Problem: The emergence of novel coronavirus (SARS-CoV-2) in Wuhan, China, in November 2019 and a growing body of information compel inquiry regarding the transmissibility of infection between humans and certain animal species. Although there are a number of issues to be considered, the following points are most urgent: The potential for domesticated (companion) animals to serve as a reservoir of infection contributing to continued human-to-human disease, infectivity, and community spread. The ramifications to food security, economy, and trade issues should coronavirus establish itself within livestock and poultry. The disruption to national security if SARS-CoV-2 and its fairly well-established effects on smell (hyposmia/anosmia) to critical military service animals including explosive detector dog, narcotics detector dog, specialized search dog, combat tracker dog, mine detection dog, tactical explosive detector dog, improvised explosive device detector dog, patrol explosive detector dog, and patrol narcotics detector dog, as well as multipurpose canines used by special operations such as used by the U.S. customs and border protection agency (e.g., Beagle Brigade). This article presents in chronological order data that both individually (as received independently from multiple countries) and collectively urge studies that elucidate the following questions. 1.What animal species can be infected with SARS-CoV-2, the likely sources of infection, the period of infectivity, and transmissibility between these animals and to other animal species and humans? 2.What are the best diagnostic tests currently available for companion animals and livestock? 3.What expressions of illness in companion and other animal species can serve as disease markers? Although it is recognized that robust funding and methodology need to be identified to apply the best scientific investigation into these issues, there may be easily identifiable opportunities to capture information that can guide decision and study. First, it may be possible to quickly initiate a data collection strategy using in-place animal gatekeepers, such as zookeepers, veterinarians, kennel owners, feed lots, and military animal handlers. If provided a simple surveillance form, their detection of symptoms (lethargy, hyposmia, anosmia, and others) might be quickly reported to a central data collection site if one were created. Second, although current human COVID-19 disease is aligning around areas of population density and cluster events, it might be possible to overlay animal species density or veterinary reports that could signal some disease association in animals with COVID-19 patients. Unfortunately, although companion animals and zoo species have repeatedly served as sentinels for emerging infectious diseases, they do not currently fall under the jurisdiction of any federal agency and are not under surveillance.

OBJECTIVE:To evaluate changes in emergency department (ED) dental-related visits in Maricopa County before and after the elimination of dental benefits for adult Medicaid-insured patients as of October 2010.METHODS:Hospital visits extracted from a hospital discharge dataset were used to calculate a yearly rate ratio of dental-related versus non-dental-related ED visits (as a comparison group) for adults, children, and payer types. Changes in ED visits over time were evaluated from 2006 to 2012.RESULTS:Overall, 1.3 percent of all ED visits (8,030,767) were for dental-related purposes. Medicaid-insured patients accounted for 41.9 percent and 44.3 percent of all dental-related ED visits in 2006 and 2012, respectively. The rate ratio for the percentage of dental-related versus non-dental-related ED visits in each age category and payer type showed little fluctuation over time indicating no evidence of change in the dental-related ED visits as a proportion of the overall number of visits due to the cuts in the dental benefits for adult Medicaid-insured patients.CONCLUSION:We found no evidence that cuts in dental benefits for adult Medicaid-insured patients resulted in increased dental-related ED visits in Maricopa County during the study period. Rather, we found evidence of a shift in payer type after the 2010 policy change where dental-related ED visits by self-paid patients increased as dental-related ED visits by Medicaid-insured patients decreased. Such payer shifts will result in high uncompensated care burdens for providers and, ultimately, governmental payers.

OBJECTIVE:To investigate the preparedness of small animal veterinary personnel to communicate with Spanish-speaking pet owners with limited English-language proficiency (LEP).DESIGN:Cross-sectional telephone survey.SAMPLE:Data from 383 small animal veterinary practices.PROCEDURES:Telephone surveys were conducted with veterinarians and office or practice managers from a random sample of US small animal veterinary practices in 10 states to estimate the number of Spanish-speaking pet owners with LEP visiting these practices, proportion of practices that used services to facilitate communication with Spanish-speaking clients with LEP, and degree of veterinarian satisfaction with their communication with those clients.RESULTS:Responses were obtained from 383 of 1,245 (31%) eligible practices, of which 340 (89%) had Spanish-speaking clients with LEP and 200 (52%) had such clients on a weekly basis. Eight percent of practices had veterinary personnel who were conversant or fluent in spoken Spanish. Veterinarians who depended on clients' friends or family to translate were significantly less satisfied with client communication than were those who could converse in Spanish with clients directly. Availability of Spanish-speaking staff and offering of Spanish-language resources were associated with an increase in the number of Spanish-speaking clients with LEP seen on a weekly basis. Industry- and practice-generated Spanish-language materials were offered at 32% (124/383) and 21% (81/383) of practices, respectively; 329 (86%) practices had no Spanish-language marketing.CONCLUSIONS AND CLINICAL RELEVANCE:Opportunities were identified for improving communication with pet owners with LEP in the veterinary clinical setting, which could ultimately positively impact patient well-being and client compliance.

OBJECTIVE To characterize patterns of dog and cat ownership and veterinary service use among Latino dog and cat owners with various degrees of English-language proficiency. DESIGN :Cross-sectional telephone survey. SAMPLE Data from 393 Latino pet owners. PROCEDURES Telephone surveys were conducted with Latino dog and cat owners from a random sample of US households to determine the number of dogs and cats owned, factors associated with veterinary service use, and satisfaction with veterinary care. RESULTS 393 of 1,026 (38.3%) respondents were pet owners. Two hundred fifty-nine of 330 (78.5%) dog owners and 70 of 115 (60.9%) cat owners reported taking their pet to the veterinarian in the past 12 months, most commonly for vaccination or examination or because of illness. Respondents were most satisfied with veterinary care provided, least satisfied with cost, and moderately satisfied with quality of communication. English-language proficiency was not significantly associated with whether owners sought veterinary care. A large proportion of respondents who wanted to receive pet health information in Spanish described themselves as speaking English well or very well. CONCLUSIONS AND CLINICAL RELEVANCE Although having limited proficiency in English was not associated with Latino pet owners seeking veterinary care, opportunities exist for veterinary personnel to improve communications with these clients. Personnel can assess their clients' language needs by asking each about the language in which they would prefer to receive their pet's health information.

Veterinary schools and colleges generally include communication skills training in their professional curriculum, but few programs address challenges resulting from language gaps between pet owners and practitioners. Due to shifting US demographics, small animal veterinary practices must accommodate an increasing number of limited English proficient (LEP) Spanish-speaking pet owners (SSPOs). A national survey was conducted to assess the interest and preparedness of US veterinary students to communicate with LEP SSPOs when they graduate. This online survey, with more than 2,000 first-, second-, and third-year US veterinary students, revealed that over 50% of students had worked at a practice or shelter that had LEP Spanish-speaking clients. Yet fewer than 20% of these students described themselves as prepared to give medical information to an LEP SSPO. Over three-fourths of respondents agreed that communication with LEP SSPOs was important for veterinarians in general, and two-thirds agreed that communication with LEP SSPOs was important for themselves personally. Ninety percent of students who described themselves as conversant in Spanish agreed that they would be able to communicate socially with SSPOs, while only 55% said they would be able to communicate medically with such clients. Overall, two-thirds of students expressed interest in taking Spanish for Veterinary Professionals elective course while in school, with the strongest interest expressed by those with advanced proficiency in spoken Spanish. Bridging language gaps has the potential to improve communication with LEP SSPOs in the veterinary clinical setting and to improve patient care, client satisfaction, and the economic health of the veterinary profession.

Giardia protozoa have been suspected to be of zoonotic transmission, including transmission from companion animals such as pet dogs to humans. Patterns of infection have been previously described for dogs and humans, but such investigations have used different time periods and locations for these two species. Our objective was to describe and compare the overall trend and seasonality of Giardia species infection among dogs and humans in the United States from 2003 through 2009 in an ecological study using public health surveillance data and medical records of pet dogs visiting a large nationwide private veterinary hospital. Canine data were obtained from all dogs visiting Banfield hospitals in the United States with fecal test results for Giardia species, from January 2003 through December 2009. Incidence data of human cases from the same time period were obtained from the CDC. Descriptive time plots, a seasonal trend decomposition (STL) procedure, and seasonal autoregressive moving-average (SARIMA) models were used to assess the temporal characteristics of Giardia infection in the two species. Canine incidence showed a gradual decline from 2003 to 2009 with no significant/distinct regular seasonal component. By contrast, human incidence showed a stable annual rate with a significant regular seasonal cycle, peaking in August and September. Different temporal patterns in human and canine Giardia cases observed in this study suggest that the epidemiological disease processes underlying both series might be different, and Giardia transmission between humans and their companion dogs seems uncommon.

12 13 The findings and conclusions in this report are those of the authors and do not necessarily 14 represent the official position of the Centers for Disease Control and Prevention. Abstract 28 Giardia protozoa have been suspected of zoonotic transmission, including transmission from companion 29 animals such as pet dogs to humans. Patterns of infection have been previously described for dogs and 30 humans, but such investigations have used different time periods and locations for these two species. Our 31 objective was to describe and compare the overall trend and seasonality of Giardia species infection 32 among dogs and humans in the United States from 2003 through 2009 using public health surveillance 33 data and medical records of pet dogs visiting a large nationwide private veterinary hospital. Canine data 34 were obtained from all dogs visiting Banfield hospitals in the United States with fecal test results for 35 Giardia species, from January 2003 through December 2009. Incidence data of human cases from the 36 same time period was obtained from the CDC. Descriptive time plots, seasonal trend decomposition 37 (STL), and seasonal autoregressive moving-average (SARIMA) model were used to assess the temporal 38 characteristics of Giardia infection in the two species. Canine incidence showed a gradual decline from 39 2003 to 2009 with a non-significant irregular seasonal component. By contrast, human incidence showed 40 a stable trend with a significant regular seasonal cycle, peaking in August and September. Different 41 temporal patterns in human and canine Giardia cases observed in this study suggest that the 42 epidemiological disease processes underlying both series might be different, and Giardia 43 transmission from dogs to humans and from humans to dogs might be uncommon.

Estimates of the prevalence of intestinal infection of dogs with Giardia spp. in the United States vary widely. Risk factors for infection in a large sample of dogs over an extended period of time have not been well characterized. A national, electronic database of medical records was used to estimate the prevalence and identify risk factors for Giardia spp. infection among dogs visiting Banfield Pet Hospital™ located in 43 states in the United States. The overall prevalence of Giardia spp. Infection was 0.44% (95% CI: 0.43-0.45%) in approximately 2.5 million owned dogs who had a fecal flotation test performed from January 2003 to December 2009. A steady decrease in annual prevalence was observed, from a high of 0.61% in 2003 to 0.27% in 2009. Seasonal increases in prevalence were noted during the winter and summer months. Giardia spp. prevalence was highest in the Mountain region, especially Colorado (2.63%; 95% CI: 2.53-2.73%), and in puppies ≤0.5 year of age (0.63%; 95% CI: 0.61-0.64%). It was lowest for dogs of mixed breeding compared with pure breeds. Infection risk was 25-30% greater in sexually intact dogs compared to spayed and neutered dogs.

Tick-borne diseases are an important cause of human morbidity in North Carolina. This study evaluated the use of routinely collected veterinary hospital and human hospital emergency department (ED) data for earlier signal detection compared with routine reporting of tick-borne diseases to the North Carolina Division of Public Health in 2006 and 2007. The Early Aberration Reporting System was used to detect the earliest indication of an increase in number of dogs infested with ticks that were brought to veterinary hospitals and in number of people presenting to EDs with a tick-related chief complaint or who had an ED International Classification of Diseases diagnosis code of tick-borne disease. Results indicate that systematic monitoring of veterinary hospital and human ED data can detect increases in tick activity 4 weeks earlier than the current surveillance method, which would facilitate timely initiation of tick prevention and increased clinical awareness among veterinarians and physicians.

Objectives: To compare the seasonal frequency of doxycycline prescriptions with tick-related emergency department (ED) visits in North Carolina, and to determine if doxycycline prescriptions are associated in time with an increase in the number of ED visits for a tick-related patient complaint or a subsequent diagnosis of a tick-borne infection. Methods: Aggregate monthly counts of total dispensed doxycycline prescriptions for each North Carolina Piedmont Metropolitan Statistical Area (MSA) were compared with the proportions of tick-related ED visits from August 2007 through July 2009. Results: Epidemic curves of tick-related ED visits for each of the 6 MSAs were characterized by increased frequency in the spring and summer months followed by a decline in the fall. However, the pattern of doxycycline prescriptions varied by MSA. Doxycycline prescriptions in Durham-Chapel Hill and Raleigh-Cary MSAs increased in the spring and summer, while for the 4 other Piedmont MSAs there was no consistent or pronounced spring-summer increase. Conclusion: Doxycycline prescription use did not always correlate well with suspected tick activity in North Carolina. Therefore, doxycycline prescription use cannot necessarily be used as a surrogate measure of tick activity for infectious disease surveillance until the reasons for this variability are better understood.

Article rationale Since the late 1970s, there has been a significant increase in the prevalence of feline hyperthyroidism (FH). It is now recognized worldwide as the most common endocrinopathy of older cats, resembling toxic nodular goiter of older humans in iodine-deficient areas. The purpose of this article is to identify the potential for iodine concentrations in the diet to contribute to the etiology of FH.Historical context Iodine concentrations of commercial cat foods vary widely. A review of historical iodine recommendations revealed that the units of iodine supplementation changed in the 1970s. Given this change, foods minimally supplemented since the late 1970s would have been iodine deficient for most cats.Practical relevance Iodine supplementation of commercial cat foods should be evaluated in the light of the iodine recommendations revised in 2006. Foods may remain deficient in iodine if supplemented at the minimum recommended concentration, possibly contributing to the development of FH.

OBJECTIVES To assess the ability of a screen-based simulation-training program to improve emergency medicine and pediatric resident performance in critical pediatric resuscitation knowledge, confidence, and skills. METHODS A pre-post, interventional design was used. Three measures of performance were created and assessed before and after intervention: a written pre-course knowledge examination, a self-efficacy confidence score, and a skills-based high-fidelity simulation code scenario. For the high-fidelity skills assessment, independent physician raters recorded and reviewed subject performance. The intervention consisted of eight screen-based pediatric resuscitation scenarios that subjects had 4 weeks to complete. Upon completion of the scenarios, all three measures were repeated. For the confidence assessment, summary pre- and post-test summary confidence scores were compared using a t-test, and for the skills assessment, pre-scores were compared with post-test measures for each individual using McNemar's chi-square test for paired samples. RESULTS Twenty-six of 35 (71.3%) enrolled subjects completed the institutional review board-approved study. Increases were observed in written test scores, confidence, and some critical interventions in high-fidelity simulation. The mean improvement in cumulative confidence scores for all residents was 10.1 (SD +/-4.9; range 0-19; p < 0.001), with no resident feeling less confident after the intervention. Although overall performance in simulated codes did not change significantly, with average scores of 6.65 (+/-1.76) to 7.04 (+/-1.37) out of 9 possible points (p = 0.58), improvement was seen in the administering of appropriate amounts of IV fluids (59-89%, p = 0.03). CONCLUSIONS In this study, improvements in resident knowledge, confidence, and performance of certain skills in simulated pediatric cardiac arrest scenarios suggest that screen-based simulations may be an effective way to enhance resuscitation skills of pediatric providers. These results should be confirmed using a randomized design with an appropriate control group.

OBJECTIVES:The first-attempt success rate of intubation was compared using GlideScope video laryngoscopy and direct laryngoscopy in an emergency department (ED).METHODS:A prospective observational study was conducted of adult patients undergoing intubation in the ED of a Level 1 trauma center with an emergency medicine residency program. Patients were consecutively enrolled between August 2006 and February 2008. Data collected included indication for intubation, patient characteristics, device used, initial oxygen saturation, and resident postgraduate year. The primary outcome measure was success with first attempt. Secondary outcome measures included time to successful intubation, intubation failure, and lowest oxygen saturation levels. An attempt was defined as the introduction of the laryngoscope into the mouth. Failure was defined as an esophageal intubation, changing to a different device or physician, or inability to place the endotracheal tube after three attempts.RESULTS:A total of 280 patients were enrolled, of whom video laryngoscopy was used for the initial intubation attempt in 63 (22%) and direct laryngoscopy was used in 217 (78%). Reasons for intubation included altered mental status (64%), respiratory distress (47%), facial trauma (9%), and immobilization for imaging (9%). Overall, 233 (83%) intubations were successful on the first attempt, 26 (9%) failures occurred, and one patient received a cricothyrotomy. The first-attempt success rate was 51 of 63 (81%, 95% confidence interval [CI] = 70% to 89%) for video laryngoscopy versus 182 of 217 (84%, 95% CI = 79% to 88%) for direct laryngoscopy (p = 0.59). Median time to successful intubation was 42 seconds (range, 13 to 350 seconds) for video laryngoscopy versus 30 seconds (range, 11 to 600 seconds) for direct laryngoscopy (p < 0.01).CONCLUSIONS:Rates of successful intubation on first attempt were not significantly different between video and direct laryngoscopy. However, intubation using video laryngoscopy required significantly more time to complete.

OBJECTIVE To estimate prevalence of intestinal nematode parasitism among pet dogs in the United States and characterize risk factors for infection. DESIGN Retrospective period prevalence survey. ANIMALS 1,213,061 dogs examined at 547 private veterinary hospitals in 44 states from January 1, 2003, through December 31, 2006. PROCEDURES Data were obtained from electronic medical records of all dogs that had at least 1 fecal flotation test. Risk factors for intestinal nematode parasitism were identified by means of multivariable logistic regression analysis. RESULTS 2,785,248 fecal flotation tests were performed during the study period. When results for only the first test in each dog were considered, prevalences of Toxocara, Ancylostoma, and Trichuris parasitism were 5.04%, 4.50%, and 0.81%, respectively. Dogs < 0.5 years old had higher odds of Toxocara and Ancylostoma parasitism, compared with dogs > 5.0 years old; sexually intact male and female dogs had higher odds of parasitism, compared with spayed female dogs; toy dogs had lower odds of parasitism, compared with dogs in other breed groups; and dogs living in the mountain region had lower odds of parasitism, compared with dogs living in other regions. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that age, body weight, sex, breed, and geographic region were risk factors for intestinal nematode parasitism among pet dogs in the United States.

Objectives. This study utilized the electronic medical records of six veterinary hospitals (operated by Banfield, The Pet Hospital®) in the vicinity of Fairburn, Georgia, to assess the health of dogs and cats following the unintentional release of propyl mercaptan from a waste-processing facility. Methods. Standardized electronic medical records were used to define clinical syndromes (eye inflammation, gastrointestinal, respiratory, fever, general weakness/change in mental state) in dogs and cats. The frequency and geographic distribution of each syndrome was evaluated before, during, and after the chemical release, using control charts, density maps, change in average mean distance from a suspected point source of chemical release, space-time statistics, and autoregressive integrated moving averages. Results. No consistent pattern of change in syndromic events was observed following the suspected release of propyl mercaptan. Some syndromes, including respiratory syndrome in cats, gastrointestinal syndrome in dogs, and eye inflammation syndrome in both cats and dogs, showed a change in time and spatial patterns following the release of propyl mercaptan into the community. These changes were consistent with clinical signs observed in people during a previous propyl mercaptan release in California as well as the release in Fairburn. Conclusions. A systematic review of electronic medical records of dogs and cats exposed to release of propyl mercaptan showed no conclusive and consistent evidence of adverse health effects. Methods for the use of medical records of pets for detecting environmental hazards require further development and evaluation.

Naturally occurring cases of influenza in cats owing to the H5N1 strain have been reported in several countries. A cat reservoir of H5N1 in the United States could provide an environment for zoonotic disease spread to humans. This scenario was the impetus to develop a model to study potential transmission of H5N1 virus in domestic cats utilizing information on cat ownership and cat-cat interaction patterns, in addition to biological properties of the virus. The roaming behaviour of cats significantly influenced epidemic dynamics, as demonstrated by the simulation results from this model. A better understanding of the behaviour of domestic cats and the H5N1 influenza virus can be used to predict epidemic dynamics following the introduction of H5N1 virus into the United States and to develop effective strategies to prevent virus transmission to both cats and humans.

Knowledge of the geographic range and seasonal activity of vector ticks is important for determining which people or animals are at risk of acquiring tick-borne infections. Several time-consuming methods requiring large-scale organization are used to map geographic and seasonal variations in tick distribution. A cost-effective, complementary approach to study tick distribution using a large nation-wide veterinary database is described in this paper. Prevalence of canine tick infestation in 40 states was estimated by analyzing electronic medical records of more than 8 million dog visits to Banfield veterinary hospitals in 2002-2004. Prevalence was defined as the proportion of dog visits in which tick infestation was recorded, and was expressed per 10,000 dog visits with 95% confidence intervals (CI). The overall prevalence (CI) of tick infestation was 52 (51, 53) dogs per 10,000 dog visits. Among states, Oklahoma (249 [229, 271] dogs with ticks per 10,000 dog-visits), Arkansas (242 [213, 274]), Connecticut (136 [119, 155]), West Virginia (130 [105, 161]), and Rhode Island (122 [97, 154]) ranked highest in prevalence of canine tick infestation. Overall prevalence peaked from May through July, although monthly prevalence varied by geographic region. In multiple logistic regression, younger dogs, male dogs, and sexually intact dogs, were at increased risk of tick infestation. Toy breeds were least likely to be infested, but no linear pattern of risk was evident with body weight. Identified risk factors should enable veterinarians to prevent tick infestation in pet dogs although differences in risk of tick infestation may be related to outdoor activity of dogs. Feasibility of collecting information for surveillance of vectors ticks on a national level using this large, electronic veterinary database is discussed.

Biomass fuel used for cooking results in widespread exposure to indoor air pollution (IAP), affecting nearly 3 billion people throughout the world. Few studies, however, have tested for an exposure-response relationship between biomass fuel and health outcomes. The aim of this study was to explore the relationship between biomass fuel, infant mortality, and children's respiratory symptoms. Eighty households in a rural community in Ecuador were selected based on their use of biomass fuel and questioned regarding a history of infant mortality and children's respiratory symptoms. Carbon monoxide (CO) and particulate matter (PM) were measured in a subset of these homes to confirm the relationship between biomass fuel use and IAP. Results showed a significant trend for higher infant mortality among households that cooked with a greater proportion of biomass fuel (P = 0.008). Similar trends were noted for history of cough (P = 0.02) and earache (P < 0.001) among children living in these households.