Hello, it's Anthony Chadwick from the webinar Vett. So pleased to have you on this webinar. We're gonna be talking about toxicara today, a topical update on Toxoara Canis and cat eye, and the impact on human toxicorrosis.

Very, very fortunate to have Ian Wright on today. Ian's going to be introduced in, in a minute by David Cahill, who is one of the technical vets at Marial. He's also, one of the vets that looks after the, the broadline product, which is obviously the, the broad spectrum Hector parasiticide in, in cats.

So, David is a vet, obviously, he's from Dublin, qualified from there in 1999, and was in practise until very recently when he's moved over to work with Marial. Very, very pleased and, and, you know, really, thankful, David, that you've, you've sponsored this. You make it possible for, obviously a lot of vets to get free CPD, which is always useful.

So I'm really looking forward to your presentation, and then we'll let you introduce Ian, and we'll look forward to the, you're the hors d'oeuvres, and of course you've got the main course with Ian. But we're looking forward to the hors d'oeuvre anyway, David, so it's over to you. Thank you very much, Anthony, and good evening, everyone.

Mariel Animal Health, Bohringer Ingelheim Company, are very proud to sponsor this talk on Toxiccara by Ian Wright. Now Mariel Animal Health have a long heritage and vaccines and range of therapeutic medications, but we also have a wide portfolio of easy to use, efficacious broad spectrum parasiticides. As Ian will discuss shortly, toxicarra is not only a risk associated with dogs, but toxicara, which is a parasite of cats, is also a serious potential zoonosis.

And toxic car is a good example of answering this question we have, which is why is parasite control important? So why is it important? Well, firstly, it is about protecting our patients and keeping them healthy.

I think that's probably the more obvious reasons. Many parasites and pathogenic such as fleas, sticks, and several worm species. And of course, toxic car is especially important in young kittens and puppies.

Secondly, some parasites have significant zoonotic potential. Again, Toxicca is a great example of that. So good parasite control not only protects the pet, but also protects the pet owner as well.

And finally, and possibly less obviously. Good parasite control helps reduce environmental contamination, which protects the family, but especially with cats that wander and go into the neighbor's gardens, it helps protect the neighbours from parasites as well. So it has a role in protecting the community.

So cats, well, cats are particularly at risk of parasites due to their behaviour. I mean, they are the evolutionary marvels, and they are extremely talented hunters, and as such, they're exposed to tapeworms carried by their preys such as Pena, and a variety of other parasites such as roundworms, strongylus abstrusis, which is cat lung worm, capillaria lia, sometimes called the vesicle or bladder worm. And all the, all cats are fastidious groomed.

And therefore, whether a flea is alive or dead, cats will incidentally ingest them, exposing them to potential infection by another type of tapeworm, the flea tapeworm called the lidium caninum. Whilst unlikely to cause any significant disease in the cat. The rectal emergence of a tapeworm segment certainly have a significant negative impact on the pet owner relationship.

No, no pet owner wants to see tape room segments wriggling out of fluffy's bottom of the living room floor, and I'm sorry if I put you off your dinner when I say that, but as much revulsion as we show, it's far worse when you're there and it's happening. And it is also important to be aware that no matter how much we may try to deter it, over 50% of pet owners admit that their cats sleep on their bed or other family member beds, and this increases the potential risk of zoonotic disease exposure as well. Cats being the independent creatures that they are tend to roam, which exposes them to wildlife reservoirs of several parasite species such as fleas, as well as environments that may be contaminated with parasites such as ticks or roundworm eggs.

And whilst there are laws in several countries controlling the disposal of dog faeces, cats bury there, making it difficult to dispose of. They also tend to choose locations to bury their faeces, which potentially increase the risk of exposure to vulnerable humans such as children. So if they, they go to the toilet in a sandpit, and again, this is a potential exposure to zoonotic disease.

So most cats are regularly exposed to a broad range of parasites when going about their daily lives. Therefore, they require a broad spectrum parasite regime. And this brings us on to one of our products called Broadline.

And broadlining is the most comprehensive parasite control for cats in a single monthly, easy to give spot on application. It comes in two weight ranges, 2 less than 2.5 kgs and 2.5 to 7.5 kgs.

Also has this unique applicator you can see in the bottom corner of the screen there. And Broadline contains 4 active ingredients, some of which you may be very familiar with a pinnamectin, and macrocyclic lactone, which has excellent efficacy against a broad range of nematodes, nematodes, of course, are roundworms. Practic quanttal with a long established record of use against stones, cestodes are tapeworms, tripreil with well-proven efficacy against fleas and ticks.

And finally, Smethyrane, an insect growth regulator, and that inhibits the development of the immature stages such as eggs and larvae. So it does broadline cover a large number of parasites? Well, there's, there are pictures of them all there.

It has a licence for the treatment and prevention of ectoparasites, including fleas, flea eggs, flea larvae, ticks, mites, that mites at the end, there's no edre cat eye. It also has a licence covering internal parasites, including gastrointestinal raworms, such as Toxicarra, toxicarra cat which we're going to talk about, including the larval stages, L3 and L4, which I'm sure we'll learn more about later. Tapeworms, tenia delitium and kind of cocky all tapeworms, hookworms, the vampires of the roundworm realm, such as alias stoma tubiforma, a lower strongalis substrus lung worm.

The bladder worm again, capillary lia, and also as a licence for the prevention of heartworm diaphylaria emits. So undoubtedly broadline has a broad spectrum of efficacious activity. I mean, that's a who's a veritable who's who of of cat parasites.

So that leads us on to the safety profile for broad line. It can be used from the 8 to 7 weeks and a minimum weight of 0 0.6 kg.

So you can do little taps. In the unlikely event of an adverse reaction, they are generally mild and transient. With local skin reactions we most likely, whilst if the product is ingested, it can cause vomiting or neurological signs, but these resolve.

Now, of course, all licenced products are safe when used as directed. Otherwise they wouldn't be licenced. However, however, should broadline accidentally not be used as directed, it does have a very forgiving overdose safety profile and has been tested at 5 times the maximum dose.

But even if you have the most efficacious, broad spectrum product, or the most reassuring safety profile, if your clients cannot give the medication, either because it's too difficult to give or they forget to give it, then it is a wasted product. And this is where broadline hopefully comes into its own. We know clients want broad spectrum, easy to get products.

73% of pet owners want a parasiticide that does fleas, take some worms. And I think we all know whether you're a cat owner or a vet owners, that cat living cats can be very, very difficult. I don't think that's a surprise.

And once more, if I cannot give them medication, you are not going to get compliance. And Broadline is easy to apply. It is a spot on.

There's this unique professional applicator that's won an award from ISFM. It's clear, so you can see how much liquid is left to be applied or has been applied. It has a plunger that ensures that all the product is applied, which is very important for correct dosing.

It's glycerol-based, so cats do not feel the free effectively with alcohol-based products, and it looks professional. It looks like something you should get from a vet. It also makes tablet theme for worms a thing of the past.

It's also a monthly application that makes it easy to remember. People are creatures of habit, and a monthly product helps establish routine. It has been shown that people rather a monthly product over a 12-weekly product, for instance.

And unsurprisingly, people would rather use a single product if they can. Cats are found to be worms more than twice as often but broadline than if separate products are used for endoparasites or ectoparasites 2.6 times per year.

The average number of times cats are traded against worms when using separate products or 6.6 times per year with broad line. So what is it ideal for?

Well, it's ideal for any cat that needs a broad spectrum protection, whether it's a kitten, outdoor roaming cats, hunting cats, cats that groom, as most cats in my book. Clients who don't want to or are unable to travel like cats, Broadline would be perfect for them. And as we're going to learn, for households with children or toxic care is a risk.

So in summary, The key benefits are broad spectrum. It's easy to apply. And it's monthly, it's easy to remember.

And this is a simple parasite control solution that makes your clients need, meets your client's needs, helps to ensure cats can get the worming treatment they need. It keeps it all simple and simple is always good. Now I mentioned that we did have a large portfolio of parasiticide just very briefly just for their neck guard, which contains a niceoxazoline called a foxlinger, famously palatable once monthly for dogs, very rapid action and killing ticks and fleas.

Nextar spectram, which is an isoxazole as well, contains toxins, which is the same with Nar for fleas and ticks, but also contains milbamycin, which has a broad range of efficacy against brownworms, nematodes. Frontex, which contains permethrin and fipronil, that has an aaridal effect, it kills ticks and insect idle effect, but also is a repellent, so it's particularly good in helping to try and prevent fracture-borne diseases. And then of course, the old reliable frontline combo, which is ipronil and S.

So thank you very much for listening to that brief, brief presentation. Please don't forget there is a draw and you have the opportunity to win one of 20 copies of Prevention of Paological Diseases of pets in the UK written by Maggie Fisher. It is a good read, and I'm sure you'll enjoy it.

If you haven't already entered, that is the link in the chat box to your right, I think. So on to the main event, and that is with in right. So Ian obtained or pursued and achieved a master's in veterinary personality.

He then went on to gain a veterinary degree from Glasgow University. Ian is a practising veterinary surgeon. However, as he was once told, once a parasitologist, always a parasitologist.

He is head of the European Scientific Council of Companion Animal Parasites in the UK and Ireland, often abbreviated as SSCAP, the SCCAP, and the guideline director for SSCAP Europe. Ian regularly publishes in peer-reviewed journals. He's on the editorial board, of the Copanion Animal Journal, in addition to peer reviewing for other journals such as, JSA Journal, Small Animal practise and Veterinary Parasitology.

I have no doubt that we will all find Ian's presentation both educational and interesting. Whilst many of us may be aware that toxic area is a public health risk, recent studies have shown that the risk is more far reaching than we may have thought. So, on that note, I will hand over to Doctor Ian Wright.

Ian. Thank you very much. Thank you for that great introduction and a little introduction to Broadline there.

But I'm, I'm gonna be talking about Toxicara tonight which perhaps, you know, hasn't had the PR of some other parasites, perhaps, you know, it tends to fade into the background for some of us, but it is certainly far and away the most common end of parasite that we treat as. And, well, I, I have a soft spot for it. It's, it's sort of very close to my heart.

Hopefully not literally, it's metaphorically. But, you know, we go back a long way. But the, the funny thing is that, you know, despite the fact that we've known about Toxoara for, for decades, there's still huge gaps in our knowledge, about how it's transmitted and the zoonotic risk.

But, I'm going to try and bring us all up to speed with what we know at the moment. And certainly what we do know is that it's the most common nematode that we're gonna see in practise, day in, day out, and, and that it is a significant zoonosis as well. But perhaps unusually, perhaps, in a similar way to toxoplasma, there is some public awareness of that zoonotic potential.

And you, you'd think, we, we'd all think that, you know, if people are worried about their medical health, they'd go and see. Their GP. But some GPs, not all, but some GPs perhaps aren't terribly well informed about toxicara and sort of worms in dogs and people, and that often sends people to vets to ask about the public health risks.

So as well as treating cats and dogs, it's very important that we're all up to speed with the zoonotic risk, and what that represents to pet owners and the wider public. And at the moment, this, this is the sort of area that the public get their information from, is things like this, Daily Mail headline that I love to share, because although, you know, I've shared it a few times now, over the years, this was 2012, this came out. It, it still staggers me, that it's, oh sorry, 2010.

It's still time rolls on, but. It still just staggers me how much of it is wrong, and yet this was shared by the BBC, multiple newspapers, Sky News, all shared this story, about this poor, poor little girl. Clearly something has happened to this poor girl's eye.

But whatever it is, she did not contract toxicara in the way in the way described. I mean it suggests that she, she sort of tripped up and fell and got these fresh dog faeces in her eye er and then subsequently developed toxicara. But you neither er get toxicara by rubbing faeces in your eye, and fresh faeces.

Don't pose an immediate risk. So although articles like this, I guess do some good in conveying the public health message that toxicara is a risk, it presents a lot of misinformation about how it's transmitted, and, and that's, that's when they come to you. So it just to remind you that that it's unembryonated eggs, it's uninfective eggs that are passed in cat and dog faeces.

And they, they take some time to brew in the environment, develop a little worm inside, which is, is known as embryonated. Now there there's still a lot of debate about what stage, what larval stage is inside that egg. We, we used to think it was the L2.

Current thinking now is that it's, it's the L3, that is going to have very little impact on your day to day lives. All you need to know is that once the worm is fully developed, then that egg is infective to other cats and dogs, but most significantly, people. And that takes around.

2 to 7 weeks to take place depending on environmental conditions. So it likes to be relatively hidden from UV light, it likes it to be a bit moist and dark and humid, which is why it likes soil so much. But cats and dogs almost never infected that way.

Dogs are infected at birth by the transplantal route, and then both cats and dogs are also infected by the trans mammary route shortly after birth. And I mean this means either at birth, shortly after birth, you've got almost all puppies and kittens infected. On top of that, cats and dogs, but certainly cats are very good at topping up those numbers by hunting, by eating paratetenicos that have consumed the eggs and are then infected themselves.

So typically rodents and birds, which, as we all know, cats love to predate. So this, this is just to remind you, if you do do a faecal float, which I always encourage in practise to have a look, and you see a toxoara egg, this is what they look like, it's the thick pitted shell makes them extremely long lived in the environment. I mean they can live for two years in the environment, in soil, sand, in the general environment, just waiting for the right conditions to embryonate if they're not optimal.

So this is what they, this is how they start out, and then over time they, they embryonate, so this is the first division and given long enough they'll then develop the worm inside the egg. So you have all of these puppies and kittens heavily infected up until 6 months if they're not treated. But then some immunity, some self-regulation kicks in at around 6 months.

And that means in adult cats and dogs, you have very variable shedding of eggs. The infection isn't often eliminated, it hides out in the tissue. Us and that can lead to this shedding on and off the whole life of, of the cat and dog.

And if you take any group of sort of cats and dogs, which they've done across Europe in various studies, you'll see huge variation in shedding. So at any one time, there might be between 3.5% and 34% of dog shedding.

Comparatively much greater variation in cats because of their lifestyle. So you'll have some urban, mostly indoor cats, you know, perhaps around about 8% shedding. If you go up to stray cats, feral outdoor hunting cats, I mean that can get up to 76%, which you know is is a fair old number of infected cats.

In the UK, really lacking a lot of recent data, studies, going back really over the last four decades have shown, a prevalence of between 3.6 and 15% in unworm dogs. Because really of, of the lack of data, and it, it's great to do a bit of research in practise, a bit of evidence-based research.

I had a look up in Lancashire, which was published last year, and I, I found, about 5.5% prevalence in dogs. But what we did find, was a very high prevalence in cats, so 26%, so that's about 1 in 4, unworm cats with a variety of lifestyles, but all outdoor access, about a quarter of those were shedding, in the sample that I took.

This is right, it's available, in JSAP from last year. So if we just just have a, have a quick look at at what I found, you'll see for, for dogs, and it's a wide variety of of worms we found at at low level prevalence, but the overwhelming sort of dominant worm that was present, which is what we suspected was Toxocara canis. And we looked at unworm dogs, some of them have been wormed as puppies, but they're not as.

Adults, some just as, as adults. One of the reasons I've put this up is if you read the paper, you think, oh, actually, do you, does worming, just as puppies have some sort of protective effect? Because it looks a bit that way, but that distance actually isn't significant.

You're still looking at at sort of relatively low figures, like I say, the average round about 5.5%, at any one time. Now if we look at cats, again, you'll see, although other worms were available, in the faeces, Toxicara, the big, the big winner, certainly by a royal mile, and those two average out at around about 26% prevalence, so very, very high numbers.

And the, the thing is, the toxicara is an infection is extremely well adapted for living in cats and dogs, so it very rarely causes clinical problems in cats and dogs. You, you can get, you get your classically pot-bellied puppy or kitten, we're all used to seeing, and in very, very heavy numbers, very occasionally you might get, into susception. And there have been studies that have shown lung damage in cats, possible links to asthma and allergic bronchitis, but you know, that very much an area still of research.

But our biggest concern by royal mile is the zoonotic potential of these eggs. And certainly one of the sort of great tragedies of toxicorosis really is that it's very young children that tend to be affected, 2 to 4 year olds most commonly. And it's not known entirely whether that is due to immunity kicking in, like it does in cats and dogs.

I suspect though, I think we can all appreciate this, those of us that have young children, that it's probably more, lifestyle orientated. So my own children. Like many others, love to play in the garden and consume deliberately or accidentally, soil, so living the dream.

But their, their hand hygiene, possibly not so great. And, you know, as a result, their levels of exposure are probably higher. And the sort of classic forms that we think of when we think of toxicara that we've known about for for decades are the visceral and ocular forms.

So the ocular form is, is where you classically get a lesion, in the retina, in the back of the eye with subsequent vision impairment, sometimes blindness. So, so can be serious. That the visceral form is due to the migrating larvae through the lungs and liver, disseminating through the organs, and that can lead to breathing problems, abdominal pain, headaches, extreme lethargy.

And that's been recognised, as I say, for a while as a syndrome. What is, what is new really is two things. There's neurological form has been recognised, so it can cause direct neurological signs by worms lodging in the central nervous system and the brain, but you also have this thing called the the covert toxicorosis, and this means that a lot of people zero convert.

So a lot of people are exposed to infection and then they feel vaguely unwell. So. Are are they, are they unwell, have they got their headaches?

Have they got a bit of abdominal pain, a chronic fatigue syndrome because they've been exposed or for some other reason? And this, this is actually quite difficult to unpick. But people have had a go and sort of over the last few years, some studies have shown some interesting, risk-based data.

So all you can do really is is take large groups of, exposed people and unexposed people and see if there are health differences between the two. So in 2012, Quattrochietal did this for epilepsy. They looked at large groups of infected people and found that they were at greater risk from epilepsy than people who weren't.

So they're not saying that it's a direct cause of epilepsy, but you're more likely to develop it if you've zero converted. And people have done similar risk factor studies for asthma and dermatitis with with mixed results, but it would seem that a picture over time is emerging that it is a risk factor for asthma and dermatitis as well. Perhaps, quite worrying really for children and the risk of children being exposed was a large scale associational study that was done in the US and that found a link between toxic cara exposure and learning difficulties in.

Young children, so these cognitive deficits, attention span problems, all sorts of sort of learning difficulty areas in these large groups of children. So we're finding more and more of these links as time goes on and. I know that there is a feeling that, you know, if you're exposed to mock and bacteria and viruses, this is good for you, it's good it's immunity building, and that's true for for many diseases.

However, I think we can safely say on current evidence that having toxoara probably isn't good for you. So how, how are people exposed? Well, they're, they're mostly exposed by ingesting embryonated eggs of, of both Tanice and teati, that both of them have been shown to be zoonotic.

So the, the level of risk that they both pose depends how many of their respective eggs are in the environment, but certainly both of them are representing a risk. There have been studies, and sort of individual cases in the literature that have shown that people have been infected by eating undercut game, so for all sorts of reasons that I could go into, if someone does present you with a lovely mallard they've showed or a lovely grouse, I'd cook it very well. But there's only really the the odd case that occurs that way.

Most cases are occurring through embryonated egg ingestion. And that that happens predominantly one of three ways. Can happen through geopasia, which is the consumption of soil either accidentally or deliberately and deliberate soil consumption, occurs in some cultures and some religious practises.

Some children just enjoy doing it, just do it out of fun or habit. Pika is when these sort of sticky eggs get transferred onto other objects, so it might be the pen that you're sucking in the allotments or sort of garden tools, it could be hands, but also, dog toys and children's toys, can very easily pick up these eggs. We, we did a study, which has been replicated now many times back in 2002, looking at direct dog contact, whether these eggs could embryonate in fur, and we found that they could, so potentially, direct sort of cuddling of of dogs, may also represent a risk.

I mean, it has to be said subsequent studies have shown they don't embryonate at the same rate as they do in soil, so it's probably not, well, it almost certainly isn't as greater a risk as soil exposure and pika, but nevertheless, good hand hygiene around dogs, I think, needs to be encouraged. Interestingly, that the same studies haven't been done in cats and it may be that's not such a big thing with cats because they, they groom themselves so fastidiously, but we, we don't know. It's another area of, of, of sort of research that needs to be done.

All of these routes have resulted in people zero converting, being exposed to infection in in various numbers across Europe. So we're looking at sort of as low as 2% in, in some countries, that's round about where the UK is, bearing in mind that's still 1 in 50 people, so it's no small number of people. But he's as high as 31% in some countries, so if we take Ireland, you know, just across the water, they're 31% 0 conversion, and we, we really have no idea why the zero prevalence is so much higher in Ireland than it is here.

I, I just show you this, I promise, I haven't set this up. This, my youngest son, this Imperial scout from Star Wars is using, the Kong toy belonging to Bella, my dog. Other, other chewable toys are available, but he's pinched this, and he's using this as an outpost, which, you know, just show.

Shows you how easy it is for dog toys where these eggs may have transferred, to come into contact with children and then for toys to get sucked, or even for these dog toys to be directly put into, into children's mouths. So, I didn't, I didn't have the heart to take it away, but, you know, it just, just shows you. So zoonotic potential, if we look at the incidence of clinical disease compared with 1 in 50 people being exposed, it's relatively low.

So if we look sort of, they're they're old figures, we don't have new figures, so, so much research to be done. But sort of historically, round about maybe 120 cases confirmed in the UK each year. But that is likely massively underreported.

I mean, first of all, reporting of confirmed cases is only voluntary, it's not a notifiable disease, but also diagnosing it is no mean feat because the, the signs are so non-specific, so. Holland and Smith in 2006 described the the symptoms as generalised, multifaceted, and cryptic, which is a scientific way of saying they're a bit vague and, you know, a bit tricky for your local GP to nail. So it's very likely that many, many, many cases get missed.

So what are the risk factors that we should be concerned about? Well, there are all sorts of risk factors that have been investigated, and one of them is the number of pets you have in a household. And again, there's been mixed results with these studies, but.

It is kind of intuitive to say that if you've got more pets in a household, then both the risk of any individual pet shedding goes up, but also environmental contamination over time will go up. And that risk has been linked both to the number of adult dogs in the household and presumably cats as well, but also having breeding dogs in a household has been investigated and because you've got puppies and then you've got more egg shedding. So that's, that's certainly something to consider.

We also need to consider, hunting adults. So if you've got hunting cats or, dogs that predate in the household, or indeed, cats and dogs on raw, unprocessed diets, that's going to increase risk. But also the incidence is higher, in children, so if you've got children in a household or immune suppressed adults in a household, so that may be people on chemotherapy, organ transplant patients, people with immune-mediated disease, they are gonna be at higher risk as well.

What is certainly new or relatively new when we consider toxicorosis is the role of cats. So we just want to spend just a a little bit of time talking about that because it it is sort of, a new concept to many vets, and certainly GPs and, and the wider public as a whole. But if we look at the prevalence of of tea cat eye shedding in cats, it's often greater than the prevalence of tea canice in dogs.

So all things being equal, you'd think that cats would be contributing more to environmental contamination. And certainly there was a very good model done in 2015 that showed if you look at the number of cats and dogs and foxes in urban environments, it's actually cats and particularly stray cats that are taking the majority role in contamination. So really it may be that they're kind of the missing link, if you like, in sort of toxicara epidemiology.

Cause sometimes you get relatively low numbers of environmental contamination and yet high zero prevalence in a country or area, and that's what led us to look for toxicara eggs in the coats of dogs. But it may actually be cats that bury their faeces and put them out of the way, that are that sort of missing link, that missing epidemiological link in human toxicorosis. And certainly they do love burying their faeces, which also means that exposure is that much more likely.

It's a bit like the ball pit, when you go to the children's play centre, you don't know what's lurking at the bottom. And they've done, filming studies. Of uncovered sandpits and they just get visited by every cat in the neighbourhood.

They're just all take it in turns, marking their own bit in the sandpit and round they go. So certainly that is a potential risk area. I am often asked about the role of foxes cos lots of people, has to be, don't like foxes very much, you know, they, they can be blamed for many things.

However, I, I don't think that toxicara contamination is one of them. And you look at sort of prevalence figures for them, for instance, if, if you wanted to go and examine one Wolfe out excellent study of fox roadkill in Ireland, they found the prevalence to be very high, off the top I I think it's around around 65%. So you know, you've got 2/3, of foxes infected with toxica, they must be contributing.

They, they visit urban areas, they visit parks. However, when models look at the numbers of them, compared with the numbers of urban dogs, that are defecating, they're contributing. Very low numbers, probably less than 10% of overall toxicara egg contamination.

So although, you know, for all sorts of parasites and health reasons, we need to think about the numbers and where they're going, I think for Toxicara, their contribution is probably minimal. So how do we control it? Because it is a significant zoonosis, and I think we all have a part to play in trying to control it.

And it, it's such a cliche now I always cringe every time I say it, when, when I, when I talk about parasites, but this is very much a one health approach. If Disease, is going to be reduced in people, then we need, GPs, we need public health groups, we need county councils, but we also need veterinary professionals, so we need vets, nurses, and receptionists to be all on board and conveying the same message. And those messages are that we need regular deworming of pets, we need good anti-dog fouling policies, so we need people to pick up their dog faeces.

We need good hand hygiene and washing of of fruit and vegetables. Balls, we need to get those sand pits covered up, which, you know, sounds like a small thing, but can make a huge difference. And I think at some point we may need to link it in, to stray cat control, and I'll I'll talk about that a little bit in a moment.

But what about the worming frequency? Well, there's actually, like so many other areas of toxicorosis, very little information on which to base a deworming interval on. However, what we have in terms of a minimum deworming frequency, I believe the evidence is taking us towards 4 times a year, every 3 months as.

Minimum frequency. There are a couple of small papers that show that that is effective at reducing egg numbers. And there's really precious little that shows that less frequent intervals, so once or twice a year, makes any difference.

I mean, it might do, but we don't know. So for me, I would say 4 times a year is a minimum recommendation. Certainly though, monthly worming, because of the pre-patent period, because of the time it takes for the worm to produce eggs, monthly worming is gonna knock out most, toxic overproduction, certainly over 90%.

So that's very, very important in puppies and kittens, which, for health reasons, initially you want to do every 2 weeks until 2 weeks post-weaning. You can start that at 3 weeks in kittens because it's trans memory transmission, but then every month up until 6 months of age to as far as possible block that egg production. And you know, we certainly want to do that in high risk adult groups as well.

But a a concept to get over, which you know really needs to sort of stress to clients if we talk about this, is that 4 times a year is really a greater good strategy. So it is well worth doing if if lots of people adopt 4 times a year for their cats and dogs, then. Shedding goes down and you'll have an environmental impact in reducing egg numbers in a similar way to anti-dog fouling measures.

So well worth doing, but it doesn't mitigate immediate risk. So in an immediate environment like a garden or a household, because there's some shedding going. And because these eggs are very long lived, they're gonna build up over time.

So this is where if you've got high risk groups, that monthly deworming of cats and dogs is so important. So those are those that, hunt, so are sort of topping up their numbers. Those on raw unprocessed diets, but also those that are living with high risk groups, so those that are living with young children or as I described earlier, immune suppressed individuals.

And it just to remind you that certainly adult toxicara worms are easy to kill. That's, that's the good news that there were sort of, you know, sort of, there are products that aren't as effective, but almost certainly as a vet or, or a nurse, anything that you've got on your shelf is gonna do the job. So this is just a sort of Selection to demonstrate that the these are contained in all sorts of different products that you, that will be available to you.

So it's not so much the choice of the product for kill that is important as the frequency and compliance, really, that, that are the most important factors. You might say, well, OK, you know, regular deworming, I can see that's important, but why can't we test instead? And certainly this is the Scandinavian outlook, this is the sort of northern European outlook, is to test rather than routinely treat.

And it's a fair question, and it's something that over time we may adopt more, but its drawback is that you are going to miss some infections, so. If we look at the study that I did that was published last year, that used that impressive piece of kit on the screen, called FLOTA, which is very, very high sensitivity flotation technique. And what it found, was that over half of the Tanni infections and about 1 in 6 of the tea cat eye infections had egg counts of less than 100 eggs per gramme.

Now those are be very, very easy to miss in a standard floatation and yet are not an insignificant amount of eggs. So it'd be very easy to miss those, but also shedding is intermittent, so you could have a cat and dog that may shed eggs but won't be on that particular day. So certainly if you were gonna look for it, you'd want to test frequently and you'd want to use pool samples.

And another drawback is that if you get a positive result, it means that zoonotic eggs are already being shed into the environment, there has already been some contamination. And finally, it's, it's last drawback is that frequent testing, which would be the most effective, is expensive. To keep doing floats, say every sort of 2 or 3 months, it is a lot of expense to the client and inevitably it will be cheaper for them just to treat, either monthly or 4 times a year.

Now there are changes afoot, there is a well known, very large lab that I believe is working on intestinal antigen studies at the moment for sort of simple patient side testing. So this may become cheaper, may become more sensitive, may become easier to do, but at the moment for flotation, again, my own view is that the regular deworming is more practical and probably better at reducing zoonotic risk, but that that doesn't. Mean that you shouldn't have a look to check that it's working, to sort of measure amounts, to look for other types of intestinal worm and parasite life stage that might be present.

So I absolutely don't want to put you off having a look, but I don't think we can rely on it alone at this stage. I just want to talk very briefly about anti-dog fouling measures, because there's been a lot of that in the news recently, and working with county councils, I mean, SAP UK and Ireland, works with a number of councils, but as vets, working with our local councils to promote anti-dog fouling measures, I believe is very important and. It's always gonna come down to carrot versus stick.

So we had a a very good example of stick, a couple of months ago with the leader of Liverpool council saying that he was going to offer free council tax for a year, if you reported someone for dog fouling. Now, In my experience, stick with dog fouling, anti-dog fouling measures hasn't worked very well, and a blogger did point out that a year's council tax is worth more than the fine, so you could always just cooperate with your neighbour, report them, and then, split the cost of the fine, and then split the. Council tax money.

So, ultimately, these things, they, they don't work. You know, you need, social cohesion, you need sort of people to get on board and believe it's important. And that's really where vets and veterinary education is so important.

So, I should also mention that there was the stick and flick, which has been in the news a lot in the last couple of weeks. This is a literal, not metaphorical stick, where you just sort of flick the faeces into the bush. I appreciate that sometimes that may be the more practical option in very rural environments, but it is going to increase the risk of spread of teenious species and then me condemnation, and even for dogs, Echinococcus granulosis, which is a zoonotic, very serious zoonotic tapeworm.

So even where you think that, you know, direct exposure is unlikely, there may still be zoonotic exposure and serious economic loss to farmers through livestock being exposed. So wherever you can, we need to promote these faeces being picked up. And this some of you may have seen in the news, the paw prints, which work, sort of, paw prints, sorry, try to promote, DNA registration in parks.

So it, this was down in Barkingham and Dagenham where it was, trialled. And you, you basically register for your dog, you get it DNA tested. You go on a database and then you can use the park, and then if any faeces get found, then they can be traced, to individual dogs or people who are registered.

So it's a voluntary scheme, that's the thing, it's a very clever way of identifying the culprit, but it is a voluntary scheme, so it's getting the community on board in a supportive way. And also children's schools are very good, so this was a sign that I saw in Cheddar down in Somerset, but also my own my own boys' school, so this is a poster that he did. And they, they love it, they love doing posters, but also it's pester power.

It's a case of sort of, you know, if you promote, good, responsible dog ownership and anti-dog fouling and regular deworming to children, then you get pester power to the parents. And certainly I, I, my children were taught about the fire alarm. Getting your fire alarm tested and then it doesn't go by when the kids don't ask me to test the fire alarm.

So pester power works, but also it is just good family education and very good PR er for veterinary practises to to go into schools, and just promote good, general responsible pet ownership. I also want to talk a little bit about the role of stray cat control because this is controversial in relation to Toxicara, but it really doesn't need to be, doesn't need to be a sort of fearful thing. But it is a good message, I think, for promotering, er, promoting er neutering and rehoming campaigns.

So, you know, if you combine your sort of neutering campaigns, . And sort of rehoming programmes with a responsible parasite control message, then hopefully it won't panic people, but it's just saying that reducing stray cats, getting them worms, getting them in a nice domestic environment where they can be looked after will reduce toxicara contamination. But in addition to that, it's very important to educate clients to cover up their sand pits to to reduce toxic cara risk.

But also there were a couple of great studies, one in France and one in the UK that showed that cats love to visit allotments and kitchen gardens, and then they love to defecate all over them. And they, they tested the cat. Faeces, and they found that they were full of toxicara, toxoplasma, Campylobacter, all sorts of things that you don't want to be consuming.

And of course, what we love to do, if you have an allotment, is to sort of, you know, you, you're very proud of the fruit and veg that you've grown. You like to pull a spring onion out of the ground and consume it. And there, there is some risk in, in doing.

That. So you still want to live the dream, you still want to enjoy your allotments, but perhaps just a rinse under the cold tap first might be the order of the day. So it is important for toxoplasma as well, to, to just point out that that's a root of infection.

And just giving, fruit and vegetables that are intended for raw consumption a rinse, is a very good idea. It's very much the way to go. So future research and knowledge gaps, you may have noticed that I've prefixed almost every slide with, well, we don't know, or oh this is historical data, or or we could do with a bit more research here.

And that is very much the story of of Toxicara. There's still a lot that we don't know. So.

We, there's still a lot we don't know about the relationship between zero prevalence and actual disease. And you know, these relationships are being established and we're learning more and more and I think it's important that veterinary professionals, vets and nurses. Is keep up to speed with what the human risk is, partially so we can give good preventative advice, but also so we can keep that risk in perspective and that we don't panic people.

We tell them that we, we have a solution in regular deworming and and good hygiene. What we really need to do, which is out of our hands but would be very useful, is differentiating between T Kati and T. Canis infection in the human patients.

So we don't actually know how many human cases are down to T cata and Tanni. What we can do is we can look, we can try and distinguish between them in the environment, that technology is available, but it's quite expensive. So hopefully over time we'll get more cost effective techniques and we'll get more information on how much proportional contamination between the two there is in the environment.

But in the meantime, to, to work out the risk that cats and dogs, propose, we really need to do bottom, bottom up research. There's no point intended there, but you know, we need to work up from the bottom and try and work out, what the proportional risk is, and that's gonna take more statistical modelling. But also more prevalent studies, and this is something that you can do in practise with simple flotation, you know, it's good publicity for your practise, you're offering free faecal flotation to clients, and you can try and establish what sort of prevalence there is in your local cat and dog population.

And in doing that we can build up a bigger picture. Across the UK and I'm certainly more than happy for vets and nurses interested in doing that to sort of contact me for sort of advice in setting that up because I think it is information that we badly need. So in summary, toxicara is the basis for roundworm deworming in the UK.

You know, there are lots of other parasites that have absolutely rightly had a lot of publicity, but the one that we treat day in, day out, is toxicara. And it's zoonotic risk to people is going to be reduced by a combination of control measures. So the regular deworming, the hand hygiene, the environmental control, and cats are certainly being identified as increasingly important in transmission, so we mustn't forget about our cats.

Most importantly, we need to stress to clients that it is a completely preventable disease. So, you know, we, we don't want to scare the living daylights out of them and, you know, send them fleeing to their home. You know, we, we need to explain that there is a risk, but then we can give them a solution, to help keep them safe.

And I just want to finish up by of course doing my always free plug, cos SAP UK and Ireland is completely independent. We are, sponsored by drug companies, but only on the condition that we can say and do, sort of what we want, based on, on the evidence. But we do very much want to give practises advice and give them as current information as we can.

So. Please, visit the website for all sorts of, sort of handouts and posters you can print off, all sorts of advice, but also you can put queries in there, if you have any queries you can email them in, and I'm also always happy for people to contact me directly by email, if you have a burning, toxicara or any other, parasite question. So, thank you very much.

Thank you for listening. Ian, thank you so much. Fantastic as always.

I do always find you very inspirational, you know, you've got a fantastic charity SAP, doing great work. All the clinical research you do, you have a practise, you then give it webinars left, right and centre. How do you find all the time?

Come on, give us a, give us two quick time management, . Well, you know, if, if I'm honest, I, I spend a lot of my time running around like a headless chicken. So if anyone out there has time management advice, that would be fantastic.

But in, in all seriousness, the wonderful thing about doing flotation studies in practise is that you can leave them to brew. So, someone sent me nothing livens up my day, like someone's sending me a feta sample in the post, and he just put it on, you just leave it to. Leave it for half an hour, come back, see what you've got, and there is nothing more exciting than seeing a beautiful parasite egg under the microscope.

Perhaps a demodex for you, but you know. Demodex. No, the one that really gets me is scabies, because when you find scabies, mate, you're doing, you're doing very well on it.

That is some achievement, yeah. So I always jump up and down, get the clients in. Always helps if someone's accidentally given them preds first, I find.

But you know, finding these things, you know. But, but, presumably also a great place to get the nurses involved. If you do get caught up in consults, you can train your nurses and say, go and have a quick look at that and tell me what you find as well.

Very much so, yes, and the, the one thing that that I tell nurses that that are interested in running these is that parasite eggs. Out like a sore thumb. So if, if you're not seeing them, they're not there, you know, I mean, even if you can't immediately identify them, you'll recognise something as a parasitic life stage.

And then, you know, you can always, go on the internet or or hit a textbook or grab a colleague and, and get it identified. Now I have a very small raised bed in which I grow my spinach for my smoothies and various other things, and I do notice that the cats think that this is their toilet area. So any, any tips on, you know, keeping them off, the, does the orange peel work or the pepper?

I, I have found, well, first of all, it won't surprise you to learn, there's no peer reviewed evidence to suggest what the best repellent is, but, I, I haven't found anything to consistently work myself, and this is, this is where the washing is, is so important. Keeping cats out, particularly from allotments, is, is a complete nightmare and you know, I appreciate, you know, it's wonderful that cats can go out and roam and. You know, these cats are having a fantastic time, but it does make it very, very important.

Well, first of all, to treat them, if you can, but also, just to make sure that those fruit and veg are well washed, because of course, you know, in the cat faeces, you've got Giardia, toxoplasma, Campylobacter, you know, as well as toxicara, which you can't treat for, you know, so hygiene, really the, the barrier that you've got. And, you know, the only thing I, the other thing is, is you guard them and every time you see a cat, you shout boo and it probably wouldn't be in a big rush to come back. They do seem quite skittish when they see me looking out at them from the kitchen.

Yeah, I couldn't possibly advise anyone to have a soaker. That'd be terrible. That might be, might be cruelty.

And just before we move on to questions, it'd be really interesting just to see where people are listening in from, so. We've got some questions here. I will start going through with them.

Obviously also pull, pull David back in as well in case there are more technical questions. But, if anybody is listening in from, exotic climes, you know, wherever you're listening in from, perhaps just tap that in and I'll, I'll kind of shout that out every so often, where, where people are listening in from, because we get them from, from all over, Ian, we've got, Durham Hechtersad, which is in Belgium. I know we've got a few Belgians.

We have Bermuda, South Africa, Norfolk, Portugal. Another Portugal, Ayrshire, East Anglia, Chorley. Very good, just down the road Turkey.

Lots of Slovenia, Spain, Newtonly Willows, North Wales, Bethlehem. Wow. You can't get better than that, can you, can you?

No, fantastic, good, isn't it, isn't it, isn't it amazing though, that if you take all of those countries, I mean, crikey, all around the world, they'll all have different parasite distributions, but they will all have toxicara. Every every continent but Antarctica has toxicara, so you know, something that we can all share. Somebody listening in from Liverpool and it isn't one of us, so that's good.

And of course fascinating, you'll have all the heartworm and everything, won't you, so it's it's all of a a mix. This is the fascinating thing because you have some parts of Europe where routine roundworm treatment is just built in because of heartworm, and yeah, you go further north, you go to Denmark and it's illegal, you know, without a diagnosis, so you know you really have those two extremes on, on mainland Europe. Yeah, and we've got a question here on, obviously somebody listening in from, Europe.

Zhao is saying, as Broadline is active against Darohalaria. He's obviously based in Portugal. Should we be testing cats for Darohylaria before starting Broadline?

Just like before, heart guardian dogs, because you can get this kind of quick death of all the, of the worms, and that can cause a problem, can't it? You can, and that is a great question. I mean, the answer is yes.

I mean, you know, certainly useful to test cats. What you have to remember though is cats carry far. Far, far fewer adults, which is the, the sort of biggest risk, you know, than, than dogs do.

So, you know, they may have no adults at all, or just 1 and 2, or 1 or 2. So the, the risk of anaphylaxis in cats is, is far, far lower. I mean, very briefly, heartworming cats tends to be more bronchial, you know, tends to be more migrating larvae in, in origins.

So, you know, it's, it's certainly worth testing, but you wouldn't antigen test, you know, you'd be looking at more sort of antibody testing, I mean, possibly ultrasound. And if you've had an untreated cat that you're then going to start treating, you know, before, you know, before you initiate that treatment. But if, if you couldn't, if it wasn't practical to do that, then the risk is lower of starting treatment in cats than it is in dogs, yeah.

David, I've pulled David on, so David, you got any comments on that one? Absolutely. I mean, everything Ian says is absolutely correct.

However, a bit more specifically with Broadline per se is that it's licence for mectin is actually prevention. And its activity is against the larval forms, the microfilaria, and actually not against the adult. And therefore, we've actually done studies where cats have been infected with adult heartworms, and we've given them 3 times the maximum dose of bloodline, and they have been fine because the target is the microfilaria, not the adults.

Now you should absolutely test them. Because if they're over 6 months of age, they may have adult worms that aren't going to be affected by broadline. So they have may have adult worms on board, but from the point of view of the mass, that's that quite rightly points out with heart card, which is the nigramain and certainly will kill adults, yes, you should always check.

Yeah, so if you've got some adult worms, obviously at some point you do want to get rid of them, but you might use. Something different, but be careful because of the, the potential problems. I mean, the, the, the strategy in cats is essentially to let the worms die of old age.

Adult aide intervention is is dangerous in cats. But in in dogs, part of the problem is if you have adults, even say if you used a rinum. In, which I mean isn't, isn't a dog product, but if you did, then it, it's the fact that they're constantly throwing out microfilaria that you might have an anaphylactic reaction to as well.

And that is, that is less likely in cats as well. So all, all round, you know, if you did use it without testing, it, it's just not as risky. Great.

OK. We've got a great question from Mel, which I'm gonna go for next. Just before I do that again, You know, David, obviously appreciate the kind of sponsorship of Mariel that's made this possible.

We've had over 500 people on. Obviously a lot of people who, will come to it as a recording. I had a couple of emails coming through saying, we can't see it now, we've suddenly had to do something and, so they'll be picking it up as a recording over the next week or two, hopefully.

But Mel's come up with a really good question, because it's, it's one that, if, if I'd have thought of, I'd have liked to have asked, so I'm gonna, read it through and . Either or of you whoever wants to jump on first, but I guess both of you will want to make a contribution to it. Mel said, my understanding is that spot on products that last monthly, or for a number of weeks will actively kill fleas every day for the duration.

Of the licence period. Does the same apply to the deworming ingredients in these spot on products, or do they peak quickly and fall away in efficacy after only a few days? Similarly, my understanding is that all oral products only last for the transit time of the gut, effectively 24 hours.

Is this outdated thinking, and do some of the modern oral products, so I'm thinking, things like Nexard S spectra, actively last for an extended period? And in effect, actively deworm the animal every day for an extended period, and that's from Mel. So I think that's a great question.

So, if you can, if you can answer that, I will also be the wiser for it as well, Mel. Well, maybe I'll answer very specifically from the broad line and the next spectra point of view. So broad line contains pinnamectin.

So the answer to that depends on what parasiticides are on the spot. Arinamectin, which is the, the roundwormer in broadline, has a half-life of just under 5 days. So that will be completely, pretty well, completely eliminated before the end of the month.

So it's not going to be killing for that entire duration. So the whole principle is, and it's a very important principle of parasitology is to catch them in their pre-patent periods, kill what's there and move on. Similarly, moving down to the next spectra, which is an old product and has milbammy in it, nilbamycin in it.

Milbamycin's half-life is also quite, quite short. It's a bit more complicated, but certainly wouldn't go beyond 5 days. So again, it's killing the parasites that are there in the form of nematodes and moo on.

Prasy Quantpo has an even shorter half-life. So again, killed, kills the tick worms over there, moves on. But from the flea and the tick point of view, yes, they have to last a month because you're, you're getting a constant burden of adults.

Yeah, not much to add to that, really. I mean it's the pre-patent period, but I mean it has to be said that, you know, for, for tapeworms, say, it makes a huge difference. So, you know, Praiquanl, half life of around 12 hours means that, you know, it really doesn't have residual activity, which is the problem with the 5 day window with the pet travel schemes.

So, you know, if, if the tapeworm has had a bit. More residual activity, but that would be great. They, they don't because, you know, I mean it's absolutely true to say they're not systemically absorbed to a certain extent where, you know, your macrocyclalactones are systemically absorbed, so there is some residual activity, but you're not relying on that, it's, it's the pre-patent period, it's the frequency of, of deworming that you're, you're relying on.

In, in some ways, having such a short period is probably good, because if you had a, a longer period where it slowly, slowly dies off, then presumably you, it sounds like a more likely situation where resistance could develop. Well, now, I, I was, I'm pleased you brought up the resistance issue, because, yes, I mean, certainly that's true for, for say tapeworms and and raziuanttal. For resistance, for reducing resistance, you need, refugia, so you need, life stages to go out into the environment and then sort of repopulate.

The the problem with toxicara is that it's zoonotic, so if you're going to attempt to reduce. Exposure, that means releasing zoonotic life stages into the environment, and that is a quandary because obviously you don't want to do that. But we're we're fortunate in that because there are arrested stages that we can't get to, because there's reservoir hosts, and I mean huge numbers of domestic pets that aren't treated at the moment as well, there isn't really the selection pressure that so far, we don't want to be complacent, but so far hasn't generated.

Resistance. Except I mean in Australia there's been a couple of cases in very intensively wormed kennel dogs, but nothing yet in, in a domestic setting. So, you know, I think, and for the moment, I think, you know, you need to take risk into account and SAP UK and Ireland doesn't believe that every single cat and dog needs monthly treatments, but I think it does very much need to be a risk assessment and the zoonotic risk has to come first.

A couple of people asking questions, Ian, about piperazine and nitroussganate, obviously older ingredients. What are your thoughts on those? Well, apparently nitrous gannate's very hard to get hold of now, but they presented two problems, .

Not that they're bad per se, but nitroganate to be effective. I mean it had to be a split dose, didn't it? It had to be on an empty stomach, you know, you possibly had to, you know, slaughter an animal under a full moon while administering it, you know, there were a lot of rules, but just remember there were a lot of rules.

So you know, there's gotta be an easier way, hasn't there? Piperazine, from what I can remember does kill adults effectively, but it's, it's percentage kill possibly, and larval stages isn't as good as, you know, more modern, if you like. And when I say.

More modern, even the sort of benzoiddazos that have been around forever are are far more effective. So, you know, my, my own opinion is that even if you go into the sort of nonprescription brackets, there are just more effective dewormers now than than perperazine. And one of the, the.

People on the webinar said that Paperizine endarid has been withdrawn. Right, OK, well there there you go, you know, I I think there is this perception because, you know, you have, say, as an example, you have gentle and it's derivative, er it's . Generics and you know you have panic here, you know you have fembendazole generics, you know, all widely, widely available and more efficacious, so on all fronts really it's kind of been out outcompeted really that's yeah.

No, that's brilliant. David, we've got a question here. Is broadline safe for use in pregnant cats?

That's a good question. It, it actually hasn't got a licence for use in pregnancy. It hasn't been tested in pregnant cats.

It has, however, been tested in lab animals such as rats and rabbits, and it didn't flag up anything from a heritage in thisity point of view idal or mattress cycle. So what we would say is that it is on a risk benefit assessment. So there's nothing particular there that you need to worry about, but it isn't licence per se.

You'd have to get a signed consent if you're going to use it in that sense, I suppose, yeah, great. Graham has said, Ian, just in case you couldn't hear the tumultuous applause, Grace, another brilliant webinar. Thanks so much, Ian.

Thank you. There you go, some, some praise and applause there. Polly saying, how well do the eggs survive in the environment after removal of faeces?

So how much risk is there in areas where faeces has been removed, not grossly visible, but there may be Contamination of the soil in that area. Well, this, this is part of the problem. So it's all, I mean, this is, they're staggeringly hard to kill.

These eggs are staggeringly hard to kill. I mean, I, when I did my master's back, back in the 90s, I looked at some human faeces, that had been sent across from Madagascar from the natives there. And that had been, that'd have been.

From Madagascar in formalin and the little worm was still wiggling around inside the egg. It was like laughing, laughing in the face of that. Now I don't think it would have hatched, but very, very difficult to kill, you know, resistant to many disinfectants, and you know, any protection from sunlight is gonna do OK.

So certainly resistant to desiccation and can survive for, you know, 2 years plus, you know, so it, it needs more the soil for conditions to embryonates out and about, it'll just tough it out. So, you know, this is why, you know, picking up dog feet is very important to reduce the bulk of the numbers. There and deworming very important to reduce the the bulk of the numbers that are there, but there will always be a little bit left behind and and that's where the hand hygiene and the washing comes in.

It it really is a sort of multi-layer one thing on its own won't won't do the job. You know, it's fascinating. It's a fascinating area because of course all of us, if we're in practise, you know, we're worming every day and it's so important to be kept current.

So thank you so much both of you for the fantastic information you're giving us. I, I'll keep on asking the questions unless you've got is the Coronation Street on or have you? No, no, no, I have, I have booked the evening off, so it's David, are you OK?

There's nothing on the telly. You, you're not gonna be watching all the Brexit news. That's not till 10, so we've got a bit more.

No, no, please, please no more Brexit news. If, if people get worms actually, can they, will they be allowed to come into the UK once we actually leave anyway, moving on. Before I get into trouble.

Diane has said, would some agree that worming Monthly is exceeding clients' expectations? Compliance could be difficulty promoting even more dosing of their pets. Also, is it correct that some milbamycin products are now suggesting that puppies only need worming up to 12 weeks, then least till 6 months.

I, I presume she means then, then less or, or less often till 6 months. So, so what would your protocol be in, in, in that place? She's asked the question specifically puppies, if, if we can just a tiny bit digress to, to talk about that.

Well, I mean, all, all the evidence at the moment is still that it is very, very important to worm every month up until 6 months old. I mean that, that is, you know, you you can imagine that when we do the SCAP, European wide guidelines, we have some lively debates. Between sort of my northern and Southern European colleagues about, you know, where to pitch this.

But we all agree that monthly worming up until 6 months is, you know, that the evidence is rock solid for that. If you don't do that, you're going to get shedding. So, you know, for, for me, you know, because of the zoonotic risk, that, that is, you know, so I recommend that to every single client, and I would recommend that everyone else does the same.

In adults, it becomes part of an overall, and this is something that we're very much promoting at the moment, with our partners is a risk-based approach to parasite controls. So you know, you say, you know, pretty much every cat and dog needs flea protection. Every cat and dog 4 times a year, and then onto that you ask a few questions such as whether there are children in the household, whether they hunt, you know, who else might be living there, who else might visit there, you know, just to try and get a picture as to whether, monthly deworming is required, whether tapeworm treatment is required, you know, whether you also need tick treatment and, in dog's lung worm prevention.

So, you know. These are all things that you're bolting on to that basic recommendation. So, you know, I, it, I think there is a danger, there is a very real danger that we could go the other way, that we should just recommend monthly deworming to everything that moves.

But I, I think it does need to be risk based, but I think probably this talk has, has, has demonstrated, there are a lot of at risk groups that are going to require monthly deworming. We, we've got another question which is very similar, but I'll just interject maybe to, to David. David, would you see, a sensible protocol perhaps being, you know, broad line is used?

The majority of the time, or let's say every other month, but maybe you use frontline combo. In the kind of other, is that something that you've looked at or or considered? That is certainly an option.

I mean, it really is about risk. Now, most cats are hunters, most cats go out and have adventures, and they encounter parasites out there in the real world. So certainly many of them will need very regular, parasite control, but In individuals where that risk is less, yeah, tailor it accordingly.

You could do your broad line one month, maybe put my combo for another 2 and then broad line again or whatever combination is required. So it really is tailoring it to the client, but also making sure that you're using something that your, your pet owners find easy to use because that has a huge impact on that, compliance at the end of the day. And, and this is where it's so good, you know, when you've gone to first principles to explain it to us, and it's important that we can go back, you know, with science to owners and say, no, we're not just trying to sell more wormin tablets or, you know, worming liquids, this is, you know, very much, tethered on, on very good, scientific information.

Again, I think cause it's just interesting going over these little case studies, if you like. Olivia says for a household with a non-hunting indoor cat, where the litter box is cleaned regularly, is there a benefit to treating for roundworm was always taught every 6 months in indoor cats, but from your data, it seems like this may have no benefit at all for tea cat eye. Well, I, I can't stress enough we don't know, and I mean some of my SAP colleagues say in sort of, you know, mid year for indoor cats will recommend a sort of once or twice year approach, but we don't know, you know, that's, that's the thing.

So I, I think there is an argument, the best I can say for the indoor cats, it is difficult to assess, some of them may be carrying toxicara and they may shed. So I think there is an argument if you're gonna use, cos you certainly need to use flea control in indoor cats because we can bring the fleas in, you know, I think all, all I can say is there are a number now of flea products that will also round them and so therefore, you know, say if you have got sort of children in that household, you've just got the option to try to, you know, in in a sort of convenient way. It's as you say, both of you, you know, talked about risk assessments.

Yeah. It's, it's not an expensive thing to do. Prevention is, is always better than, you know, cure, isn't it?

Well, and you know, you, you say about the indoor cat, but it's also who the indoor cat's living with. So if you've got an indoor cat and they're all adults with good hand hygiene, they may say, well I, you know, I, I don't want to and I think that would be completely reasonable. You know, as long as they understand the risks, you know, but I think if you've got children in there, it's just so difficult to know whether those cats are going to shed, and it's there where perhaps sometimes hygiene breaks down.

Of course. Burgess is saying thank you, Ian for a brilliant webinar. Also, many thanks to David, Anthony, and Mary.

So we all got in on the act. I don't like it all just going to you, Ian. I think you and I deserve a little bit of credit for this weather.

Anyway, somebody else is saying, would an unembryonated egg be destroyed by gastric environment? No. No is the answer.

In fact, in fact, there are numerous examples of dogs being found with, Toxoara cat eye in their faeces. And everyone goes, Oh, you know, how is that possible? Is this tea cat eye in dogs?

But it's cause dogs eat cat poo, you know. And then they just pass it out. So there is sort of mechanical transfer in in that respect, and it's also not uncommon to find dogs with horse stronggile eggs in their faeces.

So, you know, you do have to interpret the eggs that you're finding sometimes with, with caution. Brilliant. I, I, I don't think Cathy will mind.

Cathy Kisick, who's one of our famous vet nurses, has, given a little suggestion. Children's little plastic windmills pushed into soil. Keeps cats off your vegetable patches.

So always looking to do that, so I might try that out myself. Cathy's down on the Channel Islands now, so she's moved down there. She was at MAISCO, so probably some nurses have been trained by her on the webinar tonight.

So I hope you're doing well, Cathy, . Right, has anyone tried having a sacrificial sand pitt in their allotment or garden for cats? I love that.

That is brilliant. Yeah. No, I haven't, no, but I am now.

That's that's what I'm gonna install the sacrificial sandpit, brilliant. The only thing is that I find the kids have taken the lid off and they're swimming in it, that's the problem. Jodie is saying our local playground has an open sand pit.

Would alcohol hand cleaner next to it be useful? Well, oh yes, oh, not because it will kill the eggs, but it's just physically removing them from your hands. So yes, absolutely.

That's, it's simple things like that, that can make a huge difference, I think, for, you know, like I say, not just for toxicara, but for all those other faecal pathogens as well. So, you know, very simple thing to do and you know, then you're sort of scrubbed out, aren't you really? Yeah.

And I know, I know lots of people then worry about the allergy and sort of immune sort of repercussions, but they've got the whole trip home to, you know, get covered and stuff and you know, but at least that immediate risk has been mitigated. There are some cracking questions tonight, Ian, and you know, with your permission I'm gonna keep you on for a bit longer. Is that OK?

Of course, yeah, 11 of the great things about this, you see, is that we're all exchanging good tips as well, like you know that's yeah but the but the the alcohol by the sump pit is is a great idea as well. Yeah, I, yeah, absolutely, . So another anonymous viewers just said I understand prevalence of Tanus versus T cata needs further research in disease, but should there be more emphasis on cat deworming and therefore less demonization of dogs with regard to infection control?

Well. Yeah, I mean, the answer is yes. I mean, I think, I do think that cats in terms of deworming have been very seriously neglected, which is, is why, you know, it's it's very important to promote that zoonotic risk.

But I, I do believe that we can also manage the dog risk without any demonization going on at all. You know, I think that the way that you. Approach it.

So, you know, we want people, you know, there's been a huge store been made out of the the human-animal bonds and how good it is for our health to have a pet and have a loving relationship with our pets. And you don't want to do anything to damage that. You know, you want to strengthen that through the sort of, you know, the, the safe.

Knowledge that if you are washing your hands and deworming your dog and picking up his picking up the dog poo, that that's, that's good, that's all good. You know, so it, it's the way you put the message across really. But it's for cats as well.

It's not difficult to do, but I must admit it's fascinating that the cat eye stuff, you know, obviously I was less aware of as a problem, so it's been a big learning for me, this webinar, and I always say if you kind of take one thing away from. A webinar, it's probably, you know, been worth going to, but certainly just that slightly bit more of an emphasis on cats is I think really important and useful, so thank you so much for that. .

David, I've got a few questions for you because Ian's getting too much of the limelight here, so I'm gonna pass it. And Rochelle has said, I'll let him get a word in. Yeah, if you've got an MDR one and I presume that she's meaning positive dog living in the household.

With cats, what's the toxic risk from broadline? I presume, you know, discussing from the epromectin perspective. Sure.

So, of course, MDR one mutation means that they are predisposed to accumulation of certain medicines in their nervous system, which would be a bad thing. So we have a pump that pumps them out again. And certain medications are in those groups, what we call P glycoproin substrates, and that includes macrocyclic lectins, which mectin is.

Now, I think the risk for that dog just being in the household with a cat that has been treated with broadline is pretty minute. Unless you're actually using the broad line on the dog, a Prinomectin really hasn't been assessed in dogs, so that's my main reason for suggesting that you don't use it. It would not be unlicensed.

But if it's a case of the cat has been treated with broad line, is there a risk of the dog in some way contact getting in contact with the Ariumectin? Well, once broad line has dried, There should be no risk there. As long as the dog isn't licking off a puddler product, it shouldn't be a risk.

It's certainly nothing that I have encountered. So I think the risk is absolutely minimal. And Rochelle, I mean, ivermectin is, is obviously, you know, the one that we all worry about.

We know that that can cause problems from a dermatology perspective and things like Demodex. I know a lot of the other macrocyclic lactones are not nearly as toxic as ivermectin is. Ivermectin is kind of the one that we judge everything against.

Presumably, I mean, I don't know the word, but eremectin is much less toxic than ivermectin, isn't it? Well, I, I, as I say, it's, it's, use in dogs has not been, I am a hasn't really been assessed. Certain in cats it seems to be, very safe, but, and it's been used in production animals as well, but in dogs we don't know.

OK, fine. Benice has got another question for you, David. .

Do you still see fipronil as having a useful role in the future? I find that the relatively slow kill time and hyper excitable fleas that are so visible is reducing my client's confidence in the product. They still see fleas untreated, pets, of course, we know that these are probably fresh environmental fleas.

But it's hard to keep on explaining this. What, what are your thoughts on, on, on that? Well, I, I would say that the, the best time to explain what is going on with fipronil and hyperexication was very efficacious at killing fleas is to inform owners as to what to expect when you first prescribe a medication, because when they know what to expect, they're not surprised by it.

But if you don't know about the life cycle of a flea or you don't know what to expect, or you don't know about what we call hitchhikers, so fleas coming from the outside environment and jumping on the pet, they're just going to think that their pet still has fleas. So the key is client information at the beginning, and there are various ways you can do that. There are certainly reproduce things like er sheets you, you hand out to clients so that they know what is going on.

And this is where, you know, if the vet is very busy, then, you know, it's a great place for the nurse to talk because if you explain things, obviously, I do, you know, I, I'm a dermatologist, although I've stopped practising. The key is, as you've said, is the explanation if you explain what's going to happen with the product. And of course, Broadline also has methoprene in which is going to augment its flea effect anyway.

But the explanation is so important because if you explain it before it happens, people are much more likely to accept it as you've said, David. So, you know, thanks for that one. We're coming towards the end, but there have been cracking questions.

What, so Fay is saying, what does it mean when Toxicara has insisted in tissues or organs, I'll pass that on to Ian. Yeah, no, sorry, I, I should have explained that. It insisted or arrested, just means that the the immune system has sort of walled the para side off.

So it's in a sort of immune privileged site, and of course this, this is what happens in paratenic hosts. So, you know, a a sort of, you know, a rodent say will eat a toxic cara egg, and then that larvae will migrate and eventually the immune system will, will wall it off, and it will sort of sit there and it will sit there until that prey gets eaten. That's that's the plan.

It doesn't have to move again, it just has to wait for that host to be eaten. Now, you know, in our case we're unlikely to ever be eaten, well hopefully, but it causes health problems. And you know, if it causes health problems relatively say in a mouse or a rat, well that's all the more likely that it's going to get eaten.

But what's less clear in people is what those long term health consequences are, and I think compared with, you know, when you and I sort of graduated and trained, you know, more and more has has been learnt about that, and, you know, it's. Not just the lesion at the back of the eye, you know, we're finding more and more associations, and I mean that's, that's been true over time of toxoplasma as well, and, you know, sort of other zoonosis. You basically find over time that they're, they're more and more less good for you.

No, that's great. I mean, there's some of these points were made in the webinar, but I think Leonie's interested in, should dogs fed on raw diets be wormed monthly throughout life. These are currently very trendy, and you're quite right, Leonie, they are, so, Ian.

Ah yes they are. Now, I mean this is actually more important for tapeworm. So, you know, if you think about it.

Teenotate worms and Echinococcus, they're transmitted through cysts in offal and raw meat. Now, I mean if that meat has been processed, so if it's been adequately frozen or checked for sys, there shouldn't be a problem, but if you're in doubt, then you are better to to deworm if they're on a raw diet. I mean with with Toxicara, there there's very little information about the role that sort of larger animals that you might expect to be in a raw diet, you know, in terms of their sort of role as a partic host, but certainly birds, so if you're on a raw poultry diet, for instance, then you know, you may be better to institute monthly deworming there.

Great. Jan is saying any way of regulating the over the counter products, so owners who don't visit vets are at least using something effective, is there a zoonosis argument? Well, fortunately, like I say for Toxicara, more and more things, you know, the the things that aren't as effective seem to be dropping out of the market.

So, you know, of course, you know, as vets we should be trying to drive veterinary sales and certainly educate clients, if they are just nipping into their pet shop, we can be safer in the knowledge for perhaps, you know, certainly for worms that they probably are gonna get something that's that's effective. There is some worry for me in febendazole being sold as a tapewormer, because of course it's not effective against, Echinococcus or against flea tapeworm terribly. So, you know, there are exceptions and education is important, but I think for Toxicara, as time goes on, those perhaps slightly less efficacious products are sort of dropping out.

We, we also do a lot of webinars for SQPs and obviously, we've got quite a large number of those coming on. And of course, these sort of webinars are very popular on things, and I'm sure there are a couple of people at the start put their number down. Now, this is not, you know, this does not have Atra points on it, but, You're learning really, really good.

And it's good, it's good news for SQPs really. I mean, you're just, just asking what what is the role of fipronil in the future? Well, I mean, you know, it, it's in some useful combination products, but also, you know, it is available to SQPs.

And if used correctly with the right education, I think in that respect it and midoloprid very much still have a role, so it's, it's very much as you've said, if people understand it, you know, we've got some fantastic fleet treatments, but if they're not used correctly. Yes, they don't work, you know, so it's important that people are educated and I know there are a few SQPs on there may be nurses as well. You won't get points for this, but it isn't just about points.

This webinar, you know, with Ian and, and David's help, I'm sure will be very educational for you in, in talking to clients in your practises or in pet shops. . Where we've just got, I think it's 11 or 2 more, .

Somebody is very upset that I've stopped practising. I am now on my swans. Well, you know, dermatologist, Anthony.

We can feel the love for dermatologist. Yeah, you haven't really left, have you? It's, it's, who knows, I could go back at some point, but I'm just being kept busy doing all these webinars and things.

So, let me just check. I think we're pretty much out of questions. Still a huge number of people have stayed on.

We've lost a few, but a lot of people have, . Have stayed on. Very interesting.

Caroline says I love my faecal floats. You can't argue with that, can you? Leanne said brilliant webinar from all the speakers.

Thank you, Leanne. It's not all just about Ian, you know. No.

Caroline is just one quick one. How can toxicariosis be diagnosed in humans? Well, with, with difficulty is the answer, and that's part of the problem.

So you, you have sero conversion, but when we talk about serro conversion, it's having antibodies to the parasites. So you know if if you're sero positive, then your signs may be. Attributable to that.

Now, for something like visceral lava migraines, or for, ocular larval migraines, you have distinct lesions that you can diagnose. And there are other tests that perhaps we don't use so much, like Western blotting that's used. So there are more sort of advanced diagnostic tests that can be used.

But it's very involved, it, it's, you know, if, if you suspected, for instance, that you had it, then, you know, your GP is probably gonna have to get some more advice before testing you. Great. And I'm just looking there just to make sure that, we, we've, in the chat box, we've put the, we've put the URL for the quiz, and I'm just checking that that's coming up OK.

It's the webinar vet.com/merial . Broad line and just making sure that we've got this.

Quiz bit on the end. Yeah, right at the bottom you'll see it says to be entered into a free draw to win one of 20 copies of Mariel's comprehensive Parasitology textbook by Maggie Fisher. Please click below.

So if you want to do that draw, just do answer there, and I'm pretty sure there'll be a survey that might pop up, pop up at the end. So. If you do see that, please do fill it in.

It's always useful for us to get information, find out, you know, if you've enjoyed the webinar and the sort of other topics that we can, that we can run as well. So, thank you so much, everyone. I think it's been, It's been absolutely great.

It's been a fantastic webinar. So, Ian, thank you so much, and David, thank you, and also, obviously, thank, Marial for making this possible and, free to attend for everyone. Thank you very much.

Fantastic. Thank you. Alright, take care everyone, good night and we'll see you no doubt soon on another webinar.

Bye bye. Take care. Bye bye.