Worms and Germs Blog : Animal Health & Diseases : University of Guelph : Ontario Veterinary College : Zoonotic Diseases : Guelph, Hamilton, Ontario

Nature's Variety has expanded their recall based on more concerns about Salmonella contamination of their products. In a lot of ways, this makes no sense to me since you have to assume that raw meat is contaminated with Salmonella, E. coli, Campylobacter and various other pathogens. That's been clearly shown in studies of raw meat for humans and animals, and that's why we cook meat intended for human consumption and emphasize good food handling practices. It's also why there are concerns about feeding raw meat to pets, and the explanation for various studies showing pets fed raw meat have much higher rates of shedding potentially harmful bacteria like Salmonella. You have to assume that a reasonable percentage of Nature's Variety's food has been contaminated with Salmonella, not that this is an uncommon and preventable event.

Because of the problem or consumer concerns, Nature's Variety has announced that they will be treating all of their diets using high pressure pasteurization. Basically, this process uses very high pressures (with only a slight increase in temperature) to reduce bacterial levels. I can't find any scientific literature about the effectiveness of this method on Salmonella contamination of raw meat (it's mainly used with milk and cheese) but it should be able to greatly reduce bacterial levels in meat. That's a good thing, as long as it works. What's important to know, however, is whether it is really highly effective in this situation and whether all potentially harmful bacterial will be eliminated every time.

I'm concerned that if people think this food is "sterile" and it's not, they might not take the necessary food handling precautions. If this method usually, but not always, kills all of the bad bacteria, or if it reduces levels greatly but not completely, then there could still be the risk of infection of people and pets. This information is critical. In the absence of clear scientific data, I think we need to assume that some level of contamination could still be present (although probably much less often and at a much lower level), and make sure that proper food handling practices are used.

It's good to see this company taking measures to reduce the risks associated with raw meat feeding. Let's hope that some objective research is made available to indicate what risks might remain.

Image source: www.defendingfoodsafety.com

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The latest edition of the journal Emerging Infectious Diseases contains an article about a South African vet student that acquired West Nile virus from a pony. Occupational exposure to infectious diseases is an inherent risk in veterinary medicine. Vets know that they are at higher risk of encountering various infectious diseases and take (or should take) precautions to reduce those risks. Sometimes infections occur despite the best precautions. Sometime infections occur because of bad practices. This report highlights the latter.

In this case, a 4-month-old pony started off with vague signs of illness, then developed neurological abnormalities and was euthanized. A necropsy (autopsy) was then performed by a veterinary pathologist with the assistance of two vet students. As part of the necropsy, the student removed the brain and spinal cord for testing, but gloves were the only protective gear that were used. No face or eye protection was used, which is quite astounding.

The pony was eventually diagnosed with West Nile virus. Six days after performing the necropsy, the vet student developed a fever, malaise, sore muscles, stiff neck and severe headache. West Nile virus was confirmed, and the viruses from the pony and person were compared and were the same type. Fortunately, signs of infection in the student subsided after approximately 10 days.

Horses are considered 'dead-end' hosts for West Nile virus, meaning they cannot naturally transmit the virus. This is because the levels of virus in circulation in the blood are very low, and a biting mosquito can't pick up the virus to infect other individuals. However, the brain and spinal cord are a different situation since very high virus levels can be present in those tissues. It's astounding that a vet school would have a student removing the brain and spinal cord, especially without proper protective gear, since that procedure carries a risk of splashing or aerosol exposure to the virus. Anyone performing necropsies needs to be aware of the potential risks and take appropriate precautions. The paper states that after the incident, biosafety practices were improved to include the wearing of masks and eye protection during necropsies. Well, I guess it's better late than never...

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An article in Saturday's Toronto Star discussed composting options for people without organic waste pickup or the ability to have a backyard composter. The article discussed indoor composters that can be used by apartment or condo dwellers who want to satisfy their eco-friendly side.

One of the composters they highlighted states that you an add pet waste, but that's not a good idea. Pet waste can contain a wide range of potentially harmful parasites and bacteria. The composting process can generate enough heat to kill relevant bugs, but it's not guaranteed to do so, and I'd be especially concerned about small indoor composters. Having a few nasty things in the composter itself isn't necessarily a big deal, but what happens down the line? People can be exposed to these microorganisms when removing compost. Also (and maybe more importantly) compost usually ends up in gardens and can contaminate the soil, as well as anything grown in the garden.

One of concerns is the protozoal parasite Toxoplasma gondii. Cats are the natural reservoir of the parasite and can transiently pass it in their feces, yet most people that become infected are likely exposed outside in gardens or from contact with contaminated foods. Composing may not kill toxo, and therefore lead to a risk of exposure, particularly when compost is put into flower gardens that people work in or in vegetable gardens. The risk from an individual animal is admittedly low, since cats are rarely shedding this parasite (even though most have at one point), but it's a preventable risk. There are also various other microorganisms that are potential concerns. While composting is a great way to dispose of most organic wastes, it's best to keep putting dog and cat feces in the garbage or down the toilet (and wash your hands).

If you really feel the need to compost pet waste, the safest alternative is probably to have a separate composter for pet waste that you handle differently....pay careful attention to hand hygiene after handling the compost and make sure the compost doesn't get deposited in gardens or other areas that people might frequent.

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A man from Jharkhand, India, was bitten by a dog and realized that there was the potential for rabies transmission. That's good, particularly given the huge problem with rabies in India. However, he didn't take the recommended approach of proper wound care and getting post-exposure vaccination. Rather, he killed the dog (getting bitten a few more times in the process), cut out its heart with a pair of scissors and ate it raw, exclaiming that now there would be no problem with rabies.

Not a good idea.

Rabies is widespread in India. Every year, 25 000-30 000 people die of this disease. A person in India is bitten every 2 seconds and someone dies of rabies every 30 minutes.

Every dog bite needs to be considered a possible rabies exposure. If a dog that bites someone is not available for quarantine or testing to determine whether it has rabies, post-exposure treatment is necessary. That involves an injection of anti-rabies antibodies and a series of 4 or 5 vaccines, not ingestion of the animal's heart.

Hopefully, the dog didn't have rabies and this will go down as a somewhat curious little story. Unfortunately, if the dog had rabies, there is a good chance that this person has been infected, and if infected, he will almost certainly die.

Eating an animal's heart to prevent rabies transmission may just be a bizarre belief of an unusual individual. This is something that needs to be investigated, however, because if the same belief is held by many other people in the area, they will all put themselves at risk if they are bitten by not seeking appropriate and effective treatment. Not only does killing the dog and eating its heart have no chance of preventing infection, it probably increases the risk of rabies by leading to more bites. More rabies education is often needed in problem areas, and this may be the case here.

Image: Canine heart (source: www.historyforkids.org)

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Ear mites are a common problem in dogs and cats, particularly in young animals, as well as in strays and animals in shelters. The species of mite typically involved is called Otodectes cynotis. It is transmitted between individuals by direct contact (basically hopping animal to animal, as it does not survive for long in the environment), and causes an extremely itchy ear infection (which can get even worse if there is secondary infection with bacteria or fungi).

There are a few reports of suspected infections with Otodectes in people. Considering how common ear mites are in cats and the small number of reported human infections, transmission between pets and people is probably rare, but it certainly can occur. Most of the reports are somewhat circumstantial, involving people with itchy skin lesions that developed after a pet was diagnosed with ear mites. However, one curious veterinarian took it a step further. 

Dr. Robert Lopez, of Westport, New York, intentionally infested himself with ear mites from infected animals, and described the outcome in a 1993 edition of the Journal of the American Veterinary Medical Association. First, he took a sample from the ear of a cat with ear mites and placed it in his own ear. He described the scratching sounds and movement that he could feel as the mites explored his ear canal. Severe itching developed, to the point where "sleep was impossible." The intensity of the itching and mite movement decreased over time and the infection resolved by itself within a month.

Personally, I think I would have stopped there. (Actually, I wouldn't have made it to that point, but if I did, I certainly wouldn't have tried it again.) Yet, Dr. Lopez wanted to confirm his findings so, a few weeks later, he infected himself again with mites from another cat. The same type of disease developed, although it was less severe and only lasted two weeks.

Guess what he did next - he tried again, wanting to see if the reduction in severity might indicate development of immunity. So, he infected himself a third time, with the outcome being milder disease. This suggested to him (logically so) that immunity to the mites might develop, something that fits with the fact that ear mite infestations are more common in young animals.

Self-experimentation is generally frowned upon, but has been the source of remarkably scientific discoveries, even Nobel Prize winning discoveries (e.g. the role of Helicobacter pylori in gastric ulcers in people). I don't think Dr. Lopez is in line for any prizes, but it shows how a little academic curiosity along with minimal squeamishness can provide some interesting information.

What's the relevance of all this? If your pet has signs of ear mite infestation (e.g. scratching at the ears, dirty material inside the ears), get it examined and treated. If nothing else, this needs to be done because it's a very uncomfortable problem for the pet. There's also some risk of human infection, but it's probably minimal. The mites have to make it from the pet's ear to your body to cause problems. The quicker they are treated, the lower the likelihood of this occurring. Human ear mite infestations, be they in the ear or on the skin, seem to resolve by themselves, with treatment of the animal being the most important part of control. However, it can be a pretty uncomfortable condition and one most people (with the possible exception of Dr. Lopez) would certainly rather avoid.

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A Fort McMurray (Alberta) SPCA shelter has been closed because of a Giardia outbreak. Giardia is an intestinal parasite that can cause diarrhea in dogs (and other species, including people) but can also be found in about 7% of healthy dogs. Giardia infection was confirmed in four dogs in the shelter, which led to the rather aggressive measure of closing the shelter. Shelter personnel suspect that the infection started with one dog, who spread the parasite to some other dogs that were in close contact with it. Giardia is passed in stool and animals get infected by ingesting Giardia oocysts from stool contamination in their environment or water sources.

 

Shelter personnel speculated that "If [the first dog to be infected] went for a walk with the snow melting, of course there's lots of little presents underneath the snow, so when she goes for a walk and she steps in, say another dog's feces, and then licks her paws, she can get it."

 

It's pretty unlikely that old feces revealed by thawing snow were the cause, since freezing is a pretty effective way to kill Giardia. More likely, the parasite was brought into the shelter by a healthy dog, considering that a reasonable percentage of dogs are shedding Giardia at any time. Why it spread to other dogs is a different question, as is whether the other animals were sick (with diarrhea) and whether Giardia was really the cause if they were. As with any organism that can be found in healthy animals, it's hard to say for sure whether Giardia actually caused any disease or whether there was some other cause that wasn't detected and the affected dogs just happened to be shedding Giardia at the same time.

Giardia usually causes pretty mild disease that gets better on its own or with treatment. Shelter personnel stated "We are in desperate need for help from the public as far as raising funds for medical, because obviously it costs a lot of money to treat the dogs. It's a lot of money to treat an animal with giardia." It's actually pretty cheap to treat individual cases, but this makes me wonder whether they are treating all dogs in the shelter. That's not something I'd recommend because there's little evidence that treatment of non-diarrheic animals is needed or useful. 

Presumably this outbreak (whether it was caused by Giardia or something else) will end soon, either because of or despite of what was done. You never know if you did something to control the outbreak or whether it just ran its natural course. If it truly was Giardia, I'd be surprised if there are more problems, but resolution of the outbreak won't change the fact that many dogs that they bring in will be shedding the organism.

Giardia is a cause of diarrhea in people, but we now know that dogs probably play only a minor role in human disease. The type of Giardia that is most often found in dogs is a dog-specific type (Assemblage D) that cannot infect people. Unless these dogs were infected with a strain that can infect people (uncommon but not impossible), there's no risk to people. Regardless, avoiding contact with stool, especially diarrhea, is still a good idea - for prevention of Giardia and other diseases.

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Nature's Variety has recalled chicken-based raw meat products because of Salmonella contamination. After a customer complaint about "digestive problems," they tested the food and found Salmonella, prompting the recall. (For more details about the recall, click here.)  In some ways, this doesn't make a lot of sense to me. If you think Salmonella contamination should be an uncommon event and a problem, you should test routinely, not wait until animals get sick. If you think that Salmonella contamination of raw meat is expected (which it is), then why test or recall? Just assume that every raw meat sample is positive for Salmonella (and Campylobacter, and E. coli). Recalling raw meat for Salmonella isn't logical. Presumably, a large percentage of the raw meat that they have sold and which they will sell in the future is contaminated, based on various studies of commercial raw meat. Handling and feeding raw meat carries an inherent risk of human and animal infections with Salmonella, Campylobacter, E. coli and other bacteria. People that feed raw meat need to understand that risk, and consider whether it's a reasonable risk for their pets and the people in the household. I don't think feeding raw meat is a good idea, but in some situations it's a particularly bad idea (e.g. when there are infants, elderly persons or immunocompromised people in the household, when the pet is very old or very young, when the pet visits high risk people).

More information about raw meat feeding can be found on the Worms & Germs Resources page.

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A Phoenix, Arizona man is suing a pet store after he contracted rat bite fever from a rat he had purchased. It's not surprising to see a lawsuit following a serious illness, considering people in the US often try to sue for just about anything, but I'm not sure it won't get very far. I don't doubt that the man had rat bite fever, or that he got it from the rat he purchased - the question is, is the pet store really liable? Specifically, did they do anything inappropriate?

"Rats being sold to people should not have rat-bite fever," Heitzman's lawyer, M.E. "Buddy" Rake Jr., tells New Times.

Actually, the rats don't have rat bite fever... rats are healthy carriers of the bacteria that cause rat bite fever. There are two different bacteria that can cause the disease, Streptobacillus moniliformis and Spirillum minus. Streptobacillus moniliformis is presumably the cause here since it's the main cause of rat bite fever in the US. This bacterium is very commonly found in healthy rats, with upwards of 100% of healthy rats being carriers. You have to assume that every rat is carrying this bacterium.

"It wouldn't be any different if they sold someone a dog with rabies," he says. "I'm not in the nuisance-lawsuit business - he was in rough shape."

It would certainly be a different story if the store sold someone a dog that had signs of rabies. It's possible that someone could buy a dog that had been exposed to rabies but which was healthy at the time of sale, but that's pretty unlikely. However, a big difference is that there is a highly effective vaccine against rabies. There is no such thing for rat bite fever. If a pet store sells an unvaccinated dog of unknown origin that could have been exposed, despite knowing the need for rabies vaccination, there certainly could be liability issues. Selling a rat that is carrying a bacterium that we assume most or all rats carry anyway is different.

PetCo did not immediately return telephone calls this afternoon, but in its defense, there is an information pamphlet explaining exactly how to avoid contracting rat-bite fever available on the company's Web site. ...though it seems the pamphlet's best suggestion is to not get bitten in the first place.

It would be better if everyone who bought a rat was given the information sheet, but it's a start. The fact is, the best way to avoid rat bite fever IS to avoid getting bitten by a rat! Proper rat handling is a very important aspect of disease prevention, since you can never rule out the possibility that a rat is a carrier.

Our suggestion: Don't have a disgusting rat for a pet.

Whoa.  Rats can make excellent pets. They can also carry infectious diseases. However, EVERY animal can carry infectious diseases, and rats are probably no more risky than most other domestic pets. The key is to take common sense precautions to reduce the risk of injury and infection (though the risk can never be completely eliminated). For rats, this includes selection of a rat that is not aggressive or fearful, knowing how to properly take care of a rat, knowing how to take care of a bite should it happen and being aware of some diseases for which you might be at increased risk because you own a rat.

Image source: http://commons.wikimedia.org

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The Hollywood effect is quite real when it comes to various trends, including pets (remember the glut of Dalmatians after 101 Dalmatians?). I can understand how seeing a cute puppy of some breed might lead to people wanting to get one. However, when Disney's The Princess and the Frog was released, I didn't really think a lot of people who watched this movie were going to start running around kissing frogs. I assumed that some degree of common sense would apply. Apparently, I was wrong.

Various news outlets are reporting that at least 50 children (mainly kids under the age of 10) have become sick in the US after copying the movie's Princess Tiana by kissing frogs. There's not a lot of information regarding what they contracted, whether the illnesses were all clearly linked to frogs, or whether these were truly associated with the movie, but there are certainly disease risks associated with kissing a frog. While we pay more attention to reptiles as a source of Salmonella, the risk is also present with frogs, and the best thing is to do is assume that all frogs are carrying this potentially harmful bacterium. Accordingly, high-risk people (e.g. kids less than 5 years of age, the elderly, people with compromised immune systems) should have no contact with frogs - they shouldn't even be in the same house. Hands should always be washed after touching a frog, and no one should ever kiss a frog. The chances of living happily ever after with a prince are much lower than the chances of a nasty bout of diarrhea (or worse)!

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The latest edition of the journal Emerging Infectious Diseases contains a paper describing the 2008  Australian Hendra virus outbreak in horses and people.

In this outbreak, there were five horses infected and two humans infected. The horses predominantly had signs of neurological disease, not respiratory disease like some other reports describing this disease. Four horses died. One recovered but was euthanized for public health reasons.

Two people became infected after working with the sick horses, which represents 10% of the total veterinary staff that were exposed to the infected horses.  Both people started off with influenza-like illness, which seemed to improve initially, but then signs of severe neurological disease developed. They were treated with ribavirin, an antiviral drug, as part of an experimental treatment. One of them died after 40 days of illness, the other person survived.

The authors stressed that the effectiveness of ribavirin could not be determined, but they recommend it nonetheless because of the severity of Hendra virus infection and lack of other options. Ribavirin was also used in the 2009 outbreak, but it is clearly not 100% effective since one person died there also.

A number of concerning activities occurred that put people at risk of infection, including a "percutaneous blood exposure while euthanizing an infected horses" (they didn't explain exactly what this was, but it could have been a needlestick), low use of personal protective equipment, and contact with potentially infectious body fluids. This is unfortunately not surprising since the approach to infection control (particularly in terms of zoonotic infections) is often lax in equine medicine. That certainly has to change, particularly in areas where Hendra virus may be present.

Much more information about how to control this potentially devastating virus is needed. Fortunately, infections are uncommon and it is restricted to a fairly small geographic range in Queensland, Australia.

Image source: http://animalphotos.info/

This Worms & Germs blog entry was originally posted on equIDblog on 27-Jan-10.

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A paper in the International Journal of Infectious Diseases (Durdik et al 2010) describes a case of meningitis in an 11-month-old child caused by S. intermedius. (Presumably, the bacterium was actually S. pseudintermedius and they’re behind the times on identification of / nomenclature of this bacterium). This is the first report of this bacterium as a cause of meningitis in people, and obviously it’s a concern because of the potential severity of meningitis. Fortunately, the child made a full recovery with proper treatment.

S. pseudintermedius is a normal inhabitant of the skin and other body sites in dogs, and is found less commonly in cats. In this case, the child’s family owned a dog, but the dog lived outside and no direct contact was reported between the child and the dog. Indirect contact, such as someone bringing the bacterium in on their hands after touching the dog, would certainly be a possible route of transmission. Unfortunately, the authors of this study did not investigate the dog as the potential source and there was no attempt to isolate the same bacterium from the dog. The dog is certainly a likely source of infection here since S. pseudintermedius is not commonly found in people, and when it is, it is often associated with dog-contact.

There seems to have been an increase in reports of Staphylococcus intermedius/pseudintermedius infections in people lately. Reports are still very rare but there have been a couple in the past six months. That could be because there are more infections, but it could also be that people are just writing up the cases or that labs are getting better at identifying the organism. Overall, the number of apparent human infections caused by this dog-associated bacterium is very low.  While it is clearly a bacterium that can infect people, the risks to people in contact with pets is also very low. “Low” doesn’t mean “no”, however, and the very low but not negligible risk of S. pseudintermedius infection is just one of many reasons to pay close attention to good hygiene practices around pets, and ensure that your physician knows if you have pets.

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We've seen reasonably good evidence of the potential involvement of pets in the transmission of methicillin-resistant Staphylococcus aureus (MRSA) for a few years, and a study recently published in the Journal of Hospital Infection (Loeffler et al 2010) sheds a little more light on the subject.

In this UK study, they tested 608 veterinary staff and pet owners in contact with pets that were carrying MRSA or methicillin-susceptible S. aureus (MSSA). MRSA carriage was identified in 12.3% of veterinarians that treated MRSA-infected animals and in 7.5% of their owners (although the chicken vs egg conundrum comes up, i.e. are vets that treated MRSA -infected pets more likely to have MRSA because they got it from the pet or because they already had MRSA and infected their patient?). These numbers are relatively consistent with a small number of other studies that have looked at these groups, and are higher than the expected carriage rates in the general population. This is highlighted by the results from people that had contact with animals only carrying methicillin-susceptible S. aureus, since MRSA was only identified in 4.8% of veterinary staff and 0% of owners in this group. Veterinary personnel were significantly more likely to carry MRSA than pet owners. As expected, virtually all MRSA from people and pets in the study were the predominant strains present in human hospitals in the UK.

We shouldn't fear MRSA or our pets, but we should respect the potential for infection and act accordingly. Mainly, this involves basic practices like:

• Good hygiene: washing hands regularly after handling pets
• Avoiding contact with infected body sites in pets, and preventing pets from having contact with infected body sites in people
• Prudent antibiotic use in both veterinary and human medicine
• Proper and timely diagnostic testing to identify MRSA infections, to permit proper treatment and earlier implementation of appropriate infection control practices.

Ultimately, MRSA in pets is a human-borne disease. Most pets that have MRSA presumably acquire it from a close human contact, so efforts at controlling MRSA in pets need to be directed at both the pet and human aspects. Uncontrolled MRSA in people will lead to increased risk for pets, and for pets to be a source of subsequent human infection.

Image: Seven-month-old British Shorthair (photo credit: Tamila Aspen)

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There was another paper published in the August issue of the Canadian Veterinary Journal about Baylisascaris procyonis (roundworms) in raccoons, this time in Winnipeg, Manitoba (Sexsmith et al 2009). The study was actually undertaken after infection with B. procyonis larvae was identifed as the cause of death of several animals in the collection at the Assiniboine Park Zoo in Winnipeg.

The researchers collected feces from 52 active raccoon latrines around the city and from 114 "nuisance" raccoons that were caught, euthanised and submitted for necropsy to the local lab. Interestingly, the vast majority of latrines and nuissance raccoons were found close to the two major rivers that run through Winnipeg. Half (50%) of all the latrines were positive for roundworm eggs on at least one sample (out of a possible 3). Among the necropsied raccoons, 61/114 (53.5%) were positive for roundworms. Adult raccoons were almost four times as likely to carry roundworms than juveniles (which is in contrast to a previous study that found juveniles more likely to be infected), and bigger raccoons (over 2.75 kg) were more than seven times as likely to carry roundworms compared to smaller animals. Although there are regions where the prevalence of B. procyonis s reported to be very low, Winnipeg, like many other regions of North America, has joined the ranks of those where the prevalence is high and the public needs to be aware of the associated risks.

The most severe zoonotic disease caused by B. procyonis is called neural larval migrans (NLM), which results from migration of parasite larvae through the central nervous system (i.e. brain). Two of the reasons this is much more of a concern with raccoon roundworms (Baylisascaris) compared to dog and cat roundworms (Toxocara) are:

1) A massive number of parasite eggs are passed in the feces of infected raccoons (which typically have a very high burden of adult worms). Coupled with the fact that the eggs are further concentrated in areas where many raccoons defecate (latrines), this can lead to heavy exposure of people (or animals) who come in contact with the soil in these areas, which greatly increases the risk of infection.

2) The larvae of B. procyonis are very active migrators, and they get bigger as they migrate through tissues - much bigger than Toxocara larvae ever get, which means they also tend to cause a lot more damage before they're finally (if ever) trapped or killed by the body's immune response.

Natural infection of dogs living in the same areas as raccoons has been found - it's not common, but it appears to occur frequently enough to warrant noting. Dogs and cats can also be infected by their own species of roundworms, which will also result in parasite eggs being shed in the feces. It's important to have your veterinarian perform a fecal examination for your pet on a regular basis so any parasite infestations (roundworm or other) can be treated.

Dogs and cats may also be susceptible to larval migrans in the same manner as people (and the animals at the zoo in Winnipeg) if they are exposed to high numbers of infectious eggs. Remember that roundworm eggs must be swallowed in order for infection of any kind to occur, so good hand hygiene and avoiding soil contamination of food are key to preventing transmission. Also, do not allow your pet to dig or play in an area where raccoons defecate (preventing direct contact between your dog and raccoons should go without saying!).  And of course, feces of any kind (and from any species) should be treated as infectious material, and handled with appropriate precautions.

More information about Baylisascaris and raccoon latrines is available in our archives.

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I received newsletter today from Intervet (a pharmaceutical company) that is targeted at equine veterinarians. One article discussed rabies in horses. It wasn't bad overall, but I thought the section on what to do when a horse might have been exposed to rabies was worth discussing.

The article asks, "If your client suspects that a horse has been bitten by a rabies-infected animal, what should be done?"

Answer: "Contacting you as the veterinarian is always the first step."

Great first step.  A second step that wasn't mentioned should be, "Try to identify and (safely) capture the animal that bit the horse." This is often impossible but certainly worthwhile if it can be done.  However, if you're trying to catch the offending animal, make sure you don't put yourself at risk of exposure to rabies in the process.  If the animal can be caught, it's rabies status at the time of the bite can be determined (either through testing or quarantine). If it can be shown that the animal wasn't rabid, a lot of stress, hassle and expense can be saved.

"If the horse was previously vaccinated... Then isolate and observe the animal for 45 to 90 days (your clinical evaluation will involve gait analysis, radiography and a spinal tap)."

Boosting the rabies vaccine is also a good idea. The next step, however, needs to be contacting local regulatory officials to find out what you have to do. They determine if, how and how long an animal needs to be quarantined - this is NOT the decision of the local veterinarian nor the animal's owner. Most likely, they will recommend a 45 day quarantine for a vaccinated horse, since this is what is recommended in the NASPHV Compendium on Rabies. The discussion of diagnostic testing makes no sense. There is absolutely no indication to perform diagnostic tests on a horse that has been bitten by a rabies suspect. None. There are no tests that can be used to diagnose rabies in live horses (also exposed horses don't instantly develop signs of rabies). Horses should be monitored closely for signs of rabies during the quarantine period, but that's it.

"...and have the client make a list of all people who had contact with the horse."

This is often done when horses have or are suspected of having rabies, but not horses that are potentially exposed. It is done to help public health personnel contact people that may have been exposed to rabies. A horse that was just bitten by an animal is not a risk for transmission of rabies.  (However, keeping a list of people who have contact with the horse after it's been bitten (i.e. durng the quarantine period) - which should be as short a list as possible - is a reasonable precaution in the unlikely event that the horse does develop rabies.)

"If the animal was not vaccinated, your options are to euthanize and perform a postmortem examination of the brain (the only way to definitely confirm rabies)..."

Euthanasia is one of the options that needs to be considered in an unvaccinated horse that has been exposed, which is one of the reasons that identifying the biting animal and testing it is critical, if it can be done. The last part of the above sentence (from the atricle) is complete nonsense. Why would you test the brain of a normal horse that has been euthanized because it's just been bitten by a potentially rabid animal? The horse isn't being euthanized because it has rabies, it's being euthanized because of the likelihood  of it developing rabies weeks to months later. Testing of the brain will tell you absolutely nothing if the animal was only bitten recently.

"...or isolate and observe the horse for six months and develop the human contact list."

Again, this needs to be decided based on discussions with regulatory personnel who are responsible for dictating what is to be done. A six-month quarantine is a pretty standard recommendation for an unvaccinated animal. Creating a human contact list should not be necessary, since quarantine involves severely restricting contact of people with the horse and only a few (ideally one) person would have any type of contact.

The article wraps up with the very true emphasis on vaccinating horses. It's a cheap measure to prevent a relatively rare but invariably fatal disease.

Click image for source.

This Worms & Germs blog entry was originally posted on equIDblog on 05-Jan-10.

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When we have a -30C windchill and snow on the ground, my first thoughts usually aren't about survival of bacteria in the outdoor environment. However, some microorganisms are well adapted for survival in various adverse conditions and we shouldn't assume that cold=dead for every bug of concern. Along that line, we received a question recently about survival of Leptospira and I passed it along to our lepto expert, Dr. John Prescott. Here's his guest post:

A reader in Ohio owns a dog that had leptospirosis, and had some questions about leptospirosis that may be of general interest.

Q1. Since the yard is likely contaminated with leptospires, she asked “How cold does the temperature have to get before the Lepto organisms are killed?”

A1. Once it’s frozen, as it is now in January, they’re dead. Leptospires are fragile bacteria that are killed by dry heat and by freezing. They survive well in moist or wet environments, with moderate temperatures. In some countries leptospirosis is called “mud fever” or “fall fever” since this description captures so well the environmental conditions under which they thrive.

Although leptospirosis in dogs can occur at any time in the year, it mainly causes disease in the fall, late September to December, peaking in November. The increasingly mild and prolonged falls that we have experienced in the last decade are thought to be an important reason that leptospirosis has resurged in dogs. Interestingly, there is often a “blip” of leptospirosis in dogs in March in Ontario (and likely Ohio), since this is when the snow melts and conditions are wet, even though we can still get freezing at that time. I suspect that this is also the time when the raccoons that are thought to be the main source of leptospirosis for dogs are again active after the winter, and are foraging for food for themselves and their babies.

Q2. Do dogs still shed leptospires after they’ve been treated?

A2. No. Leptospires are quickly killed by the antibiotics used in treatment, amoxicillin or doxycycline. There is no danger that dogs treated for a week with these drugs are a risk to people or other animals. You may read in otherwise very reputable textbooks that these antibiotics “do not eliminate the carrier state” but I have no idea where this misunderstanding comes from.

Q3. Where can I find out more about leptospirosis in dogs?

A3. I like the web site http://www.leptoinfo.com, which is maintained by a vaccine company. I was surprised how many web sites devoted to leptospirosis that there are, but like much on the internet some contain highly misleading information. The “Worms & Germs” site has good past blogs about canine leptospirosis and is usually (just kidding, Scott) a reliable source of information.

One very common entrenched misconception, which is very hard to kill, is that vaccination does not stop animals shedding the organism. This is quite wrong. I suspect this misconception came from an experimental study half a century ago when dogs with pre-existing kidney infection with a leptospiral serovar called Canicola were vaccinated. It would not be expected by anyone that these animals would stop shedding since antibodies don’t penetrate into the place in the kidney where the leptospires live and from which they are shed in the urine. What vaccination does incredibly effectively is to prevent leptospires from actually reaching the kidney and setting up home there. The leptospires are removed by antibodies in the blood, so they never reach the kidney.

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.A Texas couple is undergoing rabies post-exposure prophylaxis after an abandoned puppy they adopted was diagnosed with rabies. They found the puppy outside and brought it into their house. One of them was subsequently bitten and they found out about the rabies diagnosis on Christmas eve.

One of the couple is quoted as saying "The doctor said 'It was a good thing they didn't wait until Monday, because it would have been too late. We couldn't have given you the shot because it wouldn't have done any good. You would have been dead within 48 hours." I really hope they completely misinterpreted what the doctor said, otherwise the doc has no clue about rabies. Prompt treatment is the goal, and you certainly don't want to wait any longer than you have to, however rabies doesn't kill in 48 hours, and you can start post-exposure treatment any time (just the sooner the better).

The couple also have seven other pets, who may also have been bitten. There wasn't any comment about what's happening to those pets. Hopefully they are properly vaccinated so they can be given a rabies vaccine booster and only undergo a short-term "quarantine" at home with the owners. (The alternative is immediate euthanasia or strict, long-term quarantine for months).

This isn't a new scenario - adopting a stray animal then finding out it has rabies. The less you know about an animal at the time of adoption, the greater the risks. I'm certainly not saying don't adopt a stray animal. But, if you are going to do it, recognize the risk, make sure you are in a low-risk household (everyone's susceptible to rabies, but some people are at greater risk for other zoonotic diseases and stray adoptions should be avoided by them), get the animal examined by a veterinarian as soon as possible, and make sure that it gets examined by a veterinarian if it develops any signs of disease.

All this leads into another another story I read a few days ago. Basically, it was a feel-good story about someone who found some puppies, stopped by a nursing home (or similar facility) and the facility adopted one or more of the puppies. This demonstrates some good points (e.g. resident's presumably had a great time watching the pups) and bad points (e.g. disease exposure, unknown temperament, injury risks from rambunctious puppies...) of animals in long-term care facilities. What if the puppies that were adopted by the home had rabies? It's happened before, and you end up having to administer post-exposure prophylaxis to a large number of people that already have enough health issues and risks. Nursing homes and other facilities should never adopt stray animals. Hopefully we don't see a news release in the next few weeks about widespread rabies exposure in that facility. 

 Video from wfaa.com

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A recent study just published in the journal Emerging Infectious Diseases evaluated risk factors for dogs having an infection with methicillin-resistant Staphylococcus aureus (MRSA) versus methicillin-susceptible S. aureus (MSSA). This study, headed by Dr. Meredith Faires, compared dogs with MRSA versus MSSA infections from three different veterinary referral hospitals in Canada and the US. Among the more important findings were the following:

• Staying in a veterinary hospital was not a risk factor for MRSA infection, reinforcing the notion that this is predominantly a community-associated disease in dogs (meaning it typically develops in dogs in the general population).
• Most infections, in both the MRSA and MSSA groups, were skin infections. While serious deeper infections can and do occur, skin and ear infections are very common.
• Prior treatment with antibiotics was associated with development of MRSA versus MSSA infections. Dogs that received any antibiotic within 90 days were approximately 3.8 times as likely to have MRSA versus MSSA infection. Dogs treated with drugs from the fluoroquinolone class of antibiotics were 4.6 times as likely to have MRSA versus MSSA infection.

The association between prior antibiotic use and development of a resistant (i.e. MRSA) infection is not surprising, but it is important to document these events and to be aware of them. Antibiotics are critically important drugs in veterinary and human medicine. They save countless lives, but are also overused and misused frequently, and resistance is a critical problem. Studies such as this demonstrate the need for prudent antibiotic use - use them when needed, but use them properly.  Don't use them when a bacterial infection is not present or unlikely to occur.

The study can be downloaded by clicking here. More information about MRSA in available on the Worms & Germs Resources page.

Image source: http://animalphotos.info/a/

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A rabies epidemic has been underway in Bali for some time. There have been 25 deaths, with 2 occurring in the past 2 weeks. There are several reasons for this ongoing problem: large numbers of dogs (especially feral dogs) with limited vaccination, rabies circulating in the feral dog population, inadequate post-exposure treatment of people, and poor education of the public regarding the risks of rabies and how to properly address dog bites.

An encouraging sign is the institution of a mass rabies vaccination program for dogs. Unfortunately it won't start until February, which is disappointing because some people may get infected and die in the interim, but there are likely considerable logistical challenges to overcome, making some delay unavoidable.

The goal of this program is vaccination of 70% of all dogs in each affected regency. According to the recommendations of the World Health Organization (WHO), 70% is the proportion of the canine population that needs to be vaccinated in order to have a chance of eradicating of canine rabies from a given area. It's a challenging goal given the number of feral dogs and the limited resources available in Bali, but it's critical to vaccinate as many dogs as possible. It is estimated that there are approximately 500 000 dogs on the island. Approximately 137 000 dogs have already been vaccinated and another 39 000 have been culled (destroyed). Vaccination will not be performed in two regions because rabies cases have not been identified there. (Hopefully they have good enough surveillance to be very sure that rabies truly isn't in the dogs in those areas. It's a bit of a gamble otherwise.)

One thing that has not been specified is how they intend to handle vaccination of feral dogs. It's not clear whether the numbers mentioned here include feral dogs and whether efforts are being directed at pet dogs only or both pets and feral dogs. Poor compliance with booster vaccinations was cited as a concern, implying this was only focused on pets. Achieving 70% vaccination of the pet population is an important step, but if there is still uncontrolled circulation of rabies in the large pool of feral dogs, eradication will not be possible. Hopefully, trap-vaccinate-and-release programs or oral rabies bating will be used to address the feral dogs.

Image: Mt. Agung, southern Bali

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My daughter's kindergarten class is having a gingerbread cookie decorating event tomorrow. They're supposed to bring a guest (in Amy's case, me) and some items (e.g. candy sprinkles, gummies) to put on the cookies. I was surprised (but impressed) to see a statement asking people to avoid bringing items from bulk bins because of the potential for cross contamination. The concern is that bulk bin items could be contaminated with items such as nuts, which are banned from schools because of allergies.

Cross contamination can also involve bacteria, and can extend into the realm of pet treats. Salmonella contamination of rawhide treats is a problem, and rawhides and other raw pet treats have been the cause of multiple outbreaks of salmonellosis in people. Salmonella (and E. coli, and other bacteria) contamination is a concern with any raw animal-origin product, and while there have been improvements in some areas in manufacturing practices, some risk will always be present. That's why rawhides, pigs' ears and similar treats shouldn't be present in households with young children, elderly individuals or people with compromised immune systems, and why good attention to hand hygiene is needed when these products are handled. Buying individually-packaged rawhides (instead of bulk bin items) is also recommended. Bulk bins may offer some cost savings, but you are at the mercy of cross-contamination and potential accumulation of Salmonella and other bacteria. If one rawhide is contaminated, it can cross-contaminate all the other rawhides in the bin. If bins are just topped up as they get low, this can lead to contamination of a large number of rawhides. There's also the risk of exposure when you reach into the bin and grab one (and it's unlikely that you'd wash your hands afterwards).

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The CDC is investigating an apparent multistate outbreak of salmonellosis associated with contact with frogs. As of December 7, 48 infected people had been identified from 25 states - a pretty remarkable distribution. People got sick between June 24  and November 14, 2009. As is normal for Salmonella outbreaks linked to animals, young children have been more commonly affected, with kids under 10 accounting for 77% of cases. Fortunately, no one has died.

As part of the investigation, contact with animals was investigated and their preliminary analysis indicates contact with water frogs like African Dwarf frogs is the likely source of infection.

Amphibians often get ignored when it comes to zoonotic diseases. The risk of salmonellosis associated with reptiles is fairly well known, but not too many people think about the risk associated with amphibians. The same general guidelines for keeping and handling reptiles should be used for amphibians:

• Children under the age of five should not have contact with amphibians, nor should people with compromised immune systems.
• Hands should be thoroughly washed after handling frogs or having contact with their environment (terrarium/aquarium).
• Frogs should not be allowed to roam freely in the house.
• Aquarium/terrarium water should not be dumped out in the kitchen sink. Ideally, amphibian habitats should be cleaned outside. Care should be taken to prevent contamination of the household environment.
• Amphibians should not be kept in childcare facilities or kindergarten classrooms.

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A very poorly-written and confusing report suggests that another Streptococcus zooepidemicus outbreak is underway in dogs in a shelter in Ohio. Five of 175 dogs on the premises died suddenly of hemorrhagic pneumonia. The report variably mentioned a "virus that mutated from horses," that it's thought to be "not contagious" despite multiple dogs being affected, and that it's a "rare form of streptococcus" (a bacterium). Presumably, they are dealing with a group of dogs with Streptococcus zooepidemicus pneumonia (technically, Streptococcus equi var. zooepidemicus). This bacterium predominantly lives in horses but periodically causes infections in other species. Outbreaks in dogs are uncommon but have been reported in other shelters. I assume that cultures from the dead dogs identified the bacterium, otherwise other possible causes such as canine influenza would also have to be considered.

The statement about it not being contagious is bizzare. Obviously, it is contagious between dogs. It may have been referring to dog-to-human transmission, but while that's rare it has been reported.

The shelter is apparently treating all dogs with penicillin prophylactically (i.e. to prevent any more dogs from getting sick). There's no clear guidelines regarding management of S. zooepidemicus outbreaks in kennels. It's now known whether mass antibiotic treatment does anything helpful, but it has been used in other outbreaks. I think it's likely that these outbreaks stop on their own, rather than penicillin having a major impact, and that there's probably another underlying cause such as a viral infection to account for outbreaks of this rare disease. However, that's just speculation for now. Hopefully this outbreak will cease with whatever treatment and infection control measures they put in place (or on it's own). Hopefully a good review of routine infection control practices will be performed at the same time, as routine practices (or lack thereof) are often a major problem in shelters.

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An article in an upcoming edition of Transplant Infectious Disease (Gisel et al) describes a case of Bordetella bronchiseptica pneumonia in a person who had received a kidney and pancreas transplant. This person had to board her dogs at a veterinary clinic while she was hospitalized for a bowel obstruction that occurred after surgery. The clinic required her dogs to be vaccinated against Bordetella bronchiseptica, a cause of canine "kennel cough." They were vaccinated intranasally (i.e. up the nose) with a modified live vaccine comprised of live B. bronchiseptica that is modified so it is unlikely to cause disease but can still induce a good immune response. The owner developed pneumonia after returning home and B. bronchiseptica was isolated. Specific testing was not performed to confirm that the vaccine strain caused disease, so it's possible that she was infected by the normal (i.e. "wild type") B. bronchiseptica (which still would have presumably come from the dogs).

Immunosuppressed individuals are at high risk for infection by microorganisms that usually don't cause disease in otherwise healthy people. Bordetella bronchiseptica is a good example of this. Care should be taken around pets by anyone whose immune system is compromised. Here are some recommendations pertaining to kennel cough vaccination:

• Immunosuppressed individuals should not receive modified live vaccines themselves, and it is probably prudent to extend this recommendation to avoid modified live vaccination of their pets with vaccines like the Bordetella (kennel cough) vaccine.
• If vaccination for kennel cough is required for entering a kennel or vet clinic, an exemption should be sought because of the potential risk to the immunocompromised person.
• If vaccination must be performed, injectable vaccination is preferred. It doesn't produce as good immunity in the dog compared with intranasal vaccination but the risks to the immunocompromised owner would be much less.
• If intranasal vaccination with modified live kennel cough vaccine is used, immunocompromised owners should not be in the same room during vaccination. They should avoid contact with the dog's mouth, nose and face for at least a few days after vaccination and should wash their hands (or use a hand sanitizer) regularly after contact with the dog.
• If respiratory disease develops in someone exposed to a dog recently vaccinated against kennel cough, the potential for vaccine-associated disease should be mentioned to the physician.

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

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

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

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

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

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

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

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

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

(Image source: www.studentsoftheworld.info)

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

Feral animals need to be exposed to H1N1

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

They need to become infected AND shed appreciable levels of virus

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

They need to be exposed to susceptible people

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

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

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

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

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

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

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

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

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

Image from: http://www.mnr.gov.on.ca/en/Business/Rabies/2ColumnSubPage/275904.html

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An Indiana woman has died of rabies. Little information is currently available.  Reports state that bat rabies was involved but that the source of exposure was not known. Presumably, they have determined that she was infected by the bat rabies variant (strain), but she didn't report being bitten or otherwise exposed to a bat. Bat rabies is a serious concern because it is easy to get bitten by a bat and not know it. Most cases of rabies in Canada and the US are associated with bat exposure. This is a tragic reminder about why we pay a lot of attention to bats and rabies (and why my family received post-exposure treatment after having a bat in the house a few years ago).

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

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Just when all those turkeys that managed to survive Thanksgiving weekend thought their troubles were over, there's new issue: H1N1 influenza (formerly known as swine flu) has been found in an Ontario turkey flock.  The H1N1 virus was first reported in birds in Chile in late August.

This is not a reason to panic.  No one can get the flu from eating a properly-cooked Thanksgiving turkey (nor from any other type of properly-cooked turkey).  The producer has voluntarily (and very responsibly) quarantined the affected flock, and no birds or eggs have left the facility.  There is no risk to the food chain.

Pigs can be infected by human, pig and bird flu viruses, and multiple infections can result in viruses trading genes and producing new viruses that can infect more species.  So it's not too surprising that H1N1can infect people, pigs and now birds as well.  This incident serves as an important reminder that we need to remain diligent about infection control and hygiene, even around animals.  It's highly unlikely that these turkeys had contact with infected pigs - most likely the virus was spread to this flock by a person.  Poultry producers may therefore need to consider getting vaccinated for H1N1 flu not only to protect themselves, but also their flocks, and anyone who may have the flu should definitely stay off these farms.  Hopefully the virus does not become established in wild bird populations (like H5N1 has in some areas), as this would make it much harder to control.

Recommendations for avoiding the flu (H1N1 or other) remain the same:

• Wash your hands and/or use alcohol-based hand sanitizer
• Sneeze into your elbow
• Disinfect commonly touched surfaces
• Stay home if you are sick
• Get vaccinated!

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You'd think, after countless outbreak of salmonellosis associated with pet turtles, that people would learn and things would start to improve. I guess not. A paper published this week in Pediatrics (Harris et al) described a large outbreak of Salmonella Java associated with pet turtles. Between May 2007 and January 2008, 107 infections were identified. The median age (the age in the middle of the range of affected people) was seven years old. Sixty percent of infected people reported exposure to turtles during the week before they got sick; 87% were small (<4 inch) turtles, and 34% were purchased at a retail store (despite the fact that the sale of turtles less than 4 inches long is banned in the US). Five infected people, all less than 10 years of age, reported kissing the turtle or putting it in their mouths.

When they compared people with Salmonella Java infection to people without the infection, 72% of people with Salmonella reported contact with turtles versus only 4% of controls.

Salmonella is far from rare but it's nothing to ignore. Thirty-three percent of infected people were hospitalized. Fortunately, no one died.

The link between turtles and Salmonella has been known for a long time. Healthy turtles can carry the Salmonella bacterium and be a source of infection, particularly for children. The sale of small turtles is banned in the US to reduce the likelihood of close contact between turtles and kids, but this law is widely flouted. An understanding of the link between turtles and Salmonella is surprisingly uncommon - only 32% of Salmonella patients in this study (and 28% of controls) reporting knowledge of this link. Clearly, there are a lot of areas which could be improved.

• If banning the sale of small turtles is truly an effective measure, then it should be enforced. "Black market' turtles are far too easy to find.
• More public education is needed, among the general population and particularly people buying turtles. You shouldn't be able to take a turtle home from a store without an information sheet about the risk of Salmonella and how to avoid it.
• People with turtles (or any reptile) need to recognize the risk and act appropriately. Good general infection control and hygiene measures are needed to reduce the risk of Salmonella exposure.
• Households with children under five years of age, or with immunocompromised individuals should not have pet turtles.
• Antibiotics are not the solution. Attempts to create Salmonella-free turtles with drugs have just led to the production of turtles carrying antibiotic-resistant Salmonella.
• Common sense needs to be a little more common. The picture above (from http://www.familylovezone.com/js_DeepAndWide.htm) was proudly posted by a parent.

More information about infectious disease risks associated with turtles can be found on the Worms & Germs Resources page.

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The US Food and Drug Administration (FDA) has warned consumers about buying antiviral flu treatments over the internet. The FDA issued this warning after it tested "Tamiflu" purchased over the internet. Most of the products contained oseltamivir, the active ingredient in the original Tamiflu, but at varying concentrations. Some were pretty obviously a problem, such as one of the orders that arrived in an unmarked envelope with a postmark from India, and consisted of unlabeled, white tablets taped between two pieces of paper. These tablets contained talc and acetaminophen (the active ingredient in Tylenol), but no oseltamivir.

The commissioner of Food and Drugs, Margaret A. Hamburg, M.D, stated in the FDA press release that “Medicines purchased from Web sites operating outside the law put consumers at increased risk due to a higher potential that the products will be counterfeit, impure, contaminated, or have too little or too much of the active ingredient.”

Another issue is that a drug like Tamiflu needs to be given very early in disease to have any effect. If you think you're getting the flu and order Tamiflu over the internet, it's pretty unlikely to have any chance of working by the time it actually arrives (if they send you the appropriate drug in the first place). Then there's the concern that few people actually need to use Tamiflu compared to the number that do, and that viral resistance to Tamiflu may develop with unnecessary use.

Bottom line: if you really need medication, you should get it from a reputable source on the recommendation of a physician. If your pet needs mediciation, you should take the same approach. It's hard to be certain about what you're getting if you order it through the internet, especially from companies that are illegally selling prescription drugs. It might seem cheaper to buy drugs over the internet, but if it's not needed or it's fake, it's going to cost you more in the long run.

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Clostridium difficile is a high-profile bacterium, being an important cause of illness and death in people. It can also be found in various animal species, including dogs and cats. In a study we published earlier this year (Lefebvre et al, Journal of the American Veterinary Medical Association, 2009), factors associated with acquisition of Clostridium difficile by dogs involved in hospital and non-hospital therapy programs were assessed. Things that were significantly associated with a dog acquiring C. difficile were:

- Contact with human hospitals: Not too surprising since it's clear that hospitals can be highly contaminated with C. difficile and the hands of some patients petting the dogs are probably also contaminated.

- Contact with children: Most parents know that kids are biohazardous (we've getting over a round of illness in our house brought home by the kids - not an unusual event). Whether the increased risk for dogs is because kids have higher rates of C. difficile carriage, or because they have closer contact with dogs (with little hygiene) or some other factor isn't clear.

- Recent use of antibiotics: No surprise here. Antibiotic use is a well-recognized risk factor for C. difficile, since antibiotics can disrupt the normal protective bacterial population of the intestinal tract and allow C. difficile to grow.

- Recent use of antibiotics by a person in the house: I think this is a fascinating result and a great example of the close inter-relatedness of people and pets microbiologically. What presumably happens is that when someone is treated with antibiotics, they are more likely to acquire C. difficile and pass it in their feces. By doing so, there is a greater chance that their dog will be exposed to C. difficile, perhaps from the person's hands or the household environment. (The toilet would be a great source if the dog's a toilet-drinker). The implications of this, for both dogs and people, are unclear. It could be primarily an academic risk (i.e. of little practical significance), or it could be that interspecies transmission of C. difficile plays a role in disease in both species. We simply don't know at this point.

This is also a good example of why educational efforts regarding prudent antibiotic use need to be directed at both animal and human healthcare.

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

Image source: www.sciencedaily.com/releases/2009/05/090507101820.htm

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Recently, a relative was bitten by a dog, and the incident emphasized that you need to take such things seriously and pay attention to making sure things get taken care of properly.

So what should you do if you've been bitten?

1) Identify the dog.

• You need to know who the dog is, and who owns it. If you can't identify the dog, you have to assume it's rabid (even though it's extremely unlikely) and get treated with a series of vaccinations.

2) Get medical care as needed.

• Bites can be associated with significant trauma and risk of infection. Getting to a doctor is particularly important if the bite is severe, occurs at a high risk body site (e.g. over the hands, joints, tendons and nerves, groin, prosthetic devices) or if you are at higher risk of infection (e.g. immunocompromised, don't have a functional spleen, very young or very old, pregnant). If in doubt, go to a doctor to be on the safe side.

Once you've done this, it's important to make sure that the offending dog actually doesn't have rabies. If you go to a doctor, they will (in most regions) report the bite directly to public health. Public health inspectors will investigate the rabies vaccination status of the animal and ensure that it is quarantined for 10 days. If the dog has rabies and is infectious, it will develop signs of infection within this 10 day period. If the dog is healthy after 10 days, it did not have rabies at the time of the bite.

Seems pretty simple, eh?

Unfortunately, there are a few places where this process can break down.

Reporting: All bites need to be reported. Bites that do not result in people going to the hospital may be missed. You don't need a serious bite to contract rabies (or another serious infection).

Public health follow-up: This is hopefully not an issue, but you should make sure that public health has investigated, and done so promptly. Don't be afraid to call to find out the status of the investigation, and make sure information has flowed quickly from the physician to a public health inspector. Hopefully they'll be in touch with you, but don't be afraid to initiate contact. The main issue with follow-up relates to the next point:

Prompt euthanasia of the dog: Sometimes, people will decide to euthanize a dog after a bite, because it's done it before, because they consider any bite unacceptable, and/or they fear for family members or legal liability. Dogs (or cats) that have bitten someone must not be euthanized before the 10 day quarantine period is over. If the dog is euthanized and the body is not available for testing, you have to consider the dog rabid and undergo post-exposure treatment. Veterinarians are required to ask whether a dog has bitten someone in the preceding 10 days prior to performing euthanasia, but it's possible that this could be missed, or people may not tell the truth because they want to have the dog put down ASAP. This is why public health inspectors need to investigate promptly - to provide another level of assurance that the animal is not euthanized inappropriately. You should follow up with public health to make sure things are underway and the dog is quarantined.

Rabies associated with dog bites is extremely rare in Canada (and many other countries) but still kills tens of thousands of people every year, mainly in Asia and the Middle East. Considering it's almost invariably fatal and pretty much 100% preventable, you need to pay attention to the risks, no matter how small.

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While in London (UK) last week, I went with a group of people to the John Snow pub. It's a bit of an epidemiologist pilgrimage, where you can sit in a pub named after one of the "fathers of epidemiology" and sign the guest book.

John Snow was a physician in London in the mid-1800's. Cholera outbreaks were a problem in Victorian London because of contaminated communal wells (for drinking water). Unlike many others, Snow did not believe in the miasma theory, which stated that noxious vapours in the air were the cause of many illnesses. While the "germ theory" of disease was not yet on the scene, Snow thought there must be some other way that diseases like cholera were transmitted, and he suspected (correctly) that the water supply was the problem.

During a cholera outbreak in 1854, he determined that a well in central London (Broad St, now Broadwick St) was a major source of the disease. Removing the handle from the pump (so that people could no longer use the well) stopped the outbreak.  Although Snow himself suggested that the outbreak was already in decline, removing that source undoubtedly played a large role in saving many lives. Back then (and even still commonly today), getting people to accept and adhere to infection control measures was not easy. After the outbreak ended, public officials fixed the pump, despite the fact that it was clearly associated with the outbreak. In hindsight, it's not surprising that this well was associated with disease, since it was shallow and very close to a cesspool.

The John Snow pub is located at the original site of the Broad Street pump.  You can see the location of the original pump from the window of the pub (there's a replica pump there and a marking on the ground at the exact site of the original pump). So, you can visit the source of a great cholera outbreak, peer out at the simple solution that helped stop it,  and have a drink in the pub named after John Snow - something that's more than a little ironic, since Snow was also famous as a teetotaler.

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At the ongoing ASM-ESCMID conference on methicillin resistant staphylococci in animals, Dr. Engeline van Duijkeren of Utrecht University (The Netherlands) presented a study on an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in their equine hospital.

From 2006-2008, several horses that underwent surgery at their hospital developed MRSA infections.  MRSA was also isolated from some healthy horses and personnel at the clinic. Early in the process, the hospital was closed for a thorough disinfection and the outbreak stopped, however another outbreak occurred later.  Further study again found people in the clinic that were MRSA carriers. Close to 15% of people in the hospital who handled equine patients were MRSA carriers, which is really astounding when you consider that less than 0.1% of the general population in the Netherlands carries MRSA. When they started testing horses coming into the clinic, they found that 9.3% of horses were carriers when they arrived. Weekly sampling of all hospitalized horses over a five-week period determined that 43% of all horses in the hospital carried MRSA at one point or another during their stay. Additionally, 53% of environmental surface samples were positive for MRSA, which is really not surprising if that many people and horses are carriers.

If horses keep coming into a facility carrying MRSA and people keep getting colonized, MRSA is hard to control. These experiences led the equine hospital at Utrecht to implement more stringent infection control practices to try to contain the problem, but the high MRSA rate in their referral population is going to pose a continual risk.

MRSA outbreaks in horses aren’t new. They’ve been reported by a few hospitals (including ours) and occur in many, many, (many!) more without ever being published. Since MRSA is present in the horse population, equine hospitals are at continual risk of MRSA outbreaks. If a large percentage of horses in the general population are carriers, the risk of outbreaks is higher.

MRSA is clearly a problem in horses in many areas. It’s important to realize that it’s a problem in the general population, not just horses in hospitals. Equine hospitals can amplify the spread of MRSA, but ultimately a lot (if not most) MRSA-positive horses originate from farms, not clinics or hospitals. Equine hospitals need solid infection control programs to reduce  the risk of outbreaks, but the risk will never be completely eliminated. Farms need good infection control programs to reduce the risk of spread of MRSA between horses and between farms, as well as from horses to people (and back). Antibiotics need to be used prudently since antibiotic use is a risk factor for MRSA carriage and infection.

More information about MRSA in horses can be found on the equIDblog Resources page.

This Worms & Germs blog entry was originally posted on equIDblog on 26-Sep-09.

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More from the ASM-ESCMID MRSA in animals meeting…

Dr. Joe Rubin presented some data on antibiotic resistance in Staphylococcus aureus bacteria from dogs and people in Saskatoon, Saskatchewan (Canada). The bacterial isolates came from dogs carrying S. aureus and from dogs infected with MRSA. When you look at the resistance patterns of the S. aureus isolates from the carrier dogs (these are an indicator of what’s around in the general population, and they can cause infections given the right circumstance), resistance was uncommon. Multidrug resistance was present in the methicillin-resistant S. aureus (MRSA) isolates, as expected.

Saskatoon’s an interesting area in terms of resistant bacteria. Various studies from the University of Saskatchewan have reported very low antibiotic resistance rates in bacteria from animals. Certainly, they have some problems like everywhere else, but I find some of their data quite remarkable. They can have a lot more confidence in the use of various first-line antibiotics compared to other regions where resistance is more common and drug options are more limited. I’m not really sure why this is the case.

• Maybe it has to do with the fact that there is less animal movement between Saskatchewan and other regions where there are more resistance problems.
• Maybe the low population density in Saskatchewan plays a role.
• Maybe multidrug resistant bacteria don’t like the frigid Saskatchewan winter (or the fact that there’s no NHL team in the province).
• Maybe they use antibiotics in animals in a much more controlled manner.

Trying to figure out why resistance rates in Saskatchewan tend to be lower would be useful because it might provide some information about how to reduce the risks in other regions.

So, if you’re in Saskatoon and your pet gets an infection, take some consolation in the fact that there’s probably a lower risk that you’re dealing with a resistant bacterium and that your first-line antibiotics will probably work.

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I'm in London (UK) for the ASM-ESCMID conference on methicillin-resistant staphylococci in animals: veterinary and public health consequences. I’ll provide various updates on interesting presentations over the next few days.

Dr. Armando Hoet from the Ohio State University (OSU) presented data on MRSA screening of dogs admitted to the OSU Veterinary Teaching Hospital. They sampled a subset of dogs admitted to the hospital every month over the course of a year.

• 5.7% of the dogs were identified as MRSA carriers. That’s a pretty impressive (and concerning) number. We know that a small percentage of dogs and cats in the general population are positive, but I’ve generally assumed the rate of carriage to be around 1-4%. However, you have to consider the study population whenever you look at numbers like this. Sixty-eight percent of the positive dogs were referral cases, meaning they had had previous contact with the veterinary healthcare system, may have been treated previously with antibiotics and may have had other diseases that increased the risk of MRSA.
• Ownership by people in the human or veterinary healthcare fields were risk factors for infection.  This is not very surprising since such owners would be more likely to pick up MRSA at work and bring it home to infect their pets.

Hopefully the true percentage of dogs in Ohio carrying MRSA is lower than this. Presumably, the rate of MRSA carriage by healthy dogs that are not owned by high-risk people is quite a bit lower. Regardless, it shows that MRSA can be found in a reasonable percentage of animals in the study area (as well as presumably other areas) and that good infection control practices are needed in veterinary hospitals to reduce the risk of transmission.

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

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This comic, based on actual (and unfortunately common) events, was developed by Los Angeles County Veterinary Public Health. It's a good example of novel ways of communication regarding zoonotic diseases. More information from Los Angeles County Veterinary Public Health (and apparently future editions of Rabies Tales) can be found on their website.

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In April, I wrote about an ongoing rabies outbreak in the popular tourist destination of Bali. Because of widespread rabies in stray dogs and fatal human infections, there were calls for the government to take aggressive action and for tourists to be aware of the risk. Apparently, things haven't improved much since then.

At least 9 people have died of rabies in Bali in slightly over a year. That's completely unacceptable for a preventable disease.

The latest victim (whose father-in-law died of rabies in August) was from an area that has not been officially declared as being part of the epidemic, so it has not received much government support. She was bitten by a stray dog in August. In any rabies-endemic area (even in the absence of an outbreak), that's clearly an indication for post-exposure treatment. However, she did not receive post-exposure treatment until 15 days after the bite, by which point it was obviously ineffective.

• Rabies post-exposure treatment must be started as soon as possible. If you wait until signs of rabies are present, death is almost certain.
• Be informed and be your own advocate. The family in this case may very well have pushed for post-exposure treatment, but it's critical to look out for yourself. If you have potentially been exposed to rabies, make sure you get treated.
• If you are going to Bali, don't be paranoid about rabies. Be smart. Avoid any contact with dogs (especially strays) and other wildlife. If you are bitten, get medical care immediately. If the animal isn't identified and quarantined for 10 days to make sure it doesn't have signs of rabies, you need post-exposure treatment. If you can't get it in Bali, get out and get to somewhere where you can be properly treated.
• If you are traveling to Bali (or any other rabies-endemic area) with the intention of working with wild or stray animals (especially dogs), get vaccinated before you go.
• More aggressive rabies control and education (including physician education) efforts are needed in Bali. Clearly, this outbreak is not under control and the fact that the latest death occurred in a new region suggests that this problem could be spreading.

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

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As a vet, I've been bitten by a wide range of animal species. When people talk about animal bites, they usually think about dogs and cats. Horses can (and do) bite as well. Most horse bites are probably playful nips that hurt a little yet don't cause major problems, but some bites can cause serious injuries and infections can result.

A recent paper in the Journal of Agromedicine (Langley and Morris 2009), with the rather unwieldy title of "That Horse Bit Me: Zoonotic Infections of Equines to Consider after Exposure Through the Bite or the Oral/Nasal Secretions". Bites apparently account for 3-4.5% of the approximately 100 000 annual emergency room visits in the US that are associated with horses. The authors of the paper review infections associated with bites and contact with organisms in the mouth and nose of horses.

A large number of bacteria have been associated with horse bite infections in people, including Actinobacillus, Streptococcus, Psuedomonas and Staphylococcus species. Some viruses can theoretically be transmitted by bites, but there's little evidence that this actually happens.

Although viruses are not of as much of a concern overall, rabies needs to be considered in every bite from a mammal. We pay a lot of attention to rabies with dogs, cats and wildlife, but it often gets ignored with horses. While I'm not aware of any reports of rabies transmission from horses to humans by a bite, it could happen.  Fortunately, rabies is rare in horses so the likelihood of exposure from this species is very low. However signs of rabies aren't always obvious initially, and rabies in horses may mimic other diseases. Sometimes, rabies looks like colic, and human exposure through bites or other contact is possible when handling, evaluating and treating affected horses.

Unlike with dogs and cats, there are no clearly defined protocols for dealing with bites from horses. Any dog or cat that bites a person is supposed to be quarantined for 10 days. The reason for this is if the animal is rabid and the disease is advanced enough for the animal to be capable of spreading rabies virus, it would invariably develop signs of rabies and die within this time period. We don't have similar guidelines for horses. I suspect the 10 day observation period would be adequate but we don't have good data. The paper states that in Kentucky, a 14 day observation period has been used by the state Department of Public Health.

At the conclusion of the paper, the authors make a few important general recommendations for reducing the risk of disease transmission from bites and oral or nasal secretions of horses:

• Use good general hygiene, especially hand hygiene, after any contact with horses.
• Use gloves and gown or lab coat when examining horses in a veterinary clinic or hospital. (This might be overkill for all horses. We don't require gloves for every horse contact, just contact with mucous membranes (e.g. mouth, nose), wounds, incision sites and other high-risk areas. I think bare hands are fine for general contact as long as there is good attention to handwashing after.)
• Consider mask and goggles if the horse is coughing or sneezing.
• Develop standard operating procedures for handling sick horses.
• Use isolation when needed.

I'd add a few more points:

• Avoid bites. Pay attention to what you are doing around horses to reduce the risk of being bitten. Do not encourage playful behaviours (e.g. nipping) that could lead to bites.
• If you are bitten and it breaks the skin, clean the site thoroughly with soap and water. If there is significant trauma, or if the bite is over a joint, hand, foot, or a prosthetic device, you should see a doctor immediately because antibiotics are most likely indicated. If you have a weakened immune system, you should be evaluated by a doctor after any bite.
• Avoid contact with the horse's mouth or nose if you have skin lesions. Cuts and scrapes can allow bacteria to enter your body and cause infections. If you have a cut on your hand, make sure it is covered with a glove or waterproof dressing if you are going to have contact with the horse's mouth or something that came from its mouth (e.g. a bit).

This Worms & Germs blog entry was originally posted on equIDblog on 02-Sep-09.

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In response to recent problems with attacks by stray cats and concerns about rabies exposure, Point Pleasant Beach, New Jersey, is planning to round up all the stray cats they can catch. Cats will be monitored in rented trailers for 60 days, and any cats that do not have signs of rabies will be adopted out (after being vaccinated and spayed/neutered). It's perhaps overly optimistic that all cats will be adoptable, since not all strays (especially older cats) are going to be appropriate for household pets, but they will hopefully find good homes for many of these cats.

While this program could be beneficial in some ways, let's hope a lot of thought has been put into it. This type of mass roundup and confinement is quite likely going to result in high transmission of many infectious diseases that circulate in the stray cat population. Hopefully there are plans for proper initial health assessment of captured cats, isolation of cats showing signs of infectious disease, cohorting of different groups to reduce the risk of disease transmission and use of good general infection control practices. Without these, they are asking for major problems.  Unfortunately, infection control is often not considered in situations like this until a major disease outbreak is already underway.

The 60 day quarantine period may raise questions, but it's a reasonable approach. If they were doing a formal rabies quarantine, it would be six months. The maximum incubation period for rabies in cats is not known, but it can be very long in humans in rare instances. Realistically, 60 days is a pretty good quarantine period under these circumstances. You can't be 100% certain that an animal isn't incubating rabies after 60 days, but it becomes very unlikely and I wouldn't be concerned after 60 days. Sixty days is also a good amount of time to identify (and hopefully address) any other major health issues.

Another issue that needs to be considered is ongoing population control efforts such as continued catching and adopting of strays, catching and neutering strays, and educational efforts to encourage people to have their cats spayed or neutered and discourage them from feeding strays. A lot of time and money can be put into a big one-time effort, but this town might end up in exactly the same stray cat situation in a year or two if nothing else is done.

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Rabies baiting is a common and effective way of controlling rabies in some wildlife populations, particularly skunks, raccoons and foxes. It involves dropping edible rabies vaccine, by airplane or by hand, into targeted areas. Millions of rabies baits are used across North America and baiting programs have been cited as a key aspect of wildlife rabies control. In one year, 1.3 million baits were dropped in targeted areas of Southern Ontario alone over a two-month period. A good series of pictures of rabies baiting is available here.

Rabies baits are usually a small rectangular block comprised of something that smells or tastes attractive to the targeted wildlife into which a liquid vaccine has been added. Some use fish meal and fish oil to attract wildlife. Others use combinations of fats, icing sugar, vegetable oil and artificial marshmallow flavour (don't ask me why - I'm certain there's a reason but I don't know if they've done taste-testing).

Often, the local public is notified in advance of the drops being made, and it is recommended that kids be closely supervised outdoors for a week or so to ensure they don't come into contact with the baits. It is also often recommended to keep pets indoors or on leash during the same period. (Pets are much more likely to be exposed to and to eat the vaccine than kids). It's also recommended that you wash your hands thoroughly if you have contact with a bait.

Rabies baits are quite safe, and these recommendations shouldn't cause concern. It's a case of being overly cautious. The baits are safe to touch, but it is still recommended that you don't touch them (if nothing else, they may make your hands smell pretty bad). Ingestion of a rabies bait by a person or pet is also unlikely to cause a problem. Any adverse affects are more likely to occur due to the non-vaccine component of the bait, particularly because of the typically high fat content. Ingestion of a lot of baits could certainly cause vomiting or diarrhea in a dog, just like ingestion of large amounts of other inappropriate foods.

Some groups recommend that you contact Poison Control if your pet has been exposed to a bait, but I'm not sure what they'd do in such a case. Other groups ask you to report to them that a pet ingested the bait, likely so they can consider exposure of people and pets when determining target areas for the next year. There's similar variation in recommendations if a person ingests the vaccine. Often it is recommended that public health be notified so they can record it, but it's very unlikely anything would be done.

On a related note, you cannot use rabies baits as a free way to vaccinate your pet. It might work, but there is no way to know, and if your pet is exposed, it would be considered unvaccinated if it was not properly vaccinated by a veterinarian with an appropriate dog/cat vaccine.

Image from: http://www.mnr.gov.on.ca/en/Business/Rabies/2ColumnSubPage/275904.html

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We've written various posts about raccoons, raccoon latrines and concerns about the raccoon roundworm (Baylisascaris procyonis). I received a question today about how to keep raccoons from coming back after a latrine has been identified and cleaned. It's a good question, and one without a simple answer.  I've looked through various sources and have found a wide range of recommendations. (Whenever I see such a wide-ranging list of recommendations, I wonder whether anything actually works.)

Home remedies include:

• Sprinkling pure soap flakes on the lawn and watering thoroughly
• Mixing bone meal in garden soil
• Sprinkling diluted tabasco sauce over fruits and vegetables (wash before eating, as you should anyway!)
• Lighting up the area where raccoons are a problem

Various commercial deterrent compounds are available, such as one that apparently has the scent of a coyote, or one that's a combination of vinegar, pepper and sulfur.

Another approach is motion-sensitive deterrents. Motion-sensor-based lights can be useful since raccoons often come rooting around in the evening or overnight, and lights that turn on when they approach could be effective. These would require a power source, which could be limiting in some places like sheds. Similarly, motion-sensor based systems that spray water or citronella (sometimes used to keep cats out of certain areas or off countertops) could be useful. Battery-operated units could be used anywhere. (Here's a link to one. I've never used it but it shows you what I'm talking about). There are also motion sensors that hook up to hoses.

One problem with deterring raccoons is their intelligence. They can often find ways around deterrents, or adapt to them. Along with any attempts to actively deter the raccoons, it is also important to try to reduce the desire of the raccoon to come to the location. If there is a good food source or other desirable attraction, the raccoon will probably try harder to stay around. Tightly covering garbage cans and removing other possible food sources (e.g. food for outdoor cats) are important steps. Making sure neighbours (or other family members) aren't feeding the raccoons is also important, because food is a great motivator.

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If you live in the suburbs of Chicago (or probably many other cities as well), chances are pretty good that you live close to a raccoon latrine. Raccoons like to defecate in specific areas (raccoon latrines) which can become highly contaminated with eggs of Baylisascaris procyonis, the raccoon roundworm. Human disease caused by this parasite is rare, but when it occurs, it can be devastating. Infected raccoons can shed around 20 000 Baylisacaris eggs per gram of feces (see image right), and the eggs can survive for long periods in the environment, so it's easy to see how biohazardous a raccoon latrine could be.

A study in the upcoming edition of Emerging Infectious Diseases (Page et al) looked at 119 backyards in the Chicago suburbs. Latrines were found in 51% of yards, with up to six latrines per yard! Baylisascaris eggs were found in samples collected from 23% of latrines. The likelihood of having a latrine in the yard was lower in houses farther away from forested areas. No other factors were identified as associated with the presence of a latrine, however there was a trend towards increased likelihood if a food source (e.g. bird feeder) was present.

The fact that raccoon latrines are so common and that a high percentage of raccoons shed Baylisascaris should raise concern, and emphasize the need for good hygiene. At the same time, the rarity of disease despite the widespread presence of infected raccoons should be remembered. You don't get infected by walking by a raccoon latrine, you get infected by ingesting (swallowing) the parasite. Avoiding this is simple, and as the folks at Barfblog (a food safety blog) would say, the key is: "Don't eat poop". Simple measures can reduce the risk, such as avoiding contact with raccoon feces and washing your hands after being in potentially contaminated areas. Young kids are at highest risk because they are more likely to put things in their mouths, so keeping children away from areas potentially contaminated by raccoon feces is important, along with good attention to hand hygiene.

Since raccoon latrines are an obvious source of infection and many (of the limited number of) human cases have been where latrines were close to childrens' play areas, eliminating latrines is also a good idea. Details on cleaning up latrines are available in an earlier Worms & Germs post.

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A horse in Harford county Maryland has been euthanized because of rabies. The horse first starting showing signs of disease in mid-July, which manifested as "striking changes in behaviour." The report doesn't say when the horse died, but animals typically die within a few days of the onset of neurological disease. The horse was transferred to the New Bolton Center where rabies was diagnosed. Subsequent testing showed it was a raccoon rabies strain, although that does not mean that a raccoon was the actual source of infection.

Public health officials implemented a 45 day quarantine of the farm. Stray cats (about 25) were caught and euthanized. Fortunately, the family pets were properly vaccinated and have received booster shots (plus presumably a period of observation at home... a much better situation than if they were not vaccinated).

People that had contact with the horse have received rabies post-exposure treatment. This includes one person who had to be tracked down overseas.

Harford County Health Department spokesperson Bill Wiseman said "There was never a risk to public safety. This incident was a great example of public health work in action and cooperation between local, state and in this case, international authorities." I don't buy the statement that there was no risk to public health. While the risk of rabies transmission from infected horses is very low, it's not zero. Rabid horses have killed people because of their abnormal and sometimes aggressive behaviour. Further, the fact that this horse had rabies means that it got it from something. Rabies can have a long incubation period so it's not guaranteed that it acquired it on the farm, but you have to be prudent and assume that there is infected wildlife in the area that could pose a risk for other animals or people. Public health authorities managed the situation well and reduced the public health risks, but there were certainly still risks.

Rabies vaccination is highly effective. There is no statement about whether this horse was adequately vaccinated but it's unlikely. Proper vaccination would likely have prevented this horse's death, as well as the death of the stray animals, cost of vaccination of people, cost of veterinary care for this horse, quarantine of the farm and the associated financial and emotional costs. A dose of vaccine that costs a few dollars could have saved thousands of dollars and emotional stress.

Rabies is a rare disease in horses but its severity means it should not be ingored. Vaccinate your horses.

This Worms & Germs blog entry was originally posted on equIDblog on 14-Aug-09.

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It seems like whenever a hit TV show or movie features an animal, there's concern about the "101 Dalmatians effect," whereby there's a mad rush to get the animal for a pet. When 101 Dalmatians was a hit movie, there was a huge spike in sales of this rather unusual breed - a breed which is certainly not for everyone. This results in unqualified breeders and puppy mills churning out marginal or poor quality pets and people getting a pet that really doesn't suit them. The end result can be a lot of disappointment, heartache and abandoned pets. This pattern has been repeated with various other breeds and animal species, and there is concern that the same will happen with guinea pigs as a result of the new Disney movie G-Force.

In terms of human health, guinea pigs are relatively benign. Bites and scratches are probably the biggest concern, and are often the result of improper handling. Bites can become infected from bacteria in the guinea pig's mouth or from bacteria on the person's skin. Allergies are also a potential problem. The number of diseases that are known to be transmitted by them is relatively small, and the risk of disease transmission is rather low.

Lymphocytic choriomeningitis virus (LCMV) is a concern with all rodents. It typically only causes disease in people with compromised immune systems, but can result in fatal infection. The risk of a guinea pig carrying this virus is likely greatest in animals from large rodent breeding facilties and when there is contact with wild rodents.

Ringworm is perhaps the most common infection that people get from guinea pigs (apart from infections following bites). Even healthy guinea pigs can carry the fungus that causes this disease.

Guinea pigs can carry Salmonella, but they are quite susceptible to infection and usually get quite sick. The risk of a healthy guinea pig shedding Salmonella, especially for a prolonged period, is pretty low. The risk is presumably greatest shortly after purchase.

Rabies is always a potential problem in mammals but the risk is very low with small rodents such as guinea pigs. (Very low isn't zero though, since hamsters have been sources of potential rabies exposure).

There are other potential problems too, but they are all quite rare.

The keys to reducing the risk of infection are:

• Purchase a guinea pig that looks healthy, is eating well, has no skin lesions or diarrhea, and is active and alert. Ideally, purchase an animal from a local breeder as opposed to a store that might have obtained the animal from a large breeder, via an animal warehouse, hundreds or thousands of miles away.
• Learn how to properly handle a guinea pig to reduce the risk of bites and scratches, as well as injury to the animal.
• Keep pet guinea pigs away from wild rodents.
• Use good general hygiene. Wash your hands after handling the guinea pig and after contact with bedding.
• Thoroughly wash any bites or scratches.
• Take particular care in the period shortly after purchase.
• Even though the cost of the guinea pig is less than the cost of a vet visit, a veterinary examination is important when the animal is sick. Apart from our ethical responsibility to take care of our pets, it's important to make sure that illness isn't caused by a disease that can be transmitted to people.

More information about the diseases mentioned above is available on the Worms & Germs Resources page. While we don't have a specific guinea pig info sheet yet, much of the information on the hamster information sheet also applies to guinea pigs.

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I received a flyer from Zoologix, a company that offers various (typically unvalidated and unproven) PCR tests for animals. The flyer headline was "Pets can carry MRSA - but testing can help."

Testing in certain situations is useful, but this is almost always limited to diagnosis of animals with active infections (i.e. they're sick). PCR is not a good way to make such a diagnosis, because the test doesn't tell you anything about the bacterium's susceptibility to other antibiotics. Screening of pets just to determine whether or not they carry MRSA is rarely needed, and currently there is no evidence that PCR is a reasonable test for this.

There are no validated PCR tests for MRSA in animals. We looked at using a human test in horses and it failed miserably. There are validated tests for use in people, and they are quite good: they accurately identify MRSA and differentiate it from other methicillin-resistant staphylococci and from methicillin-susceptible S. aureus. That's critical, because you have to know what a positive test really means.

I called the company and asked what the test actually detects. They said it detects the mecA gene, the gene that confers methicillin-resistance to staphylococci such as S. aureus. However, this gene can be present in other staphylococci that can be found in many  healthy dogs and cats (10-30% in some studies). It does not actually detect MRSA and a large percentage of samples that give positive results will be false positives. The tests that are used in humans are specifically designed to look at two things in combination: whether S. aureus is present and whether it has the mecA gene (methicillin-resistance). This is the right approach because it excludes all those other false positives. Detecting mecA alone is completely useless. It's interesting that the flyer states "PCR testing is fast, effective and accurately differentiates MRSA from other bacteria - even other Staph strains." Based on what the company told me over the phone, with regard to the test they're advertising, that's a blatant lie.

This is an example of a combination of bad science and bad ethics. This company has no business marketing this test. It's false advertising, because the test isn't an MRSA test. Their justification for using it is similarly weak. Anyone thinking about using this test should run away quickly! The issues with this test (and others) should also be considered when deciding whether to use this company for any tests.

More (and accurate) information about MRSA can be found on the Worms & Germs Resources page.

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Brucellosis can be a pretty nasty disease. Most people with brucellosis are infected through ingestion of contaminated food or contact with infected farm animals. Brucella abortus, B. melitensis and B. suis are the most common bacterial species involved. However, there is also another Brucella species, B. canis, which (as the name implies) is associated with dogs. Human infections with B. canis are much less commonly diagnosed than those caused by other Brucella species, but it is possible that this infection actually occurs more often than we realize.

Brucellosis can cause a wide range of problems, but most are rather non-specific such as fever, headache, body aches, sweating and back pain. Recurrent, undulating fever is a common sign and can persist for long periods of time. Disease caused by B. canis is similar to that caused by other Brucella species, but one reason this disease may be underdiagnosed is that screening tests for brucellosis do not cross-react with B. canis. Therefore, a physician might suspect brucellosis, but if the initial test (an antibody test) is negative, the physician is likely to move on to investigate other possibile diagnoses. Specific B. canis blood tests or culture of B. canis from blood or infected sites are required for diagnosis. Overall, it's probably still a very rare disease, but one that certain people should be aware of.

Many dogs that are infected with B. canis have no detectable signs of infection. The bacterium can circulate through the body continually or intermittently, and spread from the gentials (where it likes to reside) for years. Some infected dogs show signs of illness. Reproductive problems, including late-term abortion (miscarriage) and decreased fertility are major problems. Fever, lymph node swelling, diskospondylitis (infection in the spine) and other problems can also develop.

The risk of human exposure is highest in people in close contact with breeding animals, particularly people in contact with dogs that miscarry during pregnancy or kennels with reproductive problems. Most reported human infections involve people in close contact with dogs that miscarry. The risk to owners of household pets (especially neutered pets) is presumably very low.

• People who have been exposed to dogs that miscarry and who subsequently develop signs like fever and aches should make sure their physician considers B. canis infection.
• HIgh risk people (very young, elderly, immunocompromised, or pregnant women) should avoid contact with dogs that have miscarried, or dogs from kennels with reproductive problems or known B. canis infection.
• Care should be taken when handling dogs that have miscarried or are in the process of doing so. Gloves should be worn when handling the dog, aborted fetuses and any potentially contaminated items. Uterine (birth) fluids can have very high levels of B. canis.
• Hands should be washed regularly and after removal of gloves.
• If abortion or reproductive problems are identified in a kennel, testing for B. canis should be performed. If present, an eradication program should be started.

More information on brucellosis in dogs can be found in the Worms & Germs archives.

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New research provides more information on the debate about testing and treating of healthy dogs for Giardia. Two abstracts on the subject by researchers at Colorado State University were presented at the recent American College of Veterinary Internal Medicine conference.

In the first study (Clark et al), fecal samples were collected from 220 healthy dogs. Giardia was detected in 11.4% of samples, but no dogs carried assemblages (types) known to cause disease in people.

In the second study (Lappin et al), they evaluated whether treatment of healthy dogs that were shedding Giardia would eliminated the parasite. Sixteen infected dogs were treated with either fenbendazole or nitazoxanide. Eight (50%) of the dogs had to be removed from the study because of adverse effects from treatment! Of the dogs that completed the study, Giardia was still detected in 63% of dogs 34 days after treatment, indicating that the infection wasn't eliminated or that dogs were quickly re-infected.

These studies provide more support of the notion that there is no indication to test or treat healthy dogs for Giardia. Testing makes no sense when the parasite is so common but most infected dogs are healthy, and when strains carried by infected dogs are usually of no consequence to people. Giardia is essentially a normal part of the intestinal microflora in many healthy dogs. Treatment of healthy carriers isn't indicated because it can make dogs sick and because it doesn't work very well.  Remember: above all do no harm.

The bottom line is don't bother testing healthy dogs for Giardia or treating healthy dogs in normal households.

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In Canada, access to rabies vaccine for animals is restricted to veterinarians (i.e. only vets can buy the product itself and administer it to people's animals). In general, this is an excellent approach because it ensures that the vaccine has been handled and stored appropriately, animals have been vaccinated properly and accurate vaccination records are kept. I certainly wouldn't want rabies vaccine freely available, whereby anyone could buy vaccine, handle it poorly, vaccinate their animal improperly, and yet believe or claim to have a properly vaccinated pet.

The problem with this restriction is the fact that veterinary care is not always available. Specifically, I'm referring remote northern communities that do not have veterinary care on a regular or even a sporadic basis. I received an e-mail the other day from a medical professional in a fly-in First Nations community in Northern Ontario. They have not had a visit from a vet in a while, so the dogs there aren't vaccinated. Unfortunately, a dog was attacked by a wolf recently so it must be considered possibly  exposed to rabies, resulting in euthanasia or long quarantine. The question was about what can be done in those communities to provide rabies vaccine for people's animals. I didn't know, so I inquired with the Canadian Food Inspection Agency, the federal agency in charge of all-things-rabies.

There are actually provisions in Canadian regulations for situations like this (a provision in the Health of Animals Regulations Section 132.4 (2), if you want to know specifically). This allows rabies vaccine to be sold in accordance with written permission granted by the Minister, in specific circumstances such as in a remote area where veterinary services are not readily available. The provincial veterinary association is typically contacted to determine whether or not there is a veterinarian who could arrange to do the vaccinations. If the provincial association agrees that there is no veterinary service available to the community, then permission can be granted to purchase vaccine. 

It's quite a reasonable and logical approach that allows for access to rabies vaccine when needed, but has enough controls in place to ensure that this can't lead to abuse of the exception. People in remote communities in Canada should be aware of this. Some communities get periodic visits from vets but there are many others such as the one in this case that don't have any direct access to veterinary care, and this is a way of at least providing protection for people and pets against rabies.

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Tularemia has been diagnosed in five dogs and cats in Sioux Falls, South Dakota. At least one of the pets has died. Tularemia, sometimes referred to as "rabbit fever" is caused by the bacterium Francisella tularensis. Infections occur throughout much of the Northern Hemisphere but are much more common in certain regions, such as the central US. This bacterium has received a lot more attention over the past decade because of its potential use as a bioterrorism agent, but infections have been occurring in people and pets for a long time. In North America, the cottontail rabbit, wild hares and some rodents are the main reservoirs. People and other animals get infected through close contact with infected animals (e.g. rabbit hunting) or through bites from blood-feeding insects. 

There was no mention of human cases in the recent report from South Dakota. One of the implications of identifying this disease in pets is that whatever infected the pet could also be a risk for people. If the pets were infected by contact with wild animals, people with similar contact with wild animals could also be exposed. If there is no chance the animals had contact with infected wildlife, then insect-transmission is most likely, and the same could happen to human members of the household (or elsewhere in the area). Therefore, diagnosis of tularemia in a person or pet should put both veterinarians and physicians on the lookout for further cases in all species.

Transmission of tularemia from infected pets to humans is also a concern. This has been reported in numerous instances, most often with cats. There are published reports of transmission from dogs to humans, but these are less convincing than the numerous cat-to-human reports. There's also a report of tularemia transmission from a hamster to a child. The overall risk of transmission is probably low, but tularemia can be spread from pets to people by scratches, bites, and perhaps regular close contact.

You can reduce the risk of your pet being exposed to tularemia by:

• Keeping pets indoors as much as possible. Cats should stay indoors. Dogs should not have uncontrolled outdoor access.
• Dogs should not be allowed to hunt rabbits in areas where tularemia is endemic.
• Animals that venture outside should be checked regularly for ticks and a preventive medicine program for ticks should be in place.
• Routine measures to reduce bites and scratches from dogs and cats should be taken.

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There have been a few press articles lately about the Companion Animal Parasite Council (CAPC)'s traveling roadshow on parasitic zoonoses. Measures to increase awareness about zoonotic diseases and encourage appropriate preventive measures are needed, and traveling shows such as this have the potential to reach wide audiences. However, it's important for people to critically assess everything they are told and understand the sources. CAPC produces some excellent educational material but, to my knowledge, it is fully funded by the pharmaceutical industry. That doesn't necessarily mean that CAPC's educational efforts are suspect - people participating with their roadshow have solid credentials, but you do have to critique some of the things CAPC says.

One news article about CAPC's efforts states that "The CDC reports that about 14 percent of the total U.S. population is currently infected with Toxocara, or internal roundworms, contracted from dogs and cats." I don't think that's accurate information. I believe that this is based on seroprevalence data, meaning 14 percent of the population has antibodies against Toxocara. The presence of antibodies means that at some point in life the person's (or animal's) body was exposed to Toxocara and produced antibodies.  It does not mean that these people were ever sick and it certainly does not mean that these people are currently infected. Toxocara can cause serious infections and is a concern in some regions (although it's extremely rare in Ontario), so it warrants some attention, but we need to take a balanced and evidence-based approach.

One common theme in all of the reports that I've read lately is the statement that "The CAPC recommends that pet owners use preventive medicine year-round to control internal and external parasites for the life of their cat or dog, no matter where they live."  There's simply no evidence supporting this broad of a statement. Risks in warm southern climates are not the same as in northern areas with cold winters. Prevalence rates of different parasites vary greatly between regions. There is no evidence supporting year-round deworming of dogs and cats in all regions. Statements like this weaken the other good educational information CAPC has, particularly when you consider their funding source.

Don't disregard educational materials from CAPC or other industry-sponsored groups, just don't accept them as gospel. Critically assess the information, and don't be afraid to ask for facts, or to get information from other sources.

For more information about deworming recommendations for dogs and cats in Canada, see this previous Worms & Germs post.

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Two kids and one adult are undergoing post-exposure treatment for rabies after having contact with an infected kitten. One child saw the stray animal and went to give it some food, and he was bitten in the process. The kitten then proceeded to bite the boy's mother and another child in the neighbourhood. Fortunately, the kitten was taken to animal control and was identified as a rabies suspect. It was euthanized and testing of the brain confirmed it had rabies. Accordingly, the three bitten people are now undergoing post-exposure treatment. Animal control is handing out flyers in the neighbourhood to warn others, as there may be more rabid animals in the area. One particular concern with young kittens is that sometimes multiple animals from the litter are infected, so there may be more cute but deadly kittens in the area.

• Avoid contact with stray animals. That's the best way to avoid getting bitten by one.
• If you are bitten by a stray animal, the animal must be caught and quarantined. If you don't know the rabies status of an animal that has bitten you, you have to consider it rabid and get treated. If you are bitten by a stray or wild animal, call animal control to catch it. If you can safely contain it (e.g. lock it in a garage) without putting other people at risk, do so and then wait for animal control to capture the animal.
• Vaccinate your pets.

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A canine influenza virus vaccine has recently been released. Canine influenzais a virus that originated from a horse influenza strain and is now circulating in some dog populations. (To my knowledge, we have yet to find it in Ontario. We didn't find any evidence of it in an earlier surveillance study). It typically causes mild disease, as with influenza in people, but can also cause serious (including fatal) infections. These cases are most common in densely-populated, stressful environments like shelters and racing greyhound facilities.

Like most vaccines, this canine influenza vaccine does not claim to provide 100% protection. Veterinary vaccines can get conditional licensing and be marketed with little evidence of effectiveness. The manufacturers have produced data "supporting product purity, product safety under normal conditions of use in field safety trials and demonstration that the product has a reasonable expectation of efficacy." That means they have shown the vaccine is produced with good practices, had no obvious adverse effects in a safety study, and there is a possibility that it could be effective (presumably from showing vaccinated dogs produce antibodies against canine influenza virus). During the conditional licensing period, the manufacturers "will continue to submit data obtained in support of the product’s performance, which will be evaluated by government regulators to determine whether a regular product license may be issued."

There's a good likelihood the vaccine will be effective at reducing the incidence and severity of disease, as with influenza vaccines in other species. Basically, if a vaccinated dog gets exposed to the virus, it should be less likely to get sick, and if it gets sick, it should be less likely to have severe signs. Reducing the incidence and severity of influenza also has the benefit of reducing the chances of developing a secondary bacterial infection, which can cause very serious disease.

Deciding whether to vaccinate your dog largely comes down to the risk of exposure and the implications of your dog becoming ill. In an otherwise healthy dog that is not in a high risk environment (e.g. kennel, shelter, greyhound racetrack), it's questionable whether vaccination is needed. If canine influenza virus is in the area, it's something to consider, but the virus seems to be rare (or at least rarely identified) in pets in most regions. Discussing the risks and benefits with your veterinarian is the key.

Canine influenza is NOT considered a zoonotic disease. There is no evidence that it can infect humans. Therefore, there is no public health argument for vaccination.

Image source: www.petinsurance.com/healthzone/pet-articles/pet-health/Canine-Influenza.aspx

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There's been a lot of talk (hype) in the press about pet bites and MRSA (methicillin-resistant Staphylococcus aureus). This relates to a paper in Lancet Infectious Diseases regarding infections associated with pet bites. Some press articles are more sensational than others, but most are taking the bite infection paper and building in unrelated comments about MRSA in animals to make it seem like there's a major MRSA dog bite epidemic underway.

I realize that MRSA is a hot topic that is easy for reporters to latch onto, but the problem is that the actual research related to MRSA is being taken out of context (and blown out of proportion). MRSA was certainly mentioned in the paper, but it was not the focus of the research nor do the authors play up concerns about pets as a source of MRSA infections. Nevertheless, the impression people are getting from many news articles is that there is rampant MRSA transmission by infected pets.

Is MRSA infection a potential concern after a dog bite?

• Yes, but more because of the bite itself than the particular dog.  MRSA infections that occur after a dog bite are probably the result of contamination of the wound with MRSA from the person's own nose or from another person, for example during a visit to their physician/clinic/hospital. It's possible for MRSA to be in the mouth of the dog and for it to be transferred to the wound during the bite, but that's pretty unlikely. The person bitten or someone treating the wound is a more likely source of the bacterium. So, the bite was the ultimate "cause" of the MRSA infection, because the infection probably wouldn't have developed without that break to the body's normal defensive barriers (i.e. the skin), however the "source" of the infection was (in most cases) NOT the animal.  The same kind of infection could have happened with any similar type of trauma.

What should I do if I'm worried about MRSA and dog bites?

• Worry more about dog bites than MRSA. Bites themselves are major problems, even if MRSA is not involved. The degree of trauma can be significant, and a variety of bacteria can cause serious bite infections, not just MRSA.
• Take measures to reduce the risk of being bitten, both in terms of how you handle and train your dog and how you interact with other dogs.
• If you are bitten, immediately clean the wound as thoroughly as possible. If the bite is over a joint, tendon (e.g. wrist/ankle), prosthesis or genitals, if there is significant trauma or if you have a weakened immune system, you need to see a physician. If you have any other concerns, get examined by a physician promptly.

More information on MRSA in animals can be found on the Worms & Germs Resources page.

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In response to recent posts about Salmonella and turtles, a reader posed these questions:

Okay, so turtles and tortoises can carry salmonella.  Does that mean that all do? 

• Not all, but a lot of them do. Aquatic turtles are probably a greater risk than tortoises.

If a vet analyzes a poop sample from my Russian Tortoise and there is no Salmonella, does that mean we can quit worrying about it?

• Unfortunately no. We can never be confident in declaring a reptile "Salmonella-free." Salmonella can be shed intermittently, so a single negative sample doesn't mean the reptile is truly negative. We don't know what the optimal testing protocol is in terms of what to sample, how often to do it and how many samples are needed. I'd never tell anyone a turtle or tortoise is Salmonella-free. To err on the side of caution, we have to assume that all reptiles are carrying Salmonella.

Conversely, if the poop does show Salmonella, is there any way to eliminate it from the tortoise and then quit worrying about it?  Our tortoise is isolated from other pets and only eats what we consider clean, fresh produce - so I am hoping the chance of reinfection would be minimal.

• Unfortunately, no again. There's no proven way of eliminating Salmonella from a reptile. Getting rid of Salmonella in an animal that is a carrier is different than treating a typical bacterial infection. Salmonella is a commensal bacterium in reptiles, meaning it can be a normal component of the animal's bacterial microflora. It is very difficult to eliminate commensal bacteria since they have evolved to survive in (or on) their host. Unlike in clinical infections, which tend to be short term infections of a site where the bacterium does not normally live, using antibiotics to eliminate Salmonella carriage is unlikely to be successful. Giving antibiotics can also upset the normal intestinal bacterial population, which can actually make it more likely for bacteria like Salmonella to proliferate. Salmonella can also live inside intestinal cells, where most antibiotics can't reach them. Treatment, therefore, is unlikely to be ineffective, and might just result in increased antibiotic resistance (something we certainly want to avoid).

Check out the Worms & Germs Resources page for more information.

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The European Food Safety Authority, along with the European CDC and European Medicines Agency, have released a report about methicillin-resistant Staphylococcus aureus (MRSA) in livestock, pets and food. There's nothing too earth-shattering in it, and nothing more than what we've been saying all along, but some of the points are worth repeating.

• While food may be contaminated with MRSA, there is currently no evidence that eating or handling MRSA-contaminated food leads to increased health risks in people.
• Pets can be infected with MRSA, first acquiring it from people but then potentially transmitting it back to humans.
• Transfer of MRSA to humans from companion animals and horses is difficult to control. (I don't agree with that). Basic hygiene measures are important before and after animal contact. Additionally, avoiding contact with nasal secretions, saliva and wounds is ideal.
• Prudent use of antibiotics in animals should remain a key measure and monitoring of antibiotic use in animals should be performed to identify unnecessary use.
• Drugs of last resort for the treatment of MRSA in humans should be avoided in animals.

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At the same time that the country is drafting an animal welfare law that would ban widespread killing of dogs, a Chinese city has killed 36 000 stray and pet dogs in an effort to eliminate rabies. Since late May 2009, more than 6 000 people in Hanzhong have been bitten or scratched (presumably by dogs), and 12 have died of rabies. Certainly, this indicates multiple problems. One is the massive number of bites and scratches. Contributing factors probably include a large stray animal population, limited routine animal control efforts, and inadequate education of the public regarding bite avoidance. The number of injuries and deaths certainly indicates that an aggressive response is needed. However, there is little evidence that culls (i.e. mass killings of this type) have any effect on controling rabies and animal-associated injuries. Efforts are probably better directed at other forms of population control, vaccination of stray and pet dogs, and education of the public to keep stray dogs away and reduce the risk of bites. These types programs cost money, but the costs of treating 6 000 bites and 12 fatal rabies infections can be enormous. I don't know how many people received post-exposure treatment for rabies, or what such treatment costs in China, but it's estimated to cost  about $1500 per person in North America. That would pay for a lot of rabies vaccine for dogs.

Photo: Hanzhong, China (source: www.panoramio.com)

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There is apparently a thriving black market for baby red-eared slider turtles in Baltimore. The sale  (and possession) of small turtles is illegal in Maryland, like many other regions, largely because of public health concerns regarding Salmonella.

Over 100 hatchling turtles have been seized in the past 2 weeks. Baby turtles offer a good profit margin for black market vendors. They can be purchased from farms in the southern US for about $1 each and then resold for many times that amount. One person was caught selling turtles out of the back of a van. (Why anyone would buy anything from someone selling out of the back of a van is beyond me!)

People buy turtles thinking they make cute pets, not realizing what they need to do to keep them healthy as they grow. Turtles that are fortunate enough to be raised properly create another problem, since most people are not willing or able to take care of adult turtles that reach 10-12 inches in length. This can result in turtles being killed or abandoned.

Another major problem in the risk of Salmonella. Turtles very commonly carry this potentially harmful bacterium, and they are an important source of infection in people. The concerns are greatest with young children who may handle small turtles and put them in their mouths. People need to think before they buy. Before getting any pet, learn about the animal, including requirements for care and human health risks (and also if it's legal). A little common sense goes a long way.

More information about Salmonella and turtles can be found on the Worms & Germs Resources page.

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A recent study from the Netherlands investigated the prevalence of zoonotic parasites in pet feces and on pets' haircoats. The authors sampled feces and fur from dogs and cats, and looked for Toxocara (roundworms), Toxoplasma, Giardia and Cryptosporidium. All these parasites are of concern from a public health standpoint because they can be found in healthy pets and can also infect people.

Toxocara eggs were found on the haircoats of 12% of dogs and 3.4% of cats. Levels were low, ranging from 1-31 eggs per sample. An important aspect of this study was that they also assessed viability of these eggs, and found that none were viable.  Therefore, even though eggs were present, they were not relevant because they were dead. Exposure to UV light and lack of humiditiy were cited as possible reasons for the death of the eggs.

Toxocara were found in the feces of 4.4% of dogs and 4.6% of cats, which is consistent with other studies of healthy pets.

Toxoplasma was not found in the feces of any cat. (Cats are the hosts for this parasite so dogs weren't tested.)

Giardia was found in the feces of 15% of dogs and 13.6% of cats. However, when these strains were typed, the vast majority were species-specific types that do not cause disease in people. Only 2 of the 15 Giardia samples were assemblage A, a type that is transmissible from pets to people. This is very important to know because crude Giardia numbers don't tell you the whole story. 

Cryptosporidium was found in feces of 8.7% of dogs and 4.6% of cats. However, they were not able to type these parasites to determine if they were species that typically cause infection in humans, or whether they were Cryptosporidium felis or C. canis, which rarely cause disease in people.

The discussion section of the paper contains an interesting and relevant point about exposure to Toxocara eggs on the haircoat of pets. The authors state "Even in the worst case scenario of highly contaminated fur, e.g. with the highest Toxocara [eggs per gram] of 300 and an embryonated rate of 4% from the study of Wolfe and Wright, it is necessary to ingest more than 4 grams of hair, with 12 embryonated eggs per gram, to ingest 50 infective eggs."  Based on these data, exposure to parasites from the haircoat of pets is quite unlikely.  It might be a greater concern with stray or debilitated animals, or with puppies/kittens, who could have much greater coat contamination.

The take home message: Normal contact with healthy pets likely poses minimal risk of transmission of zoonotic parasites. That being said, regularly washing your hands is still a good idea because of the potential for exposure to other types of microorganisms (e.g. bacteria), and in rare circumstances where there may be large parasite burdens on a pet. Good deworming practices, particularly for puppies and kittens, also need to be considered.

Reference: Overgaauw et al, Veterinary Parasitology, 2009.

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There is a nice, concise commentary in the most recent issue of the Canadian Medical Association Journal about preventing infections in the home. It covers three important organisms: MRSA, Clostridium difficile and vancomycin-resistant enterococci (VRE). An excellent aspect of this particular commentary is its relatively low-key approach, with an emphasis on routine, basic practices such as hand hygiene. It also includes some comments about pets that are similarly well-balanced and go along with a lot of what we've been saying on Worms & Germs Blog. For example, in discussing MRSA, they state:

"Because domestic pets may serve as a reservoir of MRSA, hands should always be washed thoroughly with soap and water after contact with animals or their feces. In cases of outbreaks within a family of an infection caused by community-associated MRSA that cannot be arrested, a colonized pet may need to be temporarily removed from the home. However, it may be prudent to re-emphasize the importance of personal hygiene before taking such a drastic measure."

Overall, it's a commentary you might find useful. It can be downloaded by clicking here.

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Canadian Guidelines for the Treatment of Parasites in Dogs and Cats have recently been released. These guidelines were developed by an expert panel, consisting of six Canadian veterinary parasitologists and two private practitioners. They provide a good, balanced approach to the treatment of parasites, with an emphasis on the risks present in different regions and in different types of pets. There is very little objective information on which to base some of the recommendations, so many aspects are instead based on expert opinion, not necessarily hard facts, but when data are lacking, that's when opinions from independent experts are most needed. The guidelines provide an overview of recommended treatments along with an explanation of the reasoning.  This document is a useful resource for pet owners and veterinarians alike. There is also discussion about why guidelines in Canada differ from those in the US. To download these guidelines click here.

Note: Development of the guidelines was supported by a pharmaceutical company, but the information they contain was developed by the independent experts mentioned above.

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Another surge in the number of cases of Q fever in people in the Netherlands has been reported.  Prior to 2007, the average number of cases of Q fever per year in the country was only 15.  In 2007 there were 192 cases, and last year there were 958 cases, making this the largest community outbreak of Q fever ever reported.  At the beginning of May 2009, another jump in the number of cases - over 200 - was reported by the dutch newspaper de Volkskrant.

Q fever is caused by a highly infectious organism called Coxiella burnetii.  The organism can be carried by many different animals, but particular sheep and goats, and sometimes cattle.  Most of the time it does not cause a problem in these species, but it has been linked to abortions and abortion storms (i.e. when many animals in the herd abort in a short period of time).  It can be shed in manure, urine and milk, but the largest numbers of organisms are found in birth fluids and tissues (e.g. aborted fetuses, placentae).  When the tissues and fluid dry out, the organism can be stirred up into the air over short distances in dust.  Humans are highly susceptible to C. burnetii, and inhaling even a single organism can cause infection.  Most of the time people who get sick have signs very similar to the flu, but severe pneumonia and liver disease can develop in a small number of cases.

A definitive link between sheep and goats and the Q fever outbreak in people in the Netherlands has not yet been established, but it is highly suspected that many of the cases are associated with infected goats (and some sheep).  In the last two years numerous outbreaks of Q fever have been reported on dairy goat farms and one dairy sheep farm in the Netherlands.  This has lead to a cooperative arrangement between the Dutch agricultural ministry and the Dutch public health ministry - these two goverment branches have come together to help cover the costs of vaccinating sheep and goat herds in the country, in order to help stem the tide of disease and ultimately prevent more human cases.  This is a great example of the "one medicine" concept, whereby groups on both the human health and agricultural/animal health sides are working together on this problem.

Manditory vacciation is now required for sheep and goats on larger farms in the hardest-hit areas, as well as any farms reporting any cases of Q fever since 2005, and any sheep or goats that have a "public function" (e.g. petting zoo animals or occupational therapy farms).  It is very important that this last group is included under the manditory vaccination, as these animals have a large amount of contact with people.  Steps have also been taken to improve hygiene, restrict spreading manure from sheep and goats, restrict visitors to infected farms, and to make abortion storms on sheep and goat farms reportable, so they can be investigated for Q fever.  It will be interesting to see how effective these measures are at controling the outbreak in 2009.

More information on Q fever can be found in our archives.

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As a veterinary internist, I’m always looking for a good excuse to harass veterinary surgeons, and a recent study we performed with Dr. Lee Burstiner (an aspiring surgeon but a good guy anyway) at the 2008 American College of Veterinary Surgeons (ACVS) conference gives me more ammunition. This study is being presented today at the European Conference of Clinical Microbiology and Infectious Diseases in Helsinki.

A few recent studies have shown that veterinarians seem to be at higher risk for methicillin-resistant Staphylococcus aureus (MRSA) carriage, likely because of their frequent contact with animals that can also carry MRSA. As part of the study at the ACVS conference, attendees provided nasal swabs (because the nose is the main site of MRSA carriage) on a voluntary basis, and filled out a questionnaire about various potential risk factors. MRSA was isolated from 17% of participants, an astounding number considering that in the general population only about 1-3% of people carry MRSA.

In previous studies of MRSA in veterinarians, including veterinary internists, equine general practitioners and swine veterinarians, it has been equine or swine veterinarians that most often harbour MRSA in their noses. Interestingly, in this study, there was no difference between equine and small animal (e.g. dog and cat) vets, which is perhaps due in part to the steady increase in MRSA carriage by dogs and cats internationally. This is one more piece of evidence indicating that MRSA exposure is an occupational risk for veterinary personnel. Colonized personnel may be  more likely to develop MRSA infections, and are also at risk of transmitting MRSA to their patients (and possibly also their family members). This reminds us yet again of the need for good general infection control and hygiene practices in veterinary medicine.

It is truly astounding that MRSA colonization is so common in veterinarians. This is a consistent result among a few different studies now, and veterinarians may be one of the highest risk groups (if not the highest risk) for MRSA colonization. Why is this the case? Why is the prevalence not as high in human healthcare personnel? From where is the MRSA coming?  From the patients presumably? How do we control it? What are the implications for the health of veterinary personnel and their families? These are just some of the many important but unanswered questions.

All this being said, you don't need to (and shouldn't) actually consider veterinary surgeons (or veterinarians in general) biohazardous, nor should you avoid using veterinary specialists because of concerns about MRSA. MRSA is a problem in veterinary medicine in both referral and general practices, and studies like this show the need for further research to determine why this is the case, as well as the need for general improvement in infection control in veterinary medicine.

More information about MRSA in animals can be found in on the Worms & Germs Resources page. Information on MRSA in horses can be found on our sister site, equIDblog.

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ProMed recently reported about an outbreak of canine brucellosis at a "puppy farm" in Ireland. Farm is definitely the appropriate word in this case, since this operation had about 700 breeding females. The picture on the right is not from this farm, but I imagine it's a similar operation. Beyond the concerns about humane management of dogs under these conditions, such a large operation creates perfect conditions for various infectious diseases.

"The farm's owner has refused to sign an undertaking not to move the dogs off-site before an official inspection can take place to investigate the extent of the [brucellosis outbreak]."

Lack of cooperation makes any disease investigation much more difficult. It's not surprising this person doesn't want to cooperate, given the type of operation he's running.

"Someone from the farm told the Irish Times that the 2 animal welfare agencies were involved in acts of "intimidation" against the establishment."

I suspect that "intimidation" in this case means the agencies were doing their job, because I can't see how there wouldn't be significant welfare problems at a farm of this type and size.

"'We got accurate information on Friday [2 May 2009] that this man was intending moving and selling these dogs and we acted on it,' according to Jimmy Cahill, chief executive of the DSPCA [Dublin SPCA]. 'The guards  were very helpful but the owners refused to let us see the dogs or any of the carcasses.' "

The reference to "carcasses" implies that deaths have occurred. Death from B. canis in dogs is very rare but it is possible. However, a poorly managed operation with hundreds of dogs is bound to have multiple issues that could cause deaths.

Canine brucellosis is caused by the bacterium Brucella canis. This main problem with this bacterium in dogs is reproductive disease, including abortion and infertility (in both males and females). Discospondylitis (inflammation of the discs between vertebrae in the back) can also develop.

Brucella canis is a zoonotic organism. Human infections are rarely reported but it is possible that some go undiagnosed. Brucella canis can be transmitted from dogs to people through contact with body fluids from infected dogs, including urine and vaginal fluids.  The risk of transmission is likely highest when handling animals during breeding or birthing. While the bacterium can be shed in nasal secretions and saliva, levels are low in these fluids and the risks are probably correspondingly low.

One problem with preventing B.canis transmission is that infected dogs do not necessarily show any signs of disease. In people, B. canis infection can cause flu-like disease, loss of appetite, weakness, joint and back pain, vomiting and diarrhea and various other symptoms.

To control the outbreak on this "farm," quarantine and repeated testing of all dogs is needed, and positive animals must be removed from breeding. Given the information provided above, it's pretty unlikely this will happen voluntarily. I suspect this person would likely either just get rid of these dogs and get more poor-quality breeding animals, or try to continue breeding these dogs and hope people get sick of looking into his operation.

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A UK man is on a campaign to raise awareness about Toxocara, following an infection that blinded the child of a family friend. Mike Kennedy, chairman of the Grange Residents' Association, is  raising awareness about the importance of picking up "dog dirt" (i.e. dog stool).

Toxocara canis is an intestinal parasite that can be found in a small percentage (likely 2-14% in Ontario) of healthy dogs, and a larger percentage of puppies. Toxocara cati is the feline equivalent found in a comparable proportion of cats. If a person swallows an infective egg - an egg that was passed in an animal's stool and allowed to sit around in the environment for a while - infection can occur. The parasite can migrate throughout the person's body, causing various types of problems. Migration into the eye (ocular larval migrans) can cause blindness. Migration through the brain (neural larval migrans) can cause serious brain injury. These are very rare diseases, but are obviously still a concern because of they can be so severe. The risks are highest in children and people with developmental delays, since they're more likely to swallow stool, dirt, or something else contaminated with stool.

Mr. Kennedy's emphasis on educating animal owners to pick up after their pets is the key. We know a small percentage of dogs and cats shed Toxocara in their stool. You never know exactly who is shedding the parasite at any time, so removing the source of parasite eggs, the stool, is critical.  Deworming pets regularly is also important, but it is only one component of parasite control. The frequency and type of deworming needed for dogs and cats varies between regions and animals.  Your veterinarian can design an appropriate deworming program for your pet. Such a program requires a balance between adequate deworming to reduce the risk of parasites in pets (and the associated risk for human infection) and using dewormers prudently to reduce the risk of parasites developing resistance to these drugs.

Photo credit: Michael Lazarev (Clyde, the bulldog puppy)

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The World Health Organization (WHO) has provided the latest update about H1N1 influenza numbers internationally. (People are still often calling this "swine flu", but it has yet to be found in pigs and is clearly being transmitted human-human now, therefore some have recommended it be called "Mexican flu" or "North American flu" instead.  This also decreases the negative associations with pork products, which are totally unfounded because the virus is NOT a food safety concern). Regardless of the name, this pathogen continues to move across the planet. The WHO is reporting 148 laboratory confirmed cases. Ninety-one have been confirmed in the US with 26 confirmed in Mexico.

It's important to remember that confirmed cases are very much the "tip of the iceberg". It's likely that there are thousands of cases in Mexico, despite only 26 having been confirmed by laboratory testing. For a case to make this list, the sick person has to go to a doctor AND samples have to be collected for testing AND the testing has to be appropriate for identification of swine flu versus other types of influenza. Areas with more diagnostic testing capacity and public health infrastructure (like some places in the US) will end up reporting more cases, even if they actually have fewer sick people. So, we shouldn't become complacent when reading about relatively small numbers of confirmed cases, and we must take care when comparing regional rates.

Confirmed cases have also been reported in Austria (1), Canada (13), Germany (3), Israel (2), New Zealand (3), Spain (4) and the United Kingdom (5). Deaths have only been reported in Mexico and the US, with the single (to date) US death being a child that was visiting from Mexico.

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GoogleMaps has an interactive swine flu map that is quite interesting. The map indicates where cases of the disease have been diagnosed or are suspected, and it's updated frequently.  Clicking on a marker gives you more information about what is happening in that particular location. Many of the pink "suspected" markers will probably turn out to be negative, but I fear the map's going to get a lot more crowded over the next couple of days. The picture below is a captured image of the map, but click here for the live interactive version.

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The European Union's Health Commissioner has recommended that Europeans avoid all non-essential travel to the US and Mexico (Canada's apparently under the radar so far) as a measure to contain the spread of the emerging swine influenza virus. This has been met with some disdain by US officials, who emphasize the small number of cases (so far) in the US, and the much, much larger numbers of people that die in various countries every year from classical human influenza.

It's hard to say what type of restrictions are appropriate at this point in the outbreak. In general, it's better to be prudent and excessive (within limits) when dealing with a developing problem. The lack of information about the true scope of the problem, and the delays from transmission to definitive diagnosis of new cases, complicate assessments about whether the problem is truly contained, or containable.

Swine flu was most recently confirmed in Spain, and it has probably reached many different countries. It is also suspected in a group of students in New Zealand that recently visited Mexico.  Considering the massive volume of travel between North America and much of the world, and the wide geographic range of cases in North America, it's hard to envision keeping this localized.

The fact that this outbreak is going to be difficult to contain, however, should not be taken as an excuse to not try to contain it. Even if this virus spreads to many different countries, good infection control and surveillance measures can help limit the impact of the disease.

Photo: Chichen Itza, one of the major tourist attractions on the Yucutan Peninsula in Mexico (credit M. Anderson)

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In response to increasing numbers of confirmed or suspected cases of swine flu in the US, plus a still relatively unknown number of cases and at least 81 deaths in Mexico, the US government has declared a public health emergency.

This H1N1 swine influenza virus has many of the hallmarks of a virus with pandemic potential. It is of animal origin but has a unique combination of gene sequences that has not been found previously in swine or human influenza strains. People don't have pre-existing antibodies because they have not been exposed to it before, which leads to the chance for widespread disease. A big concern is that it seems to spread at least somewhat efficiently between people (unlike the H5N1 avian flu virus which is not efficiently transmitted between people). Fortunately, while it can cause death, this swine flu virus does not seem to be as deadly as avian flu, which kills approximately 50% of the people it infects. Therefore, while swine flu appears to be much more transmissible, it's probably not as fatal. (However, the large number of reported deaths in Mexico and early stage of the outbreak at this point means we need to be cautious making such statements).

It is clear that this swine flu strain is spreading in the US. It's been found in multiple US states and it is probably going to be found throughout the country.  Mild cases have already been confirmed in Canada, and there are suspected cases in other countries. The number of cases in different regions and the amount of international travel makes containment of a reasonably-transmissible virus very difficult.

Some tips to reduce the risk of catching (or spreading) swine flu:

• Wash your hands regularly, particularly after contact with other people or common-contact sites (e.g. public door handles, public transit).
• If you are sick, STAY AT HOME. The era of "sucking it up" and going to work when you are sick should be over. All you're doing is putting others at risk.

More information about swine influenza can be found on the CDC's swine influenza website.

Image from http://www.nydailynews.com

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As is common this time of year, outbreaks of Salmonella infection in wild birds have been widely reported in parts of the US. Salmonella circulates regularly at low levels in the wild bird population, and sporadic outbreaks involving large numbers of sick and dead birds are periodically encountered. These are often noticed in urban areas when dead birds are found around bird feeders.

Salmonella can infect a wide range of species other than birds, including cats (and people). Cats can be exposed to Salmonella during these outbreaks from catching and eating sick birds, or healthy birds that are carriers of the bacterium. In fact, one name for salmonellosis in cats is songbird fever, a testament to the role of birding in feline salmonellosis. An example of the potential effect of wild bird Salmonella outbreaks on cats is described in the The Daily Journal from International Falls, Minnesota. In this report, a local veterinarian explains that he has seen an increase in salmonellosis cases in pets at his practice, mainly in cats. In the past 2 weeks, he has diagnosed approximately 20 cases, which is a pretty impressive number. Most of the infected cats had known contact with wild birds or areas around bird feeders.

If your cat goes outside, it is at higher risk for Salmonella. If there is an outbreak of salmonellosis in wild birds in the area (or you're seeing dead birds around the feeder), then the risks are probably much higher. While Salmonella is usually associated with diarrhea, not all cats that are infected develop diarrhea. Some develop mild disease without diarrhea (e.g. fever, lethargy), some get serious systemic infections (septicemia), and some may show no signs of illness at all but still pass Salmonella in their stool. In any case, the bacterium can still be transmitted to and infect people.

Any outdoor cat that develops diarrhea should be considered a Salmonella suspect. Really, Salmonella should be considered in all outdoor cats with fever and signs of illness that are not specific for a particular disease. Stool culture can be used to diagnose Salmonella.

Avoiding wild-bird associated salmonellosis in cats is pretty easy - keep your cat indoors. A cat that can't catch birds or hang around contaminated areas surrounding bird feeders won't be exposed to Salmonella from wild birds. At a minimum, cats should be kept inside if there is an outbreak of Salmonella in wild birds in the area, or if dead birds are found around your bird feeder. Ideally, they should be kept inside all of the time, for many reasons.

More information about Salmonella in pets can be found on the Worms & Germs Resources page.

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Methicillin-resistant Staphylococcus aureus (MRSA) is an important  (and high profile) cause of disease in people, and an emerging problem in animals. Evaluating the types of MRSA that we find in pets can help us understand what is happening with MRSA in pets and why.

A few different studies have evaluated the types of MRSA found in pets, using different molecular typing methods. The common result from all these studies is that the MRSA types found in pets are typically the same as those found in people in the same area. Even in different countries where there are different MRSA strains, the strains most commonly found in people are the same as the ones most commonly found in pets. Also, as the types of MRSA found in people in different regions change, so do the types found in pets.  For example, USA300 (which can be a particularly nasty strain of MRSA) emerged a few years ago as a leading cause of MRSA infections in people in the general population (i.e. community-associated MRSA) in the US.  Shortly thereafter, we started to see this strain in pets too. As USA300 began to crop up in people in Ontario, we also started finding it in pets. These results strongly suggest that MRSA in pets is closely related to MRSA in humans, and that most MRSA infections in pets ultimately started off in a person. Remember, though, that pets can still transmit MRSA once they've been infected.

It's inevitable that we will see more changes in MRSA types in people in the future, and it's almost certain that these changes will then be reflected in animals. In some ways, we can use humans as sentinels for what we are going to see in pets. By monitoring what is happening with MRSA in people and how it is being addressed, we can perhaps figure out the best (and worst!) ways to address the problem in animals.

More information about MRSA in pets can be found on the Worms & Germs Resources page. Information about MRSA in horses can be found on our sister site, equIDblog.

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Quarantining animals that have potentially been exposed to rabies is a standard practice, but quarantining a whole town is new to me. Because of a large increase in rabies cases in the Flagstaff, Arizona area, a rabies quarantine was established on April 8th by the Coconino County Board of Supervisors. The quarantine requires all dogs and cats to be enclosed or secured on their owner's property. When off the property, animals must be on a leash that is no longer than six feet in length. All dogs and cats must be vaccinated, and low-cost rabies vaccine clinics have been held to help increase compliance with this requirement. Vaccination of wildlife using baits containing an oral form of rabies vaccine will also be performed. The quarantine also restricts feeding and interacting with wildlife. Also, people cannot leave pet food outside after sunset and all compost piles must be completely enclosed.

This is an aggressive approach to rabies control in an area experiencing a wildlife outbreak of the disease. They've implemented comprehensive but still quite practical measures that should help reduce the risk of exposure of domestic animals (and people) without a significant negative impact on pet owners. I've mentioned my concerns about rabies vaccine clinics in the past, but this is a situation where I think it's a good idea.

It's always hard to evaluate the effectiveness of outbreak measures, because you never know what would have happened if nothing had been done. Regardless, it will be interesting to see how well this quarantine works, both in terms of the number of new rabies cases they see and the response of citizens to these restrictions. It would be very useful if Coconino County personnel provide information about how things went when the quarantine is over - the information might be useful for management of future rabies outbreaks.

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Rabies vaccination is supposed to be given at regular intervals - typically every 1 or 3 years, depending on the vaccine. Some people don't want to vaccinate their pets on a regular basis, but they may not understand all the implications of this decision. Often, people ask whether antibody levels (titres) can be checked to determine if repeated vaccination is necessary or if it can be delayed longer. However, rabies is covered by very straightforward government regulations in Canada (and presumably in many other regions).  According to these regulations, checking vaccine titres is not considered an acceptable alternative to regular vaccination.  Knowing this, here are two scenarios to consider:

1) Your pet bites someone.

After a pet bites anyone, it must be monitored for 10 days to ensure that it does not develop signs of rabies. It makes no difference whether the animal is vaccinated or not. However, if you do not have proof that your pet has been properly vaccinated, in Ontario, it is theoretically possible that you could be charged under the Health Protection and Promotion Act.

2) Your pet is exposed to a rabies suspect.

If your pet was vaccinated, you'd have two options. Most commonly, your pet would receive a booster vaccine and would be observed at home for 45 days. Alternatively, if you wanted to avoid a booster, you could take a blood sample to check the rabies titre. If a protective titre (>0.5 IU/ml) was present, there would be a 45 day observation period. If a protective titre was not present, the pet would be treated as unvaccinated.

If your pet was not vaccinated, it would be subject to a strict six-month quarantine or euthanasia.

If your was vaccinated at some point, but not vaccinated according to the vaccine manufacturer's guidelines (i.e. it didn't receive the appropriate 1 or 3 year booster),  it would be considered unvaccinated, and be subject to the same 6 month quarantine. It would not matter if the rabies titres had been checked and a protective titre had been present in the past.

From this, it should be clear that there are serious implications of not vaccinating your pet, at least in Canada. There are some circumstances where you may be rightfully hesitant to vaccinate your pet, such as if your pet previously had a severe vaccine reaction. However, if you choose not to vaccinate, you must be aware of the implications of this decision. Neither a letter from your vet stating that vaccination would be risky nor annual rabies titre checks are going to be of any help at all because of the rules that are currently in place.

More information about rabies and rabies vaccination can be found on the Worms & Germs Resources page and in our archives.

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A recent edition of the Veterinary Record contains a case report of Weil's disease in a person that adopted a feral (wild) rat (Strugnell et al, 2009). Weil's disease is a severe disease of the kidneys, liver and other body systems that can develop after acute leptospirosis (infection by Leptospira bacteria). This group of bacteria can infect a wide range of animals and is typically shed in the urine. The person that was affected adopted the rat after it was caught by her neighbour's cat. The paper says that the rat was "urinary incontinent" - not something we usually notice about rats since they are not typically litter or house trained. I presume this means the rat was urinating frequently when out of its cage, including when it was being handled. Because of this, the owner reported that she "aimed" to wash her hands after every time she touched the rat.

A couple of weeks after adopting the rat, the woman was admitted to hospital because of lethargy, muscle aches, mild abdominal pain, cough and a bloody nose. Blood tests showed that she had decreased levels of white and red blood cells, as well as liver and kidney disease. After further testing she was diagnosed with leptospirosis. She had to be treated in the ICU, but eventually made a complete recovery. The adopted rat and the other rat that she owned were euthanized by the owner's partner shortly after she was admitted to hospital. Testing of the adopted rat identified Leptospira in the kidneys.

This is another example of why wild animals should be left in the wild, and another case highlighting the need for veterinarians, physicians and public health personnel to work together.

More information on Leptospira and leptospirosis can be found on the Worms & Germs Resources page and in our archives.

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The British Columbia Centre for Disease Control (BCCDC) has changed its rabies exposure guidelines and gone against established protocols used elsewhere. Typically, anyone who has slept in a house where a bat was present at the same time is considered to have been exposed to rabies if the bat was rabid or the bat's rabies status is not known. This is because bats can bite people while they are sleeping and the bite wounds can be so small that someone may not even notice after they wake up. People who get rabies from a bat bite almost always die. Because of the severity of this disease, the general rule has been to err on the side of caution and consider anyone even possibly bitten by a bat as exposed to rabies.

Now, the BCCDC has stated that this is "overkill," and that people who do not have known physical contact with a bat will not be given the usual post-exposure rabies vaccinations. 

Yes, rabies is a very rare disease in people in this part of the world... but you don't want to be the rare person that gets it. I understand that risk analysis may indicate that there is, overall, low risk from sleeping in the same house with a bat, and that almost all people that receive post-exposure treatment didn't actually need it. However, for a fatal disease with the potential for uncertain exposure in such a situation, I think this is important to err on the side of caution. It's always difficult to reconcile risk analysis data with human lives. The BCCDC estimates that this new policy will only result in one (1) additional rabies death every 675 years. That's not a lot, but how would you like to be that one person?

I hope this isn't a decision influenced by cost. Post-exposure treatment costs about $1500 per person, and they expect that this protocol will result in "hundreds" of fewer people receiving treatment. The treatment of all people sleeping in houses with bats actually costs a huge amount of money to prevent a small number of cases. However, what is the cost (financial and otherwise) of even a single case of rabies that could have been prevented? That's a lot harder to incorporate into a risk analysis. Personally, if I had a bat in the house overnight and my kids were potentially exposed (again!), I'd go for post-exposure treatment without any hesitation. Call me a paranoid parent if you will, but I'd sleep much better at night (for years, since the incubation period following exposure can be a long, long time).

The full BCCDC report can be found here.  More information on rabies can be found on the Worms & Germs Resources page and in our archives.

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An annual "ritual" in some schools is hatching chicken eggs in the classroom. This can be a great educational experience for children as they learn about eggs and incubation, watch them hatch and see the baby chicks. It can also be a great source of infection for children if certain precautions are neglected. The picture on the right, from an article in the Ilkley Gazette, shows a good example of a bad idea. This four-year-old boy has a newly hatched chick on his shoulder. Why does this bother me?

• Chicks are a great source of potentially harmful bacteria, particularly Salmonella.
• You can't litter train a day-old chick. I wouldn't be surprised if it left a little biohazardous "present" on the child's shoulder.
  
• Outbreaks of salmonellosis in people associated with baby chicks have been reported.
• The Centers for Disease Control and Prevention (CDC) recommends children under five years of age should not have contact with chicks.

If there are going to be chicks in a classroom:

• They should only be in classrooms with older students.
• Contact with chicks should be restricted and always supervised.
• Careful attention must be paid to handwashing.  Everyone who handles chicks or comes in contact with their environment (e.g. box, cage, incubator) should immediately and thoroughly wash their hands.
• Chicks should never be allowed to roam free in the classroom.
• Chicks should never be handled during lunch or snack time.
• Immunocompromised children should not be present in the class.

It's common sense, but it's amazing how uncommon "common sense" seems to be sometimes.

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People that work with animals are at increased risk for certain infectious diseases. That's pretty clear. Pet shop employees fit into this group as well, and they may be at particular risk for specific diseases because of their close contact with young animals, birds, rodents and reptiles. A suspected case of psittacosis in a Toronto pet shop worker is an example of this.

A bird in the pet store where this person worked supposedly died of avian chlamydiosis in mid-March (although the initial test results have been called into question). Avian chlamydiosis is caused by the bacterium Chlamydophila psittaci. This organism is relatively common in psttacine birds (parrot family), especially in breeding colonies, but can also be found in other types of birds. It can cause serious disease in birds, but it is also commonly carried by healthy birds. People can become infected from breathing in the bacterium, often from aersolized dust containing dried bird droppings. The disease in people is called psittacosis. The pet store worker developed signs that could be consistent with psittacosis: cough, lethargy and difficulty breathing.  However, these signs are still fairly non-specific and could also be caused by numerous other respiratory pathogens.  Test results are still pending.

People that have close contact with pet birds, especially psittacines, need to know that they may be at increased risk of psittacosis. They also need to ensure that their physicians know about their increased risk. This is important because early signs of psittacosis are very vague, such as fever and cough. Psittacosis would presumably not be high on the doctor's list of possible diagnoses for the average person coming in with fever and a cough. If the doctor knows a person has contact with birds, hopefully psittacosis would be considered earlier so prompt diagnosis and appropriate treatment can be given. This disease is readily treatable if diagnosed early, so awareness of the possibility on the part of the patient and physician are important.

This report also demonstrates why determining a final diagnosis for sick or dead pets is critical. While the diagnosis may not help the animal (especially if it's already dead), it may play an important role in protecting the health of people or other animals. If the bird in this case was not tested, it's hard to say how long it would have taken for psittacoiss to be considered in the case of the pet store worker.

More information about psittacosis can be found in a document from the National Association of State Public Health Veterinarians. More information about good management practices to reduce the risk of disease transmission from birds can be found in the information sheets on pet birds on the Worms & Germs Resources page.

Image from: http://www.cbc.ca/health/story/2009/04/01/parrot-fever.html

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Helicobacter species are a fascinating group of bacteria. They live in the stomach of humans and many animals, an environment that was previously thought to be completely inhospitable to bacteria. We now know that Helicobacter bacteria are beautifully adapted for survival in the stomach and are very common. In people, Helicobacter pylori is an important cause of gastritis (inflammation of the stomach), stomach ulcers and stomach cancer.

Studies looking at bacteria in the stomachs of dogs and cats have found that Helicobacter species are extremely common, with some studies finding one or more species of Helicobacter in every dog or cat that was tested. Since Helicobacter is an important problem in people, does that mean that we need to be worried about pets as a source of infection? Probably not.  Here's why:

It could be a problem because:

• A few studies have found the same Helicobacter species in infected people and their pets.

It's probably not a problem because:

• Studies looking at risk factors for Helicobacter infection in people have not identified pet ownership as a risk factor.
• A study comparing one Helicobacter species that has been mentioned as a possible zoonotic concern, H. heilmannii, reported that H. heilmannii strains from people were generally different than those from animals.
• While other Helicobacter species are common in dogs and cats, H. pylori (the main cause of problems in people) is rare in pets.
• While finding the same Helicobacter species in a person and his or her pet raises concern, studies have yet to demonstrate whether such findings are due to animal-to-human transmission, human-to-animal transmission, or infection of both person and pet from the same source.

Overall, the risks of pet-associated Helicobacter infection are probably very, very low. If there is any involvement of pets in this disease in people, it's probably sporadic at most. Avoiding contact with stool from pets and paying good attention to handwashing should decrease the risk even further.

One question that is currently unanswered is whether the mouth of a dog or cat can be a source of Helicobacter infection, because the bacterium can be found in saliva. We really don't know whether this is a risk - it's probably minimal at most, but avoiding contact with pet saliva (e.g. no sloppy wet dog kisses!) is a good idea anyway.

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ProMed mail reports two more rabies fatalities in an ongoing outbreak in Bali, Indonesia.  The first person was bitten by a stray dog, which always must be considered a potential rabies exposure, especially in an area where an outbreak is underway. He received one rabies shot but did not undergo the whole post-exposure series because of a fear of needles, and he died.

The second person was bitten by both a stray and a pet dog, another clear indication for post-exposure treatment. She refused treatment because of a fear of needles, and also died of rabies.

These were two completely preventable deaths. The decision to forgo treatment almost certainly cost these people their lives - rabies is preventable with appropriate and timely post-exposure treatment. These cases also highlight the need for proper education of the public when it comes to rabies, both in terms of avoiding strays and the need for prompt attention when there's potential exposure to the disease. I have no idea how forcefully medical or public health personnel explained the need for proper treatment. For people that want to decline treatment, aggressive and comprehensive education is needed. Ultimately, people are allowed to make bad decisions, but we need to make sure they at least make informed bad decisions.

There are various other concerning issues with this outbreak, particularly the government's response to it. Multiple sources have apparently advised the government that aggressive vaccination and halting of dog movement between the peninsula and the mainland could contain this outbreak. So far, this has not been done. Amazingly, importing rabies vaccine into Bali was illegal until December 2008, and it is still illegal to vaccinate dogs outside of the outbreak area! The cost of vaccination has been used as an excuse not to do so. Certainly, financial issues are important in developing countries. However, the estimated cost is only about $0.50 US per dog. When one considers that this area is highly dependent on the tourist industry, they need to consider this as an investment to maintain their economy. Would you like to spend your vacation in an area with an ongoing rabies outbreak?

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The following is a post by guest-blogger, Dr. David Waltner-Toews.

For North American veterinarians, the term “companion animals” covers a wide territory, from dogs, cats, and caged birds, to a variety of rodent and porcine escapees from barnyards and burrows. But when does a companion become something else? In my work with Veterinarians without Borders/ Vétérinaires sans Frontières – Canada, I find that I sometimes have to change my ideas of what companion animals are.

We have all heard about bird flu, and the fear that it might become a global pandemic. We know that wild water birds are the main reservoir for all the different kinds of influenza viruses that emerge every year from Southeast Asia and circle the world. The viruses are unstable, and historically haven’t caused many problems in birds. The disease in people can be serious, especially in older people, but large scale vaccination programs have helped. The big concern is that a new variation of the virus has evolved and has spilled from water birds into domestic poultry. A virus that not only kills birds, but also kills a high percentage of people – and other animals such as cats. Fortunately, it is difficult to contract – you pretty much have to be the one killing and cleaning the bird.

To some people, the way to stop a global pandemic is easy. If you suspect bird flu on a premise, kill all the birds and disinfect the area. Easy, isn’t it? They are, after all, “just chickens”. Or are they?

When my wife and I recently visited a part of the island of Java, Indonesia, where this new virus is thought to be endemic, that is, a lot of birds are carrying it, I already knew it was more complicated than just killing chickens. Often, poor people will “salvage” sick, dying or even already-dead birds by cooking them up and eating them before the authorities discover them. If you are hungry, it seems such a waste not to.  As a result of such situations, about 120 people in Indonesia have died of bird flu since 2003.

But, we discovered, poverty is not the only “complication”. We held a town hall meeting in one village, in the middle of this endemic area, to explore how they were coping with the disease. They told us that they didn’t have any bird flu. Certainly, sometimes, they had some sick birds, which they threw into the river, but no bird flu. They attributed their disease-free status to the fact that they fed their birds a warm porridge made from snails and papaya leaves.

After our town hall meeting, we trundled through the rain to one of the nearby chicken-owners.  When we entered the well-kept concrete-walled yard, a young boy proudly showed us his pet pigeon. His father, however, did him one better. It turns out that this family raised singing roosters, so-called Ayam Pelung, beautiful birds, about a metre high. I knew that wild jungle fowl had first been domesticated in Southeast Asia tens of thousands of years ago as fighting birds, now referred to in Indonesia as Ayam Bangkok.

I had heard about the singing birds, and had seen them in their cages at a competition at the veterinary college in Yogyakarta when I worked there in the mid 1980s, but this was my first close-up view. The men who owned them proudly crouched next to them for pictures. Periodically, one of the roosters would stand still and give a long, drawn out, low, throaty call, an avian version of some sultry lounge singer. These birds, if they win competitions throughout the country and region, apparently bring in up to 500 to 1000 U.S. dollars each. In a country where the average annual income is between $3000 and $4000, a few birds can represent a huge investment. Are these birds companion animals? Are they friends, workers, threats… or just chickens?

When is a dog or a cat or a bird more than a companion? When they sing? Race? Fight? When they are worth lots of money? In Thailand, where fighting cocks are common, and are valuable, the authorities have issued “vaccination passports”, with pictures of the roosters, indicating vaccination with a reputable influenza vaccine. When, in trying to control a disease, do we cross the line from “culling” economically important “units” to killing companions? When do we hand out passports?

If you had an amazing purebred dog worth tens of thousands of dollars, and the public health authorities threatened to kill it if it was found to be harbouring some virus which might or might not make you sick, what would you do? What if that dog was not only your companion, but your retirement investment?

Suddenly controlling a bird flu pandemic is a lot more complicated than killing “just chickens”. Welcome to the real world.

David Waltner-Toews is the founding President of Veterinarians without Borders/ Vétérinaires sans Frontières – Canada (www.vwb-vsf.ca) and a Professor in the Department of Population Medicine at the Ontario Veterinary College.

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The latest edition of the Centers for Disease Control and Prevention (CDC)'s publication Morbidity and Mortality Weekly Reports consists of the revised Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents.

Among the highlights relevant to pets:

• HIV-infected patients should be advised to wash their hands after handling pets or other animals.
• They should avoid direct contact with diarrhea or any stool from pets, particularly stray pets or dogs and cats less then six months of age.
• Gloves should be worn when handling stool or cleaning areas that might have been contaminated with stool from pets.
• Contact with calves or lambs (e.g. on farms or at petting zoos) should be limited or avoided. Attention should be paid to hygiene and avoiding direct contact with animal manure when visiting such premises.
• Contact with reptiles, chicks and ducklings should be avoided because of the risk of Salmonella.

So, nothing earth-shattering or nothing we and others have not been saying all along. That's because basic measures, while not flashy, are the most useful tools. Use common sense, avoid contact with stool and high risk animals, and above all wash your hands.

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