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

An article released today in the journal Pediatrics (Behravesh et al, 2010) provides more information about a salmonellosis outbreak linked to pet food. The outbreak itself is old news - I commented about it almost two years ago. What is new is the detailed epidemiological analysis of the outbreak, and there is some interesting information in the paper that is worth reporting. Here are the highlights:

Almost 50% of people who were infected were kids two years of age or younger.

• That's not too surprising considering kids less than five years of age are a high-risk group for getting sick after being exposed to Salmonella.

Households with sick people were almost 7 times as likely to have recently purchased the affected food.

• This provides good evidence of the link between the contaminated food and disease.

The Salmonella strain that was found in people was also found in bags of pet food at the manufacturing plant, samples from the manufacturing plant environment, and fecal samples from dogs that had eaten the food.

• This is pretty convincing evidence that the food was the source. Because they were able to type the Salmonella strain in people and it was an uncommon strain, and they then found the same uncommon strain in food, animals and people, it paints a pretty clear picture of what happened.

Illnesses occurred over a 3 year period.

• This is pretty concerning. This was more than a little lapse at a plant that led to contamination of a single batch of food or a short term event. This was a major failure in quality control that was undetected for a long period of time, resulting in at least 79 human infections in 21 US states.

A cluster of infections caused by the strain involved here, S. Schwarzengrund, was identified early in the outbreak. However, a link with pet food was not considered until the following year.

• That's unfortunate but maybe not surprising. There are a lot of other more likely sources of infection that were probably focused on initially. "What kind of pet food do you feed your dog?" was unlikely to be a routine question asked of people with infections. Identification of outbreaks caused by uncommon events is difficult and typically takes more time.

People that fed their dog in the kitchen were 4 times as likely to have an infection.

• Feeding a pet in the kitchen presumably increased the chance of cross-contamination with human food or contamination of the food preparation environment.

The cause of contamination was never identified. The authors of the paper suspected that contamination occurred after extrusion (the process during which the kibble is formed), which makes the most sense. The extrusion process results in high enough temperatures to kill bacteria like Salmonella. Possible causes of contamination include contaminated equipment used after extrusion, cross-contamination of pre- and post-extrusion food and contamination of substances (e.g. flavour enhancers) sprayed on kibble after extrusion. The fact that Salmonella was found in the room where materials were sprayed on the kibble supports this further.

In general, dry pet food is quite low-risk in terms of Salmonella contamination, but just like with other non-raw-animal products such as lettuce, tomatoes and sprouts, contamination can occur and human infections can result. The best way to reduce the risk is to use good general hygiene practices, particularly washing hands after handling food, keeping pet food and pet food bowls out of kitchens and limiting contact of young children and other high-risk individuals with pet foods.

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Recent Salmonella recalls have led to some questions about the best way to diagnose salmonellosis in dogs and cats.

The first issue is when to test. In general, there is no indication to test healthy animals. Testing should be reserved for animals with diarrhea or other signs of salmonellosis (e.g. fever).

When testing is indicated, a few things should be considered:

The Sample

• A fresh sample is best. It should be submitted for testing as soon as possible, but it can be kept cool (i.e. refrigeration temperature) for a day or more if it can't be submitted right away.  (Do NOT keep a fecal sample in your fridge at home! Take it to your local vet clinic and they will keep it in a designated specimen fridge.)
• More is better. A reasonable volume of stool (e.g. a tablespoon or two) is preferred to something like a rectal swab. Testing can be performed on rectal swabs but they are lower yield because they contain a lot less stool.  See image right: standard-size 30 mL fecal sample containers (click for source).

The Test

There are two tests used to detect Salmonella in feces: culture and PCR.

Culture is used to grow and isolate the Salmonella bacterium. Usually, enrichment culture is used, whereby the sample is first cultured in a selective broth culture medium, then put on culture plates. This increases the recovery rate but takes more time.

Advantages of culture are:

• A positive is definitive - the bacterium is definitely there and alive.
• An isolate is available for subsequent testing such as determining the susceptibility to antibiotics and typing it to see what strain is involved.

Disadvantages of culture:

• Salmonella can be hard to grow for labs that don't have a lot of experience and good protocols.
• A few days are required to obtain results, particularly if proper enrichment methods are used.

PCR (polymerase chain reaction) is a molecular diagnostic test that looks for DNA from a particular organism (in this case, Salmonella).

Advantages of PCR:

• Speed. Results may be available within 24 hours.

Disadvantages of PCR:

• Tests validated for dogs and cats are not usually available.
• The test detects both live and dead bacteria, so a positive result could theoretically be from ingestion of dead (and therefore irrelevant) bacteria.
• False negative results can occur from low levels of Salmonella or substances in the stool sample that inhibit the test.
• Lab quality control is critical but not always good.

Current recommendations are to base diagnosis on culture. PCR can be used as a faster presumptive test, but culture should be performed to confirm the diagnosis and get a bacterial isolate that can be further tested for antibiotic sensitivity and typed to see what strain is involved.

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Following on the heels of a limited recall of feline dry renal diets because of potential contamination with Salmonella, Proctor and Gamble has now recalled all Iams Veterinary Dry Products, as well as Eukanuba Naturally Wild, Eukanuba Pure and Eukanuba Custom Care Sensitive Skin. These products are sold across the US and Canada, and all products with best-before dates between July 1, 2010 and Dec 1, 2010 (so, presumably everything that is on the market at the moment) are included. The broad scope of the recall is apparently a proactive measure based on the premise that since Salmonella was found in some products made at a particular production facility, there is the potential for contamination of everything made there. More data about what they have found and how widespread the contamination is would be nice (but is not forthcoming at the moment).

No illnesses have been reported. If your pet is being fed one of the recalled diets and develops diarrhea, vomiting or other signs of illness (e.g. weakness, fever, decreased appetite), it is important to consider the possibility of Salmonella. Similarly, if any people in the house develop these types of symptoms, they should make sure their physician knows they may have been exposed to Salmonella. Presumably, the level of contamination was low and the risks to the general public (human and canine/feline) are relatively low, with higher risks to people and animals with compromised immune systems or other diseases that limit their ability to fight off a bug like Salmonella.

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A couple of more Salmonella recalls have occurred recently. Feline's Pride Natural Chicken Formula, a raw chicken diet, has been recalled, as has Natural Balance Sweet Potato and Chicken, a kibble diet.

Finding Salmonella in commercial raw diets is expected and I'm surprised about the recalls that have happened. If you buy raw meat, you need to assume that it's contaminated with Salmonella and various other potential pathogens. Salmonella in kibble diets is more surprising, and is a concern because people do not tend to handle kibble as potentially contaminated.

These recalls highlight a few points to me:

• Always assume you have Salmonella and other nasties in raw meat. Careful attention to handling of raw meat and personal hygiene (e.g. handwashing) is critical.
• While lower risk, kibble is not innocuous, so wash your hands and prevent cross-contamination of kibble with human foods.
• "Natural," along with "organic," "super premium" and other marketing catch-words tell you nothing about the quality and safety of a product. There's no evidence that any products marketed as organic, natural, or anything else along that line are at all superior to diets produced by reputable companies, particularly diets that have undergone proper development and testing, including AAFCO feeding trials.

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While I hate to initiate another round of emails from raw diet supporters, here are a few of the more common questions that I get about these diets and some answers:

I use frozen raw food. Doesn't freezing kill harmful microorganisms?

• No. Freezing is an effective way to eliminate most parasites (with an adequately low temperature and adequate time, which varies between parasites). Campylobacter also does not survive freezing well. However, other bacteria, including Salmonella, tolerate freezing quite well. Studies of previously frozen raw diets have found high rates of bacteria like Salmonella.

My dog doesn't defecate in the hospital, so why are we paying attention to intestinal bacteria?

• Inadvertent exposure to fecal bacteria is common. Most gastrointestinal infections in people are from ingestion of bacteria and viruses from feces (e.g. Salmonella, Clostridium difficile, norovirus). We don't knowingly ingest feces, but we get exposed to these organisms nonetheless. Fecal bacteria can end up on pets' haircoats, people's hands and many surfaces in the general environment, and then wind up in the intestinal tract of a susceptible person.

Is there any way to eliminate Salmonella and other harmful bugs from raw meat?

• Yes. Besides the obvious (cooking), there are a couple options. One is irradition, which is a safe and highly effective way to eliminate bacteria. The main problems are cost and consumer fears of irradiation (which is actually harmless). Another approach is high pressure pasteurization. This process uses high pressure (with a slight increase in temperature) to kill harmful organisms. The effectiveness of this for raw meat hasn't been clearly determined, but it's an option, and one company is now doing this for all of their diets.

Why don't you just go into hospitals, ask nurses whether animals visit and compare infection rates, so you can see if there is a true health risk?

• It would be nice if it was that easy. Firstly, asking nursing staff doesn't give enough information. You need to know if animals visit, but also if they visited particular patients, and whether they visited before those patients developed infection. Just comparing infection rates between hospitals or wards that allow dogs to visit, and knowing the dietary status of the dogs, is useless. A proper study would require clear documentation of which animals visited which patients (something that is rarely recorded) and whether patients subsequently developed any infections that were not present before visitation (which is not easy to document), while concurrently investigating other possible sources of infection (similarly challenging). Ideally, bacteria causing human infections would be compared to those found in animals to provide stronger evidence of a link. Because the incidence of infections is relatively low, a large number of people would need to be enrolled. There are significant logistical issues, research ethics board issues, problems with the quality and availability of medical records and other things that make this very, very difficult. It needs to be done but it's not as simple as many people think. If it was easy, it would have been done by now.
  

Dogs have a short and acidic intestinal tract and are not susceptible to Salmonella.

• This statement appears thousands of times on the internet and there's absolutely no evidence supporting it. Dogs can and do get salmonellosis. For every email I've had talking about how a raw diet has made a big difference in someone's dog's health, I get at least one email from an owner or vet whose dog got salmonellosis while eating raw meat (and sometimes people in the house also got sick). A dog that eats Salmonella can shed it in its feces. The bacterium can clearly survive passage through the intestinal tract. Most dogs that ingest Salmonella do not get sick. Some do. Sometimes their owners do as well.

Wild dogs eat raw meat. That's what they've evolved to do.

• Wild dogs also have a much, much shorter lifespan than domestic dogs. It's obviously not all related to diet, but I don't want my dog to have the lifespan of a "natural" dog, I want her to have the longer and healthier lifespan of a modern pet dog. Take a look at older cemeteries and see the number of headstones of very young children. Raw milk played a big role in many of those.
• Regardless, the question isn't about the health of dogs fed raw meat. That's a completely separate issue. The issue is the risk that raw-fed dogs might pose to the highly compromised people that are found in healthcare facilities. People need to think about the health of those susceptible individuals when they get involved in this debate.

(click image for source)

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Delta Society has recently announced a policy prohibiting animals fed raw meat or raw animal products from participating in their Pet Partners program. This policy was established because of research indicating dogs fed raw meat are much more likely to be shedding harmful bacteria like Salmonella and drug resistant E. coli in their feces compared to dogs fed commercial or home cooked diets, and the fact that these dogs come into close and frequent contact with people that are more susceptible to infections and at increased risk having severe infections.

Not surprisingly, internet chat sites are abuzz, and there's much condemnation and consternation from some. Some of the more vocal minority are stating that they'll just lie and say that they're not feeding raw.  I guess such dishonest actions would be based on a combination of ignorance and arrogance - feeding raw is your own decision, but blatantly flouting a policy that was put in place to reduce risks to those most susceptible is stupid and irresponsible.

One of the problems with peoples' reactions is the fact that they are confusing two separate issues. One debate is whether raw feeding is more healthy or more harmful to the pet. That's a controversial area, but this policy has nothing to do with that. This policy deals with the increased likelihood that raw-fed pets are shedding harmful bacteria. That's been very well proven in scientific studies. Do raw-fed pets cause disease in people in hospitals? We don't know. However, we have enough evidence to indicate there is the potential for increased risk to patients, and that added risk can be eliminated by not feeding raw meat products.

Hopefully, people will realize that this policy has been put in place for a good reason, and that it's focused on protection of people at high risk of serious illness. It's not a broad condemnation of raw diets, it's just a statement that it is not considered appropriate for dogs that will have contact with high risk populations - a recommendation that's far from new.

Details about this policy can be found here.

Disclosure: I'm a member of Delta Society's Medical Advisory Board. However, the opinions expressed here are mine and do not necessarily reflect the views of Delta Society.

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It's encouraging to see the number of press reports warning people not to bring home baby chicks or ducklings as Easter presents for kids. The warnings are because of the potential risk of salmonellosis associated with contact with poultry and fowl, particularly among children. Young kids (less than five years of age) are at high risk for this type of infection, and are at higher risk of developing more serious illness and complications. They also tend to be at higher risk for exposure because of the close nature of contact that they may have with pets, or in this case Easter chicks. Add close contact and increased susceptibility to the generally low level of hygiene associated with household animal contact, and you have a perfect recipe for sick kids.

Salmonella carriage is an ever-present concern with chicks and duckings. It doesn't matter how they were raised or from where they came - you can never know by looking it it whether a baby bird is shedding Salmonella, and you should assume that they all are to be on the safe side.

The CDC has some basic advice on the topic. The key points are:

• Never buy chicks or ducklings on a whim. If in doubt, buy a stuffed animal.
• Never buy chicks or ducklings for kids under five years of age or people with compromised immune systems. These individuals should not have any contact with chicks or ducklings.
• Don't let these animals roam freely around the house. They're not house trained and can contaminate the household environment.
• Always wash your hands thoroughly after contact with chicks or ducklings.
• Don't eat around chicks and ducklings, since it increases the chance of inadvertently ingesting Salmonella.

Baby chicks and ducklings don't make good pets because of the Salmonella risk. They also grow up, and become larger, messier, and noisier birds for which many people are not prepared to care. Don't buy a baby bird unless you have a low risk household, can properly implement measures to reduce the risk of exposure to Salmonella, and have a plan to properly take care of the bird when it gets older.

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A study by Erin Leonard of the University of Guelph and others, that has just been published in the journal Zoonoses and Public Health, once again points to the increased risk of Salmonella shedding associated with feeding raw diets to dogs.  The study looked at 138 dogs from 84 households in Ontario.  One-quarter of households (21/84, 25%) had at least one dog (32/138, 23.2%) that was shedding Salmonella at one time, which is considerably higher than the 1-4% of pet dogs that are typically expected to be shedding this zoonotic pathogen.  Only 4 of the 32 positive dogs had any history of diarrhea in the last month, so the vast majority of these dogs had no signs that they were shedding Salmonella.  Here were the study's main findings:

1. Consuming a commercial or homemade raw diet, a homemade cooked diet, or raw meat and eggs, increases a pet dog’s risk of carrying Salmonella.

Raw is raw, and by now we're hoping that people are getting the message that raw is contaminated, whether we're talking about a commercial or homemade raw diet, or feeding any raw animal products (e.g. meat, eggs).  The fact that homemade cooked diets also made the list could be explained by the fact that in order to make such a diet, owners still need to start with the raw ingredients.  Handling and cooking raw meat and animal products for your pet should be done with the same precautions as handling and cooking raw meat for yourself or your family.  If these homemade diets were not cooked as thoroughly as they should have been, or if there was contamination of the dog's dishes with raw product, that could explain the association with Salmonella shedding.  Although traditional commercial diets can also be contaminated with pathogens (usually after processing), the risk with these is much lower.

2. Testing multiple consecutive whole fecal samples greatly improves Salmonella recovery in dogs.

This is no great surprise either.  Dogs (and many other species) shed Salmonella intermittently, so not every fecal sample from a Salmonella-positive dog is going to yield Salmonella on culture.  The authors tested five daily fecal samples from each dog.  Based on this study, the sensitivity of testing a single fecal sample in a dog (i.e. the likelihood that a Salmonella-positive dog will test positive on one fecal sample) was only 35.5%.  That means almost two-thirds of positive dogs will be missed if they're only tested once.  The take-home message on this point is that in order to find Salmonella in a healthy pet dog, multiple samples should be tested.

3. Having multiple dogs in a household, using probiotics and contact with livestock are important potential risk factors that need to be investigated further.

These were factors that were flagged by the authors for future investigation, because at first they seemed to be associated with Salmonella shedding in the dogs, but when the feeding of raw diets was taken into account the associations were no longer significant.  A larger study, or one using a different design, will be needed to help tease apart the potential effects of these factors from feeding practices.

The bottom line: Feeding raw is risky business.  Some people swear by the benefits of raw diets, but the objective evidence is lacking.  There is clear evidence of the risks.  In my mind, the potential up-side simply cannot outweigh the well-established down-side of feeding raw diets to pets.

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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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Gurnee's Serpent Safari is being sued by the family of a two-year-old boy who allege the child contracted salmonellosis from a snake at the zoo. The child became ill and was hospitalized three days after visiting the zoo and petting a snake. The boy's mother got sick shortly thereafter. It's unclear if the same Salmonella strain was found in the snake or what degree of proof is present that the zoo was the source, but contact with reptiles is a huge risk factor for salmonellosis.

Exposure to zoonotic infections like Salmonella is an inherent risk of animal contact. We accept some degree of risk in everything that we do. The question is "Did the zoo take reasonable precautions to reduce the risk of disease transmission?" Based on the information in the Chicago Tribune news report, the answer is pretty clearly no.

There are standard guidelines for animal contact events that should be followed. These include:

• Children less than five years of age should not have contact with reptiles.
• There should be good, convenient access to hand hygiene (handwashing stations or alcohol hand sanitizers).
• Signs should be present to encourage people to wash their hands after animal contact and discourage high risk people (e.g. two-year-olds) from having contact with high risk animals (e.g. snakes)

The family alleges that the zoo is negligent because it:

• Did not have notices regarding handwashing after contact with reptiles.
• Did not provide hand sanitizers for patrons.
• Did not provide warnings regarding the risk of Salmonella for high risk groups.
• Allowed and encouraged the child to touch the snake.

We live in a pretty litigious society, but people need to assume responsibility for their (and their childrens') health and safety. However, exhibits that allow people to have contact with animals have a moral and legal responsibility to provide as safe of an environment as reasonably possible. Risk will never be zero and people can get sick from the best run events, but there is no excuse for failing to implement basic measures to reduce the risks.

Click image for source.

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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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My oldest daughter's latest favourite TV show is Cake Boss, a TLC show about life in a bakery (don't ask why... I guess it's better than John and Kate Plus 8). On a recent episode, they were making a cake for a circus sideshow and one of the performers appeared in the bakery's kitchen with a large albino snake. It makes for good entertainment but it's a break with common sense and presumably health codes.

Reptiles should never be allowed in a kitchen, let alone a commercial kitchen (especially one that presumably prepares items often eaten by children). Contact with reptiles is a significant risk factor for salmonellosis, and cross contamination is a concern in kitchens. All pets should be kept out of food preparation areas, but particular care should be taken around high risk species like reptiles, and every reptile should be assumed to be carrying Salmonella.

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Three Louisville, Kentucky children and their father recently contracted Salmonella from two lizards (green anoles) that the kids brought home from school. Two weeks after the lizards were brought home, the youngest child got sick. Then the other kids and the father got sick.

This outbreak highlights numerous problems:

Schools are not pet stores: Why is an exotic (and difficult to care for) pet that is a known Salmonella vector being sent home with students? Apparently, the school sent home a standard letter they use when students take home pets. (I assume sending animals home must be a very common event if the school has a standard form for it.) The letter provides "caretaking tips" but apparently mentions nothing about Salmonella and reptiles. The school has now modified the letter to include a "reminder to parents that good hygiene is imperative when dealing with any kind of living organism as a pet, so they need to make sure their kids wash their hands well after handling them or cleaning them out." That's better, but if they are sending home reptiles, they need a clear statement about the risk of Salmonella exposure. They need to be direct and highlight the greater risk associated with reptiles.

Lack of education before getting a pet: Too many pets die and too many people get sick because people don't take the responsible step of finding out about the animal before they adopt it as a pet. This is particularly true with exotic pets, and death of the pet is a common outcome. It doesn't take a lot of effort to find out basic information about reptile care, and information about the risk of salmonellosis should be easy to find.

Poor knowledge (or a poor attempt at damage control) by the school: The teacher "noted that other common pets, such as dogs, can also carry salmonella. Like lizards, they're perfectly safe as long as you practice proper handwashing when you handle them." Except for the fact that 0-1% of healthy dogs carry Salmonella while very high percentages of reptiles do, that tens of thousands of cases of reptile-associated salmonellosis occur every year, that contact with reptiles is a major risk factor for salmonellosis, and that the CDC (among other groups) recommends that children less than five years of age and other high-risk groups not have contact with reptiles.  This type of statement is misleading. It's unfortunately either an indication of ignorance of the issues or an attempt to cover their butts and not take their share of the responsibility for what happened.  Certain reptiles can be good pets in certain situations, but are clearly inappropriate in others.

The "it's never happened before so it must be safe" fallacy: The school's disappointing response was that they've been using lizards in classrooms for years and no one has gotten sick. Well, their luck just ran out. Just because I could drive around without a seatbelt and not get hurt doesn't mean not using a seatbelt is a perfectly safe plan. Risky behaviours tend to catch up with you eventually.

The "it didn't happen here so it's not our fault" excuse: School officials said teachers are well-trained on the proper way to prevent students from getting Salmonella, but that's pretty debatable since three kids got sick because of their actions (i.e. sending the reptiles to the children's home). The infections may not have originated in the school but the school was still the source of the problem.

Poor hygiene associated with reptile contact: The father admitted that they didn't wash their hands regularly after handling the lizards.

There's little excuse for sending reptiles home with kids. Reptiles require specialized care and commitment, and many (many!) die each year from inappropriate care. The last thing we need is to make it easier for people to obtain them without much forethought. Reptile-associated salmonellosis is a serious problem, especially in kids. Serious, including fatal, infections can occur. Schools need to realize the liability they might assume by sending these animals into households, especially with inadequate scrutiny and education. Reptiles should not be kept in  households with kids less than five years of age, pregnant women, elderly individuals or immunocompromised individuals. I doubt they asked whether any such people lived in the household before sending the reptiles home.

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The last time I visited the Aberfoyle (Ontario) Fall Fair, the petting zoo was so bad that I ended up writing to the fair organizers and the Wellington-Dufferin-Guelph Public Health Unit. (Neither group replied). It was pretty bad. Young poultry are inappropriate petting zoo animals because of the risk of transmission of bacteria like Salmonella, yet baby chicks were being passed around to young children. One chick was injured by rough handling and the petting zoo supervisor just threw it (still alive) in the garbage. There was a diarrheic calf, poor hand hygiene facilities, and other problems.

We went back to the fair yesterday and I was quite pleasantly surprised: no chicks, no calves, all appropriate and healthy-looking animals, a clean facility and good hand hygiene stations. There were still a couple of suboptimal things, like not having hand sanitizers by one exit, and having a "supervisor" who was staring off into the wilderness and smoking inside the tent filled with kids and straw, but it was night-vs-day compared to the last time. I doubt my letter had much to do with it, but you never know.  I think it's important that people not accept inadequacies that put the public (particularly children) at risk. People need to raise a stink when they see a problem. I wrote earlier today about a child who had her finger bitten off by a petting zoo zebra that had bitten other people. The previous bites may not have been reported because they were minor, but we need to report apparently minor problems so they don't escalate into major injuries, disease outbreaks or other bad scenarios.

Anyway, it was great to see an improvement, and people in the petting zoo appeared to be having a good time. Now if they'd just work on "Big Ned's" food concession, where the only sink seems to be a storage area with no soap or paper towels, and which appeared to be in need of a serious cleaning, or on the little midway, where they were hand cranking the questionable kiddie ferris wheel to get kids off when all the rides stopped working. Baby steps, I guess.

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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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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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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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One more post about illogical and dangerous activities associated with animals and young children and I'll hopefully get off the subject for awhile. I came across this daycare's website today. Keep in mind (again) that the the Centers for Disease Control and Prevention (CDC) recommends that children less than 5 years of age not have contact with reptiles, and that the  Compendium of Measures to Prevent Disease Associated with Animals in Public Settings published by the National Association of State Public Health Veterinarians states that wild or exotic animals may not be appropriate in school settings. The photo gallery from this particular daycare included some great pictures of things that you should NOT do with young children. Some of the more striking example are below:

1) Letting a large snake wrap its body around the neck of a young child.

 

 2) Letting a young child kiss a snake.

 

3) Letting a child touch a turtle.

 

4) Letting a young child pet a pygmy hedgehog. (Like reptiles, hedgehogs very often carry infectious pathogens, including Salmonella.)

 

I wonder...

• whether anyone made sure these children immediately washed their hands after they touched the animals.
• how may kids but their hands in their mouths before they washed their hands. (Probably almost all of them, considering the "animal visit" probably went on for quite a while.)
• whether this activity took place in the same area where the children later ate lunch or a snack.
• whether the parents knew that this was going to happen.

I'm not against young children having contact with animals. I think pet contact can be very rewarding for young children. However, these individuals are at higher risk for infection and it is our responsibility to protect them. Putting them in high risk situations like these is inappropriate. Animal visitation in daycares is not necessarily a bad thing, if it involves animals that are a low risk species (e.g. dogs and cats), that are healthy, and that have been temperament tested (to show they are at low likelihood of biting).  It is also important that parents provide consent for their children to participate, that good hygiene practices are used (and enforced), and that the people bringing in the animals know what they are doing.

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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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As you undoubtedly know, a large Salmonella outbreak has occurred in the US, associated with contaminated peanuts. The scope of this outbreak continues to expand in unexpected areas, including pets. The latest development is a voluntary recall of bird seed. The recall affects 20-pound packages of Wild Birds Unlimited Wildlife Blend bird food (produced by Kentucky-based Burkmann Feeds) with the manufacturing date code 81132200 2916 08124. 

The contaminated bird seed was linked to the deaths of several birds in North Carolina, and it was confirmed that the bird seed manufacturer received peanuts from the Georgia facility that was implicated in the Salmonella outbreak.

People that have used this bird seed should clear out their bird feeders, ideally while wearing gloves. The feeders should be thoroughly cleaned and then disinfected (although this may be easier said than done). Hands should be washed after handling the bird seed, potentially contaminated feeders or any other potentially contaminated items.

The risk to people is presumably quite low, but people handling the bird seed could potentially contaminate their hands with Salmonella and then inadvertently swallow some of the bacteria. Concerns are greatest in people with compromised immune systems, the very young, the elderly and people taking antibiotics, as they are more likely to get sick following exposure to small numbers of Salmonella.

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

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My oldest daughter is in Grade 2, and last year her class hatched chicken eggs in the classroom. As a parent, I was somewhat torn about the idea. My main concern was the risk of exposure to Salmonella. A recent article in Morbidity and Mortality Weekly Reports described outbreaks of salmonellosis associated with contact with live poultry.  Most cases were associated with handling baby chicks obtained from agricultural stores or by mail order. Infections from classroom and petting zoo-associated contacts were also reported.

Salmonella contamination of eggs and carriage by baby chicks is very common.  The CDC recommends that children less than five years old do not have any contact with baby chicks, and that older individuals pay close attention to hygiene in order to prevent transmission of Salmonella. Being six years old, my daughter was just over this age cutoff (although there's nothing magical about going from five to six years old, so I'd still consider her at somewhat higher risk). So, as long as good infection control practices were used (e.g. hand hygiene), the risk to the children was probably quite low. Were the benefits of hatching eggs in the classroom worth the risk? I don't know, but she enjoyed the experience and did learn a few things along the way. Concerns about infectious diseases are often dismissed, which is a problem, but sometimes excessive concern gets in the way of life. There's rarely a clear answer as to what is acceptable and what is too risky, given the potential benefits.

• Eggs and chicks should not be kept in classrooms where children under five years old will be present, or if there are immunocompromised children in the class. It's unclear whether all teachers would know if they had a high-risk child in the class. Parents of immunocompromised children should make sure teachers know about their child's increased risk.
• It is prudent for teachers to send home a note to inform parents if eggs/chicks will be in the classroom, or if similar activities involving animals are undertaken.
• Eggs and chicks should be kept in a complete enclosure, in an area that is always supervised when children are around.
• Chicks should always be kept in their enclosure. They should never be taken to areas (e.g. a student's desk) where food might be consumed.
• Direct contact with eggs and chicks (and their environment) should be kept to a minimum.
• Hands should be thoroughly washed or an alcohol hand sanitizer used immediately after contact with eggs, chicks or their environment.
• Appropriate thought should go into the use of eggs and chicks in classrooms. They should be there for more than the "novelty factor". There should be a clear teaching plan associated with them so they provide the maximum educational value possible.
• Testing eggs and chicks for Salmonella isn't practical. A negative result cannot guarantee that Salmonella is not there. As well, there are other infectious diseases that are of concern. Consider all eggs and chicks Salmonella-positive and handle them appropriately.

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A Las Vegas woman reportedly agreed to babysit a friend's pet python. She brought the 18-foot snake into her house, where her three-year-old son also lived. Bad move, for many reasons. At one point, the woman returned from the bathroom to find the snake wrapped around her son, who was turning blue. The mother stabbed the snake 17 times before it released the child.

Large snakes can be dangerous, particularly to young children. Without proper (escape proof) enclosures and people who know how to handle them (and some common sense), there is a real risk of injury or death, as was clearly demonstrated here. Also, reptiles of all kinds (including snakes) are prime sources of Salmonella infection. Allowing reptiles to roam the house and/or have direct or indirect contact with young children is an unnecessary risk. Various groups have stated that reptiles are not appropriate pets for children less than five years of age, nor for people with weakened immune systems, primarily because of the risks of Salmonella.

Hopefully the child in this terrifying case is alright, although he was also bitten, which can lead to complications of its own. The snake had to be euthanized because of the stab wounds. So, we have an injured child and a dead snake resulting from the stupidity of a couple of adults who didn't apparently see a problem with leaving a large predatory carnivore free in the same location as a prey-sized child. Authorities are still deciding whether to charge the mother with child endangerment.

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BarfBlog is a food safety blog run by Dr. Doug Powell, who used to be at the University of Guelph, before moving to Kansas State. (I played hockey with him and can confidently state that he is one of the better hockey goalies working in food safety in Kansas). Doug and his group have put together numerous useful, and often entertaining, fact sheets about food safety issues, as well as some related infectious disease and infection control topics. One of those is about Salmonella in pet turtles, something we've discussed on Worms&Germs periodically. The info sheet, and associated commentary from Ben Chapman, can be found here.

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People are increasingly concerned about exposure to infectious agents, both for themselves and their pets. This has led to marketing of various products to reduce the risk of disease transmission. Some are good, some might be useful but are unproven, and some are just horrible. Many in this last category manipulate scientific data to try to convince people that their product is useful. I ran into one of those today while I was reading an article that recommended the use of electrolyzed water to protect pets from Salmonella. 

Electrolyzed water is a weak electrolyte solution (such as tap water) that has had an electric current applied to it. The electric current acts on salt in the water and forms a weak acid and oxidizing agent (i.e. a weak disinfectant). It has been shown that electrolyzed water can be useful for disinfection of surfaces in food-handling areas, for reducing bacterial numbers when sprayed on carcasses in slaughterhouses, and possibly for treatment of contaminated food. The effect of spraying electrolyzed water on final food products, like pet food (raw or commercial) is unclear.

The science behind electrolyzed water has been used by some companies as an excuse to sell expensive electrolyzed water products for pets (and people) to drink. There is no evidence that drinking electrolyzed water helps reduce disease. Really, why would you want to drink a disinfectant, regardless of how "natural" it is?  Bleach (at the right concentration) can kill Salmonella, but that certainly doesn't mean that drinking a weak form of bleach is good for you.

It's likely the biggest thing you have to lose with products like this is money, but make sure you don't use unproven (or illogical) products in place of basic, common sense measures to reduce the risks of disease. If you are considering buying products to promote the health of your pets or yourself, do some research and try to find as much objective, independent information as possible. Don't rely on company information and testimonials. Here's an example of one company's website that sells electrolyzed water. This page is about the human product but their pet version is the same. My general rule is that anything that purportedly cures all that ails you probably cures nothing.

P.S: This same company's site contained one of the funniest false quotes that I've seen in a while. The site states that "The New England Journal of Medicine reports that more than 80-90% of canine skin and other problems are caused by toxins in a dog's body." The New England Journal of Medicine is a world-renowned journal of human medicine, which certainly has better things to do than report false science about dogs (or anything about dogs for that matter!).

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A report about the health risks in children associated with nontraditional pets was recently published in Pediatrics, the official journal of the American Academy of Pediatrics. The report also discusses diseases associated with animals in public settings such as petting zoos and pet stores.  Although contact with pets and animals can be beneficial to growth and development in children, it is very important to be aware of the risks associated with certain kinds of animals.  Physicians, veterinarians and public health personnel can help parents select appropriate pets in order to maximize the benefits while minimizing the risks to children.

One of the most important pathogens discussed in the report is Salmonella. Although Salmonella can be transmitted by many animal species, including traditional pets like dogs and cats, it is a particularly high risk with certain other kinds of pets, including reptiles, amphibians and baby poultry (chicks and ducklings). It has been estimated that direct or indirect contact with reptiles or amphibians is responsible for 6% of all sporadic Salmonella infections in the US, and 11% of cases among people younger than 21 years. There is also a relatively high risk of Salmonella transmission associated with animal-derived pet treats, such as pig ears, and raw meat.

The report makes several recommendations about how to reduce the risk of infection, injury and allergies from nontraditional pets, many of which you may have seen before on the Worms & Germs website. Just a few of these are:

• Always wash your hands after contact with animals, animal products or their environment, and after contact with animal-derived pet treats.
• Supervise hand washing for children less than five years old

Children less than five years of age and individuals with weakened immune systems should avoid contact with reptiles, amphibians, rodents, ferrets and baby poultry. These animals:

• Should not be kept as pets in households where children less than five years of age or individuals with a weakened immune system live.
• Should not be brought to childcare centres.
• Should not be allowed to roam freely in ANY house or living area.
• Should not be permitted in kitchens or anywhere food is prepared.

More information about Salmonella in pets and the risks associated with feeding raw meat and animal-derived treats to pets can now be found on the Worms & Germs Resources page.

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You may notice a recurring theme in many of our posts and on virtually all of the information sheets on the Worms & Germs Resources page: an emphasis on handwashing. There is increasing emphasis on hand hygiene (i.e. hand washing and use of alcohol hand sanitizers) education in hospitals because the hands of healthcare workers are a major (if not the most important) means of disease transmission between patients. Despite hand hygiene being easy, cheap and effective, people rarely wash their hands as often as they should, and they often don't do it properly.

Most of the research about hand hygiene that has been published has focused on its use and impact in human hospitals, but this area is now also being studied more with regard to animals and veterinary medicine. A study published earlier this year in Veterinary Microbiology provided more evidence that hand hygiene is a critical infection control measure when dealing with animals. The study, coordinated by Dr. Maureen Anderson (of Worms&Germs fame) looked at MRSA carriage rate in veterinarians who work with horses. In addition to finding a high rate of MRSA carriage among these veterinarians (which was consistent with other reports indicating that equine vets are at higher than average risk for exposure to MRSA), the study looked at factors associated with MRSA carriage. Vets that reported routinely washing their hands between farms and those that reported washing their hands after contact with potentially infectious cases had a significantly lower rate of MRSA carriage. That should come as absolutely no surprise, but it's one more piece of evidence that we need to pay more attention to this routine infection control measure, in human hospitals, in veterinary environments and in households.

Remember, the 10 most important sources of infection are the fingers on your hands!

Click here for instructions on how to wash your hands properly.

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Yet another reminder of the risks associated with handling turtles (and other reptiles) comes to us from a report published earlier this year regarding an outbreak of salmonellosis in people tied to contact with turtles.  In this case, more than 100 people in 33 US states were affected. The report sparked additional public education efforts in Los Angeles county, CA, where eight of the cases occurred.

The report comes as no surprise - turtles are actually relatively commonly implicated in cases of salmonellosis in people (although still not nearly as commonly as foodborne transmission). It's particularly a concern in children, because kids may have close contact with pet turtles and may be more susceptible to serious infection.

In response to the cases in Los Angeles, the county Department of Public Health emphasized that parents must be wary of buying turtles for their children. Even though the sale of small turtles (less than 4 inches long) was banned in the US over 30 years ago, unfortunately these animals are still widely available in many pet stores, flea markets, and from other sources. Los Angeles Public Health personnel reported that children were getting sick because they were kissing their pet turtles - something that is very risky and should never be done by anyone, especially children. If people have pet turtles, they must be very diligent to practice good hygiene to reduce the risk of transmission of Salmonella.

More information about the risks associated with pet turtles, and measures that should be taken by people who own turtles, is available on the Worms & Germs Resources page.
 

 

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Mars Petcare has recalled certain pet foods produced in a plant in Everson, Pennsylvania and sold in several US states. This is being done because two lots of pet food were found to be contaminated with Salmonella Schwarzengrund. This is the same Salmonella strain that was identified during a pet-food associated outbreak of salmonellosis in people in 2006-2007. Production of pet food at this facility was stopped in July because of a potential link between pet food produced there and infections in two people.  More information about this recall is available from the FDA.

While commercial pet foods undergo rigourous quality control and are much less likely to contain potentially harmful bacteria such as Salmonella than, for example, raw meat diets, it is important to remember that situations such as this can happen. So it's still a good idea to wash your hands after handling pet food, of any kind.

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Feeding raw meat diets to dogs is a very controversial issue. Some proponents passionately advocate these diets (e.g. the BARF diet) based on vague and unproven recommendations. Opponents cite various studies showing that pets fed raw meat (not surprisingly) have high carriage rates of potentially harmful bacteria such as Salmonella, and reports of diarrhea or nutritional imbalances in these animals. However, there have been only a few good studies looking at the true health benefits and risks of feeding these diets to dogs.

A recent study in the journal Zoonoses and Public Health described the risks of therapy dogs shedding Salmonella and other potentially harmful bacteria. The authors tested 200 dogs over a 1 year period, 20% of which were fed raw meat as part of their normal diet. Dogs fed raw meat were 23 times more likely to shed Salmonella compared to other dogs. They were also 17 times as likely to be shedding extended spectrum beta-lactamase (ESBL) Escherichia coli (a highly drug-resistant form of E. coli). 

The study concluded that, because of the risk of Salmonella shedding and the high-risk nature of the patients and other people that therapy dogs interact with, dogs that are involved with hospital/patient visitation programs should not be fed raw meat.

What does this tell us about feeding raw meat to pets?

Although this study doesn't answer all of the questions about the risks of raw meat diets, it reinforces the fact that pets fed raw meat have significantly higher rates of shedding of potentially harmful bacterial such as Salmonella and antibiotic-resistant E. coli. Eating pig ear treats has also been associated with Salmonella shedding. However, there was no association between a dog being fed raw meat and the animal itself developing diarrhea. In fact, raw-fed dogs had a lower incidence of extra-intestinal infections (combination of eye, ear, skin and urinary tract infections).

In general, raw meat diets should be avoided. While adverse health effects were not reported in this study, disease (including deaths) from Salmonella has been reported in dogs in other studies. While the overall risk may be low, feeding raw meat is an avoidable risk. However, it would be inappropriate to completely ignore the finding that raw-fed dogs had lower rates of certain infections. It is possible that there can be health benefits from feeding raw meat in certain dogs, but the potential benefits must be weighed against the potential risks to the animals and people with which the has contact. Raw meat diets should never be fed to pets that have contact with immunocompromised people (in the household or as part of visitation program), infants or the elderly.

If you are going to feed raw meat to your pet, make sure you take precautions to reduce the risk of infecting yourself or someone else. We'll post more on that aspect soon.

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An ongoing outbreak of listeriosis in people in Canada has been linked to prepared meat products from Ontario. At least six deaths have been reported, and others are under investigation. While it is unlikely that there has been widespread exposure of dogs and cats, it is certainly possible that some pets were fed the recalled (and potentially contaminated) meat.

Listeriosis is an infection caused by the bacterium, Listeria monocytogenes. It can affect many animal species, but it is rarely identified as a cause of disease in dogs and cats. When signs do occur, fever, diarrhea and vomiting are most commonly reported.  Rare cases of neurological disease in dogs and cats, and one case of suspected miscarriage in a dog due to listeriosis have been reported. Listeria skin infection has also been reported in dogs.

Overall, the risk of listeriosis in pets associated with the tainted meat products is very low. Pets that ate any of the recalled food products do NOT need to be tested or treated if they are not ill. However, should a pet that ate recalled meat become ill, it is important to inform the animal's veterinarian about the potential exposure to Listeria.

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Pet treats derived from raw animal products such as rawhides and pig ears (yes, pig ear treats are actually dried, raw pig ears) are widely available and commonly fed to pets, particularly dogs. Being a raw product, there is an inherent risk of contamination with potentially harmful bacteria such as Salmonella. In 1999, an outbreak of salmonellosis linked to contact with raw pet treats was identified in people in western Canada. A subsequent investigation found Salmonella in over 50% of pig ear treats and 38% of other animal-derived treats. Similar results were reported by a later study in the US, and other outbreaks of disease have been reported. In Canada, the pet treat industry and government groups met and made various recommendations to reduce the risk of contamination.

To evaluate the effect of these changes, a Canadian follow-up study was performed. Only 4% of treats were contaminated with Salmonella, which was a marked contrast to the earlier study. Even so, the fact that Salmonella was present in a detectable percentage of treats means that certain precautions are warranted.

• Always wash your hands thoroughly after handling pet treats such as rawhides and pig ears
• Avoid buying treats from 'bulk bins', as there may be an increased risk of cross-contamination between treats in the bin
• Buy packaged treats so that you don't have to touch them directly when buying them or bringing them home
• Never store treats in areas where other food is kept or prepared
• Ask whether the treats you are buying have been produced under the Guidelines for the Manufacturing of Natural Pet Treats for Pets.  There guidelines were developed by the American Pet Products Manufacturers Association with input from the Food and Drug Administration (FDA)
• Avoid buying raw treats if you have young children or anyone with a weakened immune system living in the household, as these treats may pose a small but unnecessary risk of exposure to Salmonella
• Contaminated treats seem to be a bigger problem for people than pets, however Salmonella can also cause disease in pets. If your pet develops diarrhea after eating an animal-product treat, be sure you tell your veterinarian

Image: Pig ear dog treat from www.foodpoisonblog.com

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As the owner of a dog that loves to roll in (and eat) anything she finds, I certainly understand the questions that I get about risks to dogs from dead birds. Eating a dead bird is certainly not an appealing thought to us, but overall, the risks to a dog are pretty low. The greatest potential problem is likely gastroenteritis, often referred to as ‘garbage-gut’, which typically causes diarrhea (with or without vomiting) after "dietary indiscretion" (i.e. a dog eating things it shouldn't have). Another concern is Salmonella. Some birds carry Salmonella in their intestinal tracts and dogs could become infected from eating them. This is a bigger problem in cats that hunt birds - salmonellosis in outdoor cats is also referred to as songbird fever. West Nile virus can cause death in birds, especially species such as bluejays and crows, which may then be found by your dog. The risk of transmission of West Nile virus to dogs from eating dead birds is presumably very low. Further, this disease is very rare in dogs and they appear to be quite resistant to the virus.

• Try to prevent your pet from eating/touching dead birds.
• If your pet develops diarrhea after eating a dead bird, it is probably not a health concern for anyone else but Salmonella infection is possible, so consider taking your dog to the veterinarian. This is especially important if the dog appears sick (i.e. besides vomiting and diarrhea, the dog also is not acting like itself) or if there are people in the household that are at higher risk for getting sick from bugs like Salmonella (i.e. infants, people with weakened immune systems). All diarrhea should be considered potentially infectious to other animals and people.  Extra care should be taken around affected pets and their stool, including extra attention to hand washing, and disinfecting the site of any "accidents" that occur in the house.
• In some areas where bird testing is performed for West Nile virus or avian influenza surveillance, public health personnel will collect dead birds. Contact your public health department if you are unsure what is done in your region.

If you must move or remove a dead bird, precautions should be taken. These include:

• Do not touch dead birds with bare hands.
• Use heavy-duty, leak-proof gloves to place the bird in a leak-proof plastic bag. Alternatively, fold two bags over your hand and use the bag to cover your hand when picking up the bird (like people do when poop-scooping), or use a shovel to place the bird in a bag.
• Double bag the bird.
• If the bird is not being collected for testing, contact your local waste management agency regarding disposal instructions.
• Always wash your hands with soap and water as soon as you're done.

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Last weekend, my family and I went to an (indoor) aviary for an outing because the weather was particularly miserable. A new addition to this facility was a large reptile encounter exhibit. As part of this, people were encouraged to handle a bearded dragon (a type of lizard) and a large python. Contact with the animals was extremely popular with most people, including one of my daughters. She held the snake (twice) and the bearded dragon. Part of me was enjoying the experience and seeing what she got out of the encounter, but the infectious disease side of me had some concerns.

Petting zoos and similar animal contact events carry an inherent risk of infectious disease transmission. Outbreaks of various infectious diseases have been reported, mainly associated with farm animals. Reptiles are a particular concern because they can have high rates of Salmonella carriage. Terrestrial reptiles like bearded dragons and pythons are lower risk than species like aquatic turtles, but these animals can still be the source of salmonellosis in humans.

Petting zoos can be entertaining and educational, and fairly safe if run properly. However, deficiencies are often present. At this facility, there were multiple hand hygiene stations, consisting of alcohol-based hand sanitizers, which are very effective. Food and drink were banned in the area and there were staff supervising all animal contacts. These are all good things, however the best measures are useless if they are not used or enforced. While I made sure that my family carefully cleaned their hands, we were definitely in the minority. The hand hygiene stations were not particularly easy to access and there was't one present at the exit, so if you weren't looking for it you would probably just leave. Further, despite the signs, staff allowed people to eat and drink in the area where they were handling reptiles. Allowing people to eat and drink, and not providing easy access to the hand sanitizers (two pretty basic measures) were major problems and greatly increase the risk of disease transmission.

I'm not suggesting we should avoid petting zoos. My kids enjoy them and we will surely attend a few this summer. The key with animal contact exhibits is common sense....avoid high risk animals, keep you hands out of your mouth and wash your hands thoroughly when leaving (even if you didn't touch an animal since you probably touched other surfaces). Some animal species are particularly high risk, including young poultry and young ruminants (e.g. calves, lambs, goats). Reptiles fit into this high risk group, which is why I had more concern about this event than a standard petting zoo. People with compromised immune systems should avoid animal contact, particularly with calves, chicks, lambs and reptiles.

And above all, WASH YOUR HANDS.

A good source of information about animal contact events and infectious diseases is available from the National Association of State Public Health Veterinarians.

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While most people that want a pet stick to the tried-and-true species, there are a huge number of different animals available. Some make good pets, some are relatively harmless but not suitable for most households and some are potentially dangerous. Hedgehogs probably fit into the latter 2 categories.

No...hedgehogs aren't sneaking out of their cages and attacking people as they sleep. Rather, they can carry a variety of microorganisms that can be transmitted to people. There have been a few reports describing infections associated with hedgehogs, particularly Salmonella and ringworm. An excellent report in the journal Emerging Infectious Diseases  highlighted the diseases hedgehogs have been shown to, or could, transmit to people. Hedgehogs don't have to be sick to be a source of infection.

Hedgehogs have been available for years, but they may be a fad pet at the moment. One breeder is quoted as saying “They are going up these last two months we actually have a waiting list about twenty people,” said Sarah Roberts a breeder in Mansfield. “That's never happened in the year’s of breeding we've done.”

While any pet could transmit infections to people, certain pets are higher risk. Overall, species that are rare or 'fad' pets may be of greater concern because we simply don't know much about them (i.e. what diseases they can transmit, how to reduce risks...).

These small creatures can probably be safe pets in some households, but are they really better than other species? You probably should not have a hedgehog if you or someone else in the household has a compromised immune system or if you have small children. If you do have a hedgehog, don't let it roam freely in the house and wash you hands after handling it.

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Recently, a story about a man who brought a horse into a hospital to visit his father was widely reported. The horse apparently made it to the man’s room, which included a trip in an elevator. The son, who appeared intoxicated, was eventually asked to leave (and take the horse with him). Said a hospital spokesperson “We do have a pet visitation policy, but it does not include a horse”. Strangely, the horse that was brought to the hospital apparently wasn’t even the father’s horse (which supports suspicions of the son’s lack of sobriety).

There are guidelines about which animals are appropriate for hospital visits, although it shouldn’t take an expert to figure out that a horse is not an appropriate candidate. Kicks, bites, and trauma from being crushed or run over are among the most obvious concerns. Horses can also carry a variety of bacteria that are potentially dangerous, especially to people in hospitals. These include Salmonella and methicillin-resistant Staphylococcus aureus (MRSA). There also aren’t that many house-trained horses out there.

So, while I can easily see how someone in a hospital would like to see his or her horse, there’s no way this should even be considered.

Some closing thoughts
-    Would you like to ride in an elevator with a horse?
-    Would you like to be stuck in an elevator with a horse?
-    Do you think the horse was house trained?
-    Do you think any of the healthcare personnel washed their hands after touching the horse?

This isn't the first time a horse has been in hospital, and some even get invited. The picture is from a story in Veterinary Practice News that described a program where horses were brought into hospitals!

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INFORMATION SHEETS specifically for KIDS, for VETERINARIANS, for PHYSICIANS and for PUBLIC HEALTH PERSONNEL are also available on the Worms & Germs RESOURCES page!

Click on the highlighted topics below for information sheets. Topics that are not highlighted are in development and coming soon. Sheets for other animal species and diseases are also under development and will be added when they are available.

Animals	Diseases	Other
Dogs	Rabies	Litter Boxes
Cats	Giardia	Sandboxes
Turtles	Toxoplasma	Cat Bites
Hamsters	Leptospira	Raw Meat
Rabbits	Clostridium difficile	Petting Zoos
Pet Birds	Cryptosporidium	Needlestick Injuries
Reptiles	MRSA
	MRSP
	Salmonella
	Ringworm
	Campylobacter
	Bartonella henselae

 
Please Remember:

• Your veterinarian and physician are your ultimate resource for information about the health of your pets or your family.
• Information provided here is accurate to the best of our knowledge, but infectious diseases can be unpredictable and these sheets are for general information purposes only.
• There can be great variation in disease risks in different geographic areas. The information provided was developed for Ontario, Canada, but most of the information is relevant for other regions as well.

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