From the Director s Desk

Transcription

1 Shelter Watch Our Mission: We are committed to saving lives and reducing suffering of homeless dogs and cats through education, advancement of knowledge and shelter outreach. Program Staff: Dr. Jan Scarlett, Program Director Dr. Elizabeth Berliner, Director of Clinical Programs Ms. Kelley Bollen, MS, CABC, Behavior Consultant Ms. Kelly Garner, MA, Program Coordinator Ms. Sue Honig, MS, Computer Technician Shelter Medicine Interns: Dr. Erin Henry Dr. Natalie Lowry Contact Information: Shelter Medicine Program Cornell University College of Veterinary Medicine S1-066 Schurman Hall Ithaca NY (607) Volume 2, Issue 8 From the Director s Desk Greetings after a month s break! It is has been a great summer here in the Northeast, and I hope that everyone is enjoying their summer months. August 6, 2012 Although we see kennel cough any time of year, it is often more common during the warm months in the Northeast (which is why we have devoted this Shelter Watch issue to the topic). The term kennel cough is an old name that describes the place where dogs are most likely to contract the disease, and dogs kenneled in animal shelters, boarding kennels, research facilities, daycare centers and with rescue groups are at high risk. This disease is really not one disease at all. The clinical signs are more appropriately called Canine Infectious Respiratory Disease Complex (CIRDC). It can be caused by a host of agents that include Bordetella bronchiseptica, canine adenovirus 2, canine parainfluenza, canine distemper virus, newcomers such as canine influenza, and probably other agents (e.g., canine respiratory coronavirus, pneumovirus) that circulate in dog populations. Mycoplasma and other bacterial species can also be present. These agents cause similar signs (e.g., cough, runny eyes, runny nose) and therefore, are often lumped under one name. It is impossible to accurately identify which agent or agents are causing disease in any given dog or outbreak without further diagnostic workup. Shelters usually treat the signs without understanding the exact cause (or causes), and that works well most of the time. If the disease becomes widespread in the shelter or more severe, however, that should raise suspicion that something unusual to your shelter (e.g., canine distemper, influenza) is happening. These are the scenarios where further diagnostic efforts at the outset may save the shelter much angst, and minimize suffering in the dog population. Most kennel cough cases or outbreaks are caused by relatively mild bugs that are self-limiting and non fatal, but vigilance is advised for more severe situations. The challenge for shelters is to prevent outbreaks or to break the cycle that keeps some shelters persistent reservoirs of this disease complex. Vaccination immediately at entry is one tool, along with the usual biosecurity measures of good cleaning and disinfection, fomite control, isolation of affected dogs, separation of puppies and adult dogs, good traffic patterns and so forth. In some outbreaks, collection of samples from sick and apparently unaffected dogs will be necessary to identify the cause(s) and institute measures (e.g., separating dogs into different groups by risk) to bring the outbreak under control. Depopulation is almost never necessary if appropriate protocols are adopted! So, while you will undoubtedly experience outbreaks now and again, vigilance and adherence to good preventive protocols will help insure that these occurrences are rare and relatively mild. Jan M. Scarlett, DVM, Ph.D.

2 Page 2 Shelter Watch When It s Not Just Kennel Cough : Early Diagnostics Can be Life Saving: Dr. Erin Henry Using diagnostics allows you to determine the best course of action for treating and controlling the spread of disease throughout the shelter population. In general, canine kennel cough is treated based on physical examination findings and clinical signs, without a need to determine the causative agent. But what happens when your usual treatment protocol just doesn t seem to be cutting it? What if your morbidity and mortality rates are much higher than normal? This may mean that you need to know what pathogens you re up against, and diagnostics can help! One of the most important steps that can be taken in the case of a severe kennel cough outbreak is to determine whether your increase in severity is due to infection with a more serious pathogen, or a mixed infection with the more common pathogens. Respiratory distemper virus (CDV), canine influenza (CIV), and Streptococcus zooepidemicus are all typically refractory to standard treatment protocols, and tend to have a higher mortality rate than the other causes of upper respiratory infection. Two of the most common diagnostic tests that are performed are PCR and bacterial culture. Since each infectious agent has its own DNA fingerprint, a PCR test uses amplification of the DNA found in a sample to determine what fingerprint it has. For bacterial organisms that grow quickly, a culture can be performed to try and grow the infectious agent in an external environment for identification. Canine Distemper Virus (CDV) Canine distemper can be very difficult to diagnose in a live animal. However, testing should be considered in animals that have been refractory to standard treatment protocols and develop concurrent gastrointestinal disease (diarrhea and vomiting). PCR is the test of choice, as well as serology screening in which a blood sample is taken to determine the levels of certain antibodies present, which could indicate infection. It is important to note that a negative result in one animal does not rule out distemper! Canine Influenza Virus (CIV) Canine influenza is an emerging disease in the shelter environment and, as discussed earlier, is generally refractory to the standard treatment protocol for kennel cough. CIV often presents similarly to kennel cough; however a dramatic increase in severity of clinical signs, rapid spread through your population, and nonresponse to treatment should raise concerns and indicate a need for testing. PCR is the test of choice for diagnosis of CIV early on in its disease course; however infection with CIV should be confirmed using antibody titer testing of samples collected two weeks apart (an acute and a convalescent titer). Active infection with canine influenza will show at least a 4-fold difference in titer levels. Streptococcus zooepidemicus Streptococcus zooepidemicus, or Strep zoo, is an emerging pathogen that has high morbidity and mortality rates. Testing for this pathogen should be considered in the case of a kennel cough that is characterized by a dramatic worsening of clinical signs in a very short period (typically hours), fever, difficulty breathing and progression to a bloody nasal discharge and even death; vomiting blood is commonly present as well. Therefore it is best to test potentially exposed animals (any animals that have been in contact with the sick animal) and even start prophylactic treatment quickly due to the rapid nature of disease progression. Currently the testing method of choice is bacterial culture. When submitting a culture for Strep zoo, it is important to specify what you are testing for and antibiotic sensitivity should be requested. It is also recommended that a PCR test should be submitted as well. Diagnostics for typical Kennel Cough pathogens While the morbidity of infections with these pathogens is high, the mortality is generally low. If you are experiencing an outbreak of kennel cough that seems much more severe, but the big three, previously discussed, are not present, it could be a mixed infection involving multiple typical kennel cough pathogens. PCR is the test of choice for all of the typical viral causes of CIRDC, including canine parainfluenza virus, canine adenovirus, canine herpesvirus, canine respiratory coronavirus. It is also the test of choice for Mycoplasma (a bacterial cause). In order to test for Bordetella bronchiseptica, PCR or bacterial culture can be performed.

3 Volume 2, Issue 8 Page 3 Final thoughts In conclusion, along with helping to guide treatment of the disease process, using diagnostics allows you to determine the best course of action for controlling the spread of disease throughout the shelter population. By knowing the causative agent you can determine how long a sick or recovered animal will be shedding the disease, and therefore how long they should be separated from the susceptible population. So, when it seems like you ve got a case of kennel cough that just won t quit, make sure to do some diagnostics so you know what you re fighting against! Resources for available tests and sample collection guidelines: Risk Factors for Canine Infectious Diseases Complex: Dr. Elizabeth Berliner We spend a lot of time talking about infectious agents involved in respiratory disease in both dogs and cats. And certainly controlling transmission of these agents is important in a shelter. However, it is equally important to realize how the health and well-being of the host animal (ie. dog) and the shelter environment contribute to the risk of any particular animal acquiring disease. Host Risk Factors Exposure: Dogs in contact with high numbers of other dogs are at increased risk for respiratory disease. Such settings include boarding facilities, dog shows, dog parks, and of course, animal shelters. Densely housed dogs in a shelter are obviously at higher risk of infection. Immune Status: when we talk about the immune system, we talk about innate immunity and adaptive immunity; animals use both to combat disease. Innate immunity consists of the body s natural barriers to infection, including skin, mucus membranes, and specialized white blood cells that survey for invading organisms and act quickly to minimize infection. Adaptive immunity is primarily composed of antibodies manufactured by the animal s immune system to address specific agents in response to either a natural exposure to the disease, or a vaccination. In order for an animal to have a protective immune response, it needs to be beyond 4 months of age in most cases. Innate immunity develops with low-level exposure to pathogens in the world, and adaptive immunity develops in response to vaccination or previous disease. Any single animal s ability to mount an immune response depends on health, history, and age. Some of these can be affected by shelters; in other cases, such as age, the risk factor needs to be taken into account in management of that animal in the shelter. Stress: Physiological stress negatively impacts an animal s ability to mount an immune response. Stress results in high levels of cortisol, a key hormone in the body s stress response. This hormone decreases the body s ability to fight an infection. Stress can also decrease an animal s nutritional intake, which negatively impacts overall health and immunity. Furthermore, it can bring on other illnesses, such as diarrhea and vomiting, which further contribute to a negative health status and increased susceptibility to respiratory agents. Environmental and behavioral enrichment for all animals but especially for those under obvious or greater stress is vital to decreasing disease incidence. Environmental Risk Factors The shelter environment plays a great role in assessing risk factors for canine infectious respiratory disease complex. Overcrowding, poor ventilation, failure to create or implement appropriate cleaning protocols, and/or acceptance of upper respiratory disease as a normal component of sheltering all play a role in the risk of disease at both the population and individual levels. Many shelters struggle with antiquated facilities, inappropriate air quality, overcrowding, and disease transmission, but addressing some of these elements with protocols, enrichment, and re-organization can go a long way towards decreasing risk and the incidence of disease. So, in conclusion, remember that although we talk a lot about individual agents causing respiratory disease in our dogs and cats, treatment is only a small part of addressing this disease in a shelter. Shelter veterinarians and staff should be focused on the other components of keeping animals healthy the environment, and preventive care and be proactive in preventing disease whenever and wherever possible. Strep Zoo Haiku: Sniff, cough, sudden death Strep. zooepidemicus bloody hell, darn horse. Dr. E. Berliner

4 Page 4 Shelter Watch Differentials for Canine Infectious Respiratory Disease Complex (CIRDC): Dr. Natalie Lowry While it is possible that CIRDC can be caused by a single infectious agent, mixed infections are likely more common. While it is possible that CIRDC can be caused by a single infectious agent, mixed infections are likely more common. Many pathogens are commonly associated with CIRDC: Canine adenovirus type 2: CAV2 is a DNA virus closely related to canine infectious hepatitis virus (CAV1). CAV2 may be the sole causative agent of CIRDC, or it may be one of several. Usually associated with a self-limiting upper respiratory tract (URT) infection characterized by a mild/ moderate cough, CAV2 can also invade the lungs alveolar cells, resulting in pneumonia. Canine parainfluenza virus: CPiV is an RNA virus, most commonly associated with URT infections. If the sole pathogen, clinical signs include a characteristically high-pitched, honking cough of short duration (<6 days), secondary to laryngeal swelling. Conjunctivitis and/or serous nasal discharge are also possible. Damage to respiratory surface tissue increases likelihood of secondary pathogen involvement. Bordetella bronchiseptica: B.b is a gram negative, aerobic bacterium often associated with CIRDC, but is also isolated from healthy animals, suggestive of a carrier state. Clinical signs associated with B.b include rhinitis, mucoid nasal discharge, and mild-severe cough. Paralysis of the mucociliary apparatus prevents clearance of inhalants, again increasing the likelihood of secondary pathogen invasion. Mycoplasma spp: Unique microbes similar to but distinct from bacteria, Mycoplasma can also be isolated from the respiratory tracts of healthy animals. Because Mycoplasma can colonize all respiratory tissue surfaces, clinical signs can include pus-producing URT infection, as well as lower respiratory tract (LRT) pneumonia. Streptococcus equi sp. zooepidemicus: Strep. zoo is a gram positive bacterium recently associated with CIRDC in the USA and Europe, and has been associated with hemorrhagic pneumonia. Canine distemper virus: CDV is an RNA virus capable of causing URT and/or LRT clinical signs. CDV can also cause systemic signs, including GI and neurologic disturbance. If a shelter s CIRDC has become associated with increased systemic signs and/or mortality, CDV may be involved. Canine influenza virus: CIV is an RNA virus which has recently spread from horses to dogs. Infection may be characterized URT and/or LRT signs, such as fever, nasal discharge, coughing, productive bronchopneumonia, pulmonary hemorrhage, and death. Because CIV is a relatively new pathogen, all dogs are considered vulnerable to infection, regardless of vaccination status. Canine respiratory coronavirus: CRCoV is an RNA virus, more commonly associated with gastrointestinal (GI) infection. While CRCoV has been isolated from some dogs affected with CIRDC, more research is needed to assess its role in CIRDC infections. Canine herpes virus: CHV is a DNA virus more commonly associated with sudden death in newborn puppies. Like CRCoV, it has been associated with CIRDC, but more research is needed. Obviously, it is unnecessary for a shelter to perform diagnostics on every animal that develops URT in the shelter, but a higher occurrence of disease, increase in severity, or a change in clinical signs can be a good reason to pursue diagnostic testing. In most cases, testing will reveal multiple organisms, but this can help to target treatment, management, and control. For more information, see Canine Kennel Cough Complex in Infectious Disease Management in Animal Shelters by Drs. Lila Miller and Kate Hurley.

5 Volume 2, Issue 8 Page 5 Differentials Chart for Canine Infectious Respiratory Disease Complex (CIRDC): Dr. Natalie Lowry

6 Page 6 Vaccination should be used in conjunction with good biosecurity measures to minimize the incidence of Canine Respiratory Disease Complex. The standard vaccination of dogs at entry with canine distemper virus, parvovirus, parainfluenza virus and adenovirus-2 in a modified live vaccine may help to provide some protection against kennel cough if your shelter has parainfluenza or adenovirus-2 circulating. Vaccination against canine distemper at entry can dramatically reduce risk for this disease, especially if litters of puppies are separated from each other and from adult dogs. Bordetella bronchiseptica (a bacteria) should also be in your core vaccination regimen against kennel cough. There are two basic types of Bordetella vaccines: those administered intranasally (IN) and those administered by the subcutaneous (SC) route. The IN vaccines are available with Bordetella alone or in combination with canine parainfluenza or with canine parainfluenza and canine adenovirus-2. The subcutaneous (or injectable) vaccine for Bordetella is a cellular antigen extract and contains only Bordetella. Since this vaccine is by definition inactivated, previously unvaccinated or unexposed dogs must receive two doses 2-4 weeks apart to become fully immunized. Because two doses of vaccine are required to achieve initial immunity and most dogs arrive with no vaccine history, the IN vaccines are recommended in animal shelters. IN vaccines are modified live, provide immunity at the very surface that natural virus enters, and take between 3-5 days to provide immunity following vaccination. They also need only be administered once to achieve initial immunity. When possible, dogs should be vaccinated 3-5 days before entering a shelter, but this approach is usually impossible; vaccination immediately upon entry is the next best approach. The literature regarding vaccination against Bordetella is sparse, particularly with regards to its performance in animal shelters. One laboratory-based study in puppies suggested that giving both an IN and an injectable vaccine sequentially was superior to vaccinating with only one or the other vaccine, but the injectable vaccine used in the study (a killed whole bacterin) is no longer available 1. Another study found an IN vaccine reduced coughing and shedding significantly more than a cellular antigen extract SC vaccine 2. In this same study, the investigators reported that the SC vaccine did not reduce coughing or shedding compared to placebo vaccinated controls. A follow-up study of the SC vaccine Shelter Watch So, What is the Best Vaccination Protocol for the Prevention of Canine Respiratory Disease Complex? Dr. Jan Scarlett is needed. The one published study of efficacy of IN vaccination for kennel cough in shelter dogs compared the efficacy of IN vaccination containing Bordetella and parainfluenza virus with and without the addition of canine adenvirus-2 3. This study failed to find a difference in the performance of these two vaccines when compared to each other and when compared to placebo. Don t interpret this to mean that IN vaccination is not effective in shelters, as the methodology of this study was flawed, and we are still awaiting a well designed field trial in animal shelters. What about canine influenza? It is probably not helpful to vaccinate for canine influenza, even in shelters where the virus is endemic. The vaccine is a killed product requiring two shots, a month apart, and by the time protective immunity develops, most dogs will probably have already become infected. Unfortunately, no studies have yet been published to verify this recommendation. To summarize, by vaccinating at entry for canine distemper, parainfluenza virus and adenovirus-2 with a modified live injectable vaccine combined with an IN vaccine for Bordetella (probably with or without parainfluenza or adenovirus-2), you can minimize the risk of kennel cough in your shelter. Since vaccination for many of the agents involved in the canine upper respiratory tract complex does not protect against infection, reliance on vaccination alone is ill advised. Rather, vaccination should be used in conjunction with good biosecurity measures to minimize the incidence of this pesky disease complex. 1 Ellis, J, Haines, D, West, K et al (2001) Effect of vaccination on experimental infection with Bordetella bronchiseptica in dogs. J of the American Veterinary Medical Association 218: Davis R, Jayappa, H., Abdelmagid, O, et al. (2007) Comparison of the mucosal immune response in dogs vaccinated with either an intranasal avirulent live culture or a subcutaneous antigen extract vaccine of Bordetella bronchiseptica. Veterinary Therapeutics 8: Edinboro, C, Ward, M, Glickman, LT. (2004) A placebo-controlled trial of two intranasal vaccines to prevent tracheobronchitis (kennel cough) in dogs entering a humane shelter. Preventive Veterinary Medicine 62:89-99.

7 Volume 2, Issue 8 Page 7 Separation Anxiety: Ms. Kelley Bollen, MA, CABC Dogs are social animals and as such are not genetically prepared to be alone. Unfortunately for dogs, living with humans often means being left behind. Most dogs handle this social isolation just fine but others can have all-out panic attacks when left alone. Separation anxiety (SA) is a very real disorder and very damaging to the dog s (and sometimes the owner s) emotional wellbeing. There is some thought that shelter dogs are more likely to develop separation anxiety than other dogs because of the loss of their first (or second or third) bond with their human family. We don t really know if this is true but we do know that dogs with separation anxiety are often surrendered to the shelter because their owners don t understand or can t tolerate the behaviors that manifest due to the dog s anxiety. Barking, destruction and inappropriate elimination are the most common signs of separation anxiety but that doesn t mean that every dog exhibiting these behaviors has SA. Some key diagnostic indicators are that these behaviors occur only when the dog is alone and that the dog is overly bonded to his/her people and follows them around like a velcro dog. Make sure to include these two SA indicator questions on your surrender profile to help determine if the dog may have SA or is just overly vocal, loves to chew or isn t completely housetrained. If a dog comes into your shelter with known separation anxiety or you suspect that this may be the case based on the surrender profile, you need to tailor your adoption counseling to include information on how to deal with this disorder. Adopters need to help their new dog learn that being alone in their home is not the end of the world. You should advise the adopter to keep their departures and arrivals as low key as possible so that there isn t a huge disparity between when they are home and when they are gone. They should leave the radio playing for company when they leave. A classical music station is the best option because research shows that classical music has a calming effect on animals. Another option is to tell your adopters about the Through A Dog s Ear calming music CD that they can purchase. You can also suggest they purchase an Adaptil (previously called DAP) pheromone collar and a Thundershirt to help calm the dog when alone. Next, you need to advise them to pair something really special like a food-filled Kong with their departure. At first they should give the Kong when they are just leaving the room and then slowly work their way out the door. They should stay outside for only a few minutes at first and as they progress through the program, for longer periods of time. This will teach the dog that good things happen when their people leave. While there are cases where the separation anxiety is so severe that these simple suggestions might not do the trick, they will help in most circumstances. Dogs with severe separation anxiety may need medication along with a behavior modification program and in these cases you should advise your adopters to seek the help of their veterinarian and a certified behavior consultant. Events Calendar August 2012 Sun Mon Tue Wed Thu Fri Sat Maddie s Community Cat Management Course U FL Maddie's Shelter Medicine Program is underwritten by a grant from Maddie's Fund, The Pet Rescue Foundation ( helping to fund the creation of a no-kill nation.