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As concerns about canine infectious respiratory disease in the US have taken up most of my time lately, let’s merge that issue with what I had hoped to be the focus of the week: World Antimicrobial Resistance (AMR) Awareness Week.

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Despite lots of media attention and associated fear, we’re still not sure what’s going on with all these coughing dogs, or even if there’s really a story at all. This could be something new, but more likely, it’s the usual suspects doing their usual thing (possibly at higher rates in some areas, as fairly commonly occurs periodically).

In the unlikely event this is something new, it’s likely viral. It’s much less likely to be something bacteria.

Either way, we have to think about how that might impact treatment. The short answer is: it probably doesn’t affect our treatment approach.

Viral respiratory illness can’t be treated with antimicrobials. Some affected dogs will develop secondary bacterial pneumonia, and antimicrobials are indicated in those cases. But it doesn’t matter what virus triggered it.

Primary bacterial respiratory infections in dogs are less common. The bacterium Bordetella bronchiseptica is typically the number 2 or number 3 overall cause of canine infectious respiratory disease complex (CIRDC), after canine parainfluenza virus and maybe canine respiratory coronavirus. Streptococcus zooepidemicus is a rare cause of CIRDC and usually causes sporadic but really nasty (often rapidly fatal) disease, most often in shelters or other high stress settings. Secondary infections (i.e. things that move in after a virus has already caused some damage) can be caused by a variety of different bacteria.

When considering antimicrobial therapy, we need to think about the disease we’re targeting. Cough isn’t a disease. It’s a sign of disease. Cough can be triggered by infection, be it bacterial or viral, and often persists even after the infection is over. Too often, we get into a mindset of “the dog is coughing really badly” or “the cough isn’t going away” and we unnecessarily reach for antimicrobials, hoping they will somehow help, when in reality we just need to give the dog more time to fully recover, or we can use other approaches to decrease inflammation and suppress the cough if that’s the part that’s still a problem.

Our 2017 Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats from the International Society for Companion Animal Infectious Disease are a good start for thinking about how to manage these sick dogs. We’re starting a revision, and I think we’ll see a few changes to the guideline, but most of the original content still applies. Some newer approaches to care of these cases are already incorporated into the antimicrobial use guidelines available to veterinarians through the Firstline app (see image below).

Here are some of the basic recommendations:

Basic upper respiratory tract infection: cough, runny eyes and nose, maybe a fever and a bit quiet, but dog is usually pretty bright overall.

  • No antibiotics.
  • This is likely viral, and if it’s bacterial, it’s mild and should resolve on its own. Tincture of time and supportive care are recommended.

More serious upper respiratory tract infection that is probably bacterial: more advanced signs of disease, mucopurulent (yellow, goopy) nasal and ocular discharge, but lungs are clear.

  • Consider antibiotics but most cases probably don’t need them.
  • As these cases are more severe it’s easier to justify antibiotics, but I can often go either way and have a fairly high threshold to say “start antibiotics” (at least right away). However, it’s not unreasonable in many cases.
  • Doxycycline is the drug of choice for treatment. It’s lower tier, effective, safe and works against the main bacterial pathogens of concern.
  • If there’s no response to initial treatment, we need to back up and think about whether that’s because it’s a bacterial infection is not responding, or whether what we’re seeing is more likely viral or non-infectious. That’s often hard to sort out, but we need to consider it carefully rather than just jumping to another drug every time we don’t get the response we expect on the first try.

Mild/moderate pneumonia: Varying upper respiratory signs, but with signs of lung involvement, such as audible crackles and wheezes, and radiographic evidence of pneumonia. These dogs are sicker but are stable. They are breathing reasonably normally, are quiet but alert and do are not crashing.

  • Antibiotics are definitely indicated.
  • Doxycycline is still the drug of choice. Along with the points listed above, it achieves good drug levels in the lung and is a great first line choice for pneumonia. If it’s a rare, milder or earlier Strep zooepidemicus pneumonia (mainly we’d suspect this because it’s part of an outbreak), amoxicillin would be fine instead, but usually we want a broader spectrum drug than that and one that gets better levels in the lung.
  • Some people are suggesting that enrofloxacin seems to work better in some of the more recently reported cases. That could be a true reflection of better activity against certain bugs, or issues with resistance to other drugs, but could also just be a function of using enrofloxacin as a second line option later in disease (where its use corresponds to natural resolution of disease, versus a true effect of the drug). It’s a good observation and I don’t dismiss anecdotes like that, I want to explore it more to try to tease out the reasons versus making a full switch to regularly using a higher tier drug like that. It could be that enrofloxacin is a better drug (overall or in specific areas), but given the potential issues with use of this higher tier drug, we’re best to be cautious and try to make sure we really have a firm indication that it’s necessary. If we put every dog with pneumonia on a fluoroquinolone like enrofloxacin, we won’t be able to use the drug for long because resistance will quickly become an even bigger problem.
  • Azithromycin is another option for treatment of pneumonia, as it also achieves great levels in the lung.
  • The more convinced I am of a true treatment failure, and the more severe the disease, the more I’d escalate, but sometimes we can be mislead by our observations. If it’s clear that doxycycline isn’t working in one area but another drug is, it’s logical to use that other drug, but we want to make sure we’re limiting changes in approaches and use of higher tier drugs as much as we can, because the more we use them, the quicker we lose them.

Severe/septic pneumonia

  • One of my big considerations when deciding whether to use more broad spectrum treatment in any patient is “What’s likely to happen if my drug choice is wrong?” If the answer is “the animal will probably die,” I can justify using a higher tier drug or combination to help ensure it’s effective on the first try. For the cases above, I wouldn’t typically jump to a broader spectrum combination, but with severe septic pneumonia we are dealing with a subset of dogs that are really sick with significant lung disease. They are not oxygenating well. They have low blood pressure or other signs of severe systemic inflammation. They’re at risk of crashing hard and fast, and I need to get the infection under control pronto. So, I can justify a broad spectrum antimicrobial – nothing crazy (e.g. not meropenem), but a broad spectrum drug/combination that’s higher tier and something I generally avoid, but am comfortable using in a situation like this.
  • Intravenous clindamycin & enrofloxacin, ampicillin & enrofloxacin, or an intravenous 3rd generation cephalosporin (e.g. ceftiofur, cefotaxime) would be reasonable choices in these cases.

How long do we treat a dog with pneumonia?

We have very little duration of treatment data for most infections we deal with in veterinary medicine, especially companion animals. We tend to be quite risk averse and therefore default to really long antimicrobial treatment courses.  Based on the short durations of antimicrobial use in people with similar conditions (where there’s lots of evidence that shorter is better), and even in cattle (where there’s lots of evidence and desire for shorter courses because it’s a hassle treating them), we need to be aim for shorter courses of antimicrobials in pets too.

  • Five days is what I’m recommending now. We don’t have data for that, but we also don’t have data for using any longer duration of treatment, and since we have good comparative data from other species, increasing anecdotal evidence and a duty to consider a “least harm” approach, I’m happy with five days. We can always go longer if needed, based on patient response and complicating factors, but short durations are often effective, come with fewer adverse event risks, and are cheaper and easier for owners (who, realistically, often don’t complete long treatment courses when their pet is doing well anyway).

We have to remember that antibiotics are there to help resolve bacterial infection, but eliminating the infection doesn’t immediately fix everything. Signs like cough and radiographic changes can linger, and more antibiotics don’t help those things resolve any faster.

So, while we’re not sure what’s going on with all the coughing dogs in the US right now, we can be reasonably confident we know how to treat them. Our usual approaches will still work. We need to be conservative with antimicrobials, but also ready to use appropriate drugs (including broad spectrum, higher tier drugs) when indicated. The right drug at the right dose for the right patient still applies.

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This wasn’t on my bingo card for 2023, but it looks like I need to comment on the use of Paxlovid in dogs with respiratory disease. I guess I shouldn’t be surprised, but there’s been a lot of buzz about a single report of a veterinarian using Paxlovid to treat one dog with respiratory disease – in the absence of any definitive diagnosis as to what was making the dog sick.

Some media reports are claiming Paxlovid cured the dog. Did it?

Probably not. I suspect the dog got better on its own despite Paxlovid (not because of it), but can’t say for sure. However, I can say that I don’t see any evidence that we should be using this drug in dogs, and I have a variety of concerns about its use in this manner.

Concerns about Paxlovid use in dogs (quick version)

Paxlovid is an antiviral that we know basically nothing about in dogs. We don’t have dosing or safety info in dogs, and we don’t have evidence that the respiratory disease we’re currently seeing in dogs in North America is caused by a virus that’s susceptible to Paxlovid. So, I don’t think its use is appropriate in such cases, and I suspect widespread use of Paxlovid in dogs would result in harming more dogs than it would help.

Concerns about Paxlovid use in dogs (longer version)

Using a human drug in a pet isn’t rare in veterinary medicine, and often it can be appropriate. Veterinarians often need to use drugs in an extra-label manner, since many important drugs are not licensed for use in animals. When we know how to use the drug, its safety and that it’s likely to work in an animal, this kind of extra-label use can be appropriate.

  • The less we know about things like dosing and safety in animals (which can be very different across species), the greater the risk.
  • The less we know about efficacy, the lower the value.

Treatment is typically a cost-benefit decision, based on assessing potential risks, potential unknowns and potential beneficial effects.

Paxlovid is a combination of two antiviral drugs, nirmatrelvir and ritonavir, which are both protease inhibitors, neither of which are used in dogs. The combination has been shown to be beneficial for treating COVID-19 in some types of people, in some circumstances, with the right timing. That’s based mainly on study of Paxlovid use in unvaccinated people. In Canada, it’s licensed for use in people with mild to moderate COVID-19 who are at increased risk of severe disease. It’s not meant for everyone, and it’s meant for early treatment. There are different opinions about whether it’s really of much use at this point in the pandemic, but I won’t get into that.

What do we know about Paxlovid in dogs?

Pretty much nothing. I’m not aware of any dosing or safety information.  The only thing I can find is a study that looked at Paxlovid in serum of different animal species, including dogs (i.e. they added the drug to serum in a tube, but they did not give the drug to the live animals) and did a pharmacokinetic study on just two healthy research dogs (Greenfield et al 2023). That’s a start, but the small number of dogs (2) means it still doesn’t tell us too much. The researchers reported some pretty major differences between species, including between dogs and people. They concluded that “Some species (rabbit,dog) demonstrated high plasma protein binding (PPB) that was concentration-dependent, whereas others (human, monkey, rat) did not. This can have a major impact on understanding concentration-effect relationships for both efficacy and safety endpoints. As such, it is important to consider PPB when selecting animal species for studies aimed towards understanding efficacy and safety in humans.”

My take home message from that study is it can’t tell us anything about how/if we can and should use Paxlovid in dogs, and we can’t assume safety and efficacy data in people apply to dogs.

Sometimes we use the same doses in people and dogs for a specific drug, but sometimes, the doses are quite different.

Some drugs that are useful in people also work in dogs, but some drugs do not.

Some drugs that are relatively safe in humans are relatively safe in dogs, but some human drugs are highly toxic to dogs.

If we don’t know dosing and safety in a particular species, it’s really hard to consider use of a particular drug if there isn’t a huge potential upside, e.g. because we need to treat a severe disease and we have no other options, and where the drug has a strong chance of working. That’s not the case here with canine respiratory disease and Paxlovid.

Could Paxlovid work in dogs?

Paxlovid could have an impact on some viral causes of canine infectious respiratory disease complex (CIRDC), such as canine respiratory coronavirus (which is a completely different virus than SARS-CoV-2, despite the similarity in name). However, even IF Paxlovid has effects on canine respiratory coronavirus, or other relevant viruses, that may not really mean a lot clinically. It might shorten disease and/or might reduce the risk that secondary complications developing, but that would probably still be dependent on very early treatment, something that is not likely to happen in a lot of dogs when illness is still mild, particularly given the cost of Paxlovid.

Could use of Paxlovid in dogs hurt?

Absolutely. We have no idea if the drug is safe in dogs. There are various known side effects in people, and the drug interacts with a lot of other medications. If we’re going to apply a cliché, it should be “above all, do not harm” vs “it can’t hurt.” The latter is not likely true.

What about developing resistance to Paxlovid?

There’s probably very little risk of viral resistance to Paxlovid increasing due to use in dogs. The concern would mainly be about development of resistance in viruses that can affect people, since that’s where the drug is most often used and where resistance is most likely to have a significant impact. Dogs can be infected with SARS-CoV-2, but for resistance to be a risk, a dog would have to be infected with SARS-CoV-2 at the time it had respiratory disease (likely unrelated, since SARS-CoV-2 is unlikely to cause clinical respiratory disease in dogs based on what we know) AND resistance would have to develop while the dog was infected AND that resistant virus would have to be transmitted back to a person. Dogs seem to pose very limited risk for transmission of SARS-CoV-2 to humans, so it’s fair to assume that the health risks posed to humans from use of Paxlovid in dogs are very low to negligible.

However, we understand little about antivirals and antiviral resistance in animals, and the precautionary principle would have us remain pretty conservative with their use, and to only do so after a thorough risk assessment.

At this point, my assumption is that widespread use of Paxlovid in dogs would harm more dogs that it would help.

In contrast, there’s a different story about another COVID-19 drug in cats. We have some good data about the antiviral drug Remdesivir in terms of dosing, safety and efficacy for feline infectious peritonitis, which is otherwise a pretty much invariably fatal disease. This is a drug we should be using in cats, but we still can’t get (legal) access to it in North America. We’re working on that, so it will probably be the topic of a post in the near future. Good or bad news? I don’t know yet.

There’s been a lot of discussion about canine infectious respiratory disease complex (CIRDC) going around in dogs in the US recently. In the last week, I’ve already covered this from a few different angles, including what might really be going on with all the reports of sick dogs, reports of the potential involvement of a potential novel canine respiratory pathogen and when and when not to treat dogs with respiratory disease with antimicrobials. I’ll try to get another post done soon about the data we have (and don’t have). This post will address the most common questions dog owners are asking.

What should dog owners do?

Relax. It seems like there’s more respiratory disease in dogs in some areas, but that’s something we often see. Serious disease is being reported in a small subset of infected dogs, but that’s also something we regularly see. So, being aware is good, being anxious is bad, freaking out is definitely unnecessary.

The vast majority of dogs that get CIRDC recover uneventfully. That’s as true now as it was a year or 10 years ago. However, severe disease can occur so we don’t want to be too dismissive.

My dog is sick. What should I do now?

The default answer is “talk to your veterinarian if you’re concerned.”

However, the answer is not “if your dog coughs, it must be taken to a veterinarian ASAP.” A dog should be taken to a veterinarian if it’s really sick, deteriorating quickly, not getting better over the course of several days (but remember dogs may still cough after they’re feeling better), if there might be complications, or if it’s unclear what’s going on.  If the dog just has mild upper respiratory infection, it rarely needs to be seen by a veterinarian. If it has pneumonia, it definitely needs to see a veterinarian.

Think about it in terms of how we react when we get sick or our kids get sick. If you had a cough and felt a bit run down, you probably wouldn’t go to a doctor unless you had underlying risk factors for severe disease. The same applies to dogs – if they’re pretty bright and alert, are eating and breathing normally, but just have a cough and runny nose or eyes, it’s very unlikely they need to be examined (in part because it’s very unlikely that they need any specific treatment or testing, and because a visit to the veterinary clinic might just cause more stress for the dog and risk exposing other animals.) If you felt like you could barely drag yourself out of bed or you were having a hard time breathing, you’d go to the doctor. That’s also the same for dogs.

While I want to avoid being too prescriptive about who should or shouldn’t see a veterinarian (since there are lots of exceptions and grey areas), if the following signs are present, a prompt visit to the veterinary clinic is indicated:

  • Weakness, severe depression (meaning the dog is really quiet, not engaged and just lies around, doesn’t get up when you’d expect it too (like for food))
  • Loss of appetite
  • Difficultly breathing (breathing faster and harder even when not exercising)
  • Rapid worsening of illness
  • Cough that is causing significant problems such as vomiting or making it hard for the dog to breathe

It’s especially important to see the veterinarian if these signs occur in a high-risk dog, including:

  • Elderly
  • Very young
  • Pregnant
  • Immunocompromised (by disease or treatment)
  • Underlying heart or respiratory tract disease
  • Brachycephalic (i.e. squishy-faced) breeds

What will happen when I take my dog to the veterinary clinic?

That’s depends on a lot of things, so it’s hard to say what you should expect.

  • The first thing the staff should do is assess whether it looks like your dog has infectious respiratory disease, and how stable your dog is (in terms of its lung function). Most dogs with CIRDC don’t need anything but time and TLC; so, if your veterinarian says your dog looks stable and no treatment is needed at this point, take that as a good sign. Don’t ask for unnecessary treatments like antimicrobials “just in case.”
  • If your dog’s cough is disruptive, then a cough suppressant may be warranted (but that depends on a few things).
  • If your dog has signs of pneumonia, radiographs of the chest and bloodwork will likely be needed. If pneumonia is confirmed, antimicrobials are indicated.
  • If your dog is really sick, hospitalization with intensive care, antimicrobials and oxygen therapy may be required. That’s uncommon but it happens, and when there’s more respiratory disease activity in an area at a given time, there will be more cases of severe disease too just based on numbers (e.g. 1% severe disease rate in 1000 infected dogs is more really sick dogs than 1% in 100 infected dogs).

The severity of your dog’s illness, the type of illness, what the clinic can offer and (unfortunately) sometimes budget limitations will influence what’s ultimately done.

Additionally, sick dogs should be kept away from other dogs to help reduce the risk of disease transmission. That includes no going to day care, parks or any other places where non-household dogs would be encountered. For how long? That’s hard to say without a diagnosis but I’d aim for at least 2 weeks.

My dog is healthy. What should I do?

Let’s try to keep your dog healthy by limiting its contact with other dogs, especially large numbers of different dogs with unknown health status. Contact with small, stable groups (e.g. an established walking group, a small day care with the same dogs that don’t see a lot of other dogs) is lower risk. Logically, dogs should be kept away from any obviously sick dogs.

What about vaccines for my dog?

Vaccines are available for some of the causes of CIRDC. For any dogs that have frequent contact with other dogs, vaccination against Bordetella bronchiseptica and canine parainfluenza virus is important. Mucosal vaccination (intranasal is preferred, oral is second best) should be done whenever possible. Critically, it is important to use a vaccine that covers both Bordetella and parainfluenza. I suspect that loss of parainfluenza protection because of increased use of Bordetella-only oral vaccines might be driving some of the issues we’re seeing.

Canine influenza (flu) vaccination can be considered too, but it can be hard to get (there are currently some production and backorder issues) and canine flu is a pretty sporadic disease.

My dog is healthy but higher risk for disease or complications (see high risk list above). What should I do?

Take the same precautions described above for non-high risk dogs, but with more rigour. I’d also be quicker to recommend respiratory disease vaccines for these dogs, irrespective of how much contact they have with other dogs.

My own two dogs probably fall into those two risk categories. Both have fairly cloistered lifestyles from an exposure standpoint. Their dog contacts are largely restricted to a small number of well known and similarly low risk dogs.

The young pest, Ozzie, is a one-year-old, healthy Labrador, and is therefore at low risk of exposure and low risk for serious disease. He got an intranasal Bordetella/parainfluenza vaccine this summer so he could go to day care when we were away at a cottage (to give us some Ozzie-free afternoons to relax). The old guy, Merlin, is an 11-year-old Labrador who’s on chemo for chronic lymphoid leukemia. His exposure risk is low but he’s probably at some degree of greater risk for serious disease if he gets infected. There doesn’t seem to be anything remarkable going on locally compared to normal, so it’s status quo for them, but I’d be quicker to vaccinate Merlin if I decided vaccination might be warranted, especially if influenza hit the area.

As with any emerging issue, the current situation in the US is fluid, and we’re trying to sort out more about what’s happening. At the moment, for your average dog owner, it’s still just a matter of some common sense precautions and good dog care.

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I’ve held off writing about this but since I’ve been answering many emails about it every day, here we go.

The questions I keep getting (as usual) are “What’s going on with this reported outbreak of respiratory disease in dogs in the US? What new disease is this?”

I’m not sure there’s a new disease here. I’m not even sure there’s a major outbreak (or any outbreak).

Various groups in different areas of the US are reporting cases of respiratory disease in dogs (which we refer to as canine infectious respiratory disease complex, or CIRDC) in dogs in various parts of the US. There’s always limited info about true numbers, and the disease description is vague and quite familiar (coughing dogs, some that get pneumonia, a few that die).

The issue is, that largely describes the every day status quo when it comes to CIRDC. This syndrome is endemic in dogs and has a variety of known causes (e.g. canine parainfluenza virus, Bordetella bronchiseptica, canine respiratory coronavirus, canine pneumovirus, canine influenza virus, Streptococcus zooepidemicus… roughly in that order of occurrence, and maybe the enigmatic Mycoplasma as well). There are also presumably a range of other viruses involved that have been present for a long time but that we don’t diagnose.

We see CIRDC all the time, anywhere there are dogs. There’s a background level of disease that usually flies under the radar, alongside periodic clusters of cases. I get lots of emails every week asking whether there’s more or more severe CIRDC activity at the moment, but I’ve been getting those reports for years, from across North America. To me, that reflects the fact that CIRDC is always circulating, but we notice it more at certain times than others, either because of local clusters or, increasingly, local increases in awareness, often due to media coverage. Media and social media can drive outbreak concerns. They can be great to get the word out and help sort out issues, but often, they lead to false alarms.

  • For example, we might have 100 dogs with CIRDC every week in Guelph (a complete guess since we have no way to track this). Usually, only a few people hear about it. The dogs typically get better and life goes on. However, if someone starts talking about it on social media, we might hear about 50 of those 100 cases. All of a sudden, we have an “outbreak of a disease affecting dozens of dogs” when in reality, we might just have our normal background level of disease that people are actually noticing.

The same thing can happen on a larger scale. There are thousands of coughing dogs in the US every day, since there are millions of dogs. Once people start talking about it, some of these go from “Oh, my dog is coughing. I guess he picked up something at the park. Whatever.” to “OMG, my dog has this new disease that’s sweeping the nation, I need to tell someone!” With the first approach, no one but the owner usually knows or cares. Once we hit the panic button, many owners start to tell everyone about it.

We don’t have any idea if the current stories reflect:

  • A multistate outbreak caused by some new bacterium/virus
  • A multistate outbreak caused by our usual suspects, for some reason
  • Unconnected sporadic local outbreaks caused by usual suspects
  • A slight increase in baseline disease
  • Our normal disease activity with an outbreak of media attention.

I suspect it’s one of the last two. My perception is that we have been seeing a bit more CIRDC activity over the past couple of years, and that we are now seeing a somewhat greater incidence of severe cases. However, with more cases, we see more severe disease, so those are linked. Also, with the explosion of breeds like French bulldogs that are much more likely to have severe outcomes from any respiratory disease (since a large percentage of them have been bred to have completely dysfunction respiratory tracts), increases in deaths could be linked to dog factors, not disease factors.

I never outright discount reports of something potentially new, and we continue to try (futilely so far) to get a better handle on what’s happening with regard to CIRDC activity in different areas. It’s tough, since there’s no effective surveillance system, the voluntary reporting that we’ve tried tends not to get much buy-in (understandably knowing veterinary clinics are swamped by other priorities), testing of sick dogs is expensive and rarely impacts how we care for an individual animal (great for surveillance but harder to justify the cost to an individual owner), and we have little to no funding to do much with companion animal infectious diseases at all.

My guess is this is simply an outbreak of media attention piggybacked on a somewhat increased rate of CIRDC cases that we’ve seen over the past year.

I might be wrong, which is why we’re still trying to collect more data, but I don’t currently see a reason for extra concern.

If you’re worried about canine respiratory disease:

  • Limit your dog’s contacts, especially transient contacts with dogs of unknown health status
  • Keep your dog away from sick dogs
  • If your dog is sick, keep it away from other dogs
  • Talk to your veterinarian about vaccination against canine parainfluenza virus (CPIV) and Bordetella bronchiseptica (plus canine influenza, but influenza is much more sporadic (especially in Canada) and vaccine availability is still an issue).

And, at risk of a flurry of emails, I’ll add… consider health when choosing a dog. That doesn’t mean no Frenchies, but get one that looks like they used to – one with a nose, not the current popular version of the breed.

For the past year or more, we’ve been trying to track infectious upper respiratory tract disease (officially known as “canine infectious respiratory disease complex (CIRDC)” but more commonly called “kennel cough”). It’s a tough thing to do since testing is limited, the disease is always present to some degree in the dog population, and there’s no formal reporting system. Enquiries about CIRDC in different areas seem to fill my inbox in waves, but that’s probably more related to reporting (especially social media rumours) vs actual frequency of illness. This week’s been busy so far  with a dozen or so emails asking about things like “new” respiratory diseases, or specific things like canine influenza (and it’s only Monday…).

We’re still not sure what’s going on. It does seem like there’s increased CIRDC activity over a lot of North America right now, and it’s been going on to some degree for quite a while. When we think about increases in respiratory disease reports, there are a few  potential causes (as I have mentioned many times before):

Increased disease caused by the usual suspects

  • This is my main guess at this point for what’s currently going on. Common things occur commonly, and that’s particularly true for the variety of bacteria and viruses that cause CIRDC in dogs.
  • A few potential reasons for the increased disease from these pathogens can be postulated. One is there’s more dogs mixing with each other now as people start to increase activity and get together post-lockdowns, and as people prioritize safer outdoor activities (often with their dogs). Combine that with a surge in new dogs and potentially decreased vaccination (due in part to overloaded veterinary clinics and access difficulties from earlier restrictions), and it’s easy to see how we might have more disease.
  • Another potential dynamic is increased use of oral “kennel cough” vaccines, as they are easier to administer to some dogs compared to intranasal vaccines. The problem is oral vaccines only protect against one cause of CIRDC (Bordetella bronchiseptica) while intranasal vaccines protect against Bordetella and canine parainfluenza virus (CPIV). That’s important because CPIV is the most commonly diagnosed cause of CIRDC in many areas.

Increased disease caused by a new pathogen

  • We’re always on the lookout for something new, but nothing is apparent yet. With a new virus, we’d be more likely to see widespread transmission in exposed groups, since no dogs would have any immunity. We’re not really seeing that. The cases being reported are more sporadic, as we’d expect with our typical causes of CIRDC. However, we can’t rule out a new pathogen completely, and there are undoubtedly various causes of CIRDC (mainly viral) that we simply haven’t identified yet.  I don’t think it’s the explanation for the current situation, though.

Increased reporting of disease

  • This is probably part of what we’re seeing. There’s more social media use these days so word spreads quickly. One voice can be amplified disproportionately and unsubstantiated claims can be disseminated easily. Further, it feeds on itself. When there’s more buzz about sick dogs, more people that otherwise wouldn’t have said anything chime in. So, we probably hear about a greater percentage of sick dogs simply because people are talking about them when they otherwise wouldn’t have.
  • Also, as more people are at home with their dogs, we probably hear more about the typical mild cases of CIRDC, because owners pay more attention when the dog is coughing beside them all day.

What about SARS-CoV-2?

  • SARS-CoV-2 is very unlikely to be playing a role. We can never say never, since the COVID-19 pandemic is a dynamic situation and we don’t know much about recent variants in animals. However, what we know so far is that infection of dogs and cats with SARS-CoV-2 is quite common, but disease is uncommon in cats and rare in dogs.

What about canine influenza?

  • Canine flu certainly can cause large outbreaks of respiratory disease in dogs. It spreads quickly because of limited immunity in the dog population. There has been some canine flu activity in a couple places in the US in the past few months, but these seem to have burned out (or at least burned down) relatively quickly.
  • There have been social media reports of canine flu outbreaks in Ontario. As far as I know, that’s false. Canine flu is reportable in Ontario, and no such reports have been received from any lab. We haven’t seen canine flu in Ontario since we eradicated it in 2018. I’m always on the lookout for it, but I’m most concerned about flu when there’s an outbreak that has a very high attack rate, including dogs that have had intranasal kennel cough vaccine. We’re still looking but I doubt canine flu is playing a role currently.

What can people who are worried about their dogs do?

  • Reduce contacts with large numbers of unknown dogs. Just like with other respiratory pathogens, the more contacts, the greater the risk of encountering someone that’s infectious.
  • Reduce contact with sick dogs. This can be harder but it’s common sense: if a dog looks sick (e.g. coughing, runny nose, runny eyes), keep your dog away from it.
  • Keep sick dogs at home. (Duh… but you’d be surprised.)
  • Avoid things like communal water bowls in parks that are shared by multiple dogs.
  • Get your dog vaccinated (ideally intranasally) against kennel cough if it tends to encounter other dogs regularly. My dog doesn’t get this routinely since we live in the country and he has a very limited number of other dogs with which he interacts. If I was in town and/or going to dog parks or other places where he’d mix with lots of dogs of unknown status, I’d vaccinate him (especially as he’s getting older now).
  • Consider testing your dog if your dog gets sick. Testing is useful to help figure out what’s going on and maybe to help control things. However, it rarely tells us something that influences care for the individual dog (since we don’t have specific treatments). So, the cost of testing is (understandably) hard to justify for some.

We’re also still tracking cases so people with sick dogs can provide information by filling out our quick survey here:
https://uoguelph.eu.qualtrics.com/jfe/form/SV_eP6E6AzIiJfnDlY

When we talk about vaccines of dogs*, we tend to split them into “core” and “non-core” vaccines.

(*The same applies to cats. I use dogs by default for posts like this, which sometimes gets me an earful, but I’m not actually ignoring cats.)

Core vaccines are those that every animal should get (e.g. rabies vaccine in areas where rabies exists, canine parvovirus in areas where dogs exist). Non-core vaccines are those that aren’t required by every dog, or that are less convincingly needed in every case.

Non-core vaccines are also often referred to as “lifestyle vaccines,” because the nature of the dog’s (or cat’s) lifestyle can put the animal at more or less risk of exposure to a disease, which affects the relative need for vaccination. Respiratory diseases are a great example. All dogs are at some degree of risk, but the risk is much higher in dogs whose lifestyles create more dog-dog contact (e.g. going to daycare, boarding, off-leash dog parks). That’s a good way to think about how to prioritize vaccination for an individual dog, but it misses a big part of the disease prevention equation.

When I’m assessing the need for vaccination in a pet, I think about two main things:

  1. Risk of exposure. The lifestyle aspect covers this.
  2. Risk of serious disease. This often gets ignored.

Some dogs are at higher risk of severe disease or death from respiratory infections. I’d put senior dogs, brachycephalics (i.e. flat-faced breeds), pregnant dogs, dogs with pre-existing heart or lung disease and dogs with compromised immune systems on that list. I’m more motivated to protect them because the implications of infection are higher, even if their risk of exposure may be fairly low.

Take my two dogs as an example (again):

Ozzie is 1.5 years old and healthy. If he gets a respiratory infection, most likely he’ll have transient disease and, while it will be annoying (for him and us) and I’d like to prevent it, odds are quite low he’ll suffer any serious consequences.

In contrast, Merlin is an 11 year old dog with chronic lymphoid leukemia who’s been getting chemotherapy for about 2 years. He’s doing really well, but he has a significant chronic disease and he’s old. If he gets a respiratory infection he’s at much greater risk of dying than Ozzie.

If we look at lifestyle of these two dogs, they’re similar, since they do everything together. The exception is in the summer when we go to a cottage for 2 weeks. Since 2 weeks with Ozzie at a cottage isn’t much of a vacation for us or Merlin, he went to a local day care for part of the time. (An exhausted Ozzie is a good Ozzie, and he often came home close to comatose, which was perfect.) So Ozzie has a major additional lifestyle risk factor, therefore he’ll get a respiratory vaccine again this summer (both because of the risk and because the day care requires it).

Merlin doesn’t have that same direct exposure risk, but he has some added risk through being exposed to Ozzie. Should he get a respiratory vaccine? If we just look at his lifestyle, we’d say no, he’s pretty low risk for exposure. However, his higher risk for severe disease increases my motivation to vaccinate him, and he’ll likely get a respiratory vaccine this summer at the same time Ozzie does.

Lifestyle is definitely important to consider, but we need to make sure we don’t just focus on the dog’s lifestyle and consider the dog (or cat) as a whole.

As awareness of canine infectious respiratory disease complex (CIRDC, formerly known as “kennel cough”) has spiked recently, there are more discussions happening about respiratory vaccines in dogs. A large number of different bacteria and viruses play a role in CIRDC. We can vaccinate against a few of them including parainfluenza virus (the most commonly diagnosed contributor to CIRDC), the bacterium Bordetella bronchiseptica (typically number 2 or 3 on the list of diagnosed contributors), canine adenovirus (pretty uncommon) and canine influenza (very sporadic).

We also have different ways to vaccinate dogs, specifically use of injectable versus mucosal (oral or intranasal) vaccines.

  • Injectable vaccines tend to induce a better systemic antibody responses. Mucosal vaccines provide a better local immune response at the mucosal surface. For respiratory infections, the local immune response is probably the most effective. There’s reasonable evidence that mucosal vaccines are superior to injectable vaccines for Bordetella. We don’t have good data for parainfluenza, but I’d assume the same applies. (We only have injectable influenza vaccines for dogs.)
  • Mucosal vaccines are modified live organisms – versions of Bordetella and parainfluenza that are still alive (i.e. functional) but have been attenuated so that while they can elicit an immune response, there is negligible risk of causing disease in the animal. We never say a modified live vaccine (MLV) is 100% guaranteed not to cause disease, but the risk is really low, and the protection is really good, so overall they’re beneficial for vaccination in “normal” animals. However, we tend to avoid MLVs in immunocompromised animals because low virulence organisms might be more likely to cause disease in an individual with a compromised immune system.

That’s the dog side. But, we have to remember that each dog is attached to one or more people too. When we vaccinate a dog with a mucosal vaccine, it sheds the modified bacterium/virus for a while, and might have a large load of the vaccine strain in their nose or mouth right after the initial administration.

That means people can be exposed to the vaccine strains as well. Generally, that’s not a big deal, and it’s really only a potential issue for Bordetella (because canine parainfluenza and canine adenovirus of any form don’t infect people). I get asked about this a lot, by both veterinarians and pet owners, and I write a similar post to this one every few years, but each time we have a bit more data.

Why is there concern about human exposure to Bordetella in canine vaccines?

  • Bordetella bronchiseptica can cause infections in people. They are rare, but they occur. So, if the “normal” Bordetella bronchiseptica can cause disease in people, we have to think about whether the vaccine strains can cause disease too.
  • The answer is “yes,” with a big “but” (actually, a series of “buts”).

Yes, there have been a couple of reports of human infections with canine vaccine-strain Bordetella, some of which are more convincing that others.

A recent report (Kraai et al. 2023) described vaccine-strain Bordetella bronchiseptica infection in a 43-year-old woman who was taking immunosuppressive medication.

  • She developed bronchitis with malaise and a mild fever two weeks after her dog had received an intranasal vaccine.
  • Bordetella bronchiseptica was isolated from her sputum. When it’s gene sequence was assessed, it was consistent with the vaccine strain.
  • She had mild disease and responded to antimicrobial treatment.

Clearly there is some risk with human exposure, that’s certain. Some groups have said to avoid MLVs in animals living with immunocompromised people. But let’s thing about that critically for a moment. All vaccination decisions require consideration of the costs (risks) versus benefits:

  • The risk to humans from canine vaccines is really low. Millions of doses of mucosal vaccines are given to dogs every year, yet human infections are still extremely rare.
  • Disease that has been reported in people who do get sick is mild.
  • Mucosal vaccination is superior to parenteral vaccination, and prevention of disease in dogs can also reduce the risk of exposure to the “wild type” (non-attenuated) strains of Bordetella in humans.

Broad “don’t use modified live vaccines in animals owned by high risk people” statements overlook a few big-picture issues:

  • The big one is the vaccine strain is much less likely to cause disease than the circulating (non-attenuated, disease causing) strains. A person is much more likely to be infected with the Bordetella from a naturally infected dog than from a vaccinated dog, so I’d rather prevent the dog from getting infected by vaccinating with the most effective method available.
  • Natural Bordetella infection (unlike vaccination) also tends to make the dog cough, which increases human exposure to any number of bugs in the dog’s respiratory tract.
  • If that dog needs treatment with antimicrobials, we run the risk of the person being exposed to antimicrobial resistant bacteria, some of which can pose additional risks to people.
  • Antimicrobials also increase the risk of the dog developing diarrhea, which can greatly increase human exposure to disease-causing bacteria in feces (especially if the dog poops on the floor).

Some more food for thought:

If I have a dog that was recently vaccinated with a mucosal vaccine, and I was asked to rank the top 5 zoonotic pathogens that are in the dog, vaccine-strain Bordetella wouldn’t even crack that list. There’s a mix of potentially disease-causing bacteria in every dog, all the time. Getting tunnel vision about one in particular, especially one that’s really quite low risk, is not helpful.

What about killed, injectable Bordetella vaccines?

Injectable killed Bordetella vaccines (which contain no live organisms, as the name suggested) do work, they just don’t work as well. If there’s significant concern from the owner, or some other unusual circumstance that makes use of a mucosal vaccine undesirable, then by all means, use an injectable vaccine. I’d consider that to be a rare situation.

Also bear in mind that killed “kennel cough” vaccines are just for Bordetella. They don’t include anything for parainfluenza virus, the most common cause of CIRDC. Parainfluenza is part of common combination “core” vaccines (e.g. DA2PP), but those vaccines don’t do a great job of protecting against paraflu. So, while an injectable Bordetella vaccine removes the risk of exposure to vaccine-strain Bordetella, it offers less protection against Bordetella and none against paraflu, so we have greater risk of disease in the dog overall, and the implications described above that come with it.

Let’s be clear: There’s never a zero risk situation when it comes to exposure to infectious bugs (from vaccination or pet ownership in general). We have to consider the risks and benefits in every situation.

But, almost always, for high risk households, I support vaccination whenever the dog’s lifestyle and risk factors indicate that Bordetella vaccination is warranted. I’d stick with mucosal vaccines for respiratory diseases whenever possible, since they provide much better protection and we can easily mitigate the very low risk from the vaccine. Those mitigation measures include:

  • Keeping the owner outside of the exam room when the dog is vaccinated.
  • Wiping the dog’s nose/mouth after vaccination to remove any major external contamination.
  • Recommending that the owner avoid direct contact with the dog’s oral and nasal secretions. That’s particularly important for the first 24 hours after vaccination, but it’s something I’d recommend for a high risk owner to always avoid.
  • Being diligent about routine hygiene practices (e.g. handwashing), especially after contact with the dog’s face (again, something that’s actually always important for a high risk owner).

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

This may be my last update on this topic in the short term (unless things change, of course).

The good news:

The bad news:

  • Well, it’s not really bad news, but we still don’t know what actually happened. That’s far from surprising, because with waxing and waning endemic disease conditions like CIRDC, we rarely have a clear picture of what happened and why.
  • Everything for me continues to point to a gradual increase in the rate of infectious respiratory disease in dogs over the past couple of years, with the usual intermittent local and regional peaks and valleys. This year’s issues were probably somewhat higher peaks overlaid on a higher baseline, making the issue more obvious and drawing more attention.

What was the cause of the increased cases of CIRDC?

I’m sticking to “the usual suspects, doing their usual thing, just at higher rates.” There’s been a lot of investigation looking for new pathogens and, as far as I know, nothing convincing has come to light. Given the number and quality of the research groups that have been looking, it’s pretty convincing that we don’t have a specific new pathogen that’s caused an outbreak of disease in dogs across North America.

What do we do now?

As with any outbreak, we try to learn some things from the experience:

1. Surveillance

This situation was a reminder that we don’t have a good surveillance system in place for CIRDC (or most other companion animal diseases). There’s no easy fix for that, especially with no money, so we need to continue to try to leverage the information that is available to better understand disease patterns. We need to do that on an ongoing basis, not just when there’s concern about increased cases, because when we’re concerned about an outbreak, we need to know the normal rates of disease to put things into context.

2. Vaccination

While we only have vaccines for a few of the important causes of CIRDC (Bordatella, parainfluenza, influenza), they are good vaccines, and we need to optimize their use in dogs that have a reasonable risk of exposure and/or a higher risk for severe disease.

3. Thinking about severe disease

The risk of severe disease in some dogs during outbreaks doesn’t get as much attention as it should; hopefully we’re changing that. In most dogs, CIRDC is a short term, self-limiting problem that’s fairly mild, just like upper respiratory infections in people. However, some dogs get really sick, and some even die. We can’t predict every dog that will have a severe outcome, but we know that there are groups that are at higher risk, particularly older dogs, dogs with pre-existing heart or lung disease, and brachycephalic dogs (i.e. flat-faced breeds). We need to think about minimizing exposure and maximizing vaccine coverage in these groups.

We also need to get people thinking about function over appearance in dogs they are breeding and buying. There is currently a disturbingly high number of anatomically disastrous dogs out there, because people have bred reasonably-functional brachycephalic breeds into extremely flat-faced dysfunctional dogs that have myriad respiratory issues, even without infectious diseases to complicate the situation (see the pictures below). As the French bulldog has shot to the top of the list of the most common breeds in the US, we’re going to see more dogs die from respiratory disease. Not all Frenchies are a mess, but there are enough of them that we see infectious and non-infectious complications in them all the time.

The recent situation with CIRDC also might get people thinking more about their dogs’ social networks and risks, and how to minimize those while having limited impacts on important or enjoyable aspects of dog ownership. We’ll be doing some work on dog social networks later this year, so stay tuned.

Image from: https://pedigreedogsexposed.blogspot.com/2017/08/the-frenchies-that-win-by-nose.html

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I’ll take a break from writing about widespread canine infectious respiratory disease complex (CIRDC) in North America to talk about a single case of a rare disease in a dog. Wageningen Veterinary Research has reported a case of Bluetongue infection in a dog in the Netherlands, a disease of significant consequence to livestock that’s recently been found again in the country.

Bluetongue is a viral disease caused by the unoriginally named bluetongue virus (BTV), which is endemic in many parts of the world, especially tropical and subtropical countries. However, a lot of countries put in significant effort to control this virus and maintain disease-free status, because it has major impacts on food animals. The infection often kills sheep, and while it doesn’t usually kill cattle, infection can cause a major drop in milk production. A single case of bluetongue in a previously disease-free country can result major livestock export restrictions. The Netherlands managed to control bluetongue since their last outbreak in 2007, but it was found again in the country earlier this year; based on the strain, it’s suspected the virus may have been imported from Italy.  

The bluetongue-affected dog in this report was a 3.5-year-old pregnant dog from a Dutch dairy farm. The dog had severe signs of illness, including shortness of breath, pulmonary edema, severe emaciation and lethargy. It’s interesting that someone considered bluetongue and tested the dog, especially since the disease wasn’t known to be present in cattle on the farm, though it was subsequently identified in two cattle after the dog’s diagnosis. Thanks to an astute vet and access to testing, a diagnosis of bluetongue was made through detection of BTV by PCR. Not surprisingly, it was the same strain of BTV that’s been circulating in sheep and cattle in the Netherlands.

There’s no mention of whether the dog survived and/or if it was treated. For something like this, we’d be focusing on supportive care and treating the consequences of the infection, while the dog hopefully fought off the virus itself, since we don’t have a specific antiviral treatment for BTV (or at least not one that we know is safe and effective in a dog).

This isn’t the first case of bluetongue in a dog, but it’s a very rare diagnosis. Interestingly, most of the reported canine cases have been in pregnant dogs. We don’t know why that is, but it could be for a number of potential reasons, or a combination thereof, including:

  • Just a coincidence
  • Greater likelihood of testing a sick pregnant dog
  • Increased susceptibility of dogs to infection during pregnancy

How was the dog infected with BTV?

Livestock-to-livestock transmission of BTV is mainly by biting midges (little insects), so the virus can move with infected sheep and cattle, infected midges (blown off course by storms or hitching a ride in a vehicle), or contaminated raw food items that somehow end up being fed to livestock (e.g. food scraps).

How this dog was infected isn’t clear. Contact with or ingestion of colostrum, fetal fluids or fetal membranes, raw meat or blood from an infected ruminant are considered the most likely routes of transmission. However, spread by infected midges can’t be ruled out. This dog lived on a dairy farm, had direct contact with cattle and their environment, and may have had access to high-risk tissues like placentas, so there were a variety of potential sources of exposure.

Does/did this dog pose a risk to other animals?

Presumably not. It’s assumed that dogs are “dead end hosts” for BTV. Dead end hosts can have serious disease but usually don’t produce or excrete enough virus to pass infection on to others. But that is an assumption here, and especially with a rare infection like BTV in a dog, we can’t have complete confidence in assumptions.

Does this case change anything in the big picture?

Probably not much. It’s a reminder of the unpredictability of infectious diseases, the need to consider the whole human/animal/environment ecosystem (versus having tunnel vision about certain species), and that spillover of infections from the main host to others probably occurs a lot more than we recognize for a wide range of infectious diseases.

No, I’m not talking about a need for Facebook for Dogs. I’m talking about the interaction and contact networks that dogs have, which are important for understanding and mitigating infectious disease risks. Let’s use my dogs as an example.

Dog 1: Ozzie

  • PITA (pain in the…) 1 year old Labrador.
  • Healthy, young, low risk for severe respiratory disease.

Dog 2: Merlin

  • 12 year old Labrador with chronic lymphoid leukemia who’s been on chlorambucil and prednisone for close to 2 years.
  • Otherwise healthy (for an old dog with leukemia), but presumably at higher risk for severe disease should he get a respiratory infection.

Ozzie and Merlin’s normal social network:

Their social network is pretty small. It’s predominantly just the two of them. We live in the country and they have very few random encounters with other dogs. They go for walks around our property and sometimes at the local agreement forest, so there’s always some chance for an encounter with another dog, but that’s a rare occurrence (and direct contact with another dog would be rarer still). Every week or so, Heather takes them for a walk with a friend and her dog, who has a similarly cloistered lifestyle.

They have few contacts with other dogs, the limited contact they have outside the household is a known, regular contact that’s low risk. Their risk of exposure to an infectious disease is pretty low (but never zero).

So the cost:benefit calculation is easy for me here. I don’t see a need to or benefit of disrupting their social network based on the current circulation of canine respiratory pathogens. Their network is small, low risk and the contacts are beneficial (for both the dogs and people). If one of the dogs was sick, I have no doubt any visits would be cancelled.

The “holiday effect” on their social network:

Here’s where things get more complicated. When we visit Heather’s family and the whole gang is there, it’s a bit of a gong show. We have Ozzie and Merlin, plus Maggie (adult Golden Retriever), Otis (adult behemoth of a Bernese Mountain dog) and Charlie (adolescent Labrador). That’s actually less than it could be, because Phoebe doesn’t make the trip… probably her own good as a small dog in the otherwise big dog frenzy). Otis and Charlie are from separate households in the same area of the US.

So, we have five dogs from three cities in two countries. They’re all well cared for and none have high risk lifestyles, but Otis and Charlie add a lot of unknown factors to the mix.

Is this a higher risk situation than our normal one? Yes.

Is it particularly high risk?

  • Probably not. It’s short term contact with a known but geographically distinct group of dogs.
  • We know the health status of the dogs and, as far as I know, none of them have any high risk exposures.
  • If there was rampant canine infectious respiratory disease (especially a new pathogen or severe disease) in the area from where any of these dogs came, I might reconsider getting them all together, but that would be case-by-case, since there are important family benefits of getting together (including the dogs).

Last summer’s social network

We rent a cottage for a couple of weeks every year. This year, we realized that “Ozzie + 24 hours at a cottage = not a lot of relaxation.” So, he went to a local day care for part of the day (a tired Ozzie is a much more enjoyable Ozzie). It was a typical day care, with about 20 dogs tearing around a compound. It was great for him, great for us, but absolutely higher risk for spread of respiratory disease, because it involved a lot of dogs that we know nothing about. It was a good day care and they required kennel cough vaccination, which reduces some of the risk, but doesn’t eliminate it.

So, Ozzie got a Bordetella / parainfluenza / adenovirus vaccine, and a lot of potential exposure. Merlin and the rest of us got a break from Ozzie, and we accepted the added degree of risk.

I didn’t give Merlin a kennel cough vaccine, although I considered it. Since he’s higher risk for severe disease, my threshold to get him vaccinated is lower, and it would have been reasonable to do to protect him in case something broke through Ozzie’s vaccine and he brought it home. This summer, if we’re in the same situation, I’d assess Merlin’s health status and the disease status, and decide whether or not to vaccine him too (I’d probably lean toward vaccinating him now).

The cost:benefit calculation was quite different here:

  • We greatly increased our dogs’ social networks and therefore risk of exposure to infectious diseases. However, my risk assessment deemed it worthwhile, for both the dogs and us.
  • If things were going off the rails from a disease standpoint, Ozzie wouldn’t have gone to the day care, dropping our risk back down to baseline.

There’s no standard formula to assess risk and what’s tolerable. We can’t take “x” number of contacts and “y” situations and come up with a magic number. Well, I guess we can, but it’s not going to be useful. However, sketching out a dog’s social network is useful to visualize the risks that are present and to assess each one.

  • Sometimes, you might say “that contact is not really important, it’s high risk and I can change things to avoid it.“
  • Sometimes, you might say, “that’s a risk we have to take.“

If you need to send your dog to day care to go to work, send your dog to day care. Just pay attention to where it is.

If you’re going on vacation, you may need to board your dog. If it’s a high risk dog and a high risk area, you may still have no choice, as a boarding kennel might be the best option. However, you might also be able to find a smaller well-run facility, in-home care or a willing friend to take your dog. There are often other options if you know where to look, and no one-size-fits-all solution.