infectious respiratory disease of dogs & cats€¦ · american animal shelters • upper...
TRANSCRIPT
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Maddie’s Shelter Medicine Fellowship Program A partnership between University of Wisconsin Shelter Medicine and UC Davis Koret Shelter Medicine
programs
Infectious Respiratory Disease of Dogs & Cats
Dr. Brenda Dines, Maddie’s Shelter Medicine Resident, University of Wisconsin Shelter Medicine Program, [email protected]
Dr. Kimberly Wilson, UW/UCD Shelter Medicine Eslinger Fellow and Shelter Veterinarian, Kern County Animal Services
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Objectives
Identify components (virus, bacteria, stress, fomites) involved in respiratory disease in shelters with a primary focus on cats and dogs
1Recognize components that increase the likelihood of outbreaks and/or respiratory disease in shelters
2Discuss response to disease (diagnostics + treatment)
3Formulate methods to decrease/contain disease
4
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Reasons for respiratory disease in shelters
•Prevention vs. Decreased Clinical Signs
•Delay for onset of protection
•Cross Contamination•Inadequate disinfectants•Inadequate housing
•Lack of isolation•Cross contamination•Avoidable introduction•Unavoidable introduction•Inadequate housing•LOS (exposure)
•LOS•Capacity for care•Overcrowding•Movement•Inadequate housing•Lack of enrichment
Stress Contagious Diseases
Vaccines Sanitation
Issues
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Canine Infectious Respiratory Disease Complex (CIRDC)
u Viral
u Parainfluenza
u Influenza
u Distemper
u Adenovirus Type 2
u Respiratory corona
u Herpes
u Pneumovirus
u Bacterial
u Bordetella
u Mycoplasma
u Strep Zoo
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Feline Upper Respiratory Infection (URI)
u Viral
u Herpes
u Calici
u Influenza
u Bacterial
u Mycoplasma
u Bordetella
u Chlamydia
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What do we accept, not expect?
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What matters most?
u The basics
u Vaccination
u Decreased stress
u Sanitation
u Identification
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Cage size, movement in and out of housing during daily care, and other environmental and population health risk factors for feline
upper respiratory disease in nine North American animal shelters
• Upper respiratory infection (URI) is not an inevitable consequence of sheltering homeless cats. This study documents variation in risk of URI between nine North American shelters; determines whether this reflects variation in pathogen frequency on intake or differences in transmission and expression of disease; and identifies modifiable environmental and group health factors linked to risk for URI. This study demonstrated that although periodic introduction of pathogens into shelter populations may be inevitable, disease resulting from those pathogens is not. Housing and care of cats, particularly during their first week of stay in an animal shelter environment, significantly affects the rate of upper respiratory infection.
Wagner, Denae C; Kass, Philip H; Hurley, Kate F. PLoS One; San Francisco Vol. 13, Iss. 1, (Jan 2018): e0190140.
“Cage floor space of >8 sq ft was associated with significantly lower rates of URI compared to either cage floor space of < 6 sqft or floor space between 6–8 sq ft”
“Movement of cats in and out of the cage or between cages < 2 times in the first 7 days in the shelter was also significantly associated with lower risk of URI compared to more frequent movement. Change of housing has been associated with stress and activation of feline herpesvirus”
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Decrease stress
u Enrichment
u Playgroups
u Even for sick animals
u In-cage stimuli
u Decrease LOS
u Open selection
u Open adoptions
u C4C
u Limit crowding
u Managed admissions
u C4C
u Limit movement
u Open selection
u Housing
u Double Sided
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Sanitation
• Removal of organic debris• Detergent • Disinfectant
Steps in the sanitation process
• Contact time • Concentration • Toxicity
Consider
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Efficacy & Efficiency
u Adequate cleaning process
u Right chemical, right contact time
u Less stress
u Spot-Cleaning
u Less fomites concerns
u Less stress
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“None of the disinfectants that were tested completely inactivated feline calicivirus. Canine parvovirus was not inactivated significantly by any of the QAC disinfectants.”
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Vaccination
What are they giving
When were they given• Were they given again
What route
Storage
Make up
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Some tidbits about vaccines
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Isolation
• How important for cats vs dogs?
• It is NOT all or nothing– Cleaning order
• Weighing pros and cons
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Isolation
• What if we do not have separate areas to house sick animals? – Foster– “Line in the sand” – Designated walking
patterns
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Diagnostics
• Increase in number of animals sick• Increase in severity of animals sick• Typical presentation of a disease of concern • Not responding to treatment
When?
• PCR • Titers• Necropsy• Rarely a culture
How?
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Interpreting PCR
u Sometimes tricky!
u Want a quantitative answer, not a qualitative answer
u Why?
u Keep in mind what the number means
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Story of ‘bama
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Not Black & White
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More about PCR interpretation
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Titers
Help in a risk assessment
Those exposed might already be protected
Can be done on site or sent out
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Treatment
u Is more than just antibiotics
u Supportive care
u Sometimes antivirals
u Sometimes monitoring & benign neglect
u Increased surveillance
u Isolation
u Most relevant in sick dogs
u Take a step back
u More animals sick than usual? More severe clinical signs? Not responding to usual treatment protocols?
u Is there a change?
u Overcrowding
u Increased LOS
u Vaccine protocols
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Moving on to the most interesting & inspiring part
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How to Reduce the Spread of URI
in the ShelterDistemper Outbreak Case Study
Kimberly Wilson DVM
Kern County Animal Services
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Kern County Animal Services
•Kern County is the 3rd largest county in CA
•Population 885,000
•22.7% Poverty Rate
•Annual intake 16,000
•Live Outcome 70%
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KCAS Distemper Outbreak Timeline
u January 2018 single dog tested positive at destination shelteru Titers pulled on exposed dogs, 11 titer-neg dogs quarantined for 5 wks.
u No other positive dogs linked to this positive dog.
u February 2018 through July 2018 u Sporadic cases in the community and the shelter
u Rumors of other shelters in the area with problems
u August 2018 – increased suspicion for distemper in the shelter
u September 2018- Started testing dogs for distemper
u October 2018 until now –continued testing
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Increased suspicion…
u Noticed an increase in overall URI
u Noticed an increase in the
severity of URI
u Feedback from the community
u Adopters, rescues, veterinarians
u Intake of distemper suspect animals.
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What we did
u Testing!u Started with dogs which were sick
or had previously been sick or treated foruNasal or ocular discharge
uCoughing or sneezing
uDiarrhea
u Results were surprisinguMany positive dogs were not sick
uMajority of positive dogs only mild URI
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Distemper Testing
uDistemper PCR testing revealeduSeptember 49 positives 17 wk positives 66
uOctober 28 positives 16 wk positives 44
uNovember 7 positives 3 wk positives 10
uDecember 0 positives
uJanuary 2019 0 positives
uFebruary 6 positives (1 PTS on intake, 5 rescue pulls)
uMarch 4 positives (rescue pulls)
uApril 1 positive (Sick on intake)
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Distemper Outbreak Management Options
u Depopulate (Historically done, not recommended)u 257 dogs at shelter at the time of diagnosis
u Evidence of repeated community infection entering the shelter
u Euthanize Positive Dogs (Not recommended, many alternatives)u Euthanize Positive dogs
u Make needed changes to shelter to prevent spread
u Treat every positive Dog as an individualu Seek Rescue
u Seek Foster
u Evaluation weak positive dogs
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What to do with distemper positive dogs?
u Euthanize (Not recommended unless poor prognosis, lack of resources. There are many alternatives!)
u Foster
u Rescue
u Distemper is often treatable. u 53 distemper positive dogs entered
foster care during the outbreak.
u Survival and adoption rates were 94%
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Foster Dog Success!
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Staff Training and Education
u Lots of hysteria around “Distemper Outbreak”u Webinar, Officer Training, Shelter training, medical team
training
u Vaccination handlingu We need to KNOW the vaccine we give will “work”
u Disinfection and PPEu Updated protocols
u Disease Recognition and Isolation protocolsu Training
u Clear guidelines for what to do
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We have distemper, now what?
u Prompt identification of sick dogs and immediate isolation
u Ensure proper vaccines on intake
u Establish a clean break
u Immediate removal of any PCR positive dogs
u Focus on decreasing overcrowding and decreasing length of stay
u Community Education and Vaccine Events
u Open and honest with adopters and community
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Prompt ID of URI dogs and immediate isolation
u URI is spread via
u Direct
u Aerosol
u Fomite
u Environment (less likely)
u Distemper is easy to kill with disinfectants and not very stable in the environment
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Vaccination
u Immediately upon intake
u Modified live DHPP
u Proper handling of vaccinationsu Staff training and retraining
u Monitor system for temperature control of refrigerator.
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Establish a clean break
u Need to establish an area in the shelter where incoming dogs are not exposed to Distemper
u We had distemper positive dogs in every kennel of the shelter.
u Plan:
u New Intakes are place into Q kennel
u Q kennel was deep cleaned
u Strict monitoring of clean break area, increased medicine rounds and staff training for recognition of disease on intake
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Eliminate Risk factors associated with overcrowding
uCompartmentalized housing used inappropriately
uComingling of dogs on intake
uSome in- some out housing
uDogs need to be moved during
cleaning
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Changes to housing
u Double sided-housing should be used appropriatelyu Closed guillotine doorsu Appropriate cleaningu Improved welfare
u Co-mingling of dogs u If must happen, do it after 72 hours
u All in- All Out Housingu “Full” kennel signsu Co-mingling of “reservoir” dogs
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Some in- Some out Housing
u Common practice of co-mingling dogs in a single enclosure
u “revolving door” some dogs in, some dogs out
u Increases exposure to new dogs when exposed to an older dog
u Developed a system to reduce risk.
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Overcrowding
u High intake open admissions shelter
u How do we suddenly have less animals without euthanasia?
u Program development
u Home for Healing
u Rescue rejuvenation
u Focus on animals in need
u Decreased stray holding times
u Decreased Length of Stay
u Removing roadblocks
u Decreased stray holds
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Focus on decreasing length of stay
u Open Selection u Opened holding kennel for “pre-selection”u Streamlined adoption process for adoption
interest.
u fast-trackingu Puppies and other highly adoptable dogsu Priority on surgery schedule, surgery before hold is
up?u Place in high traffic area of shelter to increase
exposure.
u decreasing stray holding timesu Working with county council to change hold timesu OSR available for immediate adoption
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Forming a Community Bond
u Veterinary Community
u You are the expert!
u Community Education and Vaccine Events
u Offered free DHPP vaccines to community
u Secured Grant money and organized free clinics in at-risk areas.
u Friends of Kern County Shelters and Jason Heigl foundation
u Complied data from both city and county shelters and organized free vaccines in the targeted areas.
u Press releases and media push to remind the public to vaccinate their dogs.
u Open and honest with adopters and community
u Press Release
u Adoption disclosure and conversations
u Rescue letters and training, webinar, etc.
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Trudy A#1093529
u Intake Date 10/08/2018
u 10/12/2018 Parvo Positive
u 10/17/2018 Parvo tx completed moved to I kennel
u Doxy added for URI
u 10/21/2018 Vet Listed URI, samples collected
u 10/24/2018 Dog entered Foster Care System
u 11/7/2018 IVF initiated
u 11/9/2018 feeding tube placed
u 11/7/2018-11/13/2018 hospitalized at vets home
u 11/14/2018 returned to foster with instructions
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Recovery…
• 11/26/2018 feeding tube removed
• 11/30/2018 discontinued doxy, gabapentinand tramadol
• 12/06/2018 discontinued enrofloxacin
• 1/23/2019 discontinued methocarbamol, started mexiletine
• 3-23-2019 still PCR positive, living her best life
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Words from Trudy’s Foster Family
u “Trudy is the glue. She has given purpose and companionship to all of the dogs and they helped her recovery with lots of exercise and love. Gertrude, “Trudy” is a fighter and a survivor. People love her story. She is special. She is very loving, with an independent spirit. She is also protective! She guards her yard and her family. She is tough as nails and we love her so much!” Mr. Faulkner
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Take Home Points
u Take URI Seriously
u Test when needed
u Help work towards a community solution
u Don’t wait for an outbreak to make important changes
u Outbreaks can be managed in life saving ways
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UW and UCD Shelter Medicine Programs are now accepting applications for the 2019/2020
Maddie’s Shelter Medicine Fellowship Program. Learn more and apply at:
www.uwsheltermedicine.com/news
Maddie’s Shelter Medicine Fellowship Program A partnership between University of Wisconsin Shelter Medicine and UC Davis Koret Shelter Medicine
programs
Today’s presentation slides will be made available at www.uwsheltermedicine.com/library search ‘expo’
Interested in the Maddie’s Shelter Medicine Fellowship?