Cross-sectional study on the knowledge about pet ownership , zoonoses and practices of pet owners in the North of Portugal

Pet ownership is common in modern society. In Portugal, 38% and 31% of all households own, at least, one dog or cat, respectively. Few studies have ascertained the knowledge of pet owners about pet ownership and zoonoses, and none of them was carried out in Portugal. The aim of the present study was to assess household knowledge and practices related to pet ownership and zoonoses in the North of Portugal. A questionnaire was completed by 424 pet owners, during November 2019 to February 2020. Most respondents (97.2%) considered pets as an important part of the family, especially women (p = 0.036); 73.1% allowed their pets free access to indoors; 41.3% denied sharing the bed with their pets and 29% assumed they did it daily; 20.3% reported never kissing their pets/pets licking their faces; 73.6% considered animals as potential sources of diseases to humans, but only 25.9% reported knowing the definition of zoonoses; 96.9% considered important the role of veterinarians in protecting public health. The low level of knowledge of pet owners and the occurrence of high-risk behaviors indicate a need to strengthen Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 3 November 2021

Despite the benefits, there are potential hazards associated with pet ownership and interaction with animals. Rabbits and rodent ownership during pregnancy and childhood seems to be linked to increased risk of non-atopic asthma [10,11]. There are studies reporting that early exposure to dogs and cats at home can predispose to pet allergies [12]. Allergies to dogs and cats affect 10 to 20% of the population worldwide and are a major risk factor in the development of allergic rhinitis and asthma [13][14][15]. Animal bites are extremely common and a serious public health problem [8,16]. Dogs are responsible for most reported bites in humans, especially in children [17]. Bites and scratches may lead to complex injuries, both physically and psychologically, but rarely to death. Low-income countries, where dog-control laws are seldom decreed or enforced, are estimated to have higher occurrence of dog bites, scratches, and consequent fatalities, due to the prevalence of rabies and lack of access to appropriate healthcare [17].
Although the number of emerging infections from companion animals is remarkably low [18], there is potential for transmission of infectious pathogens from pets to humans ( Figure 1) through skin and mucous membranes via bites, scratches or other direct contact; contact with animal saliva, urine and other body fluids and secretions; ingestion of food or drink contaminated with animal fecal material; inhalation of infectious aerosols or droplets; and through arthropods and other invertebrate vectors [19,20]. Zoonotic agents can infect healthy people, e.g., through occupational exposure. In fact, occupational zoonoses frequently occur through close contact between animals and humans due to specific settings and professional activities [21]. Therefore, veterinarians, abattoir workers, researchers and technicians, among other professionals who handle infected animals and cultures of zoonotic agents daily, can be exposed to pathogenic agents [21,22]. However, the risk of becoming infected with a zoonotic pathogen is particularly higher for those with a compromised or incompletely developed immune system, such as neonates, toddlers/children (<5 years), elderly (>65 years), pregnant women and all the people who suffer from primary/congenital or acquired immunodeficiencies, such as the acquired immunodeficiency syndrome (AIDS), impaired immunity from cancer, chemotherapy and radiation therapy, splenectomy, diabetes mellitus, diseases of bone marrow and consequent immunosuppressive therapy for transplants, and protein-calorie malnutrition [16,20,23].
It is not realistic to eliminate the possibility of acquiring a zoonotic disease but rather to reduce the risk. To this end, personal hygiene measures should be applied, such as hand washing; proper animal handling; diet and health care; and educational measures and awareness, especially to pet owners, children and immunocompromised people on zoonoses prevention, in order to help them make informed choices and, hopefully, interact safely with animals [8,19,24].
To date, few studies have assessed basic knowledge of pet-associated zoonoses among pet owners and, unfortunately, there are few longitudinal studies about this issue. Additionally, most of the published ones do not have enough data. More questionnaires are needed with a larger sample by region and country, in order to obtain the most reliable and real information possible about general public's household knowledge, attitudes, habits and risks associated to pet ownership and animal contact. The aim of this study was contributing to the aforementioned goal, using households with pets in the north of Portugal as study target. Moreover, this study aimed to strengthen the message of combating zoonoses by promoting awareness among tutors and the general public, as well as underlining the importance of animal care and raising consciousness of the reality of abandonment of companion animals, often associated to ignorance on the topic.

Materials and methods
A cross-sectional study about zoonoses and pet ownership was conducted from November 2019 to February 2020. A voluntary survey was conducted among pet owners from the North of Portugal. Individuals were eligible to participate if they 7 were at least 18 years of age and had pets in their household. After agreeing to participate in the study, everyone was asked to complete an anonymous, confidential 15-minute self-administered written questionnaire on-site (available in Portuguese upon author request). The questionnaire was based on a literature review and designed to obtain information about zoonoses and pet ownership. The questionnaire consisted of closed or short answer questions. It gathered both individual and household-level data including respondents' demographic characteristics (sex, age, education level and  Data were entered into an Excel database (Microsoft Corp., Redmond, WA, USA) and exported and analyzed using SPSS version 27.0 (SPSS, IBM Corporation, New York, USA). For descriptive purposes, Pearson χ 2 test was conducted for each variable in the study looking at gender and ownership differences. The t-test was conducted in order to examine the owners' gender differences relative to the importance attributed to knowledge and practices regarding pet animals and zoonoses. Statistical significance was based on a p-value < 0.05.

Demographics
Animal owners had a mean age of 36.9 years (SD ±15.2) and a median of 33 years.
The youngest respondent was 18 years old and the oldest was 80 years old. Regarding gender, 74.1% (n = 314) were female and 25.9% (n = 110) were male. In relation to academic background, 49.5% (n = 210) had higher education (attended or completed), 25.5% (n = 108) had secondary education (up to the 12 th year of schooling), 10.6% (n = 45) had the 3 rd cycle of basic education (up to the 9 th year of schooling), 5.9% (n = 25) had the 2 nd cycle of basic education (up to the 6 th year of schooling), and 8.5% (n = 36) had the 1 st cycle of basic education (up to the 4 th year of schooling). Regarding occupation, 28.5% (n = 121) were students, 39.9% (n = 169) had an essentially physical professional activity, 19.1% (n = 81) had an essentially mental activity, 12.5% (n = 53) had no occupation (unemployed or retired). Most respondents lived in the urban area (58.5%; n = 248) and 41.5% (n = 176) lived in the rural area (Table 1).

Opinion about the importance and benefits of having pets
Most respondents considered pets as an important part of the family (97.2%; n = 412), with most of the individuals who had this opinion being dog owners (73.1%; n = 301).
Participants (n = 412) were asked to assign the level of importance that their animals constituted for their family, where 1 was the minimum level and 5 was the maximum level. Most of the respondents considered them extremely important (level 5; 43.4%; n = 184) or very important (level 4; 30.2%; n = 128). The level 3 of importance was chosen by 20.3% (n = 86) of the participants, followed by level 2 (2.1%; n = 9) and level 1 (1.2%; n = 5), which correspond to little importance and very little importance, respectively.
In this study, 75.2% (n = 139) of the participants considered that benefits of having a pet outweighed the potential health risks. This opinion prevailed among women (p = 0.048) and 16.7% (n = 71) of all respondents had no opinion.
Most participants, 76.4% (n = 324), considered that having no pets (or reducing the number of pets in the household) would negatively affect their family. In contrast, 8.5% had no opinion.

Pet and animal contact-related attitudes
It was reported that 73.1% (n = 310) of the companion animals had free access to indoors of houses; 79.7% of the participants stated that their animals never ate or licked the dishes, in contrast with 2.1% of the respondents who reported that this happened daily. In addition, 24.1% of the owners admitted washing the pet food containers together with other dishes ( Table 2). In this study, 41.3% of the participants denied that they or someone in the family shared the bed with their pets and 29% assumed they did so constantly. The responses "frequently" and "always" were most answered by dog owners (p = 0.004). Moreover, 20.3% of the respondents reported that they never kissed their pets, or their animals licked their faces. However, the majority admitted doing it, especially among female owners (p = 0.002) ( Table 2).
In relation to contact with other animals, 54.5% (n = 231) of the owners declared that their pets had contact with other animals. About half of the owners who answered affirmatively (50.6%; n = 117) considered that these animals could be a risk for the acquisition of diseases.

Attitude towards stray animals
When asked about their attitude towards a dog or cat that they frequently found close to home, 43.4% (n = 184) of the participants answered that they would provide food and shelter. Respondents who did not have dogs at home reported having this attitude more frequently (p = 0.046), as well as respondents who were female (p = 0.028).
Only 7.1% (n = 30) would take the animals to the veterinarian to assess their health status, deworming and/or vaccination. Moreover, 37.3% (n = 158) would communicate to the responsible entities (city council, municipal kennel) or to non-governmental entities (veterinary centers, animal protection associations). This attitude was statistically associated with having a dog (p = 0.024). In this study, 31.3% of the participants would not act.

Opinion regarding stray dogs
The majority (85.4%; n = 362) of the respondents considered that stray dogs should be collected and treated. Most of the participants who had this opinion were female (p = 0.007). Only 1.2% (n = 5) considered that stray dogs should be euthanized, because of their potential for disease transmission. For 6.4% of respondents, stray dogs should be left freely on the streets if they were first neutered, vaccinated, and dewormed. The remaining 7% had no opinion.

Visits to the veterinarian
Participants declared going to the vet for guidance on issues related to estrus, pregnancy, and childbirth. In addition, only 13.2% of participants answered taking their pets for bathing and shearing. Four participants (0.9%) reported other options, such as cutting nails, bee sting and oral hygiene procedures as scaling and trimming rabbits' teeth.
Regarding external application of antiparasitic drugs, 93.9% (n = 398) of the participants reported protecting their animals against external parasites. Of these, 37.5% (n = 159) performed prevention for external parasites every 6 months; 42.5% (n = 180) applied antiparasitic drugs for external parasites more often than every 6 months; 13.9% (n = 59) reported performed prevention for external parasites annually, and 6.1% (n = 26) referred not to perform prevention for external parasites.

Zoonotic disease knowledge and educational sources
More than half of the respondents (58.7%; n = 249) were comfortable with their level of knowledge in relation to the potential diseases that may arise from the contact with animals.
Participants were asked to assign their perception of the level of knowledge they

High-risk individuals
Most participants (68.4%; n = 290) considered that there are groups of people who are at higher risk of contracting zoonotic diseases, 22.2% (n = 94) admitted not knowing what to answer, and 9.4% (n = 40) considered that there are no high-risk individuals.
The degree of risk assigned is shown in Table 3.

Transmission of zoonotic diseases
Participants were asked if they knew how animals could transmit diseases to humans, and the majority responded affirmatively (64.6%; n = 274). Of these participants, 75.9% (n = 208) considered feces as a mean to transmit zoonotic diseases, and this option was more frequently chosen by female owners (p = 0.046); 64.2% (n = 176) considered that transmission could occur through insect bite, having female owners selected this option more often (p = 0.028); the option "blood" was chosen by 56.7% (n = 155) of the respondents, followed by "physical contact" (48.9%; n = 134); 48.2% (n = 132) considered that transmission could occur through coughing and sneezing, having male owners selected this option more frequently (p = 0.021); 43.1% (n = 118) recognized the food route as a mean of transmitting zoonotic diseases, followed by vomit (41.6%; n = 114); 38.3% (n = 132) of the participants considered that it would be possible to transmit zoonotic diseases through fur, brushes and blankets of the animals.

Knowledge about protective measures
Participants were asked if they felt comfortable with their knowledge in relation to protective measures against zoonotic diseases, and 52.1% (n = 221) responded affirmatively. Subsequently, the respondents had to assign the level of knowledge they thought they had. The majority admitted not having knowledge (level 1; 47.9%; n = 203) followed by having some knowledge (level 3; 35.6%; n = 151), little knowledge (level 2; 8.7%; n = 37), a lot of knowledge (level 4; 6.1%; n = 26) and excellent knowledge (level 5; 1.7%; n = 7).
Respondents were asked to attach a level of importance to general protection measures. The highest level of importance (level 5) was assigned to primary hygiene care (41.5%), followed by frequent hand washing (38.9%) and people vaccination (33.3%) ( Table 4). Subsequently, the participants who considered themselves comfortable with their level of knowledge, had to assign a level of importance to protective measures directly associated with animals. Female owners attributed higher level of importance for 2 preventive measures: treatment of sick animals (p = 0.019) and not feeding raw meat to pets (p = 0.008). The results are shown in Table 5.

Concern about zoonotic diseases
When their animals become ill, 55.7% (n = 236) of the participants declared being concerned about the possibility of their pets transmitting diseases to themselves or to any member of the family. Those who answered affirmatively were asked to give a level of concern and the majority admitted being concerned (level 2; 49.2%; n = 116), followed by the owners who answered being just a little concerned (level 1; 22.9%; n = 54), very concerned (level 3; 19.1%; n = 45) and extremely concerned (level 4; 8.9%; n = 21).

Acquired diseases by pets and pet owners
Owners were questioned whether their pets have ever had a disease that could be transmitted to humans. According to the results, few animals contracted zoonotic diseases (4.0%; n = 17); 26.4% (n = 112) of the participants answered not knowing, and the majority (69.6%; n = 295) responded that their animals never had such diseases. Those who answered affirmatively declared their animals suffered from: dermatophytosis (n = 11), scabies (n = 2), babesiosis (n = 1), leishmaniasis (n = 1), leptospirosis (n = 1) and parasitism (n = 1).

Access to information
In this study, 87.0% (n = 369) of the respondents would like to obtain more information about zoonotic diseases, however 7.5% (n = 32) had no opinion.

The role of veterinarians
In this study, 96.9% (n = 411) of the participants considered important the role of veterinarians in protecting public health, although 3.1% (n = 13) had no opinion. No participant responded negatively.
Those who answered affirmatively were asked to assign a level of importance in which 1 represented minimum importance and 4 the maximum importance. More than half of the respondents (56.6%; n = 240) attributed the maximum level of importance. For 32.1% (n = 136), the role of veterinarians is very important (level 3), followed by the owners who attributed them some importance (level 2; 7.5%; n = 32) and minimum importance (level 1; 0.7%; n = 3). Female owners assigned the highest score values (p = 0.005).

Differences in the gender of pet owners relative to the importance attributed to different questions
Regarding the mean score, the t-test revealed that female pet owners attributed a higher value to the importance of pets in family (t = 2.103; p = 0.036). The same scenario was seen in relation to the role of veterinarians in protecting public health (t = 3.94; p = 0.000). Table 6 shows the differences between the gender of the pet owners and the importance each one attributed to different questions. Table 6. Differences in the gender of pet owners in relation to the level of importance given to different questions (n = 424).

Discussion
This study aimed to characterize household knowledge, attitudes and practices related to pet ownership in the North of Portugal.
Despite the considerable increase of households with pets, the close interaction of animals with household members and the growing recognition of the potential benefits and risks pets posed, few studies have addressed this topic [16,[25][26][27][28], and none of them have been conducted in Portugal. Although limited by a small sample of the Portuguese pet owners, this study can be a useful tool to enlighten veterinarians, physicians, politicians, and other professionals as well as the general public about pet owners' knowledge and practices.
The animal ownership patterns observed were consistent with the FEDIAF report about Portugal, with most respondents having dogs, followed by cats and birds. Most of the participants considered their animals an important part of the family and they believed that benefits of pet ownership outweigh disease risks. Indeed, several studies have reported cardiovascular benefits [29], especially in the elderly hypertensive and diabetic population [30][31][32][33][34]. Pet ownership during pregnancy, in the first year of life and childhood seem to prevent the development of food allergy [35] and reduce the risk of wheezing (associated with cat ownership) [11], atopic asthma and aeroallergen sensitization (grass, house dust mite, cat and dog allergens) [10,[36][37][38]. Dogs also increase opportunities for recreational walking, reducing the risk of obesity [39][40][41][42][43].
Pet ownership or just being in contact with animals seem to provide social support, reduce distress and anxiety and decrease loneliness and depression [6], especially among older individuals [44], children [45,46] and adolescents with autism spectrum disorder [47], immunocompromised individuals [48] and homeless people [49].
It is crucial to emphasize that few studies have ascertained the level of knowledge by pet owners about zoonoses and their prevention [16,25,28,50], and some of them have only focused on dog-associated zoonoses or zoonoses associated with endoparasites [51][52][53][54][55]. In addition, there are even fewer studies on this topic that address new companion animals (reptiles and small mammals) [56].
Pet owners, for the most part, were comfortable with their level of knowledge about zoonotic diseases, although 40.8% admitted not having knowledge. To assess zoonotic disease knowledge, respondents were asked about the definition of zoonoses.
Interestingly, most respondents did not know the word or its definition. However, they considered animals as a potential source of diseases. This finding is in line with that of other studies, which reported the lack of knowledge of pet owners and/or general public [16,28,51,54]. Moreover, since a considerable part of the surveyed pet owners were comfortable with their knowledge, they are unlikely to seek information about the topic.
Pet owners who claimed to know de term "zoonoses" were asked for examples.
Rabies was the most frequent zoonotic disease reported, and the same result has been previously stated in other studies around the world [16,25,26]. Portugal is a country officially rabies free since 1961, and vaccination of dogs against the disease is mandatory [57]. Perhaps this is one of the reasons for the greater knowledge of owners about this disease compared with others more common in the country, as salmonellosis, dermatophytosis or scabies.
Brucellosis was the second most reported zoonotic disease. In Portugal, brucellosis is a mandatory notifiable disease [58] that mainly affects cattle and small ruminants [59,60]. However, the situation has been improving in recent years due to eradication programs adapted to the current needs of each region. These programs are based on herd screening and classification, outbreak detection, animal movement control and sanitary slaughter of positive animals. Through the implementation of these measures, it has been possible to reduce the incidence of the disease in cattle and in small ruminants [57]. According to Ribeiro et al. [60], there has also been a decrease in notified cases of human brucellosis over the years, with higher number of reported cases in the North, mainly in men aged between 45 and 54 years.
There were statistically significant differences regarding the gender of the participants who referred toxoplasmosis as an example of zoonoses. In fact, only one man mentioned this zoonosis, which may suggest that women are more aware of this disease, perhaps because they are informed that childbearing women constitute a risk group. However, given the small sample and the type of questionnaire performed, it is not possible to conclude such assumption. Gargaté [16,26,28,[64][65][66]. Pet owners indicated that veterinarians only discuss this issue when asked or whenever zoonoses had been diagnosed in pets [65]. In this study, most of the respondents considered important the role of veterinarians in protecting public health. Interestingly, the majority would like to obtain information about zoonotic diseases through the media. Veterinarians were the second most chosen category. Although the difference between them is not significant, it might be prudent to rethink the way in which information is transmitted. Providing client educational materials on zoonotic diseases could be interesting [67], as well as reliable resources online [68]. Nevertheless, veterinarians will always play a central role in the promotion of pet owners' education about zoonotic diseases [24].
Findings of this study are consistent with those of others regarding the role of physicians in transmitting information about zoonoses. In fact, the limited involvement of physicians in asking about the detention of pets by their patients, advising on protective measures and discussing potential zoonotic diseases has been described [16,24,28,66,[69][70][71]. This is problematic since animal contact frequently occurred in both pet and non-pet owning households, so individuals without pets but with animal contact will likely not consult a veterinarian. Moreover, veterinarians are often unaware of the health status of the pet owners and their household members [16,67]. Therefore, physicians are the most suitable health professionals to advise and inform patients on their household zoonotic disease risks [16]. Nevertheless, veterinarians should discreetly question their clients to ascertain whether they or other household members are especially vulnerable because of pregnancy, age or immunosuppression and counsel them about appropriate precautions [28].
The One Health concept is in vogue. It is essential that the veterinary and human fields join efforts to bridge the communication and information gaps that have been reported over the years [24]. These failures are felt not only among physician/patient and veterinarian/pet owner, but also among professionals in both areas. The gap between the two professions begins even during their early professional education and training [24,72], since medical and veterinary students are rarely provided with opportunities for inter-professional learning and collaboration [73]. The One Health concept foresees using their knowledge and skills to enhance clinical management of zoonoses in humans and animals, which will ultimately benefit human, animal and environmental health [24,72,73].
The growing importance of pets, especially in industrialized countries, has led to increasingly close contact with their owners [74]. Some studies have shown that between 13% and 63% of owners allowed their pets to sleep on their bed and 40% to 60% of pets were allowed to lick their owner's face [9,28,50,51,54,[74][75][76]. The results of the present study are consistent with those mentioned above. Zoonotic infections acquired by sleeping with a pet or by being licked on the face are uncommon. However, these behaviors can increase pet-associated disease risks.
Bacterial infections, such as Yersinia pestis (plague's agent), Bartonella henselae (cat scratch disease), Methicillin-resistant Staphylococcus aureus [74] and a few cases of fatal bite wound infections by Capnocytophaga canimorsus [77] and Pasteurella multocida [78] have been documented. It has also been reported zoonotic transmission through this route for other pathogens as gastric Helicobacter spp. [79] and periodontal pathogens [80].
Besides the risk factors mentioned above, more than 70% of the respondents admitted that their pets had free access to the interior of the house, and they could roam indoors. Some participants reported household husbandry practices that increase zoonotic disease risk, such as allowing their pets to eat or lick their dishes; washing pet food containers with other dishes; allowing their pets to be in contact with potentially disease-carrying animals. Other studies reported these practices, but also high-risk habits, such as feed their animals with raw meat, eggs and animal product treats; wash their pets in the kitchen sink; remove pet's feces from the garden/backyard/litter box weekly or less often [50,68,81]. In Portugal, 10.1% of pets are fed homemade or with alternative diets, which are often nutritionally unbalance [68]. Furthermore, raw animal products in pet diets are a well-established risk factor for salmonellosis in dogs [50,[81][82][83], cats [83][84][85] and humans. Although human salmonellosis results mostly from handling or consuming contaminated food products, it can occur due to contact with companion animals, natural pet treats and biological waste from pets consuming raw diets [82,[86][87][88]. Moreover, reports of raw meat pet food containing other zoonotic foodborne bacteria as Escherichia coli and Listeria monocytogenes are increasing [88,89]. Pet owners can reduce this public health risk by not feeding natural pet treats and raw food diets to their pets [87,88]. It should also be noted that reptiles are becoming increasingly popular as pets and they are reservoirs of a wide variety of Salmonella serotypes [56]. High prevalence of Salmonella shedding by healthy reptiles and high incidence of human salmonellosis attributed to contact with reptiles have been described, especially among children younger than 5 years old [56,[90][91][92][93][94]. Therefore, safe reptile handling recommendations must be conveyed to pet owners by physicians, veterinarians, public health professionals and industry officials through conversations, educational materials and interventions [50,56,92].
Overall, more than 90% of the respondents took their pets to the veterinarian, with the most common reasons being for vaccination, antiparasitic preventive treatment or health-issues. The same scenario was reported in other studies [3,50,68,95,96]. It is worthy to note that this study did not explore the association between demographics, animal's characteristics, and socioeconomic factors.  [53] assumed that this difference may be due to the population sampled or possible bias caused by face-to-face survey.
However, the present study was based on face-to-face questionnaire and the same result was not obtained.
Pet-human contact is frequent, but the occurrence of pet-associated disease is low overall [16]. For most people, such contact does not translate into a high health risk situation [50]. However, there are more vulnerable individuals, who can get ill after infection, such as immunocompromised people (HIV/AIDS patients; people subjected to transplants; oncology patients receiving chemotherapy; post-splenectomy patients; chronically ill people, such as diabetes patients), children (< 5years), elderly people (> 65years) and pregnant women [9,28]. Additionally, they may have more severe complications and symptoms with longer duration [50]. In this study, the presence of high-risk individuals in the households was not determined. It was only intended to assess the participants' perception of the existence of high-risk groups. Although most respondents considered that there are people more vulnerable regarding zoonotic diseases, it is alarming that, for each risk group presented, 30-40% of respondents did not consider them more likely to develop severe clinical condition after infection.
This result is in line with the lack of knowledge found about zoonoses in this study and others [16,50,97].
Younger children are recognized by their hand-to-mouth behavior. Additionally, children and people with some developmental disabilities are more prone to poor hygiene care or higher risk contact with animals, which make them particularly exposed to infection [9,97,98]. There are also situations where risk groups intersect, such as children with cancer or children with diabetes. A study developed by Stull et al. [97] reported that most households with immunocompromised children or children with diabetes acquired a new pet considered high-risk for infectious disease (reptiles or amphibians, rodents and exotic species). Moreover, interactions between parents and physicians/staff members about pet ownership or zoonotic disease information were generally uncommon [97]. It is supposed that households with higher risk individuals are aware of pet-associated diseases. Overall, medical staff, but also veterinarians, must guide patients/clients in pet selection, preventive measures (such as hand hygiene) and changes in animal contact to reduce health risks [97].
When questioned about the possibility of disease transmission from animals to humans, more than half (64.6%) of the pet owners in the present study answered affirmatively. However, given a list of possible pathways of transmission, it was found that participants rarely chose all options, which proves some lack of knowledge on the topic. It was encouraging to note that most of the respondents were aware that feces, arthropods and blood were important means for transmitting zoonotic diseases.
Nonetheless, it was worrying to realize that only less than half were conscious about physical contact (scratches and bites), food route (raw meat, raw eggs, etc.) and fur as potential transmission pathways. It was mentioned above how raw meat and close physical contact between owners and pets (sleeping with pets, allowing pets to lick the face or wounds, bite accidents, scratches) impose animal and public health risks.
In relation to fur, both dogs and cats regularly lick the anus and thereafter the fur, increasing the odds of Enterobacteriaceae on their fur or footpads [9]. The prevalence of infectious embryonated eggs of Toxocara spp. on dog's fur is low, however it should not be neglected [99]. A survey conducted to Overgaauw et al. [76] reported that in 12% and 3% of investigated dogs and cats, respectively, Toxocara eggs were found in fur, but not in feces. These results prove that the presence of eggs in fur is not always due to self-contamination. The significantly higher prevalence in dogs compared to cats may be due to their behavior: dogs tend to have greater soil contact (rolling around in the grass, digging, etc.), while cats have extreme grooming habits that lead to the removal of possible existing eggs [76].
Contrarily to Steele and Mor [28] , which reported that 63 Some studies [16,28,50,51,54,97] reported practices performed by participants to reduce the risk of infection and spread of zoonotic diseases. However, in the present study, the respondents were not asked about their actions towards the goal mentioned above, but about the importance they attributed to each measure, so a direct comparison of the results is not feasible. Nonetheless, the importance of hand washing was unanimous.
The aim of this study was to gather information on pet owners from the North of Portugal. The survey was conducted with a convenience sample and estimated proportions may not be representative of all pet owners from the North of Portugal.
The higher response proportion by females most likely relates to their willingness to participate in paper-and-pencil surveys [100].
In retrospect, the present study could have had questions about the existence of high-risk individuals in the households in order to understand whether this condition Knowledge and practices may vary by species owned. However, since cats and dogs were owned by most of the pet owners (97.6%) and other species were seldom reported, the potential bias was minimal.

Conclusions
This study revealed lack of knowledge and understanding of zoonoses among cross-sectional studies should be developed to frequently update the progress made.
All the measures mentioned above are efforts that must be taken to disseminate knowledge and, consequently, reduce public's pet-associated disease risks.

Author Contributions
BV, ACC and LC participated in the study concept, design and questionnaire development. BV administered questionnaires to participants. BV and ACC were responsible for data analysis and data interpretation. BV performed the literature research and wrote the manuscript. APL, MCF and MS critically reviewed the manuscript. LC and ACC supervised and critically reviewed the manuscript. All authors read and approved the final manuscript.

Funding
This work was funded by the project UIDB/CVT/00772/2020 supported by the Portuguese Science and Technology Foundation (FCT).

Institutional Review Board Statement
The study received ethical approval from the Ethics Commission of University of Trás-os-Montes e Alto Douro (No. Doc55-CE-2019).

Informed Consent Statement
All the participants signed a written informed consent form.