In the hot zone
A cemetery of Ebola victims in the Bombali District of Sierra Leone. (Courtesy of Josta Hopps)
Citation: American Journal of Veterinary Research 76, 6; 10.2460/ajvr.76.6.480
Veterinarians are among the small army of public health workers fighting in West Africa against an epidemic that has so far killed more than 10,000 people and which the World Health Organization has described as “the most severe, acute public health emergency seen in modern times.”
Many veterinarians are helping to alleviate the current outbreak. Following are the accounts of three U.S. veterinarians who participated in the international response in the hardest-hit countries of Liberia, Sierra Leone, and Guinea.
Since early in the Ebola virus disease epidemic, Dr. James Zingeser had helped coordinate the emergency response in Liberia, Guinea, and Sierra Leone for the Food and Agriculture Organization of the United Nations. An epidemiologist on loan from the U.S. Centers for Disease Control and Prevention, Dr. Zingeser had no experience with Ebola. But he spoke French, had years of experience in West Africa, and was assured by the head of the CDC's Viral Special Pathogens Branch he was up to the task.
Dr. Zingeser spent part of April and May 2014 in Guinea, first in Gueckedou and then in the capital of Conakry along the Atlantic coast. Located in the southern part of the country near the Liberian and Sierra Leonean borders, Gueckedou was the epicenter of the Ebola epidemic.
From the beginning, some communities resisted cooperating with teams of medical personnel. Complicating matters were the negative impacts of the control strategies. “Government authorities stopped people from gathering in groups and closed markets. Farmers were afraid to go to their fields for fear of coming into contact with infected animals. These measures were harming food security and rural livelihoods,” Dr. Zingeser said.
Dr. Leigh Sawyer is a captain with the U.S. Public Health Service. She had several years of experience working with HIV in a biosafety level 3 laboratory before traveling in December 2014 to Margibi County in Liberia to oversee the clinical laboratory at the Monrovia Medical Unit, a 25-bed field hospital reconfigured to treat Ebola patients.
One of three USPHS veterinarians stationed at the same time at the MMU, Dr. Sawyer said veterinarians are an essential component in the response to public health crises such as the Ebola outbreak. “Veterinarians have a working knowledge and appreciation of the ecology and epidemiology of infectious diseases and the expectation that there is a link between human and animal diseases,” she said.
From November 2014 to February 2015, the Monrovia Medical Unit cared for 35 health care workers, 17 of whom tested positive for the Ebola virus, according to Dr. Sawyer. Eight of the infected patients had recovered and were discharged from the hospital by the time she left Liberia on Feb. 8.
Dr. Thomas Ksiazek is a world-renowned specialist in filoviruses with nearly 40 years’ experience on the front lines of infectious disease research.
As the former chief of the Special Pathogens Branch at the CDC, Dr. Ksiazek had coordinated outbreak and control responses to Ebola, Marburg, and sudden acute respiratory syndrome viruses. In August 2014, Dr. Ksiazek took a six-week sabbatical from the University of Texas Medical Branch, where he manages high-containment laboratory operations for the Galveston National Laboratory, to lead the CDC's Ebola outbreak control operations in Sierra Leone until late September.
Working with health officials in the capital of Freetown, the CDC team found that the epidemiologic data were incomplete and inconsistent. The outbreak began to expand into other areas from its initial epicenter, and the already sizable Ebola caseload exploded.
Before leaving Sierra Leone, his team had deployed a standardized case investigation form and connected local data collection sites into a national database, allowing analysis of the epidemiologic data on a national level.
Condensed from May 1, 2015, JAVMA News.
Tests find differences between pet foods, labels
About 40 percent of dog and cat foods tested in a recent study may have contained meats different from those listed on the product labels.
Study results indicated that of 52 wet and dry foods and treats, 13 contained meat from species not listed on the label, four lacked one or more meats listed on the label, and three had both problems (Food Control 2015;50:9–17). In addition, one wet cat food tested in the study contained meat from an undetermined species.
Rosalee S. Hellberg, PhD, one of the investigators for the study and an assistant professor in the Food Science program at Chapman University in Southern California, said she had seen little prior research on pet food misbranding. In contrast, several studies have examined misbranding of foods—particularly seafoods—intended for human consumption.
The pet food study was, in part, a response to Europe's 2013 horse meat scandal, which involved burgers and lasagna meat sold as beef. That led to product testing in 27 countries, with horse DNA found in about 5 percent of products labeled as containing beef, according to the European Commission.
In their article, “Identification of meat species in pet foods using a real-time polymerase chain reaction (PCR) assay,” the researchers from Chapman described performing PCR assays on samples of 52 pet foods bought in Orange County, California, to detect DNA from eight species of animals: cattle, goats, lambs, chickens, geese, turkeys, pigs, and horses. The article is available at http://dx.doi.org/10.1016/j.foodcont.2014.08.017.
Condensed from May 15, 2015, JAVMA News.
New specialists must demonstrate continuing expertise
The AVMA began a process for recognition of veterinary specialty organizations back in 1951. Ever since, most veterinarians who have completed the requirements for board certification have been considered to be board-certified specialists for life.
Starting in 2016, however, all new specialists will have to demonstrate efforts to maintain their competence, to maintain their certification.
The mission of the AVMA American Board of Veterinary Specialties is to recognize and encourage development of veterinary specialty organizations “promoting advanced levels of competency in well-defined areas of study or practice categories to provide the public with exceptional veterinary service.”
Dr. Dennis D. French, ABVS chair, said maintenance of certification “identifies and defines the fact that you have continued to demonstrate expertise.”
According to the ABVS Policies and Procedures, specialty organizations must issue time-limited certificates for new diplomates beginning no later than 2016. Maintenance of certification may be by examination or a point system. Diplomates may accrue points via a variety of activities.
Specialty organizations must evaluate their diplomates for maintenance of certification at least every 10 years. The ABVS encourages the specialty organizations to initiate systems for voluntary replacement of undated certificates with dated certificates that require maintenance.
Dr. French said all the specialty organizations now have a framework in place for maintenance of certification, but some are still developing the details. Most groups are using a point system rather than examinations. Some of the cafeteria-style options include attending meetings, completing continuing education, writing examination items, and contributing to the literature.
Condensed from May 1, 2015, JAVMA News.
USDA developing H5 vaccine
Federal agriculture researchers are developing a poultry-use vaccine against the highly pathogenic H5 influenza strains that have infected poultry and wildlife since December 2014.
Dr. David Suarez, research leader for the exotic and emerging avian viral disease unit at the Department of Agriculture's Agricultural Research Service, said the ARS was performing safety studies on a vaccine that should be well-matched against all the highly pathogenic H5 influenza viruses discovered in the U.S. since December 2014, unlike available commercial vaccines that would not provide as much antigenic similarity. The vaccine still needed to be reviewed and approved under regulatory processes before it could be handled by outside companies, which would produce the vaccine if needed.
The H5 influenza viruses have been found in states ranging from Washington to Arkansas, spreading from detection only in the Pacific flyway through February to the Central and Mississippi flyways further east in March and April. That spread has been accompanied by discovery of the viruses—mostly H5N2 isolates—in dozens of turkey flocks and a few chicken flocks.
Condensed from May 15, 2015, JAVMA News.
Outbreak of canine influenza caused by new strain of virus
An outbreak of canine influenza in the Chicago area ongoing as of mid-April has been caused by a strain of virus not previously detected in North America, announced scientists at Cornell University and the University of Wisconsin-Madison.
The scientists say the outbreak has been caused by a virus closely related to Asian strains of influenza A H3N2 viruses, currently in wide circulation in Chinese and South Korean dog populations since being identified in 2006. The Chicago outbreak had been attributed to the H3N8 strain of virus, which was identified in the U.S. dog population in 2004 and has been circulating throughout the country since.
Both influenza strains can cause high fever, loss of appetite, coughing, nasal discharge, and lethargy. Signs of illness may be more severe in cases caused by the H3N2 virus. Some infected dogs may not show any signs of illness. H3N2 can cause infection and respiratory illness in cats, although there is no evidence that the virus can be transmitted to humans.
It is not known if the current vaccine for dogs against H3N8 will provide any protection against H3N2.
Diagnostic testing of samples from sick pets can be done with a broadly targeted influenza A matrix reverse transcriptase PCR assay. The canine-specific influenza A H3N8 RT-PCR assay in use in several laboratories will not detect H3N2. Serologic testing to detect H3N2 is available from Cornell.
Resources on canine influenza are available from the AVMA at www.avma.org/KB/Resources by clicking on “Reference Guides.”
Condensed from May 15, 2015, JAVMA News.
College enrollment up, applicant-to-seat ratio down
The applicant-to-seat ratio at veterinary colleges has decreased more than previously thought, while first-year enrollment has seen a noticeable bump in the past two years, but tuition growth may be slowing. All that's according to the 2014–2015 Association of American Veterinary Medical Colleges annual data report.
Resident tuition at U.S. veterinary colleges grew 12.3 percent from 2010–2015, compared with 21.3 percent from 2006–2010; the mean for 2015 was $22,448. Nonresident tuition, which includes private universities’ rates, increased 5.6 percent from 2010–2015, compared with 10.3 percent from 2006–2010; the mean for 2015 was $46,352.
There was a 26 percent increase in first-year class size from 2010–2015 at U.S. veterinary colleges. The biggest jumps came in just the past two years, from a total of 2,981 first-year students in 2013 to 3,310 in 2014 to 3,586 in 2015. That's on top of the total growth rate of first-year seats from 2005–2010, which was 10.3 percent.
It appears as though growth in the number of applicants to veterinary colleges has not kept pace with the growth in number of first-year seats. Applicants through AAVMC's Veterinary Medical College Application Service increased by about 52 percent—from 4,440 to 6,769—from 2002–2013.
In 2008, the applicant-to-seat ratio was 2.4 applicants for each available seat. Then the AAVMC revised the information it gathered to reflect applicants to and seats available to U.S. students at international AAVMC member institutions. The ratio dipped the following year, hitting an all-time low of 1.5:1 in 2012.
For more information, visit www.aavmc.org/About-AAVMC/Public-Data.aspx.
Condensed from May 1, 2015, JAVMA News.
Building up practice
“Explain things in a way I understand.”
“Share test results with me.”
“Treat me as a partner.”
“Provide guidance and ways to make preventive care easy.”
These are among the factors that dog and cat owners say strengthen their bond with their veterinary practice, according to the AAHA State of the Industry 2015 report. The American Animal Hospital Association released the report during its yearly conference, March 12–15 in Tampa, Florida.
Dr. Mike Cavanaugh, AAHA chief executive officer, presented the State of the Industry 2015 report in a special session. The association has produced the annual report with Idexx Laboratories Inc. for the past three years.
Practice revenues increased a mean of 5.1 percent from 2013–2014, averaging across thousands of AAHA-accredited and nonaccredited animal hospitals. The number of active patients, or patients with at least one transaction during the year, increased a mean of 0.9 percent. Patient visits increased a mean of 1.4 percent.
The 2015 report included results from a January 2015 survey by Idexx of 1,001 dog and cat owners who visit a veterinarian regularly. Ninety-three percent of respondents believed the bond they have with their practice is important to their pet's health.
The survey revealed that, among the reasons that clients stayed with their current veterinarian, the veterinarian explaining things in an understandable way was important to more pet owners than reputation, cost, or level of medical advancement. Dr. Cavanaugh said, “The level of medicine you provide won't be appreciated if you can't make it understandable and relevant to pet owners.”
Condensed from May 15, 2015, JAVMA News.
Pet ownership down slightly, but spending up
The American Pet Products Association reports that U.S. pet ownership decreased slightly between 2012 and 2014, but spending in the U.S. pet industry increased between 2013 and 2014—including spending on veterinary care.
The APPA biennial survey of pet owners found that 79.7 million U.S. households owned pets in 2014, down 3.5 percent from 2012 but up about 50 percent over two decades. Baby boomers comprised 37 percent of pet owners. More than 10 percent of pet owners were new owners, mostly from generations X and Y.
More pet owners than two years previously, 74 percent, said they are not influenced by the economy when it comes to their pets.
The annual APPA report on pet spending found that overall spending in the U.S. pet industry increased 4.2 percent between 2013 and 2014 to $58.04 billion. The APPA predicts a 4.4 percent overall increase for 2015.
Spending on veterinary care increased 4.7 percent to $15.04 billion in 2014. The APPA predicts a 4.6 percent increase in spending on veterinary care for 2015.
In the biggest category, pet food, spending increased 3.2 percent to $22.26 billion in 2014. In the category of pet supplies and over-the-counter medications, spending increased 4.6 percent to $13.75 billion.
Spending on pet services such as grooming, boarding, walking, training, and day care increased more than in any other category, up 9.8 percent to $4.84 billion in 2014. Spending on purchases of pets decreased 3.6 percent to $2.15 billion.
Condensed from May 1, 2015, JAVMA News.
Supply increasing for large-volume fluids
The supply of large-volume polyionic fluids for parenteral administration in large animals was projected to increase as of press time in late April.
According to the Food and Drug Administration, “The current shortage has been triggered by several factors, including increased demand combined with reduced manufacturing of the sizes most suitable for use in large animals.”
Zoetis Inc. shipped 5-L bags of Plasma-Lyte in mid-March and mid-April and shipped 5-L bags of lactated Ringer's solution in mid-April. The company had acquired Abbott Laboratories’ animal health assets in February and continued operating existing fluids contracts and agreements with suppliers and distributors. Zoetis advised veterinarians to contact their distributors to obtain fluids.
According to a statement from the company, “Zoetis remains acutely aware of how sensitive this situation is and of the importance of fluid supply for our veterinary customers.”
The FDA announced April 24 that large-volume fluids would be arriving from abroad. The FDA is allowing the distribution of certain foreign products in the United States temporarily.
Dechra Veterinary Products will provide products from its Ireland manufacturing facility via distributor Vedco Inc. Baxter Healthcare Pty. Ltd. in Australia will distribute products via Henry Schein Animal Health. Sypharma Pty. Ltd. of Australia will distribute products via Animal Health International Inc.
The FDA is working closely with manufacturers to meet the needs for large-volume fluids. As products become available, the agency is providing updates at http://jav.ma/1czrV4u. Visitors to the page may sign up for email alerts.
Combined from May 15 and June 1, 2015, JAVMA News.
Pain relief needed in youngest pigs
Veterinarians have no approved drugs to reduce pain in pigs, but Dr. Michael D. Apley thinks they have extralabel use options.
He said drugs used in pets and others used in humans may be useable for anesthesia and analgesia in pigs, under federal regulations that allow use of those drugs in the absence of options approved for use in food animals. But he warned that detectable residues from drugs without established tolerance levels would be illegal.
In the absence of established tolerance levels, veterinarians can still estimate withdrawal times, but must do so on the basis of limited data or by extrapolation beyond currently available data.
Dr. Apley, a professor of production medicine and clinical pharmacology at Kansas State University, was among presenters on pain management in pigs during the American Association of Swine Veterinarians annual meeting, which this year ran Feb. 28-March 3 in Orlando, Florida. Dr. Ronnie L. Brodersen, who became AASV president during the meeting and chaired the program committee, said in an interview that pain management is an important issue in swine medicine.
Dr. Locke A. Karriker, director of the Swine Medicine Education Center at Iowa State University, said the public has increasing concern about pain control in animals raised for food, particularly with regard to husbandry practices such as castration and tail docking. A lack of objective pain assessments has been a limiting factor in creating dosage regimens, he said, and pharmacokinetic data for one pig age group cannot be extrapolated to others.
Dr. Karriker described a study that indicated meloxicam, an NSAID, administered orally to a sow could be passed to nursing pigs through milk, with indications it reduced pain- or stress-associated vasoconstriction.
Condensed from May 1, 2015, JAVMA News.
