Rabies update

ProMed Mail's monthly US rabies update often contains some interesting cases, and the last one is no exception.

A llama in Georgia became aggressive, started biting itself and was spitting at one of its caretakers. A spitting llama certainly doesn't mean rabies (I have dodged enough llama spitballs to know that) but any sudden change in behaviour, especially with aggression, should raise some major red flags. Here, the llama was diagnosed as rabid and the person that was spat on is receiving post-exposure treatment.

bobcat attacked a man and boy in Massachusetts, and not surprisingly, was diagnosed with rabies. In this case, the bobcat pounced on the man, bit his face, clawed his back and held him in something akin to a bear hug, before moving on to the man's nephew. Wild animals don't typically attack except under extenuating circumstances (e.g. being cornered, protecting offspring), so this type of event should be considered a rabies exposure until proven otherwise. The man shot the bobcat and it was confirmed as rabid.

In an all-too-common scenario, a family that took in a stray kitten ended up needing post-exposure treatment because the kitten was rabid. They found the sick kitten and tried to nurse it back to health, but it died the next day. Fortunately, animal control arranged for rabies testing, something that could have easily been overlooked if no one thought about rabies and just assumed the kitten was sick for some other reason. Two dogs in the household were also considered exposed, but fortunately had been properly vaccinated, so typical recommendations would be for a 45-day observation period versus 6 months strict quarantine or immediate euthanasia had they not been vaccinated.

In a similar scenario, two women are undergoing post-exposure treatment after being bitten by a stray kitten they were trying to catch. After they caught the kitten, they took it to a local Humane Society, where it was euthanized because of the bite. This ended up being an efficient approach, but more often there would be a 10 day observation period of an animal that had bitten someone, to see if it developed signs of rabies.  If signs occurred the animal would be euthanized and tested for rabies, but if not then (theoretically) the animal would not have been shedding rabies virus at the time the bite occurred. Immediate euthanasia after a bite is not the typical recommendation, so I wonder whether the kitten was already showing some signs of disease. Otherwise, it wasn't a textbook approach to bite management but it ultimately resulted in the right outcome. 

These cases have a few recurring themes:

  • Changes in animal behaviour should lead to consideration of rabies.
  • Be wary of stray animals. It's best to stay away from them. If you end up taking in a stray, if it gets sick and dies, ensure that it is tested for rabies.
  • Vaccinate your pets because you never know when you'll encounter rabies.

Israel issues rabies travel warning for tourists to India

Israel's Health Ministry is recommending rabies vaccination for people traveling to India.This seems to be mainly in response to the recent high-profile case of an English woman who died of rabies acquired from a dog in India. While it was high-profile, that certainly wasn't the only travel-associated rabies infection in the past year.  Rabies exposure is a serious concern for people who might encounter dogs (intentionally or accidentally) while traveling in countries with endemic canine rabies. The news report states that rabies vaccine is available at clinics in Israel for would-be travelers, however it doesn't say whether the cost of vaccination is covered by the government. Human rabies vaccination is quite expensive, which may be a limiting factor when it comes to convincing travelers to get vaccinated, unless the government foots some or all of the cost.

Raising awareness of the problem with rabies in some developing countries is good. Most people don't really think about travel-associated disease (beyond the ubiquitous diarrhea that comes with travel to some areas), particularly something like rabies. In addition to focusing on vaccination, however, it would be even better to see a broader initiative to remind people to avoid contact with stray dogs (and other animals) and to make sure they get proper medical care after potential rabies exposure. Also, while India is certainly a hotbed of canine rabies, it's important to remember that there are many other countries where dog rabies is a major problem, and similar measures need to be taken for travel to these places too.

A surprisingly large number of people get sick and die every year from diseases acquired during travel. Travelers need to be aware of disease risks in areas they visit, know what preventive measures they should take and how to get proper medical care in any region they visit. While thinking about this might put a damper on vacation planning, it's worth the effort. When it comes to rabies, unless you know that a region is officially (and truly) rabies-free, assume that any encounter with a wild mammal, especially a stray dog, could be a source of rabies exposure. You don't want to travel in a bubble and stick to sterile locales, but you also don't want to come down with a fatal disease when some basic precautions could have prevented it.

Latest round of rabies news

ProMed's latest accumulation of rabies reports has the typical mix of domestic animal and wildlife rabies cases, and some recurring themes.

Fox / dog / human, North Carolina

In this case, a rabid fox had a "direct encounter" with several people, then it was killed by a dog. Three people have started post-exposure treatment.

  • The article states that the dog was vaccinated against rabies, which is good to hear. However, it goes on to say that exposed pets need to be euthanized or have a 6 month quarantine. In reality, standard guidelines are that unvaccinated pets are treated like this while vaccinated pets undergo a less rigourous 45 day observation at home. Hopefully the discrepancy is simply due to inaccurate reporting and not misinterpretation of guidelines by local officials.

Cat / human, Maryland

A rabid stray cat scratched five people, who have been urged to undergo post-exposure treatment. Officials are calling for anyone who potentially had contact with this cat go to an emergency room.

  • However, odds are if someone goes to an emergency room and says they might have had contact with this cat, they're just going to sit around until someone tells them they don't know what needs to be done, or to go home and deal with someone else. Rabies exposure is a medical urgency, not an emergency. People should take a little extra time to work with their physician and/or public health rather than go to the emergency room.
  • People who may have had contact with the cat need a proper assessment to determine if they were potentially exposed to rabies, since just being around the cat or having casual contact is not a risk. Scratches are a bit controversial since they are low risk for rabies transmission (unless the scratches become contaminated with saliva from the animal), and there are conflicting guidelines regarding what to do for a person who is scratched.
  • This is also a good reminder to stay away from stray cats.

Fox / human, Pennsylvania

In this report, authorities are trying to find a person that cradled an injured fox in a blanket. The fox was subsequently identified as rabid and they need to determine whether the person was potentially exposed to the virus.

  • Again, another reminder to stay away from wildlife, and if there is contact with wildlife, make sure rabies exposure is considered.

Bat / human, Indiana

A student was bitten by a rabid bat while he slept in an Indiana University dorm room. He woke up after being bitten (good thing, since he probably wouldn't have noticed otherwise due to the often tiny marks left by a bat bite).  He is now receiving post-exposure treatment.

Rabies isn't going away, at least any time soon. People need to be aware of the risks in rabies-endemic areas, take care around wildlife and vaccinate their pets.

Photo credit: Rob Lee (click for source)

Niagara (NY) SPCA under scrutiny

The executive director of the SPCA of Niagara is under pressure from charges that he's "presided over the killing of hundreds of animals." As is common with shelter controversies, sorting through the emotion and rhetoric is difficult. At best, running a shelter can be a thankless task, due to the overwhelming number of animals, emotion, lack of understanding by the public (and often personnel) of the relevant issues, financial challenges and often poorly designed facilities. At the same time, bad things do happen in shelters, and it's critical to put in the time and effort to determine whether things are being done poorly and what needs to be fixed. Here are some of the issues from the Niagara situation.

"From Oct. 1 to Dec. 15, the local SPCA euthanized 473 cats and 100 dogs, a staggering total of killings, according to sources familiar with the situation at the Lockport Road shelter."

  • Apart from the problem of relying on information from anonymous sources, it's hard to put this number into context. You need to know the overall number of animals that come in and the shelter's capacity. It's a sad fact that about 50% of cats are euthanized at most shelters internationally because of massive overload. Shelters shouldn't be cat warehouses. It does no one (including the cats) any good to stockpile huge numbers of cats that never have a chance of adoption, and it creates a perfect environment for disease outbreaks. So, while that number of animals seems high at first glance, it may just reflect the reality of supply and demand, shelter capacity and the health/adoptability status of the animals.

"When he was hired, Faso admitted, “My animal care experience is very minimal.”"

  • A shelter director doesn't need to be an expert in shelters and animal health. In fact, some excellent shelter directors have come into the job with no experience whatsoever. Their job shouldn't be running animal care. They should be running the shelter, managing personnel, raising funds, liaising with the community and doing a host of other activities. The key is having good veterinary and animal care support, and a willingness to listen to those people. It would be great if every shelter manager was a veterinarian with a shelter medicine residency under his/her belt, along with an MBA and training in communications, but that's not going to happen. Someone with little animal knowledge but the ability to listen and take advice can be an excellent shelter director.

"McAlee and others tell horror stories of animals brought to the shelter for surrender or picked up on the streets and in need of medical care, who are then left to suffer in their cages. In one case, a cat that appeared to be suffering from a broken jaw was brought in and allowed to stay for a week in a cage without treatment. Finally, a concerned staffer took the cat to an emergency veterinary clinic where it was treated and then returned to the shelter."

  • That's a big problem. If true, and if this was done because of pressure from the director overriding advice from medical staff, then that's completely inappropriate. Interference with medical decisions and medical care does occur in some shelters and is a major problem.

"When the cat then developed a common respiratory infection, rather than provide further medication for the animal, Faso directed that it be euthanized."

  • This is a tougher issue. I hate to see potentially treatable animals euthanized, but euthanasia is an appropriate response in some situations. If they are unable to properly manage an infectious case or are overwhelmed with healthy cats, keeping an infectious cat may pose a huge risk to all of the other cats in the facility. It's impossible to say much here without more details.

"Other sources tell the Gazette that cats at the shelter have been injuring themselves in out-dated display cases and that a donor offered to fund the replacement of those cages. Faso, reportedly, refused to accept the donation."

  • Poor housing is a common problem in shelters. Good cages are expensive. It would be bizarre for a shelter manager to turn down money (that came with no strings attached) and if that was done, it would be another sign that Mr. Faso's not right for the job.

"..he has reportedly told board members and others that the local SPCA will “never be a no-kill shelter because it’s too expensive."

  • That's an unfortunate fact. No kill shelters just aren't viable in the grand scheme of things. Individual shelters can be no kill, but that's often done by cherry picking the adoptable animals.

It comes down to math. If 50% of cats coming into shelters are euthanized every year because of lack of space, to convert to a no-kill approach we'd need to massively increase shelter capacity every year to accommodate the increasing population. Millions of dollars would be required to create cat warehouses where millions of unadoptable cats lived marginal lives in facility confinement until dying of natural causes or from the massive disease outbreaks that would be certain to happen. I know I'll get reams of emails complaining about this paragraph, but to me it's a simple fact. If you increase supply by 100% per year by not euthanizing any animals, and demand doesn't increase, the math quickly shows you the size of the problem that would be created.

The only way to get to the point where no-kill is a viable approach is to have more responsible pet owners and better animal population control. Euthanasia rates are much, much lower in dogs, in part because of much better population control and also because people tend to try harder to recover lost dogs compared to lost cats. Recovery rates of lost dogs that make it to shelters are very high. Cats... not so much.

So, if you want to help out shelters and the animals in them:

  • Spay and neuter your pets.
  • Donate to good quality shelters to help them provide optimal care.
  • Volunteer, if you have the time and interest.
  • Hold shelters to a high standard, but make sure it's a realistic standard.
  • Encourage municipalities to properly fund animal shelters and enforcement.
  • Consider adopting from a shelter if you are getting a new pet.
  • Take the time to learn about the issues, and make assessments based on fact, not just emotion.

Dog rescue issues

The Toronto Star has an article describing the efforts of Naz Sayani to bring home a group of street dogs from India. As an animal lover, she was touched by the number of stray dogs roaming around New Delhi while accompanying her daughter to India for medical treatment. She borrowed a car and started driving around the city dropping off food for strays.

  • This is a high-risk activity for rabies exposure. Rabies is very common in India and contact with strays is a prime source of human infection. Ideally, anyone working with strays should be vaccinated against rabies. At a minimum, they should be aware of the risk and be ready to get post-exposure treatment if exposed (possibly through a quick trip out of the country, since knowledge about rabies prevention and access to rabies post-exposure treatment is variable in India).

A pregnant stray dog caught Naz's eye, and after hearing about people threatening or abusing the dog (and later her and her pups), she tried unsuccessfully to find them homes. Eventually, she made the decision to bring them to Canada, in order to try to find homes for them here.

I can certainly see how this would happen, as it's easy for people to get attached to a friendly, needy animal. It's also hard to balance a case-based scenario like this, when someone has an attachment to a specific animal, with the bigger picture of animal rescues, and all the associated pros and cons.

I get a surprising number of advice calls and emails from people "rescuing" dogs from various places.

  • The typical questions goes something like "I am organizing a rescue of a group of dogs from [insert one of many central or southern US states here] and want to know if there are any infectious disease issues I have to worry about".
  • Worse are the calls that go "I just got some rescue dogs from [wherever] and now my other dogs are sick. What might be going on?"

People that are rescuing dogs usually do it because they have big hearts. Some people like the "status" that they see attached to certain rescue dogs ("You have a new Mercedes? Well I have a new Hurricane Katrina rescue dog"). My problem with international rescue efforts is the question of a) whether it's a good use of resources and b) whether it poses unnecessary infectious disease risks to people and other animals.

Resources

  • Organizing rescues, fulfilling regulatory rules, shipping dogs and finding them homes takes a lot of money. It would make more sense if there was a shortage of adoptable strays in Ontario. However, I haven't heard any shelter personnel lament their lack of dogs, undercrowded facilities or excessive financial resources. 

Diseases

  • Moving animals between different regions carries an inherent risk of transmission of infectious diseases. The more movement, the more mixing and the greater the difference in infectious diseases in the areas, the greater the risk of making more animals sick, and potentially doing more harm than good.
  • Rabies is one concern, and rabid dogs have been imported into North America in the past. Since rabies has a long incubation period, it's hard to be certain that a dog's not incubating a rabies infection.
  • More likely to be imported would be a wide range of other bacteria, viruses, parasites and fungi. These are a concern from several standpoints. Some might cause disease in the imported animal, and diagnosis may be delayed or missed because of it being a disease with which local veterinarians have no experience. Some might bring an unusual pathogen into the area that could be spread to a few other in-contact dogs. Worse, some might bring in a new pathogen that could then establish itself in the local (or national) dog population. We don't know how often any of these scenarios occur, but they are always a risk, and need to be part of the cost-benefit analysis of animal rescue operations and associated animal importation.

At the end of the day, it's hard for me to support rescuing dogs from other regions when we already have a large population of dogs in our own shelters and animal being euthanized here because there are no homes for them. I can't justify the expense and risk of importing dogs if, for every new dog imported, one other dog in a local shelter gets euthanized because it doesn't have a home. Does importation really mean fewer adoptions here? We don't know, but it stands to reason.

A situation like this is a little different, as a chance and presumably (hopefully) one-time event prompted by a specific human-animal bond. Overall though, we could do better for the dog populations both here and in regions where there are massive stray problems by focusing attention on better care and adoption here, and international programs aimed at helping stray populations abroad through vaccination, education and sterilization efforts.

Miami Beach's Cat Poop Map

Miami Beach officials, disturbed by reports of a hookworm outbreak, have taken a rather unique approach to the problem: they've created a cat and cat poop map.

This fall, several cases of cutaneous larval migrans were reported - and highly publicized - in the Miami Beach area, something that is of particular concern for a tourist city that doesn't want people thinking the city's beaches are biohazardous.

Cutaneous larval migrans is a skin condition caused by migration of hookworm larvae through the skin. Dogs and cats can be carries of hookworms and pass eggs in their feces. Larvae then hatch from these eggs and can penetrate the skin (of people and animals alike) after being in the environment for a few (usually 2-9) days. If someone has contact with infectious larvae, such as by stepping on them while bare foot on a beach, the larvae get into their skin and start migrating, causing this very itchy skin condition.

Feral (stray) cats are the main problem in Miami Beach. Stray cats and beaches are a bad combination, since stray cats tend to have high rates of hookworm carriage, they often defecate in sand on the beach, and of course people often have direct contact between bare skin and beach sand. Identifying where stray cats live (and poop) is important for disease control and public education. "We needed to identify where the cats are eating — and where they're pooping — to address this problem" stated a program organizer. To do this, city sanitation workers were given GPS devices and instructions to go find cats. Data were uploaded into a mapping system, and areas where cats tend to congregate were identified. Not surprisingly, certain areas of sane dunes are being used as industrial-sized litterboxes by the cats.

This type of information can be used in several ways. It can be useful for evaluating cat populations: where they are, where they go, and what happens to them over time. It can help identify areas where the cat population needs to be addressed through measures such as trap, neuter and release programs (as are being used in Miami Beach). It can also help with development of targeted education programs, by putting up warnings in heavily cat- and cat poop-infested areas. City health officials think that the combination of tracking, the increased spay/neuter program and targeted warnings to sunbathers have helped staunch the outbreak.

Image source: http://blogs.miaminewtimes.com

No good deed goes unpunished: Cat rabies version

A Royal Oak, Michigan resident is undergoing rabies post-exposure prophylaxis after being bitten by a rabid cat. The person found a sick cat by the side of the road and took it to a vet clinic... a good deed in theory, but problematic in many ways. One obvious risk is the potential for rabies exposure, as occurred here. The cat was subsequently diagnosed as rabid, and having been bitten the good samaritan was clearly exposed. Fortunately, the veterinarian kept the contact information for the person who dropped off the cat, who can therefore now receive the necessary treatment.

Associated with this event, the Royal Oak Animal Shelter has issued the following reminder:

  1. Do not approach any animal if it appears sick. Call the Police to get animal control involved.
  2. Tell your children to stay away from any stray animals, whether they are skunks, dogs, or cats. Any of these could be infected.
  3. Vaccinate your dogs for rabies. It is the law.
  4. If you let your cats outside, STOP doing so. If you can't stop, please make sure your cats are vaccinated for rabies.
  5. If they already have been vaccinated, talk to your veterinary professional about having a booster administered to protect your animal. There is no cure for this deadly disease.

(click image for source)

Infectious disease considerations for fostering pets

Humane societies and shelters are often overwhelmed by the number of animals that come in. It's pretty uncommon to see much (if any) empty space in most shelters, and overcapacity shelters lead to increased risk of disease transmission, outbreaks and suboptimal care of the animals that are there.

One way of helping deal with overcrowding is fostering animals to people's homes for periods of time. Typically, foster homes take animals when shelters are at capacity, or take specific animals such as nursing cats, which are more difficult to care for properly in a shelter.

Most places have protocols for fostering, but they're not always very comprehensive and they don't always adequately cover some important areas. If you are thinking about fostering shelter animals, you need to think about the risks and whether you can manage them.

Are there people in the household that are at increased risk of infection?

Fostered animals should be assumed to be at higher risk of carrying and transmitting various infectious diseases. They can have high rates of carriage of various intestinal bacteria and parasites, along with a host of other microorganisms (e.g. ringworm). They may also be more likely to bite and scratch, not necessarily because they are aggressive, but often because they are young animals that may do so when playing. They may also be more likely to poop in the house.

Households with children under the age of 5, elderly individuals, pregnant women or people whose immune systems are compromised are at increased risk of various infections, both in terms of the likelihood of becoming infected and the likelihood of developing more severe disease. Households with these types of individuals should not foster animals. They are much better off having their own lower-risk pets.

Are there any "resident" pets in the household?

You might expect that someone willing to foster animals would also have their own pets, but that's not always the case. Non-pet owners are actually ideal, since this negates any risk of diseases being spread from or to household pets that live there long-term. However, it's more typical that foster homes also have such resident pets.

Are there any pets in the household that are at higher risk for infection?

As with people, there are some animals that are at increased risk of infection. These include the very young, very old, pregnant and pets with compromised immune systems. The latter group would include pets with chronic illnesses, those being treated with high doses of steroids for various diseases, animals with cancer, animals with diabetes, and a range of other issues. People owning a pet that fits into one of these categories should not foster animals because of the risk to their own pet. 

How do you reduce the risks associated with fostering animals?

  • May sure there are no high risk people or pets in the household.
  • Make sure the shelter or organization knows what they are doing. Make sure they have a clear protocol that says who will be fostered and how it's done.
  • Look at the animal before you get it. Visit it at the shelter. See if it looks healthy. If you have any questions, make sure it's examined by a vet before it reaches your home.
  • Use good hygiene. Wash your hands regularly. Properly clean up feces and clean litterboxes regularly.

If you have pets of your own:

  • Make sure they are vaccinated and on an appropriate parasite control program.
  • Keep the new animal away from your pet at the start. That lets you find out more about the animal, and it gives you more time to see if there are potential infectious disease concerns.
  • Do a controlled introduction of the new animal. Slow, supervised introduction of the animals can reduce the risk of bites or scratches.

Fostering is a good way to reduce pressures on humane societies and shelters, and to provide better care for some animals, like pregnant animals or those with young kittens/puppies. A good fostering program can be set up with limited risk to all involved, but infectious disease risks can never be completely eliminated. By accepting a new animal into your house, you increase the risk of exposing yourself and anyone else (human or animal) to infectious diseases. That's just a fact of life.

(click image for source)

Rabies galore

ProMed's monthly rabies update contains some recurring themes:

  • A couple of incidents of dog versus rabid raccoon. The dog usually comes out on top, but the raccoon can exact revenge at the end of the day through the need for quarantine or euthanasia. If the dog is not vaccinated, a long quarantine or euthanasia is required. If the dog is vaccinated, only a shorter observation period is needed.
  • A rabid skunk was found wandering around during the day with a wobbly gait and drooling. Any wild animal that is acting strangely should be considered rabid until proven otherwise. They don't have to be showing signs of severe neurological disease. Something as simple as not being afraid of people or wandering around in areas or at times when they would not usually be found should raise the suspicion.
  • A child who was sleeping outside woke up to "find a raccoon, kind of, scratching at his leg." (I  assume they mean it was "kind of scratching at the kid's leg," (whatever that means), instead of it was "kind of a raccoon.") The raccoon wasn't caught for testing but the child is undergoing post-exposure treatment because a normal raccoon wouldn't be expected to do that, so there is a significant chance of rabies exposure. Scratches are not high risk since rabies virus does not live in the claws, however it is possible that saliva from the raccoon could have been present on the animal's feet or the raccoon could have licked the child before scratching, such that the scratches could have then inoculated rabies virus into the tissues.
  • A couple of reports of rabies in rabid kittens. These cute little rabies vectors cause repeated problems, and lead to public alerts notifying anyone who may have handled the kittens to get evaluated to see if they need post-exposure treatment. Handling of strays should be avoided.
  • A family received post-exposure treatment after being bitten by their rabid cat. Vaccination of pets is not just for the health of the pet. It's to reduce exposure of people as well.

Trap/neuter/release controversy

Trap/neuter/release (TNR) programs involve trapping feral (stray) cats, then spaying or neutering and vaccinating them. Some cats are adopted, while the majority are released. The goal is to reduce the feral cat population by limiting the number of breeding animals, and to increase overall vaccine coverage in order to reduce illness and deaths. One such TNR program has come under fire in a Texas town.

In Leander, Texas, trapping wild animals (including feral cats) is illegal, but authorities have ignored the rules for groups that run TNR programs. One citizen, Carmen Amaya, is leading a charge to get authorities to start enforcing this so that TNR programs can't happen. The main reason appears to be that she's upset her dog was scratched by a feral cat and ended up with $800 in vet bills (not something I'd be happy with either, but is this really the best way to direct her anger?).

A non-profit group, Shadow Cats, has led the TNR effort and has trapped, neutered and vaccinated  about 3000 cats in Central Texas since 2004. About 500 were adopted and the rest released. The organization knows they are working outside the law and have lobbied for it to be changed. That was being considered in June, but opposition from Amaya and others has led to the creation of a task force to make a recommendation, which is due next month. In the meantime, Shadow Cats has ceased activities in Leander.

I'm not sure what the opponents to TNR really want. If it's just cessation of the program, there's no benefit to them.  Without the program:

  • Stray cats will continue to be around, and there will probably be more of them.
  • Potentially adoptable cats won't be taken into homes to improve the lives of those cats.
  • Vaccine coverage of the population will decrease. That's a critical point, because it will result in lower "herd immunity."   With herd immunity, the greater the percentage of a population that is immune to a disease (i.e. vaccinated), the lower the likelihood of the disease establishing itself in and spreading through the population, even among those individuals who don't get vaccinated.

On the other hand, if these people simply want Shadow Cats to stop releasing the neutered cats back into the neighbourhood, it means either 1) finding a way to care for all those cats in shelter, which simply isn't realistic for a multitude of reasons, not the least of which is cost, 2) releasing the cats elsewhere, which doesn't actually solve the problem, it just makes it someone else's, or 3) euthanizing all the cats instead of neutering and releasing them.  If they're hoping that by objecting to the TNR program that all the cats being trapped will be euthanized instead, they need to realize:

  • It's not going to happen as long as volunteer "rescue" groups are in charge of the program. These groups aren't going to trap and kill.
  • The city is unlikely to do it either, and there's a cost to having city personnel catch the cats and take them somewhere to be euthanized.
  • Most importantly, culling has been shown time and time again to be an ineffective way to control feral animal populations. What's needed is a combined approach that includes measures such as neutering and vaccination, education to reduce the risk of human and domestic animal exposure to feral animals, and taking steps to discourage feral animals from spending time in close proximity to people and domestic animals.

Amaya states that "her" feral cat is a nuisance and she doesn't want it on her property. So what is she trying to accomplish? If anything, her actions will just help her single stray cat turn into a large extended family of stray cats that are susceptible to rabies.

There are certainly concerns with feral cats and TNR programs. They are not perfect and not always run well. Some people are opposed to them for various reasons, some of which are quite reasonable. It's a tough issue because one person's idea of success might be completely different from someone else's. Some people focus on the number of animals, while others focus on the quality of life of the animals, public health aspects, impacts of feral cats on wild bird populations and other diverse areas. A local council isn't going to be able to solve these problems, and it really comes down to an assessment of the potential usefulness of the program and the ability of the people involved to do it safely, ethically and legally.

Personally, I'd rather see well-designed, well-run and regularly-evaluated programs to try to reduce feral cat (and dog) populations, and (perhaps more importantly) increased vaccination coverage in the feral animal population, than nothing. Feral animals aren't going to disappear if we ignore them.

Image source: www.shadowcats.net

Rabies in a household but hopefully not in a nursing home

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

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

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

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

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

 Video from wfaa.com

Bali rabies vaccination plan

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

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

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

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

Image: Mt. Agung, southern Bali

Stray cats and H1N1 influenza

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

Feral animals need to be exposed to H1N1

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

They need to become infected AND shed appreciable levels of virus

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

They need to be exposed to susceptible people

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

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

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

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

Stray cat roundup in New Jersey

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

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

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

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

Attention Sears shoppers... Avoid rabid kittens!

State public health officials are trying to get the word out about a potential rabies exposure in Annapolis, Maryland.  A rabid kitten was discovered outside a Sears store at the Westfield Annapolis shopper center. The concern is that people may have handled the kitten and been exposed. It's a major concern with kittens because they can be hard to resist - a pathetic-looking/cute little kitten sitting around in a public place could easily be picked up by many people. Also, when rabies is found in a young kitten, there are often other rabid kittens from the same litter in the area. Rabid stray kittens have caused widespread exposure in the past, and this case may be no different.

Anyone who recently had contact with a stray kitten in the area in question should contact public health officials as soon as possible. Simply touching the kitten is not a rabies exposure risk, but anyone that has had any contact with a potentially rabid animal should talk to public health officials to determine whether there is any risk of infection and whether post-exposure treatment is required.

While kittens are hard to resist, avoid handling stray kittens. This is especially true if it's transient handling where you will never know what happened to the kitten afterwards (as opposed to someone adopting a kitten off the street - this is still risky from some standpoints, but at least you know if the kitten gets sick and you can make sure that it is tested for rabies or other other zoontic diseses, if need be).

Oprah's Parvo Pups

The latest issue of Oprah's magazine "O" features the icon talking about her recent puppy dog adoption drama involving canine parvovirus. It just goes to show that even the pets of the biggest celebrities in the world are not beyond the reach of common microscopic infectious pathogens.

A couple of months back, Oprah adopted two cocker spaniel puppies from a shelter in Chicago. Unfortunately, within two weeks they both came down with parvovirus infection and had to be hospitalized. I'm sure both dogs received top-of-the-line care with no expense spared, but even so one of the puppies died. The other puppy came very close to dying as well, but happily she apparently has now recovered completely and is doing just fine (or quite likely better than fine, considering who her new owner is!).

Oprah also mentioned how one of her other dogs, Solomon, also suffered from a parvo infection years ago, but that dog was over a year old when he became ill. It's actually quite unusual for any dog to get parvo beyond one year of age - most adult dogs are not affected by the virus, unless perhaps their immune system is compromised for some reason.

These stories bring up a few interesting points to ponder:

It's great to adopt an animal from a shelter and give a homeless animal a home. It is an act of great kindness that I don't want to take anything away from in the least. However, it's important to realize that you never know what shelter dogs may be carrying, nor how well vaccinated they are.

  • Even if the animals are vaccinated once at the shelter, the protective effect may be less than ideal if a properly timed vaccination series is not completed.
  • In this case the pups may have been exposed to parvo after leaving the shelter, but they could have just as easily been exposed at the shelter, which begs the question of what else might they have been carrying? Bacterial pathogens such as Salmonella and Campylobacter are also particularly common in young dogs and cats (even healthy ones), and these are potentially zoonotic agents.

Young animals, particularly from shelters, are higher risk in terms of the infectious diseases they can carry and transmit. That doesn't mean they shouldn't be adopted, but it does mean taking some extra precautions for the first several weeks they're in their new home. These include being very diligent about controlling stool contamination of any kind (which can be easier said than done during the house-training phase), preventing contact with high-risk individuals (e.g. young children, the elderly, anyone with a weakened immune system) and lots of handwashing on the part of everyone involved with the puppy (or kitten!).

Parvo is a very serious disease in puppies, yet people sometimes become a little complacent about vaccinating for parvo and other puppyhood diseases.   Remember, though, that the reason parvo has become so much less common than it used to be is largely because of widespread and effective vaccination.  I have to wonder about how well vaccinated Oprah's dog Solomon was to get the disease at the age he did, but there could easily be other factors involved as well.  The virus is still out there, and if we become lax in our infection control practices - including decreasing exposure of puppies to the stool of other dogs, as well as vaccination - it's waiting in the wings for its opportunity to move in. Even with the very best care the infection can still be fatal.

It's also relevant to note that, as demonstrated by Solomon's case, just because parvo is very uncommon in adult dogs doesn't mean it's impossible for them to get it.  It's important to always remain diligent.

Parvoviruses are quite species specific, so thankfully people cannot get parvovirus from dogs, but remember that puppies can get diarrhea from pathogens like Salmonella, which can be transmitted to people. There is also a human parvovirus which is the cause of Fifth disease. Just like the dog virus cannot infect people, the human virus cannot infect dogs.

Image source: http://omg.yahoo.com

Cat Scratch Disease - Bartonella henselae

Bartonella henselae is a small, Gram-negative bacterium that is host-adapted to cats. It may rarely cause mild illness in cats, but most felines, from tiny house cats to the king of the beasts, carry the bacteria with no clinical signs whatsoever. Unfortunately, when B. henselae infects a person it can cause any of several serious conditions (most of which have very long names!).  These include bacillary angiomatosis (formation of masses of abnormal blood and lymph vessels), endocarditis (infection of the lining of the heart), chronic lymphadomegally (enlarged lymph nodes), and pyogranulomatous lymphadenitis, better known as cat scratch disease. There are at least four Bartonella species (among many, many other Bartonella species) that can infect cats, but B. henselae is the most common.  There are at least nine Bartonella species that can infect humans, seven of which are zoonotic.

Between 5% and 40% of cats in the USA have B. henselae in their bloodstream. It is most common in cats from temperate areas, and is much less common in Canada. Bartonella spp. live in the red blood cells of their host – quite a clever strategy really, because it makes the bacteria readily available to be picked up by vectors like blood-sucking fleas, it protects the bacteria from the hosts immune system so it can live there for a long time, and it may even partially protect the bacteria from antibiotics. Cats can maintain a waxing and waning infection for months or even years. The bacterium is transmitted between animals by the cat flea (Ctenocephalides felis felis). Studies have shown that transmission does not occur between cats kept in a flea-free environment. Some ticks may also be able to transmit the disease. Diagnosis in cats is difficult – blood culture is the most reliable means, but it is not always sensitive. Antibody production only confirms exposure but not active infection. Polymerase chain reaction is often faster but no more sensitive than blood culture. An effective treatment regimen to eliminate B. henselae infection in cats has yet to be determined.

Transmission of B. henselae from cats to humans is thought to occur through contamination of scratches and bites (broken skin) with flea dirt (i.e. partially digested blood from the infected animal that is excreted by fleas = flea poop). Infection in individuals with weakened immune systems can be extremely serious or even fatal. In otherwise healthy people, the infection tends to remain localized, but can still cause massive swelling and abscessation of local lymph nodes. The type of disease that occurs may depend on the strain of Bartonella involved.

There are a few simple steps people can take to decrease the risk of cat scratch disease. These are particularly important for individuals with compromised immune systems, in which infection can be much more severe:

  • Keep your pets flea- and tick-free. Effective treatment and prevention products are available from your veterinarian.
  • Avoid or prevent situations that may result in bites and scratches from your pet. There is more information about this on the Worms & Germs Resources page and in our archives. If you do accidentally get scratched or bitten, be sure to clean the wound thoroughly. Consider seeking medical attention for bites in particular.
  • Be aware of where cats come from. Stray or shelter cats less than one year old are most likely to be infected with B. henselae.

It is also important to note that there is NO evidence that declawing cats decreases the risk of transmission of B. henselae to humans!

As a point of interest, Bartonella quintana (a human-adapted Bartonella species) was the cause of trench fever in World War I, and was transmitted by lice.
 

Stray kittens

While visiting my parents this weekend, we came across a litter of stray kittens in the backyard. This is not an uncommon event and many people obtain their cats this way. Adopting stray kittens can be a great way to get a cat because it provides  a good home for kittens that would otherwise end up increasing the feral cat population. However, there are some things to consider to reduce the risks to your family and your other pets.

Various bacteria that can cause diarrhea in people can be carried by kittens, including Salmonella and Campylobacter. These are shed in the stool of infected animals, and people can become ill from handling the animal or stool-contaminated areas. Kittens may have higher rates of carriage of these bacteria than adult cats. Another bacterium that can be carried commonly by kittens is Bartonella henselae, the cause of cat scratch disease. This is transmitted by bites, scratches and fleas, and is just one reason for proper flea control.

Stray kittens are also more likely to carry Toxoplasma, a parasite that is a concern in pregnant women and immunocompromised individuals. Other intestinal parasites such a roundworms are also a concern. Kittens are more likely to have these parasites than adult cats.  Stool contamination of the haircoat is presumably more common in kittens as well because they are not as good about cleaning themselves as adult cats.  So just handling a kitten, even if you avoid its stool, may result in exposure to some of these parasites and bacteria.

Rabies is always a concern, and widespread exposure of people to rabies has occurred from infected litters of kittens.  While uncommon, rabies is a major concern because it is almost invariably fatal. Any stray (or recently rescued) animal that starts acting strangely should be considered a rabies-suspect and be taken to a vet immediately. [More information on rabies, and other topics, is available in our Resources page].

Stray kittens can also carry various infectious diseases that can be transmitted to other cats in the household, such as feline leukemia virus, panleukopenia, rhinotracheitis and calicivirus.

Overall, the risks from adopting stray kittens are low, but they are real. If you are going to adopt/rescue a stray kitten, keep these things in mind:
  • Take the kitten to your vet as soon as possible to identify any health issues and determine the required vaccination, deworming and flea control program
  • Wash your hands after handling the new kitten
  • Keep the new kitten in a confined area while litterbox training is underway to reduce accidents throughout the house
  • If you have another cat, make sure it is up-to-date on vaccinations before the kitten comes into the house.
  • If the kitten gets sick, make sure it is taken to a vet. If it dies suddenly, make sure you take it to your vet to determine whether testing for rabies is required.
  • Pregnant women and households with immunocompromised individuals should not adopt stray kittens.