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Zoonotic disease: a concern for everyone.

Rabies. Psittacosis. Mycobacteria. In exotic animal practice, whether you work exclusively with pet exotics, wildlife, or zoo animals, you need to be aware of and concerned about potential zoonotic disease for yourself, your associates, and your clients. Most veterinarians are educated about some zoonoses in veterinary school, but many are not educated about even some of the common zoonotic diseases that exotic animals can transmit. Furthermore, most veterinary technicians and assistants are even less knowledgeable about zoonotic conditions, and these individuals are perhaps the people most in contact with animals that are potential disease carriers. To better understand which zoonotic diseases exotic animal veterinary professionals are most at risk for and how they might protect themselves and their clients better from these risks, I have asked several individuals who work in a variety of different settings with exotic animals that could potentially carry zoonotic diseases to discuss how they approach the concept of zoonoses in their practices. The participants are Jeff Applegate, DVM, North Carolina State University School of Veterinary Medicine, Raleigh, NC, USA; Michelle Hawkins, VMD, Dipl ABVP (Avian Practice), UC Davis School of Veterinary Medicine, Davis, CA, USA; Katherine Quesenberry, MS, MPH, DVM, Dipl ABVP (Avian Practice), The Animal Medical Center, New York, NY, USA; Greg Rich, DVM, Avian & Exotic Animal Hospital of Louisiana, Metairie, LA, USA; and Paul Welch, DVM, Forest Trails Animal Hospital, Tulsa, OK, USA. I hope that hearing their statements will make all veterinary professionals stop and consider whether they are taking necessary steps to learn about these diseases and to protect themselves, their staff, their clients, and even their patients from situations involving potential zoonotic disease transmission.

Laurie Hess, DVM, Dipl ABVP (Avian Practice) Associate Editor

Question: What zoonotic diseases do you worry about most in your practice?

Dr Applegate:

The diseases I worry about most are rabies, chlamydiosis, dermatophytosis, E cuniculi, influenza, Cheyletiella, mycobacteriosis (more often in fish than other animals), Salmonella, Giardia, and West Nile virus. We have a pretty active infectious disease committee, and it is very often that they err on the side of caution regarding infectious disease; thus, personal protective equipment, restriction of animals, and even isolation is pretty common.

Dr Hawkins:

I worry about the following 5 diseases most:

1) Chlamydia psittaci is of most concern as it is the most common zoonotic disease identified in pet birds in our practice. Not only are there still plenty of psittacine cases, but also our clinic has identified numerous birds of prey with clinical signs and diagnostic evidence of chlamydiosis.

2) Salmonella spp, especially now with the dramatic rise of the backyard poultry industry.

3) West Nile virus is still a significant disease of wild birds here in California during mosquito season, and already this year there have been 2 human cases in our state.

4) Mycobacterium spp is also a disease we are concerned about, primarily in captive and freeranging wildlife but sometimes in pet birds. Of course, some are of more zoonotic concern than others but we remain vigilant for all species.

5) Because we are a border state, we are constantly on the lookout for the potential for foreign animal diseases. For example, our clinic identified and reported a low pathogenic H5N2 in an Amazon parrot that had not been identified in the US previously.

Dr Quesenberry:

I work in a large referral hospital that sees dogs, cats, and exotic pets. Because of this, we are concerned about zoonotic diseases that pertain to all of these species, as well as infectious diseases that are not zoonotic. Many of our zoonotic disease concerns have to do with dogs and cats, more so than exotics, such as leptospirosis, salmonellosis, and more recently, influenza. We have a formal Hospital Infection Control Committee, and we track reports of potential zoonotic disease, multi-drug-resistant bacteria, and surgical site infections.

Dr Rich:

Psittacines: salmonellosis and psittacosis; poultry and reptiles: salmonellosis; rabbits: dermatophytosis; nonhuman primates and zoological species: salmonellosis and mycobacteriosis.

Dr Welch:

As far as birds are concerned, Chlamydia psittaci is something that we always keep in mind, although it isn't as prevalent as it was in the 1980s, when bird trafficking was common. We pay attention to and discuss Salmonella risks with our reptile clients and are alert to rabies because of our wildlife work. There are other potential zoonotic diseases out there, but these are the top 3 that we make sure to discuss.

Question: As a practitioner who works with birds or other exotic animals, which zoonotic diseases do you think are most important for other veterinary professionals in your field to be educated about?

Dr Applegate:

Most important are chlamydiosis, E cuniculi, Salmonella, West Nile virus, and rabies, of course.

Dr Hawkins:

I think all zoonotic diseases are important; no one wants to have any exposure to a zoonosis occur in his or her clinic. But I believe it depends on geographic location, as well. Some diseases are much more prevalent than others in a certain locale. Here in Northern California, the aforementioned list is the most important that we are concerned about, but perhaps in Florida or the Midwest, this list might be somewhat different.

Dr. Quesenberry:

Three of the diseases that I consider most important for exotic pet veterinarians to be educated about are psittacosis, salmonellosis, and rat bit fever. These diseases at present pose the most direct zoonotic potential between pets and people, and in some cases, can be life threatening. Psittacosis is a disease that we have been aware of for a long time, and many veterinarians who work with birds have contracted this disease, myself included. Most veterinarians are very aware of the threat of Salmonella from reptiles, but recently there has been a dramatic increase in incidence of salmonellosis in people because of the rise in popularity of hobby backyard poultry. Rat bite fever, I believe, is more under the radar of most veterinarians. But pet rats are very popular, and infected animals exhibit no clinical signs. Bites from rats can cause very severe disease and sometimes death in people, particularly in children and immunocompromised individuals. There are several other diseases in pet exotic animals that pose threats, such as mycobacteriosis and MRSA, but for the most part, there are few to no reports of transmission from pets to people, whereas reverse zoonosis, people-to-pet transmission, is reported. Veterinarians should also understand the basics of avian influenza virus, but fortunately, this is not of direct concern currently in pet birds seen in practice. Veterinarians, in general, are more at risk for contracting a zoonotic disease because of our increased exposure. For example, at some point in my career, I contracted Q fever, likely from animal exposure, but I cannot pinpoint exactly how this occurred.

Dr Rich:

Salmonellosis, psittacosis, mycobacteriosis, and dermatophytosis.

Dr Welch:

The top 3 concerns for veterinarians and for human physicians are C psittaci, Salmonella, and rabies.

Question: Do you train your staff about zoonotic disease, and if so, how?

Dr Applegate:

Yes, we actually have online modules that can be accessed and reviewed at any time (or upon hire). However, much of the awareness of zoonotic diseases is found in commonplace discussions with students and staff and is used as a learning opportunity to review a disease and its process.

Dr Hawkins:

Yes, it is part of our initial (and ongoing training) for our staff of faculty, house officers, and registered veterinary technicians at the Davis School of Veterinary Medicine via online training modules and verbal training for biosafety. Annual biosafety training is mandatory for all employees, and in our clinic, it includes the most important zoonotic diseases. We also train veterinary students who rotate through our clinic either directly in the clinic with patients or during rounds. House officers have zoonosis journal club with faculty at least one time during their residencies.

We are fortunate that we are still able to offer a free postmortem examination, and so we can submit cases of interest from client-owned and wild birds. If a potentially zoonotic disease is identified, the clinical veterinarians are all informed via the pathology reports. The clinician responsible for the case will then inform the rest of the staff involved.

Finally, when a zoonotic disease is identified, we self-report through the university biosafety programs regarding the specific disease, how it was handled, which staff and students were involved, and any ways that the potential for spread of the disease was reduced or ameliorated. This selfreview has helped us to improve our future management of potentially zoonotic cases.

Dr Quesenberry:

Yes. We have written protocols for handling suspect zoonotic and infectious disease cases. Our veterinary technician staff and animal handlers are trained in use of personal protective equipment. Our protocol states exactly what protective measures and isolation procedures, if any, need to be taken with suspected or confirmed cases of specific diseases.

Dr Rich:

Most definitely. All staff members are trained about specific diseases through educational handouts and with case discussions concerning suspected zoonotic diseases as they present.

Dr Welch:

We constantly discuss diseases and situations to be aware of. Hand washing needs to be a habit, and we limit those who are allowed to assist with wildlife when we have cases that carry a potential rabies risk.

Question: Do you require your staff to be vaccinated or tested in any way for specific zoonoses?

Dr Applegate:

It is highly recommended that all students be rabies vaccinated, and flu shots are generally promoted and recommended annually. Doctors are required to be up to date with rabies, as are technicians.

Dr Hawkins:

Yes. Because we also work with zoos, everyone is tested annually for Mycobacterium tuberculosis via blood test. We used to collect and store plasma from staff in the event of a disease so we could test paired titers, but the university no longer provides this storage. We also used to test for C psittaci antibodies annually, but we stopped a number of years back. Now we have a protocol to test for paired titers during acute disease and then during convalescence.

Dr Quesenberry:

No. Many veterinarians at our hospital are vaccinated for rabies, however. We have considered checking rabies titers of staff but, as of yet, the logistics have not allowed it.

Dr Rich:

Due to our low incidence of zoonotic diseases, no. We have not seen a case of psittacosis in over 7 years, of Salmonella in any species in over 3 years, and only 1 case of Mycobacteria avium referred to Louisiana State University School of Veterinary Medicine in the last 18 years.

Dr Welch:

In our practice, all the veterinarians and several of the veterinary assistants are vaccinated for rabies.

Question: Do you discuss zoonotic diseases with your clients, and if so, which ones?

Dr Applegate:

Yes, most commonly E cuniculi, Salmonella, and chlamydiosis.

Dr Hawkins:

In general, for a new bird examination, we always discuss chlamydiosis. If a psittacine bird is kept outdoors, we discuss West Nile virus and vaccination, since this is still an issue out here. Of course, if any cases arise in the clinic, we discuss them in detail with the clients, zoos, or wildlife rehabilitation centers.

Dr Quesenberry:

Yes. I am most concerned in situations where I am dealing with families that have newborns or very young children, women who are pregnant, or immunocompromised persons. We also have teachers that have school pets, and reptiles are very popular for this. If children come in with their parents when pets are brought in for examinations, I make a point of speaking to the children directly about washing their hands after handling the pets, especially with reptiles.

Dr Rich:

Reptile and chicken owners are warned about cleanliness as it refers to potential salmonella exposure. Clients with immune-related issues or those planning to take their pets to pet therapy at hospitals or nursing homes are educated about Chlamydia testing.

Dr Welch:

We make it a point to discuss concerns with our clients. Although chlamydiosis isn't as com mon in my area as it once was, we do make it a point to make clients aware of it. When dealing with our reptile clients, I always discuss Salmonella risks.

Question: Have you ever had an incidence of zoonotic disease spread from client to animal or vice-versa in your practice?

Dr Applegate:

Yes--suspicion of dermatophytosis spreading from owner to small mammal pets, and suspicion of influenza spreading to ferret from owner. We once had an owner test his children and dog for E cuniculi; that was complicated. There were no positive results in the family.

Dr Hawkins:

For birds specifically, to my knowledge, only once, and 1 was the recipient! I was the first-year resident on a Chlamydia psittaci case in an Amazon parrot. To save money, I reused a gown that was part of my personal protective equipment with the case (we wear gowns, gloves and N95 masks). Five days later, I had a temperature of 105[degrees]F and felt like I would rather die.

When I went to the ER, I had to beg the resident to let me talk to the attending physician, and then I had to convince the attending that it wasn't likely just the flu and that they really should take a titer and prescribe me doxycycline! That was back when the university did take initial titers, and so I was vindicated a week later. That gown reuse was a rookie mistake, and it really drove home the point that I had to be much more careful for myself and for the staff who work so hard for us.

Dr Quesenberry:

Fortunately, no, not in our hospital that I am aware of. Bite wound injuries are the most common work-related injuries we see in our practice. However, as veterinarians, we may have difficulty determining disease spread from animals to clients, unless we are working directly with a medical facility or are directly informed by the clients themselves. I have been contacted by physicians who have suspected zoonotic disease in their patients, but I had no direct knowledge of particular cases.

Dr Rich:

In 32 years of private practice, we have had only one client contract Salmonella from his pet iguana. We have had over 2 dozen cases of chlamydiosis in psittacines and 4 cases of mycobacteriosis, but no transmission of either disease to other pets or humans.

Dr Welch:

I have had to take rabies shots once in the past and have had several clients in the past become infected with C psittaci. The C psittaci cases were all from either cockatiels or Amazon parrots.
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Title Annotation:Round Table Discussion
Publication:Journal of Avian Medicine and Surgery
Article Type:Report
Date:Sep 1, 2017
Words:2426
Previous Article:Compendium of measures to control Chlamydia psittaci infection among humans (psittacosis) and pet birds (Avian Chlamydiosis), 2017.
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