Cat hoarding and rabies

Over 50 cats have been euthanized in Delaware, US, after rabies was diagnosed in one 4-week-old kitten.

The cats were mainly indoor cats owned by one person - a pretty classical case of cat hoarding. All were in very poor condition. There were vaccination records for 15 of them, but there was no way to figure out which record corresponded to which cat (e.g. "black cat" doesn’t help much when you have 30 black cats in the group).

Since all of the cats had to be considered unvaccinated and they were exposed to a rabid animal, that left two options: euthanasia or 6 month quarantine. The logistics and cost of a 6 month quarantine, along with the poor condition of the cats themselves (and probably concerns about finding adequate homes after quarantine) led to the decision to euthanize the group.

Sometimes, these decisions have to be made despite knowing that the true risk of rabies exposure was very low. However, that’s not the case here. There was one confirmed rabid kitten, but other kittens in the litter had already died by the time that one was tested. The others may have also had rabies. The kittens had to get rabies from something, and if they were indoor (which is probably the case here given the primarily indoor nature of this group and their age), that means the virus probably came from one of the indoor-outdoor cats or from the mother (no word on her health status), which means there were multiple potential sources of exposure for the larger group than the one kitten that tested positive.

In some ways, they got lucky here. The kitten was taken to a veterinary clinic, where it bit a technician. The clinic fortunately did things right and reported the bite, and the kitten was tested. Otherwise, this would not have been picked up and there’s a much greater chance that the owner or someone else would have been exposed, and possibly died.

Inadequate rabies vaccination of this group led to the deaths of 50 cats, expensive post-exposure treatment of a few people (the veterinary technician, an animal control officer who was also bitten, and likely the owner), and presumably a lot of time and effort investigating this.

This case, and other recent rabies diagnoses, is plotted on wormsandgermsmap.com

More information about rabies is also available on the Worms & Germs Resources - Pets page.

2013 US rabies recap

It’s that time of year. No, not for snow (although it is snowing here at the moment). It’s time for the annual US rabies surveillance report in the Journal of the American Veterinary Medical Association (Dyer et al. Rabies surveillance in the United States during 2013).

The highlights…

  • Over 5800 rabid animals were identified in the US. 92% of those were wildlife. That’s going to be a profound underestimation since most rabid wildlife aren’t caught and tested, but it shows that rabies is still alive and well in the US.
  • Rabies was most commonly diagnosed in raccoons, followed by bats, skunks and foxes.
  • Among domestic animals, there were 247 cats, 89 dogs, 86 cattle, 31 horses/mules, 9 sheep/goats, 3 pigs, 2 llamas, and a partridge in a pear tree. (Obviously the last one’s my lame attempt at early winter humour. Birds aren’t a rabies concern).
  • Other species affected included mongooses (38; as always, just from Puerto Rico), groundhogs (37), bobcats (16), coyotes (5), deer (5), otters (3), opossums (2), wolves (2), marmots (2), a rabbit and a fisher. Most of those are fairly typical, both in terms of the species affected and the numbers. 
  • Pennsylvania had the most rabid cats, while Texas won for most rabid dogs.
  • Vaccination history was not usually available for rabid dogs and cats. None of the rabid cats had been properly vaccinated against rabies. One of the rabid dogs had been vaccinated, a 10-month-old dog that developed rabies 7 months after receiving its first dose. This one’s a bit concerning, though. By being vaccinated at 3 months of age, it would have been considered "up-to-date" on rabies vaccination and this would therefore be a vaccine failure. No vaccine is 100% effective (although rabies vaccine is considered very effective as vaccines go) and the dog having only received only one dose because of its age was probably a key factor. 
  • The dominant rabies virus variants had a typical geographic distribution (see map above).

Three people were diagnosed with rabies during the year.

  • The first was a person who died of raccoon rabies. There was no history of animal exposure, but he had received a kidney transplant 17 months earlier. The donor had been diagnosed with severe gastroenteritis, but also had some neurological abnormalities and when banked samples from the donor were tested, rabies virus was found. Three other organ recipients were then given post-exposure prophylaxis.
  • The second person was a man from Guatemala who was detained trying to enter the US. While in custody, he developed neurological disease and died. Central American canine rabies variant was identified.
  • I assume the third reported case was the organ donor from the first case, since the case was diagnosed in 2013 (even though the person died in a different year).

As per usual, there’s a little information about Canada and Mexico in the paper.

  • 116 rabid animals were identified in Canada, 88% of those being wildlife. There were also 12 cats and dogs (combined) and 2 horses.
  • In Mexico, an important finding was the fact that, for the first time since 1938, no people died of rabies. Eleven rabid dogs were identified. However, care must be taken in comparing data from different countries because of potential differences in testing (if you don’t look too hard, you don’t find).

 

Animal Ebola guidance documents, hot off the press

Today, guidance documents coordinated by the US Centers for Disease Control and Prevention and the American Veterinary Medical Association were released. CDC descriptions of the two documents are below. Click on the title to get the document.

Interim Guidance for Public Health Officials on Pets of Ebola Virus Disease Contacts

This document provides interim guidance based on the latest scientific evidence and recommendations from national organizations, for the management of pets, specifically dogs and cats, owned by Ebola virus disease (Ebola) contacts.
 
Interim Guidance for Dog or Cat Quarantine after Exposure to a Human with Confirmed Ebola Virus Disease

The intent of this interim guidance is to provide guidance for companion animals, specifically dogs and cats with exposure to a person with Ebola, based on the latest scientific evidence and recommendations from national organizations. This interim guidance describes the process for conducting a risk assessment for exposure of dogs or cats that had contact with a human with laboratory-confirmed evidence of Ebola, and it describes how to implement quarantine of dogs or cats if deemed appropriate by state and federal human and animal health officials.

Image: Scanning electron micrograph of Ebola virus particles budding from a cell. (Source: CDC Public Health Image Library #17775)

Lyme disease & ticks: New infosheet

The latest Worms & Germs infosheet, all about Lyme disease and ticks, is now available on the Resources - Pets page.  Although it's getting colder and occasionally snowy up in Ontario, there are lots of parts of North America where ticks are active all year round.  It's particularly important for any "snowbirds" who may travel south with their pets over the winter to be aware of the potential for exposure to ticks and the diseases they transmit (not just Lyme disease!), and to make sure their pets (as well as they themselves) are properly protected.  (The same goes for exposure to mosquitoes, which can transmit (among other things) heartworm.)

Remember that dogs (nor any other mammal for that matter) cannot transmit Borrelia burgorferi, the bacterium that causes Lyme disease, to people; however, this is a good example of a "one health" disease that clearly affects both people and animals.  Finding the disease in one species is an indication that the other is at risk as well, when there is exposure to a common source (i.e. the ticks).

Thanks to University of Guelph professor and parasitologist Dr. Andrew Perigrine for his input on the infosheet as well.

Image: A female blacklegged tick, Ixodes scapularis, engorged with a host blood meal. (Source: CDC Public Health Image Library 15993)

Another dog importation mess

In some ways, I get it. However, the rest of me just wants to bang my head against the wall.

The short story: a blind dog was imported from Iran. Upon arrival, it was found to have (probably among other things) leishmaniasis, a concerning parasitic disease that we’re seeing occasionally in imported dogs. Leishmaniasis is nasty, hard to treat, expensive to manage and there are concerns about whether these dogs could pose a risk to people (i.e. due to disease transmission). Dogs are the main reservoir of the parasite (Leishmania spp.) in many regions, and people become infected when sandflies bite an infected dog, then later bite a person. We don’t have those sandflies in Canada, but we can’t be certain that there are no other biting insects that could transmit Leishmania. It’s probably a low risk but it’s an unnecessary one.

Back to the dog from Iran: Now, the adoption fell through and the foster home won’t keep him because of his health problems, so there’s a search on for donations and someone willing to adopt a blind, sick dog that will require long-term and expensive veterinary care, probably with a poor prognosis.

I wonder how much time, effort and money was put into bringing this dog from Iran to Canada, and the stress that the dog endured through a very long trip (alone in the cargo hold of a plane), probably to ultimately be euthanized. Yes, in some ways it’s nice that the dog was given a chance, but it should have been pretty obvious that this wasn’t a good idea and wasn’t going to end well.There are finite resources to care for animals, and investments of time and money such as this don't make sense to me.

While these are approached with good intentions, the lack of health screening by some of these "rescue" groups, combined with our completely lax canine importation requirements allow situations like this to occur.

Check out the kijiji ad for more details.

Leptospirosis in dogs...risks and costs

Leptospirosis is a bacterial infection that’s been described as a re-emerging problem in dogs in North America. (It’s been described as that for many years now so maybe we should drop the "re-emerging" and just say it’s a problem). The causative agent, Leptospira interogans, is a widespread bug that’s carried by a variety of wildlife species, and it can cause disease in many different animals, including dogs and people.

In dogs, lepto is an important cause of kidney disease in some regions, and infected dogs pose some degree of risk to people who come in contact with their urine. While it used to be mainly associated with rural dogs here in Ontario, it’s increasingly being found in urban dogs because of the proliferation of raccoons (that can shed the bacterium in their urine) in cities.

A recent study from the University of California Davis (Hennebelle et al, Risk factors associated with leptospirosis in dogs from northern California: 2001-2010, Vector Borne and Zoonotic Diseases, 2014) looked at 67 dogs with lepto and 271 non-lepto controls. You can’t extrapolate all the results to other regions, because there are different animal reservoirs and other factors to consider, but the study provides some good information.

Here are the highlights:

  • Vomiting, lethargy, increased white blood cell count and increased kidney values (azotemia) were the most common presenting problems. That’s not surprising but it’s a constant problem. Dogs don’t come in screaming “I have lepto!!!” They often have vague signs and it may be a little while (and a lot of handling) before lepto is considered or diagnosed. That in-between period poses a risk to handlers if good practices to avoid urine contact aren’t used, so practicing good general infection control and keeping lepto under consideration in any of these cases are important to reduce human risks.
  • Dogs with lepto can be pretty sick and treatment can be pretty expensive. On average, affected dogs were hospitalized for 11 days at a cost of $5459 (USD). This doesn’t mean it’s always this expensive. This is a referral hospital that probably sees a caseload that’s sicker than average, but regardless, it’s a serious and often very expensive disease.
  • 13% of affected dogs died. Again, that’s based on a biased caseload, but still shows it’s not to be taken lightly.
  • The main serovar was Pomona. That’s different than we see here in Ontario, where Grippotyphosa (mainly from raccoons) predominates.
  • There were regional differences even in California, with more cases from the central or south coast, Sierra Nevada foothills, San Francisco bay area or north coast compared to the distribution of control dogs.
  • Owners of dogs with lepto were more likely to report that their dog had contact with water or wildlife, or visited a ranch. These are risk factors for lepto that have been found in other studies as well, and make sense biologically.
  • Other risk factors included being 5-10 years of age or over 10 years of age, or being hound breeds.

Lepto’s a big problem in many regions, including around here. That’s why my dog Merlin’s vaccinated against the disease. Lepto vaccines have gotten a bad rap because the older ones were relatively ineffective and associated with increased risk of adverse reactions. However, today’s vaccines protect against the important strains (for most regions) and are quite safe. Discussing the risk of lepto and whether vaccination is indicated is something every dog owner should do with their veterinarian. Knowing regional trends in lepto help make that determination.

Some information about lepto distribution in dogs is available at http://www.wormsandgermsmap.com We don’t have a lot of cases entered yet, so more data would help.  If you are a veterinarian or veterinary technician and would like to know how you can help contribute data, click here.

Spanish statement about euthanized Ebola virus-exposed dog

Spanish authorities have issued a statement through ProMED-mail about their decision to euthanize the dog owned by a nursing assistant with Ebola virus disease.

Regarding the news [that] appeared in the magazine "Veterinary Record", dated 18 Oct 2014, where it was questioning the scientific reasons on which euthanasia of the dog Excalibur were based, we are
sending a report based on the opinion of the leading Spanish and European renowned specialists on this subject, epidemiologists, virologists and experts in preventive medicine on animal health.

Case background: [On] 6 Oct 2014 afternoon, the 1st indigenous clinical case of Ebola virus (EBOV) disease was confirmed in a health worker in Spain. The health worker had been involved in the care of a severely diseased missionary who had contracted the virus in Sierra Leone and had died on 25 Sep 2014. The patient developed fever on 29 Sep 2014, and at the time of the confirmation of the diagnosis, she presented with high fever and other typical clinical signs like vomiting and diarrhea. The cohabitation between the patient and the animal was close and constant during some of the period of virus excretion, and therefore the potential for disease transmission could not be ruled out.

In the epidemiological investigation, it was noticed that the health worker was cohabiting with her dog Excalibur in their apartment during the acute phase of her infection and before admission to the hospital. She kept close contact with the dog during the 5 days previous to the confirmation. Thus, the exposure of Excalibur to the virus was very likely, as well as the risk of its contagion.

There are numerous knowledge gaps related to the infection of dogs with EBOV. Allela et al. (2005) studied the potential role of dogs in the epidemiology of EBOV disease. They observed specific antibodies against the virus in pet dogs living in Gabon during the 2001-2002 epidemics. In fact, the apparent seroprevalence reached up to 25 percent in villages with confirmed viral activity. Although the study failed to detect the virus, the authors hypothesized that dogs may carry the virus without showing any clinical sign. Also not determined is possible viral excretion from dogs, the viral loads in these excretions and the lapse of time between the infection of animals and the potential viral shedding. Thus, the risk of EBOV transmission from dogs to humans cannot be ruled out.

The desire of the Spanish authorities would have been to move the dog to quarantine and confirm its infection. Unfortunately, there are no veterinary medical means in Spain to do so respecting the biosafety level 4 (BSL4) requirements pertaining to this virus (CDC, 2009). These missing minimal needs include proper means to carry the dog alive, contrasted protocols for this situation, BSL4 facilities for its quarantine, and training of personnel handling the animal. In addition, the procedure followed the 'precautionary principle', due to the lack of sufficient evidence to eliminate the potential role of EBOV transmission from dogs or other pets to humans, as stressed by Dr. Bernard Vallat, Director General of the World Organization for Animal Health (OIE) to AFP [Agence France-Presse].

Due to these uncertainties and the highly possible risk of infection, the Madrid regional government authorized the euthanasia of Excalibur on 8 Oct 2014 through a court order due to the rejection of the
husband of the patient to allow the health operatives to enter the apartment. The procedure was performed by highly qualified staff of the Health Surveillance Centre of Madrid (VISAVET) and following the strictest animal welfare measures.

The Spanish episode has been repeatedly compared with another EBOV case in Dallas (Texas, United States), although epidemiological and logistic differences exist. The American case occurred in a nurse who had contact with Thomas Eric Duncan and was confirmed on 12 Oct 2014. This nurse also has a dog, which was living with her before the diagnosis confirmation. In contrast to the Spanish case, the period of contact between the patient and the dog comprised the 1st 2 days of clinical infection, in which the viral load in the excretions is lower, so the contagion was less likely than in the Spanish dog. In addition, the US government has sufficient means to maintain the animal in quarantine.

In conclusion, the euthanasia of Excalibur was not an automatic procedure, but a health measure carried out in the best available way and always aimed to protect public health.

Secretaria
Direccion General de Ordenacion e Inspeccion Consejeria de Sanidad
Comunidad de Madrid
c/ Aduana 29 - 4a
28013 Madrid
Spain

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Fake service animals in action

I go on periodic rants about people abusing service animal rules to take their pets places they cannot normally go (while potentially compromising the critically important need for true service animals to have unfettered access).

Sometimes, it's nice to know I'm not the only one.

A recent article (pointed out by a writer from the VIN News Service) in The New Yorker describes the exploits of the article's author, Patricia Marx, as she tested the ability to talk your way into various situations with over-the-top examples.

While I have some concerns about some of the scenarios (e.g. turtle bathing in a bowl of water in a deli, a stressed out turkey...) it showed how easy it is for people to manipulate the system. If you can get away with things like she did, it's easy to see how it's so easy for people with fake service dogs (complete with fake ID, vests and other paraphernalia) to do it.

(click image for source)

Skunk + late vaccine + inflexibility = dead dog

A Brockton, MA dog was euthanized after being bitten by a rabid skunk, because of a combination of the skunk's rabies diagnosis, a relatively minor lapse in the dog's vaccinations, and regulatory inflexibility. The ten-year-old Schnauzer cross was bitten in its own yard, and the skunk was subsequently caught, tested and diagnosed as rabid.

Clearly, this needs to be considered rabies exposure. But, what needs to be done?

  • If the dog was up-to-date on its vaccines, it would receive a booster vaccination and be subject to a 45 day observation period (typically at home).
  • If unvaccinated, it would be boosted and quarantined for 6 months, or euthanized.

However, a dog doesn’t suddenly go from protected to unprotected immediately after the 1 year or 3 year vaccination duration passes. One year and 3 years are nice easy dates to remember and vaccines are known to provide that degree of protection because they've been tested at these intervals.  However, since vaccine-induced antibodies aren’t programmed to self-destruct on a specific "best-before-date", there’s a grey area with animals whose vaccination has lapsed by only a short period. Here, the dog was two weeks overdue - immunologically probably almost identical to what its protection status was at the time its vaccination lapsed.

“It is really sad. My heart goes out to the animal’s owner,” Animal Inspector Megan Hanrahan said. “But those two weeks make the animal not covered.”

Yet, it’s not that clear-cut. NASPHV guidelines state “Animals overdue for a booster vaccination should be evaluated on a case-by-case basis based upon severity of exposure, time elapsed since last vaccination, number of previous vaccinations, current health status, and local rabies epidemiology to determine need for euthanasia or immediate revaccination and observation/isolation."

It’s definitely grey, and being bitten by a rabid skunk is concerning, but a ten-year-old dog that was two weeks overdue (and hopefully previously vaccinated many times over its life) certainly deserved some consideration of this grey area. I think a 45-day observation period would be entirely justifiable here.

Regardless, this is a good reminder of why people need to pay close attention to vaccination dates and ensure that their animals are properly covered at all times (and, no, testing antibody titres does not replace the need for vaccination).

Photo credit: http://www.birdphotos.com (click image for source)

Another Capnocytophaga infection in a healthy person

OK…time to get back to work writing. A couple weeks of conference organizing and uncountable Ebola calls are hopefully winding down, so back to the neglected blog.

This bug is an obscure one that I write about regularly: Capnocytophaga canimorus. It’s found in the mouth of most dogs, so people are commonly exposed to it. It almost never causes a problem, but when it does, it’s bad. Capnocytophaga infections classically occur in people who don’t have a functional spleen, alcoholics or those who have a compromised immune system. We focus on education of these high-risk people in terms of avoiding exposure to dog saliva and good bite-management practices. But, as with most things in infectious diseases, there are very few true “nevers”, and there are sporadic reports of Capno infections in people who are (seemingly, at least) otherwise healthy.

Another report appeared in a recent volume of Infection, “A case of Capnocytophaga canimorsus sacral abscess in an immunocompetent patient “(Joswig et al. 2014). Long story short, this person developed an abscess in the sacrum (the bone at the base of your spine), with a pet dog being the presumed source. There was no obvious incident of exposure such as a bite, and the person had no apparent risk factors, so it’s an unusual case. The fact that it was an abscess and not an overwhelming systemic infection (as is often the case) is also unusual, and may relate to the fact that this person had a normal immune system that was able to prevent a rapid, life-threatening infection.

This report doesn’t really change anything, but it’s another example of how some of these potentially nasty infections that we associate mainly with high-risk people can also occur in healthy individuals. This doesn’t mean we should be paranoid of dog saliva, but we should be practically cautious. Avoiding contact with saliva, avoiding bites and proper bite first-aid are all basic measures that can presumably go a long way to helping prevent a wide range of infections.