Originally posted on July 9, 2018 at NAIA Official Blog, reposted with permission.

More troubling news from the wild world of rescue import has been picked up by the Worms & Germs blog : a rescue dog with a known history of chronic health issues is imported into a private U.S. shelter from Thailand and tests positive for Melioidosis, a nasty zoonotic bacterial disease. This discovery leads to several potentially exposed people receiving blood tests (one showed signs of exposure, but none got sick), and ultimately the euthanasia of the dog.

Melioidosis is bad news

 

The plea for common sense from Worms & Germs author, Scott Weese (Ontario Veterinary College – University of Guelph), could have been written by us:

 

Logical importation practices are needed. How much time and expense went into shipping a paralysed dog transcontinentally from one shelter to another, when it was ultimately euthanized in the end anyway? I realize everything is done with good intentions, but thank about what could have been done for local homeless animals with the time, effort and expenses that were incurred here.

 

Dr. Weese generously labels the shelters and importers as well intentioned. But honestly, there must be a point where, when operations are carried out with such casual disregard for the health of shipped and local dogs (and adopters), where intentions can not be labeled as “good” — or at the end result is so damaging as to make intentions irrelevant.

 

Rescue importation, fueled by a lack of adoptable local dogs in many parts of the U.S. and the power of social media, has grown by leaps and bounds over the last two decades while U.S. dog import laws have not been updated since 1956. As a result, we are seeing dogs arrive here with everything from canine brucellosis, rabies, and the canine flu, to parasites and other vector-borne diseases. These are very serious issues, which is why NAIA has been working to modernize dog import laws for the last several years.

For more information, contact Patti Strand, NAIA President, at naia@naiaonline.org.

 

 

An interesting study about ordinances governing backyard poultry ownership in Colorado was recently published, titled “A Method for Guarding Animal Welfare and Public Health: Tracking the Rise of Backyard Poultry Ordinances” (the “Report”).

The Report “tracks the development of municipal ordinances, with attention to provisions for animal health and welfare and significant concerns for public health.”

Public and animal health officials, as well as large commercial poultry operations, have been concerned about the spread of infectious, contagious diseases, such as avian influenza virus from small backyard flocks where owners are unaware of and not familiar with the typical biosecurity measures that are generally recommended in animal agriculture.

USDA has published a number of guidance documents for people interested in raising poultry for their personal consumption of eggs.

In “Biosecurity for Birds,” USDA explains:

Raising backyard poultry is a growing trend across the United States. It is very important for all backyard poultry owners to know the signs of two deadly poultry diseases, as well as the basic ‘biosecurity’ steps you can take to protect your birds. APHIS runs the Biosecurity for Birds campaign to help raise awareness among backyard, hobby and pet bird owners.

On the other hand, animal rights activists often blame commercial agriculture for the spread of avian influenza.  See, e.g., An HSUS Report: Human Health Implications of Intensive Poultry Production and Avian Influenza, and Avian Influenza Just One Marker of Sickness in Industrial Agriculture .

The fact is that avian influenza is most often spread from wildlife to privately owned domestic flocks, regardless of the size of the flock.  Therefore, for animal and public health concerns, statutes and regulations̶̶-federal, state, or local-should provide for the health and welfare of laying hens as well as ensuring quality standards for eggs.

Federal and state laws govern standards of egg quality relating to the prevention of contamination with Salmonella.  As the Report discusses:

The federal regulations include requirements related to egg handling and storage prior to point of purchase by consumers, as well as testing for Salmonella on farms that have more than 3000 hens and implementation of biosecurity programs on those farms to control egg safety risks. For poultry meat safety, USDA inspects live birds and carcasses at federally inspected slaughter plants (i.e., plants that process meat for export or interstate commerce) to ensure that they are free of disease, and also evaluates conditions at those plants to ensure that they are sanitary and following ‘good commercial practices.’

However, as the Report states, local ordinances that permit ownership of backyard poultry usually do not include provisions related to either the health or safety of the hens.

[B]ackyard birds may pose significant risks to the general public. The outbreak of highly pathogenic avian influenza (HPAI, H5N1) in Egypt offers a shocking example. The majority (107/112) of Egypt’s clinically confirmed HPAI cases of human infection from 2006 to 2009 are linked to close contact with diseased backyard birds resulting in 36 deaths and human-to-human spread. In addition, the 2002 California outbreak of Exotic Newcastle Disease (END) originated in backyard flocks. The outbreak spread into commercial operations and resulted in depopulation of over 3 million birds, costing taxpayers $161 million. (citations omitted).

The Report, analyzing backyard poultry ordinances in Colorado, found, in part:

  1. The most common guidelines for poultry ordinances pertain to housing design and placement, the sex of birds, and total number of birds allowed, including specific space requirements for birds, in come cases.
  2. Ordinances commonly required housing to be predator resistant, easily cleaned, and maintained regularly to prevent the development of pests, rodents, or odors that would cause nuisances.
  3. In urban locations, the number of birds permitted was often limited to between 4 and 6 birds per lot.
  4. Ventilation requirements were often not included in ordinances.
  5. Roosters were commonly prohibited.

Notably, the Report stated that “[r]egulations pertaining directly to animal health and welfare were rare.”

The Report concluded that ordinances should include these provisions.

[O]ur study indicates that there are fewer guidelines for the health and welfare of backyard poultry than their commercial counterparts. Regulation is important in disease prevention. Fragmented oversight of animal welfare and health creates policy blind spots critical to shared human and animal health.

I concur.

While rescue and adoption have largely replaced traditional pet sales, these marketing channels have increasing risks, especially since the “no-kill shelter” movement is being promoted by many.

In addition to risk from infectious, contagious diseases, sometimes fatal, there are risks from the adoption of dogs with known behavioral abnormalities, including predatory aggression.

As reported in the Zanesville’s TimesRecorder by Shelly Schultz in “Vet confronts commissioners about conditions at dog adoption center,  a veterinarian responsible for oversight at an animal shelter—Dr. Brian Williams—expressed his concern about dogs being adopted despite his risk-based assessment of their behavior.  As the National Animal Interest Alliance posted about Dr. Williams concerns, adopting out dogs known to be aggressive, creates “an immediate risk to public safety . . . [and] also threatens the mission of rescue as a whole.”

Unfortunately, the adoption of aggressive dogs has been reported to me a number of times.  In many cases, the dogs are immediately re-adopted to unwitting families even after viciously attacking and injuring the previous adopter.

As Dr. Williams observed, there are some dogs that are not suitable as pets for most people, based on their known aggressive behavior.   A shelter or rescue can attempt to rehabilitate such dogs, but even so, should inform any potential adopter about the complete medical and behavioral history and strongly consider euthanasia if the dog cannot be placed in a home without risking injury to humans or other animals.

For more, read the TimesRecorder article and NAIA’s blog.

Pet therapy programs have been expanding throughout the country, based largely on the increasing recognition that humans benefit from the human-animal bond.  The human-animal bond is defined by the American Veterinary Medical Association as:

a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors that are essential to the health and well-being of both. This includes, but is not limited to, emotional, psychological, and physical interactions of people, animals, and the environment.

While the IRS, in (PLR 201719018), has recently ruled “that a charity’s planned pet therapy program, which would bring trained therapy dogs to visit hospital patients and elderly nursing home residents, furthers charitable purposes under Section 501(c)(3),” that ruling does not consider or even mention public health concerns related to such programs.

“In support of its ruling, the IRS cited revenue rulings concluding that providing services to hospital patients and other individuals suffering distress in an effort to east that distress and provide them comfort furthers charitable purposes . . . [and] that activities designed to meet the special needs of the elderly may further charitable purposes.”  See Pet therapy program is a Section 501(c)(3) charitable activity, IRS rules (citations omitted).

However, no matter how well intended and “charitable” these programs are, there are serious potential public health risks from exposure of elderly, sick, immunocompromised patients to zoonotic diseases that pets can carry and transmit.  See, e.g., “Diseases you can share with your pets” previously discussed.

Those in the veterinary community understand these risks, as noted by Dr. Lucas Pantaleon, stating, the “[r]isk of zoonoses also arises with therapy dogs in human hospitals. The dogs go through screening but could bring zoonoses from the hospital back into the community.”  See “Speaker: Animal hospitals must practice infection control” reported by Katie Burns, June 1, 2017.

Researchers at Tufts University recently published the results of a “survey of United States hospitals, eldercare facilities and therapy animal organizations revealed their health and safety policies for therapy animal visits varied widely, with many not following recommended guidelines for animal visitation.”  See, Could Therapy Animal Visitation Pose Health Risks at Patient Facilities?”, June 19, 2017.

The survey included “responses from 45 eldercare facilities, 45 hospitals, and 27 therapy animal organizations across the country on their existing policies related to animal health and behavioral prerequisites for therapy animals and Animal-assisted intervention (‘AAI’) programs.”

Alarmingly, researchers found that many programs had deficient preventive guidelines to at least minimize the potential exposure of zoonotic pathogens from pets to people, finding:

AAI programs have a potential risk of transmission of zoonotic disease—diseases spread between animals and people. This risk is especially high when health, grooming and handwashing protocols are not carefully used. Another potential risk could come from therapy animals eating raw meat-based diets or treats, which are at high risk of being contaminated with bacteria such as Campylobacter, Salmonella and Cryptosporidium. These pathogens may pose risks to both humans and animals, and especially immunocompromised patients.

Zoonotic disease transmission has also been reported in people contracting salmonella from backyard poultry, where almost one third of the 790 victims confirmed by the Centers for Disease Control and Prevention “are children younger than 5 years old.”  See “Salmonella victims from backyard flocks more than double,” Food Safety News, July 14, 2017.

The human-animal bond benefits both people and animals, especially the elderly and children, and should be encouraged.  However, proper protocols and controls should be in place to keep everyone healthy.

 

FDA, gearing up for the implementation of the Veterinary Feed Directive (VFD), recently “issued a letter reminding retail establishments that sell medically important antimicrobials for use in feed or water for food animals that the marketing status of those products will change from over-the-counter (OTC) to prescription (Rx) or to veterinary feed directive (VFD) at the end of calendar year 2016.”

As reported in the Daily Herald, those servicing livestock producers in Utah have also been trying to spread the word:

“Local veterinarians, feed suppliers and livestock producers gathered in Lehi on Thursday to learn how the federal feed directive, which goes into effect on Jan. 1, will affect their operations.

The meeting is just one of a series of meetings being held across the state to make sure livestock producers aren’t taken by surprise when the new directive takes effect. It is expected to affect almost everyone who raises animals for human consumption — from 4-Hers to turkey farmers to bee keepers.”

The VFD sets forth “the process for authorizing use of VFD drugs and provides a framework for veterinarians to authorize the use of medically important antimicrobials in feed when needed for specific animal health purposes” as reported by Lydia Zuraw on JUNE 3, 2015 at Food Safety News.

FDA announced that the final rule is:

“an important piece of the agency’s overall strategy to promote the judicious use of antimicrobials in food-producing animals. This strategy will bring the use of these drugs under veterinary supervision so that they are used only when necessary for assuring animal health.”

Notably, as previously discussed here, the rule memorializes the concept that veterinarian may only prescribe antibiotics to animals “within the context of a veterinarian-client-patient relationship (VCPR), which includes sufficient knowledge of the animal, visits to the farm, and follow-up evaluation or care.”

While many states include that requirement in state veterinary medical practice acts, not all states include a definition of or specifications for the “veterinarian-client-patient relationship.”  (See table of state laws compiled by AVMA).

The VFD will require veterinarians to follow state-defined VCPR requirements as long as the state requirements include the key elements in the final VFD.

FDA requires:

“the veterinarian engage with the client (i.e., animal producer or caretaker) to assume responsibility for making clinical judgments about patient (i.e., animal) health, have sufficient knowledge of the animal by conducting examinations and/or visits to the facility where the animal is managed, and provide for any necessary follow-up evaluation or care.”

However, “where the FDA determines that no applicable or appropriate state VCPR requirements exist, veterinarians will need to issue VFDs in compliance with federally defined VCPR requirements.”

FDA issued a draft revised guidance for industry, “General Principles for Evaluating the Human Food Safety of New Animal Drugs Used In Food-Producing Animals” in July 2016 that “described the type of information that the Food and Drug Administration’s (FDA’s) Center for Veterinary Medicine (CVM) recommends sponsors provide [the agency] to address the human food safety of new animal drugs used in food-producing animals.”

In addition to proving that drugs are safe and efficacious in the targeted livestock species, drug companies (sponsors) face increasing hurdles to prove that “food derived from treated animals is safe for human consumption.”

FDA has already begun implementing other changes to “the way medically important antibiotics have been used in animal agriculture for decades.” See FDA’s Guidance #213.

As reported on its website, FDA explains:

“[o]nce the changes are fully implemented, it will be illegal to use these medically important antibiotics for production purposes, and animal producers will need to obtain authorization from a licensed veterinarian to use them for prevention, control or treatment of a specifically identified disease.”

Food animal veterinarians and livestock farmers are concerned about their ability to treat animals with antibiotics appropriately when needed. In response,

“[t]he FDA acknowledges the important role medically important antimicrobials play in treating, controlling, and preventing disease in food-producing animals. However, the agency has been actively engaging veterinary organizations, animal producer organizations and other stakeholders to express our position that medically important antibiotics labeled for continuous or undefined durations of use is not consistent with judicious use principles, as outlined in previously-released guidance documents.”

In “General Principles for Evaluating the Human Food Safety of New Animal Drugs Used In Food-Producing Animals” FDA “provides, in one document, an overview of the overall process for the human food safety evaluation of new animal drugs used in food-producing animals, including:

  • Determining an acceptable daily intake (ADI);
  • Calculating safe concentrations;
  • Assignment of a tolerance;
  • Calculation of a withdrawal period and a milk discard time; and
  • Evaluation of carcinogenic compounds.”

In addition to analyzing the appropriate withdrawal times for meat, milk, and eggs, the agency evaluates the proposed drugs for their potential to create additional pressures on antibiotic resistance in humans.

However, FDA has identified drugs that may not have to undergo this analysis if it (and its metabolites and excipients) are not:

  • “regularly considered to have properties that would exert pressure towards the emergence or selection of bacteria of public health concern;
  • used to treat zoonotic gastroenteritis or other bacterial diseases in humans;
  • under development to treat bacterial diseases in humans; or
  • indicated for a bacterial disease in food-producing animals (i.e., indication is instead antifungal, antiprotozoal, anthelminthic, etc.).”

With the emergence of new methods of disease treatment and  prevention (using, for example, genetically immune livestock) hopefully veterinarians and farmers will not have to rely on antibiotics to treat animals and keep them healthy, since it will be increasingly difficult to obtain and retain the ability to use these drugs in livestock.

The management of feral cat colonies is extremely controversial.

On one hand there are people and nonprofits who are vehemently protective of these colonies, feeding and caring for these homeless animals.  On the other hand, there are concerns about the impact these colonies have on local wildlife and concerns about the diseases and parasites these animals can transmit to other animals and humans.

In Illinois, where legislators have identified these concern, a recently introduced bill SJR 53

would create the Feral Cat Task Force to examine the Animal Control Act, the Humane Care for Animals Act, the Animal Welfare Act, and any other relevant statutory provisions and make comprehensive written recommendations for change.

The 18-member task force will have quite a task sorting out this highly controversial issue.

As reported by the National Geographic News (from a 2004 report):

Some feline experts now estimate 70 million feral cats live in the United States, the consequence of little effort to control the population and of the cat’s ability to reproduce quickly.

The number concerns wildlife and ornithology organizations that believe these stealthy predators decimate bird populations and threaten public health. The organizations want the cats removed from the environment and taken to animal shelters, where they are often killed.

Feline predators are believed to prey on common species, such as cardinals, blue jays, and house wrens, as well as rare and endangered species, such as piping plovers and Florida scrub jays.

Cats, like other mammals can spread disease and parasites, facts that have been used in support of laws adopted by local jurisdictions to limit or eliminate feral cat colonies.

On its website, the CDC lists “[t]he most common diseases associated with cats that can cause human illness”[1] including: Campylobacteriosis; Cat-scratch Disease (Bartonella henselae); Cheyletiellosis; Cryptosporidiosis; Echinococcosis; Giardia; hookworms; MRSA (Methicillin-Resistant Staphylococcus aureus); Pasteurellosis; Plague (Yersinia pestis); Rabies; Ringworm (Microsporum canis); Roundworm (Toxocara spp.); Salmonellosis (Salmonella spp.); Sporotrichosis (Sporothrix schenckii); Toxoplasmosis (Toxoplasma gondii).

 

The AVMA recently revised its policy on “free-roaming and abandoned feral cats,” a process it described as:

the culmination of more than two years’ work by the Animal Welfare Committee, which is comprised of veterinarians and others representing expertise and a wide range of perspectives regarding animal welfare. Although the Animal Welfare Committee includes among its members representatives from the feline, avian, and wildlife veterinary communities, it did not tackle this question alone, but instead asked the Committee on Environmental Issues and the Council on Public Health and Regulatory Veterinary Medicine to assist with its review. Recognizing that feral cat management is a highly controversial issue, the group revised the policy to reflect new information, help build consensus, and provide leadership per the management of free-roaming abandoned and feral cats.

In New Jersey, the Department of Health “does not endorse or oppose the concept of establishing properly managed cat colonies utilizing trap-neuter-return (TNR) techniques.”

However, if a municipality wishes to allow cat colonies, they should develop standards through ordinances for the proper and managed operation of such colonies, based on the guidelines below, that would provide accountability and oversight by the health officer and animal control officer.

There remains a large overpopulation of cats, unlike dogs, in New Jersey and other Northeastern States, who comprise the greatest percentage of animal shelter residents, contributing to increasing costs to care for these animals.

[1] For a description of these diseases, click here or visit the CDC website.

Pets are increasingly important in this and other developed countries.

Many pet owners are unaware of the diseases and parasites their pets may harbor that can cause illness to humans.  This is one reason that proper veterinary care through routine visits to a veterinarian is so important.

The transmission of diseases between people and pets is the basis for the “One Health Initiative” whose goal is to “unite human and veterinary medicine.”  Check out their website, where you will find information about the history of this organization and the important work they are undertaking to share information about the new or re-emerging diseases, 70% of which are zoonotic (spread between animals and humans) or vector-borne (transmitted by vectors, including insects).

As recently discussed here, cats, like other animals can harbor and transmit a number of diseases and parasites to humans.  The Centers for Disease Control and Prevention, the leading public health institute in the United States, contains a plethora of scientific information and data on its website, including “[t]he most common diseases associated with cats that can cause human illness.”

The description of these diseases and parasitic disorders is republished below to demonstrate why it is so important for cat owners to take of their pets, which, in turn will help keep all family members healthy.

Campylobacteriosis

Campylobacter is a type of bacteria that spreads through contaminated food (meat and eggs), water, or contact with stool (poop) of infected animals. Cats infected with Campylobacter may show no signs of illness at all or may have diarrhea.

Most people who become sick with campylobacteriosis will have diarrhea, cramping, abdominal pain, and fever within 2-5 days after exposure to the organism. Campylobacter bacteria can cause serious life-threatening infections in infants, older persons, and those with weakened immune systems.

Cat-scratch Disease (Bartonella henselae)

Cat-scratch disease is a bacterial disease that people may get after being bitten or scratched by a cat. About 40% of cats carry the bacteria at some time in their lives, although kittens younger than 1 year of age are more likely to have it. Most cats with this infection show no signs of illness.

People who are bitten or scratched by an affected cat may develop a mild infection 3-14 days later at the site of the wound. The infection may worsen and cause fever, headache, poor appetite, and exhaustion. Later, the person’s lymph nodes closest to the original scratch or bite can become swollen, tender, or painful. Seek medical attention if you believe you have cat-scratch disease.

Cheyletiellosis

Cheyletiellosis is a mild, short-term skin inflammation caused by mites that feed on skin cells. Cheyletiella is spread through contact with infested animals. Pets such as rabbits and adult cats may not show signs of infestation. However, affected kittens may have patches of scaly skin with dandruff.

The most common symptoms of cheyletiellosis in people include itching, redness, and raised bumps on areas of the skin that touched the infested animal.  Cheyletiellosis in people generally resolves on its own.

Cryptosporidiosis

Cryptosporidiosis is a parasitic disease that is transmitted through contaminated food or water from an infected person or animal. Cryptosporidiosis in cats is rare, but they can carry the germ without showing any signs of illness.

Cryptosporidiosis can cause profuse, watery diarrhea with cramping, abdominal pain, and nausea in people and many types of animals. Illness in people is usually self-limiting and lasts only 2-4 days, but can become severe in people with weakened immune systems.

Echinococcosis

Echinococcosis is a disease caused by eating or drinking food and water contaminated with tapeworm eggs or through contact with an infected animal. Cats become infected by eating tissue of an infected animal. Cats rarely show any signs of disease, but can be infected with a large number of adult tapeworms.

Although Echinococcus invades many different organs of the body, most people who are infected with the disease will not have any signs of illness for years. Symptoms start when the slow-growing cysts become large enough to press on the organs they have invaded. The tapeworms grow slowly in several different organs of the body, most commonly the liver and lungs.

Giardia

Giardia is a parasite that causes diarrhea in animals and people. Giardia is transmitted to animals and people through food or water contaminated with stool.

Symptoms for animals and people include diarrhea, greasy stools, and dehydration. People can also have abdominal cramps, nausea, and vomiting. Symptoms can last 1-2 weeks.

Hookworms

Cat hookworms are tiny worms that can spread through contact with contaminated soil or sand. Cats can also become infected with hookworms through accidentally ingesting the parasite from the environment or through their mother’s milk or colostrum. Hookworm infections can cause anemia and weight loss in kittens. Severe infections can be fatal.

People become infected with cat hookworms while walking barefoot, kneeling, or sitting on ground contaminated with stool (poop) of infected animals. Hookworm larvae enter the top layers of skin and cause an itchy reaction called cutaneous larva migrans. A red squiggly line may appear where the larvae have migrated under the skin. Symptoms usually resolve without medical treatment in 4-6 weeks.

MRSA (Methicillin-Resistant Staphylococcus aureus)

Staphylococcus aureus is a common type of bacteria that is normally found on the skin of people and animals. Methicillin-resistant Staphylococcus aureus (MRSA) is the same bacterium that has become resistant to some antibiotics. Cats and other animals often can carry MRSA without being sick, but MRSA can cause a variety of infections, including of the skin, respiratory tract, and urinary tract.

MRSA can be transmitted back and forth between people and animals through direct contact. In people, MRSA most often causes skin infections that can range from mild to severe. If left untreated, MRSA can spread to the bloodstream or lungs and cause life-threatening infections.

Pasteurellosis

Pasteurellosis is a bacterial disease associated with animal bites and scratches. Pasteurella is a normal bacterium that lives in the mouths of healthy cats. The bacteria do not typically make cats sick; however, cats can develop abscesses or skin infections in places where they were scratched or bitten by another animal.

In people, pasteurellosis causes painful wound and skin infections. In severe cases, it can cause widespread infection and might even affect the nervous system.

Plague (Yersinia pestis)

Plague is a bacterial disease in animals and people that can lead to serious illness or death if left untreated. Cats are highly susceptible to plague and their symptoms are similar to those experienced by humans. Cats that hunt wild rodents and rabbits in the western, particularly the southwestern, United States are at greatest risk of becoming infected.

People most often become infected through flea bites or from contact with body fluids of infected animals. Bubonic plague is the most common form; symptoms include sudden onset of high fever, chills, headache, malaise, and swollen lymph nodes. The other two forms of plague, septicemic and pneumonic, cause more severe disease. Cats infected with plague can infect people through bites, scratches, coughs, or sneezes.

Rabies

Rabies, a fatal neurologic disease in animals and people, is caused by a virus. Animals and people are most commonly infected through bites from rabid animals. Infected cats may have a variety of signs, but most often have sudden behavioral changes and progressive paralysis. Cats may also appear restless, pant, and attack other animals, people, or objects. Animals with rabies typically die within a few days of appearing sick. Owners should vaccinate their cats against this deadly disease.

The first symptoms in people can start days to months after exposure; they include generalized weakness, fever, and headache. Within a few days, symptoms progress to confusion, anxiety, and behavioral changes. If you have been bitten by a cat or other animal and feel that there is a risk for rabies, contact your health care provider right away.  Once symptoms appear, it is almost always too late for treatment.

Ringworm (Microsporum canis)

Ringworm is a condition caused by a fungus that can infect skin, hair, and nails of both people and animals. Ringworm is passed from animals to people through direct contact with an infected animal’s skin or hair. Cats infected with ringworm typically have small areas of hair loss around their ears, face, or legs, with scaly or crusty skin. But some cats carrying ringworm have no signs of infection at all. Kittens are most commonly affected.

Ringworm infections in people can appear on almost any area of the body. These infections are usually itchy. Redness, scaling, cracking of the skin, or a ring-shaped rash may occur. If the infection involves the scalp or beard, hair may fall out. Infected nails become discolored or thick and may possibly crumble.

Roundworm (Toxocara spp.)

Toxocara roundworms cause a parasitic disease known as toxocariasis. Cats and people can become infected by swallowing roundworm eggs from the environment. Cats can also become infected as young kittens. Larval worms can come through the milk of a mother cat, passing the infection on to her kittens. Infected kittens usually do not seem sick. Those that do may have mild diarrhea, dehydration, rough coat, and a pot-bellied appearance.

In people, children are most often affected with roundworm. There are two forms of the disease in people: ocular larva migrans and visceral larva migrans. Ocular larva migrans happens when the larvae invade the retina (tissue in the eye) and cause inflammation, scarring, and possibly blindness. Visceral larva migrans occurs when the larvae invade parts of the body, such as the liver, lung, or central nervous system.

 

Salmonellosis (Salmonella spp.)

Salmonella spreads to people through contaminated food (eggs and meat) or contact with stool of certain animals, including cats. Cats can get salmonellosis through eating infected birds. While it usually does not make the cats sick, Salmonella infection can cause serious illness when it is passed to people.

People infected with Salmonella bacteria may have diarrhea, vomiting, fever, or abdominal cramps. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness.

Sporotrichosis

Sporotrichosis is a fungal disease that can affect both animals and people. It is usually acquired from the environment through a cut or scrape in the skin but can be acquired from contact with animals as well. Infection with sporotrichosis in cats can range from no signs of illness to very serious disease. Signs often begin with small draining wounds that become raised lumps with the surface eroded away. The disease can worsen.

Three forms of sporotrichosis can infect people.

  • The first form is the cutaneous or skin form, which can progress from small raised areas on the skin to infection invading the lymph nodes and forming nodules that eventually ulcerate.

  • The second is the disseminated form, which occurs when the infection affects the internal organs and bones.

  • In the third form, the pulmonary form, a person acquires the infection through inhalation the fungus into the lungs, which often leads to chronic disease similar to tuberculosis.

Toxoplasmosis

Most healthy people who become infected with Toxoplasma show no signs or symptoms. However, pregnant women and people who have weakened immune systems may be at risk for serious health complications.

  • Toxoplasmosis is a parasitic disease that can spread to people and animals through contaminated soil, water, or meat, and contact with stool from an infected cat. Cats are the main source of infection to other animals but rarely appear sick.

  • The latter two forms are potentially fatal.

Despite a new amendment to the public health laws in New York State that permit dogs to accompany their owners at outdoor bars and restaurants as of October 26, 2015, a restaurant patron, Sondra Hargro, sued a restaurant owner, Scott Ross, for injuries she received from a dog bite from another patron’s dog inside Ross’s restaurant.

The Court found that Ross “was not liable, under the theory of strict liability, in absence of any evidence that restaurant owner had actual or constructive knowledge that dog had any vicious propensities.”  Hargro v. Ross, 21 N.Y.S.3d 520 (N.Y. App. Div. 2015).

The Court also held that Hargro could not prevail “under a theory that restaurant owner was negligent in failing to maintain safe premises.”

Most interesting, and relevant to New York’s newly amended public health law is that the restaurant owner’s alleged violation of provision of State Sanitary Code regarding presence of animals in food service establishments was only some evidence of negligence.

Not many facts were included in the published slip opinion in Hargro v. Ross, but it seems as if the dog was inside the restaurant, not outside.  The state amendments only permit companion dogs at outdoor dining areas.

 

 

 

 

 

Specifically, the law provides:

§ 1352-e. Companion dogs at food service establishments
1. Companion dogs under the control of a person may be allowed in an outdoor dining area at a food service establishment if all of the following conditions are satisfied:
(a) the owner of the food facility elects to allow companion dogs in its outdoor dining area or a designated portion of it, and subject to any restrictions that the owner of the facility may establish;
(b) a separate outdoor entrance is present where companion dogs enter without going through the food establishment to reach the outdoor dining area and companion dogs are not allowed on chairs, benches, seats or other fixtures;
(c) the outdoor dining area in which companion dogs are allowed is not used for food or drink preparation or the storage of utensils. A food employee may refill a beverage glass in the outdoor dining area from a pitcher or other container;
(d) food and water provided to companion dogs shall only be in single-use disposable containers;
(e) food employees are prohibited from having direct contact with companion dogs while on duty. A food employee who does have such prohibited direct contact shall wash his or her hands as required by law;
(f) the outdoor dining area is maintained clean. Surfaces that have been contaminated by dog excrement or other bodily fluids shall be cleaned and sanitized;
(g) the companion dog is on a leash or confined in a pet carrier and is under the control of the companion dog owner;
(h) there is reasonable signage indicating that companion dogs are allowed in the outdoor dining area or a designated portion of it. The signage shall state that restrictions on companion dogs do not apply to guide, hearing or service animals;
(i) the food facility owner ensures compliance with local ordinances related to sidewalks, public nuisance and sanitation; and
(j) such other control measures approved by the enforcement agency are complied with.
2. This section shall not impair or diminish the right of an individual to be accompanied by an animal where otherwise permitted by law, including but not limited to the rights of people with disabilities using guide, hearing or service animals.
3. For purposes of this section:
(a) “Food service establishment” shall mean any business which has areas, including outdoor seating areas, in which food is sold for on-premises consumption.
(b) “Companion dog” shall mean a domesticated dog accompanying an individual or owner for the purpose of companionship or convenience of such individual or owner, and shall not include guide, hearing or service dogs.

The regulation in question has not been amended to reflect changes in the law and prohibits live animal from food service operations, except for “patrol dogs accompanying security police officers or guide dogs accompanying blind persons.”  10 NYCRR 14-1.183.Since it is likely that this incident occurred before the amendments to the law were in place, the existing regulations would apply.  However the law only permits dogs in outdoor dining areas.

Finally, it is important to keep this in mind: with more dogs accompanying their owners to restaurants and other public places, there will be increased incidences of injuries to people and pets and related lawsuits.

December 18, 2015 / 64(49);1359-62

Julie R. Sinclair, DVM1; Ryan M. Wallace, DVM2; Karen Gruszynski, DVM3; Marilyn Bibbs Freeman, PhD4; Colin Campbell, DVM5; Shereen Semple, MS5; Kristin Innes, MPH5; Sally Slavinski, DVM6; Gabriel Palumbo, MPH1; Heather Bair-Brake, DVM1; Lillian Orciari, MS2; Rene E. Condori, MS2; Adam Langer, DVM1; Darin S. Carroll, PhD2; Julia Murphy, DVM3

Canine rabies virus variant has been eliminated in the United States and multiple other countries. Globally, however, dogs remain the principal source for human rabies infections (1). The World Health Organization recommends that when dogs cross international borders, national importing authorities should require an international veterinary certificate attesting that the animal did not show signs of rabies at the time of shipment, was permanently identified, vaccinated, or revaccinated, and had been subjected to a serologic test for rabies before shipment (1). On June 8, 2015, an adult female dog that had recently been picked up from the streets of Cairo, Egypt, and shipped by a U.S. animal rescue organization to the United States was confirmed to have rabies by the Virginia Department of General Services Division of Consolidated Laboratory Services (DCLS). This dog was part of a large shipment of dogs and cats from Egypt that rescue organizations had distributed to multiple states for adoption. During the investigation, public health officials learned that the rabies vaccination certificate used for entry of the rabid dog into the United States had intentionally been falsified to avoid exclusion of the dog from entry under CDC’s current dog importation regulations. This report underscores the ongoing risk posed by U.S. importation of domestic animals that have not been adequately vaccinated against rabies.

Case Report

On May 30, 2015, a shipment of eight dogs and 27 cats arrived at John F. Kennedy International Airport in New York City from Cairo, Egypt. The animals were distributed to several animal rescue groups and one permanent adoptive home in New Jersey, Pennsylvania, Maryland, and Virginia. Four dogs from the shipment arrived in Virginia on May 31, 2015, and were distributed to three foster homes associated with a Virginia-based rescue group (animal rescue group A).

On June 3, an adult female street dog (dog A) imported by animal rescue group A became ill. The dog had been imported with an unhealed fracture of the left forelimb, and 4 days after arrival at a foster home in Virginia, developed hypersalivation, paralysis, and hyperesthesia. Because of concern about rabies, a veterinarian euthanized the dog on June 5 and submitted brain tissue for rabies testing at DCLS. On June 8, DCLS confirmed rabies infection by direct fluorescent antibody testing and contacted CDC to coordinate shipment of specimens to assist with variant typing. CDC determined that the variant was consistent with canine rabies virus circulating in Egypt.

Public Health Investigation

After DCLS confirmed the rabies diagnosis, the Virginia Department of Health, the New Jersey Department of Health, the New York City Department of Health and Mental Hygiene, and CDC initiated human and domestic animal rabies exposure assessments associated with the entire animal shipment. The infectious period for dog A was considered to have begun 10 days before symptom onset and continued until death (i.e., from May 24 to June 5) (2). The investigation also involved the Maryland Department of Health and Mental Hygiene, the Pennsylvania Department of Health, U.S. Customs and Border Protection, the foreign airline that transported the animals, the Egyptian Ministry of Health and Population, and the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service.

Potential human exposures were identified by interviewing U.S.-based airline cargo staff members, the U.S. transporter, dog A’s caretaker, and volunteers and employees associated with animal rescue group A. Upon the shipment’s arrival in New York, eight persons were involved in moving the dogs and cats from the plane onto a transport trailer and then into the U.S. transporter’s vehicle. The New York City Department of Health and Mental Hygiene interviewed these eight persons; all reported having worn leather gloves while handling the crates and having had no direct contact with the animals. Public health investigators determined that the animals did not have contact with each other during transport except for dog A and her puppy aged 10 weeks (dog B), which were transported in the same crate. Both dogs had reportedly been collected off the streets of Cairo 5 days before shipment.

Among the eight dogs in the Egyptian shipment, only dog A and two dogs aged 6 months (dogs F and G) had certificates indicating rabies vaccination at or after age 3 months and ≥30 days before arrival at a U.S. port of entry (Table), as required by CDC dog importation regulations (3). Following dog A’s rabies diagnosis, rescue workers reported that the dog’s vaccination certificate had been intentionally predated in Egypt.

The Virginia investigation focused on contact with dog A after departing the airport cargo area through the time of the veterinary assessment in Virginia. Health department personnel in Virginia evaluated 30 persons for possible rabies exposure; no bite exposures were reported. Eighteen persons initiated rabies postexposure prophylaxis (PEP), including 10 who were considered to have been exposed and eight who requested PEP despite reporting no clear rabies exposure. Eight of the 18 persons receiving PEP reported having previously received rabies preexposure prophylaxis.

Domestic animal exposure investigations revealed that all animals in the Egyptian shipment, except for dogs A and B, had been crated individually in the airplane’s cargo hold and held separately after arriving in the United States, until delivered to their final destinations. Investigators thought it unlikely that the cats in this shipment had interacted with dog A, even while in Egypt. CDC’s cat importation regulations do not require that cats be vaccinated against rabies; therefore, the cats were not required under federal regulations to be confined, vaccinated, or revaccinated against rabies.

The Virginia Department of Health considered that the only dog among the animals in the Egyptian shipment to have been exposed to dog A during the rabies infectious period was her puppy, dog B. Dog A’s caretaker was pet sitting a neighbor’s dog and providing care within her household for eight other dogs, as well as nine other animals. The Virginia Department of Health identified seven dogs in dog A’s caretaker’s home as having been exposed to rabies. (Dog B was housed with a different caretaker.) The local health department determined that all of the exposed dogs except dog B had current rabies vaccination certificates from licensed veterinary hospitals. The dogs with current certificates received a rabies booster vaccination followed by 45 days of confinement at their owners’ homes, as recommended by the Compendium of Animal Rabies Prevention and Control (4). Dog B, who was aged <12 weeks at the time and had not received an initial dose of rabies vaccine, was vaccinated against rabies and placed in strict isolation* for 90 days, followed by 90 days of home confinement (Table). To ensure that the dog was vaccinated according to the vaccine manufacturer’s label specifications (at age ≥3 months), another dose of rabies vaccine was administered to dog B 1 month before release from strict isolation (Table). Dogs C and D each received a booster dose of rabies vaccine, followed by 90 days of home confinement.

The New Jersey Department of Health interviewed volunteers from a canine rescue group in New Jersey (animal rescue group B) that had received four of the eight dogs from the Egyptian shipment. All four dogs received either their initial rabies vaccination or a rabies booster vaccination and were ordered to be confined in their owners’ homes for 6 months (Table).

Discussion

Rabies, the deadliest of all zoonotic diseases, accounts for an estimated 59,000 human deaths globally each year (5). The virus can infect any mammal, and once symptoms appear, the disease is almost invariably fatal (6). Importation of rabid animals into the United States has broad public health implications. The reintroduction of a canine rabies virus variant† or introduction of any nonendemic rabies viruses into a naïve animal population has the potential to change the epizootiology of rabies in the United States, leading to severe health consequences and economic losses (7).

To prevent human rabies exposures and introduction of rabies viruses, U.S. federal and state regulations place strict rabies vaccination requirements on dogs. Current CDC dog importation regulations require that dogs being imported from countries not considered rabies-free§ be accompanied by a valid rabies vaccination certificate (3). A valid rabies vaccination certificate documents a rabies vaccination for a dog aged ≥3 months that was administered ≥30 days before arrival in the United States (3). State regulations often are more strict. For example, all dogs and cats imported into Virginia by rescue groups must be accompanied by a Certificate of Veterinary Inspection issued by a veterinarian in the state or country of origin no fewer than 10 days before the animal enters Virginia. In addition, if the animal (i.e., a dog or cat) is aged ≥4 months, it must be vaccinated against rabies.

These importation regulations are difficult to enforce because of limited resources at U.S. ports of entry to inspect dog shipments. This report details the fourth known instance of a rabid dog imported from a non-U.S. territory since 2004 and the second instance of importation by a rescue organization of a rabid dog from the Middle East (4,8). However, other cases might have gone unreported because rabies can have a variable clinical course (4) that might not prompt animal owners or veterinarians to seek postmortem rabies testing.

CDC and state agencies have previously received reports of invalid or questionable health and rabies vaccination certificates for imported dogs (9); in at least one reported case, a veterinarian issued a Certificate of Veterinary Inspection for a dog that was already showing signs of rabies infection (10). CDC has attempted to address mounting concerns about importation of inadequately vaccinated dogs, either resulting from inaccurate rabies vaccination certificates or from legal importation under an existing mechanism allowing exceptions to CDC’s regulatory requirement (i.e., issuance of a dog confinement agreement that serves as a legal and binding agreement between CDC and the importer and lists requirements for vaccination and confinement of the animal).

In May 2014, CDC issued the health alert notification “Imported Dogs with Questionable Documents” specifically because of ongoing concerns with dogs’ entry documents listing incorrect ages and rabies vaccination status. In addition, in July 2014, CDC published the notice “Issuance and Enforcement Guidance for Dog Confinement Agreements”¶ in the Federal Register clarifying that entry into the United States of dogs that are inadequately vaccinated against rabies and coming from countries where rabies is endemic would only be allowed on a limited and case-by-case basis. In the incident described in this report, under the criteria outlined in the Federal Register notice, CDC would ordinarily have excluded five of the eight dogs in the shipment (dogs B, C, D, E, and H). However, CDC was not notified of the arrival of these dogs until after the dogs had already been admitted into the United States and left the port of entry. Because dog A was accompanied by a rabies vaccination certificate that only later was reported to have been falsified, CDC would most likely have admitted dog A.

This report underscores the current difficulties in verifying any imported dog’s rabies vaccination certificate and health status. The United States also is vulnerable to an increasing risk for rabies introduction and spread from other imported domestic animals, such as cats and ferrets. Considering the public health risk posed by importation of animals for the purposes of placing them in adoptive homes in the United States, and the current oversupply of adoptable animals already in the United States, persons and organizations involved with importing pets for the purposes of adoption should consider reevaluating, and potentially redirecting, their current efforts. Globally, animal welfare stakeholders should consider focusing their efforts on supporting local organizations that provide adoptive homes, along with health care services, for street animals in their own countries. In addition, although this report focuses on imported dogs and rabies, all animals pose a risk for transmission of zoonotic diseases (e.g., brucellosis, leishmaniasis, campylobacteriosis, leptospirosis, giardiasis, and cutaneous or visceral larva migrans). Documentation of overall health status, not just rabies vaccination, is critical to minimizing the risk from importing animals carrying zoonotic diseases.

Acknowledgments

Bryant Bullock, Lorrie Andrew-Spear, Fairfax County Health Department, Virginia Department of Health; Douglas Hubbard, Allison Hubbard, Marta Segarra, Whitney Wright, Charles Devine, David Goodfriend, Alison Ansher, Andrea Young, Erica Thompson, Patrick Jones, David Ferrell, Katherine Merten, Barbara Downes, Audrey Ryan, Brooke Rossheim, Maribeth Brewster, Matthew Lipani, Brent McCord, Rebecca LePrell, Laurie Forlano, Virginia Department of Health; Katherine Feldman, Maryland Department of Health and Mental Hygiene; Alexandra Newman, New York State Department of Health; David Chico, New York State Department of Agriculture and Markets; Enzo Campagnolo, Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC; James Misrahi, Office of the General Counsel, CDC; Jorge Ocana, Harlem Gunness, Gale Galland, Yonette Hercules, Katrin Kohl, Ashley Marrone, Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Mary Reynolds, Inger Damon, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Egyptian Ministry of Health and Population; U.S. Customs and Border Protection; U.S. Department of Agriculture Animal and Plant Health Inspection Service.

1Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 2Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3Virginia Department of Health; 4Virginia Department of General Services Division of Consolidated Laboratory Services; 5New Jersey Department of Health; 6New York City Department of Health and Mental Hygiene.

Corresponding authors: Julie R. Sinclair, jsinclair@cdc.gov, 404-429-4299; Julia Murphy Julia.Murphy@vdh.virginia.gov, 804-864-8141.

References

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* Isolation in this context refers to confinement in an enclosure that precludes direct contact with humans and other animals. In Virginia, this means that an animal is placed in a double walled enclosure that allows for feeding, watering, cleaning, and general care but will not allow for any person or other domestic animal to have contact with the isolated animal.

† In this incident, the phylogenetic reconstruction based on the complete nucleoprotein gene is closely related to a canine rabies virus variant circulating in domestic dogs in Egypt (Africa 4 clade).

¶ Available at http://www.cdc.gov/importation/laws-and-regulations/dog-confinement-agreements.html.