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On High Alert

By Graham Garrison
August, 2018
As vector-borne disease cases increase throughout the country, both animal and human health organizations are working hard to raise awareness

An invasion is happening in the United States. Creepy crawlies carrying all sorts of vector-borne diseases are on the march, or airborne. And neither pets, nor people, are safe.

Illnesses from mosquito, tick and flea bites have tripled in the U.S., with more than 640,000 cases reported during the 13 years from 2004 through 2016, according to a report by the Centers for Disease Control and Prevention. Nine new germs spread by mosquitoes and ticks were discovered or introduced into the United States during this time.

“Zika, West Nile, Lyme, and chikungunya – a growing list of diseases caused by the bite of an infected mosquito, tick, or flea – have confronted the U.S. in recent years, making a lot of people sick. And we don’t know what will threaten Americans next,” said CDC Director Robert R. Redfield, M.D. “Our Nation’s first lines of defense are state and local health departments and vector control organizations, and we must continue to enhance our investment in their ability to fight against these diseases.”

Widespread and difficult-to-control diseases from mosquito, tick, and flea bites are major causes of sickness and death worldwide. The growing number and spread of these diseases pose an increasing risk in the United States. The report found that the nation needs to be better prepared to face this public health threat, the CDC said in a release.

With dogs and cats trekking inside and out of households, pet owners need to be especially aware and prepared. However, judging from compliance rates of preventive products, and consumer studies, there is a lot of work to be done.
 

Knowledge gap
One recent study, conducted by The Harris Poll on behalf of Merck Animal Health, exposed some serious knowledge gaps among U.S. pet owners related to the identification, prevention and treatment of fleas and ticks.

More than 1,300 pet parents (defined as those who own a dog and/or cat) were surveyed. The results found that despite the dangers of flea infestations, ticks, and Lyme disease, many pet parents may not be as knowledgeable – or as prepared – as they think. In fact, one third (33%) say that they do not give their pets regular flea/tick medication and nearly half (48%) don’t bring their pets in for routine exams to protect against these parasites. More than three in five pet parents (61%) say they are “very knowledgeable” about fleas and ticks; however nearly two in five (38%) were unable to correctly identify at least one symptom commonly associated with Lyme disease.
 

New landscape
Indeed, general awareness thus far hasn’t matched the speed at which vector-borne diseases are spreading.

Most people have probably heard of a few diseases transmitted by fleas, ticks and/or mosquitoes, such as Lyme disease and West Nile Virus, says Cameon Ohmes, DVM, MS, MBA, DACVIM-LA, senior veterinarian at Bayer Animal Health. “But most are also unaware of all the other vector transmitted diseases and how they are spread by parasites, causing sickness or sometimes even death in both humans and animals. New diseases are being discovered on an annual basis and we as a society, need to talk more about this. We need to make sure people understand that a.) there is risk associated with finding a tick or having an itchy mosquito bite and b.) there are measures to be taken to help prevent fleas, ticks and mosquitoes from biting us and our pets.”

Ticks are the headliners when it comes to transmitters of vector-borne disease, and seem to be the parasitic threat most on the move. Yet, they weren’t really more than a dot on the radar twenty years ago, according to Joyce A. Login, DVM, senior manager of veterinary specialty operations at Zoetis.

“Twenty years ago, we had a hard time controlling fleas,” Login says. “We never thought anything about ticks, we were just worried about fleas and we didn’t have a good product.”

This was right around the time that more effective flea products were being introduced into the market. “When those products came out, things changed,” Login says. “We got the fleas under relative control – although they are still winning when pets aren’t protected – but we also were able to control ticks on the back end. These products work on ticks but not everybody understood that at the time.”

Now, the situation has flipped. There is an awareness of fleas in the home, but people are also understanding the value of keeping ticks off their dog.

Login attributes the change to three things. First, Lyme disease has become much more of an issue. “When I was in practice first out of school, Lyme disease was the tiny little quirky disease only in Connecticut. Within ten years it’s become huge – the No. 1 infectious disease reported in people. That’s raised awareness that ticks can be a problem.”

The second thing is organizations such as the Companion Animal Parasite Council are educating clients about ticks and vector-borne diseases and the importance of protecting the pet from these.

The third point? Proximity. People are much closer with their pets. “The human animal bond is tighter than ever,” she says. “The level of acceptance of what you have on your dog has changed. Fleas might have been OK in the past if you could knock it down. Now, one flea on your dog is not OK. There is a greater awareness, because dogs are in the house. They are family members.”

Another reason the knowledge gap may exist is the rapid entry of parasitic diseases into regions unaccustomed to their presence. Login says the seasons, and regional assumptions, can get in the way of a consistent, industry-wide message on parasitic diseases and prevention.

“It’s one of those ‘It’s not me, it’s not in my town or in my house,’” she says. People may acknowledge that the threat exists, but they believe the threat is somewhere else.

Most people know that Lyme disease is a problem. But they’re not thinking about the other diseases they could get from fleas and ticks, Login says. “They also may not be aware that their dogs can get these diseases as well.”

Login says there is a lot of confusion in how flea & tick preventatives are recommended depending on where people live. “There is a lot of seasonality, which in general is very confusing to clients. We tell them when to start and when to stop. In my experience, compliance increases when there is strong messaging explaining why this is so important. You need to keep them on the year-round product without fail. It’s something that we as veterinarians need to strongly believe in as well.”

The conversation will vary slightly depending on the area of the country, says Ohmes. “For instance, an emphasis on ticks and tick borne diseases in the Northeast compared to heartworm disease in the deep South,” she says. “However, the mission of CAPC to have ‘every pet tested and protected’ and the variable climate changes indicate we shouldn’t leave anything out. The biggest task is working with the pet owner to determine which product fits their lifestyle the best.”

 “A new engagement strategy”
One animal health organization that believes strongly in year-round prevention is the Companion Animal Parasite Council (CAPC). In 2011, the board members of CAPC agreed that they needed to come up with a strategy that engaged veterinarians, pets owners and even doctors on the prevalence and spread of vector-borne diseases, and parasitic diseases in general. “What we started in 2011 was a new engagement strategy,” says Christopher Carpenter, DVM, MBA, Chief Executive Officer of CAPC. The engagement strategy included two key components – prevalence maps and forecasts.

When Carpenter worked in a veterinary clinic in the 1990s, they would have to rely on older Heartworm Society maps that were hard to discern the threat level in specific areas. Technology has changed, and so too have the capabilities to track parasitic diseases. The Prevalence Maps are designed to meet today’s data expectations. “All of us have the expectation of pulling up the weather on our smartphones,” Carpenter says. “If I want to look up weather in Nashville right now and see it, I can. Our goal at CAPC was to give local parasite data now to clients so that they can see what’s going on in their area. That was the foundation for all our work.”

Using the contributions of IDEXX Laboratories and Antech Diagnostics as the foundation for the maps, CAPC is able to provide county by county rates and levels of parasitic diseases. It’s forced veterinarians, and clients (if they are shown the data) to take notice. “People can’t be dismissive.” For instance, veterinarians in one county can pull up the data and show that there were 28 cases of heartworm last month. “People can’t be dismissive and say it’s not in their area. It’s here.”

The other component of the engagement strategy involves forecasts. CAPC went outside the industry to help create the forecasts. They reached out to Dr. Robert Lund at Clemson University, who is an expert at forecasting hurricanes and climatology. Lund agreed to partner with CAPC to start a forecast for parasites in companion animal pets.

How have the forecasts measured up? Carpenter says that of four publications (and a fifth that is in the works) they’ve never gone below 94% accuracy in their forecasts. “When we forecast a disease, we are accurate,” he says. “Your weatherman would be proud to say if he or she was as accurate on a day-to-day basis with their forecast.”

If you tell them, will they come?
Compiling the data is one thing. But what will pet owners do with the knowledge once they have it? To answer that question, CAPC worked with Bayer Animal Health on some market research, Carpenter says. They asked pet owners:

  • “Would you want to know about the local parasite prevalence in your area from your veterinarian?”
  • “If you got that information, what would you do?”

“There were 2,000 respondents, and 90 percent said they would want their vets to share local parasite prevalence numbers,” Carpenter says. “Almost nine out of ten (89 percent) said that if the veterinarian sent out an alert that the prevalence was high, they would make an appointment.”

CAPC also did a test with VCA Hospital with almost 300,000 households involved, Carpenter says. They shared the local forecast for Lyme disease, or local parasite prevalence numbers for Lyme disease via e-mail to clients. Among the results:

  • There was a 58 percent higher visitation rate from the people who got those emails.
  • When those clients who received the emails came in, they purchased Lyme disease products, such as Lyme vaccinations, Lyme testing and tick prevention at a 76% higher rate.


“What we learned from that study of almost 300,000 households was that if you send out local data in an email, people come in at a higher rate to the clinic, and that they buy at a higher rate.”

With the combination of prevalence maps, which talk about what has happened, and the forecast maps, to project with a high degree of accuracy of what will happen, CAPC believes they have shown the way veterinarians can engage pet owners. “CAPC has taught the industry that if pet owners know the local risk, if they believe there is a threat in their county using recent data, they will come in,” Carpenter says.
 

Get ahead of it
“In my experience, pet owners seem to be very interested in getting facts and impact information,” says Ohmes. “When the issues are explained, they are horrified. It seems that pet owners will act at a much higher rate when the information is able to illustrate immediate impact to their pet and is coupled with recommended actions to minimize disease exposure.”

As veterinarians, there is an opportunity to make sure this information is disseminated to pet owners in a way that they fully understand the implications, says Ohmes. “Many of us are guilty of not spending enough time talking about parasites and their risks during wellness appointments because there is so much information to cover when it comes to the health of your client’s pet. If we can make it a priority to start these discussions before they start seeing parasites in their region, we can help prevent the number of pets being bitten by parasites. It only takes one bite to cause disease and if we aren’t proactive, we may be too late.”

Carpenter says veterinary practices should be proactive with sharing the parasitic disease information. “Don’t wait until they come into the clinic,” he says. “Share it with your client, via your Facebook page, or the newsletter you send out. Share it like VCA did – via email to clients – because it’s really just an awareness that they don’t know there is a threat in their local area.”

Every time veterinary practices do this, they position themselves as the expert on parasite control. Every time they put up the local data, their clients view them as the expert. We’re trying to teach veterinary practices to share local data, consistently over time.”

Parasites are now a dynamic, ever-changing part of veterinary medicine, Carpenter says. “We’re trying to teach pet owners that ticks and other parasites are spreading their ranges, carrying diseases and doing things you never knew you needed to be up to date on it. We’re teaching pet owners that their veterinarian is their local expert.”

For veterinarians, Carpenter says CAPC is reinforcing the need to stay up to date and tell pet owners, “this is one of the most important areas where you need to protect your pets.” Parasites are changing, in some cases quite rapidly.

For instance, Several years ago, people in Toronto, Canada didn’t have to worry about Lyme disease. “Not anymore,” Carpenter says. CAPC has a Canadian board member, who knows firsthand that Lyme disease is spreading rapidly in the Toronto area. “The more that veterinarians stand up and take the role to teach pet owners in their area about the risks, the better off we will all be,” Carpenter says.

Veterinarians can get tired of talking about fleas and ticks, but they shouldn’t give up, Login says. “What I would love for us to remember is that the speech you have given to clients a thousand times, for that new client, it’s the first time,” she says. “They are just learning. We have to keep that in mind every time we do vaccines and preventive checkups. They don’t know what we know. As tiring as it may get to repeat the same message, it is helpful to remember we are educating.”

Some of the ticks that are expanding their presence in the U.S. are the following, according to Zoetis:

  • Gulf Coast Tick – Pet owners that live in coastal areas along the Atlantic Ocean and Gulf of Mexico should watch out for the Gulf Coast Tick. This tick is light brown, ranging in size, and can be found in grass prairies and coastal uplands. Gulf Coast Tick carries rickettsiosis, a form of spotted fever – and most flea & tick preventive medicines don’t protect pets from the Gulf Coast Tick.
  • Lone Star Tick – Once only found in the southeast, the Lone Star Tick has migrated to the north and west. This tick is brown with a white spot on its back and is known for making people “allergic” to meat. The meat allergy causes itching, hives and shortness of breath.
  • American Dog Tick – This tick is located throughout the United States, but has been spotted recently on the west coast. The American Dog Tick is a rather colorful tick and is commonly found in highly wooded, shrubby, and long grass areas. The tick is known for carrying Rocky Mountain spotted fever.

Talking Points
Cameon Ohmes, DVM, MS, MBA, DACVIM-LA, senior veterinarian at Bayer Animal Health, recommended the following talking points veterinary practices can use with their clients to gain better compliance:

  • Open ended questions and creating a dialogue are key to engaging a pet owner. Determining the pet owner’s level of knowledge prior to overwhelming them with information gives them the opportunity to become a part of the conversation.
  • Images and videos can be more powerful than words. Taking the time to explain the CAPC prevalence maps and/or pictures and videos of infestations and clinical disease in animals and humans are one place to start.
  • Using the CAPC information/maps to create talking points that are specific to the pet owners’ region and tie them to clear recommended actions to best manage the types of parasites prevalent in their area can be effective. Set the expectation that by taking action to minimize infestation and/or exposure to parasites, they are helping to protect their pet.

CDC Report Key Findings

  • A total of 642,602 cases of disease caused by the bite of an infected mosquito, tick, or flea were reported in the U.S. and its territories from 2004 through 2016.
  • The number of reported tickborne diseases more than doubled in 13 years and accounted for more than 60 percent of all reported mosquito-borne, tickborne, and fleaborne disease cases. Diseases from ticks vary from region to region across the U.S. and those regions are expanding.
  • From 2004 through 2016, seven new germs spread through the bite of an infected tick were discovered or recognized in the U.S. as being able to infect people.
  • Reducing the spread of these diseases and responding to outbreaks effectively will require additional capacity at the state and local level for tracking, diagnosing, and reporting cases; controlling mosquitoes and ticks; and preventing new infections; and for the public and private sector to develop new diagnostic and vector control tools.

“The data show that we’re seeing a steady increase and spread of tickborne diseases, and an accelerating trend of mosquito-borne diseases introduced from other parts of the world,” said Lyle Petersen, M.D., M.P.H., director of the Division of Vector-Borne Diseases in the CDC’s National Center for Emerging and Zoonotic Infectious Diseases. “We need to support state and local health agencies responsible for detecting and responding to these diseases and controlling the mosquitoes, ticks, and fleas that spread them.”

Millennials misinformed?
According to The Harris Poll conducted on behalf of Merck Animal Health, younger pet parents (those aged 18-34) were especially susceptible to misinformation about fleas and ticks, and are more likely than older pet parents to falsely believe:

  • Fleas and ticks are only active in the spring and summer months (34% versus 24% of those aged 35+)
  • Ticks can only be found in heavily wooded areas (36% versus 19% aged 35+)
  • Dogs and cats living in urban areas don’t need flea and tick protection (15% versus 4% aged 55+).


However, the study confirmed that nearly all pet parents, regardless of age, want to keep their pets free of fleas and ticks – with 90% citing that they would “do anything” to protect their pets from these pests.

One Health
Many parasitic diseases like Lyme disease are zoonotic. The same tick that transmits Lyme disease to dogs transmits it to humans too. Unfortunately, the education being done on the animal health side hasn’t translated to more awareness on the human side.

“They don’t do the screening we do for Lyme disease,” says Christopher Carpenter DVM, MBA, Chief Executive Officer of the Companion Animal Parasite Council (CAPC). “They aren’t as proactive, and there is no vaccination protocol.”

However, Carpenter says there is huge opportunity to unite human and animal health to combat parasites. “I’ve learned that parasitology is the best One Health topic there can be,” Carpenter says. “If your dog has been exposed to a tick that carries Lyme disease, there is a good chance you have too. You live in the same house, go on walks together outside, you’re probably in the same areas.”

Carpenter says CAPC is working to show that this is a One Health issue to human health organizations and stakeholders. “Parasitic control is a One Health issue,” he says. “You’ve got to protect your dog against ticks because you’re protecting your family. That’s what CAPC is focusing on in the coming year, to make that connection between our alerts, forecasts and maps, to humans.”

Topics: Cover Story, Flea & Tick, Flea/Tick/Pest, Disease

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