It should be, even if it may not be as exciting as the latest laser device or other high-tech innovation.
The reason is, boarding kennels are still extremely vulnerable to outbreaks of Bordetella bronchiseptica (Bordetella/kennel cough) and CIV (canine influenza virus/canine flu), as this Cornell University map shows for CIV.
Madeleine Stahl, DVM, associate director, scientific marketing affairs, Merck Animal Health, told us, “Respiratory diseases, such as canine influenza, are highly infectious and spread very quickly from dog to dog or through fomites such as clothing or hands. A coughing dog on day 1 can quickly escalate to 10 or 20 dogs in a matter of days. Vaccines are preventatives and must be implemented before exposure.”
Most boarding facilities — and veterinary practices that offer boarding — won’t accept patients that haven’t been vaccinated for or that show signs of these illnesses. But clients don’t usually know what “signs” are, and practices may not be taking these diseases seriously enough.
Eileen Ball, DVM, veterinary medical lead/biologicals and infectious diseases, Zoetis, told us, “There’s a perception that respiratory infections in dogs are almost always mild and often self-limiting. While this can certainly be the case Bordetella bronchiseptica… canine influenza virus — as well as many other bacteria and viruses that can cause respiratory infections in dogs — can cause severe illness and in some cases, be deadly.
“Dogs with co-infections, simultaneous infection with more than one bacterium and/or virus, are thought to be at risk of developing more severe illness,” she said. “When respiratory infections are thought of as ‘not a big deal’ there may be a tendency to under-vaccinate at-risk dogs.”
Wow. Sounds like we all need to give respiratory infections more attention, especially for dogs that may spend time in boarding facilities. You can play a major role in this effort while you’re on the front lines with practices every day.
To help us understand the current picture of these infections and today’s solutions, we asked Dr. Stahl and Dr. Ball to answer the following important questions that will help you start the conversation with clinics.
What’s the main problem today in trying to manage Bordetella and CIV in veterinary patients/practices?
- Not all respiratory pathogens are created equally and, unfortunately, we don’t have vaccines to help prevent all the different respiratory pathogens that can infect dogs. Some pathogens, such as the bacterium bronchispetica, are very common, and dogs have had the benefit of vaccination to help prevent infection for many years. As a result, there tends to be relatively good underlying immunity in the canine population. Other pathogens, such as canine influenza virus (CIV), are novel. There is little or no underlying immunity in the population. When there is no immunity present in the “herd,” infection can spread rapidly and many dogs can become clinically ill. In addition…
- Diagnostic testing tends to be underutilized or not considered at all in dogs that present with clinical signs of respiratory disease, such as coughing, sneezing, ocular and nasal discharge. One advantage of diagnostic testing is that, when used, it can help to determine what pathogen(s) may be involved in the infection. Such knowledge can help influence treatment decisions and help to identify when new pathogens, such as CIV, are involved.
When diagnostic tests are used, it’s important to ensure the right tests are run at the right time in the illness. Common testing options include PCR, which looks for genetic material from the bacteria or virus in the sample… and serology, which looks at a blood sample to see if the immune system has mounted a response. For PCR to be an effective testing option, the dog has to be actively shedding the bacteria or virus.
CIV can be trickier than other pathogens to diagnose with PCR as the bulk of virus shedding often occurs prior to the dog displaying clinical signs of illness. Even a slight delay in obtaining samples for PCR testing can potentially lead to false negative results. Serology is typically run later in infection and may be run as a paired test. This involves the collection of an initial sample as well as a follow-up sample, which is typically obtained 1-2 weeks later. The two results are then compared. Such testing can help to determine if the immune system is actively responding to an infection.
What are some of today’s solutions that distributor Ssales representatives (DSRs) can bring to the clinic?
Dr. Stahl: (DRSs can) provide materials that outline tips for diagnosing the type of respiratory pathogen, sanitation protocols and biosecurity measures. (Help practices) implement a vaccination protocol for social dogs to get ahead of a potential respiratory outbreak. Discourage clinics from waiting for a breaking news story of an outbreak in their area – then it’s too late!
Clinics can also be encouraged to utilize social media to provide their clients tips on minimizing the risk of canine flu. Lifestyle questionnaires can be posted on Facebook or used during appointments to identify dogs at risk.
Dogs at highest risk for canine influenza virus (CIV) can be targeted by using the clinic database. Patients vaccinated for Bordetella and other respiratory pathogens, such as parainfluenza, lead a lifestyle that also puts them at risk for CIV. Owners can be contacted to update them on the risk from dog flu and to schedule an appointment for vaccination.
Dr. Ball: When it comes to vaccines, manufacturer support is an important and often underemphasized aspect of the decision-making process. When DSRs can convey the ways companies support their vaccines, they can help customers become aware of additional product attributes available when the need arises.
For example, “An ideal vaccination experience includes the patient appearing comfortable during the administration process, displaying no apparent adverse effects in the post-vaccination period, and subsequently developing immunity to the vaccine antigens. When an immunized patient is re-exposed to a pathogen for which it has been vaccinated, the immune system should be able to respond in a quick and robust fashion to help protect infection from occurring and clinical signs of disease from developing.”
Scenarios such as the one described above frequently occur; however, any time vaccines are administered, there is a possibility, albeit small, of the patient experiencing an adverse event or an immune response that is less than ideal. In the event concerns with either vaccine safety or efficacy develop after administration, it is beneficial for clinics to understand the support that is available to them.
What is the overall opportunity for practices if they follow their reps’ (and industry) recommendations?
Dr. Stahl: Having a good vaccination program and robust sanitation program can help prevent outbreaks and keep patients healthy and happy. If there is a respiratory outbreak, clinics may be forced to close for decontamination and to prevent the spread to other patients; this can have a significant financial impact on the clinics they service. In addition to the emotional and financial cost that can be incurred, it can have a negative impact on the reputation of the hospital as well.
Dr. Ball: It is important to note that with vaccination, not only can you help prevent disease in the patient receiving the vaccine in some instances — CIV is a great example — vaccination of multiple patients can begin to create a situation of herd immunity. This occurs when a sufficient number of dogs in the population are immunized. The underlying immunity helps to prevent infection from spreading through the population.”
What are the specific benefits of today's solutions?
Dr. Stahl: As a business partner, distributor sales representatives can help guide doctors on how to provide the best medicine, protect their practices, and generate income.
Dr. Ball: Today’s solutions can flex to meet the protocols and preferences of customers… (such as) multiple options for B. bronchiseptica vaccination of dogs including products licensed for oral (PO), intranasal (IN), and parenteral (SQ) administration. Additionally, customers can choose vaccine combinations that include canine parainfluenza virus and canine adenovirus-2 antigens. The IN and PO vaccines described above are available in a traditional presentation that is prepared with syringe and needle which must be removed prior to mucosal administration. They are also available in a presentation that utilizes syringe-free (SF) applicators (to help reduce the risk of accidental injection). A few vaccines also provide one year duration of immunity for B. bronchiseptica. CIV vaccines are available for both CIV H3N2 and CIV H3N8.
How would you suggest that DSRs open the boarding infections conversation with veterinarians?
- What is your current canine respiratory disease risk-assessment protocol?
- What vaccines do you recommend for social dogs? What do you consider a social dog?
- What challenges do you face when vaccinating for respiratory disease?
- What type of testing do you perform when you have coughing dogs?
- How would an outbreak of coughing dogs impact you?
- How are you prepared for a potential canine influenza outbreak?
- What’s your protocol in the event of a canine influenza outbreak?
- What kind of financial impact would it have on your practice if you had to close for decontamination?
- Are your staff members vaccinating their dogs against both strains of canine influenza (H3N8 and H3N2)?
- What are your preferred vaccination protocols for bronchiseptica, canine parainfluenza virus, canine adenovirus 2 and CIV?
- Do you consider vaccination to help prevent infectious respiratory disease in dogs core or non-core?
- Are there specific products that you prefer… and if so, can you share the reason(s) for your preference(s)?
- In clinics that do not routinely consider CIV vaccination for dogs that may be boarded, groomed, or attend doggie day care, it is important to ensure they are aware of the risk of not vaccinating. Because CIV vaccination requires an initial series of two doses, it should be emphasized that dogs are not expected to have protective immunity from the vaccine until about 2 weeks after they receive their second dose. In other words, they should consider that it will be at least 6 weeks after the initial vaccination before they can expect CIV vaccines to help protect their patients. Once a CIV outbreak is occurring, it is too late to vaccinate.
Do you know of any resources reps can use to help educate practices and clients?
Dr. Stahl: Distributor sales representatives can partner with manufacturer sales reps to provide guides reviewing diagnostic testing, sanitation, and tips for controlling the spread of respiratory disease in the clinic. In addition, infographic posters, lawn signs and pet owner brochures to inform clients are also available. DSRs can encourage staff members to share their vaccination experience with clients to demonstrate the safety of the canine respiratory vaccines. They can also refer them to reputable websites, such as www.doginfluenza.com which has influenza prevalence maps for both H3N8 and H3N2, as well as other information concerning canine influenza for pet care professionals and pet owners.
Dr. Ball: Cornell University maintains a great website that tracks both CIV testing submissions as well as positive test results:” (See our map image in this post)
Let’s give boarding-facility infectious diseases the attention they deserve, so outbreaks can be minimized or even avoided during the busy spring and summer boarding season.