Journal Citation
Gurry GA, Campion V, Premawardena C, Woolley I, Shortt J, Bowden DK, Kaplan Z, Dendle C. High rates of potentially infectious exposures between immunocompromised patients and their companion animals: an unmet need for education. Intern Med J. 2017;47(3):333-335.
Published Abstract
A cross-sectional survey of 265 adult patients with haematological malignancy, haemoglobinopathy or human immunodeficiency virus was performed to determine the potential risk of infection from animal exposures. One hundred and thirty-seven (52%) owned an animal; the majority were dogs (74%) and cats (39%), but 14% owned birds and 3% reptiles. Eighty percent engaged in behaviour with their animals that potentially put them at risk of zoonotic infections. The most frequent behaviours were picking up animal faeces 72 (52%), cleaning animal areas 69 (50%) and allowing animals to sleep in the same bed 51 (37%). Twenty-eight percent allowed the animal to lick their face. Of all patients, 80 (30%) had been bitten or scratched by an animal. Only 16% of those who owned pets could recall receiving education regarding safe behaviours around animals. These immunocompromised patients are at risk of infection through exposure to pets. Our study highlights the need for increased education of patients regarding how to remain safe around their pets.
Context
Humans can catch infections from animals (“zoonotic infections”). Increased contact with animals puts people at greater risk of catching those infections. Immunodeficiency (a suppressed immune response) puts people at risk of more invasive and symptomatic illnesses from those infections. Understanding this is important because many people who are ill find solace and companionship in a pet, companion, or service animal. Pets and companion animals are often obtained without medical consultation. This study was aimed to identify the level of knowledge about these risks among animal owners with immunodeficiency diseases, and to identify the extent to which they partake in such risky behaviors.
Findings
A cross-sectional survey was conducted at a large tertiary care hospital in Melbourne, Australia, selecting patients with one of three disease groups: haematological malignancies (chronic lymphocytic leukaemia and lymphoma), haemoglobinopathies requiring transfusion, and patients living with human immunodeficiency virus (HIV). Consecutive adults attending one of these clinics were asked to complete the anonymous, self-administered questionnaire, consisting of questions about demographic information, animal ownership, types of animal contact, and whether the subject recalled receiving education regarding safe animal contact, from a healthcare worker.
The survey was completed by 275 subjects, with 64% male. The median age was 48 years (range of 17–92 years). Fifty-two percent of the surveyed subjects owned some type of animal (more or less evenly distributed between the three patient populations). Of the animals owned, 74% were dogs, 36% were cats, 14% birds, 3% reptiles, 2% rabbits, 1% rodents, and 19% something else.
Of the subjects who owned animals, 80% engaged in at least one activity that may have exposed them to zoonotic infections, such as picking up animal feces (66% of those engaged in risky behaviors), cleaning animal living areas (63%), or sleeping in the same bed (47%). Thirty percent of the subjects who owned animals reported having been bitten or scratched. Only 17% of subjects who owned animals recalled receiving advice from a healthcare worker regarding safe practices around animals.
Discussion
Pet ownership is quite common throughout much of the world, and this study of immunocompromised subjects informs us that pet and companion animals are commonly owned by these patients as well: Over half of the surveyed subjects owned a companion animal. What’s more, approximately 80% of the animal-owning individuals engaged in behavior that placed them at increased risk of contracting a zoonotic infection.
The significance of this is brief but well-summarized and referenced by this study’s authors. Contraction of microbes from the dog to the human has been well-documented by several earlier studies of patients who kissed, were licked by, or slept with their dogs or cats, compared to those who simply owned dogs or cats. In fact, in at least one published study, a patient died from their infection, acquired from a dog lick. Animal bites carry an even greater risk of transmitting infection, and there are multiple reports of immunocompromised patients dying as a result. The authors also remind us of the prior study that estimates that 14% of all human illness caused by common enteric (intestinal) pathogens are attributable to animal contact.
Perhaps even more disturbing than the frequency of risky behavior among immunocompromised patients is the lack of needed counseling by their health care providers. Speaking as a health care provider for many immunocompromised patients, I have to admit that I rarely think about this issue during my office visits, which are so commonly monopolized by disease pathology and complications, medication, drug interactions and side effects, etc. This is not intended to be a “cop-out,” but rather a confession that our current office-visit protocols will need to change if we are to make room for preventive counseling about safe handling of companion animals.
For me, the take-away message from this article was: Many of my patients – including those with chronic or immunocompromising diseases – own animals, and need to be counseled regarding safe behaviors with those animals.
The take-away question was: How can I do a better job counseling those patients? Printed materials exist, though they are limited in number and scope. Handing out printed materials saves time and is arguably “better than nothing,” but probably not much better. Without the doctor or nurse discussing the issue, whatever is written on the brochure – if it is read at all – will not carry as much sway / power / influence. I believe the medical health care provider and the veterinarian both have the obligation to counsel at least at-risk individuals. Even if only one sentence is said (perhaps as the brochure is handed out), the message will likely be considered and remembered more seriously than would be the case of simply handing out a brochure without any verbal communication. Of course, as this study’s authors conclude, only a prospective study evaluating the impact of educational interventions on pet-handling behaviors will clearly inform us about the best approach to minimizing the zoonotic infection risk.
-Reviewed by Ron Sherman, MD