The question that is on the mind of many dog owners right now is what is this mysterious respiratory illness that is spreading across the country and why don’t we have an answer yet? The simple answer is - that it’s a COMPLEX problem! The truth is that we OFTEN do not know the exact name of the respiratory infections.
If clients bring their pets in for a respiratory virus, they often wait until we are very sick and not getting better, and by then the picture changes. There are more infectious organisms involved and we don’t know which one started it or which one is most problematic. Buckle up my friends, this will be a long explanation, but judging from the number of questions I am answering about this right now, I think a long explanation is necessary.
As a veterinarian, I see infectious coughing dogs nearly every day. Outbreaks are not that unusual. Since coughs are spread by aerosolized respiratory droplets they can spread RAPIDLY making respiratory outbreaks more common. Especially in a kennel where the dogs are barking. The force of the air in a loud bark causes the droplet to travel further. But, you don’t have to be in a kennel to catch an infectious cough! I wish more people understood this.
It's a Syndrome, not one disease
Canine Infectious Respiratory Disease Complex (CIRDC) is a syndrome of diseases caused by several different bacterial and viral pathogens that mostly affect the upper airways like the trachea and larger airways in the lungs. We call it collectively Kennel Cough but it is not limited to kennels. "Kennel cough" is an Upper Respiratory Infection of the large airways and it has been around forever. Sometimes it turns into pneumonia (lung infection) which is more serious. But again – this is not new.
Viruses are constantly evolving and antibiotic resistance is a constant worry for medical professionals. Respiratory infections causing cough and pneumonia are as old as veterinary medicine itself even if they are slightly changed. This topic is old news to veterinary professionals but new to pet owners so I want to give you the scoop.
What is happening is most likely called an Outbreak.
Veterinarians believe they are seeing more cases of CRID. Some veterinarians are reporting their patients are staying sick longer than expected with typical Kennel Cough and there have been more cases of acute pneumonia. The veterinary community is asking for more sick patients to be tested so we can know if there is something new going around or if there are just more of the known pathogens. Outbreaks are not necessarily a new thing. The public often never hears about them.
I remember a couple of novel viral outbreaks in my career and here is what happened behind the scenes. Veterinary diagnostic laboratories, State, University, and Local veterinarians worked together to identify and treat the new strain of a virus. And the public knew very little about it. We didn't even give these viruses new names, just a new number on the end of the name of the virus. For example, the strain of Canine Influenza H3N8 was discovered in 2004. Today this strain is included in the Canine Flu Vaccine. Did you know that there are actually four stains of Parvovirus? It's okay, your vet knows.
Right now, veterinarians are not sure if there is a new strain of virus, or if a bacteria has developed a resistant property, or if there is simply an increase in the number of cases around. The reason we aren't sure about this is because we need more testing. When we test, we might find multiple organisms or none, depending on when we test. Let me explain.
It's like Ocean's Eleven with pathogens!
These infections OFTEN OCCUR AS CO-INFECTIONS. More than one pathogen is involved. Pathogens are opportunistic. One infection may cause the immune system to be weakened – the natural defenses of the respiratory tract are overwhelmed and another pathogen joins the party.
Think of it like a gang of criminals attacking a neighborhood, some hack the security system (the immune system), and others climb over the fence. If we remove the ones who attack the security system, the others can’t get over the fence. So sometimes antibiotics help kennel cough but they don’t completely resolve the disease. The immune system does that when given enough time.
Testing Who, What, When, Where - Why testing is problematic.
Who needs to be tested?
Dogs with a respiratory infection. Healthy dogs may have an organism in their throat but that doesn't mean much so routine screening is meaningless. Before an outbreak is obvious, many dogs who have an infectious cough will get better before a test is returned. Testing is usually reserved for cases that seem unusual. During an outbreak, vets will recommend testing more often in routine cases but that still doesn't mean we always get an answer.
What to test? The Big Four
We may already know what this disease is called but it is pretty difficult to prove. There are at least 11 known canine respiratory pathogens which means the respiratory panel is a little pricey and has to be timed perfectly. Shelter vets say certain pathogens are most important to consider in an outbreak but we should not ignore the rest. These are the most common organisms to cause outbreaks in groups of dogs.
Canine Distemper - causes a severe disease but most of our pets are vaccinated against this with the "Distemper/ Parvo" combo vaccine and is therefore less common.
Pneumovirus – this virus is capable of causing large outbreaks among dogs in close-proximity like shelters but is usually self-limiting.
Influenza - there are multiple strains and we know that the strain H3N2 currently active in South Carolina and Georgia.
Streptococcus Zooepidemicus - this bacteria is capable of causing pneumonia and can cause severe and sometimes fatal pneumonia and might cause dogs to cough up blood.
When to test?
We have to test patients in THE FIRST 3 DAYS of infection for the test to be accurate. This means the timing of the test is likely the biggest barrier to effective testing. We have to get the organism on a swab to test it and the organism moves! The infections start in the nose, go to the throat then travel down to the lungs. We can swab the nose or throat but we can't swab the lungs. Because infections start with subtle clinical signs, like lethargy or inappetence, the window of opportunity is fleeting. Most clients don’t bring their dog to the vet the minute it they hesitate to eat and I don’t blame them. A test on day 7 may be negative for 10 organisms doesn't really mean that the infection is any more mysterious than respiratory disease always is - it might just mean we didn't test in time.
Where to collect a sample to test?
The technique is critical for a respiratory test. If a vet has an opportunity to test a dog early in the infection, you have to swab its nose. Did you ever have a COVID test done at the doctor or health center? It felt like they swabbed your brain right? Have you ever tried to stick something up your dog’s nose? I give the activity zero stars - they hate it as much as we do but vets get it done!
In order to solve the mystery illness, we need to TEST and test correctly. That means we TEST the RIGHT DOG at the RIGHT TIME with the RIGHT TEST with the RIGHT TECHNIQUE. Easier said than done!
Now I know this is a lot more information that I would normally share with clients. It's plain scary and a bit overwhelming. My infectious disease class was not for the faint of heart! But here is the most important thing I learned in my class, your pet's immune system kills most of what attacks them before they can even get sick! And we can boost their immune system by vaccinating them!
An ounce of prevention is worth a pound of cure!
Vaccines
Why vaccinate when we don't know what this infection might be? Remember the part about there being Co-Infections? Because respiratory tract infections are a Big Party for the bad guys! Don't miss a chance to protect your pet's security system (the immune system). There are vaccines for common respiratory infections like Distemper, Bordetella, Adenovirus (2) and Influenza. These are HIGHLY recommended!
DHPPV / Distemper Vaccine - Distemper is included in the 5 in 1 vaccine with Adenovirus, Parainfluenza (types 1 and 2) and Parvovirus. This is given several times to puppies and then every 1 to 3 years.
Kennel Cough Vaccine - Many people are familiar with the Kennel Cough Vaccine which includes these vaccines: Bordetella bronchiseptica, Adenovirus- 2 and Parainfluenza which are three pathogens that can cause an infectious cough. We vaccinate annually but with dogs who are "high-risk", every 6 months is best. People might believe that this vaccine is only necessary for dogs that go to a boarding facility, training classes, grooming facilities or dog parks but here is something to remember - respiratory diseases are spread not only directly from dog to dog but also from human hands to other dogs. By touching a dog with a respiratory infection, we can spread it to another dog and who can resist petting a dog?
Flu Vaccine- A less common respiratory vaccine is Influenza and again it is usually recommended for dogs who are "high risk" and visit a groomer or boarding facility often.
How can I reduce my dog's risk of getting an infection?
Avoid Risky Situations
There are high-risk situations wherever dogs gather and go "nose to nose" such as training classes, dog parks, shelters, boarding facilities, grooming salons and even crowded veterinary waiting rooms. With the holiday season, more Americans are traveling with, boarding, or having their pets groomed for family gatherings.
For dog parks, grooming salons, and boarding facilities, only choose facilities with a vaccine policy. If you can use a pet sitter in your home, that is best. Unnecessary play dates are not advised.
When you must take your dog around another dog, check to make sure that both dogs are healthy, vaccinated, and have not recently been in a high-risk environment. If your dog is slightly lethargic or skipped a meal, stay home (or call your vet!)
Remember that dogs don't have to seem sick to spread disease too. You should wait a few days after taking your dog to a dog-park before allowing them to be around other dogs, especially high-risk individuals.
Some dogs are high-risk individuals.
Every respiratory infection is not the same for every pet. Some pets are naturally more susceptible to respiratory disease. French Bulldogs, English Bulldogs, Pugs, are called Brachycephalic breeds. They have short noses, narrowed nostrils, and long soft palates. They have a harder time clearing a respiratory infection and often get pneumonia when they are faced with CRID. Elderly and immunosuppressed animals such as dogs with Cushing's disease or Diabetes are also high risk. If you own a high risk dog, be extra diligent and protect them.
To be fair, during an outbreak of a respiratory disease, I assume that all of my canine patients are at a higher risk and recommend caution and vaccination. We have no reason to believe that any other species is involved. This is a dog-only concern. Be aware that we can spread the infection with our hands to other dogs. And who can resist petting a dog?
What if they do get sick? How do we treat these dogs?
We are not helpless! Specific treatments depend on specific clinical factors but here are the cliff notes:
For viruses, supportive care plays a big role. Antivirals are not as useful as antibiotics overall. Mostly, canine respiratory infections are treated just like we treat a cold for ourselves. I can hear my Mom telling me - "Stay hydrated, eat something warm and soothing" And that is sound advice. I will also add, "Take the antibiotics".
For bacterial infections, antibiotics are important. We don't just grab the strongest antibiotic on the shelf because we don't want to cause antibiotic resistance. If the first line of antibiotics are not working or if our patient is suddenly extremely sick, then we might choose a stronger drug.
We’ve got this!
Veterinarians are talking to each other, they are urging caution, but they are not panicking. We treat pneumonia and upper respiratory infections every single day and we use more than just antibiotics. We use treatments like nebulization, IV fluids, Cerenia, coupage, oxygen, bronchodilators, or steroids. By testing more dogs earlier in the process and vaccinating our patients, we are doing more for the community of dog owners than it might seem.
As for solving the mystery, realistically we may never solve it, it might just go away.
Respiratory outbreaks often slow down on their own! Sometimes, respiratory outbreaks go away before we have enough data to name them. Last year, there were several reports of a severe respiratory infection and I am not sure we got to the bottom of it. Maybe this is a resurgence. It is nearly impossible to answer that question. It takes time to discover novel diseases because of all the problems outlined here.
Maybe a novel strain of Flu or an antibiotic-resistant-Streptococcus will be discovered, or maybe it will remain a mystery. I remember several years of GI outbreaks that seemed unusual but no new disease was discovered and it just kind of quieted down. Since we are already seeing fewer cases in the western states, it is possible that this outbreak will soon slow down.
Locally here in the Greater Jacksonville, Florida area my colleagues and I think we are seeing fewer cases this past week. Thanksgiving weekend did not bring any new respiratory cases to the ER and I consider that a big win! With the holidays around the corner, I hope dog owners will stay diligent and we won't have another resurgence. By spreading the word in the media, we can spread awareness - not fear - and we can slow the spread of canine infectious respiratory disease.
To summarize:
Don't take unnecessary risks
Vaccinate your dogs
Get medical attention earlier than later
Submit to testing if your vet recommends it
Give the antibiotics as directed if prescribed
If we all do these things then there is no reason to worry that our dogs will have the experience we did in 2020. No "mask policy", "remote play dates" or a need to pass a respiratory test before being allowed in the dog park.
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