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The National Association of State Public Health Veterinarians (NASPHV) understands the positive benefits of humananimal contact. Although eliminating all risk from animal contacts is not possible, this report provides recommendations for minimizing disease and injury.
NASPHV recommends that local and state public health, agricultural, environmental, and wildlife agencies use these recommendations to establish their own guidelines or regulations for reducing the risk for disease from human-animal contact in public settings. Multiple venues exist where public contact with animals is permitted (e.g., animal displays, petting zoos, animal swap meets, pet stores, zoological institutions, nature parks, circuses, carnivals, farm tours, livestock-birthing exhibits, county or state fairs, schools, and wildlife photo opportunities). Persons responsible for managing these venues should use the information in this report to reduce risk for disease transmission.
Guidelines to reduce risks for disease from animals in healthcare and veterinary facilities and from service animals (e.g., guide dogs) have been developed (2)(3)(4)(5). These settings are not specifically addressed in this report, although the general principles and recommendations are applicable to these settings.

# Introduction
Contact with animals in public settings (e.g., fairs, farm tours, petting zoos, and schools) provides opportunities for entertainment and education. However, inadequate understanding of disease transmission and animal behavior can increase the likelihood of infectious diseases, rabies exposures, injuries, and other health problems among visitors, especially children, in these settings. Zoonotic diseases (i.e., zoonoses) are diseases transmitted from animals to humans. Of particular concern are instances in which large numbers of persons become ill. Since 1991, approximately 50 human infectious disease outbreaks involving animals in public settings have been reported to CDC (1). During the preceding 10 years, an increasing number of enteric disease outbreaks associated with animals in public settings (e.g., fairs and petting zoos) have been reported (1). reported outbreaks, diseases, or injuries attributed to humananimal interactions in a public setting; and soliciting comments or suggestions from the NASPHV membership and questions posed by the public. During November 2006, NASPHV members and external expert consultants met at CDC in Atlanta, Georgia. The first day of the meeting was dedicated to reviewing scientific information regarding recent outbreaks, associated risk factors, pathogen biology, and interventional studies. A moderated discussion of each section of the recommendations was conducted. The committee reviewed scientific evidence and expert opinion in revising the document. A committee consensus was needed to add or modify existing language or recommendations.

# Enteric (Intestinal) Diseases
Infections with enteric bacteria and parasites pose the highest risk for human disease from animals in public settings (6). Healthy animals can harbor human enteric pathogens. Many of these organisms have a low infectious dose (7)(8)(9). Because of the popularity of animal venues, a substantial number of persons might be exposed. Illness and outbreaks of enteric diseases among visitors to fairs, farms, and petting zoos are well documented. Pathogens responsible for outbreaks include Escherichia coli O157:H7 and other Shiga toxin-producing E. coli (STEC), Campylobacter, Salmonella, and Cryptosporidium (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Although reports often document cattle, sheep, or goats as sources for infection, poultry (23)(24)(25)(26), rodents (25)(26)(27), and other domestic and wild animals also are potential sources.
The primary mode of transmission for enteric pathogens is fecal-oral. Because animal fur, hair, skin, and saliva (28) can become contaminated with fecal organisms, transmission can occur when persons pet, touch, feed, or are licked by animals. Transmission has occurred from fecal contamination of food, including raw milk (29)(30)(31), sticky foods (e.g., cotton candy ), and water (33)(34)(35). Illness also has been associated with contaminated clothing and shoes (11,17), animal bedding, flooring, barriers, and other environmental surfaces (15,17,25,(36)(37)(38).
Animals carrying enteric organisms pathogenic to humans (e.g., STEC, Salmonella, and Campylobacter) frequently exhibit no signs of illness and can shed these pathogens intermittently. Removing ill animals (especially those with diarrhea) is necessary but not sufficient to protect animal and human health. Animals that appear to be healthy often shed pathogens that contaminate the environment (39). Some pathogens live for months or years in the environment (40)(41)(42)(43)(44). Because of intermittent shedding and limitations of laboratory tests, culturing fecal specimens or attempting to identify, screen, and remove infected animals might reduce, but will not eliminate, the risk for transmission. Antimicrobial treatment of animals cannot reliably eliminate infection and shedding of enteric pathogens or prevent reinfection.
Multiple factors increase the probability of disease transmission at animal exhibits. Animals are more likely to shed pathogens because of stress induced by prolonged transportation, confinement, crowding, and increased handling by persons (45)(46)(47)(48)(49)(50)(51). Commingling increases the probability that animals shedding organisms will infect other animals (52). The prevalence of certain enteric pathogens is often higher in young animals (53)(54)(55), which are frequently used in petting zoos and educational programs. Shedding of STEC and Salmonella is highest in the summer and fall when substantial numbers of traveling animal exhibits, agricultural fairs, and petting zoos are scheduled (50,55,56).
The risk for infections is increased by certain human factors and behaviors, especially in children. These factors include lack of awareness of the risk for disease, inadequate hand washing, lack of close supervision, and hand-to-mouth activities (e.g., use of pacifiers, thumb-sucking, and eating) (57). Children are particularly attracted to animal venues and have increased risk for serious infections.
The layout and maintenance of facilities and animal exhibits also can affect the risk for infection (58). Risk factors include inadequate hand-washing facilities (59), structural deficiencies associated with temporary food-service facilities (12,14,17), inappropriate flow of visitors, and incomplete separation between animal exhibits and food preparation and consumption areas (60). Other factors include contaminated or inadequately maintained drinking water and sewage-or manure-disposal systems (33)(34)(35)38).

# Lessons from Outbreaks
In 2000, two E. coli O157:H7 outbreaks in Pennsylvania and Washington prompted CDC to establish recommendations for enteric disease prevention associated with farm animal contact. Risk factors identified in both outbreaks were direct animal contact and inadequate hand washing (60,61). In the Pennsylvania outbreak, 51 persons (median age: 4 years) became ill within 10 days after visiting a dairy farm. Eight (16%) of these patients acquired hemolytic uremic syndrome (HUS), a potentially fatal consequence of STEC infection. The same strain of E. coli O157:H7 was isolated from cattle, patients, and the farm environment. In addition to the reported cases, an increased number of diarrhea cases in the community were attributed to visiting the farm. An assessment of the farm environment determined that no areas existed for eating and drinking separate from the animal con-tact areas, and the limited hand-washing facilities were not configured for children (60).
The protective effect of hand washing and the persistence of organisms in the environment were demonstrated in an outbreak of Salmonella infections at a Colorado zoo in1996. A total of 65 cases (most among children) were associated with touching a wooden barrier around a temporary Komodo dragon exhibit. Children who were not ill were substantially more likely to have washed their hands after visiting the exhibit. Salmonella was isolated from 39 patients, a Komodo dragon, and the wooden barrier (17).
In 2005, an E. coli O157:H7 outbreak among 63 patients, including seven who had HUS, were associated with multiple fairs in Florida. Both direct animal contact and contact with sawdust or shavings were associated with illness (12). Persons who reported feeding animals were at increased risk. Among persons who washed their hands after leaving the animal area, using soap and water was protective for those who created a lather (62). Drying hands on clothes increased the risk for illness. Persons were less likely to become ill if they reported washing their hands before eating or drinking or were aware of the risk for illness before visiting the fair.
During 2000-2001 at a Minnesota children's farm day camp, washing hands with soap after touching a calf and washing hands before going home were protective factors in two outbreaks involving multiple enteric organisms. A total of 84 illnesses were documented among attendees. Implicated organisms for the human infections were E. coli O157:H7, Cryptosporidium parvum, non-O157 STEC, Salmonella enterica serotype Typhimurium, and Campylobacter jejuni. These organisms and Giardia were isolated from calves. Risk factors for children included caring for an ill calf and getting visible manure on their hands (20).
Enteric pathogens can contaminate the environment and persist in animal housing areas for long periods. For example, E. coli O157:H7 can survive in soil for months (38,40,42,63). Prolonged environmental persistence of pathogens was documented in an Ohio outbreak in 2001 of E. coli O157:H7 infections in which 23 persons became ill at a fair after handling sawdust, attending a dance, or eating and drinking in a barn where animals were exhibited during the previous week (38). Fourteen weeks after the fair, E. coli O157:H7 was isolated from multiple environmental sources within the barn, including sawdust on the floor and dust on the rafters. Fortytwo weeks after the fair, E. coli O157:H7 was recovered from sawdust on the floor. In 2004, an outbreak of E. coli O157:H7 infection was associated with attendance at the North Carolina State Fair goat and sheep petting zoo (12). Health officials identified 108 patients, including 15 who had HUS. The outbreak strain was isolated from the animal bedding 10 days after the fair was over, and from the soil 5 months after the animal bedding and topsoil were removed (58). In 2003, a total of 25 persons acquired E. coli O157:H7 at a Texas agricultural fair. The strain isolated from patients also was found in environmental samples 46 days after the fair ended (15).
Transmission can occur even in the absence of direct animal contact if the pathogen is disseminated in the environment. In an Oregon county fair outbreak, 60 cases occurred, mostly among children (25). Illness was associated with visiting an exhibition hall that housed goats, sheep, pigs, rabbits, and poultry; however, illness was not associated with touching animals or their pens, eating, or inadequate hand washing. The same organism was recovered from ill persons and the building. Transmission of E. coli O157:H7 from contaminated dust was implicated in two outbreaks in Ohio and Oregon (25,38).
Improper facility design and inadequate maintenance might increase risk, as illustrated by one of the largest waterborne outbreaks in the United States (34,35). In 1999, approximately 800 suspected cases of E. coli O157:H7 and Campylobacter infection were identified among attendees of a New York county fair where the water and sewage systems had deficiencies. Temporary facilities are particularly vulnerable to design flaws (12,17). Such venues include those that add an animal display or petting zoo for the purpose of attracting children to zoos, festivals, roadside attractions, farm stands, pick-yourown-produce farms, and Christmas tree lots. In 2005, an E. coli O157:H7 outbreak in Arizona was associated with a temporary petting zoo at a municipal zoo (12). Child care and school field trips to a pumpkin patch with a petting zoo resulted in 44 cases of E. coli O157:H7 infection in British Columbia (14). The same strain of E. coli was found both in children and in a petting zoo goat. Running water and signage recommending hand washing were not available, and alcohol hand sanitizers were at a height that was unreachable for some children. A total of 163 persons became ill with STEC O111:H8 and/or Cryptosporidium at a New York farm stand that sold unpasteurized apple cider and had a petting zoo with three calves (64).
Several outbreaks have occurred because of failure to understand and properly implement disease-prevention recommendations. Following a Minnesota outbreak of cryptosporidiosis with 31 ill students at a school farm program, specific recommendations provided to teachers were inadequately implemented (18). A subsequent outbreak occurred with 37 illnesses. Hand-washing procedures were inadequate (e.g., only water available, crowding at sink, and drying hands on clothes). Coveralls and boots were dirty, cleaned infrequently, and removed after hand-washing. In addition, inadequate hand washing and cleaning of contact surfaces resulted in an outbreak of salmonellosis associated with dissection of owl pellets in elementary schools (65).

# Sporadic Infections
Although not identified as part of recognized outbreaks, sporadic infections have been associated with animal environments. A study of sporadic E. coli O157:H7 infections in the United States determined that patients, especially children, were more likely than healthy persons to have visited a farm with cows (66). Additional studies also documented an association between E. coli O157:H7 infection and visiting a farm (67) or living in a rural area (68). Studies of human cryptosporidiosis have documented contact with cattle or visiting farms as risk factors for infection (69)(70)(71). A case-control study identified multiple factors, including raw milk consumption and contact with farm animals, associated with Campylobacter infection (72). In other studies, farm residents were at a lower risk for infection with Cryptosporidium (71) and E. coli O157:H7 (73) than farm visitors, presumably because the residents had acquired immunity as a result of their early and frequent exposure to these organisms. However, livestock exhibitors became infected with E. coli O157:H7 in at least one fair outbreak (15).

# Additional Health Concerns
Although enteric diseases are the most commonly reported illnesses associated with animals in public settings, other health risks are of concern. For example, allergies can be associated with animal dander, scales, fur, feathers, body wastes (e.g., urine), and saliva (74)(75)(76). Additional health concerns addressed in this report include injuries, rabies exposures, and other infections.

# Injuries
Injuries associated with animals in public settings include bites, kicks, falls, scratches, stings, crushing of the hands or feet, and being pinned between the animal and a fixed object. These injuries have been associated with big cats (e.g., tigers), monkeys, and other domestic and zoo animals. . For example, a Kansas teenager was killed while posing for a photograph with a tiger being restrained by its handler at an animal sanctuary (77).

# Rabies Exposures
Contact with rabid mammals can expose persons to rabies virus through bites or contamination of mucous membranes, scratches, or other wounds with infected saliva or nervous tissue. Although no human rabies deaths caused by animal contact in public exhibits have been recorded, multiple rabies exposures have occurred, requiring extensive public health investigation and medical follow-up. For example, thousands of persons have received rabies postexposure prophylaxis (PEP) after being exposed to rabid or potentially rabid animals (including cats, goats, bears, sheep, ponies, and dogs) at a variety of venues: a pet store in New Hampshire ( 78), a county fair in New York State (79), petting zoos in Iowa (80,81) and Texas (J. Wright, Texas Department of Health, personal communication, 2004), and school and rodeo events in Wyoming (59). Substantial public health and medical care challenges associated with potential mass rabies exposures include difficulty in identifying and contacting persons, correctly assessing exposure risks, and providing timely medical prophylaxis. Prompt assessment and treatment are critical to prevent this disease, which is usually fatal.

# Other Infections
Multiple bacterial, viral, fungal, and parasitic agents have been associated with animal contact. These organisms are transmitted through various modes. Infections from animal bites are common and frequently require extensive treatment or hospitalization. Bacterial pathogens associated with animal bites include Pasteurella, Francisella tularensis (82), Staphylococcus, Streptococcus, Capnocytophaga canimorsus, Bartonella henselae (cat-scratch disease), and Streptobacillus moniliformis (rat-bite fever). Certain monkey species (especially macaques) kept as pets or used in public exhibits can be infected with herpes B virus, either asymptomatically or with mild oral lesions. Human exposure through monkey bites or bodily fluids can result in a fatal meningoencephalitis (83,84).
Skin contact with animals in public settings is also a public health concern. In 1995, a total of 15 cases of ringworm (club lamb fungus) caused by Trichophyton species and Microsporum gypseum were documented among owners and family members who exhibited lambs in Georgia during a show season (85). Ringworm in 23 persons and multiple animal species was traced to a Microsporum canis infection in a hand-reared zoo tiger cub (86). Orf virus infection (contagious ecthyma or sore mouth) has occurred following contact with sheep at a public setting (E. Lederman, CDC, personal communication, 2006). In addition, orf virus infection has been described in goats and sheep at a children's petting zoo (87) and in a lamb used for an Easter photo opportunity (M. Eidson, New York State Department of Health, personal communication, 2003). After handling various species of infected exotic animals, a zoo attendant experienced an extensive papular skin rash from a cowpox-like virus (88). In 2003, multiple cases of monkeypox occurred among persons who had contact with infected prairie dogs either at a child care center (89,90) or a pet store (J.J. Kazmierczak, Wisconsin Department of Health and Family Services, personal communication, 2004).
Ecto-and endoparasites pose concerns when humans and exhibit animals interact. Sarcoptes scabiei is a skin mite that infests humans and animals, including swine, dogs, cats, foxes, cattle, and coyotes (91,92). Although human infestation from animal sources is usually self-limiting, skin irritation and itching might occur for multiple days and can be difficult to diagnose (92,93). Animal flea bites to humans increase the risk for infection or allergic reaction. In addition, fleas can carry a tapeworm species that can infect children who unintentionally swallow the flea (94,95). Animal parasites also can infect humans who ingest soil or other materials contaminated with animal feces. Parasite control through veterinary care and proper husbandry combined with hand washing reduces the risks associated with ecto-and endoparasites (96).
Tuberculosis (TB) is another disease of concern in certain animal settings. In 1996, a total of 12 circus elephant handlers at an exotic animal farm in Illinois were infected with Mycobacterium tuberculosis, and one handler had signs consistent with active disease after three elephants died of TB. Medical history and testing of the handlers indicated that the elephants had been a probable source of exposure for most of the human infections (97). During 1989-1991 at a zoo in Louisiana, seven animal handlers who were previously negative for TB tested positive after a Mycobacterium bovis outbreak in rhinoceroses and monkeys (98). In 2003, the U.S. Department of Agriculture (USDA) developed guidelines regarding removal of TB-infected animals from public contact as a result of concerns over the risk for exposure to the public (99).
Zoonotic pathogens also can be transmitted by direct or indirect contact with reproductive fluids, aborted fetuses, or newborns from infected dams. Live-birthing exhibits, usually involving livestock (e.g., cattle, pigs, goats, or sheep), are popular at agricultural fairs. Although the public usually does not have direct contact with animals during birthing, newborns and their dams are frequently available for petting afterwards.
Q fever (Coxiella burnetii), leptospirosis, listeriosis, brucellosis, and chlamydiosis are serious zoonoses that can be acquired through contact with reproductive materials (100).
Coxiella burnetii is a rickettsial organism that most frequently infects cattle, sheep, and goats. The disease can cause abortion in animals, but more frequently the infection is asymptomatic. During birthing, infected animals shed substantial numbers of organisms that might become aerosolized. Most persons exposed to C. burnetii develop an asymptomatic infection, but clinical illness can range from an acute influenza-like illness to life-threatening endocarditis. A Q fever outbreak involving 95 confirmed patients and 41 hospitalizations was linked to goats and sheep giving birth at petting zoos in indoor shopping malls (101). Indoor-birthing exhibits might pose an increased risk for Q fever transmission attributed to inadequate ventilation.
Chlamydophila psittaci infections cause respiratory disease (commonly called psittacosis) and are usually acquired from psittacine birds (102). For example, an outbreak of C. psittaci pneumonia occurred among the staff at the Copenhagen, Zoological Garden (103). On rare occasions, chlamydial infections acquired from sheep, goats, and birds result in reproductive problems in humans (102,104,105).

# Recommendations
Guidelines from multiple organizations contributed to the recommendations in this report (106)(107)(108). No federal laws in the United States address the risk for transmission of pathogens at venues where the public has contact with animals. Certain states have specific legislation for venues where animals are present in public settings (59,61,(109)(110)(111). In 2005, after a state fair outbreak, North Carolina passed a law requiring agricultural fairs to obtain a permit from the Department of Agriculture for all animal exhibits open to the public (http:// www.ncleg.net/Sessions/2005/Bills/Senate/html/S268v4. html).
Certain federal agencies and associations in the United States have developed standards, recommendations, and guidelines for venues where animals are present in public settings. The Association of Zoos and Aquariums has accreditation standards for reducing risk for animal contact with the public in zoologic parks (112). In accordance with the Animal Welfare Act, USDA licenses and inspects certain animal exhibits for humane treatment of animals; however, the act is not intended for human health protection. In 2001, CDC issued guidelines to reduce the risk for infection with enteric pathogens from farm visits (61). CDC also has issued recommendations for preventing transmission of Salmonella from reptiles to humans (113). The Association for Professionals in Infection Control and Epidemiology (APIC) developed guidelines to address risks associated with the use of service animals in health-care settings (2).

# Recommendations for Local, State, and Federal Agencies
Communication and cooperation among human and animal health agencies should be enhanced and include cooperative extension offices. Additional research should be conducted into the risk factors and effective prevention and control methods for health issues associated with animal contact. To improve use of these recommendations, agencies should:
- To evaluate and improve these recommendations, surveillance for health issues associated with animal contact should be enhanced. Agencies should:
- Conduct thorough epidemiologic investigations of outbreaks.
- Include questions about exposure to animals and their environment on disease report forms and outbreak investigation questionnaires. - Follow appropriate protocols for sampling of humans, animals, and the environment and for testing and subtyping of isolates. - Report outbreaks to state health departments and CDC.

# Recommendations for Education
Education is essential to reduce risks associated with animal contact in public settings. Experience from outbreaks suggests that visitors knowledgeable about potential risks are less likely to become ill (12). Even in well-designed venues with operators who are aware of the risks for disease, outbreaks can occur when visitors do not understand and apply diseaseprevention recommendations.
Venue operators should:
- Know the risks for disease and injury associated with animals and be able to explain risk-reduction measures to staff and visitors.
- Be familiar with and implement the recommendations contained in this report.

# Recommendations for Managing Public and Animal Contact
The recommendations in this report were developed for settings in which direct animal contact is encouraged (e.g., petting zoos) and in which animal contact is possible (e.g., county fairs). They should be tailored to specific settings and incorporated into guidelines and regulations developed at the state or local level. The public's contact with animals should occur in settings where measures are in place to reduce the potential for injuries or disease transmission and to increase the probability that incidents or problems identified with animal contact settings will be reported, documented, and handled appropriately.
The design of facilities and animal pens (Figure ) should minimize the risk associated with animal contact, including contact with manure, and should encourage hand washing (Appendix C). The design of facilities or contact settings might include double barriers to prevent contact with animals or contaminated surfaces except for specified interaction areas. Temporary exhibits should be carefully planned, designed, and managed to avoid problems identified from previous outbreaks. Common problems include inadequate barriers, floor surfaces that are difficult to keep clean, insufficient plumbing, and inadequate hand-washing facilities (12,17,34,35). Specific guidelines might be necessary for certain settings (i.e., schools ).
Recommendations for cleaning procedures also should be tailored to the specific situation. All surfaces should be cleaned thoroughly to remove organic matter before disinfection. A 1:32 dilution of household bleach (e.g., half a cup of bleach per gallon of water) is needed for basic disinfection. Quaternary ammonium compounds (e.g., Roccal  or Zephiran  ) also can be used per the manufacturer label. For disinfection when a particular organism has been identified, additional guidance is available at / resources/disinfectants/Disinfection101Feb2005.pdf. All compounds require a contact time of >10 minutes.
The venue should be divided into three types of areas: nonanimal areas (areas in which animals are not permitted, with the exception of service animals), transition areas (located at both entrances and exits to animal areas), and animal areas (where animal contact is possible or encouraged) (Figure ).

# Nonanimal Areas
Nonanimal areas are those in which animals are not permitted.
- Do not permit animals, except service animals, in nonanimal areas. - Prepare, serve, and consume food and beverages only in nonanimal areas. - Provide hand-washing facilities and display hand-washing signs where food or beverages are served (Appendix C).

# Transition Areas Between Nonanimal and Animal Areas
Establishing transition areas through which visitors pass when entering and exiting animal areas is critical. One-way visitor flow is preferred with separate entrance and exit points. The transition areas should be designated as clearly as possible, even if they must be conceptual rather than physical (Figure ).
Entrance transition areas should be designed to facilitate education.
- Post signs or otherwise notify visitors that they are entering an animal area. - Instruct visitors not to eat, drink, smoke, place their hands in their mouth, or use bottles or pacifiers while in the animal area. - Exclude strollers, food, and beverages (establish storage or holding areas for these items). - Control visitor traffic to avoid overcrowding.
Exit transition areas should be designed to facilitate hand washing.
- Post signs or otherwise instruct visitors to wash their hands.
- Provide accessible hand-washing stations for all visitors, including children and persons with disabilities (Figure). - Position venue staff near exits to encourage compliance with hand washing.

# Animal Areas
- Provide adequate ventilation for both animals (115) and humans. - Exclude food and beverages. Animal feed and water should not be accessible to the public. - Exclude toys, pacifiers, spill-proof cups, baby bottles, and strollers. - Prohibit smoking.

# FIGURE. Examples of designs for animal contact settings, including clearly designated animal areas, nonanimal areas, and transition areas with hand-washing stations and signage
- Promptly remove manure and soiled animal bedding from animal areas. - Store animal waste and specific tools for waste removal (e.g., shovels and pitchforks) in designated areas restricted from public access. - Avoid transporting manure and soiled bedding through nonanimal areas or transition areas. If this is unavoidable, take precautions to prevent spillage. - Where feasible, disinfect animal areas (e.g., flooring and railings) at least once daily. - Supervise children closely to discourage hand-to-mouth activities (e.g., thumb-sucking), contact with manure, and contact with soiled bedding. If hands become soiled, supervise hand washing. - Assign trained staff to encourage appropriate humananimal interactions, to identify and remove potential risks for patrons (e.g., by promptly cleaning up wastes), and to process reports of injuries and exposures. - Allow feeding only when contact with animals is controlled (e.g., with barriers). - Do not provide animal feed in containers that can be eaten by persons (e.g., ice cream cones) to prevent children from eating food that has come into contact with animals. - Use animals or animal products (e.g., animal pelts, animal waste, and owl pellets) (65) for educational purposes only in designated animal areas (Figure). Animals and animal products should not be brought into school cafeterias and other food-consumption areas. - Do not use animal areas for public (nonanimal) activities. Zoonotic pathogens can contaminate the environment for substantial periods of time (38). If animal areas must be used for public events (e.g., weddings and dances), these areas should be cleaned and disinfected, particularly if food and beverages are served. Materials with smooth, impervious surfaces (e.g., steel, plastic, and sealed concrete) are easier to clean than other materials (e.g., wood or dirt floors). Remove organic material (e.g., bedding, feed, and manure) before using disinfectants. - For animals in school classrooms, specific areas must be designated for animal contact (Appendix D). Designated animal areas must be thoroughly cleaned after use. Parents should be informed of the benefits and potential risks associated with animals in school classrooms.

# Animal Care and Management
The risk for disease or injuries from animal contacts can be reduced by carefully managing the specific animals used for such contacts. These recommendations should be considered for management of animals in contact with the public.
- Animal care: Monitor animals daily for signs of illness, and ensure that animals receive appropriate veterinary care. Ill animals, animals known to be infected with a pathogen, and animals from herds with a recent history of abortion or diarrhea should not be exhibited. Animals should be housed to minimize stress and overcrowding, which can increase shedding of pathogens. - Veterinary care: Retain and use the services of a licensed veterinarian. Vaccination, preventive care, and parasite control appropriate for the species should be provided.
Certificates of veterinary inspection from an accredited veterinarian should be up-to-date according to local or state requirements for animals in public settings. A herd or flock inspection is a critical component of the health certificate process. Routine screening for diseases is not recommended, except for TB in elephants (97-99) and primates, and for Q fever in ruminants in birthing exhibits (116,117). - Rabies: All animals should be housed to reduce potential exposures from wild animal rabies reservoirs. Mammals should also be up-to-date on their rabies vaccinations (118). These steps are particularly critical in areas where rabies is endemic and in venues where animal contact is encouraged (e.g., petting zoos). Because of the extended incubation period for rabies, unvaccinated mammals should be vaccinated at least 1 month before they have contact with the public. If no licensed rabies vaccine exists for a particular species used in a setting where public contact occurs (e.g., goats, swine, llamas, and camels), consultation with a veterinarian is recommended regarding the off-label use of rabies vaccine. Use of off-label vaccine cannot provide the same level of assurance as vaccines labeled for use in particular species; however, offlabel use of vaccine might provide protection for certain animals and thus decrease the probability of rabies transmission. Vaccinating slaughter-class animals before displaying them at fairs might not be feasible because of the vaccine withdrawal period that occurs as a result of antibiotics used as preservatives in certain vaccines. Mammals that are too young to be vaccinated should be used only if additional restrictive measures are available to reduce risks. These measures can include using only animals that were born to vaccinated mothers and housed to avoid rabies exposure. - Dangerous animals: Because of their strength, unpredictability, venom, or the pathogens that they might carry, prohibit certain domestic, exotic, or wild animals in exhibit settings where a reasonable possibility of animal contact exists. Species of primary concern include nonhuman primates (e.g., monkeys and apes) and certain carnivores (e.g., lions, tigers, ocelots, wolves/wolfhybrids, and bears). In addition, rabies-reservoir species (e.g., bats, raccoons, skunks, foxes, and coyotes) should not be used for direct contact. - Animal births: Ensure that the public has no contact with animal birthing by-products. In live-birth exhibits, the environment should be thoroughly cleaned after each birth, and all waste products should be properly discarded.
Holding such events outside is preferable. If held indoors, ventilation should be maximized. Hoses that are accessible to the public should be labeled "water not for human consumption." Operators and managers of these settings in which treated municipal water is not available should consider alternative methods for disinfection of their water supply or should consider methods to disinfect their water supply.

# Additional Recommendations
animal areas clean and disinfected to the extent possible and limit visitor contact with manure and animal bedding. Allow feeding of animals only if contact with animals can be controlled (e.g., over a barrier). Do not use animal areas for public (nonanimal) activities. - Design transition areas for entering and exiting animal areas with appropriate signs or other forms of notification regarding risks for and location of hand-washing facilities. Maintain hand-washing stations that are accessible to children and require hand washing upon exiting animal areas. - Ensure that animals are appropriately cared for.
- Prohibit consumption of unpasteurized products (e.g., milk products and juices). - Provide potable water for animals to consume.
Operators and staff must educate visitors, for example:
- Provide simple instructions in multiple formats that are age-and language-appropriate. - Warn visitors about the risks for disease and injury.
- Notify visitors that eating and drinking or placing things in their mouths should not occur after leaving the animal area until after their hands are washed. - Advise visitors to closely supervise children and to be aware that objects such as clothing, shoes, and stroller wheels can become soiled and serve as a source of germs after leaving an animal area. - Direct visitors to wash their hands and assist children with hand washing following contact with animals or visiting an animal area. - Make visitors aware that young children, older adults, pregnant women, persons who are mentally impaired or immunocompromised are at increased risk for illness.
Venue operators should know about risks for disease and injury, maintain a safe environment, and inform staff and visitors about appropriate disease and injury-prevention measures. This handout provides basic information and instructions for venue operators and staff. Reading this handout does not substitute for reading the entire compendium.
Operators and staff must know about risks, for example:
- Disease and injury have occurred following contact with animals in public settings. - Healthy animals can carry organisms that make visitors sick. - Visitors can become infected with organisms when they touch animals or their droppings or enter the animal's environment and do not wash their hands. - Some visitors are at increased risk for developing serious or life-threatening illnesses, especially young children (i.e., aged <5 years), older adults, pregnant women, persons who are mentally impaired, and persons with weakened immune systems.
Operators and staff must maintain a safe environment:
- Design the venue with safety in mind by having designated animal areas, nonanimal areas, and transition areas as described in the Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2007. - Do not permit animals, except service animals, in nonanimal areas. Provide hand-washing facilities where food and beverages are prepared, served, or consumed. - Assign trained staff to monitor animal contact areas.
Exclude food and beverages, toys, pacifiers, spill-proof cups, and baby bottles and prohibit smoking. Keep the - Owl pellets -Assume owl pellets to be contaminated with Salmonella. Dissections should not be done in areas where food is consumed. Thoroughly clean and disinfect contact surfaces. Wash hands after contact.

# Animals Not Recommended in School Settings
- Inherently dangerous animals (e.g., lions, tigers, cougars, and bears). - Nonhuman primates (e.g., monkeys and apes).
- Mammals at higher risk for transmitting rabies (e.g., bats, raccoons, skunks, foxes, and coyotes). - Aggressive or unpredictable animals, wild or domestic.
- Stray animals with unknown health and vaccination history. - Venomous or toxin-producing spiders, insects, reptiles, and amphibians.

# Appendix C Hand-Washing Recommendations to Reduce Disease Transmission From Animals in Public Settings
Hand washing is the single most important prevention step for reducing disease transmission. Hands should always be washed upon exiting animal areas and before eating or drinking. Venue staff should encourage hand washing as persons exit animal areas.

# How to Wash Hands
- Wet hands with running water; place soap in palms; rub together to make a lather; scrub hands vigorously for 20 seconds; rinse soap off hands. - If possible, turn off the faucet by using a disposable paper towel. - Dry hands with a disposable paper towel. Do not dry hands on clothing. - Assist young children with washing their hands.

# Hand-Washing Facilities or Stations
- Hand-washing facilities should be accessible and sufficient for the maximum anticipated attendance and configured for use by children (low enough for them to reach or equipped with a stool), adults, and those with disabilities. - Hand-washing stations should be conveniently located in transition areas between animal and nonanimal areas and in the nonanimal food concession areas. - Maintenance should include routine cleaning and restocking to ensure adequate supply of paper towels and soap. - Running water should be of sufficient volume and pressure to remove soil from hands. Volume and pressure might be substantially reduced if the water supply is furnished from a holding tank. Therefore, a permanent pressured water supply is preferable. - The hand-washing station should be designed so that both hands are free for hand washing by having operation with a foot pedal or water that stays on after turning on hand faucets. - Hot water is preferable, but if the hand-washing stations are supplied with only cold water, a soap that emulsifies easily in cold water should be provided. - Communal basins, where water is used by more than one person, do not constitute adequate hand-washing facilities.

# Hand-Washing Agents
- Liquid soap dispensed by a hand or foot pump is recommended. - Alcohol-based hand sanitizers can be used if soap and water cannot be made available and are effective against multiple common disease agents (e.g., shiga toxin-producing E. coli, Salmonella, and Campylobacter). However, they are ineffective against certain organisms (e.g., bacterial spores, Cryptosporidium, and certain viruses). - The U.S. Food and Drug Administration recommends using an alcohol-based hand sanitizer with a concentration of 60% or higher to be effective against common disease agents. - Hand sanitizers are less effective if hands are visibly soiled.
Therefore, visible contamination and dirt should be removed to the extent possible before using hand sanitizers.

# Hand-Washing Signs
- At venues where human-animal contact occurs, signs regarding proper hand-washing practices are critical to reduce disease transmission. - Signs that are reminders to wash hands should be posted at exits from animal areas (exit transition areas) and in nonanimal areas where food is served and consumed. - Signs should be present to direct all visitors to handwashing stations upon exiting animal areas. - Signs with proper hand-washing instructions should be posted at hand-washing stations and restrooms to encourage proper practices. - Depending on the setting, hand washing signs might need to be available in different languages.

# Example of a Hand-Washing Sign*
- Sign available at . Additional resources on animals in public settings or zoonotic diseases are available at .

# Appendix D Guidelines for Animals in School Settings
Animals are effective and valuable teaching aids, but safeguards are required to reduce the risk for infection and injury.

# ACCREDITATION

# Continuing Medical Education (CME).
CDC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CDC designates this educational activity for a maximum of 1.25 hours in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

# Continuing Education Unit (CEU). CDC has been reviewed and approved as an Authorized Provider by the International Association for

# Continuing Nursing Education (CNE).
This activity for 1.25 contact hours is provided by CDC, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation.

# Continuing Veterinary Education (CVE)
. CDC has been approved as an authorized provider of veterinary credit by the American Association of Veterinary State Boards (AAVSB) RACE program. CDC will award 1.0 hour of continuing education credit to participants who successfully complete this activity.

# Goal and Objectives
This MMWR provides evidence-based guidelines for reducing risks associated with animals in public settings. The recommendations were developed by the National Association of State Public Health Veterinarians, in consultation with representatives from CDC, the National Assembly of State Animal Health Officials, the U.S. Department of Agriculture, the American Veterinary Medical Association Council on Public Health and Regulatory Veterinary Medicine, the Association of Zoos and Aquariums, and the Council of State and Territorial Epidemiologists. The goal of this report is to provide guidelines for public health officials, veterinarians, animal venue operators, animal exhibitors, and others concerned with disease control to minimize risks associated with animals in public settings. Upon completion of this activity, the reader should be able to describe 1) the reasons for the development of the guidelines; 2) the disease risks associated with animals in public settings; 3) populations at high risk; and 4) recommended prevention and control methods to reduce disease risks.

# Which one of the following are recommendations for animal areas to reduce the risk for disease from animal contact?
A. The best time to remove manure and soiled bedding is at the end of the event when the animals are removed. B. Removal of animals with E. coli 0157:H7 in their gastrointestinal tract will eliminate the risk for infection associated with the animal contact venue. C. Ice-cream cones are an ideal container for feeds used by children in feeding animals. D. Animal contacts should be carefully supervised for children aged <5 years to discourage hand-to-mouth contact and ensure appropriate hand washing. E. None of the above.

# Which of the following is true about hand-washing recommendations to reduce disease transmission from animals in public settings?
A. Hands must be washed vigorously with soap and running water for at least 2 minutes. B. If no hand sinks are available, use alcohol-based hand-sanitizers. C. Cold water is more effective than warm water. D. A and B. E. All of the above.

# Which of the following is true about guidelines for animals in school settings?
A. Baby chicks and ducks are an excellent choice for all children in school settings because of their small size. B. Animals can be allowed in food settings (e.g., a school cafeteria) if they have a health certificate from a veterinarian. C. Animals should not be allowed to roam or fly free, and areas for contact should be designated. D. A and C. E. All of the above.

# If no licensed rabies vaccine exists for an animal species on display in
a petting zoo, options to manage human rabies exposure risk include. . . A. using an animal born from a vaccinated mother if it is too young to vaccinate. B. penning the animal each night in a cage or pen that will exclude rabies reservoirs (e.g., bats and skunks). C. asking a veterinarian to vaccinate the animal off-label with a rabies vaccine. D. A and B. E. A, B, and C.

# Which best describes your professional activities?
A