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

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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A friend recently asked me about having service dogs in classrooms. Her sister, who is a learning resources teacher, told her about an autistic child who will be attending her school with a dog. The dog prevents the child from bolting and helps reduce anxiety. She thought this was an interesting topic because of the various pros and cons that need to be considered, and I certainly agree. It may seem simple at first glance, but when you think about it, it's a rather complex situation.

Contact with animals always comes with some risk. We can never eliminate the risk entirely. What we need to do is determine how to maximize the benefits and minimize the concerns, and ultimately decide whether the benefits are worth the risks.

In this situation:

Potential concerns/risks (to the child and/or those around him/her):

• Zoonotic disease transmission
• Bites/scratches
• Allergies
• Anxiety in children/adults who are fearful of dogs
• Management issues (e.g. who's responsible for making sure the dog gets walked)
• Classroom disruption (e.g. barking, whining, wandering)

Benefits:

• Letting the child attend and get the most out of school
  

That's a pretty big benefit, and it's clear this is a good situation as long as the risks are controllable.

What should be done in a situation like this?

• The true need for the dog has to be assessed. Is it really beneficial? Presumably yes, but the question has to be part of the assessment. There should be a formal evaluation/way to determine that "yes, this animal is needed so we should do everything we can to facilitate it." It doesn't  need to be a restrictive process at all, but it should be in place. (The situation in the US with the ADA complicates this - pretty much anyone can say they have a service animal and the amount of scrutiny that can be applied is minimal. More discussion about this can be found in a previous post, just click here).
• The dog should, ideally, come from a recognized service dog organization. This ensures that the dog/person pair is properly evaluated and the dog is trained. If this is not possible, then the next best thing is for the pair to be involved with a service organization so they get similar (but after-the-fact) training. Getting a formally trained dog may be difficult under some conditions because, while some service dog types (e.g. guide dogs for the blind) are well established, formal programs to provide trained dogs for many other conditions are uncommon or or non-existent.
• The school board should be notified as early as possible. This gives them the chance to make any necessary arrangements.
• Parents of other children in the classroom should be notified. They don't need to be told why the dog is needed (privacy of the student bringing the dog is an important issue), but they should be told a service dog will be in the class and what the school will do to reduce any potential problems. If there are any concerns (e.g. serious allergies, fear of dogs) they should be allowed to move their children to another class without any hassles. Ideally this should be done before the school year starts to reduce any possible stigma of someone being moved because of the dog.
• The teacher should be educated about risks and benefits of therapy dogs. The teacher is a critical link as he/she will oversee routine management of the animal. The teacher needs to understand the benefits of service animals in order to accept the animal in the class. The teacher also needs to understand the potential problems so he/she takes his/her role in management of the situation seriously.
• General hygiene practices (e.g. hand washing after touching the dog) should be emphasized and enforced.
• Any "incidents" must be recorded and reported. Furthermore, follow up to figure out  what happened, why and how it can be prevented is crucial. Any aggressive or other disruptive behaviour by the dog cannot be tolerated and requires an immediate review. A proper service dog should not pose any significant behavioural risks (e.g. biting, barking during class, wandering around). The less the scrutiny of the dog at the start, and the less the specific training, the greater the likelihood of such problems occuring.
• The dog's veterinarian should know it's a service animal. The dog must be examined by a vet at least yearly, and at a minimum it must be properly vaccinated against rabies. If the dog becomes sick, it must be taken to a vet promptly. If the vet identifies a disease that might be transmissible to people, the dog must not go to school until the risk period for transmission has passed.
• A plan must be established for walking the dog and handling feces. The dog should not be taken to defecate on the playground. It should have a separate grassed area in which to defecate that is away from where children play. Feces must be promptly removed and disposed of, and hands washed.

Service animals can be a contentious and emotional topic. They certainly do provide tremendous benefits to some people, so we need to do what we can to facilitate them. At the same time, we need to properly manage the situation to reduce risks to others. Usually, a thorough proactive review of risks and benefits, and a detailed discussion of what will be done, can greatly reduce any concerns and maximize the benefits. They key is actually thinking about these issues and doing something about them before there is a problem.

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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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I'm constantly amazed at what some people do with bats. Bats are a leading cause of human rabies exposure in North America.  Despite extensive efforts to educate people about the importance of avoiding contact with bats, some people still either don't know or don't take these warnings seriously.

The latest bizarre example of stupid things done with bats occurred in Montana, where a parent brought a dead bat to a school and let young children (kindergarten and grade 5 students) touch it. Touching a bat in itself is a bad idea, let alone touching one that has died of unknown causes and encouraging kids to touch it. The teachers apparently had no objections to this activity. The parent who brought the bat had the students use an alcohol hand sanitizer after touching the creature, but it is still very irresponsible for someone to encourage children to touch a high-risk animal, regardless of what is done after. I'm sure the parents of the children didn't know beforehand, and certainly some were no doubt very upset when they found out about the incident (or livid would be a better description, if it was my kids that were involved). School officials did not find out about the dead bat until after its little visit, at which time the local and state public health authorities were contacted. The bat was tested and was positive for rabies.

Overall, the risk of rabies transmission is probably low in this case, but not zero.  It has therefore been recommended that the 80 students that may have touched the bat be given post-exposure rabies shots, which may cost up to $800 per child!. Another ten children may have touched the bat at a soccer practice - for a dead bat, it sure covered a lot of ground!

• Never touch a bat, dead or alive.  Obviously, if you shouldn't touch a bat, you shouldn't encourage kids to do so either!
• Unstructured and unapproved contact with animals in classrooms should be prevented. Animals can be good educational tools, but only if student and animal health and welfare are properly addressed.

More information on Rabies is available on the Worms & Germs Resources page.

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