Medical Treatment on a Shoestring Budget

CONTAINING HIGHLY CONTAGIOUS DISEASES LIKE PANLEUKOPENIA

AND CALICIVIRUS

Ellen Jefferson, DVMExecutive Director

Kristen Kjellberg, DVM

Veterinarian

Basics

Calicivirus

Panleukopenia

CONTAINING CONTAGION

Detection What to look for What is it? What does it look like?

Isolation How is it spread? What kills it? How do I treat it?

Re-introduction

BASICS

What to look for Groups of animals with the same symptoms The usual suspects

parvo, distemper, panleukopenia, ringworm Things you are always on the lookout for

The unusual suspects Canine influenza, virulent strain calicivirus, etc. Can be harder to detect

What is it? Virus? Bacteria? Fungus?

DETECTION

How is it spread? Aerosol Saliva Fecal matter Fomites

What kills it?How do I treat it?Location?

ISOLATION

What is the quarantine period?When is it safe for aff ected animals to be re-

introduced to the general public?

RE-INTRODUCTION

All of a sudden, we had several adult cats in cattery not eating and with fevers

They all had ulcers…

THE HUNGER STRIKE KITTIES

What is it? Similar to feline herpes

virus, but hardier in the environment

Usually causes relatively benign URI in kittens

Can mutate to different strains like the flu

What does it look like? Typical calici: fever, mouth

ulcers, URI Virulent calici: vaccinated

adults severely affected, skin lesions, limping

VIRULENT CALICIVIRUS

How is it spread? Nasal Oral Conjunctival **Fomites

What kills it? Lasts days to weeks or more dried on surfaces, longer in

cold wet conditions First, remove organic debris Then bleach:water 1:30

ISOLATION

Who goes? Affected Exposed (ideally separately)

Scrub in/out procedure Designated staff Scrubs Footbath/foot covers Keep pens, litterboxes, spray bottles

within the ward Wash hands between patients!

We eventually considered all exposed

Closed catteryUtilized off site and foster homes

ISOLATION

Antibiotics Doxycycline Amoxicillin

Pain Sucralfate +/- buprenex

Fever: dipyroneNutrition

TREATMENT

What is the quarantine period? Sometimes there isn’t

enough research to know Make an educated guess

When is it safe for aff ected animals to be re-introduced to the general public? Couldn’t afford to test

them all like parvo or panleuk

Have a plan for if you make the wrong decision

Educate adopters

RE-INTRODUCTION

Voodoo and Venus, post-calici!

RE-INTRODUCTION

Everyone will panicMake a plan, assess, then

continue to change itFind the silver linings

Survival rate Knowing that it can’t go on

foreverYou’ll be amazed at what

you can do when killing isn’t an option

WHAT WE LEARNED

“Feline Distemper”Actually a parvovirusActs similar to Canine

parvovirus- infects small intestine

Spreads easily in animal shelters

Causes vomiting and/or diarrhea and/or anorexia

Generally runs its course in 3-7 days

Lives in environment for 6-12 months

PANLEUKOPENIA- WHAT IS IT?

Very hard to identify because not cut and dry like in dogs

Usually vomit/diarrhea

Testing is inconclusive False positive tests

occur within 10 days of vaccination

False negatives can occur if early in the disease

WHAT DOES IT LOOK LIKE?

1. The Community.

1. Most kittens live outside

2. Ubiquitous virus3. Least likely

continual source of outbreak

1. But probably first source

5 PLACES OUR KITTENS COULD HAVE GOTTEN PANLEUKOPENIA

City FacilityOn intake kittens

are:weighed, heldphotographed Entered into computers

sometimes fed/treated before pick up.

2/5 PLACES

APA! Medical Clinic. All incoming kittens

are: tested and held given wellness handled by the

technicians treated on the exam table

Medicine bottles the technicians'

clothes/hair, the cabinet knobs, often overlooked areas to

sanitize appropriately

3/5

APA! Nursery is especially vulnerable to disease spread due to: the proximity of kittens, the invasive handling to feed and

care huge number of diff erent people

involved, the cross use of medicine bottles

for dispensing, the time kittens spend there, and

the use of small gauge (and thus diffi cult to sanitize) enclosures.

Remember: all of these kittens would have been dead if they did not go to the Nursery Weigh risk vs. benefit

4/5

Foster homes. risk is smaller

Smaller population Less stress

5/5

Believable Positive: unvaccinated or not-recently-vaccinated cat

signs of illness

Exposed within previous 5 days Not longer

WHEN CAN YOU TRUST A TEST?

A reliably positive-tested cat can have no vomiting, no diarrhea, and even be eating. Or she can be very sick with

copious diarrhea and vomiting.

A negative-tested can have copious diarrhea and vomiting and be unresponsive to antibiotics (kills secondary bacteria, not virus) with what we assume to be Panleukopenia. Test every 12 hours x 2 more

tests

INCONCLUSIVE SIGNS

Vaccines FVRCP vaccine is

extremely effective for prevention If given to kittens

younger than 4 weeks of age, it will give it to them

Must be given as soon as 4 weeks of age if in an outbreak = 1 lb

Repeat every 2 weeks while in shelter

PREVENTION

Test as soon as you see signs that are not normal for diet changes but only when appropriate

Keep sick kittens isolated from healthy kittens

All In and All Out Areas: Keep smaller all inclusive areas for each group of “naïve” catsRemove positive cats and exposed cats asap

Develop alert system to identify kittens who lose weight or are not gaining

PREVENTION (CONTD)

ALL IN AND ALL OUT MODEL

1. Test and kill symptomatic cats

2. Kill all cats in same room in case of exposure Empty cages and

clean

3. Resume normal operations

TRADITIONAL METHOD OF HANDLING AN OUTBREAK

The same way but no killing

1. Identify the problem

2. Isolate and treat the problem

3. Don’t add to the problem

Yes, it is harder.

NO KILL WAY TO HANDLE OUTBREAK

Test: Figure out who has it Who has been exposed in last 5

days to everyone who tested positive?

Questions: Where was the positive cat housed

when symptoms began? Which people were handling it? What supplies from those places

are shared with other cat spaces? Were there any other cats in same

area that are no longer there when cat fi rst showed symptoms? Watch these closely and limit

handling Where are they now? Who, of those that might have

been exposed, is symptomatic even a little? Test those and start questions all

over.

STEP 1: IDENTIFY THE PROBLEM

Create a “parvo ward” just like in dogs

No unauthorized access/locked

All directly exposed (sharing same cage) and positive cats go to ward immediately Deep clean after removal of

animalDedicated supplies,

clothing, and teamKeep until tests negativeDischarge with bath back

to adoption/foster

ISOLATE AND TREAT THE PROBLEM

X 3 days or until all symptoms are gone

Subcutaneousy: Baytril sq once a day in

fl uids Ampicill in/polyfl ex or

Cefazolin two-three times per day

Cerenia once or twice a day Force feeding! Every 4 hours

until eating SQ Fluids: Iv fl uids are very

hard to give to tiny kittens we found we could save them

with constant feeding and sq fluids/meds

APA TREATMENT

Create a Quarantine Area (can be current exposed area)

Clean everything Dedicated staffPut all susceptible cats

that were exposed to same people and stuff here for 5 days

No public access If no symptoms after 5

days, ok to move out to adoption

Consider bath

ISOLATE AND WATCH THE PROBLEM

All incoming cats and kittens go to CLEAN place with new supplies and dedicated staff

No cross over with quarantine area

DON’T ADD TO THE PROBLEM

The virus is just like Canine removal of all organic

debris (feces, vomit) Cleaning with detergent

disinfection with a parvocidal cleaner (used appropriately)

Extreme temperatures (steam) and roccal will not kill the virus

Throw everything you can away

CLEANING UP

Who to test- is it just diet change?

When to isolate negative-tested kittens? All neonatal kittens

get diarrhea due to diet change, and the difference between that and Panleukopenia can be difficult to determine

CHALLENGES

QUESTIONS?