Our health is inextricably linked to our environment through the air we breathe, the food we eat, and the water we drink. Animals are an integral part of this environment, and our lives are increasingly intertwined with theirs. The recent H1N1 pandemic (swine flu) and an outbreak of E. coli 0157:H7 associated with farm animals in BC have highlighted the importance of this close relationship.
Almost everyone has some daily interaction with animals, whether through food animals and animal products, wildlife, or household pets. In particular, pet ownership, including exotic animals such as reptiles and birds, is increasingly widespread in Canadian households. It is estimated that more than 50% of Canadian households have at least one cat or dog in their home, which speaks to the importance of pets within the family structure.
There are benefits and risks associated with pet ownership. Examples of benefits include companionship, improvement in mood (e.g., through animal-assisted therapy), increased physical activity, and protection of owners from harm. The risks are primarily related to pet-associated infections. These risks may be elevated when children, pregnant women, and immunocompromised individuals live in the home. Other health concerns include allergens and trauma.
For the primary care physician, it is important to remember that pets are part of the family. An assessment of the risk-benefit ratio of keeping pets is important in the overall care of the patient. Communicating this risk to your patient can be challenging. Recommending outright that susceptible patients get rid of their pets may not be the solution, especially if they cherish their companion animal. The patient may not agree with your recommendation and insist on keeping the pet.
Consider whether the risk is short-term or long-term to guide your advice. If short-term (e.g., pregnant woman susceptible to toxoplasmosis from cat feces), the solution may be to designate another member of the household the task of waste disposal. If long-term (e.g., allergy to dog dander triggering severe asthma attacks), negotiate with your patient an acceptable threshold for taking action. For example, your patient may be willing to increase his or her medications to control asthma, but not be willing to find a new home for the dog.
A thorough history is an essential diagnostic tool. Consider documenting in your patients’ charts whether they are pet owners, and periodically ask about the health of their pets. If a patient has an unusual clinical presentation and is a pet owner, a phone call to a veterinary colleague could prove invaluable. Veterinary resources within BC include local and provincial veterinarians and the BC Veterinary Medical Association web site: www.bcvma.org.
The veterinarian might provide information on the potential zoonotic diseases associated with that animal species and on the prevalence and distribution of the disease. For example, if you care for an immunocompromised child, the veterinarian could advise on pet species your patient should avoid (e.g., reptiles due to the high risk of salmonellosis).
Such interdisciplinary collaboration intended to better understand the disease within the animal health context may also expedite your patient’s diagnosis and treatment. The veterinarian may be able to provide recommendations on how to minimize the risk of disease transmission, which you can then relay to your patient. Examples of recommendations that would benefit both your patient and his or her pet may include vaccinating the pet against rabies or treating a suspected Campylobacter infection in the animal.
Close interaction of humans with companion animals is here to stay, and there are many good reasons to promote this relationship. For the physician caring for the health of a family, it is imperative to remember that pets are family too. In addition to recommending that your patients take precautions such as hand washing after contact with pets and proper disposal of their waste, communication with a veterinarian can aid in disease prevention, diagnosis, and treatment.
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2. Barker SB, Wolen AR. The benefits of human–companion animal interaction: A review. Veterinary Med Educ 2008;35:487-495.
3. Rabinowitz PM, Gordon Z, Odofin L. Pet-related infections. Am Fam Phys 2007;76:1314-1322.
4. Hemsworth S, Pizer B. Pet ownership in immunocompromised children—a review of the literature and survey of existing guidelines. Eur J Oncol Nurs 2006;10:117-127.
Dr Pollock is a field epidemiologist with the Canadian Field Epidemiology Program, Public Health Agency of Canada. She is currently placed at the National Collaborating Centre for Environmental Heath within the BCCDC Environmental Health Services Division and at the Centre for Coastal Health. Dr Stephen is a veterinarian epidemiologist and director of the Centre for Coastal Health. He is an associate professor in the Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, the University of Calgary.
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