So begins the Google description for Contagion, a 2011 fictional movie that tracked the day-by-day progression of the rapid spread of an infectious disease. 

Eight years later, in December 2019, a new, unknown virus producing pneumonia-like symptoms in humans emerged in Wuhan, China, before rapidly erupting into a global pandemic. But, this time, it was not the stuff of Hollywood make-believe and movie stars. 

Known as a novel (new) coronavirus (type of virus that typically leads to upper respiratory infections), formally dubbed HCoV-19 or COVID-19 (short for coronavirus disease 2019), the virus has disrupted virtually every aspect of daily lives and conducting business. The virus is believed to have originated from bats but may have had intermediate carriers (that is, before transferring humans) such as civet cats or pangolins.

The world has received a crash course on pandemics, but they are not new to this century. In 2003, a mysterious disease with flu-like symptoms that came to be known as Severe Acute Respiratory Syndrome (SARS), ultimately spread to 26 countries, infecting more than 8,000 people and killing close to 800. While the source of what is considered to be an animal virus remains somewhat uncertain, it is believed SARS started in bats and then spread to other animals. SARS was found to be carried and spread by civet cats and raccoon dogs, as well as domestic cats and ferrets.¹ 

The Middle East Respiratory Syndrome (MERS), which first appeared in 2012, has since spread to 27 countries; it has been traced to originating in camels. 

But none of those numbers compare to the Spanish flu which, from around 1917 to 1918, infected an estimated 500 million people worldwide and killed an estimated 50 million people. One theory for the source of the Spanish flu is a bird flu that migrated to pigs and then jumped to humans. 

What do these viruses have in common and why should you, an animal care provider, care? 

They are all zoonotic and airborne.

Zoonotic Diseases

A zoonotic disease can be transmitted from animals to humans or from humans to animals. The SARS virus, as noted previously, is believed to have ultimately spread to and been carried by domestic cats and ferrets, and COVID-19 is believed to have been carried by bats and, possibly, civet cats or pangolins, but could humans give the virus to animals? 

In a widely publicized news report, on February 28, 2020, a pet dog of a COVID-19 patient in Hong Kong tested “weak positive” for the disease but did not display any “relevant symptoms.” The widely held presumption was the “weak positive” test may have been the result of environmental contamination of the dog’s mouth and nose. That is, a dog being a dog, the pet may have picked up ( licked up) traces of the virus. Upon additional testing which resulted in “weak positive” results, some experts concluded that the dog had a “low level” infection caused by human-to-animal transmission² but, as of mid-March, the Centers for Disease Prevention and Control (CDC) has maintained:

“To date, CDC has not received any reports of pets or other animals becoming sick with COVID-19. At this time, there is no evidence that companion animals including pets can spread COVID-19. However, since animals can spread other diseases to people, it’s always a good idea to wash your hands after being around animals.”

For the latest, particularly as it pertains to animals, be sure to check the CDC’s Coronavirus Disease 2019 (COVID-19): Frequently Asked Questions: COVID-19 and Animals.³

Airborne Infection

In addition to being zoonotic, COVID-19, Spanish flu, SARS and MERS are also viruses that may be spread by the airborne route.

In its published information for health care professionals on the subject of COVID-19, the American Society of Anesthesiologists (ASA) addresses the airborne route as follows: 

“Droplets are larger liquid particles that settle from the air rapidly and typically do not travel more than 3-6 feet from the source. Droplets may be transmitted directly by settling on a potential host’s mucous membranes or indirectly by settling on surrounding environmental surfaces and then spread by hand contact to vulnerable hosts. Hand hygiene and other contact precautions are important ways to prevent spread of droplet infections.”

But (and this is key), as the ASA continues, those droplets “may be ‘aerosolized’ into smaller particles by coughing or sneezing…The smaller particles may become suspended in air currents in which they may travel longer distances.” 

In other words, droplets are larger, heavier particles that are expelled. Droplet nuclei are the dried residual of droplets typically generated from the respiratory system. These infective particles are small enough to evaporate quickly and therefore become aerosolized traveling on dust particles and remain infective for hours, days or weeks, depending on the particular pathogen. 

The distinct possibility of aerosolization received further support on March 11, 2020, when scientists at Princeton University, the University of California-Los Angeles and the National Institutes of Health (NIH)  posted the results of federally funded tests that stated the viable virus “could be detected in aerosols up to 3 hours post aerosolization.” The study also found the virus viable up to 4 hours on copper, up to 24 hours on cardboard, and up to 2-3 days on plastic and stainless steel.⁴

In one high-rise apartment building in China, the virus reportedly spread to different floors—the two people initially infected lived directly above each other but 10 floors apart. At least one working theory pointed to transmission of the virus via the building’s pipes. As described in an article by Live Science, Dr. Amesh Adalja, an infectious disease specialist and a senior scholar at the Johns Hopkins Center for Health Security in Baltimore, Maryland, explained that a faulty piping system could allow the virus to become “aerosolized” out of a pipe and get into the surrounding air.⁵

Whether spread from animal to human, human to human, or animal to animal, the airborne route of transmission is a serious one. Surface cleaning is not enough to prevent transmission. And, when it comes to new and emerging diseases, there are no ready-to-go vaccines. Beyond those airborne diseases that impact humans, what about those that impact the animals in your care? For example, canine cough, dog flu and feline calicivirus may all be spread via the airborne route. 

One Health

According to the CDC, six out of every 10 infectious diseases in people are zoonotic. In short, these diseases are an integral part of the human-animal bond. So, in protecting animal health and welfare, animal care providers contribute toward improving human health. The interdependence of human health and animal health has led to an initiative known as “One Health,” which takes an integrative approach to attain optimal health for people and animals, as well as the environment. 

As the human-animal bond continues to grow, and as the human population continues to expand geographically, as noted by the American Veterinary Medical Association, “The contact between human and wild animal habitats increases, introducing the risk of exposure to new viruses, bacteria and other disease-causing pathogens.” 

Simply put, optimal health for both humans and animals requires an approach beyond considering human-to-human or, separately, animal-to-animal transmission. Rather, in sickness and in health, there is a human-animal bond. 

In October 2019, the American Association of Feline Practitioners (AAFP) released their updated Feline Zoonoses Guidelines. In publishing the guidelines, the AAFP aims to provide accurate information about feline zoonotic diseases to owners, physicians and veterinarians to allow logical decisions to be made concerning cat ownership. Further, as announced by the AAFP, the guidelines provide “a document that can be used to support the International One Health movement, which is a globally recognized practice of studying the similarities in disease processes between humans and animals.” 

Infection Control for the Known and the Unknown 

According to the World Organization for Animal Health, five new human diseases appear every year, three of which are of animal origin. Some of these new diseases will make big headlines, like COVID-19, but most will stay under the radar, known only to those humans impacted, their medical care providers and a few dedicated researchers. The infection control protocols you have in place are protecting you, your staff and the animals in your care not only from known pathogens, but unknown ones as well. 

In 2004, an unknown respiratory illness in dogs was reported that was determined to be caused by equine influenza A(H3N8) viruses. As a newly detected illness, there was no vaccine. In September 2005, it was considered by experts as a “newly emerging pathogen in the dog population” and, today, has been detected in dogs across the U.S. Also, today, there is a vaccine for what is now commonly known as dog flu but there wasn’t one in 2004. 

In 2006, a second form of canine influenza was identified in South Korea and southern China—H3N2. In April 2015, the Chicago area became a hot spot for this variant of avian flu and outbreaks in dogs in other parts of the U.S. were reported throughout 2015. Approximately eight months after the CDC reported the H3N2 outbreak in Chicago, a vaccine for H3N2 received conditional approval from the U.S. Department of Agriculture. 

What’s the next unknown respiratory illness? What’s the next “dog flu” that’s spread by the airborne route but has no vaccine, possibly for months on end while one is being developed and tested and submitted for approval? 

As animal care providers, you are on the front line of both animal health and human health, which is why your infection control must be multi-pronged to go beyond surface cleaning and vaccine protocols to include cleaning the air as well. You’re not only protecting against the spread of known pathogens, but unknown ones as well. As described by the ASA above, aerosolized pathogens may become suspended in air currents and travel longer distances. 

Whether human or animal, whether COVID-19 or H3N8, aerosolization is a studied, researched and supported fact of the airborne transmission route, which makes eliminating those aerosolized pathogens while they’re in the air imperative. Air can be sanitized and achieve up to a 99.9% kill rate of pathogens with ultraviolet germicidal irradiation (UVGI) if it’s done properly. This type of UV has been used in human healthcare for close to a century to disinfect, sanitize and control infection in hospitals and other highly sensitive environments where maintaining sanitary air circulation is critical. 

Animal care should be no different, particularly where there are fewer barriers to transmission (animals typically don’t wear surgical or respirator masks). For effective air sanitizing, it’s also imperative to work with experts who understand the human-animal bond, and understand animal pathogens and human pathogens—both existing and emerging.⊂

References

1. Why Tracing The Animal Source Of Coronavirus Matters, www.cbc.ca/news/health/coronavirus-zoonosis-1.5440146

2.  Low-level of infection with COVID-19 in Pet Dog, https://www.info.gov.hk/gia/general/202003/04/P2020030400658.htm 

3. Frequently Asked Questions: COVID-19 and Animals, https://www.cdc.gov/coronavirus/2019-ncov/faq.html#animals

4. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1,  https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v1.full.pdf

5. Can The New Coronavirus Spread Through Building Pipes, www.livescience.com/coronavirus-spread-building-pipes.html

The post In Sickness and in Health: The Human-Animal Bond and New and Emerging Pathogens appeared first on PetVet Magazine.

In the coming centuries, ringworm was understood to be a fungal infection, but the name stuck and belief in the ways it can be (or not be) transmitted also remained stuck. Ringworm can be transmitted from animals to humans (and from humans to animals) by direct contact with contaminated sources—this is without debate—but can ringworm also be transmitted through the air? 

A Very Brief History of Ringworm Perception and Treatment

While little was known about ringworm at the time, in the 1800s, its spread among humans was generally attributed to poor hygiene and diet. In the April 1912 publication of Popular Science Monthly, an explanation of “immigration law as it stands since the legislation of 1907” noted the required mandatory exclusion of immigrants with “loathsome or dangerous diseases,” including ringworm. 

Up until the mid–twentieth century, treatment for ringworm was something akin to “slash and burn,” with hair removed and caustic chemicals applied to destroy the fungus. In 20th century London, children with the fungal infection were relegated to “ringworm schools” and treated with x–rays. 

How ringworm was spread and treated was more closely and accurately examined during the Second World War when members of the military began contracting ringworm and other fungal diseases, particularly in tropical locations, and during the 1950s when the toxicity of contemporary ringworm treatment was called into question.

But what do medieval names, immigration laws, London ringworm schools, x–rays and military movements have to do with ringworm in dogs and cats? In short, how ringworm is spread in animal care environments remains a subject of debate and knowledge should always be evolving. As indicated by the name of this fungus, nothing about ringworm is a straight line. 

What Causes Ringworm in Pets?

Ringworm is caused by pathogenic fungi known as dermatophytes. Among the dermatophytes that cause ringworm, the Microsporum canis fungus is responsible for 98 percent of the ringworm cases in cats and 70 percent of ringworm in dogs (followed by Microsporum gypseum at 20 percent and Trichophyton mentagrophytes at 10 percent). 

In addition to dogs, cats and humans, ringworm can occur in all domesticated species of animals. The fungus feeds on the dead keratin in upper layers of skin, hair and nails. The tell–tale patchy hair loss in animals is the result of easily broken, weakened and brittle hair shafts. As the fungal spores multiply, the infection can spread. Ringworm can typically remain viable for up to 18 months.

Generally speaking, ringworm is more common in cats than in dogs, but geographic location can also play a role. As the fungus thrives in a warm, damp environment, not surprisingly, ringworm is reportedly more common in the southern part of the United States. Since Hurricane Harvey hit the Houston, TX area in 2017, the Houston Humane Society notes an increase of ringworm that shows no signs of abating. Ringworm flourishing is attributed to the area’s typical warmth and humidity.

Not every pet or person exposed to ringworm spores will experience an infection. A variety of factors play a role, including age, health, suppressed or compromised immune system and nutrition, as well as the number of spores present to establish the infection during the circumstances of the exposure. 

How Is Ringworm Transmitted?

Ringworm is transmitted by direct contact with the fungus, whether from an infected animal or person (including an asymptomatic carrier), a contaminated fomite or surface. The spores of the ringworm fungus are remarkably hardy; able to remain viable for longer than 18 months given the right environment. Direct contact transmission of ringworm, as just described, is without debate, but is there another mode of transmission? Can ringworm be aerosolized? And, if so, can it still cause infection?

Arnold Plotnick, MS, DVM, ACVIM, a board–certified veterinary internist, feline specialist and the owner of Manhattan Cat Specialists describes the potential for aerosolized ringworm fungus: 

“Spores are small and may also be carried on air currents and on dust particles. Once the spores reach the coat, if they survive the cat’s natural defense mechanisms (for example, grooming and sunbathing), they adhere to and invade cells called keratinocytes on the hair shaft and skin (and occasionally, the nails) and they germinate, initiating the infection…”

Microsporum canis, the dermatophyte responsible for 98 percent of the ringworm cases in cats and 70 percent of ringworm in dogs, is between two and three microns in size. That is, as suggested by its name, microscopic. In an animal care environment, fungus spores that are continuously shed create a high pathogen load, depending on the number of infected animals.

As further described by Dr. Plotnick, “Ringworm spores can persist in the environment for a long time, perhaps 18 to 24 months. The spores are microscopic and can be spread easily by air currents and contaminated dust, and through heating ducts and vents.”

The premise that ringworm spores can be aerosolized finds notable support in a 2003 study: “Environmental Detection of Microsporum Canis Arthrospores in the Households of Infected Cats and Dogs,” published in the Journal of Feline Medicine and Surgery. The researchers, collecting air samples using a Sas super–100 air sampler found, “In this study, infected cats appeared to be a striking source of contamination in their environment, and also provoke a massive airborne presence of viable fungal elements.”

In the 2014 clinical review, “Feline Dermatophytosis: Aspects Pertinent to Disease Management in Single and Multiple Cat Situations,” also published in the Journal of Feline Medicine and Surgery, the author acknowledges, “The question of airborne transmission of spores inevitably arises, both in private homes and in shelters,” and cites the above–referenced 2003 article. 

However, in contrast to that earlier study, Dr. Plotnick describes, “In a field study conducted by the author, airborne transmission of spores was monitored in a dedicated treatment facility. Contact plates placed over forced air heating vents on random sample days were never found to be culture positive, even though at times more than 20 cats were present in the facility. However, furnace filters during this time period were always culture positive, indicating that infected hairs and spores were drawn into air vents and trapped in the furnace filter and not being blown throughout the facility.” 

Can the 2003 study and 2014 be reconciled? It may come down to air sampling methodology. In short, a school of thought holds that putting plates in front of an air supply vent is not a valid air sampling strategy. Impaction of spores on the plate requires a velocity faster than what is simply needed to spread spores within a room, which may explain why spores were not collected in the 2014 study. 

Ringworm Transmission Reality Evolution

Despite increasing discussion of ringworm fungus aerosolization, there is no doubt the common perception that it is not aerosolized is firmly entrenched but, as documented above, the premise that it can be aerosolized is not without support. Bearing in mind the previously discussed 2003 study and the uncertainty in the sampling methods of the 2014 study, here is the minimum of what is known: The ringworm spore is no greater than three microns, an easily aerosolized size, and the spores can remain viable for at least a year and a half. 

Google “ringworm” and virtually every article kicks off with some variation of “ringworm is a fungus, not a worm.” A 15th century understanding of this fungal infection commonly persists because of perception without knowledge. For some, there is no debate as to how ringworm is—and isn’t—transmitted. But when the health of animals and the humans who care for them is at stake, the goal should be to never stop learning and evolving to safely prevent the spread of disease. Additional studies may help further understand the transmission of ringworm. +

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Decades later, Word, the McNugget, and Tom Cruise are all still with us. As are sick buildings. A sick building can spread outbreaks of upper respiratory infections (e.g. canine influenza), along with dizziness, asthma and allergies related to poor indoor air quality. Any of these can lead to temporary closures and long–term damage to your (and your business’s) reputation, as well as negatively impact staff health and performance. The potential health effects caused by the air in your business can ultimately impact the financial health of your business.

How Do Buildings Get Sick?

Historically, the 1973 oil embargo and consequent energy crisis led to an effort by builders and regulatory agencies to make buildings air tight and more energy efficient. Making buildings “tighter” meant reducing the amount of outdoor air provided for ventilation. Bitter cold and brutal heat were managed, and pleasant indoor temperatures maintained—all thanks to heating, ventilation and air conditioning (HVAC) systems.

However, tighter buildings also meant that the occupants breathed the same air, day in and day out. Just consider the quality of that air. This led to what was described by the Environmental Protection Agency (EPA) as, “Indoor Air Facts No. 4: Sick Building Syndrome”:

“Most indoor air pollution comes from sources inside the building. For example, adhesives, carpeting, upholstery, manufactured wood products, copy machines, pesticides and cleaning agents may emit volatile organic compounds (VOCs), including formaldehyde. Environmental tobacco smoke contributes high levels of VOCs, other toxic compounds and respirable particulate matter. Research shows that some VOCs can cause chronic and acute health effects at high concentrations, and some are known carcinogens. Low to moderate levels of multiple VOCs may also produce acute reactions.”

The EPA also points to chemical contaminants from outdoor sources, such as motor vehicle exhausts, biological contaminants such as bacteria, molds, pollen and viruses as contributing factors to sick buildings—and potentially sick occupants.

What Does This Mean for Your Veterinary Hospital?

Translating the EPA’s description to veterinary medicine, here are a few common biologic contaminant examples: A dog infected with canine influenza coughs, a cat infected with feline calicivirus sneezes and both shed dander.

Chemical contaminant examples could include: VOC emission from your freshly painted reception area and “fragranced” surface cleaners.

In veterinary hospitals, airborne contaminants may be heavy enough to eventually fall to the surface but most (including the aerosolized droplet nuclei from infected animals) will remain in the air and move throughout your building on air currents. These are generated by your HVAC system as it works to keep your business warm in the winter and cool in the summer. Simply put, your building’s HVAC is the “lungs” of your business, recirculating that same air, breathing in and breathing out…and potentially leading to sick business syndrome in your own hospital.

How Sick Buildings Can Impact the Financial Health of a Business

The negative, if not potentially catastrophic, impact to an animal care business that suffers from an infectious disease outbreak among animals is obvious. Temporary closures of the clinic or business for the cleaning of a room, area or building equal a financial hit. However, the potential for long-term damage to your or your business’s reputation can be even more devastating.

What may be less obvious when it comes to the indoor air quality is the negative effect on staff performance. This can be due to simple decision–making impairment (e.g. headaches) or high rates of absenteeism thanks to the spread of colds or flu.

Published March 21, 2017 for Harvard Business Review, author and researcher Joseph G. Allen tackles the impact of unhealthy building air on the decision–making performance of office employees, in his article “Research: Stale Office Air Is Making You Less Productive”.

Allen notes that, “While sick building syndrome is decades old, its associated set of symptoms such as eye irritation, headaches, coughing and chest tightness is still an issue today.” He continues to say, “Study after study has shown that the amount of ventilation, or fresh outdoor air brought inside, is a critical determinant of health. Good ventilation has been shown to reduce sick building syndrome symptoms, cut absenteeism and even reduce infectious disease transmission.”

For his own study, Allen measured workers’ decision-making by altering air quality conditions of a highly controlled work environment from a conventional environment, which merely met minimally acceptable standards, to an optimized one. The levels of VOCs in the space were changed by controlling the number of common materials that emit these chemicals–e.g., surface cleaners, dry erase markers, dry cleaned clothing and building materials.

The workers’ decision–making performances were evaluated using a standardized cognitive function test that researchers have used for decades. The results? Breathing better air led to better decision–making performance and higher test scores. Further, the biggest improvements were in areas that tested how workers used information to make strategic decisions and how they plan, stay prepared and strategize during crises.

Without even addressing the specifics of other potential health benefits, such as reduced sick building syndrome and absenteeism as a reason for improving indoor air quality, Allen concludes, based on his study that, “Ultimately, managers would be wise to routinely incorporate health impacts into all of their cost–benefit calculations. When health is accounted for, the costs for enhancing the indoor environment can be properly weighed against the health and productivity benefits. For example, an executive will clearly see that an enhanced facilities budget will reduce human resource costs. This makes buildings, in essence, a human resource tool.”

Maintaining Optimal Indoor Air Quality in Your Business

While most of us would prefer to throw open the windows and rely solely on fresh air, increasingly record–topping hot and cold temperatures make HVAC systems a necessity for operating an animal care business. As the lungs of your building and, ultimately your business, your HVAC system must be cared for to reduce the spread of disease, improve cognitive function and decrease absenteeism. Here are a few ways to improve your air quality and reduce sick building syndrome:

1. Improve the Functionality of Your HVAC System with Regular Maintenance

• Change the filters. For most buildings, HVAC filters should be changed at least every three months, but animal care can be an entirely different animal. Depending on how dirty or plugged the filters get, filters should be changed as often as every two weeks and certainly at least once a month. Be sure to check your HVAC manual to see what kind of filter you need to buy and recommendations for filter change.
• Clean the coils. An integral part of your HVAC system are evaporator coils that absorb heat from the indoor air as it is blows over them. These coils become dirty as dust and dander settle on them along with “biofilm”, a build–up of microorganisms that creates an impenetrable layer over the coils.

Not only do dirty coils prevent the HVAC system from working efficiently by demanding increased electricity to function and decreasing air flow, but they can also create breeding grounds for bacteria. Cleaning the coils should be part of your regular routine. Again, be sure to consult your HVAC manual for more information specific to your system, but be aware of this important caveat: if you wait too long to clean your coils, not only will the biofilm be more difficult to remove, but aggressive cleaning to try to do so can result in damage to coils.

2. Utilizing Ultraviolet Germicidal Irradiation (UVGI) to Improve Air Quality, Enhance HVAC Performance & Reduce Maintenance Time

Ultraviolet Germicidal Irradiation (UVGI) offers an opportunity to dramatically improve the air quality of your business to prevent the spread of disease, reduce VOCs and other contaminants and keep your HVAC system working efficiently. UVGI has been used for 100 years to disinfect, sanitize and control infection in hospitals and other highly sensitive environments where maintaining sanitary air circulation, as well as surface areas, are critical.

Briefly, UVGI works as a mutagen to bacteria, viruses and other microorganisms on a cellular level, penetrating the cell wall. This disrupts the microorganism’s DNA, breaking the carbon bond which causes the death of the cell and/or renders it helpless. Additionally, the right UVGI unit used in conjunction with photocatalytic oxidation can reduce VOCs and foul smells by breaking down the odors into carbon dioxide (CO2) and H2O.

Portable and upper air UVGI products can target specific areas of your business, but UVGI can also be integrated with your HVAC system to disinfect the air throughout your business. The UVGI unit, when placed in your HVAC system, works as the indoor air passes through it, killing pathogens and breaking down VOCs. Further, UVGI placed by HVAC coils automatically cleans the coils, eliminating the need for, and cost of, regular coil cleaning maintenance and the use of harsh cleaning chemicals, all while increasing efficiency. The right amount of UVGI, along with correct installation of UVGI for HVAC systems, can provide both coil cleaning efficiency as well as air sanitization.

Healthy Building, Healthy Business

The impact of sick buildings has been recognized and studied for decades, and the evidence continues to mount. Unhealthy air can have a wide range of negative impacts on a business, from infectious disease outbreaks to staff absenteeism and cognitive impairment, all of which can impact your financial bottom line. Maintaining healthy indoor air quality by taking care of your HVAC system and considering the use of UVGI will help keep the rest of your business healthy as well. +

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