A Review of Zoonotic Disease Threats to Pet Owners: A Compendium of Measures to Prevent Zoonotic Diseases Associated with Non-Traditional Pets Such as Rodents and Other Small Mammals, Reptiles, Amphibians, Backyard Poultry, and Other Selected Animals
2022; Mary Ann Liebert, Inc.; Volume: 22; Issue: 6 Linguagem: Inglês
10.1089/vbz.2022.0022
ISSN1557-7759
AutoresKate Varela, Jennifer A. Brown, Beth Lipton, John R. Dunn, Danielle Stanek, Casey Barton Behravesh, Helena J. Chapman, Terry H. Conger, Tiffany Vanover, Thomas Edling, Stacy Holzbauer, Angela M. Lennox, Scott Lindquist, Suzan M. Loerzel, Shelley Mehlenbacher, Mark A. Mitchell, Michael J. Murphy, Christopher W. Olsen, Cody M. Yager,
Tópico(s)Vector-Borne Animal Diseases
ResumoVector-Borne and Zoonotic DiseasesVol. 22, No. 6 ReviewOpen AccessCreative Commons licenseA Review of Zoonotic Disease Threats to Pet Owners: A Compendium of Measures to Prevent Zoonotic Diseases Associated with Non-Traditional Pets Such as Rodents and Other Small Mammals, Reptiles, Amphibians, Backyard Poultry, and Other Selected AnimalsKate Varela, Jennifer A. Brown, Beth Lipton, John Dunn, Danielle Stanek, NASPHV Committee Consultants, Casey Barton Behravesh, Helena Chapman, Terry H. Conger, Tiffany Vanover, Thomas Edling, Stacy Holzbauer, Angela M. Lennox, Scott Lindquist, Suzan Loerzel, Shelley Mehlenbacher, Mark Mitchell, Michael Murphy, Christopher W. Olsen, and Cody M. YagerKate VarelaAddress correspondence to: Kate Varela, One Health Office, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4018, USA E-mail Address: nwn2@cdc.govhttps://orcid.org/0000-0002-3885-4496One Health Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Search for more papers by this author, Jennifer A. BrownNational Association of State Public Health Veterinarians.Indiana Department of Health.Search for more papers by this author, Beth LiptonNational Association of State Public Health Veterinarians.Seattle & King County Public Health.Search for more papers by this author, John DunnNational Association of State Public Health Veterinarians.Tennessee Department of Health.Search for more papers by this author, Danielle StanekNational Association of State Public Health Veterinarians.Florida Department of Health.Search for more papers by this author, NASPHV Committee Consultants1Casey Barton BehraveshOne Health Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.Search for more papers by this author, Helena ChapmanDivision of Infectious Diseases and Global Medicine, University of Florida College of Medicine.American Association for the Advancement of Science at NASA Applied Sciences.Search for more papers by this author, Terry H. CongerU.S. Department of Agriculture Animal (USDA) and Plant Health Inspection Service (APHIS) Veterinary Services.Search for more papers by this author, Tiffany VanoverInternational Poultry Retail Consultant.Search for more papers by this author, Thomas EdlingAmerican Humane.Pet Advocacy Network Consultant.Search for more papers by this author, Stacy HolzbauerMinnesota Department of Health.CDC Preparedness and Response Career Epidemiology Field Officer Program.Search for more papers by this author, Angela M. LennoxAvian and Exotic Animal Clinic (Indianapolis).Search for more papers by this author, Scott LindquistWashington State Department of Health.Search for more papers by this author, Suzan LoerzelUSDA APHIS Animal Care.Search for more papers by this author, Shelley MehlenbacherU.S. Animal Health Association.Search for more papers by this author, Mark MitchellLouisiana State University School of Veterinary Medicine, Veterinary Clinical Sciences.Search for more papers by this author, Michael MurphyFood and Drug Administration Center for Veterinary Medicine.Search for more papers by this author, Christopher W. OlsenAVMA Council on Public Health.Department of Pathobiological Sciences, University of Wisconsin-Madison School of Veterinary Medicine.Search for more papers by this author, and Cody M. YagerUSDA APHIS Animal Care.*See Acknowledgments for more information.Search for more papers by this authorPublished Online:17 Jun 2022https://doi.org/10.1089/vbz.2022.0022AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Table of ContentsIntroduction.......................................................................304Background.........................................................................305I. Rodents and other small mammals..........................................309II. Reptiles (turtles, snakes, and lizards).................................312III. Fish, reptiles, amphibians (frogs, toads, salamanders, and newts) and invertebrates that live in aquatic environments.............................................................................316IV. Backyard poultry........................................................318V. Feeder animals...........................................................321Recommendations....................................................................323I. Overview.................................................................323II. General recommendations for all partners................................324A. Awareness and education (suggested messaging for NTP owners and the general public)................................................................................................324B. Handwashing..............................................................328C. Antimicrobial use, resistance, and stewardship...........................329D. Occupational health......................................................331III. Partner–specific recommendations................................334A. Industry: breeders, distributors, retailers..............................334B. Human healthcare and veterinary care providers: a One Health approach....337C. Industry groups, associations, and other affiliated organizations........338D. Government agencies......................................................338IV. Summary.................................................................339V. Acknowledgments..........................................................339Bibliography.......................................................................340Appendices.........................................................................348A. NTP literature review and NORS/ACOSS data request results................348B. Table of selected zoonoses...............................................349C. Glossary.................................................................354D. Industry layout..........................................................355E. Handwashing..............................................................356F. Guidelines for animals in schools, childcare settings, and long-term care and assisted living facilities.......................................................................................357G. Selected recommendations, standards, guidelines, and regulations for non-traditional pet species..........................................................................................358H. Selected educational resources...........................................360IntroductionAs people and a wide variety of animal species have increasingly close contact in diverse settings, guidance on preventing zoonotic diseases, caused by pathogens that spread between animals and people, is urgently needed. According to data (Annual Report of Animal Contact Outbreaks, 2021; Reptiles and Amphibians, 2022; Salmonella from Small Mammals, 2021; US Outbreaks of Zoonotic Diseases Spread between Animals & People, 2021) from the Centers for Disease Control and Prevention (CDC), three major groups of animals have repeatedly been associated with local, regional, and national outbreaks of zoonotic diseases in people in the United States: rodents, backyard poultry, and reptiles. This Compendium presents information on these and other non-traditional pet (NTP)* animal species associated with a high risk of zoonotic disease transmission in any setting. Other animal species covered in this Compendium include non-rodent small mammals (e.g., hedgehogs, ferrets), amphibians (e.g., African dwarf frogs), and other aquatic species (e.g., fish, coral) that are less frequently linked to illness or outbreaks, but nonetheless pose a risk of zoonotic disease transmission.Many zoonotic disease exposures occur at home through direct or indirect contact with pets, agricultural animals, or feeder animals. Zoonotic diseases also affect workers employed in various segments of the pet industry, including animal breeders, pet store and other retail employees, and pet importers and distributors, as well as volunteers working closely with animals. This Compendium will provide guidance on addressing the zoonotic disease risks related to NTPs that are specific to these groups and settings, which may be different from those for other settings, populations, and animals. For guidance on preventing zoonotic diseases associated with animals in public settings (e.g., agricultural fairs, educational farms, petting zoos, schools, and other public venues), see the Compendium of Measures to Prevent Disease Associated with Animals in Public Settings and the Compendium of Measures to Control Chlamydia psittaci Infection among Humans (Psittacosis) and Pet Birds (Avian Chlamydiosis), 2017. For guidance on preventing occupational exposures to veterinary professionals see Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel.*For the purposes of this document, the animals in this Compendium will be referred to as "non-traditional pets," even though some of the animals listed are categorized as food-producing animals or livestock.Recommendations and best practices in this Compendium were developed using a One Health approach with the goal of preventing zoonotic disease transmission between NTP species and people and reducing zoonotic disease risks in environments with animals and people (One Health, 2022). The intended audience for these recommendations includes employers, animal workers and leaders in the pet industry, NTP owners, human and animal healthcare professionals, public health officials, animal health officials, and others involved in controlling disease and reducing health risks.ONE HEALTH means a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional, national, and global levels—with the goal of achieving optimal health outcomes that recognize the interconnection between people, animals, plants, and their shared environment (One Health, 2022).BackgroundNon-traditional pet (NTP) ownership in the United StatesPet ownership in the United States is increasing, with approximately 57–70% of households owning one or more pets (AVMA Pet Ownership and Demographics Sourcebook, 2017; "Pet Industry Market Size," 2021) The majority of pets in the United States are dogs and cats; however, ownership of companion animal species other than dogs and cats, defined here as "non-traditional pets" (NTPs), is increasing. For the purpose of this document, these animals will be referred to as NTPs, even though some of the animals listed are categorized as food-producing animals or livestock. NTPs may include those species generally thought of as wildlife, species that are imported or rare in the United States, or livestock and poultry not typically kept as pets such as backyard poultry, which are not considered pets in most states. The number of backyard poultry owners climbed 23% in five years, with 1.1% of all US households owning backyard poultry in 2016 (AVMA Pet Ownership and Demographics Sourcebook, 2017). During the COVID-19 pandemic, agricultural stores and media outlets reported record purchasing of poultry during 2020 for egg and meat consumption and to have as pets (Nichols et al, 2021). Ownership of NTP species is increasing at an annual rate of 4% ("Pet Industry Market Size," 2021). More than 13% of US households owned an NTP at the end of 2016, a 25% increase from 2011 (AVMA Pet Ownership and Demographics Sourcebook, 2017).Non-Traditional Pet (NTP) species covered in this Compendium:Rodents and other small mammalsBackyard poultryReptilesAmphibiansAquatic speciesPet ownership is associated with mental and physical health benefits in people (Allen et al, 2001; Baun and Mccabe, 2003; Carr et al, 2020; Ein et al, 2018; Kertes et al, 2017;,Maugeri et al, 2019). Pets can increase feelings of well-being, encourage more active lifestyles, and play a role in forming social support networks (Arhant-Sudhir et al, 2011; Wood et al, 2015). According to the American Heart Association, pet ownership, particularly dog ownership, may be associated with decreased cardiovascular disease risk (Levine et al, 2013). Asking about pets during a medical exam was shown in a recent study to have positive effects on practice and patient-provider relationships (Hodgson et al, 2017). The National Association of State Public Health Veterinarians (NASPHV) and the Centers for Disease Control and Prevention (CDC) recognize the many benefits of pets and support safe, healthy, and responsible pet ownership. Responsible pet ownership can prevent pet injury to people, reduce animal stress, and improve animal health. This includes avoiding impulsive decisions when selecting a pet, researching what the pet needs to be healthy, choosing a pet appropriate for a particular household, and providing appropriate husbandry, food, housing, handling, veterinary medical care, and socialization for the pet to keep it healthy. Responsible pet ownership also includes preventing zoonotic disease transmission from people to pets; it is important to separate sick people from pets to avoid transmission of germs such as human (seasonal) influenza viruses or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Animals and COVID-19, 2022).In addition to the individual benefits, pet ownership benefits local, regional, and national economies. The amount spent on pets, pet supplies, veterinary medical care, and other services is increasing, with an estimated $97.1 billion spent in 2019 and $103.6 billion spent in 2020 ("Pet Industry Market Size", 2021). The increasing trends in NTP ownership and spending are expected to continue over the next several years ("Pet Industry Market Size", 2021).NTPs and zoonotic diseasesContact with NTPs increases the risk of exposure to zoonotic pathogens (i.e., pathogens spread between animals and people). NTPs can appear healthy while carrying zoonotic pathogens, putting pet owners and others at risk, especially those in high-risk groups (People at Higher Risk for Illness from Animals, 2022). NTPs should be recognized as potential primary or intermediary hosts in novel zoonotic pathogen emergence. As new NTP species become popular and the number of imported pets from around the globe increases, people and animals are at increased risk for emerging or reemerging zoonotic diseases, including those that have not previously been found in the United States (Smith et al, 2012). People can infect NTPs with zoonotic diseases as well, such as seasonal influenza virus transmission from humans to ferrets (Belser et al, 2018).Transmission of zoonotic pathogensMost pathogens described in this Compendium do not cause illness in the animal host. NTPs can appear healthy while carrying a pathogen that can cause illness in people, putting the people in contact with them at risk. Transmission and infection mechanisms of some zoonotic pathogens associated with NTPs are not well-described. A better understanding of routes of transmission and time periods of shedding (the time the animal is infectious and spreading the pathogen in its environment), immune responses, and prevention strategies (e.g., vaccination) for people and animals would enhance the ability to control zoonotic pathogens in NTPs and protect the health of people who come into contact with these species.People at higher risk of illnessAnyone can become sick from a zoonotic disease, including healthy people. However, some people are at higher risk for serious illness or death from these infections. People at higher risk of illness include: Children younger than 5 years oldAdults 65 years and older,People with weakened immune systems due to illness (e.g., HIV/AIDS, cancer, diabetes, liver disease, kidney disease, and multiple sclerosis)People taking certain medications including those that weaken the immune system (e.g., steroids, cancer chemotherapy, and drugs used to treat autoimmune diseases like rheumatoid arthritis or psoriasis)Pregnant peopleZoonotic pathogens associated with NTP species and other animals can be transmitted by direct or indirect animal contact. Direct transmission of zoonotic pathogens can occur when people pet, touch, or kiss animals via accidental ingestion of feces from contaminated fur, feathers, scales, or spines; contaminated saliva from feeding an animal by hand or being licked by animals; or contact with other body fluids (Daly et al, 2017). Direct transmission of zoonotic pathogens can also occur via animal bites and scratches. Though rare, rabies, tetanus, and other highly pathogenic infections such as infections with Streptobacillus moniliformis (rat bite fever), Francisella tularensis (tularemia), or Pasteurella can be associated with NTP bite and scratch injuries, depending on the NTP species involved (Daly et al, 2017). Some NTP species such as venomous arthropods (e.g., scorpions and centipedes), arachnids (e.g., spiders), reptiles, amphibians, and fish can cause envenomation through stings, bites, or other contact. NTPs may also carry parasites (e.g., ticks, fleas) that may transmit vector-borne diseases to people (Daly et al, 2017; Mendoza-Roldan et al, 2020; Smith et al, 2012).Common risk factors that lead to illness associated with NTP species:Not washing hands after handling animals or their food,waste, habitats, or other supplies (e.g., toys, leashes)Engaging in risky forms of contact (snuggling, kissing, or holding near face)Eating or drinking around NTPsCleaning habitats in the kitchen or in other food preparation areas that leads to cross-contamination of kitchenware used for people (e.g., baby bottles)Allowing animals to roam freely in the home or in food preparation areasZoonotic disease transmission can also occur indirectly via contact with a surface or environment contaminated by an animal's urine, feces, blood, saliva, nasal secretions, or other body fluids; via contamination of food preparation areas and items; or less commonly through infectious droplets or aerosols (Daly et al, 2017). In multiple outbreaks of human illness linked to NTP species, contamination of food preparation surfaces by the animals themselves, contaminated items (e.g., by cleaning animal dishes or habitats in kitchen sinks), and allowing NTP species to freely roam indoors have been identified as important preventable risk factors for human infection (Gaffga et al, 2012; Loharikar et al, 2013; Loharikar et al, 2012; Zarecki et al, 2013).Proper handwashing can interrupt many of the common routes of zoonotic disease transmission. Handwashing is discussed further in the Recommendations section of this document and Appendix E. Handwashing.Transmission of zoonotic diseases from people to animalsThe COVID-19 pandemic has shown that diseases in wildlife, such as coronavirus infection in animals, can spread from animals to people and then between people (Animals and COVID-19, 2022) Some pathogens, including influenza viruses (Influenza in Animals, 2018) and SARS-CoV-2, can also spread from people to animals in some situations, especially during close contact. This is a public health concern because of the potential for pathogen mutation or reassortment that can result in new strains that may be capable of adapting to new hosts or ecologic environments (Ghai et al, 2021). As of September 2021, farmed mink, zoo and aquaria animals (including large cats, otters, gorillas, hippos), companion animals (including dogs, cats, and a ferret), and wildlife (including free ranging white-tailed deer (Animals and COVID-19, 2022) in the United States have been naturally infected with SARS-CoV-2 as a result of close contact with people with COVID-19 including farm workers, caretakers or keepers, pet owners (Cases of SARS-CoV-2 in Animals in the United States, 2022). Wild white-tailed deer have been confirmed to be infected with SARS-CoV-2 in several US states (Animals and COVID-19, 2022). Ferrets are susceptible to influenza viruses, including human seasonal influenza A viruses, and avian and swine influenza A viruses (Ferrets, 2021). People can protect pets and other animals by avoiding contact with animals including pets, livestock and other production animals, and wildlife when they have any illness (e.g. influenza virus), or are suspected or confirmed to be infected with SARS-CoV-2.Transmission of zoonotic pathogens associated with NTP contact can occur in settings inside and outside the home. Transmission in public settings, such as petting zoos and other public animal exhibits, is addressed in the Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2017 (Daly et al, 2017).Special contact settings with non-traditional petsPeople may have contact with non-traditional pets in a variety of settings. Here are some examples (Daly et al, 2017):- Home - contact with pets; farm animals; breeding animals; feeder animals- Group settings - classrooms; child care facilities; long-term care facilities- Retailers - retail pet stores; agricultural and feed stores;online sales; hobby or trade conventions; live animal markets and auctions; flea markets; street vendors; souvenir shops; roadside stands; toy stores or other retail stores- Special events - seasonal events (e.g., Easter egg hunts); swap meets; hobbyist meetups; rat races; barn-hunting; birthday parties- Exhibitions - petting zoos; agritourism venues; animal exhibition shows (e.g., those put on by 4H or National FFA Organization); animal shelter/rescue fundraising events; performing animal shows- Occupational settings - veterinary clinics; commercial and in-home breeders; distributors; retail workers at pet, agricultural, or other stores where NTPs are sold; diagnostic laboratories; mail carriers; animal transporters; animal shelters and rescue organizations; and volunteers in those workplacesNTPs can also pose occupational health risks. Zoonotic disease outbreaks linked to NTPs in recent years have affected workers in a variety of occupations, including workers at animal breeding and rearing facilities; those involved in animal distribution (e.g., postal workers); workers at retail locations such as pet stores and feed stores; and veterinary clinic staff. Examples of worker-related illnesses related to NTPs include rat bite fever in a pet shop employee (Shvartsblat et al, 2004); lymphocytic choriomeningitis virus (LCMV) infection in employees of a feeder-rodent operation (Knust et al, 2014); Seoul virus infection in the owners of a rat-breeding facility (Kerins, 2019) ; and monkeypox infections in veterinarians, pet shop employees, and animal distributors (Monkeypox in the United States, 2022; Croft et al, 2007). Postal workers, feed store employees, and others involved in the distribution and selling of backyard poultry have acquired Salmonella infections (Behravesh et al, 2014). Additional occupational health considerations and recommendations will be covered throughout this Compendium.Summary of identified outbreaks and case reports associated with NTP species in the United States from 1996 through 2017CDC conducted a literature review to characterize the number of outbreaks, case reports, and types of pathogens associated with NTP species in the United States from 1996 through 2017. Key search terms included scientific pathogen names (e.g., "Salmonella"), NTP species of interest (e.g., "poultry," "turtles"), "pet ownership," "outbreak," and other related terms (Appendix A. NTP literature review and NORS/ACOSS data request results). In addition to the literature review, outbreak reports were retrieved via data request from CDC's National Outbreak Reporting System (NORS), a web-based platform launched in 2009 for local, state, and territorial health departments to report to CDC domestic outbreaks of foodborne and waterborne disease as well as outbreaks of enteric disease transmitted by contact with environmental sources, infected persons or animals, or unknown modes of transmission (National Outbreak Reporting System (NORS), 2019).Animal contact outbreaks reported through NORS are captured by the Animal Contact Outbreak Surveillance System (ACOSS) (Animal Contact Outbreak Surveillance System, 2020). Reports retrieved from ACOSS through NORS were reviewed in detail if they described outbreaks (2 or more cases) that occurred during 2009–2017 that were associated (suspected or confirmed) with contact with an identified NTP species covered in this Compendium. Outbreaks or case reports that reported multiple species were included so long as there was an NTP species reported. Outbreaks and case reports retrieved from the literature search and outbreak-associated illnesses from ACOSS that met the criteria for further review were recorded in a database for analysis. If an outbreak or case report appeared in both the literature and in ACOSS, then only the data from ACOSS were recorded in the database because they are updated in real time as reported by the jurisdiction. ACOSS only captures enteric illnesses associated with animal contact, whereas the literature review included enteric illnesses and non-enteric illnesses.Salmonella and NTP speciesThe pathogen most commonly identified across all NTP-associated outbreaks and case reports were Salmonella bacteria.What is Salmonella?Salmonella are zoonotic bacteria found in the intestinal tract of many healthy animals, including rodents, reptiles, amphibians, and backyard poultry (Behravesh et al, 2014)Why is it important?Salmonella is well-described as the most common source of bacterial infection in people during outbreaks associated with NTPs. Salmonellosis linked to all animal contact is estimated to cause >100,000 illnesses annually (Hale et al, 2012).FindingsSalmonella bacteria caused 81% of 243 NTP-associated outbreaks and case reports during 1996–2017.Rodents & other small mammals (17 outbreaks)Reptiles (62 outbreaks, 6 case reports)Fish & amphibians (8 outbreaks)Backyard poultry (105 outbreaks)A total of 9,798 individual NTP-associated salmonellosis cases were detected.112 Salmonella outbreaks were multistateCDC estimates that for each human Salmonella infection reported, 29 additional cases occur.Using these methods, a total of 243 outbreaks and case reports were identified that described disease linked to contact with NTP species. These were largely attributable to four major pathogens: Salmonella bacteria (Behravesh et al, 2014; Hale et al, 2012), lymphocytic choriomeningitis virus (LCMV), Streptobacillus moniliformis bacteria (rat bite fever), and Seoul virus (a member of the hantavirus family). When combined, the literature review and ACOSS reports described 9,875 human illnesses attributable to these four pathogens, with 1,461 (15%) occurring in children younger than 5 years old. A total of 1,752 (18%) were hospitalized and 33 (0.3%) deaths were associated with these illnesses. Small numbers of human illnesses linked to contact with NTP species and associated with other pathogens, including Campylobacter species, monkeypox virus, and Francisella tularensis, were also captured in the literature review.A limitation of this literature review and ACOSS data request is that reporting through NORS is voluntary and agencies may experience limited ability to investigate and report these outbreaks, therefore infections with these pathogens are likely underreported (Hale et al, 2012). For example, national reporting is not required for rat-bite fever (Kache et al, 2020) or LCMV ("Notes from the Field: Congenital Lymphocytic Choriomeningitis," 2021), and infections are required to be reported by few states. ACOSS only includes enteric pathogens associated with animal contact, so does not include some of the pathogens captured in the literature review.Practicing antimicrobial stewardship in NTPs helps prevent antimicrobial resistanceAntimicrobial resistance (AMR) is an increasingly recognized One Health issue affecting both human and animal health, including NTP species. Antimicrobials are valuable tools used to fight bacterial, viral, parasitic, and fungal infections in both animals and people, but improper use or overuse of these medications can create drug resistance and reduced effectiveness of antimicrobials for the treatment of animal and human illnesses (Antibiotic/Antimicrobial Resistance, 2021). CDC estimates that more than 2.8 million antibiotic-resistant and antifungal-resistant infections occur in the United States each year and more than 35,000 people die as a result (Antibiotic/Antimicrobial Resistance, 2021). When bacteria, viruses, and fungi are exposed to antimicrobials, strains that are able to survive can multiply. These strains can then share the mechanisms or genes that confer resistance or resistance determinants with other organisms that may not have been exposed to the drug. Antimicrobial-resistant bacteria may spread between colonized or infected people and animals. Contact with the environment (e.g., water, soil) may also play a role in the spread of antimicrobial-resistant bacteria. AMR is one of the biggest threats currently facing public health and is an important One Health issue requiring collaboration across disciplines and sectors (Antibiotic/Antimicrobial Resistance, 2021; Antimicrobial Resistance, 2021; World Health Organization, 2017). In CDC's 2019 Antimicrobial Resistance Threats in the United States report (2019 AR Threats Report, 2019), drug-resistant Salmonella and drug-resistant Campylobacter strains were listed as serious public health threats that require prompt and sustained action. Drug-resistant Salmonella and Campylobacter strains associated with NTPs and other animals also pose a threat to human health. Recent outbreaks in NTP species highlight the importance of antimicrobial stewardship for human and animal health (Outbreak of Salmonella Infections L
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