26 Apr 2020
Climate change, increased pet travel and the incoming tide of overseas rescues means it is not just old enemies your practice needs to be ready for – new threats are on the horizon, too. But fear not, as practices have never been in a better position to take the flight to the enemy...
Suzanna Nolan
Job Title
The Greek philosopher Heraclitus famously pronounced that the only constant in life is change, and that is certainly true of the veterinary industry – especially when it comes to parasite control in companion animals in recent years.
The landscape of parasitic threats is ever evolving, and to provide the best level of care for our patients, practices have had to think long and hard about the recommendations they provide to their clients.
This has always been the case, but in recent years, factors such as the relaxation of the rules of the EU Pet Travel Scheme (PETS), the influx of imported pets, increased pet travel and climate change mean practices now need to consider a whole new range of exotic diseases and their prevention.
The PETS regulation changes in January 2012 have meant it is far easier for clients to travel with their dogs, cats and ferrets around the EU, and many of us in practice have seen a large uptake in pet passport requests since then. While this is no doubt more convenient for our clients, it must be remembered that the removal of compulsory tick treatment could result in pets returning from their holidays with extra unwanted baggage.
Unfortunately, the door to the UK has been left wide open to a diverse range of ticks and tick-borne disease, among other parasites. Many veterinary entomologists’ fears were realised when, in 2016, we saw an outbreak of canine babesiosis in Harlow, Essex.
This outbreak consisted of four confirmed cases in untravelled dogs. Dermacentor reticulatus ticks were collected in the area that all the dogs had been walked and, of 17 ticks collected, 14 were found to be positive for Babesia canis1. Another outbreak consisting of two cases occurred later in August 2016 in nearby Romford, and a single case was confirmed in Ware, Hertfordshire, in August 20171.
These outbreaks confirm that Babesia-carrying D reticulatus ticks are present and, therefore, now endemic in the UK.
Of course, the PETS regulation changes have not just made it easier for UK-based owners to take their pets on short holidays. Ease of travel has also contributed to the seemingly endless flow of imported rescue dogs from abroad. The plights of these dogs have pulled on the heartstrings of our dog-loving British public, but it is not without risk for our pet and human populations here.
These dogs may carry a range of parasites – such as Thelazia callipaeda (eye worm), Linguatula serrata (tongue worm), Dirofilaria species or Leishmania infantum. L infantum is transmitted by the sandfly; however, a case existed in the UK in a dog that had not travelled abroad2, having become infected by suspected dog-to-dog transmission. Therefore, this disease must be considered in suspicious cases now, even without a history of travel.
Since 2012, a marked increase has occurred in the number of Rhipicephalus sanguineus ticks found on dogs that have entered the UK from abroad3.
This tick prefers a warm environment, and several indoor infestations have now been reported in the UK, in houses in which imported rescue dogs were living3. This is important as R sanguineus is an important vector for many diseases, including canine ehrlichiosis and human Mediterranean spotted fever3. This can prove extremely difficult to exterminate from a home.
This tick has not flourished outdoors, as it is not suited to our colder UK climate. However, perhaps that will not always be the case when we consider the ongoing effects of global climate change.
Cases of heartworm, caused by Dirofilaria immitus, are also becoming more common in the UK, seen in pets that have travelled or been imported. Our current climate does not support its vector, the mosquito, but this may change in the future if global temperatures continue to climb.
Certainly, the warmer winters and wetter summers that we have seen recently have helped to boost tick numbers, with ticks now being found questing all year round.
The incidence of Ixodes ricinus and I hexagonus ticks, the most common tick species found in the UK, is increasing – thought to be due to several reasons. These include climate change, increasing deer populations, and changes in farm practices4.
These ticks readily infest both dogs and cats, with I hexagonus found to be the most common tick found on cats in urban areas5 highlighting that ticks are not just a problem in dogs and rural settings. I ricinus and I hexagonus ticks carry Borrelia burgdorferi, the spirochaete causing Lyme disease, of which the prevalence in humans appears to be increasing4,6.
As a zoonosis, it is crucial that veterinarians recognise this disease not only for our patients, but also from a public health perspective. Added to this, Public Health England announced in autumn of last year that I ricinus ticks had been found to be carrying tick-borne encephalitis virus in two locations in England7.
Lyme disease is not the only existing threat that appears to be gaining new ground. Angiostrongylus vasorum has been steadily increasing in prevalence and distribution8. It is now being seen outside the previously reported endemic foci8, making it an important consideration when drawing up preventive protocols across the whole of the UK.
But good news does exist among all this doom and gloom. We have an opportunity to limit our patients’ exposure to many of these parasites or the vectors that allow transmission.
We, as veterinarians, also have a role to play in public health, as in the case of ticks, by using ectoparasiticides on our pets that kill them. We’re helping not only protect our veterinary patients, but also our human populations.
We are fortunate to have a wide range of effective parasiticides to combat these new and existing threats, including the novel isoxazolines, giving veterinarians even more choice when it comes to providing sound recommendations. Doing so involves thorough assessment of local threats and disease incidence, and in this way practice protocols can be created. Where possible, it is best practice to discuss the individual lifestyle of each pet with his or her owner and, therefore, tailor your advice to each patient.
All staff should be well versed in the parasiticides available in their practice and confident making effective recommendations. It is worth remembering that clients come to veterinary clinics for trusted advice, and expect it to be forthcoming. Also, as some of these parasites that we regularly protect against can pose a serious zoonotic threat, it is our responsibility to ensure our clients are following sensible protocols.
Empowering the practice workforce with information to confidently and proactively engage your clients in these discussions is crucial to good outcomes, which build a strong bond between your practice and your clients. The client who gets a seamless recommendation from the consulting room through to reception is much more likely to follow the good advice provided.
It is well known that compliance can be a big problem when it comes to clients administering any kind of medication to their pets. A good way to improve this is to recommend uncomplicated, easy-to-remember protocols, and dispensing medications that the owner finds simple to administer. How we administer medications can have a huge impact on their efficacy. For example, some need to be given with food for adequate absorption, hence it’s important that we clearly communicate these finer points to our clients so they get the most from the products.
Staff training will also enable all staff to work through any objections that they may face from the client. Occasionally, the issue of resistance, or the potential development of it, is sometimes mentioned as an objection against worming or flea treating regularly.
Anthelmintic resistance is a well-known occurrence in livestock and horses, but has yet to be definitively reported in small animals. At present, the zoonotic risk of Toxocara and Echinococcus likely pose a higher threat than does the risk of resistance developing, so anthelmintic treatment should not be withheld on these grounds6.
Indeed, with Toxocara species carried by 25% of dogs9 and 26% of cats10, regular worming – especially in households with immunocompromised people and children – is imperative, with the European Counsel Companion Animal Parasites (ESCCAP) recommending monthly worming in such cases11.
Flea treatment resistance is often quoted as a reason for failed eradication of fleas, and although product failures have been reported, definitive demonstration of actual resistance has not12. However, misuse of flea products (for example, not given frequently enough, or in-contacts or environment not treated correctly) are often the reason behind a perceived treatment failure6. Again, with guidance, everyone in the practice can be trained to have these discussions to ensure the best possible outcome for each patient.
Not only will this create a great rapport, it is also undoubtedly good for practice profitability.
Every practice will have its quiet and busy periods, but as parasitic sales are around 29% of product sales13 from a veterinary practice, they’re a significant source of revenue and can provide a steady income to the practice throughout the year – so that even the practice directors can relax in a quiet spell.
Pet health club schemes formalise this approach and have grown in popularity over the years, allowing owners and vets to be proactive with their preventive health care, while providing a steady income for the practice.
So, although new threats are out there, with some existing ones seeming to gain new traction, the old adage is true: prevention is better than cure – and keeping parasitic prevention protocols and practice training up to date not only protects our patients and our clients, but practice profitability, too.
