Community associated MRSA in animals

1. Community associated MRSA in animals J Scott Weese DVM DVSc DipACVIM

2. We are not a population of people, in populations of dogs, cats, horses… We are a population of animals.

3. FAQ’s • I have diagnosed a dog/cat/horse with MRSA infection… • What does this mean? • Where did it come from? • What should I tell the owners? • Are there any precautions that should be taken? • Might I be infected?

4. I was diagnosed with MRSA. My physician… • Said it came from my dog/cat… • Told me to get rid of my pet • Said it is of no concern for my pets • Told me to bath my cat in triclosan daily for a week • Told me to treat my dog/cat with ___ • Has no clue that I have pets

5. My dog is involved with therapeutic visitation…what are the risks? • During visitation at a long term care facility, my dog interacted with someone with an MRSA infection…what does this mean to my dog/me? • Animals regularly visit our hospital…is there anything we should be doing?

6. MRSA in Animals • Emerging problem • Concerns • Transmission of MRSA from infected animals to humans • Colonized animals as reservoirs of MRSA in the community • Human / animal origin • Animal disease

7. Different species…different issues • Horses • Nasal/facial contact • Fecal contamination • International movement • Household pets • Degree/duration/intensity of contact • Pet birds • Fecal contact / aerosolization of fecal matter • Food animals

8. MRSA in horses

9. Key Points • Appears to be endemic in certain horse populations worldwide • Readily moves between horses and humans • CMRSA-5/USA500 predominates internationally • Reason unclear • Does not appear to be related to commensal equine S. aureus • Infection control measures can eradicate MRSA from farms

10. Skin Infections in Equine NICU Personnel

11. Skin infections in equine NICU personnel(Weese et al, Vet Microbiol 2005) • 3/36 (8.3%) personnel developed skin infections after 4 hour ‘barriered’ contact • 10/107 (9.7%) of other screened individuals colonized • 19% colonization rate in Foal Watch personnel

12. MRSA infection and colonization in household pets

13. Initial reports • Sporadic infections or small clusters in US, UK, Canada, Australia, Korea (Pak et al J Vet Med Sci 1999, Tomlin et al Vet Rec 1999, Weese et al ISSSI Proc 2004)

14. Rapid increase in reported cases • 95 infections in pets in UK(Kearns et al ISSSI Proc 2004) • 106 small animal infections in UK(Boag et al Vet Rec 2004, Rich et al Vet Rec 2004) • 17 infected or colonized dogs, cat, rabbit, seal from Ireland(O’Mahoney et al 2005) • PVL + MRSA from 11 dogs, cats, rabbit, parrot with SSTI, pneumonia in US (Rankin et al 2005)and transmission of PVL+ strain in household(van Duijkeren et al 2005)

15. Colonization • Uncommon in general pet population • 2/203 (1%) dogs admitted to academic referral centre (Hanselman et al, ACVIM abstract 2005) • 0/139 dogs and 0/39 cats at primary care veterinary clinics in Ontario (Murphy et al ACVIM abstract 2005) • 2/131 (1.5%) dogs and 0/250 cats in the community (Unpublished data) • Sporadically high in veterinary clinics • 8.9% of dogs housed in a UK referral clinic (Loeffler et al 2005)

16. Typing • Pet isolates indistinguishable from common human clones (Rich and Roberts 2004, Weese et al 2004/2006, Kearns et al 2004, Loeffler et al 2005, Baptiste et al 2005, Leonard et al 2006) • Initially, USA 100/CMRSA-2 predominated in Canada, United States, UK EMRSA-15 in UK, Ireland • Recent identification of USA300/CMRSA-10 in pets • First in California, now more widespread

17. Intra- and inter-species transmission Weese et al, Vet Microbiol 2006

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25. Recent Case • March: MRSA infection in foot of a cat • In veterinary hospital for amputation

26. Jan • female owner: MRSA abscess on hand, negative nasal screen • Late Feb • male owner: open heart surgery • Early March • female owner: MRSA ocular infection, negative nasal screen • Late March • infection in cat

27. Where did MRSA originate? • Was the cat involved in transmission? • What to do with the cat in this household? • Has there been subsequent transmission within the vet clinic? • Is there a household cycle that needs to be broken?

28. Broader Picture • Is intra-household/inter-species transmission of bacteria common? • Concurrent colonization of people and pets with S. aureus in 8.3% of households and S. intermedius in 5% of households

29. MRSA colonization of veterinary personnel

30. Recent studies from Canada, UK and Ireland reporting colonization of veterinary personnel • Is veterinary medicine an occupational risk factor?

31. Veterinary Internal Medicine Conference

32. MRSA from 27/417 (6.5%) personnel • 13/94 (13.8%) equine veterinarians • US, UK, Denmark • 9/239 (3.8%) small animal veterinarians • US, Germany • 5/34 (14.7%) technicians • US • Equine personnel • 87% CMRSA-5/USA500 (including UK, Denmark) • Small animal personnel • 92% CMRSA-2/USA100

33. Animal Assisted Therapy • Cross-sectional study in Ontario • 0/102 (Lefebvre et al, J Hosp Infect 2006) • Prospective study (ongoing) • MRSA acquisition by 3 dogs following start of visitation careers • 2: USA300 • Hand contamination with MRSA after petting dog that had performed visitation

34. Questions • Are pets important sources of community associated MRSA infection in humans? • Do pets become colonized when an infected/colonized person returns from hospital? • Impact on recurrence • Are pets of healthcare workers more likely to become colonized? • Source of recurrent colonization

35. Should pets be screened in cases of CA-MRSA or recurrent MRSA infection? • When, how, by whom? • What precautions should be taken in households with infected/colonized people or pets? • What about therapeutic visitation dogs? • Screening, contacts, IC protocols…

36. Should people that routinely contact horses be considered high risk and be screened upon admission to hospital? • Is MRSA a concern for therapeutic riding facilities? • Do people and their pets routinely ‘share’ a variety of pathogens?

37. The End