Thank you, Bruce, and good afternoon and good evening to you all and thank you for turning up. So I would like to talk about shelter medicine today because it's what I'm really interested in, and you'll see we have this fairly ambitious list of learning outcomes. I'm not gonna read them all through, but we're gonna work through them slowly one by one.
So I was really, really pleased to be asked to do this session, but I have to admit I was asked, sometime in the middle of last year when I've not long had a baby and I was in a bit of a fog of sleeplessness. So I wrote the abstract and I came back to it at the end of last year to write the talk and I thought, oh my goodness, I might have overpromised here. So the list of learning outcomes is ambitious.
So we can't really have the time to go through all of them in detail. It's gonna be a bit of a top tip session, hopefully with some practical stuff that you can all take away and used based around the common questions I get asked in shelter medicine. Having said that, if at any point you feel like you need a bit more explanation on anything because I'm going to rattle through fairly swiftly, please do ask questions.
I will endeavour to stick to time and finish at 10 to 6, so we've got time to ask those questions and please make sure you do, because whatever you ask, I'm sure several other people will be asking. So we better get on with it. So I really wanted to know why you're at this session.
So I've got a bit of a poll question, so I'll hand you over to Bruce and. Right, folks, so quite easy, up on the screen are the poll questions with the answers. Simply just click on the answer that most represents, what you feel.
And, we will let this pole run for about 45 seconds or so. So get clicking, get your fingers exercising. And remember, this is completely anonymous.
So don't feel scared, don't feel embarrassed, don't feel, ooh, I don't want it. Just get in there, click the answers and let's get some feedback going, so that Jenny can get the answers that she wants as well. All around, everybody wins it, makes it a much more Exciting interactive webinar, which is exactly what we're aiming for.
So we have got another 10 seconds to go and then we're going to stop this poll. Come on guys, if you're sitting on the fence, hop off. That's it.
One more coming and another one, let's go. Right. Here we go.
Jenny, I'm gonna yeah I'm gonna end this poll and share those results. Can you see those? I can see those.
That's really good to know. OK, so most of you are working for a private practise for a rescue client, but there's some of you also think you might want to do more shelter medicine. Yeah, OK, there's a bit of a variety there that really helps me to know.
So, so for some of you, some of the things I'll be talking about might be quite familiar. For some of them, they might be more new and that really helps me. I'm encouraged to see that several of you want to do more of this stuff because I think it's a great opportunity.
So we're gonna start right at the beginning and we're gonna talk about history and physical exams because that's where we start with all of our patients. But what I really want to reinforce is that here our patient isn't a single animal. Yes, we do see individual animals, but a history and physical examination where the shelter itself is the patient, and that's really key to any shelter relationship.
And I put this quote in, not because I think I'm clever, quite the opposite. The older I get, the less clever I get, but because in shelter medicine, you have the opportunity to make a huge difference to the welfare of large numbers of animals, and that's a huge responsibility because when you get it right, there's nothing like it in the world. It's brilliant and it's rewarding.
When it does go pear shaped, though, it can go pear shaped on quite a large scale. And that's why I think, you know, the mistakes tend to be correspondingly hugely. That's why this, this quote really resonates for me.
So when we think about shelter history, we begin at the beginning. I call on the Cotton Eye Joe questions, where do they come from? Where do they go?
And there's lots of different intake policies, but broadly, they're either selective. All all managed or they're open. So open intake is the shelter takes any animal thrown at it, no matter how many there are, no matter what type.
Selective intake might be, I'll only take this particular breed. It's a breed rescue, or I'll only take this particular age group or this particular type of cuteness, or, or I'll take them to fit a certain profile. Managed intake is between the two.
So, for example, some shelters are largely open intake, but they'll take no more than 10% of geriatric animals, for example, and that again stops their systems being clogged up because they would have so many geriatric animals they'd never rehome anything. So there's lots of different ways of managing intake, but obviously that's a really key question. And the management, yeah, is it types of animals or availability.
So, Is space an issue? So for example, in the UK we have shelters that have stray contractors, which means they're contractually obliged for dogs to take any dog presented, whether they've got room or not. So if you've got 20 dogs coming in today and you have no spare kennels, then you've got to shift 20 dogs out to accommodate the ones you're contractually obliged to take in.
Whereas some of the shelters will say, well, I've got 3 spaces this week, so I'll go find 3 dogs that fit the profile of my shelter. Neither one's right or wrong. They're both valid strategies, but they're really, really key in how you manage your shelter.
Until you know which you're working with, it becomes really difficult to move any further, really. And then we think about staff training. So is there any?
I mean, some shelters are highly professional and there's lots of training and there's training manuals and people dedicated their training. Some places are very volunteer led some volunteers are highly professional, so being volunteer led doesn't necessarily mean that you don't have a high standard. Some shelters will train their staff but not the volunteers.
So that's quite important. And then we get to the other half of the cottony, Joe question, where do they go? Who can have an animal?
Do they only open between 10 and 3 on weekdays? That essentially excludes anybody who works. Do they do home visits?
Do they exclude anyone who lives by a busy road? Do they run with the assumption that anyone can have an animal is just finding the right one? Shelters really, really vary in their policies and their attitudes towards the public.
And I think that's quite important as well, because, yes, it's a very . Real thought that some of the animals that come to shelters have been through a lot and you want to find them the perfect home, but equally, if you're interested in 3, maybe a good enough home and a shorter stay is overall better. So they, you know, there are different strategies and as I say, none, no one is right or wrong, but it's worth knowing these things about the the organisation you're working with.
And then when you're thinking about assessing biosecurity, you wanna ask them do they separate groups at different risks? So if they were cattle, you'd separate the cards from the heifers. From the breeding hazards from the cows, whereas here you want to separate the groups most at risk, which again will be neonatal animals, new intake, animals known to be sick, animals thought to be healthy.
Do they move around the shelter or do they stick in one spot? And do they have stated biosecurity policies and practises. Do they have any biosecurity policies and practises for the stated or not?
And does everybody who works in the shelter follow any practises they do have? So, you know, it, it's quite a tricky business assessing biosecurity. And of course one of the things we're most interested in is the PrevMed policy.
Are all animals examined by a vet at some point in their stay? That is certainly not a universally true thing. If they are, is there a policy on that?
So are they all examined within 1 day, within 2 days, within a week, or is it just hit and miss? Are all animals vaccinated? It's really, really controversial subject.
I went to a shelter. I think there's a picture of it in here somewhere. I'll point it out when we get there.
A lady who keeps about 60 cats in her home and garden in a little terraced house, and I asked her about vaccinations. She said, Oh no, we don't have flu problems. And there were literally cats with their eyes hanging out.
So again, you have to be aware of people's perceptions of what they need because it's not always going to tally with yours. If animals are vaccinated, when are they vaccinated? What antigens do you use, what kind of vaccination?
And are animal, any animals excluded? We'll come back to this a bit later when we talk about vaccine protocols. And are there any other preventive treatments like deworming or flea treatment given?
In different shelters and in different situations, there may be more or less opportunity for transmission of these kinds of diseases within the shelter, but are animals treated on entry? And do they perceive they have existing issues? Now, as I said, that can depend on their perception.
So what's their normal incidence of common diseases? So I've been to shelters where 60, 70, 80% incidence of respiratory disease is considered normal. And there's another, I work with regularly if the incidence hits 10%, they instigate high security procedures and call it an outbreak.
So what what is normal to them? Is a really, really important driver of that behaviour and it can be quite hard to challenge. So this is the World Health organisation, a definition of an outbreak, and it says the outbreak is an occurrence of cases of disease in excess of what would normally be expected.
It's a beautiful definition, but obviously it depends on your expectations. If you expect your cats to have their eyes hanging out, you won't perceive that you have a flu problem. Equally, if you expect to have no flu in a shelter.
You're probably gonna be disappointed if I'm honest, but it's a great expectation to work towards. There are some other useful questions. There are lots of other useful questions.
Some of them take a bit of delicate handling, . I think it's always worth asking the aims and objectives of the rescue. Do they have them explicitly stated out?
If they're a registered charity, they should have them somewhere. Is it staff or volunteer led because that can really make a difference. Sometimes keeping volunteers on side if they're not doing exactly what you want, you know, is something that's important to the organisation because they rely on the or the volunteers so much that even if they're not following protocol, they just want to hang on to them.
Is there any post adoption care follow up, which might be a phone call, which might be. Behavioural support for life, you know, it can really vary. Do they have a rule that if the animal ever gets sick, it has to come back to them?
Do they provide veterinary care? Do they fund veterinary care long term, for example, for animals with chronic conditions? Do they do community engagement?
Do they have joined up thinking? What do I mean by that? I'll come to that in a moment.
Other question that's really worth asking is the euthanasia policy. We need to talk about death more. And it can be a really delicate subject because particularly for those of us who are veterinary professionals, euthanasia can be in many instances a positive welfare step and a good choice for many animals.
But for some people, not all, but some people working in animal rescue, it can be an admission of failure. So it can be a really difficult subject to approach, but a really important one. So the organisational aims, it's helpless, they're clearly defined.
It's helpful if everybody knows them and everyone agrees with them. And it's worth coming back to them and evaluating them in case you make some changes. And they need updating.
And in any decision that is difficult and contentious, we need to return to the aims and go, OK, is this going to help further the aims of our organisation? Is this consistent with what we said we'd do? Because sometimes you can get a bit lost in the fog, especially with individual animal decisions you need to return to your aims, and that can be quite tricky.
Because people are people and we're not automater, and it doesn't always add up. So this is a young feral kitten that I neutered. I don't have a problem with early neutering of cats.
I think it's easy and fun and I like doing it. This is a cat eye pregnant spade. Many of us have done it.
It can be really contentious. Not all terary professionals will do it. Most veterinary professionals don't like doing it.
I know I don't. . Sometimes the public or charitable organisations are very strongly and vociferously against it.
These are some kittens that I euthanized because it was literally nowhere for them to go. And I use this slide with my students, and I say that I don't really like doing pregnant space, but I'd rather do that than kill kittens. And sometimes that's what you just have to do.
So this is the lovely David Yates, who is the director of Manchester SPCA and he says, I bought more kittens each year through pregnant spades than the total number of cats I rehome through all of my rehoming centres. So he's doing something that's consistent with his mission to manage cat numbers. He might not like it, but he does it.
This is a Quote from a study we did asking rescues what they thought their big problems were. I would like it to be made law all pets are spayed and neutered. I feed over 100 cats a day, strays, and this feral cat worker clearly didn't think that they're feeding these cats was any showed any kind of responsibility towards them.
It didn't mean that they needed to spay or neuter them themselves. It's really interesting because obviously them feeding 100 cats a day was a strong contributor to these cats breeding. So people don't always see the big picture.
People don't always like it and to find it adds up, and that can be our role and sometimes that can be quite tricky to do. I have some favourite questions that I always ask, and the one that's the top of my list is what is your length of stay? Because for me, that's a key performance indicator of any shelter.have a few days off that and you can increase your throughput.
A lot of shelters aren't that keen on numbers and figures, and I can definitely without taking my socks off, I can tell you the number of shelters who know the answer to their length of stay without checking. And you know, really any business would know its key performance indicator, but shelters don't. Some of them even sort of pride themselves on it, and I think this is a real niche for us.
I think this is a real role for veterinary professionals to get in there. And help them to look at these numbers and figures, not as an onerous task, but something that can help them in their core mission to help as many animals as possible. Length of stay is such an important driver.
One of my other favourite questions is what you feel is your biggest problem? And you know, we wrote a paper on it. It's brilliant.
The answers you get are spectacular and very revealing. And the other thing I really like to ask is, what are you trying to achieve and how will you know when you've succeeded? Shelters aren't very good at measuring, but when they do measure, they often measure input rather than outcome.
They say, OK, we've seen this many animals. But in terms of, is that having an impact on your community? Is that reducing the number of unwanted strays?
Is that reducing welfare problems? That's much more difficult to measure, but much more important. And again, there was a study in America.
Of shelters and thinking about shelter medicine being a clinical specialty in the states, much more established than it is in the UK. Only 6% of the shelter surveyed had an infectious disease plan written by a vet. Now thinking about that, thinking about the skills that we have and how much we've got to offer, you know, I think that there's such a role for us and we're really underutilised.
And this just shows what we can do. I'm not gonna say a lot about imported diseases, but I'm just gonna mention it. We've got, a paper hopefully to come out soon.
We've surveyed people who've imported pets and why they did, and the problems they encountered. I think the answers will surprise nobody here. As we know, it's increasingly popular to adopt from overseas.
It's really fashionable. And there's probably other reasons, including the profile, particularly dogs in the shelters we have in the UK versus the ones we import. There is at the moment No requirement to have a permanent record of travel.
So if these dogs do get passed on, they may come into vets who are unaware that they have even travelled, which can cause some difficulties. Many of them are imported inappropriately under the pet's passport rather than ballet directive, but we don't need to worry about that right now because if this hash of Brexit goes through, then all that's subject to change anyway. There's no statutory requirement to screen for imported diseases.
Some of them do come in quite proudly leash positive . But others will come, some of these diseases do have quite long incubation periods, so the owners may not be aware that they're carrying these diseases. So we've got things like leash, diophylaria, Babeia aliia, many others, and they can come as a little surprise extra with these imported dogs, particularly dogs and cats.
And a chinococcus, of course, is a worry. I'm not gonna speak more about imported pets because it's such a big topic and we don't have time today, but it's always important to check if your rescue has got a little sideline in bringing in dogs from Romania or something similar. So to return, we've taken our history and to return to our shelter physical exam.
Like any physical exam, you need to cover the basics and you need to repeat it regularly because things can change. So I'm thinking about a physical exam, thinking about obvious issues. So remember the shelter I mentioned to you, with the 60 cats in the home and garden, and I don't have flu.
These were some of the cats from that shelter, and I think we can all agree they're looking a bit winky blinky missing eyes. So if you see these kinds of issues walking around a shelter, you know where you can get. But general hygiene is important.
This is that same shelter. This is where the cat's clean bedding was kept. Obviously, there's a, a really good source of foam like spread of anything there.
This is a dog shelter, a lovely little cat that likes to come in through the window and steal the dog food, potter about the place. If you've got a foot baths, it's nice if they're lovely and clean like this one, and you can actually clean your shoes. This is a foot bath at the same dog shelter where the cat is munching away.
As you can see, it's a cat litter tray filled with dirty water. Most disinfectants don't work particularly well in the presence of organic debris, so it's really more of a token gesture rather than an actual effective measure. And again, this is the same shelter actually.
This is just a bowl of pet food that's been left out in the rain and got some flies and slugs and things in it. So if you see poor general hygiene, it can be a bit of a marker to start with. You want to ask about the presence of quarantine and isolation and just as a refresher because we often use those terms interchangeably.
Quarantine is where we put animals when we don't know if they're ill or if there's a problem, just to see what happens. Isolation is, we know there's a problem. And let's keep those animals which are sick away from others.
It's worth checking how your shelter is using those terms because they often, as I say, use them interchangeably. And It's important to make sure that they're used appropriately as quarantine and isolation. So there's a lovely big sign here, staff only isolation.
It's a high risk area, do not take anything from this area, you know, it really helps people to be informed. Whereas this one on the right with a little cat, you'll see the big man sized door that is the door to the group housing cat area. And these cages on the left are the quarantine cages, and this is a cat that just likes to hang out here.
So it's obviously not a very effective quarantine environment because you can see direct contact is possible, and also quite a stressful environment. So just because they have quarantine or isolation, it doesn't necessarily mean they're used as such. Those lovely kennels I used to go to.
It's been changed a lot now, but they tended to use the isolation area only for bitches in season, just to keep them away from the main body, which again is a good idea behaviorally, but they did have some hooching disease problems and perhaps it would have been a more effective way to use them. And biosecurity covers a lot of bases, but some aspects of good biosecurity and good hygiene are just making it really easy for people, making it really obvious and making it possible to do the right thing. So if everything is colour coordinated, so it becomes really obvious when your equipment's in the wrong spot, it just helps people to behave in the way you want them to behave.
You know, carrot is a lot easier than stick. Drainage is a thing I'm obsessed by. Where does the poo go?
What happens to it? Faecal oral spread is a really good route. So this This shelter on the left, it's actually a shelter in the state, and I love the drainage here.
It was in the middle of the floor. Each kennel had its own drainage, didn't share it. It was lovely.
It was very effective. And when it was all covered, there was no danger or slip hazard. .
This shelter has a beautiful dirty open drain, which actually is working very effectively, partly because it's cracked, partly because it's not on an appropriate slope. You can see it's collecting really dirty water there, and you don't have to step over it or in it every time you go in or out of the kennel. This kennel here has had its drains updated.
You can see it's just been washed down and it's drying. But the measurements haven't been done properly, so the kennels themselves overhang the open drain. Which again is quite an effective way for spreading muddy, shitty water up and down your kennel block.
And drainage isn't just about the drains, it's about the floor space. So again, we've got quite a damp kennel here. We've got a cracked floor, which is uneven, and there's water collecting.
It's very cold and clammy in here, and it just feels damp and it smells awful. I can tell you I was there on Thursday. It's not a great environment to be in.
Ventilation is another really important subject. So this kennel here on the right is where this dog is. You can see there's a little natural light coming through, which is great, but the roof is really low.
There's no ventilation apart from the door front, at the front, and there's no surprise that there's high respiratory disease rates in this particular kennel block. This is the same shelter actually, a different block, and at this point, this was the quarantine area. So dogs were here for a few days before moving to the main block, and as you can see, there were no solid barriers between them.
It's a really easy place for aerosol transmission to occur. So it has a lot better ventilation and, you know, dilution is a solution to pollution, but it was also quite a good place to swap respiratory pathogens as well as being quite stressful environment. Cleaning and disinfection.
So you can see these, there's a poo scoop, but you can see it's soaking and disinfectant, but it's still covered in poo. Soaking and disinfectant will not get rid of poo. All you'll get is what, please don't be offended, but a colleague of mine calls nicely smelling shit.
It doesn't work particularly well. Again, these are full of grit and rubbish at the bottom. They're just being left to soak and disinfectant, but it's just not going to be very effective.
You need to clean first. With a detergent, get rid of the organic debris and then disinfect, otherwise you're gonna have problems. There was one particular kennel I was working with, and they had persistent outbreaks of crypto in the puppy block, and the puppies kept having diarrhoea, and they'd clean it out, and more puppies would come in and they'd have diarrhoea and they'd have crypto.
We were scratching our heads because they were quite well trained and it was all quite effective, and my colleague went and watched them clean. And they were just bleaching down the diarrhoea because it was smeared all over the floor. So it wasn't, the bleach wasn't working very effectively.
They needed to clean it properly with detergent before disinfecting. And it's just an example of how an infection can persist in the environment if you don't have good hygiene pro procedures. OK, and there's human factors as well, so nobody wants to look like the Andromeda strain, you know, everyone wants an environment where people can walk in there and feel like it's a safe environment, but equally, what you don't want is the public leaning over your puppies, playing with them, and then going on to the next ones and playing with them as well.
So there has to be a balance between making it a scary place full of Biohazard tape and a place where anyone can lean over and cuddle puppies obviously great for their socialisation potentially if people are handling them appropriately, but in for disease control, not so much. And just in general, is this kennel, is this shelter a good place to be? So what I tell my students when I'm going around a kennel or a shelter of any kind is to imagine putting their own animal in there and how long would it be appropriate for your animal to stay there if you're boarding it?
You know, this dog is in a really miserable, barren environment. It doesn't look very happy. It's got quite a stressed expression on its face.
It's quite noisy in there. How long is it OK for the animal to be there? 1 week, 2 weeks?
A month? How long is fair? Because some shelters will keep animals for months or years, because ultimately rehoming is the goal.
How long is that animal OK in that environment? Imagine it's yours and work from there. I know that's, you know, a little bit anthropomorphic in some ways.
But you know, life at all costs is not the only way forward. I would strongly suggest. And if you're gonna keep an animal like this in this kind of environment with 20 minutes out a day for long periods, I would suggest it's not in its best interests.
So Those are the basics of history and physical examination. I'm gonna move on to vaccination because it's what I get asked about a lot. Be aware, I'm gonna talk about the use of vaccines in an off-license way and although I'm going to provide references for that, obviously you need to be comfortable.
With the protocols that you use and use them in an informed way, for your clients. So when do we vaccinate, when don't we vaccinate, and the risks and benefits are kind of things I'm gonna cover. So I've got another poll question here.
I'm gonna hand over to Bruce. Right folks, the poll is open. The question is, what is your vaccination policy?
You've got answers there. ASAP following entry, 2 to 4 days after entry, 4 to 7 days after entry, greater than 7 days after entry. Other or it varies.
So give us a click, give us an answer and let's again give Jenny some feedback. It's really very simple. Just anonymous.
And easy to do. You just gotta be awake. You just gotta be willing to get off the fence.
15 more seconds. Ah, it's brilliant Jenny, you've got everybody sitting on the edge of their seat. They're all voting very bad.
I'm very pleased. I didn't have to go around and knock on the screen and wake up. Right.
Yeah, absolutely. Let's end that and share those results with you. You should be able to see those.
Oh, that's fantastic. OK, so we've got, the most common result being as soon as possible after entry followed by it varies, and then most people are still giving within a week after entry. And again, obviously it depends on the practicalities of your relationship with your shelter, how often they have a vet on site, how big they are, how often they have animals enter.
So I'm not saying there's right or wrong, but I just wanna have a look at the thought processes between choosing different strategies. So let's move forward. And I've got another poll question here, Bruce, can I hand it back to you?
Yep, no worries. There's the next poll straight into it, folks. Do you vaccinate?
A, healthy animals only. B, will vaccinate even if mild concurrent disease. C, will vaccinate more or less any animal at entry, even if moderate or severe disease and then down the bottom, other.
So if you're worried about getting off the fence, get off the fence and jump into other. How's that? I'm an epidemiologist, there's always got to be in other categories.
Somebody's taken me literally. They've just clicked on other. OK guys, I'm really I am.
OK, let's give you another 10 seconds or so on this one. The audience is wide awake today, Jenny, this is brilliant. Right, so let's end that poll and share those results with you quickly and there you should be seeing them.
That's really interesting. So for most of you, you'll only, vaccinate a healthy animal. Quite a number of you will vaccinate if there's mild concurrent disease, but there's nobody who's saying that they'll, vaccinate if there's more severe disease and one other.
I really wish I could ask you the ins and outs of that and the whys and wherefores, but as I can't, as this is a webinar rather than a, . An in-person session. I'm gonna, I'm gonna move on and I'll try and represent what I think you might be thinking.
Hopefully I'll get it right, but let me know in the comments if I don't. So some of you would vaccinate some of these animals. So there's a cat with mild flu, there's a cat with quite a bit of flu.
There's a puppy there with some hemorrhagic diarrhoea, and there's a very snotty dog there. So I'm guessing that some of you might vaccinate this one, some of you might vaccinate this one. I don't, I guess, none of you would vaccinate these two animals here.
So, vaccination policies run from no vaccination at all to some animals to most at some point to everything being vaccinated. And as I say, there's not necessarily a right or wrong, but there are some things that I would tend to push for in most circumstances. These are specials, aren't they?
The pregnant animals and the very little animals are also very special. So thinking about shelter animals and vaccination, and just to point out that is my most of a cat, . So, our pets are private clients.
We'll vaccinate only when healthy. We won't vaccinate them if they're stressed because we know that they are endogenous steroids might be how we worry about the vaccine not working to its maximal efficacy. And we'll have a primary course wherever the licencing interval is 6 and 10 weeks, 9 and 12, as appropriate.
Shelter animals, I would strongly urge you to consider vaccinating even if they're not 100%. And the reason being, severe vaccine reactions are rare. It's unlikely that a vaccine is gonna make an animal significantly worse off.
But an animal coming into shelter is going to come into a disease endemic environment. If the animal is fighting off a concurrent infection, the worst that's gonna happen is the vaccine's not gonna work as well as it might. The best thing that's gonna happen is it might actually be protected from getting more disease, from getting another disease.
Most live vaccines will start to work within a few days. So the worst you're gonna do is have lack of efficacy unless you, it's one of the very unlucky animals that has a, you know, a vaccine reaction. The best you're gonna do is actually help the animal that's already struggling to fight off more disease.
So that's why I would say under most circumstances, I'll vaccinate more or less anything personally. And again, I would vaccinate as soon as possible after entering the shelter. There's been studies done, so for example, feral cats are neutering or animals with concurrent steroid administration that shows that for most animals, it doesn't have a significant effect on impairing the vaccine.
So I don't think I would worry about vaccinating animals as soon as possible after entering the shelter. The only thing that might put me off is if there's very low disease rates and you have something, for example, like an animal with very severe behavioural issues and you worried that it will make it worse, you might want to delay it. But in general, there's not many reasons I would delay vaccination.
You can always give an extra one. Vaccines are cheap, infectious disease is expensive, especially when you take on the ramifications of an outbreak, additional biosecurity, treating the disease, staff time, staff morale, potentially closing to visitors. Vaccines are cheap.
Infectious disease is expensive in terms of all sorts of things that aren't just money. So I'm a big fan of vaccination. And again, I'm not going to go into the sort of the hows and whys and wherefores of maternity derived antibodies, but we know that in puppies and kittens it can persist for up to 18 to 20 weeks.
If you've got an orphaned or, you know, poorly doing litter, you can start early. There's a licenced parvo vaccine for dogs in the UK for 4 weeks, but you can use vaccines off licence. Other vaccines off licence from 4 weeks.
I wouldn't go much below 4 weeks because they're unlikely to work very well and there may be some bone marrow depression. And you could then vaccinate at intervals of 2 to 3 weeks, up to sort of 18 to 20 weeks if they still remain in the shelter. Hopefully they won't.
But you know you've got a disease endemic environment. If they've got low MDA, they're vulnerable early. If they've got high MDA.
You know, just when you think they're vaccinated 1012, 14 weeks, and they start to wander around the shelter, that's the time they could be the most vulnerable. So again, this depends on your shelter. It depends on your experience.
If what you have isn't this and it's working for you, that's absolutely fine. But if you're finding you're getting vaccine breakdowns in puppies and kittens, these are things to consider. And just the references to these vaccines, the Aha, the shelter veterinar the Association of Shelter Veterinarians, and the WAPA guidelines there.
Remember, guidelines are guidelines, so it's a bunch of people sat around the table giving their opinions. So they're not necessarily based on evidence always. They may not suit you.
And don't be afraid to pick and choose what does suit you. It just gives you precedent because for some of these recommendations, you'd be going off the data sheet. And so precedent helps because it's accepted practise.
But, all these people think that shelter vaccination is different. So I think it's always helpful to know that someone's been there before. When you are making a vaccine protocol from scratch, just have a think about the the incoming population.
Do you have a lot of very old or very young dogs? Are they likely to have been previously vaccinated or exposed to disease? And are they overall pretty healthy, or are they all overall pretty sick?
So if you're getting lots of animals from hoarding households, you can have a very different risk profile to stray and feral animals. Well, you shouldn't be taking feral animals to shelters, but stray animals. To a lot of animals that are coming from a home environment.
And if you've got planned admissions from a home environment, if it's practical, vaccinate them before before relinquishment. So if you know that Mrs. Meggins is giving you her cat in 2 weeks, then book a vaccine.
It's worth the, if Mrs. Meggins will pay for it so much better, but if not, it's probably worth a shelter funding it because it's one less cat that's going to be struggling against infectious diseases when it comes in. We also need to think about the riskiness of the environment.
So the hygiene, are animals being socially mixed, so animals being group housed are obviously going to have a high risk of transmission that animals are individually housed. Is the environment really stressful or is it quite a nice place to be? And how long do you anticipate the animals staying?
Because stress, we think, is probably high on entry and then diminishes the animals start to relax and get used to it, and then at some point then they start to get frustrated and bored. And the duration of time for that curve to occur varies according to the animal and the environment, but we think that that's probably what happens. If you've already got a vaccination protocol, well, when should you change it?
Well, it's not rocket science. If you've got a change to the population that's coming in. If you've got to change to the management strategy, so for example, going from individual to group housing or vice versa, or if you've just got a current protocol that isn't working and you think you've got more infectious disease than you really need to have, then it might be time to reexamine your vaccine protocol and just look at what animals are affected.
So how do you know if it's not working? Well, it can be really obvious if you've got cats with eyes hanging out or you've got parvo everywhere. But sometimes if you've just got endemic disease, you're used to having a bit of cat flu, you're used to having a bit of kennel cough.
It's really hard to know if it's worse or if this is just a normal ongoing situation. So a little bit of clinical audit can be really, really helpful. And when we talk about this, we talk about prevalence and incidents.
Now, prevalence is how many of us right now have got a cold? I'll hold my hand up. It's what it's, it's a point measure of right now what's happening.
And that's OK, but it's, it's, it doesn't stand up very well as a measure. You're much better with instances, which is the rate over time, how many new cases occur in a given period. So I'm just gonna show you an example of this.
So this is an imagined shelter over a week, and you can see that over that week, several of the cats got flu. Ian and Mary had already had flu from the previous week, so that's carried over. Fluffy started on Wednesday and Georgina started on Friday.
So if I measure prevalence, depends when I measure it. On Friday, the prevalence is 40%. If I measure it on Sunday, the prevalence is 10%.
So you can see that the prevalence as a measure is not very robust because if an animal's got a disease for a long period, that can artificially inflate it. If it's got a disease for a short period, prevalence can miss it. So it's not that helpful a measure.
Incidence is how many new cases of flu did we see this week? And the incidence is 20%. 2 out of 10 cats, Fluffy and Georgina, got a new case of flu this week.
And any day you choose to measure that in the week, it's still gonna be an incidence of 20%. That is how it is. So incidence is a really useful measure, new cases in a given time period.
And you can do it syndromically. You don't have to do it with a specific diagnosis. It can be kennel cough, it can be diarrhoea.
They're the common ones or cat flu. And you measure the incidence before you make a change, and then you measure the incident after. Now bearing in mind that you can have seasonal effects.
So for example, anecdotally, you get more kennel cough at the change of weather in the spring and autumn. But still, you can see the impact of changes that you make. And these are imagined figures, but they're imagined figures based on some real events.
So remembering that the incidence is a number of new cases in a given time period. This is a dead simple Excel spreadsheet, number of dogs in the shelter that week, number of new cases, and they've got the incident, which is just a real simple formula. It's that over that times 100.
So you can see in that week, the incidence of 3.9%. To a peak of 13% and then you begin vaccination, there you go, and the incidence goes down again.
Excel's lovely because you can just plot it as a graph, which I'm quite visual. I find that a lot easier. So you can see that kennel cough was going up.
We start kennel cough vaccination, there's a bit of a lag period and then it starts dropping right off. So sometimes making changes, especially ones that cost money and take time, can take a bit of persuasion. Keeping figures, keeping statistics can be really, really helpful, because sometimes your gains are small and they occur over time and there's a bit of wobbliness to the impact, but keeping figures, keeping statistics is super helpful in showing that what you've done works or doesn't work and you need to try something different.
So, I'm gonna leave the vaccination protocols and in 10 minutes, we're gonna talk about diagnostic tests, which is gonna be a good fun challenge. So Never forget the history and physical exam, a diagnostic test. So I work in a university.
And students get talked about minimum database a lot. For me, minimum database is history and physical exam. For my colleagues, it's anything up to an MRI, but I get a bit cross about that.
History and physical exam are massively important diagnostic tests, whether they're of the individual animal or of the shelter itself. There's a test of treatment which can be wait and see. And of course, you can do what we think of as formal diagnostic tests.
And obviously, any diagnostic test needs to be interpreted in the light of clinical findings. I think some, some people seem to worship at the ultra diagnostic test, but a test is a test is a test. It's not the truth.
And Archie Cochrane, who is a hero of mine, if you've never heard of him, look him up, he's amazing, said before ordering a test, decide what you do if it is 1 positive or 2 negative. If both answers are the same, don't take the test. He was a very wise man.
So some of the problems with diagnostic tests. Are sort of encapsulated in this example of FELV and we think about when to test, how to test, and what the heck do you do with the test result. So thinking about SCLV testing again, this is a real common question that I get asked which cats should we test for FCLV Should we test for FCV?
What happens? What do we do with them? There's all these SELV tests.
They're common. They're quick, the patient side should we use them? Maybe we should because they're really handy.
So I want to ask what your shelter policy is on testing and I'll hand over to Bruce. The pole is live. Let's see what happens without me stirring.
Oh your audience are wide awake, Jenny. On the edge of their seat like I am. This is absolutely fascinating to just hear and and and listen to, you know, the, the perspective from somebody who's been there and done it.
It's really, really good. So lots of votes coming in. Come on folks.
Let's go, let's get these votes rolling in. Another 20 seconds. What is the shelter's policy on FELV FIV?
Don't test. Test only if individually indicated. Test according to risk.
Test all or other. Of course, although it might be that they only have dogs. Oh well, yeah, or other people who are interested that don't are not in the shelter.
So that's that's fair. That was a good response as always. Let's end that and share those results for you.
Interesting. OK, some great results there. So, most tests according to risk, which is really nice, or if only individually indicated, there's still a few people testing all, which is fine.
I'd be intrigued to know what the other is and, one who doesn't test. OK, well, we'll just examine the reasons for different testing strategies and again, like everything else, there's not necessarily one right or wrong answer, but it's just about thinking through the reasons. So looking at FELB tests available in the UK, these are the published sensitivity and specificity of the tests.
The students all growing when I talk about sensitivity and specificity, they've all got their own ways of memorising what those are. I'm just going to briefly just run through them just in case anyone needs a bit of a refresher. I think of them in terms of airport security.
So every diagnostic test has its own sensitivity and specificity. That's a property of the test. And the sensitivity is, if it's really in there, will I find it?
The specificity is, if the test goes beep and tells me it's positive, is it right? Or has it picked up a negative? Wrongly And the reason I think about airport security is that you want your airport security to be sensitive enough to pick up someone who's got a bomb in his shoes.
But if you keep the sensitivity really high, that means that some people with an artificial hip or an underwear bra will sometimes go beep as well. So it is a trade-off. Sometimes high specificity means you're gonna, high sensitivity means you're gonna lose specificity and vice versa.
No test is perfect. What does that mean in practise? So an FERV test has a sensitivity of roughly 99%.
So if a cat's positive, it's almost certainly going to be picked up. It has a specificity of 97%, which means if 100 cats are negative, don't have it, then 97 of them will test negative and 3 might test positive. That's just a property of the test.
It means it cross reacts to something else in their sample. We don't really know the population prevalence at the moment, but best data in the general population of cats is probably about 1%. So just as a little thought experiment, we've got 100 cats, what happens?
So we know we've got a population prevalence of 1%, so a little red cat there is our 1 positive cat. So we know the high sensitivity of the test means it's gonna pick up that one red cat. But we also know that due to the specificity of the test being what it is, it's probably gonna pick up around about 3 other cats.
They're gonna look positive. They've not got FCLV but they're gonna test positive. So overall, we're gonna get 4 positives.
Results of 100 tests, but only one of those cats will really have the disease. So of our 4 positive results, only 1 is correct, and 3 are false positives. Which means what we call our positive predictive value is 1 in 4 or 25%.
So only 1 in 4 of our positive test results is true. Or flip and neck, what do we do? Well, for the FVRV test, I think what we typically do, finance is allowing is send off an alternative test, which would probably be PCR.
We might not do that. If it's a feral cat, we might take the test at face value because we don't want to hospitalise a cat until we get test results. But still, we've got to do something.
So, confirmatory test is really useful. Because, a false positive or negative is an error with the test itself. If you use a different test, it's unlikely to have the same error twice.
So for FEV as to say that the, confirmatory test of choice would probably be PCR. So, again, continuing our thought experiment, we've got a shelter called Cats R Us. We have about 200 cats at any one time.
We have about 1000 cats a year. So I'm just thinking about cost. I don't know what you pay for your FELVFIV tests.
But let's have a look at what Cats are us do. We, let's say we pay about 10 a test, and if they do test all cats. They're gonna pay 1000 a year testing.
We're gonna get 40 positives. Remember, I'm just scaling up my previous results, 4 in 100, 40 in 1000 caps. If we're going to do FERV confirmatory testing around 50 quid each, it's gonna cost another 2000 pounds.
So to test 1000 cats a year, it's gonna spend 12,000 pounds to detect 10 true positives at a cost of £1200 per positive cat. I know it's a quick run through, a quick rattle through, but hopefully you can see the logic of the figures. If we're going to test every cat, every time, it can be quite expensive, especially in conditions of low prevalence.
Because if we're testing every cat that comes in, we're working with that population prevalence of 1%. I shouldn't say this at the end of the talk, should I? So the individual cat perspective.
It's helpful to test every cat because if it's a true result, you can manage that appropriately, whether that's saying it's disease-free or doing whatever you do with a positive cat. And it may improve its chances of rehoming if it's negative. The cons are quite small because all it has to do is undergo a blood test, but then you're worried about the false negatives and false positives.
If you're thinking about this protocol on a population basis, the protocol for cats are us, you know, they obviously have some significant disadvantages. You're spending $120 a year, which is a heck of a large amount of money. You could neuter a lot of cats to detect 10 positives.
Remember looking at this, 10 positive cats, 120 pounds a year, not a great spend, I would argue. So you do have lots of possible. Solutions to this, you know, it depends on what your priority is.
If you want to guarantee freedom from disease, you're going to continue to test every cat. Is it the most rational use of resources? Well, that might depend.
You might have really good public education. I know shelters where they ask each owner when they rehome the cat for an extra 10 pounds to cover the cost of the test, and that's great, that works really well for them. If you do test all cats, you really need to know what you're going to do with the positives.
If you don't test any, you need to be prepared. You're going to miss some, and other private vets in the area, as soon as the owner adopts a cat from you, it's going to test and some of those are going to rebound on you quite rightly. Some owners are going to rehome a cat from you that has an infectious disease, and that's going to be quite tricky situation, quite unpleasant for everybody.
Testing out risk cuts seems to be what many of you are doing what you're actually doing about that. Is looking at your selection criteria and thinking, OK, which cats are most likely to have this disease? You know, cats that have been sexually active, cats that have been scrapping cats that are feral and missing an ear tip.
And in that, in that case, what you're doing is increasing the population prevalence. So if we rerun our thought experiments, same sensitivity, same specificity, 100 cats with the prevalence of 10%. We've got is 10 cats that really have the disease that are picked up by the test, and 3 cats that don't have the disease that are picked up by the test.
And so we've got 13 positives, but of them, 10 of them really have the disease. Our positive predictive value is 10/13, which is about 70%. It's certainly a heck of a lot better than the 25% it was more than before.
So by increasing the population prevalence, We're keeping the same test, but we're trusting the result more. I'm forgetting the figures, it's just purely intuitive. If I looked in a cow's mouth today and saw an ulcer on its tongue, I would think it had an ulcer on its tongue and not worry too much.
If I'd done that in 2001 when there was a high prevalence of foot and mouth disease, my diagnostic test, my physical exam, I would have been likely to conclude the cow might have had foot and mouth disease. So intuitively we interpret our test results, whether that's a biochemical test or a physical exam differently in the light of the prevalence around us. So no right or wrong.
It depends on your circumstances. But it's helpful to define it upfront, particularly for feral cats or special cases, because when you come to euthanas a cat, it helps to know beforehand well if it tests positive for FVLV. I want to euthanase it, and I would argue that in most circumstances, that's the appropriate thing to do.
It may be helpful to have an information resource both for owners rehoming cats from you and for local vets if you're not testing all cats to know why, what the reason is for that. So I'm just gonna finish now by saying that is a very whistle stop tour of some key concepts in shelter medicine. And what I would say if you do nothing else, remember that the shelter itself is a patient, so physically examine it and take it shelter history that's appropriate to that patient.
Keeping metrics and doing order is really, really useful. It's not sexy, but it works really well. And if you have an approach that works for you and your shelter, that's absolutely fine.
If you disagree with everything I've said, that's absolutely fine. I'd really like to have a discussion and hear more. But there's lots and lots of options.
There's as many options as there are shelters. So just to return, these are the learning outcomes and hopefully we more or less covered them all, if not in detail, then at least partly. I will not get rich from this, however many copies we sell, I will not get rich from this, but a lot of smart people have contributed lovely chapters to this.
So, it's a nice resource. It's out at the moment. I think they've got a January offer.
If this is your bag, you may find it helpful thing to read or have a look at, . So yes, I would have to sell thousands of copies before I could buy you all a pint. So please don't think this is a personal plug.
And that's me. Any questions? Ginny, that was absolutely insightful and thought provoking.
I have to say there's a lot of questions running around my head about these shelters and everything else. And certainly I think even for, for vets like myself who don't work in shelter medicine, just some of the questions you You know you hear criticism of the shelter and you go, oh yeah, no that's not very good. But if you go one step back and I certainly will do this myself now, you think, hm hang on a second.
What is their policy and are they following their policy? And you know, it, it just makes so much more sense. It really does.
Yeah, I think that's a good point. I think there's a lot of disconnect between shelter vets and vets in private practise. Sometimes vets do work in both, but I think if we can understand each other better, that's really helpful because often the decisions we make in shelter medicine, then get turned on their head when that animal takes a step from being a shelter animal to being a privately owned client animal.
And it's really tricky on that cost, what decisions do you make? They may be appropriate for a shelter environment, but you'd make completely different decisions for an individual animal, and they can, it can cause some conflict. Absolutely.
And I think it is really, really important that we as vets and, and colleagues, strive to bridge that gap and, and not make snap judgments and everything else from the outside. So I think that's really, really good thought food for thought. Yeah, thank you.
Oh, I can see some questions here. Am I allowed to talk about them? MDA.
Yeah, I would say that for a live vaccine, personally, I would say no, for something like lepto, if you're restarting a primary course, I think that's worth doing. The only caveat I'd say, and it, and we shouldn't really be driven by kennels, but sometimes we're driven by kennel policy. So some kennels will not accept an animal without a currently OK primary course.
Yeah, personally, I wouldn't bother restarting in a healthy adult animal because as you say, there's no MDA, except for a kill vaccine like Leppo. You know, particularly if you're changing to a train you think the animals not had before, so moving from something like L2 to L4, I definitely get a primary course, because of the nature of the immunity. Yeah, I hope that answers that question.
Yeah, that's that you euthanizing FLV cats? Yes, so, and again, people might disagree. I would say particularly in, so if you've got a shelter cat that's FELB positive and you've managed to do a confirmatory test, because as we know, a lot of the patients like tests might be false positives.
So either if you've done a confirmatory test, or if you've got a sick cat, in which case you've increased the population prevalence, you trust the test more, or you've got a feral cat, in which case you definitely don't want to keep it housed. Yes, I would euthanize it because. For me, those animals are gonna be gonna die a really unpleasant death in a relatively short order.
Now I know there are some people who say, well, we were home as FELB positives with full consent and knowledge of the owner that they're going to be dead within 3 years at the outset. That's not my bag. I don't believe in that also because transmission through saliva is possible.
You know, FIV, you really need to be fighting or having sex to transmit, whereas FELV transmission is a bit easier. Having said that, there has been some data showing cats with FELV living side by side with cats without it, without transmission. But for me, I think I, I, I would be pro euthanizing those cats.
Others might disagree, but for those reasons, I would. I, I just have the sense that that kind of situation and some of the questions you asked in the beginning as well could be seen as absolute fighting talk and it it depends on the the Ethics and morals of the vet plus the shall we say borderline sanity or insanity of the public and the you know the volunteer workers in the shelter and all these sorts of things. I, I think that would be a hot potato that I would like to stand on the outside and watch that conversation.
Yeah, you don't always get to be doing this stuff. No, no, I'm, I'm sure for that. I, I know I'm like you, I have spayed pregnant cats.
I, I believe there are enough beautiful live cats wanting homes then you know, oh go go it's pregnant, we've got to save the. Kittens. So I'm happy personally as a vet to spay pregnant cats, but that in itself is just such a hot topic that, yeah, even just amongst, you know, 9 vets in one building, I can imagine if you get a shelter going on that one, it's gonna be really good.
We've got another question coming through which is very dear to my heart and that's, supporting our young vets and our, our vets of the future and developing and growing them. We've got a question that says, I'm currently a 4th year vet student. What tips do you have for students who are about to go into shelter EMS or rotations?
What a great question. I'm really glad you asked it. If you're in the UK, join the Association of Charity vets, we're getting together a student chapter and we certainly have student representatives.
We just had a conference last week. Join us, we will welcome you. We've got a stream at BSAVA this year and we'll be hanging out there.
If you're not in the UK, see if you can find other like-minded people to hang out in. If you're about to go into shelter EMS or rotation, think about what you want to go out, get out of it and prepare well. So do you want to learn to early neuter, in which case the cat protection free online video is a great resource.
If you go in there prepared and knowing things like your landmarks, then people are much more likely to give the experience you want. Again, if you're in the UK, there are some really good places to go, like Manchester SPCA. David Gates is a great teacher, and he welcomes students.
Find a shelter that is going to make you comfortable, like with any other EMS placement or job, find a place where you feel comfortable and you get on with the people, and you're likely to get a good experience there. And good luck. Yeah, that's excellent advice.
And I think even, even for vets that are not in shelter medicine and that sort of thing, like myself, I, I have found great benefit from this because I'm going to think twice or even 3 times the next time I have a shelter medicine animal coming in and out. You know, what, what is the policy. Don't criticise, you know, walk in their shoes.
What is their policy? Can we support them? Do we need to talk to them?
Do we need to open debate and that sort of thing. So yeah, Jenny, this has been absolutely fabulous. It really has.
And sadly we've run out of time. I would love to keep this discussion going but I really do appreciate you being here and thank you for the time. And something that people off air don't realise the absolute grit and and determination to get on with all the technical issues we had before we went by.
So good on you and thank you very much.