# Resident primary care practitioners’ awareness and handling of zoonotic diseases: an explorative online survey in the Hameln-Pyrmont district, Lower Saxony, Germany

## TL;DR

This study explores German primary care doctors' awareness and confidence in handling zoonotic diseases, finding that borreliosis is most recognized, but confidence in diagnosis and treatment is lower than in transmission.

## Contribution

The study provides new insights into German primary care practitioners' awareness and confidence regarding zoonoses, highlighting gaps in diagnostic and therapeutic confidence.

## Key findings

- Borreliosis was the most frequently mentioned zoonosis by primary care practitioners.
- Confidence in transmission was higher than in diagnostics and therapy for both general and self-reported zoonoses.
- About two-thirds of respondents were unaware of the term 'One Health'.

## Abstract

Primary care practitioners often are the first medical professionals to see patients with zoonoses. So far, studies on awareness and management of zoonoses in primary care have focused on specific zoonoses, most prominently Lyme disease. Additionally, (diagnostic) uncertainty vs. confidence of this group of practitioners regarding zoonoses has rarely been examined. Finally, little is known about zoonoses in primary care in Germany. This study aims to describe German resident primary care practitioners’ awareness and handling of zoonoses, and their confidence regarding diagnostics, therapy, and transmission.

A cross-sectional online survey of primary care practitioners in the Hameln-Pyrmont district, Germany, was conducted between November 6, 2022-January 5, 2023 via regional physician associations. Items on practitioners’ awareness and handling of zoonoses in practice were designed to fit the study’s aims, and explicitly excluded coronavirus disease 2019 (COVID-19). Data were analyzed descriptively and by Wilcoxon signed-rank tests and t-tests for paired samples.

N = 43 of the 88 practitioners in the district took the survey (response rate: 48.9%). Zoonoses were seen as more relevant than for the time period before COVID-19 (p < 0.001). Among the up to three zoonoses respondents could mention to occur in practice, borreliosis (21 of 98 mentions overall), salmonellosis (10) and toxoplasmosis (7) were named most often. Practitioners’ confidence ratings on diagnostics, therapy, and transmission of zoonoses were higher for self-reported zoonoses than for zoonoses in general (with few exceptions, differences were statistically significant: p ≤ 0.030). Confidence was higher for transmission than for diagnostics and therapy for self-mentioned zoonoses and zoonoses in general (p ≤ 0.012). Ratings for diagnostics and therapy did not show statistical significance. Almost two thirds of the respondents (64.7%) did not know the term “One Health”.

Borreliosis appears to be the zoonosis with the highest level of attention in primary care. Results on confidence regarding diagnostics and therapy indicate capacities in terms of relatively high confidence regarding salient zoonoses, and room for improvement signified by the lower confidence regarding diagnostics and therapy than transmission. Awareness of uncertainties regarding zoonoses in primary care may trigger continuing medical education, cooperation between medical doctors and veterinarians, and One Health implementation.

The online version contains supplementary material available at 10.1186/s12875-025-02918-7.