A review of moxidectin vs. other macrocyclic lactones for prevention of heartworm disease in dogs with an appraisal of two commercial formulations.

Macrocyclic lactones (MLs) are the only drug class currently licensed for heartworm disease prophylaxis. Macrocyclic lactones kill third- and fourth-stage larvae of Dirofilaria immitis, thus preventing the development of adult worms in dogs, which are responsible for heartworm disease, a potentially life-threatening condition. Despite considerable overlap in terms of endectocide spectrum, several important differences distinguish moxidectin from other MLs. Moxidectin has beneficial pharmacokinetic characteristics, such as a longer half-life and greater tissue distribution compared to ivermectin. Additionally, moxidectin has a greater margin of safety compared to ivermectin in dogs with ABCB1 (previously MDR1) gene-defect, which is commonly recognized in collies and other breeds. Multiple laboratory studies have shown that moxidectin is more effective than other commonly used heartworm preventives against resistant strains of D. immitis. This improved efficacy benefits individual dogs and helps reduce the risk of spreading resistant strains within the community. Despite the presence of proven resistant strains in the United States, non-compliance with preventive measures remains a major factor contributing to the diagnosis of heartworm disease in dogs. In retrospective analyses, the oral moxidectin combination product Simparica Trio® (sarolaner, moxidectin, and pyrantel) was associated with increased compliance, resulting in more time of protection compared to dogs receiving flea/tick and heartworm preventive products separately. Compliance with the extended-release moxidectin injectables ProHeart® 6 and ProHeart® 12 was higher than with monthly heartworm preventives, as they provide 6 months or a full year of protection with one single injection, respectively, and revenues remain in the veterinary clinics as injectable moxidectin cannot be sourced through online retailers.

Dog Owners' Perceptions of the Convenience and Value of Chewable Oclacitinib: Quantitative Survey Data from an International Survey.

Oclacitinib is an oral therapy indicated for pruritus associated with allergic or atopic dermatitis in dogs. This study sought to assess pet owners' perceptions of the relative convenience and value of the conventional film-coated formulation and the chewable formulation. A quantitative discrete-choice experimental methodology was applied, comparing (conventional, film-coated) oclacitinib versus chewable oclacitinib using unbranded treatment profiles. Initially, a qualitative interview phase with pet owners and veterinarians was conducted to develop detailed treatment profiles. Subsequently, pet owners participated in a quantitative survey. Overall, 1590 pet owners provided survey responses. Most respondents (62%) reported having experienced challenges administering tablet-based therapies to their dog(s). Half of all respondents (52%) had experience administering flavoured or chewable tablets to their dog. Comparing oclacitinib and chewable oclacitinib (with or without associated costs), the majority of the respondents preferred the chewable formulation in all regions across short-term and long-term scenarios (≥58%; all p < 0.05). The current research is one of few survey-driven studies for treatment preferences in companion animal medicine. Veterinarians may offer chewable or palatable treatment options where available, with potential positive impacts on convenience, compliance, outcomes, quality of life, and the human-animal bond.

Diminished antimicrobial drug use in dogs with allergic dermatitis treated with oclacitinib.

Introduction: Dogs with allergic dermatitis often suffer concurrent skin and ear infections. The objective of this study was to retrospectively quantify the number of systemic and topical antimicrobial transactions in dogs with allergic dermatitis, following administration of oclacitinib or a glucocorticoid, compared to dogs that did not receive a pruritus therapy when there is an initial diagnosis of pyoderma. A secondary objective was to demonstrate that dogs on oclacitinib use fewer antimicrobials and concomitant therapies over time and have improved quality of life. Materials and methods: This was a retrospective case-control study using a large, centralized database to identify canine patients receiving pruritus therapy along with a concurrent diagnosis of pyoderma. For the second objective, 58 client-owned dogs diagnosed with allergic dermatitis were enrolled in a prospective owner and dog quality of life and treatment satisfaction (QoL&TS) study that also evaluated concomitant therapy use over time. In Part A, data consisted of anonymous transaction records from 1,134 hospitals across the United States, representing pyoderma visits between December 2018 and December 2019. Odds ratios comparing the relative odds of having additional antimicrobial agent transactions were calculated, given initial pruritus therapy compared to dogs that did not receive pruritus therapy. Parametric bootstrapping was used to calculate goodness-of-fit statistics. In part B, dogs entered the study on Day 0 and returned for examination on Days 14, 21, 30, and 60. Owner determination of QoL&TS was performed on Days 0, 1, 3, 14, 21, 30, and 60. On Days 0, 14, 21, and 60, a veterinarian assessed concomitant therapies and dermatitis severity scoring. Least Squares Means and Standard Errors for QoL&TS, and Dermatitis Vet VAS (Visual Analog Scale) Scores were calculated using a Linear Mixed Model Approach for Repeated Measures (α = 0.05). The percent reduction in therapies was also calculated. Results: Dogs that received oclacitinib (n = 5,132) or a glucocorticoid (n = 7,024) had reduced odds (OR: 0.8091; p = 0.0002 and OR: 0.7095; p < 0.0001, respectively) of having a follow up antimicrobial drug transaction after initial antimicrobial therapy compared to dogs with no pruritus therapy at the initial visit (n = 12,997). In part B, oclacitinib demonstrated a statistically significant improvement in QoL&TS scores over time QoL (p < 0.05). Veterinarian assessment showed a 70% reduction in dermatitis severity over time (p < 0.05), supporting oclacitinib's anti-inflammatory effects. Oclacitinib therapy was also associated with an 83% reduction in concomitant treatments, including a 100% reduction in systemic antimicrobial therapy over eight weeks. Discussion: Dogs receiving oclacitinib showed no increase in antimicrobial therapy transactions compared to glucocorticoid recipients at the initial pyoderma diagnosis. Having a pruritus therapy at the index pyoderma visit reduced the odds of subsequent antimicrobial transactions. In addition to reducing concomitant therapy usage, oclacitinib improved owner and pet QoL, suggesting a paradigm shift in treatment success that could reshape allergic pruritus therapy recommendations. The study provides empirical evidence of oclacitinib's reduction in antibacterial therapy, supporting its therapeutic value and antimicrobial stewardship.

Retrospective analyses of heartworm (Dirofilaria immitis) disease and ectoparasite preventive medication compliance in veterinary practices in the USA.

BACKGROUND: Compliance failure with administration of heartworm (HW) disease preventives has been reported as the main contributor to HW disease incidence in medicalized dogs. This study aimed to evaluate purchase compliance with different canine HW preventive products in the USA. METHODS: Anonymized transaction data from clinics throughout the USA served as the basis for two retrospective analyses. We first examined the monthly equivalent doses of HW preventive purchases from clinics that had implemented extended-release moxidectin injectables ProHeart® 6 (PH6) and/or ProHeart® 12 (PH12) compared to clinics that prescribed monthly HW preventatives (MHWP) only. In the second analysis, the purchase compliance in practices that dispensed only flea and tick (FT) and HW products separately but did not dispense combination products (dual-therapy practices) was compared to the purchase compliance with the combination product Simparica Trio® (sarolaner, moxidectin, and pyrantel chewable tablets), purchased in clinics having implemented combination therapy in their formulary (combination-therapy practices). In both analyses, the numbers of monthly doses dispensed annually per dog were calculated. RESULTS: Transaction data from 3,539,990 dogs in 4615 practices were included in the first analysis. In dogs administered PH12 or PH6, the numbers of monthly equivalent doses were 12 and 8.1, respectively. In both clinic types, the average annual number of MHWP doses totaled 7.3. In the second analysis, a total of 919 practices were identified as combination-therapy practices and 434 as dual-therapy-only practices. A total of 246,654 dogs (160,854 dogs in dual-therapy practices and 85,800 dogs in combination-therapy practices) were included in the calculation of the average annual number of monthly doses, which totaled 6.8 (HW preventive products) and 4.4 (FT products) in dual-therapy practices compared to 7.2 months for both FT and HW preventives with Simparica Trio® across both practice types. CONCLUSIONS: The injectable HW preventive PH12 is the only product that provides 12 months of heartworm disease prevention in a single veterinarian-administered injection. When choosing a monthly preventive, the combination therapy was associated with a greater purchase compliance compared with FT and HW products being dispensed separately.

Prevention and long-term outcomes of naturally occurring canine heartworm infection in primary care settings.

Background: This study had two objectives: first, to examine the association between the history of heartworm preventive purchase compliance and the risk of positive heartworm tests, and second to preliminarily investigate the long-term cardiac outcomes of heartworm disease in dogs that had undergone successful adulticidal therapy. Methods: A retrospective cohort study design was used for both analyses, using anonymous transaction data from Covetrus (retrospective analysis 1) and anonymized medical records from Banfield Pet Hospital (retrospective analysis 2), both including canine patients across the USA. The first analysis examined the relative risk (RR) of a positive heartworm test in dogs with lapses in heartworm preventive purchase history compared to dogs that had no history of a preventive purchase six to 24 months prior to the test. In the second analysis, a long-term evaluation of structured diagnostic codes pertaining to cardiac diseases and risk assessment of outcomes was performed in dogs that had previously been successfully treated for heartworm disease compared to dogs that never had a positive heartworm test. Results: 83,478 unique patients were included in the first analysis. Compared to 32,413 dogs with no history of a heartworm preventive purchase, 44,410 dogs with lapses in monthly preventive purchases had a reduced risk of testing positive for heartworm disease (RR = 0.36, p < 0.0001). Dogs (n = 6,655) with lapses in injectable heartworm preventive administration had a decreased risk of a positive test versus dogs with no preventive purchases (RR = 0.15, p < 0.0001), as well as versus dogs with lapses in monthly heartworm preventive purchases (RR = 0.28, p = 0.0024). In the second analysis, 6,138 patients treated for heartworm infection were found to have significantly (p < 0.001) elevated risks of right heart failure (RR = 3.59), left heart failure (RR = 1.83), or cardiomyopathy (RR = 2.79) compared to 4,022,752 patients that never had a positive heartworm test. Conclusion: This study highlights the importance of compliance with heartworm preventive guidelines, to reduce the risk of heartworm disease in dogs, which is not only a potentially life-threatening condition in the short-term but also associated with long-term negative cardiac outcomes.

The compliance and revenue benefits of ProHeart Vs monthly heartworm disease preventives in the US.

The aim of the current study was to understand how the canine heartworm disease preventive ProHeart® 12 (extended-release injectable moxidectin, PH 12), impacts heartworm preventive purchase compliance and veterinary practice revenue over time compared to monthly heartworm disease preventives. This was a preliminary observational purchase compliance and revenue study based on a retrospective review of transaction data from 4,615 general practices across the United States. The review period was from September 2018 to August 2020. Anonymous transaction records of over 13 million canine patients were analyzed. Of these, only 3.5 million (25.7%) patients purchased any heartworm preventive, as has been presented in other studies. Practices that implemented PH 12 demonstrated the most growth in canine heartworm prevention revenue, patients, and patient compliance levels during the 12-month observation period, compared to previous year. These practices saw year over year growth in percent patients receiving heartworm protection, as well as 10% and 15% growth in the proportion of preventive patients compliant for more than 6 months and 12 months respectively. In contrast, practices that did not bring on PH 12 and only dispensed monthly heartworm preventives saw a decline in the proportion of canine preventive patients that were compliant for more than 6 months. Similarly, PH 12 practices experienced 15% growth in preventive revenue, and practices that did not bring on PH 12 only experienced 3.9% growth in preventive revenue. PH 12 was single-handedly responsible for all growth in patients compliant for more than 6 months in this study. Growth in protection of canine patients with PH 12 proves a helpful tool where mitigation strategies have thus far failed to curb increasing canine heartworm disease prevalence in the US.

Pharmacoeconomic Analysis of Heartworm Preventive Compliance and Revenue in Veterinary Practices in the United States.

Background: Heartworm disease (HWD) is a potentially fatal condition caused by the nematode Dirofilaria immitis. It is endemic in North America, and the American Heartworm Society recommends that owned dogs be on a Food and Drug Administration-approved HWD preventive year-round. The objective of this study was to compare the 12-month HWD preventive purchase compliance rates of injectable moxidectin (ProHeart® 6) and the dose equivalent in monthly HWD preventives and their associated economic value to the veterinary hospital. Methods: This study used retrospective anonymized transactional data of 7,926,392 unique dogs from 3,737 companion animal practices across the US for the period 2014-2017. Compliance was defined using American Heartworm Society guidelines. Comparisons were purchases of a 6-month moxidectin injection or six doses of any monthly HWD or HWD combination preventive product, tracked for the next preventive purchase 5-7 months later. Total revenue, HWD prevention cost, 12-month repurchase compliance, and patient retention were calculated. Data were expressed on an annualized basis. Compliance comparisons were calculated based on proportion analysis with the SAS ProbNorm function (SAS 9.4, Cary, NC), using a two-sided t-test, at the 5% level of significance (P < 0.05). Results: At 51.7%, annual compliance with injectable moxidectin was higher than the dose equivalent in monthly HWD preventives, which was 24.4% (P = 0.0001). Eighty-five percent of patients on injectable moxidectin recorded additional transactions during the first visit (average invoice of $161), compared with only 55% of pet owners who purchased monthly HWD prevention (average invoice $141) or monthly HWD combination (average invoice of $171). The average costs of 6 months of HWD preventives were as follows: injectable moxidectin, $48 (29.7% of the total visit invoice); monthly HWD prevention, $45 (31.0% of the total invoice); and monthly HWD combination, 95 (55.6% of the total visit invoice). Finally, dogs receiving injectable moxidectin had a higher proportion of patients with repeat injections within 12 months between 2014 and 2017, with 68% retention rate after 4 years. In comparison, the six-dose monthly HWD cohort retention rate dropped to 55% by 2017. Conclusions: Dogs receiving injectable moxidectin had higher HWD preventive compliance, generated more practice revenue, and had a higher rate of practice retention compared with monthly HWD products.

Corrigendum: Retrospective Analysis of Heartworm (Dirofilia immitis) Prevention Medication Compliance and Economic Value in Dogs in Veterinary Practices in Australia.

[This corrects the article DOI: 10.3389/fvets.2020.602907.].

Indicators of Health-Related Quality of Life in Cats With Degenerative Joint Disease: Systematic Review and Proposal of a Conceptual Framework.

Objectives: The assessment of health-related quality of life (HRQoL) is becoming increasingly important in companion animals. This study describes a systematic review and development of a proposed conceptual framework to assess HRQoL in cats with osteoarthritis (OA). Methods: The conceptual framework was developed according to published guidelines. A comprehensive search of the CAB Direct, Scopus, PubMed, and Web of Science databases was carried out for publications in English from inception to November 12, 2019. Search words used were "cat", "feline", "chronic pain", "pain", and "quality of life". Publications were selected if they were full-text and peer-reviewed, based on primary data, and identified or measured behavioral symptoms of chronic musculoskeletal pain in cats. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A data extraction form was developed from categories identified in the literature review and piloted on a small number of studies to ascertain the appropriateness for relevant data extraction. Categories were then finalized, and key domains were identified. The domains were then synthesized to develop a conceptual framework. Results: A total of 454 studies were identified, of which 14 met the eligibility criteria and were included in the meta-synthesis. All 14 were assessed to be of good quality. Seven domains related to HRQoL in cats with OA were thematically identified from the data: mobility, physical appearance, energy and vitality, mood, pain expression, sociability, and physical and mental wellbeing. The three main HRQoL domains were pain expression, mobility, and physical and mental wellbeing, which impacted all the others. Pain and mobility impacted all six other domains, with increased pain and decreased mobility negatively impacting physical appearance, energy and vitality, mood, sociability, and physical and mental wellbeing. Conclusions and Relevance: This is the first study to develop an evidence-based conceptual framework for the assessment of HRQoL in cats with OA. The proposed conceptual framework suggests that effective management of chronic pain in cats may improve their overall HRQoL.

Optimizing heartworm diagnosis in dogs using multiple test combinations.

BACKGROUND: Various heartworm (HW) diagnostic testing modalities detect products of, or reactions to, different life cycle stages of Dirofilaria immitis. Microfilariae (Mf) can be directly visualized in blood, antigen (Ag) from immature and adult heartworms may be detected on commercial assays, and antibody (Ab) tests detect the host immune response to larval stages. Ag and Mf tests are commonly used in dogs, which frequently carry adult HW infections, but Ab tests have only been validated for use in cats. In some HW-infected dogs, Ag is blocked by immune complexing leading to false-negative results. Heat-treatment (HT) to disrupt these complexes can increase the sensitivity of HW Ag tests. The aim of this study was to compare different methods for diagnosing HW infection in dogs at high risk using individual and paired diagnostic tests, including an exploration of using Ab tests designed for cats to test canine samples. METHODS: One hundred stray adult (≥ 2-year-old) dogs in Florida shelters were tested using Mf, HW Ag, and HW Ab tests (feline HW Ab tests currently not commercially validated/approved for use in dogs); two versions of each test platform were used. RESULTS: Fourteen dogs tested positive using point-of-care (POC) Ag tests; an additional 2 dogs tested positive with microtiter well assay, and an additional 12 dogs tested positive using HT Ag testing. For individual tests, Ag test sensitivity/specificity compared to HT Ag was 50-57%/100%, and Ab tests were 46-64%/82-94%. Sensitivity estimates for individual tests were higher when comparing to non-HT Ag. Pairing POC Ag tests with Mf tests improved sensitivity without loss of specificity, while pairing POC Ag and Ab tests modestly increased sensitivity at the expense of specificity. CONCLUSIONS: Screening dogs for HW infection using both POC Ag and Mf detection, which is recommended by the American Heartworm Society, improved diagnostic performance in this study compared to single Ag test use, but may have missed more than one in four infected dogs. The need to improve access to highly accurate, rapid, and inexpensive large-scale HW testing for dogs in animal shelters remains largely unmet by current testing availability. The development of practical and validated protocols that incorporate heat or chemical treatment to disrupt Ag-Ab complexes in POC testing or decreasing the cost and time required for such testing in reference laboratories might provide solutions to this unmet need. Similar studies performed in countries where the prevalence of parasites such as D. repens or A. vasorum is different to the USA could potentially yield very different positive predictive values for both HT and non-HT Ag tests.

Retrospective Analysis of Heartworm (Dirofilia immitis) Prevention Medication Compliance and Economic Value in Dogs in Veterinary Practices in Australia.

Background: Canine heartworm (HW) is endemic in Australia. Prevention usually involves monthly topical or oral preventives, or annual injections of extended-release moxidectin (ProHeart SR-12*), hereafter referred to as injectable moxidectin (IM). Poor compliance can leave dogs susceptible to infection. This pharmacoeconomics study used retrospective transactional data from 52 Australian veterinary practices to examine the economic value of compliance, revenue, and patient retention associated with veterinarian-sourced canine HW prevention. Methods: This longitudinal descriptive study utilized anonymized transaction records of 228,185 dogs identified to have visited a veterinary practice at least twice in the period 2010-2015. Purchase compliance against a benchmark of 12 months HW protection per year was measured for IM or monthly HW (MHW) preparations each year and for consecutive years. The average annual cost per dog by preventative modality was also determined. Results: Between 2010 and 2015, of the 228,185 dogs identified, 73.0% recorded either zero or one purchase of HW preventive from their veterinary clinic; 18.7% recorded at least two IM purchases, and 10.6% purchased MHW prevention at least twice. Single-year purchase compliance was 92.8-96.9% for IM vs. 26.9-36.5% for dogs receiving MHW products. Consecutive-year purchase compliance was 76.7% for IM and 24.4% for MHW medications. Dog owners spent $AU108.29/dog/year (Australian dollars) on IM vs. $AU131.96/dog/year on MHW prevention products, which may have treated other parasites concurrently, although repeat MHW purchasers only purchased enough to cover an average of 7.2 months per year. Dogs recording at least two HW prevention transactions generated more revenue for veterinary practices/dog/year compared to dogs with less than two. Finally, dogs receiving IM, especially those that started at <15 months old, had the highest retention rate in this population. Conclusions: In the 5 years from 2010 to 2015, 73% of dog owners who visited a veterinary practice at least twice made less than two purchases of HW preventatives from the veterinary practice. For those with at least two preventative purchases, 76.7% of dogs receiving IM and 24.4% of dogs prescribed with MHW products purchased enough doses to provide continuous protection over the observation period.

Owner and Veterinarian Perceptions About Use of a Canine Quality of Life Survey in Primary Care Settings.

This paper describes dog owner and veterinarian perceptions around the use of a validated canine quality of life (QOL) survey to facilitate wellness conversations in two clinical settings: a veterinary teaching hospital (pilot, Phase 1) and five corporate general practice hospitals (Phase 2). Phase 1 results showed that dog owners felt the survey was valuable for understanding their dog's QOL, with 81% of owners expressing interest in learning more about canine QOL. Phase 2 reinforced owner perceptions about the survey conveyed during the pilot phase, and veterinarians reported that the survey facilitated client communication related to preventive care without increasing consultation time. These results demonstrate that beyond using QOL assessments to track patient health, the use of a QOL survey during veterinary visits could improve owner-veterinarian discussions around QOL, wellness, services and preventive care. To fully realize these benefits in clinical settings, veterinary staff preparation may be needed to communicate the purpose of QOL assessments to clients and thus facilitate deeper conversations about client needs and concerns. Key tools for achieving these could therefore include (1) sufficient veterinary team training to understand the QOL assessment and its purpose (2) training in how to communicate QOL to clients, and (3) reflexive use of QOL assessment results to engage clients in preventive care discussions. The veterinarian and client can then discuss the pros and cons of the various aspects of QOL and preventive care to arrive at a cooperative decision.

Side Effects to Systemic Glucocorticoid Therapy in Dogs Under Primary Veterinary Care in the UK.

Objectives: Systemic glucocorticoids are widely used in companion animals. This study aimed to estimate the frequency, describe the characteristics and to evaluate risk factors for common side effects to systemic glucocorticoid therapy in dogs under primary veterinary care in the UK. Methods: A cohort study using VetCompass™ data from 455,557 dogs under primary veterinary care during 2013 estimated the frequency of side effects to systemic glucocorticoid therapy occurring within 31 days of therapy. Risk factors for the most common side effects, polyuria and polydipsia (PUPD), were evaluated using multivariable logistic regression modeling (P < 0.05). Results: During 2013, 28,472 study dogs received systemic glucocorticoids (6.2%, 95% CI 6.2-6.3). Review of the records of 3,000 randomly selected treated dogs identified 148 (4.9%, 95% CI 4.2-5.7%) dogs with at least one side effect recorded within 31 days of therapy. The most frequent side effects were polydipsia (39.2% of total presenting signs), polyuria (28.4%), vomiting (16.2%) and diarrhea (14.9%), dogs receiving only oral systemic glucocorticoids (odds ratio, OR: 3.72) and dogs receiving both oral and injectable systemic glucocorticoid (OR: 10.71) had increased odds of PUPD compared with dogs receiving only injectable systemic glucocorticoid. Focusing on the active substance used, treatment with prednisolone tablets only (OR: 3.53) and treatment with both prednisolone tablets and injectable dexamethasone sodium phosphate (OR: 7.62) showed increased odds of PUPD compared to treatment with injectable dexamethasone sodium phosphate only. Brief: These results can assist veterinarians to optimize therapeutic selection for reduced side effect, to inform owners on common side effects, and help protect the welfare of pets and their owners.

Heartworm prevalence in dogs versus cats: Multiple diagnostic modalities provide new insights.

The cornerstones of diagnosis of heartworm (HW) in dogs are the detection of circulating antigen from adult female Dirofilaria immitis or the visualization of microfilariae in whole blood. These tests are less sensitive in cats because of the feline immune response leading to low numbers of adult worms, but heartworm antibody tests are also licensed for use in cats. HW antibodies in cats are detectable when there has at least been larval development in the tissues, but positive antibody tests cannot distinguish between current and previous larval infections; thus, cats with positive antibody test results are considered currently or previously infected with D. immitis. The aim of the present study was to use multiple HW diagnostic modalities to maximize detection of infection in dogs and cats at high risk of infection and to compare infection prevalence between these two hosts. Blood samples collected from 100 stray dogs and 100 stray cats at Florida animal shelters were tested for HW antigen (before and after heat treatment) and microfilariae; cats were also tested for HW antibody. Dogs were significantly (P = 0.0001) more likely to be diagnosed with adult HW infection (28 %; 95 % CI: 20.1-37.6%) when compared with cats (4 %; 95 % CI: 1.6-10.2%) on the basis of positive antigen and microfilariae test results. Cats with current or previous adult, immature adult, or larval HW infections comprised 19 % (95 % CI: 12.4%-27.9%) of the feline population, which was not significantly different (P = 0.1) from the prevalence of adult D. immitis infection in dogs. Testing unprotected cats for heartworm antibodies demonstrated a similar, high risk of infection to the matched unprotected dog population in Florida, which supports the use of HW preventives in cats in areas where HW transmission occurs.

Heartworm prevalence in dogs versus cats: Multiple diagnostic modalities provide new insights.

The cornerstones of diagnosis of heartworm (HW) in dogs are the detection of circulating antigen from adult female Dirofilaria immitis or the visualization of microfilariae in whole blood. These tests are less sensitive in cats because of the feline immune response leading to low numbers of adult worms, but heartworm antibody tests are also licensed for use in cats. HW antibodies in cats are detectable when there has at least been larval development in the tissues, but positive antibody tests cannot distinguish between current and previous larval infections; thus, cats with positive antibody test results are considered currently or previously infected with D. immitis. The aim of the present study was to use multiple HW diagnostic modalities to maximize detection of infection in dogs and cats at high risk of infection and to compare infection prevalence between these two hosts. Blood samples collected from 100 stray dogs and 100 stray cats at Florida animal shelters were tested for HW antigen (before and after heat treatment) and microfilariae; cats were also tested for HW antibody. Dogs were significantly (P = 0.0001) more likely to be diagnosed with adult HW infection (28 %; 95 % CI: 20.1-37.6%) when compared with cats (4 %; 95 % CI: 1.6-10.2%) on the basis of positive antigen and microfilariae test results. Cats with current or previous adult, immature adult, or larval HW infections comprised 19 % (95 % CI: 12.4%-27.9%) of the feline population, which was not significantly different (P = 0.1) from the prevalence of adult D. immitis infection in dogs. Testing unprotected cats for heartworm antibodies demonstrated a similar, high risk of infection to the matched unprotected dog population in Florida, which supports the use of HW preventives in cats in areas where HW transmission occurs.

Systemic glucocorticoid usage in dogs under primary veterinary care in the UK: prevalence and risk factors.

Glucocorticoids are widely used in primary care veterinary practices. The study aimed to quantify the usage of systemic glucocorticoids (SGC) in dogs in the UK using primary care treatment records recorded during 2013 in the VetCompass Programme. From a study population of 455 557 dogs, 28 472 dogs (6.2 per cent, 95 per cent CI 6.2 to 6.3) received a total of 50 971 SGC therapy events in 2013. Prednisolone represented the most frequently used oral preparation (27 362 events, 90.0 per cent of oral events). Dexamethasone sodium phosphate was the most commonly used injectable agent (12 796 events, 62.7 per cent of injectable events). The most common breed treated was Staffordshire Bull Terriers (2236/28 472 dogs, 7.9 per cent, 95 per cent CI 7.5 to 8.2) and within-breed prevalence of SGC usage was 2236/32 635, 6.9 per cent, 95 per cent CI 6.6 to 7.1. The most commonly treated age group was dogs older than eight years (8931/28472, 31.4 per cent) and the most commonly treated bodyweight group was 10.01-20.0 kg (7918/28 472, 27.8 per cent). Dexamethasone and prednisolone were the most commonly prescribed SGC. Short-acting and intermediate-acting injectable SGC were more commonly used compared with long-acting injectable SGC. Older and medium size dogs were most likely to receive SGC and certain breeds appeared predisposed. These data can provide a useful benchmark for glucocorticoid usage and highlight the benefits from 'Big Data' analyses.

Pilot study of the financial and practice protocol impacts of canine influenza virus (H3N2) outbreaks in example veterinary practices.

Since March 2015, canine influenza virus (CIV) H3N2 has caused widespread outbreaks in dogs across the USA. The effects of local H3N2 outbreaks on veterinary practices were investigated using an online interface and followed with phone calls to respondents when necessary. An outbreak was defined as confirmed diagnosis of H3N2 by either PCR or serology in at least four dogs. Of 30 practices invited to participate, five met the entry criteria: at least one documented H3N2 outbreak in the previous 12 months, a predominantly (≥70%) small animal caseload, and adequate financial records to complete the survey. Respondents reported 1-3 H3N2 outbreaks/practice over the last 12 months, with 4-8 dogs diagnosed/outbreak. For each participating practice, self-reported direct financial impact data was collected from the single H3N2 outbreak that involved the most dogs. The two most substantial categories of self-reported financial loss occurred due to boarding facility closure (estimated cost per practice: median $5000), and treatment costs borne by the practice (estimated cost per practice: median $2850). Median extra biosecurity costs were $300/practice. Median total direct costs of an H3N2 outbreak were $8945/practice. Lost foot traffic included cancelled appointments, appointments redirected to other veterinary hospitals for the duration of the outbreak, and loss of revenue from ancillary services provided during usual business (calculated cost per practice: median $450). Cost/practice normalized by the number of fulltime veterinarians in each practice was calculated and additional effects, such as interruptions to daily practice routine, reduced productivity, reputation loss and poor staff morale, were also reported. Vaccination against H3N2 was introduced as part of routine practice vaccination protocols or was made mandatory before boarding in three of five practices. In the remaining two practices, a focus on client education about canine infectious disease, especially H3N2, emerged in response to outbreaks. H3N2 outbreaks had substantial impacts on veterinary practice finances, daily routines and staff morale, and was associated with enhancements in vaccination, biosecurity and client education protocols.

'One health' and development priorities in resource-constrained countries: policy lessons from avian and pandemic influenza preparedness in Zambia.

'One World, One Health' has become a key rallying theme for the integration of public health and animal health priorities, particularly in the governance of pandemic-scale zoonotic infectious disease threats. However, the policy challenges of integrating public health and animal health priorities in the context of trade and development issues remain relatively unexamined, and few studies to date have explored the implications of global disease governance for resource-constrained countries outside the main centres of zoonotic outbreaks. This article draws on a policy study of national level avian and pandemic influenza preparedness between 2005 and 2009 across the sectors of trade, health and agriculture in Zambia. We highlight the challenges of integrating disease control interventions amidst trade and developmental realities in resource-poor environments. One Health prioritizes disease risk mitigation, sidelining those trade and development narratives which speak to broader public health concerns. We show how locally important trade and development imperatives were marginalized in Zambia, limiting the effectiveness of pandemic preparedness. Our findings are likely to be generalizable to other resource-constrained countries, and suggest that effective disease governance requires alignment with trade and development sectors, as well as integration of veterinary and public health sectors.

The contribution of veterinary medicine to public health and poverty reduction in developing countries.

Few studies have explicitly examined the linkages between human health, animal disease control and poverty alleviation. This paper reviews the contribution that veterinary medicine can make to poverty alleviation in sub-Saharan Africa. Our analysis attempts to explore aspects of this contribution under five themes: food production; food safety; impact and control of zoonotic infections; promotion of ecotourism; and environmental protection. While these areas of human activity have, more or less, fallen under the influence of the veterinary profession to varying degrees, we attempt to unify this mandate using a 'One Health' narrative, for the purpose of providing clarity on the linkages between the veterinary and other professions, livestock production and poverty alleviation. Future opportunities for improving health and reducing poverty in the context of developing African countries are also discussed. We conclude that veterinary science is uniquely positioned to play a key role in both poverty reduction and the promotion of health, a role that can be enhanced through the reorientation of the profession's goals and the creation of synergies with allied and related professions.