Rabid Horse In Texas

A rabid horse has been identified in Bandera County, Texas - this is the first case of rabies in a Texas horse in almost 40 years. The horse started acting strangely, erratically and at times violently. Rabies was eventually diagnosed (diagnosis involves testing the brain after the horse dies or is euthanized) and the owners are undergoing post-exposure treatment.

Rabies is a rare disease in horses, but there is always a risk of exposure in regions where rabies is present in wildlife. The fact that equine rabies is rare is a good thing, but it can also breed complacency and lead to decreased vaccination rates.

Decreasing vaccination is a bad thing. Vaccination is cheap insurance for a very serious disease. Rabies is invariably fatal in horses. It's also a risk to anyone around the horse. Transmission of rabies from horses to people is theoretically possible through bites or other contacts that result in introduction of saliva into wounds, cuts or possibly the mouth, nose or eyes. I'm not aware of any documented cases of equine-to-human transmission of rabies, but given the severity of rabies, we need to be careful. Additionally, rabid horses have killed people because they can be unpredictable and aggressive. Based on all these factors, it's important that we not become complacent about rabies in horses, and a key component of rabies control is vaccination. However, vaccination is not the only aspect of rabies control. Using various management practices to reduce the risk of wildlife exposure and controlling rabies in wildlife in the area are other important measures, but individual horse owners can have the greatest impact on their horses' health by ensuring they are properly vaccinated against rabies.

If you own a horse, make sure it's vaccinated against rabies unless you live in a rabies-free region.  More information about rabies in horses is available on the equIDblog Resources page.

Image source: www.bbc.co.uk

6 Good Parasite Tips

TheHorse.com has a good article about deworming, which includes six good parasite-fighting tips from Dr. Craig Reinemeyer. Check out the full article for all the details. Here are the key points and some comments:

1. Stop focusing on the wrong things

It's easy for people to get hung up on a few concepts or topics and not see the big picture or the real problems. We need to think in terms of the horse(s), not the parasites. We're trying to optimize horse health. That doesn't necessarily mean killing all parasites, nor does it mean relying soley on drugs to control them. Conceptually, we need to think about parasite control, not just deworming.

2. Plan parasite control around parasite biology, not a calendar

There is no "standard" deworming program. Every program needs to be tailored to the geographic region, farm and horse. What happens here is Ontario is very different from what happens in Florida in terms of parasites.  For example, the risk of transmission in horses turned out on pasture in Florida in February is certainly different from those turned out in snowy fields in Ontario at the same time of year. Even in the same region, what happens on one farm may be very different than what happens on another. When designing a parasite control program, you need to consider what is going on with worms in the horses and in the environment to determine the optimal approach.

3. Don't encourage resistant parasites

Most people know antibiotic-resistant bacteria are a bad thing, but often concerns about anti-parasitic resistance are ignored. We only have a limited number of antiparasitic drugs, and there aren't many more coming in the near future. Heavy use or misuse creates an environment where resistance may emerge. It's being seen with certain bugs and certain drugs, and needs to be taken seriously - now.

4. Don't treat all horses the same

As I mentioned above, you need to tailor parasite control to something that is relevant for the region, farm and horse. Different horses are at different risks of exposure. Some horses are naturally more resistant to parasites, so these animals don't need to be (and indeed shouldn't be) treated the same as more susceptible horses. Deworming should be tailored to the needs of the individual horse. Yes, it takes more effort and some thought, but it's worth it.

5. Practice evidence-based parasite control

That means use all available information to make decisions. It includes knowing what parasites are a concern on the farm (which requires testing), what antiparasitic drugs have been effective on the farm (which requires testing to determine treatment success), an understanding of farm management practices, and information from research about deworming strategies and drugs. Performing fecal egg counts is a critical component of this, and something that is not done nearly enough.

6. Be prepared to change

Something that works today may not work in the future. You can't get stuck in your ways and assume that since something worked in the past, it will always work.

Image source: www.ponytalesblog.com

Alcohol Wipe Before Injection?

It's common for people to wipe injection sites in horses with alcohol before inserting the needle. It's so ingrained into some peoples' minds that they may complain if their veterinarian doesn't use an alcohol wipe before injecting. But what does that little swab really do, and is it needed?

Alcohol is a disinfectant and can kill many (but not all) bacteria and viruses. Therefore, wiping an injection site with alcohol could theoretically reduce bacterial counts and maybe reduce the risk of an injection site infection. However, alcohol does not work well in the presence of organic debris (i.e. dirt), and may not (and likely won't in most cases) penetrate through a horse's haircoat down to the skin. The best aspect of alcohol is some situations is wetting down the hair to help see the area you're injecting (for example, when visualizing the vein for an intravenous injection).

The risk of injection site infection is very low in the average horse, and the true benefit of wiping the site with alcohol is unknown. There is no clear evidence that this practice reduces infections. The most serious injection-associated infection, clostridial myonecrosis, is caused by either inoculation of clostridial spores (which are resistant to alcohol) or by spores that are dormant in the muscle tissue. In either case, wiping the skin with alcohol won't help prevent it.

Bottom line: There's no evidence that alcohol wiping is needed, or useful. There's also no reason not to do it, so it's really a matter of personal preference. Not using alcohol wipes is not an indication of poor practice, but a lot of people will use them on the chance that they are effective, knowing that at worst they will do no harm.

More information about clostridial myonecrosis can be found on the equIDblog Resources page.

Review Of CEM and Implications For Canada

Hard to believe that the whole conundrum about contagious equine metritis (CEM) that is still affecting the Canadian equine industry started a little bit more than a year ago, when a Quarter Horse stud in Kentucky tested positive for the causative agent, Taylorella equigenitalis. Tracing the contacts of that stud lead to the quarantine and testing of 990 horses in 40 states, as well as 19 mares in Canada, including 9 in Ontario. Out of 274 exposed stallions, 22 were ultimately found to be positive, none of which had any detectable clinical signs that they were infected, meaning if they hadn’t been tested, they may have kept on going about their business breeding – and possibly infecting – mares for years to come. The rest of the exposed horses were mares, five of which turned out to be infected. One particularly interesting fact was that four of these mares had been bred by artificial insemination - previous to this it was thought that CEM was only readily transmissible by live cover from an infected stud, not via semen shipped in a straw.

Thankfully all of the Canadian mares were negative, but unfortunately the Canadian equine industry is still suffering the consequences of what has happened to our close southern neighbour. Fourteen countries have increased import requirements for Canadian (and obviously US) horses in terms of CEM testing, and another major blow was the loss of Canada’s low-risk status with the UK's Horserace Betting Levy Board (HBLB).

Canada must maintain strict import requirements for horses to prevent CEM from getting into the country. Most of the horses imported into Canada come from CEM-positive countries, and it’s getting more difficult to argue not including the US on that list as well. The risk is constantly present, and remaining diligent about quarantine and testing – and rules like ensuring horses are not on antibiotics for some other reason when they’re cultured – is key. Semen import restrictions for semen coming from the US to Canada will stand for 2010. While this certainly causes a headache for breeders, requiring an import permit and a health certificate for the stud stating that it has not stood on a CEM-quarantined farm, is it enough to protect Canadian horses? The next step would be to require all studs to be tested for CEM before their semen can be imported to Canada. That is no small request. Testing a stud involves culturing the stud himself, and then having him test-breed two mares which then also need to be culture-negative. Anecdotally the entire process can cost in the neighbourhood of $5-7K per horse, which at the moment all needs to be borne by the horse owner. That gives you some idea of what an enormous undertaking it was to quarantine and test 274 exposed stallions during last year’s outbreak.

In the US, 87% of exposed horses have now been cleared, and there have been no new positives in the last 8 months. However, there are still 17 states where there are quarantined farms. There is talk of voluntary testing of over 2000 studs in the US in 2010, as well as targeted surveillance of stallions imported in the last 10 years and those standing at large AI centers. Only time will tell if these extra efforts will serve to calm the fears of countries that are now hesitant to import horses and semen from the US, or whether they will reveal more cases of CEM and confirm the fears that CEM may have unknowingly become endemic in the US in the past decade.

More information on CEM is available in our archives.

This blog is based on a presentation by Dr. Tracey Chenier, a theriogenologist and faculty member at the Ontario Veterinary Collge, given at the recent 2010 Ontario Veterinary Medical Association Conference.

Photo credit: David Campbell (click for source)

Strangles And Disinfection

Often, when someone calls and asks about management of strangles, one of the first questions is "What disinfectant should I use?"

There are basically two answers that I give:

1) Streptococcus equi, the cause of strangles, is susceptible to most disinfectants, provided they are used properly. That means using them at the proper concentration, providing the recommended contact time (5-30 minutes, depending on the disinfectant) and ensuring that there is minimal organic debris (e.g. dirt, manure, pus) present on the surface to be disinfected. The latter is a key point, as disinfectants do not work well in the presence of debris, so it's therefore understandably very difficult to really disinfect a stable. Some stable surfaces (e.g. sealed solid walls and floors, buckets) are able to be disinfected if it is done properly, while other surfaces (e.g. dirt floors, unsealed wood walls, leather) are essentially impossible to disinfect.

2) Disinfection is a very minor component of strangles control. It is something to pay attention to and it should be done properly, but too often people to focus on disinfection as the key infection control measure. Just disinfecting surfaces, but ignoring aspects like cohorting exposed and unexposed horses, restricting horse movement, testing for carriers, regular temperature checks of all horses to detect early cases, using good personal hygiene and using protective outerwear, is bound to fail in terms of controlling an outbreak.

So, don't ignore cleaning and disinfection, but don't' rely on it as the main component of strangles control.

More information about strangles can be found on the equIDblog Resources page.

2008 Australian Hendra Virus Recap

The latest edition of the journal Emerging Infectious Diseases contains a paper describing the 2008  Australian Hendra virus outbreak in horses and people.

In this outbreak, there were five horses infected and two humans infected. The horses predominantly had signs of neurological disease, not respiratory disease like some other reports describing this disease. Four horses died. One recovered but was euthanized for public health reasons.

Two people became infected after working with the sick horses, which represents 10% of the total veterinary staff that were exposed to the infected horses.  Both people started off with influenza-like illness, which seemed to improve initially, but then signs of severe neurological disease developed. They were treated with ribavirin, an antiviral drug, as part of an experimental treatment. One of them died after 40 days of illness, the other person survived.

The authors stressed that the effectiveness of ribavirin could not be determined, but they recommend it nonetheless because of the severity of Hendra virus infection and lack of other options. Ribavirin was also used in the 2009 outbreak, but it is clearly not 100% effective since one person died there also.

A number of concerning activities occurred that put people at risk of infection, including a "percutaneous blood exposure while euthanizing an infected horses" (they didn't explain exactly what this was, but it could have been a needlestick), low use of personal protective equipment, and contact with potentially infectious body fluids. This is unfortunately not surprising since the approach to infection control (particularly in terms of zoonotic infections) is often lax in equine medicine. That certainly has to change, particularly in areas where Hendra virus may be present.

Much more information about how to control this potentially devastating virus is needed. Fortunately, infections are uncommon and it is restricted to a fairly small geographic range in Queensland, Australia.

Image source: http://animalphotos.info/

Equine Infectious Anemia In Britain

Equine infectious anemia (EIA) virus, a chronic and potentially devastating bloodborne virus, was identified in two horses in Britain. The two affected horses were from a group of horses imported from Romania via Belgium. They were tested as part of standard import testing regulations designed to do exactly what happened here - diagnose this important infectious disease at the time of importation so that the infected horses cannot spread the disease in the country. The two positive horses will be euthanized, the unfortunate but standard response to this virus, because infected horses can pose a risk of infection to other horses for their entire lives. Other horses on the premises are under quarantine and are likely being tested further. The risk of transmission to other horses during the presumably short period of time they've been on the farm is probably low because, as an insect borne disease, biting fly activity has probably been pretty low during the cold British winter weather. (Transmission by sharing needles or other human-associated ways of cross-contamination of blood is also a concern, and has been a problem in other outbreaks.)

Chief veterinary officer Nigel Gibbens stated that these are the first imported cases of EIA identified since 1976. This is a good example of why we need to continue routine infection control measures such as import testing, even when nothing is found for years. Some people try to argue that since certain problems don't seem to be present, or at least are not identified, that infection control testing or activities should be decreased. This situation illustrates why that's bad thinking. Despite only picking up one incident in the past 34 years, this is a very important finding - failure to detect the positive horses could have lead to widespread infection in the country, which would ultimately make it very difficult and expensive to try to control. You never know when the next outbreak is lurking around the corner, and complacency is a big enemy of infection control.

Image source: www.collectgbstamps.co.uk

Case: Antibiotic-Induced Diarrhea

A three-year-old Standardbred gelding was presented to the hospital for evaluation and treatment of diarrhea (colitis). The previous week the horse had developed a mild hind-limb lameness which seemed to come and go, and it was decided to treat the horse with antibiotics “just in case” it had something to do with an infection. The horse was treated with ceftiofur (an antibiotic, often sold under the brand name Excenel or Naxcel) for five days. On the fifth day, the gelding developed moderate to severe diarrhea. The next morning the horse also had a fever. He was treated with anti-inflammatories and quickly referred to the hospital for intensive care.

On presentation, the gelding was very quiet. He had a very high heart rate, reddish gums and he was significantly dehydrated. Intestinal sounds could not be heard over the abdomen, indicating that the horse’s intestines were not moving normally, and there was a “ping” on the right side of the abdomen, indicating that there was gas accumulating in the cecum (part of the large intestine). Treatment with intravenous (IV) fluids was started right away to try to correct the dehydration and keep up with the amount of fluid the horse was losing in its diarrhea.

By the next morning the horse’s attitude was improved, but his gums were still an abnormal colour (“toxic mucous membranes”, see picture), indicating that there were inflammatory cytokines (substances released by cells when they’re in distress) and likely bacterial toxins in horse’s bloodstream. Also, despite the IV fluids, the gelding was still dehydrated, likely because he was pooling fluid from his body tissues in his intestine, as well as the more obvious loss of fluid in his ongoing diarrhea. This went on for another two days, despite intensive treatment in the hospital. On the fourth day, the gelding developed severe signs of colic. His large colon became progressively more distended with gas, and the contents of his small intestine started to back-up into his stomach. His heart rate became extremely high, and his pain could not be controlled with sedatives or anti-inflammatories. A belly-tap yielded a red-tinged fluid (normally belly fluid is light yellow), and the concern at that point was that the intestines had become twisted (which can happen in horses with diarrhea as a result of their abnormal intestinal motility). Despite the risks, it was decided to take the horse to surgery - but there was no twist in the bowel. The cause of the colic was that the large colon was severely distended with gas and fluid, and it was barely moving at all. The appearance of the large colon was consistent with extreme inflammation, and the tip of the cecum looked so bad that the surgeons decided to remove it because it was likely dead or dying.

The horse recovered from anesthesia, and IV fluid therapy was continued. Later that day, when the horse was offered some pellets, some intestinal sounds were detectable. The horse soon started to pass diarrhea again, but overall his attitude was much brighter, and his hydration status and (remarkably) blood protein levels remained stable.

Unfortunately the day after surgery the gelding became reluctant to move around the stall. Increased digital pulses were detected on the front feet, and the horse was sensitive to hoof testers – the gelding was developing laminitis. Despite additional treatment, the signs of laminitis became worse and worse. In the end the horse was euthanized, less than a week after being admitted to the hospital.

On necropsy, the entire large colon was severely thickened, filled with green-yellow fluid, and the mucosa (inside surface of the intestine) was ulcerated. Signs of severe acute laminitis were present in all four feet. A specific causative agent of the colitis could not be identified – tests for Salmonella and clostridial toxins were all negative. This is not too surprising as no agent is identified in over half of all adult horse colitis/diarrhea cases. But there is no doubt what set this terrible chain of events in motion – treatment with antibiotics, for a condition that may or may not have ever required antibiotic treatment in the first place.

We talk a lot about antibiotic-induced colitis/diarrhea in horses, but until you’ve seen it for yourself, it can be hard to believe that drugs used every day in both people and animals can have such a devastating effect on a horse. Antibiotics certainly do save lives, but unfortunately there are no “miracle cures” that are entirely without drawbacks. This case clearly demonstrates one of the most important reasons why we so strongly advocate prudent use of antibiotics in horses – their use should never be employed lightly. Although this is a “worst case scenario” that overall occurs uncommonly, the potential is there and should always be taken into consideration.

Photo credit: M. Anderson 2007

How To Approach Rabies Exposure In Horses

I received newsletter today from Intervet (a pharmaceutical company) that is targeted at equine veterinarians. One article discussed rabies in horses. It wasn't bad overall, but I thought the section on what to do when a horse might have been exposed to rabies was worth discussing.

The article asks, "If your client suspects that a horse has been bitten by a rabies-infected animal, what should be done?"

Answer: "Contacting you as the veterinarian is always the first step."

Great first step.  A second step that wasn't mentioned should be, "Try to identify and (safely) capture the animal that bit the horse." This is often impossible but certainly worthwhile if it can be done.  However, if you're trying to catch the offending animal, make sure you don't put yourself at risk of exposure to rabies in the process.  If the animal can be caught, it's rabies status at the time of the bite can be determined (either through testing or quarantine). If it can be shown that the animal wasn't rabid, a lot of stress, hassle and expense can be saved.

"If the horse was previously vaccinated... Then isolate and observe the animal for 45 to 90 days (your clinical evaluation will involve gait analysis, radiography and a spinal tap)."

Boosting the rabies vaccine is also a good idea. The next step, however, needs to be contacting local regulatory officials to find out what you have to do. They determine if, how and how long an animal needs to be quarantined - this is NOT the decision of the local veterinarian nor the animal's owner. Most likely, they will recommend a 45 day quarantine for a vaccinated horse, since this is what is recommended in the NASPHV Compendium on Rabies. The discussion of diagnostic testing makes no sense. There is absolutely no indication to perform diagnostic tests on a horse that has been bitten by a rabies suspect. None. There are no tests that can be used to diagnose rabies in live horses (also exposed horses don't instantly develop signs of rabies). Horses should be monitored closely for signs of rabies during the quarantine period, but that's it.

"...and have the client make a list of all people who had contact with the horse."

This is often done when horses have or are suspected of having rabies, but not horses that are potentially exposed. It is done to help public health personnel contact people that may have been exposed to rabies. A horse that was just bitten by an animal is not a risk for transmission of rabies.  (However, keeping a list of people who have contact with the horse after it's been bitten (i.e. durng the quarantine period) - which should be as short a list as possible - is a reasonable precaution in the unlikely event that the horse does develop rabies.)

"If the animal was not vaccinated, your options are to euthanize and perform a postmortem examination of the brain (the only way to definitely confirm rabies)..."

Euthanasia is one of the options that needs to be considered in an unvaccinated horse that has been exposed, which is one of the reasons that identifying the biting animal and testing it is critical, if it can be done. The last part of the above sentence (from the atricle) is complete nonsense. Why would you test the brain of a normal horse that has been euthanized because it's just been bitten by a potentially rabid animal? The horse isn't being euthanized because it has rabies, it's being euthanized because of the likelihood  of it developing rabies weeks to months later. Testing of the brain will tell you absolutely nothing if the animal was only bitten recently.

"...or isolate and observe the horse for six months and develop the human contact list."

Again, this needs to be decided based on discussions with regulatory personnel who are responsible for dictating what is to be done. A six-month quarantine is a pretty standard recommendation for an unvaccinated animal. Creating a human contact list should not be necessary, since quarantine involves severely restricting contact of people with the horse and only a few (ideally one) person would have any type of contact.

The article wraps up with the very true emphasis on vaccinating horses. It's a cheap measure to prevent a relatively rare but invariably fatal disease.

Click image for source.

Piroplasmosis In New Mexico

At some point, the US is going to have to admit that piroplasmosis, the bloodborne parasitic infection caused by Theileria equi, is endemic in some regions of the country. It's a declaration that will have major impacts on horse movement to some areas but, it's better for everyone to know what's going on. Piroplasmosis is technically still considered an exotic disease in the US, but there have been many cases identified over the past year and a clear source for the individual outbreaks in lacking, indicating there must be a reservoir in some part(s) of the country.

The latest incident involves the diagnosis of piroplasmosis in three race horses in New Mexico, which were picked up as part of routine screening. There were only three positives out of about 1200 horses tested, so the disease is still rare, but the fact that it was there and none of the positive horses had any link with previous outbreaks is definitely a concern. The OIE report states that transmission is suspected to have been from "artificial" means like sharing needles between horses, not natural tick transmission. This could account for the multiple horses affected but doesn't explain where the disease came from it the first place, and it's unclear how solid that hypothesis really is.

It's quite interesting (surprising, frustrating...) that few comments are put forth in any of these outbreaks indicating where the infections may have originated and why we are seeing recurrent, unrelated infections. Is increased testing in different areas helping to pick up cases that would otherwise have been missed (i.e. were already there), or is piroplasmosis in the US an emerging problem? How confident are they that there are no ticks capable of transmitting T. equi in some of these areas? Is wider screening of horses required to determine the extent of the problem and to determine whether it can be controlled? Is broader screening of ticks in the affected areas needed to see if there are ticks known to be able to transmit T. equi? Are studies needed of other tick species in areas where unexplained cases have occurred to determine if some tick species that are not currently known to be able to spread the parasite can actually do so? Lots of questions... hopefully someone's trying to find some answers.

Click image for source.

Umbilical Care In Foals

As foaling season approaches, it's a good idea for people to review proper umbilical care. The umbilicus is an important route of infection in foals, and can be associated with problems including local umbilical abscesses, large abdominal abscesses extending to the liver, and overwhelming body-wide infection (sepsis). The reason the umbilicus is such a critical structure is that it contains three major blood vessels (two arteries and one large vein) and the urachus (which connects the umbilical cord to the foal's bladder) . When the umbilicus ruptures shortly after birth, these structures are exposed to the bacteria-laden environment of the outside world and can be a route of entry for local and deep infections. Care of the umbilicus during the initial high-risk period is a key part of raising a healthy foal.

Do all foal's need specific umbilical care? Not really. Most foals, especially those born normally in a clean environment to a healthy mare and who received adequate colostrum, don't need anything done. However, it's not always easy to differentiate these low-risk foals from others, and it is possible for the healthiest foal born in the cleanest environment with ingestion of an adequate volume of good quality colostrum to develop complications, so most people perform some form of post-birth umbilical care (and that's a good thing). The key is making sure that it's the right umbilical care.

The goals of umbilical care are pretty basic:

  • Prevent bacteria from entering the umbilicus.
  • Avoid damaging the umbilicus and other body tissues, and avoid delaying normal drying of the umbilicus.

What to use?

  • Research has indicated that a 0.5% chlorhexidine solution is the optimal umbilical dip. Other disinfectants can also kill local bacteria on the umbilicus but may not be as effective, may not work as well in the presence of debris (dirt, manure...), or may be irritating to body tissues.

Read the label:

  • Make sure you are actually using 0.5% chlorhexidine and that it's a solution (diluted in water), not a tincture (diluted in alcohol). If you don't have 0.5% chlorhexidine solution and are unsure about how to dilute it properly, ask your veterinarian.

More is not better!

  • Don't think that since 0.5% is good, 5% must be 10 times better. The stronger the concentration, the greater the chance of damage to local tissues, which can increase the risk of complications. Stick with 0.5%.

More is not better! Part 2

  • The umbilicus should be dipped in disinfectant, not marinaded in it! The goal is to cover the umbilicus and not other tissues (e.g. the abdominal wall). You don't need to soak the umbilicus or hold the disinfectant in place over it. Short term contact (dip) is adequate. Dip it and walk away. The umbilicus needs to dry up - repeated soaking isn't helpful.

More is not better! Part 3

  • The umbilicus should be disinfected shortly after birth, then every 6-8 hours for the first 24 hours of life. That's usually enough. If the umbilicus still appears wet at that time, it can be dipped again. Continued dipping "just is case" is not needed.

Don't tie off the umbilicus:

  • Tying off the umbilicus can actually increase the risk of complications such as infection and patent urachus (urination through the umbilicus).

Hands off!

  • Don't touch, poke or otherwise make contact with the umbilicus with your hands. It's not needed and it's a great way of transferring bacteria to the umbilicus.

If in doubt, call your veterinarian:

  • A proactive call to your veterinarian is much better and cheaper than an umbilical infection, umbilical abscess, septic foal or patent urachus. These are all expensive complications and  often difficult to treat successfully. Foals can change very quickly, and waiting to "see what happens" for a day or two can be the difference between a minor complication and a life-threatening problem.

Case Presentation: Chronic Weight Loss

An eight-year-old Quarter Horse gelding was presented for examination due to chronic weight loss over several months. Lately he’d also been lying down frequently and exhibiting increased breathing effort, so he was treated for what was suspected to be mild signs of colic, but failed to improve. He’d also collapsed once during mild exercise.

On examination, the gelding was quiet, alert and otherwise physically normal except for his poor body condition. However, on rectal palpation there was a large, firm, non-painful mass within the caudo-dorsal (i.e. upper rear) abdomen. revealed a large (42 centimeter) firm mass in the caudo-dorsal abdomen. The mass was further evaluated using ultrasound via the rectum. the mass was multi-lobulated (i.e. made up of many pockets on the inside) and had a large blood supply. It did not appear that the mass was directly attached to or growing in any abdominal organs (e.g. kidneys, intestine). Blood work showed a high white blood cell count (mature neutrophilia), moderate anemia, and high protein levels due to an abnormal increase in globulins (hyperglobulinemia).

These findings were highly suggestive of a large abdominal abscess, but a cancerous mass could not yet be ruled out. It was decided to take the horse to surgery the next day in order to better evaluate the mass, collect samples and remove it if possible. In surgery, the mass was found to be right at the root of the intestinal mesentery (the large membrane that carries the blood supply to the intestines), and there were a large number of adhesions between the mass and the base of the cecum, as well as to some loops of the small intestine. A needle and syringe were used to remove a sample of the mass’s contents in a sterile manner. The fluid retrieved had the appearance of thick pus, which further supported the tentative diagnosis of an abscess. Unfortunately, due to the location and size of the mass, as well as the number and size of adhesions, it could not be safely removed. The horse was therefore euthanized while still under anesthesia.

Necropsy examination confirmed that the mass was an abscess. The capsule of the abscess was extremely thick and tough, indicating that it had been developing over a very long period of time. A long-standing abscess such as this explained all of the gelding’s clinical signs – weight loss and moderate anemia due to chronic disease, high globulin levels due to constant stimulation of immune cells by the infectious focus, and recumbency and collapse due to discomfort caused by entanglement of the intestines in the adhesions associated with the abscess.

Culture of the fluid sample retrieved at surgery yielded a heavy, pure culture of Streptococcus equi subsp. equi – the bacterium that causes strangles. This horse had what’s known as “bastard strangles,” which is a recognized complication that occurs occasionally in horses that have had the classic upper respiratory infection. In these cases the S. equi invade beyond the respiratory tract and can end up anywhere in the body. Then, just as the bacterium does in the lymph nodes around the head and throat in classic cases, the S. equi can form abscesses. The abscesses may form in internal lymph nodes (which is likely what happened with this gelding) or in organs like the kidneys or even the brain. These abscesses tend to develop slowly and insidiously. Even if they can be identified, they are typically extremely difficult to treat effectively, and unfortunately euthanasia is often the end result. Other bacteria that can cause similar abscesses include Rhodococcus equi, Corynebacterium spp. and Arcanobacterium pyogenes.

Strangles is endemic in the horse population – whenever horses are mixed or brought together in large groups there is a risk of strangles transmission. We cannot eliminate the risk, but we can try to reduce it as much as possible using basic infectious disease control measures. More information about strangles is available on the equIDblog Resources page and in our archives.

Image: A Standardbred in poor body condition due to chronic debilitation as a result of large abdominal abscess, similar to the case described here (photo credit: M. Anderson).

Why Can't We Eradicate Equine Herpesvirus?

Eradication of infectious diseases is a great goal, but it's rarely practical. The best known (and perhaps only) example of infectious disease eradication is the elimination of smallpox. So, why is it so hard to do?

The following general criteria need to be in place to eradicate a disease:

  • It must have a clearly defined host range and that range is ideally only one species. A disease that can affect multiple species is very hard to control.
  • It must predictably cause disease in individuals that are infected.
  • There must be no long-term carriage state. Once a person/animal gets over the illness, he/she/it must get rid of the infection completely in a defined and predictable period of time.
  • A highly effective vaccine should be available.
  • There must be a commitment to put in lots of time, money and effort everywhere the disease exists.

This isn't the case with most diseases, and equine herpesvirus (EHV) has many characteristics that make eradication impossible:

  • Unpredictable disease: EHV infection doesn't always cause signs of disease. When it does cause disease the signs can be quite variable and difficult to easily differentiate from other infections.
  • Longterm carriage: This is the biggest problem with herpesviruses. EHV is able to survive in a latent (dormant) state in the body after infection. It can lie dormant for a long period of time, but infected animals can always start shedding the virus again. A large percentage of horses are carrying EHV in their bodies and there's no way to get rid of it.
  • Vaccine: Vaccines are available but they are by no means 100% effective at preventing infection.
  • Time, effort, money and cooperation are terms that are not commonly associated with disease control in horses. Getting everyone to follow a standard recommendation (if one were able to control disease) would be difficult to impossible. The entire horse-owning population would not be willing to spend the money for broad control measures, and there's no real impetus for governments to do so. Even getting people to agree to follow basic vaccination and infection control recommendations is difficult.  If there is any negative impact on use of horses, ease of management or any other minor inconvenience, 100% compliance with any recommendation becomes impossible to obtain.

We have to live with EHV. It will always be a risk to horses. Good infection control measures and vaccination of certain groups (e.g. pregnant mares) can help control the impact of the virus.

Equine Herpesvirus Outbreak In Florida

Three barns at Calder Race Course in Florida have been quarantined after a horse was diagnosed with equine herpesvirus (EHV-1) infection. Horses from this barn are quarantined for 3 weeks and are not allowed to race. Other horses will not be allowed to enter the grounds for the next 2 weeks, but racing will continue with horses that are currently on the grounds and not under quarantine (1800 horses are present at the track). Track personnel believe the infection has been restricted to one horse but are taking these measures proactively.

Equine herpesvirus can cause a range of clinical signs, including fever and respiratory disease, severe neurological disease and abortion. The affected filly in this case had neurological disease and was euthanized. Outbreaks of abortions or neurological disease are the greatest concern, and a specific type of EHV-1 has been implicated as the main cause of neurological disease.

It's always hard to say what the most appropriate response is to a scenario like this. Equine herpesvirus is an endemic virus that is present throughout the world and lies dormant within a large percentage of healthy horses. Most infections are sporadic and only involve a single horse or small number of horses, but outbreaks can occur and that's why aggressive measures are sometimes taken. With only a single diagnosed case and no apparent evidence of transmission to other horses in this case, it's uncertain whether such an aggressive approach is required. However, it's worse to be too lax initially than too aggressive, and a logical approach is to implement aggressive measures, and then reassess them as more information becomes available. If no other horses develop signs consistent with EHV-1 infection, then loosening of the restrictions would be reasonable. If there is evidence of transmission and disease in other horses on the property, continuation with aggressive measures makes the most sense.

A great resource regarding EHV-1 is the ACVIM Consensus Statement on this subject, which is available on the equIDblog Resources page.

Image source: www.calderracecourse.com

Bug of the Month: Rotavirus

Rotavirus is an important cause of diarrhea in young horses. (It's also a major cause of diarrhea in infants, but a different rotavirus is involved). Exposure to rotavirus is very common - most, if not all, horses are exposed to it early in life. Disease only occurs in foals, but not every foal that gets exposed becomes sick. Most often, rotavirus causes diarrhea if foals between 1 and 6 months of age, with most cases occurring between 1 and 3 months of age. Foals less than 1 month of age can be affected, but it's less common.

Foals become infected by swallowing the virus, which they usually pick up from the feces of other horses (including their mares) in their environment. The exact source of infection is rarely identified. It is likely that some healthy adult horses are the reservoirs and shed the virus in their manure.

Like other types of diarrhea, rotaviral diarrhea in foals can range from mild diarrhea alone to severe diarrhea with weakness, loss of appetite and dehydration. Colic can occur because of intestinal cramping associated with diarrhea. You cannot differentiate diarrhea due to rotavirus from other types of diarrhea by appearance alone. The diarrhea must be tested to identify the cause.

There is no specific treatment for rotavirus infection, but "supportive care" is often provided. One of the primary components of supportive care is fluid therapy, which may be needed for foals that start to become weak and dehydrated. Aggressive intravenous fluid therapy may be needed in some cases, depending on the severity.

Rotavirus vaccines are available in some regions, although there is limited evidence that they have much of an effect. Few people recommend vaccination. Rather, good attention to foal management practices, hygiene and early diagnosis of infected foals is the key. Foaling mares outside on pasture has been an effective practice in some outbreaks, presumably because there is less rotavirus contamination on pasture.

Image: Colourized TEM of rotavirus particles (source: CDC PHIL 173)

equIDblog - Thanks To Our Readers!

equIDblog has now been active for one year, and look how far it’s come! Just this week we surpassed 75 000 unique hits since our launch. We now regularly have over 700 unique hits on the site per day during the week, and the numbers are still growing. It's great that we're able to provide a reliable source of information about equine infectious diseases to such a wide and diverse audience.

Everyone involved in equIDblog would like to take this opportunity to thank all the visitors who come to our site, and especially those who keep coming back for more! Please continue to help us spread the word about equine infectious disease control so everyone can do their part to help protect our equine companions, on a local, national and even global scale!  Questions, comments and suggestions are always welcome!  -Scott & Maureen

(Image credit: Tatiana Sapaterio)

Antibiotic Awareness Day

European Antibiotic Awareness Day is an initiative of the European Centre for Disease Prevention and Control.  This year it falls on November 18.  The aim of the Day is to provide an annual opportunity for raising awareness about the threat to public health of antibiotic resistance and how to use antibiotics responsibly.

Responsible use of antibiotics can help stop resistant bacteria from developing and help keep antibiotics effective for the use of future generations.  Successful national public awareness campaigns are already resulting in more rational use of antibiotics and a reduction in levels of antibiotic resistance in Europe.

Responsible use of antibiotics includes use in people and in animals.  Here are some of the things you can do to help with regard to antibiotic use in your horses:

  • Only give your horse antibiotics if directed to do so by your veterinarian.
  • Make sure your horse gets the full dose of medication at the correct time(s) of day.  If you are having problems injecting medication or getting your horse to swallow pills, contact your veterinarian as soon as possible.  Your veterinarian may be able to give you advice on some "tricks" for getting your horse to take the medication, or sometimes the medication can be provided in a different form (e.g. a liquid instead of a pill, oral versus injectable).
  • Always ensure your horse finishes the entire prescription.  There should be no leftover pills or medication.  Do not stop giving your horse the antibiotics just because it looks/acts like its feeling better.  This is a common mistake that can have disasterous consequences!  You should NEVER "save a few pills for the next time."
  • Never give your horse antibiotics that were prescribed for you, another person or any other animal, whether they are expired or not.

This equIDblog entry was originally posted on the Worms & Germs blog on 18-Nov-09.

US Piroplasmosis Outbreak Widens

A large number of infected horses has now been identified in association with the ongoing outbreak of piroplasmosis in the US. Three hundred seventeen (317) positive horses have been identified in 11 states: Texas, Alabama, California, Florida, Georgia, Louisiana, Minnesota, North Carolina, Tennessee and Wisconsin. Two hundred eighty eight (288) of the positive horses are from the index farm in Texas. All positive horses are under quarantine (and will likely be euthanized), and testing of other in-contact horses is ongoing.

This report is very concerning for several reasons:

  • A previous report indicates that positive horses were likely on the index farm for at least a year or two, making it likely that more infected horses are out there. The longer a disease like this goes unnoticed, the farther it can be spread before it's detected and controls are put in place. It's possible that an even larger number of infected horses are in the US now.
  • The widespread infection makes it more likely that the disease will establish a true foothold in the US. This bloodborne parasitic disease (caused by Theileria equi) is naturally transmitted by certain types of ticks (not all tick species are able to transmit the parasite). The more areas in which infected horses are found, the greater the chances that infected horses will be bitten by ticks that can transmit the parasite. If it gets established in the tick population, it becomes much harder to control.
  • It's not known how so many horses became infected. With this number of infected horses, it seems to me that tickborne transmission is more likely, rather than human-associated transmission through re-use of needles or other means of transmitting bloodborne pathogens. If the disease is being spread through it's natural route, it's harder to control.
  • It is still not clear where this outbreak (or the other recent US outbreaks) originated. If you don't know how something started, it's hard to prevent it from happening again.

Piroplasmosis may be on its way to becoming an endemic (established) disease in the US. Broad investigation is required to see if it is present beyond the affected premeses identified so far.

Image source: http://animalphotos.info

Infectious Agents In Foal Diarrhea

A new study was recently published in the Journal of Veterinary Internal Medicine (Frederick et al. 2009) which looked at infectious agents found in the feces of foals with diarrhea. Specifically, they looked for rotavirus, Clostridium perfringens, C. difficile, Salmonella, parasite eggs and Cryptosporidium oocysts.

They found at least one infectious agent in the feces of 122 (55%) of the 233 foals in the study. That means, despite testing for a wide range of pathogens, they could not identify an infectious agent in 45% of the diarrheic foals. This is very similar to the situation typically found in adult horses with diarrhea. This could have happened for a number of reasons:

  1. No test is perfect. It’s possible that in some of the cases one of the test results was a “false negative,” meaning it did not detect the infectious agent even though it was there.
  2. A few cases may have been caused by other infectious agents that were not included in the diagnostic panel.  For example, Rhodococcus equi is a common cause of respiratory disease in foals, but it has also been associated with diarrhea in some cases.
  3. The diarrhea was caused by an agent of which we are unaware, and for which we have no test. Researchers are constantly looking for other bacteria, viruses or parasites that may be capable of causing or contributing to diarrhea in foals and adult horses.
  4. The diarrhea was not caused by an infectious agent. For example, the authors failed to discuss foal heat diarrhea as a cause of clinical diarrhea in very young foals. This is a well recognized cause of foal diarrhea, but no infectious agents are involved.

The most commonly identified pathogens were rotavirus (20% of cases), Clostridium perfringens (18%), Salmonella (12%) and C. difficile (5%). Overall 191 (87%%) of the foals survived, and survival was not associated with any pathogen identified in the feces (i.e. in this study, foals were not more likely to die if they had one particular pathogen in their feces than another). This must be interpreted very cautiously, however, because the study does not account for other kinds of illness in these foals, or even whether diarrhea was the primary problem for which they were referred to the hospital. Diarrhea, especially in very young foals, can be very serious because they can dehydrate very quickly and are very susceptible to shock of various kinds.

There were a few other issues with this study that are important to keep in mind as well:

  1. The group of foals they looked at ranged in age from newborns to 10-months old. The digestive tract of a foal undergoes drastic changes in the first year of life, and it is well known that certain infectious agents only cause disease in foals of particular ages. For example, different parasites may take weeks to months to develop within the intestine of a foal, so even if a foal is infected as soon as it’s born, these parasites cannot cause disease for quite some time. For this reason, it would have perhaps been more useful to look at the data separately for different age groups.
  2. There was no control group in this study. Most of the time, if an animal has diarrhea and the test you perform tells you there is a known diarrhea-causing pathogen in the feces , you assume the diarrhea is due to that agent. This is not necessarily always the case. Some pathogens are carried around by totally normal animals, who may get diarrhea for a completely different reason. So what we really need to know now is: if the authors tested 233 foals with normal feces (and the same ages), how common would each of these pathogens be?

While the data may be interesting to look at, this paper doesn't really tell us anything new that will change the way we treat or manage foals with diarrhea in general.  Nonetheless, the information may still be useful for helping to design and interpret future research studies about these pathogens and diarrheal disease in foals.

Image source: www.bbc.co.uk (credit: George Ring)

Piroplasmosis And The US: Let's Just Call It An Endemic Disease

Following on the heels of a few outbreaks of piroplasmosis in the US over the past year is a report of two piroplamosis-positive horses from New Jersey. This bloodborne parasitic disease is officially a foreign disease in the US, but the number of recent outbreaks and their unknown origin certainly suggest that this disease has a solid foothold in the US. The latest situation in New Jersey involves two horses purchased from the Texas farm which is currently under quarantine due to its involvement with the most recent outbreak of piroplasmosis in that state. However, these two horses were purchased in 2008, which strongly suggests that this disease has been in the Texas herd (and presumably elsewhere) since at least that time. Odds are this disease is actually wide-spread in some areas of the US.

Losing national piroplasmosis-free status could have significant repercussions on horse movement to and from the US, and a major impact on the equine industry overall. For this reason, some people might prefer to try to ignore the problem and hope it goes away. But, as I've said before, hope is not an infection control strategy.  It's much better to investigate this carefully and transparently to figure out what is going on. Without knowing the scope of the problem, it's impossible to control it.

Image source: www.australiasigns.com.au

Texas Piroplasmosis Update

The following report was provided by the Texas Animal Health Commission.

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November 4, 2009

Equine Piroplasmosis Disease Investigation Continues

Canada and a number of U.S. states have imposed movement restrictions or additional entry requirements for horses from Texas after equine piroplasmosis, a tick-transmitted blood disease of equine animals, such as horses, donkeys, mules and zebras, was detected in South Texas in mid-October.  Equine piroplasmosis may be carried and transmitted by as many as 15 species of ticks.  Although ticks have been collected from the South Texas ranch for testing, final results are not complete, and it is not known whether any of the ticks can serve as a host for the disease.

“Before moving horses from Texas, we urge you and your veterinarian to check with animal health officials for any state of destination, to ensure the animals have met all entry requirements,” said Dr. Bob Hillman, Texas’ state veterinarian and head of the Texas Animal Health Commission (TAHC), the state’s livestock and poultry health regulatory agency.  “Regulatory requirements can be fluid as disease situations evolve, so it is essential to call each state each time you haul.”  As states provide entry restrictions and requirements, the documents are posted on the TAHC web site at http://www.tahc.state.tx.us.  Dr. Hillman urged equine owners and veterinarians to call state animal health officials directly before hauling, as many states have not yet distributed entry requirement information. Contact information for state veterinarians may be obtained from the TAHC at  800-550-8242, ext. 710, or by emailing ceverett@tahc.state.tx.us.

“We are continuing the equine piroplasmosis disease investigation initiated in October in South Texas. No horse movement is being allowed from or to the ranch where the infection was detected,” said Dr. Hillman.  “While this tick-borne disease has not been considered endemic in the U.S., cases of the disease, scientifically known as Theileria equi, and previously called Babesia equi, have been detected in the U.S.   Our epidemiologists are tracing the movement of specific equine animals. Blood tests will be conducted, and the animals will be examined for ticks. Individual equine owners will be contacted, if their horse needs to be tested by animal health officials.”

Dr. Hillman refrained from speculating on how many equine animals will be tested or how many may be exposed or infected.  “Until the epidemiological work and testing of potentially exposed horses is completed, there is no way to predict how many horses may be affected with this tick-borne illness,” he said.

Dr. Hillman said horses infected with equine piroplasmosis may appear well, while others may exhibit a host of non-specific clinical signs, such as fever or anemia. These clinical signs also could be attributed to a variety of other diseases or causes. Blood tests are needed to diagnosis the disease. 

“Equine owners should talk with their private veterinary practitioners about complying with interstate movement requirements, testing recommendations and protecting their horses from ticks.  If a horse appears to be ill, it should be evaluated by an accredited private veterinary practitioner,” said Dr. Hillman.

Texas Animal Health Commission
Bob Hillman, DVM * Executive Director
For info, contact Carla Everett, information officer, at
1-800-550-8242, ext. 710, or ceverett@tahc.state.tx.us

We thank Carla Everett, Texas Animal Health Commission for sending this report.

Putting A New Spin On Old Drugs

At the recent symposium of the American College of Veterinary Surgeons, there was an interesting abstract presented about liposome technology.  Liposomes are basically teeny-tiny "bubbles" made up of the same basic components as cell membranes.  They are sometimes call nanoparticles because they are so small, but they are still much bigger than even large molecules, which gives them some interesting biological abilities.  When liposomes are injected into the bloodstream, they go all over the body, but they tend to accumulate where there is tissue inflammation, because blood vessels become "leaky" in inflamed tissue, allowing these nanoparticles to escape the bloodstream.  What's great about liposomes is you can put different things inside them (such as drugs), and they help deliver their contents to inflamed sites in greater concentration and over a longer period of time, while reducing the exposure of the other body tissues to whatever they're carrying.  This can ultimately help improve the efficacy and safety of the drugs they carry.  Liposomes also tend to accumulate in tumors, so they are sometimes used to deliver anti-neoplastic chemotherapy drugs to these sites.

Liposomes have actually been around for a long time.  They were first described by Dr. Alec Bangham in 1961, and since then have become valuable tools in biology, biochemistry and medicine.  The technology still has its share of problems that need to be worked out.  Some people may have acute adverse reactions when liposomes are injected intravenously.  Sometimes the body's immune system will "attack" the liposomes, taking them out of circulation prematurely.  Much work is still being done to find better ways to help liposomes target particular tissues.

In terms of treating infectious diseases, liposomes can be used to deliver antibiotics to infected tissues.  Because of the targeted delivery system, the toxic/side effects of drugs on the rest of the body can be reduced while still achieving the same (or higher) concentrations of drug at the site of infection.  An example of this is the drug Abelcet (Enzon Pharmaceuticals), which is a liposomal preparation of the very toxic antifungal drug amphotericin B.  Abelcet has been licensed for use in the US and Europe since 1995.

The abstract presented at the ACVS (C. Underwood et al.) described the use of liposomes containing a radioactive marker (99-m Technetium) in horses.  They injected 10 healthy horses with a dose of liposomes, monitored them for adverse effects (of which there were none detected), and then used the radioactive marker to determine where the liposomes accumulate in a horse under normal conditions.  Their ultimate objective is to determine if liposomes can be used to better deliver antimicrobials to areas of infected bone (osteomyelitis), which are typically very difficult to treat.  Liposome technology still has a long way to go before it's being used widely in horses, but this was an important first look at how liposomes can possibly be applied to equine medicine in the future.

Image credit: Kosi Gramatikoff (1999)

Case Presentation: Neurologic Mare

A five-year-old Quarter Horse mare was found down in the field in the mid-afternoon.  The horse was seen moving around the field normally less than eight hours earlier.  She was found near a fence, but there were no external signs of trauma on the mare's body.  Some green feed material was present at the nostrils.  With encouragement the mare was able to stand, but she was very unsteady and uncoordinated, particularly in the hind limbs. Upon examination by the veterinarian in the field, it was also noted that the horse could not open her mouth normally (lockjaw - which is often a sign of tetanus in horses), and the mare seemed "dazed".  There were three other horses kept in the same field, all of which appeared completely normal.  All the horses were fed the same round-bale hay (a new bale was just put out the previous day).  The mare was vaccinated for rabies in 2008 and West Nile in 2009 (spring).  There was no movement of horses on or off the farm (i.e. the horses were not taken to shows/competitions or off-site rides).

When the horse arrived at the hospital, she was down on the trailer.  By that time she had a fever, high heart and respiratory rates, and she was dehydrated.  Although she was still aware of things going on around her, she was very depressed.  She was still able to see, and she could move all four legs and her tail.  However, it was even difficult for her to lie on her chest (e.g. sternal recumbency), so she would roll to one side instead (e.g. lateral recumbency).  Her jaw remained rigid, but she could still move her tongue a little.

With a lot of encouragement and help the mare was able to stand up and stumble off the trailer, but she was so weak and uncoordinated in all four legs that she fell down again before she could even walk the 10 metres to her stall.  Eventually she made it to her stall, and she was able to stand for about an hour before she lied down (or fell down) again.  A urinary catheter had to be used to drain the mare's bladder because she did not seem to be able to urinate on her own.

The mare was treated with intravenous fluids (supportive therapy), and anti-inflammatories and steroids to try to reduce the inflammation that was suspected to be going on in her brain and spinal cord.  Despite all this, her condition continued to worsen, and by the next morning the mare could not even sit up and was becoming less aware of her surroundings.  The mare was therefore humanely euthanized.

Post-mortem tests in this mare confirmed there was inflammation in the brain based on a high number of inflammatory cells in her cerebral spinal fluid (CSF).  Because of the clinical presentation, some of the brain tissue also had to be sent away for rabies testing, which was (thankfully) negative.  Once that result was back, samples were also tested for evidence of infection with equine herpes virus (EHV-1), West Nile virus and Sarcocystis neurona (the cause of equine protozoal myeloencphalitis), all of which were also negative.  Botulism was also considered, but this disease is very difficult to test for in horses.  In the end, the final diagnosis, and the cause of the mare's neurological signs, was infection with eastern equine encephalitis (EEE) virus .

This case of EEE was diagnosed in September 2009 in Southwestern Ontario.  The description of the presentation, and how rapidly this mare deteriorated, demonstrates just how devastating and severe this disease can be.    This case also tells us that there are mosquitos in the area that are carrying EEE.  Vaccination of the other horses in the region will not provide protection before the end of this mosquito season, but owners of horses in the same area should seriously consider (and discuss with their veterinarian) vaccination of their horses against EEE in the spring, prior to the next mosquito season.  No one can say for certain if vaccination of this mare would have prevented the infection, or decreased the severity of the infection, but it likely would have helped.  In the meantime, as always, decreasing exposure to mosquitos as much as possible (if there are any left) should be the priority.

Image: TEM of the salivary gland of a mosquito infected with eastern equine encephalitis (EEE) virus (source: CDC Public Health Image Library #7057).

Can The US Be Piroplasmosis Free?

The ongoing large piroplasmosis outbreak on a Texas farm, following on the heels of a few other US outbreaks, raises concern that this infection is not really a "foreign" disease in the US (at least not anymore). Although the source of the earlier outbreaks was not identified, they did not raise too much concern because ticks capable of transmitting this bloodborne infection were not found (which reduces the risk of uncontrolled spread of the disease). However, the situation may be different in Texas. Following identification of the first case, 31 more positive horses were identified on the affected farm. That's a lot of infected horses, and given the number it's probably less likely that the infection was spread by human activity (e.g. reusing contaminated needles) than by ticks. Concern has been expressed over the past couple years that Boophilus microplus and Rhipicephalus microplus, ticks capable of transmitting this parasite, might be establishing themselves in the state of Texas. If this is the case, this may not be an easily controllable situation, and the US may lose its piroplasmosis-free status. Intensive investigation of the source of this outbreak, how it was spread on this farm, whether there are other affected horses in the region and whether these tick species are present, is urgently needed.

Image: A "hard tick" (male brown dog tick (Rhipicephalus sanguineus)) from the same genus as R. microplus, one of the tick species capable of transmitting piroplasmosis (Theileria equi) to horses. (CDC Public Health Image Library #7646)

More Piroplasmosis In The US

For a country that is "piroplasmosis-free," the US sure has a lot of piroplasmosis. The Texas Animal Health Commission has reported that this bloodborne disease, caused by Theileria equi, has been confirmed on a ranch in south Texas. The farm is quarantined and testing is under way to determine the scope of the problem. They are presumably also looking at ticks in the area to see if the types of ticks that are able to transmit the infection are present, and trying to figure out where the infection came from.

This is one of a couple of recent outbreaks of piroplasmosis in the US. The source of infection in these outbreaks is typically not found, but careful testing and quarantine of animals is usually effective at containing the disease. Unfortunately, positive horses can be infected for life, and are therefore usually euthanized. Long-term isolation or shipping infected horses to a country where the disease is endemic are other options.

Interestingly, I've not seen any comments about whether this outbreak could be linked to the recent outbreak is Missouri, where some infected horses were taken out of quarantine and have disappeared. It's certainly logical to consider that one of the fugative horses may have been  smuggled into Texas and been the source of this latest infection. Hopefully this is a small, contained outbreak that doesn't result in widespread death of horses and economic disruption. Hopefully the source is identified promptly and measures are taken to reduce future problems. Only time will tell.

Think Globally, Treat Locally!

If you have a horse, sooner or later you have a horse with a gash somewhere on its body.  Horses seem to have an uncanny ability to find the one sharp branch or protruding splinter of wood or nail in any paddock, pen or stall that no one else can ever find, no matter how hard you look.  But in the end, horses, just like people, sometimes get cuts.  Some cuts probably never even get noticed.  Thankfully, a lot of them heal by themselves with no interference from us.  In other cases, though, the cuts can get infected, and that's when you and your veterinarian need to step in and help that horse out.

Unfortunately, the "knee-jerk" reaction in many of these cases seems to be to put the horse on antibiotics.  Under some circumstances I don't disagree that this may be necessary, especially if the wound may involve tendons or a joint or deeper tissues.  In a lot of cases, however, this type of treatment may not be the best thing for the animal.  Use of local therapy for wounds, instead of systemic (e.g. oral or injected) antibiotics, should always be carefully considered.

Local therapy for wounds can include a variety of different types of treatments, such as drainage of discharge, removal of dead tissue (debridement), flushing of the wound (lavage), topical antibiotics, antiseptics, and sometimes newer (or older) compounds like honey.

Let's compare some of the potential pros and cons of local versus systemic therapy:

  • Treating what counts: Local therapy is targeted at the site of infection - the wound itself.  Some antibiotics that are too toxic to be given systemically, or can't be given safely at a high enough dose to be effective, can be applied directly to the wound at a higher concentration, delivering a more effective blow to the infecting organism.
  • Not treating what doesn't count: Avoiding the use of systemic antibiotics decreases exposure of the bacteria that are part of the horse's normal bacterial flora, particularly those in the intestinal tract.  This helps to decrease the risk of disrupting the flora, which can otherwise result in antibiotic-associated diarrhea.  It also helps decrease the risk of other bacteria in the horse's body developing resistance to the antibiotic being used.
  • "Taking out the trash": Drainage, debridement and lavage help remove all the "junk" in a wound by getting rid of dirt, pus and dead tissue.  Often times, these are the most important components of treatment, and likely have more of an effect on the outcome than any of the drugs that may be used.  Whatever can be physically removed from the wound decreases the amount of junk and bacteria with which the horse's body needs to deal, and also eliminates material in which bacteria can hide from the immune system.
  • Cost savings: Often times local therapy involves more time for cleaning and bandaging, but less drugs, because you're only treating the infected site, not the entire horse.

 

  • It's not easy: As difficult as it sometimes can be to give a horse needles or make it swallow medication, these methods are often chosen because they are perceived as the "easy way out." Local therapy for a wound can be a lot of work - it takes time, it sometimes means getting yourself a little dirty, and some owners don't like the "ick" factor of having to deal directly with the wound itself.  However, systemic antibiotics should not be used as a substitute for proper wound care.
  • Every wound (and every horse) is different: Not every infected wound is amenable to local treatment.  Deep wounds can be especially difficult to treat this way, because the deepest parts of the wound simply aren't accessible.  Also, depending on the temperament of the horse and/or the location of the wound, the animal may not tolerate local therapy of the site without sedation, in which case it is best left to your veterinarian.  It is always very important to ensure that you can safely treat your horse.

Even for wounds that do require systemic antibiotic treatment for one reason or another, local therapy should not be neglected, and can be critical to achieving a successful outcome.  It's important to try to resolve infections (of any kind) as quickly and efficiently as possible in order to avoid complications associated with chronic infection, and minimize the risk of antibiotic resistance developing (if antibiotics are used).  That means using all the available tools at our disposal, including simple wound care and local therapy, to treat them. But remember:

  • Always wear disposable gloves if you need to clean, treat, bandage or otherwise touch a wound, and wash your hands well with soap and water afterward.  This will help prevent bacteria from the wound from being transmitted to you, and bacteria from your hands from infecting the wound.
  • Do not give your horse antibiotics of any kind before consulting your veterinarian.

Hoosier Park Quarantine Lifted

After a rather lengthy process, Hoosier Park (Anderson, Indiana) has lifted its strangles quarantine. A quarantine was implemented on September 12th after a horse on the premises began exhibiting signs of strangles. Fifty-four horses were placed under quarantine. When S. equi, the bacterium that causes strangles, was identified in a quarantined horses, officials decided to move all quarantined horses out of the track facility. Presumably, once it was clear that the quarantine was not just a matter of waiting for confirmation that all horses were actually negative, they decided that the risk of having potentially infectious horses living at the track was unacceptable (pretty logical thought process). Now that those horses have been removed and no other cases have been found in the approximately 1000 other horses housed in the other track barns, they are back to business as usual. The quarantined barn is being disinfected and will not be used for the rest of the 2009 racing season.

This incident demonstrated a very aggressive but apparently effective response to strangles. They have presumably ended this latest outbreak and hopefully won't have to deal with it again. However, infectious diseases and outbreaks are inherent risks in the racing industry (as well as other competitive horse industries). The way we manage race horses, moving them around, mixing them, having various (and sometimes minimal) preventive medicine programs, having minimal measures to keep sick horses off the track, and a financial disincentive (i.e. people lose money) to keep horses away, means that infectious disease risks are not going to go away. It's not a question of whether there will be another strangles outbreak on a racetrack. It's a question of when and where.

Rhodococcus Infects More Than Lungs

Rhodococcus equi is a bacterium that is an important cause of respiratory disease in foals. It typically causes numerous abscesses in the lungs, and it is an important cause of illness and death in foals from a few weeks to about six months of age. Infections of other parts of the body can occur, and these can cause serious problems because they can be hard to diagnose and hard to treat.

A recent study in the Journal of the American Veterinary Medical Association (Reuss et al 2009) described extra-pulmonary disorders (EPDs, disorders in parts of the body besides the respiratory tract). They studied 150 foals, and 74% had a least on EPD. These included:

  • Immune-mediated synovitis (25%): This is a well-recognized problem where R. equi-infected foals get enlarged joints because of accumulation of excess joint (synovial) fluid. Fluid-distended joints can occur with joint infections, but with immune-mediated synovitis it's caused by the immune system alone. This typically does not result in long-term joint problems, although it's important to determine whether the foal has an infection which needs aggressive care, or just inflammation which is best left alone.
  • Abdominal abscesses (17%): This is a very serious problem and abscesses in the abdomen can be very difficult to treat. These foals often die.
  • Uveitis (11%): Inflammation of the eye, which can occur as a result of the immune response or infection. 
  • Septic synovitis (9%): As opposed to immune-mediated synovitis, this is an infection in the joint. This is very serious and can cause permanent joint damage.
  • Pyogranulomatous hepatitis (11%): This is inflammation of the liver with abscesses and pus.
  • Pleural effusion (3%): Accumulation of fluid between the lungs and body wall. This can be the result of severe lung disease.
  • Meningitis (3%): Infection of the layer covering the brain, which is never a good thing.

Foals that had EPDs were more likely to die than foals with infections only involving the lungs, which isn't particularly surprising. In particular, the presence of uveitis, bloodstream infection, joint infection (not immune-mediated synovitis) and abdominal abscessation were associated with failure to survive.

Herd immunity

Herd immunity is an important infectious disease concept. Basically, it involves trying to ensure that a high enough percentage of a population is resistant to an infectious disease so that the disease cannot be spread easily through the group. Ensuring that a large percentage of the population is vaccinated helps protect individuals that cannot be vaccinated (because of allergy, disease or other reasons) or that did not properly respond to vaccination (not all vaccines protect all vaccinated individuals).

"Herd immunity" usually refers to this concept when applied to herds of animals (such as horses or cows), but the "herd" can be a a small local population, a regional population, or broader, and it can be people or animals. For some human infectious diseases, it's been shown that vaccination of 75-95% of the population is required to prevent outbreaks. If vaccination rates start to slip, the chance of an outbreak increases. This is best seen in some areas where vaccination rates decline in certain groups of kids because parents are reluctant to have their children vaccinated (for one reason or another), and subsequently outbreaks of disease start occurring (or increasing).

Vaccination is an important (but not the only!) infection control tool. For diseases that are transmissible between horses (or dogs, or people, or whatever other "herd" is being considered), vaccination of a single horse helps protect that individual from disease, and also helps protect the rest of the population.

During a public health infectious disease course that I teach, a student showed a link to this interesting and amusing demonstration of herd immunity from the UK. Make sure you have your sound turned on. It's an entertaining description of the concept of herd immunity.

When you're deciding on your vaccination program, for both individual horses or a farm, be conscious of the herd immunity concept.

This equIDblog entry was originally posted on the Worms & Germs blog on 05-Oct-09.

EEE in Nova Scotia

A Nova Scotia horse has died of eastern equine encephalitis (EEE). EEE is a rare disease in Canada, but it is sporadically identified in some provinces. It was reported that this is the "first case" in Nova Scotia, although it wasn't clear if they meant in 2009 or ever.

EEE is a highly fatal mosquito-borne viral disease of horses. There is no specific treatment. The virus can also affect (and kill) people, but horses cannot transmit the infection to people -  horses and people (and some other species) are infected by being bitten by infected mosquitoes.

The veterinary clinic that diagnosed the case reported that 120 doses of EEE vaccine will be delivered there this week. A ProMed moderator commented that he/she hoped a major vaccination campaign will be started. However, it's far from certain that any vaccination efforts will be effective, particularly for this season. EEE is a very sporadic disease in Canada, but since it's so severe, vaccination certainly should be considered. However, considering most horses in Nova Scotia have never been vaccinated previously for EEE, it will likely take a couple of doses and several weeks before adequate antibody levels are present. By that time, the risk of exposure may be even lower because the mosquito season is ending in the maritimes. I'm definitely not saying don't vaccinate, however, because of the short remaining mosquito season and the lag time from vaccination to effective immunity, the immediate focus should really be on mosquito avoidance.

Deciding whether or not to vaccinate against EEE in areas where it is very rare and sporadic can be tough. From a population standpoint, it's somewhat difficult to recommend vaccinating all horses against a disease that may only affect a handful or horses, if any. However, from an individual horse standpoint, it's bad news if you happen to be that rare horse that gets infected. Really, it comes down to risk aversity and economics, and it's up to each horse owner (in consultation with their veterinarian) to determine what diseases they should vaccinate against.

MRSA Outbreak In Dutch Horses

At the ongoing ASM-ESCMID conference on methicillin resistant staphylococci in animals, Dr. Engeline van Duijkeren of Utrecht University (The Netherlands) presented a study on an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in their equine hospital.

From 2006-2008, several horses that underwent surgery at their hospital developed MRSA infections.  MRSA was also isolated from some healthy horses and personnel at the clinic. Early in the process, the hospital was closed for a thorough disinfection and the outbreak stopped, however another outbreak occurred later.  Further study again found people in the clinic that were MRSA carriers. Close to 15% of people in the hospital who handled equine patients were MRSA carriers, which is really astounding when you consider that less than 0.1% of the general population in the Netherlands carries MRSA. When they started testing horses coming into the clinic, they found that 9.3% of horses were carriers when they arrived. Weekly sampling of all hospitalized horses over a five-week period determined that 43% of all horses in the hospital carried MRSA at one point or another during their stay. Additionally, 53% of environmental surface samples were positive for MRSA, which is really not surprising if that many people and horses are carriers.

If horses keep coming into a facility carrying MRSA and people keep getting colonized, MRSA is hard to control. These experiences led the equine hospital at Utrecht to implement more stringent infection control practices to try to contain the problem, but the high MRSA rate in their referral population is going to pose a continual risk.

MRSA outbreaks in horses aren’t new. They’ve been reported by a few hospitals (including ours) and occur in many, many, (many!) more without ever being published. Since MRSA is present in the horse population, equine hospitals are at continual risk of MRSA outbreaks. If a large percentage of horses in the general population are carriers, the risk of outbreaks is higher.

MRSA is clearly a problem in horses in many areas. It’s important to realize that it’s a problem in the general population, not just horses in hospitals. Equine hospitals can amplify the spread of MRSA, but ultimately a lot (if not most) MRSA-positive horses originate from farms, not clinics or hospitals. Equine hospitals need solid infection control programs to reduce  the risk of outbreaks, but the risk will never be completely eliminated. Farms need good infection control programs to reduce the risk of spread of MRSA between horses and between farms, as well as from horses to people (and back). Antibiotics need to be used prudently since antibiotic use is a risk factor for MRSA carriage and infection.

More information about MRSA in horses can be found on the equIDblog Resources page.

 

New Zealand Trainers Banned For Strangles

Another strangles scare has resulted in a trio of horse trainers being banned from racing in New Zealand until October 7.  New Zealand Thoroughbred Racing (NZTR) is taking a hard line with this particular outbreak, especially with the upcoming Kelt Capital Stakes premier raceday on October 3.  While they're trying to do the right thing to protect the larger racing population, there are a few things going on that simply don't quite add up.

All horses from the affected farms are banned from racing facilities for 21 days after the last known case had run its course (reportedly September 16): That's great, but... 21 days is the isolation period typically used to detect clinical cases of strangles (i.e. exposed horses that get sick will usually do so within 21 days).  However, some horses, particularly those recovering from being sick, can shed the strangles bacterium for much longer than this.  In order for such a ban to really be effective, horses from the property should also be tested to ensure they are not shedding Streptococcus equi subsp equi before being allowed in more public facilities.

In a press release issued by NZTR on September 23, it is stated that "An isolation period of six weeks is usually necessary to ensure that the disease is not still incubating before ending the isolation.": Why would they make such a statement and then only isolate these properties for three weeks?

The same press release states "...controls have been put in place, as recommended, and this should ensure that the risk of further spread will be effectively controlled."  If the NZTR thinks that banning horses from the affected farm and the neighbouring properties from the track is going to eliminate the risk of strangles, they're deluding themselves.  As we've said before, strangles is an endemic disease in the horse population, and there are certainly other horses in New Zealand that are carrying strangles.  Any time a large group of horses get together there is risk.    The best way to reduce the risk is to ensure that simple, practical infectious disease control measures are in place, and followed, every day.  Statements like this just give people a false sense of security.

Strangles was initially identified in a horse from a sale that was brought onto the farm over a month earlier.  The horse was isolated on September 8 for being sick, and diagnosed sometime in the following week:  There are a few good points here.  First of all, it demonstrates a classic example of a "normal" carrier animal (the "trojan horse" if you'll forgive the pun) from a sale (making it high risk for carrying infectious diseases) that was brought onto a farm and likely not isolated and tested, ultimately resulting in an outbreak on the farm which is now affecting the ability of all the horses there to race.  Classic.  Furthermore, this horse from the sale arrived on a truck with several other horses which were delivered to three other properties in the area.  There is no indication that these other horses have been tested to see if they are carriers, nor that the other properties have been inspected.  Based on the ban that has been slapped on the currently affected property and its neighbours, I could see trainers and owners being reluctant to report any new cases, or even horses with a fever, for fear of the same thing happening to them.  Also, I have to wonder, if there was a known strangles case on the index farm since at least last week, why did it take until September 23 for the NZTR to issue the ban? 

"...once strangles was diagnosed, all the horses on the Cottle property - minus the infected ones - were vaccinated [for strangles].": Vaccination in the face of an outbreak is actually not recommended according to the strangles consensus statement from the American College of Veterinary Internal Medicine.  Particularly with a known carrier having been on the farm for a month, by that time all the other horses were likely already exposed, and vaccinating them at that point merely puts another drain on their systems.

"The barn yard was disinfected but the bedding was not replaced.":  I've never seen nor heard of a barn yard that could actually be effectively disinfected.  It would have to made entirely of sealed wood/concrete or metal, and even then it would be a momentous task and likely still impossible.  I don't doubt they gave the area a thorough cleaning, but it was not disinfected.  The fact that the bedding was not replaced surprises me - this seems like one of the simpler, easier things to do.  While it also can't guarantee a strangles-free stall, any horse that is shedding the bacterium is likely to have highly contaminated bedding, and removing it at least decreases the environmental pathogen burden.  The article also states that "the bacteria can survive in bedding and soil for at least eight months."  Perhaps under ideal sheltered conditions this may be possible, but a study presented last year showed that in the "real world" S. equi probably only survives in the environment for a few days.

Both the article and the press release do make a few sound recommendations in the end, including adopting hygiene guidlelines such as replacing bedding, disinfecting water troughs and feed buckets and other equipment, avoiding mixing and moving horses, being aware that people are a potential source of cross-contamination, and of course our favorite: "As with any contagious
disease, handwashing is a simple and effective tool.
"

More information on strangles is available on the equIDblog Resources page and in our archives.

Image: Banned trainer/owner Tim Symes, with his horse Molly O'Reilly (source: www.hawkesbaytoday.co.nz)

Hoosier Park Horses Banned

The Kentucky state veterinarian has banned horses kept at Hoosier Park racetrack (Anderson, Illinois) from barn areas of any Kentucky racing facility because of concerns about strangles. Two Hoosier Park horses were diagnosed with this highly infectious disease caused by the bacterium Streptococcus equi, and 57 horses have been quarantined. Horses from Hoosier Park that have been isolated and monitored for 21 days may enter Kentucky facilities.

The idea behind the 21 day quarantine is that within 21 days, most horses that have been exposed to strangles will develop signs of disease within that time period. However, the problem is that horses that have been infected with strangles can get over the infection and look great for 21 days (or much, much longer) but still carry S. equi in their throats or guttural pouches. So, while this is a reasonable approach, it by no means guarantees that S. equi will be kept out of Kentucky. However, in reality there are never any guarantees when it comes to infectious diseases like this. While some cases of strangles get a lot of attention, it's an endemic disease that is circulating in the horse population, and certainly is present in some horses in Kentucky already. Responding to outbreaks and limiting the risk of outbreak-associated transmission is very important, but it's equally important to make sure that routine infection control practices are in place on tracks (and elsewhere) to reduce the risk of disease transmission every day.

More information about strangles can be found on the equIDblog Resources page.

US Piroplasmosis Outbreak "Resolved"

The recent piroplasmosis outbreak in Missouri and Kansas has been declared resolved. The concluding report has a few interesting findings:

Evidence indicates that in this outbreak, ticks, the typical vector of the disease, did not play a role in the transmission of the bacterium that causes piroplasmosis, Theileria equi. No infected ticks were identified and all ticks that were found on the farms were species that have not been shown to transmit the infection.

Disease transmission was attributed to poor management practices such as needle sharing between horses, which can result in transmission of bloodborne disease, including piroplasmosis. (Needle sharing is always a bad idea. There aren't too many bloodborne diseases in horses, but it's still stupid to reuse needles. They're incredibly cheap and there is no valid reason to do this).

The failure to find ticks that can transmit disease suggests that the risk peiod is over in the affected area. No one has explained, however, where this infection came from in the first place. That's an important issue that hasn't received a lot of attention.

There's also the sticky issue of the vanishing quarantined horses. Three infected horses were illegally taken out of quarantine and still have not been recovered. Therefore, "resolved" is a questionable term. The local outbreak is probably over, but these three escapee horses could still be a threat to the horse population wherever they are. The report states that unsubstantiated information indicates the horses may have been taken out of the country. That's obviously a concern for neighbouring countries like Canada.

Hopefully, this episode is really over. Hopefully the infected horses have been taken to an area where there are no ticks capable of transmitting disease. Hopefully people that have them are smart enough not to reuse needles. Hopefully the illegal and reckless action of sneaking out infected horses doesn't cause an outbreak elsewhere and result in the deaths of more horses. However, hope should not be an infection control strategy.

Weanling ADR (Ain't Doing Right)

We've survived the summer, and with cool(er) weather soon on its way we are now into what I like to call "weanling season" (which follows naturally after "foal season").  One of the common things veterinarians get called about at this time of year is 5-6 month-old foals that just "aren't right."  They may not be growing well, they may be skinny, they may not have the same healthy haircoat as other foals in the same group, and they may generally just be "dragging their heels" a bit - not very energetic, and maybe sometimes a little depressed.  Of course this is particularly problematic in the fall when some farms are trying to get their foals ready for sale, and they want them looking their best!

Bloodwork on these scraggy foals often shows low - sometimes extremely low - protein levels in their blood.  Blood protein is very important for normal body function and controlling tissue fluid levels, and the body (especially the liver) works very hard to maintain normal levels.  Low blood protein (also called hypoproteinemia) in these animals usually indicates that the protein is being lost from the body, and the most common route for this to happen is through the intestine. (It can also be lost through the kidneys, but renal disease in young animals is generally uncommon.)  Some of these foals have diarrhea as well, or may go on to develop diarrhea if left untreated.

What is it that turns a foal's intestine into a protein sieve?  One possibility, and a hot research topic at the moment, is the bacterium Lawsonia intracellularis, which causes the condition known as proliferative enteropathy.  But any severe infection of the intestine has the potential to affect the barrier that normally keeps blood protein fluids in the bloodstream, so other causes of enteritis and colitis such as Salmonella and Clostridium also need to be considered.  Heavy burdens of intestinal parasites can cause similar problems - some of these may be difficult to test for because the larval stages do not produce eggs that can be found on a fecal test, and developing resistance issues mean that routine deworming cannot guarantee that parasites are not present.  There are no doubt other causes as well that haven't been identified - in half of all diarrhea cases in (adult) horses, a causative agent cannot be identified, even with a complete diagnostic work-up. 

In horses, if only the small intestine is affected (enteritis) - even in severe cases - the animal usually will not have diarrhea.  However, if the infection spreads to the colon, or if the bacterial populations in the colon are affected badly by the foal's poor health status and abnormal "flow" of feed material due to the infected intestine "upstream", then colitis will develop as well, resulting in diarrhea.  Anytime the normal intestinal bacteria of a horse are disrupted, the animal also becomes more susceptible to other bacterial pathogens such as Salmonella and Clostridium as well.

What should be done with these "scraggy" weanlings?

1. Have them examined by your veterinarian as soon as possible.  Don't wait for them to start looking really sick.  These weanlings can be frustrating to diagnose and treat at the best of times, but the farther they're allowed to slip, the harder it is (and the longer it takes) to bring them back.

2. Look for other foals that might be affected.  Especially in larger groups of foals, one particularly sick animal may stand out, but there could be several others flying just under the radar that you may not notice unless you really take the time to look at each foal individually.

3. Separate healthy weanlings from those that aren't 100%.  It may be difficult or impossible to individually isolate all the "scraggy" animals depending on numbers and the facilities available, particularly more severely hypoproteinemic foals that may take weeks to months to recover.  At a minimum, the foals that appear healthy should be separated from and always handled before the ones that may be affected by an intestinal infection.  Any animal with diarrhea should be isolated.  The duration of isolation required will depend on the specific diagnosis (if one can be made).

More information about Lawsonia is available on the equIDblog Resources page and in our archives.

Image source: www.virginiawildhorserescue.com

Declaring A Farm "Strangles-Free"

During a strangles outbreak, people often ask how (and when) they can say their farm is "strangles-free." They usually don't like the answer. Declaring a facility to be free of strangles, a highly contagious disease caused by the bacterium Streptococcus equi, is not cheap, easy or quick. It is, however, important.

A major source of the strangles bacterium is horses that have been infected but either didn't get sick or have recovered, yet are still shedding S. equi in their nasal secretions. In some horses, S. equi can persist for long periods of time (i.e. months) in their nasopharynx (throat area) or guttural pouches. Identification of these carriers is crucial for strangles control and must be done to have confidence that strangles has really been eradicated from a farm.

Identification of carriers involves taking samples from the nasopharynx to test for the bacterium. Nasopharyngeal washes are preferred but nasopharyngeal swabs (note: this is different from a nasal swab) are also acceptable. These should be collected by a veterinarian. They can be tested for S. equi by culture or PCR (a molecular test), or both. Any positive horses need to be investigated further, including endoscopy and culture of the guttural pouches.

Three negative samples from the nasopharynx and/or guttural pouches, collected weekly, are required to declare a horse free of strangles. If a positive horse is identified during the process, the clock starts again on its testing, plus all other horses with which it has had contact. Even though a horse may have had three negative samples, if it has been in contact with a positive horse, you have to assume there's a chance it was infected after testing started, so you need three more samples after its last contact with any positive horse.

While this process is not cheap, easy or quick, it is strongly recommended.

At the same time, it's also a good idea to review why the strangles outbreak occurred and how it can be prevented in the future. This is a step that's often overlooked.

More information about strangles can be found on the equIDblog Resources page and in our archives.

Image: A horse with draining tracts from classic strangles abscesses between the lower jaw bones

Time To Improve 'Wussy' Equine Farm Infection Control

An Australian horse group, the Queensland Horse Council, is calling for the equine industry to change its culture in terms of biosecurity. I agree completely, however, as I've said before, I think the term "infection control" is really what we are talking about here. Biosecurity involves keeping pathogens off a farm, as is done with tight controls on pig farms. Infection control also tries to do this, but realizes it's not completely possible with how we manage horses, and therefore also focuses on controlling the impact and spread of infectious diseases on the farm.

This is obviously in response to the recent Hendra virus outbreak in Australia. It usually takes a remarkable (and sometimes tragic) event to get people talking about infection control. It becomes a hot topic, people call for improved efforts and resources, and everyone gets on board... for a few weeks. After a short period of time without problems, people tend to revert to their usual behaviour, and infection control often gets marginalized again. The key, therefore, is establishing a sustained effort. That's the hardest part of infection control, be it in a hospital or on a farm.

Queensland Horse Council (QHC) president Debbie Dekker is quoted in the Sydney Morning Herald as saying "We are a pretty gung-ho lot and biosecurity is treated like some sort of wussy thing. Everyone needs to tighten up their biosecurity practices."

Well said.

"We still have a lot of people who don't know about Hendra virus so we need to get the information out to horse owners."

Communication and education are key. Just telling people they need to do something is not going to be very effective. Infection control practices usually involve some degree of effort or change in normal practices. If people don't understand why they should change, they are less likely to do so.

Sporadic infectious diseases and outbreaks will continue to happen (in horses, people and others). We can never completely eliminate the risk. We can, however, reduce some of the risks. While nothing can change what has happened with the most recent Hendra virus outbreak, we should at least make sure some good comes out of it, and that it leads to improved infection control awareness in Queensland and beyond.

Thanks to Dr. Doug Powell of Barfblog for the headline.

Image source: www.qldhorsecouncil.com

Hendra Virus Vaccine: For Horses or People?

In the wake of the death of Dr. Alister Rodgers from Hendra virus, there have been increasing calls for the Australian government to put significant resources into Hendra virus research. Various areas need to be investigated, including how this virus is maintained in the bat population, how it is transmitted from bats to horses, ways to treat infection and ways to prevent infection. Vaccination is an obvious topic, and creation of a vaccine appears to be possible. However, as I wrote the other day, there's a question about whether a company would put millions of dollars into development of a Hendra virus vaccine for people, given that the disease is very rare, is currently limited to one region, and only appears to be a risk for people in close contact with sick horses.

One thing that needs to be considered is whether it may be better to develop a vaccine for horses rather than people. Think about it:

  • All reported human Hendra virus infections have come from people in close contact with sick horses.
  • Human vaccines are very expensive to develop, test, get approved and market.
  • Vaccines for animals are much cheaper to make because testing and regulatory requirements are not as strict. (This can lead to marketing of vaccines for animals with limited evidence of effectiveness, but the upside is that vaccines can get to market quicker and with less expense.)
  • People are often more willing to get their horses vaccinated than to get vaccinated themselves.

So, even though it might sound strange, development of a Hendra virus vaccine for horses may be a more effective way to protect people.

If this approach is taken, a key step would be continued research into the epidemiology of Hendra virus infection to investigate other routes of human exposure. If people can get infected by other routes, vaccination of horses obviously wouldn't address the entire problem. However, based on what we know currently, vaccination of horses might be the most effective, timely and economic response to this pressing problem.

Horse Bites

As a vet, I've been bitten by a wide range of animal species. When people talk about animal bites, they usually think about dogs and cats. Horses can (and do) bite as well. Most horse bites are probably playful nips that hurt a little yet don't cause major problems, but some bites can cause serious injuries and infections can result.

A recent paper in the Journal of Agromedicine (Langley and Morris 2009), with the rather unwieldy title of "That Horse Bit Me: Zoonotic Infections of Equines to Consider after Exposure Through the Bite or the Oral/Nasal Secretions". Bites apparently account for 3-4.5% of the approximately 100 000 annual emergency room visits in the US that are associated with horses. The authors of the paper review infections associated with bites and contact with organisms in the mouth and nose of horses.

A large number of bacteria have been associated with horse bite infections in people, including Actinobacillus, Streptococcus, Psuedomonas and Staphylococcus species. Some viruses can theoretically be transmitted by bites, but there's little evidence that this actually happens.

Although viruses are not of as much of a concern overall, rabies needs to be considered in every bite from a mammal. We pay a lot of attention to rabies with dogs, cats and wildlife, but it often gets ignored with horses. While I'm not aware of any reports of rabies transmission from horses to humans by a bite, it could happen.  Fortunately, rabies is rare in horses so the likelihood of exposure from this species is very low. However signs of rabies aren't always obvious initially, and rabies in horses may mimic other diseases. Sometimes, rabies looks like colic, and human exposure through bites or other contact is possible when handling, evaluating and treating affected horses.

Unlike with dogs and cats, there are no clearly defined protocols for dealing with bites from horses. Any dog or cat that bites a person is supposed to be quarantined for 10 days. The reason for this is if the animal is rabid and the disease is advanced enough for the animal to be capable of spreading rabies virus, it would invariably develop signs of rabies and die within this time period. We don't have similar guidelines for horses. I suspect the 10 day observation period would be adequate but we don't have good data. The paper states that in Kentucky, a 14 day observation period has been used by the state Department of Public Health.

At the conclusion of the paper, the authors make a few important general recommendations for reducing the risk of disease transmission from bites and oral or nasal secretions of horses:

  • Use good general hygiene, especially hand hygiene, after any contact with horses.
  • Use gloves and gown or lab coat when examining horses in a veterinary clinic or hospital. (This might be overkill for all horses. We don't require gloves for every horse contact, just contact with mucous membranes (e.g. mouth, nose), wounds, incision sites and other high-risk areas. I think bare hands are fine for general contact as long as there is good attention to handwashing after.)
  • Consider mask and goggles if the horse is coughing or sneezing.
  • Develop standard operating procedures for handling sick horses.
  • Use isolation when needed.

I'd add a few more points:

  • Avoid bites. Pay attention to what you are doing around horses to reduce the risk of being bitten. Do not encourage playful behaviours (e.g. nipping) that could lead to bites.
  • If you are bitten and it breaks the skin, clean the site thoroughly with soap and water. If there is significant trauma, or if the bite is over a joint, hand, foot, or a prosthetic device, you should see a doctor immediately because antibiotics are most likely indicated. If you have a weakened immune system, you should be evaluated by a doctor after any bite.
  • Avoid contact with the horse's mouth or nose if you have skin lesions. Cuts and scrapes can allow bacteria to enter your body and cause infections. If you have a cut on your hand, make sure it is covered with a glove or waterproof dressing if you are going to have contact with the horse's mouth or something that came from its mouth (e.g. a bit).

How To Prevent Antibiotic-Associated Diarrhea

Horses sometimes need to be treated with antibiotics. That's an unavoidable fact. Some horses that are treated with antibiotics develop diarrhea, which can be fatal. That's another unavoidable fact. While those two situations can't be avoided, the risks can be decreased.

Addressing the first point, "sometimes horses need to be treated with antibiotics," involves various factors such as having a good preventive medicine program, good infection control and only using antibiotics when they are truly needed. We'll never absolutely eliminate the need for antibiotics, but we can reduce their use.

The second point is a little harder to address. Any horse being treated with antibiotics is at some risk of developing antibiotic-associated diarrhea. In addition to hopefully killing or inhibiting the bacteria at the site of the infection, antibiotics also reach the intestinal tract, where there can have effects on the complex resident bacterial population. Disruption of this normal bacterial population can allow "bad" bacteria to overgrow, resulting in diarrhea. How do we reduce the risk?

  • Use antibiotics only when necessary and with the advice of your veterinarian.
  • Avoid high-risk antibiotics (e.g. tetracyclines, erythromycin in adult horses) unless absolutely required.
  • Use local (i.e. topical) therapy whenever possible instead or oral, intravenous or intramuscular administration. This limits the amount of antibiotic that makes it to the intestinal tract.
  • Try to minimize other potential risk factors for diarrhea such as diet changes, high grain diets, transportation and other stresses.
  • Monitor your horse closely and contact your vet if there are any signs of colic or diarrhea.
  • It might be reasonable to avoid anti-ulcer drugs, since it's possible there could be increased risk of diarrhea while being treated with these drugs (possible, but not proven).

Probiotics are often used, but there is currently no evidence they are effective in horses. Mixed results have been obtained in people.  It's possible that certain probiotic organisms at certain doses may help reduce the risk of certain types of diarrhea in certain horses. We just don't know what "certain" means at this point. Probiotics probably won't hurt, but we can't have any confidence in them yet that they are really beneficial.  No other supplements have been shown to be effective, and there is little reason to suspect that any would be effective.

Understanding Antibiotics: Gram Positive/Gram Negative

I often get asked "what's the best antibiotic?" The short answer (but the one people really don't want to hear) is "the one that works." It's obvious more complex than that, but, in reality, the best antibiotic to use for any given horse and any given disease IS the one that works, and the one that does so with minimal side effects, including both patient side effects (e.g. diarrhea) and microbial side effects (e.g. emergence of drug resistance).

Sometimes, certain drugs are referred to as "powerful" antibiotics, which really isn't a good description. What people are usually referring to is the ability of these drugs to work on bacteria that are resistant to many other antibiotics. These "powerful" antibiotics are not necessarily any better at treating an infection caused by a more susceptible bacterium, they are just able to work on bacteria resistant to other drugs.

When choosing an antibiotic, it's important to consider whether the bacteria involved in the infection are Gram-positive or Gram-negative. Gram staining is a simple technique used to divide bacteria into these two groups. Under a microscope, after staining Gram-positive bacteria appear purple and Gram-negative bacteria appear red (or pink). The differences in staining are a result of differences in the bacterial cell walls, which also play an important role in determining a bacterium's susceptibility to different antibiotics.  Part of describing the function of an antibiotic is stating whether it is effective against Gram-positive bacteria, Gram-negative bacteria or both. (There are other aspects such as whether there is effect on aerobic versus anaerobic bacteria (those that can versus cannot survive in the presence of oxygen), but I'll address that some other time).

Some antibiotics have broad spectrum activity, being able to kill Gram-positive and Gram-negative bacteria. At first that might seem like a good thing, and indeed it is when you are treating an infection with an unknown bacterium. However, broad spectrum activity is not desirable when you know exactly what bacterium you are trying to eliminate. If possible, it's much better to target treatment more specifically against the offending bacterium for various reasons, such as to reduce the risk of resistance emerging in other bacterial groups.

Some antibiotics are narrow spectrum. Some are most effective against Gram-positive or Gram-negative bacteria, with little activity against the other.  In general, we want to use an antibiotic of the most narrow spectrum possible. We can do this is a few ways:

Educated guess: A six-month-old foal with a lung abscesses most likely has Rhodococcus equi pneumonia. Even without a culture to confirm, we would usually treat the foal with drugs specifically targeting this Gram-positive bacterium, with little concern about Gram-negatives.

Gram stain: If the infection is in a location that can be sampled, then a Gram stain can be performed. This is very easy, quick and cheap, and can tell you whether you are dealing with a Gram-positive, Gram-negative or mixed infection.

Culture: This is the best method, but culture is not always possible and results may take several days. Culture can tell you the which bacterium is involved and exactly which antibiotics it's  susceptible to in the lab.

Economic Realities of Hendra Virus Vaccine

Hendra virus, as you've probably seen here and elsewhere, is back in the news as the cause of another outbreak in horses in Australia with subsequent transmission to people. This bat-borne disease is very rare but devastating, with high mortality rates in both horses and people. Currently, a veterinarian is in critical condition in the ICU of a Brisbane hospital fighting this virus, while other exposed horse farm personnel are waiting to see whether they get sick too. Last year, another veterinarian died. Because of the severity of disease, vaccination gets discussed. Development of a Hendra virus vaccine is possible and a prototype vaccine has been produced. However, the question is will such a vaccine ever get used?

Vaccines are very expensive to develop, test and market. Given the nature of the pharmaceutical industry, there usually has to be a reasonable expectation that the costs will be recovered through sale of the vaccine. Some treatments for rare diseases that have no chance at making money are produced by pharmaceutical companies as a service to society, but not every money-losing product can be made. The problem with Hendra virus, in terms of vaccination, is that it is such a rare disease. Only 7 people have been diagnosed with the infection. It's tough for companies to justify spending millions on a vaccine for such a rare disease if they don't think people will use it. Vaccines for rare diseases can be profitable if a lot of people get vaccinated (e.g. rabies). However, given the sporadic nature of Hendra virus, the limited geographic range where it occurs and the fact that it seems only people with close contact with horses are at risk, the market would be very small. Unless things change with respect to how common this disease is (and we all hope not to see any more of such a terrible disease), I doubt we'll ever see this vaccine on the market.

Erythromycin In Horses

Erythromycin is an interesting drug in horses, having saved the lives of countless numbers of foals but able to readily kill an adult horse. Erythromycin is an antibiotic of the macrolide class. It is effective against many Gram-positive bacteria (e.g. Staphylococcus, Streptococcus, Rhodococcus), but not Gram-negative bacteria (e.g. E. coli, Salmonella).

There are several very good aspects of erthyromycin, including its ability to kill bacteria that have invaded cells (intracellular bacteria) and the ability to treat abscesses (many antibiotics can't do that very well at all). Erythromycin is also available in an oral form, which makes it much easier to give. It is most commonly used for the treatment of Rhodococcus equi pneumonia in foals, almost always in combination with the antibiotic rifampin, and it's a highly effective treatment.

However, the news isn't all good.  Erythromycin is far from a benign drug, and should only be used in certain situations. Some of the problems associated with its use are:

Diarrhea: Any antibiotic can cause intestinal upset, ranging from mild diarrhea to fatal colitis, but erythromycin is a particularly high-risk drug. Diarrhea can occur in foals being treated with erythromycin, but this is not very common and when it occurs diarrhea is not usually very severe. However, giving oral erythromycin to an adult horse is a very high-risk proposition that can easily result in fatal colitis. In Sweden, there have been reports of fatal colitis in mares whose foals were treated with erythromycin - the hypothetical cause of this phenomenon is that mares were exposed to extremely low amounts of erythromycin from the foals' mouths or feces. Erythromycin should be avoided in adult horses at all costs.

Hyperthermia: This is a strange but rare side effect that is most often seen in foals being treated in sunny areas without access to shade. Some treated foals lose the ability to properly control their body temperature, and can develop extremely high fevers. The classic situation is an otherwise healthy foal that is responding nicely to treatment suddenly found down in the field one day with a life-threateningly high body temperature. This is uncommon, but it is a concern and treated foals should always have access to shade and be closely monitored.

Erythromycin can be a very useful drug is some situations. It's use is declining somewhat as related drugs like azithromycin are sometimes being used in its place, but it can still be a good treatment option in some cases. Because of the risks of adverse effects (and because of basic principles of antibiotic use), you should only use erythromycin under the direction of a veterinarian. Never use it in an adult horse unless you have no other choice, and realize there is a reasonable chance the horse will develop potentially fatal diarrhea.

Image: 3D model of erythromycin molecular structure (source: www.3dchem.com)

Pigeon Fever Warning for Colorado Horse Owners

Colorado State University veterinarians have issued a warning to horse owners in the state to be on the lookout for pigeon fever. They are reporting a spike in cases along the northern Front Range of Colorado.

Pigeon fever is a highly contagious disease caused by the bacterium Corynebacterium pseudotuberculosis. It is an important disease in areas where it's common, but it is essentially unheard of in other regions (I've never seen a case myself). This bacterial infection typically causes abscesses along the horse's chest, midline and groin. The condition can be very painful, and affected horses may be very lame or reluctant to move.  The infection also causes fever, lethargy and weight loss. In some cases, it can be fatal.

Corynebacterium pseudotuberculosis can live in the soil and enter the horse's body through wounds or other breaks in the skin. Flies, especially cattle horn flies, may also transmit the infection. People are not affected, but can transmit the bacterium on their bodies (e.g. hands), clothing or other items.  Despite the name, horses do not get the infection from contact with pigeons.

People in this region of Colorado (plus other areas where this disease occurs) should be on the lookout for affected horses. Initial signs are often vague and the diagnosis may not be apparent until the disease is already advanced. If you think your horse may be affected, contact your veterinarian as soon as possible. In the interim, your horse should be isolated to reduce the risk of further transmission. Areas on the farm where affected horses have been should be quarantined until they are adequately cleaned and disinfected - bacteria in pus from draining abscesses can survive for several weeks in the environment.

Image source: http://docsusan.blogsome.com/

Reporting Adverse Reactions

A recent post about mandatory vaccination in show horses sparked a discussion about concerns regarding adverse reactions to vaccines. Dr. Carolyn Cooper of the Canadian Food Inspection Agency posted the following comment.

"There is mandatory reporting of adverse vaccine reactions in Canada by the vaccine manufacturers to the Veterinary Biologics Section (VBS) of the Canadian Food Inspection Agency. VBS monitors the type and frequency of reports in order to identify any potential issues with the safety and efficacy of licensed products. In order to increase the usefulness of mandatory adverse reaction reporting, veterinarians should report all suspected adverse reactions to the vaccine's manufacturer. Any comments regarding the licensing of veterinary vaccines in Canada, or adverse reaction reporting in Canada, can be directed to VBS at http://www.inspection.gc.ca/english/anima/vetbio/conpere.shtml "

This is a very important reminder for veterinarians and horse owners. While there is mandatory reporting, adverse reactions to drugs and vaccines are rarely reported by veterinarians. There's nothing underhanded about the lack of reporting, it's mainly that people don't think about it when it happens. Without good data, however, we are left to debate the true risks of vaccines and drugs with only incomplete information. Drugs and vaccines can be marketed for animals with rather minimal safety data. Even with large studies, safety issues can be missed until the drug/vaccine is mass marketed, as has been shown with some high-profile human drugs. If regulatory agencies don't get the data (i.e. if the reactions aren't reported to them), then they can't adequately monitor safety concerns. If your horse has an adverse reaction to a pharmaceutical product, you should make sure this is reported. It doesn't take your vet much time and shouldn't take any effort on your part.

Mandatory Horse Show Vaccination Complaints

Last year, there was a large equine influenza outbreak at the Crawford County Fair in Pennsylvania. In response to that, a mandatory influenza vaccination policy was implemented. However, registrations for this year’s fair have dropped by 1/3 from 457 to 310. One horse owner says “It’s because of the shots.”

This is a pretty unfortunate response by horse owners. Mandatory vaccination is an entirely reasonable component of an infection control program that should be more widespread. Shows are optimal environments for transmission of disease. Huge numbers of horses get sick ever year from infections acquired at shows and outbreaks are not exactly rare.

One horse owner explains her decision not to show as “It’s the expense, plus there’s the risk of an adverse reaction to the shots.” That’s code for “It’s the expense.

Vaccines are pretty cheap, especially when you consider how much money is spent on the horse and showing each year. People often spend huge amounts on boarding, (largely unnecessary) supplements, tack and other supplies, along with the costs of registering and traveling to shows. Concerns about adverse reactions are often used to justify non-vaccination, but it’s usually just an excuse. Adverse reactions to vaccines are quite rare and typically minor. Adverse reactions to intranasal influenza vaccination are extremely rare to non-existent.

Hopefully this fair sticks with this policy. They should be commended for taking a responsible action and more fairs should be doing the same thing. Personally, this is a fair that I’d want to show at. The vaccination requirement means there’s less chance of a horse acquiring influenza. Also, weeding out people who are too cheap or otherwise unwilling to use good preventive medicine strategies should decrease the pool of horses that are carrying other infectious diseases. Those people can organized their own vaccine-free show (the biohazard games).

Rabid Horse in Maryland

A horse in Harford county Maryland has been euthanized because of rabies. The horse first starting showing signs of disease in mid-July, which manifested as "striking changes in behaviour." The report doesn't say when the horse died, but animals typically die within a few days of the onset of neurological disease. The horse was transferred to the New Bolton Center where rabies was diagnosed. Subsequent testing showed it was a raccoon rabies strain, although that does not mean that a raccoon was the actual source of infection.

Public health officials implemented a 45 day quarantine of the farm. Stray cats (about 25) were caught and euthanized. Fortunately, the family pets were properly vaccinated and have received booster shots (plus presumably a period of observation at home... a much better situation than if they were not vaccinated).

People that had contact with the horse have received rabies post-exposure treatment. This includes one person who had to be tracked down overseas.

Harford County Health Department spokesperson Bill Wiseman said "There was never a risk to public safety. This incident was a great example of public health work in action and cooperation between local, state and in this case, international authorities." I don't buy the statement that there was no risk to public health. While the risk of rabies transmission from infected horses is very low, it's not zero. Rabid horses have killed people because of their abnormal and sometimes aggressive behaviour. Further, the fact that this horse had rabies means that it got it from something. Rabies can have a long incubation period so it's not guaranteed that it acquired it on the farm, but you have to be prudent and assume that there is infected wildlife in the area that could pose a risk for other animals or people. Public health authorities managed the situation well and reduced the public health risks, but there were certainly still risks.

Rabies vaccination is highly effective. There is no statement about whether this horse was adequately vaccinated but it's unlikely. Proper vaccination would likely have prevented this horse's death, as well as the death of the stray animals, cost of vaccination of people, cost of veterinary care for this horse, quarantine of the farm and the associated financial and emotional costs. A dose of vaccine that costs a few dollars could have saved thousands of dollars and emotional stress.

Rabies is a rare disease in horses but its severity means it should not be ingored. Vaccinate your horses.

Why Should I Isolate My Horse After It Comes Back From An Equine Hospital?

It's a good general practice to isolate and monitor any horse that has been off the farm, especially one that has been to an equine hospital. This is often a touchy area for equine hospitals - telling people to isolate and monitor their horses might suggest to owners that the hospital has an infectious disease problem, and lead to negative perceptions of the facility or having people take their business elsewhere. However, it's been proven time and again that the "head in the sand" approach does not work for infectious diseases. Discussions of infectious disease risks in horses that have been hospitalized should be taken as an indication that the facility has an open and proactive infection control program. Therefore, places that talk about disease rates may very well be the safest facilities, because they are monitoring infectious disease, taking precautions and showing that they care about infection control.

Horses coming home from equine hospitals are always going to be at some increased risk of shedding infectious agents. Here's why:

  • Some healthy horses carry various infectious agents at any given time. Stress, shipping, diet change, antibiotic treatment and other factors that occur during hospitalization can result in increased shedding of these organisms that the horse was already carrying. For example, equine herpesvirus lives dormantly in a reasonable percentage of healthy horses. They don't usually shed the virus, but may start shedding when they are stressed. So, a horse that was not shedding herpesvirus could start shedding as a result of hospitalization, and thereby expose other horses on the farm. Similarly, stress, shipping, diet change, antibiotics and anesthesia can cause horses that were already carrying low levels of Salmonella to start shedding high levels of the bacterium, potentially resulting in disease in the affected horses or transmission to others.
  • Horses can acquire infectious agents in hospitals. An inherent risk of visiting any hospital (like any fair or other event) is exposure to infectious agents. Horses that go to hospitals are at higher risk of picking up things because of the reasons described above. The more horses present and the poorer the infection control program, the greater the risk. Regardless of the quality of infection control at the equine hospital, some risk always remains, but a good infection control program can greatly reduce the risk.
  • Horses that return from hospitals are often at higher risk of becoming infected with (i.e. more susceptible to) various bacteria and viruses for a short time after they return home. Therefore, they might be at greater risk of picking up something that is circulating on the farm already but not causing major problems to the otherwise healthy horses.

Routine isolation and monitoring of horses returning from equine hospitals is a good management practice. The likelihood of a problem developing is low, but it's much better to have problems occur when the horse is isolated so they can be contained. A short isolation period lets horses get rid of infectious agents they have picked up or started shedding as a result of hospitalization, so they don't expose other horses. It also lets you identify problems that develop (e.g. diarrhea, cough, fever) as a result of being off the farm, before the horse is expose to other animals on the farm.

The ability to properly quarantine horses on a farm is variable, depending on the facility, but effort should be taken to provide the greatest degree of isolation/quarantine that is feasible and practical. Every farm should have an infection control program that includes a plan on how to handle horses that have returned from equine hospitals.

Piroplasmosis Makes Horses Vanish

TheHorse.com reports that a third horse that tested positive for the reportable, foreign disease equine piroplasmosis (Theileri equi infection) was illegally removed from quarantine in Kansas... in June. Two other horses were broken out of quarantine shortly after they were diagnosed in June, and have yet to be found. These horses could be anywhere spreading this disease, and may result in the US losing its piroplasmosis-free status. The latest OIE report indicates that the third horse was reported missing the day after the other two horses. That's one more potentially infectious horse on the loose, and one more threat.

This appears to be a good example of what can happen when you combine recklessness, carelessness and stupidity (perhaps with a little bit of laziness on the side). Any effective quarantine needs to be properly implemented and monitored. Any breaches of quarantine need to be immediately identified, reported, investigated and communicated. I haven't seen any previous information about the missing Kansas horse; I can't find anything in earlier press releases or other statements. If this information was withheld, it shows pretty blatant disregard for effective communications. People need to know when there are disease threats. Knowing that a horse with piroplasmosis is on the loose is important because this horse has to have gone somewhere - possibly a public stable or other facility with other horses. If people knew a horse was broken out of quarantine one night and someone showed up at the barn with a horse the next day, they could ask some questions or call the authorities to help protect their farm and their animals. Without this information, they're helpless.

(Image source: www.funnyphotos.net.au)

"Long-Acting" Penicillin in Horses

"Long-acting" penicillin, a combination of benzathine penicillin and procaine penicillin, is available for use in horses. The idea is that the drug releases penicillin slowly into the body so that a single injection lasts a few days. Good in theory - but not in reality.

The problem with long-acting penicillin is the penicillin levels achieved in the body (i.e. the concentration of penicillin in the blood and other tissues) aren't actually high enough to do anything (except perhaps to help encourage the development of penicillin resistance among bacteria). There are some exquisitely susceptible bacteria that might be killed by long-acting penicillin, but the vast majority of horses that get better after treatment with long acting penicillin probably get better despite treatment (i.e. they would get better on their own anyway).

If you need to use an antibiotic, use an effective one that has been prescribed by your veterinarian. Don't use long-acting penicillin.

As a paper looking at the pharmacokinetics of penicillin in the horse (Love et al, 1983) stated, "Fortified benzathine penicillin appears to have little value for antimicrobial therapy in the horse." That says it all.

Do Horse Owners Need Tetanus Shots?

Here's a question I received the other day:

"Do people who work with animals and who work in barns need a tetanus shot as a result of this type of work?  We have Therapeutic Riding Programs in the region and there is a sense that perhaps the volunteers and those who frequently tend the horses need to receive this.  Is this the case?"

Tetanus is a disease that we are quite concerned about in horses because horses are very susceptible to it. That's why we vaccinate them yearly. Tetanus can also affect people, but very rarely because of vaccination and because people have lower susceptibility to the disease. While we pay a lot of attention to tetanus in horses, this does not mean that being around horses increases a person's likelihood of exposure to tetanus. The bacterium that causes tetanus, Clostridium tetani, lives in soil and commonly present in the environment. The more environmental exposure that you have (especially to soil), the greater your risk of exposure to C. tetani. Being around horses doesn't increase your risk any more than doing other things outside.

Whether you have contact with horses or not should not change your approach towards tetanus prevention. You should be vaccinated against tetanus every 10 years. Many (probably most, actually) adults are not up-to-date on tetanus vaccination. Adults tend not to get booster shots on schedule, and often only receive them when they have had a wound that requires medical care. For example, If you get stitches, the medical staff will almost certainly inquire about your last tetanus shot, and give you another one if you haven't been vaccinated in the past 10 years (or if you can't remember).

More information about tetanus in horses is available on the equIDblog Resources page.

Bug of the Month: Equine Infectious Anemia Virus

Equine infectious anemia (EIA) is a rare disease but one that a lot of time, effort and money are put into avoiding. Most people know about this disease by way of the most common test (formerly) used to diagnose it: the Coggin's test (see image).

Equine infectious anemia is caused by a virus of the same name ( equine infectiious anemia virus, EIAV). EIAV is a lentivirus which, like all other lentiviruses, causes persistent infection. Unlike most other lentiviruses that cause slow, gradual preogression of disease, EIAV infection usually causes a sudden onset of disease (acute phase) followed by recurrent disease. After the initial (acute) phase, horses can appear normal, which means they can be a silent reservoir of the disease. That's why routine testing for EIAV is required in many circumstances: to detect silent carriers so they cannot continue to transmit infection.

Signs of acute EIA vary, but usually include fever, lethargy and decreased appetite. Anemia (decreased red blood cell count) and thrombocytopenia (decreased platelet count) can be detected. Anemia is more common and pronounced with recurrent infections. Intermittent illness often develops after the first acute episode. Affected horses may experience short (3-5 day) periods of fever, lethargy and decreased appetite. The severity of the anemia often correlates with the severity and frequency of these disease episodes. In some horses, these episodes are very common, long and severe, and these horses often have severe weight loss and anemia. However, most infected horses stop developing obvious signs of disease after a year and seem perfectly healthy.  This may be good for the one horse, but it's bad for other horses in the area to which the virus may be transmitted.

EIAV is a bloodborne virus that can be transmitted by blood-feeding insects, especially tabanid flies (horseflies, deerflies). Stable flies can also transmit EIAV but do so less effectively. Contaminated medical supplies such as reused needles and syringes can also transmit EIAV.

Fortunately, EIA is now rare in most regions and positive tests are quite uncommon. Routine testing for EIA is usually required for shows, sales, transportation and other situations where horses are mixed, in order to detect and remove carriers. Unfortunately, identification of a horse as a carrier is not good for the horse or owner (or other horses in the area) - EIA is not treatable, and horses that have positive tests ("reactors") are quarantined, as are all other horses that are housed within 200 yards. Horses living close to reactors are tested (usually 30 and 60 days after removal of the reactor) and only released from quarantine after getting negative test results at least 60 days after the last reactor was removed. Reactors are usually euthanized. If prompt euthanasia is not chosen, reactors are usually prominently branded or tattooed. They must be kept under quarantine for the rest of their lives, and at least 200 yards from other horses. (200 yards is used because the flies that transmit the disease don't usually travel that far.)

The best way to reduce the risk of EIA is ensuring that all horses are regularly tested. New horses coming onto a farm must be tested BEFORE arrival or after arrival but while in quarantine at least 200 yards away from other horses. Needles and other items that might be contaminated with blood should never be re-used, both due to the EIA risk and to avoid other potential problems.

Overall, EIA is a very rare disease, but the severe implications of a positive test mean that we need to be vigilant.

Image from http://www.aht.org.uk/science_eia.html

Still No Sign Of Missing Piroplasmosis Horses

There is apparently still no evidence regarding the location of two horses with piroplasmosis that were stolen out of quarantine in Missouri. I've been trying to find out more information, to no avail. TheHorse.com quotes a senior USDA veterinarian who states that, as of June 30, the location of the horses was still not known.

This is a pretty concerning situation. While piroplasmosis is not highly transmissible, these two missing horses could be putting many other horses at risk, as well as the piroplasmosis-free status of other regions of the US (if they have been moved to other states or infected other horses that have subsequently traveled to other states).

Piroplasmosis, which is caused by the bloodborne parasite Theileria equi, is transmitted by ticks and through contaminated needles.  If these horses are in an area where there are tick species that are capable transmitting this parasite, piroplasmosis could be silently spreading. Whoever took these horses, and anyone associated with this situation, are incredibly irresponsible and are putting many other horses at risk. This is another good reminder of why you need to be careful and ensure you know as much as possible about all horses (and their owners) that you allow on your property.

EEE in Louisiana

It was only a matter of time, but eastern equine encephalitis (EEE) has been found in more US states this year. EEE is an seasonally important disease in some areas, including Louisiana. More cases in more states, and perhaps even some regions of Canada, are likely over the course of the summer and fall.

The latest case of EEE infection was reported in a horse in Rapides Parish, Louisiana. Not surprisingly, the horse died, as EEE has a very high mortality rate in horses - and in people.

If you live in a region where EEE cases have been identified or typically occur, you should have your horse vaccinated. Really, you should have already had your horse vaccinated, because it takes time for the vaccine to work after administration. However, even if your horse hasn't been vaccinated yet this year, get it done (better late than never).

Another important aspect of preventing EEE cases is mosquito control. EEE, like Western equine encephalitis and West Nile virus, is transmitted by mosquitoes. Measures should be taken to reduce mosquito populations in the area and mosquito exposure, both for your horse and yourself.

Vesicular Stomatitis In New Mexico

Not long after the first reported case of vesicular stomatitis (VS) of 2009 in Texas, the disease has now also been identified in De Baca County, New Mexico. It's not too surprising, because infectious diseases tend not to pay attention to state boundaries, and New Mexico tends to be one of the first states affected by VS during outbreak years. Reportedly, only a single horse has been infected in New Mexico so far, and the farm involved has been quarantined.

This will presumably result in many regions placing travel or import restrictions on horses from New Mexico, as was done with horses from Texas. Previously in some years when this disease has been detected in the US, it has been contained to a single state. During other years, multi-state outbreaks involving large numbers of horses have occur. Only time will tell what this year will bring.

People that live in or adjacent to areas where vesicular stomatitis is present should closely observe their horses for signs of this disease, including:

  • Drooling
  • Lesions in the mouth, ranging from raised, white lesions to blisters. After lesions rupture, ulcerated areas are present.
  • Swelling, inflammation and lesions around the coronary band (these are less common than mouth lesions).

This disease is primarily spread by insects, so direct contact with an infected horse is not required for disease transmission. Therefore, even closed herds need to be on the lookout. If signs consistent with vesicular stomatitis are found, movement of horses on and off the property should immediately cease and a veterinarian should be contacted as soon as possible.

Vesicular Stomatitis In Texas

Vesicular stomatitis (VS) has been identified in a horse in south Texas. This viral disease is highly infectious and is a concern for various reasons.

Horses are often the first animals affected when an outbreak of VS develops. A quick response can help prevent the virus from spilling over into other species. It's a particular concern in cattle and sheep because VS can look very similar to foot and mouth disease, a tremendously important foreign disease that can have a devastating economic impact (just ask anyone from the UK).  Even though it is not usually fatal, vesicular stomatitis can also result in severely decreased production in food animals, and therefore also have a significant economic impact.

The impact of VS on infected horses varies. It causes painful blisters (most commonly on the upper surface of the tongue, surface of the lips and around nostrils, corners of the mouth and the gums) which can limit the use of the horse for a period of time (although infected horses can't compete anyway because the must be strictly quarantined). Some horses may be too sore to eat or drink normally, and therefore require supportive care. In unusual situations, the lesions are so severe that euthanasia is elected.

Vesicular stomatitis is a reportable disease in the US, and identification of this case has prompted a rapid outbreak investigation and response. The last outbreak, in 2006, was contained to 17 horses and 12 cattle in Wyoming. A much larger outbreak in 2005 infected livestock on at least 445 premises in 9 states. To help keep this virus contained, restrictions on livestock movement are promptly implemented. Infected animals and their herdmates are quarantined, neighbouring farms may be investigated and/or quarantined, and people are put on the alert to look for more cases. A fast response and cooperation of horse owners is critical. A major concern is  that people may have horses that develop vesicular stomatitis but don't tell anyone because that want to avoid being quarantined. This type of situation can prevent containment of the problem and lead to ongoing transmission and even bigger problems in the long run. Good communication and cooperation are essential.

Image from: http://www.newsinfo.colostate.edu

Piroplasmosis In Missouri

Equine piroplasmosis, a foreign reportable disease, has been identified in a horse in Missouri.  On June 2, the affected horse (a seven-year-old Quarter Horse) was presented to an equine hospital with signs consistent with a bloodborne disease (although the exact signs have not been reported). The horse was isolated because of the potential for piroplasmosis, and an investigation was started. The sick horse and other horses from the same farm were examined for ticks (the vector of piroplasmosis) and none were found.  On June 10, the diagnosis of equine piroplasmosis was confirmed. The other 63 horses on the farm are currently being tested, the results are pending.

No source of infection has yet been suggested. The US was considered free of piroplasmosis after the last horse in a Florida outbreak cleared the infection earlier this year. This newly affected horse was apparently purchased six months ago, but no information was provided about where it came from. The lack of a clear source of infection is concerning because it could indicate that there are unknown cases somewhere else in the US.

Piroplasmosis is a tickborne disease cause by the protozoal parasite Theileria equi. It can cause signs of illness such as fever, anemia (decreased red blood cell count), jaundice, respiratory signs, reddish urine and weight loss. Up to 20% of affected horses may die. The parasite is naturally transmitted by ticks. It can also be transmitted through the re-use of needles or other blood-contaminated medical equipment, and perhaps through breeding if the semen contains blood. One problem with identification and control of piroplasmosis is that many infected horses show no signs of disease. Further, horses that recover can carry the parasite for prolonged periods of time and become long-term sources of infection for other horses, if the appropriate ticks are around to transmit the pathogen. Horses that are carrying this parasite therefore need to be strictly quarantined. Horses that become persistent carriers of piroplasmosis need to  be quarantined for life, euthanized or sent to a country where the disease is endemic. More information about the source of infection in this case and how far it has spread is anxiously awaited.

Horses Leaving The Farm: What To Do When They Return

The horse population is perpetually at risk for major disease outbreaks. Sometimes we get lucky and nothing happens, sometimes we get regional outbreaks of disease, and rarely we see large national outbreaks (e.g. influenza in Australia). There are many reasons for this risk, and most involve how we manage our horses. Unlike other domestic animals that rarely travel and are not commonly exposed to large numbers of "new" animals on a routine basis, some sectors of the horse population are highly mobile and there are regular chances for disease exposure. Some of these risks are inevitable (e.g. traveling for competition, emergency visits to an equine hospital).

Ideally, every horse that leaves the property for any reason, be it a show or a stay at an equine hospital, should be isolated upon return. Keeping a horse isolated for 1-2 weeks provides time for transmissible infections to be identified, and for elimination of certain infectious diseases that are only shed for a short period of time (e.g. equine influenza). This is most important when there are high-risk horses on the property (e.g. pregnant mares) or when horses are traveling to places with a high risk of exposure to an infectious disease.

Obviously, isolation of all horses upon return is not practical in all situations, such as when horses are leaving for events on a regular basis or when appropriate facilities do not exist. In these situations, you have to accept that you are putting yourself (and the other horses in the barn) at increased risk for infectious diseases. Therefore, other components of a good infection control program are even more critical, such as rapid identification of horses that might have an infection,  a sound infection control plan when such horses are detected, a solid preventive medicine program and good general hygiene measures. Good management practices will reduce (but not eliminate) the risk of disease transmission when an unknown carrier gets on the farm.

If isolation of all returning horses is not possible, you should take particular precautions around:

  • Horses that have been to events where sick horses are present.
  • Horses that have been in contact with horses from sales.
  • Horses that have been at an equine hospital (especially one without an infection control program).

Even if you can't (or won't) isolate new arrivals, you can do other things, such as:

  • Make sure that new horses are checked carefully on a daily basis (or more often) for signs like fever, loss of appetite, cough, nasal discharge, enlarged lymph nodes and diarrhea. Also, make sure something happens with that information! It's not helpful if someone is checking temperatures but doesn't know what to do if they identify a horse with a fever.
  • Keep new horses as far away as possible from resident horses. For example, keep them at the least-used end of the barn, maybe with an empty stall in between them and any other horses. It doesn't replace true isolation but it's better than nothing.  In particular, keep new horses away from the highest risk horses, like broodmares.
  • If you have to turn out new arrivals, turn them out by themselves or at least always turn them out with the same group horses, so that if they are infectious, a limited number of horses are exposed.
  • If you have any doubts about the health of a new horse, get it examined by a veterinarian. Some diseases have narrow windows of time when horses may show signs of infection but not yet be able spread the disease (e.g. horses with strangles will spike a fever before they start to shed the bacterium). Therefore, prompt action is critical. Calling a veterinarian out earlier can help determine the appropriate measures to take and make the difference between one sick horse and one sick farm.

Equine Herpesvirus Consensus Statement

The American College of Veterinary Internal Medicine (ACVIM) has released a consensus statement on equine herpesvirus type 1 (EHV-1). The ACVIM is the specialty organization for veterinary internal medicine in North America, and every year it produces consensus statements on selected large and small animal topics. These are developed by a group of experts in the field, who review current knowledge (and knowledge gaps) and come up with a comprehensive overview of the subject. This consensus statement has detailed information on various aspects of EHV-1, including diagnosis, vaccination and infection control. It can be accessed through the ACVIM website, on the equIDblog Resources page, or by clicking here.

Bug of the Month: Clostridium piliforme

Tyzzer's disease is a rare but devastating disease caused by the bacterium Clostridium piliformeThis bacterium causes severe liver disease and sudden illness in young, otherwise healthy foals between the ages of 1 and 6 weeks. Usually on any particular farm only one foal is affected at a time, but small outbreaks can occur.

There is still a great deal we don't know about C. piliforme and Tyzzer's disease. It is presumed that foals become infected by ingesting the bacterium from the manure of other horses or from the environment. No one knows how often foals are exposed to the bacterium in this way - it may happen to a lot of foals, but only a few of them get sick, or it may happen very uncommonly, but make most of the exposed foals sick.  Tyzzer's disease occurs very suddenly and progresses incredibly fast.  Affected foals are often simply found dead, even though they looked completely normal only hours earlier.  If they are found alive, foals may be slightly to extremely weak and lethargic, and they may have a fever, diarrhea, and increased heart and respiratory rates. The gums and whites of the eyes may be yellowish (i.e. jaundice), which is sign of liver failure. Even if foals with Tyzzer's disease are found alive, their condition usually worsens very quickly and they often start having seizures before they die.

A diagnosis of Tyzzer's disease is usually made by post mortem (necropsy) examination. Clostridum piliforme cannot be grown on regular culture plates in the lab like most of the disease-causing bacteria with which we deal (this also makes it very difficult to study). Special stains of liver tissue (silver stain) can help identify C. piliforme under the microscope. Real-time PCR, a molecular method that detects the DNA of C. piliforme, is also available.

Unfortunately, most foals with Tyzzer's disease die before, or shortly after, they are found to be ill.  In most cases there is hardly enough time to even start treatment because the disease is so severe and progresses so rapidly. There are only three foals ever reported to have survived Tyzzer's disease, or what was strongly suspected to be Tyzzer's disease.  Very aggressive therapy (i.e. in a referral hospital) is needed immediately to try to save affected foals, but the prognosis is very grave.

There are no known measures that can be taken to help prevent Tyzzer's disease in foals.  Fortunately, the condition is rare, and there is no evidence that it is transmissible to humans.

Severe Diarrhea Caused By Clostridium difficile

The latest issue of the Journal of Veterinary Diagnostic Investigation contains a case report by Dr. Glenn Songer's research group about a 14-year-old Quarterhorse that had been treated with ceftiofur (an antibiotic) because of suspected salmonellosis, and subsequently died of severe colitis (sometimes called colitis X, but I don't like that name). This pattern is all too familiar when it comes to horses: antibiotic treatment for an undiagnosed infectious disease results in death due to colitis (diarrhea). It's even more frustrating when you consider there is very little indication to treat adult horses with salmonellosis with antibiotics.

The colitis in this case was caused by Clostridium difficile.  The strain of C. difficile was ribotype 027 (also called NAP1, BI and toxinotype III, depending on the method used to type the strain), which is typically considered the most serious strain in people. It is often associated with outbreaks of disease, and has been blamed for the increased frequency and severity of C. difficile infections in people internationally over the past few years. This strain has also been found in dogs, cattle and pigs, as well as retail meat samples (e.g. from the grocery store).

While the information in this paper isn't particularly surprising, it should act as a reminder that C. difficile is an important problem in horses and that important strains of C. difficile can infect many different animal species. When you consider how big of a problem C. difficile is in human medicine, it should be a reminder that we need to take this problem seriously in horses too, and also continue to investigate whether people can be infected by horses. A small percentage of healthy horses shed C. difficile in their manure, and we don't really know if that poses a risk to people. When you consider how much C. difficile can be present in diarrhea, the huge volume of diarrhea that a horse can pass and the potential for human exposure because of the big mess that is made, we certainly should consider diarrheic horses as a possible source of infection for people, just as we do for Salmonella.

Antibiotic use is a well known trigger for C. difficile infection in people.  While disease in horses can occur even when antibiotics are not given, it is widely suspected that antibiotic use is a major risk factor for severe colitis due to C. difficile. Anecdotally, ceftiofur seems worse for this than many other drugsin some regions.  This is consistent with studies in humans that have shown that antibiotic drug class used can have a significant impact on the risk of C. difficile infection.

What should we take home from this report?

  • Only use antibiotics when they are really needed. Antibiotic administration can lead to fatal complications, although these are rare.
  • Consider C. difficile in all cases of diarrhea in horses.
  • Consider all horses with diarrhea potentially infectious to other horses and people, and handle/house them appropriately.

Photo source: http://www.microvet.arizona.edu/Faculty/songer/diag.htm

Foal Diarrhea Part 2: Foal Heat Diarrhea

As previously discussed, diarrhea in young foals can range from a messy inconvenience to a rapidly life-threatening condition. A very common but fortunately relatively harmless cause is a syndrome called foal heat diarrhea, so named because it usually occurs around the time of the mare's first heat after foaling, when the foal is about 7-10 days old. Foals with foal heat diarrhea have diarrhea but no other problems like weakness, decreased appetite, colic or fever. If any of these other signs are present, then the foal has something other than (or in addition to) foal heat diarrhea.

The cause of foal heat diarrhea is not known. It doesn't actually have anything to do with the mare's heat, or the mare at all in fact - it even occurs in foals that are bottle raised and have no contact with a mare. It's likely the result of normal changes in the bacterial microflora in the intestinal tract of the foal that just happens to occur at this age.

Foals are usually diagnosed with foal heat diarrhea when they are the right age and have mild diarrhea but no other problems. Testing for (and ruling out) other causes of diarrhea like salmonellosis helps to support this diagnosis.

Any foal with diarrhea must be monitored closely for developing signs of illness.  Don't fall into the trap of simply chalking up a diarrhea episode to foal heat diarrhea and forgetting about it.  If you're wrong, a foal with diarrhea due to an infectious cause can go from looking "okay" to too weak to stand and nurse (or worse) within a matter of hours.

Foal heat diarrhea does not require any treatment in almost all cases. Occasionally, foals can get weak or dehydrated if they don't drink enough to make up for the fluid lost in the diarrhea, but this is quite rare. Foals almost always get better on their own. If they don't, there is probably something else going on and diagnostic testing is needed to determine what that is.

The fact that foal heat diarrhea gets better on its own may be one reason there are so many "proven" foal diarrhea treatments by which people swear. Some people are convinced that certain treatments are highly effective because when they treat foals, they get better. However, with foal heat diarrhea, which is probably the most common cause of diarrhea in foals, the animals get better regardless of (or despite) what you do. That's why well-designed research trials that include untreated control groups are needed to determine if treatments actually work.

Rhodococcus equi in Horses and People

Rhodococcus equi is a very well recognized pathogen in horses – it is a common cause of pneumonia in foals between the ages of 1-6 months, and infection is also sometimes associated with other problems such as diarrhea, swollen joints and abscesses in other parts of the body. The infection can be very difficult to treat because the bacteria are able to live inside white blood cells, which helps protect them from the body’s immune system, and because they often cause abscesses to form, which are difficult for antibiotics to penetrate. Rhodococcus equi infection in foals has been studied extensively, but there’s still a lot we don’t know how the body defends itself against this organism.  These are a few things we do know:

  • Almost all foals are exposed to R. equi as neonates, but most of them never develop signs of infection.
  • Giving newborn foals hyperimmune plasma (plasma with extra antibodies against R. equi) may have some beneficial effects on farms where the infection is a recurrent problem, but this practice is still controversial.
  • Adult horses are essentially immune to the infection.
  • In almost all cases if clinical disease in foals, the R. equi strain involved carries a special gene called vapA.
  • Mortality rates in foals vary considerably from 0% to 30%.
  • So far, efforts to develop a vaccine to help protect foals have been unsuccessful, but research in this area is ongoing.

People can also be infected with R. equi, and as in foals, pyogranulomatous pneumonia (infection of the lungs which results in the formation of many abscesses) is one of the most common conditions caused by this organism. However, there are a few important differences between infection in people and infection in horses:

  • 85% to 90% of people with R. equi infection are immunocompromised, meaning their immune system is weakened or suppressed for some reason, e.g. HIV infection, or immunosuppressive drugs taken by organ transplant or cancer patients.
  • Among people infected with R. equi who have normal immune systems (i.e. immunocompetent), about half of the infections are localized, meaning they only affect one small part of the body. Many of these are associated with wound infections.
  • Only 20% to 25% of the R. equi isolates in people carry the vapA gene.
  • Infection in immunocompetent people can be fatal in approximately 11% of cases, but among HIV-infected patients the mortality rate from R. equi infection can be as high as 50% to 55%.

Rhodococcus equi is actually a soil organism, and this is likely the most common source of the organism for both horses and people. Only approximately 1/3 of humans infected with R. equi report that they have had contact with horses or pigs (pigs can also carry the bacterium). So we don't know how much of a risk an infected foal is to a person.  However, it is prudent for people, particularly those with weakened immune systems, to take precautions to avoid potential transmission of R. equi from horses.

  • Try to reduce dust levels on the farm. Because R. equi most often lives in the soil, it can get stirred up into the air in dusty areas, which can then lead to inhalation by animals and people. Doing things like planting grass or other vegetation, installing windbreaks in high-traffic areas, or wetting down dusty stalls or paddocks can help reduce dust levels in the air.
  • Keep open wounds and other broken skin covered when working around animals.
  • Always wash your hands after handling a foal (or any horse)
  • If you have a foal that develops signs of R. equi infection, make sure you have your veterinarian examine it as soon as possible so the diagnosis can be determined and the foal can be treated properly as soon as possible. Some foals with R. equi may develop severe pneumonia very quickly, so it’s important that they are examined right away.

This equIDblog entry was originally posted on the Worms & Germs blog on 09-May-09.

Rhodococcus equi: More Than Just Pneumonia

Rhodococcus equi is a common pathogen in foals between the ages of 1 and 6 months of age that is most infamous for its ability to cause pneumonia. Classic R. equi infection results in the formation of large abscesses throughout the lungs of young foals (see picture left), which can be especially difficult to treat because the bacteria are able to hide from the body’s immune system by living within white blood cells. However, this organism’s bag of tricks doesn’t end with lung abscesses – it can also travel to other parts of the body and cause all sorts of trouble. These kinds of infections may occur with or without the classic lung infection, and are referred to as extrapulmonary disorders (EPDs).

At the 2008 Forum of the American Association of Equine Practitioners (AAEP), researchers at Texas A&M presented the results of a study they recently completed looking at EPDs in 150 foals with R. equi infection over a 20 year period. Here are some of the highlights:

  • 74% of the foals had an EPD associated with their R. equi infection. On average foals had two EPDs each and up to as many as nine EPDs in a single animal.
  • Many of the EPDs did not cause separate, detectable clinical signs. These were therefore most often found on necropsy in foals that died.
  • The most common EPD was diarrhea, which occurred in 50 foals (33%).
  • Immune-mediated polysynovitis (inflammation and swelling of the joints without infection of the joints themselves) was the second most common EPD
  • 31 foals (21%) had ulcers and inflammation somewhere in their intestine (ulcerative enterotyphlocolitis), all of which were diagnosed at necropsy
  • 25 foals (17%) had abscesses in the abdomen, 71% of which could be detected by ultrasonography

Thirty-nine different EPDs were identified in the group.  Other EPDs included uveitis (inflammation of the eye), hepatitis (inflammation of the liver), septic arthritis (joint infection), lymphadenopathy (enlarged lymph nodes), peritonitis (inflammation of the lining of the abdomen) and septicaemia (bloodstream infection).

  • Among the foals with EPDs, 43% survived hospitalization, whereas 82% of foals without EPDs survived.  However it is very important to remember that many EPDs were only detected at necropsy, therefore they were more often found in foals that died, but it is unknown if they actually occurred more commonly in one group or the other.
  • Risk factors for foals developing EPDs included longer time from onset of clinical illness to referral (e.g. foals that were sick at home for longer before being sent to the hospital were more likely to have an EPD), higher heart rate on admission and a higher white blood cell count.

It’s important to remember that even though an infectious pathogen may usually affect an animal in a certain way, “the bugs don’t read the textbooks” (as we often say), and they can cause problems in other ways. That’s just one of the reasons it’s so important to have your veterinarian perform a full physical exam of your animal if it is sick - even if it looks similar to something you’ve seen before - in case the pathogen causing the problem starts to affect other parts of the body, which may require more or different kinds of treatment.

Photo credit: M. Anderson

Botulism Suspected in Wyoming Horse Deaths

Botulism is suspected in the deaths of 10 horses on a farm in Wyoming, USA. Very few details are available to indicate why botulism is suspected or what the source might be. It was reported that six horses died initially, and four others that were lethargic and unable to stand died within 24 hours. These signs fit with botulism, which is characterized by profound muscle weakness and progressive paralysis. Death is caused by an inability to breathe when the paralysis starts to affect the muscles that control breathing. Making a diagnosis of botulism can be difficult in horses - it is often a "diagnosis of exclusion" whereby the diagnosis is made because everything else that could cause the condition has been ruled out.  Testing of some of the affected horses is underway. It was not reported whether possible sources of the disease (e.g. feed) are also being tested.

Botulism is caused by a toxin produced by the anaerobic bacterium Clostridium botulinum. In adult horses, the disease almost always occurs from consuming the toxin in contaminated feed.  If the bacterium (which can be found in the soil in many regions) gets incorporated into feed, under the right conditions the organism will grow and multiply, and produce the powerful neurotoxins that cause botulism. Fermented feeds like haylage and silage are common sources, because the way they are stored is more likely to create an environment where C. botulinum can grow.  However, various other food sources have also been implicated in some outbreaks.

Botulism is rare, but typically fatal in adult horses. Some basic tips to reduce the risk of botulism are:

  • Avoid feeding horses haylage and silage, especially in areas where botulism is more common. There are some benefits to using feeds, so they are commonly used in some regions, but if you use fermented feeds you should discuss the risk of botulism with your local veterinarian, and take measures to reduce the risk of C. botulinum growth.
  • Vaccines against botulism are available. Adult horses are usually not vaccinated, other than mares which are vaccinated to reduce the risk of botulism in their foals (known as "shaker foal syndrome"). Adult horses being fed high-risk feeds could be considered for vaccination, but if the feed is so high risk that vaccination is warranted, perhaps the feed program should be reconsidered.  Furthermore, there are several types of C. botulinum, but the vaccines only protect against some of them. If you are thinking about vaccinating, you should make sure that the vaccine you're going to use protects against the botulism strains found in your area.

If you ever have a horse that is showing signs of botulism (e.g. weakness, difficulty rising, dropping food out of its mouth, difficulty swallowing), or if botulism is suspected in a sudden death, immediately stop feeding any potential high risk feeds until the cause of the disease is identified. This might help reduce the number of affected horses.

More information on botulism can be found in our botulism archives. An information sheet about botulism in foals can be found on the equIDblog Resources page.

Selenium Overdose Blamed In Polo Pony Deaths

Toxicology tests have confirmed suspicions that selenium overdose was the cause of the sudden death of 21 polo ponies in Florida. The pre-event supplement the horses received was suspected early in the investigation, and the compounding pharmacy that provided it confirmed that the selenium level turned out to be too high.  They would not say whether this was due to a pharmacy error, or if the wrong amount of selenium was specified on the original veterinary order.

While this is hopefully an extremely rare event, it raises questions about what we give horses and why. The amount of money that is spent on supplements for horses is astounding. It's questionable whether most (or any) are needed, even for the highest level performance horse - yet a large percentage of horses, including "backyard" pleasure horses, are regularly treated with a variety of unproven supplements. I'm not saying that all supplements don't work, but for most of them there's just no evidence that they do work. There are also issues with quality control, as has been clearly shown with probiotics and glucosamine supplements.

Using supplements is very clearly a "buyer beware" situation. Most supplements have not been shown to be effective. Most are likely safe, but toxic reactions to some compounds (especially some herbs), contaminants and mixing errors can occur. Supplements are also a concern in terms of positive drug tests if their contents are not very clear, if they contain small amounts of contaminants, or if the contents have similar properties to tested drugs.

Am I saying stop using supplements? No. What I'm saying is think before you buy. Don't fall for flashy sales pitches and testimonials. Don't use a supplement because "everyone else is using it." Remember the general rule: above all, do no harm.

Foal Diarrhea Part 1: Clostridium difficile

Diarrhea is a relatively common problem in foals. It can range from very mild to fatal, and sick foals can get worse (i.e. "crash")  very fast. Outbreaks of diarrhea in foals can also occur.  So while most cases of foal diarrhea are mild, the implications of this condition for both the foal and the farm can be huge.

There are a variety of potential causes of diarrhea in foals. One is Clostridium difficile, a bacterium which can be found in the intestinal tract of a small percentage of healthy adult horses and foals, but which can also cause disease under certain conditions. Clostridium is a type of spore-forming bacterium - it produces spores that are able to survive for a very long time (i.e. years) in the environment, and that are resistant to most disinfectants. Most cases of C. difficile infection in foals are single, sporadic cases, but outbreaks on breeding farms can occur and can be very difficult to control. Typically such outbreaks start out with a few individual (sporadic) cases of foal diarrhea early in the foaling season, with a gradual increase in the number of cases over the following weeks to months. Often it gets to the point that  all foals born later in the season develop diarrhea. You cannot tell the difference between diarrhea caused by C. difficile and that caused by other infectious agents just by examining the foal - diagnostic tests are needed to make the diagnosis (watch for an upcoming post for more information about this kind of testing).

There is little information about control measures for C. difficile infection that have been proven to work. However, our understanding of the organism and what it does in horses and other species lets us make some general recommendations:

  • Only use antibiotics when it's really necessary. "Routine" use of antibiotics in foals (which some people use to try to compensate for poor management practices) is not needed, and may increase the risk of C. difficile.
  • Use good general hygiene practices, particularly around the time of foaling and in areas where neonatal foals live or often are. Clostridium difficile is spread by the fecal-oral route, meaning foals swallow the C. difficile from manure contamination in their immediate environment.
  • Isolate all horses (foals and adults) with diarrhea so that they are less likely to spread it to other horses.
  • Do not try to treat healthy horses or foals to try to get rid of C. difficile. There's no evidence that it works and it could actually make it more likely that the horse/foal will get sick.
  • Let your veterinarian run the appropriate diagnostic tests to identify the cause of diarrhea in any adult horses or foals, particularly on farms where more foals are expected to arrive. It's better to find out early with what you are dealing, in case specific preventive or early treatment measures can be used to help stop an outbreak from occuring.
  • Make sure you have a good infection control program for your farm.

No vaccine for C. difficile is currently available, nor will one be available in the near future. Other techniques for preventing this disease are being evaluated but none are yet proven.

More information about Clostridium difficile can be found on the equIDblog Resources page.

Pharmacy Error Implicated in Polo Pony Deaths

CNN has reported that Francks Pharmacy, a compounding pharmacy in Ocala, Florida, has acknowledged that it improperly prepared medication that was given to 21 polo ponies that died in Florida on Sunday (April 19).

While few details have been provided, a representative of the pharmacy stated an internal investigation "...concluded that the strength of an ingredient in the medication was incorrect." A problem with the pre-event treatment was suspected early in the course of the investigation because of the nature of the deaths and the fact that all 21 horses that received the treatment died, while 5 other horses from the team that were not treated had no problems.

Hopefully more details will emerge about what the actual problem was, as it is not clear what ingredient in the medication has been implicated.  Franck's Pharmacy has pledged to cooperate fully with the investigation, and it will be very important to determine how such an error happened. Toxicology test results from the dead ponies will also be necessary to determine if the compounding mistake was indeed responsible for the tragedy.  If the pharmacy is found to be at fault, I assume a large lawsuit or insurance settlement would be inevitable, but that's little consolation to the people that worked with those horses.

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Polo Pony Deaths In Florida

At least 21 ponies belonging to a Venezuelan polo team died shortly before a competition yesterday in Florida. Not much information about what happened has been released. It was reported that the ponies exhibited signs of dizziness and disorientation, then collapsed. Some died on site while others died en route to a nearby veterinary facility. It is unclear if any affected horses survived. Necropsies (autopsies) are being performed to try to determine the cause of death.

One veterinarian has stated that it was "clearly" caused by a toxin of some sort. That's a reasonable suspicion based on what has been reported. An infectious cause seems unlikely. Unlike on TV or in the movies, multiple individuals rarely become fatally ill from an infection at the exact same time. Even if all the horses were exposed to an infectious agent at the same time, it's extremely unlikely that they would die in rapid succession. The lack of reported cases in horses other than those on the team also supports a point-source exposure to a toxin. It is likely that it will take some time to determine the cause of these deaths, if it can be determined at all. Hopefully samples of food, water and any other substances to which the horses were all exposed (e.g. supplements, medications) have been collected for testing.

Diagnosing disease caused by toxins is not always easy and often takes a long time. Considering the number of deaths and the value of these horses, I assume that testing will be done as quickly as possible, and we're anxiously awaiting any more information.

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Disinfecting Stalls

Disinfection of stalls is an important infection control tool, especially stalls that have housed horses with potentially infectious diseases and stalls used for foaling. Unfortunately, proper disinfection of stalls is difficult even at the best of times, and is rarely achieved on most farms.

Three things are required to successfully disinfect a surface:

  • A surface that is amenable to disinfection
  • The right disinfectant
  • Proper use of the selected disinfectant

Surface amenable to disinfection can be difficult to come by in a barn. Surfaces must be cleaned prior to disinfection. You cannot disinfect dirt, bedding, manure or similar substances. You also cannot thoroughly disinfect porous surfaces because bacteria can live in the pores and cracks, and thereby avoid contact with the disinfectant.   Another issue is biofilms - accumulations of debris produced by bacteria on surfaces that protect the bacteria from disinfectants. Good physical cleaning helps reduce biofilm accumalation. A common problem with disinfection in barns is failure to remove organic debris (e.g. bedding, manure, dirt) prior to applying a disinfectant.

Using the right disinfectant is critical. I’ve done many infection control investigations on farms where I've found that the "disinfectant" being used is actually just a cleaning agent with no disinfectant properties. Even among disinfectants, not all products are created alike. There are differences in range of activity against microorganisms, activity in the presence of organic debris, how quickly they kill, toxicity to animals and people, and how hard they are on surfaces.

Even an excellent disinfectant will be ineffective if it’s not used properly. Common errors include not diluting the disinfectant properly and not providing adequate contact time with the surface in question. Disinfectants do not typically kill instantly - they need time to take effect. Often, 10-30 minutes of contact time is recommended.

Here are some tips for disinfecting stalls:

  • Make the stall as disinfection-friendly as possible. Wood surfaces should be sealed with two coats of marine-quality varnish or paint, and repainted whenever defects in the surface are found. Concrete is very porous - any concrete that needs to be disinfected should also be painted to seal it.
  • If you use removable rubber floor mats, remove them and disinfect them separately. Sunlight is a great "disinfectant" - leaving mats in the sun for a day or two is a great supplemental disinfection tool. If you leave mats in the stall during cleaning and disinfection, bacteria will live in the nice moist area under the mats that you don't reach with the disinfectant.
  • Thoroughly clean the stall before trying to disinfect it. Disinfection cannot be achieved without proper pre-cleaning. Remove all bedding and other debris. Scrub surfaces so they are clean prior to disinfection. However, avoid power washers as these can damage surfaces, creating nooks and crannies in which bacteria can hide, and can spread bacteria into the air.
  • Choose a disinfectant that works relatively well in the presence of some organic debris.
  • Read the label of the disinfectant carefully to ensure that you are using the proper concentration and contact time.
  • Don't forget to also disinfect buckets, hay nets and other items that are in the stall.

West Nile Virus in Canada: 2008

Here's a recap of West Nile virus activity in Canada in 2008.

Humans: There were 36 people diagnosed with disease caused by West Nile virus. Five had neurological disease, 29 had non-neurological disease (i.e. West Nile fever) and in two cases the clinical syndrome was not defined. Most affected people were from Saskatchewan (17) and Manitoba (12), with three from Ontario and two from Quebec. There were single cases in Alberta and British Columbia, and both of those were thought to have been acquired outside of the respective provinces.

Horses: West Nile virus infection is an immediately notifable disease in Canada, whereby the Canadian Food Inspection Agency must be notified of all diagnosed cases in animals. Six positive horses were reported in Canada in 2008, including two in Ontario horses, both in eastern Ontario. Two other cases were reported in Saskatchewan and two more were reported in Quebec. Whether this low number of diagnosed cases is because the disease is now actually this uncommon in canadian horses, or because there is less testing for the disease is unclear. Based on anecdotal information from other veterinarians and horse owners, I suspect that West Nile virus infection in horses is truly rare in Ontario, but is more common in Saskatchewan. This makes sense considering the different types of mosquitoes in the two provinces, as well as the corresponding difference in the number of human cases. These questions highlight the need for proper diagnostic testing to be performed on all horses with neurological disease. The more confidence we have in the surveillance data, the better conclusions we can make about patterns of disease and the need for vaccination.

Bug of the Month: Streptococcus equi

This post was written by guest author Dr. John Prescott, Professor, Department of Pathobiology, University of Guelph.

April’s "bug of the month" is Streptococcus equi subspecies equi, the cause of equine strangles, specifically strain 4047. This is the first strangles strain to have its entire genome (i.e. all of its DNA, including every gene) sequenced. The March 2009 issue of the open-access journal Pathogens, published by the Public Library of Science (PLoS), describes how British scientists think the strangles organism evolved to be such a scourge of horses, by comparing its genome to that of the first equine Streptococcus equi subspecies zooepidemicus strain to also have its genome sequenced, strain H70. It is believed that S. zooepidemicus was the ancestor of the S. equi that causes strangles.

Like all evolution, the story involves both loss and gain. As far as loss is concerned, the strangles organism has more genes that have been "turned-off" (inactivated genes) than does S. zooepidemicus. These genes were turned off by a large number of extra pieces of DNA called insertion sequences which S. equi picked up over time. These sequences get inserted in many different places within the bacterium's DNA (its genome) leading to inactivation or loss of various genes. Loss of genes in this manner can often result in bacteria becoming restricted to a particular type of host - S. equi essentially only infects horses and other equids, while S. zooepidemicus still has a broader host range.

What S. equi lost by becoming restricted to equids, it gained by becoming a nastier bug. It did this by becoming "infected" by four unique bacterial viruses. (Bacterial viruses are viruses that only infect bacteria. Some of these viruses "transmit" (transfer) genes to the bacteria they infect but leave the bacteria alive. Other bacterial viruses can kill bacteria after infecting them). Most bacteria have anti-viral defense mechanisms to protect themselves from these viruses, but S. equi's defenses may have been damaged or turned-off by insertion sequences. Being infected by these four bacterial viruses gave S. equi many genes not found in S. zooepidemicus. One of these viruses is thought to be capable of leaving S. equi and killing S. zooepemidicus in the horse’s throat - a useful trick for S. equi to wipe out the competition in this area so it can move in more easily and cause infection. A second virus gives the strangles organism a phospholipase enzyme which is known to be involved in the bacterium's ability to cause disease. The third and fourth viruses each donated two different superantigen genes – these genes help S. equi to cause inflammation and impair the ability of the immune system to fight off the bacteria. A unique additional piece of “foreign” DNA that S. equi acquired is associated with the ability to capture iron. This allows S. equi to grow better in infections than S. zooepidemicus, because the body of the infected host will often try to bind up as much iron as possible so the bacteria can’t use it to grow. The scientists speculate that this iron-capturing gene was the key to starting S. equi on its evolutionary spiral to becoming a major horse pathogen.

A final thought is that the bacterial viruses that made S. equi what it is today have many similar DNA sequences to bacterial viruses found in Streptococcus pyogenes, a major human bacterial pathogen. Humans might have had an unwitting hand in creating this pathogen from one of their own.

More information on strangles can be found on the equIDblog Resources page.

African Horse Sickness: US Outbreak Scenario

The latest edition of Equine Disease Quarterly, a newsletter produced by the Gluck Equine Research Center, has a couple of interesting articles. Coincidentally, one involves African horse sickness (AHS), a disease foreign to North America that I've mentioned in the past week. The article is about the potential threat of AHS being introduced into the US, and  gives a relatively brief but excellent overview of the disease and why there is concern. The authors discuss a hypothetical outbreak scenario in the US, which is certainly not beyond the realm of possibility - many of the required pieces to the puzzle are already in place when in comes to the potential for this virus to spread in the US:

  • The US has a large and often concentrated pool of susceptible horses. Very few horses have any immunity against the AHS virus.
  • Many areas of the country have weather conditions that are suitable for survival of the insect vectors (Culicoides midges) that might be introduced carrying the virus.
  • A different midge species, Culicoides sonorensis, is widespread in the US (except for the northeastern part of the country) and has been shown experimentally to be a highly capable vector for the AHS virus.

So what is needed for an outbreak to occur?

First, the virus needs to enter the country. This could occur by 1) inadvertent introduction of an infected midge (e.g. a "hitchhiker" on a plane would be one way for this to happen) or 2) introduction of an infected reservoir host. The reservoir host for this virus is zebras - fortunately  few zebras get imported into the US because of successful captive breeding programs, so this is probably less likely than the first. The other possibility, which certainly can't be ignored, is 3) intentional introduction of the virus: bioterrorism.

For an outbreak to maintain itself, a large population of reservoir hosts is needed. In Africa, the virus resides in zebras. Midges get infected by feeding on infected zebras, then infect horses by biting them. The lack of a large zebra population in North America could be the difference between a minor introduction and a major outbreak, unless there is another species that can act as a reservoir host in North America. This is one of the crucial unknown factors in the equation, but we shouldn't count on the lack of zebras as our main line of defense against this devastating disease.

The April 2009 edition of Equine Disease Quarterly can be downloaded here.

Image from: http://www.vet.uga.edu/vpp/fad/horse/vector.htm

Canadian Breeders and CEM Hassles

Canadian horse breeders are calling for efforts to streamline semen importation requirements that have been implemented by the Canadian Food Inspection Agency in response to the "outbreak" of contagious equine metritis (CEM) in the US. The new regulations and increased paperwork are causing tremendous problems for breeders trying to import semen in a timely manner. Any delays in clearing semen shipments at customs can result in decreased viability of the semen as well as problems scheduling personnel to perform insemination of the recipient mares. Sometimes, samples can't get through at all. Breeders shipping semen from the US must get health papers (sometimes from someone a few hours away) to send with shipments. Many of the challenges are simply logistical and bureaucratic problems that should be able to be addressed with some common sense and willingness to help. Regulatory and industry personnel need to figure out ways to address these problems without compromising the health of Canadian horses. 

While important regulations should be reviewed to see if they can be more practical and efficient, it is critical that biosafety not be sacrificed for convenience. The impact of a single case of CEM in Canada would be tremendous. It's increasingly clear the the CEM situation in the US is not completely understood.  It is not a readily definable outbreak with a clear source that can be tracked. Rather, this disease appears to be have been present in the US for a few years (at least), and that efforts to get the situation back under control will be very complicated. A "loose" effort in Canada could have disasterous effects.

Many equine veterinarians are concerned that the regulations currently in place are not adequate to prevent CEM from entering Canada. One major concern is the failure to evaluate horses moving across the border. The current regulations only deal with horses from farms where CEM has been diagnosed - it's far from certain that US authorities know where all the CEM-infected animals are. Since transmission of CEM is more likely during live breeding than artificial insemination, horses from these farms are a big concern. This is also potentially a situation where well-intentioned rules could have the wrong effect. Some people are shipping their horses to the US for breeding, because sending them down and bringing them back up doesn't require any extra precautions for CEM if the farm is not a "known" CEM farm. If there are some breeding farms that are infected but not identified, which is definitely possible, then the unregulated movement of these breeding animals could create a very hazardous scenario.

Should I Test My Horse For MRSA?

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging problem in horses. Owners often ask if they should have their horses tested to see if they are MRSA carriers. There's no simple answer that applies to all farms, but basic points that need to be considered include:

  • MRSA is endemic in the horse population. A small percentage (<5%) of healthy horses carry MRSA at any given time, and it likely circulates regularly between groups of horses.
  • MRSA infection only occurs in a small percentage of the horses that are exposed to the bacterium - most horses never develop signs of illness.
  • MRSA can be transmitted to between horses and people.

So you can see why people might want to test their horses and there are few situations where screening really makes sense. Remember, though, that screening is only useful if you plan to do something about the results. If your horse is MRSA positive, what will you do? If the answer is nothing, or you'll just make sure you wash your hands well after handling your horse, I'd tell you that you should be doing that anyway and not bother with the test. However, there are a few scenarios when screening horses for MRSA is a good idea:

  • Screening is a key component to any plan to eliminate MRSA from the farm. Eradication of MRSA can usually be accomplished quite effectively using screening and good infection control practices (and, if there are no clinically infected horses, not one dose of antibiotics!).
  • Some farms routinely screen incoming horses for strangles before they are allowed to have contact with resident horses. This can be done for MRSA as well, to reduce the risk of MRSA getting onto the farm and silently spreading from horse to horse. It's not as straightforward for MRSA as it is for strangles, because we know less about the best  screening methods and, probably more importantly, people (not just horses) can bring MRSA onto the farm.
  • When an MRSA outbreak is underway, or when efforts are being made to determine why a particular horse developed an MRSA infection, screening can be useful - but again, only if there's a plan to use the results.
  • Our equine hospital screens horses for MRSA on admission, so that we can isolate carriers and reduce the risk of transmission to our highly susceptible hospitalized patients. It also helps us identify farms with MRSA problems that might benefit from implementing an eradication program. We also screen horses at the time of discharge to make sure MRSA has not been transmitted to them while they were in hospital.

Screening your average horse on your average farm is harder to justify. A single negative result might give you a false sense of security, because a horse that is negative today might be positive tomorrow, or it might positive already but the current testing methods couldn't detect it.  The use of good infection control practices is much more important than testing for day-to-day MRSA control.  Screening for MRSA is something that is usually only considered in specific circumstances.

More information about MRSA can be found on the equIDblog Resources page.

Preventing Catheter Site Complications

In equine hospitals, intravenous (IV) catheters are often placed in the large jugular vein in the neck of horses to make it easier for everyone (the horse included) to give the animal fluids and/or medication. However. any time the body's normal barriers (e.g. the skin) are broken (e.g. by placing a catheter through the skin into a vein), there is an increased risk of infection. Catheter site complications can range from mild inflammation of the skin around the catheter, to serious infection causing thrombosis (blockage) of the vein and abscesses.

Several routine practices are used to help reduce to risk of complications from catheters. Typically, a small (~2 cm X 2 cm) area of skin over the vein is shaved or clipped. Next, the area is usually cleaned with antibacterial soap, and then wiped several times with alcohol and a disinfectant like chlorhexidine or povidone iodine. This is done to help reduce the number of bacteria on the skin at the site where the catheter is placed so the site is less likely to become infected.

At some facilities, clipping  the neck before the catheter is places is often not performed. Also, sometimes owners request that the site not be clipped because they don't want it to be apparent that their horse needed a catheter because it was sick or had surgery. I've always been very reluctant not to clip, although there hasn't been a lot of objective evidence proving that clipping is important.

A recent study published in the Veterinary Record (Geraghty et al. 2009) has provided some information about the effects of catheter site preparation. In this study, researchers looked at different skin preparation methods. They cultured swabs from the skin before and after different procedures. 

The most important findings were:

  • Clipping and shaving had a significant effect on bacterial numbers, even before disinfection. Disinfection resulted in essentially eliminating all detectable bacteria, whether the haircoat was clipped, shaved or left intact.
  • Clipping, shaving or leaving the haircoat intact were equally effective if a disinfectant was used afterwards. However, clipping or shaving were still preferred over leaving the haircoat intact. (Clipping or shaving both reduced initial bacterial numbers, and this might be important in situations where the haircoat is highly contaminated or dirty).
  • Clipping and shaving may be useful for reasons other than disinfecting the catheter site. They can make the vein easier to see, which may make it easier to place the catheter. Difficulty placing the catheter and repeated attempts to place the catheter can cause  additional tissue damage and most likely increase the risk of complications. Leaving the haircoat intact also may increase the risk of introducing foreign material (e.g. hair, dirt) into the body when the catheter is placed.
  • Since it was possible to effectively eliminate detectable numbers of bacteria from an unclipped haircoat with proper disinfection, placing a catheter without clipping is acceptable "when rapid intravenous catheterisation is necessary as a clinical priority."  To me, this means that it's okay to place a catheter without clipping if the time needed for clipping might make a major difference to the chances of the patient surviving. This is not the case in situations where people just want to avoid evidence that their horse has had a catheter. While the true risk of not clipping is unknown, it makes no sense to not clip when there is no real downside (other than aesthetics) and there is a logical possibility that it could decrease the risk of complications.
  • Chlorhexidine and povidone iodine were equally effective disinfectants. However, chlorhexidine has been shown to be more effective in people at preventing infections. It has a broader spectrum of activity against microorganisms, and is less inhibited by dirt and debris. The small size of the study might have limited the ability to detect a difference between the two products. Since there is no real reason to use povidone iodine over chlorhexidine, and chlorhexiinde has been shown to be better in people, it makes sense to use it in horses.

This study provides some very useful information. Because it looked at bacterial numbers on the skin, not complications/infections per se, we have to be careful not to over-interpret the results. This study (as usual for studies like this) only assessed the transient bacterial population on the skin, not the resident population. The resident population is deeper in the skin and harder to kill. So, even though no bacteria were found after certain procedures, we can't assume the area was truly sterile. Nonetheless, the transient bacteria tend to cause most of the problems, so this type of study is still useful.

Intravenous catheterization is a very important tool in equine medicine. While there are always risks, the benefits of having a catheter in place almost always greatly outweigh any risks. Careful preparation of the catheter site, good catheter placement technique and close monitoring of the catheter site help reduce the risk of complications.

Needlestick injuries in horse personnel

In a recent post on our sister site, Worms & Germs Blog, I commented on an article by Toronto Star columnist Linda Diebel. The article prompted me to write about a topic I've wanted to address for a while -  needlestick injuries. In the column, Ms. Diebel discusses her cat with idiopathic cystitis (a bladder disorder) and the need to treat it at home periodically with subcutaneous fluids (injections of fluid under the skin) and injectable medications. These are relatively easy procedures that most pet owners can manage with a little training, and it can be instrumental to improving the quality and length of life of some animals. However, safe and appropriate needle handling and needlestick injuries are rarely discussed.

The same holds true for horses. Some horse owners often (too often, in some situations) inject their horses with drugs or vaccines. Needle handling, needlestick injuries and avoiding contact with blood are (generally) very poorly managed by the veterinary profession and by horse owners. Needlestick injuries are incredibly common in the veterinary field, yet there is often little effort taken to reduce the risk of such injuries occuring. In contrast, there is a great deal of effort expended to prevent needlesticks in human medicine, largely because of concerns about transmission of viruses such as HIV and hepatitis B.  Fortunately, (currently) there are no common pathogens in horses that are transmitted by contact with blood and that are a significant concern in people. However, new diseases are emerging all the time, and there's no way to guarantee that the next big infectious disease in horses won't  be a bloodborne virus that can be transmitted to people by blood or dirty needles. It's not very likely, but you don't want to be the first person to get it if it does happen!

When it comes to injecting horses with medications, vaccines or anything else, some very basic precautions can greatly reduce the risk of injuries. The most important are:

  • Know how to handle needles. You should be properly instructed on how to handle needles and treat your horse by your veterinarian.
  • Make sure your horse is properly restrained. If the horse is not under control, you may get injured by the horse or accidentally inject yourself.
  • Never recap a needle. This is a very common cause of injury!  When trying to recap, it's easy to miss the cap and stick yourself.  Instead of recapping the needle, after use dispose of it immediately in an approved sharps container. These containers are puncture-proof and are designed to help prevent anyone from getting the needles back out (either by accident or intentionally).  You can get a sharps container from your veterinarian or a medical supply store. Once the container is 3/4 full, put the cap on it (once on the cap cannot be removed) and take it to your veterinarian for disposal. There may be a small fee for disposal, but it shouldn't be too expensive.
  • Never leave an upcapped needle lying around anywhere for any period of time.
  • Never put a needle in your pocket.  Pretty obvious why.
  • Never put needles in your regular garbage.  People collecting and handling your garbage could get stuck by the needles.

Even though needlestick injuries associated with animals are incredibly common, fortunately they don't usually cause problems (although they still hurt, of course!). However, various types of infectious, allergic and other reactions can occur, and serious consequences, while rare, can develop. This may be a greater concern with horses than dogs and cats, because larger volumes of drugs are used (so more could get injected into you), and because the larger needles used can cause more damage. More information on needlestick injuries in veterinary medicine can be found in a commentary published recently in the Canadian Veterinary Journal.

Syndromic Surveillance on Equine Farms

The other day, I wrote about a few different types of surveillance that can be used in equine hospitals - active, passive and syndromic. Infectious disease surveillance, however, is not just for hospitals. Every horse farm should have some form of infection control program. In most situations, it doesn't need to be complicated, fancy or time consuming, but it means organizing some basic infection control policies and procedures. Syndromic surveillance is great for use on horse farms.

Syndromic surveillance involves looking for specific syndromes (e.g. particular clinical signs (not specific diseases per se) such as fever, cough, diarrhea, or off feed) that might indicate an infectious disease. These basic, easy-to-identify syndromes can be the early warning that something might be amiss, then closer examination can be used to determine if there is actually is a problem.

An important key to disease surveillance is it is only effective if something is done with the information collected. There has to be a plan based on the results of the syndromic surveillance, with regard to what needs to be done for the affected horse and on the entire farm.   For the horse, it usually means a visit from a veterinarian to determine what's wrong, and if it might be due to an infectious pathogen.  For the farm, it means making sure that horse doesn't have a chance to infect other horses (in case it is an infectious disease), and ensuring that the information is recorded so bigger problems (e.g. outbreaks) can be identified as early as possible. The plan for what to do when one of these syndromes is detected needs to be written down so it's very clear for everyone, and easy to find if someone's not sure what to do. One of the most important steps is making sure someone (i.e. someone "in charge") is notified.

Here's a scenario: A horse develops a mild fever overnight and doesn't eat all its grain.

Response 1 (what should happen): The fever and decreased appetite are identified and the person in the barn in charge of the surveillance program is notified. They record that a horse has a fever and talk about what to do with the horse so everyone knows. The horse is restricted to its stall until the cause of the fever is identified. An hour later, the same person in charge of surveillance gets reports from two other people about horses with fever. This obviously raises concern and they try to determine what is happening. They know that a new horse arrived a while ago and that the horses with fever were turned out with it. They immediately call the veterinarian, who suspects strangles may be the cause. All horses with a fever are isolated and tested. Other horses in the barn are closely monitored for signs of illness. Because horses with strangles spike a fever a couple days before they are able to transmit the disease, these horses do not spread the disease any further.

Response 2 (what usually does happen): The first fever and decreased appetite may or may not be identified. Since the horse doesn't really look sick, they decide to wait and see how it looks over the next day or two. A couple days later, someone notices the horse has enlarged lymph nodes. Then they call the vet, who diagnoses strangles. As the vet looks around the barn and talks to people, he/she finds out that a few other horses have big lymph nodes, and realizes that an outbreak of strangles is already well underway. Most horses may have been exposed at this point and a large outbreak is probably inevitable.

Which scenario would you want? Which response would be most likely in your barn?

Surveillance scares off many people just because of the name and the thought that it is expensive, complicated or requires special training. It doesn't. All it needs is people in a barn who communicate and some basic written policies on how to handle horses and potential diseases.

Disease Surveillance in Equine Hospitals

Infectious disease surveillance is an important part of the infection control program. Equine hospitals with good infection control programs have put thought and effort into designing a surveillance program that is right for them. Like many (or most) aspects of infectious diseases, there is no "standard" program, because the risks and benefits vary greatly between facilities.

There are various types of surveillance that can be used. Here are some examples:

Active surveillance
This involves going out and "actively" collecting information that would not otherwise be collected for other reasons. This includes things like taking extra samples from horses for testing strictly for infection control reasons. This is discussed further below.

Passive surveillance
This involves using data that are already available. It's a cheaper and somewhat easier form of surveillance, but it doesn't provide as much detailed information as active surveillance. An example of this is compiling all the culture results from fecal samples that were already submitted for routine testing (as required by the case).  This helps us know what bugs tend to cause certain infections, and to what antibiotics they are usually susceptible.

Syndromic surveillance
Syndromic surveillance can be active or passive. It involves looking at the occurrence of specific clinical signs (syndromes), not specific diseases/diagnoses. For example, routine monitoring for fever in hospitalized animals is a useful tool. It doesn't tell us what the specific problem is, but it can alert us that something might be going on.

I'll outline the active surveillance component of the Ontario Veterinary College's active surveillance program here (I'll get to the other types some other time):

Salmonella

  • All horses that are at high-risk for shedding Salmonella in their feces (i.e. horses with colic) and all horses that are at increased risk for becoming infected (i.e. horses undergoing anesthesia and surgery) are tested.  Horses with diarrhea - the highest risk group for shedding Salmonella - are also tested as part of the routine case work-up.
  • Stalls that have housed diarrheic horses are quarantined until they have been tested for Salmonella. The stall environment is sampled and culture is performed. Stalls are not opened until negative culture results are received.

Methicillin-resistant Staphylococcus aureus (MRSA)

  • A nasal swab is collected from all horses at the time of admission, weekly during hospitalization (if they stay that long) and at the time of discharge.

Other

  • Additional active surveillance for Salmonella and MRSA can be conducted at the discretion of the Chief of Infection Control (i.e. me). If I have any concerns about a particular disease, I institute additional active surveillance.

Who pays for it?
Active surveillance costs (as opposed to routine diagnostic testing like Salmonella culture in a horse with diarrhea) are covered by the Hospital. It's a cost of doing business. Financially, it also makes sense, because it is cheaper to prevent infections than it is to deal with hospital-acquired infections and outbreaks.

Don't be afraid to ask about the infection control program at your equine hospital. A hospital should be more than willing to tell you what they're doing to help reduce the risk of your horse developing an infection.

More information on equine hospital infection control can be found in on the equIDblog Resources page.

An Alternate Point of View on West Nile Vaccination

Scott and I are having a difference of opinion. Speaking from experience, it’s certainly difficult to win a debate with him most days (that might be a huge understatement), but I’ll weigh in with my two cents on this one. If Scott were to vaccinate a horse for West Nile virus (WNV), he’s stated that he wouldn’t do so until July, based on when the peak incidence of disease and therefore presumably the period of highest risk is. I would still vaccinate a southern-Ontario horse in April. Here’s why:

West Nile vaccines are labeled to provide protection for 12 months. Before they can be marketed with such a label, these vaccines have to be tested to prove that they still offer some protection for the animal for at least that long. For some vaccines, like rabies, protection likely lasts much longer than the label claim, but until recently no one’s bothered to study most vaccines beyond one year. I have no doubt that the protective immunity does decrease with time – the protective effects of vaccine are likely highest (as Scott said) about 30 days post vaccination, and lowest at the end of the 12 months. But there is no evidence that the immunity drops off so fast that after 4-6 months the vaccine would require a booster to be adequately, if not maximally, effective. There are vaccines, like herpesvirus and influenza, for which we recommend boosters for horses semi-annually, but this is for animals that are at ongoing high-risk for exposure to these diseases, which are very common. Six months after mid-April is mid-October, and in this part of the world there are very few mosquitoes still flying around at that point.

Scott pointed out that the first part of the summer is likely lower risk in terms of WNV transmission, at least for horses. But there is a time of year when the risk is even lower – October to April, when (as I just said) there are virtually no mosquitoes. If you vaccinate a horse in July, its immunity will be lowest over the first three months of the summer, when there are still birds and mosquitoes around that are carrying WNV. If you vaccinate a horse in April, its immunity is lowest in the late winter, when there’s almost no risk of transmission, so it doesn’t matter! I would rather have a horse protected for the entire mosquito season (May-September), and in the vast majority of cases the animal’s immunity will still be quite adequate come peak season in August, even without an extra booster in July. (Although we want to protect our animals from infectious disease, we also don’t want to give them any more vaccines than we have to.)

I don’t think there’s a right or wrong answer in this case. The best thing to do is talk to your veterinarian about the pros and cons of doing things either way, while taking into consideration the conditions in your specific region in terms of vector populations, disease prevalence, and the health management priorities for your own animals.

Photo: Transmission electron micrograph (TEM) of the West Nile virus (WNV). (Credit: Cynthia Goldsmith, CDC Public Health Image Library ID#10701)
 

When to Vaccinate Against Mosquito-Borne Diseases

As spring approaches (slowly... at least here in Ontario!), people once again start thinking about vaccination programs for their horses. A question that comes up every year is when is the best time to vaccinate against mosquito-borne diseases? Depending on your region, the pathogens of concern may include West Nile virus (WNV), as well as Eastern/Western or Venezuelan equine encephalitis virus (EEE, WEE and VEE, respectively). Often people get the generic response of "30 days before mosquito season," which isn't always very helpful.

Why? It comes down to some basic mosquito biology and timing.

All mosquitoes are not alike. There are two main groups of mosquitoes when it comes to  transmission of diseases like WNV that circulate primarily in the bird population. One group is called "amplifiying vectors." These mosquitoes feed on multiple birds, thereby spreading WNV and increasing the number of WNV infected birds. However, these mosquitoes rarely feed on other types of animals, so they are not very important in transmission of WNV to horses and people. The other group of mosquitoes is the "bridging vectors." These mosquitoes feed on many different types of animals, not just birds. They can pick up WNV by feeding on infected birds, and then transmit the virus when they subsequently feed on horses or people. This is the most important type of mosquito in terms of disease transmission. Areas that have larger populations of more efficient bridging vectors tend to have greater problems with WNV.

The "30-day" part of the recommendation comes from the concept that we want to vaccinate animals about 30 days prior to the risk of exposure, so that the vaccine has ample time to work. The hard part is deciding when to start counting. One of the important things to consider is when do cases typically occur? If, as in many areas, WNV cases are not seen until late August or September at the earliest, vaccinating in April is probably not optimal. Your veterinarian and/or public health department may be able to tell you when West Nile virus activity is typically highest in your area. While there's no guarantee that things will be the same every year, it's unlikely that the WNV season would start well in advance of earlier years. Here in Ontario, disease due to West Nile is rarely reported in horses any more, but the cases that do occur still tend to appear in late August, at the earliest. Therefore, I'd be hesitant to vaccinate for WNV in the spring. If a horse is vaccinated in late April, it will be four months between vaccination and the time of peak risk. The period of peak protection would occur over a few months when there is little evidence of risk of exposure. So, if I was going to vaccinate against WNV, I'd start in late July. If a horse had been vaccinated in the spring, I'd consider a booster in the fall to make sure that the periods of peak immunity and peak risk conincide.

Oral Antibiotics in Horses

In people, as well as many other species like dogs and cats, oral antibiotics (e.g. liquids or pills that are swallowed) are very commonly used, because it's usually easier (and less uncomfortable) than giving antibiotics by injection with a needle.  A wide range of oral antibiotics are available for use in humans, and while antibiotic-associated complications such as diarrhea certainly can occur, oral antiboitics are relatively safe for most people.

So, why don't we use many oral antibiotics in horses?

Horses have a very different intestinal tract than people (and dogs and cats). A horse's intestinal tract is much likely to develop problems from antibiotic use, particularly antibiotic-associated diarrhea or colitis, which can be fatal. The root of the problem in these cases is  disruption of the normal bacterial populations that live in the intestine (the microbial "flora"), which can allow harmful bacteria to multiply and spread. This can occur with antibiotics given by any route (even by injection), but using oral antibiotics can result in higher drug levels in the intestinal tract, which creates a greater chance of causing problems. The likelihood of a horse developing complications from any antibiotic is probably a combination of what bacteria the antibiotic kills and how much makes it to the intestinal tract.

  • Some oral antibiotics can be used relatively safely in horses. Trimethoprim sulfa (TMS) is very commonly used, and quite safely for the most part, in many areas (including Ontario).
  • Chloramphenicol and enrofloxacin (Baytril) are also given orally to horses, but these drugs should be reserved for problems for which they are specifically indicated.
  • Some antibiotics can be used more safely in foals than adults, such as erythromycin. While diarrhea can occur in foals, erythromycin (and related drugs in the macrolide class) are commonly used without problems in young stock. Macrolides are higher risk drugs in adult horses. I've used them a few times in adults when I've had no other choice, but it's always a scary prospect.
  • Never use an oral antibiotic that is not known to be relatively safe for use in horses. One of the first cases that I saw during my residency was an expensive racehorse owned by a physician. He had cultured a minor foot wound and grown a Staphylococcus that was susceptible to cloxacillin. He got some cloxacillin and gave it to the horse orally - something no veterinarian would do. The horse developed severe diarrhea and died despite intensive treatment.

More Venting About Strangles

I seem to be on a run of strangles posts at the moment. There was a recent article in the Brown Daily Herald about the school’s equestrian team, in which was mentioned a recent strangles outbreak in the team’s horses. Two horses were affected according to the article, and the encounter with this highly infectious disease was described as a "hiccup". I’ve written about different approaches to infectious diseases and outbreaks (the good and the bad) and commented on the need for a logical, proactive and open response to diseases like strangles. This report includes some glaring deficiencies.

With 2 horses affected, there has presumably been transmission of the disease on the farm. That means that every horse was potentially exposed, and many horses could be incubating infection or be carriers. The proper response would be to consider everyone infected until proven otherwise, ideally by culturing all the horses for the bacterium that causes strangles, Streptococcus equi.

The description of the response to the outbreak was pretty brief, so I’ll go with the assumption (hope) that the writer didn’t describe the entire response. One of the precautions that was described was “dipping their boots into bleach before mounting any horses.” Boots are a minor to irrelevant source of infection, and this alone is not going to do much to prevent the spread of strangles.

"It was easy to tell that something was wrong in the barn on Friday, March 13. The sides of Bristol's stall were boarded with fresh wood and the entrance was blocked off by a rope. Bristol stood in the stall with a green warmer wrapped around him, facing the outside of the barn, and his slow, warm breaths were visible in the cold barn air. But the team had to continue. They had a competition the next day.

Here’s where I get more concerned. It's good that they took measures to isolate the affected horse, but there was a strangles outbreak in the barn that was (as of yet from the description) uncontrolled, yet the riders were going to a competition the next day, and no additional precautions were mentioned. That’s a great recipe for turning a minor single-farm cluster into a regional outbreak.

With the strangles infection in the barn last Friday, Coach Michaela Scanlon wanted to make sure that her riders took extra precautions, such as not wearing any equipment that they had worn at earlier practices, so as not to spread the infection.

This is a more useful measure, to help reduce transmission of S. equi from contaminated gear. However, changing clothes still doesn’t help much in the absence of a concerted infection control response.

Hopefully Brown’s equestrian team didn’t spread strangles to other horses at the show. I understand the desire to go to a competition anyway, when you have infected horses in the barn but many horses that appear healthy. A lot of effort and money can go into preparation for shows. However, people should take infection control seriously and realize their ethical obligation to do their best to protect their and other peoples’ horses. Infectious diseases are always a risk at shows and we can’t eliminate them altogether. Every infectious disease that a horse acquires at a show is not necessarily an indication that someone did something wrong, but a lot of illness could be prevented if people use common sense and have some consideration for the impact their actions may have on other people and their animals.

More information on strangles can be found in on the equIDblog Resources page.

Strangles in Newmarket, UK

I usually hesitate to write posts about strangles cases or outbreaks. I don't want to give the impression that these are unusual events, because strangles is not a rare disease, in terms of either single cases or outbreaks. When I post about an outbreak, it's usually because there's something particularly interesting about the outbreak or the report about it. Such is the case with the recent identification of strangles in a horse in a Newmarket (UK) racing stable. At last report, only a single horse was infected, the horse has been isolated, and infection control measures have been implemented (although it would be nice to have some details about exactly what those infection control measures are).

What is noteworthy is the rapid and open response. Mark Tompkins, chairman of the Newmarket Trainers' Federation, said the following about Mr. William Jarvis, the trainer in charge of the stable where the infected horse was found:

"He has done everything right by letting everyone know about it as early as possible. He has been absolutely brilliant... His string of horses are being tested and swabbed constantly and he will exercise his horses in the afternoon when no-one else is on the heath."

This is what needs to happen when strangles is identified: a rapid, no-nonsense response with open communication between all parties involved. Too often, people try to hide cases or don't tell the whole story. Horse owners and trainers that think hiding the disease is the best way to handle things ought to take note of the statement by Tim Morris, the British Horseracing Authority equine science and welfare director, who said no restrictions were being imposed on Mr Jarvis's horses because he had shown a responsible attitude by reporting the sickness.

Strangles is an endemic disease. It's not going away. Having a horse with strangles shouldn't be considered something that needs to be hidden. There's nothing illegal or unethical about having a sick horse, but trying to hide the fact that you have a horse with a disease than can infect other horses... that's another story altogether.

Susceptibility of Lawsonia to Antibiotics

Lawsonia intracellularis is an important cause of disease in weanling foals, causing a disease called proliferative enteropathy. Antibiotics, mainly erythromycin,are usually used as part of the treatment for this condition. However, little is known about the true antibiotic susceptibility of this bacterium. The problem is that Lawsonia does not grow in culture plates in a lab like most other bacteria with which we deal - it can only grow in cells, which makes it very difficult to test for  antibiotic resistance.  Antibiotic therapy for this disease is therefore chosen based on basic knowledge about the bacterium and anecdotal information about how animals respond to treatment.  Obviously, this is not the ideal situation.

A little more information is now available on this topic. In a recent edition of Veterinary Microbiology, researchers from the University of Minnesota published a study of the activity of different antibiotics on L. intracellularis. The study, by Suphot Wattanaphansak and colleagues, only involved 10 isolates of the bacterium, all of which were from pigs. (Lawsonia infection is an even bigger problem in pigs than it is in horses).  They only tested with a few drugs that are used in horses, and they used an unvalidated (but reasonable) test, so it's very important to be careful (and conservative) when extrapolating the results to Lawsonia in horses. However, they did have some potentially equine-relevant results. One important finding was that there was variation in susceptibility to some drugs between isolates, meaning some strains were susceptible and some were resistant to certain drugs. Although this isn't really surprising, it emphasizes the fact that the same treatment may not be suitable for all cases - antibiotic resistance can be present, and if it is it's critical to identify and address the issue.  This particular study showed that tetracycline, a drug sometimes used in horses, had "intermediate activity" against Lawsonia... not great, but not horrible. Unfortunately, they didn't test erythromcyin or chloramphenicol, which are two drugs more commonly used to treat Lawsonia in foals.

This study doesn't tell us much more about how to treat horses with this infection, but it does emphasize the need to test equine strains against drugs used in horses to see if we are doing things right, whether resistance to important equine drugs is present, and to determine if there are better and faster ways to detect resistance.

More information about Lawsonia intracellularis can be found on the equIDblog Resources page and in our archives.

Mandatory Vaccination Protested

A mandatory influenza vaccination policy at the Crawford City Fairgrounds (Pennsylvania), implemented this year following an outbreak of influenza at the facility in 2008 is being met with disdain.

Among the complaints:

"A two-day horse show is different than an eight-day fair exhibition.'" Two days is lots of time to transmit infectious diseases.

"If a horse is sick and can’t perform, people won’t bring them to a show." Unfortunately, that's not the case. Also, not all horses that are shedding infectious diseases look sick.

"All these requirements will not guarantee healthy horses." Absolutely true. But, with infection control, we are trying to reduce the risk and incidence of diseases. We know we'll never eliminate the risk.

"There’s no sense giving a shot that will do more damage than the disease." Influenza vaccination is very safe. While adverse effects can occur with any vaccine, influenza vaccines are quite low risk.

"Potentially, requiring a 30-day vaccination for each show will cost horse exhibitors and 4-H members in horse clubs too much money." The cost of vaccination is dwarfed by other costs of participating in such events. People spend a lot of money on board, feed, tack, supplements (many of which are useless), trailering and many other items. In the grand scheme of things, vaccines don't add much to the total yearly cost.

No one knows whether mandatory vaccination against influenza ought to required for all horse shows as an infection control precaution. However, given the fact that outbreaks can occur, that all events involving mixing of large numbers of horses pose a high disease risk, and that vaccination is relatively cheap and effective, it seems like a logical requirement to me.

Urinary Tract Infections in Horses

Unlike dogs, which commonly have urinary tract disease, urinary tract infections (UTIs) are very uncommon in horses, but they can occur.

  • Foals less than a month old are at risk of developing upper urinary tract infections (affecting the kidneys themselves) secondary to bloodstream infections (septicemia).
  • Critically ill foals that are given broad spectrum antibiotics to treat serious bacterial infections can (rarely) develop fungal infection of the lower urinary tract (affecting the urethra and bladder) caused by Candida sp. These infections can also “ascend” the urinary tract, eventually traveling from the bladder up the ureters to the kidneys as well.
  • UTIs in adults are very uncommon, but when they occur they usually affect the lower urinary tract. Mares are slightly more likely to develop UTIs than geldings and stallions because they have a much shorter urethra, so it’s easier for bacteria to reach the bladder (they don’t have as far to go!).

Upper UTIs are very serious because the kidneys themselves are affected (nephritis), which can ultimately lead to kidney failure. Animals with this kind of infection are typically very sick, depressed, and can have a fever. In general, lower UTIs are not as serious, but they do make it very uncomfortable for the animal to urinate (the same is true for people!). However, lower UTIs that result in or are the result of stones in the urinary tract can be life threatening if one of the stones becomes lodged in the urethra, preventing the horse from urinating altogether (this is similar to the situation with “blocked cats,” which occurs relatively commonly). Most of these infections are caused by the same common types of bacteriaE. coli, Proteus mirabilis, Klebsiella sp., Staphylococcus sp., Enterobacter sp., Corynebacterium sp., Pseudomonas aeruginosa – but sometimes fungi can be involved (such as Candida sp.) and there are also some parasites which rarely can affect the urinary tract of horses.

The important thing to remember, though, is that these infections are uncommon in general, and they are very rare in otherwise healthy horses. So if a horse has signs of a UTI (e.g. difficulty urinating, unusual behaviour when urinating, frequenting “squirting” without emptying the bladder completely, scalded skin from urine dribbling, blood in urine), there is often something else wrong. An important predisposing factor is bladder paralysis, when a horse loses control of the muscles in the bladder wall that make the bladder contract. When the bladder can’t contract, it never empties, and the urine just sits there, allowing bacteria to grow and sometimes even allowing infection to travel up to the kidneys (i.e. ascending infection). Bladder paralysis can result from diseases or certain toxins affecting the central nervous system (e.g. equine herpesvirus type 1 (EHV-1), Sorghum spp. toxicosis). In horses, it is often difficult to determine if stones (uroliths) are the cause of a UTI or the result of the UTI.

As in any other animal, the best way to definitively diagnose a UTI is to culture bacteria from a urine sample that has been collected as aseptically as possible (usually by passing a catheter, as in the photo above). It’s important to collect a urine sample for culture before starting any antibiotic treatment. If you suspect your horse may have a UTI, it should be examined by your veterinarian as soon as possible.

Infections in Neonatal Foals

Infectious diseases are a major problem in young foals. Diseases, including diarrhea, pneumonia, meningitis, umbilical infections and joint infections can range from mild to rapidly fatal.  Even in foals that survive the initial infection, these conditions can sometimes result in permanent problems. A study published in a recent edition of the Equine Veterinary Journal (Wohlfender et al, 2009) looked at infectious diseases in the first 30 days of life in 1031 foals on 36 breeding farms in the Newmarket, UK area. This very large study provided some interesting information:

  • The overall incidence of infectious diseases was 8.3%, meaning around 1 in 12 foals developed some type of infectious disease during the first 30 days of life.
  • The most common infectious problem was diarrhea, which occurred in 5.9% of foals. Foals with diarrhea that didn't have other signs of illness were not included.  This is because most young foals with diarrhea and no other abnormalities likely have foal heat diarrhea, which is not an infectious disease.
  • Umbilical infections developed in 0.7% of foals.
  • Joint infections occurred in 0.4% of foals.
  • Bone infections occurred in 0.2% of foals.
  • Respiratory infections were uncommon, occurring in only 0.6% of foals.
  • There was no difference in the incidence of infections in foals that were treated routinely with antibiotics to "prevent" infections. Whether or not this practice is effective has been a controversial issue for a long time.  The best way to answer the question would be to have a study that randomly assigned foals to receive antibiotics or no antibiotics, and then monitored both groups for infections.  This study didn't do that, so there could be some "bias" to this particular finding, but the results are still useful. I don't find the results surprising - there has never been good evidence that antibiotics are routinely needed in newborn foals. This study may help control routine (and in my opinion unnecessary) antibiotic treatment in healthy newborn foals.

This study provided more information confirming that infectious diseases are a significant problem in foals, and that measures are needed to reduce the incidence of infections. It also provided evidence that routine antibiotic use is NOT an effective means of doing this. While there is a lack of good, objective evidence, routine hygiene, sound management and every-day infection control practices are probably critical factors for infectious disease prevention in these young animals.

Strangles Death at Northlands Park

 An outbreak of strangles has resulted in at least one death and the closing of one barn at Northlands Park in Edmonton. The 150 horse barn will be cleaned, disinfected and kept empty for three weeks, until March 23.  The article refers to the disease as equine distemper, which is another common name for strangles.  It should not be confused in any way with canine or feline distemper, both of which are caused by viruses.  Strangles (equine distemper) is caused by the bacterium Streptococcus equi subsp. equi.

Strangles is an endemic disease that circulates through the horse population. As Horse Racing Alberta commission veterinarian stated, "It is not even something highly unusual. It is a disease of horses and has been around since Christ was a cowboy."

There seems to be some major communication issues regarding this particular outbreak. Good communication and a team approach are absolutely necessary for a prompt and effective outbreak response. Too often, this doesn't happen. This may be the case here as, according to the veterinarian, "The horsemen are supposed to tell me (about any deaths), but they don't want me to know which makes it so frustrating. If there was a rule that any horseman caught with a horse with distemper (strangles) would be thrown off the grounds you would probably get better results."

A rule mandating reporting of certain infectious diseases is certainly useful, as long as it's not punitive, as this often deters people from reporting infectious diseases. I share Dr. Martin's frustration. Outbreaks can be draining on everyone involved, and it's incredibly frustrating to be in the midst of an outbreak response and continually butting heads with the people you're trying to help.

As is often the case with outbreaks, people are trying to lay blame. It's human nature, but often ends up with effort being misdirected. Horsemen are apparently pointing the finger at Northlands Park, but for a disease like strangles, they should probably be looking at themselves. As Dr. Martin states "Northlands didn't bring in the distemper; the horsemen, or at least one horseman, did. It's the horsemen's barn when they occupy it."

Facilities can help reduce the risk of strangles, but the most effective way for them to do that is to have strict infection control guidelines, including routine quarantine and testing, and it's unlikely horsemen would be too happy about that.  Alternatively it's the horsemen that need to take action. Isolating new arrivals, testing high risk horses, getting prompt veterinary care when a horse appears sick, and ensuring that control measures are rapidly implemented when a suspected infectious disease is identified are more important factors, and these are up to the horsemen.

Dr. Martin also commented that poor ventilation in the barn may have been a contributing factor, but I have to disagree with that. Proper ventilation is important for many reasons, but poor ventilation would not play a significant role in strangles transmission. The bacterium that causes strangles is primarily spread through direct contact (e.g. nose to nose).

  • Strangles is always out there.  It is widespread in horses and outbreaks can happen. Good routine infection control practices are needed to reduce the risks.
  • Holding back information during disease investigations is a very bad idea. Good communication is the first step in an effective disease control response.

Treating Abscesses in Horses

Abscesses are common problems in horses. They can range from easy-to-identify-and-treat foot abscesses to abscesses that are very difficult to diagnose and even harder to treat (e.g. brain abscesses, abdominal abscesses).

An abscess is an accumulation of pusPus is basically dead bacteria, partly broken-down cellular debris, and white blood cells. Sometimes there can be a thick capsule of tough, fibrous tissue surrounding an abscess, particularly if it has been there for a long time (see picture left). Most abscesses occur as the result of a local infection that the body was able to contain (at least partly), but could not eliminate altogether, and that didn't "drain" naturally to an open space (e.g. outside the body). Over time, some abscesses may continue to grow and become quite large, which can cause many different problems depending on where the abscess is. "Sterile" abscesses can also occur, but are much less common - these lesions are not associated with a bacterial infection, but may occur following a severe trauma or in association with certain tumours.

Because abscesses are usually caused by an infection, it's logical for people to think about using antibiotics to treat them. However, antibiotics are not very effective at treating abscesses because:

  • Abscesses have very little blood supply. A good blood supply is needed to deliver antibiotics to an infected site.
  • Many antibiotics do not penetrate into abscesses well because of the tough capsule and the type of fluid within the abscess. Some do a better job than others, but none are great.
  • Even if an antibiotic is able to penetrate an abscess, it may be only minimally effective due to the amount of pus and bacteria that are usually present.

 So, if we can't use antibiotics effectively, what do we do? The most effective treatment for any abscess is incision and drainageThis involves lancing the abscess to remove as much of the infected pus as possible. It also allows for local treatment such as flushing with antiseptics.  Antibiotics should only be used when there is no way to drain (lance) an abscess, such as with lung abscesses.

If an abscess can be lanced, it should be, with very few exceptions. That may involve paring out a foot abscess, lancing a strangles-infected lymph node, or opening a large abscess from a wound. Lancing of abscesses should always be done by a veterinarian. While it may be tempting to "pop" an obvious abscess yourself, there may be important blood vessels or nerves in the area that need to be avoided. The abscess that you see may be only one part of the problem, and other diagnostic tests or treatments may be needed. A veterinarian can pick the best part of the abscess to lance, to ensure the best possible drainage, and a veterinarian can provide proper sedation and local anesthesia for the horse during the procedure. An ill-placed stab at an abscess can make things a lot worse.

Photo: A large abdominal abscess from a horse that was drained and opened to show the very thick outer fibrous capsule, and many thinner, internal loculi. (M. Anderson)

MRSA in Horses

As part of the 2008 Conference of the American Association of Equine Practitioners, equIDblog's own Dr. Maureen Anderson gave a presentation about MRSA in horses and people. While there, she gave in an interview for the The Horse, which can be found here. This short video gives some good general information about MRSA in horses and people that work with horses.

More information about MRSA can also be found in our MRSA archives and on the equIDblog Resources page.

Piroplasmosis Quarantine Finally Over in Florida

In August 2008, there was an outbreak of equine piroplasmosis in the state of Florida.  The index case was a gelding that was euthanized following a three-week illness.  The diagnosis was made based on testing of samples collected at necropsy.  The US has been considered free of this reportable foreign animal disease since 1988, so the discovery lead to automatic notification of the authorities, who started an investigation and implemented quarantine of numerous facilities.  During this outbreak, 20 horses on 7 farms were identified as infected. A total of 25 farms were quarantined.

Representatives from the state of Florida announced recently that the last farms quarantined during the August 2008 outbreak of equine piroplasmosis have now been released. All horses are now free of the parasite. Florida (and the US as a whole) is once again considered free of equine piroplasmosis.

Equine piroplasmosis is a blood-borne disease that is caused by the parasites Babesia equi and Babesia caballi.  Infected horses may develop mild disease characterized by weakness and loss  of appetite. In more serious cases, horses may develop fever, anemia, jaundice (yellow gums and eyes), a swollen belly and respiratory problems. Other signs that are sometimes present include neurological abnormalities, red urine (secondary to destruction of red blood cells) and death. In contrast, many infected horses may no signs of illness whatsoever. Horses that recover may carry the parasite for a long period of time, and these horses can be a source of infection for other horses if there are ticks in the area capable of transmitting the parasite (not all species of ticks can transmit the disease). This can lead to the need for long quarantines. Horses that become persistent carriers of piroplasmosis need to  be quarantined for life, euthanized or sent to a country where the disease is endemic.

How this outbreak started and spread is unclear. No infected ticks were ever identified. A recent update concluded that "Evidence uncovered during the investigation indicated that transmission of the [equine piroplasmosis] organism occurred due to management practices and not by natural transmission which occurs via ticks." I'd love to know exactly what they found and what specific "management factors" were the problem.  Blood-borne pathogens can be transmitted in some cases on equipment that is contaminated with blood, such as reused needles and dental equipment.

A good fact sheet on equine piroplasmosis is available from the US Animal and Plant Health Inspection Service (APHIS).

Photo: Red blood cells infected with Babesia spp. (source: CDC Public Health Image Library, ID#5943)

Bug of the Month: Actinobacillus equuli

Actinobacillus equuli is a common Gram-negative (i.e. looks red/pink with Gram stain) bacterium, the natural host of which is (not surprisingly, based on the name "equuli",) the horse. This organism can be found quite commonly in or on healthy horses, for example, as part of the normal bacterial flora of the upper respiratory tract.  However, A. equuli can cause disease in certain situations.

Horses that most often become infected and sick from A. equuli are foals. This bacterium can cause a wide range of infections in these young animals, including septicemia (bloodstream infection), meningitis, pneumonia, omphalophlebitis (umbilical infection) and septic arthritis (joint infection). Foals can get infected from contact with other horses or even their own mares because the bacterium is so common.  However, it typically only becomes a problem in foals that do not receive adequate colostrum immediately after birth, or that do not receive proper umbilical care.

Disease in adult horses due to A. equuli is uncommon. As in foals, the bacterium can cause a variety of infections in adults, including pneumonia, wound infections and guttural pouch infections. These infections are usually opportunistic - they occur following another problem that affects the animal's normal defense mechanisms, such as viral pneumonia or lacerations. Primary infections with A. equuli, including peritonitis, pleuritis and septicemia, can occur in healthy adult horses, but are very rare.

Infection with A. equuli is diagnosed by culturing the bacterium from the infected body site.  Culture also permits identification of what antibiotics may or may not be effective for treating the infection.  Actinobacillus equuli is usually susceptible to a variety of routinely-used antibiotics.

Diarrhea: Why Culture?

Diarrhea is a potentially life-threatening condition in horses. It's also frustrating from a diagnostic standpoint because, even with the most complete/comprehensive testing, a cause is only identified in a minority of cases. This is true for other species too, including people, and is a reflection of the complex nature of the intestinal tract and the numerous possible causes of intestinal disease. Diagnostic testing obviously costs money, so if it gives us an answer less than half the time anyway, it begs the question - why bother? Well, here are some points to consider:

  • In some situations, you may find a cause that requires a different treatment, so diagnosis has a direct impact on patient care and probably the outcome.
  • Many causes of diarrhea are infectious and it's important to know if other horses may have been exposed to a transmissible pathogen.
  • Some causes of diarrhea, especially Salmonella, can also infect people, and it's important to know to what people have been exposed.
  • It's also important to know whether a horse might still be shedding a transmissible pathogen after its diarrhea resolves. For example, horses with salmonellosis can shed Salmonella for a while (often a few weeks, sometimes longer) after they have recovered from their diarrhea. This could be a source of infection for other horses and people.
  • Outbreaks of diarrhea can occur. It's much better to know early on what you are dealing with, rather than waiting until mulitple horses have been infected.

I consider diagnostic testing money well spent in cases of diarrhea. Some people don't want to test because they don't want to know, particularly about Salmonella. However, it's been proven again and again that the "head-in-the-sand" approach will backfire when it comes to infectious diseases.

Strangles at Truro Raceway

I don't know whether Truro Raceway (in Nova Scotia, Canada) has bad luck, bad infection control or is just really open about any problems. Following an outbreak of strangles in December (see here for details), strangles has again been identified in a horse at the track. One horse has tested positive and two barns have been quarantined until 3 negative cultures are obtained from the horses. Racing, fortunately, has not been affected.

This isn't a surprising situation because strangles (caused by the bacterium Streptococcus equi) is an endemic disease in the horse population, meaning it is always present in a small percentage of horses at any time. It circulates regularly through the population - mixing of horses contributes to its spread. Racetracks are a great place for infectious diseases to spread and early control is the key. Truro seems to be on the right track based on their aggressive but balanced response. They've identified a problem, taken a logical course of action, but have not overreacted. Presumably, they feel that the two quarantined barns are the only ones likely to have been exposed to the pathogen, so there is no need to take broader action. Sometimes, people panic and take excessive actions in an outbreak. This can lead to people being hesitant to report problems (for fear of a draconian response), which can end up making things worse in the end. I wonder whether any increased infection control practices were implemented following the December outbreak, and/or whether any are being considered now.

The risk of strangles can be reduced, but not eliminated, through use of good infection control practices. More information on this disease can be found in our strangles archives and on the equIDblog Resources page.

Flu Outbreak Leads to Mandatory Vaccination at Fair

Following an influenza outbreak that sickened at approximately 70 horses last year, the Crawford Country Fair in Pennsylvania is requiring influenza vaccination for all equine participants this year. This year, all horses must be vaccinated between 6 months and 15 days prior to the fair. Vaccination against such an infectious disease is a sound recommendation to be sure, although the six-month window might be a little long. I'd prefer to see the horses vaccinated closer to the time of the fair, in order to maximize the protective effect during the highest-risk period.

The fair board is also requiring a certificate of veterinary inspection for each horse at the fair, issued within 30 days prior to opening day. I'm not sure that this kind of inspection will do much in terms of preventing sick horses from participating in the fair, as most infectious diseases (including influenza infection) don't last for 30 days.

  • If a horse is clinically healthy 30 days before the fair, it certainly doesn't mean the animal won't be infectious at the time of the fair if it is exposed to a virus (or other pathogen) in the interim.
  • If a horse has influenza 30 days before the fair, there's not much chance it will still be shedding the virus by the time of the fair.

While I wholeheartedly agree with the sentiment that regular veterinary examination is important for infectious disease control, but the time frame in this case just won't do much for control of influenza. If the fair board really wanted to reduce the risk of sick horses attending, they'd have to require inspection much closer to the date of the fair.  However, such a requirement could turn into a logistical nightmare, since a large number of horses would need to be evaluated by a small number of veterinarians over a short period of time. Furthermore, if someone competed at many fairs during the year and they all had similar requirements, a horse might have to undergo a weekly exam before each event, which could be cost-prohibitive.

Despite the limitations, this is still a good, proactive step on the part of the fair board, and similar precautions ought to be considered elsewhere. We need to stop simply accepting that some horses will get sick following fairs and that outbreaks will happen, and realize that there are practical measures that we can do the reduce (although not eliminate) the risks. One of the best things that could be done would be to require examination of all horses upon arrival at a show or event. The examination could be done by a veterinarian or veterinary technician.  At a minimum,  requirements could include that horses have no signs of respiratory disease, diarrhea or fever. Horses with these problems could then be immediately send home, greatly reducing the risk of disease transmission to other animals at the event. Yes, it would take some effort and money, but it really wouldn't be that hard to do, and could be a very useful preventive measure.  Compared to the cost and headache of quarantining and treating sick animals when an outbreak does occur, the idea really sells itself.

I'm not trying to be negative about the approach taken by this particular fair board. I think their awareness of the need to do things to reduce the risk of infectious diseases at their event is great. 

Rabid Horse in Kentucky

A recent case of rabies in a horse in Kentucky should serve as a reminder of the importance of vaccination against this disease. The affected horse was a Thoroughbred that was presented to a referral clinic for signs of severe colic. After surgery, the horse began showing signs of neurological disease, developed violent seizures and was euthanized. This type of presentation is not unusual, as rabid horses often start out looking like they have other problems such as colic. The scenario of taking a horse to surgery due to signs of severe colic and finding out later that it actually had rabies is nothing new. A major concern with the non-specific nature of the early signs of rabies in horses is that a large number of people may be exposed to the horse before rabies is even considered.

Rabies is always fatal in horses. Transmission of rabies from horses to humans is extremely rare, but is a potential concern. Rabid horses can also be very dangerous due to their unpredictable and sometimes very violent behavior, and rabid horses have killed people. At the same time, rabies vaccination is cheap and very effective.  All horses should be vaccinated against this devastating disease.

Vaccinating Foals

While it's a little early in the foaling season, it never hurts to think about vaccination plans for foals. Vaccination is an important part of the disease prevention program - but it's only one part... general infection control practices are as, or often even more, important. Vaccination of foals is not the same as vaccination of adult horses. Foals may be more or less susceptible to certain infections. They may have greater or lower risks of exposure, and they may respond differently to vaccines.

There is no standard vaccination program for foals. Specific vaccination programs need to be designed for each horse on each farm based on risk of exposure and infection, cost and many other factors. Your veterinarian can help you determine what your animals should be vaccinated against. When it comes to foals, here are some important things to considered:

  • Foals typically need to be vaccinated several times to get the desired immune response. There are at least a couple of reasons for this. First, if a foal has high antibody levels from colostrum, it may not respond properly to the vaccine until those antibodies are used up. These antibody levels drop over time, but the rate and timing of the drop is different for each foal. Vaccinating the foal several times (at appropriate intervals) helps reduce the risk of vaccine failure from colostral antibodies. Second, foals are born with a fully functional immune system, but the immune response to an infectious agent or vaccine is slow and low the first time an individual encounters it. The first dose of vaccine may produce some response, but a much higher response is generated with boosters.  This is actually true of adult horses as well.
  • Over-vaccination can be a problem. Vaccination too early and/or too frequently could actually result in a decreased immune response or complete vaccine failure, a phenomenon known as immune tolerance. So, giving many doses of vaccine starting at a very young age may actually be counter-productive. This is probably a bigger concern with influenza vaccination compared to other vaccines.

Talk to your veterinarian about vaccination. Over-, under- and improper vaccination can lead to increased disease risks, plus wasted time and money.

Guidelines for vaccination of foals have been developed by the American Association of Equine Practitioners. These are also available from the link on the equIDblog Resources page.

More Thoughts on Taking Temperatures

I find it amazing that mammals can regulate their body temperature they way they do, despite drastic changes in the temperature of their environment. It was -30 degrees celcius  this morning (welcome to Ontario in February!) as I was waiting with my daughters for the school bus, and despite the feeling that my ears were going to freeze and fall off, I'm sure my core body temperature was about the same as it was when I left the house. Body temperature regulation is a key function in mammals that is controlled by the central nervous system.  The body expends a lot of energy and great effort to keep its temperature within quite a narrow range.

Increased body temperature (i.e. fever) is often a key indicator of disease, and usually, but certainly not always, infection.  Other things that can cause increased body temperature include exercise (particularly during hot weather), some toxins, and sometimes cancer. Fever is a natural response to infection that can actually help the body fight infection.  Unfortunately, fever can also have adverse effects on the body, particularly if it is prolonged or extreme.   Different sources use slightly different ranges for the "normal" body temperature of a horse, but 37.5-38.5C (99.5 to 101.4F)  is commonly used. Slight elevations can be present in healthy horses, so a true fever is usually considered a temperature above 38.9C (102F) .

Taking a horse's temperature is a standard part of any physical examination. A high temperature usually triggers concern about infection, and leads to further investigation. A few things need to be considered when taking and interpreting a horse's temperature.

  • An accurate reading is critical. The thermometer used must be in good working order. New, digital thermometers are cheap and accurate, and usually the best option.
  • If there is air in the rectum, the horse's temperature may read falsely low. This is most problematic if someone has performed a rectal exam shortly before taking the animal's temperature.  This is one reason that the temperature is taken early in an examination.
  • There are some horses that normally have a temperature outside the range that is considered "normal" for the majority of other horses. Knowing your individual horse's normal temperature when it's healthy can help interpret temperature changes when your horse is sick.
  • Body temperature normally varies throughout the day. This diurnal variation usually follows a regular pattern - usually higher during the day and lower at night.  The temperature of an individual horse can vary by as much as 1C (1.8 F) over a 24-hour period. This needs to be considered when interpreting temperature changes in a sick horse.
  • A normal body temperature does not rule out infection, especially in young foals. Temperature is just one of many important factors used to identify illness.
  • If you are going to take your horse's temperature, make sure you know how to do it safely. Don't get kicked in the process. Make sure you are always in a safe position. Although it may seem counter-intuitive, the closer you stand to a horse, the harder it is for the horse to kick you hard.  Don't rely on your horse's normal good temperament, especially if it's sick.  Animals that are sick or in pain may turn on even their closest companions.
  • Don't let go of the thermometer... ever.

On a final, admittedly picky note, when students tell me a horse "has a temperature", I usually respond "So does a dead horse.  Everything has a temperature.  Does it have a fever?" Does that make me an anal academic (pardon the pun)?

Penicillin Allergy vs Procaine Reaction

Penicillin is an old, but still very useful, antibiotic. It is effective for treating many kinds of infections and is relatively cheap and safe. However, allergic reactions to penicillin, though rare, are reported in both people and animals, including horses.  Signs of a reaction may include hives, sweating, weakness and collapse shortly after treatment.

What many people may not realize is that a horse that has a reaction to a penicillin injection is not necessarily allergic to the penicillin.  Most of these animals actually react to procaine, which is a component of the white penicillin that is given by injection into the muscle. If procaine reaches the blood supply too quickly (e.g. if the injection accidently goes directly into a vein instead of the muscle), it can cause a very sudden, dramatic reaction including signs of hyperexcitability, manic behaviour and rearing over. Horses that have procaine reactions typically recover quickly, but they can injure themselves when falling.

It is important to differentiate penicillin allergy from procaine reaction. If a horse has a penicillin allergy, it should never be treated with penicillin (of any kind) ever again. Diagnosing a horse with a penicillin allergy is therefore not something that should be done lightly or unnecessarily, because penicillin is a very useful drug. A small percentage of individuals with penicillin allergy are also allergic to the related antibiotic class, cephalosporins (including the common drug ceftiofur (Excenel, Naxcel)). Only a small percentage of horses are allergic to both classes, so we don't automatically ban the use of both drug classes in a horse with a penicillin allergy.  However, it does warrant caution when a cephalosporin is used in the animal for the first time, and a veterinarian should be present in case there is a reaction. If a horse has had a severe allergic reaction to penicillin, cephalosporins should probably be avoided anyway, to be on the safe side.

If you are going to use penicillin, you should ensure that you know how to inject it properly. Improper injection technique increases the risk of a procaine reaction.

White penicillin must NEVER be injected intravenously.

While penicillin is cheap and easy to get, but as with any antibiotic, it should only be used on the recommendation of your veterinarian.

Photo: Penicillium notatum, the mold from which penicillin was originally produced
(photo source: Dept of Biology, University of North Carolina at Charlotte)

Buyer Beware - Scrutinizing New Products

New animal health products are released on a daily basis. A great deal of time, effort and money is usually spent to market these products - sometimes more than was put into developing them. As a consumer, it's important to think before you buy, especially with new products.  Take a moment to consider whether a product is right for your animal, and whether the product's intended use and claims are  reasonable. The biggest problems tend to occur with "alternative" or non-traditional products, which encompass a huge range of products that are aggressively marketed, with little to no research or testing to back them up.  Here are some specific points to think about:

  • Ask for research proving that the product works. "Data on file", anecdotes and other non-scientific sources are not adequate. Demand published research in peer-reviewed scientific journals. That means that the research has been independently scrutinized. Published data are not a guarantee that something will work, because some journals are not very strong and may publish weak research, but the lack published research altogether may indicate that research was not done, was not done right, or showed no benefit to using the product. Regardless of the type of product, there is no reason why proper research cannot be done to prove it is beneficial if it actually works.
  • When looking at promotional literature, read it with a bit of skepticism. Think about whether or not what they say makes sense. A good general rule that I have is something that claims to cure all that ails you, probably cures nothing.
  • If promotional materials do talk about research, check if they did a proper statistical analysis to really show that the product is better than the alternative. Showing a difference in numbers between two groups really mean nothing without proper analysis. For example, you could flip a coin 10 times and get 6 heads and 4 tails. Someone else may flip the coin 10 times and get 5 head and 5 tails. Clearly there's a difference in the numbers, but does it mean there's a difference in the ability of the two people to toss a head or a tail? Absolutely not.
  • Don't get taken in by endorsements from "big names". More often than not, they're being paid for the promotion.
  • Consult your veterinarian about new products. Be aware, however, that bad science is often marketed to vets as well and your veterinarian needs to be equally diligent.

At the end of the day, it's still "buyer beware". However, thinking about these basic points may help weed-out some particularly poor products. Additionally, and more importantly, increasing demands by consumers to see solid supportive research may be the only way to get companies to actually invest in testing and research to make sure their products work.

How Not To Take A Foal's Temperature

This is one of my favourite radiographs. It's from a foal that was referred to the Ontario Veterinary College because of diarrhea. While we were taking the history, we learned that someone had tried to take the foal's temperature before it was referred, but the thermometer got "lost". They assumed that the thermometer had been dropped in the stall.  A radiograph was taken when the foal got to the hospital, and as you can probably see, there was a glass/mercury thermometer right in the middle of the foal's abdomen. (The really white part is the mercury in the tipof the thermometer. You can see the rest of the thermometer as a more faint white line running diagonally from the bottom left to the top right). They had apparently inserted the thermometer into the foal's rectum and left it unattended. The thermometer then migrated in the into the foal, working it's way in through over one metre of intestine (but it did, thankfully, stay within the intestine and the thermometer did not break). We ended up having to surgically remove the thermometer.

Beyond the novelty factor of the radiograph, this case highlights a couple of important points:

  • Never leave a thermometer unattended while taking a horse's temperature. Digital thermometers that are available these days don't take long at all to get a reading, so just hang on to them.
  • Don't use old glass/mercury thermometers. They can (and do) break.  This releases liquid mercury (which can be very toxic), and the broken glass can also cause problems. Digital thermometers are cheap, accurate and easy to find, so there's no excuse not to use them.

Bug of the Month: Streptococcus zooepidemicus

Streptococcus zooepidemicus (technically Streptococcus equi subspecies zooepidemicus), commonly called Strep zoo, is an important bacterium in equine medicine. It is one of the most common bacteria isolated from infections in horses. Like other streptococci, S. zooepidemicus is a Gram positive coccus, meaning that it stains purple with Gram stain and has a ball shape (coccus). Streptococci tend to stick together in chains (see picture right) which are often described as "string of pearls."

Streptococcus zooepidemicus can be found in the upper respiratory tract of healthy horses. In most instances, it lives there without causing any problems.  Strep zoo is considered an opportunistic pathogen - a bacterium that can live in harmony with its host, but can also cause disease in certain situations. Strep zoo  can cause a variety of infections, including most commonly pneumonia, lung abscesses and guttural pouch infections. More severe conditions, like bloodstream infections, joint infections and meningitis, can also occur, but are uncommon and most often affect neonatal foals.

Diagnosis of disease caused by S. zooepidemicus requires culture of appropriate samples collected from the horse. Care should be taken when interpreting cultures of samples collected from the nasal passages or upper respiratory tract, since S. zooepidemicus is often present there even in normal animals, so finding it does not necessarily mean it is causing disease.

Unlike some bacteria that cause infections in horses, S. zooepidemicus tends to be susceptible to numerous antibiotics, including penicillin and trimethoprim-sulfa. However, since some strains can be resistant to various drugs, culturing the bacterium and testing its susceptibility to antibiotics in the lab is still required to determine the optimum treatment, .

Strep zoo is of minimal risk to people. Human infections caused by this bacterium have been reported but they are considered very rare.

Foals Gone Wrong - See The Signs

With foals, as with so many other things, one bad thing tends to lead to another.  This is compounded by the fact that when neonatal animals start to "crash", they tend to crash fast.  So in order to stop the vicious downward spiral before it's too late, it's important to recognize the early signs of things gone wrong and take appropriate action as soon as possible.

Septicemia is one of the most serious conditions in foals, and unfortunately a relatively common occurence in neonates.  It is caused by infection of the bloodstream that causes inflammation all over the body, so there are a lot of different clinical signs that can be associated with septicemia.  Most affetced foals will have several of these signs, but not necessarily all of them.  Some of these signs can also be caused by other problems, but remember that a newborn foal with problems of virtually any kind is at higher risk for developing septicemia.  Signs of septicemia may include:

  • Depression
  • Lack of suckle reflex (normal foals should try to suck on a person's fingers or a bottle nipple if placed in the foal's mouth)
  • Fever (too high a temperature), or hypothermia (too low a temperature)
  • High heart rate (most new born foals have a heart rate between 80-120 beats per minute)
  • High respiratory rate or trouble breathing
  • Gums and lips an abnormal colour (e.g. dark red or purplish)
  • Swollen, painful joint(s)
  • Cloudy eyes (i.e. anterior uveitis)

In septic foals (i.e. foals with septicemia) other signs may develop depending on what organs are most severely affected.  For example, inflammation in the brain may lead to seizure activity, and inflammation of the kidneys can lead to renal failure and lack of urine production.

In most cases, the appropriate action to take if you have a foal with any combination of these signs is to call your veterinarian as soon as possibleA sick neonatal foal is an emergency.  Even a few hours can make a huge difference in the outcome of some cases, and the difference of a day can sometimes be the difference between life and death.  It is better to be safe than sorry, so have the foal examined by a veterinarian as soon as possible so it can be given the treatment it needs.

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Foals Gone Wrong - One Bad Thing To Another

It's incredible how the vast majority of neonatal foals, perhaps especially those born in the cold mid-winter, are able to survive all the challenges they face the moment they hit the ground - clearing their lungs to take their first breath, learning to stand and suckle so they can get milk from the mare before their body reserves run out, suddenly being exposed to the elements and having to regulate their own body temperature, and a world of bacteria, viruses and other pathogens just waiting to take advantage of their unprepared immune system.

Mother nature has found ways to protect these unsuspecting newborns from many of these threats.  Horses are precocial animals, meaning their young are born relatively mature, so normal foals are able to stand and even walk within hours of birth.  This is in contrast to altricial species, like dogs, cats and people, whose young are born essentially helpless.  The umbilicus is meant to close off as it breaks off the placenta and soon dries out in foals that are able to stand, which helps prevent bacteria from invading through this portal.  The most important protection from infection for foals comes from the mare's colostrum, which provides antibodies that the foal absorbs into the bloodstream within hours.  The foal also receives special antibodies from the mare that stay in the intestine, coating the intestinal lining to help prevent invasion from bacteria the foal swallows while exploring its new world.  When everything goes according to plan, foals are happy and healthy and actually require very little human intervention to get there.

Unfortunately, when things go wrong with foals there is often a domino effect, with one bad thing leading to another.  If a foal can't stand, it can't get its colostrum, its umbilicus doesn't dry properly, and it soon becomes weak as its very limited energy reserves run out, making it even less likely to be able to stand.  If the umbilicus doesn't break properly or dry out as it should, bacteria may invade the foal's body, leading to infection of the bloodstream, liver or bladder, or a patent urachus which causes the foal to urinate through its umbilicus.  Without colostrum, even the normal bacteria from the foal's own mare and stall can be harmful.  One of the most serious consequences of any complication with a neonatal foal is called septicemia - the presence of bacteria and bacterial toxins in the bloodstream, which causes inflammation throughout the body, and can result in infection in almost any organ or body system.  The mortality rate for foals with septicemia varies widely between studies, anywhere from 33-75%.

There are a few things people can do to help prevent neonatal sepsis without interfering with mother nature, who already does far more than we ever could:

  • Keep things clean: Barns are not sterile environments, but making sure your mare foals in a nice clean stall on clean dry bedding can significantly decrease the amount and number of pathogens (particularly bacteria) that a foal first encounters when it hits the ground.
  • Keep mom clean: The very first creature a foal will encounter is its own mare, specifically her hind end.  As the mare approaches her foaling date, it's important to keep her hind end, tail and udder especially as clean as possible. (Most mares will foal when there's no one around, so you may not have a chance to clean her up right before she foals!).
  • Warm and dry: A cold, wet environment represents an additional challenge to a newborn's system, which can interfere with its ability to stand, suckle and fight off infection.  Try to ensure that the foal is born in a warm, dry place.
  • Colostrum:  Make sure the foal drinks enough colostrum.  If anything else goes awry, this is one of the most important things you can do to help protect the foal against additional complications.  If the foal doesn't nurse from the mare, bottle feeding and tube feeding colostrum are other options.
  • Umbilical care: The foal's umbilicus should close and dry out on its own, but in this case a little prophylactic treatment is warranted.  Dipping the umbilicus (without constantly soaking it) can help prevent bacterial invasion until it has dried out completely.

More information on colostrum and umbilical care are available in our archives and on the equIDblog Resources page.

Canadian Update on CEM Outbreak

The investigation of the outbreak of contagious equine metritis (CEM) in Kentucky last month continues throughout many states in the USA, and has also spilled over into Canada.  At this time, four farms in Alberta and six farms in Ontario remain under quarantine.  These farms either received frozen semen from one of the three infected Kentucky stallions in the spring of 2008, or have mares that were shipped to Kentucky for artificial insemination with semen from one of these stallions.  So far, no confirmed cases of infection have been reported on any of these farms.

The Canadian Food Inspection Agency (CFIA) is responsible for the investigation of reportable animal diseases in Canada, including the current CEM investigation.  Representatives of the CFIA will present an update on the situation at the Breeds & Industry Delegate Assembly at the Equine Canada Convention in Ottawa on February 7.

Any horse in Canada suspected of being affected by CEM must be reported to the CFIA.  The most apparent, classic sign of CEM in mares is a thick, purulent (pus) vaginal discharge after breeding, without systemic illness (i.e. no fever or depression).  However, some mares and almost all stallions can carry the causative organism, Taylorella equigenitalis, without any obvious clinical signs of infection, which is why the disease can be difficult to control if people aren't careful.  Taylorella equigenitalis does not affect people.

The CFIA has made several recommendations to Canadian horse owners to try to prevent the spread of this disease into Canada, and to prevent its spread should it be found here at any time:

  • Until the outbreak investigation in the USA is complete and the disease is contained, use extreme caution or simply refrain from importing breeding animals, semen, embryos etc. from the USA.
  • Emphasize strict hygiene measures when handling breeding animals.  Wear disposable gloves when washing or otherwise coming into contact with a horse's tail or genitalia.  Change gloves (and wash your hands!) before handling another horse.
  • Use separate equipment (e.g. buckets, sponges, tail wraps) for each horse.  Any equipment that must be shared should be thoroughly cleaned and then disinfected between horses.  Taylorella equigenitalis is susceptible to most common disinfectants, including bleach.

Vaccination: How Often??

Here's a good question posted by a reader on equIDblog:

Could you please comment on adverse reactions to routine vaccinations? I have two mares - a  9 year old welsh cross pony and an eight year old paint - that have both experienced painful neck swelling for a week after their rabies and tetanus shots. They aren't able to stretch their heads to the ground to eat and I've had to elevate their food. The affected area involves the entire neck, not just the injection site, and there are no abscesses involved. My veterinarian suggested giving Banamine prior to the vaccination, but just the fact that he has developed a routine to deal with this tells me that it's not all that uncommon. I'm now debating whether to put my horses through the ordeal at all or perhaps vaccinating every other year. Do mature horses reach a point where they no longer need boosters? Your input would be greatly appreciated.

Vaccine reactions are fairly uncommon and are usually mild, but some horses are prone to more severe reactions and it's often hard to decide what to do with them. Vaccinating them obviously poses some risk, be it short term discomfort or the potential for more serious problems. Not vaccinating also poses risks, if the horses are left more susceptible to infectious diseases. As the veterinarian in this case suggested, sometimes pre-treating the horse with an anti-inflammatory like Banamine (flunixin meglumine) can help reduce the risk or severity of some adverse reactions. However, even this doesn't work in all cases.

The question of whether adult horses need to be continually re-vaccinated is a good one. The answer really is we don't know. It is likely that for many diseases, yearly vaccination of older horses may not be necessary. We simply don't have any good data on how long immunity persists in older horses following vaccination and the risks associated with extending vaccination intervals. In cats, vaccination recommendations have been changed in recent years to include decreased frequency of vaccination of older cats, largely because of concerns about serious adverse effects in some of these animals. These recommendations were made by the American Association of Feline Practitioners, a prominent feline veterinary group. I'm not aware of a similar initiative to investigate this issue in horses.

An important difference between vaccinating house pets and horses that we need to consider is herd immunity.  Protection of a large population of horses is increased by maintaining a high level of "herd immunity" through vaccation of a large percentage of horses. Since horses more often live in large groups, move between groups and are probably at greater risk of infectious disease exposure compared to your average household cat, extrapolating from vaccination recommendations for cats should be done with great caution. What we need are sound scientific studies of how long protective immunity lasts in most horses, and the potential implications of decreasing vaccination frequency. Unfortunately, it's unlikely that most pharmaceutical companies would put much time or money into this type of research.

So, there's no clear answer. In a situation where a horse is known to have adverse reactions to vaccines, I'd either pre-treat with anti-inflammatories or vaccinate less frequently. If the horse was low risk for infectious disease exposure based on its management, use and lifestyle, I'd be more likely to avoid vaccination or do it less frequently. However, you have to realize that there might be an increased risk of disease from this. Also, not maintaining rabies vaccination could have major implications if the horse is ever exposed to a rabid animal.

Potomac Horse Fever

Potomac Horse Fever (PHF), a disease named for the river near Washington DC where it was first identified, is caused by Neoricketsia risticii.  The technical name for PHF is equine monocytic ehrlichiosis (EME).  This causative organism is normally found in a trematode parasite with a somewhat complex life cycle involving bats, snails and certain aquatic insects. It is therefore associated with swampy/marshy areas in certain regions.  Horses are aberrant hosts of N. risticii, in which infections can cause a range of disease from very severe colitis and laminitis to mild non-specific illness.  The organism is typically very sensitive to treatment with tetracyclines, but the disease can progress very quickly, so treatment early in the course of disease (if PHF is strongly suspected) is crucial.

In general, PHF is an uncommon disease in horses, but there are certain areas of Ontario where cases occur with some regularity. For example, cases have been reported in Eastern Ontario (Brighton to Kemptville), Keswick area and Ancaster. The incidence is usually highest in late summer. Transmission is normally associated with horses grazing pastures containing infected flies (caddisflies).

Although vaccines for PHF are available and appear to be safe, their efficacy is very questionable. At least in part, this may be due to the fact that multiple strains of N. risticii occur naturally, but only a single strain (from the 1980s) is included in the vaccines.  Vaccination is not considered necessary for horses in areas where the disease has not been previously reported. Given the peak incidence of the disease in late summer and the nature of the vector, if someone wants to vaccinate, they should do so in late spring. Preventing access of horses to areas near swamps and other insect breeding grounds may be as (or more) effective than vaccination alone.

Photo Credit: Buck Cash, Great Falls, Potomac River, VA

 

Tetanus Antitoxin in Foals

I was reading a fact sheet on foal care today that was available online. It was one of those sources that gives a mixture of good, mediocre and bad information. One thing that I didn't like was a reference to tetanus antitoxin administration being a common practice in newborn foals. That might have been the case a couple of decades ago, but it is certainly not recommended now.

Tetanus is certainly a serious problem in horses, and foals are at risk for exposure because the bacterium that causes the disease, Clostridium tetani, is widespread in the environment. Good measures need to be in place to reduce the risk of foals developing tetanus. The most important steps are:

  • Ensure the mare is properly vaccinated for tetanus prior to foaling. This includes a booster that should be given approximately 30 days before foaling.
  • Ensure that the foal gets enough good quality colostrum (see the information sheet on the Resources page for more details about colostrum for foals).
  • Treat the umbilicus properly after birth (for more information, see our previous post entitled "Starting Out Right - Foal Umbilical Care").

If these things are done, there is no need to give tetanus antitoxin to a newborn foal. In fact, it's not only unnecessary, it's a potential health risk. Tetanus antitoxin neutralizes tetanus toxins that are in bloodstream. It used to be widely used in horses of all ages if they were wounded. However, administration of tetanus antitoxin has been associated with a disease called Theiler's Disease or serum hepatitis. While rare, this is a severe and almost always fatal liver disease.

Tetanus antitoxin is only potentially indicated in foals whose mares were not vaccinated against tetanus (or their vaccination status is unknown) and possibly in foals that did not receive adequate colostrum.

More information on tetanus, colostrum and vaccination recommendations can be found on the  equIDblog Resources page.

Contagious Equine Metritis - USA Outbreak

In December 2008, an outbreak of contagious equine metritis (CEM) was reported in Kentucky. The index case was a healthy stallion that underwent routine testing for exportation of semen and the causative agent, Taylorella equigenitalis, was isolated by cutlure on December 15. By the end of the month, three more stallions on the same farm were also identified as infected. At the moment, it is estimated that there are 28 horses in Kentucky and another 156 horses outside Kentucky that have been exposed. Another 250 horses are being traced across 27 states. The last outbreak of CEM in the USA was in 1979 in Missouri, although a few sporadic cases have been identified in the country in the last three decades. It is a reportable disease in both the USA and Canada, and there are strict import (and export) regulations for horses entering the USA and Canada from CEM-positive countries.

CEM is a venereal disease of horses. It is spread by stallions who can carry the bacteria on their external genitalia without any noticeable clinical signs, as well as by infected mares, during breeding. The bacterium can also be transmitted through artificial insemination, particularly on contaminated equipment. The diseases causes temporary infertility in mares. Typically mares do not conceive when they are first infected, but if a mare does become pregnant she may abort, or the foal may be born a carrier. Some mares develop a heavy purulent vaginal discharge (pus) for up to two weeks after breeding, but others may only have a shortened heat cycle. Some mares will clear the infection on their own, but in some cases a mare may become a chronic carrier of T. equigenitalis and transmit the bacteria to stallions during breeding. The organism does not cause any clinical signs in stallions, so the only way to detect the bacteria in males is to culture it. However, T. equigenitalis is notoriously difficult to grow in a laboratory, so false-negative results can occur. Therefore adjunctive tests are also used, and additional testing methodologies (including molecular techniques such as PCR) are being developed for the detection and study of this organism.

The good news is that infected horses can be treated, and T. equigenitalis is typically susceptible to most common antibiotics. Local treatment and repeated flushing of the external genitalia of infected horses is also part of the treatment regimen. Compared to other diseases, the spread of CEM is also relatively easy to control, because it is only transmitted by breeding (either live cover or artificial insemination). The major problem is that this disease is also one that can easily “fly under the radar” for some time before it is discovered, because carrier animals show no clinical signs of infection, and stallions in particular, as in this case, may expose many mares before the bacterium is discovered. Hopefully this outbreak will be brought rapidly under control so that the equine industry in the USA can avoid devastating economic loses due to the presence of this disease.

Molecular Diagnostic Testing: Pros and Cons

This post originally appeared (in modified form) on www.wormsandgermsblog.com on January 1, 2009.

An important step in diagnosing infectious diseases and determining the optimum approach to treatment and management is rapid and accurate diagnostic testing. Many different testing methods are used, particularly bacterial culture (at least for bacterial diseases). Molecular testing has revolutionized the field of microbiology, and is making inroads into the field of diagnostic testing. Polymerase chain reaction (PCR) testing is a very powerful tool that can be used to detect DNA or RNA from specific microorganisms.  This technique can be very useful, but it can also be easily misused or misinterpreted.

The potential PROS of molecular diagnostic testing include:

  • Rapid turnaround time: Testing can take as little as a few hours versus a few days for other tests like bacterial culture.
  • Sensitivity: Organisms that are difficult or impossible to grow in a lab can be detected, and they can often be detected at lower levels than with other diagnostic methods.

The potential CONS of molecular diagnostic testing include:

  • Sample contamination: This is a common concern with highly sensitive molecular tests - even a minute amount of contamination in the sample can cause a false positive result.
  • Test inhibition: Samples from complex biological sites (e.g. stool) can contain substances that interfere with the many complex molecular reactions upon which the tests rely. Without good (and proven) methods to prepare the sample, this can result in a false negative result.
  • Biologically irrelevant results: Some bacteria that cause disease are also commonly found as part of the normal microflora in healthy animals - simply finding it does not tell you that it is necessarily relevant to the problem. For example, Clostridium difficile can be found in the intestine of normal, healthy horses, but the diagnosis of C. difficile diarrhea requires detection of the bacterial toxins in stool samples, not just the bacterium itself.  A molecular test that simply identifies the presence of C. difficile, even if it identifies strains that possess the genes to produce toxins, tells you nothing about whether the bacterium was actually producing toxins in the animal.
  • Lack of validation: This is a common problem with many (if not most) molecular tests. Some companies, especially those that just run molecular tests, offer a huge array of completely unvalidated and sometimes illogical tests.  It is also important to remember that tests must be validated for each species in which they are used - a test that works well in people will not necessarily work on a sample from a horse or a dog.

Molecular testing can be useful in some situations. If you are unsure, here are some things to ask the lab:

  • Do they have a validated test that provides relevant results?  If they don't have good data (ideally published data) that their test is useful, accurate and reproducible, I'd avoid it.
  • Do they have a quality control program, which includes running positive and negative control samples with each test batch?

Finally, as with any test that we use in veterinary (or human) medicine, it's important to evaluate all  results in the context of what is happening with the animal - treat the patient, not the test result.

Starting Out Right: Foal Umbilical Care

The umbilical cord is the foal's lifeline in the uterus. Unfortunately, it can also be a great way for bacteria to enter the foal's body after birth. Infection of a neonatal foal's umbilicus can result in local infection at the site, a patent urachus (an open communication between the umbilicus and the bladder, resulting in urination through the umbilicus), abscessation of the umbilicus (which can extend all the way to the liver or back to the bladder) or sepsis (bloodstream infection). Fatal disease from an umbilical infection is not uncommon. Therefore, it's obvious that we need to try to reduce the risk of bacteria entering the umbilicus and causing infection.

Everyone that has foals should know about proper umbilical care. If umbilical care is neglected altogether or done improperly, the foal may be at serious (and unnecessary) risk of infection. Improper umbilical care, especially the use of irritating substances, can damage the delicate tissues, and may in fact do more harm than good.  Here are some important points about proper care of the umbilicus for foals:

  • Ideally, the umbilicus should be inspected and treated within 30 minutes of foaling (see picture right: normal umbilicus 20 minutes post-foaling).
  • The umbilicus should be dipped with a 0.5% chlorhexidine solution (NOT a tincture, which contains alcohol). This is preferred to iodine-based products. If iodine is used, milder forms (i.e. povidone iodine) should always be used, and they should be diluted properly prior to use. Stronger is not better - high concentrations of iodine can be very irritating and cause severe skin damage.
  • The entire umbilicus should be treated, but care should taken to prevent soaking areas around the umbilicus.
  • Umbilical treatment should be repeated every 6-8 hours for the first 24 hours of life, but do not over-treat the umbilicus - it is crucial that the tissues ultimately dry out.  The umbilicus should not be kept moist all the time, as this makes it easier for bacteria to invade the tissues.
  • Avoid touching the umbilicus directly with your hands. If this is necessary, hands should be washed thoroughly first or gloves should be worn.  Always wash your hands thoroughly after.
  • Any problems with the umbilicus (e.g. bleeding, urine coming out, large size, hot and painful, chronically moist) should be reported promptly to your veterinarian.
  • Suturing, tying or other forms of closing off the umbilicus should be avoided if at all possible.

Miniature Horses Don't Get Miniature Doses of Vaccines

Most pharmaceutical products are dosed on the basis of weight (e.g. milligrams of drug per kilogram of body weight). That means an animal twice the size of another gets twice the dose.

Other drugs (mainly chemotherapeutic drugs, like those used for cancer treatment) are dosed based on body surface area (e.g. milligrams of drug per square metre of body surface). With this type of dosing, large individuals get more than small individuals, but the differences are not as great as with weight-based dosing.

Vaccines are a different story. They are administered based on the "antigenic dose" which is independent of body size. Therefore, the same dose is required for a miniature horse and a clydesdale. While it may be tempting to split doses of vaccine between several miniature horses (and initially this may seem logical (based on their small size) to those who do not realize how the dose is determined), this may result in ineffective vaccination. Trying to save money by splitting vaccine doses can end up costing money through increased risk of disease. Always give the full dose of vaccine as described on the label.

Influenza Vaccine Failure

Recently, I discussed issues regarding equine influenza vaccines and how they are not updated as regularly as human vaccines.  The H3N8 type of equine influenza is the main concern in horses. This strain has two main groups, European and North American.  Standard WHO/OIE recommendations are that equine vaccines should include a representative of each of these groups. An outbreak of equine influenza in Croatia in 2004 (reported by Barbic et al. in the journal Veterinary Microbiology) highlighted the need to follow these recommendations, and the need to be diligent about looking for causes of vaccine failure.

The outbreak occurred at a racetrack in Zagreb. Not surprisingly, an H3N8 strain was responsible. Investigation of the cases determined that vaccine status had no influence on disease - both vaccinated and unvaccinated horses became equally sick. The vaccine used in Croatia at that time contained three influenza strains, including two different H3N8 strains, but the strains that were used were from 1963 and 1979. When they compared the strain that caused the outbreak and the vaccine strains, there were multiple genetic differences, which is not surprising given influenza's capacity to evolve over time. There were far fewer differences with the more recent strains used in vaccines in most other countries.

The study concluded "Further surveillance of the equine population and updating of equine influenza vaccine strains in accordance with the recommendations of the Expert Surveillance Panel is necessary in Croatia to reduce the likelihood of further outbreaks as a result of vaccine failure."

While this outbreak was clearly a result of not following standard recommendations, it's a good reminder that ongoing surveillance is needed to detect and control emerging strains against which horses will not be protected by current vaccines.

Salmonella Kills at Least 22 horses in Outbreak in Iceland

An outbreak of salmonellosis has killed at least 22 horses in Kjalarnes, Iceland. A total of 41 horses were infected.  This is a very high mortality rate (>50%) for what I assume is a group of otherwise healthy horses, as compared to the more compromised populations which are usually present in equine hospital outbreaks. It is unclear whether the high mortality rate may be due to a particularly nasty (virulent) strain of Salmonella or the unavailability of aggressive supportive medical care which is needed in severe cases of diarrhea in horses.

The source of infection was thought to have been a sedimentation pond in the horses' pasture. The article contained no information about potential sources of contamination of the pond, or about the the strain of Salmonella involved.

  • Outbreaks of salmonellosis are uncommon on farms, but they can occur.
  • Mortality rates with salmonellosis can be high, especially without (but sometimes even in spite of) aggressive (and expensive) medical care.
  • Prompt investigation is critical to identify the source(s) of infection and try to prevent further exposure and additional cases.
  • Good routine infection control measures should be in place to reduce the risk of entry of Salmonella onto a farm, as well as transmission of Salmonella between horses (and between horses and humans) if it makes in onto a farm.

Rabies Vaccination in Horses: Core Issues

This post originally appeared on the Worm & Germs Blog site on December 12, 2008.

In 2008, the American Association of Equine Practitioners (AAEP) published updated vaccination guidelines for horses.  One of the changes from the previous set of guidelines was the inclusion of rabies as a core vaccine (meaning every horse should receive it).  There was lots of discussion about this at the recent AAEP Annual Convention in San Diego, CA.

Some veterinarians don't like the idea of vaccinating every horse against rabies.  Just like veterinarians and owners of dogs and cats who are concerned about over-vaccination in these species, the same concerns exist in equine medicine.  Equine rabies vaccines are not approved for use every three years like some canine and feline vaccines, so they still need to be given every year until someone can determine for how long a vaccinated horse is protected from infection.   Furthermore, there has never been (to my knowledge) a case of human rabies due to transmission from a horse.  These are all valid points, but there are also a lot of reasons why including rabies as a core vaccine for horses is very good idea:

  • Rabies is a very deadly disease, in both animals and people.  To some owners, their horse is every bit a part of their family as any dog or cat could be.  To other owners, their horses represent a great investment, and part of their livelihood.  Even if the risk of disease in horses is low, protecting them is safe and easy, so it just makes sense.  As the saying goes, an ounce of prevention is worth a pound of cure, but when there is no cure and prevention is so simple... you do the math.
  • Rabies vaccination is extremely effective in horses, producing an excellent immune response even with a single dose.  It does not require complex adjuvants that some other vaccines need to stimulate the immune system, which also makes it less likely to cause an abnormal vaccine reaction.
  • Rabies is not a seasonal disease like many of the respiratory viruses or insect-borne diseases (e.g. West Nile) for which horses are also typically vaccinated.  Rabies boosters only need to be given once a year, so this can be done during a time of year when no other vaccines are required, if there are concerns about giving too many vaccines at once.
  • Horses live outside and in barns.  Most are far less supervised than dogs and cats, but even these animals are at risk of rabies exposure.  A rabid animal could easily be "brave" enough to attack a horse, even though it normally wouldn't.  Bats can also easily get into and out of many barns - you may never know one was there, and finding a bite mark from a bat on a horse would be like looking for a needle in a haystack, but that's all it takes to transmit the virus.  So it makes sense to give your horse added protection by vaccinating it.
  • Rabies in horses may not look like rabies at first.  One of the most common early signs is actually colic.  A rabid horse that looks like a colic may expose the people who are trying to look after it before they realize what the horse has.  In other horses the signs may be recognized too late, like the rabid horse that was found at the Missouri State Fair earlier this year, that resulted in exposure of many people.
  • While rabies transmission from horses to people has not been documented, rabid horses have killed people, particularly horses that develop the "furious" form of rabies, which can cause them to become very violent.

For more information on rabies, see our rabies archive or the information sheet available on the equIDblog Resources page.

Quarantine Lifted at Truro Raceway - Did They Learn Anything?

Recently, Truro Raceway (the original home of Standardbred champion racehorse "Somebeachsomewhere"), was quarantined because of two suspected cases of strangles, a highly infectious equine disease caused by the bacterium Streptococcus equi subspecies equi (more information about strangles can be found on the equIDblog Resources page and in the  strangles archives). The first round of tests from December 7 came back negative on December 18, and the quarantine has now been lifted (apart from the barn with affected horses).

That's all good news. In the bigger picture, though, was anything learned, and were any measures taken to reduce the risk of this happening again?  A lot of this comes back to the debate about accepted versus acceptable disease risks, which we've covered before on equIDblog.

I've never been to Truro, but I assume they are no better and no worse than the vast majority of tracks, meaning they are in a perpetual state of waiting for an outbreak to happen. Let's hope they have performed (or will perform) a good review of what happened, and consider how to reduce the risk of future problems, including the following measures:

  • A mandatory reporting system for signs potentially associated with infectious diseases of concern: This would allow for prompt investigation and implementation of any needed control measures. A balanced approach to diseases control is necessary so that horsemen don't feel the pressure to withhold such information for fear of being ostracized or having their livelihood compromised by excessive or unnecessary quarantines. Education is key to convincing people that this is important.
  • An improved (or establishment of) a 'culture of infection control': People need to be thinking about infection control on a daily basis, not just when there is an outbreak.
  • Performance of an infection control review and development of a formal written infection control program for the facility: This should involve experts in veterinary infection control, but also track managers and horsemen so that all relevant parties have input. This type of review needs to consider the facilities (e.g. barn layout, quarantine areas, sinks for handwashing in barns) as well as protocols (e.g. ship-in protocols, reporting and managing potentially infectious horses, infection control education).

Are Wildlife A Source Of Lawsonia?

Lawsonia intracellularis is a bacterium that causes an intestinal disease called proliferative enteropathy in young horses. One of the reasons we still don't know a lot about this disease is that this bacterium can't be grown in a lab. One of the areas in which researchers are working to find more information is from where horses that become sick initially get Lawsonia...  Is it from healthy horses that are carriers? Does it circulate in the horse population, or is there an outside source? Does it come from pigs (pigs can also be affected by disease due to Lawsonia infection)?  Do other animal species such as wildlife carry it?

A recent study by researchers at the University of California (Davis), published in the Journal of Wildlife Diseases (2008 44:992-998), looked at the presence of Lawsonia in wildlife on horse farms. They found DNA from the bacterium in feces from jackrabbits, striped skunks, Virginian opossums, and coyotes, but not from feral cats, Brewer's Blackbirds, raccoons, or ground squirrels.

This study provides some interesting insights about Lawsonia in horses, and raises the possibility that wildlife could be a source of infection. However, it does not tell us how to prevent the disease or whether wildlife really are a relevant issue when it comes to infecting horses. We certainly do NOT recommend trying to eradicate wildlife in the vicinity of horse farms as a Lawsonia prevention tool. However, making horse barns (especially feed storage areas) less inviting to wildlife is a good idea - this is a sound standard infection control measure that everyone should consider, as it may reduce the risk of several infectious diseases (e.g. equine protozoal myeloencephalitis (EPM)).

More information on Lawsonia can be found on the equIDblog Resources page, and in our earlier post entitled "Lawsonia intracellularis - New Horizons".

Equine Infectious Anemia - Eradication From Ireland

Another presentation from the recent 2008 AAEP Convention, this one by Dr. Simon More, described the outbreak and successful eradication of equine infectious anemia (EIA) from Ireland in 2006.  A review of the outbreak itself, its investigation and management was also published in the most recent issue of the Equine Veterinary Journal (2008; 40(7):702-711).

Equine infectious anemia (EIA) (aka "swamp fever") is a very important disease in horses, and can also affect donkeys and mules.  This is the disease for which horses are given a Coggins test, which is required every six months for horses attending most shows and competitions, and for horses traveling internationally.  EIA is caused by a retrovirus, more specifically a lentivirus.  Other important viruses in this group include several immunodeficiency viruses such as HIV.  When the EIA virus infects a cell, it actually permanently incorporates its genes into cell's DNA, so affected animals are infected for life.  Horses go through repeated bouts of illness - the earliest episodes are usually the most severe.  Horses that survive the acute phase become persistent, often inapparent carriers, and serve as a reservoir for the virus.  The primary means of transmission is via transfer of blood from infected horses.  This can occur through blood-feeding insects such as horse flies and deer flies, or through use of blood-contaminated equipment such as dirty needles, surgical instruments and dental equipment.

Signs of EIA during acute episodes include fever, depression, lack of appetite, decreased red blood cell count (anemia) and decreased platelet count  (thrombocytopenia).  Lack of platelets can lead to petechial hemorrhages (tiny dots of blood, often first noticed on the gums or inside of the lips).  Episodes typically last 3-5 days, but weeks or even months may go by between episodes.  Illness may also be precipitated by stressful events or treatment with immunosuppressive drugs.  In some horses the episodes become more frequent, and signs of chronic EIA develop.  In addition to anemia and thrombocytopenia, these horses (often called "swampers") become very thin and may develop edema over their lower abdomens.  If the condition becomes very severe, a horse may have very pale or yellow mucous membranes (e.g. gums, around the eyes), and some may have nose bleeds or even neurological signs.

Prior to the outbreak of EIA in June 2006, Ireland was free of EIA, an advantageous status for the horses who lived there, as well as their owners.  Between June and December, 38 horses became infected with EIA.  It is believed that the outbreak started with four foals that were given hyperimmune plasma for prevention of Rhodococcus equi infection that had been illegally imported from Italy.  It is likely that the plasma was contaminated with the EIA virus, but unfortunately by the time the outbreak was identified there was no remaining plasma that could be tested.  Transmission of the virus was thought to have occured through mechanical transfer of blood during veterinary procedures and vector transmission via horse flies. Additionally, it was suspected that several mares may have been infected through close contact with foals.  Ongoing surveillance in Ireland has not identified any additional cases in the last two years, so it is believed that the disease has been eradicated.  Investigation and control of the outbreak took a lot of cooperation between many different organizations and individuals.  The study of the epidemiology was also very important in controling the disease, as not all of the cases followed the book!

Lawsonia intracellularis - New Horizons

On December 9, the Infectious Diseases session was held at the 2008 AAEP Conference in San Diego, CA. Topics presented covered several conditions, including MRSA, Clostridium difficile, equine infectious anemia (EIA), parasite resistance and deworming protocols, and Lawsonia intracellularis.

Lawsonia intracellularis is a bacterium that causes a disease called (among other things) proliferative enteropathy in foals and weanlings. More information about this disease is also available on the equIDblog Resources page. This disease is relatively new in the horse world, being first identified in the 1990s. It has traditionally been considered a disease of pigs, where it causes several syndromes of clinical disease, including one similar to that seen in foals. In pigs that carry the bacteria in their intestine, clinical disease is brought on by stressful events, and the same may be true in foals. The infection causes severe thickening of parts of the small intestine, and the inflammation causes loss of large amounts of protein from the bloodstream. Affected foals are usually very “unthrifty” and quiet/depressed, and many often develop edema (non-painful, cool swelling) along their abdomens or under their jaws.

In pigs, prevention of disease due to Lawsonia infection involves decreasing stressful events and vaccination with an oral vaccine. Dr. Nicola Pusterla of the University of California (Davis) presented the results of a study that was done recently looking at the effects of vaccination of foals against Lawsonia in three different ways – giving the vaccine orally, giving the vaccine orally after treating the foals for three days with a gastroprotectant (omeprazole), and giving the vaccine rectally. The reason for the last two groups was to decrease the risk of the vaccine being destroyed by the acidic environment of the normal stomach. Indeed, they found the antibody response to the vaccine in the bloodstream was better in these groups than in the untreated foals that were given the vaccine orally. Of the 12 foals that received the vaccine, all of them stayed healthy throughout the study period (42 days).

Although seeing some work on developing a vaccine for this disease is great, we are still a long way from being able to use vaccination to prevent disease in foals. While the animals in the study produced antibodies in the bloodstream, Lawsonia actually lives inside cells, where antibodies usually cannot get to them. Immunity against intracellular pathogens like this requires cell-mediated immunity, which is much harder to measure. It’s also important to remember that even with a vaccine, control of this disease (as with any infectious disease) depends on a lot of other factors, like reducing stress on animals and preventing transmission and spread of the bacteria. Unfortunately, no one is even sure exactly what the source of the Lawsonia is in most foals (although there’s a good chance that they ingest it, possibly with fecal contamination from foals that are shedding Lawsonia).

As more and more cases of Lawsonia are seen, both in North America and now in Europe, researchers will continue to learn more about how this disease is spread, and hopefully one day develop a vaccine to help us prevent it.

Keep watching this site for more of the latest and greatest from the 2008 AAEP Conference!

Updating Equine Influenza Vaccines - How Often?

Influenza vaccination is an important preventive strategy in people, and much effort is made to vaccinate as many people as possible with effective vaccines. Every year, the World Health Organization makes recommendations about which influenza vaccine strains should be included in the upcoming year's vaccine. This year, three strains were recommended for the Northern Hemisphere: an A/Brisbane/59/2007 (H1N1)-like virus, an A/Brisbane/10/2007 (H3N2)-like virus and a B/Florida/4/2006-like virus.

The decision about what influenza strains to include is critical, because vaccination against one strain may not provide much protection against other strains. There are many human influenza strains in circulation, and the virus itself often changes slightly with time, which can decrease the  effectiveness of the vaccine. The decision of what strains to include in the human flu vaccine each year can be highly contentious.  It is based on knowledge of circulating influenza strains and informed "predictions" (guesses) about what strains will be the most important later in the year. Some years, their guesses are right on.  Other years... not so much.

People often ask the logical question: why do the strains included in equine influenza vaccines not get updated as often as those in the human vaccine? It appears that equine influenza is more stable and less likely to change, therefore the same vaccine remains effective for much longer. Currently there is also less variation in equine influenza strains found in different countries and on different continents compared to human influenza strains.  The H3N8 equine influenza strain has been the predominant strain for years. Therefore, changing of vaccine strains on a yearly basis is not required for horses as it is for humans.

However, all influenza strains are prone to change.  Small, gradual changes, due to a phenomenon called antigenic drift, can reduce vaccine effectiveness over time.  Major, sudden changes, due to antigenic shift, can result in new strains against which current vaccines provide no protection.   Ongoing surveillance of strains causing disease and vaccine effectiveness, in both humans and horses, is therefore a very important measure to ensure that vaccines are kept up-to-date. Companies that produce vaccines need to be diligent to ensure that vaccine strains are updated when necessary.

Strangles Controversy In BC

A recent article from British Columbia, Canada, described the complaints of horse owners that they were not warned about cases of strangles (Streptococcus equi subsp equi infection) in the Maple Ridge, BC area. The issue revolves around a small number of cases of this highly infectious - but relatively common - equine disease.

One horse owner stated "If I had known it was out there, I would have done things differently." While I understand where she's coming from, it's important for all horse owners to remember than exposure to infectious diseases is an ever-present risk. Streptococcus equi, and various other infectious agents, are widespread in the horse population, and there is never a "no-risk" situation. For that reason, we should be taking practical measures to reduce the risk of disease transmission at all times, not just when we know there is an infectious disease in the area.

Increasing infection control measures during outbreaks or during particularly high risk periods is an important disease prevention measure, however too often, people only pay attention to infection control during high-profile events. While outbreaks get the most attention, most infectious diseases occur as sporadic events, not outbreaks. Focusing solely on outbreaks has a minimal impact on infectious diseases overall.

Addressing strangles infections is a tough and often controversial area. Frequently, cases of strangles are kept quiet because people are afraid of being stigmatized. That certainly doesn't help because it can facilitate spread of the infection. In contrast, sometime excessive (approaching paranoid) responses occur. Like most things, there needs to be a happy medium, where strangles cases are properly diagnosed, appropriate control measures are implemented and relevant people are notified, but without widespread panic and unnecessary restrictions or ostracism.

More information about strangles can be found on the equIDblog Resources page and in our strangles archives.

Guttural Pouch Mycosis: Ticking Time-Bomb

One (of many) unique anatomical aspects of horses is their guttural pouches. These pouches open into the throat area and are essentially large openings in what is the equivalent of a horse's Eustachian tube. They contain several important structures including nerves and major blood vessels such as the carotid artery (see top picture right). The reason horses have guttural pouches is unclear, but it has been proposed that they are used to help cool the blood going to the brain during intense exercise under hot conditions. Regardless of their purpose, horses can develop a variety of problems with their guttural pouches, some of which can be life-threatening.

One such problem is fungal infection of a guttural pouch, which is a condition known as guttural pouch mycosis. This condition may go completely unnoticed for quite some time, but it becomes very serious if the fungus begins to grow over one of the large blood vessels in the pouch, particularly the carotid artery. The fungal infection can weaken the wall of the artery, ultimately causing it to rupture.  This results in massive blood loss (which comes out of the horse's nose) and it is a potentially life-threatening event.

Early signs of guttural pouch mycosis may include a slight bloody nasal discharge, typically from just one nostril. A few other problems can cause this type of discharge too, like an ethmoidal hematoma. However sometimes there are no warning signs before the horse has a major bleed. I've had cases where there was just a trickle of blood reported by the referring veterinarian, but by the time the horse arrived at the hospital, the blood was gushing from the nose like water from a hose. These massive bleeds can lead rapidly to death due to blood loss. Ideally, cases are identified before a major bleed occurs, but this is not always possible. Here are some points to consider:

  • Take all nosebleeds seriously. Don't panic, but have your horse evaluated promptly by your veterinarian in order to identify the source of the blood, even if the cause of the bleeding can't be determined.  The cause of blood coming from a guttural pouch should be considered guttural pouch mycosis until proven otherwise.
  • The fungi that cause guttural pouch mycosis are widespread in the environment. The reason that some horses develop this type of infection while others do not is not known. There is nothing that can be done to prevent it.
  • If guttural pouch mycosis is diagnosed (or suspected), the horse should be referred to an equine hospital. The best way to prevent a severe bleed is to cut off the blood supply to the affected area of the artery, which is done surgically. In the case of the carotid artery, which is connected to several other major blood vessels at the base of the brain by a structure called the Circle of Willis, the blood supply must be blocked both above and below the level of the fungal plaque in the guttural pouch.  If the artery is only blocked on the side closest to the heart, then the collateral circulation from the Circle of Willis can still result in a severe bleed.  This collateral circulation is also the reason that a major artery, like the carotid, can be blocked on one side (right or left) without harming the horse.
  • The fungus in the pouch "feeds" off the blood supply from the affected artery, so when the blood vessel is occluded, the fungal infection becomes much easier to treat.  Treatment of guttural pouch mycosis with anti-fungal medications that are infused into the guttural pouch is typically not effective, and the risk of a fatal bleed is always present, until the blood supply to the affected artery is cut off.

Respiratory Disease: When Antibiotics Aren't Needed

I'm trying not to sound like a broken record when it comes to antibiotics, but it's a very important topic so you'll see many posts on the subject. When you consider that antibiotic-associated diarrhea is a potentially life-threatening problem in horses, and that antibiotic-resistant bacteria are becoming more common in general, it should be obvious that we need to limit the use antibiotics to when they are actually needed, and potentially effective.  Horses with respiratory disease are commonly treated with antibiotics.  However, as discussed in a previous post ("Snotty-Nosed Horses: What To Do?"), there are many causes of respiratory disease in horses, and most of them are not bacterial.

A common cause of nasal discharge and coughing in horses is inflammatory airway disease (IAD, which is somewhat similar to asthma in people). This condition is different from heaves, which typically occurs in older horses and causes more severe clinical signs.  However, horses with IAD  may cough and/or have clear nasal discharge. They may also have decreased athletic performance. They do no have a fever, decreased appetite or other signs associated with an infection. However, antibiotics are (unfortunately) commonly used to "treat" these horses, which makes very little sense.  A few years ago a study was done looking at antibiotic treatment history (i.e. prior to diagnosis) in 55 horses diagnosed with non-septic inflammatory airway disease at the Ontario Veterinary College. Here are the highlights:

  • 69% of horses were given an antibiotic for treatment of their respiratory disease. 52%  received more than one antibiotic, and 19% received 3 different antibiotics.
  • Horses were treated with antibiotics for extended periods of time, with an average of 9.9 days.
  • No testing was performed to detect bacterial infection in any horse prior to treatment.
  • 21% of the horses that received antibiotics did not have any abnormal clinical signs beyond poor performance - not even nasal discharge.
  • Horses with a history of coughing were more likely to have received an antibiotic, but cough is a very non-specific clinical sign that does not necessarily indicate an infection, let alone a bacterial infection.

Antibiotics are important drugs, but we overuse them (in people and in animals). We need to be careful with when and how we use to ensure they have the maximum beneficial effect and to reduce the risks of side effects or increasing bacterial resistance.

More information on inflammatory airway disease is available in the consensus statement on IAD in horses from the American College of Veterinary Internal Medicine (ACVIM).

Accepted Versus Acceptable

A few years ago, I investigated an equine herpesvirus (EHV) outbreak associated with a yearling sale. We found a lot of sick horses, both from the sale and horses that were infected when purchased horses were brought home. A lot of actively racing horses got sick and missed races, which cost people even more money.  Part of the investigation was asking people what percentage of horses from sales they expected to get sick right after the sale. The average answer was 80%, and many people said 100%. When you think about it, it's absolutely astounding that people will spend what is often a great deal of money to buy a horse that they expect will get sick, and then (more often than not) put it in the same barn as their other horses, thereby putting all the animals at risk of infection.

Why do we put up with a system where we accept this degree of illness? Is this expected and accepted rate of disease really acceptable? More specifically, are there practical (and really just common sense) measures that can be used to reduce the risk of horses getting infected at sales and/or transmitting disease to other horses once they reach the home farm?

Specific thoughts and facts about how to reduce disease transmission on farms, tracks, sales and everywhere else horses gather will come in other posts, but infection control is not rocket science. Basic measures can greatly reduce the risk of disease transmission. However, the first step is to change people's attitudes - it should never be considered "normal" for such a high percentage of animals to be sick.  If 80% of the horses get sick, we're doing something wrong.

Strangles Exposure and Antibiotics

I often get asked "My horse has been exposed to a horse with strangles. Can I treat him with antibiotics to prevent infection?" It's a reasonable question, but unfortunately there is no clear answer.

Strangles is an infection caused by the bacterium Streptococcus equi subsp equi, which is often simply called Strep equi or S. equi for short.   This pathogen is always circulating somewhere in the equine population, and it can cause sporadic cases of strangles in individual horses, or large  outbreaks in groups. It is transmitted mainly by nasal secretions and pus from infected horses when they come in contact with other horses.  The classical and most prominent feature of strangles is the formation of large abscesses in the lymph nodes between the jaw bones.

Treatment of strangles with antibiotics is typically frowned upon because antibiotics do not penetrate abscesses well. Draining the abscesses is the key to treatment in most situations. However, antibiotics can kill the S. equi if they are used before abscesses develop. Therefore, if a horse has been exposed to strangles and is in the very early stages of developing an infection, but it does not have any abscessed lymph nodes, then treatment with antibiotics could be useful.

The downside of this kind of treatment is, while it stops the immediate infection from developing, the horse does not develop immunity against S. equi like it would if its body had to fight the infection. This is not a problem if good infection control measures are in place to prevent further S. equi transmission. However, if transmission is not controlled, then the horse is at risk of being re-exposed, and could be infected again after the antibiotics are stopped.  This can lead to a vicious cycle of exposure-treatment-susceptiblity-exposure-treatment...  I've seen farms where this goes on for a long time with horses receiving multiple courses of antibiotics, and they often eventually getting the disease anyway.

Antibiotics can be useful in horses with early disease (i.e. fever, no lymph node enlargement) IF they are used as part of an overall infection control program that has a heavy emphasis on implementation of sound infection control measures. If potentially infected horses can be rapidly detected and isolated, thus minimizing the risk of exposure to other horses, then early antibiotic treatment of horses that are developing strangles can be useful. Antibiotic treatment alone, without concurrent use of good infection control measures, is bound to fail. While uncommon, antibiotics can be associated with adverse effects in horses, so we want to make sure that we are only using them when they are needed.

More information about strangles can be found on the equIDblog Resources page.

So Far, So Good With EHV in Maryland

As of this morning, no new cases of equine herpesvirus (EHV) infection have been identified at Laurel Park in Maryland. (See our previous reports regarding this situation.) More than 50 horses on the premises have tested  negative for the virus, and no new horses have developed signs of disease. While they are not yet at the end of the period during which horses infected by the sick filly could develop disease, the fact that no new cases have been found so far is very encouraging. Horses at Laurel Park will remain under close monitoring for new cases for 21 days, but if no cases are found in the first 7-14 days, then it is unlikely that additional cases will develop.

Unfortunately, the affected filly had to be euthanized on Saturday. The track will still be under quarantine until around December 6.  This will be 21 days after the last evidence of clinical disease in any horse (in this case November 15 when the filly was euthanized), which represents the last chance of exposure of other horses to the virus.

Snotty-Nosed Horses: What To Do?

Respiratory tract disease is a very common problem in horses that has a wide range of causes, including bacterial and viral infections, as well as non-infectious conditions. Nasal discharge (i.e. a "snotty nose") is often one of the first signs of respiratory disease noticed by owners. Unfortunately, the nasal discharge itself cannot tell you what the problem is, nor how to deal with it.  If your horse develops nasal discharge, you should contact your veterinarian to determine the best approach to diagnose the cause and the best way to treat the animal.  Here are just a few of the factors that need to be considered:

  • Does the nasal discharge come from one or both nostrils? Discharge that predominantly comes from just one nostril is more likely due to a problem in a sinus, or possibly one of the guttural pouches (but guttural pouch infection can also cause discharge from both nostrils, even if only one side is affected).
  • Does the horse have a fever? Bacterial or viral infections usually (but not always) also cause a fever.
  • Are there any other signs of illness, such as decreased appetite or decreased energy. If so, an infection is more likely.
  • Is there more than one horse affected? This may indicate that a transmissible pathogen (virus or bacterium) is involved.
  • Have new horses been introduced to the barn, or has the horse encountered other horses while off the farm? If so, this increases the likelihood of a viral infection.
  • What does the discharge look like? Thick, yellow discharge is more often (but not always) caused by bacterial infection.  Clear, watery discharge may be caused by viral infection, or sometimes non-infectious causes such as heaves. Bloody discharge can indicate serious problems.
  • Does the horse cough, and if so, when?  Is coughing more common during exercise, when the horse is inside, or while the horse is eating hay?  These signs may be associated with a non-infectious condition such as heaves.

Nasal discharge is a sign that something abnormal is going on. Some causes of nasal discharge are very minor, but others are very serious. Some are not infectious, but others can be easily transmitted to other horses. Good communication with your veterinarian is important.  Do NOT give your horse antibiotics unless your veterinarian prescribes them.  Nonetheless, if there are any signs that suggest an infection (viral or bacterial) might be present, you should isolate your horse right away, at least until it has been examined by a veterinarian, in order to prevent possible infection of other horses.

Healing With Honey

As we encounter more infections caused by antibiotic-resistant bacteria (e.g. MRSA), we need to explore treatment options other than antibiotics. While we usually focus on "new" treatments, sometimes we can look back in time for ideas to treat infections. An old treatment method that is getting increasing attention these days is the use of honey. While not used much in equine medicine at this time, honey may be a safe, effective and affordable treatment option in many cases. Click on the picture to view a video by Dr. Karol Mathews, a critical care specialist at the Ontario Veterinary College. Everything that is discussed regarding dogs and cats can apply equally to horses.

EHV Confirmed at Laurel Park: Track Under Quarantine

Equine herpesvirus type 1 (EHV-1) infection was confirmed in a filly at Laurel Park in Maryland (see yesterday's post). As a result, the track is now under strict quarantineHorses are not allowed to be shipped onto the track (except from an associated training facility) and horses already at those facilities may not leave. This is being done to reduce the risk of transmission of the virus to horses on other properties. As discussed yesterday, EHV is tough to control because it can be found in a dormant state in so many healthy horses, and we really don't understand enough about how the neurological form of disease is transmitted. It's possible that these quarantine restrictions are over-kill, but since we don't have enough information to say with certainty what is or is not necessary, and because large outbreaks of EHV-1 have occurred in the past, using a very cautious approach is understandable. Only time will tell whether there was transmission of this virus before the restrictions were implemented.

Colostrum: Planning Ahead

As every horse breeder should know, colostrum is one of the keys to any foal's survival. This antibody-rich first milk is critical for preventing early, often fatal infections in foals. Foals that don't get an adequate volume of good quality colostrum within the first 18-24 hours of life (while they can still absorb antibodies through their intestine) are at high risk of dying from any of a number of different infections.

Sometimes colostrum from a newborn's mare may not be availableThis is an emergency situation, so every breeder (whether they have one mare or 100 mares) should have a contingency plan for treating the foal or obtaining colostrum from another source, just in case.  This may be necessary if:

  • The mare does not produce any milk (i.e. she doesn't "bag up") prior to foaling.
  • The mare leaks colostrum/milk from her udder prior to foaling.
  • The mare dies during delivery.

Finding an alternate source of colostrum after a foal is born, within those critical first 18-24 of life, can be very difficult.  Like most things, planning ahead can make finding such a source much easier, and a little proactive effort may save your foal's life. A few potential options are:

  • Save extra colostrum from other mares on your farm.  Most mares produce more colostrum than their own foal will need.  Any extra colostrum can be milked out and frozen for use later in the year, or even in future years (although the quality of the colostrum does decrease somewhat when it is stored for a very long time).  Always make sure each mare's own foal gets enough colostrum first.
  • Get colostrum from a colostrum bank, if there is one in the area.
  • Get together with local breeders and start your own colostrum bank, with different people saving colostrum and/or being on call to collect colostrum from newly foaled mares, if anyone needs some.

Foals can also get the antibodies they need from plasma, which can be given intravenously (as a transfusion) or even orally (within the first 18-24-hours).  However, commercial plasma is usually quite expensive, and it doesn't replace many of the other components of colostrum from which newborn foals benefit.  Feeding the foal equine colostrum, from one source or another, is still the best recommendation.

More information on colostrum is available on the equIDblog Resources page.  More information about colostrum banking is available in this article from the California Thoroughbred magazine.

Helpful vs Harmful: Antibiotic Risks in Horses

The discovery of antibiotics was one of the most important medical advances in history, and these drugs have had an immense impact on human and animal health. While antibiotics have saved countless lives, their use can also be associated with some very serious side effects and complications.  For example, in horses, antibiotic-associated diarrhea (colitis) is a major issue.

By the nature of their intestinal tract, horses at among the highest risk species for developing serious diarrhea associated with antibiotic use.  The intestinal tract of a horse is full of billions of bacteria of different types. These bacteria are important for normal digestion, and also help to prevent infection by "bad" bacteria such as Salmonella and Clostridium difficile.  Antibiotics can disrupt the balance of this complex bacterial population.  The imbalance itself can cause problems, and can also make it easier for bad bacteria to move in, grow and cause disease.

Here are some important points to remember about antibiotics, particularly in horses:

  • Antibiotics can only kill bacteria. They should not be used when a bacterial infection is not present and not likely to occur. Antibiotics are too commonly misused for viral infections in horses, which puts the animals at unnecessary risk.
  • Any antibiotic can cause diarrhea, but some drugs are considered higher risk. Erythromycin and tetracyclines are considered high-risk in most areas of North America. Certain drugs, such as lincomycin and oral penicillins, are such high risk that they should never be used in adult horses.
  • Both oral and injectable antibiotics can also cause diarrhea. Drugs that are injected can still reach the intestinal tract and affect the bacteria there. Some drugs, like tetracycline, are actively pumped into the intestinal tract from the bloodstream, resulting in relatively high concentrations in the intestine, even if the drug was given by injection.
  • While some antibiotics can be purchased over the counter in some areas, antibiotics should never be given without the direct recommendation of a veterinarian.
  • If your horse is being treated with antibiotics and develops diarrhea, contact your veterinarian immediately.
  • There is no known way to reduce the risk of antibiotic-associated diarrhea in horses, other than to avoid unecessary use of antibiotics. Some people treat horses with probiotics or yogurt, but currently there is no evidence that this is beneficial (but it probably doesn't hurt, at least in adult horses).

Another major concern with antibiotic use is the development of antibiotic resistance in bacteria, but that's a topic for another post (or two, or three or more!).

More information about Clostridium difficile and probiotics in horses can be found on the equIDblog Resources page.

Israeli Outbreak Mystery Revealed

Recently, I wrote about a large disease outbreak involving horses in Israel that resulted in a country-wide quarantine. Equine viral arteritis (EVA) has now been identified as the cause of the outbreak. This viral disease can cause a wide range of clinical signs in horses. It is often associated with abortion, but flu-like disease is common in adult horses, and is consistent with what was reported in Israel. The EVA virus is spread mainly by the respiratory route - contact with infectious nasal discharge is a prime means of transmission between horses.

It is currently unclear where the Israeli outbreak originated, or how it was propagated.  Transportation of horses to shows, races and other events with subsequent mixing of horses is a great way to rapidly spread such a virus over a large area. The World Organization for Animal Health (OIE) reports that this virus has never been identified in Israel before. If this is indeed true, it could explain why the outbreak was so rapid and widespread - when a virus encounters a population of horses who don't have any immunity because they have not been exposed or vaccinated, more animals are likely to become sick and spread the virus further.  The massive influenza outbreak in Australia last year was a great example of that.

It will be interesting to see what happens with this outbreak. The implementation of a nationwide quarantine, while certainly disruptive to many people, may have been an important step in limiting further transmission of the virus.  A vaccine for EVA (which cannot be used in pregnant mares) is available, and could be used as part of outbreak control. However, good infection control practices are more important - vaccination will not be effective if it is the only measure taken.

Click here for more information on equine viral arteritis (EVA).

Welcome to equIDblog

Welcome to equIDblog, a new public resource all about equine Infectious Diseases! This site, sponsored by the Ontario Veterinary College Teaching Hospital (OVCTH), is designed to provide high quality information about infectious disease topics related to horses.

The main equIDblog page is regularly updated with posts about equine infectious disease, in a blog format. It provides information and commentaries about recent and important issues pertaining to this field. New posts will be going up every day or so, so check back regularly. Periodically there will also be "case posts", which describe a horse with a particular infectious disease, with an emphasis on explaining what the problems and issues are with similarly affected horses.

Don’t miss the equIDblog Resources page, which contains detailed information sheets on various infectious disease topics which can be downloaded and/or printed.  More information is available on specific diseases, as well as issues such as vaccination and antibiotic use.

Also on the Resources page is an infection control section, focused on equine hospitals. There you’ll find infection control resources, including hospital protocols and information sheets developed by the OVCTH for clients. 

You can also register on the main page to receive automatic e-mail notification when new posts go up, so you'll never miss the latest updates!  We hope that you'll find this site educational and informative, and we welcome any comments and suggestions for future blog topics.

Stopping Show Sickness: Avoiding Infection at Horse Shows

Infectious disease risks increase whenever you mix large numbers of horses together, especially horses from many different farms. The risk is further increased if horses are allowed to have direct contact with each other, and indirect contact through people that touch many different horses. Add a little stress from shipping and you have a prime situation for infectious disease transmission.  Unfortunately, this very same situation is something that happens countless times every week, at horse shows and other events. Diseases associated with horses being at shows are very common. Some people think that horses getting sick is an unavoidable aspect of competing. While it is true that you can never completely eliminate the risk of infection, I think that our traditionally "accepted" degree of illness in show horses should not be considered "acceptable," and that we should be working harder to decrease the risks of disease transmission in these animals.

Here are some general recommendations to help do just that:

  • Avoid direct contact between your horse and other horse - don’t let horses touch each other. 
  • Make an extra effort to avoid going near any horses that appear to be sick, such as those that are coughing, or have nasal discharge or diarrhea.
  • Don’t share items like water buckets, feed bins and hay nets between horses.
  • Wash your hands or use an alcohol-based hand sanitizer after touching another horse.
  • Don’t take a sick horse, or a horse that might have been exposed to a horse with an infection, to an event. You don’t want your horse to get sick at a show, and you also shouldn't put other peoples’ horses at risk of infection.
  • Make sure your horse is appropriately vaccinated. Horses that go to shows or other events are at higher risk of exposure to certain infectious diseases. Your veterinarian should design a vaccination program that is appropriate for your horse.
  • Make sure events that you attend have strict rules for keeping sick horses off the property. If they don’t, or if those rules aren’t being followed, let them know that you think it is unacceptable.

Unknown Infectious Disease Outbreak Hits Israeli Horses

An outbreak of an unknown infectious disease has occurred in Israel, sickening hundreds of horses and possibly causing death in a few. The disease is characterized by fever, lethargy and loss of appetite, yet the cause has not been identified. At least 30 different farms have been affected, and the spread of disease has prompted the Ministry of Agriculture to implement a nation-wide quarantine of horses. All horse events in Israel have been canceled.  Similar precautions were taken when the outbreak of  equine influenza hit Australia last year.

The described clinical signs in affected horses are very non-specific, so it's hard to speculate about the causative pathogen. There are a variety of potential culprits, including equine influenza virus (EIV), but so far testing has not detected EIV or any other known pathogens.  This "mystery" disease does not appear to affect other animals or people (but without knowing what is causing it, this is difficult to say for certain).  It is possible that this is a "new" disease, but the vast majority of infectious disease outbreaks are caused by pathogens that we already know about. Specialists from Britain have been called in to help with the investigation. Hopefully more information will be available soon.

Survival of Streptococcus equi

Streptococcus equi is the bacterium that causes of strangles, and important and highly infectious disease of horses. This bacterium is widespread in the horse population and outbreaks of strangles are not uncommon. Outbreaks are manageable if adequate time and resources are available, but some aspects of strangles control are complicated by a lack of good information.

One area that people often ask questions about is the ability of S. equi to survive outside of a horse, and how to handle the general environment (e.g. barn, paddocks) during an outbreak of strangles. Two older studies reported that S. equi can survive on environmental surfaces for up to 60 days. This has led some people to recommend prolonged quarantine of pastures that have been used by infected horses. However, these studies were conducted in the controlled and relatively hospitable environment of a laboratory, without exposure to sunlight, temperature changes and competing bacteria that are found in the "real world".

A recent study, presented the 2008 Forum of the American College of Veterinary Internal Medicine (ACVIM), evaluated S. equi survival in a more "real world" situation: outdoors, on objects like fence rails, feed bins and water buckets. These items were experimentally contaminated with S. equi, and the length of time that the bacteria survived was studied. Surprisingly, S. equi only lived for a short period of time under these conditions, typically a day or less.

Does this mean that we should allow horses into potentially contaminated areas after only a couple days? Probably not. The results of this study only apply to the conditions that were studied, that is outside with exposure to sunlight, and during the summer. It is safe to assume that survival is short term on farms under these conditions, but it could be longer during cloudy periods and in shady areas. We don’t know the optimal time for which to quarantine stalls and paddocks, but it is reasonable to assume that long-term quarantine, as has been recommended in the past, is not needed in most situations. If it is sunny and there is exposure to sunlight, 1 to 2 weeks is probably well beyond the survival period of S. equi.

More information about strangles will soon be available on the equIDblog Resources page.

Eastern Equine Encephalitis Kills Emus in Ontario

Eastern equine encephalitis (EEE) was recently identified as the cause of an outbreak of disease in emus on a farm near Brockville, Ontario. EEE is a viral disease that is spread by mosquitoes, and can cause severe neurological disease in horses.  Previous equIDblog posts describe EEE in more detail.

Emus are quite susceptible to EEE.  Although EEE cannot be transmitted fro emus to horses, the relevance of this report to horse owners is that the emu outbreak indicates that the virus is present in mosquitoes in that region.

Most of the emu deaths in this outbreak occurred in mid-October.  It is unclear whether there is any further risk to horses, people or other animal species. Being a mosquito-borne disease, EEE transmission should decrease dramatically after the first few hard frosts in the fall. It is unlikely that there is a significant risk of further EEE transmission in the Brockville area this year.

Vaccination of horses in Ontario at this time of year is probably not useful because of the low risk of mosquito transmission and the time required for immunity to develop after vaccination. However, people should consider the risk of exposure in subsequent years, and try to reduce this risk. This can be done through a combination of avoiding and controlling mosquitoes (which are also important for prevention of West Nile virus infection) and vaccination against EEE. Since EEE is so rare in Ontario, it is not typically considered a "core" vaccine in horses. However, vaccination for EEE should be considered in regions where the disease has previously been identified.

Your Mother Was Right! Wash Your Hands

You may notice a recurring theme on equIDblog anytime we talk about infectious disease control, particularly when it comes to zoonotic diseases (those that can be transmitted between animals and people): an emphasis on handwashing. There is increasing emphasis on hand hygiene (i.e. hand washing and use of alcohol hand sanitizers) education in hospitals because the hands of healthcare workers are a major (if not the most important) means of disease transmission between patients. Despite hand hygiene being easy, cheap and effective, people rarely wash their hands as often as they should, and they often don't do it properly.

Most of the research about hand hygiene that has been published has focused on its use and impact in human hospitals, but this area is now also being studied more with regard to animals and veterinary medicine. A study published earlier this year in Veterinary Microbiology provided more evidence that hand hygiene is a critical infection control measure when dealing with animals. The study looked at MRSA carriage rate in veterinarians who work with horses. In addition to finding a high rate of MRSA carriage among these veterinarians (which was consistent with other reports indicating that equine vets are at higher than average risk for exposure to MRSA), the study looked at factors associated with MRSA carriage. Vets that reported routinely washing their hands between farms and those that reported washing their hands after contact with potentially infectious cases had a significantly less likely to be carrying MRSA. That should come as absolutely no surprise, but it's one more piece of evidence that we need to pay more attention to this routine infection control measure, in human hospitals, in veterinary environments, out in the barn, and even in households.

Remember, the 10 most important sources of infection are the fingers on your hands!

Click here for instructions on how to wash your hands properly.

Horses and MRSA

Many people in the horse world have heard the hype about methicillin-resistant Staphylococcus aureus (MRSA) in horses. MRSA can cause infection in horses, just like it can in people, dogs, cats and many other animals. It’s usually what we call an “opportunistic” pathogen, meaning it usually takes advantage of a person or an animal that is already sick or injured, like someone who’s in the hospital and has just had surgery. And because MRSA is resistant to many different antibiotics, the infection can be difficult to treat. The big concern with MRSA in recent years is that infections are now sometimes occurring in people who aren’t sick, and who don’t have wounds or incisions, which is where MRSA usually likes to move in. It’s very important to find out from the start if an infection is being caused by MRSA, so that it can be prevented from spreading to other people and animals, and so that it can (if necessary) be treated with the right kind of antibiotic.

Horses are a bit of a special case when it comes to animals and MRSA. When researchers look at the DNA of MRSA from a dog or a cat, it usually turns out to be one of the common human MRSA strains (usually called a “clone”) from the same area. This means that the dog or cat probably picked up the MRSA from a person somewhere.  When researchers look at the DNA of MRSA from horses, however, they often find a different clone, which seems to be more common in horses and people who work with horses than in people in general. A very similar situation has also been discovered in pigs. The worry is that this “horse MRSA clone” can survive in and be transmitted between horses better than the human MRSA clones. That means that in order to control MRSA, just controlling it in the people won't do the trick - we need to take steps to stop the spread of MRSA in horses specifically as well.

Here are some key points to help reduce the risk of your horse (and you!) getting MRSA
:

  • Always wash your hands with soap and water (or use an alcohol-based hand sanitizer) after handling a horse, and before handling another horse.
    • This is especially important if you have touched a horse’s nose, or any cuts or wounds that the horse may have.
    • Don’t go down the row of stalls in the barn and pet every horse on the nose! They love the attention, but this is a great way to spread MRSA if it’s there!
  • New horses coming into the barn, or animals coming back from a hospital, should be kept separate from all the other animals and only dealt with after all the other horses, for 3-4 weeks.
    • This is an important measure for controlling many infectious diseases, not just MRSA.
  • If your horse has a cut that looks infected, cover it with a bandage of some kind and contact your veterinarian. Your veterinarian can culture the wound to determine if it is an MRSA infection.

This equIDblog entry was originally posted on the Worms & Germs blog on 06-May-08.

Biosecurity vs Infection Control

When people talk about prevention of infectious diseases on horse farms, they often use the term "biosecurity." I don’t.  I prefer to use the term "infection control." Here’s why:

  • Biosecurity is a term often used in association with rearing of food animals, particularly chickens and pigs. In these types of facilities, new animals are rarely or never introduced to an established group, control of personnel access is very strict, and significant efforts are made to prevent exposure of animals to new infectious agents.
  • In my opinion, we do not (and cannot) practice true biosecurity on horse farms because of the way horses are managed - the movement of horses on and off farms, movement of people that work with horses, and diseases that are always circulating in the horse population. The simplest daily, weekly or monthly activities - going to a show, buying a new horse, going off-site on a ride, bringing in visitors/farriers and other people that have had contact with horses - in combination with the fact that even healthy horses can carry  potentially harmful bacteria and viruses, means that there is always an risk of exposure to infectious agents on horse farms.
  • We are not able to completely exclude infectious agents like bacteria and viruses from entering horse farms (i.e. making them "biologically secure"). However, what we need to strive for is to limit the problems that develop when these agents do enter the farm. For example, we know that the majority of horses carry equine herpesvirus in a dormant state in their bodies. We can’t eliminate it, but we try to reduce the risk of problems like herpesvirus abortion in mares by vaccinating mares while they're pregnant.

While it may be somewhat an issue of semantics, I think it’s important that horse owners have a realistic mindset. There is always, and will always be, infectious disease risks when dealing with horses in any situation. Some risks are avoidable while others are not.  The key is to implement measures to reduce the inevitable impact of infectious disease exposure on our horses.

Why Do I Vaccinate My Horse So Often?

A common (and reasonable) question that I get asked periodically is “Why do I vaccinate my horse every year against tetanus but I only get a booster every 10 years?”   There are actually some good reasons for the difference.

Tetanus is a devastating disease caused by the bacterium Clostridium tetani. It used to be very common, but is now rare because of effective vaccination. Although the disease is rare, the bacterium that causes it is very common, and can be found in soil and manure almost anywhere. Horses typically get exposed to C. tetani through soil contamination of  wounds, especially puncture wounds of the foot or lower leg.

  • Horses are probably more at risk of exposure to C. tetani than people, because these types puncture wounds happen frequently in horses, and the wounds are possibly more likely to be contaminated with the tetanus bacterium.
  • Horses are extremely susceptible to tetanus (more than people and most animals), so situations that would not necessarily cause a problem in people could cause tetanus in a horse.

Given their risk of exposure, their susceptibility to the disease, and the difficulty (and high cost) of treating tetanus in horses, and the safety and effectiveness of vaccination, it is recommended that horses are vaccinated frequently for tetanus. It is possible that longer intervals for vaccination than every year could be used, but there is currently no information that tells us how long we can stretch it. So, erring on the side of caution, and considering tetanus vaccination is safe and cheap, it makes sense to vaccinate horses every year.

More information on tetanus is available on the equIDblog Resources page.

Suspected Botulism Outbreak Kills Dozens of Florida Horses

Preliminary evidence has suggested that botulism might be the cause of botulism may be the cause of death of approximately 100 horses at a large breeding facility in Florida housing approximately 400 mares. The horses died over a period of about 7 days, with signs of neurological disease. There are no reports of affected horses at other facilities in the area.  The clinical signs in these horses and lack of evidence of another disease are strongly suggestive of botulism. This farm apparently fed the horses haylage (although some reports seem to alternate between using the words "hay" and "haylage"), which is a high-risk feed source for botulism.

In adult horses, botulism is caused by ingesting a toxin produced by the bacterium Clostridium botulinum. This bacterium will not grow in the presence of oxygen, however in can grow in conditions that are sometimes present in improperly fermented haylage and silage. As the bacterium grows, it produces botulinum toxin, one of the most potent toxins on the planet. Ingestion of botulinum toxin leads to progressive paralysis (i.e. severe weakness and flacid muslces).

Treatment of botulism is difficult and can be expensive, and the mortality rate for this disease is high. Some people choose to feed haylage and silage despite the risk of botulism. If you choose to feed haylage, silage or other high-risk feeds:

  • Ensure that haylage/silage is properly prepared and stored.
  • Consider vaccinating horses that are fed haylage/silage against botulism. Be aware, however, that vaccines do not protect against all strains of botulism.
  • Immediately stop feeding haylage or silage if any horses show signs that could be consistent with botulism (e.g. weakness, problems eating).

Cheap Vaccines: You Get What You Pay For

In some areas, vaccines are readily available from multiple sources, including the internet. Some people like to purchase vaccines and administer them to their horses themselves in order to save money. But are the savings really worth the risk? Here are some things to consider:

  • Your veterinarian obtains vaccines through a reputable distribution system, which ensures quality control, tracking of products, and proper shipping and storage conditions. When you buy vaccines from other sources(especially the internet), you don't have that same level of assurance. Vaccines that have been improperly handled may not be effective.
  • Some sources of vaccines and drugs are of questionable quality - in these cases you can't always be sure that you are even getting what you think you ordered. Ineffective vaccines or contaminated products are a concern. It's not saving you money if the vaccine doesn't work!
  • While uncommon, vaccine reactions do occur. If your horse has an anaphylactic (severe allergic) reaction after being vaccinated, the reaction usually happens right away.  The horse's chances of survival are much greater if your veterinarian is there, because the needed expertise, drugs and equipment are readily available. If you administered the vaccine yourself, your horse may die by the time a veterinarian arrives.
  • If your horse develops any problems associated with a vaccine administered by your veterinarian, the manufacturer may get involved and assist with the problem. This will NOT happen if you buy the vaccine from another source and give it yourself.
  • Rabies vaccines MUST be given by a veterinarian. (In some areas it's illegal for a non-veterinarian to even possess rabies vaccine.)  A horse that has received a rabies vaccine from a non-veterinarian is considered unvaccinated by public health authorities.  If an unvaccinated animal is exposed to rabies, the repercussions may be much more severe, and may even include euthanasia.
  • Vaccination is just one part of your horse’s "wellness program". Some of the pressure for people to vaccinate their own pets is a failure of the veterinary profession to adequately emphasize the importance of preventive medicine, of which vaccines are just one component. Simply charging an owner for "annual vaccines" leads people to want to vaccinate their pets themselves because they can get the vaccines for much less money. Veterinarians need to emphasize that what they are charging for (and what is the most important component of the preventative medicine program) is an annual physical examination and health consultation, and that only a small portion of the fee is for the vaccines.

Vaccination is a minor component of your horse's preventive medicine program. A careful physical examination and consultation about potential, developing and ongoing health issues are the most important parts of this program. Even if you vaccinate your horse yourself (which is still not recommended for the reasons above), it is still critical that your horse has an annual examination.  It's better for your horse's health, and it can be easier and cheaper in the long run because problems can be detected and treated early.

This equIDblog entry was originally posted (in modified format) on the Worms & Germs blog on 16-Oct-08.

 

Deadly Hendra Virus Resurfaces in Australia

This summer, a small outbreak of the potentially deadly Hendra virus was identified in a group of horses near Brisbane, Australia. This virus has caused periodic cases of illness and death in horses, and can be transmitted to people working closely with infected horses. In the latest outbreak, 3 horses died, making this the worst outbreak since 1994 when 14 horses and 2 people died.  A human case was also identified. This person worked at a veterinary clinic that treated infected horses. This individual was admitted to hospital overnight but was discharged, so  presumably was not very ill.

While Hendra virus (genus Henipavirus) is only found in Australia, it is a good reminder for everyone about the strange nature of some infectious diseases. The natural reservoir of the virus is the fruit bat. It is believed that horses become exposed when infected fruit bats give birth and contaminate horse pastures with uterine fluids. Horses develop respiratory disease ranging from mild to fatal. Human cases have been reported in people working closely with infected horses. A horse trainer and veterinarian's assistant died in the 1994 outbreak. Close contact is required for transmission to people.

Picture: Locations of previous Henipavirus outbreaks (red stars – Hendra virus; blue stars – Nipah virus) and distribution of Henipavirus flying fox reservoirs (red shading – Hendra virus; blue shading – Nipah virus)

It's very difficult to take specific measures to protect horses, people or other animals from sporadic, rare diseases such as Hendravirus infection. However, common sense infection control measures can reduce the risks associated with any animal contact.

  • Wash your hands after contact with any animal.
  • Avoid contact with sick animals - consider sick animals to be potentially infectious until proven otherwise.
  • Remember that  new animal diseases are regularly being identified, and that they might be able to infect people.
  • People that work in veterinary clinics must be diligent and use good infection control practices because they are at higher risk of exposure to various diseases.

This equIDblog entry was originally posted on the Worms & Germs blog on 15-Jul-08.

Eastern Equine Encephalitis - Not Just For Horses

Over 50 horses have died from Eastern Equine Encephalitis in Florida this year. The disease, caused by a virus of the same name, affects the brain, resulting in a broad range of clinical signs from behaviour changes to blindness to irregular gait. The disease is also sometimes called “sleeping sickness” because some horses may become severely depressed, with low head carriage and droopy eyes, ears and lips. Almost all horses that develop neurological signs from this infection die. Only 35 cases were reported in Florida in 2006 and 2007 combined.

There are actually three related equine encephalitis viruses – Eastern, Western and Venezuelan – which are called EEE, WEE and VEE for short. VEE is found in South and Central America and Mexico, and occasionally in the southern United States, but has never been reported as far north as Canada (VEE is a reportable disease in Canada). It is unique among the three diseases as the only one in which an infected horse will carry enough virus in its bloodstream to infect a mosquito, which could then pass the virus on to another animal. The EEE and WEE viruses, just like the West Nile virus, do not reach high enough levels in the bloodstream of horses to do this. The mosquitoes usually pick up the viruses from passerine birds, which do not become ill from the viruses (unlike West Nile virus in birds from the family Corvidae).

People can also be infected by EEE, WEE and VEE. About 10 fatal cases of EEE in people are reported in the United States every year. But horses cannot transmit EEE or WEE to humans, even if they’re bitten by the same mosquito. A higher number of cases in horses, however, may mean a higher number of mosquitoes that are carrying the virus. There is no vaccine for these viruses for humans, but there are vaccines available for EEE, WEE and VEE for horses.

In the end, EEE is just one more good reason to make sure you wear mosquito repellent when you’re enjoying the great outdoors during the summer. Visit the Health Canada website for safety tips on using personal insect repellents. EEE is very uncommon in Ontario, but horses that live in or travel to the southern United States should be vaccinated. Talk to your veterinarian about whether or not your horse should be vaccinated. Remember that fly control is also important for our equine companions (and also helps protect them against West Nile!).

This equIDblog entry was originally posted on the Worms & Germs blog on 02-Aug-08.

University of Guelph Infection Control Resources

The following are infectious disease control resources that have been developed at the Ontario Veterinary College (OVC), as well as information regarding the infectious disease control polices of the Ontario Veterinary College Teaching Hospital (OVCTH) in Guelph, Ontario.

OVCTH MRSA Screening Policy

OVCTH Information for Owners of Salmonella-Positive Horses
CCAR Infection Prevention and Control Best Practices in Small Animal Clinics OVCTH Infection Control Manual (revision pending)
   
   

 

Other Infectious Disease Resources