Volume 28-01
1 January 2002

[Table of Contents]

A SURVEY OF KNOWLEDGE, ATTITUDES, AND PRACTICES OF DOG AND CAT OWNERS WITH RESPECT TO VACCINATING THEIR PETS AGAINST RABIES, OTTAWA-CARLETON, ONTARIO, JULY 2000

Introduction

In July 2000, on behalf of the Ottawa-Carleton Health Department (as of 2001, City of Ottawa, Public Health and Long-Term Care Branch), the Field Epidemiology Training Program conducted a survey seeking information about the knowledge, attitudes, and practices of dog and cat owners in the Ottawa-Carleton region with respect to vaccinating their pets against rabies. The risk of dogs and cats catching rabies from raccoons has increased over the past few years because a strain of rabies virus that is mainly carried by raccoons has moved north from the United States into Ontario⁽¹⁾. The Animal Disease Research Institute, Canadian Food Inspection Agency (CFIA) identified the first case of raccoon rabies in Ontario in 1999 and by year end had confirmed a total of eight cases⁽²⁾. As of 5 June, 2000, prior to study implementation, 23 cases of raccoon rabies had been confirmed in Ontario that year (R. Rosatte, Ontario Ministry of Natural Resources, Rabies Research Unit, Peterborough: personal communication, 2000). Raccoon rabies represents a serious public health threat. Despite the active trap-vaccinate-release program and aerial baiting program implemented by the Ministry of Natural Resources to prevent the spread of raccoon rabies, there was concern that raccoon rabies would arrive in the Ottawa-Carleton region by the fall of 2000.

In Ontario, the Health Protection and Promotion Act, Rabies Immunization R.R.O 1990, Reg. 567⁽³⁾ permits local jurisdictions to require that residents vaccinate their domestic dogs and cats against rabies. Despite this requirement in Ottawa-Carleton, the Health Department was concerned that rates of rabies immunization among dogs and cats were inadequate. In 1994, staff in all of Ontario's public health units collected data on rabies vaccination rates over 1 year while they were investigating dogs and cats that had bitten people. From these data, immunization rates for cats and dogs living in jurisdictions without compulsory vaccination were 24% (180/767) and 61% (728/1,186) respectively. In contrast, the rates in cats and dogs living in jurisdictions with compulsory  vaccination were 39% (153/387) and 69% (890/1,296) respectively (Dr. C. LeBer, Public Health Branch, Ontario Ministry of Health, Toronto: personal communication, 2000). Although Ontario data were limited, it suggested that immunization rates are low, that cats are less likely to be immunized than dogs, and that vaccination rates may differ somewhat according to whether or not the jurisdiction has compulsory immunization.

In 1998, on behalf of Quebec's ministère de la Santé et des Services sociaux, the Centre d'épidémiologie d'intervention du Québec conducted a telephone survey on the knowledge and behaviours of the Québec population with respect to the transmission of rabies⁽⁴⁾. Rabies vaccination is not mandatory in Québec. Among those persons with a domestic animal, 81% reported that their dog was vaccinated against rabies and 64% reported that their cat was vaccinated. The Québec study did not ask respondents to identify barriers to having pets immunized.

We designed our survey to determine, among residents in the Ottawa-Carleton region who own cats or dogs, general knowledge about rabies and its transmission; specific knowledge about raccoon rabies; knowledge about mandatory rabies vaccination; rabies vaccination rates of domestic dogs and cats; and barriers and enabling factors with respect to rabies vaccination.

Methods

Participants in Health Canada's Field Epidemiology Training Program developed a structured telephone questionnaire that was implemented in English and French between 8 July and 10 July, 2000. Household telephone numbers were selected at random from a CD-ROM (Select Phone, Canadian Edition^®, 2000, ProCD) containing listed Canadian residential numbers current for the year 2000. The household was included if 1) it was within the Ottawa-Carleton boundary, 2) it had at least one domestic dog and/or cat, and 3) the resident providing care for the animal(s) was >= 18 years of age, could communicate in English or French, and provided verbal consent to participate. The study participant was selected by asking to speak to the person most responsible for the health of the pet. When asking about the last, and next, due date of rabies vaccination, participants were asked to find their pet's vaccination certificate. If unable to do so, participants relied on memory to give the last vaccination date. For the subgroup of participants who agreed, we contacted their veterinarians to provide more detailed data regarding scheduling of past and future vaccinations and the exact type of vaccine given. These data were used to validate the responses of pet owners.

Results

Of the 1,531 numbers called during the study period, 1,399 (91%) were valid numbers, the remaining numbers being fax modem or business lines. Of the 1,399 valid numbers, contact was made with 965 (69%) households. Of the 965 successfully contacted households, 570 (59%) were ineligible. Of the 395 eligible households, 223 (56%) completed the survey and 172 (44%) refused. Of the successfully contacted households that did not complete the survey, 129 owned a dog or a cat.

The 223 respondents reported on a total of 369 pets (171 dogs and 198 cats). The population who completed the survey was  well educated (56% of the respondents had completed a college or trade diploma or achieved a higher education level) and 68% were female (Table 1). The average age of respondents was 45 years of age (range: 18 to 85 years). Responding households were twice more likely than non-responding households to be rural (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.58-2.88). Of the 139 participants who agreed verbally to having their veterinarian contacted, 73 returned a signed consent form with contact information for 75 veterinarians. Of the 75 letters faxed to local veterinarians, 60 were returned and contained information for 103 pets (52 cats and 51 dogs).

Table 1. Demographic Profile of Respondents
	Number	Percent (N=223)
Gender
Female	151	67.7
Male	72	32.3
Education
Less than High School	12	5.4
High School	53	23.8
Some Post-Secondary	33	14.8
College or Trade Diploma	39	17.5
Undergraduate Degree	66	29.6
Post-Graduate Degree	20	9.0
Municipality
Cumberland	21	9.4
Gloucester	5	2.2
Goulbourn	39	17.5
Kanata	34	15.2
Nepean	20	9.0
Osgoode	12	5.4
Ottawa	72	32.3
Rideau	20	9.0
Urban/Rural Status
Urban*	97	43.5
Rural†	126	56.5
* Telephone exchanges belonging to the municipalities of Osgoode, Cumberland, Rideau, Goulbourn, and West Carleton were designated as rural areas. † Telephone exchanges belonging to the municipalities of Gloucester, Nepean, Ottawa, and Kanata were designated as urban areas.

Greater than 90% of household respondents were aware that skunk (201/214), raccoon (213/221), and fox (213/222) are common carriers of the rabies virus. When asked about rabies transmission, 95% (212/224) of respondents stated they were likely to get rabies from a bite, and 77% (163/211) from a scratch of a rabid animal. However, participants were confused about what type of scratch could result in transmission of rabies. Greater than 90% (205/221) of respondents said they would likely call or see a doctor if bitten by a wild animal; this dropped to 39% (86/222) if bitten by their own pet. The proportion of respondents reporting that they would call the Health Department was the least regardless of whether the animal was wild, stray, or pet. Only 39% (88/223) of respondents stated that the risk of raccoon rabies in the region was increasing. Only 27% (60/222) of respondents felt that rabies was a risk in the region to their pet. When asked about mandatory  vaccination, 65% (146/223) of respondents were aware of this legislation.

The overall vaccine coverage rates for this study were 88% (95% CI 85.0 to 91.8) for all pets, 95% (95% CI 91.0 to 98.0) for dogs, and 83% (95% CI 77.1 to 88.1) for cats. Thirty-one percent of respondents were able and willing to find recent vaccination certificates for their pets. When reporting the last year of vaccination, agreement between veterinarians and those owners that located their pet's certificate was higher than agreement with those owners who relied on memory (85% vs. 64%). This level of discordance did not impact significantly on the vaccination coverage rates, given that the immune status of only six of the 101 pets in the sub-group analysis would have changed based on the data provided by the veterinarians. The agreement between veterinarian and owner information was 79% when assessing the date that the next vaccination was due.

Respondents living in households with non-immunized pets were more likely to report that updates about the rabies situation in the region (OR 2.3; 95% CI 0.98-6.35) and having rabies drop-in clinics (OR 2.6; 95% CI 1.15-5.93) would motivate them to immunize their pets. Households with non-immunized pets were also more likely to report that the cost of the vaccine (OR 2.0; 95% CI 0.92-4.41), difficulty in transporting pets to the veterinarian (OR 3.6; 95% CI 1.48-8.60), time spent in the veterinarian's office (OR 2.9; 95% CI 0.98-7.99), and the veterinarian's office being too far away (OR 4.0; 95% CI 0.93-15.5) as barriers to immunizing their pets.

Respondents suggested numerous ways to encourage vaccination; these included having a rabies warning advisory that is announced on the weather channel or during the local news, mailing postcards at the onset of rabies season with reminders to vaccinate pets, and sending vaccine reminder pamphlets/postcards in the same envelope as the garbage/recycle pick-up calendar.

Discussion

Although the proportions of households owning at least one dog, at least one cat, and at least one dog and one cat, were similar to the results of the National Population Health Survey in 1994⁽⁵⁾, there were a number of selection biases that may have influenced our results. Rural households were more likely to complete the questionnaire than urban households because they were more likely to own a dog or cat. As well, interviewers felt that rural dwellers may have been more likely to be at home during the weekend when telephone calls were made. We estimated that approximately 10% of households had more than one telephone number listed in the CD-ROM thus making their chance of being selected greater. Households with unlisted telephone numbers, homeless and "telephone-less" pet owners were not included in the survey.

Given the short time period for questionnaire development and implementation, the questionnaire was not adequately pilot tested. Certain questions caused difficulties during the implementation of the survey and the data from these questions were not analyzed. If this questionnaire were to be used in future similar studies, it would need further revisions to address those areas causing confusion among the respondents.

The vaccine coverage rates found in this study (89% of all pets, 95% of dogs, and 83% of cats) were higher than those previously found by the Ontario Ministry of Health in 1994 and Gaulin et al. in 1998⁽⁴⁾. We speculate that our rates may be higher because of selection bias. Pet owners with unvaccinated pets may have refused to participate after listening to the introductory information that the survey was about issues relating to rabies. To assess the impact of this potential bias, we conducted a sensitivity analysis. We assumed that all pets belonging to the 129 successfully contacted households that did not complete the survey were not protected against rabies. Using the survey average of 1.6 pets per household, we added 95 unprotected dogs and 111 unprotected cats to the survey pet population and estimated conservative vaccine coverage rates to be 54% for all pets, 61% for dogs only, and 53% for cats only.

The results of this study may also be influenced by recall bias as some participants relied on memory when recalling their pets' last rabies vaccinations while other participants were willing and able to locate their pets' vaccination certificates. As expected, the agreement between veterinarians and those owners who located their pets' certificates was higher (85%) than the agreement with those owners who relied on memory (64%). If we assume that the discordance between veterinarians and pet-owners with respect to immunization status can be generalized to the entire study population, the estimated vaccine coverage rates would still be within the 95% confidence limits for the rates in this study. The agreement between veterinarian and owner information was 79% when assessing the date that the next vaccination was due. We cannot explain the discrepancies between the data recorded on the pets' vaccination certificates and that reported by the veterinarians from their clinical records.

Conclusions

This survey provides information about the knowledge, attitudes and practices of dog and cat owners with respect to vaccinating their pets against rabies in the new City of Ottawa. There are no other reports of surveys of this kind conducted in Ontario. We caution against generalizing these results to other regions in Ontario or to jurisdictions where rabies vaccination for dogs and cats is not mandatory. Based on the results of this study, we focused our recommendations on the following areas:

1. The Health Department needs to continue to educate the public about their role in investigating bites and scratches from wild or stray animals, as well as from pets, regardless of whether these animals are perceived as being healthy.

2. To reinforce its key messages, the Health Department should clarify whether all scratches require action regardless of whether they are caused by teeth or claws or whether they break the skin. As well, efforts must be made to heighten public awareness in the region of the increased risk of raccoon rabies and about mandatory pet vaccination.

3. The Health Department should work with the local veterinarian community to provide lower cost, closer to home drop-in rabies immunization clinics. The Health Department could encourage all veterinarians to send out reminders to their clients when the next rabies vaccination is due. The  Health Department may also wish to consider additional interventions to improve vaccination coverage such as updating the public annually on the current wild animal rabies situation in the region.

Acknowledgements

We wish to acknowledge the contributions of Abdulhakeen Al-Thaqafi, Eng-Soon Chan, Karen Doucette, Martha Fulford, Eleni Galanis, Jeannette Macey, Diane Medeiros, Robert Phillips, David Richardson, Rob Stirling and Barb Strauss, all of whom participated in the Field Epidemiology Summer Course 2000. We also thank Margaret de Groh and Peter Buck for their technical assistance in the development of the questionnaire and the project overall.

References

1. CDC. Update: Raccoon rabies epizootic - United States and Canada, 1999. MMWR 2000;49:31-35.

2. Rosatte R. Report to Ontario Ministry of Natural Resources. An emergency response to the first three confirmed cases of raccoon rabies in Ontario: point infection control. Rabies Research Unit, Ontario Ministry of Natural Resources, October, 1999.

3. Health Protection and Promotion Act. Rabies Immunization R.R.O. 1990, Regulation 567.

4. Gaulin C, Arruda H, Provost S et al. Enquête sur les connaissances et les comportements de la population Québécoise âgée de 18 ans et plus à l'égard de la transmission de la rage (Québec, juin, 1998).
   Le Médecin Vétérinaire du Québec 1998;28:124-26.

5. Statistics Canada. National Population Health Survey (from DIAS Data Information and Sharing V.6), 1994.

Source: R Goodwin, MSc; DH Werker, MD, MHSc, FRCPC; J Hockin, MD, MSc, Field Epidemiology Training Program, Health Canada; E Ellis MD, MPH, FRCPC, A Roche CIPHI(C), Public Health and Long Term Care Branch, Ottawa, Ontario.

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