When two dogs imported to Canada from Iran on separate occasions in 2021 developed deadly canine rabies, alarm bells rang loudly for public health officials. They scrambled to trace dozens of people who may have been in contact with the animals’ saliva to give preventive treatment before it was too late.
The quick action staved off what could have become a fatal disease in at least 60 people, including the dogs’ foster and adopted families, their friends, as well as staff at several veterinary clinics across Ontario.
For epidemiologists, cases such as those underscore the importance of surveillance for new strains of viruses and bacteria coming into Canada by way of animals, a subject highlighted in a review paper published in Science Translational Medicine last week.
“It’s pretty concerning for individuals when they’re told that a dog you came in contact with had rabies,” said Dr. Tasha Epp, a veterinarian and epidemiologist at the University of Saskatchewan in Saskatoon tracking diseases that can be transmitted between animals and humans.
Epp is among several researchers on the lookout for more dog rabies in North America. The authors of the review paper apply the same principles to other illnesses originating in wild and domestic animals.
Prevention and control key
While wild animals act as carriers for rabies in Canada, human cases are extremely rare. Still, doctors recommend staying clear of wildlife and seeking treatment if bitten.
Canada has been free of the canine form of rabies for decades, which federal public health officials say is thanks to excellent prevention and control programs.
A stray cat licks its nose as it peers through the door of a coffee shop in Belgrade. Roaming cats are changing the dynamics between people, pets and wildlife, a virologist says. (Marko Djurica/Reuters)
But the recent scare has them looking at precautions and tightening cross-border rules.
The challenge comes from how long the rabies virus can incubate in a dog before it starts changing its behaviour, such as becoming uncharacteristically aggressive.
Rabies is typically transmitted to people from the bite of a rabid animal through direct contact with its saliva (such as through broken skin or membranes in our eyes, nose or mouth). It affects nerves.People can first feel tingling around the wound or scratch, then weakness, fever or headache. Muscles can become paralyzed followed by coma and eventually death.
In the first of the two 2021 cases of dog rabies, the three-month-old puppy that arrived from Iran didn’t need to be quarantined because it was a personal pet.
The pup had no known exposure to wildlife carriers in Canada.
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Seven months after arriving, however, the puppy developed neurological symptoms and was eventually euthanized.
“You can’t just say, ‘OK, well, if we watch them for a couple of weeks after they arrive, they’re good,'” said Scott Weese, who specializes in infectious diseases at the Ontario Veterinary College at the University of Guelph.
“They can incubate the disease for quite a long period.”
It’s possible the dog was properly vaccinated with a valid certificate and a good quality vaccine, Weese said.
“It was just too little, too late because it had been exposed beforehand.”
Vaccinate and don’t leave unsupervised, say experts
In the second case, public health officials with the Simcoe Muskoka District Health Unit based in Barrie, Ont., found 24 individuals who had contact with a dog diagnosed with rabies.
Of these, 14 were considered exposed and received post-exposure prophylaxis — immunoglobulin and vaccines to stop the virus in its tracks — at an average cost to the province of about $2,000 per person.
Steven Rebellato, vice-president of the environmental health department at the Simcoe Muskoka unit, worked on the investigation.
Rebellato said pet dogs, cats and ferrets over three months of age, as well as certain horses, cattle and sheep, need to be vaccinated against rabies by a licensed veterinarian and with an approved vaccine. Similar laws exist across Canada.
He also encouraged pet owners to protect their animals from rabies by ensuring they don’t wander unsupervised, especially at night when bats, foxes, raccoons and skunks are most active.
Import rules and loopholes
Travellers may be at risk of contracting rabies. In many countries outside North America, health officials flag dog rabies because of domestically acquired infections and factors such as a lack of readily available post-exposure treatments.
Epp heads a project to check that newly imported dogs aren’t bringing new forms of pathogens, such as canine rabies, into the country. She’s still recruiting participants and is pleased the dogs have been in good shape so far. Researchers in Ontario used an online questionnaire for a similar project.
Veterinarians and physicians encourage dog owners to keep a close eye on pets while walking them near wildlife. (Katerina Georgieva/CBC)
While Ukraine is listed as one of the high-risk countries for dog rabies, Canada’s rules allow people to bring in their pets on compassionate grounds, and some of the people fleeing the war in Ukraine made use of that, said Epp.
“As long as they’re fully vaccinated, and they come through that system, there’s always some little loopholes … in terms of where dogs are coming [from] and why are they coming.”
The Canadian Food Inspection Agency’s “imported dog” category is a broad one. It lumps in everything from well cared for rescue dogs and dogs owned by Canadians returning home who spend part of the year in the U.S. to illegally trafficked animals from puppy millsand elsewhere that pose health and welfare risks, Weese said.
Infections rise and awareness lags
Virology professor Gary Whittaker at Cornell University in Ithaca, N.Y., who co-authored the recent review paper with his colleagues, says the animals that can transmit infections to humans range from companion dogs, cats or horses to wild birds or backyard chickens and other creatures that pass through yards or parks: think raccoons, bats, squirrels, coyotes or skunks.
“We’ve got a changing dynamic in pet ownership, and I think that’s what is concerning me the most,” Whittaker said. “Our awareness of diseases isn’t really keeping up to pace.”
Whittaker’s especially interested in infections in roaming cats, such as the feral felines increasingly interacting with raccoons in Brooklyn’s parks and cemeteries.
Indoors, when a large, dense population of cats or dogs are in close proximity at shelters or moving between foster homes, kennels or doggy daycare, it’s an opportunity for superspreader events of influenza to occur, he said.
Superbugs from raw pet food
Whittaker and other scientists are also keeping a close eye on antimicrobial-resistant bugs and have zeroed in on trendy raw pet food because of its potential to spread such bugs between cats, dogs and people and vice-versa.
Dr. Scott Weese says raw pet food diets bring extra risks without more benefits. (Dave MacIntosh/CBC)
“There is at least one [human] death identified in the U.K. a few years ago from E. coli O157 that was in a pet diet,” Weese said.
“Diet can definitely play a role in health, but there’s not really any indication for a raw diet. They bring in extra risk and cost without conferring extra benefits.”
Pets rarely pass on multi-drug-resistant infections, or superbugs, that they’ve picked up in raw food to us, but that risk could be reduced to zero if we dispensed with raw pet food altogether, he said.
Another way to help combat the problem, he said, is for farmers and veterinarians to avoid giving livestock, including poultry, unnecessary antibiotics so that medical doctors still have them available to fight infections in humans.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
