For the third time in the past year, Macon-Bill Animal Welfare in Georgia (USA) has a problem with canine parvovirus. The shelter is closed for two weeks in response to a puppy testing positive for this highly contagious virus that can cause serious disease in dogs (almost exclusively in unvaccinated puppies). At first glance, it may seem like an overly-aggressive response. A single parvo case isn’t too surprising in a shelter, and if appropriate routine precautions are followed, there are sound protocols to isolate parvo suspects and a good vaccination program, the risk to other animals can be contained.
In this outbreak, 14 puppies have been euthanized (though some reports differ). Again, the news reports are pretty crappy and it’s unclear whether all the puppies were sick or whether they were euthanized because they were exposed. The statement that parvovirus infection is "most times fatal for dogs" is wrong, since it’s usually treatable, but it certainly takes time, effort and money - things that may be of limited availability in a shelter. Also, if the shelter has inadequate facilities or personnel to properly treat and contain parvo, euthanasia gets considered more readily that in better equipped facilities.
The first report also says that the shelter refunded adoption fees of people who adopted puppies that subsequently died from parvo, so it does sound like there was probably a real (and possibly large) outbreak.
Closing a shelter is an extreme move but it’s sometimes required. It helps reduce the number of animals in the facility in order to make isolation of sick animals, separation of groups, management of exposed and infected animals and many other aspects of the infection control response easier. It also stops adding fuel to the fire, by halting admission of new susceptible animals that can get sick and thereby propagate the outbreak.
Some shelter outbreaks are the result of poor routine management (and some incompetence). Some are the result of inadequate response to an infectious animal. Some are an over-reaction to a limited and containable problem. Some will occur despite the best practices in the best facility. That’s the nature of infectious diseases. Any time there’s an outbreak, a shelter needs to figure out which of the above categories they fit in so that they can reduce the risk of future problems.
(For tracking of selected infectious diseases and outbreaks, stay tuned for the launch of WormsAndGermsMap. More information to come!)
A proposed Florida bill would require shelter operators to produce monthly and annual euthanasia reports. The reported goal of the effort is to "reduce euthanasia of unwanted animals." But how? The idea has various pros and cons.
Potential good points
More transparency: Euthanasia rates are often considered the "dirty secret" of the shelter world. In reality, it's not the shelters' fault that animals are being euthanized. It's society's fault because of overpopulation. Shelters should be reporting these numbers (and ensuring they are accurate), not as part of a "we kill fewer than you do" competition, but to highlight the challenges, increase public awareness and to work toward improving the shelter system.
More data: The more we understand the epidemiology of adoption, euthanasia, disease and other events in shelters, the better. Knowledge helps us figure out better ways to run things.
Potential bad points
Animal welfare: Will shelters resist euthanizing sick or injured animals that would otherwise be euthanized to keep their rates lower? If an animal is very sick, will there be the temptation to let it die rather than euthanize it, if deaths are not reportable but euthanasias are?
Overpopulation in shelters: If shelters try to avoid euthanising animals because the rates are reportable, there will be more animals in the shelters - likely more than they can actually handle. More animals in a shelter does not mean more adoptions. Overcrowding leads to many problems such as increased disease risk, deceased quality of care, decreased human contact and increased shelter operation costs.
Outbreak potential: Yet another issue related to overcrowding is when you cram in as many animals as possible (often using carriers and other temporary housing stashed anywhere there's spare space) and decrease the time you spend with each animal, you create great potential for a disease outbreak. The more animals are present, the more likely the outbreak will take hold and the harder it will be to control.
Needless transfers: Will shelters try to transfer animals that are unadoptable to areas where this law is not in effect, simply to be euthanized outside of the recording system? Beyond the humane aspects of putting the animal through the stress of a transfer for no real reason, shipping shelter animals is notoriously high risk for shipping diseases along with them.
Cherry-picking: This already happens with some shelters, but one way to keep euthanasia rates low is to refuse to admit animals that are not likely to be adopted. Turning them away doesn't help the animal or society (and may result in more animal suffering, among other things, if the animals are simply abandoned), but it keeps euthanasia numbers low.
Will this work?
Shelters don't euthanize for fun. They do it because there is a finite number of homes available and the number of animals coming into shelters (especially cats) is way beyond that. This bill will not magically create millions of new homes for shelter animals. So, how will it "reduce euthanasia of unwanted animals"?
A representative of a group working to reduce shelter euthanasias added "We do not believe that it is the conscious will of the people of the state of Florida to kill over 50% of the lost and homeless shelter pets each year." It's not their conscious will but what can/will they do about it? Euthanasia numbers might help spur interest in adopting from shelters, and if so, that would be great. But the fact is that if 50% of animals in shelters are being euthanized, it's because they don't have homes.
Probably a well-intentioned but poorly thought-out approach to the pet overpopulation problem.
The Guelph Humane Society has re-opened after a temporary closure to manage a potential ringworm outbreak. The shelter took an aggressive, proactive approach to the issue, including testing and treatment of all animals and thorough disinfection of the facility.
Looking back on a proactive outbreak response like this one, it's always hard to say if a bad outbreak didn't develop because it wasn't going to, or because of the early aggressive response (i.e. did it get better because of what they did or despite what they did). However, if you sit back and wait (or remain in denial), you can be sure that it's much more likely that badness will develop.
Once things have settled down, people sometimes complain that an aggressive response was unnecessary because nothing bad happened, but they're often the same people that complain that not enough was done when an major outbreak occurs. An ongoing challenge in infection control is fighting complacency, since successful infection prevention and control programs sometimes lead to people forgetting about the bad things that can happen and why such programs are in place to begin with. We should applaud facilities that "suck it up" and accept the negative PR, time and financial consequences of an appropriate response in order to protect the health and welfare of the animals for which they care and all the people (employees and public) who have contact with them.
On my way to Beth's soccer practice yesterday, I heard a blurb on the radio about how Frank Klees, MPP (Member of Provincial Parliament) told the legislature that the Newmarket OSPCA was going to euthanize all their animals because of a ringworm outbreak, and that three employees had been fired because they objected to the number of euthanasias. His statement that "We have a repeat now, at the same shelter, of what took place nearly a year and a half ago" was pretty concerning, given the severity of the earlier "ringworm" debacle. Klees, the veteran PC party MPP, has been a vocal critic of the OSPCA in the past.
Later that night, I found a little more information, which was mainly centred around complaints about the number of animals being euthanized for various reasons, and a subsequent statement by the OSPCA that there was no outbreak.
Now, it appears that a protest is being planned for today (Friday), although it's not really clear to me what they are protesting. Maybe there's more to it than is being reported and an outbreak or cull is actually underway. However, in the absence of that, their protest is better directed at the state of the animal population rather than OSPCA euthanasias.
While I don't have a lot of confidence in Newmarket OSPCA management at this point, it's hard to blame the them for euthanizing a lot of animals. It's a function of supply and demand, as well as limited capacity.
North America wide, the euthanasia rate for cats entering shelters is about 50%. That's a staggering number, but it's not usually the fault of the shelter system - it's because of the massive overpopulation of cats. When twice as many cats come in as there are available homes, something has to give. You can either build new shelters every year (obviously unrealistic), pack current shelters to the ceiling with cats crammed into crates in every corner (a perfect situation for a large outbreak and hardly fair to the cats) or euthanize many and focus efforts and resources on the most adoptable animals. As much as the "no-kill" concept has market appeal, it's completely unrealistic for cats at this time because of the simple fact that millions of new cats are born every year with no hopes for a home. A small shelter can run as a no-kill shelter, but that just means that they limit their admissions and/or don't accept cats with limited adoption potential. A large shelter like Newmarket that takes whatever cats arrive will euthanize many of them, even without an outbreak going on. In fact, to do things right, a large shelter has to euthanize lots of cats to allow them to properly care for and find homes for other cats. Sad but true.
So, while euthanasia is obviously undesirable and it gets people worked up, yelling at the OSPCA doesn't do anything. They're not going to stop euthanizing cats, because they can't. Efforts are better spent helping deliver care to stray animals and preventing the cat population from expanding.
One of the most important things anyone can do to help the problem is make sure to (as Bob Barker used to say) have your pet spayed or neutered (and pass the message along to those you know as well!).
'Tis the season for ringworm, I guess.
The Guelph Humane Society has closed to visitors, and adoptions have been suspended in response to concerns about the potential for a ringworm outbreak. Implementing a proactive response, all animals are being tested for ringworm and all cats are being treated. While the scope of the problem isn't yet clear (and hopefully it's minimal), this type of response is the optimal approach because waiting to "see what happens" and waiting for culture results (which can take a long time) before deciding to take aggressive measures results is a much greater chance of things getting out of hand.
In an outbreak like this, the first week or so is critical. Introduction of an animal that's carrying ringworm is hard to prevent, as is limited transmission within a shelter (even with good routine infection control practices) from that first case. That's the non-preventable component of shelter diseases. However, it's the 2nd generation of transmission (transmission of ringworm from that initial animal or group of animals to the broader population) that leads to things getting out of control. That's the preventable fraction of infections, on which we can have the biggest impact. It's during this early phase where intervention is critical It's always better to have an overly aggressive response and simply tone it down after a few days, than to have an inadequate response that lets things spiral out of control.
More information about ringworm can be found on the Worms & Germs Resources - Pets page.
The scope of the outbreak isn't really clear from press reports, but "a couple" of other animals now have signs of the skin disease. Investigation of the timing and likely sources of exposure of new cases is crucial. They may just be animals that were infected early, before the problem was recognized (the best case scenario) but investigating these "new" cases is very important because if these animals were exposed after the outbreak was identified, then there are problems with containment.
Shelter personnel have declared that they aren't planning on euthanizing more animals, but the shelter remains closed for adoptions. Stray animals will continue to be accepted. This creates a tricky situation where new animals (e.g. fuel for the fire, if things aren't under control) come in and can actually propagate the outbreak. It also creates overcrowding issues since the shelter was probably pretty full to start with, and continuing admissions with no adoptions can't be maintained for long. The shelter is looking at renting units in which to put animals - this is a relatively common approach for creating more contained spaces, and one that can be useful if good infection control practices are in place (although I've seen too many outbreaks where the offending pathogen quickly makes its way into the new units). Clear policies, sound training, careful supervision, exquisite planning and good communication are critical for making a situation like that work.
While the shelter has gone from an unrealistically optimistic time frame to a warning about long-term efforts, as with most things in life, the middle ground is usually the most accurate. Ringworm outbreaks can't be declared over in a few days (it's possible to contain it in a short period of time, but not declare an outbreak over). A few days isn't even enough time to get culture results back to figure out exactly what's happening. Testing, isolation, cohorting, mass treatment, evaluation of training, evaluation of infection control practices, and similar measures are needed, but if done right, an outbreak can be contained in a reasonably short period of time. Given the need to repeatedly treat all animals (affected animals are being bathed every three days with a medicated solution) and the time lag for ringworm culture, it's going to take at least a few weeks, but let's hope this outbreak ultimately gets measured in weeks rather than months.
The facility was closed to the public on August 4th because three cats and one dog were showing unspecified signs of ringworm.
Samples were collected for testing, but they decided to euthanize the 4 animals.
"You’re kind of under the gun to decide what you want to do,” said their operations manager. I can certainly empathize. It's not easy to deal with an outbreak. However, from my standpoint, if you feel like you're under the gun in that kind of situation, you're likely to make (or to have already made) mistakes. If you're managing the situation well, getting advice and following standard practices, you may be stressed, exhausted, humbled and concerned, but you shouldn't feel "under the gun." Maybe euthanasia was warranted here, but with a small number of infected animals, the ability to potentially isolate and treat them, and lots of information about how to manage ringworm to avoid further spread, it's important to avoid a panic response that leads to premature euthanasia decisions.
The three cats that were euthanized apparently did not have ringworm, but the shelter is "certain" (not sure how) that the dog had ringworm. Sudden onset of skin lesions in dogs and cats at the same time is certainly suggestive of ringworm, and if the dog was truly infected, it's hard to believe the cats were not (especially since cats are most often affected in ringworm outbreaks compared to dogs). So I wouldn't be too quick to rule out ringworm in the cats. Ringworm culture can take a couple of weeks, so it's not clear to me whether this interpretation is based on culture results or not.
"With the results being better than expected, the humane society will not have to move larger numbers of possibly infected animals to a different facility — the usual procedure in an outbreak." While I can't say too much from a distance, I can say that moving animals to another facility is certainly not a typical outbreak response measure. It's an effective outbreak propagation measure, since it can easily disseminate ringworm to other places, so it's good to hear that they are not planning on moving animals. It's much better to manage things well at one site than to have to manage things at multiple sites.
They state that "the situation now appears to be under control." Hopefully that's true, but it's way too early to say. You can't declare an outbreak over a few days after you declare that it started. There hasn't even been enough time for any animal or environmental ringworm culture results to come back. Closing, testing, treating all exposed animals and thorough cleaning and disinfecting of the environment can be a great start, but trying to say "we won" too early often leads to inadequate response and continuation of the outbreak.
"We’re keeping our fingers crossed and hoping that everything comes back negative so we can be open for business sometime next week" Again, I'm not involved and I'm working with sparse information, but this seems to be way too early to reopen the shelter. You need to make sure things are really under control before you get out of "outbreak mode" and before you can be "open for business" again. That's especially true with a disease like ringworm that is highly transmissible and can be spread to people. Too often, a small outbreak is identified and declared over prematurely, only to be followed by a big mess in short order. Let's hope that's not the case here.
Image: Photo of a dermatophyte-positive culture specimen, which can take two weeks or longer to grow.
A short distance down the road from here, the Kitchener-Waterloo Humane Society has been quarantined because of an apparent ringworm outbreak. There's no information on the facility's website and information in the press has been pretty vague (both concerning aspects), but it sounds like a ringworm outbreak. Adoptions have been ceased and the Humane Society will apparently "reassess its safety protocols by the end of the week." The outbreak appears to have been going on since at least last week, so hopefully they're getting on this and have a strong outbreak investigation and control plan in place.
I haven't been involved in this outbreak so I know nothing more than what is in the press, but ringworm can be a big problem in shelters. It's a controllable disease, but the situation can get completely screwed up with a poor outbreak response. It's also sometimes an overblown problem (or not a true problem at all) in some situations, so it's critical that the outbreak is properly investigated and managed. That's not always the case, and the consequences can be serious.
There are a lot of factors that go into good outbreak management that are hopefully being done at the KW Humane Society. These include:
- Good communication both internally and externally.
- Sound containment practices.
- Getting good advice.
- Actually listening to the good advice (and not bad advice).
- Taking the time to do it right.
- Ensuring one is acting on correct information.
- Spending money where it needs to be spent, be it testing, treatment, personnel or other factors. Trying to save money during an outbreak response often ends up costing much more in the end.
The independent report of the 2010 ringworm debacle at the Newmarket OSPCA should be important reading for any shelter trying to figure out what to do, and what not to do.
The Redlands Animal Shelter in California is looking into bird control measures after blaming Giardia infections in dogs on exposure to wild bird poop. On Facebook, Redlands Friends of Shelter Animals have declared "We have a serious problem with birds at the shelter. They land on the kennels and poop goes into the water bowls and give the dogs giardia - which is a parasite that gives them explosive diarrhea."
Giardia is a protozoal parasite that can cause diarrhea in dogs and other species. It can also be carried by healthy dogs, at relatively high rates in some groups. The scope of the problem at the Redlands shelter isn't clear since the news article only talks about one case. Whatever the scope, shelter management is blaming the birds.
Apparently, discussions are underway with different companies about a solution to the bird problem, something that is anticipated to be expensive. However, it's all too common for people to jump the gun on expensive interventions when there's an outbreak and overlook the root causes. While news reports don't always give the whole story, I'd be wary about blaming birds without much more evidence.
Can wild birds carry Giardia? Yes. However, there's more to the Giardia story than that. It doesn't sound like they've actually tested the bird feces to determine whether Giardia is there. Additionally (and critically) it doesn't sound like they've determined the type of Giardia that's infecting the dogs. There are different types (assemblages) of Giardia and most have a limited range of species they can infect. The vast majority of dogs with Giardia in most regions are infected by Assemblage D, a dog-specific strain that comes from other dogs and poses no risk to people. I'm not aware of Assemblage D being found in birds. Dogs can also be infected by Assemblage A, a type that infects people, and also can infect birds.
So, if Assemblage D is involved, they need to look at transmission between dogs within the shelter. If Assemblage A is involved, they still need to focus on dogs but could investigate birds as a potential source.
Overall, Giardia transmission is much more likely due to breakdowns in cleaning, disinfection, hand hygiene and general shelter practices rather than birds pooping in water bowls. It's a lot cheaper to address these shelter management practices (which will also help control various other infectious diseases) rather than dumping a lot of money into controlling bird exposure when in fact that may not be causing the problem. Trying to reduce exposure to bird poop is a good thing as a general practice, but it's important to focus efforts and resources on finding and addressing the true root problems during an outbreak.
More information about Giardia can be found on the Worms & Germs Resources page.
The executive director of the SPCA of Niagara is under pressure from charges that he's "presided over the killing of hundreds of animals." As is common with shelter controversies, sorting through the emotion and rhetoric is difficult. At best, running a shelter can be a thankless task, due to the overwhelming number of animals, emotion, lack of understanding by the public (and often personnel) of the relevant issues, financial challenges and often poorly designed facilities. At the same time, bad things do happen in shelters, and it's critical to put in the time and effort to determine whether things are being done poorly and what needs to be fixed. Here are some of the issues from the Niagara situation.
"From Oct. 1 to Dec. 15, the local SPCA euthanized 473 cats and 100 dogs, a staggering total of killings, according to sources familiar with the situation at the Lockport Road shelter."
- Apart from the problem of relying on information from anonymous sources, it's hard to put this number into context. You need to know the overall number of animals that come in and the shelter's capacity. It's a sad fact that about 50% of cats are euthanized at most shelters internationally because of massive overload. Shelters shouldn't be cat warehouses. It does no one (including the cats) any good to stockpile huge numbers of cats that never have a chance of adoption, and it creates a perfect environment for disease outbreaks. So, while that number of animals seems high at first glance, it may just reflect the reality of supply and demand, shelter capacity and the health/adoptability status of the animals.
"When he was hired, Faso admitted, “My animal care experience is very minimal.”"
- A shelter director doesn't need to be an expert in shelters and animal health. In fact, some excellent shelter directors have come into the job with no experience whatsoever. Their job shouldn't be running animal care. They should be running the shelter, managing personnel, raising funds, liaising with the community and doing a host of other activities. The key is having good veterinary and animal care support, and a willingness to listen to those people. It would be great if every shelter manager was a veterinarian with a shelter medicine residency under his/her belt, along with an MBA and training in communications, but that's not going to happen. Someone with little animal knowledge but the ability to listen and take advice can be an excellent shelter director.
"McAlee and others tell horror stories of animals brought to the shelter for surrender or picked up on the streets and in need of medical care, who are then left to suffer in their cages. In one case, a cat that appeared to be suffering from a broken jaw was brought in and allowed to stay for a week in a cage without treatment. Finally, a concerned staffer took the cat to an emergency veterinary clinic where it was treated and then returned to the shelter."
- That's a big problem. If true, and if this was done because of pressure from the director overriding advice from medical staff, then that's completely inappropriate. Interference with medical decisions and medical care does occur in some shelters and is a major problem.
"When the cat then developed a common respiratory infection, rather than provide further medication for the animal, Faso directed that it be euthanized."
- This is a tougher issue. I hate to see potentially treatable animals euthanized, but euthanasia is an appropriate response in some situations. If they are unable to properly manage an infectious case or are overwhelmed with healthy cats, keeping an infectious cat may pose a huge risk to all of the other cats in the facility. It's impossible to say much here without more details.
"Other sources tell the Gazette that cats at the shelter have been injuring themselves in out-dated display cases and that a donor offered to fund the replacement of those cages. Faso, reportedly, refused to accept the donation."
- Poor housing is a common problem in shelters. Good cages are expensive. It would be bizarre for a shelter manager to turn down money (that came with no strings attached) and if that was done, it would be another sign that Mr. Faso's not right for the job.
"..he has reportedly told board members and others that the local SPCA will “never be a no-kill shelter because it’s too expensive."
- That's an unfortunate fact. No kill shelters just aren't viable in the grand scheme of things. Individual shelters can be no kill, but that's often done by cherry picking the adoptable animals.
It comes down to math. If 50% of cats coming into shelters are euthanized every year because of lack of space, to convert to a no-kill approach we'd need to massively increase shelter capacity every year to accommodate the increasing population. Millions of dollars would be required to create cat warehouses where millions of unadoptable cats lived marginal lives in facility confinement until dying of natural causes or from the massive disease outbreaks that would be certain to happen. I know I'll get reams of emails complaining about this paragraph, but to me it's a simple fact. If you increase supply by 100% per year by not euthanizing any animals, and demand doesn't increase, the math quickly shows you the size of the problem that would be created.
The only way to get to the point where no-kill is a viable approach is to have more responsible pet owners and better animal population control. Euthanasia rates are much, much lower in dogs, in part because of much better population control and also because people tend to try harder to recover lost dogs compared to lost cats. Recovery rates of lost dogs that make it to shelters are very high. Cats... not so much.
So, if you want to help out shelters and the animals in them:
- Spay and neuter your pets.
- Donate to good quality shelters to help them provide optimal care.
- Volunteer, if you have the time and interest.
- Hold shelters to a high standard, but make sure it's a realistic standard.
- Encourage municipalities to properly fund animal shelters and enforcement.
- Consider adopting from a shelter if you are getting a new pet.
- Take the time to learn about the issues, and make assessments based on fact, not just emotion.
Infectious diseases are continuous challenges for animal shelters. Unfortunately, outbreaks are not uncommon. Sometimes they're the result bad luck and the inherent risks involved in bringing together lots of animals of questionable health status from different sources. However, if you compound these risks with things like inadequate facilities, overcrowding, poor training of personnel, poor adherence to protocols, bad protocols, lack of awareness about infectious diseases and failure to get expert help early in any outbreak, the likelihood of "badness" increases.
A few shelter outbreaks are underway at the moment, and they highlight some of the infectious disease challenges posed by different diseases in animal shelters.
- The Oakville and Milton Humane Society (in Ontario) is closed because of a ringworm outbreak that's been going on since early September. Ringworm, while of limited health consequences, is an important shelter problem because it's common, highly transmissible, can be hard to control and can infect people. At last report, 22 cats were confirmed or suspected to have ringworm, along with at least four staff members. It's not clear who's coordinating the outbreak response, but hopefully they're getting good advice and they've read the comprehensive report from the Newmarket OSPCA ringworm debacle.
- 72 kittens were euthanized in the Miami-Dade County Animal Services because of "cat plague," which is a common name for feline panleukopenia. This viral disease is preventable by vaccination, but it's a serious concern in shelters were there are often lots of unvaccinated or inadequately-vaccinated cats and lots of susceptible kittens. In this shelter, all cats with clinical signs consistent with panleukopenia are being euthanized. Euthanasia is always a tough decision, but with a serious disease like this, it's a reasonable response. Outbreaks like this highlight the need for excellent infection control practices to reduce the risk of spread of pathogens like this once they make it into a shelter.
- Upper respiratory tract infections have resulted in suspension of adoptions at the Bergen County Animal Shelter in New Jersey. News reports are calling it a canine influenza outbreak, and canine flu is definitely on the list of possibilities, but it doesn't sound like it's been confirmed. Respiratory infections are a common cause of problems in animal shelters because some causes (e.g. canine parainfluenza virus, canine influenza virus) are quite transmissible. Canine flu poses extra challenges when it moves into a new area, since few if any dogs have antibodies against the virus and therefore it can spread rapidly. The report also mentions transmission by dogs not showing signs of disease. That's a problem with some infectious agents. For example, with canine flu, dogs tend to be able to shed the virus before they show signs of illness. Therefore, there's a period of a couple of days after infection but before disease where you can have a silent reservoir of infection. That's why quarantine of new admissions is critical, since it gives animals a few days to show signs of diseases they may be brewing at the time of admission. (Unfortunately, it's not easy to find space in which to quarantine an animal in an overcrowded shelter.)
A common denominator in all of these outbreaks is the potential that something could have been done differently to prevent the problem. It's possible (although unlikely) that everything that was done perfectly, however it's a rare outbreak where you can't find multiple areas for improvement. A key aspect of outbreak management is, once the crisis is over, performing an investigation of what really went wrong and why, and taking measures to reduce the chance of it happening again.
Image: Ringworm infection in a cat is not always readily apparent, but in some cases can cause obvious patches of hair loss.
As many of you know, there was a large ringworm "outbreak" at the Newmarket (Ontario) OSPCA shelter in 2010 that led to a public outcry in response to plans to depopulate the shelter. In the aftermath of the event, an independent investigation was launched, headed by Mr. Patrick LeSage (former Chief Justice of the Ontario Superior Court) and Dr. Alan Meek (former Dean of the Ontario Veterinary College). The investigation involved a comprehensive examination of activities pertaining to the outbreak and shelter operations, in conjunction with relevant experts (disclosure: I was one of those).
The report of the investigation is now available, and covers important aspects such as whether an outbreak was actually present (short answer: no) and whether there were major problems in shelter operation (short answer: yes). Most importantly, it provides a comprehensive set of recommendations to improve the operations of the Newmarket shelter and OSPCA as a whole.
The report, in its entirety, was released today by the OSPCA and is available for download on their website. The report is on the site in multiple files: the main report is listed as "Index" and contains the ~90 page overview and recommendations. The expert reports, which might also be of interest, are tables D1-3, E, F and G.
The situation occurred in March 2010, when a stray dog taken to a North Dakota animal shelter was diagnosed with rabies. An investigation was undertaken to look into human and animal exposure.
- Potential exposure was investigated in 32 people. Of these, 21 were determined to fit criteria for requiring post-exposure prophylaxis. This included nine shelter employees and one volunteer.
- Twenty-five dogs at the shelter were considered exposed. According to the report "In accordance with 2009 Compendium of Animal Rabies Prevention and Control guidance (1), the 25 dogs in the shelter with the rabid dog were euthanized." That's a somewhat misleading statement. Immediate euthanasia is not the only recommendation in this kind of situation, it's just one of the options. In a dog that has not been vaccinated (or whose vaccination status is unknown), euthanasia OR six months of strict quarantine is indicated. The decision to euthanize was probably a logistical one, not being able or wanting to quarantine this many dogs for such a long period of time. It's a reasonable decision given limited isolation capacity (and budget).
- Twenty-five other unvaccinated dogs that were adopted or claimed by their owners were also exposed. (Presumably, these were dogs that had contact with the infected dog, then went to homes before the rabid dog was diagnosed). Of these, 11 were euthanized, 13 were quarantined for 6 months at home, and one was 'unintentionally killed' (whatever that means). All euthanized dogs were tested and were negative for rabies.
A few issues were raised in the report:
Rabies vaccination of shelter personnel: "In addition, preexposure prophylaxis for animal shelter workers or other persons whose activities bring them into frequent contact with potentially infected animals should be considered, in accordance with Advisory Committee on Immunization Practices recommendations (6)" This is a complex issue. It would be ideal for all shelter employees to be vaccinated, and I'd love to see that done. The problem is actually getting it done. Shelters often have many employees and volunteers, and a very transient worker population. Getting all these people vaccinated is tough. Vaccinating short term, part time and temporary employees is tough enough, let alone volunteers. Cost is also an issue. Is it realistic to make people volunteering or earning low wages to pay the expensive cost of vaccination? Can shelters afford to pay for vaccination? What happens if someone doesn't want to be vaccinated? This is an ongoing issue in shelter medicine and one where there is no clear consensus. Shelter personnel clearly fit standard recommendations as being a group in which vaccination should be considered, but it's easier said than done.
Vaccination of animals: "First, all domestic animals should be vaccinated against rabies, in accordance with guidelines (1,8)." This is another issue that is very good in principle but tougher in practice. Rabies vaccination must be done by a veterinarian in most regions, and most shelters do not have a resident veterinarian. Getting animals vaccinated promptly after admission can be difficult. Ideally, shelters would have better and closer relationships with veterinarians, but it's quite variable (and an area that needs improvement). Vaccination would also not help much in some situations, since it does not result in immediate protection. Dogs that are vaccinated are not considered protected for 28 days. Therefore, even if they were vaccinated at arrival, some of the dogs in this situation would still be considered unprotected. Nonetheless, I don't want to dismiss the role of vaccination, and I think shelters need to significantly increase rabies vaccination rates. It's not a simple problem, however.
Contact in the shelter: "Second, animals without documentation of vaccination against rabies should be kept separate from the public, wildlife, and other animals to prevent transmission of the virus (5,8)." Another "good in principle, but have you ever been to a shelter?" statement. Shelters don't have lots of space. Having enough room to properly separate incoming, sick, and adoption animals is hard enough. Having to separate all those groups into rabies-vaccinated and non-vaccinated, or individually isolate animals, is going to be impossible logistically in most facilities. The concept of cohorting animals of different risks is excellent and can be improved on, it's just not possible to isolate all animals that are unvaccinated or of unknown vaccination status (i.e. almost every animal coming into a shelter). This is particularly true since they are not considered protected until 28 days after vaccination.
Infection control practices: "In this case, 36 dogs had to be euthanized because employees and volunteers might not have consistently followed the shelter's policy of preventing muzzle-to-muzzle contact between dogs." Compliance with infection control practices is an issue, and it could be improved. It's an area we're working on now.
Definition of contact: In this particular situation, a very broad definition of contact (that may result in exposure) was used. "Although the shelter's animal handling policies likely minimized contact among dogs, muzzle-to-muzzle contact could not be ruled out; therefore, BOAH and NDDoH recommended that all dogs present in the shelter from March 9--20 be euthanized." It's quite unlikely that any of these other dogs were truly exposed if this is the only kind of contact they may have had with the rabid dog. Balancing public health and animal welfare is difficult. Certainly, you need to err on the side of caution, but how far do you go? Quarantine would have been ideal because of the extremely low likelihood of exposure, however if it's not practical (or feasible or affordable) in a shelter situation, euthanasia may be the only option.
This was a bad situation but it's not surprising, nor will it be the last time it happens. A single rabid dog led to the euthanasia of 36 other dogs, and expensive (and probably stressful) treatment of 21 people. Shelter management can be improved to reduce the risk of this happening, but there's no way to absolutely prevent it.