2003;23;66AAP News Sue Wallace

contracting zoonotic infectionsSnakes, snails and puppy dog tails : Teach patients to practice proper hygiene around animals to reduce their risk of

http://aapnews.aappublications.org/content/23/2/66The online version of this article, along with updated information and services, is located on the World Wide Web at:

Illinois, 60007. Copyright © 2003 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397. AAP News is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, AAP News is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948.

at UNIV OF CHICAGO on March 25, 2013http://aapnews.aappublications.org/Downloaded from

30% for use on children. She also recommendedwearing long pants and sleeves and doing a tick checkwhenever kids are outdoors in areas endemic to Lymedisease.Rabies is another serious zoonotic infection that is

associatedwithwild animals, especiallybats, accord-ing to Dr. Schutze. Skunks, raccoons and other wildanimals also can carry the virus.

In addition to avoiding contact with wild animals,Dr. Schutze suggested being particularly cautious ifawild animal is acting unusual. However, it's not alwaysobvious when a wild animal is acting strangely. "Ifyou see a skunk in the daytime, that's very unusualand there's a good chance that it's rabid," he advised.

Ask about exposure"Part ofthe problem in diagnosing zoonoses is that

you have to think of them as possibilities," said Dr.Glaser. Asking about animal contact canbe an impor-tant part oftaking a history.

Pediatricians need to be on the alert for unusualzoonoses, said Dr. Glaser. "Whowould have dreamedofmonkeypox?" she asked. But "whenever we intro-duce a new animal into an environment, there's apotential for something to happen."

For more information on zoonoses, visit the CDCWeb site(www.cdc.govlhealIthypetslheaIth_profhtm) .

Research Continuedfrom page65

Nearly 90% of pediatricians reported discussingpassenger safety with famflies of patients youngerthan 12 months of age. However, the percentage ofpediatricians counseling families decreased as thechild's age increased, with only half of pediatricianscounseling adolescents.Passenger restraint systems also were discussed

with greater frequency for younger patients. Almost60% of pediatricians reported discussing such sys-tems at every preventive visit with famflies ofinfantscompared with 51% who discussed at every preven-tive visit for toddlers and 40% for older children.While most pediatricians reported feeling confi-

dent about their abflity to discuss the need for andselection of passenger restraint systems, only 45%reported feeling equipped to answer questionsregarding proper installation. In addition, only 28%reported feeling comfortable discussing choice ofappropriate systems for premature infants, and only15% felt comfortable discussing systems for childrenwith special needs.

For more information about these and otherAAPresearch programs, visit www.aap.orglresearch.

by Sue Wallace, R.N.Correspondent

Spurred bymedia reports ofmonkeypox,West Nilevirus and other zoonotic infections, parents may askfor your opinion on how they should protect theirfamilies against these diseases. With more than 250known zoonoses, the risk is not uncommon."With the greater expansion of surburbia [into

areas that formerly were inhabited by wildlifel, thepotential for the spread of these diseases is tremen-

dous," said Leslie Barton, M.D.,FAAP, professor of pediatrics and

_--t ~~zoonoses expert at the University of_ ~~~Arizona College of Medicine.

At the same time, however, therisk of zoonoses needs to be bal-

~~~anced against the benefits that~~~animals provide, Dr. Barton added.

Dr. Barton "Children are attracted to them,they're wonderful companions and teach childrenwonderful lessons," said Dr. Barton. "Animals haveinherent risks, but some animals are safer thanothers."

Diseases spread by pets"Dogs and cats are great pets," said Carol Glaser,

M.D., D.V.M., medical officer, Viral and RickettsialDisease Laboratory Branch in the CalforniaDepartment of Health Services, although some dis-eases, such as toxocara from both cats and dogs andcat scratch disease from cats, can be issues."Awareness and common sense are important,"

said Dr. Glaser. Her children always wash their handsafter touching an animal, immediately wash anyscratches and never eat around animals. Patients'parents can be advised to take these steps with theirown families to decrease their childrer's risk ofcatch-ing a zoonotic infection.While dogs in the United States and Canada typi-

cally do not carry the rabies virus, it still needs to beruled out in the event ofa bite, which is an extremelycommon event. There were 4.7 mfflion dog bites, ofwhich almost 800,000 required medical treatment in1994 (the most recent year with available data),according to the Centers for Disease Control andPrevention (CDC) (www.cdc.gov/mmwr/PDF/wk/mm5226.pdf).Other animals, such as small rodents, can be safe

if appropriate safeguards are taken.For example, rats are popular pets, said Dr. Glaser,

but parents should be cautioned that iftheir childrenwere to share food with a rat or to be bitten by the rat,they could get rat bite fever. The disease typically isspread via bites, but can be spread via secretionswithout being bitten. "Rat bite fever is verv treatableand it doesiYt happen very often, but if it doesn't getdiagnosed it can get severe," said Dr. Glaser.

Risks from reptilesThere are some animals that are inappropriate pets,

especially for families with young chfldren."Kids under 5 years old shouldn't have reptiles as

pets due to the increased risk of salmonellosis," saidGordon Schutze, M.D., FAAP, who presented a sessionon zoonoses and vector-borne infections at the AAPPREP meeting in July.

In addition to reptiles, CDC also advises againstexposing children under 5 years old to amphibians,

baby chicks and ducklings due to the risk ofsalmonellosis (www.cdc.gov/healthypets/_child. htm)._

Exotic animals also are not appropriatepets_for chfldren or adults, said Dr. Barton. i_

"If you want to enjoy exotic animals, see -1them in the zoo," suggested Dr. Barton."Then_wash your hands before you get your ice _cream cone."y Becau

contai

Petting zoos and farms anima

The importance ofhandwashing, as well asnot mixing animals with eating, was demonstratedafter outbreaks of Escherichia coli 0157:H7(www.cdc.gov/mrmwr/preview/mmwrhtml/mm5015a5.htm). In 2000, 58 children became ill and 19 werehospitalized after contactwith farm animals. Many ofthe chfldren experienced diarrhea, and nine ofthemdeveloped hemolytic-uremic syndrome.

Dr. Barton pointed out that direct contact with afarm animal is not necessary to transmit pathogenicmicroorganisms. Undercooked or raw foods areanother potential source of infection, and the U.S.Department ofAgriculture recently recalled 739,000pounds of steak due to possible contamination withE. coli 0157:H7 (www.cdc.gov/ncidod/ecoli/).

Wildlife and insectsSome of the most publicized zoonotic infections

involve wild animals. Deer are a preferred host oftheticks that spread Borrelia burgdorfieri, the bacteriaresponsible forLyme disease.West Nile virus is prima-rily spread by mosquitoes, which become carriersafter biting an infected bird. Prevention efforts forthese diseases focus on the invertebrate carrier.DEET is effective against both ticks and mosqui-

toes, said Martha S.Wright, M.D., FAAP, a member ofthe AAP Section on Injury and Poison Prevention.The Academy recommends concentrations of up to

ise petting zoos and farms can be a culprit of Esch7erichia colitmination, visitors should wash their hands after visitingals.

The 'hidden' uniinsuredChildrenwho lacked health insurance for part ofa

calendar year experienced delays in receiving healthcare similar to those who were uninsured the fullyear, an AAP analysis of the 2000 National HealthInterview Survey indicated.Approximately one in eight families in both unin-

sured groups reported that cost was a factor in notreceiving medical care comparedwith less than2% ofchildren insured for an entire year (irrespective ofwhether fulfl-year coverage was public or private).The authors noted that these findings highlight the

importance of policy supporting health insuranceretention, continuous Medicaid/State Children'sHealth Insurance Program eligibility, and reductionof waiting periods to enroll in government-fundedhealth insurance programs.

Pediatricians and passenger safetyResults from a recentAAP , PERIODIC

Periodic Survey indicated rl \SURVEYthat while child passenger , .OF FELLOWSsafety counseling is a prior-ity for most pediatricians, there are likely to be age-related differences and gaps in that counseling.

66a AAP News www.aapnews.org August 2003

Snakes,~snisadppp o alTeach natients to practice proper hygiene around animalsto reduce their risk of contracting zoonotic infections

at UNIV OF CHICAGO on March 25, 2013http://aapnews.aappublications.org/Downloaded from

2003;23;66AAP News Sue Wallace

contracting zoonotic infectionsSnakes, snails and puppy dog tails : Teach patients to practice proper hygiene around animals to reduce their risk of

ServicesUpdated Information &

http://aapnews.aappublications.org/content/23/2/66including high resolution figures, can be found at:

Permissions & Licensing/site/misc/Permissions.xhtmlInformation about reproducing this article in parts (figures, tables) or in its entirety can be found online at:

Reprints/site/misc/reprints.xhtmlInformation about ordering reprints can be found online:

at UNIV OF CHICAGO on March 25, 2013http://aapnews.aappublications.org/Downloaded from