Now that human-dog transmission of monkeypox has been identified, there’s a lot more interest in what to do about animals that have been exposed to infected people. As more people get monkeypox, more animals will be exposed. We want to reduce the risk of the animals getting infected (and maybe infecting people), while at the same time not causing undue stress on the animals or people.
(Big déjà vu moment here…..this is pretty much the exact same topic I had to write about for COVID-exposed animals at the start of the pandemic).
As always, good guidance is tough because of knowledge gaps, changing information and differences between households, lifestyles, risk tolerance and other factors. However, we can probably break it down to three main approaches.
Remove the pet ASAP
- This one gets mentioned as an ideal option but I think it’s probably the worst option unless it’s certain that the animal has not yet been exposed.
- If the animal was already exposed to the infected person, they could already be infected and incubating monkeypox. Moving the animal therefore creates a risk of moving monkeypox and exposing whoever takes it.
- Prompt removal of the pet would reduce the risk of a pet getting infected, but it also increases the risk of a pet spreading monkeypox. Considering how little we know about the risks of those, I’m more concerned about the implications of an animal spreading monkeypox than I am it getting it in a household where monkeypox is already present and being contained, and where the animal has probably already had a lot of exposure.
Keep the pet in the house and use strict isolation measures
- This is the ideal response, in my mind. It’s not easy, though, in part because we don’t really understand the likelihood of human-dog infection, or dog-human infection, and about transmission risks in households.
- Contact with skin lesions probably poses the biggest risk, but other types of contact also have to be considered. The degree of risk from aerosol transmission is also still controversial.
So, some basic practices would be…
- If there are uninfected (or not known to be infected) people in the household, they should be the animal’s primary caregiver
- Keep the pet away from skin lesions.
- Keep skin lesions covered, whenever possible.
- Limit contact with the pet as much as possible.
- Keep the pet in a separate room as much as possible (being practical and considering the pet’s welfare)
- Keep the pet away from bandages, clothing or other materials that have come into contact with the skin, especially skin lesions.
- Don’t let the pet on furniture that people use.
- Limit the amount of time in the same airspace
- Don’t let the pet sleep in the same bedroom as people.
- Pay good attention to hand hygiene, especially before any animal contact and contact with things like food and water bowls.
- Maximize ventilation in the house and if possible, have a HEPA filter running in areas where infected people tend to spend time (esp in the pet is in the same area).
To mask or not to mask, that is the question
- Mask use will reduce the risk of aerosol transmission. It would make sense to wear an N95/KN95 or equivalent when in close proximity to the pet. That’s tough to maintain over time but if nothing else, doing it when close contact is required can be practical.
Keep the pet in the house and carry on
- This approach is based on an assumption that the pet is already exposed and/or that isolation measures will not be able to be done effectively. I understand those points and there’s some validity to them. However, ‘do nothing’ is a hard thing to support. I’d rather see ‘do as much as you can from the list above’ vs surrendering and saying ‘what happens, happens’.
In my (limited) experience to date, a combination of #2 and #3 has been most common. By the time people are diagnosed and think about potential pet risk issues, there’s already been lots of exposure to the pet. They try to take some precautions like limiting contact, keeping the pet away from their skin lesions and keeping the pet out of the bedroom. But, it’s hard to strictly isolate in the household when you have to care for the animal, and motivation decreases over time (especially when people think that they’re not able to strictly isolate). So, by the end, measures are limited. That’s not a criticism…it’s a reality. It’s hard to strictly isolate. In some households, it’s really difficult. Pets can be peoples’ support systems when they are going through a tough time. People realize that they have maybe already exposed their pet. All those things considered, while they don’t want to infect their pet, they often drift from ‘strict isolation’ to ‘let’s do what we can do’. That’s still useful, though.
What if the owner cannot care for the animal and/or the animal has to be moved?
In some situations, the pet might have to be temporarily removed from the household. That could include if the infected person cannot care for it, if the pet can’t be safely managed (e.g. it has to go in an elevator and through busy common areas to go outside multiple times a day) or if the owner ends up hospitalized and no one else is present in the household. There are a few possible approaches.
- If the owner cannot care for it but the pet can stay in the home, one option is for someone else to come and care for the pet a couple times a day (easier with cats and caged pets). That prevents having to have the pet live with someone else and makes it easier to have short term exposure to the pet and to facilitate use of personal protective equipment, as needed.
- If the pet has to be moved, it should be moved to a low risk environment, ideally one with few people, no kids or immunocompromised people, no other animals and where it can be easily contained and managed. The caretaker would have to understand and accept the unknown degree of risk (as it’s pretty much completely unknown).
These are far from impossible, but require some work and come with a good degree of uncertainty.
Regardless of the option chosen, there needs to be an effort to reduce exposure of the animal to other animals and people.
- only if essential and it can’t be postponed for a few weeks.
Time in the yard
- short, supervised periods are ok. What we don’t want to see are exposure of wildlife or through-the-fence transmission to neighbouring people or animals. (I’ve seen fence line transmission of both canine flu and canine parainfluenza. Different bugs but those shows there’s some degree of concern).
- this would come down to context and need. The concern is close contact. If the animal can be walked and be sure to be away from others, the risk is negligible. That might be very easy or next-to-impossible, so the specific situation needs to be assessed and the walker needs to be diligent.
How long do these measures need to be done?
That’s a tough question too. Measures to reduce the risk of transmission from the owner should be maintained until the owner has been told they are no longer infections. Often, that’s considered to be 21 days.
But… (there’s always a but)..
We have to think about the 2nd part of our concerns….whether the pet can infect someone else. If we say the person was infectious until day 21, then the pet could have been exposed up until day 21. So, if we assume a similar 21 day isolation period for exposed animals, that would start at the end of the owner’s isolation period. That’s a bit hard to enforce since it’s not what’s done for human contacts, but since we know nothing about whether dogs, cats and other species can be subclinically infected (infected without obvious signs) and able to transmit the virus if subclinically infected, some degree of prudence is indicated. At a minimum, I’d want to keep an exposed dog from situations like groomers, kennels and off leash dog parks for a while after the owner was sprung from isolation.
As always, these are initial thoughts and subject to change as we learn more. But infection control isn’t rocket science. It’s a lot of basic measures that apply to a wide range of situations, so I think the approaches outlined above are a good starting point.