“Kennel cough” (now more conventionally termed “canine infectious respiratory disease complex’)  is a fairly common problem in dogs that can be caused by an array of bacteria and viruses. We commonly see it in outbreaks, often linked to kennels, but sometimes we see higher levels of disease in the broader community. What we’re more concerned about is new problems , new patterns or more severe disease.

We may be seeing an increase in respiratory disease activity in dogs in a few parts on Ontario at the moment. It’s always hard to say for sure because it’s based on information from different sources, and whether it’s a true increase, an increase in reporting of the normal amount of disease, or just a misperception is hard to say.

We don’t want to over-react, but we also don’t want to miss the start of something important, so we’re paying attention to the information that’s coming in and trying to make sense of it.

An important limitation to the available data is the amount of diagnostic testing that gets done. Only a small percentage of dogs with “kennel cough” get tested to try to determine which viruses and bacteria are actually involved.

Should all dogs with “kennel cough” be tested?

  • No.  Since a lot of pathogens can cause the clinical signs we see with this syndrome and we can’t test for them all, the test results rarely impacts how we treat an individual dog. It’s nice information to have but it’s usually hard to justify the cost for an average household pet. This recommendation is also part of the 2017 ISCAID  treatment guidelines for respiratory disease in dogs and cats.

When is testing more rewarding?

  • Testing is more useful when something is unusual about the scenario or the patient. From the patient standpoint, testing can be more useful when it involves a kennel or shelter, since the result could affect the infection control response. It also can help differentiate “vaccine breakthrough” from the presence of a bug we can’t vaccinate against.
  • By “unusual scenario” I mean something different in the incidence, distribution or severity of disease. If we think we’re seeing more disease, testing is useful to see if disease is mainly caused by one bug, whether we have a mix of causes, or whether the cause can’t be identified (suggesting something different/new might be present).

When do I really want to test dogs with respiratory disease?

  • When I’m concerned about a foreign disease like canine flu, I definitely want to get testing done. Figuring out when to worry about that comes down to two big factors: high attack rates and links to imported dogs, especially from Asia. When most dogs in a group get sick, I worry about something new like flu and want to test them, so that we find out as early as possible if flu is present and we can take measures to contain it, like we successfully did last year. A high attack rate was what led to identification of the biggest flu cluster we had when canine flu hit Ontario in 2018.

So, what about now in Ontario?

  • I’d like more information but don’t have any money for testing, so I’m relying on information that comes in from various sources. It’s always a fine balance between raising awareness and causing paranoia, so it’s important to put things in perspective. We’re on the lookout for respiratory disease in dogs and want to learn more, but we’re far from panicking about the situation.
  • The average dog owner doesn’t need to do anything more than good routine care and using common sense. However, we’d like to figure out if something new or interesting is going on.

More to come (hopefully).

Kennel cough, also (and more properly) referred to as canine infectious respiratory disease complex (CIRDC), has been in the news lately. This condition is a syndrome, not a specific disease, being potentially caused by a range of bacteria, viruses and Mycoplasma, including canine parainfluenza virus, canine influenza virus, canine respiratory herpesvirus, canine adenovirus, distemper virus, Bordetella bronchiseptica and Streptococcus zooepidemicus. Regardless of the cause, it’s still a highly infectious disease characterized by a hacking cough. Serious illness, including deaths, can occur but is uncommon.

Here are a couple of kennel cough issues have hit the press lately:

  • Mandatory kennel cough vaccination is now required for dogs competing in the Iditarod Trail Sled Dog Race. It’s easy to see how this disease is a concern in these sled dogs, given the stress and rigours of competing and the mixing of many dogs from different areas. Kennel cough vaccination doesn’t prevent all cases, since it only protects against Bordetella bronchiseptica +/- parainfluenza virus, but it’s a useful infection control tool in high risk populations. The requirement has been implemented in part due to cases of kennel cough that were encountered in the 2011 race, along with the publicity that was generated (including the attention of PETA).
  • In Rocklin, California, a dog park was closed for two days because of a kennel cough outbreak. It seems the closure was in response to the diagnosis of kennel cough in two dogs, and it’s an unusual move given the apparently low number of cases. The issue isn’t the park environment itself being biohazardous – rather, the park provides an opportunity for dog-dog transmission. Given that, it’s a questionable control measures since it’s unlikely that people will keep their dogs at home. Rather, they’ll probably just go to another park, where the same risks will be present. It’s a bit like the debate around school closures with pandemic influenza. On the surface, it seems like a good idea, since kids won’t pass around flu at school. However, in reality, what happens is kids congregate at the mall and other places if schools are closed, so it just moves the site of transmission somewhere else and probably doesn’t have any net benefit. Here, a better response would probably be an educational campaign to get people to keep sick dogs at home, have people keep their dog away from other dogs at the park and encourage vaccination of high risk dogs (which would include those that go to a park and interact with other dogs).
  • A kennel cough outbreak was reported in Bozeman, Montana, with veterinarians asking owners to be on the lookout for disease. Local veterinarians reported a spike in the number of cases, with one clinic reporting  around 20 cases in the past month, which is a pretty remarkable number for your average vet clinic.
  • And locally… nothing specific, but I keep getting reports of clusters of respiratory disease in dogs. We often don’t get a chance to investigate small clusters to figure out the cause, since information often gets to me after the fact, but it’s a recurrent problem in Ontario. Most of the reports are rather poorly defined clusters of sick dogs, with occasional severe outbreaks involving fatalities (including one I’m dealing with at the moment).

An article from NBCMontana.com describes a kennel cough outbreak in dogs in Bozeman, Montana. It’s a pretty basic article that outlines a rather typical presentation of kennel cough (now largely referred to as canine infectious respiratory disease complex – a respiratory infection that can be caused by a range of viruses, bacteria and Mycoplasma).

As part of the story, they state that if you have a sick dog, the "best course of action is to call your local veterinarian and get medication." I realize it’s a quick statement, perhaps tossed in without much consideration, but there are some important issues to consider.

Should someone call a veterinarian and get medication, or should a veterinarian actually see the dog?

  • Sometimes dogs just need to be given time and rest. Viruses are often the cause of this condition, and it just takes time for the infection to resolve (just like person with a cold virus). If that’s the case, a little over-the-phone veterinary advice might be fine. If drugs are needed, then the dog needs to go to a veterinarian. Affected dogs might need something to control cough, which need to be given by prescription, and occasionally antibiotics are needed, but in either case a veterinarian needs to see the dog first. If the dog is sick enough that it needs additional treatment above and beyond this, then of course it needs to be seen by a veterinarian.

Are there any problems with a dog like this going to the veterinarian?

  • Here’s where the ball often gets dropped. The last thing we want to see is someone walking through the from door with a hacking, biohazardous dog who goes nose-to-nose with other dogs in the waiting room, breathes on half of the surfaces in the room, sits there for ten minutes while waiting for the appointment, and gets handled by every staff member before they realize the dog might be infectious. A situation like that can turn a veterinary clinic into a source of infection for many other dogs, and help an outbreak spread.

A very basic but well coordinated approach can greatly reduce the risk of dogs infecting other dogs in the clinic. These would include:

  • Not taking a biohazardous dog into the waiting room. The owner can call from the car upon arrival or come in without the dog to let the clinic know they’re there.
  • The dog can be admitted directly into isolation or an exam room, thereby avoiding contact with other animals in the waiting room or elsewhere in the clinic.
  • Veterinarians and techs that are going to work with the dog can know in advance and come in prepared, wearing appropriate protective outerwear (e.g. gloves and a labcoat or gown that they use for only that appointment) to prevent contamination of their clothing or body.

Very easy to do. Probably very effective too, but often not done.

It’s very common for kennels to require dogs be vaccinated against "kennel cough" before they are allowed in. There are two main reasons for this:

  1. Reducing the risk that a dog will bring kennel cough into the facility and spread it to other dogs.
  2. Reducing the likelihood that a dog will acquire kennel cough if someone else brought it in.

Overall, it’s a sound policy, but it’s far from 100% effective and it needs to be part of an overall kennel infection control program to work. Relying solely on vaccination to prevent kennel cough is a weak approach that can ultimately fail, particularly if other infection control practices are poor or if vaccination protocols are illogical.

Why isn’t it 100% effective?

1) Kennel cough is a syndrome, not a specific disease. It can be caused by many different viruses and bacteria, often in combination. Kennel cough vaccines are typically targeted against Bordetella bronchiseptica +/- canine parainfluenza, two important causes of kennel cough, but not the only causes.

2) No vaccine is 100% effective. Vaccines help reduce the risk of illness, but they don’t completely eliminate it. Some vaccines are better than others, and some animals respond better to vaccines than others.

3) Timing is another issue. One of the weak points of many kennel protocols is the requirement that the dog be vaccinated "before entry," or within a certain number of weeks or months. The problem with this is vaccines are not immediately effective. What often happens is people decide to board their animal at the last minute or realize the night before that they need their dog vaccinated, so the vaccine gets given a day (or less) before kenneling. The intranasal kennel cough vaccine (squirted up the nose) takes a few (3-5) days to be effective, and the injectable vaccine takes even longer (a week or more). Vaccination very soon before boarding, particularly for a dog that has never been vaccinated against kennel cough before, is unlikely to result in protection from infection by the time of boarding.

Requiring vaccination before boarding makes sense, but it’s important to remember that:

  • It’s not 100% effective.
  • It doesn’t negate the need for a good infection control program.
  • It needs to be given at an appropriate time to be effective.

I had a call from a colleague in Ottawa (Ontario) the other day, asking if I’d seen an increase in kennel cough in dogs lately. Kennel cough is a respiratory infection of dogs that can be caused by a variety of different viruses and bacteria, or combinations thereof, but is often associated with the bacterium Bordetella bronchiseptica. Apparently, this colleague’s clinic has seen a large number of cases compared to normal, and he was wondering if the trend was more widespread and/or if there’s something new out there to be concerned about.

Informal reports like this are often the key to identifying new problems. There are only a few reportable diseases of companion animals (such as rabies), and existing federal and provincial public health and animal health agencies tend to have little mandate regarding non-reportable infectious diseases of companion animals. That means that there is no centralized reporting or investigation for all these other diseases (in other words: we’re on our own).

Most often, reports of higher disease rates or suspected outbreaks don’t end up leading to anything. Things tend to revert back to baseline fairly quickly without any explanation of what happened. Sometimes, however, reports like this are the first in a series that can flag the emergence of a new disease or a change in existing disease patterns.

Is anything actually going on with kennel cough in Ottawa? It’s hard to say. A report like this could be due to:

  • A focal outbreak caused by exposure at a single kennel, park or event.
  • A local outbreak of "run-of-the-mill" kennel cough that is being spread from multiple sources, but which involves the normal kennel cough bacteria and viruses.
  • Increased reporting of the normal baseline rate of disease, with increased awareness leading to the appearance of an outbreak.
  • A new disease (either a brand new disease or, more likely, the first instance of an existing disease in the area).

Whenever I hear reports like this in Ontario, I think about canine influenza. This virus is present in dogs in many regions of North America, but we have yet to identify it in Ontario (at least from the last data I have. We also couldn’t find any evidence of canine influenza virus in a surveillance study we did a while ago). It is certainly possible that this virus could make it to Ontario, and I would not be surprised at all if canine flu caused a readily detectable cluster of respiratory disease cases when it arrived.

Should dog owners in Ottawa be worried? No.

Should dog owners and veterinarians in Ottawa pay attention? Sure. It’s always good to be aware of things that are happening locally. Dog owners need to be aware of the risk of exposure to a variety of infectious diseases. Veterinarians should consider testing for canine influenza (and dog owners need to be willing to pay for the testing) if they see changes in respiratory disease patterns in their area.

How can dog owners reduce the risk of exposure of their dogs to respiratory diseases? Common sense. The more dogs that a dog meets, the closer they get to them and the less vaccination in the population, the greater the risk. Kenneling and other situations where many dogs get together increase the risk, and preemptive kennel cough vaccination should be considered in such cases. This vaccine doesn’t protect against all causes of respiratory infection, but it can protect against some of the most likely causes. People should keep their dogs away from other dogs that look sick (especially dogs that are coughing), and if they have a sick dog, they should keep their dog away from other dogs for a few weeks.

(click image for source)

A large whooping cough (pertussis) outbreak has been ongoing in people California in 2010. This bacterial infection, caused by Bordetella pertussis, is a highly transmissible disease that can result in serious problems (including death) in young infants. At last report, there were over 6000 cases of whooping cough, making this the largest outbreak in 60 years. Over 200 infants have been hospitalized, and there have been at least 10 deaths. Nine of the 10 deaths were in infants less than two months of age.  Infants in this age group have little to no immunity to the disease because they haven’t been vaccinated, and they are more prone to severe complications.

Bordetella pertussis is a human bacterium. It does not infect animals and animals are not direct sources of infection. (Actually, experimental infection of neonatal puppies with large doses of B. pertussis can result in shedding of the bacterium by a small percentage of dogs, but that’s not particularly relevant to the normal household situation). Therefore, people don’t need to worry about infecting their pets and pets passing the infection on to other people. However, it’s not impossible that pets could play an indirect role in transmission. A pet’s haircoat could possibly become contaminated with the pertussis bacterium from someone coughing around it, or touching it with contaminated hands. The bacterium could survive on the haircoat for a while (probably days), and someone could potentially get the bacterium on their hands by petting it, and subsequently become infected.

What are the odds of this happening? Who knows. It’s not something that anyone has investigated, as far as I know.

Could dogs and cats be important sources of pertussis in households? Probably not. I assume that if there is a person with whooping cough in a household, that person is more likely to be the source of infection for other people than a pet. 

Could pets spread pertussis outside the home? That might be a more realistic concern. People with pertussis might keep themselves away from others and stay at home, but if they contaminate their dog’s coat and the dog meets people on a walk or at the park (or at a veterinary clinic, or anywhere else), I have to wonder whether there could be the potential for spread of the disease.

What should we do about this? Common sense should prevail, and itt’s important for pertussis as well as other diseases. If someone in the household has an infectious disease that is transmissible and for which a pet could potentially be a vector, some basic precautions should be taken. Good attention to hygiene might help reduce contamination of the pet’s haircoat. This includes regular handwashing (especially after coughing and before petting an animal), avoiding coughing close to the pet and not letting the pet sleep close to the person’s head. Keeping the pet away from people outside the house, or at least limiting it’s contact with high-risk people might also be useful. In particular, keeping pets that might have been contaminated away from infants would be wise.

Overall, the risks are very low. We don’t need to fear dogs and cats as potential pertussis vectors. However, in the absence of proof that there’s no risk, and with a highly transmissible and potentially serious disease, use of some simple infection control measures makes sense. https://youtube.com/watch?v=KZV4IAHbC48%3Ffs%3D1%26hl%3Den_US

Kennel cough is a highly infectious respiratory disease in dogs. The disease got its name because infection and outbreaks often occur in kennels, where many dogs from various backgrounds are mixed together.  Some of the dogs in kennels may be carrying infectious diseases, and other dogs may be very susceptible these diseases – putting them all together in what can be a stressful environment for any dog creates a recipe for infection.

Kennel cough itself is more of a syndrome than a specific disease. It can be caused by a few different bacteria and viruses (and combinations thereof) that produce the same type of clinical signs. These pathogens include Bordetella bronchiseptica, Mycoplasma, canine parainfluenza virus, canine adenovirus-2, canine distemper virus and canine herpesvirus. Of these, only Bordetella bronchiseptica is a potential concern in terms of transmission to humans.  Bordetella bronchiseptica can cause respiratory infections in people, but this is probalby quite rare and largely confined to high-risk individuals, like those with a weakened immune system, who have had their spleen removed, who already have underlying respiratory disease of another kind, and pregnant women. The evidence of transmission of B. bronchiseptica from pets to people is relatively weak and circumstantial – it is not clear whether the human Bordetella infections in these cases were truly due to contact with a pet.

In households with individuals with a weakened immune system (e.g. HIV/AIDS, transplant or cancer patients), some measures that can be taken to help reduce the risk of transmission of Bordetella from pets include:

  • Avoid boarding dogs at kennels or veterinary clinics. If boarding cannot be avoided, ensure that dogs have been properly vaccinated against Bordetella bronchiseptica, and that the kennel or clinic requires all other dogs boarding there to be vaccinated as well.
  • Avoid obtaining a dog directly from from an animal shelter.
  • Wash your hands regularly after handling any dog, particularly if you’ve touched the dog’s  nose or mouth.
  • Don’t allow dogs to lick your face or hands.

The Bordetella vaccine for dogs is a modified live vaccine, meaning that a live but less virulent (pathogenic) form of the bacterium is administered to "prime" the immune system against regular Bordetella. Concern has been raised by some people that exposure to the vaccine strain could actually cause disease in high-risk individuals, whose immune systems might be unable to fight off even this "weaker" version of the bacteria.  It is unclear whether exposure to the vaccine strain actually poses any risk.  Nonetheless, it is reasonable to pay extra attention to avoiding contact with the dog’s face for a day or two after vaccination. Also, it is probably wise for immunocompromised owners to not hold the dog when it is being vaccinated, in order to reduce the risk of exposure to the vaccine. 

I’ve recently received a few reports of serious (including fatal) respiratory disease in dogs in regions east of Toronto, Ontario. We often see localized variations in the incidence of “kennel cough” (aka canine infectious respiratory disease complex (CIRDC)), including sporadic outbreaks, but in this case there is particular concern about the number of severe infections and deaths. No cause has been identified yet, so I’m trying to collect some more information to facilitate the investigation and get a better idea of what’s happening.

If you are a veterinarian or or owner of a dog with recent respiratory disease in Ontario, you can help by filling out this quick survey: https://uoguelph.eu.qualtrics.com/jfe/form/SV_832gfSKndCStP7g

I’ll post more information about these reports soon.

We continue to track cases of canine infectious respiratory disease in various parts of Canada, for what it’s worth. The data are obviously a bit dodgy because it’s primarily from self-reporting, but I think we’re getting some interesting information. Cases seem to be slowing down, but we continue to get reports from the two main areas in Canada (and a trickle from the  US). Part of the clustering we’re seeing is probably due to local increased awareness and reporting, but I don’t doubt that a couple of reasonable-sized outbreaks have been ongoing.

Click here for the latest version of our canine infectious respiratory disease complex (CIRDC) map (December 31), now with the ability to display cases reported by month.  A snapshot of the map is also shown below.

Here are some additional details from the data we’ve collected via the reporting survey:

65% of affected dogs had been vaccinated against “kennel cough” in the past year.

  • That’s not too surprising. Kennel cough vaccines protect against one, two or three of the many potential causes of CIRDC, but not all of the causes, by any means. Furthermore, no vaccine is 100% effective. These data don’t tell us anything about how well those vaccines work (they actually work quite well).

Of that 65% of affected dogs that were vaccinated in the past year:

  • 40% were vaccinated orally: The oral vaccine only covers Bordetella bronchiseptica, which consistently comes in as the #2 cause of CIRDC in Canada. It’s a good vaccine for that bacterium but has less coverage than intranasal vaccines.
  • 29% got an intranasal vaccine: Intranasal vaccines in Canada cover Bordetella bronchiseptica and canine parainfluenza virus, giving protection against the top 2 causes or CIRDC. Some also include protection against canine adenovirus type 2.
  • 35% received an injectable vaccine: Injectable vaccines are less protective when it comes to CIRDC. Oral and intranasal vaccines provide better protection where the infection occurs – in the upper respiratory tract.
  • 26% were unsure of the vaccine type: So whether these dogs were truly vaccinated against kennel cough is unclear.

Over half of affected dogs had visited a dog park shortly before they got sick.

  • That’s not surprising at all, since CIRDC is spread dog-to-dog, and parks are a place where dogs congregate.  Groomers came in as the #2 most common previous contact, followed by doggie day care.
  • Since we just looked at sick dogs, we can’t say anything about risk factors (e.g. we don’t know if visiting a dog park was more common among sick dogs since we couldn’t compare them to healthy dogs).
  • There were a couple specific parks that were frequently named, so it’s likely there were some true hot spots of transmission at those parks.

Diagnostic testing was performed on 17% of sick dogs, but nothing remarkable was apparent in terms of diagnosis.

  • That’s actually a pretty high percentage for testing in cases like this. Testing isn’t commonly recommended for routine cases of CIRDC since the cost is hard to justify where there’s little impact of test results on individual patient care.
  • Testing is more useful when there’s an outbreak (to figure out what the culprit is and see if there are any control measures that might be applied), with imported dogs (worried about bringing in influenza strains), kennels (outbreak potential) and breeders (outbreak potential, risk of more severe disease in young and pregnant dogs).
  • Limited test results were provided on the survey but nothing remarkable was present.

Most of these outbreaks of CIRDC die out over time and we never find the cause.

  • Canine parainfluenza is always high on my list since it’s common (common things occur commonly) and can be missed with routine testing because the virus isn’t shed for long. By the time the dog is taken to a veterinarian and sampled, PCR tests looking for the virus may be negative (and other approaches like antibody-based testing aren’t usually done).
  • A “new” or (more likely) established but unknown cause of illness is certainly possible. There are undoubtedly many canine respiratory viruses out there that we don’t know about.
  • Introduction of canine influenza from imported dogs is always a concern. It’s a “foreign” disease, but canine influenza was introduced to Ontario a few years ago, and was ultimately eradicated (as far as we can tell).  Here, since there haven’t been any positive test results, it’s unlikely to be the cause. That virus is shed for a while in infected dogs, and I’d expect to see a positive result with a reasonable number of tests. Introduction of influenza into areas where few to no dogs have immunity to the virus would almost certainly result in more widespread disease. So, I think flu is pretty unlikely here, but the potential for flu is a reason to test. We’ve shown it can be controlled when it’s caught early, but if it’s not, it can cause a lot of damage.

Disease tracking like this won’t provide clear answers, but helps identify and refine things we need to look at, so I think there’s a role for it  as an easy, low-cost surveillance tool.

Not uncommonly, I get questions about outbreaks of “kennel cough” (more formally known as canine infectious respiratory disease complex (CIRDC)). It’s not uncommon for us to see little outbreaks of this kind of respiratory illness in dogs, and we don’t have a good handle on the amount of “background” disease that’s always present in the community at large. So, it’s hard to interpret whether an “outbreak” is really an outbreak of disease versus an outbreak of awareness of disease, and to figure out much about true outbreaks.

In the past 24 hours, I’ve had a few calls about what seem to be fairly large outbreaks of respiratory disease in dogs in two different parts of Canada: southern Ontario and Calgary, Alberta.

I’ve tried different ways to investigate reports of CIRDC outbreaks in the past.  Getting reliable information is always a challenge, but we’re going to try again. This time, we’ve launched a very short survey that owners/veterinarians with dogs showing signs of infectious respiratory disease can complete. It asks a few basic questions, like location, date of onset of signs, whether the dog has been vaccinated for “kennel cough” and if a potential source of exposure to other sick dogs is known. I know the data will be really biased, so it’s not intended for for research use. It’s merely meant to identify changes in disease patterns, such as disease rates or potential point sources, that we can investigate further.

So, if anyone has (or is treating) a dog with suspected infectious respiratory disease, completing this short, anonymous survey may help us figure out what’s going on. While the recent reports are from Calgary and the Guelph area, anyone can participate.

The survey can be accessed using the link or the QR code below: https://uoguelph.eu.qualtrics.com/jfe/form/SV_9smQ5X5ZSytbPZH