The veterinary team’s role in the One Health tularemia system

Abstract

Tularemia is a zoonotic disease of One Health importance, with Kansas having the highest incidence of human tularemia cases reported in the United States in 2022. This project was designed with the Kansas Department of Health and Environment to determine the knowledge, attitudes, and common practices of veterinarians and veterinary technicians in Kansas regarding tularemia. Specifically, we aimed to better understand occupational risk, personal protection behaviors, patient diagnostic testing and management preferences, zoonotic risk communication, and public health reporting. This was a cross-sectional study with an online survey from June to September 2024, recruiting veterinarians and veterinary technicians who serve dogs and cats. The survey was completed by 109 veterinarians and 19 technicians from all regions of the state. Forty-three percent of veterinarians reported diagnosing tularemia in cats, and 13% reported diagnosing tularemia in dogs. Seven percent of veterinarians reported having had tularemia at some point in their career; the majority suspected they contracted it from a hospitalized tularemia feline or canine patient. Veterinarians reported that glove use was 100% when performing high-risk procedures, but other personal protective equipment use was inconsistent. A tularemia-specific cage sign was created to help veterinary staff understand what veterinary procedures were considered high risk and appropriate personal protective equipment and other precautions that should be taken. Forty-two percent of veterinarians reported that they never submit a diagnostic test to confirm the diagnosis of tularemia, with owner finances being the primary hurdle; the most common diagnostic tests used were PCR and antibody titer. For treatment of tularemia, Kansas veterinarians most commonly prescribe either fluoroquinolones or doxycycline, but there are no approved drugs or efficacy studies. Ninety-one percent of veterinarians reported discussing public health implications with pet owners, and 63% reported always documenting these discussions in the pet’s medical record. Veterinarians and technicians have inconsistent knowledge about reporting regulations, with fewer than 20% knowing that tularemia is only reportable when diagnosed in a human patient. In conclusion, veterinarians and technicians play an essential One Health role in the prevention and control of tularemia in Kansas. Moving forward, veterinary personnel need additional continuing education, staff training, and hospital protocols to ensure they are protecting themselves from zoonotic transmission. Ongoing efforts should be made to expand the availability and affordability of diagnostic testing. Controlled clinical trials are needed to determine the optimal antimicrobial therapy for veterinary patients with tularemia. Veterinary teams would benefit from additional educational tools for clients of tularemia patients. Designating tularemia as mandatory for reporting in Kansas when diagnosed in animals would allow improved public health surveillance and response.