaled, it can result in severe pneumonia. Blastomycosis (infection with Blastomyces) can be difficult to diagnose and very difficult (and expensive) to treat. So while blastomycosis is rare in general, it is still an important disease, especially in areas where it is more common.
Recently, a study was published in the journal Medical Mycology (Chen et al, 2008, 46: 843-852), regarding blastomycosis in dogs in Tennessee. This was a case-control study that compared dogs with blastomycosis to dogs that did not have the disease. Here are some of the results:
- Male dogs were 2.7 times as likely to be affected as females.
- Working and sporting dogs were at higher risk (4.6 and 6.2 times as likely, respectively).
- Dogs 2-4 years of age were at highest risk.
- Close proximity to water was also a significant risk factor for infection.
In Ontario, blastomycosis seems to be most common around Georgian Bay. In the US, it is more common in central and northern states, with most cases reported in Wisconsin, Tennessee, Mississippi, Kentucky and Arkansas.
Blastomycosis can also occur in people, but blastomycosis cannot be transmitted from dogs to humans (or between any animal species). Only the mold form of the fungus that lives in the soil is infectious.
The weather outside is frightful (at least up hear in Canada!) - it’s getting colder, the weatherman now warns us about “flurries” instead of “showers”, there’s frost on the cars in the morning, and we’ve all had to start putting on those extra bulky layers before leaving the house in the morning. There's lots of grumbling about the oncoming winter weather. Let’s take a look at the silver lining though – people who live at more northern latitudes often don’t appreciate what a few months of cold weather does for us!
Insects in particular, including mosquitoes, ticks and others that transmit various diseases, are almost entirely inactive outdoors when it’s cold outside. Many insect species can’t even survive Canadian winter weather, which is why they are only concerns in more southern climates. For example, the brown dog tick (Rhipicephalus sanguineus), which can transmit many diseases including canine babesiosis, anaplasmosis, and Rocky Mountain Spotted Fever (RMSF, which can also be transmitted to people), doesn't exist in Canada except on dogs that have travelled to the south. The cold weather also helps keep heartworm in check through mosquito control - the prevalence if heartworm in North America decreases dramatically the farther north you go. Bacterial pathogens are often good at surviving in the cold, but many are killed by freezing, and even if they can survive, it is almost impossible for bacteria to grow and multiply in the cold. Winter provides a reasonable knock-down effect for a lot of pathogens and parasites that often thrive in the outdoor environment during the summer months.
Of course, microbes and insects can still survive in the same environments where we do over most of the winter – indoors, where it’s nice and warm. So it’s still important to do things like wash your hands after handling your pet and before you handle food. And, as always, come spring we’ll have to be prepared for the return of all those worms and germs as we venture back to our favourite warm-weather outdoor activities.
In the meantime, grumble though we may, try not to give old man winter too hard a time – a few months of freezing temperatures isn’t all bad afterall.
It's that time of year again - we're coming up on flu season, and the ads on the radio and the television are out, encouraging everyone to get their "flu shot," (aka influenza vaccination). Influenza isn't just a problem in people - it is a very versatile group of viruses that can infect many different species of animals.
Equine and swine influenza viruses cause serious problems in horses and pigs, respectively. Last year there was a massive outbreak of equine influenza in Australia. Because Australia was previous free of equine influenza, most of the horses there had never been vaccinated against the virus. Therefore the entire population was very susceptible to the disease and it spread very quickly. The outbreak has since been brought under control. A previous Worms & Germs post talked about an outbreak of canine influenza in dogs in Chicago IL this past summer.
Equine and canine influenza (and usually swine influenza) cannot be transmitted to people. However, there are some strains of influenza that can cross species. The most well-recognized one is certainly avian influenza (bird flu), which caused outbreaks in a number of Asian countries in 2004. Although people are much less susceptible to avian influenza than birds, the H5N1strain has caused significant illness and fatalities in people.
A lesser known fact about influenza is that pet ferrets are very susceptible to the virus, including human strains. This is part of the reason ferrets are often used as animal models of the disease in research studies. Signs of the flu in ferrets are similar to what you'd expect to see in people - fever, sneezing, runny nose and lethargy. A pet ferret can both transmit to and catch the flu from a person. Unfortunately for the ferrets, there is no available vaccine for the flu in these animals.
Lucky for us, people can be vaccinated against influenza. Most people are still far more likely to get the flu from another person than from any kind of animal. Getting your flu shot is the best way to help prevent yourself from getting the flu, and spreading it to others. However, it's important to remember that no vaccine is 100% protective, so it's still important to take a few common-sense precautions, like washing your hands frequently, and sneezing/coughing into the crook of your arm, not into your hands. (And watch out for sick ferrets!)
There is lots of information about influenza and flu vaccine available on the web, including some of the links in this post, and also on the CDC Influenza (Flu) website.
You may notice a recurring theme in many of our posts and on virtually all of the information sheets on the Worms & Germs Resources page: an emphasis on handwashing. There is increasing emphasis on hand hygiene (i.e. hand washing and use of alcohol hand sanitizers) education in hospitals because the hands of healthcare workers are a major (if not the most important) means of disease transmission between patients. Despite hand hygiene being easy, cheap and effective, people rarely wash their hands as often as they should, and they often don't do it properly.
Most of the research about hand hygiene that has been published has focused on its use and impact in human hospitals, but this area is now also being studied more with regard to animals and veterinary medicine. A study published earlier this year in Veterinary Microbiology provided more evidence that hand hygiene is a critical infection control measure when dealing with animals. The study, coordinated by Dr. Maureen Anderson (of Worms&Germs fame) looked at MRSA carriage rate in veterinarians who work with horses. In addition to finding a high rate of MRSA carriage among these veterinarians (which was consistent with other reports indicating that equine vets are at higher than average risk for exposure to MRSA), the study looked at factors associated with MRSA carriage. Vets that reported routinely washing their hands between farms and those that reported washing their hands after contact with potentially infectious cases had a significantly lower rate of MRSA carriage. That should come as absolutely no surprise, but it's one more piece of evidence that we need to pay more attention to this routine infection control measure, in human hospitals, in veterinary environments and in households.
Remember, the 10 most important sources of infection are the fingers on your hands!
If you are looking for an interesting website to play around with, you should try HealthMap. This is a website created by the Harvard-MIT Division of Health Sciences and Technology that maps infectious disease reports from various sources. You can search by region and see what disease problems have been reported recently, or select specific diseases and find out where they've been reported. Some examples are shown below. The top image shows all disease reports worldwide (in the last 30 days), while the bottom image shows reports of Salmonella in North America during the same time period. The site relies on reports of diseases (many cases of various diseases occur but are never reported), so it focuses mainly on outbreaks or high profile cases , but it is still quite interesting.
Above: All reported disease outbreaks/cases worldwide in the last 30 days.
Below: Reported outbreaks/cases of Salmonella in North America in the last 30 days.
See the HealthMap site for more details.
Brucellosis is an infection caused by bacteria of the genus Brucella. The most common species of Brucella in companion animals is Brucella canis, which typically causes infection in dogs. This bacterium is very rare in Ontario - in a survey of 2000 dogs, only 0.3% had evidence of exposure to B. canis. So it was unusual that a case of canine brucellosis was recently diagnosed in the province, until it was discovered that the dog originally came from a rescue shelter in the southern USA - an area where exposure to the bacterium is much more common (approximately 8% of dogs).
Brucellosis in dogs typically causes reproductive problems such as infertility and an enlarged scrotum in males, and late-term miscarriage in bitches (breeding females), with few or no other signs of clinical illness. But in some cases the bacteria have been found to infect tissues other than the reproductive tract, including intervertebral discs (leading to back problems), the eyes, the kidneys, or the tissues around the brain and spinal cord (i.e. the meninges). The bacteria, and antibodies to the bacteria, can be very difficult to detect in the early stages of infection. The infection is usually diagnosed by a blood test, but it may take 8-12 weeks before test will yield a positive result. There are also problems with high numbers of false-positive test results due to cross-reaction with other species of Brucella. Any positive test result should therefore be confirmed by a second, different laboratory test.
Human infection with any species of Brucella is now uncommon. When illness does occur, the signs are often non-specific (e.g. fever, headache, myalgia), but more severe infections have been reported. Transmission of B. canis from an infected dog to a person is possible. The bacterium is transmitted by contact of a mucous membrane (e.g. eyes, nose, mouth) with blood, urine, milk, semen, or vaginal discharge from an infected animal. The highest-risk materials (i.e. most likely to contain a high number of the bacteria) are placental tissues and fluids that are passed during whelping (delivering puppies). Treatment for infection is available, but the course is often long and recurrence of infection can occur.
Although brucellosis is very rare in dogs in Ontario (and Canada in general), here are a few things you can do to help avoid B. canis:
- Always wash your hands right away if you accidentally come in contact with blood, urine, milk, semen or vaginal discharge from any dog.
- Prevent contact between your dog and urine, milk, semen or vaginal discharge from other dogs, especially if you travel with your dog to an area where the prevalence of B. canis is relatively high (such as the southern USA).
- Dogs used for breeding should be tested for B. canis. Many breeders will require dogs to be tested before allowing their animal(s) to be used, because the infection can be transmitted through breeding and can have such detrimental effects on fertility.
- Newborn pups should be handled as little as possible, but if you must handling them wear disposable gloves and wash your hands as soon as you take your gloves off. Exercise the same precautions when cleaning up the area where a bitch has whelped.
More information about brucellosis can be found on the CDC's Brucellosis website.
Everyone is familiar with the human immunodeficiency virus (HIV) - the retrovirus that causes acquired immunodeficiency syndrome (AIDS) in people. Although HIV can only infect humans and some primates, cats can be infected by a very similar virus from the same genus (Lentivirus) with a similar name – feline immunodeficiency virus (FIV). The FIV virus is transmitted from cat to cat by contact with blood, usually through a cat bite. In Canada and the USA, up to 3% of healthy cats may be infected with FIV.
As with HIV in people, FIV attacks a cat’s immune system, which can leave the animal susceptible to many different infections that a healthy cat could normally fight off. Some of these infections, like toxoplasmosis, are similar to those that occur in AIDS patients. (More information on toxoplasmosis and Toxoplasma is available on the Worms & Germs Resources page). Depending on a number of factors, an FIV-positive cat may remain healthy for years, but once the animal begins to show signs of a weakened immune system, it will often develop chronic or recurrent health problems. The infection is life-long – there is no “cure” for FIV.
Some key points to remember:
- Cats cannot get HIV. People cannot get FIV. They are related but different viruses.
- Keeping your cat indoors will prevent fighting with other cats and decrease the risk of your cat contracting FIV.
- There is a vaccine available for FIV, but it remains uncertain if the vaccine can protect cats from all strains of the virus. The vaccine also interferes with tests for FIV infection. Therefore, preventing exposure to the virus is still the best way to prevent FIV infection.
- If your cat already has FIV, it is important to keep it indoors to decrease exposure to pathogens that could make your cat sick, and to prevent your cat from spreading the virus to other cats.
More information about FIV can be found on the Cornell Feline Health Center website.
Some people consider tuberculosis to be a disease of historical interest, but TB is alive and well, and spreading. TB is caused by Mycobacterium tuberculosis, a microorganism that can cause severe lung disease. TB rates are climbing rapidly in some countries and the emergence of highly drug resistant strains is a major concern. Anytime infectious diseases become more common in people in the general population, there is the potential for exposure of household pets. Recently, transmission of TB from humans to different animal species, including a dog, was reported. This follows earlier sporadic reports of TB in dogs. Finding TB in pets, albeit a small number, raises concerns about the potential role of pets in transmission of TB back to people.
Diagnosis of TB in pets is not particularly surprising, since it has been clearly shown by a few other infectious diseases that disease trends in people can sometime be reflected in their pets. It's hard to say if this is an under-recognized problem, an emerging problem or a very rare event that gets a lot of publicity. Really, the only way to tell will be to see what happens over time. Currently, TB is very rare in pets so it is important to keep possible risks and concerns in perspective. There is no reason for pet owners with TB to give up their pets. People with active TB should consider their pets as part of the family, and interact with them as they have been instructed to with people (i.e. if they are supposed to avoid close contact with people they should do the same with their pets).
There is currently no indication that infected pets can transmit TB back to people, and the risks are probably very low. TB is most easily spread through coughing, and pets with TB rarely develop respiratory disease with coughing. That, combined with the rarity of TB in pets, means that the risk of acquiring TB is much, much higher from other people than from pets.
This is just one more example of the "one medicine" concept, whereby we need to break down the barriers between 'animal diseases' and 'human diseases' (because the bugs are clearly doing so).
An ongoing outbreak of listeriosis in people in Canada has been linked to prepared meat products from Ontario. At least six deaths have been reported, and others are under investigation. While it is unlikely that there has been widespread exposure of dogs and cats, it is certainly possible that some pets were fed the recalled (and potentially contaminated) meat.
Listeriosis is an infection caused by the bacterium, Listeria monocytogenes. It can affect many animal species, but it is rarely identified as a cause of disease in dogs and cats. When signs do occur, fever, diarrhea and vomiting are most commonly reported. Rare cases of neurological disease in dogs and cats, and one case of suspected miscarriage in a dog due to listeriosis have been reported. Listeria skin infection has also been reported in dogs.
Overall, the risk of listeriosis in pets associated with the tainted meat products is very low. Pets that ate any of the recalled food products do NOT need to be tested or treated if they are not ill. However, should a pet that ate recalled meat become ill, it is important to inform the animal's veterinarian about the potential exposure to Listeria.
A horse in Ontario was recently diagnosed with Eastern Equine Encephalitis (EEE), a serious neurological disease caused by a virus of the same name, which is transmitted by mosquitoes. The horse was from the North Durham region. The last reported cases of EEE in Ontario were in 2004. A few weeks ago, the Worms & Germs Blog talked about a large number of cases of EEE that have been reported in Florida this year.
Here are some of the key points to remember about EEE:
- Like West Nile, EEE is a seasonal disease. It is more common in warmer areas, especially some regions of the southeastern US. It is rare in cooler climates, but occasionally EEE is found in horses in Ontario.
- EEE is usually fatal in horses, and there is no effective treatment.
- EEE can also occur in people, and can be fatal in some cases.
- Infected horses cannot transmit the EEE virus to people, but if a horse gets EEE from the mosquitoes in the area, then people could also potentially be exposed to the virus by mosquitoes.
- A vaccine for EEE is available for horses, but most horses in Ontario are not vaccinated for EEE because it is so rare. Nonetheless, vaccination can be considered because the disease is so devastating when it occurs.
- As for West Nile virus, avoiding mosquitoes - for both horses and people - is an important preventative measure for EEE.
For more information, see the Worms & Germs Blog post "Eastern Equine Encephalitis – Not Just For Horses", or the CDC's website on arboviral encephalitides.
In Ontario, and many other regions, mid-August is the beginning of the high risk period for West Nile virus infection in people and animals such as horses. The Ontario Veterinary College has published an informational video on YouTube. This video has information about measures you can take to reduce the risk of West Nile virus exposure and disease, for both people and horses. Click on the image to watch the video. More information about West Nile virus is also available in the blog post entitled West Nile virus in dogs and cats.
People often ask me questions about "Clostridium" in dogs and cats, with the impression that "Clostridium" is a specific disease. Actually, Clostridium is a large bacterial genus (a group of related bacteria), which includes species that range from harmless to deadly. Some of the more important species are described below:
Clostridium perfringens: This is a common bacterium that can be found in the stool of a large percentage of healthy animals and people. It is a common cause of "food poisoning" in people, and is probably an important cause of diarrhea in dogs and cats. Our understanding of the role of this bacterium in disease in dogs and cats is limited by the fact that it is found in so many healthy animals, so simply growing it from the stool of a diarrheic dog or cat does not prove that it is causing the animal's illness.
Clostridium difficile: This bacterium is a very important cause of diarrhea (and more severe intestinal disease) in people, and is possibly an important cause of diarrhea in dogs and cats. It is rarely found in healthy adult pets, but is relatively common in puppies and kittens.
Clostridium botulinum: This bacterium produces the toxin that causes botulism, a potentially devastating disease that is very rare in dogs and cats. Botulism usually occurs following ingestion of food that has been improperly stored, in which C. botulinum has grown and produced its potent toxins.
Clostridium tetani: This bacterium produces the toxin that causes tetanus, which can occur in dogs and cats, however these species are relatively resistant to this disease. Tetanus usually occurs when a wound becomes contaminated with C. tetani from the soil, followed by growth of the bacterium and production of potent toxins.
Other clostridia: A large number of different species exist, and it is likely that many more clostridia are around but have not been identified and named. Many clostridia are part of the normal bacterial population in the intestinal tract. Some of these can probably also cause disease.
As you can see, "Clostridium" is more than a single bacterium or disease. An understanding of this concept, and the different disease-causing clostridia, is important. More information on Clostridium difficile can be found on the Worms & Germs Resources page.
Image: Photomicrograph of C. botulinum stained with Gentian violet. From CDC's Public Health Image Library (PHIL), ID number #1979.
There is no indication why this conclusion was reached, and it seems to be a rather strange conclusion based on the reported information. There is no reported evidence that the same strain of E. coli was even present in the cat. I suspect that they are blaming the cat because there is no other obvious source (e.g. an identified foodborne outbreak of E. coli). I doubt the cat played any role in this person's illness.
The risk of contracting E. coli from contact with a cat is very low. However, common sense should be used when handling cats and particularly cat stool. The most important measures are avoiding contact with stool and appropriate hand washing after handling a cat or its litter. More information about litter box management is available on the Worms & Germs Resources page.
Q fever is an infection caused by the proteobacterial organism Coxiella burnetii. Although usually not very common, C. burnetii can be carried by sheep, goats, and cattle, as well as birds and even sometimes cats and dogs. Animals often show no signs of illness, although the infection sometimes causes miscarriage, particularly in sheep and goats. Coxiella burnetii is also transmissible to humans. People are much more susceptible than animals to disease from Q fever. Even so, only about 50% of individuals that become infected show signs of illness, which can range from flu-like symptoms to pneumonia and hepatitis (liver infection). About 1-2% of infections in people are fatal.
Infected animals shed C. burnetii in their stool, urine and milk, but the highest number of organisms are shed in birth fluids and placentae. Coxiella is able to survive very well in hot, dry soil, and when dust and dirt from contaminated areas are stirred up into the air, the organism can be inhaled. This is the most common means of transmission, although direct contact with an infected animal or its stool or urine can also transmit the disease. Transmission from drinking milk from an infected animal is very rare, but is more likely if the milk has not been pasteurized. Cats and dogs can be infected by and transmit C. burnetii in all the same ways (especially through birth fluids), but they very rarely get sick. Ticks can also transmit the disease.
Q fever is one of the most infectious diseases in the world. As little as one C. burnetii organism is enough to infect a susceptible person. There are a few things to keep in mind to help reduce the risk of being exposed to this pathogen:
- Only eat/drink pasteurized dairy products.
- The main risk from cats and dogs (especially cats) is when they give birth. If you have a cat or dog that has kittens/puppies, wear gloves if you have to touch the babies or any placentae. Afterwards, cleaning the area very thoroughly to physically remove any tissue or fluid residue is very important, because most disinfectants cannot kill C. burnetii. Always wash your hands thoroughly after handing newborn kittens or puppies.
- On dry, windy days, avoid farms or areas where sheep or goats are kept.
- Avoid sheep and goat farms during the lambing/kidding season.
While E. coli can be a serious problem in people and some animals, it is usually not a major problem in dogs. E. coli can cause diarrhea in dogs - it is most often linked to a disease called granulomatous colitis that is classically found in Boxer dogs. However, it is not a common cause of disease nor is it often associated with hemolytic-uremic syndrome in dogs. The O157:H7 strain of E. coli is rarely found in dogs, although transmission to people from the small number of dogs it has been found in has been reported. Almost all of the dogs that were found to be carrying E. coli O157:H7 were from farms, where they were probably exposed to the bacteria by eating cattle manure. The risk of transmission of E. coli O157:H7 from dogs to humans is very low.
- Even though E. coli O157:H7 is very rare in dogs, a number of other kinds of bacteria that can infect people can be present in the stool of both diarrheic and healthy dogs.
- All dog stool should be considered potentially infectious. Avoid contact with dog stool, and always wash your hands thoroughly if you have direct or indirect contact with dog stool.
- Because E. coli O157:H7 can be found in raw meat, it is reasonable to suspect feeding raw meat to a dog may increase the risk that it will have E. coli O157:H7 in its stool.
- The most important things you can do to avoid E. coli O157:H7 are:
- Handle raw meat properly to avoid contamination of other foods and surfaces.
- Make sure you cook meat at an appropriate temperature and for an adequate amount of time.
- Handle raw meat properly to avoid contamination of other foods and surfaces.
Over 50 horses have died from Eastern Equine Encephalitis in Florida this year. The disease, caused by a virus of the same name, affects the brain, resulting in a broad range of clinical signs from behaviour changes to blindness to irregular gait. The disease is also sometimes called “sleeping sickness” because some horses may become severely depressed, with low head carriage and droopy eyes, ears and lips. Almost all horses that develop neurological signs from this infection die. Only 35 cases were reported in Florida in 2006 and 2007 combined.
There are actually three related equine encephalitis viruses – Eastern, Western and Venezuelan – which are called EEE, WEE and VEE for short. VEE is found in South and Central America and Mexico, and occasionally in the southern United States, but has never been reported as far north as Canada (VEE is a reportable disease in Canada). It is unique among the three diseases as the only one in which an infected horse will carry enough virus in its bloodstream to infect a mosquito, which could then pass the virus on to another animal. The EEE and WEE viruses, just like the West Nile virus, do not reach high enough levels in the bloodstream of horses to do this. The mosquitoes usually pick up the viruses from passerine birds, which do not become ill from the viruses (unlike West Nile virus in birds from the family Corvidae).
People can also be infected by EEE, WEE and VEE. About 10 fatal cases of EEE in people are reported in the United States every year. But horses cannot transmit EEE or WEE to humans, even if they’re bitten by the same mosquito. A higher number of cases in horses, however, may mean a higher number of mosquitoes that are carrying the virus. There is no vaccine for these viruses for humans, but there are vaccines available for EEE, WEE and VEE for horses.
In the end, EEE is just one more good reason to make sure you wear mosquito repellent when you’re enjoying the great outdoors during the summer. Visit the Health Canada website for safety tips on using personal insect repellents. EEE is very uncommon in Ontario, but horses that live in or travel to the southern United States should be vaccinated. Talk to your veterinarian about whether or not your horse should be vaccinated. Remember that fly control is also important for our equine companions (and also helps protect them against West Nile!).
In 1894, HA Johne and L Frothingham discovered a tiny bacterium that was later found to be the cause of a disease in cattle characterized by chronic and severe weight loss and diarrhea. The condition ultimately became known as Johne’s disease, and it has been a thorn in the side of even very well-run dairy farms ever since. The disease is caused by a bacterium called Mycobacterium avium subsp. paratuberculosis (or MAP for short), which is in the same group as the bacterium that causes tuberculosis (TB). These bacteria typically live inside cells (usually white blood cells), and can therefore hide from the body’s immune system, which makes them hard to kill, even with antibiotics. It can also make them hard to detect. In cattle, the bacteria hang out in the lymph nodes and lymph tissue in and around the end of the small intestine (parts of the cow that do not enter the human food chain). The body’s attempts to kill the bacteria over time lead to chronic inflammation, which interferes with the ability of the animal to absorb nutrients from the intestine. This eventually leads to weight loss and diarrhea, even though the cow still eats. The disease also occurs in sheep and goats.
Yes, cows with Johne’s can still produce milk, and even before they’re sick MAP can sometimes be found in the stool and milk. On July 7, 2008, the CBC National ran a story about the possible link between Johne’s disease in cattle and Crohn’s disease in people. This is a very controversial topic, and arguments both for and against a relationship between bovine MAP and Crohn’s disease have been reviewed. There are even cases of Crohn’s that were thought to have been cured by the consumption of raw milk, which is more likely to contain live MAP bacteria (and potentially a lot of other bacteria most people shouldn’t be drinking). It’s also clear that there are genetic and environmental factors that affect whether or not a person will develop Crohn’s disease. It’s a very complicated picture, but I don’t find there’s enough evidence at this point that people need to start boycotting milk and dairy products for fear of Crohn's disease. For now, I’d say cook your meat well, wash your hands, avoid cattle manure whenever possible, and stick to pasteurized dairy products, but don’t be afraid to enjoy a cheeseburger and a glass of milk on a beautiful summer afternoon :)
Cattle (both beef and dairy) are usually infected with Mycobacterium avium subsp. paratuberculosis (or MAP for short) as newborns, but it may take 2 to 10 years to develop any signs of Johne’s disease. The condition is essentially impossible to treat in cattle, so efforts have focused on trying to prevent young animals from becoming infected in the first place.
The Canadian cattle industry is actively addressing the problem of Johne’s disease through the Johne’s Disease Prevention Project. At the moment, Johne’s control programs are still voluntary in Canada, but more and more farms are getting on board. It’s a long, slow process that takes years, but eventually the disease can be eliminated from the herd. Whether or not eliminating Johne’s disease from cattle may have an impact on the occurrence of Crohn’s disease in consumers remains unknown, but it certainly won’t hurt. Regardless, being Johne’s free is better for the farm, and better for the cattle.
For more information on Crohn’s disease, check out the Crohn’s and Colitis Foundation of Canada website.
Various bacteria can cause hot spots. Most commonly, Staphylococcus pseudintermedius is involved. Hot spots are quite low risk for transmission to other animals or to people, although it is possible for concerning bacteria like methicillin-resistant S. aureus (MRSA) to be involved. Only a culture of the infected site can determine the bacterium that is involved.
- Most hot spots are easily treated. This typically involves clipping the hair around the infected site and scrubbing the area with antibacterial soap. Sometimes, antibiotics and/or anti-inflammatories are also needed. The infected site should be kept as clean and dry as possible.
- While most hot spots are not caused by bacteria that are a major concern for transmission to people or their animals, any infected site should be handled with care. Direct contact with the hot spot should be avoided.
- If the infected site needs to be touched, gloves should be used if possible, and hands should always be thoroughly washed after touching the site.
- Care should be taken when touching hot spots because they can be very painful, and touching them could make some dogs bite.
- Prompt examination by your veterinarian will help ensure your pet gets the treatment it needs as soon as possible, and ultimately helps speed recovery.
- Always follow your veterinarian's recommendations closely and completely. Stopping treatment too early can lead to recurrence of the infection, which may be more difficult to treat.
I've had this question a few times recently. There isn't really a straightforward answer, and it depends what people mean when they say 'get'. I've broken the question into a few components.
Can C. difficile be found in dogs and cats?
Yes. A small percentage (1-5%) of healthy dogs and cats carry C. difficile in their intestinal tract, and pass it in their stool. Higher carriage rates are found in certain groups, such as young animals, animals in veterinary hospitals and animals that visit human hospitals as part of therapy programs. Most animals that are carrying C. difficile do not get sick.
Does C. difficile cause disease in dogs and cats? (i.e. do they get sick?)
The answer to this one is 'probably'. I don't think we can say for sure, but C. difficile appears to be a cause of disease in dogs and cats, ranging from mild diarrhea to fatal severe colitis. There is evidence indicating that C. difficile might be one of the more common causes of diarrhea in dogs. In people, C. difficile infection is most common in hospitalized individuals and those being treated with antibiotics. The situation is different in dogs and cats, where disease seems to be most common in households (not veterinary hospitals), and in animals not being treated with antibiotics.
Information sheets on Clostridium difficile can be found on our Resources page.
A small outbreak of the potentially deadly Hendra virus was identified in a group of horses near Brisbane, Australia. This virus has caused periodic cases of illness and death in horses, and can be transmitted to people working closely with infected horses. In the latest outbreak, 3 horses have died, making this the worst outbreak since 1994 when 14 horses and 2 people died. Now, a human case has been identified. This person works at a veterinary clinic that treated infected horses. This individual was admitted to hospital overnight but was discharged, so is presumably not very ill.
While Hendra virus (genus Henipavirus) is only found in Australia, it is a good reminder for everyone about the strange nature of some infectious diseases. The natural reservoir of the virus is the fruit bat. It is believed that horses become exposed when infected fruit bats give birth and contaminate horse pastures with uterine fluids. Horses develop respiratory disease ranging from mild to fatal. Human cases have been reported in people working closely with infected horses. A horse trainer and veterinarian's assistant died in the 1994 outbreak. Close contact is required for transmission to people.
Picture: Locations of previous Henipavirus outbreaks (red stars – Hendra virus; blue stars – Nipah virus) and distribution of Henipavirus flying fox reservoirs (red shading – Hendra virus; blue shading – Nipah virus)
It's very difficult to take specific measures to protect horses, people or other animals from sporadic, rare diseases such as Hendravirus infection. However, common sense infection control measures can reduce the risks associated with any animal contact.
- Wash your hands after contact with any animal.
- Avoid contact with sick animals - consider sick animals to be potentially infectious until proven otherwise.
- Remember that new animal diseases are regularly being identified, and that they might be able to infect people.
- People that work in veterinary clinics must be diligent and use good infection control practices because they are at higher risk of exposure to various diseases.
Where do you think the goat's mouth just came from? The ground, along with manure from various animals.
What might the bottle have been contaminated with? E. coli O157, Salmonella, Campylobacter, Clostridium difficile...
Where do you think this bottle is going next? The baby's mouth.
What will probably happen to the child?: Nothing.
What might happen to the child?: Disease caused by one of the above-named microorganisms (or others), ranging from mild diarrhea to fatal infection.
While there is good information available about precautions that should be taken for petting zoos, such as from the National Association of State Public Health Veterinarians, not all petting zoos take adequate precautions. A recent study pointed out common deficiencies.
Some important points to consider:
- Petting zoos are safe for the vast majority of the population if common sense measures are used.
- Items that will end up in the mouth of a child should never go into a petting zoo.
- Children should be closely supervised in petting zoos.
- Uncontrolled animal contact should be prevent.
- Hands should be washed after contact with animals or the petting zoo environment.
Plague is caused by the bacterium Yersinia pestis, which is carried primarily by wild rodents. Infection with Yersina pestis can cause bubonic plague (swollen lymph glands), septicemia plague (bloodstream infection) or pneumonic plague (pneumonia/lung infection). An average of 13 human cases are diagnosed in the US every year. In today's modern times, the infection can be effectively treated with antibiotics, but if left untreated the mortality rate is still 50-90%. The Canadian Notifiable Disease Database has never received a report of plague in a human.
Plague has been reported in a variety of animal species, including cats and dogs. However, dogs seem to be relatively resistant to the infection compared to cats. Yersinia pestis gets from rodents to other animals and people mainly by flea bites. Fleas become infected by biting an infected animal, and can then pass on the infection by biting another animal or person. It is also possible for plague to be transmitted by direct contact with infected animals, but this is less common.
A recent report described an outbreak of plague in prairie dogs in western South Dakota. There is concern that the disease could also affect the endangered black-footed ferret in that area. Plague almost always kills prairie dogs, and black-footed ferrets almost exclusively eat prairie dogs.
When plague is present in wild animals in a region, there is always a risk of transmission to people and pets through contact with infected animals or bites from infected fleas. Some basic measures to reduce the risk of plague exposure in areas where the disease exists in wild animals are:
- Keep cats indoors
- Talk to your veterinarian about a flea control program for your pets
- Never touch wild animals, especially sick or dead ones
- Don't keep wild animals as pets
- Try to keep wild animals away from your pets
(Centers for Disease Control and Prevention (CDC) / Janice Carr)
The last decade has witnessed a surge in leptospirosis in dogs throughout much of North America. Ontario and Québec have been part of the surge, which is associated with two serovars of Leptospira, grippotyphosa and pomona.
The reasons for the dramatic increase relate to: 1. The apparent spread of infection in raccoons and to a lesser extent skunks; 2. A changing climate that favours prolonged survival of these bacteria outdoors in the milder fall temperatures; 3. Perhaps to a minor extent increased awareness of the disease by veterinarians. Gillian Alton, a Masters student at the University of Guelph, has shown that the increased infection rate observed in recent years appears to have leveled off, which may be the result of widespread vaccination.
Leptospirosis should be suspected whenever there is kidney or liver inflammation of unknown origin, particularly in the fall of the year. In 2007, there were about 80 positive and 170 suspicious cases in Ontario based on blood tests submitted to the Animal Health Laboratory (AHL), University of Guelph. Since not all such blood tests go through the AHL, it is likely that there would have been about 160 positive and 350 suspicious cases based on this testing throughout Ontario, and an unknown number of cases diagnosed by PCR (a DNA-based test). If one includes cases diagnosed based on clinical signs but without laboratory testing, and about half the suspicious cases as positive cases, then there may be about 400 clinical cases (i.e. cases where the animal actually gets sick) of leptospirosis in dogs occurring annually in Ontario. Clinical leptospirosis in dogs is a serious disease and this number, if the assumptions are correct, represents a high burden of infection.
Arguments for recommending the new 4-way leptospiral vaccines as a “core” vaccine (i.e. all dogs should be vaccinated) in Ontario are:
- The suggested size of the problem;
- The often serious nature of the disease;
- The zoonotic potential of the infection (a small number of human infections acquired from dogs have been recognized in Ontario and Québec in recent years);
- The ongoing widespread presence and sometimes large numbers of raccoons in suburban and urban Ontario;
- The diagnosis of canine leptospirosis throughout the province;
- The diagnosis of the disease in dogs of all types, not just the “male hunting dog” which is sometimes conventionally regarded as “high risk”.
- The sporadic nature of the infection, including the lack of exposure of some dogs to raccoons and other wildlife sources;
- The number of vaccine reactions associated with leptospiral vaccines (this is not a significant problem with at least one of the vaccines);
- The considerable confusion caused by the (almost certainly totally unfounded) suspicion that serovar autumnalis causes canine leptospirosis, but is not in the new vaccines;
- The lack of inclusion of serovar bratislava in the vaccine (although this serovar seems to cause only mild disease in dogs);
- The annual cost of revaccination.
I often get asked about testing of healthy pets for Clostridium difficile. This bacterium is an important cause of disease in people. While most common in people in hospitals, cases of C. difficile infection are occurring more in people in the general population. Also, C. difficile can be found in various animals, including dogs and cats. This has led to concerns about the role of pets in C. difficile infection in people. The role of animals in human infections has not been determined, but it is plausible that C. difficile could be transmitted between people and pets, in both directions.
I have been diagnosed with C. difficile. Should my pet be tested?
No. There is no evidence that it is useful. Even if C. difficile is isolated from your pet, it would not tell you if the pet was the source. Your pet could be carrying a completely different strain of C. difficile. Molecular typing of the recovered bacteria (from both you and your pet) would be needed to determine if they are the same strain, and this type of testing is not readily available. Even if you both had the same strain, your pet could have picked it up from you. So, testing of your pet really wouldn't tell you anything.
I'm worried that I may have acquired C. difficile from my pet. Can I just have my pet treated at the same time I'm being treated?
No. Treatment of healthy pets to eliminate C. difficile is not recommended. There is no evidence that we can eliminate C. difficile from a healthy pet with antibiotics.
More information on Clostridium difficile can be found in our Resources page.
You should see a doctor about any cat bite on a hand, over a joint, over a tendon sheath (such as the wrist or ankle), over a prosthesis or implant, in the genital area, or that causes a deep tear. You should also see a doctor for any bite if you happen to have a weakened immune system for any reason (e.g. HIV/AIDS, cancer or transplant patients).
The best way to prevent infection is to prevent the cat from biting you in the first place!
- Use common sense – know how to handle a cat properly so that it is not frightened or uncomfortable. If a cat growls at you or tries to get away, let it go!
- Don’t let cats play with your hands, feet or hair. Use a nice cat toy instead.
- Don’t approach strange cats, especially strays. If you are bitten by a cat that may not have been vaccinated for rabies, it is very important to report the incident to you local public health department and your doctor, as you may need to receive rabies post-exposure prophylaxis (PEP).
Tularemia is a disease caused by the bacterium Francisella tularensis. It causes different signs of illness depending on how the bacteria enter the body. If the bacteria are inhaled, it tends to cause pneumonia (pneumonic tularemia). If the bacteria get in through a break in the skin, infection may cause the local lymph nodes (glands) to become very swollen, and in some cases the skin itself may become infected resulting in the formation of large sores (ulcers). Infection can also cause sores in the mouth and diarrhea. The earliest, most common signs are things like fever, headache, chills, sore muscles, and sore throat which often come on very abruptly. The infection can be treated with antibiotics, but it is important to see a doctor and start treatment as soon as possible.
Tularemia is also sometimes called "rabbit fever," because the bacteria are often carried by animals such as rabbits and hares. Rodents (including beavers, rats, mice, squirrels etc.) can also carry F. tularensis, and occasionally so can cats and dogs. Some biting insects like deerflies and certain species of ticks can carry the bacteria and transmit it when they bite. Francisella tularensis can also survive in water and soil for a long time. People can become infected by being bitten by an infected insect, handling an infected animal (dead or alive), or coming into contact with feces from an infected animal. Occasionally a person may inhale the bacteria if it is in the air, as may happen with disturbed, dusty, contaminated soil.
More information on tularemia can be found on the CDC's tularemia website.
Things you can do to avoid tularemia:
Avoid touching or handling wildlife (dead or alive), especially rabbits and rodents.
Don't let your pet touch or eat dead animals.
Always wash your hands if you have been working outside in the dirt/soil.
Wear insect repellent containing DEET (visit the Health Canada website for more safety tips)
Make sure you only wash food with and drink water that has been properly treated.
One of the reasons tularemia is such a big deal is it is very infectious - as few a ten bacteria can be enough to make even a healthy person sick! But it is still quite uncommon in North America - about 100-200 cases are reported in people in the USA every year. Between 2002-2004 there were 34 cases reported in Canada, most of which occurred in Quebec and in adults. However, infection can be fatal in a very small number of cases, especially if proper treatment is not given as soon as possible.
One thing that has become very clear around my house the past few days is that mosquito season has arrived. Along with the annoyance, buzzing and itching, mosquitoes are of concern because they can transmit various viruses, including West Nile virus. While West Nile season tends to be later in the summer and fall in most regions, West Nile virus awareness and mosquito bite avoidance should be considered whenever mosquitoes are around.
Most of the attention about West Nile virus has been paid to humans, horses and birds, because of widespread illness and death in those species. Dogs and cats can certainly be exposed to West Nile virus if they are bitten by an infected mosquito; just like people and other animals. However, there are very few reports of West Nile virus infection in dogs, and even fewer in cats. Most dogs and cats that are infected do not develop signs of disease and simply develop antibodies against the virus.
Even if dogs or cats develop West Nile virus infection, there is no risk of transmission to other animals or human. This is because there is never a large enough amount of virus in the blood of these animals for a mosquito to pick it up and transmit it to another animal or person. The virus also can't be transmitted by direct contact with an infected dog or cat. West Nile virus is not found in saliva, so it is also unlikely to be transmitted by an animal (instead of an insect) bite.
There is no reason to be concerned about transmission of West Nile virus from your pets. If you live an area where West Nile virus is present, you should take precautions to avoid mosquito bites, such as avoiding mosquito-dense areas, wearing insect repellent with DEET, wearing long pants, long sleeves and socks when outside, avoiding peak mosquito hours (dusk and dawn) and eliminating any areas of standing water where mosquitoes can breed.
Strep throat is caused by Group A Streptococcus, a bacterium that can be found in the throat and on the skin of some healthy people. Strep throat and impetigo are the most common diseases caused by Group A Streptococcus, although severe (‘invasive’) infections can occur, including ‘flesh-eating disease’. Group A Streptococcus is typically spread between people, both from people that are sick and healthy carriers.
Group A Streptococcus carriage by dogs and cats is extremely rare, and it is unlikely that they are involved in transmission to people. There were some older studies implicating dogs in transmission of Group A Strep, however there were weaknesses in the methods used by those studies which probably lead them to misidentify other types of Streptococcus that are often found in dogs as Group A Streptococcus. There is currently no convincing evidence that pets are a source of strep throat infection, although the possibility cannot be completed dismissed.
I have had questions about treatment of pets when recurrent strep throat infections were present in a household, which is not supported by any evidence and could lead to problems like antibiotic resistance and side-effects from antibiotic use such as diarrhea. It’s hard to say whether there is any indication to test dogs or cats when recurrent strep throat is present in a household. Collection of a throat swab by a veterinarian and culture of the swab is fairly easy to do. It’s not unreasonable to consider that but a few things must be remembered:
- Even if Group A Streptococcus is found in a pet, it does not mean that the pet is spreading it. The pet might just be an ‘innocent bystander’ that was infected by a family member. It makes no sense to test the pet if the rest of the household is not being tested.
- Proper identification must be performed by the laboratory to differentiate Group A Strep from other strep. Just finding ‘Streptococcus’ is not useful.
- There are no guidelines for what to do in the unlikely event that a pet is identified as a carrier.
Overall, pets are not likely a major (or even minor) source of strep throat. If strep throat is circulating within a household, it's most likely being spread between people.
Canine parvovirus is a highly infectious cause of life-threatening diarrhea in dogs, mainly puppies. Canine parvovirus vaccination is a very important component of routine vaccines for dogs.
Questions often arise about whether dogs can be a source of Fifth Disease, or whether people with this disease can infect dogs. The parvovirus that causes Fifth Disease is not the same virus that causes disease in dogs. Human parvovirus cannot infect dogs, nor vice versa.
An interesting fact about Fifth Disease is the origin of its name. The name originates from a standard list of causes of rash from the early 1900s. This condition was the fifth on the list, and for some reason, it became known as ‘Fifth Disease’. None of the other disease were named by their ranking.
Public Domain image from Wikimedia.org
But there are also dangers lurking in the forests – microscopic dangers carried by tiny insects and other bugs. Ticks in particular are problematic. Certain ticks can carry a number of diseases that can make dogs sick, including Lyme disease (caused by Borrelia burgdorferi) and Rocky Mountain Spotted Fever (RMSF)(caused by Rickettsia rickettsii ). Both Lyme disease and RMSF are more common in certain areas where the tick species that carry them are present. You can NOT catch these diseases from your dog, but both you and your dog can be infected by the ticks that carry them. People can also be exposed to these pathogens by accidentally crushing an infected tick while trying to remove it from their dog. Ticks must be removed very carefully to ensure that the entire tick is removed, including the head and mouth pieces, without crushing it. If you're not sure how, contact your veterinarian. Also, the sooner the tick is removed, the less likely it is to transmit certain diseases, so be sure to check your dog thoroughly for ticks when you come back from a walk in the bush.
The Minnesota Department of Health recently reported that the number of cases of (human) Lyme disease increased in that state in 2007. This could be because of spreading tick populations, more people participating in activities in tick-inhabited areas, or increasing awareness and diagnosis of the disease by physicians.
If you and your canine companion will be spending time in some of the wilder and woodier parts of the great outdoors, talk to your veterinarian about what you can do to protect your dog. There are vaccines available for Lyme disease and the bacterial infection leptospirosis (which is also transmissible to people). Flea and tick preventatives are also very important, and many of today’s products are very effective. People should always wear insect repellent when camping or hiking in the woods. Visit the Health Canada website for safety tips on using personal insect repellents. All dogs should be vaccinated for rabies, whether they go camping in the backwoods or they’re house-bound city-slickers.
My dog licked someone with HIV/AIDS, and they had an open sore. Can my dog get HIV?
Can a dog that bites someone with HIV get infected?
If a dog bites someone with HIV then bites someone else right after, can it spread the virus?
The answers are no, no and it's very, very unlikely.
HIV (human immunodeficiency virus) does not infect dogs. Regardless of how a dog is exposed, it will not develop an infection. HIV is also a very fragile virus. It does not survive long in the environment and a dog's mouth is not a very hospitable location. It is theoretically possible that if a dog bit someone with HIV and then immediately bit someone else, it could transfer the virus, but this has not ever been identified and is very unlikely. In some countries, the source of all cases of HIV are investigated, and an animal bite has never been implicated as a potential cause.
Bottom line....don't worry about HIV and your pets.
Avian flu is a tremendous concern at the moment. While it is not (currently) easily transmitted between people, bird-to-human infections have been reported in various countries. Mortality rates are very high, and the concern is that this strain could change to become easily transmitted between people, and lead to a pandemic (worldwide outbreak) not seen since the Spanish flu pandemic in the early 20th century. While birds and people are the focus, some attention has been paid to other species, such as cats.
Fatal avian flu developed in leopards and tigers in a zoo in Thailand during an avian flu outbreak. It was suspected that they ate infected chickens. Similarly, avian influenza in a pet cat was thought to have resulted from eating a dead pigeon (the pigeon presumably having died of avian flu). The potential role of cats in transmitting disease was highlighted by a study that reported that cats can become infected by eating infected birds, and can transmit avian flu to other cats.
While unproven, cats could theoretically play a role in transmitting this virus from birds to people. It's unlikely cats would be a major factor in a flu pandemic, but if such a situation were to arise, any possible source of transmission would need to be considered.
Should we worry about cats and avian flu right now? Worry....no. Be aware....yes. H5N1 avian influenza is not currently present in North America and it's hard to say if/when it will appear.
Should we think about cats when making plans for management of avian influenza if/when if reaches us? Absolutely. It's issues like this that get overlooked in outbreak planning.
Should I keep my cat inside? Yes. Outdoor cats are exposed to a large number of different infectious agents, including parasites and bacteria that can infect people. Outdoor cats can also get into fights, during which animals can transmit important diseases or cause nasty wounds. Also (obviously), an indoor cat isn't like to get hit by a cat...an important cause of premature death in cats.
Avian flu is just one more indication that our relationship with infectious diseases is much more complex than we've thought, and that broad (ecological) approaches to infectious disease control are required. We need to think about household pets when considering emerging infectious diseases because of the close and prolonged contact that millions of people have with their pets.
INFORMATION SHEETS specifically for KIDS, for VETERINARIANS and for PHYSICIANS are also available on the Worms & Germs RESOURCES page!
Click on the highlighted topics below for information sheets. Topics that are not highlighted are in development and coming soon. Sheets for other animal species and diseases are also under development and will be added when they are available.
- Your veterinarian and physician are your ultimate resource for information about the health of your pets or your family.
- Information provided here is accurate to the best of our knowledge, but infectious diseases can be unpredictable and these sheets are for general information purposes only.
- There can be great variation in disease risks in different geographic areas. The information provided was developed for Ontario, Canada, but most of the information is relevant for other regions as well.