What do MDs know about zoonoses? Not a lot

Shutterstock.comIf you visited your doctor and asked her to fill you in on zoonotic disease risks, how much do you think she'd be able to tell you, and how comfortable do you think she'd feel talking about it?

Most likely not very comfortable at all, says Audrey Ruple, DVM, MS, PhD, DACVPM, MRCVS, assistant professor of epidemiology at Purdue University's College of Veterinary Medicine and speaker at a recent Fetch dvm360 veterinary conference. When it comes down to it, zoonosis is the purview of veterinarians, Dr. Ruple says.

First, let's look at what the average human patient knows about zoonosis, according to research compiled by Dr. Ruple. In a survey conducted in 2009, only 54% of respondents said they knew they could get intestinal helminths from dogs.1 People just don't know what they don't know. Here are some more findings:

98% of respondents had heard of rabies (that's good!), but only 58% knew that rabies exposure could be deadly (that's bad).

83% of respondents would go to the ER if exposed to rabies, and 89% of respondents knew you could get rabies from bats.

But wait. It gets better. When asked where they got their information about zoonotic disease:

49% of respondents thought TV, newspaper or the internet was the most important source of information about zoonotic diseases.

35% of respondents thought veterinarians were the most important source of information about zoonotic disease.

Only 6% of respondents thought doctors were the most important source of information about zoonotic disease.

According to that last statistic, people seem to already know that their doctors don't know much about zoonosis. Here's more evidence supporting the case, as presented by Dr. Ruple: Tennessee is a hot area for Rocky Mountain spotted fever in both people and pets, but in a 2009 survey about knowledge, attitudes and practices regarding Rocky Mountain spotted fever among healthcare providers in Tennessee:2

Only 39% of doctors knew how to treat the disease in children or were aware of the case fatality rate. However …

71% knew the incubation period, and

77% knew the treatment time frame.

What about obstetrician-gynecologists' knowledge of cryptosporidiosis? Dr. Ruple discussed yet another set of study findings:3

Just 44% of OBGYNs would include crypto on a rule-out list for prolonged diarrhea in a pregnant woman.

19% of OBGYNs knew animal contact was a risk factor.

14% of OBGYNs knew hand sanitizers didn't inactivate Cryptosporidium species.

Less than 10% of OBGYNs were aware that crypto was a reportable disease.

You might think that physicians would make a special effort for their patients at higher risk of contracting a zoonotic disease, but that doesn't seem to be the case, Dr. Ruple says. In a 2009 study, 50% of MDs who had patients with known animal contact (in other words, farmers) were mostly or strongly uncomfortable with their knowledge of zoonotic diseases.4 In a 2012 survey of both veterinarians and medical doctors:5

71% of MDs said they never or almost never asked their HIV-positive patients if they had contact with animals.

94% of MDs never or almost never initiated discussions about zoonotic diseases with patients with HIV or AIDS.

54% of MDs felt uncomfortable or very uncomfortable advising patients with HIV/AIDS on the potential of zoonotic diseases.

How often did patients with HIV/AIDS initiate discussions with doctors about zoonoses? Never. How often did MDs contact DVMs for advice on zoonotic disease? Never. But when veterinarians were asked the same questions as MDs,5 here's what researchers found:

Only 13% of veterinarians felt uncomfortable advising clients with HIV/AIDS on the potential of zoonotic diseases.

90% of veterinarians discussed the risk of contact between any immunocompromised person and a pet that had a diagnosed zoonotic disease.

MDs consider zoonotic diseases to be a diagnostic challenge for several reasons, Dr. Ruple says, including the fact that many zoonoses have nonspecific flulike symptoms and they occur infrequently (or so physicians think). Plus, MDs inquire about animal contact and pet ownership only inconsistently during history-taking, and zoonotic pathogens are linked to 130 species! It's true: Zoonotic disease is hard. Veterinarians are clearly more comfortable and confident in these discussions, as Dr. Ruple's research indicates. A 2008 study found that:6

77% of DVMs thought it was very important to educate clients about zoonotic disease prevention.

43% initiated discussions about zoonotic disease with clients on a daily basis.

57% kept client education materials about zoonotic disease in their practice.

Interestingly, another investigation Dr. Ruple discussed found that if a human patient was diagnosed with a zoonotic disease and their doctor recommended that they consult with a veterinarian, 80% said they would-and they would pay out of pocket. Ninety-one percent said they would consult with a veterinarian if insurance covered it.7

It's obvious that veterinarians have the knowledge and feel more comfortable talking about zoonotic disease, while many MDs are uncomfortable discussing zoonotic disease and lack appropriate knowledge about the subject. So why aren't more veterinarians working with medical doctors to combat zoonotic disease? For the sake of public health, it's time to open up the lines of communication, Dr. Ruple says. Here are some of her tips on how to open the lines of communication and build bridges with your local MD community:

Consider starting a journal club made up of veterinarians and MDs. Take turns choosing journal articles on zoonotic disease to read and present to each other. That way you all learn together. Pediatricians love this stuff because children are at higher risk, Dr. Ruple says.

Speaking of children, give a talk about zoonoses at your local school. Kids love veterinarians! And they'll go home and tell their parents about all the yucky diseases they learned about.

Check with your health department to see if there are any openings on the board. Most public health departments hold a space for a veterinarian.

Call the CDC and see if they have any posters that they can send you, then jazz your clinic up with pictures of cutaneous larva migrans.

Add a zoonotic disease section to your website.

Considering that 60% of all diseases are zoonotic and 75% of emerging diseases are zoonotic, Dr. Ruple thinks it's high time that animal doctors, who have the knowledge, and human doctors, who have the influence, take their jobs as sentinels of human health seriously and work together to keep the public educated and safe from zoonotic disease.

References

1. Bingham GM, Budke CM, Slater MR. Knowledge and perceptions of dog-associated zoonoses: Brazos County, Texas, USA. Prev Vet Med 2010;93(2-3):211-221.

2. Mosites E, Carpenter LR, McElroy K, et al. Knowledge, attitudes, and practices regarding Rocky Mountain spotted fever among healthcare providers, Tennessee, 2009. Am J Trop Med Hyg 2013;88(1):162-166.

3. Domjahn BT, Hlavsa MC, Anderson B, et al. A survey of U.S. obstetrician-gynecologists' clinical and epidemiological knowledge of cryptosporidiosis in pregnancy. Zoonoses Public Health 2014;61(5):356-363.

4. Kersting AL, Medeiros LC, LeJeune JT. Zoonoses and the physicians' role in educating farming patients. J Agromedicine 2009;14(3):306-311.

5. Hill WA, Petty GC, Erwin PC, et al. A survey of Tennessee veterinarian and physician attitudes, knowledge, and practices regarding zoonoses prevention among animal owners with HIV infection or AIDS. J Am Vet Med Assoc 2012;240(12):1432-1440.

6. Lipton BA, Hopkins SG, Koehler JE, et al. A survey of veterinarian involvement in zoonotic disease prevention practices. JAVMA 2008;233(8):1242-1249.

7. Speare R, Mendez D, Judd J, et al. Willingness to consult a veterinarian on physician's advice for zoonotic diseases: A formal role for veterinarians in medicine? PLoS One 2015;10(8):e0131406.

Dr. Sarah Wooten divides her professional time between small animal practice in Greeley, Colorado; public speaking on associate issues, leadership and client communication; and writing. She enjoys camping with her family, skiing, SCUBA and participating in triathlons.