VPHJ Issue 2/2014

VetPubHealth Journal ISSUE 2 IVSA Standing Committee on One Health May 2014

IVSA Standing Committee on One Health

meets Spring!

Editorial by Theofanis Liatis

Public Health within IPSF by Sheena Patel

Why donkey milk? by Nikoleta Makri

Anthrax: a potential threat of animals and human life by Arslan Mehboob

Working and therapeutic animals as potential carriers of bacterial pathogens by Tina Zitnik Oitzl, Mateja Naralockik

Table of Contents...

Think globally, act locally

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Editorial...

The VetPubHealth Journal (VPHJ) Edition

Editors Team: Bastola Sirjan, Nakade Mangesh, Ntemka Katerina, Yablonovich Ilana Designer & Chief Editor: Liatis Theofanis

A publication of the Standing Committee on One Health (SCOH) of International Veterinary Students’ Association (IVSA)

https://www.facebook.com/thescoh [email protected] ©2014

Dear readers,

We are very glad that you welcomed the 1st VPHJ of SCOH in February 2014. Our goal

was achieved. Many articles from all over the world were published in order to give a taste

of Public/One Health throughout the world and of course vet’s role in it.

In this issue, you can find very interesting articles and a great article of Sheena Patel, the Chairperson

of Public Health of IPSF (International Pharmaceutical Students’ Federation).

IVSA/SCOH is going to collaborate formally with IPSF and our pharmaceutical colleagues in order to

promote the interdisciplinary collaboration and the importance of many joint sectors and especially

Antimicrobial Resistance.

I also would like to thank Sheena, as I was invited to write an article for IPSF’s journal.

Please guys, entertain yourselves!

Friendly,

Theofanis K. Liatis

Chief Editor

Veterinary Public Health Director of IVSA

Chairman of Standing Committee on One Health 2013/2014



PUBLIC HEALTH WITHIN IPSF

International Pharmaceutical Students’ Federation

By Sheena Patel, IPSF Chairperson of Public Health 2013/2014

IPSF Collaboration

Hello everyone! My name is Sheena Patel

and I am the current Chairperson of

Public Health within International Phar-

maceutical Students’ Federation (IPSF). I

am currently a Pharmacy Student at

Wilkes University in United States of

America. I will be graduating school this

May, so VERY excited for this!! IPSF now

represents more than 350,000 pharmacy

students and recent graduates in 70

countries worldwide. IPSF is the leading

international advocacy organization of

pharmacy students promoting improved

public health through provision of infor-

mation, education, networking, and a

range of publication and professional

activities.

So my role is mostly focused on

Public Health. I help our members edu-

cate patients all over the world on seven

Public Health Campaigns. These seven

Projects have been selected based on

prevalence of each issue. The Public

Health Campaigns IPSF focuses on are

the Humanitarian Campaign, Medicine

Awareness Campaign, Anti-Counterfeit

Drug Campaign, Diabetes and Healthy

Living Campaign, HIV/AIDS Campaign,

Tobacco Awareness Campaign, and Anti-

Tuberculosis Campaign.

In the Humanitarian Campaign we

chose three international projects to

support, the Vampire Cup, PLAN, and

Books for Africa. The Vampire Cup is a

competition where countries all over the

world compete to raise the most num-

ber of units of blood. The country within

IPSF that raises the most number of units

of blood will win the Vampire Cup.

Books for Africa is where IPSF members

can donate Pharmacy textbooks to stu-

dents in Africa who may not have access

to these resources. PLAN aims to im-

prove the quality of life for deprived chil-

dren in developing countries. IPSF mem-

bers can support Plan’s efforts through

one-time donations, sponsoring a child,

or purchasing “gifts of hope.”

This year for the Medicine

Awareness Campaign we are focusing on

issues that are important to one of our

main external Public Health partners, the

World Health Organization. They have

felt that this year anti-microbial re-

sistance and non-medical use of prescrip-

tion drugs are an issue. So we have

asked our members through a ‘Mission

Impossible’ concept to educate patients

on how to prevent these two issues. The

members will create a video of them

carrying out this mission which we will

be showcased during our World Con-

gress held in Porto, Portugal this July/

August.

Anti-Counterfeit Drugs Campaign

is self-explanatory in the fact that we

want to educate students and Pharma-

cists on counterfeit medications. This

year we are asking our members to

share a picture of themselves wearing

yellow t-shirts and forming the letter ‘X.’

They will include a small summary of

their activities with their picture. All of

this will be posted on a map under the

ACDC section of Public Health on the

IPSF website.

For each of our Awareness Cam-

paigns we did a different project. For

example for Diabetes and Healthy Living

Campaign we had members share pic-

tures from their Diabetes events on Fa-

cebook, while members wrote an essay

on discrimination for our HIV/AIDS

Campaign. In the Anti-Tuberculosis

Campaign, we are having members cre-

ate a poster on the importance of Tu-

berculosis to our patients and our mem-

bers. Finally for IPSF’s Tobacco Aware-

ness Campaign we are having members

create a short video on our fight against

Tobacco.

“I want to keep the mem-

bers active in Public

Health…”

As you can see we are very busy

within Public Health in IPSF. I want to

keep the members active in Public

Health not only to be involved in the

organization, but also be involved in pa-

tient care. A Pharmacists’ role is chang-

ing towards a more patient centered

treatment. At the center of this change is

Public Health. In order to help treat pa-

tients with medications Public Health is

needed. It provides the awareness aspect

as well as the patient interaction of Phar-

macist oriented care. This is just one

aspect that helps unify and strengthen

the role of the Pharmacist on a global

scale.

Thank you for taking the time to

read my summary of my role as IPSF

Chairperson of Public Health! I hope this

inspires you to get involved in Public

Health not only in IVSA, but also in your

local association!

“Public Health Rocks!”


TUBERCULOSIS IN INDIA By Kelvin Momanyi, IVSA India

Zoonoses

Tuberculosis is a chronic disease of Human

being as well as animal species caused by bacteria of

the genus Mycobacterium. It is characterized by de-

velopment of tubercles in the organs of most spe-

cies. Bovine tuberculosis is caused by Mycobacterium

bovis and in humans by Mycobacterium tuberculosis.

Both the species have significant zoonotic Im-

portance.

History

Tuberculosis was first discovered by the Dr.

Robert Koch in the year 1882. He announced in

Berlin that cause of tuberculosis means the TB ba-

cillus. He declared publically about this virulent hu-

man infectious disease and explained about the eti-

ology of the tuberculosis through the presentation

of many microscope slides. During his announce-

ment in the Berlin, it was spreading very fastly in

the Europe and the Americas of which the death

ratio was one out of seven. His discovery about the

tuberculosis had opened a big door in front of the

people to get diagnosed and cured of tuberculosis.

Types of tuberculosis

The human type – M. tuberculosis

The bovine type – M. bovis

The avian type – M. avium

There is a fourth type that affects fish

Modes of infection

The routes by which tubercle bacilli gain en-

trance to the body are:

Respiration, Ingestion, Inoculation, Congenital, Gen-

ital – infection by way of genital tracts.

Geographical Distribution in India: India ac-

counts for 20% of the world’s TB cases and the dis-

ease infects 3 million people a year and kills over 3

lakh every year. In Jan 2012 things got even uglier

as India played host to an extremely dangerous ver-

sion of tuberculosis which experts termed Totally

Drug Resistant Tuberculosis (TDR-TB) – a disease

that afflicted 12 people in Mumbai. This new version

of TB was resistant to all forms of anti-TB drugs

and unlike earlier drug resistant versions like multi-

drug resistant (resistant to two drugs) and exten-

sively-drug resistant (resistant to four drugs). Not

only was it resistant to every known TB drug but it

had afflicted people in a densely populated city like

Mumbai where the potential for an outbreak was

immense.

Zoonotic Aspect M. bovis in India

Till 1916 Tuberculosis in cattle was consid-

ered very rare because

Indigenous cattle are naturally resistant

Low virulent tubercle bacilli isolated from indige-

nous cattle

Open air system where animals are housed

During 1980s, Indian council of Agriculture

Research (ICAR) started scheme they found preva-

lence of bovine TB in India varies from 1.6 to 16%

in cattle and 3 to 25% in buffaloes.

Proportion of human disease caused by M.

bovis show regional variation depending on the pres-

ence and extent of disease in cattle population, the

social and economic situation, standard of food hy-

giene besides application of preventive measures. Studies in United Kingdom and United States of

America confirm that by 1937, upto 25% of TB cas-

es in humans were due to M. bovis. The majority of

these cases were non-pulmonary TB with only 2.5%

pulmonary TB. A high rate of M. bovis infection is

commonly associated wih occupational exposure.

Veterinarians working with infected herds show

high rate

http://health.india.com/news/totally-drug-resistant-tb-lands-in-india/


of tuberculin positivity (45.4%) and overt T.B.

(4.1%) although it is not established that such infec-

tion and disease is only due to M. bovis.

Zoonotic Aspect of M. tuberculosis in India

M. tuberculosis infects 3 million people a year and

kills over 3 lakh every year. But it is not distinguish-

able M. tuberculosis is alone responsible for this cas-

es.

Veterinary Public Health Measures for zoon-

otic TB

Routine testing and inspection of cattle even at

slaughterhouses

Detecting infected herds and removing them to reduce the spread of TB within herds.

Adopting control strategies to reduce transmis-

sion by: (i) Effective ventilation; (ii) Reduction of

group size; (iii) Minimizing contamination of feed,

grazing and water with respiratory secretions or

faeces by attention to hygienic practices, buildings

and equipments.

Promoting research on accurate diagnostic tests

and the potential role of other domestic and wild

animal species as disease reservoir.

Creating awareness in the community especially

farmers and those involved in slaughtering and

meat trading.

Public health precautions like pasteurization/ heat

treatment of milk that can reduce the danger of

TB particularly to infants.

Efficient surveillance system and co-ordination

between medical and veterinary professionals

through effective communication for contact trac-

ing and joint epidemiological investigations

Regular health check- up for occupational groups

at risk including examination for non-pulmonary

forms of TB such as lymphadenitis beside sputum

microscopy and chest radiology, if required. A co-ordinated strategy for developing and testing

of new vaccines for tuberculosis in man and ani-

mal.

Funding agencies need to be encouraged to spon-

sor regular workshops to facilitate collaborations

and achieve scientific consensus on research pri-

orities besides developing an E-mal discussion

groups and video conference.


WHY DONKEY MILK? By Nikoleta Makri, IVSA Thessaly

Food Safety

Eventually Greek consumers can drink

Donkey milk, as the Ministry of Rural De-

velopment and Food published a new Decision on the require-

ments and conditions in order to be followed for the produc-

tion, processing and disposal of equine milk, creating the frame-

work for this new market. In order to understand the im-

portance of this, not as much as we suggest “new product” ,we

must have a look at the history of donkey milk. It is well known

that some of the most beautiful women of ancient times, partic-

ularly appreciate the beneficial qualities of donkey milk. Cleo-

patra, the Queen of Ancient Egypt, known for her stunning

beauty as well as the second wife of the Roman Emperor Nero,

Poppea Sabina took their daily baths in Asse’s milk. Studies

showed the presence of vitamins A1, B1, B2, C and E in large

quantities as well as a great rate of immunoglobulins, magnesi-

um, calcium, potassium, phosphorus, zinc and sodium in don-

key’s milk. Furthermore, donkey’s milk proteins provide re-

markable moisturizing and nourishing properties and it is gener-

ally believed that effaces facial wrinkles. Today, plenty products,

like soaps and moisturizers, are made of this kind of milk.

In addition to its cosmetic use, Hippocrates (460 – 370 BC) -

the father of medicine- prescribed asses’ milk for numerous

purposes, such as liver troubles, infectious diseases, fevers, ede-

ma, nose bleeds, poisonings, and wounds. Asse’s milk has found

to be the closest in the human breast milk and exhibited unique

nutritional characteristics because it contains more lactose and

less fat than cow’s milk. As a result of this advantage, it is given

in some cases to premature infants to ensure their proper

growth. The high content of lactose increases the absorption

rate of calcium, an important fact for the development and

maintenance of the human body and thus it can be used by el-

derly people with osteoporosis problems. The high content in

omega-3 makes it a functional food for human consumption,

even more for adults, where the risk for cardiovascular disease

increases. Compared with breast milk, donkey milk contains a

higher amount of essential fatty acids for the body. In addition,

it has a low-fat percentage, only 1%, while cow's milk has a fat

percentage of 3.9%, goat’s 3.5% and sheep’s 6%. It is worth-

mentioning that donkey milk can be a solution for people intol-

erant to cow's milk. Studies have been carried out on children

allergic to cow's milk; they have shown that Donkey's milk is

tolerated by most of them. Furthermore it has sweeter taste

which makes it more pleasant and well accepted, unlike -other

formulas or products, whose use among children allergic to

cow's milk is rightly compromised because of their bitter taste

and after-taste.

Therefore taking into account all the above, it could be said that

donkey milk is more nutritious and beneficial for the body than

the milk of a goat or cow. Is it however the same resistant in

pathogens or is a food most vulnerable? Latest research data

showed that it is a product with very low microbial load that

can be eaten without having undergone any heat treatment,

such as pasteurization. The lack of pasteurization constitutes

the immediate freezing after milking, while the transfer process

from the producer to the consumer, but also the storage re-

quire special attention to prevent contamination.

Eventually the donkey milk is not the super-product that will

magically meet all our nutritional deficiencies. But it is a valua-

ble food and a natural supplement, which within a relatively

balanced diet offers us something “extra” we are all looking for.


ANTHRAX: A POTENT TRHEAT OF

ANIMALS & HUMAN LIFE By Arslan Mehboob,

Undergraduate student of the Faculty of Veterinary & Animal Sciences of Lahore, Pakistan

Zoonoses

Introduction

Anthrax is the most fatal and zoonotic disease caused by a gram positive bacterium

bacillus anthracis. According to OIE (Office International des Epizootics). It is consid-

ered as A category notable disease. This should be reported to WHO (world health

organization) and OIE within 24 hours of its occurrence.

Etiology

It is caused by bacteria known as Bacillus anthracis.

Morphology of Causative Agent

Bacillus anthracis is a gram positive rod shaped aerobic non motile capsulated spore

forming bacteria having cell wall made up of peptidoglycan and a capsule around it.

This bacteria has plasmid encoded virulence factors; a capsule which resist in the phagocytosis. It

also has a plasmid named pXO2.The bacterium is characterized by having tripartite toxins having edema factor, lethal and protective

antigens. Mostly genotyping is done to perform epidemiological studies. This organism has capable of producing toxins that survive

in the environment for decades and remains active. The bacterium is capable of producing terminal endospores that are frequently

called as spores but it may not be confused with the spores of fungi. These spores can be found everywhere in the earth including

Antarctica. They can cause infection even when they come in contact with skin, inhaled or ingested. They rapidly activate and multi-

ply rapidly.

Spores of bacteria

Spores are much resistant to the extreme climatic conditions included in salting phenomenon of hides, standard disinfections and

temperature fluctuations. The spores are viable up to 60 years in the soil in the presence of organic matter. Soils acidic in nature

reduce the chances of survival for Bacillus anthracis. As spores are soil bore. They may cause infection about 60 year later of their

production .Disturbed grave sites are the major cause of spore transmission to the other areas.

Anthrax spores can be produced artificially in vitro. It does not spread directly by the contact instead it spreads through the fatal

spores. The spores can be transmitted either by clothes or contaminated shoes. The blood and secretions of affected animals also

have spores that become activated. It is a potent disease which is used as a chemical source of war head used by most of the coun-

tries. Although the culturing of bacillus anthracis is banned worldwide, a number of countries are culturing it as a potent source of

bio weapon. In powder form the culture of this organism is used as a biological weapon.

Anthrax is considered as category A disease by CDC (centers of disease control and prevention). Eating meat of the affected ani-

mals act as a source of pathogen entry into the body.

Epidemiology

Until the twentieth century thousands of animals and humans died each year from anthrax. The disease has worldwide distribution

and probably has origin from sub Saharan Africa. It is reported both in human as well as in veterinary sector. Prevalence areas vary

from the type of soil, the climatic conditions and most importantly the efforts which are being made to suppress its occurrence.

Anthrax Belts are the specific areas where anthrax is enzootic.

Morbidity and mortality rates

Most of its cases are sporadic and randomly occur in a population. Morbidity is about 1% but the mortality is 100%.Now a day's

many sudden deaths occurs without showing any clear cut signs. In tropics the organism remains in the soils where mostly frequent

outbreaks are reported. In some of the Saharan areas the disease mostly occurs in the summer months and attains its peak in heavy

rain fall months having devastating effects. Mostly predators are an inert carrier of the infection so majority of deaths occur in those

areas. In temperate areas sporadic infection usually occurs due to soil borne infections. Most common sources in the areas are the

pastures affected from tannery wastes and the contaminated bone meal. In this case number of animals infected and incidence of

outbreaks are small.


Use in Bioterrorism

In United States in 2001, White House officials received a letter having a white powder. The letter was written to US Presi-

dent. Forensic experts later found that the envelope was full of spores of anthrax. It was used as a threat and active biological

agent. In early 2010 in Cagayan province of Philippines, about 400 people got infection by consuming the meat which was previ-

ously infected with anthrax spores. The disease ended with great morbidity and two people died.

Routes of transmission

There are three major routes of its transmission, principal off which is inhalation. Other routes include are oral and cutaneous.

Spores play most active role in transmission of disease and enter the body through inhalation. After getting entry into the body

the organism is surrounded by macrophages. The organism is resistant to phagocytosis due to the availability of poly D glutam-

ic acid capsule

Forms of disease

Inhalation anthrax

Inhalation anthrax is also named as Woolsorter's disease or Ragpicker's disease. These professions were more associated with

the disease occurrence. The use of animal skin and horns for production of different articles was a potential source of suscepti-

bility.

Gastrointestinal anthrax

Gastrointestinal type of disease in human is caused when spores are ingested in the body. Initially there is GIT disturbance,

bloody vomit and inflammation of whole tract. Lesions occur more on the intestine where necrosis also occur. The spores

actively propagate and produce toxins that frequently go in the blood and condition becomes worse. The case fatality of this

form is 25 % to 60%. It is treatable but rarest form of the disease. In United States only two cases were reported. The first one

being reported in 1942 and the second case reported in 2010 in Philippines.

Cutaneous Anthrax

In human beings the cutaneous form of this infection is characterized by formation of boil like lesion that eventually converts

into a black centered scar tissue. In general in 2 to 5 days a black colored eschar appears on the skin that resembles with black

mold. In the beginning the eschar is painless with intense itching. Unlike bruises or other infections of skin, the typical lesion of

anthrax has no pain. Cutaneous anthrax is caused when skin comes in contact with infective spores. Spores may enter in the

body through cuts in the skin. This form is most commonly present in those people who are involved in animal skins and hides

handling. It is not a lethal form as infection is only limited to a specific area. In cutaneous form there is no entry of edema fac-

tor, lethal factor and protective antigen form. If untreated about 20% of cases may die due to toxemia.

Cutaneous anthrax can occur in the veterinarians dealing with the carcasses for the postmortem examinations. Major areas

affected are neck and fore arm regions. Initially infection starts with the formation of a papule which swells and within 1-2 days

it bursts that later converts into necrotic ulcer with a central scar of black colour. There is also swelling of regional lymph

nodes.

Vaccination and treatment protocol

US CDC center of disease control and prevention department suggest that persons having exposed to bacillus anthracis as Bio

Weapon must be vaccinated as early as possible. However vaccination prior to attack is not recommended in these groups. In

human populations, post exposure vaccination is done by inactivated vaccine at 0, 2 and 4 week interval along with the combi-

nation of antibiotics for 3 doses. Doxycycline or ciprofloxacin may be an ideal choice in this case .the drugs of choice are Peni-

cillin and doxycycline. These antibiotics are only effective to the germinated Bacillus and are inactive against the spores of dis-

ease. The safety and efficacy of vaccine is not been studied in pregnant women and children, therefore it is not recommended

to use the vaccine in these groups. The duration of protection provided by the vaccine is also unknown. However it is believed

that the protection remains for 12 months. If subsequent exposures occur, repeated vaccination is recommanded.immediate

washing is recommended in case of cutaneous infections. In GIT and Cutaneous forms, there is no recommendation in post-

exposure prophylaxis. Because of the severity in GIT form maximum emphasis is put on post exposure vaccination along with

regular antibiotic therapy to reduce the risk of spore formation and to subside the disease.


WORKING AND THERAPEUTIC ANIMALS AS PO-

TENTIAL CARRIERS OF BACTERIAL PATHOGENS

By Tina Zitnik Oitzl, Mateja Naralockik

IVSA Slovenia

Zoonoses

Therapeutic and working animals have become very important in various human activities. However, certain requirements

should be fulfilled. Besides having the adequate temperament, the animals must be completely healthy and must not carry

infectious transmissible to humans. We have to pay attention to microorganisms which colonise skin, fur, apparent mucosa

and digestive system. Animals that are colonised with microorganisms can be a potential threat to people, especially as mostly

therapeutic and working animals come in contact with immune-compromised people. On the other hand, these patients are

potential source for animal colonisation. The purpose of our study was to find out the state of colonisation of therapeutic

and working animals with bacteria that cause hospital infections. We studied three bacterial species which are the most im-

portant agents of nosocomial infections and are difficult to treat with antibiotics: methicillin-resistant Staphylococcus aureus

(MRSA), E. coli with extended-spectrum beta-lactamases (ESBLs) and Clostridium difficile (CD). We examined 84 animals: 14

therapeutic horses and 70 working dogs (48 therapeutic dogs, 17 rescue dogs and 5 dogs that live with therapeutic animals).

Control group consisted of 28 animals (18 dogs and 10 horses). Our goal was to ensure safety of people that come in close

contact with therapeutic and working animals, their owners and lastly these animals alone.

In genus Staphylococcus are coagulase negative and positive species. The latter are clinically more important. S. aureus causes

hospital and community associated infections which often gain resistance for antibiotics (HA-MRSA and CA-MRSA), and lately

livestock associated MRSA (LA-MRSA). The S. intermedius group (S. intermedius, S. delphini, S. pseudintermedius) are isolated in

animals, the latter in dogs and cats rather than S. aureus. Staphylococci colonise skin and mucosa and cause pyodermatitis,

otits externa, inflammation of genitourinary tract, respiratory system and surgical wounds, often as a secondary infection.

Escherichia coli is a part of intestinal micro flora. Strains are classified as enterotoxic, enteropathogenic, enteroinvasive, en-

teroaggregative and enterohaemorrhagic. Resistance is acquired horizontally from other intestinal micro flora species or

caused by beta-lactamase enzymes. E. coli causes infections of genitourinary and respiratory system, sepsis, abscesses, perito-

nitis etc.

Clostridium difficile is sporogenic bacteria and a part of intestinal micro flora. Enterotoxigenic strains cause infection when in-

testinal micro flora is altered. Clinical manifestation is diarrhoea, haemorrhagic colitis, pseudo membrane colitis or even gut

perforation.


We collected nasal swabs to determine the presence of coagulase-positive staphylococci and their resistance to methicillin.

We examined rectal swabs or faeces to determine the presence of E. coli with extended-spectrum beta-lactamases (ESBLs)

and the presence of anareobic bacterium C. difficile. MRSA was not isolated from any canine or equine sample. However, co-

agulase-positive staphylococci (S. pseudintermedius, S. aureus, S. intermedius and S. schleiferi subsp. coagulans) were isolated

from 21 samples. Low resistance to beta-lactam antibiotics, aminoglycosides and macrolides was determined for these iso-

lates. Three faecal samples of dogs were positive for E. coli ESBL/AmpC (4.3%) and one for C. difficile (1.4%). All equine faecal

samples were negative for both bacteria.

According to the available literature, no study on colonisation of therapeutic animals regarding zoonotic bacteria has been

performed in Slovenia up to date. Therefore, the available data is insufficient. Taking into account results of this study and the

literature data from other countries, we prepared basic guidelines for microbiological control of therapeutic animals in par-

ticular, as they are often exposed to and colonised with the agents of nosocomial infections and can therefore become the

source of human infections.

We do not require regularly testing on presence of zoonotic bacteria in working animals. However, we do recommend some

general and specific guidelines to be taken in account. Hand hygiene of owners, hospital staff and patients is in first place for it

can prevent many infections. Therapeutic animals should be well groomed, healthy, without wounds, injuries or skin diseases.

They must be regularly vaccinated against rabies (vaccination against some other infectious diseases is also recommended)

and receive antiparasitic treatment. In case of contact with person who is positive on potentially zoonotic bacteria should be

tested. If the results are positive, that animal is not allowed to visit patients until two consecutive samples in one week inter-

val are negative. Animals should not visit risky patients like the one with insufficient immune system, intensive care patients,

oncologic patients or those in quarantine. If those patients expressly want to be visited, it should be at the end of predicted

visit time. Animals are not allowed to jump on patients’ bed or lick them and patients should not shake their paws. We

strongly advise not to feed animals with raw meat, especially chicken and beef. Animals should be regularly veterinary exam-

ined, properly socialized and have good temperament. Cats are less appropriate because they are of higher risk for gastroin-

testinal diseases and dermatophitosis transmission and also their character is less predictable.


Documents

VPHJ Issue 2/2014