Zoonotic infections in veterinarians

Knowledge of Brucellosis, Health-Seeking Behaviour, and Risk Factors for Brucella Infection amongst Workers on Cattle Farms in Gauteng, South Africa

Brucellosis in humans is under-detected and underreported in sub-Saharan Africa. Risk factors associated with Brucella infection and health seeking behaviour in response to brucellosis-like symptoms, amongst cattle farm workers and veterinary officials in South Africa, are unknown. Farm workers and veterinary officials (N = 230) were screened for brucellosis using commercial Rose Bengal Test (RBT^®), IgM Enzyme-linked Immunoassay (ELISA)^®, IgG ELISA^® and the BrucellaCapt^® test. Knowledge of brucellosis and risk factors for exposure to Brucella were also investigated. Seroprevalence varied according to test used: 10.1% (RBT^®), 20.9% (IgG ELISA^®) and 6.5% (BrucellaCapt^®). Only 22.2% (6/27) of veterinary officials opt to visit a clinic, doctor, or hospital in response to self-experienced brucellosis-like symptoms, compared to 74.9% (152/203) of farm workers (p < 0.001). Of the BrucellaCapt^® seropositive participants, 53% (7/15) did not visit a clinic in response to brucellosis-like symptoms. Weak evidence of an association between the handling of afterbirth or placenta and infection of a short evolution (RBT^®, IgM ELISA^® and IgG ELISA^® seropositive) was found (OR = 8.9, 95% CI: 1.0–81.1, p = 0.052), and strong evidence of an association between this outcome and the slaughter of cattle (OR = 5.3, 95% CI: 1.4–19.6, p = 0.013). There was strong evidence of a positive association between inactive/resolved infection and veterinary officials vs. farm workers exposed to seropositive herds (OR = 7.0, 95% CI: 2.4–20.2, p < 0.001), with a simultaneous negative association with the handling of afterbirth or placenta (OR = 3.9, 95% CI: 1.3–11.3, p = 0.012). Findings suggest a proportion of undetected clinical cases of brucellosis amongst workers on cattle farms in Gauteng.

Despite high-risk exposures, no evidence of zoonotic transmission during a canine outbreak of leptospirosis

Leptospirosis is a bacterial zoonosis that affects many mammals, including humans and dogs; dogs can transmit the bacteria to humans, but the frequency of transmission and highest risk exposures are poorly understood. During 2016-2017, the Maricopa County Department of Public Health, Arizona Department of Health Services and Centers for Disease Control and Prevention investigated the zoonotic potential of a canine leptospirosis outbreak in the Phoenix metro area. We identified symptomatic persons exposed to canine leptospirosis cases by conducting active and passive surveillance. We tested dog owners (n = 9) and animal care providers (n = 109) for serological evidence of Leptospira spp. infection (via the microscopic agglutination test [MAT]) and interviewed these persons about their specific exposures to canine cases and general exposures to canine blood and urine. Through surveillance, seven symptomatic persons were identified; six were tested and all were negative by MAT, and of these six, four persons were negative by PCR (two did not have PCR testing). All serosurvey participants (n = 118) were also seronegative. Among animal care providers, bare skin contact with urine/blood from a canine case was reported by 23.2%; two persons reported dog urine splashing in their face. Veterinary technicians were more likely to have bare skin contact with blood from a canine case compared to veterinarians and boarding facility staff (p < 0.001). Infection control practices were inconsistent; when working with specimens from a canine leptospirosis case, 44.6% of participants reported always wearing gloves when working with urine (i.e., collecting specimens), and 54.5% always wore gloves when working with blood. Veterinary technicians were also most likely to engage in all activities involving potential urine/blood contact, such as conducting laboratory tests (p < 0.01). We therefore recommend that veterinary technicians specifically receive targeted education about infection control practices. Our results suggest that dog-to-human transmission of leptospirosis is uncommon.

Prevalence and risk factors for Leptospira exposure in New Zealand veterinarians

This study assessed seroprevalence and risk factors for Leptospira (serovars Hardjo, Pomona, Ballum, Copenhageni, Tarassovi) exposure in New Zealand veterinarians. Veterinarians (n = 277) at one of two conferences were voluntarily enrolled and blood samples taken. Microscopic agglutination test (MAT) titres ⩾48 were considered seropositive. Fourteen veterinarians (5·1%, 95% confidence interval 2·8−8·3) were seropositive to Leptospira. Home slaughter of cattle or pigs were significant risk factors for Leptospira exposure. There were no clear relationships between the animal species handled at work and serostatus. However, veterinarians spending a ‘mid to high’ proportion of their time (>50% to ⩽75%) with pets had higher odds of being seropositive than those not working with pets. A borderline positive association (P = 0·09) was observed between seropositivity and clinical influenza-like illness (⩾3 days off work) in the 18 months before the study. Assuming causality, this suggests that 8·3% of these cases may be attributed to Leptospira exposure.

A survey of the risk of zoonoses for veterinarians

The objectives of this study were to identify factors associated with zoonotic infections in veterinarians, the incidence of physician consultation and treatment and the incidence of diagnostic and treatment errors. Veterinarians in any area of practice were solicited to participate in an online survey through an invitation letter sent to the Oregon Veterinary Medical Association. Proportions of respondents to various factors were analyzed for differences among gender, age, time since graduation and type of practice in which they worked. In all, 216 complete responses were received. In all, 13.9% of respondents had never been vaccinated against rabies, and 20.8% had been exposed to suspect rabid animals, mostly (64.4%) a single time. Other zoonoses were reported by 47.2% of respondents: mostly diseases transmitted via contact (57.4%) especially ringworm, followed by those with oral transmission (21.7%). Most zoonotic infections were reportedly acquired by young veterinarians working in primary care veterinary practice. Cats were the species most commonly reported as the animal source of a zoonotic infection. Veterinarians likely self-diagnosed zoonotic diseases, especially those transmitted by contact. Medical care providers were consulted for diagnosis of more serious diseases. Diagnosis and treatment errors were uncommon. Results of this study emphasize the need to educate future veterinarians during their early years in veterinary school about the risks associated with their future jobs.

A review of published reports regarding zoonotic pathogen infection in veterinarians

OBJECTIVE

To identify published reports regarding zoonotic pathogen infection among veterinarians.

DESIGN

Literature review.

PROCEDURES

The PubMed electronic database of medical literature published between 1966 and November 2007 was searched. Clinical case reports and reports of outbreak investigations were also identified through searches of the literature outside of PubMed and searches of references listed in included articles. Reports eligible for inclusion included controlled and uncontrolled studies examining seroprevalence of animal pathogens in veterinarians, serosurveys involving veterinarians, and reports of zoonotic pathogen infections causing clinical illness.

RESULTS

66 relevant articles were identified. This included 44 seroepidemiologic studies (some examined > 1 pathogen), 12 case reports, 3 outbreak investigations, and 7 self-reported surveys (including 4 related to personal protective equipment use). Of the 44 seroepidemiologic studies, 37 (84%) identified an increased risk of zoonotic pathogen infection among veterinarians, and 7 (16%) identified no increased risk or a decreased risk. Surveys also documented that veterinarians often failed to use recommended personal protective equipment.

CONCLUSIONS AND CLINICAL RELEVANCE

Our review indicated that veterinarians had an increased risk of infection with a number of zoonotic pathogens. It also suggested that veterinarians may inadvertently serve as biological sentinels for emerging pathogens and could potentially spread zoonotic pathogens to their families, community members, and the animals for which they provide care. Professional and policy measures should be implemented to reduce the risk that veterinarians will become infected with, or transmit, zoonotic pathogens.

Cancer in veterinarians

OBJECTIVES

Veterinarians come into contact with several potentially carcinogenic exposures in the course of their occupation. These exposures include radiation, anaesthetic gases, pesticides (particularly insecticides), and zoonotic organisms. This review aims to summarise what is known about the carcinogenic risks in this profession.

METHODS

The levels of exposure to potential carcinogens in the veterinary profession are examined and evidence is reviewed for carcinogenesis of these substances in humans at doses similar to those experienced by veterinarians. The few published studies of cancer in veterinarians are also summarised.

RESULTS

Veterinarians have considerable potential for exposure to several known and potential carcinogens. Risks may be posed by work in clinics with poorly maintained x ray equipment, by use of insecticides, and from contact with carcinogenic zoonotic organisms. The few studies available suggest that veterinarians have increased mortality from lymphohaematopoietic cancers, melanoma, and possibly colon cancer.

CONCLUSIONS

The exposures examined in this review are not unique to the veterinary profession, and, as a consequence, information gathered on the carcinogenic risks of these exposures has implications for many other occupations such as veterinary nurses, animal handlers, and some farmers, as well as dentists, radiographers, and anaesthetists.

Low prevalence of antibodies against the zoonotic agents Brucella abortus, Leptospira spp., Streptococcus suis serotype II, hantavirus, and lymphocytic choriomeningitis virus among veterinarians and pig farmers in the southern part of The Netherlands

Serum samples from 102 veterinarians and 191 pig farmers from the southern part of the Netherlands were investigated for antibodies against Brucella abortus, Leptospira spp, Streptococcus suis serotype II, Hantavirus (HV), and lymphocytic choriomeningitis virus (LCMV). All samples were collected in 1993 and stored until this study was performed. The prevalence of antibodies against B.abortus in veterinarians (4.5%) was significantly higher (P = 0.01) than in pig farmers (0%). None of the veterinarians (0%) and only one pig farmer (0.5%) had antibodies against Leptospira spp. Furthermore, significantly (P = 0.015) more veterinarians (6%) than pig farmers (1%) had antibody titres against muramidase-released protein (MRP),a protein of pathogenic S. suis serotype II strains. None of the veterinarians and a total of 3 (1.6%) pig farmers had antibody titres against HV. The prevalence of antibodies against LCMV tended to be higher in pig farmers (2.6%) than in veterinarians (0%) (P = 0.10). It can be concluded that the prevalence of antibodies against the investigated zoonotic agents in veterinarians and pig farmers is low.

Prevalence of hazardous exposures in veterinary practice

All female graduates of a major U.S. veterinary school were surveyed by mailed questionnaire to obtain details of work practice and hazard exposure during the most recent year worked and during all pregnancies. Exposure questions were based on previously implicated occupational hazards which included anesthetic gases, radiation, zoonoses, prostaglandins, vaccines, physical trauma, and pesticides. The response rate was 86% (462/537). We found that practice type and pregnancy status were major determinants of hazard exposure within the veterinary profession. Small-animal practitioners reported the highest rates of exposure to anesthetic gas (94%), X-ray (90%), and pesticides (57%). Large-animal practitioners reported greater rates of trauma (64%) and potential exposure to prostaglandins (92%), Brucella abortus vaccine (23%), and carbon monoxide (18%). Potentially hazardous workplace practices or equipment were common. Forty-one percent of respondents who reported taking X-rays did not wear film badges, and 76% reported physically restraining animals for X-ray procedures. Twenty-seven percent of the respondents exposed to anesthetic gases worked at facilities which did not have waste anesthetic gas scavenging systems. Women who worked as veterinarians during a pregnancy attempted to reduce exposures to X-rays, insecticides, and other potentially hazardous exposures. Some potentially hazardous workplace exposures are common in veterinary practice, and measures to educate workers and to reduce these exposures should not await demonstration of adverse health effects.

Risks of zoonoses in a veterinary service

A survey was undertaken among the veterinary staff of the Ministry of Agriculture, Fisheries, and Food and the Institute for Research in Animal Diseases to estimate the distribution of occupationally acquired zoonoses in this population. A self-administered questionnaire was distributed to 1717 staff, 1625 (95%) of whom responded. It was observed that both laboratory and technical support staff were at risk from a variety of zoonotic infections, though generally to a lesser extent than veterinary surgeons. A history of injury while handling animals was reported frequently by veterinarians (45%). Accidental self-injection with vaccines was also commonly reported. It is suggested that both injury from animals and accidental self-injection are associated with the risk of zoonotic infection.