Examination Room: Jenny Stavisky

Jenny Stavisky spent several years in mixed practice before completing a PhD in epidemiology and virology and, following a brief spell back in clinical practice, she joined the University of Nottingham School of Veterinary Medicine and Science, where in 2013 she began a clinical lectureship in shelter medicine.

Dr Stavisky is a founding member of the Association of Charity Vets and co-editor of the BSAVA Manual of Shelter Medicine. She also instigated and runs Vets in the Community, a project providing free veterinary care to homeless and vulnerably housed pet owners in Nottingham. We asked her to step into the Examination Room to find out more…

Q

How long have you been in your current role and what led you into this area?

A

I’ve been in my present role for seven years. I originally came to Nottingham in 2010 to do a postdoc in shelter medicine, and three years later persuaded the vet school it needed a lecturer in shelter medicine. I have an ongoing debate with my lovely friend Ruth van der Leij at Utrecht as to which one of us had the first shelter medicine lectureship in Europe.

I’ve always been interested in shelters, volunteering there when I was growing up and getting involved with overseas neutering after graduation. During my PhD, I met Kate Hurley, the first shelter medicine resident in the US (it’s a clinical speciality there). I decided I wanted her job, but as at the time it didn’t exist here – I sort of had to make it happen.

Q What have been the most significant learnings, from your work in shelter and charity medicine, in relation to disease prevention?

A

I think the thing I’ve really taken to heart is the importance of prevention – especially in a population context. We often use the analogy of a dairy cow culled for mastitis. In this instance you’d consider all the costs of loss from the herd – milk drop, time and medications. A lot of knock-on impacts exist. Similarly, the real impacts of infectious disease – especially in shelters and kennels – are significantly broader than you might immediately think.

This makes investing in preventive measures such as vaccination even more cost-effective – not just financially, but in terms of time and, of course, animal welfare.

Q How significant is the move away from using the term kennel cough to canine infectious respiratory disease?

A

I think moving away from using the term kennel cough is a really good idea, because it’s a misnomer really.

Most dogs are susceptible to infectious respiratory disease. They don’t have to be in a kennel environment. This includes any dog that has contact with other dogs, and particularly those attending training classes, doggy day care and walking in densely populated parks.

Many years ago, one of my dogs got it twice just from coming to work with me in practice. However, I’m not really sure canine infectious respiratory disease (CIRD) has really stuck yet – it’s accurate, but doesn’t seem to have caught on yet.

Q Which dogs benefit most from preventive treatment for CIRD?

A

Any dog could benefit from preventive treatment for CIRD – it’s a generally very safe intervention, and CIRD can be pretty unpleasant for both the dog and the owner.

Obviously, a dog that goes to boarding kennels – or is in a shelter, breeding or working kennel – would be the first ones I’d think of. However, dogs with large social networks of other dogs – such as those that attend doggy day care, agility or puppy classes – would be particularly high on my list.

Also, dogs that are frequent flyers at the veterinary clinic, for any reason, would benefit from being vaccinated, as my old dog would no doubt have agreed.

Q What are the main clinical signs and forms of treatment for CIRD?

A

The common clinical signs of CIRD are really well known, with the classic honking cough. Dogs are also commonly presented as retching, or because the owner thinks they have something stuck in their throats.

For many dogs, it’s a relatively mild and self-limiting disease, which I would suggest is similar to having a cold for us. We feel a bit rubbish for a few days or a couple of weeks, but overall we’re not systemically that unwell.

However, more severe forms exist, and that can correlate to pathogens implicated, environmental factors such as poor ventilation, specific dog factors such as age, or in fact all three. In more severe cases, dogs can become severely unwell, and we do see bronchopneumonia and even deaths.

Most dogs will recover well, with no treatment, or perhaps some NSAIDs. Some require more intensive medication, and the International Society for Companion Animal Infectious Diseases guidelines (https://iscaid.org/guidelines) provide a really useful template for this. More details on this are on my Vet Times Podcast from February 2020 (Ep 27).

Q What do you see as the main reasons that disease prevention rates for CIRD are relatively low compared to other preventable infectious diseases?

A

Apparently I’m not quite a boomer vet, but I would certainly say that vets like me, of a certain vintage, might be put off by the memory of early CIRD vaccines, which had to be given every six months and dogs found extremely aversive. These have improved, however, and are now much easier to administer.

Making sure animals have a good (or at least not negative) experience at the vets is so important for everyone’s safety and well-being, and giving the old vaccines was pretty stressful for everyone. I think some practitioners also feel that CIRD is either not that common, or not that serious, so it may not be worth pursuing vaccination.

Undoubtedly, some variation by practice and by season exists. However, both the Small Animal Veterinary Surveillance Network and VetCompass have found CIRD is generally a common presentation.

I think people also worry sometimes about the on-label precaution of using a live Bordetella vaccine in a situation where the members of the household may be severely immune compromised. This is a largely theoretical precaution, but it is something to take into account when planning vaccination.

Q Why would you encourage vets to raise the levels of preventive treatment for CIRD?

A

While CIRD isn’t life-threatening for most dogs, it is still pretty unpleasant for the dog and owner. When I’m in the midst of a winter cough and cold, I know if anyone offered me a vaccine, I’d jump at the chance.

In terms of the fear some dogs experience with intranasal vaccination, given that we now have a really good range of products and options, we don’t have to have a one-size-fits-all approach.

Q What approach would you recommend vets use to the applications of available products?

A

It’s great that we now have intranasal, transmucosal and SC vaccines available. Each has its own profile – in terms of ease of administration, onset and duration of immunity – so it’s about selecting the product that will best suit that patient and client.

If you do decide to use intranasal vaccines, which have the advantage of a very quick onset of immunity, some good techniques exist that you can use to reduce stress for everyone. It will be interesting to see if the conversations we’re having with clients about vaccination in general, and about CIRD vaccination in particular, will evolve in the light of our current situation.