Parent and pediatrician knowledge, attitudes, and practices regarding pet-associated hazards

Pediatric dog bite injuries in the USA: a systematic review

Introduction

Dog bites are one of the leading causes of non-fatal emergency room visits in children. These injuries not only cause physical harm but can lead to long-term psychological stress. This study evaluated the current literature related to pediatric dog bite injuries to identify research gaps which should be prioritized to improve a major public health concern.

Methods

We performed a keyword search of PubMed, Scopus, and OVID Medline databases (January 1980– March 2020) for all published studies focused on dog bite injuries in the pediatric population (≤18 years of age) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Results

Out of 1859 abstracts screened, 43 studies involving 86 880 patients were included. Twenty-nine studies were retrospective chart reviews characterizing the epidemiology of dog bites and their associated treatment outcomes; six were prospective cohort studies; two were cross-sectional studies; and six were experimental studies. Synthesized results demonstrate that children <9 years of age suffer the greatest burden of injuries, with children <6 years of age at higher risk of more severe injuries involving the head, neck, and face.

Conclusion

Studies analyzing the prevention or psychosocial consequences of dog bites injuries are needed.

Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution

Dog bite injuries remain a common form of pediatric trauma. This single-institution study of 1616 consecutive dog bite injuries over 4 years revealed a much higher prevalence of dog bites as compared with other similar centers. Though inpatient admission was rare (9.8%), 58% of all patients required laceration repair, primarily in the emergency department. Infants were more than 4 times as likely to be bitten by the family dog and more than 6 times as likely to be bitten in the head/neck region. Children ≤5 years old were 62% more likely to require repair; and 5.5% of all patients required an operation. Pit bull bites were implicated in half of all surgeries performed and over 2.5 times as likely to bite in multiple anatomic locations as compared to other breeds. The relatively high regional prevalence and younger age of injured patients as compared with other centers is a topic of further study but should draw attention to interventions that can minimize child risk.

Dog and cat bite-associated infections in children

Millions of people throughout the world are bitten by animals each year. About 90 % of the bites are caused by dogs and cats, and infections are the most common complications. As children are the most frequently bitten subjects, pediatricians should provide parents with everything they need to know in order to confront the problem. However, this does not seem to be case and, as the treatment of bite wounds is frequently inappropriate and delayed, the risk of acute infection and sequelae is increased. The main aim of this review is to discuss the epidemiology, microbiology, and clinical characteristics of infections due to dog and cat bites in children, and suggest the best approach to their management. Analysis of the published literature shows that prompt treatment is necessary in order to reduce the risk of infection. The therapeutic measures include wound washing, specific prophylaxis (i.e., tetanus and/or rabies), and antibiotics in the case of immunocompromised patients or deep wounds (particularly if there is evidence of edema or crushing), facial bites, or any wound over a tendon or bone.

Dog bites: an opportunity for parent education in the pediatric emergency department

OBJECTIVES

This study focuses on parental report of exposure to dogs and highlights the potential for using a computer kiosk in an urban pediatric emergency department to increase knowledge around dog bite safety.

METHODS

Nine hundred one parents of young children completed a kiosk assessment and received a report that contained information aimed at increasing knowledge about either dog bite prevention (PAR-DB, n = 453) or other safety behaviors (PAR-S, n = 448). The participants who received the dog bite prevention report (PAR-DB) were asked questions about exposure to dogs as part of the baseline assessment. All participants were telephoned 2 to 4 weeks later for a follow-up interview to measure knowledge differences.

RESULTS

The majority of respondents who answered the exposure questions reported seeing stray dogs (53%) and having dangerous dogs (43%) in their neighborhood. Few respondents reported that their child had been bitten by a dog (1%), but the majority (56%) reported having knowledge of another child having been bitten. Few respondents reported having a dog in their home (11%), and only 1 reported that her dog had bitten a child. A majority (56%) of dogs had not been spayed or neutered. Of families with dogs in the home, 20% reported leaving their child unattended with the dog. A minority (45%) of dogs left alone with children had been spayed or neutered.

CONCLUSIONS

PAR-DB parents achieved knowledge gains as a result of the Parent Action Report generated by the kiosk, demonstrating the potential to improve knowledge via a computer kiosk in a busy pediatric emergency department.

Household knowledge, attitudes and practices related to pet contact and associated zoonoses in Ontario, Canada

Background

Many human infections are transmitted through contact with animals (zoonoses), including household pets. Although pet ownership is common in most countries and non-pet owners may have frequent contact with pets, there is limited knowledge of the public’s pet contact practices and awareness of zoonotic disease risks from pets. The objective of this study was to characterize the general public’s knowledge, attitudes and risks related to pet ownership and animal contact in southern Ontario, Canada.

Methods

A self-administered questionnaire was distributed to individuals at two multi-physician clinics in Waterloo, Ontario, Canada during 2010. A single adult from each household was invited to participate in the study.

Results

Seventy five percent (641/853) of individuals approached completed the questionnaire. Pet ownership and contact were common; 64% of participants had a pet in their household and 37% of non-pet owning households had a member with at least weekly animal contact outside the home. Pet ownership was high (55%) for households with individuals at higher risk for infections (i.e., < 5 yrs, ≥ 65 yrs, immunocompromised). Most respondents (64%) indicated that they had never received information regarding pet-associated disease risks. When given a list of 11 infectious pathogens, respondents were only able to correctly classify just over half on their potential to be transmitted from pets to people (mean 6.4); independently, pet owners and those who recalled receiving information in the past about this topic were able to make significantly more correct identifications. Pet (36%) and non-pet owning households (10%) reported dog or cat bites or scratches during the preceding year. Households with individuals at higher risk for an infection did not differ from the remaining households regarding their perceived disease risk of pets, zoonotic disease knowledge, recall of being asked by their medical provider if they owned any pets, or recall of having received information regarding pet-associated disease risks and preventive measures.

Conclusions

These results suggest that there is a need for accessible zoonotic disease information for both pet and non-owning households, with additional efforts made by veterinary, human and public health personnel. Immediate educational efforts directed toward households with individuals at higher risk to infections are especially needed.

Exposure to nontraditional pets at home and to animals in public settings: risks to children

Exposure to animals can provide many benefits during the growth and development of children. However, there are potential risks associated with animal exposures, including exposure to nontraditional pets in the home and animals in public settings. Educational materials, regulations, and guidelines have been developed to minimize these risks. Pediatricians, veterinarians, and other health care professionals can provide advice on selection of appropriate pets as well as prevention of disease transmission from nontraditional pets and when children contact animals in public settings.

Behavioral assessment of child-directed canine aggression

OBJECTIVE

To characterize behavioral circumstances of bites to children by dogs presented to a veterinary behavior clinic.

METHODS

Retrospective case series examining medical records of dogs presenting by referral to a university veterinary hospital for aggression and which had bitten a child <18 years old. Behavioral data included age of victim, familiarity with dog, and circumstances of bites.

RESULTS

Records of bites to 111 children were examined. Children <6 years old were most commonly bitten in association with resource guarding (44%), whereas older children were most commonly bitten in association with territory guarding (23%). Similarly, food guarding was the most common circumstance for bites to familiar children (42%) and territory guarding for bites to unfamiliar children (53%). Behavioral screening of the 103 dogs examined revealed resource guarding (61%) and discipline measures (59%) as the most common stimuli for aggression. Anxiety screens revealed abnormalities in 77% of dogs. Potential contributory medical conditions were identified/suspected in 50% of dogs. When history before presentation was known, 66% of dogs had never previously bitten a child, and 19% had never bitten any human. Most dogs (93%) were neutered, and 66% of owners had taken their dogs to obedience training classes.

CONCLUSIONS

Most children were bitten by dogs with no history of biting children. There is a high rate of behavioral abnormalities (aggression and anxiety) in this canine population. Common calming measures (neutering, training) were not routinely effective deterrents.

ORF virus infection in children: clinical characteristics, transmission, diagnostic methods, and future therapeutics

Orf virus leads to self-limited, subacute cutaneous infections in children who have occupational or recreational contact with infected small ruminants. Breaches in the integument and contact with animals recently vaccinated for orf may be important risk factors in transmission. Common childhood behaviors are likely important factors in the provocation of significant contact (ie, bites) or in unusual lesion location (eg, facial lesions). Clinician recognition is important in distinguishing orf infection from life-threatening cutaneous zoonoses. Recently developed molecular techniques provide diagnostic precision and newer topical therapeutics may hasten healing.

Salmonella Montevideo outbreak in military kennel dogs caused by contaminated commercial feed, which was only recognized through monitoring

A large outbreak of canine salmonellosis in military watch dogs due to Salmonella Montevideo and/or Salmonella Give was only recognized through a monitoring program, implemented by the military forces. In 51 out of 80 exposed dogs (63.8%) from four kennels Salmonella was isolated from fecal samples. The prevalence per sampling day ranged from 5.6 to 77.8%. Clinical disease with mild diarrhea but without fever appeared only in nine dogs (11.3% of study population, 16.9% of cases) from one kennel (***P < 0.001). Risk analysis identified "dog food A" (odds ratio 3.33 [1.12 < OR < 10.06] *P < 0.05) and "dog food C" (odds ratio 3.40 [1.07 < OR < 11.22] *P < 0.05), two commercial dehydrated dog feeds, as suspected infectious sources. Feeding "dog food C" alone or together with "dog food A" was significantly associated with clinical disease (***P < 0.001). S. Montevideo and S. Give with similar plasmid profiles and PFGE-restriction patterns were isolated from the suspected dog feeds and fecal samples. This outbreak demonstrates not only that Salmonella infections in dogs occur without clinical symptoms but also that large outbreaks occur after feeding dehydrated dog feeds. Especially in households with known risk group patients this finding demonstrates a particular risk for their owners, as they often live in close contact with their animals.

Models of antimicrobial resistance and foodborne illness: examining assumptions and practical applications

Antimicrobial resistance is an issue of increasing global concern. Several investigators have suggested that antibiotic use in food-producing animals is a major contributor to the increasing incidence of antimicrobial-resistant organisms causing illness in humans (F. J. Angulo, K. R. Johnson, R. V. Tauxe, and M. L. Cohen, Microb. Drug Res. 6:77-83, 2000; P. D. Fey, T. J. Safranek, M. E. Rupp, E. F. Dunne, R. Efrain, P. C. Iwen, P. A. Bradford, F. J. Angulo, and S. H. Hinrichs, N. Engl. J. Med. 342:1242-1249, 2000; S. A. McEwen and P. J. Fedorka-Cray, Commun. Infect. Dis. 34(Suppl. 3):S93-S106, 2002; D. L. Smith, A. D. Harris, J. A. Johnson, E. K. Silbergeld, and J. G. Morris, Jr., Proc. Natl. Acad. Sci. USA 99:6434-6439, 2002; D. G. White, S. Zhao, R. Sudler, S. Ayers, S. Friedman, S. Chen, P. F. McDermott, D. D. Wagner, and J. Meng, N. Engl. J. Med. 345:1147-1154, 2001; W. Witte, Science 279:996, 1998). In this paper, we discuss this and other assumptions relevant to a quantitative risk assessment model for salmonellosis in humans. We also discuss other important aspects of modeling food safety and food-associated antimicrobial resistance risk to humans. We suggest that the role of food-producing animals in the origin and transmission of antimicrobial resistance and "foodborne" pathogens has been overestimated and overemphasized in the scientific literature; consequently, nonfoodborne transmission, including pet-associated human cases, has been underemphasized. Much evidence exists for the potential contribution to infectious disease that may be of human or pet origin (that may contact humans through food but not be of a food origin). Risk analyses that do not acknowledge the potential for these sources of cross-contamination will understate the contribution that origin has in the realm of foodborne and food-associated diseases (e.g., Salmonella) and the resulting uncertainty levels in the food system, thus leading to biased inferences. We emphasize the importance of evaluating both the foodborne and nonfoodborne transmission risk for salmonellosis and outline the basics of an analytical modeling approach in food safety with examples to illustrate strengths and limitations in the modeling. Examples illustrate, on a simplistic level, how varying assumptions and other inputs can influence the output of food-associated quantitative risk models.

Neonatal jaundice, animal-based injuries, and immunizations

The authors describe current investigation in three areas of pediatrics commonly faced by the office practitioner. Despite the fact that changes in medical practice and in patient demographics have resulted in the reemergence of severe hyperbilirubinemia and bilirubin encephalopathy, clinical assessment and evaluation of discharge bilirubin levels may help predict those infants at greatest risk. Progress in the use of inhibitors of bilirubin production may eventually decrease the need for phototherapy. Although dog-associated injuries continue to affect children disproportionately, additional attention to anticipatory guidance may prove beneficial. The practice of routine immunization has reshaped our view of pediatric illness. The development of pneumococcal, meningococcal, and rotaviral vaccines will alter significantly the prevalence of common pediatric infectious disease. However, with the advent of additional vaccines, attention to pain control will take on increasing urgency.