Jason W. Stull

Household knowledge, attitudes and practices related to pet contact and associated zoonoses in Ontario, Canada

BackgroundMany human infections are transmitted through contact with animals (zoonoses), including household pets. Although pet ownership is common in most countries and non-pet owners may have frequent contact with pets, there is limited knowledge of the public’s pet contact practices and awareness of zoonotic disease risks from pets. The objective of this study was to characterize the general public’s knowledge, attitudes and risks related to pet ownership and animal contact in southern Ontario, Canada.MethodsA self-administered questionnaire was distributed to individuals at two multi-physician clinics in Waterloo, Ontario, Canada during 2010. A single adult from each household was invited to participate in the study.ResultsSeventy five percent (641/853) of individuals approached completed the questionnaire. Pet ownership and contact were common; 64% of participants had a pet in their household and 37% of non-pet owning households had a member with at least weekly animal contact outside the home. Pet ownership was high (55%) for households with individuals at higher risk for infections (i.e., < 5 yrs, ≥ 65 yrs, immunocompromised). Most respondents (64%) indicated that they had never received information regarding pet-associated disease risks. When given a list of 11 infectious pathogens, respondents were only able to correctly classify just over half on their potential to be transmitted from pets to people (mean 6.4); independently, pet owners and those who recalled receiving information in the past about this topic were able to make significantly more correct identifications. Pet (36%) and non-pet owning households (10%) reported dog or cat bites or scratches during the preceding year. Households with individuals at higher risk for an infection did not differ from the remaining households regarding their perceived disease risk of pets, zoonotic disease knowledge, recall of being asked by their medical provider if they owned any pets, or recall of having received information regarding pet-associated disease risks and preventive measures.ConclusionsThese results suggest that there is a need for accessible zoonotic disease information for both pet and non-owning households, with additional efforts made by veterinary, human and public health personnel. Immediate educational efforts directed toward households with individuals at higher risk to infections are especially needed.

Pet husbandry and infection control practices related to zoonotic disease risks in Ontario, Canada.

BackgroundMany human infections are transmitted through contact with animals (zoonoses), including household pets. Despite this concern, there is limited knowledge of the public’s pet husbandry and infection control practices. The objective of this study was to characterize zoonotic disease related-husbandry and infection preventive practices in pet-owning households in Ontario, Canada.MethodsA self-administered questionnaire was distributed to individuals at two multi-physician clinics in Waterloo, Ontario, Canada during 2010. One adult from each household was invited to participate in the study.ResultsFour hundred one pet-owners completed the questionnaire. Households reported ownership of dogs (68%), cats (48%), fish (13%), exotic mammals (7%), such as hamsters, and reptiles and birds (each 6%). Across all species, individuals at higher risk of infections (i.e. < 5yrs, ≥ 65yrs, immunocompromised) were often (46-57%) present in households. Children < 16 yrs of age had close pet contact, as households reported dogs (13%) and cats (30%) usually slept in a child’s bed and dogs often licked a child’s face (24%). Household husbandry practices that increase zoonotic disease risk were frequently identified; some fed high-risk foods (i.e. raw eggs, raw meat, or raw animal product treats) to their dogs (28%) or cats (3%); 14% of reptile-owning households allowed the pet to roam through the kitchen or washed it in the kitchen sink. Reported hand washing by children was high for all species (> 76% washed hands sometimes or greater after touching the pet, its feces, or housing), although fewer reported children always washed their hands (3-57%; by species). With a few exceptions, practices were not associated with the presence of higher risk members in the household or recall of having previously received zoonotic disease education.ConclusionsThe results suggest there is a need for education on zoonotic disease prevention practices for pet-owning households with individuals at higher risk of infection and those with high-risk species (e.g., reptiles). Further research is needed to determine the role of education in altering higher risk pet practices.

Carbapenemase-Producing Enterobacteriaceae Recovered from the Environment of a Swine Farrow-to-Finish Operation in the United States

ABSTRACT Carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to public health. While use of carbapenem antimicrobials is restricted for food-producing animals, other β-lactams, such as ceftiofur, are used in livestock. This use may provide selection pressure favoring the amplification of carbapenem resistance, but this relationship has not been established. Previously unreported among U.S. livestock, plasmid-mediated CRE have been reported from livestock in Europe and Asia. In this study, environmental and fecal samples were collected from a 1,500-sow, U.S. farrow-to-finish operation during 4 visits over a 5-month period in 2015. Samples were screened using selective media for the presence of CRE, and the resulting carbapenemase-producing isolates were further characterized. Of 30 environmental samples collected from a nursery room on our initial visit, 2 (7%) samples yielded 3 isolates, 2 sequence type 218 (ST 218) Escherichia coli and 1 Proteus mirabilis, carrying the metallo-β-lactamase gene blaIMP-27 on IncQ1 plasmids. We recovered on our third visit 15 IMP-27-bearing isolates of multiple Enterobacteriaceae species from 11 of 24 (46%) environmental samples from 2 farrowing rooms. These isolates each also carried blaIMP-27 on IncQ1 plasmids. No CRE isolates were recovered from fecal swabs or samples in this study. As is common in U.S. swine production, piglets on this farm receive ceftiofur at birth, with males receiving a second dose at castration (≈day 6). This selection pressure may favor the dissemination of blaIMP-27-bearing Enterobacteriaceae in this farrowing barn. The absence of this selection pressure in the nursery and finisher barns likely resulted in the loss of the ecological niche needed for maintenance of this carbapenem resistance gene.

Effects of disinfection on the molecular detection of porcine epidemic diarrhea virus.

Abstract Routine detection of porcine epidemic diarrhea virus (PEDV) is currently limited to RT-PCR but this test cannot distinguish between viable and inactivated virus. We evaluated the capability of disinfectants to both inactivate PEDV and sufficiently damage viral RNA beyond RT-PCR detection. Five classes of disinfectants (phenol, quaternary ammonium compound, sodium hypochlorite, oxidizing agent, and quaternary ammonium/glutaraldehyde combination) were evaluated in vitro at varying concentrations, both in the presence and absence of swine feces, and at three different temperatures. No infectious PEDV was recovered after treatment with evaluated disinfectants. Additionally, all tested disinfectants except for 0.17% sodium hypochlorite dramatically reduced qRT-PCR values. However, no disinfectants eliminated RT-PCR detection of PEDV across all replicates; although, 0.52%, 1.03% and 2.06% solutions of sodium hypochlorite and 0.5% oxidizing agent did intermittently produce RT-PCR negatives. To simulate field conditions in a second aim, PEDV was applied to pitted aluminum coupons, which were then treated with either 2.06% sodium hypochlorite or 0.5% oxidizing agent. Post-treatment surface swabs of the coupons tested RT-PCR positive but were not infectious to cultured cells or naïve pigs. Ultimately, viable PEDV was not detected following application of each of the tested disinfectants, however in most cases RT-PCR detection of viral RNA remained. RT-PCR detection of PEDV is likely even after disinfection with many commercially available disinfectants.

Reducing the risk of pet-associated zoonotic infections.

Pet ownership can have health, emotional and social benefits; however, pets can serve as a source of zoonotic pathogens. One large, regional survey reported more than 75% of households having contact with a pet,[1][1] and close, intimate interactions with pets (e.g., sleeping in beds with owners,

Hospital-Associated Infections in Small Animal Practice

Hospital-associated infections (HAIs) occur in veterinary hospitals of all types and sizes, and their frequency is likely to increase. Urinary tract infections, pneumonia, bloodstream infections, surgical site infections, and infectious diarrhea are the HAIs most frequently identified in veterinary medicine. A hospital infection control program, consisting of an infectious disease control officer, written protocols, and staff training, is critical to reducing HAIs and promoting patient, staff, and client health. Infection control protocols (plans) should include discussion of hand hygiene and use of personal protective equipment, cleaning and disinfection, patient management, with-in hospital surveillance, and antimicrobial stewardship.

Staphylococcus delphini and methicillin-resistant S. pseudintermedius in horses, Canada.

To the Editor: Staphylococcus aureus is a well-known pathogen of horses (1), but the role of other coagulase-positive staphylococcal species in these animals is unclear. S. pseudintermedius and S. delphini, members of the S. intermedius group (SIG), cause infections in some companion animals and equids (2), can be multidrug resistant, and could be a concern in horses. Members of SIG are difficult to differentiate by using biochemical methods and require molecular techniques for accurate species-level identification (3); therefore, misidentification of these pathogens could occur. Methicillin-resistant or unusual staphylococci that are isolated at the Ontario Veterinary College Health Sciences Centre by the University of Guelph Animal Health Laboratory (AHL) routinely undergo further characterization. During 2011, the laboratory tested 5 isolates from different horses that were coagulase-positive staphylococci other than methicillin-resistant S. aureus (MRSA). Isolates were identified by using matrix-assisted laser desorption/ionization–time of flight (MALDI-TOF) mass spectrometry, S. pseudintermedius or S. delphini PCR (4), and sodA sequence analysis (3). Isolates were further characterized, as indicated, by direct repeat unit typing (5), pulsed-field gel electrophoresis (PFGE) (6), mecA PCR (7), penicillin-binding protein 2a latex agglutination test, and antimicrobial drug susceptibility testing by broth microdilution and/or disk diffusion. A search of AHL’s database was performed to identify other S. pseudintermedius and S. delphini isolates for all submissions of samples from equids during January 2011–August 2012. Of the 5 isolates from the horses, 1 was identified as methicillin-resistant S. pseudintermedius (MRSP) and 4 as methicillin-susceptible S. delphini (Table). The MRSP isolate was classified by direct repeat unit typing as dt11a, a predominant MRSP clone in dogs in North America (8). In addition to β-lactams, the MRSP isolate was resistant to chloramphenicol, clindamycin, erythromycin, gentamicin, tetracycline, and trimethoprim/sulfamethoxazole and susceptible to nitrofurantoin, rifampin, streptomycin, and vancomycin. Table Results of investigation of Staphylococcus delphini and S. pseudintermedius infection in horses, Canada* The 4 S. delphini isolates were initially identified biochemically as S. pseudintermedius but subsequently classified as group A (n = 1) and group B (n = 3) S. delphini by molecular methods (Table). One isolate (SD-4) was resistant to only erythromycin; the remaining isolates were susceptible to all tested antimicrobial drugs. PFGE showed that 2 of the S. delphini isolates (SD-1 and SD-2) were possibly related, with a 4-band difference. The remaining isolates were unrelated to each other and the 2 related isolates. Two of the horses (sources of isolates SD-2 and SD-3) had been recently acquired at the same auction and were sampled on the same day; however, PFGE showed that these samples were not related and came from different groups (A, B). No common epidemiologic links were identified for any of the horses. The AHL database search identified 8 additional horses from which S. pseudintermedius was biochemically identified; on the basis of drug-resistance patterns, 6 (75%) of these isolates were determined to be MRSP (Table). One additional S. delphini isolate was identified by using MALDI-TOF. No common epidemiologic links were identified for these infections. MRSP is an emerging pathogen in dogs and cats (1) but has been rarely identified in horses (2). The role of these bacteria in disease in horses is unclear, but given their ability to cause opportunistic infections in other species, these pathogens should not be dismissed. S. pseudintermedius rarely causes disease in humans (9), and transmission normally occurs from infected or colonized animals. Although rarely reported, infection with MRSP might be overlooked in horses; misidentification as S. aureus is possible if laboratories assume that coagulase-positive staphylococci from horses are S. aureus, and misidentification as methicillin susceptible is possible because the use of cefoxitin susceptibility and S. aureus breakpoints is ineffective for determination of methicillin resistance in S. pseudintermedius (10). Additionally, S. pseudintermedius generates coagulase-positive results by tube testing but coagulase-negative results by slide testing, which creates the potential for misidentification as coagulase-negative staphylococci. Given the rapid expansion of S. pseudintermedius infections among dogs, the potential for zoonotic transmission, and the highly resistant nature of this pathogen, ongoing surveillance is indicated in the equine population. Recently, S. delphini has been divided into groups A and B (3). The typical hosts for group A are believed to be mustelidae (i.e., mink, ferret, badger), whereas hosts for group B remain unknown. S. delphini has rarely been identified in horses, but, as we observed, it may be misidentified by conventional methods. Although colonization or contamination appeared most likely in the instances we describe, these findings suggest that this opportunistic pathogen can be found in horses and might be pathogenic in certain situations. Our findings highlight the importance of using additional identification methods (e.g., MALDI-TOF, Staphylococcus species–specific PCR) for differentiation of SIG members (notably S. delphini and S. pseudintermedius) to effectively document the emergence of these species in horses. In addition, these findings indicate the need to ensure proper differentiation of S. aureus from SIG in equine isolates, despite the historical predominance of S. aureus, because of the differences in methods for determination of methicillin resistance. Future studies are needed to determine prevalence trends and disease roles for these species in equids.

Zoonotic Disease Risks for Immunocompromised and Other High-risk Clients and Staff: Promoting Safe Pet Ownership and Contact

Pets can be a source of disease (zoonoses) for humans. The disease risks associated with pet contact are highest among young children, the elderly, pregnant women, and immunocompromised hosts. These individuals and household members display limited knowledge of pet-associated disease, rarely recall receipt of pet-associated disease information, and report pet ownership practices that are often at odds with established disease prevention recommendations. Veterinary staff are in a key position to promote safe pet ownership and contact practices. Encouraging and safeguarding client disclosure of immunocompromising health conditions and promoting veterinarian-physician communications are critical for effectively providing this service.

Knowledge, Attitudes, and Practices Related to Pet Contact by Immunocompromised Children with Cancer and Immunocompetent Children with Diabetes

OBJECTIVE To compare knowledge, attitudes, and risks related to pet contact in households with and without immunocompromised children. STUDY DESIGN A questionnaire was distributed to parents of children diagnosed with cancer (immunocompromised; n=80) or diabetes (immunocompetent; n=251) receiving care at the Childrens Hospital of Eastern Ontario. Information was collected on knowledge of pets as sources of disease, concerns regarding pet-derived pathogens, and pet ownership practices. Data were analyzed with multivariable logistic regression. RESULTS The questionnaire was completed by 65% (214 of 331) of the individuals to whom it was given. Pet ownership was common; 45% of respondents had a household pet when their child was diagnosed, and many (households with a child with diabetes, 49%; households with a child with cancer, 20%) acquired a new pet after diagnosis. Most households that obtained a new pet had acquired a pet considered high risk for infectious disease based on species/age (diabetes, 73%; cancer, 77%). Parents of children with cancer were more likely than parents of children with diabetes to recall being asked by a physician/staff member if they owned a pet (OR, 5.9) or to recall receiving zoonotic disease information (OR, 5.3), yet these interactions were reported uncommonly (diabetes, ≤13%; cancer, ≤48%). Greater knowledge of pet-associated pathogens was associated with recalled receipt of previous education on this topic (OR, 3.9). Pet exposure outside the home was reported frequently for children in non-pet-owning households (diabetes, 48%; cancer, 25%). CONCLUSION Improved zoonotic disease education is needed for pet-owning and non-pet-owning households with immunocompromised children, with ongoing provision of information while the children are at increased risk of disease. Additional efforts from pediatric and veterinary healthcare professionals are required.

Infection Control in Veterinary Small Animal Practice

This issue of Veterinary Clinics of North America: Small Animal Practice addresses the topic of “Infection Control in Veterinary Small Animal Practice.” Infection control has been acknowledged as a cornerstone of human medicine for decades. Attention to, and progress in, this area is regarded as one of the most important advances in human health care. Despite this recognized prominence, veterinary medicine has been slow to adopt infection control principles. This is particularly evident in small animal practice. Although there are likely a number of reasons for this deficiency (eg, lack of perceived importance, minimal local or national regulations), perhaps one of the greatest obstacles has been limited published practical guidance and recommendations for all scopes of practice, from the smaller single veterinarian private practice to larger referral or teaching hospitals. In this issue, we have carefully selected topics and authors to address these information gaps, ensuring practical guidance is finally available for all small animal veterinary clinic types and sizes. The topics were carefully selected to cover (in our minds) all key areas of infection control pertinent to small animal practice. The first articles in this issue introduce the topic, providing evidence for the utility of infection control in our practices and directing practitioners and staff toward key areas to address identifying and preventing the major types of hospital-associated infections in veterinary patients: urinary tract infections, pneumonia, bloodstream infections, surgical site infections, and infectious diarrhea. The next articles target crucial strategies aimed at reducing hospital environmental, equipment, and staff contamination by pathogens and antimicrobial stewardship approaches to reduce the occurrence of multi-drug-resistant organisms. The final articles address veterinary workplace safety, including zoonotic disease risk for immunocompromised clients and staff, as well as legal implications for such hazards. Together, these eleven articles provide the key elements and practical examples for the development of a clinic-specific infection control plan, allowing for a safer environment for patients, staff, and clients.