The recent ringworm outbreak in a Newmarket, Ontario shelter has focused a lot of attention on shelter outbreaks, outbreak prevention and management. A common question that I’ve been getting in the last couple of days is "Why do these outbreaks occur?"

There are many reasons why an outbreak can develop. I have no first-hand knowledge of the Newmarket outbreak, and don’t know what prompted that outbreak, but here are some general causes of outbreaks.

Inadequate protocols:

• Shelters need clear and logical protocols for all things dealing with animal care. This needs to include aspects like where new animals go, what types of evaluation and monitoring are performed, vaccination and deworming plans, when animals need to be tested or treated, when they can be released from quarantine, how to record and report infectious diseases, how to clean and disinfect areas and items, personal hygiene, and protective clothing, among other things. These protocols need to be in writing and accessible to all personnel.

Inadequate training:

• Shelters often have large numbers of staff, many with minimal training in animal husbandry or medicine. Proper training is required to ensure that they know what to do and why. (The latter is important because if people know why they need to do something, they are more likely to do it.) Training programs need to be well-structured and formal, not casual, follow-someone-around-and-see-what-they-do training.

Inadequate supervision:

• Even with good protocols and training, the facility managers need to ensure that protocols are followed. They need to enforce protocols and address problems with compliance. They need to make sure their protocols are up-to-date and consistent with best practices.They need to monitor disease rates and concerning trends of illnesses, so that problems can be identified early. They need to know when to get advice and who to ask (see below).

Infrastructure challenges:

• Some facilities (or actually, most facilities) are not well designed in terms of infection control. That makes it harder to prevent disease transmission and contain problems. Limitations in isolation/quarantine areas may result in mixing of new (and more likely infectious) animals with those ready for adoption. Few sinks may reduce handwashing, a key component of infection control. A facility that is too small for the animal load results in cramming in too many animals.

Poor awareness:

• If staff (from management on down) don’t understand the issues, they may not act appropriately. Proper routine preventive measures and outbreak response measures may not be convenient, easy or cheap. There must be motivation to implement them. If there is little awareness of the problem, people are less likely to do what is needed.

Failure to act appropriately when the first cases are identified:

• It is much easier to contain a problem when you act early. If only a few animals have been infected or exposed, it’s much easier to take aggressive measures. Once you get a large number of infected or exposed animals, it’s much harder to do things like properly separate different groups (e.g. infected vs potentially infected vs non-infected). The more animals affected, the greater the chance of further transmission. Keeping your head in the sand and hoping things will go away can result in a small containable outbreak becoming a facility-wide,  difficult-or-impossible-to-contain outbreak.

Failure to get good advice:

• People working in shelters can’t be expected to be experts in all aspects of infectious diseases and infection control. That’s why getting good advice (and following it) is critical. Sometimes, people don’t ask for advice or don’t go to the real experts. This can happen because they don’t really understand the problem, don’t know who to contact, don’t want to admit they don’t know everything or don’t realize they are in over their heads. A little good advice, especially early, can make a world of difference.

Bad luck:

• Ultimately, you can have an exceptionally run facility and still get an outbreak. By the nature of what shelters do, they bring in a lot of animals with potentially infectious diseases and have many animals that are at higher risk of getting sick if they get exposed. It’s much less likely to occur with a good infection control program, but you can never 100% guarantee nothing bad will happen. You can’t do much about this. All you can do is make the best program possible, and try to limit any problems that develop.