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, bdines@wisc.edu

Dr. Kimberly Wilson, UW/UCD Shelter Medicine Eslinger Fellow and Shelter Veterinarian, Kern County Animal Services

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

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

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

Feline Upper Respiratory Infection (URI)

u Viral

u Herpes

u Calici

u Influenza

u Bacterial

u Mycoplasma

u Bordetella

u Chlamydia

What do we accept, not expect?

What matters most?

u The basics

u Vaccination

u Decreased stress

u Sanitation

u Identification

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”

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

Sanitation

• Removal of organic debris• Detergent • Disinfectant

Steps in the sanitation process

• Contact time • Concentration • Toxicity

Consider

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

“None of the disinfectants that were tested completely inactivated feline calicivirus. Canine parvovirus was not inactivated significantly by any of the QAC disinfectants.”

Vaccination

What are they giving

When were they given• Were they given again

What route

Storage

Make up

Some tidbits about vaccines

Isolation

• How important for cats vs dogs?

• It is NOT all or nothing– Cleaning order

• Weighing pros and cons

Isolation

• What if we do not have separate areas to house sick animals? – Foster– “Line in the sand” – Designated walking

patterns

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?

Interpreting PCR

u Sometimes tricky!

u Want a quantitative answer, not a qualitative answer

u Why?

u Keep in mind what the number means

Story of ‘bama

Not Black & White

More about PCR interpretation

Titers

Help in a risk assessment

Those exposed might already be protected

Can be done on site or sent out

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

Moving on to the most interesting & inspiring part

How to Reduce the Spread of URI

in the ShelterDistemper Outbreak Case Study

Kimberly Wilson DVM

Kern County Animal Services

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%

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

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.

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

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)

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

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%

Foster Dog Success!

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

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

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

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.

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

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

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

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.

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

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

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.

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

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

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

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

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?