Epidemiology and One Health: Collaborative Research Investigating Public Health Challenges Related to Canines in Rural, Urban, and Remote Communities in Canada by Danielle Arlaine Julien A Thesis presented to The University of Guelph In partial fulfilment of requirements for the degree of Doctor of Philosophy in Population Medicine Guelph, Ontario, Canada © Danielle Arlaine Julien, June 2020 ABSTRACT EPIDEMIOLOGY AND ONE HEALTH: COLLABORATIVE RESEARCH INVESTIGATING PUBLIC HEALTH CHALLENGES RELATED TO CANINES IN RURAL, URBAN, AND REMOTE COMMUNITIES IN CANADA Danielle Arlaine Julien Advisor(s): University of Guelph, 2020 Dr. Jan M. Sargeant Dr. Sherilee L. Harper (Co-Advisor) This thesis is an investigation of public health challenges related to dogs in rural and urban communities in southern Ontario, and in remote Iqaluit, Nunavut, Canada, using cross- sectional observational studies. First, we conducted a scoping review of canine zoonotic and vectorborne research in North American countries, categorized by the Inequality-adjusted Human Development Index (IHDI). Most research was conducted in “very high” and “high” IHDI countries. Second, the prevalence of Giardia spp. and Cryptosporidium spp. were investigated in dogs in Iqaluit, Nunavut. Using Ecohealth and One Health approaches, feces were collected from three dog populations (sled (n=79), shelter (n=111), and community dogs (n=104)). The fecal prevalence of at least one parasite when one sample was chosen at random for all dogs was 8.16% (95% CI: 5.52-11.92), and of Giardia spp., and Cryptosporidium spp. was 4.42% (95% CI: 2.58-7.49) and 6.12% (95% CI: 3.88-9.53), respectively. We identified Giardia intestinalis, zoonotic assemblage B (n=2), and species-specific D (n=3) and E (n=1); and 5 samples containing Cryptosporidium canis. Third, we explored the prevalence of dog ownership, canine rabies vaccination, and the incidence of self-reported dog bites in humans; knowledge of zoonoses; and sources of dogs as pets in southern Ontario using an online questionnaire of n=1,002 rural and 1,004 urban respondents. The probability of owning at least one dog was higher in rural households than in urban households (OR=1.24, 95% CI: 1.04-1.48, p=0.02). Irrespective of dog ownership, the incidence risk of at least one bite victim over a one- year period in rural households (6.09% per year) was less than in urban households (10.76% per year). Of respondent-owned biting dogs, 16.67% were unvaccinated against rabies. Many respondents were aware of canine zoonoses (55.88%) and there were no differences in awareness between rural and urban respondents. Finally, over a seven-year period, 731 (36.44%) respondents domestically sourced, and 55 (2.74%) imported at least one dog, most frequently from the USA (n=29 of 55 (52.73%)). Findings highlight that in three geographically distinct communities, culturally sensitive and appropriate public health strategies are needed to mitigate risks of public health challenges related to dogs and enhance public knowledge of canine zoonoses. iii DEDICATION Ah, but a man’s reach should exceed his grasp, Or what’s a heaven for? Robert Browning I dedicate this dissertation to Sofia Mae Julien-Wright, Margot Jean Julien-Wright, and to all the little girls from Grenada sitting on the front steps of their homes, cuddling teddy bears in one hand and beloved dogs in another, emphatically expressing to their parents, “I want to make dogs well!” - You can and you will! iv ACKNOWLEDGEMENTS It takes a village to raise a child – African proverb I would argue, it also takes a village for an individual to complete a PhD. I am extremely grateful to my thesis committee Drs. Jan Sargeant, Sherilee Harper, and Catherine Filejski, for their unyielding advice, counsel, and dedication to my growth, development, and success. Jan, you will never know just how much you positively impacted the course of my life, particularly during a time when I did not feel disserving of such an incredible opportunity as being able to do a PhD. I am eternally grateful for your exceptional mentorship, guidance, advice, patience, and genuine interest in my growth and development as a professional but also as a human being. You were, and will always remain, one of the most fascinating women I have ever had the privilege of knowing. Thank you for engaging with me in diverse conversations about the most wonderful and varied topics ranging from Jean-Claude Duvalier, to my indeterminate future as a young veterinarian. I feel extremely fortunate for having had you as my advisor and being one of your last PhD students. You are brilliant. And, while I often felt intimidated by your mind, I have learned more from you than I could ever possibly have imagined. I will never forget your kindness to me, your encouragement, and in every interaction that we have had to date, your ability to foster in me the ability to think about things differently - to extend my mental reach past its grasp. I will never be able to repay you for the incredible opportunities you provided for me but, I look forward to a future in which I am readily available to help you as your colleague and friend. Thank you from the bottom of my heart Jan! Sheri, you are an extraordinary mentor and advisor and I will never forget your time, advice, and genuine compassion. I have always loved writing, but through your consistent v efforts, I have learned to appreciate and strive for exceptional prose. Your kindness and support, particularly when Jan was on sabbatical, will always remain one of the most fundamental learning opportunities in my entire life. Although I have always admired you, my ignorance, in its truest definition, meant that unfortunately, I did not always fully appreciate you. I simply cannot comprehend your ability to accomplish all that you do in your professional life while being the source of support and guidance you are as an advisor. I am eternally grateful to you. You were not only unfaltering in your dedication to me as your student, you were also an incredible support for my personal well-being. I have cried, laughed, wondered, “ah – Ha!” -ed, worried, and grown in your presence, and I will always be indebted to you for the pivotal role you have played in my development as an epidemiologist and human being. Thank you for listening to me and for being such a magnetic voice of reason. I want to be a better student and person because of you - Thank you, Sheri! Catherine, you have been my mentor since my internship, under your supervision, at the Ontario Ministry for Health and Long-Term Care in the summer of 2012. I have learned such an incredible amount from you regarding public health and life itself. I am always astounded by your ability to conceptualize ideas and bring them to fruition. Thank you for always redirecting me to our purpose – gathering and using data for the betterment of public health. I will never forget our conversations, each and every one of them a significant learning opportunity. Your incredible kindness and support have helped me through the tough times and given me impetus to continue through the good. Thank you, Catherine. I look forward to continuing professional relationships and friendships with Drs. Sargeant, Harper, and Filejski. vi Thank you to the wonderful people and dogs in Iqaluit, Nunavut, Canada. To all of the sled dog owners in Iqaluit, Nunavut, my heart felt thank you. Our research would never have been possible without your help, and trust in me as a person and burgeoning researcher. I appreciate your time in helping with collecting stool samples and inviting me into your homes and into your lives – it meant the world to me. Thank you for your expertise in developing the knowledge translation materials. To the Nunavut Innovation and Research Institute (NIRI), thank you for your guidance, support, and advice in conducting research in Iqaluit, Nunavut. I really appreciated the kindness everyone extended to me; I felt very welcomed at NIRI. To the people of Iqaluit, Nunavut, I am eternally grateful to you for opening your hearts and community to me. Thank you for giving me the opportunity to experience the incredible beauty of your land and your hospitality. I look forward to maintaining meaningful relationships with sled dog owners, NIRI, and the Iqaluit community as friends and research collaborators in the future. Nakurmiik! To the graduate student village: Drs. Kate Bishop-Williams, Stephanie Croyle, and Carly Moody I could not imagine better human beings with whom to spend time in preparing for qualifying exams. You are such strong, resilient, and devoted women, and it was an honour to exchange and create knowledge with each and every one of you. To Amanda Armstrong, Katherine Davenport, Michele Bergevin, Dr. Emma Gardner, Brianna Hagen, Dr. Melissa MacKinnon, Ben Ouyang, Jordan Pelkmans, Dr. Jennifer Perret, Jocelyn Rivers, Dr. Steve Roche, Dr. Dan Shock, Alex Swiriski, Carol Tinga, Amanda Rotella, Dr. Salah Udin-Khan, Dr. Lee Wisener, Dr. Charlotte Winder, and Wendy Xie, thank you for your constant support over the years. You were ears, shoulders, arms, and rapidly firing neurons when mine had come to a standstill. You are all inspiring, passionate, and fantastic individuals and I will be forever vii grateful to you for your friendship, time, and encouragement. I look forward to maintaining relationships with each of you and perhaps even collaborating with you on research endeavours in the future! To all within the Harper lab village: Thank you to everyone in the Harper lab for the innumerable times that you lent me your ears, and, in particular, being so welcoming to me when I returned to the PhD after my first maternity leave.