A new Expert Guidance Document has been released by the Society for Healthcare Epidemiology (SHEA) and published in Infection Control and Hospital Epidemiology.
R Murthy, G Bearman, S Brown, K Bryant, R Chinn, A Hewlett, BG George, EJC Goldstein, G Holzmann-Pazgal, ME Rupp, T Wiemken, JS Weese, DJ Weber. Animals in Healthcare Facilities: Recommendations to Minimize Potential Risks. Infect Control Hosp Epidemiol 2015
The guidance document covers 4 main areas
- Animal assisted activities (aka pet therapy, hospital visitation….)
- Service animals
- Research animals in healthcare facilities
- Personal pet visitation
The document provides recommendations for practices to reduce the risk of animal-associated diseases from these activities. There’s also some introductory survey information that highlights a few reasons why this guidance is important.
- Pet therapy was allowed at 89% of surveyed US hospitals.
- Personal pet visitation was permitted at 40%.
- Research animals were present in 35%.
- Many hospitals that allowed animals had no policy covering their activities.
- All facilities that allowed pet therapy permitted dogs. 21% also allowed cats, 5% miniature horses and 2% primates (ugh!).
- A few US facilities, including a Veteran’s Hospital, indicated that they did not allow service animals, something that contravenes the Americans with Disabilities Act.
This should be required reading for anyone involved in hospital administration, hospital infection control or pet therapy programs.
From CTVnews.ca "A Brazilian [soccer] player was taken to a hospital for an anti-rabies shot after being bitten by a police dog during a match. The incident happened in the second half of a first-division game between Democrata and Tupi on Sunday in the Minas Gerais state regional championship. Democrata striker Joao Paulo was bit on his left arm after running out of bounds and falling too close to a police officer's dog behind one of the goals. The dog was on a leash but the officer was not able to pull it back in time to avoid the attack. Joao Paulo returned to the match after doctors wrapped his arm in bandages, but the team said he was taken to a hospital immediately after the game to receive the anti-rabies vaccine.”
Oops, on a few different levels.
Firstly, it’s surprising that a police dog would bite in a situation like this. They’re not typically trained to attack in the face of soccer field boundary transgressions.
Secondly, the medical response is a bit bizarre. Yes, rabies needs to be considered after any bite from a dog. You’d hope the police dog was vaccinated against rabies, making it a pretty low risk situation. Regardless, rabies post-exposure prophylaxis is completely unnecessary. Presumably, they’d be able to quarantine and observe the police dog for 10 days. If they can do that, there’s no need for rabies treatment. If the dog’s not showing signs of rabies after 10 days, it could not have been infectious at the time of the bite. That’s a lot more logical response than treating the bitten player.
What the player really needed was proper bite first aid. Placing a bandage on might be the quickest way to get him back on the field, but properly flushing the wound is the best way to prevent infection (something that could keep him off the field much longer).
Two cases of fatal equine herpesvirus type I (EHV-1) neurological disease have been confirmed in the Dickinson, Texas, area. Three more recent deaths are suspected to be associated with the virus as well. The horses were from two boarding stables that are currently under quarantine, as is a veterinary clinic. As always, there’s a need for prudence and common sense in this situation. EHV-1 outbreaks are typically small and easily contained, but the right combination of bad luck and bad management can lead to widespread problems. The keys to containing an outbreak like this are prompt investigation to identify exposed horses, good communication, honesty (e.g. not hiding the fact that you have a sick or exposed horse), cooperation/compliance and basic infection control practices. So far, it sounds like none of the monitored horses have developed signs of infection and hopefully this one’s going to be done soon.
A more perplexing situation is the report of glanders (Burkholderia mallei infection) in a German horse. Glanders is a very serious disease in horses that can also be transmitted to people, and B. mallei is considered a potential bioterrorism agent. Glanders has been eradicated in many regions of the world, but some are concerned that eradication may be at risk. This case supports that concern since Germany hasn’t seen a case of glanders since 1955, and the affected horse in this case never left the country. The horse wasn’t sick, but it had serological (antibody) evidence of having been infected. Testing was only performed because the horse was being exported. Serological testing was repeated and was still positive, so the horse was euthanized. Glanders was subsequently confirmed through identification of bacterial DNA from skin scabs. None of the 30 other horses that were being monitored developed disease and all were negative on blood tests. The situation is considered "resolved," but with no source identified. The OIE report concludes “It is known that the affected animal had never been moved outside of Germany. There might have been indirect contacts to South America. The source of infection is still unknown.”
H5N8 avian influenza has been identified in a dog in Korea. The dog was from a duck farm in the South Gyeongsang province. While other dogs in the past have been found to have antibodies against the virus, this the first report of finding the antigen in a dog.
It’s an important distinction.
Antibodies mean a dog has been exposed to the virus and mounted an immune response. Antigen means that the actual virus was found, usually at an external surface such as the nose, throat or in feces. It’s not clear where the virus was found (e.g. nasal swabs, feces...) or how it was detected.
It’s suspected that the dog ate an infected bird on the farm. That makes sense, since ingestion of infected birds has been shown to transmit the virus to other species as well. What this means in the bigger picture is unclear.
The dog was clinically normal, which is good for the dog but also raises some public health concerns. If dogs can be infected and shed live virus, then there would be concern that they could be infectious (able to transmit the virus) to other animals or people. It’s a big step from "antigen + clinically normal" to "infectious," and most likely dogs are rare, dead-end hosts (i.e. individuals that can become infected but do not pass on the virus). Care must be taken not to over-react, but it means that the potential role of dogs in virus transmission needs to be studied.
I haven’t seen any information about what happened to the dog. Hopefully it was just isolated and monitored, since only short-term influenza shedding would be expected.
So, what does it mean when the critter draws blood?
Sun Prairie, Wisconsin residents will find out this year, after Jimmy the Groundhog bit the town’s mayor. After a limo ride (which probably didn’t do much to calm Jimmy), the mayor leaned in to hear Jimmy’s prediction and Jimmy chomped on his ear.
Apparently, Sun Prairie needs to practice the whole groundhog day thing. Not only did their groundhog attack a person, the mayor and the groundhog handler apparently disagree about Jimmy’s interpretation.
"[Jimmy’s caretaker Jerry] Hahn added this was Mayor Freund’s first time participating, which could have added to the confusion."
- Shadow/no shadow…doesn’t seem to prone too confusion to me.
No word on whether Jimmy’s under a rabies observation period.
Image credit: April King 2004 (click for source)
Echinococcus multilocularis is causing increasing concern in Ontario lately (amongst the few people who are aware of it, at least) as there’s evidence that it may have become established in the province. This parasite is a tapeworm harboured by canids (including both domestic dogs and wild ones like coyotes and foxes), and can cause serious disease in people. It’s an insidious problem since the incubation period in humans is many years, meaning it takes a long to realize that there’s a problem.
We don’t know the status of this parasite in the province but there’s enough evidence to be concerned and look into the issue further.
If you want to learn more about it, Dr. Andrew Peregrine’s recent seminar on the topic is a great start.
Concern (paranoia?) about Ebola in animals has died down lately, which is a good thing. In the meantime, guidelines have been developed to help handle potential animal Ebola-exposure issues, which is also a good thing.
While I’ve been slow posting them, Canadian guidance for management of companion animals potentially exposed to Ebola virus and for animal contacts of people potentially exposed to Ebola virus have been finalized. It was a lot of effort for something we’ll probably never use, but if we have to use them once, we’ll be very glad we went through the process. There were also benefits of getting various groups working together and thinking about the issues, so even if we don’t use them, the process was still valuable.
Part of the process also included a practice-run of certain procedures (done in collaboration with OMAFRA staff) using our dog Merlin as the "exposed" animal. For more pictures, see the earlier W&G post or the recent University of Guelph press release.
For anyone who's curious, here they are:
As reported on barfblog.com (with, as ever, an entertaining title: You see a cute turtle, I see a bug factory: Infant botulism from C. butyricum) a recent paper in the journal Epidemiology and Infection (Shelley et al. 2015) reports an unusual turtle-associated disease.
When we think about turtles and infections (especially infections of young kids), the first thing that comes to mind is Salmonella. That’s fair because it’s common and can be serious. However, like any animal, turtles can carry a range of microbes that can infect people. Apparently, we need to add the bacterium Clostridium butyricum to the list.
The paper describes botulism in two infants caused by this bacterium and related to turtle exposure. Botulism is classically caused by Clostridium botulinum, a bacterium that can produce some of the most potent neurotoxins known to science. However, a couple of other bacteria, including C. butyricum, can produce similar toxins and cause the same disease. Infants are highly susceptible to disease caused by ingestion of the bacterium, since it is able to grow in their gut because of their poorly developed intestinal bacterial flora. (In more mature individuals, botulism isn’t usually caused by ingestion of the bacterium itself. Rather, it's caused by eating food that contains the toxin that was produced when the bacterium was able to grow in the food).
The first case was an 11-day-old boy that was presented to a hospital with various neuromuscular abnormalities. As is common, he had to be put on a ventilator to help him breathe, but fortunately he made a full recovery over the next 10 days. Botulism was suspected early in the course of disease and he received antitoxin (antibodies against the toxins), which probably played a key role in his response. However, C. butryicum, not C. botulinum, was identified in his stool and it was confirmed that the bacterium was able to produce botulinum toxin E.
The second case was a child of about the same age admitted to hospital with breathing problems and a few other issues. Botulinum toxin E was found in his stool, and C. butyricum was isolated.
Investigation of possible sources of the bacterium ensued. Various food and environmental surfaces, plus feces from the parents, were tested. For the first boy, C. butyricum was isolated from his mother’s feces, as well as their turtle aquarium water, sediment and turtle food. The same batch of food from the pet store was negative, so the food was probably contaminated in the house.
The only positive location in the second child’s case was the turtle tank water in a relative’s house, not the child’s house. The relative had held and fed the baby.
These cases also led to a review of a case of C. butyricum botulism that had occurred in 2010. It was assumed to have been caused by honey ingestion, but further investigation revealed the presence of the same type of turtle (yellow-bellied terrapin) in the house.
This report doesn’t change anything in terms of recommendations regarding how to manage turtles, but is good to raise awareness. Turtles should not be in households that have kids less than 5 years of age, for multiple disease reasons. Infection of the second child via a relative who owned turtles raises concern about how pathogens can be spread indirectly from turtles to high-risk individuals. The relative was reported to have put her finger in the baby’s mouth to soothe him at one point, and that would be a logical source of exposure, highlighting the need for good hygiene practices after having contact with animals and their environments, especially high-risk species such as turtles.
As the authors conclude “Adherence to advice that reptiles, including terrapins, should not be kept as pets in homes where there are children aged <5 years, primarily to prevent salmonellosis, would also prevent cases of infant botulism associated with terrapins. The importance of hand washing after handling these pets also needs to be stressed, especially while visiting families with small children.”
Residents of the Nunavut community of Kugluktuk are being warned about rabies in the area after a puppy that originated there was diagnosed with the disease in Saskatchewan. It’s not the first time rabies has been transported from a northern community in a dog, and this case should serve as yet another reminder of the risks of transporting diseases with animals (even within Canada). It looks like the puppy was "rescued" from the community and adopted in Saskatchewan. There are a lot of feral and semi-feral dogs in some northern areas, and various groups try to re-home them (with the best of intentions) to more southern communities.
The Deptartment of Health is warning Kugluktuk residents to stay away from dogs that behave strangely, and to make sure that they go to a health centre if bitten or scratched - good advice, although I’d expand it to staying away from all strange dogs, regardless of how they’re behaving.
There are two other important issues that this story brings up. One is vaccination of dogs, which can be difficult in communities that have limited access to veterinary care and/or where many dogs are "community dogs", without a defined owner to take responsibility for their care. Increasing vaccination is important to reduce the risk of rabies transmission, and there are efforts in many areas to do this. The other issue is adoption of animals. While rabies is now fairly rare in Canada, this isn’t the first time this has happened, so groups that wish to remove animals from northern communities should ensure that the animals are properly vaccinated prior to transportation, and that new owners are warned about the increased risk of rabies (albeit still quite low). You can never 100% prevent disease transmission associated with animal movement, but making sure animals appear healthy before shipping, having good preventive medicine practices in place, and adequately tracking animals after they are shipped are important (and practical) measures to reduce the risk.
This case (and the location of Kugluktuk) can be found on wormsandgermsmap.com
I had a question the other day about roundworms in feral cats. Specifically, how do you deworm a group of cats that you don’t handle and may not be able to catch? There are a few possible approaches, from trapping and treating (oral or topical) to trying to get a dewormer into them via food. Neither is a great option in many situations, because you can't usually catch all the animals (and feral cats aren’t always the nicest to handle...), or they might not get the proper dose of drug if its given in food.
Baits are a convenient way to treat wild and feral animals, since they are easy to administer and can work quite well. Rabies vaccine baiting has been highly effective in wildlife, and a similar approach could be used for parasite control.
A recent study in Emerging Infectious Diseases (Page et al. 2014) shows the potential usefulness of dewormer baiting for control of the raccoon roundworm, Baylisascaris procyonis, in urban raccoons. The researchers made dewormer baits similar to those used for rabies vaccine, with marshmallow flavoring (don’t ask me why, but raccoons love marshmallows). They mixed a dewormer, pyrantel pamoate, with marshmallow crème, and sealed it in a hollow fishmeal polymer bait container. They then distributed baits in the vicinity of raccoon latrines in suburban Chicago and also tracked a set of untreated latrines. Fecal samples were collected from the environment before and after one year of monthly baiting.
Pre-treatment, B. procyonis was identified in 13% of samples, equally distributed between sites they subsequently baited and sites they did not bait (to act as controls).
After the one year baiting period, B. procyonis eggs were found in 21% of samples from the untreated control sites but only 3% of the treated sites. That's a pretty dramatic (and statistically significant) difference.
This shows the potential impact of a relatively easy and cost-effective method to deworm raccoons, to reduce contamination of the environment and subsequent human exposure. It couldn’t be a one-shot deal, though. You’d never eradicate the parasite and raccoons will continue to be exposed, even if levels in latrines decrease. So, ongoing baiting would be needed to control the parasite and keep contamination down. That involves more effort and cost, but could be reasonable in high risk areas, such as parks with lots of raccoons and lots of human and pet traffic, or in other areas where elimination of latrines is not practical but there is a reasonable risk of human or domestic animal exposure.
It also raises questions about whether this might be an effective approach for feral cat colonies... stay tuned.