The bycatch of trap-neuter-vaccinate-return

In a recent letter, Weedon et al¹ argue that trap-neuter-vaccinate-return is the one approach that has been successfully used to address the problem of free-roaming cats. In their letter, however, they fail to acknowledge the harm that free-roaming and feral cats can cause for populations of songbirds, rodents, amphibians, reptiles, and insects. It is generally accepted that millions of birds and other creatures are killed or maimed annually by free-roaming and feral cats. Ignoring the damage done by cats to wildlife species, I believe, flies in the face of what we as veterinarians have pledged to do.

Weedon et al¹ state that outdoor community cats have healthy weights and do not have higher rates of infection than pet cats. I find this hard to believe, but even if it is true, it is, to me, beside the point. Consideration for species preyed on by free-roaming and feral cats must be taken into account in any discussion about solving the free-roaming and feral cat population problems.

Ed Wolff, dvm

Stevensville, Mont

Contamination of commercially available dog foods with thyroid tissue

In the recent article describing dogs with exogenous thyrotoxicosis attributed to feeding commercial dog food or treats containing excessive thyroid hormone,¹ the authors mention the products that were consumed, but they don't mention whether these products were produced in the United States or some other country. Although the manufacturers of most of the suspect diets were located in California, this does not necessarily mean the products themselves or the raw ingredients were produced in the United States. Considering recent problems with some pet foods from China, I believe it would have been helpful to identify the source of the ingredients included in the dog foods and treats suspected to have caused exogenous thyrotoxicosis in these 14 dogs.

Donald Marcus, vmd

Methuen, Mass

The authors respond:

We wish to thank Dr. Marcus for his interest in our report. Furthermore, we agree that information about the sources of ingredients used by the manufacturers of the dog foods and treats identified in our report may prove interesting. The goal of our report, however, was simply to make practicing veterinarians aware of the possibility that thyrotoxicosis may occur in pets secondary to consumption of commercially available dog foods and treats containing high concentrations of thyroid hormone as a result of contamination with thyroid tissue. As the authors of this report, we were not in a position to demand, nor were we provided with, details of the ingredients or the sources of the ingredients used in the dog foods and treats identified in our report. We consider determining the origin of the offending thyroid tissue a matter for the appropriate regulatory agencies. Toward that end, we forwarded our results as well as available samples of the dog foods and treats to the FDA for their analysis.

In the wake of recent problems with some pet foods originating from China, it appears many pet food companies are seeking to distance themselves from ingredients originating outside the United States. Although we cannot speak to the accuracy of their statements, several of the companies whose products were implicated in our report claim on their website to feature products “made in the USA” or that “all meats are sourced from USA, New Zealand or Australia.”^1–3 Regardless of the source of the meat products used, we believe that the process of gullet trimming is itself inherently prone to unintended collection of thyroid tissue. The global nature of this concern is demonstrated by cases of exogenous thyrotoxicosis identified in people in Canada, Japan, The Netherlands, the United States, and Uruguay.

The USDA effectively ended outbreaks of exogenous thyrotoxicosis in people in the United States in 1986 by banning the practice of gullet trimming for the collection of meat products intended for human consumption.⁴ Currently, the USDA lists beef gullets and tracheas as acceptable for use in pet foods. As long as meat destined to be included in pet foods is harvested by means of gullet trimming, we believe that veterinarians should include exogenous thyrotoxicosis secondary to dietary consumption of excessive thyroid hormone in their list of differential diagnoses for dogs with high serum thyroid hormone concentrations.

Michael R. Broome, dvm, ms

Advanced Veterinary Medical Imaging Tustin, Calif

Mark E. Peterson, dvm

Animal Endocrine Clinic New York, NY

Robert J. Kemppainen, dvm, phd

Department of Anatomy, Physiology and Pharmacology College of Veterinary Medicine Auburn University Auburn, Ala

Valerie J. Parker, dvm

Department of Veterinary Clinical Sciences College of Veterinary Medicine The Ohio State University Columbus, Ohio

Keith P. Richter, dvm

Veterinary Specialty Hospital San Diego, Calif

Management of dogs and cats overdue for rabies booster

I was pleased to read the recent report by Moore et al¹ comparing anamnestic responses to booster rabies vaccination in dogs and cats with current versus out-of-date rabies vaccination status. Hopefully, state departments of health will use the findings as an impetus to review their regulations concerning management of pet dogs and cats potentially exposed to rabies, particularly dogs and cats overdue for a booster vaccination. Recommendations in the Compendium of Animal Rabies Prevention and Control² have always been somewhat vague concerning management of previously vaccinated dogs and cats overdue for booster vaccination, leading many states to group them with animals that have never been vaccinated. The compendium² warns that “[t]iters do not directly correlate with protection” against rabies and that “evidence of circulating rabies virus antibodies in animals should not be used as a substitute for current vaccination in managing rabies exposures or determining the need for booster vaccinations.” Nevertheless, titers can be used in management decisions. Hawaii, for instance, which has a tremendous financial and ecological stake in rabies prevention, uses titers when determining whether the import quarantine for pet dogs and cats should be 120 days or only 5.

The findings by Moore et al¹ should also prompt a review of regulations in those states and counties that do not follow the recommendation² that previously vaccinated dogs and cats overdue for a booster be revaccinated and subsequently placed on a booster schedule in accordance with the label duration of the vaccine used. It is my understanding that some localities refuse to recognize a 3-year vaccine given to a pet overdue for a rabies vaccination as good for 3 years.

Two years ago, I cared for two 13-year-old sibling cats that were 3 months overdue for their fifth lifetime rabies vaccination. The male had grabbed, but apparently not harmed, a brown bat that was allowed to fly away. Hoping the information would be considered, I obtained pre- and postvaccination rabies neutralizing antibody titers on both cats. For the male cat, pre- and postvaccination titers were 10 and 12 U/mL, respectively, and for the female cat, titers were both > 12 U/mL, well beyond the titer considered protective. Both cats were ordered held in a quarantine facility for 6 months. Luckily, the owners were able to afford the cost of quarantine, and the cats fared well. But as Moore et al¹ indicate, for many pets, because of age, medical or behavioral conditions, or, primarily, cost, an order for a lengthy quarantine is a death sentence. We need to be vigilant and improve the abysmally low vaccination rates of dogs and cats, but overly strict regulations, labeling pets as overdue in some localities when they would be considered current in others, and lengthy quarantines are a financial burden on the public and pet owners, strain the human-animal bond, cost pet lives, and do nothing to protect human lives. I sincerely hope that the proof of a rapid and strong immunologic response in dogs and cats with an out-of-date rabies vaccination status presented by Moore et al¹ will stimulate a review of vaccination protocols and quarantine regulations.

Patricia Burke, dvm

Providence, RI

Continued recognition of the AVMA Council on Education

The National Advisory Committee on Institutional Quality and Integrity (NACIQI) advises the Secretary of Education on matters related to postsecondary education accreditation, including recognition of accrediting agencies by the US Department of Education.¹ On December 11, 2014, the NACIQI held a hearing regarding continued recognition of the AVMA Council on Education (COE) as the accrediting agency for schools and colleges of veterinary medicine in the United States. The NACIQI staff identified concerns regarding COE compliance with four sections of the US Department of Education criteria for recognition.² Of these, the most important appears to be concerns related to compliance with section 602.13, which states that the agency must demonstrate wide acceptance among educators and practitioners.

Given the findings of the NACIQI staff, I believe that it is essential that the AVMA reach out to its members to gain wider acceptance of COE methods and procedures for veterinary college accreditation. Now is the time for the AVMA to intently listen to its constituents.

It is clear that there are some within the veterinary profession who believe that the COE is not using a strict enough interpretation when applying the standards of accreditation. While there may be a temptation for the AVMA to dismiss these individuals as a minority interest, I believe that, at end, their major concern is maintaining the highest quality standards and their major objective is preserving the value of the veterinary degree. Thus, I believe the AVMA would be wise to consider the opinions of this minority.

One of the responsibilities of the COE, as stated in the AVMA Bylaws, is to ensure that the council meets “the needs of society by promoting active programs in veterinary medical education by, among other things, encouraging and assisting schools and colleges of veterinary medicine to meet the requirements for full accreditation.” In this regard, I believe it would be helpful for the COE to clarify the criteria it uses to determine whether it is meeting the needs of society and for the AVMA Board of Directors to provide its comprehensive vision of the future of veterinary medical education in the United States. By doing so, I believe the AVMA will demonstrate true leadership and create a stronger relationship with its members.

Robert B. Cherenson, dvm

Lander Veterinary Clinic Turlock, Calif

The AVMA Council on Education responds:

As members of the Executive Committee of the AVMA Council on Education (COE), we would like to respond to Dr. Cherenson's letter. The US Department of Education recognition process is a voluntary process, and accreditors must show they meet specific criteria to be eligible to participate in the process. One criterion is that an agency must demonstrate that, for at least one of the institutions it accredits, accreditation by the agency is required to establish eligibility to participate in a federal program. In this regard, the COE is eligible to participate in the US Department of Education recognition process because veterinary students must attend a veterinary college accredited by the COE to participate in the Health Professions Student Loan program.

The US Department of Education recognition process requires that accreditors be reevaluated for compliance with the recognition criteria every five years. During a December 2012 meeting with the National Advisory Committee on Institutional Quality and Integrity (NACIQI), which advises the Secretary of Education on US Department of Education recognition of accrediting agencies, the COE, similar to the case for other accreditors, was found to not be in compliance with a number of recognition criteria. Changes were made to address these issues, and in a follow-up meeting in December 2014, the COE was found to have adequately addressed many of the concerns. However, three issues still remained and two new concerns were identified by the NACIQI. The COE is committed to coming into compliance with these remaining recognition criteria.

Irrespective of membership in the AVMA, input from all members of the veterinary medical profession is welcomed by the COE. A stakeholder listening session was held by COE representatives at this year's North American Veterinary Community Conference, and additional listening sessions are planned for other venues. The input received from these sessions will be brought to the full COE for deliberation.

Members of the veterinary profession and the public are routinely solicited to provide feedback to the COE. All proposed changes to the COE accreditation standards are open for public comment and posted on the public section of the AVMA website. In addition, the 11 standards as a whole are reviewed every four years. The COE has received and will continue to receive input from outside sources, and information from all sources is reviewed and discussed, with any proposed changes coming out of those discussions published for further comment.

Council membership includes broad representation and expertise from across the veterinary profession as well as representatives from the general public. Council members spend numerous hours in volunteer service to the COE, as do partners, associates, faculty, and other colleagues who support the council's activities. As our colleagues, COE members are focused on maintaining the high quality of veterinary medical education. Colleges are evaluated on the basis of compliance with each of the COE accreditation standards. Compliance with some standards can be verified on the basis of available data; however, compliance with other standards requires the use of the collective professional judgment of the COE. The recent initiation of a standard evaluation rubric will enhance the consistency of site team evaluations of veterinary colleges and provide guidance and clarity to site teams in the interpretation of the standards. This rubric gives guidance on the intent of each standard as well as the type of evidence needed to determine compliance. The evaluation rubric can be found in Appendix I of the Accreditation Policies and Procedures of the AVMA COE.¹

A number of changes have occurred in the accreditation process over the past two years. We encourage our colleagues to learn more about these changes and to provide input as the COE continues to evolve.

Frederik J. Derksen, dvm, phd

COE Chair East Lansing, Mich

Ronald E. Gill, dvm

COE Vice Chair West Salem, Ill

Nicole K. Roberts, phd

COE Academic Affairs Committee Chair New York, NY

John R. Pascoe, bvsc, phd

COE Evaluation Committee Chair Davis, Calif