Examination is the key to diagnosis and helps determine the type of treatment needed. The veterinarian needs to know what to look for. A pet owner can help by examining their pet’s teeth and mouth at least monthly.First, smell your pet’s breath. If you sense a disagreeable odor, your pet may have gum disease. Periodontal disease is the most common ailment of small animals and is treatable.  Gum problems begin when bacteria accumulate at the gumline around the tooth. Unless brushed away daily, these bacteria can destroy tooth-supporting bone, and cause bleeding, and tooth loss. Usually, the first sign is bad breath.

When examining your pet’s mouth, look for tooth chips or fractures on the tooth’s surface. Contrary to their popularity, chewing on cow hooves, antlers, rocks, bones, or other hard materials may break teeth. If the fracture is deep you may notice a red, brown, or black spot in the middle of the tooth’s surface. The spot is the tooth’s nerve and inside vessels, which when exposed to the oral cavity may eventually lead to a tooth painful abscess.

When your home exam reveals dental problems or if you are still uncertain, a trip to the veterinarian is in order. The veterinary oral examination will begin with a complete visual examination of the face, mouth, and each tooth. Frequently pets’ mouths have several different problems that need care. The veterinarian will usually use a record chart similar to the one used by human dentists to identify and document such dental problems.

A more detailed exam then follows. Unfortunately, cats and dogs cannot point to dental abnormalities with their paws, and to determine the proper treatment plan, other tests are usually necessary. General anesthesia is essential for a proper tooth-by-tooth evaluation. There is a wide array of safe and effective anesthetics and monitoring equipment that make anesthesia as safe as possible.

Expect your veterinarian or dental assistant to use a periodontal probe to measure gum pocket depths around each tooth. One or two millimeters of probe depth normally exists around each tooth. When dogs or cats are affected by periodontal disease, the gums bleed and probing depths may increase, which requires additional care to save the teeth. Unfortunately by the time some pets come in for dental care, it is too late to save all of the teeth. Your veterinarian may also take x-rays of the entire mouth. X-rays show the inside of the tooth and the root that lies below the gum line. Many decisions are based on x-ray findings. Usually, the veterinarian will visually examine the mouth, note any problems, take X-rays under anesthesia, and then tell you what needs to happen to treat the problems found if any.

Plaque removal and preventative care with periodic checkups should help hinder the loss of additional teeth. Plaque and tartar preventative products can be found at the Veterinary Oral Health Council. 

If your dog or cat needs advanced dental care, where can you go?

Many veterinarians have taken post-graduate dental training in order to better serve their patients. Some veterinarians have passed advanced written and practical examinations given by the American Veterinary Medical Association, which certifies them as dental specialists. If you need one, your veterinarian can refer you.

Dogs and cats do not have to suffer the pain and discomfort of untreated broken or loose teeth or infected gums. With the help of thorough examinations, x-rays, dental care, and daily plaque prevention, your pet can keep his teeth in his mouth where they should be.

We advise people who are concerned about exposure risk, precautions and latest news to consult the CDC informatiion and the Worms and Germs blog, as they are expected to contain the most up-to-date information.

Can SARS-CoV-2 infect dogs, cats and other animals? (updated 11/30)

We don’t really know.  Preliminary evidence suggests that one dog in Hong Kong that lived with a person infected with the virus tested positive multiple times over multiple days.  This suggests that the dog was in fact infected, rather than just contaminated with the virus.  Subsequently, a second dog tested positive by RT-PCR.  Neither dog showed clinical signs (the first dog died after quarantine from causes unrelated to the virus).  In mid-March, 2020, the World Health Organization stated that there is no evidence at present that dogs and cats can be infected with SARS-CoV-2, develop the disease, or spread the disease.  It is important to note that SARS-CoV-2 was not isolated from the first dog in Hong Kong – only RNA was identified via RT-PCR, although subsequent serological testing identified antibodies in the dog’s blood confirming infection.

In late March 2020, a cat living with an infected person in Belgium tested positive for SARS-CoV-2 virus.  The viral RNA was identified in the cat’s feces.  A second cat tested positive in Hong Kong via RTPCR on March 31 2020, with viral RNA identified from oral, nasal and rectal samples.  The first cat showed vomiting, diarrhea and respiratory signs.  The second cat showed no clinical signs.  

Ferrets have been infected experimentally, and variably showed clinical signs of fever, decreased activity and some coughing.  Multiple studies have shown that mink can become infected and transmit this infection to humans.  In Denmark, multiple cases of infection in people were associated with mink farming, leading to en masse culling of mink in that country. Subsequently, mink farms in at least 6 countries, including the US, have identified SARS-CoV-2 in their animals.    

SARS-CoV-2 utilizes two receptors in humans: It binds Angiotensin-Converting Enzyme 2 (ACE2) and then fuses with the cell membrane with help from a type-II transmembrane serine protease (TMPRSS2) (similar to the original SARS virus in the early 2000s).  Sequence homology for ACE2 at the critical binding sites suggests that SARS-CoV-2 might be able to bind to ACE2 receptors in cats and ferrets.  Given the findings from the one dog in Hong Kong (see Worms-and-Germs Blog), we can reasonably suspect that dogs might also bind the virus.  Rats and mice appear not to be able to bind the virus, because their ACE2 receptors are different enough from those of dogs or cats.

Infection, however, requires additional steps than just virus binding and membrane fusion.  Viral replication, avoiding the host immune response etc. are also necessary components of infection and potential transmission.

Can infected dogs and cats transmit the disease to people? (updated 11/30)

This is changing.  Although no transmission from animal to human has been documented, a new study found that ferrets and cats (but not dogs) could be infected, and infected cats could transmit virus to other cats (transmission between ferrets was not tested).  Experimentally infected dogs developed antibodies and viral RNA (but not live virus) was detected in feces from the infected dogs.  Uninfected dogs did not appear to become infected. Subsequent studies have shown that cats can be infected and transmit virus to each other (Halfmann et al 2020), but they did not investigate transmission to people or other non-human animals.  A study from Wuhan found that multiple cats in an epidemiological study had detectable virus, or antibodies suggestive of prior infection. Cats with the highest virus load shared households with infected people.  

To date, all transmission has been human-to-human, after the initial jump from bats (most likely) to humans.  It is worth noting that the original SARS virus could also bind to the dog and cat ACE2 receptor, but no reported cases of pet-to-human transmission of that virus were ever reported, although that outbreak was much smaller and investigation of domestic animals was limited.  Evidence suggests that mink might, however, serve as s reservoir for the virus and possibly transmit it to humans (see previous section).

Consequently, caution should be taken when handling pets of people who are known to be infected, especially cats or ferrets.  Precautions should be also adopted when handling dogs of infected people, however, the risk with dogs transmitting infection to humans appears, for the moment, lower than it might be with cats or ferrets.

What about your pets when you have COVID-19? (new 4/3)

In a household with a person with COVID-19, the infected person poses the greatest risk to others in the household. However, some emerging data suggest that certain pets can get infected, and might be able to transmit the infection (this has not yet been confirmed). Even uninfected pets could track the virus out of the household on their coats, although this risk is considered to be much smaller than people disseminating the virus. Therefore, it makes sense to take simple steps to reduce exposure of pets and keep exposed pets away from others.

The goal is to keep exposed animals away from unexposed people. We now know that cats and ferrets can likely become infected, and can produce live virus that could infect other cats, ferrets or, potentially, people.  We know that dogs can become infected, but they might not be able to infect others (we don’t have evidence of that yet).  We suspect that pigs might not capable of being infected, but additional studies are necessary to confirm this (so all you mini-pig owners – don’t hug your minipigs just yet!).

As we’ve said all along, if you’re sick, stay away from your animals just like you would other people. However, if you have COVID-19 and have been around your pets, keep the pets inside and away from other people (even others in your family who do not have the infection).  If you’re self-isolating, so is your dog/cat/ferret! If you are positive for COVID-19, and your dog/cat/ferret has been snuggling up with you, there is a reasonable chance that the pet is positive. Dogs and cats probably will not show signs although ferrets might show mild signs.  The pet should not come into contact with uninfected household members (unless this is unavoidable – see below).

If possible, your dog should be walked by the infected person.  They should be walked only in an enclosed space (e.g. your yard but away from neighboring dogs) and only for the purposes of elimination (peeing and pooping).  Walks for exercise are out until the person recovers and is no longer shedding virus (tests negative). If the infected person is too sick to do this, other household members should take out the dog isolated with the infected person.  If one or more of the household members have recovered from the infection, they should do it – they’re likely immune to reinfection. 

If no recovered people are available, and the infected person is too sick, then nominate a household member to do the pet care.  The dog should remain isolated with the sick person, not roam free through the house.  The person responsible for letting the dog out should wear gloves (and not let the dog lick their hands/face, etc). You do NOT need to wear disposable gloves.  Dish-washing gloves are fine.  Whoever takes the dog out should carefully wash the gloves (or use rubbing alcohol to clean them) and then wash their hands for at least 20 seconds after removing the gloves upon returning from outside and returning the dog to the isolation area where the infected person is. The risk of transmission from a dog leash is low because the dog is unlikely to have secreted virus onto it, unless it’s a leash chewer – then you’ll want to wash it or disinfect it.  Dog bowls should be cleaned periodically with detergent and water, after which, hands should be washed or disinfected (remember, pet mouths go into the bowl, and pet mouths can carry infected saliva).  Do not touch or handle the bowl while dispensing food; if you do, wash your hands right away.

Ferrets and cats are our main focus, both in terms of keeping infected people away from them (so the animals don’t get infected) and, again, keeping exposed animals away from unexposed people.  The fomite risk is pretty small, although with cats self-grooming, there has to be a greater risk of viral contamination of the fur than in dogs.  Therefore, if uninfected, do not handle the cat if it can be avoided – let the infected person medicate, feed and water the cat if at all possible.

If an uninfected person must take care of a potentially infected (i.e. exposed) cat or ferret, the person should wear gloves while handling the cat, the food and water bowls, litter boxes and ferret condos. Avoid touching the cat or ferret.  Again, kitchen gloves are fine; wash them thoroughly after you’re done as described above, then wash or disinfect your hands.

While these precautions will not guarantee protection against infection, they should hopefully reduce the risk. 

Again, the best solution is to avoid having the pet come into contact with an exposed or infected individual who is self-isolating.

Additional views on this can be found here.

Can pets serve as fomites in the spread of COVID-19?

(A fomite is an object such as a dish or a doorknob that may be contaminated with infectious organisms and serve in their transmission. Answer from the American Veterinary Medical Association)

This question has been addressed by the AVMA. Here is the direct quotation:

“COVID-19 appears to be primarily transmitted by contact with an infected person’s bodily secretions, such as saliva or mucus droplets in a cough or sneeze.COVID-19 might be able to be transmitted by touching a contaminated surface or object (i.e., a fomite) and then touching the mouth, nose, or possibly eyes, but this appears to be a secondary route. Smooth (non-porous) surfaces (e.g., countertops, door-knobs) transmit viruses better than porous materials (e.g., paper money, pet fur), because porous, and especially fibrous, materials absorb and trap the pathogen (virus), making it harder to contract through simple touch.

Because most pet hair is porous and also fibrous, it is very unlikely that a person would contract COVID-19 by petting or playing with a pet. However, because animals can spread other diseases to people and people can also spread diseases to animals, it’s always a good idea to wash hands before and after interacting with animals; ensure the pet is kept well-groomed; and regularly clean the pet’s food and water bowls, bedding material, and toys.”

Could the SARS-CoV-2 virus cause clinical disease in dogs, cats or ferrets?

We don’t know.  The two dogs that might be infected in Hong Kong showed no clinical signs.  The closely related SARS virus did not cause disease in cats (but cats were able to transmit the virus to other cats). In contrast, disease did occur in experimentally infected ferrets. There is currently no evidence that domestic animals can develop disease from this virus or, if infected, transmit it to other animals or people. However, study of animals to date has been limited.

COVID and The Bronx Tiger – what does this mean? (new 4/6)

As we have noted, cats appear to be susceptible to infection with SARS-CoV-2.  They might also be able to transmit the disease from one cat to another.  Because lions and tigers are cats, it’s not surprising that they are also able to be infected.

What this case shows is that people who are asymptomatic or presymptomatic (as was the zoo keeper) can infect others.  That includes cats.

So, can cats infect us?  Currently, there are no reported cases of cats (or dogs or ferrets or tigers) transmitting the virus to humans. How would a cat, living indoors, get infected?  From an infected house member.  And that house member would pose a greater risk to uninfected house members than the cat would. 

What about the cat that is indoor-outdoor?  It’s much harder to enforce a neighborhood wanderer to practice social distancing. Therefore, it might be reasonable to keep a cat like this indoors for the near future.

However, it would be reasonable to suspect that an infected cat might be able to infect a human.  Therefore, if a cat lives with a person who is infected, the cat should be treated as potentially infective – uninfected people should not handle the cat, or if they have to, they should handle the cat while wearing gloves and then wash their hands or disinfect their hands immediately.  Given that cats groom themselves, consider that a potentially infected cat is likely to have virus on its coat.

If there is a cat who has not been near the infected person, keeping that cat separated from the infected person should be sufficient to prevent the cat from becoming infected.

Should I (can I) test a pet for SARS-CoV-2?

Many animal diagnostic laboratories are not currently set up to test for this specific coronavirus.  Some are, and might be able to test animals with known exposure.  For example, if the owner is infected (confirmed), it could be possible for them to ask for testing of their pet dog or cat (or ferret).  However, given that the current data suggest that these pets are not infective to people, the rational for doing this is questionable.

The dilemma about testing pets increases, given that any owner with a known infection (has tested positive) should be quarantined, and their pet should be considered, from a health-and-safety perspective to also be contaminated or infected.  Consequently, you would be required to adopt precautions to prevent infection, by wearing PPE, a face mask, and face shield (to prevent contact from the pet’s contaminated haircoat, or, if infected, saliva or droplets getting into your conjunctival mucosa) etc.  Most clinicians are not set up to do this.

What disinfectants can I use to decontaminate surfaces?

The CDC has provided information for the public about decontaminating and disinfecting surfaces.

A group of German investigators has identified several commonly available disinfectants that should inactivate SARS-CoV-2. These include:

• Isopropyl alcohol (70%), commonly called rubbing alcohol
• Bleach can be diluted by putting 4 teaspoons of bleach per 1 quart of water or 20 milliliters of bleach into 1 liter of water
• 0.5% hydrogen peroxide
• 0.1% sodium hypochlorite

Can ivermectin prevent infection or reduce viral load? (updated 4/7)

Suggested that ivermectin could reduce viral load in vitro. This immediately generated excitement and interest in the idea that ivermectin could be used to either prevent or treat the infection. That’s patently untrue. The study does not provide the doses of ivermectin used to inhibit replication; however, examination of the figures suggests that a concentration of approximately 7 uM was required to effectively suppress viral replication. You would have to give over 100 times that dose – which would likely be fatal to most animal species – to even come close to the concentrations used in the study. That amount is approximately 6,000 monthly doses of the large-dog size ivermectin-based heartworm preventive.

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Can a veterinary client-patient relationship be established via a telemedicine consultation to minimize exposure risk but still provide veterinary care?

A veterinary client-patient relationship (VCPR) is established primarily by state law. On the Federal front, the FDA has issued guidance noting that due to the current pandemic they “may” not prosecute for extralabel drug use in animals where VCPR doesn’t exist, but this limited potential exception does not change state law. As a general rule, you cannot establish VCPR using telemedicine. On the other hand, once you have VCPR using traditional standards, you can certainly use telemedicine for ongoing care. Regardless, remember you are responsible for meeting the medical standard of care – using telemedicine does not change the standards.

Can I still go to the veterinarian if I am sick?

It’s best if you self-quarantine. The CDC says that If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed. Perhaps someone else can take your pet in. 

For everyone’s safety, if you believe you have been exposed to COVID-19, call your veterinarian before having your pet seen for any health conditions. Practice social distancing. You and your veterinarian can discuss the safest approach for all concerned whether he needs immediate medical intervention or not. Prescriptions can be mailed, but make sure you call early enough so that they will arrive in the mail by the time you need them. 

Perhaps they engage in abnormal repetitive behaviors and cannot stop. It can be hard to determine if your pet is suffering because the behavior has not improved.

In human medicine, these types of disorders are referred to as psychological or mental health disorders. There has been a history of discounting psychological disorders, but medical professionals now know that these are diseases, like cancer or diabetes. Sometimes the pet has a true emotional disorder that is not man-made through mistreatment or lack of training. These concerns cannot be solved “with love”, through “putting the animal in its place”, or by taking obedience lessons.

Psychological or behavioral diseases are diseases of the brain, just as cancer is a disease of the cell. Some cancers respond to treatment, some will not. Some will appear to respond initially, then relapse. Cancer which resolves quickly in one individual may be terminal in another. Some cancers generally considered treatable are fatal for others. Some patients may not be able to tolerate the treatment that is designed to save their life. Although veterinary behavioral medicine has progressed so many behavior disorders can be managed and treated, there will be variable responses among animals. 

If you are considering euthanasia for behavioral reasons, there may be alternative options to consider first.

Have You Taken Your Pet to the Veterinarian?

Many behavioral problems have underlying medical conditions that contribute to behavior. Conditions such as ear infections, dental disease, arthritis, and even skin allergies can cause pain and irritability, increasing your pet’s anxiety levels, or resulting in a bite when stressed. Scheduling a check-up with your veterinarian should be first on your list with any noted behavioral change, especially if this change is recent or your pet is older.

Have You Sought Out Professional Help? 

A board-certified veterinary behaviorist is a licensed veterinarian with advanced training in animal behavior for all types of behaviors. Applied Animal Behaviorists also have advanced academic training although these professionals do not need to be licensed veterinarians. Medications may be helpful in treating your pet’s aggression or anxiety problems, but only a licensed veterinarian can prescribe medications for your pet.

A qualified dog trainer can help you implement a management, training, and behavior modification plan often prescribed by your veterinarian or veterinary behaviorist. Unfortunately, experience levels, education, and training methods are not standardized among dog training professionals; therefore, it is important for you to do your homework before hiring a trainer. Understanding that some training methods can do more harm than good is important.

Have You Considered Rehoming? 

This may not be the solution for all pets, but some behavior problems can be managed well in a different environment. Fighting dogs and cats may do better when separated and away from the common stressors in their life. The same for dogs with a bite history towards kids. Sometimes a home without kids is just what your pet needs to feel safe. Not all pets benefit from, nor should be, rehomed.  In general, finding a new and safe home for your pet can be difficult. Animals with behavior problems are often at greater risk for abuse and neglect in new environments because, in these situations, they may not have as close of a relationship with the new owners as they did with you.

What Are Some Criteria To Consider When Making the Decision To Euthanize Your Pet?

Cats that eliminate outside the litterbox can also be harder to place. Transparency in shelter adoptions is important from both a legal and ethical standpoint.

Emotional well-being and mental suffering may not be as visible to us as physical pain and disease but can significantly affect your pet’s quality of life and, therefore, yours. When making euthanasia decisions, it is important to consider your pet’s overall emotional state and well-being.  

Remember, behavioral euthanasia is a hard decision, so have all the information before making that phone call. There is never a wrong answer but if you make this decision, it is important to know you are not alone and will always be supported.

Working with your veterinarian to explore medical options, you may decide that euthanasia is the best choice for your pet, your family, or the public. Regardless of the psychological cause, euthanasia may be a valid treatment plan and may be the only option. Behavioral euthanasia is hard for both the family and the veterinary team. Mutual respect and open communication without preconceived opinions or biases are important for everyone involved.

Bacterial diarrheas are generally a nuisance for the adult animal but can be lethal to a small puppy, kitten, or even a human baby. Most of these problems stem from contaminated food or fecal contaminated environment. Feeding raw food diets to pets dramatically increases the exposure to infectious organisms to the humans in the family. Since these conditions are also human diseases, it is helpful to have some understanding of what they are, even if there are no young pets or immune-suppressed individuals (human or otherwise) at home.

Campylobacter

Plus, because they are small, fluid loss from diarrhea hits them much harder. Furthermore, puppies and kittens are more likely to be housed in groups where fecal cross-contamination is common so they may be more likely to become infected than adult animals. Adult animals commonly have Campylobacter organisms living in their intestines, but they do not experience any sickness due to it.

In humans, Campylobacter infection is a leading cause of gastrointestinal (GI) disease; infected dogs and cats can carry the organism and spread it even if they do not have symptoms themselves.  For this reason, pets used for therapy in assisted living communities and similar situations should be screened for Campylobacter by fecal culture before exposure to people with suppressed immunity. Humans are also infected by consumption of contaminated food, water, or raw milk; only 6% of human Campylobacter infections are attributed to dog exposure.  That said, exposure to a dog with diarrhea triples a person’s risk for developing enteritis from Campylobacter jejuni or Campylobacter coli. Studies screening pet animals for inapparent Campylobacter infections have found surprisingly high incidences of inapparent infection. In one study in the Midwest, 24% of 152 healthy cats were positive, for example.

After consuming Campylobacter organisms, they travel to the lower small intestine, attach, and multiply. They produce a toxin that destroys the lining of the intestine with the result being a bloody, mucous diarrhea (though occasionally a more watery diarrhea is described).  Sometimes a fever results, appetite becomes poor, and vomiting can occur.  Incubation is 2 to 5 days.  The organism can survive as long as a month in environmental feces.

Diagnosis is made by seeing the sea gull-shaped organisms under the microscope; however, there are so many bacterial organisms on a fecal sample that finding the culprit can be tricky. For this reason, a culture is often performed as a more accurate test. Because the organism is microaerophilic, specific culture requirements must be met; the facilities of a reference laboratory are needed.

Treatment is with appropriate antibiotics, such as erythromycin, chloramphenicol or tylosin.

Salmonella

The same is true with puppies and kittens; adult animals are almost never affected by Salmonella infection.

An important exception to the “Salmonella is rare in adult dogs” rule is the case of dogs fed a raw food diet. It has become popular to feed raw foods to pets with the idea that a raw food diet more closely approximates the natural diet that the feline or canine body evolved to consume, and thus, such a diet should be healthier than commercially prepared foods. In fact, cooking food is central to removing parasites, bacteria, and bacterial toxins from food. A recent study evaluating raw food diets found that 80% of food samples contained Salmonella bacteria and that 30% of the dogs in the study were shedding Salmonella bacteria in their stool. Adult dogs are often asymptomatic, but any infected animal or person will shed the organism for at least six weeks, thus acting as a source of exposure to other animals or people. Salmonella organisms are difficult to remove from the environment and easily survive three months in soil. Again, dogs used for therapy around the elderly or children should be cultured for Salmonella.

There are two syndromes associated with Salmonella: diarrhea and sepsis. Salmonella bacteria, once consumed, attach to the intestine and secrete toxins. The toxins produce diarrhea that can be severe and even life-threatening in the young. If this were not bad enough, some Salmonella can produce an even more serious “part two” (sepsis) should these bacteria invade the body through the damaged intestine, causing a more widespread and much more serious infection.

In young animals, the syndrome resulting is similar to that of canine parvovirus thus similar treatment is expected.

E. Coli

Enterotoxigenic E. coli is a common cause of diarrhea in young animals as well as human infants and is responsible for the famous traveler’s diarrhea. These bacteria produce what is called an enterotoxin in the upper small intestine. This toxin, similar to the toxin of cholera, causes the intestine cells to secrete the body’s fluid into the intestine, creating spectacular watery diarrhea and what can be life-threatening dehydration for smaller living creatures.  Young pigs, cattle, and other livestock are commonly lost to this kind of dehydration. Again, the younger and smaller the patient is, the more serious this infection is.

Enteropathogenic E. coli also produce diarrhea in humans and animals. Rather than a secretory diarrhea as above, they simply destroy the intestinal cells where they attach. Diarrhea still results, but it creates more damage to the intestinal lining.

Enterohemorrhagic E. coli is similar to enteropathogenic E. coli but with more associated inflammation. This type does not seem to be a problem for small animals though they can carry it asymptomatically.

It would seem that antibiotics would be the obvious treatment for a bacterial disease, yet for E. coli it is surprisingly controversial. It seems that the use of antibiotics can enhance the synthesis of toxins by these bacteria; plus, oftentimes, antibiotic use only serves to make E. coli more resistant in the GI tract. Antibiotics are generally reserved for those animals (or people) who seem the most sick or who have evidence of bacterial invasion in the bloodstream. Basically, treatment is supportive care until the patient’s immune system regains the upper hand.

In Conclusion

Bacterial diarrheas are an especially serious consideration in the very young and in the weak or compromised, be they human or non-human. It is not unusual for apparently healthy animals to carry these organisms and shed them into the environment and feeding raw foods greatly increases the risk of this kind of latent infection. If you are considering raw food diets, especially if someone in the home is very young or has a compromised immunity, discuss prevention of these infections with your veterinarian.