Canine Parvovirus Exposure
A 4-month-old intact male crossbreed puppy was presented with acute onset of lethargy, inappetence, and soft stools.
History
The puppy had been purchased at a flea market 4 days before presentation. According to the clients, who were new to the practice, the puppy had been vaccinated and dewormed, but no other details were available.
Related Article: The Case: Puppy with Parvovirus Infection
In-Clinic Findings & Procedures
At examination, the puppy was quiet but responsive. Excessive salivation was noted. Mucous membranes were moist but mildly hyperemic. No other abnormalities were noted.
The puppy passed a small amount of diarrhea during rectal temperature measurement, at which time the clients reported that it had had a fecal accident in the waiting room but they had not notified front office staff. In the waiting room, diarrhea was present near a client with a 13-year-old dog and 6-month-old puppy.
The result of rapid in-house ELISA of the fecal sample was positive for canine parvovirus; infection control response was immediately initiated (see Infection Control Response).
Although all infection control procedures were completed, disruption to the practice was significant, including evaluation of the 2 dogs exposed to the virus while in the waiting room and calming the owner accordingly.
Related Article: Preventing Spread of Infectious Disease in an Outpatient Setting
Ask Yourself
To avoid similar situations, initiation of which of the following would be most appropriate?
A. Admit all new patients directly to isolation.
B. Better educate front office staff about monitoring the waiting room area for fecal accidents.
C. Implement syndromic surveillance measures that identify high-risk patients.
D. No procedure can lower the risk for similar situations.
Best AnswerC. Implement syndromic surveillance measures that identify high-risk patients.
Syndromic surveillance2 is a simple method that takes advantage of identifying basic infectious disease risk indicators (eg, vomiting, diarrhea, cough) that are readily recognizable by owners and lay personnel (see Syndromic Surveillance Plan). Although not all animals displaying a selected indicator are infectious, some basic signs can suggest an increased risk and the need for further action.
Related Article: Practical Guide to Molecular Diagnostic Testing: Polymerase Chain Reaction
Admitting all new patients directly to isolation is impractical, is almost always unnecessary, and may leave a poor impression with clients. Bettering the education of front-office staff about monitoring the waiting room is important but would be a reactive measure that identifies problems early in the process rather than preventing them.
Although infectious diseases are an inherent risk in all practice settings, practical measures can be implemented to lower the risk for pathogen transmission.
The Take-Home
Prompt identification of infectious disease risks is critical for early intervention and to minimize widespread exposure and environmental contamination.
Although not all infectious patients are readily identifiable, some basic clinical signs are indicative of infectious agents and the increased risk for shedding.
Ensuring that practice policy includes a viable syndromic surveillance plan is essential to avoid and/or minimize animal and human contact with high-risk patients.
J. Scott Weese, DVM, DVSc, DACVIM, is veterinary internist and microbiologist, chief of infection control at University of Guelph Ontario Veterinary College Health Sciences Centre, and Canada research chair in zoonotic diseases. Dr. Weese’s research foci are infectious and zoonotic diseases (particularly of companion animals), infection control, staphylococcal infections, Clostridium difficile infection, and antimicrobial therapy.