As the unprecedented outbreak of H5N1 avian influenza continues in North America, there are various concerns about where this outbreak is going and the threats to other species….domestic and wild mammals, and people (us being just another ‘domestic animal’).  My inbox is filled with questions about various concerns and scenarios. The one I’ll address today is about risks to vet clinics that treat backyard poultry.

Backyard poultry are increasingly common in many areas and, since they are outside and not managed with anywhere near the same degree of biosecurity as most commercial poultry, they are at high risk of exposure to avian flu if it’s circulating in wild birds in the area.

The good news

This H5N1 strain is not well adapted to infect humans (or mammals, in general). It lacks some of the genetic material that makes it able to effectively infect people. Only a couple human infections have been reported, including one in the US where the only symptom was fatigue. Transmission to other non-avian species is probably rare too, but all we can say is ‘probably’ because of limited testing of wildlife. Spillover has occurred, such as the recent cases in foxes in Ontario. Whether that’s a really rare event or a really rarely diagnosed event isn’t clear and is a big question. Still, it’s safe to say that, at this point, spillover risks are limited.

The concerning bits…

It’s still a flu virus and flu viruses change. The circulating strain can evolve and reassort (swap genes with other flu virus strains). We have other influenza viruses circulating in North America, including a human flu season that’s dragging on and influenza in other species such as pigs, horses and (in the US) dogs. There are also other avian flu strains around sporadically. The more flu viruses in circulation, the greater risk of them getting together to re-assort and make a new strain, potentially with more affinity for people.

So, back to the clinic situation.

Backyard poultry sometimes need vet care. Most often, that falls on small animal clinics, since poultry vets are limited (and may not treat backyard birds). Unlike most livestock, backyard poultry that need vet care are typically taken to the clinic (as opposed to livestock where vets visit the farm). This creates a few scenarios to consider for the vet clinic.

Transmission to people

  • Fortunately, this seems to be very rare, at least at this point. Rare doesn’t mean it can’t happen, but the odds of bird-human infection (at least infection that causes noticeable disease) seems to be very low. So, it’s not likely someone handling an infected bird will get sick, but it’s possible.
  •  Another dynamic is worth considering, though. Hopefully the ‘stay home if you’re sick’ message is getting across but we know that’s not always the case, and people that are infected with influenza don’t always have symptoms. We might be getting into excessively theoretical issues here (I doubt it, though); however, we need to think about the potential impact of people that have human influenza getting exposed to birds that might have avian flu. If one infects the other (and therefore has an infection with two different flu viruses), that’s the recipe for re-assortment to create a new strain.

Overall, the risk is low. A comment I made today to someone was “There’s some degree of risk but in the absence of sick birds, the zoonotic risk isn’t likely any greater than that posed by your average new puppy (e.g. Campylobacter).” I think that’s a fair statement, but at the same time, one of my goals in life is not to become a case report describing a rare/new infectious disease, so I still want to take care.

Transmission to mammals

  • The issues are similar to humans. The risk of transmission is low but not zero. I wouldn’t get too concerned about it, but I’d still rather not create the chance for rare bird-mammal transmission in the clinic, especially since we can largely prevent it with some basic practices (see below).

Transmission to other birds

  • This is probably my main concern. That could be transmission to other backyard poultry (not too likely since there usually aren’t multiple backyard chickens at a clinic at the same time) or transmission to other pet birds. Susceptibility amongst different bird species varies but we’re seeing lots of wild birds dying from this virus. We don’t want to see it spread in a clinic to someone’s pet bird (or worse, to someone’s aviary). That creates risk of illness and death for the bird(s), and more human exposure to the virus.

So, what do we do?

  • We do what we do every day….we assess and manage risk.

Risk reduction

We can never 100% eliminate risk. That’s just not an option for most infectious diseases, especially flu. However, we can use some basic, common sense measures to reduce risk of avian flu transmission.

Risk assessment

Since healthy looking birds can be infected, there’s no way to guarantee that a given bird isn’t shedding avian flu virus. However, we can identify situations where the risk is higher and increase the infection control measures that are used. These would include when..

  • The bird is sick with signs that could be avian flu infection (including neurological disease)
  • Other birds in the group are sick
  • Other birds in the group have died
  • Avian flu has been found in wildlife in the area

Physical separation

If we can keep poultry away from people and animals as much as possible, we greatly reduce the risk. That can be done a few ways..

  • Admitting birds directly to isolation or another separate, contained space (vs hanging around in the waiting room)
  • Examining birds outside so they never set foot in the clinic
  • Housing hospitalized birds in isolation or a separate area

Limiting contact

Minimizing the number of people that handle the birds in the clinic reduces transmission points. One or two people may be required for examination and procedures but that can be kept to a minimum.

Appointment scheduling

Trying to make sure that poultry come into the clinic at a time when no other birds are present isn’t always possible if there’s a high bird caseload or for emergencies, but it’s something that can often be done.

PPE and hand hygiene

Some basic infection control practices can go a long way. We use routine practices on the assumption that any patient might be harbouring something infectious. Routine things like wearing proper protective outwear (basic lab coat) and hand hygiene will help. This can be increased if there’s specific concern (e.g. sick bird, dead birds in the group, lots of avian flu activity in the area) to include a disposable gown, mask and eye protection.

Testing

Rapid tests would be nice and are available for avian flu. However, we have not had success getting permission to import the tests for screening in places like clinics and wildlife rehab facilities. They’re not perfect and can never rule out flu. However, like with COVID-19 rapid tests, they could be a useful screen as a positive would indicate a need to user stricter precautions, get confirmatory testing done and provide more surveillance info. There was reluctance to use rapid tests for COVID initially, but they ended up being an easy and useful tool. Currently, the only testing we can get done is PCR testing through diagnostic labs, which doesn’t help us from a clinic control standpoint since the turnaround time is a few days.

 

The current H5N1 avian flu outbreak is definitely something to be concerned about. It’s having major impacts on domestic and wild birds. We want to control it to reduce the impact on those population and reduce the risk of this developing into something more. However, vet clinics should be able to treat poultry without much risk, if some basic measures are used.

Photo credit: https://www.insauga.com/backyard-chickens-may-come-home-to-roost-in-ajax/

 

A recent publication in the Journal of Veterinary Diagnostic Investigation (Haydock et al. 2022) describes an interesting but unfortunate case of tuberculosis in a dog. Published reports of rare cases like this are often of limited value, but sometimes they highlight important broader issues, and I think this one fits that category.

The patient was four-year-old mixed breed dog that was presented to the Ontario Veterinary College because she had some liver and lung masses, and fluid in her chest. She had a very extensive workup, including lots of bloodwork, radiographs, a CT scan, ultrasounds, bronchoalveolar lavage, and even exploratory surgery to get samples of the masses for testing. I was involved because an infectious cause seemed likely, but a specific cause wasn’t readily apparent despite a pretty vast array of infectious disease tests.

There’s another twist to this story based on the origin of the dog: she was living in Toronto, but had been adopted through a rescue 18-24 months earlier, originally having come from a remote community in northern Quebec. Whether it’s a dog from another country or from another region of Canada, we have to think about what different infectious diseases might be involved when we see dogs from other places. That can be a challenge since we often don’t have good data on disease risks in different areas. There were a few things we considered in this case, but nothing really fit.

As things progressed, it seemed there was a good chance the dog had a Mycobacterium species infection. Mycobacterium is a genus of bacteria that includes a lot of different species, including the causes of human (M. tuberculosis) and bovine (M. bovis) tuberculosis, along with a big group of environmental species that rarely cause disease. We divide Mycobacterium into two main groups, tuberculous mycobacteria (including M. tuberculosis and M. bovis) and non-tuberculous mycobacteria (NTM, which includes the important M. avium complex, or MAC).

At that point, I suspected the dog was infected with MAC, a fairly ubiquitous group of environmental mycobacteria that can sometimes cause severe disseminated infection.

  • I was partly correct, but that wasn’t much consolation when we got PCR results saying it indeed was mycobacterial – but it was M. tuberculosis, the cause of human TB.

I think the first thing I said in response to the result was “I suspect there’s an issue with the test. We’ve seen cross-reaction before in samples from that lab for that test. It’s probably a non-tuberculous Mycobacterium since that’s more common and the disease fits.”

  • But it turns out, that was not the case.

It was subsequently confirmed as M. tuberculosis by culture. Whole genome sequencing and MIRU-VNTU profiling showed it was a near exact match with a TB isolate from a person from Quebec, providing more support that the dog was infected before being moved to Ontario.

So, we had a diagnosis. Unfortunately, the dog deteriorated and was euthanized shortly before we got the TB result.

However, that led to a whole new issue: human exposure to TB from the dog. This dog had obviously had close contact with its owners for close to 2 years, and was cared for by numerous veterinary personnel at the referring veterinary clinic and at OVC, including some high-risk procedures (e.g. intubation for surgery, close contact in ICU). We don’t know a lot about dog-to-human transmission of TB, but there was certainly potential risk since the dog had lung lesions and could therefore have had viable M. tuberculosis in its respiratory secretions.

Public health units in both Guelph (where we are) and Toronto (where the dog lived) were informed, and coordinated contact tracing, using definitions for exposure we created for this situation (see table below). A lot of investigation and testing was required, but fortunately in the end there was no evidence anyone was infected by the dog.

TB has been reported in dogs before, but it originates from humans in these cases. Concern has been raised about importation of TB-infected dogs from areas where the disease is common in people, and this scenario both supports that risk and highlights how “importation” should really be thought of as “dog movement,” since there can be risks with dogs from other areas of the country, even if they haven’t crossed an international border.

Dogs don’t seem to be very good hosts for M. tuberculosis, but we don’t have great data about how often human-to-dog transmission occurs, in part because testing of dogs is a challenge. Typical human tests for TB (e.g. tuberculin skin test) do not work well in dogs, so there’s no quick and easy way to screen dogs who have been exposed to people with TB. Presumably, human-to-dog transmission occur sporadically but usually doesn’t result in severe disease in dogs. Transmission from dogs back to people is hard to evaluate, since most infected dogs come from infected households, so figuring out who infected who is a challenge. Scenarios like this, where an infected dog came into the household where there were no other known sources of exposure can help us figure these things out, but aren’t commonly encountered. The fact that no one got infected from this dog is encouraging, but it’s a pretty small sample size from which to draw conclusions.

This report doesn’t mean we need to think that every dog with strange disease has TB. This is a rare case. However, it should be taken as a reminder that strange things do happen, and that the origin of a dog needs to be considered when thinking about infectious diseases. We’re getting better at asking if dogs were imported. However, it’s not the act of changing countries that increases risk. It’s traveling between different risk areas, or between communities with different disease risks, even if they’re within Canada. We need to pay more attention to dog origin and dog movement (including people who take their dog on vacation), not just whether the dog was “imported.”

Image: Medical illustration of Mycobacterium tuberculosis (source: CDC Public Health Image Library 23254)

H5N1 influenza was recently found in two wild fox kits in St. Marys, Ontario. It’s a pretty noteworthy event given the scope of the current H5N1 highly pathogenic avian influenza (HPAI) outbreak across Canada, and the fact this is the first identification of H5N1 influenza in wild mammals in Ontario. The fox kits were submitted by a wildlife rehabilitation centre; these centres are great sources of information about emerging wildlife diseases as they are on the front lines and often bear the brunt of such issues. One of the fox kits was found dead and the other had severe neurological disease and died shortly after admission. Influenza virus was found in their brain tissue and was likely the cause of death. Further characterization of the virus identified it as an H5N1 strain of influenza A, more specifically of the A/goose/Guangdong/1996 (Gs/GD) lineage.

Is this surprising?

Not really. We don’t recognize much spillover of flu viruses into wild canids, but when you consider how widespread this virus currently is, it’s not a shock that spillover would happen. (It’s maybe more of a shock that we’d actually find it.)

We know that foxes, like other canids, are susceptible to various flu viruses. In an experimental study (Reperant et al. 2008), researchers were able to infect foxes by feeding them carcasses of infected birds, though the infected foxes were only mildly sick, at most. In a more recent study (Rijks et al. 2021) found two naturally infected red fox kits in the Netherlands. Those foxes also had neurological disease, like the one Ontario fox kit and as is often seen with severe infections in certain types of birds. In April 2022, avian influenza was also reported in a fox found dead in Japan; the strain was not reported in this case, but is likely related to the H5N1 strains circulating around the globe in migratory wild birds.

Why foxes and not other canids?

It’s not clear (to me, at least) whether foxes are predisposed to infection with influenza, or whether it’s a matter of there being more foxes than other canids in affected areas that get tested. I suspect it’s a numbers and surveillance bias rather than foxes being predisposed or particularly susceptible to infection.

Have more wild mammals been infected in Ontario than these two fox kits?

It’s hard to say, but it’s likely. These were only identified because they happened to be presented to a rehab facility AND they were submitted for testing. That doesn’t happen with most sick or dead wild animals. So, we don’t know if this was a very lucky identification of a very rare event, or a result of something bigger happening in the wildlife population of which we are as of yet unaware.

Let’s back up a bit… What do we know about influenza in canids in general?

There are two main situations to consider when it comes to influenza in canids: 1) infection with flu strains that are adapted to canids (including domestic dogs, foxes, coyotes, wolves, etc.) and 2) spillover infection with other non-adapated flu strains in canids.

“Canine flu” strains are influenza A strains that effectively circulate in the dog population. Currently the most common canine flu strain is an H3N2 that’s endemic in Asia and causes sporadic outbreaks in the US, often associated with imported dogs.  Canine H3N2 influenza was introduced into Canada this way back in 2018, but as far as we know was rapidly eliminated.  That’s not the strain we’re dealing with here (at least at this time).

Dogs (and other canids) can also get “spillover” infections of influenza from other species. For example, human-to-dog transmission of seasonal human influenza strains can occur. It’s probably more common than we realize, because dogs don’t usually get very sick and testing is uncommon, but it still seems to be a pretty uncommon event. Spillover of equine H3N8 influenza has also been reported.

Most of the time, spillover events are sporadic and a dead end for the virus, as the animal gets infected but doesn’t effectively spread a strain that isn’t adapted to that host, so it dies out in that individual. However, that’s not guaranteed in every case. Canine H3N8 is believed to have originated in horses, with subsequent adaptation to dogs to become a true canine flu virus.

Why do we care about H5N1 influenza in a couple of foxes?

From a dog health standpoint, spillover events are not a big deal because they are rare and don’t typically cause severe disease. However, the foxes in this report died, so we can’t assume all infections will be benign.

The main big-picture concern with spillover infections is the potential for emergence of a new flu variant, through adaptation of that strain to the new species, or (more critically) recombination of influenza viruses within the new host, which can happen when two different flu viruses infected an individual at the same time and swap genes. If the new variant that emerges is still able to infect a particular species (like humans) and is highly transmissible, yet different enough from the original virus that we have little immunity from previous infections or vaccination, it’s a recipe for a new pandemic virus. Dogs are unlikely to be the source of a new strain, but the more flu viruses that can infect them, the greater the risk. Since dogs can be infected by strains of human flu, dog flu and spillover of avian flu, there’s a theoretical chance that a dog could be infected with two different flu viruses at the same time. That’s why we want to control and eliminate flu viruses in dogs (and other species) as much as possible. Realistically, the recombination risk is probably greater in other species (including people), but we’d rather not roll the dice unnecessarily.

How did the fox kits get infected?

Presumably it was from eating an infected bird, especially since we know that can occur based on the previous experimental study. Whether these kits both got infected from the same infected bird, whether one got infected and then infected the other, or whether both were infected by a littermate or their vixen is impossible to say. I guess we also can’t rule out they got it from another mammal that acquired it from a bird, but then we’d be talking about a spillover from a spillover, which is quite a stretch.

What should the average dog owner do about influenza in dogs during the current outbreak in birds?

Step 1: Relax. Yes, this virus currently wreaking havoc in wild birds and domestic poultry around the globe can presumably infect domestic dogs. So can lots of other viruses (including many that are more serious, and yet we don’t panic about them either). Don’t ignore the issue, but let’s keep things in perspective.

Step 2: Use some common sense measures to reduce the risk of dogs being exposed to influenza-infected birds.

Step 3: Use some common sense measures to reduce the risk of dogs being exposed to influenza from other species.

Here are some examples of easy and practical measures:

  • Keep dogs away from sick and dead birds.
  • If avian flu is reported in your region, stay away from areas where infected birds have been found and keep your dog under control so it can’t wander off and snack on a recently dead bird.
  • Remove bird feeders to reduce congregation of birds, reduce the potential for bird-to-dog contact, and reduce exposure of dogs (and other animals, including people) to potentially influenza-contaminated bird poop.

Likely the most important thing the average person can do to reduce the risk of their dog getting a spillover influenza infection is for that person to get a flu shot, to reduce the risk of getting infected themselves and exposing their dog to flu.

Is there a flu vaccine for dogs?

Yes, but it won’t help us here. Flu vaccines aren’t great at providing cross protection against other strains. The canine vaccines are for H3N2 and/or H3N8, not the strain we’re currently dealing with in wildlife.

A recent commentary in the Journal of Clinical Pharmacy and Therapeutics by Moore et al. entitled “A doggy tale: Risk of zoonotic infection with Bordetella bronchiseptica for cystic fibrosis (CF) patients from live licenced bacterial veterinary vaccines for cats and dogs” discusses concerns about using the most common “kennel cough” vaccines in animals owned by people with CF.

Bordetella bronchiseptica is just one of the causes of “kennel cough” (or using our current terminology, canine infectious respiratory disease complex (CIRDC)). It’s a highly transmissible bacterium that can cause disease in dogs and cats, but is also found in some healthy animals.

We have two main types of vaccine for this B. bronchiseptica: injectable vaccines with a killed form of  the bacterium, and oral / intranasal vaccines with a modified live form of the bacterium.

  • Modified live vaccines use bacteria or viruses that have been attenuated to cause no or very mild disease, but still maintain the ability to cause a low grade, transient infection.
  • These vaccines can be highly effective, because they induce an immune response that’s the same as when the “wild type” circulating strain of the pathogen that causes diseases is encountered, but without the same risk of illness.  They are much more protective than the injectable, killed vaccines.  If I want a pet to be protected against B. bronchiseptica, I absolutely want to use a modified live vaccine.
  • However, while the vaccine strains are attenuated, they’re not completely harmless.  The concern is that they could cause disease in individuals (human or animal) who have compromised immune systems. That’s why we typically avoid giving this type of vaccine to individuals with significant immunodeficiencies.

The published commentary focuses on the use of modified live vaccines in pets whose owners have CF, who are at particularly high risk for certain respiratory infections. Infections with Bordetella bronchiseptica have been reported in people with CF, so there’s good reason to consider the risks. However, like most things, we need to think about the risks and the benefits, and it’s often not as clearcut as it might seem at first glance.

Concerns about vaccinating pets

The issue is exposure of the owner to an attenuated form of a bacterium that can (uncommonly) cause disease in people.

Is this really a significant concern?

  • That’s debatable. Attenuated B. bronchiseptica in the vaccine is a much less virulent form of a bacterium that even in its normal, unattenuated state rarely infects people. Add “less virulent” to an already minimal-risk bacterium and you get a very low risk situation, but it’s not no risk, which is why we’re talking about it.

What evidence of risk do we have?

  • Not much. There’s one report that suggests a B. bronchispetica vaccine caused disease in a boy, but he was squirted in the face with the vaccine, so it’s different than exposure to a vaccinated animal. Furthermore, they never tested to see if the boy was actually infected with the vaccine strain (or even Bordetella bronchiseptica). They simply attributed his respiratory disease that occurred shortly after the exposure to the vaccine (reasonable but presumptive).
  • Another report described B. bronchiseptica infection in a transplant patient. Their dog had been vaccinated with a modified live vaccine, but they didn’t do any testing to see if the person was infected with the vaccine strain or not. So it’s suggestive, at best.

That’s not meant to dismiss the risk. We want to avoid infections, but we need to keep things in perspective. Millions of dogs are vaccinated with these modified live vaccines every year. Huge numbers of high risk people have contact with these dogs. Large numbers of high-risk veterinary personnel also get exposed (often at high levels) routinely. Yet, there’s very little evidence of anyone getting infected. Little isn’t zero, but we rarely have zero risk situations when dealing with zoonotic diseases of any kind.

Concerns about NOT vaccinating pets

This part doesn’t often get discussed, but we have to consider the downsides of not vaccinating, and there are a few:

  • The obvious concern is that the animal will be more likely to get infected withe the “wild type” disease-causing bacterium. Human infections with wild type strains are rare but presumably much (much!) more likely than with the attenuated vaccine strain. I’d be much more worried about a person with CF being exposed to a sick dog with wild type B. bronchiseptica, than to a dog that was just vaccinated with the attenuated strain.
  • A sick pet may increase exposure of the owner to various other bacteria from coughing, sneezing and nasal discharge. The mouth and nose harbour myriad bacteria, many of which can cause disease (and do so much more commonly than B. bronchiseptica). An animal that is coughing, sneezing or depositing nasal discharge everywhere presumably greatly increases the risk of exposure of people to this array of bacteria.
  • A sick pet may be more likely to be treated with antibiotics, which are often used (often unnecessarily, but that’s a different issue) to treat kennel cough. Antibiotic use is a known risk factor for dogs and cats acquiring and shedding antibiotic-resistant bacteria, some of which cause disease in people, and can be very difficult to treat.

Overall, whether or not to vaccinate a pet is a cost-benefit decision, but we have limited data on the true costs and benefits when it comes to modified live B. bronchiseptica vaccines. My main considerations when deciding whether to recommend a kennel cough vaccine are focused on the dog/cat: what’s their risk of exposure, and what are the potential implications of infection for the animal. A high-risk owner doesn’t mean I shy away from modified live kennel cough vaccines. In some ways, it pushes me towards wanting to use them, because my concerns with the pet getting sick because it’s inadequately vaccinated and then exposing the owner to something are greater.  We can take some basic measures to reduce the risks associated with vaccination procedure itself. The commentary rightly talks about the potential importance of Bordetella transmission from pets to CF patients, but if anything, I take that as more of a reason to vaccinate, to reduce the risk of this happening.

Risk reduction measures are pretty straightforward. The main concern is avoiding human exposure to large numbers of live bacteria from the vaccine.

  • Keep the owner out of the room when vaccinating to prevent inadvertent exposure to the vaccine itself, including when the animals (often) sneezes right after it’s given.
  • Consider wiping residual vaccine off the pet’s face after vaccination.
  • Tell the owner to avoid close contact with the pet’s face, and to avoid allowing the pet to lick the owner for at least a day (but really I recommend both these measured most of the time for high risk owners regardless).

It’s great to see the human medical folks putting some thought put into pet related disease issues. Too often, these issues are not on the radar at all. However, zoonotic disease issues related to pets in high risk households are often complex and nuanced, and that is often not recognized or considered.

The concluding statement of the commentary is great, and to me is the most important recommendation they make:

“Patients should make their veterinarian aware of their CF status, so that a safe and efficacious vaccine strategy is formulated, both mitigating the potential infection risks from live components of the vaccine, but simultaneously offering maximum immunological protection to the animal.”

That’s the key. People need to engage their veterinarian about risks in their households, and veterinarians need to be part of the team that manages risk to all members of the household.

Photo credit: Dr. Kate Armstrong (from Weese & Evason, Infectious Diseases of the Dog and Cat, A Color Handbook)

As the world tries to (prematurely) transition back to some semblance of normalcy (or at least what used to be “normal”), it’s a challenge to figure out what changes to make, and when. There will never be agreement between everybody. Some want full reversion to “normal” now, some want third-wave-level restrictions until further notice… like most things, there’s presumably a sweet spot in the middle.

I won’t try to address that particularly contentious area (I get enough hate mail as it is). Instead I’ll stick to a discussion about animal shelters, based on some talks I’ve given lately and requests for information, as shelter personnel and management struggle with what to do.

Some people might think “Why do shelters in particular warrant discussion? Animals shelters can be treated like any retail operation since they have staff, members of the public who come into the building, and they don’t provide care for high risk (human) individuals.

That’s all true.  But…

Animal shelters are an essential service, and impacts to that essential service can be harmful in more ways than one.  When thinking about control of SARS-CoV-2 in an animal shelter, there are 4 main issues to consider:

  • Preventing infection of animals (from people or other animals)
  • Preventing infection of people FROM animals
  • Preventing infection of visitors/adopters
  • Preventing infection of staff

AND there is one more important goal that also needs to be remembered:

  • Protection of the shelter itself and its operations.

Preventing infection of animals

Human-to-dog/cat transmission of SARS-CoV-2 is common, but rarely does it cause a significant problem for the dog/cat. So, while we’d like to minimize such transmission and we should take basic precautions to reduce transmission, the overall impact of infection in animals on the animals themselves is probably very limited and not a driving factor.

Preventing infection of people FROM animals

The risk of dog/cat-to-human transmission is low but not zero. This risk has not been well documented, even though it presumably it occurs, but we need to put it into context. It’s more of a concern when there’s less risk of human-to-human transmission. When there’s rampant community transmission of SARS-CoV-2 between people, the potential impact of animal-to-human transmission is limited. An animal shelter worker is much more likely to get infected outside of the shelter, even if there are infected animals in the shelter.

Preventing infection of visitors/adopters

The relative risk of SARS-CoV-2 transmission posed by adopted animals is really low, and, as noted above, if an adopter has abundant risk of exposure from people, the added risk from the animal is minimal. If someone is taking strict measures to isolate from people, the relative risk from the animal goes up a bit. We focus mostly on risk from animals from known COVID-19-positive households, since the incidence of active infection in dogs and cats coming into shelters without a history of recent exposure to an infected person is very low. The main risk to adopters (in terms of the adoption process) is human-to-human contact, and shelters can take measures to limit that (e.g. do as much interaction remotely/virtually as possible) and mitigate risk from required visits (e.g. ventilation, masks, distancing, making sure sick people don’t come in).

Preventing infection of staff (human-to-human)

This is the big one. Staff can be exposed to SARS-CoV-2 by other staff and by visitors. The more COVID-19 there is in the community, the greater the risk.  That’s the same for any other workplace where staff and customers mingle, and we know outbreaks occurs in those settings. The impact is the issue. We can’t shift animal care to remote for a couple of weeks while an outbreak among staff is underway. People need to attend to the animals. Staffing issues are a major concern in a wide range of industries, but many of those can handle things through shifting to remote activities or pausing some activities.  Shelters can’t.

The more people who get sick in a shelter, the more animal care can be compromised.

  • That can lead to suboptimal general care and impacts on preventive medicine or veterinary care for animals in the shelter.
  • It can probably increase the risk of outbreaks of other diseases in the animals through reduced monitoring and infection prevention practices.
  • It can also lead to pausing or slowing adoptions if staff can’t maintain those operations. That creates more risk and cost for the shelter, and also causes capacity issues.
  • Severe staffing shortages could also lead to an inability to take in new animals, which could lead to abandonment or euthanasia of animals.

Since shelters often have many personnel, including the large number of volunteers that are often involved, the odds of someone coming into the shelter with COVID-19 are high. If lots of people are coming in (especially in an unstructured manner) to look at animals, the risk goes up even more.

What do we do to balance being proactive and practical, reducing disease risk while maintaining as much normalcy as possible in shelter operations?

Good question.  To be honest, we’re making it up as we go (because we have to), and there’s no one-size-fits-all solution.

However, there are some basic practices and concepts that certainly apply and need to be considered carefully in any situation:

  • Maximize vaccination of staff (and that means 3 doses, not 2).
  • Maintain basic non-pharmaceutical interventions such as masks.
  • Monitor and improve ventilation.
  • Continue to have a strict “if you’re sick, stay home” policy.

Managing visitors/adopters is also important, including measures such as:

  • Minimize the number of visitors in the shelter.  Do as much remotely as possible. Discussions about animals and adoption protocols can be done online or by phone.
  • Minimize the number of people in the shelter in general or in any specific area of the shelter at one time.  Keep access to the shelter by appointment only, so that there are no crowded periods. Keep people spaced out
  • Maximize the use of outdoor spaces for interviews and animal visits.
  • Require visitors to wear masks.

Some adopters won’t like it, but it’s a case of “your facility, your rules.” If someone won’t use these very basic precautions (during a pandemic that’s still in full swing), it may be a red flag about how well they will follow any other requirements associated with adoption as well.

An recent news article from Thailand entitled Superbugs lurk in local food systems came to my inbox the other day. There’s nothing really new in it, but it has some talking points that are commonly used (and sometimes misused) when we discuss and debate antimicrobial use (AMU) and antimicrobial resistance (AMR) in food animals.

Here I’ll break down these various statements, not really to defend, support or criticize them, but hopefully to show some of the complexities and challenges around these issues (the article quotes are in italics).

Antibiotics are the silent props of the factory farm system, preventing stressed, confined animals from otherwise getting sick due to the dismal conditions they live in.

  • I don’t like it when articles start with “factory farm.” It shifts the focus from AMU/AMR to the ethics of large scale food animal production systems. That’s not to say there aren’t (sometimes major) issues there, but we need to separate those out. Some huge farms do a great job with AMU (and welfare). Some small farms are horrible with both. Certainly, large farms can have more challenges, and bad practices can have disproportionate impacts when they involve so many animals. However, “big = bad” and “small = good” isn’t accurate. There’s likely a sweet spot in the middle, where farms are big enough to have the expertise and finances to improve animal health and animal management, incorporate optimal disease prevention strategies and have a good antimicrobial stewardship program, but small enough to limit some of the other concerns that often come with large-scale production. These factors also vary a lot by animal species.
  • Like most things around AMR in livestock, over-simplification and buzz words can make us lose focus.

Around 131 000 tons of antibiotics each year are used in farming globally, comprising 3/4 of the antibiotics produced in the world, and the amount is expected to rise to 300 000 tons in 2030, according to an academic article entitled “Reducing antimicrobial use in food animals” published in the journal Science in 2017

  • There’s no doubt massive amounts of antibiotics are used in animals, mainly in food animals. The relative use of various drug classes in food animals and humans tends to quite different, and we’re trying to foster less use of “critically important’” antimicrobials in animals.
  • Looking at the mass (tons) of antimicrobials used is (relatively) easy, but oversimplifies things and can therefore be misleading. Explaining this alone could be a whole series of blog posts, so I’ll just add a few comments for now. Not all drugs are equally potent. If I change from using a drug that is dosed at 20 mg/kg two times a day to one that is used at 2 mg/kg once a day, I’ve dropped from 40 mg/kg/d to 2 mg/kg/d.  If I look at tons of drug used, that would look like a huge improvement, and a farm could do that quite easily in some situations. But, if in the process they switch from a lower-tier drug (e.g. a penicillin) to a “highest priority critically important” antibiotic, that would be a huge mistake that can cause a lot of harm, even though it looks good from a tonnage perspective.
  • There are also some drugs that are used in animals that have no relevance in humans – they are not used in people and there’s no cross resistance with antibiotics that are used in people. They are largely irrelevant from an AMR standpoint (at least in terms of human health) but can skew the tonnage data for AMU in animals.
  • We need better metrics for measuring AMU and more thought and analysis than just looking at a single number. The easy sound-bite approach to data collection and dissemination isn’t really helpful.

There is now abundant research showing how this overuse of antibiotics in farming is a leading cause of “superbugs”, and that these superbugs are infecting workers and spreading into the food supply chain and our environment.

  • “A” is an important word here. Most AMR issues in humans relate to AMU in humans. At conferences, I’ve occasionally asked the audience “what percentage of AMR in people is likely attributable to AMR in animals?” I’ve gotten responses from 1-96%. It’s probably actually fairly low, but there are nonetheless some important issues there and AMU in animals is absolutely a contributor to AMR in people. How much of a contributor…? We don’t know.
  • So, AMU in farm animals is an important factor when it comes to AMR. However, it’s not an issue of addressing AMU in just farm animals. We need to address AMU in all sectors, including people. Failing to do that means we’ll never address the problem adequately.

Indeed, more than 100 Thais die every day because of superbugs. Yet even though the mortality rate is higher than COVID-19, there is almost a complete lack of awareness about this public health threat.

  • A great statement. AMR has been called the “silent pandemic.” It was well established before COVID-19, and it isn’t going away soon. Yet, people pay relatively little attention to it. Governments have less motivation to properly fund work on AMR and AMU, whether that’s research or stewardship initiatives. Canada has a framework for a national action plan for AMR that was released in 2017 and has been sitting on a desk for 5 years. We have a plan (that’s getting outdated) but no funding or action. So, we don’t have a plan, really.

Antibiotics are typically used at factory farms to either treat sick animals, promote their growth, or prevent disease. Fortunately, the use of antibiotics for growth promotion in several countries, including Thailand, has been bannedThe abuse of antibiotics in farming in Thailand is mostly to prevent stressed animals from getting sick due to farms’ poor welfare and management. The drugs are typically mixed with food and water and given across group herds. 

  • It varies by region, but there is definitely a large component of this in animal agriculture. Antibiotics can be used as a crutch to compensate for poor management, especially if antibiotics are cheaper and easier than good management or changes to things like animal housing.
  • As indicated, antibiotics aren’t used for growth promotion in many countries now. But, we need to increase that number. That’s relatively low hanging fruit. It just needs action at the national level in countries where antimicrobials are still used like this, and support for farmers to improve their practices so they don’t feel a need to use antimicrobials as growth promoters.

The root cause of the issue is the poor welfare in which farmed animals are kept in factory farms, and this must be addressed. Improvement in this area will support United Nations Sustainable Development Goal to ensure access by all to safe food. 

  • This is may be the most important statement in the article (although I’d remove the factory farm comment). As a member of the Global Leader’s Group on AMR, I bring this up repeatedly. We need to improve animal health systems to reduce the need for antimicrobials in animals, and to improve how they are used, when they are needed. Similarly, we need improvements in human health systems to optimize AMU in people. Healthier people and healthier animals need fewer antimicrobials.

Pig factory farms in Thailand are discharging huge quantities of pig waste (manure and urine), containing significant quantities of antibiotic-resistant genes and superbugs, into public waterways and the wider environment. 

  • AMR is a classic One Health issue, impacting human, animal and environmental health. Environmental impacts are often ignored, in part because they’re harder to see and understand. However, it’s impossible to argue that AMU in animals (and humans) doesn’t have profound environmental impacts. Some of those can come back to bite us too, as the environment can be a source of new resistant bacteria or resistance genes.

These findings by World Animal Protection also raise questions as to why superbugs from banned antibiotics can still be found in the environment near factory farms four years into the implementation of the national plan. 

  • Whether it’s in the environment, animals or people, changes in antibiotic use don’t instantly result in changes in resistance. It can take a long time to see changes, sometimes decades. We still see widespread chloramphenicol resistance in bacteria in livestock in Canada, despite the fact that this drug has been banned in food animals for decades. There’s no easy or quick fix for AMR. That’s why we need to focus on prevention and act now.

A ban on the preventive use of antibiotics in factory farms by increasing animal welfare standards would drastically reduce the presence of superbugs in our environment, but also guarantee safe meat for all. 

  • As with many things, a bit more nuance is needed. Bans aren’t the way out of the AMR problem. Reductions are (ideally massive reductions). Banning certain drugs and practices is reasonable. However, even well-raised animals (and people) sometimes need antibiotics. Sometimes, short courses of preventive treatment using lower-tier drugs are better for both health and AMR than needing to treat sick (or sicker) animals with other drugs, maybe for longer periods of time.
  • A lot of preventive use is unnecessary. Sometimes it’s done because of poor management. Sometimes it’s done because of inadequate education. Often it’s done because of historical reasons (“I’m doing this because that’s the way we’ve always done it and I’m afraid to make a change.”). Reducing AMU requires addressing all these factors, with improved health, improved education, access to better decision support mechanisms and addressing the social science components of AMU that are too often neglected.

This is a huge topic, and this long blog post can’t even start to do it justice. However, hopefully it raises awareness of some of the issues and highlights some of the complexities of the situation.

Everyone has a role to play in controlling AMR. It’s not just prescribers, farmers and regulators. It’s everyone involved in the chain of drug production to prescription to use to disposal. That’s pretty much everyone. The average person may think there’s little they can do, but there are lots of little things we can all do:

  • don’t press for antibiotics (for people or animals)
  • use antibiotics properly when prescribed
  • improve health of people, animals and the planet through other means (even small things)
  • call for change (give governments a reason to act)

That sounds a bit daunting, but for most people, it’s just little things, and lots of people doing little things can have a big impact.

Concerns about the animal aspects of the COVID-19 pandemic continue to come in waves. Most of the time they are ignored or dismissed, but there are also periodic flurries of attention and (often over-) reaction.  Lately, questions about vaccination of animals against SARS-CoV-2 follow have been on the rise.

Should domestic and wild animals be vaccinated against SARS-CoV-2?

  • Yes, no and maybe… but mainly no.  To properly assess this question, we need to step back and think about what vaccines can potentially do.

There are 4 main areas I think about when considering whether vaccination may be useful in any given species:

  • Prevention of disease:
    • This is really “prevention of severe disease.” If a species doesn’t get very sick and just has mild, transient illness, there’s little value in vaccinating from an animal health standpoint.
  • Prevention of transmission of the disease to people:
    • Transmission of SARS-CoV-2 from animals to humans has been documented or suspected in very few species. Most transmission is human-to-animal, and animals are most often dead end hosts (e.g. if my cat gets infected, he got it from someone in my household and is unlikely to spread the virus to any other humans).
  • Prevention of transmission to other animals:
    • Can the animal spread SARS-CoV-2 to other animals of the same species? Or be a bridge, spreading the virus to other domestic animals or wildlife?
  • Prevention of establishment of an animal reservoir where new variants could emerge:
    • This is the big concern with certain animal species (e.g. deer, mink) that are both highly susceptible and have a large population with frequent, close contact between animals, which allows for for potential long term, continued transmission of SARS-CoV-2.

Not many species check many (or any) of those boxes when it comes to vaccination against SARS-CoV-2.

The other thing to consider is what vaccines for animals may or may not actually be able to do. We have very little information about the very limited vaccines for animals that are currently out there. These vaccines are based on older technology than our human mRNA vaccines, and the older tech hasn’t been known to be able to produce highly effective coronavirus vaccines in the past. Vaccine science is improving, and I’m not trying to bash the animal vaccines or the companies (I’m grateful they’re working on them),  but I’m trying to be realistic.

Vaccines can have a range of effects, depending on their efficacy:

  • Reduction of severe disease
  • Reduction of disease
  • Reduction of infection (with or without disease)
  • Prevention of infection (sterilizing immunity)

We don’t know how effective animal vaccines are in different species.  Based on what we know about the more technologically advanced human vaccines, reduction of severe disease is likely a much more realistic target than reduction or prevention of infection (which would reduce the risk of transmission).

Another issue is the level of vaccine coverage that would be needed in a given species. For example, if we want to use vaccination as a tool to reduce establishment of the virus in wildlife, we need a vaccine that significantly reduces infection and transmission AND we need to vaccinate a large percentage of the population AND keep vaccinating animals over time, since population turnover is high in many wildlife species.

We also don’t know how long immunity persists in different species, or how it might hold up against different variants of SARS-CoV-2 (which we wonder about it humans as well…).

Once we start thinking about all these factors, I think it shows that the utility of vaccination in animals currently is going to be limited to a few niche situations.

Dogs / cats

  • Dogs and cats commonly get infected, but rarely get seriously ill. They are rarely going to be the source of infection for people (they are usually infected by their owners).
  • Dogs and cats don’t live in large groups where virus transmission can be sustained long term, such that it could create a reservoir and become a source of virus variants.
  • Indoor-outdoor cats are more of a risk as a bridge between infected households and other people or animals, but the odds of them playing a significant role in transmission are fairly low AND any effect on this would require a vaccine that prevents infection and virus shedding (unlikely).  The far easier and more effective solution is to keep cats from infected households indoors until the risk period for transmission has passed.
  • I’m glad we have vaccines ready in case something changes and we get a strain that causes more serious disease in dogs or cats, but I can’t see a use for vaccination in these species now.

Mink

  • Mink check a few of the boxes for vaccination, as a species that is susceptible, gets sick, is housed in large populations (i.e. farmed mink), that has generated new variants in the past, and can spread the virus to people  and other species.
  • Vaccination of all mink on a farm is also possible.
  • Vaccination is probably a more effective tool for mink health than public health, given the questions above about whether vaccines actually reduce or prevent infection, and therefore transmission. If vaccination just reduces disease but still allows for transmission between and from mink, then it might not be useful or might even be counterproductive for public health purposes.

Zoo animals

  • Here’s where there’s the most potential for benefits from vaccination against SARS-CoV-2 in animals. Some zoo species are highly susceptible and can die from infection with this virus. These animals can be valuable emotionally and economically, and from a conservation standpoint. So, more zoos are vaccinating their non-human primates (e.g. apes) and big cats. Some are also vaccinating their mustelids (i.e. species related to mink; some, like the black footed ferret, are highly endangered) and cervids (i.e. species related to deer, since we know white-tailed deer are quite susceptible and can spread the virus).

Wild deer (specifically white-tailed deer)

  • Deer check a few of the boxes for vaccination, as they are highly susceptible and may be able to maintain circulation of the virus in area where they have a high population density, potentially leading to new “deer” variants.
  • However, we would need a vaccine that significantly reduces infection and therefore the risk transmission (and I’m not very confident we have that).  Deer don’t appear to get significantly ill themselves (thus far), so vaccination isn’t directly helpful to the deer.
  • To be useful, it would also require vaccination of a LOT of animals. For example, if we need to vaccinate 80% of the wild deer population… well, good luck finding a way to do that.
  • Furthermore, lots of new deer are born every year so vaccination campaigns would have to be continued until SARS-CoV-2 is out of circulation in deer and people.  That doesn’t seem very practical to me. Rabies vaccination of some wildlife species is used in some areas (including Ontario) and it’s highly effective. However, it uses a highly effective vaccine that can be delivered through baits that can eventually cover a pretty high percentage of the target population, and it does have to be repeated at least annually until the virus is eradicated from an area.  It also takes a lot of effort and coordination.  It would be very tough to do the same for SARS-CoV-2 vaccination in deer.

We’re not going to vaccinate our way out of animal issues with this virus. We need to control SARS-CoV-2 in humans to have any hope of controlling SARS-CoV-2 in animals. Vaccine research is important so that we have vaccines available should opportunities for their use be identified, and continued vaccine development may get us to the point where we have a highly effective vaccine that stops transmission. However, without that, the potential impact of vaccination of most animals is limited.

We soft launched this a few weeks ago and I haven’t gotten around to publicizing it too broadly yet, so here goes…

We’ve launched app-based antibiotic prescribing support for small animal veterinarians, which uses the Firstline platform (an app originally designed to help provide similar guidance for human healthcare providers).  Our content provides clinical guidance for treatment of a wide range of diseases in dogs and cats, as well as information on related topics such as multidrug resistant bacteria, treatment of neonates, surgical prophylaxis and sample collection techniques. There are also sections on specific pathogens (still pretty preliminary) and specific antimicrobials.

To access it, “Firstline – Clinical Decisions” (formerly Spectrum) can be downloaded from the Apple App Store or Google Play Store. After launching the app, scroll down and select “OVC-CPHAZ” (Ontario Veterinary College – Centre for Public Health and Zoonoses) as your “location.”

The guidelines are open access, free and non-commercial (the cost is being split between the OVC Dean’s Office and CPHAZ ).

Feedback is always appreciated:

  • What’s missing?
  • What do you not understand or are there things with which you don’t agree?
  • What did I misspell? (I’m sure I haven’t found all the typos).
  • How can we make it better?

The goal is to make the guidelines and the interface as useful and user friendly as possible, and for it to be a practical tool for as many veterinarians as possible. Some treatment recommendations and drug availabilities differ by country, but the vast majority of the content is probably applicable pretty much anywhere.

If you’re looking for large animal information, the Canadian Veterinary Medical Association also has their antimicrobial use guidelines on Firstline (just search and select “CVMA” as your location instead). It’s restricted to veterinary personnel in Canada but if you’re in that group, it’s another resource. We’re harmonizing the small animal guidelines so you should get the same dog and cat info from both versions, but the CVMA provides guidance for a larger range of species, including equine, bovine, small ruminant and poultry, with more to come.

We’ve come a long way in terms of medical diagnostic technology in recent years. It’s now cheap and easy to identify a wide range of viruses and bacteria, including some we’ve never seen before. However, our ability to find pathogens has outpaced our ability to understand the role they may (or may not) play in disease. So, we end up in lots of situations where someone finds a “new” pathogen and we have to figure out if it’s really new (vs we just didn’t know it was there before) and whether it’s relevant.

If we test a bunch of dogs with respiratory disease, we’ll find a variety of viruses.

  • Some are viruses we know cause disease, but we can often still find them in some healthy dogs too.
  • Some are viruses that we suspect have the potential to cause disease, but we don’t know how relevant they are, or under what specific circumstances they may be relevant.
  • Some are viruses about which we simple have no clue.

That’s a long winded introduction to a story about an outbreak of canine pneumovirus in an animal shelter in Florida.

As with any situation like this, they could be dealing with:

  • A pneumovirus outbreak.
  • An outbreak caused primarily by some other pathogen, but pneumovirus is co-infecting dogs and making it worse.
  • An outbreak caused by some other pathogen, and pneumovirus just happened to be present in the dogs at the same time but isn’t actually part of the problem.

Details are limited in the available news articles, but it sounds like a lot of dogs tested positive for pneumovirus. Knowing how many dogs were tested, and for what other things they were tested would be helpful.  Presumably they didn’t find any of our usual suspects like canine parainfluenza virus, Bordetella bronchiseptica, canine influenza or canine respiratory coronavirus, otherwise those would have been mentioned first.

What is canine pneumovirus?

I always talk about pneumovirus when I list potential causes of infectious respiratory disease in dogs, but usually with the disclaimer “I don’t really know how important it is.” Studies that have looked at different dog populations have reported finding canine pneumovirus in 1-15%% of dogs with respiratory disease, but most often in less than 5%. Rates of 0-6.1% have been reported for healthy dogs. Finding the virus in healthy dogs doesn’t mean it can’t cause disease, it just makes it harder to determine if it’s relevant in sick dogs.

Studies looking at antibodies against the penumovirus in dogs (an indication of previous infection) have found high rates in healthy dogs, often over 50%. Dogs often develop antibodies to the virus after being admitted to a shelter. This suggests that this virus is circulating widely in the dog population and probably not causing much disease, or at least not much serious disease. When dogs mix in congregate settings like shelters, the risk of infection goes up.

My guess is that this virus does cause some disease, but likely usually just mild upper respiratory tract infections, with exposure being common when younger dogs start mixing. Once they’ve been infected, dogs are probably low risk for getting sick later in life. Shelters are high risk for exposure because of the number and variety of dogs in close quarters.  Dogs that haven’t been previously infected would be susceptible, and that could lead to an outbreak with what I’d expect to be relatively mild disease.

So, back to this canine pneumovirus outbreak in Florida.

Is it really a pneumovirus outbreak?

  • Quite possibly. Shelters are high risk and if they have tested enough samples to find a lot of pneumovirus and no other causes, it’s a reasonable (albeit always presumptive) diagnosis.

What does it mean?

  • Not a lot in the big picture. Outbreaks are always a pain for any shelter, and they’re taking measures to contain it; however, I wouldn’t be worried about broader community issues.  Pneumovirus already circulates and is widespread in the dog population. It’s not like canine influenza, where we’d be worried about it spreading rapidly in a largely naïve dog population. Good ol’ infection control is the key to letting the outbreak burn itself out and limiting spread outside the shelter. Nothing major required, just good use of routine practices and awareness.

Can canine pneumovirus infect people?

Not that we know, and I don’t have any real concerns about that. It’s related to human respiratory syncytial virus, an important cause of disease in kids, but there’s no suggestion that this virus infects anything but dogs.

Imagine you’re a vet doing an exploratory abdominal surgery in a dog. You’re poking around in the belly and feel something abnormal. You grab it and as you pull it out of the abdomen to have a look, you see it’s a red tubular structure. As you continue to pull (and pull, and pull), it just keeps coming… Eventually you realize it’s not attached to anything in the dog, and it comes out completely, partly to your relief but partly having to resist the urge to pitch it across the room and yell as you realize it’s a giant worm that’s squirming around as you handle it.

That’s a scenario we sometimes see with one of the grosser (and also largest) parasites of dogs (and other mammals), the giant kidney worm (Dioctophyme renale).

I’ve had a couple of calls this week about this parasite, both about worms found in dogs that were rescued from northern Manitoba, a relative hotbed region for D. renale.

Like a lot of parasites, this one has a somewhat screwy and complex life cycle. Adult worms live in the kidneys of various mammals, particularly mink. The worms lay eggs that are passed in urine. If the eggs end up in water, embryos form inside them If embryonated eggs are eaten by an intermediate host (an earthworm), larvae hatch and mature. If the infected earthworm is then be eaten by a mammal like a dog, or first eaten by a frog or fish (a paratenic host) that is then eaten by a dog, the parasite goes on a “road trip” around the body and usually ends up in the kidney (most commonly the right kidney), where it’s now completed its life cycle. However, since worms can grow up to 50 cm long and kidneys aren’t very big, the adult worms can destroy the kidney in the process.

Sometimes these worms are just an incidental finding that’s detected when imaging the kidney or abdomen for some other reason, or (as in this case) they’re seen directly during surgery, but otherwise don’t seem to be causing a problem. Sometimes the worms destroy one of the kidneys. Rarely, they cause damage in other areas of the body. The treatment of choice is physically removing the worm. That’s easy if it’s swimming around the abdomen. If it’s destroyed one kidney, the whole kidney gets taken out. If there are worms in both kidneys, then the animal is in trouble. Just like people, a dog can live happily with one healthy kidney, but zero kidneys isn’t an option.

For most people, there’s no risk of their dog being exposed to this parasite. The parasite is present internationally, but the risk tends to be focused in specific geographic areas. In Canada, most of the cases I deal with are from Manitoba and northwestern Ontario. People who live in areas where D. renale exists need to be aware of it and try to prevent their dog from eating frogs or fish, or earthworms. That’s easier said than done, though, because as many people know, if a dog has a tendency to eat things like that, it can be hard to stop it. It’s also important for people who move or adopt dogs from endemic regions – and their veterinarians – to be aware of the potential for dogs to be infected with this parasite.  (This is also a reminder that a rescue dog doesn’t need to come from outside of Canada to be at risk of some unusual diseases.)

Are people at risk for infection with D. renale?

  • Yes, but not from infected dogs. People can get infected by eating the same kinds of animals that can result in infection in dogs (e.g. fish, frogs). Human infections are rare, but occur in areas where the parasite is endemic (especially when freshwater fish are a core component of the diet, and they may not always be thoroughly cooked).

Below is an old video of giant kidney worm removal (if you’re squeamish, don’t watch when eating lunch).  You can also click here for a slightly shorter, possibly more digestible and more recent video (also from the Ontario Veterinary College) of a similar case of D. renale removal in a dog.