VMDiva

Rabies virus is my favorite zoonotic disease because it is a rule breaker. It kills its host in a rapid time period which, on a evolutionary level, is a poor method of propagating the virus. Because it affects behavior and is shed in saliva, it finds a way to spread quickly and effectively despite the host’s imminent death. The disease process is brilliant and highly effective. Rabies is a disease to be feared because it is uniformly fatal in people and animals infected with it.  Please join me in spreading the word on the importance of rabies vaccination in companion animals!

PRESS RELEASE: World Rabies Day

World Rabies Day 2009: Awareness is the Best Defense against Rabies

The world is again joining together on September 28th to raise awareness and understanding about the importance of rabies prevention. Rabies is the oldest and deadliest disease known to mankind and I im supporting this initiative.

Led by the Alliance for Rabies Control and supported by numerous human and animal health organizations worldwide, World Rabies Day is a unique campaign that brings together hundreds of thousands of people across the world to reinforce the message that rabies is a preventable disease, yet kills 55,000 people needlessly each year, half of which are children under the age of 151.

“Rabies is primarily a disease of children, who are particularly at risk from this terrible disease, due to their close contact with dogs, the major global source”, said Dr. Debbie Briggs, Executive Director of the Alliance for Rabies Control. “Children are more likely to suffer multiple bites and scratches to the face and head, both of which carry a higher risk of contracting rabies. Children are often unaware of the danger that dogs transmit rabies and may not tell their parents when a bite, lick, or scratch has occurred from an infected animal”, says Briggs.

Rabies is a viral disease that can be transmitted to animals and humans. The disease is transmitted mainly by bite, but exposure may also occur through contamination of broken skin or mucous membranes with saliva from an infected animal. Once neurological symptoms of the disease develop, rabies is fatal to both animals and humans. The good news is that rabies is easily preventable. “Vaccination prior to possible exposure is a crucial part of health management of domestic animals, and is the single most important factor in rabies prevention”, said Peter Costa, Global Communications Coordinator for the Alliance for Rabies Control.

Rabies prevention starts with the animal owner. Protect yourself, your pet and your community by taking animals to be vaccinated. Avoid stray animals and wildlife. If you are bitten, wash bite wounds with soap and water and seek medical attention immediately. If your pet is bitten, consult your veterinarian immediately. Prompt and appropriate treatment after being bitten and before the disease develops can stop rabies infection and/or prevent the disease in humans and animals.

The World Rabies Day initiative also raises money towards local rabies prevention and control programs, with eight projects funded since 2008. “Through the World Rabies Day campaign we continue to engage all the major stakeholders associated with rabies to take action”, says Costa. “We invite everyone to join the team that is Making Rabies History!”

More information on World Rabies Day can be found at the official web site, www.worldrabiesday.org.

References:
1 WHO. Human and Animal Rabies, Rabies: A neglected zoonotic disease. Available at: http://www.who.int/rabies/en/. Accessed on July 23, 2008.

A routine appointment recently presented for “something stuck in mouth.” The 5 year old rambunctious golden retriever jumped around the exam room but did give me a good enough look in her mouth to see some yellow/brown foreign material impacted into her gingiva along the outside of her fourth premolar and first molar on her left mandible. Oral exams are always a challenge in dogs because you never know when their patience will run out and they’ll snap their jaws closed on your fingers. Her owner noted the dog liked to chew on sticks and had also vomited up pieces of a toy that morning. The dog was pleasant enough that I decided to try to dislodge the material using a pair of hemostats. No luck. It barely budged and the mouth started bleeding.  One more try yielded the same results as the first and I decided to move on to plan B. I explained to her owner we would need to anesthetize her. We talked about how in instances like these, it was impossible to know how big the object was and how much damage had been inflicted. I thought we may be dealing with a deep pocket of tissue that would require closure with sutures.

Once under anesthesia, oral exam revealed semi-firm material lodged between the two aforementioned teeth as well as being impacted on the outside of her tooth. Some elbow grease and patience allowed removal of the material but revealed a bigger problem. The foreign body had worn away the alveolar bone, or the bone that sits around the teeth, so severely that the rostral (front) root of the first molar was nearly entirely exposed. The tooth had minor mobility. I made the decision to remove the molar because, with an exposed root, a tooth root abscess, fractured tooth, or food impaction could occur.

Removing a healthy multirooted tooth can be time consuming and arduous. I made a gingival flap on the buccal (cheek) aspect of the molar. This was done by running a #15 blade along the tooth to a depth of about 0.5cm. I then incised the periodontal ligament, which is a strong band of connective tissue between the tooth and socket and is responsible for keeping the tooth in place. A cutting disc was used to cut the molar in half transversely and the two halves were removed using dental elevators and root forceps. The two sections of tooth came out cleanly and the flap was then used to cover over the bone and socket left behind. Absorbable sutures were used to close the incision. Her prognosis for a full recovery is excellent.

Canine parvovirus (CPV) is a highly contagious virus affecting puppies and unvaccinated young dogs in the United States.  Since evolving via a series of viral mutations in the early 1980′s, CPV has maintained a mortality rate of up to 30%. The advent of the parvovirus vaccine has dramatically decreased the incidence of disease. CPV specifically targets intestinal cells thus causing severe diarrhea, vomiting, dehydration, and weight loss.  Infections also cause bloodwork abnormalities including leukopenia with a neutropenia (low white blood cell counts). This makes infected dogs more susceptible to sepsis and subsequent cardiovascular collapse and hypoglycemia. Other complications include hypovolemic shock, disseminated intravascular coagulopathy (DIC), and acute respiratory distress syndrome. Dr. Linda Schell, DVM, DACVIM notes that “in experimentally affected dogs, mortality without treatment has been reported as high as 91%. However, with prompt recognition of dogs infected with CPV-2, and aggressive in-hospital supportive therapy of severely affected puppies, survival rates may approach 80-95%. ” At risk breeds include all dogs but Rottweilers, Dobermans, Pit Bulls, Labradors, and German Shepherd Dogs are most susceptible.

Clinical Presentation

• Gastrointestinal – vomiting, diarrhea, inappetance, weight loss
• Hematologic – immunosuppression secondary to depletion of lymphoid tissue, bone marrow
• Cardiovascular – hypovolemic shock with circulatory collapse (poor pulses, pale mucous membranes, poor tissue perfusion), hypercoagulability, DIC, rarely viral myocarditis
• Other clinical signs involving liver, kidneys, and central nervous system secondary to sepsis, dehydration, and endotoxemia

Diagnosis

• Fecal ELISA, also known as the Parvo Snap Test, tests for parvoviral antigens in the feces. False negatives occur due to short period of viral shedding. False positives can occur if the dog has been vaccinated within the past 5-15 days although research from Idexx, makers of the snap test,  has indicated that 0 of 64 recently vaccinated beagles tested falsely positive.
• Other tests include: virus isolation, PCR, electron microscopy, culture, and serologic studies for hemagglutination inhibition. These tests are not commonly performed.

Incubation/Infectious Periods

• Virus can be found in blood 3-5 days following infection
• Incubation period is 7-14 days, though animals can shed virus in feces prior to any clinical signs
• Fecal shedding can occur for up to 10 days post-viremia
• Virus is stable in environment for months to two years in the environment after fecal shedding but can be destroyed by a 1:30 bleach solution (See Environmental Decontamination below)

Treatment
Depending on severity of disease, any number of treatments may be necessary and include:

• Intravenous fluid therapy including colloidal fluids and potassium/destrose supplementation
• Blood transfusions for severely anemic animals
• Antibiotic therapy to combat secondary bacterial infections
• Antiemetics like maropitant, metocloprimide, and odansetron
• Gastrointestinal protective agents like famotidine, sucralfate
• Dr. Schell provides information on Tamiflu (oseltamivir phosphate): “Tamiflu is a neuraminidase inhibitor. Neuraminidase is a protein found on the surface membrane of many viruses that allows the virus to bud from the host cell to infect other cells; it is required for the virus to pass through mucous to reach non-infected cells. Unfortunately, the CPV (and the canine distemper virus) does not have neuraminidase. However, it has been theorized that the improvement seen in Tamiflu-treated CPV cases is because of inhibition of neuraminidase activity related to inflammation and bacteria (secondary sepsis). Tamiflu’s use is controversial for several reasons. By the time symptoms of CPV infection appear, the disease may be too far along for the drug to be useful. There are no proof of efficacy studies. It is expensive. Appropriate dosing is unknown. Finally widespread use of it in veterinary medicine could result in development of resistance mechanisms that would make this drug less useful in the event of a human influenza pandemic.”

Recovery

• Recovery is dependent on when the disease is diagnosed and how aggressively it is treated.
• Dogs who recover from CPV have immunity from reinfection for years or even their lifetime.

Prevention

• Ensure your new puppy has been vaccinated appropriately against CPV. Talk to your veterinarian to find out if your dog has been adequately protected.
• Keep your puppy away from unfamiliar dogs and out of dog parks until it is fully vaccinated.

Check out this great article on Environmental Decontamination

Check out this video from Dr. Manny Alvarez, Managing Editor for foxnewshealth.com, about service dogs and Canine Partners for Life!

Influenza viruses are a specific class of virus with assortments of proteins on the surface.  Canine influenza virus (H3N8) acts much like other influenza viruses in that it causes fever and respiratory disease. This influenza can mimic bordetellosis (aka Bordetella bronchiseptica infection, kennel cough, infectious tracheobronchitis). It is most common in groups of densely populated dogs, like seen in shelter situations, and was first recognized in a colony of racing greyhounds in Florida. The incubation period for development of disease is 2 to 5 days and the course of infection is between 2 to 4 weeks. Canine influenza virus is NOT related to Swine Flu (H1N1).

Because this is a relatively new disease, many dogs have little to no immunity to it. Therefore, infection rate is high with up to 80% of dogs developing clinical signs of disease. Some studies indicate 20-50% will naturally clear the infection without any signs of illness. Dogs with signs of infection may present to their veterinarian with fever, coughing, nasal discharge, and lethargy. A vast majority of infected dogs will recover with appropriate supportive treatment (antibiotics, nebulization, etc.). A small percentage (up to 20%) of dogs will get a secondary bacterial pneumonia and supportive care must be more aggressive. Most of these dogs will recover as long as they receive proper care. Dr. Melissa Kennedy, Clinical Virologist at the University of Tennessee College of Veterinary Medicine, states the mortality rate is “less than 10%, probably less than 1%. Most infections are mild and self-limiting.” This information contradicts some news reports of 100% mortality.

The CDC recently released a statement noting upwards to 30 states have confirmed cases of canine influenza. Testing is available at veterinary diagnostic centers but is not widely performed at this time. The CDC reports, “The tests can be performed using respiratory secretions collected at the time of disease onset or using two blood samples; the first collected while the animal is sick and the second 2 to 3 weeks later.” Ask your veterinarian about testing options.

A vaccination has been developed by Intervet Schering-Plough. Dr. Alice Wolf, a well recognized expert in small animal veterinary medicine, notes,”This is a killed virus vaccine that apparently provides non-sterilizing immunity. Information says that it “lessens the frequency and severity of lung lesions, reduces viral shedding, and reduces duration of coughing.” In other words, it does not prevent infection nor does it completely prevent clinical signs of infection.” She notes it is “definitely” not a core vaccination for every dog but also concedes it “maybe something to consider for shelter animals IF there is an outbreak in (the) shelter.” This vaccination will not provide immunity until 2 weeks following the second booster vaccine which can be given 2-4 weeks following the first. Therefore, this vaccine does not confer rapid immunity and is not useful for dogs immediately entering a boarding kennel or shelter situation.

Canine Influenza will most likely spread to the remaining states in the years to come. Diagnosis may become easier but the treatment modalities are similar to those for moderate to severe infections with Bordetella or other respiratory pathogens.  Awareness without panic and sensationalism is key.  Vaccination is not widely accepted in the veterinary community at this time except in areas of crowded canine populations. Vaccinations are being given to dogs who will be boarded in areas of known outbreaks.  It is merely a matter of time before boarding facilities require this vaccination along with Bordetella for admittance. Even in those situations, the efficacy of this vaccination remains to be proven.

Many new pet owners can walk out of their first veterinary appointment and wonder “What did the vet just tell me?” With talk of vaccines, deworming, flea and tick preventatives, food recommendations, crate training and more it is easy to feel overwhelmed. With a little preparation and use of the tips below, you can maximize your first appointments and ensure the health of your new furry friend.

1) Bring Your Paperwork…and a Stool Sample
Make sure you bring any paperwork you received when you purchased or adopted your new pet. This information typically contains your pet’s date of birth and vaccine/deworming history and is important in letting the veterinarian decide what vaccines are needed. Some pets come into your lives without any paperwork. If this is the case with your new pet, be prepared to start a vaccination schedule from scratch.

Bring a fecal sample to your first appointment. Nearly all puppies and kittens have gastrointestinal parasites like hookworms, roundworms, whipworms, and tapeworms. Roundworms are transmissible to people via fecal-oral contamination and hookworm larvae can penetrate a person’s skin. If your new pet is diagnosed with any of these parasites, your veterinarian will prescribe a deworming medication.

2) Write Down Your Questions

Some of the most prepared new pet owners come in with a list of questions on a pad of paper. Write down questions as you think of them and be sure to ask about every item on the list. Don’t be afraid to ask “silly” or “stupid” questions. Your vet has likely answered those questions in the past and can provide the reassurance you need to confidently raise your pet.  If you don’t ask, you’ll never know.

3) Don’t Try to Remember Everything

Your new pet will most likely require two or more appointments to ensure adequate vaccination. A good veterinarian will reiterate information provided in the first appointment during subsequent visits. And as I always tell my clients, it’s my job to remember your pet’s vaccination needs.

4) Schedule Your Next Appointment

Before you leave, schedule your next appointment. Even the best intentions can be thwarted by busy schedules, unseen events, and procrastination. To ensure your new furry friend is fully vaccinated, you need to adhere to the vaccine schedule laid out by your veterinarian. Lapses in vaccinations can result in development of serious illnesses or even death.

With information and a healthy foundation,  just relax and enjoy your new pet!