Exposure to Nontraditional Pets at Home and to Animals in Public Settings: Risks to Children
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CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care
Exposure to Nontraditional Pets at
Home and to Animals in Public
Settings: Risks to Children
K Larry, Pickering, MD, Nina Marano, DVM, MPH, A Joseph, Bocchini, MD, J Frederick, Angulo, DVM, PhD, and the Committee on
Infectious Diseases
Exposure to animals can provide many benefits during the growth and
development of children. However, there are potential risks associated with
animal exposures, including exposure to nontraditional pets in the home and abstract
animals in public settings. Educational materials, regulations, and guidelines
have been developed to minimize these risks. Pediatricians, veterinarians, and
other health care professionals can provide advice on selection of appropriate
pets as well as prevention of disease transmission from nontraditional pets
and when children contact animals in public settings.
INTRODUCTION
The majority of households in the United States own 1 or more pets. In
national surveys conducted by the American Pet Products Manufacturers
Association, the percentage of US households that have 1 or more pets
increased from 56% in 1998 to 63% (71.1 million homes) in 2007.1 Dogs are
owned by 44.8 million households, cats are owned by 38.4 million, freshwater
fish are owned by 14.2 million, birds are owned by 6.4 million, small animals
are owned by 6.0 million, horses are owned by 4.3 million, and saltwater fish All clinical reports from the American Academy of Pediatrics
automatically expire 5 years after publication unless reaffirmed,
are owned by 0.8 million. Total US pet industry expenditure in 2007 is revised, or retired at or before that time.
estimated at $40.8 billion.1 In recent years, the number of families that have
The guidance in this report does not indicate an exclusive course of
chosen nontraditional pets has increased.1 treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.
Many pet owners and people in the process of choosing a pet often are
unaware of the potential risks posed by certain animals, especially DOI: https://doi.org/10.1542/peds.2008-1942
nontraditional pets. These risks are associated with changes in physical and PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
behavioral characteristics as young animals reach maturity. Pediatricians, Copyright © 2020 by the American Academy of Pediatrics
veterinarians, and other health care professionals are in a unique position to
offer advice on proper pet selection, to provide information about safe pet
To cite: Larry K, Joseph A, Frederick J, AAP and the
ownership and responsibility, and to minimize risks to infants and children. Committee on Infectious Diseases. Exposure to
In addition to exposure to animals in their homes, children may come in Nontraditional Pets at Home and to Animals in Public
Settings: Risks to Children. Pediatrics. 2008;122(4):
contact with animals in a variety of public settings.2 Although there are
e20081942
many benefits to experiences with animals outside the home, contact with
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PEDIATRICS Volume 122, number 4, October 2008:e20081942 FROM THE AMERICAN ACADEMY OF PEDIATRICSanimals in public settings also can be The terms “nontraditional pets,” “exotic Table 1 provides examples of animals
associated with significant risks to animals,” “farm animals,” “pets,” that are considered nontraditional pets
children, including infections and “wildlife hybrids,” “indigenous wildlife,” as well as animals to which children
injuries. These potential risks are “reptiles,” and “rodents” were selected may be exposed in public settings.
enhanced when there is an inadequate as Medical Subject Headings (MeSH),
understanding of disease transmission, and text words were combined in the Since 1992, the number of exotic
methods of preventing transmission, search strategy. In addition, the “related animals available in the United States
animal behavior, or appropriate links” option on PubMed was used. has increased 75%.1 In 2005, 87 991
facilities for animals. References in all relevant published mammals (including 29 species of
articles, including reviews, letters, rodents), 1.3 million reptiles, and 203
This report deals with the potential
commentaries, and Web sites, also million fish were imported legally into
exposure of infants, children, and
were reviewed to identify original the United States. The US Fish and
adolescents to nontraditional pets in
research. Wildlife Service estimates that in 2002,
the home and to animals in public
365 000 birds were imported legally.
settings. The objectives of this report Studies were assessed as to whether Reptiles are now in 4.4 million homes.1
are to (1) summarize information they should be included in this review In addition, there is a worldwide illegal
regarding emerging and reemerging on the basis of their reporting or trade of exotic animals, estimated at $6
infectious diseases, injuries, and summarizing original data that to $10 billion dollars annually,3–5 only
allergies associated with exposure to examined infections or injuries in exceeded by the trafficking of arms and
nontraditional pets in the home and to children resulting from nontraditional drugs. This illegal trade subverts rules
animals in a variety of public settings, pets in the home or animals in public established by regulatory agencies to
(2) outline regulations and settings. Previously published reduce introduction of disease and
recommendations applicable to these recommendations to prevent potentially dangerous animals through
exposures, and (3) define measures to infections and injuries were reviewed. importation restriction, inspection,
minimize or prevent illness and injury
For the purpose of this report, and/or quarantine.5
in children from exposure to these
animals and cite resources for nontraditional pets include exotic
animals, defined either as imported, A number of public health concerns are
additional information for health care related to human contact with
professionals and families. nonnative species or species that
originally were nonnative but now nontraditional pets and, specifically, to
are bred in the United States; exotic animals. Most imported
METHODS indigenous wildlife; and wildlife nonnative species are caught in the wild
To identify original research hybrids (wildlife crossbred with rather than bred in captivity. Health
publications and review articles domestic animals producing offspring screening often is not performed before
dealing with infections, injury, and known as hybrids). The definition of shipment of these animals to the United
allergies in children resulting from nontraditional pets includes reptiles States, and there is mixing of animal
nontraditional pets, including exotic and certain species of mammals. species in holding locations, including
animals, in the home and from animals that might be ill or incubating
animals in public settings, a search of illness or carriers of potential
the National Library of Medicine’s NONTRADITIONAL PETS pathogens. In addition, the significant
Medline database was performed by Nontraditional pets are increasing in wildlife black market, through which
using PubMed, and the Cochrane popularity among a pet-loving public a large number of exotic animals enter
Library was searched for articles as lifestyle choices of owners dictate the the United States, compounds the risks
published between 1975 and 2007. need for smaller or more unusual pets. of introduction of zoonoses.6
TABLE 1 Animals That Are Considered Nontraditional Pets and/or Animals That May Be Encountered in Public Settings
Categories Examples
Amphibians Frogs, toads, newts, salamanders
Fish Many types
Mammals: wildlife Raccoons, skunks, foxes, coyotes, civet cats, tigers, lions, bears, nonhuman primates
Domesticated livestock Cattle, pigs, goats, sheep
Equines Horses, mules, donkeys, zebras
Weasels Ferrets, minks, sables, skunks
Lagomorphs Rabbits, hares, pikas
Rodents Mice, rats, hamsters, gerbils, guinea pigs, chinchillas, gophers, lemmings, squirrels, chipmunks, prairie dogs, hedgehogs
Feral animals Cats, dogs, horses, swine
Reptiles Turtles, lizards, iguanas, snakes, alligators
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2 FROM THE AMERICAN ACADEMY OF PEDIATRICSDespite the popularity of otherwise not present in the United REPTILES
nontraditional pets, after making States. Contact between animals from Among nontraditional pets, reptiles
the initial decision to acquire different areas of the world can lead pose a particular risk because of high
a nontraditional pet, owners may to the appearance of disease in a new carriage rates of Salmonella species,
discover that they are unable to species and establishment of the intermittent shedding of
provide the animal with the a pathogen in a new geographic Salmonella organisms in their feces,
environment or nutrition required for area.13 An example occurred in and persistence of Salmonella
a healthy life and often subsequently organisms in the environment.15,17–19
2003 when human monkeypox
abandon or release the animal into The US Food and Drug
was introduced into the United
the wild, which poses risks for Administration (FDA) ban on
States. Investigators determined
zoonotic disease and injury to commercial distribution of turtles
people and other animals.7 that the source of monkeypox was
importation of African Gambian with shells less than 4 inches long in
1975 resulted in an important and
rats, which, in turn, ultimately
ZOONOSES ASSOCIATED WITH sustained reduction of human
infected prairie dogs being sold as
NONTRADITIONAL PETS Salmonella infections as a result of
pets, which infected humans in close
Zoonotic diseases or zoonoses are prevention of transmission of
contact with the prairie dogs.14 In Salmonella from these reptiles,
infections transmitted between other
this case, prompt recognition and although illegal distribution of small
vertebrate animals and humans. Most
public health efforts controlled this turtles with subsequent disease in
emerging infectious diseases in
outbreak and may have been humans continues to occur.20,21
humans are zoonotic in origin.6,8–11 A
list of 1415 human pathogens responsible for preventing Amphibians also can serve as
demonstrates that 61% are known to establishment of monkeypox in a source of salmonellosis in
be zoonotic, and pathogens with North America. households.15 Six percent of all
multiple host species are twice as likely sporadic Salmonella infections in the
to be associated with an emerging Zoonotic transmission of infections by United States (11% among people
infectious disease.9 From 1980 to 2003, household pets or animals with which younger than 21 years)—
more than 35 new infectious diseases children come in contact in their approximately 74 000 cases annually—
have emerged in humans, many of homes or public settings is a common are the result of direct or indirect
which are zoonoses.10 The leading event. Infections can be caused by contact with reptiles or amphibians.15
causes of their emergence are human bacteria, viruses, fungi, and parasites.
behavior (travel and leisure activities, Transmission may be direct or
RODENTS
preferences for pet ownership) and indirect through contact, aerosols,
modifications of natural habitats, bites or scratches, contamination of Multistate outbreaks of salmonellosis
including expansion of human the environment, food or water, or attributable to contact with
populations and encroachment on hamsters22 and other rodents23
disease-carrying vectors. Animals
wildlife habitats, changes in food- purchased from retail pet stores have
may become ill or, more commonly,
production processes, changes in been described. Hamsters also have
are asymptomatic carriers of specific
agricultural practices, and global trade been associated with outbreaks of
organisms and may contaminate the
in wildlife.5,6,10 Domestic animals and disease attributable to lymphocytic
environment to which children are choriomeningitis virus.24 Hedgehogs,
humans may acquire zoonotic
exposed. Infants and children originally from Europe, Asia, and
pathogens from nontraditional pets.
Wild animals also can serve as younger than 5 years are at the Africa and now estimated to be in
reservoirs for transmission of zoonotic greatest risk, in part because they approximately 40 000 US households,
agents to domesticated animals and to have less-than-optimal hygiene have proven to be an important
humans.8 An outbreak of tularemia in practices, attraction to or curiosity source of Salmonella serotype Tilene
US wild-caught prairie dogs held in about animals, and developing in the United States.25 Other
a commercial facility in Texas led to immune systems15 but also because Salmonella serotypes as well as
human transmission.12 Some of the these infections tend to be more Yersinia pseudotuberculosis,
infected animals were distributed to severe in infants and young children. Mycobacterium marinum, and rabies
a pet shop in Texas and were exported People of all ages with primary or also have been shown to be zoonotic
as far away as the Czech Republic. secondary immunodeficiencies are at diseases carried by hedgehogs.
Exotic animals imported to the United risk of more severe disease, as are The natural reservoir of plague is
States have been associated with pregnant women and elderly wild rodents, with humans becoming
introduction of infectious agents people.16 infected through bites of infected
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PEDIATRICS Volume 122, number 4, October 2008 3rodent fleas and through handling Streptococcus iniae, and Erysipelothrix museums; temporary, such as in
infected animals, especially rodents, rhusiopathiae.36 shopping malls, schools, or
lagomorphs, and domestic cats.26,27 community events; or recurring, such
In parts of the United States where as agricultural fairs and petting
plague is endemic, people with OTHER SOURCES OF INFECTION zoos.41 Petting zoos are common at
rodent-seeking animals can be Infection attributable to Salmonella agricultural fairs, animal parks, and
exposed to Yersinia pestis through species can be acquired from other other public events. Although
direct contact with plague-infected sources. Outbreaks of Salmonella numerous positive benefits of human-
pets or their fleas.27 People who live species infections in people who have animal contacts exist, including
in areas where plague is endemic been in contact with chicks and other opportunities for education and
should follow a flea-control program baby poultry purchased at entertainment, infectious diseases,
designed by their veterinarians to agricultural feed stores have been injuries, and other health problems
keep their cats and dogs free reported.37 Parents who purchase associated with these venues are well
from fleas. these birds for their children documented. Infections with enteric
generally are not aware that bacteria and parasites pose the
Skin infections also can be acquired
Salmonella infections can be highest risk of human disease from
from nontraditional pets and include
ringworm, monkeypox, orf, cutaneous transmitted from poultry to humans. animals in public settings. Although
anthrax, tularemia, erysipeloid, In addition to direct exposure to ruminant livestock (cattle, sheep, and
ectoparasites, and endoparasites.28–33 animals, exposure to animal-derived goats) are the major source of
Hedgehogs pose a significant risk, pet food treats and pet food has infection, poultry, rodents, and other
because their spines readily penetrate resulted in human infections domestic and wild animals are also
skin and can be the source of M attributable to Salmonella.38,39 potential sources.2
marinum and Y pseudotuberculosis Animals may become colonized with
From 1991 to 2005, more than 55
infections.25 Salmonella after ingesting
contaminated pet food treats or raw outbreaks of human disease, the most
meats. These animals may remain common of which were enteric,
NONHUMAN PRIMATES
asymptomatic and become involved animals in public settings.3
Herpes B virus (cercopithecine unrecognized sources of Serious infections with Escherichia
herpesvirus 1) is a zoonotic agent contamination in the household. coli O157:H7 have been associated
that can be found in macaque Handling of pet food treats by with multiple animals in public
monkeys that are kept as pets or humans may result in infection.39 In settings.42–55 The primary reservoir
displayed in public exhibits. The virus the United States, pet treats are of E coli O157:H7 is ruminant
is endemic in macaque monkeys, regulated by the FDA. Salmonella- livestock, which are colonized
which may remain asymptomatic or contaminated pet treats are asymptomatically. In many studies,
may develop mild oral lesions. Herpes considered adulterated under the the primary route of transmission has
B virus infections in humans have Federal Food, Drug, and Cosmetic Act been foodborne,49 but person-to-
been reported after animal bites, (21 USC x301–399). The American person spread, direct animal contact,
scratches, or percutaneous Pet Products Manufacturers and contact with environmental items
inoculation with infected material or Association published guidelines to contaminated by animals are
splashes to mucous membranes. educate its members about risks of common.44 In 2004 and 2005, there
Human infections most often result in contamination of pet treats.40 In were 3 E coli O157:H7 outbreaks,
fatal meningoencephalitis.34 2004, the FDA initiated annual accounting for 173 cases from 3
nationwide testing of pet treats for states associated with direct and
Salmonella species. indirect animal contact at petting
FISH zoos.45 Outbreaks17 and sporadic
Mycobacterial infections are among DISEASES ASSOCIATED WITH cases of salmonellosis and outbreaks
the major zoonoses that can be ANIMALS IN PUBLIC SETTINGS of cryptosporidiosis56–58 have been
transmitted by aquarium fish,35 but Infants and children can come in described after visits to farms at
other organisms have been reported contact with numerous different which visitors had either direct or
after exposure to aquarium water, animal species (Table 1) in a number indirect contact with animals.
usually sporadically or in of public settings (Table 2), Additional illnesses include
immunocompromised people. These potentially resulting in millions of salmonellosis, campylobacteriosis,
organisms include Aeromonas human-animal interactions annually. tuberculosis, rabies, orf virus
species, Vibrio species, Edwardsiella Public animal exhibits can be infection, giardiasis, tularemia,
species, Salmonella species, permanent, such as zoos and science ringworm, and infected bites or
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4 FROM THE AMERICAN ACADEMY OF PEDIATRICSTABLE 2 Potential Exposures of Children to Animals in Public Settings
Area Animal Involved Organism
Metropolitan zoo Elephants, giraffes, rhinoceroses, buffaloes M tuberculosis59,60
Komodo dragons Salmonella serotype enteritidis18
County or state Cattle, calves E coli O157:H741,48,54,67
agricultural fairs
Cattle Campylobacter species53
Reptiles Salmonella species17
Goats Rabies65,67
Farm tours or visits Cattle, calves E coli O15741–43,46,47,49,50,55,65
Raw milk Campylobacter species, Salmonella species67
Calves Cryptosporidium species, E coli O157:H7, Salmonella species,
Campylobacter species51
Sheep, goats, calves Cryptosporidium species41,56–58,67
Sheep Orf28
Livestock exhibits Cattle E coli O15748
Pet stores Hamsters, mice, rats Salmonella species23
Kittens Rabies64
Hamsters Tularemia,12 lymphocytic choriomeningitis24
Prairie dogs Monkeypox14
Petting zoos Cattle, sheep, goats E coli O15741,45,52,67
Rabbits Giardia species67
Bear cubs Rabies66
Rodeo events Ponies Rabies63
Fish tanks Fish Mycobacterium species,35 Salmonella species36
Agricultural feed store Baby poultry (chicks, ducklings, goslings, turkeys) Salmonella species37
wounds.12,18,28,51,53,59,60 Direct Although human rabies deaths caused Association (AVMA), National
contact with animals (especially by animal contact in public exhibits Association of State and Public
young animals), contamination of the have not been reported, exposure to Health Veterinarians (NASPHV),
environment or food or water rabid mammals at pet stores,64 and Council of State and Territorial
sources, inadequate hand-washing county fairs,65 petting zoos,66,67 and Epidemiologists (CSTE) recommend
facilities or lack of education about rodeo events67 have required enactment and enforcement of state
hand hygiene, and inappropriate extensive public health investigations laws that prohibit importation,
layout and maintenance of facilities at and medical follow-up. For example, distribution, and/or relocation of
animal exhibits have been implicated raccoon-variant rabies in pet rabbits these animals. The AVMA has
as sources of or reasons for infection and a guinea pig have led to recommended that wild animals
in these public settings.2 As an postexposure prophylaxis of adults or hybrids not be kept as pets
example, in a study of observations of and children.68 Prevention of (www.avma.org/careforanimals/
practices at petting zoos in Canada, rabies in domestic cats, dogs, and animatedjourneys/petselection/
hand-hygiene facilities were provided ferrets can be achieved by regular consider.asp).
but often not used, items that would rabies immunization and
come into contact with mouths of reimmunization.62,63 Control of rabies INJURIES AND ALLERGIES
infants and children (pacifiers, infant
among wildlife reservoirs is difficult, Infants and children younger than
bottles, sippy cups) were carried into
and use of licensed oral vaccines 5 years are at increased risk of
the petting zoos, and education about
for mass immunization of free- injuries associated with animal
hygiene was lacking.61 The
ranging wildlife depends on the interactions because of their size and
recommendation to wash hands
circumstances surrounding each behavior. Bites, scratches, kicks, falls,
immediately after leaving an animal
animal rabies outbreak and is and crush injuries of hands or feet or
exhibit is the single most important
restricted to use in state and federal from being pinned between an animal
prevention step to reduce the risk of
rabies-control programs.62 No and a fixed object can occur at home
disease transmission, even if an
animal is not touched. parenteral rabies vaccine is licensed or during exposure to animals in
for use in wild animals or hybrids. a public setting. Serious and fatal
Because of the risk of rabies in wild injuries can be caused by a large
RABIES animals (especially raccoons, skunks, animal or an animal with aggressive
Rabies is a fatal viral zoonosis and coyotes, foxes, and bats), the behavior. Some nontraditional pets
a serious public health problem.62,63 American Veterinary Medical are chosen when they are young and
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PEDIATRICS Volume 122, number 4, October 2008 5small without consideration that they hypersensitivity reactions to iguanas. States is complex. No single federal
may grow into dangerous, aggressive In 1 case, a person with respiratory agency has the authority to limit
adults. For example, iguanas sold allergic symptoms was found to be importation, interstate distribution,
shortly after birth measure less than allergic to iguana scales.31 In addition, movement, sale, or ownership of
8 inches but grow to several feet in 2 an iguana bite–induced exotic animals in the United States.
to 3 years, and baby chicks become hypersensitivity reaction has been Federal agencies that do have
full-grown chickens and have a life reported.32 regulatory authority over some
span of up to 20 years. aspects of the exotic-animal trade as
it relates to their individual mission
An estimated 4 to 5 million animal REPORTABLE DISEASES ACQUIRED include the CDC, the Animal and Plant
bites occur in the United States FROM NONTRADITIONAL PETS AND Health Inspection Service of the US
annually. Although approximately ANIMALS IN PUBLIC SETTINGS Department of Agriculture, the FDA,
90% of bites are from dogs or cats,
Many national and state-notifiable and the US Fish and Wildlife Service.
severe and fatal bites can occur from
diseases can be transmitted from There also is a patchwork of state
large or aggressive nontraditional
animals. Public health officials at state bans, permits, and tracking systems
pets. Animal bites or scratches often
health departments and personnel for exotic animals. Agencies
become infected. Infectious
from the Centers for Disease Control responsible for enforcing regulations
organisms, depending on the biting
and Prevention (CDC) collaborate in vary among states.
animal, include Pasteurella multocida,
determining which infectious
Francisella tularensis, Among the federal agencies, the CDC
diseases should be notifiable
Capnocytophaga canimorsus, is responsible for regulations
nationally; states determine which
Streptobacillus moniliformis, Spirillum regarding importation of dogs and
diseases are reportable within their
minor, Bartonella henselae, leptospira, cats; nonhuman primates, small
borders. A disease may be added to
and herpes B virus. Tularemia turtles, terrapins, and tortoises;
the national or state list as a new
occurred in a 3-year-old child who African rodents; civets; and birds
pathogen emerges, or a disease may
was bitten by an infected hamster from countries with H5NI influenza.
be removed from the list as disease
that was purchased at a pet store.33 In addition, CDC regulations include
incidence decreases. Because disease
Reptiles can produce injuries by bites, etiologic agents, hosts, and vectors,
reporting varies according to state,
with claws, or with tails. Severe hand under which importation of bats is
specific requirements should be
injury32 and cellulitis29 have been regulated. The US Fish and Wildlife
obtained from the appropriate state
reported after green iguana bites. Service requires permits to import
health department. Provisional data
Unprovoked attacks by ferrets on fish, reptiles, spiders, wild birds,
are published weekly in the Morbidity
children, particularly infants sleeping rabbits, bears, wild members of the
and Mortality Weekly Report, and final
or lying down, can be severe, with cat family, and other wild or
data are published each year by the
mutilation of the ears or nose.69,70 endangered animals. The FDA
CDC in the annual “Summary of
Attacks on sleeping infants are regulates interstate transactions
Notifiable Diseases,” which can be
similar to those inflicted by rats.71 involving turtles, molluscan shellfish,
found online (www.cdc.gov/ncphi/
psittacine birds, prairie dogs, and
Although the frequency is not known, disss/nndss/phs/infdis.htm). These
African rodents. Many states also
the potential for having an allergy to data are necessary for the study of
have laws that make it illegal to own
nontraditional pets is likely to be epidemiologic trends and
or keep certain wild animals or
significant. The American Academy of development of disease-prevention
a variety of exotic pets, including
Allergy Asthma & Immunology policies. Physicians and other health
nonhuman primates.
estimates that approximately 15% of care professionals should report
the population experiences allergies suspected cases of human illness to The Animal Welfare Act (7 USC
to dogs and cats.72 Allergy to animals local and state health departments as x2131-216) covers the sale and
usually is attributable to sensitization soon as possible, especially when the exhibition of wild/exotic animals and
to their dander, scales, fur, feathers, patient has a history of visiting an the wholesale distribution of pet
body waste, or saliva. Flea bites also animal exhibit during the incubation animals. Wholesale breeders, dealers,
can lead to allergic manifestations. period. exhibitors, and research laboratories
Hives have been described in people are covered by this act. Birds, rats,
who have contact with hedgehogs.73 and mice are exempted; dogs, cats,
Although scaly animals are not as IMPORTATION LAWS AND REGULATIONS and other animals have limited
likely to be as allergenic as furry REGARDING EXOTIC ANIMALS coverage; and cold-blooded species
animals, there are case reports of Addressing importation and such as reptiles are not regulated
allergic rhinitis, asthma, and contact regulation of animals in the United under this act. Small retail breeders
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6 FROM THE AMERICAN ACADEMY OF PEDIATRICSand pet shops that sell only domestic associated salmonellosis or Parents can be made aware of Web
pet animals are not regulated under toxoplasmosis.75 sites that provide guidelines for safe
this act; these animals usually are pet selection and appropriate handling
covered by local (state, county) Pediatricians and veterinarians of pets. Proper pet health maintenance,
anticruelty laws and, in some together can remind parents, immunization, flea and tick control,
instances, by local animal regulations children, and pet owners about the deworming, and diet and activity can
or public health laws. The US importance of measures to avoid minimize the risk of infection or injury
Department of Agriculture has issued illness. Simple and effective advice and ensure the health of the pet.
a position statement on risks of includes frequent hand-washing and Referral to a veterinarian also can be
ownership of large, wild, and exotic avoiding direct contact with animals helpful when parents are
cats (www.aphis.usda.gov/animal– and their environments. This is contemplating purchase of
welfare/downloads/big–cat/ particularly important with animals a nontraditional animal. Veterinarians
position.pdf). from which transmission of enteric can provide information about
pathogens is a risk, including young appropriate pet selection, the size of an
CDC efforts are underway to ruminants, young poultry, reptiles, animal when it attains adulthood, the
galvanize partner agencies into rodents, amphibians, and animals that temperament and husbandry needs of
further actions to enhance protection are ill. Young children always should an animal, and suitability as a pet.
of humans from zoonotic diseases. A be supervised closely when in contact
meeting of stakeholder organizations with animals in public settings. The A history of contact with pets in the
was held at the CDC in 2006, NASPHV has developed an excellent home or animals in public settings
a summary of which was published in compendium with standardized should be part of every well-child
the Federal Register.74 The AVMA, recommendations for use by public evaluation and especially should be
CSTE, and NASPHV have each issued health officials, veterinarians, animal part of an evaluation of a suspected
position statements calling for venue operators, animal exhibitors, infectious disease. A history of
a coordinated federal approach to and others who are concerned with nontraditional pets in the home or
better control of infectious disease disease control and minimizing risks contact with animals in public settings
risks associated with the exotic- associated with animals in public can lead to specific testing and
animal trade (these publications are settings.2 additional management
available through the Web sites of the recommendations and occasionally will
respective organizations). Uniform To reduce the possibility of injury, result in early identification of an
importation laws, better quarantine health care professionals should unusual infection from another part of
and surveillance methods for animals remind pet owners about matching the world.
coming into the country, and the size and temperament of a pet to
prevention of illegal wildlife trade are the age and behavior of their infant or
AVAILABLE RECOMMENDATIONS AND
necessary components of an overall child, providing close supervision of GUIDELINES
plan to protect the public. younger children, and educating all
children about appropriate human- Recommendations from several
animal interactions. organizations dealing with
PREVENTION MEASURES AND THE ROLE nontraditional pets and animals in
OF PEDIATRICIANS AND The decision to obtain public settings have been developed
VETERINARIANS a nontraditional pet by parents with and are summarized in Table 3. In
Pediatricians and veterinarians play children in the household is often not addition, Table 4 provides Web-site
an important role in guiding parents discussed with a physician or addresses for health care
and their children about mitigation of veterinarian. However, as trusted professionals and parents at which
risks associated with ownership of sources of health care information, information for prevention of human
nontraditional pets or contact with pediatricians and veterinarians are in disease from nontraditional pets and
animals in public settings. Parents a unique position to offer information animals in public settings can be
and pet owners typically lack and advice to families considering the found. Recommendations for
knowledge about the multiple modes purchase of a nontraditional pet or to prevention of enteric disease
of transmission of zoonotic infectious families who already have transmission from animal contact in
diseases from pets. Although a nontraditional pet in the household. public settings resulted from
pediatricians recognize the Informational brochures and posters outbreaks of E coli O157:H7 at farms
importance of anticipatory guidance available for display in physician and open to the public at which animal
about pet-related hazards, only 5% veterinarian offices could allow for contact and inadequate hand hygiene
reported that they regularly educated parent education without occurred.43 The NASPHV and CDC
patients or families about pet- significantly increasing time of a visit. have established recommendations to
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PEDIATRICS Volume 122, number 4, October 2008 7TABLE 3 Guidelines for Prevention of Human Diseases From Nontraditional Pets at Home and wildlife–domestic animal hybrids do
Exposure to Animals in Public Settings not make good pets. These animals
General are dangerous and are a hazard to
Wash hands immediately after contact with animals, animal products, or their environment human health, other animals, and the
Supervise hand-washing for children younger than 5 y environment. The AVMA also
Wash hands after handling animal-derived pet treats
Never bring wild animals home, and never adopt wild animals as pets
recommends that ferret owners have
Teach children never to handle unfamiliar, wild, or domestic animals even if the animals appear knowledge about the species and
friendly stress that no one who is incapable
Avoid rough play with animals to prevent scratches or bites of removing himself or herself from
Children should not be allowed to kiss pets or put their hands or other objects into their mouths the bite of a ferret should be left
after handling animals
Do not permit nontraditional pets to roam or fly freely in the house or allow nontraditional or
unattended with a ferret. Measures
domestic pets to have contact with wild animals to control and prevent psittacosis in
Do not permit animals in areas where food or drink are prepared or consumed humans and birds were published by
Administer rabies vaccine to mammals as appropriate a committee formed by the NASPHV
Keep animals clean and free of intestinal parasites, fleas, ticks, mites, and lice and were endorsed by the AVMA,77
People at increased risk of infection or serious complications of salmonellosis (eg, children younger
than 5 y, older adults, and immunocompromised hosts) should avoid contact with animal-derived
the CSTE, and the Association of
pet treats Avian Veterinarians.
Animals visiting schools and child-care facilities
Designate specific areas for animal contact Guidelines for animals that might
Display animals in enclosed cages or under appropriate restraint have contact with children in a child-
Do not allow food in animal-contact areas care setting have been published by
Always supervise children, especially those younger than 5 y, during interaction with animals
Obtain a certificate of veterinary inspection for visiting animals and/or proof of rabies immunization
the National Resource Center for
according to local or state requirements Health and Safety in Child Care and
Properly clean and disinfect all areas where animals have been present Early Education.78 These guidelines
Consult with parents or guardians to determine special considerations needed for children who are state that any pet or animal present at
immunocompromised or who have allergies or asthma
the facility, indoors or outdoors,
Animals not recommended in schools, child-care settings, and hospitals include nonhuman primates,
inherently dangerous animals (lions, tigers, cougars, bears, wolfdog hybrids), mammals at high should be in good health; show no
risk of transmitting rabies (bats, raccoons, skunks, foxes, and coyotes), aggressive animals or evidence of carrying any disease; be
animals with unpredictable behavior, stray animals with unknown health history, reptiles, and fully immunized; and be maintained
amphibians on a flea-, tick-, and worm-control
Ensure that people who provide animals for educational purposes are knowledgeable regarding
program. A current (time-specified)
animal handling and zoonotic disease issues
Public settings certificate from a veterinarian should
Venue operators must know about risks of disease and injury be on file in the facility and state
Venue operators and staff must maintain a safe environment that the specific pet meets these
Venue operators and staff must educate visitors about the risk of disease and injury and provide conditions. All contact between
appropriate preventive measures
animals and children should be
Animal specific
Children younger than 5 y and immunocompromised people should avoid contact in public settings supervised by a caregiver who is
with reptiles, amphibians, rodents, ferrets, baby poultry (chicks, ducklings), and any items that close enough to remove the child
have been in contact with these animals or their environments immediately if the animal shows signs
Reptiles, amphibians, rodents, ferrets, and baby poultry (chicks, ducklings) should be kept out of of distress or the child shows signs of
households that contain children younger than 5 y, immunocompromised people, or people with
treating the animal inappropriately.
sickle cell disease and should not be allowed in child-care centers
Reptiles, amphibians, rodents, and baby poultry should not be permitted to roam freely throughout The caregiver should instruct
a home or living area and should not be permitted in kitchens or other food-preparation areas children on safe procedures to follow
Disposable gloves should be used when cleaning fish aquariums, and aquarium water should not be when in close proximity to these
disposed in sinks used for food preparation or for obtaining drinking water animals (eg, not to provoke or startle
Mammals at high risk of transmitting rabies (bats, raccoons, skunks, foxes, and coyotes) should not
animals or touch them when they
be touched by children
are near their food). Potentially
aggressive animals should not be in
prevent disease outbreaks associated posed by contact with baby poultry.37 the same physical space with
with animals in public settings.2 The Guidelines for prevention of zoonoses children. The facility should not keep
CDC has issued recommendations for in immunosuppressed people also are or bring in turtles, iguanas, lizards, or
preventing transmission of available.16,76 other reptiles; ferrets; psittacine
Salmonella organisms from reptiles to birds; or any wild or dangerous
humans21 and information regarding The AVMA supports the view that animals. Recommendations for hand-
health risks from Salmonella species exotic animals, wildlife, and washing by staff, volunteers, and
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8 FROM THE AMERICAN ACADEMY OF PEDIATRICSTABLE 4 Web Sites With Information on Prevention of Human Diseases Transmitted From Nontraditional Pets and Wild Animals
Health care professionals
CDC Health Pets Healthy People site for resources and recommendations related to www.cdc.gov/healthypets/health–prof.htm
animal contact
FDA tips on keeping pets and people healthy www.fda.gov/fdac/features/2004/104–pets.html
CDC and Healthcare Infection Control Practices Advisory Committee guidelines for www.cdc.gov/ncidod/dhqp/pdf/guidelines/Enviro–guide–03.pdf
infection control in health care facilities
Guidelines for veterinarians for prevention of zoonotic transmission of ascarids and www.cdc.gov/ncidod/dpd/parasites/ascaris/prevention.htm
hookworms of dogs and cats
Educational materials for physician offices/parents
CDC search engine for diseases associated with specific animals www.cdc.gov/healthypets/browse–by–animal.htm
Department of Public Health, Commonwealth of Massachusetts recommendations for www.mass.gov/dph/cdc/epii/rabies/petzoo.htm
petting zoos, petting farms, animal farms, and other events and exhibits where
contact between animals and people is permitted
NASPHV report of standardized recommendations for public health officials, www.nasphv.org/documentsCompendia.html and www.cdc.gov/mmwr/
veterinarians, animal venue operators, animal exhibitors, visitors to animal venues preview/mmwrhtml/rr5605a1.htm
and exhibits, and others concerned with disease control and with minimizing risks
associated with animals in public settings
NASPHV safety at animal exhibits and hand-washing posters www.nasphv.org/documentscompendiaAnimals.html
CDC information on health risks posed by contact with baby poultry www.cdc.gov/healthypets/easter–chicks.htm
Guidance for pet selection
CDC information about health-related risks of owning and caring for animals www.cdc.gov/healthypets
Guidance for minimizing risk of disease transmission
CDC Pet-Scription: guidelines for staying healthy while enjoying your pet and for www.cdc.gov/healthypets/petscription–gen.htm
animal-specific diseases
CDC regulations for importation of pets, other animals, and animal products into www.cdc.gov/ncidod/dq/animal/index.htm
the United States
NASPHV recommendations on hand-washing, venue design, animal care and www.nasphv.org/documentsCompendia.html and www.nasphv.org/
management, and risk communications regarding disease and injury prevention Documents/AnimalsInPublicSettings.pdf
associated with animals in public settings
Association of Zoos & Aquariums guide to accreditation of zoological parks and www.aza.org/Accreditation/Documents/AccredGuide.pdf and www.aza.
aquariums org/Accreditation/Documents/AccredStandPol.pdf
children as well as maintenance of policy statements of their SUMMARY
animals housed on the premises are organizations or calls to action. There Most nontraditional pets pose a risk
provided in the guidelines.78 In was a consensus that rules and to the health of young children, and
addition to exposures to animals regulations need to be strengthened their acquisition and ownership
within a center, child-care and school and standardized to reduce risks should be discouraged in households
field trips can result in disease. A field associated with exotic pets and that with young children. Exposures
trip to a petting zoo at which hand- federal and state efforts are needed to
to animals in public settings also
hygiene facilities were not adequate eliminate illegal wildlife trade. In
pose specific risks. Parents need to
resulted in 44 cases of E coli O157:H7 addition, the Zoonoses Education
be educated about the increased
infection in British Columbia.79 Coalition organized by the CDC aims
risks of exposure to nontraditional
Guidelines for infection control in to increase partnerships between
pets and animals in public settings
health care facilities are not part of government and industry. An effort is
for infants and for children
this document but are available underway by a number of regulatory
(www.cdc.gov/ncidod/dhqp/pdf/ and public health agencies and younger than 5 years and for
guidelines/Enviro–guide–03.pdf). veterinary organizations to address immunosuppressed people of all
issues raised by legal and illegal ages and should be made aware of
importation of exotic animals and to the general recommendations for
FUTURE develop a comprehensive set of reduction of risks of infection, injury,
In 2006, the CDC hosted a meeting regulations to protect the public and allergy. Resources are available
dealing with infectious disease risks (J. McQuiston, DVM [veterinary for physicians, veterinarians, and
associated with exotic-animal epidemiologist, Viral and Rickettisial parents, and recommendations,
importation and trade. The CSTE, Zoonoses Branch, National Center including specific guidelines for
NASPHV, and AVMA—3 organizations for Zoonotic, Vector-Borne, and reducing the risk of Salmonella
involved in the issue of infectious Enteric Diseases, CDC], verbal infection from reptiles, are offered
disease risks associated with the personal communication, August by a number of organizations.
exotic-animal trade—presented 2007). In addition, physicians and
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PEDIATRICS Volume 122, number 4, October 2008 9veterinarians are encouraged to EX OFFICIO Rep. 2007;56(RR-5):1–14. Available at:
work together to educate one Carol J. Baker, MD www.cdc.gov/mmwr/preview/
another and to communicate Red Book Associate Editor mmwrhtml/rr5605a1.htm. Accessed
a common message to pet Larry K. Pickering, MD January 23, 2008
owners regarding the benefits Red Book Editor 3. Steinmuller N, Demma L, Bender JB,
and risks of pet ownership and Eidson M, Angulo FJ. Outbreaks of
of contact with animals outside CONSULTANTS enteric disease associated with animal
the home. Joint training seminars contact: not just a foodborne problem
Edgar O. Ledbetter, MD
and joint sponsorship of health- H. Cody Meissner, MD
anymore. Clin Infect Dis. 2006;43(12):
1596–1602
communication campaigns in
pediatrician and veterinarian 4. Check E. Health concerns prompt US
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offices would greatly increase review of exotic-pet trade. Nature. 2004;
Nina Marano, DVM, MPH 427(6972):277
awareness in pet owners. The Frederick J. Angulo, DVM, PhD
“One Medicine” initiative 5. Karesh WB, Cook RA, Bennett EL,
supported by the AVMA to increase Newcomb J. Wildlife trade and global
veterinary collaboration with STAFF disease emergence. Emerg Infect Dis.
counterparts in human medicine is Alison Siwek, MPH 2005;11(7):1000–1002
an excellent step forward to benefit 6. Chomel BB, Belotto A, Meslin FX.
clinical medicine and public health 2019 REFERENCE UPDATE Wildlife, exotic pets, and emerging
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William Steinbach, MD, FAAP
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