Hawaiian Monk Seal K13

K13 is an endangered Hawaiian Monk Seal. The scientific name for this species is Monachus schauinslandi but I prefer the Hawaiian name ilio-holo-i-kauaua which means ‘dog that runs on water’ or ‘dog running in rough seas’. Monk seals are named for the loose folds of skin around their necks that look like a monk’s cowl. I was lucky to see K13 napping on a beach on the island of Kauai. This old girl has had a tough life. Look closely and you will see a large scar behind her left flipper. She also lost her left nostril and is blind in her left eye from shark bites.

Despite her physical limitations, K13 has managed to survive and thrive. On April 20, 2018, she gave birth to a female pup on a remote Kauai beach. Monk seal pups weigh around 35 pounds at birth and are about three feet long. K13 stayed on the beach and nursed the little one for 37 days straight without eating. This is normal behavior for Monk Seals. The mother survives on the fat stored in her body. The average pup will put on about 100 pounds when nursing.  When all of the fat is depleted, lactation stops and the mother goes back to foraging for food.  The newly weaned pup must learn to forage for food and avoid predators. It is a dangerous time for these babies. Beside sharks, other threats include aggression from male seals, infectious disease, parasites, toxins and danger from human interactions. Dogs have attacked and injured the helpless pups. The good news is that K13’s daughter is doing well!

After weaning her pup, K13 has been busy foraging for food to replace all the weight lost during lactation. She hunts at night for fish, octopus, squid and crabs then comes ashore during the day to rest. While resting, volunteers with NOAA Pacific Island Fisheries Science Center (PIFSC) watch over the seals. That’s how I met Lloyd, a volunteer who told me all about K13. After erecting signs to keep people from bothering K13, Lloyd took detailed pictures to help further our understanding of this endangered species then spent the rest of his time educating curious visitors.

Most of the seals are found in the Northwestern Hawaiian Islands. Unfortunately, their population has decreased while the number of seals on the main islands of Maui, Kauai, Oahu and the Big Island has increased. The 2016 survey estimates the population of monk seals to be between 1,348 to 1,542. From 2013 to 2016, their population actually increased by 3% per year for the first time after decades of decline.

I would like to thank Lloyd and the other volunteers at NOAA PIFSC, the Marine Mammal Center on the Big Island and NOAA PIFSC for their work to save the endangered Hawaiian Monk Seals and other creatures. For more information or to make a donation, please go to www.marinemammalcenter.org or www.pifsc.noaa.gov/hawaiian_monk_seal.

Sources:                                                                                                                                      -www.marinemammalcenter.org                                                                                          -www.pifsc.noaa.gov/hawaiian_monk_seal

 

The Morris Animal Foundation Funds New Feline Studies

The Morris Animal Foundation has a long history of funding studies that help diagnose, treat and prevent disease in animals. Since 1950, the foundation has funded many many projects that have led to significant discoveries. They have invested $15.8 million in 368 studies at 60 different institutions around the world. Here is a list of the five new cat studies funded for 2018:

  1. Gastrointestinal Disease Caused by Virus – Panleukopenia is a devastating disease causing three different clinical presentations; “fading kitten syndrome”, neurological disease in kittens infected in utero and severe gastroenteritis. Researchers at the University of Sydney, Australia will be investigating the role viruses play in this highly infectious disease that kills many shelter cats.
  2. Feline Infectious Peritonitis (FIP) – FIP is caused by a corona virus that causes two different clinical syndromes in cats. The wet form is characterized by the accumulation of a straw colored fluid in the chest and/or abdomen. The dry form is characterized by accumulations of white blood cells called granulomas throughout the internal organs. Both forms are fatal.  Researchers at Colorado State University are looking at new ways to diagnose this disease. Currently, the most commonly used test only indicates exposure to a corona virus. There are no current tests that indicate if the kitten will develop FIP.
  3. Heart Disease – Cats with heart disease are at risk for forming blood clots that travel through the aorta until they reach the area where the aorta splits into the right and left iliac arteries that supply blood to the back legs. The clot sticks in this area, called the saddle, restricting or completely blocking blood flow. Researchers at the University of California, Davis, will be investigating why the anti-clot drug clopidogrel doesn’t work in all cats. They will look at genetic mutations in cats with heart disease.
  4. Chronic Kidney Disease – Kidney disease is a common problem in older cats. Beside maintaining hydration, the kidneys remove amylase, an enzyme used in digestion, from the blood stream. Scientists at the University of Tennessee will study the effectiveness of omeprazole in suppressing stomach acid production.
  5. Herpesvirus-related Infections – Herpesvirus infections in cats often start as a severe upper respiratory infection in kittens. These kittens come into the clinic breathing through their mouths because of the thick pus draining from their eyes and nose. They are really sick. Even with intensive care, many will die. The lucky survivors will be infected for the rest of their lives. The virus lies dormant in their bodies until the cat is stressed, then makes the cat sick again. They will also shed the virus leading to the infection of more cats. Researchers at Michigan state University will study the immune response to feline herpesvirus with the hope of making a better vaccine for this virus.

Source: Cat Report 2018, Morris Animal Foundation, morrisaniamlfoundation.org.

The Morris Animal Foundation Funds Many New Studies on Dog Diseases

The Morris Animal Foundation has a long history of funding studies that help diagnose, treat and prevent disease in dogs and cats. Since 1950, the foundation has funded many many projects that have led to significant discoveries including the first vaccine to prevent parvovirus enteritis in dogs. This infectious disease destroys rapidly dividing cells in the body causing severe vomiting, diarrhea and bone marrow suppression. Even with aggressive medical treatment, some of the pups will die. One of my own dogs came to me as a 10 week old pup infected with parvo. For a week, he was in isolation receiving intensive care before he turned the corner. He was one of the lucky ones.

The following is a list of the new studies funded by Morris in 2018.

  1. Hemangioscarcoma – This cancer is usually found on the spleen, heart and liver in large breed dogs. In most cases, it is diagnosed after the tumor ruptures and bleeds. The new studies will look at how the cancer cells use fat as energy to grow as well as other medications for chemotherapy.
  2. Inflammatory Bowel Disease (IBD) – Dogs with IBD suffer from severe gastrointestinal problems including vomiting, diarrhea, weight loss, cramping and gas. New studies will look at what triggers this condition.
  3.  Stem Cell-Based Therapies  – A new stem cell will be tested as a potential treatment for IBD and other immune-mediated disease.
  4. Environmental Chemicals and Cancer – Research will focus on how dogs neutralize chemicals that have been linked to cancer in humans.
  5. Blood Transfusion – Blood for dogs is collected into bags containing additives and stored for use. Research will focus on how additives effect the function of platelets which clot blood.
  6. Spinal Cord Disease – Spinal cord problems including degenerative myelopathy can be difficult to diagnose and monitor. A new study will look at how advanced imaging can be used to monitor spinal cord disease.
  7. Osteosarcoma – Bone cancer is very difficult to treat in dogs requiring amputation of the affected limb. Research will look at what stimulates these abnormal cells to grow and methods to block it.
  8. Lymphocytic Leukemia – Like humans, leukemia and lymphoma are common cancers in dogs. New treatments will be explored for an especially aggressive type of leukemia called B-cell chronic lymphocytic leukemia.
  9. Severe Bleeding Disorders – Dogs with autoimmune hemolytic anemia (IAHA) produces antibodies against their own platelets leading to destruction. Without platelets, these dogs will bleed to death. Research will look at an enzyme called thrombopoietin, that stimulates the bone marrow to produce more platelets.

In addition to these new studies, The Morris Animal Foundation is funding many other ongoing studies in dogs. The Golden Retriever Lifetime Study is following over 3,000 golden retrievers with the hope of learning more about their common health issues. Right now, the FDA has launched a review of taurine levels in grain-free diets with peas, lentils, other legume seeds or potatoes after participants in this study developed dilated cardiomyopathy (DCM) at a higher rate than expected. Normally, DCM is a disease of giant breed dogs as well as American and English Cocker Spaniels. More information is available through the Food & Drug Administration Animal Veterinary News Service.

If you would like to support these vital research projects, please consider donating or volunteering with The Morris Animal Foundation. More information is at morrisanimalfoundation.org.

Source:

-Dog Report 2018, Morris Animal Foundation.org.

Grain Free Diets High in Legumes Associated With Cardiomyopathy in Golden Retrievers

Given the marketing push behind grain free diets, I feel urgency to share the following information.  Veterinary Cardiologist, Dr. Joshua Stern, has noticed a a disturbing trend in dogs. Golden Retrievers are developing acquired dilated cardiomyopathy, (DCM) caused by lack of an amino acid called taurine. The other form of dilated cardiomyopathy is called inherited or familial DCM.  It is a common cause of heart failure in large breed dogs including boxers, dobermans and great Danes.

According to Dr. Janet Olson, “Taurine is an amino acid that is found in high concentrations in heart and muscle. Among its many functions, it aids in normal contractile function. Evidence shows that taurine helps mediate calcium channel transports and modulates calcium sensitivity of the myofibrils.”

Taurine deficiency causing cardiomyopathy in cats was a huge problem in the late 80’s. Cats are obligate carnivores who cannot make taurine from other amino acids. They must consume it in their diet. After commercial diets were supplemented with taurine, the incidence of DCM decreased dramatically. The problem was rarely seen in dogs because dogs can synthesize taurine from two other amino acids, methionine and cysteine.

Unfortunately, DCM is now being seen in dogs on grain free diets. Dr. Stern noticed an increased incidence of acquired DCM in Golden Retrievers on grain free diets that  contain high levels of legumes. Merriam-Webster defines legumes as the fruit or seed of leguminous plants (peas or beans) used for food.  Examples include peas, alfalfa, beans and peanuts.

Dogs who have been fed or are currently on a grain free diet should be tested for taurine levels. A simple blood sample is all that is required. If the level of taurine is below normal limits, veterinary cardiologist, Dr. Janet Olson, recommends chest films. If the heart is enlarged, then more diagnostics are needed to to access cardiac function.

Clinical signs of DCM including coughing, exercise intolerance and an increased respiratory rate. Unlike heart disease caused by leaky valves, patients with  DCM usually don’t have heart murmurs. That is why Dr. Olson recommends chest films to access heart size.

Treatment begins with changing the diet to one without legumes. In dogs with low blood levels of taurine, supplementation may be needed. Dogs suffering from clinical signs of heart failure may require oxygen therapy as well as diuretics to reduce fluid build-up and other heart specific medications. If acquired DCM is caught early, the heart damage can be reversed with taurine supplementation. Unfortunately, even with aggressive therapy and supplementation, dogs with severe cardiac dysfunction may succumb to this disease. My colleague told me about a family with two dogs that developed acquired DCM. Both had been fed grain free diets since they were pups. Even with aggressive therapy, one of the dogs died. He was only three years old!

In my own practice, I am seeing a large number of owners relying on the advice they receive from the (let’s be honest – untrained ) clerk at the pet store rather than their veterinarian. The marketing campaigns touting grain free diets make things even worse. When grain is taken out of dog food, it is replaced with fat or a carbohydrate with an even higher glycemic index. Because of this, I am seeing more diabetes and pancreatitis in dogs. I am also seeing more urinary tract infections and crystals in dogs on grain free diets.  Now I have to look for acquired DCM as well. While I’m making a small fortune fixing the medical problems caused by grain free diets, it breaks my heart to see these animals suffer needlessly.  If your veterinarian suggests a specific diet, especially a prescription diet, please heed their advice. Don’t fall for a slick marketing campaign based on the human grain free craze. Your dog’s health is depending upon it.

 

Source:

-Olson, Janet. Taurine Deficiency Induced Dilated Cardiomyopathy in Golden Retrivers. Memo, Veterinary Cardiology Specialists.

‘S. zooepidemicus’ Infects Dogs at Maricopa County Animal Shelter

On January 21, 2018, Mary Martin, Director at Maricopa Animal Care Centers (MCACC), announced that Streptococcus equi subspecies zooepidemicus was found at their east valley shelter located at 2630 W. Rio Salado Parkway in Mesa, AZ. S. epidemicus is a serious bacterial disease that effects horses, dogs, cats and immune compromised people in rare circumstances. As of yet, there are no confirmed cases of human infection after direct contact with infected dogs. Most of the human cases occurred after consuming unpasteurized dairy products from infected cows or working with infected horses. Infected people developed pharyngitis, glomerulonephritis, meningitis and pneumonia.

S. epidemicus is a bacterium often found in the respiratory tract of horses and ruminants including goats and cows. When given the opportunity, it will invade other species. In dogs, it usually causes hemorrhagic pneumonia. Although MCACC has not declared this an outbreak, previous outbreaks at other facilities throughout the U.S. have been associated with crowded, kennel-like situations. At this time 30 dogs are showing clinical signs of illness in the Arizona facility.

Clinical signs of S. epidemicus  in dogs include:

  1. Coughing, sometimes bringing up a bloody material
  2. Nasal Discharge, sometimes bloody
  3. Anorexia
  4. Fever
  5. Bloody Urine
  6. Vomiting
  7. Labored Breathing
  8. Death

S. epidemicus is diagnosed by either culturing the bacteria or with a PCR test performed on samples taken from infected tissues. The advantage with PCR is a much faster turn around time as well as better accuracy. The advantage with culture is that antibiotic sensitivity can be performed to determine the best antibiotic for treatment. Early diagnosis and treatment with antibiotics is the key to saving effected dogs. Unfortunately, doxycycline resistance is starting to occur with S. epidemicus.

To prevent further infections, MCASS has shut down all playgroups and non-mandated services at the east location. They have held press conferences to warn local veterinarians about the disease. They are also adopting out animals for free in order to get them out of the shelter before contracting this disease. This last action step is surprising to many including me for fear of spreading the disease to dogs outside the shelter. According to the New York City Department of Health and Mental Hygiene, ‘Streptococcus equi subspecies zooepidemicus is an extremely rare pathogen in dogs and typically limited to shelter settings. Unpublished observations suggest transmission of Streptococcus equi subspecies zooepidemicus from shelter dogs to other dogs following adoption is unlikely.’

Although I understand their decision is based on the above information, I still worry that this action may end up spreading the disease. I am especially worried about animals and people with compromised immune systems including chemotherapy patients and valley fever patients. Therefore, I recommend isolating newly adopted pets from this shelter from all other animals for a least 2 weeks. Do not bring your existing pets to this shelter. Clean all equipment including bowls, leashes and combs between animals. Last, wash hands well and change clothes after visiting the shelter.  In other words, I would not adopt pets from there right now and strongly feel the facility should be quarantined until the incubation period has passed.

For a more detailed discussion of this horrible disease, watch Dr. Cynda Crawford’s presentation at the UF Maddie’s Shelter Medicine Conference 2011 on Streptococcus zooepidemicus. 

Sources:

-Slavinski, Sally. “2009 Veterinary Alert#1: Streptococcus equi subspecies zooepidemicus Identified in Shelter Dogs.” NYC Health:  NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL HYGIENE, 1.12.2008.

-Tanabe, Morgan. “More than 30 dogs showing symptoms of ‘Strep Zoo’ at Maricopa County animal shleter.” ABC15news,com, posted 1.21.18.

 

 

 

 

FDA Issues Warning for Dog Bone Treats

The Food and Drug Administration has issued a warning for dog bone treats. From November 1, 2010 to September 12, 2017, many dogs have fallen ill after eating commercially produced dog bone treats. Unfortunately, 15 dogs died. According to their report, the treats are marketed under the names, “Ham Bones, Pork Femur Bones, Rib Bones and Smokey Knuckle Bones.” Some are smoked or baked with additional chemicals added for flavor.

According to the FDA, the clinical signs reported are:

  • Gastrointestinal obstruction (blockage requiring surgical removal)
  • Vomiting
  • Choking
  • Diarrhea
  • Damage to the mouth
  • Bleeding from the anus
  • Death

As a veterinarian, I do not recommend bones of any kind. Beside the problems listed above, I see a lot of tooth fractures from bones. The large upper premolar is often fractured when the dog chews the bone. This results in a painful infection along the roots that causes a swelling under the eye. Removal of the tooth is the only way to end the pain.

More information on the FDA warning can be found at: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm208365.htm

Trump Placed Hold on Decision to Allow Elephant Trophy Imports But Still Allows Lion Trophy Imports

It is with great dismay that I read of the Trump administration’s decision to allow importation of lion and elephant trophies. Lions and elephants are classified as ‘threatened’ which means they are likely to become endangered (become extinct in all or part of their normal habitat) soon. The ban was put in place in 2014 because the populations of endangered and threatened species in Zimbabwe and Zambia are dropping due to poaching, game hunts and loss of habitat. Zimbabwe is where the beloved Cecil the lion was killed. He was lured out of a national park for a so-called “game hunter”, Walter Palmer, to kill. These countries also allow ‘lion hunting’ which means shooting confined lions who are acclimated to humans. This is not hunting as the animals do not have any chance of escape.

‘Serengeti Elephants’ taken by Kristen Nelson

The argument made by the hunting industry is that big game hunting brings money to the local communities. According to Richard Leakey of Kenya Wildlife Service, the amount of money generated by killing wildlife is minuscule compared to the millions generated by tourists coming for ecotourism. I was fortunate to go on safari in Tanzania this year. Seeing the animals living in their native habitats was amazing. Based on the number of tourists I saw on safari, I sincerely believe what Mr. Leakey is reporting. The animals are worth far more alive than dead.

On Friday, President Trump said he would halt the import of elephant “trophies” pending his personal review. Unfortunately, he did not halt the importation of lion “trophies”. The Trump family appears to be divided on this issue. Although President Trump has expressed disgust over game hunting, two of his sons have gone on big game hunts in Africa. Lara Trump, the president’s daughter-in-law, has been campaigning for several important animal issues including providing therapy dogs for veterans, saving wild horses and burros from slaughter and tighter regulation of puppy mills. Hopefully, she will take up this issue as well.

‘Ngorongoro Crater Lions’ taken by Kristen Nelson

If you care about the ethical treatment of animals and helping Zimbabwe and Zambia care for their greatest natural resource, please express your opinion to the White House, US Fish & Wildlife Service and our Interior Department. Please join me in asking President Trump to please keep the ban in place on importation of elephant and lion “trophies”. Keeping these magnificent animals alive is the right thing to do.

Sources:

– Eilperin, J & Gearan, A. ‘Trump face public and private pressure to halt elephant hunting trophy imports.’ WASHINGTON POST, 11/18/17, 6:12PM

– https://blog.humanesociety.org/wayne/2017/11/interior-department-allow-imports-elephant-lion-trophies-africa-reversing-obama-policies.html

 

 

A Tribute to Fozzie the Scottsdale Crisis Response Dog

Fozzie, the Scottsdale Crisis Response Dog died last month. This golden retriever responded to all kinds of crimes providing comfort to people suffering from psychological trauma. From homicides to school shootings and everything in between, Fozzie was there ready to help. His big brown eyes and wagging tail were simply irresistible!

Photo: Jim Vail

Animal-assisted therapy came about after studies showed that spending time with animals decrease blood pressure, heart rate, cholesterol and triglyceride levels in humans. According to his bio, Fozzie was the first full-time crisis response dog in America. He was trained by Paws With A Cause and donated to the Scottsdale Police Department where he worked for ten years. Service dogs are also being used in airports, courtrooms, schools, libraries, hospitals and with our military to reduce stress.

Hanna and Topaz help Fozzie celebrate his first anniversary with dog-friendly cupcakes. Photo: Jim Vail

Fozzie will be greatly missed by many citizens and officers of the Scottsdale Police Department. He lived life to the fullest bringing his own special furry love to all he met. Rest in peace Fozzie.

Fozzie with volunteer, Jim Vail

Sources:

-Friedmann, E. et al, Social Interaction & Blood Pressure:  Influence of Animal Companions. J of Nervous and Mental Disease 17 (8): 461-465.

-Morse, Samantha. ‘Scottsdale POlice bid farewell to beloved 10-year veteran, Fozzie’, SCOTTSDALE INDEPENDENT, November 2017.

-Seigel J.M., Stressful Life Events and Use of Physician Services Among the Elderly:  The Moderating Role of Pet Ownership. J. Person Soc Psych 1990; 1081-1086.

-Serpell, J.A. Evidence for long term effects of pet ownership on human health, Pets, Benefits and Practice, Waltham Symposium 20, April 19, 1990.

 

Halloween Dangers for Dogs & Cats

Halloween is a fun holiday for people of all ages to dress up, trick or treat and maybe scare a friend or two. But the noises, decorations and costumes can frighten our pets. Here’s a few tips for keeping cats and dogs safe during Halloween:

  1. Pet costumes – Make sure pet costumes do not contain dyes or paints that are toxic if ingested. Costumes should fit the pet comfortably, allowing them to walk and lie down. Check around the neck and legs for elastic bands that may cut of circulation or make it difficult to breathe. Never use rubber bands! Also, make sure your pet can’t chew off and swallow their costume. Cats love to eat costume jewelry and ribbons while dogs favor the fake skeletons.
  2. Costumes – Pets often find costumes scary. People they know suddenly become monsters when wearing a costume with a mask over their face. A normally social pet may bite. As Dr. Kathleen Shaw wrote in her article, Halloween can be Spooky for Pets, “Remember, you are responsible for controlling your pet and insuring that he doesn’t bite any guests.”
  3. Decorations – Halloween decorations can be scary as well as dangerous for pets. Fake skeletons may be too realistic for some dogs to resist. Many cats find the fake cobwebs enticing. Eating these items may obstruct the animal’s gastrointestinal system leading to expensive surgery to remove the decorations.
  4. Jack-o-lanterns – Keep all pets away from jack-o-lanterns. Pets, especially cats, are drawn to the flickering light inside. After Halloween, I see many pets with singed whiskers. The battery operated candles don’t cause fires but are highly toxic if ingested. I saw a lab who suffered greatly after eating a pumpkin with a battery operated light inside.
  5. Electric cords – Keep pets away from cords to prevent electrocution.
  6. Accidental escape – The loud noises, scary costumes and open doors for trick-or-treaters lead to many lost pets during Halloween. I recommend letting your pet sit this holiday out with some treats in the back bedroom away from all the action. Play music to distract from unusual noises. Bring all animals indoors. Even when pets are in secure outdoor enclosures, there is a greater risk of theft with all the people coming and going. Please take extra care with black dogs and cats. Over my career, I have seen horrible animal abuse associated with this holiday – particularly with animals whose fur is black.
  7. Candy – Candy possesses a variety of dangers for pets. First, there is the danger of chocolate toxicity from having too many fun bars. Second, foil wrappers and lollipop sticks may causes intestinal obstruction. Third, many candies contain the artificial sweetener xylitol that causes life-threatening drops in blood sugar. One stick of sugar-free gum can kill.

With a little planning, Halloween can be fun for the entire family. Please follow these tips to make sure everyone has a good time. Happy Halloween!

 

Source:

Shaw, Kathleen. ‘Halloween can be Spooky for Pets’, Veterinary Partners, VIN.com, 2013.

Campylobactor Infections After Contact With Puppies

A multi-state outbreak of Campylobacter has occurred in people associated with puppies from Petland as well as private breeders. According to the Centers for Disease Control and Prevention, “a total of 55 people with laboratory-confirmed infections or symptoms consistent with Campylobacter infection who live in Florida, Kansas, Maryland, Missouri, New Hampshire, New York, Ohio, Pennsylvania, Tennessee, Utah, Wisconsin and Wyoming have been linked to this outbreak.” The organism is spread through the fecal-oral route which means a person ingests feces from an infected dog. Clinical signs in dogs include vomiting, diarrhea and fever. Some dogs may be asymptomatic carriers which means they shed the organism without having any signs of illness. Humans often have severe stomach cramps in addition to fever, vomiting and diarrhea. Symptoms usually last 5-7 days.

Unfortunately, this strain of Campylobacter is resistant to many antibiotics commonly prescribed for this disease including tetracycline, azithromycin, ciprofloxacin, clindamycin and erythromycin. This makes it a dangerous bacteria for all dogs and people, most especially those with compromised or immature immune systems.

The Arizona Veterinary Medical Association, of which I am a member, encourages people to take the following precautions:

  • “Wash hands thoroughly with soap and warm water after each encounter with the dog, their food, or waste.
  • Pick up and dispose of pet waste immediately, and disinfect the area, especially in areas where children might play.
  • Thoroughly clean areas occupied by sick pets and keep them isolated from other pets in the house.
  • Don’t let pets lick areas around owner’s mouth, face, or areas with broken skin.”
  • In addition, seek medical attention immediately for all sick dogs and/or humans with gastro-intestinal disease.

Sources:

-‘Multistate Outbreak of Multidrug-Resistant Campylobacter Infections Linked to Contact with Pet Store Puppies’, Outbreak Advisory, Centers for Disease Control and Prevention, posted Oct. 3, 2017.

-‘Zoonotic Disease Health Advisory: Multistate Outbreak of Human Campylobacter Infections Linked to Pet Store Puppies’ Arizona Veterinary News, AZVMA, October 2017.