To Their Health: Treating Parvo, Panleukopenia and

Heartworm

Jennifer Wilcox, DVMErin Katribe, DVM, MS

Outline

• Decision-making and general principles

• Parvovirus and panleukopenia

• Heartworm disease

Should we treat?

• Live outcomes for treated animals

• Capacity for care for medical conditions

• Space limitations and length of stay

• Budget

• Staff to provide care

Staff resources

• Staff veterinarian

• Contract veterinarian

• Outsourcing care to private practices

• Support staff– Technicians and assistants

– Trained foster caregivers

– Trained volunteers

Disease prevention

• Cheaper than treatment!

• Intake

– Vaccination

– Recognize signs of contagious disease

• Sanitation and biosecurity

Recent Intake/Healthy

Rabies Quarantine

URI Recovered

Sniffling

Outbreak Map in Dog Adoptions (old PACC): Adoption Floor 2016

Fomites (including US) spread disease.

In what order shouldWe ALWAYS be

CLEANing?

Healthiest

SickestDistemper

Mild CIRDC

Biosecurity is CRITICAL when you start treating infectious disease.

Outbreak Map in Dog Isolation, 2016 (old PACC)

Pick your favorite fomite

Disease prevention

• Reduce overcrowding and stress

• Reduce length of stay

• Fast-tracking

• Reduce movement

• “All in, all out”

Disease prevention

• Outbreak management– Isolate the infected

– Quarantine the exposed

– Transmission in shelter vs. prior to intake

– “Clean break”

– Ask for help!

• Prevention is also cheaper than an outbreak!

Reducing costs

• Protocols for staff to increase efficiency

• Send to foster care, utilize volunteers

• Limit expensive diagnostics

• Alternatives for expensive drugs

Treating parvo and panleuk in a shelter setting

•Viral pathogen of canine intestinal tract: CPV-2 emerged in 1970s

•Transmitted by nose/mouth exposure to CPV+ feces

•Recognized by vomiting/diarrhea

Exposure/Infx

Day0 Day3 Day5

Replicates in blood Day 1-5

Day7 Day14

Shed in feces starting Day 4-5

Clinical signs Start Day 7-14

• DEATH by dehydration, sepsis, low blood glucose, heart damage (young pups).• Treatment is supportive care only: no antiviral therapy. Immunoglobulin tx: no benefit found.

Canine parvovirus (CPV) infection

• Prevention by VACCINE. In shelter pups, start MIN 4 weeks age.- Need series as maternal antibodies wane- Consider vaccinating rejected pups/orphans earlier

• Diagnosed by ELISA SNAP test (IDEXX): Detects virus ANTIGEN.- Parvo vax contains antigen: possible False+ 5 days post vaccination

- IDEXX denies that vaccine can cause False+ on SNAP test

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Canine parvovirus (CPV) infection (continued)

• Infx virus lasts in environment 5 mos to 1 year. UV kills.

• Disinfect with 1:32 bleach, 1:16 Rescue, “strong” Trifectant.

• Hand sanitizer? HELL, NO!

• Viral PARVOVIRUS. Oldest known viral disease in cats: “feline distemper.”

• Transmitted by nose/mouth exposure to FPV+ feces; maybe aerosol. Like fomites.

• Clinical signs: acute death, fever, lethargy, vomiting, diarrhea.

• DEATH by dehydration/shock, sepsis, low blood glucose.• Treatment is supportive care. HIGH MORTALITY = 50%-80% WITH treatment, recent publication.

Feline panleukopenia virus (FPV) infection

Exposure/Infx

Day0 Day3 Day5

Replicates in blood Day2-7

Day7 Day14

Shed in feces, urine, saliva, vomitus starts Day2, then 3-6 weeks

Clinical signs Start Day 2-7 after exposure

• Prevention by VACCINE. In shelter kittens, MIN 4 weeks age.- Need series as maternal antibodies wane- CAN’T vaccinate earlier due to risk of cerebellar disease (published)

and vaccine-induced dz (anecdotal)

• Diagnose by CANINE parvo ELISA SNAP test (IDEXX): Detects virus ANTIGEN.- Panleuk vax contains parvo antigen, possible False+ 14 days post vax

- Parvo tests 50%–80% accurate for panleuk

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Feline panleuk (FPV) infection (continued)

• Infx virus lasts in environment 5 mos to 1 year. UV kills.

• Disinfect with 1:32 bleach, 1:16 Rescue, “strong” Trifectant.

• Hand sanitizer? HELL, NO!

Canine parvovirus (CPV) infx: Can you recognize it?

Meatball Test

Feline panleukopenia virus (FPV) infx: Can you recognize it?

Puppies puke, should kittens?

What about symptomatic animals that SNAP neg?

Treat them like infx parvo/panleuk

In past 12 months: 14 pups

>20 kittens tested NEG for parvo on SNAP

What about symptomatic animals with NEG SNAP tests?(continued)

When is YOUR worst month for parvo?

Parvo/panleuk: Treatment and costs

“Standard” treatment: BAR-QAR, good reserves, not bloody diarrheaProtocol = 3 day Colorado “outpatient” treatment

▪ Cefovecin (Convenia) 7mg/kg SQ once▪ Maropitant (Cerenia) 0.9mg/kg SQ SID x 3 days▪ Vitamin B12 SQ once▪ Syringe of Nutrical▪ SQ LRS 20ml/kg BID-TID x 3-5 days

Consumables cost for 15# = $38/pup for 3 days tx- Parvo SNAP $35 if singleton- Only test RUNT in litters to save $$

Consumables cost for 2# kitten = $12

Parvo/panleuk treatment (continued)

“Aggressive” treatment:Bloody diarrhea, lethargic, poor BCS, severe dehydrationProtocol = 3 day outpatient treatments, PLUS:▪ IVC catheter▪ IV LRS ¼ shock bolus▪ IV Metronidazole 15mg/kg BID▪ IV 5% Dextrose/NaCl at 5ml/kg/hr

Cost for Ave 15# Pup = $10(Agg) + $38 (Standard) for 3 daysCost for 2# kitten = $10(Agg) + $12 (Standard) for 3 days

Live outcomes: Parvo

Past 12 months: 298 parvo+ dogsEuth 15 at intake due to grave prognosis

Standard treatment (all) = 86%

Aggressive treatment survivorship = 70%-16% of pups need aggressive tx

Always worry about your puppies, but DON’T ignore Vomit/Diarrhea in Adults too!

Parvo ward is full, foster homes are full: Euthanize?

Harness the labor of the owner/finder!- Intake the pup(s)- Sign up the person as a foster caregiver- Teach them outpatient protocol and SEND HOME- They get preferred option to adopt after spay/neuter- 36 parvo pups “fostered” in 2018 (35 survived)

Got firm poop at day #5 in pup parvo? SNAP, BATHE, S/N!

Parvo: Our ONLY source of small-breed and PB puppies*

*Studies show purebred dogs more susceptible to CPV infx — in particular, Rottweiler, Doberman, Lab, staffie, husky

https://youtu.be/ftRvH04zUPA

Panleuk infections in pregnant queens can result in abortion, nervous system defects, eye deformities in kittens.

Where do those adorable head-bobbing kittens come from?

Panleuk: How to treat and costs

Best Friends:▪ Ampicillin 20mg/kg SQ BID▪ Metronidazole 10mg/kg PO BID▪ Cerenia 1mg/kg SID PRN▪ Probiotics▪ SQ LRS 20ml/kg BID-TID▪ If no vomit/diarrhea for 2 days, test runt

and bathe. Retest q3days until Neg▪ “Graduate” 1 week later, S/N 2 weeks

later, no cohousing for 6 weeks

Consumables = $10/2# kitten for 3 days tx- Parvo SNAP costs $35 if singleton

APA:▪ Ampicillin 10mg/kg PO BID▪ Baytril 4.4mg/kg diluted SQ SID▪ Cerenia 8mg/kg SID▪ SQ LRS 20ml/kg BID-TID▪ Force feed 1-3mls q1hr▪ If no vomit/diarrhea for 3 days, test runt

and bathe twice

Consumables = $15/2# kitten for 3 days tx- Parvo SNAP costs $35 if singleton

Live outcomes: Panleuk

Best Friends: 64%

APA: 80%

PACC: Current outbreak, TBA!

Can parvo and panleuk be comingled? Parvovirus = Parvovirus?

NO!▪ Recent studies in U.K. found 30% of healthy

shelter cats shed virulent canine parvovirus

▪ Rarely, virulent canine parvovirus strains cause clinical signs of panleukopenia in kittens

Collateral damage from cohousing or merging litters?

Before you isolate for 2 weeks, Vaccicheck!

Positive predictive value = 94%

Nervous about having contagious parvo EVERYWHERE?

Get creative, but SCARE your staff and volunteers for good compliance.

Ounce of prevention?

5 off-site free clinics 2017-18, 1,100 animals received:– Vaccines and microchips– Deworm and flea, tick, mite tx– Spay/neuter vouchers

Within the shelter: Only PUBLIC can cuddle puppies and kittens (without PPE)

Questions?

Heartworm Disease

Incidence in the U.S.

Prevalence in shelters

• 10 times the prevalence in owned dogs

• Reports of 10% to 50% in shelters

Biology and life cycle

Canine clinical signs• Cough

• Exercise intolerance

• Difficulty breathing

• Right-sided heart failure

• Caval syndrome

• Sudden, severe difficulty breathing

• Pigment in urine

• Pale gums

Diagnostic screening

• ELISA testing– Detects female worms

– Antibody complexes can interfere

• Microfilaria testing – Send to lab

– Slide examination

• 6 months from infection to a positive test or microfilaria Acanthocheilonema reconditum (top)

Dirofilaria immitis (bottom)

American Heartworm Society recommended treatment

• Prevention for 2 months

• Doxycycline for Wolbachia

• Melarsomine intramuscularly

– 3 injection protocol

• Steroids to reduce complications

• Activity restriction

Susceptibility gap

Two injection protocol

• Doxycycline, prevention• Two back-to-back melarsomine injections • Pros

– Shorter time for treatment– Expense

• Cons– Kills ~90% of worms– Cleared dogs of all worms only 50% of the time– More complications

Slow-kill• Prevention and doxycycline only

• Pro: Less expense

• Cons– Takes months to years to clear worms

• Activity restriction

• Ongoing damage to heart and lungs

– Transmission during treatment

– Increased resistance to preventives?

– More complications

Prevention

• Monthly oral and topical, every 6 month injectable options

• Oral ivermectin

• Lack of efficacy– Compliance

– Resistance

• AHS recommends year-round

Feline heartworm disease

• Clinical signs– Cough, difficulty breathing (like asthma)– Weight loss– Vomiting– Collapse– Sudden death

• No melarsomine!• Don’t test in shelters

Challenges and solutions for heartworm disease management

Length of stay

• Extended LOS before, during, after treatment

• Activity restriction

• Behavioral decline and welfare

• Solutions– Foster

– Treatment AFTER adoption

– Transport prior to treatment

– 2 injection protocol

Expense

Prevention

• Reduce transmission

• Commercial products

– Cost for large dog: $3-$5/month

• Solutions

– Shelter discount: $1.61/month

– Ivermectin• Toxicity risk

• “White feet, don’t treat”

Expense

Treatment• 50-pound dog with AHS-

recommended protocol: ~$250• Required diagnostics?• Solutions

– Consider alternative treatment options• Based on individual animal risk

– Informed adoption with waiver– Skip diagnostics

Informed adoption• Provide adopters with full disclosure

• Adoption waiver

• Heartworm Resource Task Force brochures

• Encourage them to consult with their vet

“Adult heartworms are a grave risk to our canine patients. The longer they remain in an animal, the

greater the damage to the cardiopulmonary system and the greater the risk of illness and death. It is probable that treating in the absence of

diagnostics, while not ideal, is better than refusing to perform a needed treatment.”

– American Heartworm Society, 2018

Treatment failure

• Wait six months (or more) to retest

• Shelters usually don’t recognize

• Reasons for failure:

– Retesting too soon

– Susceptibility gap

– Two injection or slow kill protocols

Transport

• Not all states allow positive dogs

• AHS guidelines

Complications

• Reaction to treatment

– Monitor for the day

• Labored breathing

– Due to clots in the lungs or inflammation

– Rare with activity restriction

• Plan ahead

Elective surgery?

Asymptomatic or mild disease: Proceed with surgery

Moderate or severe disease: Treat and recover prior to surgery

What do real shelters do?

• Most give prevention

– Ivermectin use is common

• About half tested only some dogs

• 85% treated at least some dogs

– Treatment varied

Summary

• Incidence is increasing

• Significant challenge for shelters

• Share resources and minimize spread with safe transport

• Focus on LIFESAVING!