INFECTIOUS DISEASES STRATEGIES TO LIMIT HOSPITALIZATION,REDUCE RISK AND ADD VALUE
Common Infectious Diseases in Shelters...–Treat for co-infections/diseases •Environment...
Transcript of Common Infectious Diseases in Shelters...–Treat for co-infections/diseases •Environment...
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Common Infectious Diseases in Shelters
Jennifer Morris, DVM
Director of Shelter Medicine
Atlanta Humane Society
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Epidemiological Triangle
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Pathogen Factors
• Virulence
• Strain
• Dose
• Method of spread
• Route of inoculation
• Carrier states
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Common Pathogens
• Canine
– CIRD• Bordetella
• Mycoplasma
• Distemper
• Adenovirus
• Parainfluenza
• Canine Flu
• Strep. zooepidemicus
– Parvovirus
– Dermatophytosis
– Sarcoptic mange
• Feline
– Upper Respiratory Infection• Feline Herpesvirus
• Calicivirus
• Bordetella
• Chlamydophila
• Mycoplasma
– Panleukopenia
– Dermatophytosis
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Vaccinations Available
• Canine
– CIRD• Bordetella
• Mycoplasma
• Distemper
• Adenovirus
• Parainfluenza
• Canine Flu
• Strep. zooepidemicus
– Parvovirus
– Dermatophytosis
– Sarcoptic mange
• Feline
– Upper Respiratory Infection• Feline Herpesvirus
• Calicivirus
• Bordetella
• Chlamydophila
• Mycoplasma
– Panleukopenia
– Dermatophytosis
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How are infectious diseases spread?
• Direct contact
– Sarcoptic mange
– Dermatophytosis
– FIV – deep bite wound
• Aerosolization/inhalation
– Canine Infectious Respiratory Disease (CIRD)
• Ingestion
– Intestinal parasites
– Parvovirus
• Vectors
– Heartworm disease
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#1 Factor in Disease Spread
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Environmental Factors
• Frequency of exposure to illness – Infectious Dose
– Sanitation• What chemicals kill this microbe? Are we using them correctly?
• Controlling fomite transmission?
• Cleaning of multi-use items – bedding, toys, bowls
– Contact with others • Nose to nose when walking?
• Separation of ages?
• Quarantine for symptomatic animals?
• Housing density
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Infectious Dose
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Host Factors
• STRESS
• Co-infection
• Other disease processes
• Inadequate vaccination
• Genetics
• Age – immature immune system
• Insufficient maternal antibodies
• Nutritional status
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Herd Immunity
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What Factors Can We Control?
• Host
– Ensure herd immunity by timely vaccination
– Treat for co-infections/diseases
• Environment
– Reduce environmental contamination
– Reduce exposure to other animals• Isolate sick animals
• Plan animal traffic pattern and housing
– Reduce stress (cortisol release) in shelter• Behavioral enrichment
• Low stress handling
• Light:dark cycles
• Adequate housing
• Noise control
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0%
25%
50%
75%
100%
Canine Distemper Virus Canine Parvovirus
Not Protected Protected
Do we need to vaccinate?
Source and Health Status had no effect!
Neutered & reclaimed dogs were more
likely to be protected against CDV.
n = 431
Lechner ES, Crawford PC, Levy JK, et al. Prevalence of protective antibody titers for canine distemper virus and canine parvovirus in dogs entering a Florida animal shelter. JAVMA 236 (12), 2010.
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0%
25%
50%
75%
100%
Feline Panleukopenia Feline Herpesvirus-1 Feline Calicivirus
Not Protected Protected
Do we need to vaccinate?
Health Status had no effect!
Neutered cats were more likely to be protected against FPV.
n = 418
DiGangi BA, Levy JK, Griffin B, et al. Prevalence of protective antibody titers for feline panleukopenia virus, feline herpesvirus-1, and feline calicivirus in cats entering Florida animal shelters. JAVMA 241(10), 2012.
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Vaccine Administration
Proper storage of vaccines (35-45oF)
Reconstitute vaccine product
– Do not interchange diluents
Administer within 30-60min of
reconstitution
– Protect from temperature extremes
Never mix multiple products
Never split doses for smaller animals
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Does it matter when vaccination occurs?
Disease Time to protection Type of vaccine
Canine parvovirus 3-5 days Live virus
Canine distemper 4 hours to 3-5 daysLive virus;
Recombinant
Bordetella
bronchiseptica2 days* Live virus - Intranasal
*These vaccines are not designed to prevent infection, just to
minimize duration and severity of illness.
Disease Time to protection Type of vaccine
Feline panleukopenia 24 hours to 3-5 days Live virus
Feline herpesvirus-1 4 days* Live virus
Feline calicivirus 1 day*Live virus
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Vaccinations in the Shelter
• ON INTAKE – FVRCP, DA2PP, Bordetella
• Repeated in 2 weeks
• Repeated every 2 weeks until 16-20 weeks of age
• Rabies at adoption if >3 months
• Pregnant
• Nursing
• Sick
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Vaccinations in the Shelter
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Other Vaccines?
• Canine Influenza
– Killed
– Does not prevent disease
– Requires 2 doses 2 weeks apart
– $$$
• FeLV
– Only if group housing
– Unlikely to spread via fomite
– $$$
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Vaccine Locations
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Response to Illness
• Know how to identify
– Common signs
– Cage side tests• Giardia, Parvo/panleuk
• Necropsy
– Laboratory tests• PCR, IFA, histopath
• Titer - are you protected?
• Quarantine – time from exposure to illness
– Negative titer or too young
• Isolate/treat – keep in mind shedding period
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Sample Case
• Possible diseases?
• How to test for each?
• Routes of transmission?
“What do we do now Doc?!”
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Sample Case
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Sample Case
• Who is exposed?
• Who is susceptible?
• Who is likely immune?
• Who should be titered?
• Space considerations
– Room to quarantine?
– Room to isolate/treat?
• Staff/resources
– Staff trained in PPE and quarantine procedures?
– Staff trained to treat?
– $ available to treat?
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Sample Case
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Sample Case - PPE
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Sample Case - Quarantine
• How long to quarantine? • How long for isolation/treatment?
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Sample Case
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Sample Case - Treatment
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Sample Case - Outcome
• No additional breaks in quarantine room after 14 days (good PPE and cleaning)
• No breaks among other puppies in the shelter (no fomite transmission)
• Positive puppy recovered and isolated during shedding (knowledgeable staff and Drs.)
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Canine Infectious Respiratory Disease (CIRD)
• Can be one or several viruses/bacteria involved
• Morbidity ranges from mild serous nasal discharge to pneumonia and death
• Spread via fomites, direct contact, and aerosols
• How far can a dog sneeze?
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20 feet!
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CIRD Pathogens
– CIRD• Bordetella
• Mycoplasma
• Distemper
• Adenovirus
• Parainfluenza
• Canine Flu
• Strep. zooepidemicus
• Diagnosis
– Typically by clinical signs
– PCR
– Culture/Sensitivity
– IFA
• Know your tests!
– What does a positive result mean?
– What does a negative result mean?
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Feline Upper Respiratory Infection (URI)
• Typically viral with secondary bacterial infections
• Majority of cats come to the shelter having already contracted Herpesvirus or Calicivirus and are asymptomatic until…..
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Transmission
• Fomites
• Direct contact
• Aerosolization?
• How far can a cat sneeze?
About 5 feet
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#1 Factor Causing URI in Cats
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CIRD/URI Treatment
• Isolation from healthy population until asymptomatic
• PPE
• Reduce stress
• Antibiotics?
Doxycycline first
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Dermatophytosis
• Presentation
– Young animals, esp. cats
– Hairloss +/-
• Testing
– Woods lamp
– DTM
– PCR
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Dermatophytosis
• Treatment
– Itra/Fluconazole
– Lyme dips
– Topicals?
– Shave?
• Prevention
– Isolation until cure w/PPE
– Decontamination
– Closely examine incoming animals for hair loss
– Woods lamp all incoming young animals
– Dip on intake?
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Intestinal Parasites
• Assume every animal is infected
– Treat at intake and repeat with vaccines
• Pyrantel pamoate
– Roundworms
– Hookworms +/-
• Ponazuril (Marquis)
– Coccidia
• Fenbendazole (Panacur)
– Rounds, Hooks, Whips
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Also on Intake…
• Head to tail exam
• Documentation
• Identification
• Flea/tick treatment & prevention
• Heartworm test (>6mo)
• Heartworm prevention
• FeLV/FIV test +/-
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Questions?