Proceedings of the European Veterinary Conference Voorjaarsdagen

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Close this window to return to IVIS www.ivis.org Proceedings of the European Veterinary Conference Voorjaarsdagen Amsterdam, the Netherlands Apr.

1 Close this window to return to IVIS Proceedings of the European Veterinary Conference Voorjaarsdagen Amsterdam, the Netherlands Apr. 5-7, 2012 Next Meeting: Apr , Amsterdam, the Netherlands Reprinted in IVIS with the permission of the Conference Organizers

2 Brains Over Fungus: Management of Dermatophytosis in Animal Shelters Dermatophytosis, commonly referred to as ringworm, is one of the more complex infectious disease problems facing shelters. If given enough time and assuming the cat is healthy and in a stress free environment, this disease will resolve in most pet cats. However, because the disease is highly contagious to cats and other animals and a known zoonosis, it can be life threatening in shelters. Outbreaks have resulted in serious problems for shelters, especially when people contract the disease from animals adopted from the shelter. Misdiagnosed outbreaks, where incomplete or incorrect identification of dermatophytosis leads to the wrong conclusion, have also led to substantial problems for many organizations. The disease is often thought to be too difficult for shelters to diagnose and treat and that successful environmental decontamination of the long-lived, resistant spores is virtually impossible to achieve. Dermatophytosis can be managed successfully in many shelters without resorting to widespread depopulation1-3. Several successful screening and treatment programs have been established at shelters in the US. Consultation work done with other shelters and multiple animal facilities, has shown repeatedly that dermatophytosis can be well managed in a shelter setting. Outbreaks of dermatophytosis have been much more frequently reported in shelter cats, rather than dogs, as a problem severe enough to debilitate an entire organization. Approximately 90% of feline dermatophytosis is caused by Microsporum canis; dogs may be infected with M. canis, M. gypseum, or Trichophyton mentagrophytes. Infection and clinical signs are significantly more common in cats than in dogs. In regions with colder winters, infection in dogs is uncommon. Cats can also be infected 188 with alternate species such as M. persicolor or Trichophyton spp.. M. canis, which may be readily transmitted between humans, cats and dogs is the pathogen of greatest significance in shelters. Pathogenesis Exposure occurs from contact with another infected animal, a fomite or a contaminated environment. But simply being exposed to spores does not necessarily result in an infection. For an infection to become established, spores must reach the skin surface and defeat host protective mechanisms. Natural skin flora, sebum, grooming and the skin immune system are the first lines of defense. Incubation In general, the incubation period from exposure until development of clinically obvious lesions is approximately 2-4 weeks. In experimentally induced infections, infected hairs have been noted in less than a week7. Lesions may be detected soonest by a highly trained observer. Development of clinical lesions is preceded by infection of the hair follicle. The relatively long incubation period compared to other infectious diseases must be considered when attempting to map an outbreak or determine potential sources (in-shelter vs. community source) for infections. Due to the long incubation period, simply quarantining potentially exposed animals in an effort to watch for development of dermatophytosis is not recommended. Diagnosis Diagnosis of dermatophytosis in animals moving through animal shelters and other animal welfare organizations can be simplified by using a systematic screening process right from the point of intake. A systematic process will facilitate safely sending animals to foster care or be making them available for adoption. Because of the infectious potential for humans and animals, early identification and prompt response are essential. A detailed description of the recommended systematic screening process, including specifics of how each diagnostic tool can be effectively used in animal welfare organizations, is provided in the chapter on dermatophytosis in Infectious Disease Management in Animal Shelters, Hurley and Miller. The recommended systematic screening process consists of coordinated and consistent use of the five basic diagnostic tools:

3 History Visual exam Wood s lamp exam Direct exam of fluorescing hairs Fungal culture with microscopic identification A thorough working understanding of all five aspects of this screening process is required in order to develop a working protocol for screening, prevention, and treatment in a shelter setting. The same systematic screening process can be used at admission, any important control point, or when responding to an outbreak. Screening is crucial at the time of admission to prevent disease transmission. Admission screening provides an opportunity to identify infected, potentially contagious animals, take preventative action, and start treatment promptly when resources allow. Screening for dermatophytosis using a step-by-step process, adds only add a few minutes to admission procedures if the designated area is properly equipped for the screening exam and intake staff have been properly trained. At minimum, at least the examination steps of the screening process should be repeated at critical infectious disease control points (such as moving animals into public areas, group housing, or foster or adoptive homes) in order to identify any lesions or infections that may have been missed or developed since intake. Systematic screening is also an essential part of an outbreak response plan. Other diagnostics work best in conjunction with information gathered during the screening process to help guide treatment and management decisions. Population Management: Pathway planning and animal flow-through Pathway planning is a means of actively tracking each animal s shelter stay, along a defined path, from the moment they come in to the shelter (or even before) to the moment they leave. The idea behind pathway planning is that each animal is on the road to an outcome from the very beginning so each next step can be anticipated, scheduled, and completed on time. Capacity needs and limits can also be evaluated for each individual pathway, helping to target priorities or identify problems. Pathway planning does not mean an animal can never change the road they re on. It just means that each animal is always understood to be going somewhere, with a plan in place for how to get there. Pathway plans for each animal should be evaluated daily to be sure each animal is on an appropriate path. The pathways themselves should also be monitored regularly to be sure they are running smoothly. Many shelters are already doing pathway planning to some extent. Most shelters have several possible different pathways. A few examples of possible pathways: Reproduction CHAPTER 2 Foster to adoption Holding to adoption No holding to adoption (owner surrender) Open selection to adoption Fast track Adoption (Direct to adoption) Holding to transfer 189

4 Trap/neuter/return program Bite quarantine to return to owner Probable euthanasia Many shelters have developed innovative life saving systems for getting animals through the shelter quickly and efficiently. These systems use good management and proactive planning to reduce risk for the population as whole and for the individual animals. Here is an example: A woman calls to say she has found a healthy, friendly 6 week old male kitten and plans to bring him into the shelter that afternoon. This shelter knows, because of state laws, they will not be able to place the kitten up for adoption for another two weeks. Rather than have the kitten stay in the shelter, a foster parent, who has signed up and received training at the beginning of the season, is ready and waiting. The foster family has made plans to accept the kitten knowing it was their turn to take the next healthy kitten that came in. The kitten comes in, is evaluated at entry by intake staff and found to be in good condition. The kitten is checked for a microchip, vaccinated, dewormed, and screened for infectious diseases. A photograph of the kitten is posted in the shelter and on the shelter website. Records of kittens reported lost are cross-checked. The on-call foster kitten delivery service arrives later that afternoon to transport the kitten to his new foster home. The intake staff have already scheduled an appointment for the kitten to come in for an exam and to get neutered, revaccinated and de-wormed before being made available for adoption in two weeks. If the kitten is reunited with his lost family, the appointments will be cancelled. This same scenario goes on multiple times a day, all week long. Critical flow through points In the example above, an initial pathway of foster to adoption is assigned even before the kitten comes into the shelter system. Assignment to that category was made based on an understanding that the kitten was: healthy, friendly, and too young for adoption. If, at intake, the staff feels the finder did not accurately describe the kitten, the pathway may change. There are several critical flow through points in this pathway where the kitten will need some kind of care to be able to continue along the pathway towards adoption. 190 The kitten will need an intake exam, foster pick up, foster care, return from foster exam and neuter, followed by placement in an adoption housing unit. Waiting time, due to insufficient capacity, at any of these points of care will cause the length of stay for the kitten to grow longer. The worst place to have delays would be in the shelter. Kittens have higher susceptibility to disease and require specialized care to keep them healthy and happy. The best place to have delays would be while the kitten is in foster care, but even extended stays in foster care mean it takes that much longer to open up space in that foster home again. Additionally, in many communities, kittens tend to have the best chance of adoption when they are very young so delays in making this kitten available may decrease his potential for adoption. The planning process This shelter has done an excellent job of planning this pathway. The first assessment was to compare intake to likely outcomes for kittens. Based on previous years statistics, they believed they would be able to place most healthy kittens coming in if they could keep them healthy. Adoption driven capacity was evaluated to determine an optimal daily population for kittens on the adoption pathway. Early in the year, well before kitten season, data was evaluated to estimate how many of the kittens likely to come in would need foster care because they are stray or too young. This shelter realized they would need, on average, one litter each day to go to foster care throughout kitten season. Foster homes were proactively recruited (increasing capacity for care in foster). Foster parents received training and were assigned to tiered levels of husbandry difficulty. A Foster On-Deck system was created so foster parents would be ready and waiting when kittens came in. Problems with foster kitten pick-up could cause in-shelter delays so they even planned a volunteer driven foster kitten delivery service. Capacity was evaluated for intake exams as well as spays and neuters to be sure they would have adequate opportunity to provide surgery for foster kittens promptly, just as they return from foster care. Housing space was evaluated in their adoptions area to be sure kittens wouldn t wait in the back for adoptions space to become available. The shelter even noticed which days of the week kittens are most likely to get adopted and changed their main kitten return day to Thursday, rather than Sunday, to coincide with higher adoptions for kittens on the weekends.

5 Intake capacity was also evaluated by looking at staffing for intake procedures allowing enough time for a thorough evaluation of kittens including all procedures necessary prior to foster placement. Intake capacity is crucial. If this initial critical flow through point has inadequate capacity, then the kitten would never even be able to get on the pathway. Through careful planning, length of stay for kittens is minimized to what is really necessary both in the shelter and in foster homes, freeing up much needed resources and capacity to care for more animals. In addition, kittens are better protected from the risks of being in the shelter. Guidelines for Standards of Care in Animal Shelters Association of Shelter Veterinarians Animal sheltering has evolved considerably since its early days, with most shelters today caring for as many, if not more, cats than dogs. For some animals, shelter stays continue to be short, whereas others may receive extended, even lifetime, care. Sheltering organizations can now be found for almost any companion or domestic animal species (eg, rabbits, birds, rodents, horses, livestock), and for many exotic species as well. The entities delivering services varying from large, well established agencies with significant resources, to grass-roots groups, loosely-networked individuals, or individuals acting alone. The spectrum of programs is equally diverse traditional open-admission shelters; care-for-life sanctuaries and hospices; home-based rescue and foster care networks; virtual internet-based animal-transport programs; behavioral rehabilitation centers, limited or planned admission shelters; No-Kill shelters; high volume adop- tion agencies; and many permutations of these various approaches. In this document the term shelter is meant to apply to all of the entities mentioned above. In contrast to zoos or laboratories, the care of animals in all of these sheltering efforts remains unstandardized and unregulated at the national level, and is inconsistently and often inadequately regulated and monitored at the state or local levels. As of 2009, at least eighteen states require animal shelters to be registered or licensed (CO, GA, IL, IA, KS, MA, ME, MI, MN, MO, NE, NH, NJ, NC, PA, RI, VT, WI), and six require establishment of an advisory board (CO, KS, LA, ME, MO, TX). [ASPCA 2006, Mass department of AG.]. Some animal care statutes cover only municipal shelters or pounds, whereas others also cover any incorporated non-profit entity. A few cover any entity providing care for homeless animals, including residential foster homes. In 2008, the Association of Shelter Veterinarians, a professional organization with over 750 members, initiated a comprehensive effort to review the scientific literature and develop this document to highlight optimal practices and identify unacceptable practices applicable to a wide variety of situations in which care for companion animals is delivered in a population setting. This document presents the first edition of these standards, which will be reviewed and revised periodically. This document does not attempt to provide specific operational instructions, as these must be tailored to each individual setting. References are provided which can be used to obtain more detailed information. 2. The Need for Standards It is regrettable that serious deficiencies in companion animal care in shelters continue to occur. There is convincing evidence that societal expectations have increased for the care and welfare of animals. This ethic is reflected in the professional literature as well as in extensive guidelines and/or codes of ethics issued by trade organizations, regulatory bodies, advisory boards and policy making agencies for animals in almost every conceivable setting except animal shelters, 3. The Five Freedoms and Companion Animals The AVMA has recently revised its brief care guidelines for companion animals including some recommendations for humane societies (AVMA 2003). A broader, independent set of standards developed from within the shelter veterinary community is needed to identify best and unacceptable practices as well as minimum standards of 191 Reproduction CHAPTER 2

6 care for shelter animals whether in a large organization, a small home-based effort, or something in between. In order to be flexible enough to guide any type of sheltering situation, standards need to clearly describe some general principles without being overly prescriptive. The welfare principles enumerated as the Five Freedoms (Table 1), (Farm Animal Welfare Council) provide a model that is applicable across situations and species including animal shelters. There is ample evidence the Five Freedoms are broadly accepted as guidelines for welfare. For example, a survey of large animal faculty at veterinary schools indicated strong support for these principles in the US (Heleski 2005) and it has been recommended that they are equally useful as a framework for zoo animal welfare (Wielebnowski 2003). The Five Freedoms also form the basis for minimum standards for dogs, cats, and animals in boarding facilities promulgated by the New Zealand Ministry of Agriculture (New Zealand 1998, 2007) and recently, for standards from the Canadian Veterinary Medical Association for cats (CVMA 2009). This approach has also been embraced by the laboratory animal community (NIH Guide; SCAW 2001; CACC 1993; Bayne 1998). As performance standards, rather than engineering standards, the Five Freedoms define outcomes and imply criteria for assessment, but do not prescribe the methods by which to achieve those outcomes. Table 1: five freedoms for animal welfare (Farm Animal Welfare) 1. Freedom from Hunger and Thirst by ready access to fresh water and a diet to maintain full health and vigor. 2. Freedom from Discomfort by providing an appropriate environment including shelter and a comfortable resting area. 3. Freedom from Pain, Injury or Disease by prevention or rapid diagnosis and treatment. 4. Freedom to Express Normal Behavior by providing sufficient space, proper facilities and company of the animal's own kind. Feline Upper Respiratory Disease Complex Significance of disease URI or FURDC is a frequent common problem in many shelter settings. US Shelters serve between 2 and 4 million cats per year. Rates of disease are estimated at 30-90%. Disease leads to euthanasia and death for many cats; causes acute and chronic suffering; negatively affects community animal health; and hurts the shelter s image often leading to fewer possibilities for positive outcomes. FURDC also consumes significant resources that could be expended on other life saving programs. In a large proportion of US shelters FURDC is endemic. In some, disease is almost inevitable. But some shelter settings have consistently lower incidence and severity. In a comparison of two studies looking at disease risk, the risk of disease in the US study showed a 30% risk (661/2203) compared to a 4% risk (60/1434) looking at shelters in the UK. Disease does not have to be inevitable Preventive practices can succeed and do play an important and often life saving role. Key factors for prevention include: Reasonable protection from disease exposure Air quality Meaningful and continuous stress elimination beginning at intake Attentive population management/crowd control Communication and overall management within the shelter 5. Freedom from Fear and Distress by ensuring conditions and treatment which avoid mental suffering. 192 FURDC has many potential impacts on adopters pets and private practices that work with shelters and rescue groups as well as the groups them selves. Many newly adopted cats come from overcrowded environments

7 incubating or shedding infectious disease. Cats may present to private clinics, post-adoption, with fulminant clinical signs of disease and a heart broken new owner. FURDC transmission In shelter environments, FURDC transmission occurs most often via fomites rather than aerosol spread, as is commonly thought. This has been demonstrated for herpesvirus and calicivirus. When cats were kept in open sided wire cages in a common air space separated by 6 feet, there was no transmission, when healthy cat cages were cleaned first and fomite transmisiion was strictly controlled. When cleaning was random, with sick cats being cleaned first some of the time, transmission occurred frequently. Virus can be easily transmitted on clothing, particularly if it is present on hair picked up by caretaker s clothing. Because cats groom themselves, virus present in saliva or respiratory secretions is likely present on hair. In outbreaks of virulent systemic feline calicivirus, pet cats belonging to veterinary technicians have been fatally infected, presumably via virus transported on clothing or shoes. Stress and Herpes virus recrudescence Since many cats present to shelters with latent herpes infections, in many cases transmission is often not even necessary for disease to present. Herpes virus is reactivated by many stressors, leading to viral shedding and sometimes development of clinical signs of FURDC. In particular, herpes is likely to be activated by the following: Pregnancy/birthing Moving from cage to cage Introduction of new cats into a group especially intact cats Vaccination: FVRCP FURDC is not a vaccine preventable disease. Cats vaccinated for herpesvirus are significantly less likely to be shedding herpes than non-vaccinated cats. However, there was no significant difference in likelihood of shedding calicivirus between vaccinated and nonvaccinated cats. provides, at best, limited protection against only some strains. It cannot be assumed that a vaccinated cat will not develop calicivirus infection. Caution should be exercised in exposing pet cats to cats with signs of calicivirus infection (e.g. through foster care, adoption or in a veterinary clinic), whether or not the pet cats have been vaccinated. Disinfection: Calicivirus Bleach 1:32 (ideal conditions) Calcium hypochlorite Potassium peroxymonosulfate (aka.trifectant or Virkon-S) Accelerated hydrogen peroxide Alcohol hand sanitizer: most effective choices are 70% ethanol or 1-propanol (62% may be the best you can find). Hand washing is a more reliable option, but hand sanitizers can be a helpful adjunct Diagnosis Most often not necessary May be helpful for periodic population screening Often won t effect your treatment plan May be considered if signs persist > 1 month in an individual Unusually severe or frequent disease in population May be able to distinguish shelter or clinic-origin disease from pre-existing infection. Pathogens and pathogenesis Viruses (80-90%) Bacteria Modified live vaccines (mild signs in most cases) FeCV, FIV, fungal infection, polyp, piece of grass snorked up into nasal passages Even though it is one of the viruses the great majority of the time, don t forget to rule out less likely causes in a cat that is not getting better! Reproduction CHAPTER 2 Feline calicivirus is extremely variable, and mutates from year to year. Currently available vaccines are based on strains of feline calicivirus isolated many years ago and do not protect against many of the strains of calicivirus now seen. The bottom line is that vaccination against calicivirus 193

Bringing your Shelter into the 21st Century to Improve Animal Welfare and Achieve Capacity for Care Part One: The Basics

Bringing your Shelter into the 21st Century to Improve Animal Welfare and Achieve Capacity for Care Part One: The Basics In so many animal care facilities, the crux of the problem is that there seem to