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Clinician's Forum: Expert Views from a Roundtable on Canine Respiratory Disease Part 1

Kate Hurley, DVM, MPVM

Richard Meadows, DVM, DABVP

Kathleen Neuhoff, DVM, DABVP

James Roth, DVM, PhD, DACVM

Rebecca Ruch-Gallie, DVM, MS

LeMac’ Morris, DVM, MPH, DACVPM, Moderator

Respiratory Medicine

|February 2015 |Sponsored

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Sponsored by an educational grant from Boehringer Ingelheim Vetmedica, Inc. 

Canine infectious respiratory disease complex (CIRDC), more commonly referred to as kennel cough, continues to challenge private-practice and shelter-based clinicians. Even with increased awareness of the multiple pathogens potentially involved, complex environmental factors present obstacles to care. In this roundtable, a panel of experts discusses their experiences in managing this challenging condition.

Participants

  • Kate Hurley, DVM, MPVM, Director of Shelter Medicine, University of California–Davis, Davis, California
  • Richard Meadows, DVM, DABVP, Director of Community Practice, University of Missouri, Columbia, Missouri
  • Kathleen Neuhoff, DVM, DABVP, Co-Director of Magrane Pet Medical Center, Mishawaka, Indiana
  • James Roth, DVM, PhD, DACVM, Professor of Veterinary Microbiology and Preventive Medicine, Iowa State University, Ames, Iowa, (contributes in Part 2)
  • Rebecca Ruch-Gallie, DVM, MS, Service Chief of Community Practice, Colorado State University, Fort Collins, Colorado
  • LeMac’ Morris, DVM, MPH, DACVPM, Moderator, Veterinary Technical Manager—Pet Business, Boehringer Ingelheim Vetmedica, Inc., Saint Joseph, Missouri

Canine Infectious Respiratory Disease Complex Part 1: Pathogens & Risk

Dr. Morris: Let’s direct the first question to the practitioners in the group. Why is the term CIRDC replacing kennel cough and infectious tracheobronchitis?

Dr. Neuhoff: Well, it’s a much more complex disease than kennel cough or tracheobronchitis, with multiple etiologic agents. Clients are used to thinking of kennel cough as a minor nuisance disease, and they feel their pets couldn’t possibly be at risk if they haven’t stayed in a kennel. In reality, this disease is far more complicated. By using the term canine infectious respiratory disease complex, we can discuss it in a way that makes clients understand the importance of treating and preventing it.

Dr. Ruch-Gallie: People think of Bordetella bronchiseptica as kennel cough, even though that was never really intended. I think this term allows us to reflect the complexity of those upper and lower airway diseases.

THE PATHOGENS

Dr. Morris: What are the pathogens actually causing this condition?

Dr. Neuhoff: The organisms that are commonly found include Bordetella, Streptococcus zooepidemicus, Mycoplasma, parainfluenza, adenovirus type 2, canine influenza, distemper, respiratory coronavirus, and pneumovirus. In our area, we haven’t seen much parainfluenza or adenovirus or distemper, but that’s because we’ve been protected by vaccination for decades.

Dr. Ruch-Gallie: We’re actually seeing pneumovirus in Colorado, particularly in some of our regional shelters. We’ve also seen canine influenza in both shelter and daycare facilities here. Bordetella is probably one of the more common pathogens, as well as Mycoplasma. And I would add canine herpesvirus.

Dr. Meadows: I haven’t personally seen these, but there are published reports of reovirus, bocavirus, and the canine homolog of hepatitis C.

Dr. Hurley: In shelter dogs we see the whole array, including quite a bit of Bordetella. But in outbreaks, we see less of Bordetella because vaccination keeps that in check. We see respiratory coronavirus and Mycoplasma in very high frequency. At times, we see canine distemper at a subclinical level—vaccination keeps it from expressing its full virulence, but the dogs are set up to be more vulnerable to different respiratory pathogens.

Dr. Morris: Is there a universal pathogen that you see? And are the others secondary pathogens, or are they primary drivers as well?

I think it’s safe to say that Bordetella bronchiseptica is a primary pathogen. It’s not the only cause, but it is a major driver.—Dr. Meadows

Dr. Meadows: I think it’s safe to say that Bordetella bronchiseptica is a primary pathogen. It’s not the only cause, but it is a major driver. At the University of Missouri, Dr. Leah Cohn noticed Bordetella can facilitate disease caused by secondary pathogens, such as Mycoplasma cynos, which wouldn’t normally cause significant disease on their own.

Dr. Hurley: In the shelter environment, we assume that Bordetella is an important driver. But the vaccine against Bordetella is used pretty consistently in most shelters, so we don’t see big Bordetella outbreaks as much as we see outbreaks associated with the other pathogens for which there isn’t a vaccine.

Dr. Morris: So if Bordetella is the primary driver, why should veterinarians be aware of these other pathogens?

Clients are used to thinking of kennel cough as a minor nuisance disease…By using the term canine infectious respiratory disease complex, we can discuss it in a way that makes clients understand the importance of treating and preventing it.—Dr. Neuhoff

Dr. Neuhoff: It clearly has some bearing on what we use for our preventative. In our area, influenza is not presently part of our routine vaccination protocol, although we are testing for it. If pets are infected with a viral pathogen for which they haven’t been vaccinated, the chances of a rapid resolution are much less.The client needs to know from the beginning they’re in for a long haul. We’re not going to just put them on 10 days of antibiotics.

Dr. Ruch-Gallie: It’s also important to know what pathogens are present in our community. We’ve said Indiana isn’t seeing very much influenza, but we are seeing it here in Colorado. So, is there dog movement across state lines? What are they potentially bringing in? Knowing where those animals are coming from is going to be critical for us to be able to protect our population. 

Risk Factors

SHELTERS

  • Lack of vaccination
  • Moist environment
  • Adverse flow of air into kennel
  • “Some in/some out” kenneling
  • Crowding

GENERAL PRACTICE

  • Lack of/inappropriate vaccination
  • Contact with other dogs
    • groomers
    • daycare
    • dog parks
    • social encounters
    • pet stores
    • veterinary clinics

RISK FACTORS: CLIENT OWNED & SHELTER DOGS

Dr. Morris: Tell us some of the risk factors that really set up a population to be at risk for CIRDC.

Dr. Hurley: From an animal perspective, it’s a lack of vaccination on intake, especially if there’s distemper or canine influenza endemic in the community. From an environmental perspective, air quality is really important. When ventilation systems break down, we often see an increase in respiratory disease in dogs. Moisture is another risk factor. It’s difficult to get kennels fully dried for at least a few hours every day, so we’ve had people go in with towels and leaf blowers to really dry them out. A big risk factor that you see in some parts of the country is “some in/some out” kenneling of dogs, where there is no room to house each dog individually. Crowding is an underlying factor that can exacerbate air quality, moisture, and other problems. Thus, we often see outbreaks at times of high population density, whether in a shelter or boarding environment (eg, over a big holiday weekend).

Dr. Morris: Give us some ideas of strategies you can use to help minimize these issues in a shelter population.

The education of clients is really critical because we have lots of doggy daycares, lots of dog parks.—Dr. Neuhoff

Dr. Hurley: First, be sure that dogs are vaccinated immediately upon intake, or even before intake, as we see more shelters going toward the scheduled admission process for owner-surrender pets. From the environmental perspective, there are cost-effective things that can be done to direct the flow of air into the kennel where the dog is breathing. Make sure that kennels are dried out—mechanically if necessary—and make sure that kennels are in good repair. If shelters are stuck with that “some in/some out” housing situation, they should house by day of the week so that they can move all dogs out of a pen and completely empty them on at least a weekly basis.

Dr. Morris: How do the risk factors compare in private practice?

Dr. Neuhoff: In general practice, the runny nose that might be missed in a shelter is going to be a big deal to a client who has one puppy, so we see them more quickly. When they come in for their vaccine series, we can educate them on when they should call. The education of clients is really critical because we have lots of doggy daycares, lots of dog parks. The groomers don’t require vaccinations for anything except rabies, so clients need to understand the importance of vaccines if they’re taking their pet to a high-exposure area.

Dr. Hurley: Ideally, shelters experiencing respiratory disease issues in their dogs would ask people to do a voluntary quarantine for a couple weeks after adoption where they don’t have the dog around a lot of unvaccinated dogs, except maybe to go to the vet if they need to. I especially recommend people keep puppies out of pet stores, since that’s often the first place people will go with a newly adopted, high-risk pet.

With any dog-to-dog contact, especially if you aren’t familiar with the other dog, there is going to potentially be a risk.—Dr. Ruch-Gallie

Dr. Ruch-Gallie: With any dog-to-dog contact, especially if you aren’t familiar with the  other dog, there is going to potentially be a risk. In my area, all of our feed stores and big box stores allow dogs to come in on-leash. And in the large university setting where we’re using communal waiting rooms, people don’t think about isolating their puppies from the other dogs in there that may have something.

MANAGING THE PATIENT

Dr. Morris: Let’s talk about how you work up a suspected case of CIRDC. Give us some idea of what kind of tests you’re running.

Communication is a key issue, and most  clients aren’t aware they can put their animals at risk. Even when they’re on a walk, they don’t consider those cute nose-to-nose interactions with another dog as anything other than that, a cute interaction. There is a potential pathogen transfer meet-up.—Dr. Meadows

Dr. Neuhoff: I don’t work up every dog that comes in coughing. If it’s a young dog that was recently adopted and is acting normally, doesn’t have a fever, and just has a sensitive trachea on palpation, we usually start doxycycline without a workup. But if they have any systemic clinical signs or if we hear congestion on lung auscultation, we start with radiographs of the chest and trachea. Or, if we start antibiotics and they aren’t doing much better in 3 days, then those dogs also get chest and tracheal x-rays. If they have systemic disease, we’ll also do a complete blood count to rule out any additional problems. If they aren’t responding, we do an influenza test, a transtracheal wash, and our in-house cytology. We also send out for culture and sensitivity testing.

Dr. Ruch-Gallie: I won’t necessarily start antibiotics unless I see systemic signs or mucoid or purulent mucoid discharge. If there’s just a little cough, I’ll educate clients to keep them away from other dogs and give them some tincture of time. If the dog’s cough is particularly bad, then we’ll throw in something with hydrocodone to quiet it for the evening so that everybody can get some sleep. But I’m not going to work up every dog that comes in with those signs. It’s going to depend on how sick they are or what I’m hearing.

Dr. Meadows: I may or may not start them on antibiotics, but being in a college town, we’re more likely to work up a fair number of them just because that’s what our clientele wants.

Dr. Hurley: For a shelter that has just a few cases of respiratory disease a year, maybe they consider any case to be cause for concern. When a shelter has a background level of 30% respiratory disease, on the other hand, they might not be concerned until they hit 50% or 60%. When diagnostic tests are going to be done at a population level, we suggest they send out at least 5 to 10 samples from affected dogs for a respiratory panel. It’s also a good idea to have the veterinarian observe the vaccination process and go check the ventilation system to make sure it’s turned on and working as expected, and physically observe cleaning to make sure nothing has gone wrong to contribute to an outbreak.

PREVENTIVE STRATEGIES

Dr. Morris: Given the risk factors, let’s talk about what tools we have that can aid in prevention. Can you tell us about your vaccine strategies?

For Bordetella, intranasal or oral vaccination is recommended in a shelter environment because of the rapid onset of protection and the potential for nonspecific local protection.—Dr. Hurley

Dr. Hurley: On intake, we recommend a modified live subcutaneous vaccine for distemper. For Bordetella, intranasal or oral vaccination is recommended in a shelter environment because of the rapid onset of protection and the potential for nonspecific local protection. 

Dr. Meadows: We like to get them good broad-spectrum protection, but I am less worried about parainfluenza, so I use either a DA2+PL or a DA2P+PL modified live vaccine to get broad-spectrum coverage for the severe pathogens. Then we use the oral Bordetella vaccine to get a quick and durable immune response. This Bordetella bronchiseptica is a very quick pathogen in terms of immunologic response, so we need that protection up front now. 

Dr. Ruch-Gallie: That’s pretty much the same protocol we use. I want to make sure we use combinations that cover all of the pathogens that we have vaccines for.

Prevention in Shelters 
  • “All in/all out” kenneling
  • Scheduled animal intake
  • Mechanical environmental drying
  • Attention to positive air flow/ventilation
  • Quarantine
  • Vaccination on intake

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