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Pet ownership can have health, emotional and social benefits; however, pets can serve as a source of zoonotic pathogens. One large, regional survey reported more than 75% of households having contact with a pet,1 and close, intimate interactions with pets (e.g., sleeping in beds with owners, face licking) are common.1,2 Additional surveys suggest that the general public and people at high risk for pet-associated disease are not aware of the risks associated with highrisk pet practices or recommendations to reduce them; for example, 77% of households that obtained a new pet following a cancer diagnosis acquired a high-risk pet.1,3 This statistic is not surprising - studies suggest physicians do not regularly ask about pet contact, nor do they discuss the risks of zoonotic diseases with patients, regardless of the patient's immune status.1,3,4 Patient surveys and epidemiologic studies on the topic suggest that the occurrence of pet-associated disease is low overall.1,8 Owing to a relative absence of reportable pathogens and complicating factors (e.g., non-pet exposure pathways, frequent subclinical shedding by pets), the proportion of human disease attributable to pets is unknown, and any reported frequency of such infections is likely underestimated. Yet, pet contact has been identified as a risk factor for many diseases, with case-control studies and molecular typing data strongly supporting pet sources for bacterial (e.g., Campylobacter, Salmonella), fungal (e.g., dermatophytes), parasitic (e.g., Toxoplasma gondii) and viral pathogens (e.g., lymphocytic choriomeningitis virus).6,9-12 Although pets do not typically directly transmit arthropod-borne diseases to people (e.g., Lyme borreliosis, ehrlichiosis, anaplasmosis), they do bring the zoonotic disease vectors - ticks and fleas - in close proximity to people, potentially increasing disease risk. In immunocompetent people, salmonellosis most often results in self-limiting gastrointestinal disease, although serious disease can develop. The disease can be more severe in patients at high risk, resulting in bacteremia or serious systemic and localized infections, such as meningitis (in newborns) and osteomyelitis (in patients with sickle cell anemia). Although many pet species have been implicated in human disease, amphibians, reptiles, exotic animals, rodents and young poultry pose the greatest risk. Reptiles and amphibians are estimated to be responsible for 11% of all sporadic Salmonella infections among patients less than 21 years of age,11 and direct contact with such animals is not required for zoonotic transmission. In one study, 31% of reptile-associated salmonellosis cases occurred in children less than 5 years of age and 17% occurred in children aged 1 year or younger; these findings highlight the heightened risk in children and the potential for reptile-associated Salmonella to be transmitted without direct contact with the animal or its enclosure.12 Outbreaks of pet-associated salmonellosis involving hedgehogs, rodents, young poultry, frogs and turtles have recently been reported, in which children accounted for a high proportion of cases (35%-70%).23 In addition, various animal foods (e.g., raw meat, raw eggs and raw treats such as pig's ears) are commonly contaminated with Salmonella species. The feeding of these products are well-established risk factors for salmonellosis in pets, and associated human outbreaks have been identified.24,25

Pediatric uptake and outcomes in antiretroviral treatment (ART) programmes have lagged behind adult programmes. We describe outcomes from a population-based pediatric ART cohort in rural southern Malawi. Data were analyzed on children who initiated ART from October/2003 -September/2011. Demographics and diagnoses were described and survival analyses conducted to assess the impact of age, presenting features at enrolment, and drug selection. The cohort consisted of 2203 children <15 years of age. Age at entry was <1 year for 219 (10%), 1-1.9 years for 343 (16%), 2-4.9 years for 584 (27%), and 5-15 years for 1057 (48%) patients. Initial clinical diagnoses of tuberculosis and wasting were documented for 409 (19%) and 523 (24%) patients, respectively. Median follow-up time was 1.5 years (range 0-8 years), with 3900 patient-years of follow-up. Over the period of observation, 134 patients (6%) died, 1324 (60%) remained in the cohort, 345 (16%) transferred out, and 387 (18%) defaulted. Infants <1 year of age accounted for 19% of deaths, with a 2.7-fold adjusted mortality hazard ratio relative to 5-15 year olds; median time to death was also shorter for infants (60 days) than older children (108 days). Survival analysis demonstrated younger age at ART initiation, more advanced HIV stage, and presence of tuberculosis to each be associated with shorter survival time. Among children <5 years, severe wasting (weight-for-height z-score