Beat the Bugs with Infection Control

Infection Control
What o o o o o do people think of? Abscesses Quarantine Outbreaks Strangles Racetracks and shows

Why is it important?

Australian Flu
>50,000 horses affected Direct costs: >$100 million Indirect costs: >$1 billion

Problem #1
Many (most) equine environments are horrible situations for infection control o Barns o Tracks o Shows o Yearling sales

Yearling Sale Nightmare

Mixing large number of horses o Varying backgrounds Disease exposure Vaccination status Overall health Transient/mobile populations Regional/national/international movement o They come, they transmit, they go Confinement housing Human contact

o Grooms, trainers, officials Excessive antibiotic use Variable veterinary care o Changing owners and vets o Poor record keeping o Poor record transfer All living creatures are biohazardous

Problem #2
You cant always tell when a horse (or human) is carrying an infectious agent o Carriage by healthy animals Shedding before onset of disease Mild (undetected) disease Shedding post-disease Latent infections

Biosecurity vs. Infection Control

Biosecurity: keep the bugs completely out Infection control: realizing that animals could be carrying infectious agents, but are minimizing effects on other animals Remember: o Infectious diseases are an unavoidable consequence of having horses We cannot eliminate the risk But We can reduce the risk

Preventable Fraction
Those infections that could have been avoided through use of reasonable precautions Non-preventable fraction o Infections that occur despite reasonable precautions

Problem #3
Some horse owners o Dont want to hear about it, dont want to see it, and dont want to talk about it

Scenario #1
Large standardbred yearling sale 264 yearlings sold No vaccination requirements No specific examination of animals at entry Starting 2 days after the sale o 5 dead yearlings presented to OVC for testing o Similar histories Sudden onset of illness Rapid deterioration Fever Neurological signs Recumbency

The Aftermath
Numerous barn-wide outbreaks after bringing home new yearling Multiple horses scratched from OSS Gold Finals because of illness

When you buy a yearling from a sale, what percentage of them do you expect to become sick?
Over 80% o Answer from polled people It is accepted that a certain percentage (quite high) of horses will be affected by infectious diseases

3 Key Principles of Infection Control

1. Decrease exposure o Only way to guarantee that disease will not occur

 Simple Difficult Nearly impossible Actually impossible 2. Decrease susceptibility 3. Increase resistance

Sources of Exposure
Other horses o Resident horses o New horses o Visiting horses o Horses encountered at races/shows Direct contact Indirect contact Food Water Environment People o Vets o Farriers o Caretakers o Paddock officials Equipment Wildlife/insects

Other Horses Influenza Strangles Equine herpesvirus Salmonella MRSA

Wildlife/Insects EPM West Nile virus o Vaccinate in July (West Nile more popular late-summer)

 Food

Rabies

Botulism

Environment People Salmonella MRSA Tetanus Potomac Horse Fever

Susceptibility/Resistance
More o o o o o o susceptible Stress Antibiotics Poor management Poor nutrition Other diseases Age

o Vaccination o Immunostimulants o Probiotics Vaccination is important but infection control vaccination

Vaccination 3rd Line of Defense

Very useful, but.. o Not all vaccines are 100% protective o Some horses may not respond to vaccination as well as others o Some vaccines are designed to reduce severity of disease, not prevent disease o Some vaccines that reduce disease se verity may not impact pathogen shedding Most effective with other infection control measures

Vaccination Programs
Tailored to individual horse and farm o Risk of exposure E.g. tetanus o Risk of severe disease/complications E.g. rabies, EEE o Contact with high-risk animals o Seasons and timing o Risk aversion o Cost

Quarantine and Isolation are Crucial

Isolate as much as possible o Physically o Procedurally o Equipment Monitor health status Consider disease screening o Risk assessment Consider vaccination/deworming Quarantine as long as possible o But be practical/reasonable o Anything is better than nothing Quarantine which horses? o Any new arrival to the barn o Especially horses From sales With unknown disease status From events/farms with infectious disease issues From equine hospitals for Influenza Active/incubating EHV-1 infection Active/incubating strangles infection

Good o o o

Maybe good for o Salmonella o MRSA Not good for o Strangles carriers o Latent EHV-1 infections o Intestinal parasites o Equine infectious anemia o Clostridium difficile

More Ideas on Reducing Exposure

Cohorting o Keep contact with other horses minimal if quarantine is not possible Pest control Mosquito avoidance Hand hygiene Farrier/vet hygiene

Fever = infectious until proven otherwise

Equine influenza Strangles Equine herpesvirus Brewing diarrhea o Salmonella o Clostridium difficile

Disease Monitoring is Not Rocket Science

What easily identifiable signs suggest an infectious disease might be present? o Snotty nose o Diarrhea o Lethargy

o Fever o Anorexia o Cough o Abortion Can help prevent a small problem from becoming a big problem if you do something with the information Syndromic surveillance = monitoring + action plan

Syndromic Surveillance
Easy Cheap Allows quick identification of high risk cases for further action o Isolate o Call the vet

Communication is Key
Things to remember: o o o o Lack of information is fodder for rumours Truth is rarely worse than rumours Never announce a problem without announcing a plan If you are announcing what to do, always explain why as well

How to Handle it
Prompt and aggressive farm-based response o Quarantine and cohort Identify infected and exposed horses Prevent further exposure Buy yourself some time to figure out whats going on o Test Determine whos infected o Communicate Whats the problem? Whats being done?

Why?

Facility Quarantine?
Who can quarantine a facility? o The Federal Government nationally notifiable disease o Province hazard to animal/public health Vague Voluntary response is always better than forced quarantine Better to be overly aggressive at first and then back off vs. Missing the chance to stop a developing problem

Write it Down
Spell o o o out expectations Infection control policies and procedures Reduce confusion Readily available reference

Include infection control procedure and expectations in boarding contracts Cover your ass legally

Compliance is the Hardest Part of Infection Control

Why dont people do what theyre supposed to do? o Inadvertent (forgot) o Non-malicious omission (didnt know) o Unavoidable o Purposeful (lazy)

Cleaning and Disinfection

Clean first, then disinfect o Manure, nasal secretions

Most important for common items o Equipment (tack, twitches) o Stall equipment (wheelbarrows, forks, shovels) o Water troughs and buckets o Areas (crossties, wash stall) Disinfection takes [contact] time

What to Use
Bleach o Very effective against lots of pathogens o Cheap o Deactivated by organic matter o Strong smell Quats (quaternary ammonium compounds) Alternatives o Virkon (corrosive) o Other peroxygen products

What Can I do to Start?

Look o o o o o at your facility with an infection control mindset: Physical layout Horse/people movement Horse mixing Cleaning and disinfection Hygiene

o Veterinary care Consider possible high risk situations o Sales, races, shows

Other Things You Can Do

Develop an infection control plant o What happens when new horses arrive? o What happens when a horse gets sick? o Vaccination program o General hygiene/cleaning

 o Work

Write it all down! with your vet Evaluate disease risks Vaccination program Deworming program

Realize You Cant Do Everything, But You Can Always Do Something

Always better than nothing Dont try to change anything at once (one piece at a time)

Take-Home Messages
Infectious diseases are a fact of life You can reduce the risk o Protect your horses o Protect the horses around you o Identify highest risks Try to only make a few changes at a time o Communicate o Write it down o Work on compliance

Resources
http://www.equineguelph.ca/Tools/biosecurity_2011.php