Managing zoonotic disease risks:need for greater physician and veterinarian collaboration
http://www.100md.com
Laura H. Kahn
zoonotic,Managingzoonoticdiseaserisks:needforgreaterphysicianandveterinariancollaboration,INTRODUCTION,ZOONOTICDISEASESOFCOMPANIONANIMALS,DEVELOPINGC
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Managing zoonotic disease risks:need for greater physician and veterinarian collaboration(pdf)
Correspondence to Laura H.Kahn,MD,Princeton University，221 Nassau Street, 2nd floor，Princeton, NJ 08542
Tel:(609)258-6763,Fax:(609)258-3661
INTRODUCTION
Zoonotic diseases are diseases that can be transmitted to humans from domestic and wild animals and are significant threats to human health. Approximately 60% of infectious agents that infect humans are zoonotic, and zoonotic pathogens are twice as likely to be associated with emerging or newly discovered infections compared to non-zoonotic pathogens[1].Despite the importance that animal exposures play in zoonotic disease risks, one study found that physicians are generally not comfortable discussing the role of animals in the transmission of zoonotic diseases and would prefer that veterinarians play a role[2].Most patients, however, do not view veterinarians as a source of information for human health. For example, the authors found that only 21% of HIV-infected patients ask their veterinarians about disease risks associated with pet ownership[2].
The results of these differing expectations contribute to few medical and veterinary medical professionals advising their patients or animal-owning clients, respectively, on these issues. To improve this situation, there needs to be greater communication and collaboration between physicians and veterinarians in the clinical setting to better assess and manage disease transmission risks between humans and animals[3].This issue is particularly important for people who are chronically immunosuppressed but depend on animals for companionship and/or for their livelihoods. Historically, rabies has been the zoonotic disease of most concern, but there are many others that deserve discussion. This paper will briefly discuss a few common zoonotic disease risks and discuss how collaborative efforts between physicians and veterinarians could be achieved.
ZOONOTIC DISEASES OF COMPANION ANIMALS
Approximately 63% of all US households own at least one pet[4].The most commonly owned animals include cats (90.5 million), dogs (73.9 million), small mammals (18.2 million), and birds (16.6 million.)[4].Almost 140 million freshwater and over nine million saltwater fish are owned[4].In addition to the typical animals, millions of exotic and unusual animals, such as tigers, monkeys, and dangerous reptiles, are also kept as pets in private homes, roadside zoos, and menageries[5].Indeed, in the US, more tigers are kept as pets than exist in the wild worldwide[6].
Ownership of exotic or unusual animals such as imported African rodents can lead to exposure to pathogens previously unknown in the United States. For example, the 2003 monkeypox outbreak in the Midwest occurred in normal, healthy individuals who owned infected pet prairie dogs[7].These prairie dogs had been exposed to monkeypox from giant Gambian rats while they were co-housed in a large pet distribution facility[7].
For chronically immunosuppressed pet owners, the risks of pet ownership, particularly of exotic animals, are considerably greater than for the immunocompetent. For example, virtually all reptiles carry Salmonella in their normal intestinal tract flora, and exposure to these animals leads to almost 100,000 cases of reptile-associated salmonellosis in the US each year[8].
Zoonotic disease risks do not always come from exotic animals. For example, the domestic cat, the most commonly owned pet in the US, is a major reservoir for Bartonella henselae, the causative agent of cat scratch disease in immunocompetent individuals and bacillary angiomatosis-peliosis in immunocompromised individuals[9，10]. These infections are extremely common as more than 40,000 cases of cat scratch disease are reported each year[11].The exact mechanisms of how the organism is transmitted from cats to humans is not well understood, but in addition to scratches and bites, fleas are thought to play a major role[11].
Dogs and cats are the host species for the roundworms: Toxocara canis and Toxocara cati,respectively[12].Humans, particularly children, are usually infected through accidental ingestion of embryonated eggs although there have been reports of infections resulting from the ingestion of sub-adult or adult worms from infected kittens and cats[13].Infections with the eggs leads to clinical disease depending on which tissues and organs have been invaded by the larvae: visceral larva migrans (VLM) or ocular larva migrans (OLM)[14].The risk factors for acquiring T. canis and T.cati in pediatric populations include: geophagia, litter of puppies or kittens in the home, and race[15~17]. One study found that infection with T. canis is common in urban children and may be associated with adverse neuropsychological effects[17].
ZOONOTIC DISEASES OF LIVESTOCK AND LABORATORY ANIMALS
Zoonotic disease risks extend beyond pet ownership: occupational exposure to zoonotic pathogens pose a serious risk to human health. For example, Campylobacter infection is an occupational risk for packers in poultry factories, and Streptococcus suis can cause meningitis or occasionally fulminant sepsis in pig farmers[18-20].
Work with laboratory animals also poses risks, and while zoonotic disease risks in this line of work appears to be low, for the few cases that do occur, the results can be deadly[21]. For example, B virus (Cercopithecine herpesvirus 1) infection is widespread in rhesus and cynomolgus macaques which are frequently used in biomedical research[22].Although this virus, which is related to the human herpes virus, causes no disease in its simian hosts, in humans, the death rate from infection can be greater than 70% if the wound or exposed mucous membrane is not properly washed, and if deemed appropriate, treated promptly with anti-viral medications.
IMMUNOSUPPRESSED HUMANS AND ANIMALS
What should be of concern for physicians who manage patients living with compromised immune systems is also the immune status of their pets, particularly dogs, because they are increasingly being treated with immunosuppressive drugs. For example, canine atopic dermatitis is a relatively common condition. A study of 31,484 dogs seen in 52 private veterinary practices in the US found that approximately 9% of the dogs were diagnosed with atopic/allergic dermatitis, atopy, or allergy[23,24].The recommended treatment for this condition is oral glucocorticoids and cyclosporine A[25].While the dosages used are primarily at anti-inflammatory and not immunosuppressive levels, superficial bacterial, such as Staphylococcus intermedius, and yeast, Malassezia pachydermatitis, infections commonly occur in dogs with this condition due to either their disease or to the treatment[26,27].
Many of the autoimmune diseases of humans, such as inflammatory bowel disease and immune-mediated hemolytic anemias, are also seen in dogs[28,29]. These diseases are treated with immunosuppressant drugs such as high dose glucocorticoids, cyclosporine, and azathioprine[28~30].
To date, there are no studies investigating the risk of transmission of zoonotic diseases from immunosuppressed pets to their human owners. Theoretically, immunosuppressed pets could pose particular risks to their owners if the owners were immunosuppressed as well. It is unlikely that veterinarians would know their animal patients‘ owners’ immunologic status before prescribing immunosuppressive drugs to their pets unless voluntarily offered by the pet owners themselves.
ANIMALS THAT SHOULD NOT BE PETS
In some circumstances, the risk of disease transmission is too great to approve of pet ownership or of working with certain animals. For example, physicians should advise immunosuppressed individuals, or healthy individuals with young children, that they should not own or work with reptiles because the Salmonella in their intestinal tracts can not be eradicated. Humans should not own monkeys, particularly rhesus and cynomolgus macaques as pets because of the risk of acquiring the deadly B virus. In addition, monkeys make poor pets since they are wild, unpredictable, and frequently bite or scratch. Large carnivorous animals do not make good pets either, and physicians and veterinarians could do much to improve public health by discouraging their patients and clients from owning them or other wild animals.
For other zoonotic diseases, the risks of transmission can be greatly reduced. For example, pet cats' fleas should be controlled to prevent transmission of Bartonella henselae[10].Similarly, dogs and cats should be regularly assessed and treated for Toxocara. Physicians and veterinarians should always instruct patients and clients on the importance of careful hand washing after handling pets[31].
DEVELOPING COLLABORATIONS
Physician-veterinarian collaborations would be most important for chronically immunosuppressed individuals who own pets. An immunosuppressed patient who owns a pet cat or dog would benefit greatly by having both his physician and veterinarian keep close tabs on potential zoonotic disease risks. Rather than bring in the pet only when it is sick, the immunosuppressed pet owner would be encouraged to have his pet undergo regular checkups to ensure that preventable zoonotic diseases are promptly treated.
There is an integral link between the pathogens that infect and/or co-exist in animals and the potential transmission to humans. It behooves physicians and veterinarians to work together to provide the best possible care for both their human and animal patients, respectively. Since companion animal ownership provides considerable psychological benefits, particularly for those at risk for social isolation such as the elderly,efforts should be made to allow individuals, including immunocompromised individuals, to keep their pets while minimizing zoonotic disease risks[32].
In an era in which zoonotic diseases are newly emerging or becoming increasingly common, assessing potential risks should be a priority in medical settings. In addition to asking about behavioral risk factors such as cigarette and alcohol use, physicians could also routinely ask about zoonotic risk factors. The Centers for Disease Control and Prevention provides excellent information on its “Healthy Pets Healthy People” website, including “Pet-Scriptions” for physicians and veterinarians to distribute to their patients and pet-owning clients on ways to reduce zoonotic disease risks[33].
In addition to improving care for individual patients and their pets, there should be increased communications between physicians and veterinarians regarding human and wildlife health. For example, hospital epidemiologists should develop relationships with veterinarians in their area so that if the veterinarians see large wildlife die-offs, as they did during the West Nile virus outbreak in New York City in 1999, they should be notified, along with the public health authorities, as soon as possible in order to be on the look out for possible human involvement[34].This direct communication between physician epidemiologists and veterinarians could help to expedite a rapid response particularly in states in which local public health agencies either do not exist or are not involved in zoonotic disease surveillance[35].
Finally, jointly sponsored medical and veterinary medical conferences on zoonotic risks to human health would go a long way in helping to forge new ties and provide opportunities for collaborative efforts. There need to be jointly sponsored studies to assess whether immunosuppressed pets pose increased zoonotic disease risks to their owners. This issue would be particularly important if the owners were immunosuppressed themselves. By working together, physicians and veterinarians could greatly improve our ability to identify and control the zoonotic diseases that plague both humans and animals.
ACKNOWLEDGEMENT
The author has no conflict of interest or financial investments to disclose.
The author would like to thank Bruce Kaplan, DVM (retired) for his invaluable comments and suggestions.This work was funded by a grant from the Josiah Macy, Jr. Foundation of New York City.
REFERENCES
1. Taylor LH, Latham Sm, Woolhouse MEJ. Diseases of humans and their domestic mammals: pathogen characteristics, host range and the risk of emergence. Philos Trans R Soc Lond B Biol Sci., 2001, 356: 983-989.
2. Grant S, Olsen CW. Preventing zoonotic diseases in immunocompromised persons: the role of physicians and veterinarians. Emerg Infect Dis.,1999,5: 159-163.
3. Kahn LH. Confronting Zoonoses, Linking Human and Veterinary Medicine. Emerg Infect Dis.,2006, 12: 556-561.
4. American Pet Products Manufacturers Association (APPMA) Industry Statistics & Trends. Pet Ownership statistics from the APPMA's 2005/2006 National Pet Owners Survey (Available at URL: http://www.appma.org/press_industrytrends.asp)
5. Animal Protection Institute. A Life Sentence: The Sad and Dangerous Realities of Exotic Animals in Private Hands. (Available at URL: http://www.api4animals.org/a3b_exotic_pets.php)
6. Altman LK. Tackling the Animal-to-Human Link in Illness. New York Times. March 25, 2006.
7. Centers for Disease Control and Prevention. Update: multistate outbreak of monkeypox-Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep., 2003, 52: 642-646.
8. Council of State and Territorial Epidemiologists. Reptile-associated salmonellosis and prevention education. CSTE position statement 1999-ID 13. Available at (URL: http://www.cste.org/ps/1999/1999-id-13.htm)
9. Tappero JW, Mohle-Boetani J, Koehler JE, et al. The Epidemiology of Bacillary Angiomatosis and Bacillary Peliosis. JAMA, 1993, 269: 770-775.
10. Koehler JE, Sanchez MA, Garrido CS, et al. Molecular Epidemiology of Bartonella Infections in Patients with Bacillary Angiomatosis-Peliosis. NEJM, 1997, 337: 1876-1883.
11. Tompkins LS. Of Cats, Humans, and Bartonella. NEJM,1997, 337: 1915-1917.
12. Overgaauw PA. Aspects of Toxocara epidemiology: Toxocarosis in dogs and cats. Critical Reviews Microbiology, 1997, 23: 233-251.
13. Eberhard ML, Alfano E. Adult Toxocara Cati Infections in U.S. Children: Report of Four Cases. American Journal of Tropical Medicine Hygiene, 1998, 59: 404-406.
14. Despommier D. Toxocariasis: Clinical Aspects, Epidemiology, Medical Ecology, and Molecular Aspects. Clinical Microbiology Reviews, 2003,16: 265-272.
15. Herrmann N, Glickman LT, Schantz PM, et al. Seroprevalence of Zoonotic Toxocariasis in the United States: 1971-1973. American Journal of Epidemiology, 1985, 122: 890-896.
16. Ellis GS Jr, Pakalnis VA, Worley G, et al. Toxocara canis infestation. Clinical and Epidemological Assocations with Seropositivity in Kindergarten Children. Opthalmology, 1986, 93: 1032-1037.
17. Marmor M, Glickman L, Shofer F, et al. Toxocara canis infection of children: Epidemiologic and Neuropsychologic Findings. American Journal of Public Health, 1987, 77: 554-559.
18. Wilson IB. Airborne Campylobacter infection in a poultry worker: case report and review of the literature. Commun Dis Public Health, 2004, 7: 349-353.
19. Perseghin P, Bezzi G, Troupioti P, et al. Streptococcus suis meningitis in an Italian blood donor. Lancet,1995,346: 1305-1306.
20. Barelink AK, van Kregten E. Streptococcus suis as a threat to pig farmers and abattoir workers. Lancet, 1995,346: 1707.
21. Weigler BJ, DiGiacomo RF, Alexander S. A National Survey of Laboratory Animal Workers Concerning Occupational Risks for Zoonotic Diseases. Comparative Medicine, 2005, 55: 183-191.
22. Huff JL, Barry PA. B virus (Cercopithecine herpesvirus 1) infection in humans and macaques: potential for zoonotic disease. Emerg Infect. Disease, 2003, 9: 246-250.
23. Hillier A, Griffin CE. The ACVD task force on canine atopic dermatitis (I): incidence and prevalence. Veterinary Immunology and Immunopathology, 2001, 81: 147-151.
24. Lund EM, Armstrong PJ, Kirk CA, et al. Health Status and Population Characteristics of Dogs and Cats Examined at Private Veterinary Practices in the United States. Journal of the American Veterinary Medical Association, 1999, 214: 1336-1341.
25. Olivry T, Mueller RS; The International Task Force on Canine Atopic Dermatitis. Evidence-based Veterinary Dermatology: A Systematic Review of the Pharmacotherapy of Canine Atopic Dermatitis. Vet. Dermatology,2003, 14: 121-146.
26. Olivry T, Sousa CA. The ACVD task force on canine atopic dermatitis(XIX): general principles of therapy. Veterinary Immunology and Immunopathology, 2001, 81: 311-316.
27. DeBoer DJ, Marsella R. The ACVD task force of canine atopic dermatitis (XII): the relationship of cutaneous infections to the pathogenesis and clinical course of canine atopic dermatitis. Veterinary Immunology and Immunopathology, 2001, 81: 239-249.
28. Weinkle TK, Center SA, Randolph JF, et al. Evaluation of prognostic factors, survival rates, and treatment protocols for immune-mediated hemolytic anemia in dogs: 151 cases (1993-2002). J Am Vet Med Assoc, 2005, 226: 1869-1880.
29. Craven M, Simpson JW, Ridyard AE, et al. Canine inflammatory bowel disease: retrospective analysis of diagnosis and outcome in 80 cases (1995-2002). J Small Anim Pract, 2004, 45: 336-342.
30. Allenspach K, Rufenacht S, Sauter S, et al. Pharmacokinetics and clinical efficacy of cyclosporine treatment of dogs with steroid-refractory inflammatory bowel disease. J Vet Intern Med, 2006, 20: 239-244.
31. Reed, CA and Kaplan B. Neglected but Commonsense Steps to Prevent Foodborne Illness. Journal Am. Vet Med Assoc, 1996,209: 1053.
32. McNicholas J, Gilbey A, Rennie A, et al. Pet Ownership and Human Health: A Brief Review of Evidence and Issues. BMJ, 2005, 331: 1252-1254.
33. Centers for Disease Control and Prevention. National Center for Infectious Diseases. Healthy Pets Healthy People. (Available at URL: http://www.cdc.gov/healthypets/index.htm).
34. US General Accounting Office. West Nile virus outbreak. Lessons for public health preparedness. Washington: The Office; 2000. GAO/HEHS-00-180.
35. Kahn LH. Confronting Zoonoses, Linking Human and Veterinary Medicine. Emerg Infect. Dis., 2006, 12: 556-561.
Woodrow Wilson School of Public and International Affairs，Princeton University,Princeton,NJ08542,US
(Editor HOU)
Managing zoonotic disease risks:need for greater physician and veterinarian collaboration(pdf)
Correspondence to Laura H.Kahn,MD,Princeton University，221 Nassau Street, 2nd floor，Princeton, NJ 08542
Tel:(609)258-6763,Fax:(609)258-3661
INTRODUCTION
Zoonotic diseases are diseases that can be transmitted to humans from domestic and wild animals and are significant threats to human health. Approximately 60% of infectious agents that infect humans are zoonotic, and zoonotic pathogens are twice as likely to be associated with emerging or newly discovered infections compared to non-zoonotic pathogens[1].Despite the importance that animal exposures play in zoonotic disease risks, one study found that physicians are generally not comfortable discussing the role of animals in the transmission of zoonotic diseases and would prefer that veterinarians play a role[2].Most patients, however, do not view veterinarians as a source of information for human health. For example, the authors found that only 21% of HIV-infected patients ask their veterinarians about disease risks associated with pet ownership[2].
The results of these differing expectations contribute to few medical and veterinary medical professionals advising their patients or animal-owning clients, respectively, on these issues. To improve this situation, there needs to be greater communication and collaboration between physicians and veterinarians in the clinical setting to better assess and manage disease transmission risks between humans and animals[3].This issue is particularly important for people who are chronically immunosuppressed but depend on animals for companionship and/or for their livelihoods. Historically, rabies has been the zoonotic disease of most concern, but there are many others that deserve discussion. This paper will briefly discuss a few common zoonotic disease risks and discuss how collaborative efforts between physicians and veterinarians could be achieved.
ZOONOTIC DISEASES OF COMPANION ANIMALS
Approximately 63% of all US households own at least one pet[4].The most commonly owned animals include cats (90.5 million), dogs (73.9 million), small mammals (18.2 million), and birds (16.6 million.)[4].Almost 140 million freshwater and over nine million saltwater fish are owned[4].In addition to the typical animals, millions of exotic and unusual animals, such as tigers, monkeys, and dangerous reptiles, are also kept as pets in private homes, roadside zoos, and menageries[5].Indeed, in the US, more tigers are kept as pets than exist in the wild worldwide[6].
Ownership of exotic or unusual animals such as imported African rodents can lead to exposure to pathogens previously unknown in the United States. For example, the 2003 monkeypox outbreak in the Midwest occurred in normal, healthy individuals who owned infected pet prairie dogs[7].These prairie dogs had been exposed to monkeypox from giant Gambian rats while they were co-housed in a large pet distribution facility[7].
For chronically immunosuppressed pet owners, the risks of pet ownership, particularly of exotic animals, are considerably greater than for the immunocompetent. For example, virtually all reptiles carry Salmonella in their normal intestinal tract flora, and exposure to these animals leads to almost 100,000 cases of reptile-associated salmonellosis in the US each year[8].
Zoonotic disease risks do not always come from exotic animals. For example, the domestic cat, the most commonly owned pet in the US, is a major reservoir for Bartonella henselae, the causative agent of cat scratch disease in immunocompetent individuals and bacillary angiomatosis-peliosis in immunocompromised individuals[9，10]. These infections are extremely common as more than 40,000 cases of cat scratch disease are reported each year[11].The exact mechanisms of how the organism is transmitted from cats to humans is not well understood, but in addition to scratches and bites, fleas are thought to play a major role[11].
Dogs and cats are the host species for the roundworms: Toxocara canis and Toxocara cati,respectively[12].Humans, particularly children, are usually infected through accidental ingestion of embryonated eggs although there have been reports of infections resulting from the ingestion of sub-adult or adult worms from infected kittens and cats[13].Infections with the eggs leads to clinical disease depending on which tissues and organs have been invaded by the larvae: visceral larva migrans (VLM) or ocular larva migrans (OLM)[14].The risk factors for acquiring T. canis and T.cati in pediatric populations include: geophagia, litter of puppies or kittens in the home, and race[15~17]. One study found that infection with T. canis is common in urban children and may be associated with adverse neuropsychological effects[17].
ZOONOTIC DISEASES OF LIVESTOCK AND LABORATORY ANIMALS
Zoonotic disease risks extend beyond pet ownership: occupational exposure to zoonotic pathogens pose a serious risk to human health. For example, Campylobacter infection is an occupational risk for packers in poultry factories, and Streptococcus suis can cause meningitis or occasionally fulminant sepsis in pig farmers[18-20].
Work with laboratory animals also poses risks, and while zoonotic disease risks in this line of work appears to be low, for the few cases that do occur, the results can be deadly[21]. For example, B virus (Cercopithecine herpesvirus 1) infection is widespread in rhesus and cynomolgus macaques which are frequently used in biomedical research[22].Although this virus, which is related to the human herpes virus, causes no disease in its simian hosts, in humans, the death rate from infection can be greater than 70% if the wound or exposed mucous membrane is not properly washed, and if deemed appropriate, treated promptly with anti-viral medications.
IMMUNOSUPPRESSED HUMANS AND ANIMALS
What should be of concern for physicians who manage patients living with compromised immune systems is also the immune status of their pets, particularly dogs, because they are increasingly being treated with immunosuppressive drugs. For example, canine atopic dermatitis is a relatively common condition. A study of 31,484 dogs seen in 52 private veterinary practices in the US found that approximately 9% of the dogs were diagnosed with atopic/allergic dermatitis, atopy, or allergy[23,24].The recommended treatment for this condition is oral glucocorticoids and cyclosporine A[25].While the dosages used are primarily at anti-inflammatory and not immunosuppressive levels, superficial bacterial, such as Staphylococcus intermedius, and yeast, Malassezia pachydermatitis, infections commonly occur in dogs with this condition due to either their disease or to the treatment[26,27].
Many of the autoimmune diseases of humans, such as inflammatory bowel disease and immune-mediated hemolytic anemias, are also seen in dogs[28,29]. These diseases are treated with immunosuppressant drugs such as high dose glucocorticoids, cyclosporine, and azathioprine[28~30].
To date, there are no studies investigating the risk of transmission of zoonotic diseases from immunosuppressed pets to their human owners. Theoretically, immunosuppressed pets could pose particular risks to their owners if the owners were immunosuppressed as well. It is unlikely that veterinarians would know their animal patients‘ owners’ immunologic status before prescribing immunosuppressive drugs to their pets unless voluntarily offered by the pet owners themselves.
ANIMALS THAT SHOULD NOT BE PETS
In some circumstances, the risk of disease transmission is too great to approve of pet ownership or of working with certain animals. For example, physicians should advise immunosuppressed individuals, or healthy individuals with young children, that they should not own or work with reptiles because the Salmonella in their intestinal tracts can not be eradicated. Humans should not own monkeys, particularly rhesus and cynomolgus macaques as pets because of the risk of acquiring the deadly B virus. In addition, monkeys make poor pets since they are wild, unpredictable, and frequently bite or scratch. Large carnivorous animals do not make good pets either, and physicians and veterinarians could do much to improve public health by discouraging their patients and clients from owning them or other wild animals.
For other zoonotic diseases, the risks of transmission can be greatly reduced. For example, pet cats' fleas should be controlled to prevent transmission of Bartonella henselae[10].Similarly, dogs and cats should be regularly assessed and treated for Toxocara. Physicians and veterinarians should always instruct patients and clients on the importance of careful hand washing after handling pets[31].
DEVELOPING COLLABORATIONS
Physician-veterinarian collaborations would be most important for chronically immunosuppressed individuals who own pets. An immunosuppressed patient who owns a pet cat or dog would benefit greatly by having both his physician and veterinarian keep close tabs on potential zoonotic disease risks. Rather than bring in the pet only when it is sick, the immunosuppressed pet owner would be encouraged to have his pet undergo regular checkups to ensure that preventable zoonotic diseases are promptly treated.
There is an integral link between the pathogens that infect and/or co-exist in animals and the potential transmission to humans. It behooves physicians and veterinarians to work together to provide the best possible care for both their human and animal patients, respectively. Since companion animal ownership provides considerable psychological benefits, particularly for those at risk for social isolation such as the elderly,efforts should be made to allow individuals, including immunocompromised individuals, to keep their pets while minimizing zoonotic disease risks[32].
In an era in which zoonotic diseases are newly emerging or becoming increasingly common, assessing potential risks should be a priority in medical settings. In addition to asking about behavioral risk factors such as cigarette and alcohol use, physicians could also routinely ask about zoonotic risk factors. The Centers for Disease Control and Prevention provides excellent information on its “Healthy Pets Healthy People” website, including “Pet-Scriptions” for physicians and veterinarians to distribute to their patients and pet-owning clients on ways to reduce zoonotic disease risks[33].
In addition to improving care for individual patients and their pets, there should be increased communications between physicians and veterinarians regarding human and wildlife health. For example, hospital epidemiologists should develop relationships with veterinarians in their area so that if the veterinarians see large wildlife die-offs, as they did during the West Nile virus outbreak in New York City in 1999, they should be notified, along with the public health authorities, as soon as possible in order to be on the look out for possible human involvement[34].This direct communication between physician epidemiologists and veterinarians could help to expedite a rapid response particularly in states in which local public health agencies either do not exist or are not involved in zoonotic disease surveillance[35].
Finally, jointly sponsored medical and veterinary medical conferences on zoonotic risks to human health would go a long way in helping to forge new ties and provide opportunities for collaborative efforts. There need to be jointly sponsored studies to assess whether immunosuppressed pets pose increased zoonotic disease risks to their owners. This issue would be particularly important if the owners were immunosuppressed themselves. By working together, physicians and veterinarians could greatly improve our ability to identify and control the zoonotic diseases that plague both humans and animals.
ACKNOWLEDGEMENT
The author has no conflict of interest or financial investments to disclose.
The author would like to thank Bruce Kaplan, DVM (retired) for his invaluable comments and suggestions.This work was funded by a grant from the Josiah Macy, Jr. Foundation of New York City.
REFERENCES
1. Taylor LH, Latham Sm, Woolhouse MEJ. Diseases of humans and their domestic mammals: pathogen characteristics, host range and the risk of emergence. Philos Trans R Soc Lond B Biol Sci., 2001, 356: 983-989.
2. Grant S, Olsen CW. Preventing zoonotic diseases in immunocompromised persons: the role of physicians and veterinarians. Emerg Infect Dis.,1999,5: 159-163.
3. Kahn LH. Confronting Zoonoses, Linking Human and Veterinary Medicine. Emerg Infect Dis.,2006, 12: 556-561.
4. American Pet Products Manufacturers Association (APPMA) Industry Statistics & Trends. Pet Ownership statistics from the APPMA's 2005/2006 National Pet Owners Survey (Available at URL: http://www.appma.org/press_industrytrends.asp)
5. Animal Protection Institute. A Life Sentence: The Sad and Dangerous Realities of Exotic Animals in Private Hands. (Available at URL: http://www.api4animals.org/a3b_exotic_pets.php)
6. Altman LK. Tackling the Animal-to-Human Link in Illness. New York Times. March 25, 2006.
7. Centers for Disease Control and Prevention. Update: multistate outbreak of monkeypox-Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. MMWR Morb Mortal Wkly Rep., 2003, 52: 642-646.
8. Council of State and Territorial Epidemiologists. Reptile-associated salmonellosis and prevention education. CSTE position statement 1999-ID 13. Available at (URL: http://www.cste.org/ps/1999/1999-id-13.htm)
9. Tappero JW, Mohle-Boetani J, Koehler JE, et al. The Epidemiology of Bacillary Angiomatosis and Bacillary Peliosis. JAMA, 1993, 269: 770-775.
10. Koehler JE, Sanchez MA, Garrido CS, et al. Molecular Epidemiology of Bartonella Infections in Patients with Bacillary Angiomatosis-Peliosis. NEJM, 1997, 337: 1876-1883.
11. Tompkins LS. Of Cats, Humans, and Bartonella. NEJM,1997, 337: 1915-1917.
12. Overgaauw PA. Aspects of Toxocara epidemiology: Toxocarosis in dogs and cats. Critical Reviews Microbiology, 1997, 23: 233-251.
13. Eberhard ML, Alfano E. Adult Toxocara Cati Infections in U.S. Children: Report of Four Cases. American Journal of Tropical Medicine Hygiene, 1998, 59: 404-406.
14. Despommier D. Toxocariasis: Clinical Aspects, Epidemiology, Medical Ecology, and Molecular Aspects. Clinical Microbiology Reviews, 2003,16: 265-272.
15. Herrmann N, Glickman LT, Schantz PM, et al. Seroprevalence of Zoonotic Toxocariasis in the United States: 1971-1973. American Journal of Epidemiology, 1985, 122: 890-896.
16. Ellis GS Jr, Pakalnis VA, Worley G, et al. Toxocara canis infestation. Clinical and Epidemological Assocations with Seropositivity in Kindergarten Children. Opthalmology, 1986, 93: 1032-1037.
17. Marmor M, Glickman L, Shofer F, et al. Toxocara canis infection of children: Epidemiologic and Neuropsychologic Findings. American Journal of Public Health, 1987, 77: 554-559.
18. Wilson IB. Airborne Campylobacter infection in a poultry worker: case report and review of the literature. Commun Dis Public Health, 2004, 7: 349-353.
19. Perseghin P, Bezzi G, Troupioti P, et al. Streptococcus suis meningitis in an Italian blood donor. Lancet,1995,346: 1305-1306.
20. Barelink AK, van Kregten E. Streptococcus suis as a threat to pig farmers and abattoir workers. Lancet, 1995,346: 1707.
21. Weigler BJ, DiGiacomo RF, Alexander S. A National Survey of Laboratory Animal Workers Concerning Occupational Risks for Zoonotic Diseases. Comparative Medicine, 2005, 55: 183-191.
22. Huff JL, Barry PA. B virus (Cercopithecine herpesvirus 1) infection in humans and macaques: potential for zoonotic disease. Emerg Infect. Disease, 2003, 9: 246-250.
23. Hillier A, Griffin CE. The ACVD task force on canine atopic dermatitis (I): incidence and prevalence. Veterinary Immunology and Immunopathology, 2001, 81: 147-151.
24. Lund EM, Armstrong PJ, Kirk CA, et al. Health Status and Population Characteristics of Dogs and Cats Examined at Private Veterinary Practices in the United States. Journal of the American Veterinary Medical Association, 1999, 214: 1336-1341.
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Woodrow Wilson School of Public and International Affairs，Princeton University,Princeton,NJ08542,US
(Editor HOU)
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