Shelter Medicine 101 - Petfinder [PDF]

Shelter Medicine 101

Stephanie Janeczko, DVM, MS, DABVP, CAWA 2015 Adoption Options series 1

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Why are infectious diseases such a big deal? •Cause suffering •Easily spread •Leading cause of euthanasia •Source of frustration •$$$, time for treatment •Poor reputation for shelter – sick animals •Zoonotic potential

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Shelters face unique challenges •Large number of animals •Grouping of different ages, susceptibilities •Constant introduction of new “unknown” animals •Arrival or sick and/or injured animals •Limited ability to isolate +/- quarantine •Aging or poorly designed facilities •Stress •Limited resources 6

Addressing disease outbreaks starts with prevention! •Disease prevention •Stress prevention •Why prevention? •Reduce risk of euthanasia •Kinder to the animals •More efficient than treatment (time & money)

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Shelter Challenges •Ensuring that animals remain or become healthy requires a plan! •For the individual

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Shelter Challenges •Ensuring that animals remain or become healthy requires a plan! •For the “herd”

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Epidemiology 101 The Agent

The Environment

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The Host

Animal Factors •Species •Age •Genetics •Nutritional status

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•Stress level •Immune status •General health •Co-infections •Drug treatment

Animal Factors •Species •Age •Genetics •Nutritional status

•Stress level •Immune status •General health •Co-infections •Drug treatment

Goal: support the animals’ ability to resist disease by implementing comprehensive shelter pet wellness protocols

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Agent Factors •Virulence •Strain •Method of transmission •Incubation periods •Carrier states •Dose Goal: understand characteristics of specific disease agents and develop written SOPs for control of each of them. 13

Environmental Factors •Housing density •Temperature •Ventilation •Noise control •Light:dark cycles •Traffic patterns •Housing segregation •Pest control

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•Cleaning & disinfection protocols •Disease recognition •Quarantine, isolation •Biosecurity protocols •Education & staff training

Goal: create an environment that minimizes disease transmission and supports the animals’ health and well-being

How are infectious diseases spread? •Usually cat-cat or dog-dog •Some can infect both •Some can infect people •Zoonotic = to/from animals and people

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How are infectious diseases spread? •Direct contact vs. indirect contact •Various routes of transmission: •Ingestion (fecal-oral) •Inhalation or mm contact •Includes droplet and airborne

•Transplacental or transmammary •Vector-borne •Mechanical •Fomite

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??? ? ? ? ?

What is a fomite?

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So what is a fomite? An inanimate object (such as a toy, food bowl, mop, etc.) that may be contaminated with infectious organisms and serve in their transmission

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Why care about fomites? •Fomites are often overlooked & underestimated •Very important for most diseases •The most important for a few diseases

•Nobody likes a fomite – so don’t become one!

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Just to freak out all the germ-phobes…

Yuck!

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Disease Transmission •Particular shelter practices may enhance transmission through a variety of routes:

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Disease Transmission •Particular shelter practices may enhance transmission through a variety of routes: • Overcrowding

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Disease Transmission •Particular shelter practices may enhance transmission through a variety of routes: • Overcrowding • Co-housing and co-mingling, including play groups

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Disease Transmission •Particular shelter practices may enhance transmission through a variety of routes: • Overcrowding • Co-housing and co-mingling, including play groups • Housing design

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• Inadequate isolation facilities and practices

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• Inadequate isolation • Cleaning procedures

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• Inadequate isolation • Cleaning procedures

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• Inadequate isolation • Cleaning procedures • Common areas and surfaces

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Controlling Infectious Disease •Plan A: Keep them from getting exposed •Plan B: Have them as healthy as possible to minimize how sick they might get

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Controlling Infectious Disease

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Preventive Strategies • Plan A: Prevent exposure • If exposure can’t be zero, limit the dose to as little as possible: • • • • • • • • 31

Excellent sanitation Fomite control Biosecurity protocols Appropriate segregation Adequate isolation +/- quarantine Ventilation Avoid overcrowding Reduce length of stay

Preventive Strategies

• Plan B: Strengthen host defense • Good husbandry, nutrition • Treat concurrent infections • Vaccination • Reduce stress

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Cleaning & Disinfection Protocols •There are TWO steps here! •Step 1: Clean •Remove organic material •Detergent activity– soap it up! •Step 2: Disinfect •Kills the germs •Apply to clean surfaces, sit for required contact time 33

Sanitation Basics • Sanitation is critical – we can’t rely on pathogens going away on their own • Some pathogens are very resistant • Don’t rely on quats for unenveloped viruses – despite the label  • Many parasites notoriously difficult to kill

• Porous, organic materials are harder or impossible to sanitize • Limit animal contact with hard to disinfect surfaces 34

Common Disinfectants •Quaternary ammonium compounds •Sodium hypochlorite - Household bleach (5%) •Potassium peroxymonosulfate - Trifectant •Calcium hypochlorite - Wysiwash •Sodium dichloroisocyanurate Bruclean •Accelerated hydrogen peroxide AccelTB •Chlorhexidine - Nolvasan •Ethanol - Alcohol hand sanitizer 35

Common Disinfectants •Quaternary ammonium compounds •Sodium hypochlorite - Household bleach (5%) •Potassium peroxymonosulfate - Trifectant •Calcium hypochlorite - Wysiwash •Sodium dichloroisocyanurate Bruclean •Accelerated hydrogen peroxide AccelTB •Chlorhexidine - Nolvasan •Ethanol - Alcohol hand sanitizer 36

Newer Disinfectants •Calcium hypochlorite - e.g. Wysiwash® and Sodium dichloroisocyanurate - e.g. Bruclean® •Dry tablets, special applicator system •No detergent activity, inactivated by organic matter

•Accelerated hydrogen peroxide - e.g. AccelTB® •Liquid form, more options for application •Good detergent activity, short contact time •Less inactivated by organic material 37

A few words on bleach •Bleach is an excellent disinfectant – but it is frequently misused •At best – doesn’t work •At worst – can hurt the cats, ruin your facility

•The ground rules: •You can’t clean with bleach •You must mix it appropriately and let it sit •More isn’t better

•Mixing bleach •Use a measuring cup!!! •Mix fresh daily, keep covered, discard if soiled 38

A few words on bleach •Regular use = 1:32 dilution •½ cup regular household bleach per gallon of water •Will work for non-enveloped viruses

•Ringworm or “deep cleaning” use = 1:10 dilution

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•Not for regular use •Irritating to the respiratory tract, corrosive •Must remove animals and have good ventilation

Phenols •Excellent disinfectant properties - will kill lots of pathogens of concern… but can also kill cats 

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Phenols •Excellent disinfectant properties - will kill lots of pathogens of concern… but can also kill cats 

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Shouldn’t we just leave the cage open for a while? •1, 3, 5, or even 30 days won’t help if sanitation was inadequate •Multiple thorough episodes of cleaning and disinfection can help but are not time dependent 42

Sanitation Basics Laundry: • Hot water, detergent, bleach • Dry thoroughly! • Discard if heavily soiled • Caution in and moving to laundry areas

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A Simple, Yet Critical Fix •Wash your hands, change your gloves, wear PPE!!! •We can be our own worst enemies – minimize fomite spread!

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WASH YOUR HANDS!!! •The best practice – good old soap and water! •Alcohol hand sanitizers  at least 60% alcohol •Limited efficacy for hard to kill viruses •Inactivated by organic debris

•30 seconds contact time •Sing the alphabet song twice!

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Preventing Exposure •Excellent sanitation procedures and fomite control •Appropriate use of housing •Labeled, dedicated equipment •Dedicated staff •Appropriate order of cleaning •Diligent hand sanitation

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Preventing Exposure •Excellent sanitation procedures and fomite control •Appropriate use of housing •Labeled, dedicated equipment •Dedicated staff •Appropriate order of cleaning •Diligent hand sanitation Invest your time where you’ll get the most bang for your buck! 47

How about footbaths?

Stockton, K. A., P. S. Morley, et al. (2006). "Evaluation of the effects of footwear hygiene protocols on nonspecific bacterial contamination of floor surfaces in an equine hospital." J Am Vet Med Assoc 228(7): 1068-1073. 48

How about footbaths? •Not reliably effective

•Can actually help spread disease


How about footbaths? Dedicated footwear and/or shoe covers are better choices


What does it mean to be clean? •Kennels •Cages •Transport carriers •Windows and walls •Lobbies and halls •Doors and doorknobs •Play yards •Vehicles •Exam tables

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•Bedding •Toys •Food and water bowls •Litter boxes •Scoops, brushes, mops •Clothing and Footwear •Ventilation ducts •Phones, keyboards, etc. •HANDS!!!

That’s impossible…why bother?

It doesn’t have to be perfect… You can still make a difference by reducing the dose!

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Segregate Pets • By species and preypredator status • By age – very young from juveniles from adults

• By health status

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Isolate sick animals

• Contagious animals CANNOT remain in the general population

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Quarantine vs. Isolation

Question: What’s the difference between isolation and quarantine?

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Quarantine vs. Isolation Answer: • Isolation is for animals you know are sick • Quarantine is for animals you are worried about due to known or suspected exposure Isolation

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Quarantine

Isolation Requirements • Isolation should be: • Separated by species • Targeted by disease • Sufficient for humane treatment of disease • Able to contain the disease from spreading to the rest of the population

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For Sick Pets!

Treatment Considerations •Ability to provide humane level of care •Supplies and equipment •Space/housing •Staffing – skill, training, numbers

•Ability to protect the rest of the population

•Retain focus on prevention

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What is ‘adequate’ isolation? •Ideally: physically separate building •Minimally: separate, easily disinfected area •Appropriate PPE for the specific disease •Adequate monitoring and sufficient staffing mandatory

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Treatment Considerations •Prompt identification of infected animals is key: •Remove from general population early to reduce spread •Timely treatment helps improve outcome

•Written SOPs: •Description and case definition •Treatment

•Do you treat? If so, who? how? •Containment and management steps •Intervention points and next steps

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Housing or Population Density • •

Overcrowding is an extremely potent stressor “Just one more” animal can threaten the health and welfare of the entire population of animals

Overcrowding costs lives!

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lives! 61

But keeping more animals in the shelter does not necessarily mean that more lives will be saved…

…in some cases it actually means that fewer animals will be helped. 62

Why overcrowding costs lives •

Worsens the effects of many other negative factors •

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Stress, noise, poor air quality

Increases overall amount of germs present in the environment, increases contact rate between animals Compromises animal care Compromises customer service Leads to worse and worse crowding as staff is too overwhelmed to make good decisions

Preventing Exposure Avoid overcrowding – stay within your capacity for care •Crowding = major stressor and risk factor for disease outbreaks •Exacerbates challenges shelters already struggle to manage •Not inevitable!

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Capacity for Care • Housing capacity: • Not just an open cage, but an appropriate enclosure for that particular animal • Ideally below your max capacity

• Staffing capacity • Staff and/or volunteers to meet the physical and behavioral needs of that animal

• Additional sufficient resources as needed for that animal 65

• Medications, vet care, training

Why length of stay matters • Shelter stays are stressful and come with risks • Physical health • Behavioral well-being

• Exposure to infectious disease goes up: • Strongest prognostic factor for coughing was number of days spent at the shelter: each day increasing the risk of coughing by 3% • Days in the shelter only factor significantly associated with flu seroconversion • Long LOS highly correlated to feline URI

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Planning for success •Calculate holding capacity, adoption driven capacity, and amount of time available for animal care

•Knowing capacity for care, LOS, and average shelter populations helps with decision-making •Resource allocation •Staffing •Intake and adoption decisions •Cage space

•Moving animals efficiently through the system is a win-win-win! 67

Daily Rounds •The idea: •Performed DAILY  •Look at each animal in your care •Decide where they are going •Determine what they need to get there

•Figure out how to make it happen!

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INTAKE

OUTCOME

What can we do TODAY to move that animal closer to their final outcome? • Written SOP and criteria for behavior, medical to determine adoption, transfer, etc • Eliminate holds and bottle necks – extra staffing, resources, fast track/slow track program, etc. 69

Daily Rounds •Requires: •Someone with training, knowledge, and authority •A commitment by all staff and management to make it a priority • Accurate data collection and entry • Process +/- equipment to make it work • Ideally, a rounds leader or task master with a team

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Good Nutrition & Husbandry

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Good Nutrition & Husbandry

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Vaccinations •ONE component of a herd health program •NOT a magic bullet •Protocols must consider: •When to vaccinate •Who to vaccinate •What product to use •By what route •How often

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What are vaccines? •What vaccines are: •Biological products designed to trigger an immune response that will product animals from future disease

•What vaccines are not: •Preformed antibodies •Instant immunity •An absolute guarantee 74

Vaccines: The Basics •Lessen the severity of future diseases •Prevent SOME diseases altogether •Vaccines = actual live viruses •Similar to the ones that cause disease •Result in antibody production that provides protection against the real thing •Need to be handled carefully & administered appropriately 75

National vaccination guidelines •American Animal Hospital Association’s (AAHA) “Canine Vaccination Guidelines” and American Association of Feline Practitioners’ (AAFP) “Feline Vaccine Advisory Panel Report” • Written by a panel of experts in the field • Represent the current thinking on vaccination for cats and dogs • Available on-line for free

•Vaccines are classified as: • Core: recommended for all • Non-core: recommended for certain segments of the population • Not recommended

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Vaccination Resources •Guidelines are available on the organizations’ websites in a downloadable format: AAFP “Feline Vaccine Advisory Panel Report” - 2013 • http://www.catvets.com/guidelines/practice-guidelines/felinevaccination-guidelines

AAHA “Canine Vaccination Guidelines” - 2011 • http://www.aahanet.org/About_aaha/About_Guidelines_Canine06.html

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Shelter animals are different •Animals entering shelters: • Have a high likelihood of exposure to infectious disease • Are often housed in high-density environments with new animals arriving daily • Often have had little or no preventive care prior to admission • Are at tremendous risk for infection

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How Early Can Vaccines Be Given? •The minimum age for a dog/cat to receive vaccines in the shelter is 4 weeks.

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Recommendations for Cats •FVRCP vaccination against panleukopenia, herpesvirus, and calicivirus for all cats on entry •Starting at 4-6 weeks of age •Repeated every 2 weeks of age in high-risk environments until 16+ weeks of age •One booster for adults ideal, but not required •Can be administered as an injection or as an intranasal vaccine •Also give a SQ panleuk vaccine if you are giving intranasal product!

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Recommendations for Dogs •DA2PP vaccination for all dogs on entry •Starting at 4-6 weeks of age •Repeated every 2 weeks of age in high-risk environments until 18-20 weeks of age •Boosters as for pet dogs if very long term stays

•Intranasal Bordetella and Parainfluenza for all dogs on entry •Starting as early as 3 weeks of age •No booster necessary unless < 6 weeks old at intake 81

Rabies vaccination •For both cats and dogs at least 12 weeks of age: •At intake for long-term stays •At intake or prior to release for short term stays

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Maternally-derived Antibody Interference

Antibody level

•AKA – why puppies and kittens need so many vaccines!

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Age (in weeks)

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Maternally-derived Antibody Interference •AKA – why puppies and kittens need so many vaccines!

Blocks vaccine

Antibody level

Protects from disease

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Age (in weeks)

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What’s stressful about the shelter? • • • • •

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Transport Handling/restraint Noises Strange smells Other cats Other dogs Lacking control

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• • • • •

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Irregular schedules Temperature changes Drafts Overcrowding Isolation Anything unfamiliar or unpredictable

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Response to Stress •

Affected by: • •

Genetics/personality Perception • •

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Socialization Prior experience

Duration Severity Predictability Escapable vs Inescapable

Physiological impacts of stress •

Adrenaline • •

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Other hormones: cortisol •

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“Fight or flight” Decompensation/death of ill animals

Chronic stress lowers immunity, increases susceptibility to disease Increased sensitivity to novel stimuli

Impacts of stress •May result in abnormal clinical signs and/or behaviors, including: •Vomiting, diarrhea •Loss of appetite •Depression and withdrawal •Self-mutilation •Aggression

•Can’t distinguish from other causes easily, or at all 88

Impacts of stress •Do not underestimate the effects of stress on the individual animal and the entire shelter population •Stress reduction should be a major goal of any shelter health care program

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Reasons to Minimize Stress •

Behavior • •

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Health • •

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Tractability Adoptability

Infection rate Disease transmission Recovery from disease Essential component of every medical plan

Where can I learn more? •Good news! Lots of shelter medicine resources available at low or no cost • • • •

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Books and publications Websites Webinars Conferences and seminars

Where can I learn more? •Conferences and seminars • Animal sheltering/welfare focused: • • • •

Adoption Options Animal Care EXPO SAWA training & management conferences State and local federations

• Shelter medicine and spay-neuter • Local or regional shelter med conferences • Tracks at larger veterinary conferences

• Animal law committees, non-profit management, others 92

Where can I learn more? •Shelter medicine programs and animal welfare support • Shelter Medicine Programs • ASPCA • Cornell • UC Davis • University of Florida

• General support • ASPCApro.org • Animalsheltering.org • Alley Cat Allies

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Where can I learn more? •Books and publications •Shelter Medicine for Veterinarians and Staff •Infectious Disease Management in Animal Shelters •Coming soon: behavior and surgery texts •ASV Guidelines for Standards of Care in Animal Shelters and veterinary medical care guidelines for spay-neuter programs •Animal Sheltering magazine •NACA training guide •ASPCA and HSUS stores 94

Where can I learn more? •Free webinars! •Watch live and ask questions •Check out archives for staff training

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Sample topics •Parvo 101 •Proactive Community Animal Control •Fundamentals of Emergency Sheltering

•Helping Cats Who Hiss and Hide •Increasing adoptions •Using social media

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•Options include: •ASPCApro: http://www.aspcapro.org/recorded-webinars.php

•Maddie’s Institute: http://www.maddiesfund.org/Maddies_Institute/Webcasts.html

•Petfinder: http://pro.petfinder.com/online-learning-center/ •PetSmart Charities: http://www.petsmartcharities.org/pro/learn 97

Where can I learn more? •Professional guidelines, position statements and training materials •Association of Shelter Veterinarians http://www.sheltervet.org/position-statements

•HSUS Animal Sheltering magazine and website http://www.animalsheltering.org/

•National Animal Control Association http://www.nacanet.org/guidelines.html

•Society of Animal Welfare Administrators http://www.sawanetwork.org/operational-info.html

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[email protected]

(212) 876-7700 x4406

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Time for Q&A!

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Acknowledgements & Slide Credits

•Special thanks to Drs. Brian DiGangi and Brenda Griffin

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