It seemed like a normal day, but then, the first day of an outbreak always does. Mr. McGregor was calling first thing in the morning, concerned that his dog was eating rabbit feces again; a kind owner had brought in cupcakes which had about a 0.3% chance of still being present in the break room after 9 am; the lead nurse in charge of inventory was grumbling about the excessive numbers of delivery boxes in the hallway; and, oh, a 10 am coughing dog appointment was just added to the schedule. The dog had just come home from boarding at a local boarding facility and seemed a bit under the weather. That was, in and of itself, not unusual. What was unusual was when said coughing dog presented emergently at 9:15 am, cyanotic, frantic owner in tow, and ultimately required a sedative and oxygen support to get him stabilized. Thoracic radiographs revealed a concerning alveolar pattern. Given the history, infectious pneumonia was the top differential. Over the coming days, more and more dogs with both greater and lesser severity of clinical signs presented to your clinic. The tearful owners looked you in the eye and said, “How could this happen?”
Indeed, how DOES this happen? Is it a fluke? Bad karma? The inevitable cycles of health and disease? Of the three, the last is closest to the truth in that these outbreaks of respiratory disease tend to be cyclic and inevitable. They are inevitable in the same way that summer housecleaning plans get derailed by weekend after weekend of social engagements, and for much the same reason. Our pets, like us, are social creatures. They want to be where the people (and pets) are! The catch is that our pets cannot appreciate the risk posed by these extensive social interactions, whereas humans, with our new appreciation for the myriad ways in which respiratory disease can be easily transmitted, are rather more on the lookout for these risks than we have been previously.
However, where I believe a disconnect often occurs for pet owners is in realizing that their pets are susceptible to nearly all of the same types of health ailments that humans are. Imagine the following scenario. You’re in a social situation and someone finds out that you are a veterinarian. “Oh!”, they exclaim. “Did you know that dogs can get seizures too? Just like people?!?” We’ve all been there. But it’s important to realize that this same element of shock and awe applies to the concept that respiratory disease is highly contagious and prevalent in dogs as it is in humans. As an example, owners are often not aware that prior to the advent of widespread vaccination, canine parainfluenza could be isolated from as much as 50% of dogs housed in close social situations who were displaying clinical signs of infectious canine respiratory disease.1 This lack of awareness for the risks of canine parainfluenza can lead owners to underestimate the importance of vaccination for not only parainfluenza, but also other members of the canine infectious respiratory disease complex (CIRDC), if they have awareness that CIRDC exists at all.
Failure to be informed about the risks and subsequent failure to pursue vaccination leads to pockets of higher prevalence, as was demonstrated in a recent study in Georgia showing canine parainfluenza to be the most prevalent infectious agent identified in their samples.2 It’s a vicious cycle. And unlike humans, who have nightly news reports elaborating on the most up-to-date facts and figures of SARS-CoV-2 with descriptions of the at-risk populations, pets don’t have a daily column headline devoted to detailed accounts of local infectious respiratory disease outbreaks. Owners aren’t confronted regularly with pictures of hospitalized puppies in oxygen cages, or videos displaying incessant paroxysmal coughing keeping the pup (and everyone else in the house) awake all night.
Which begs the question, how can we talk to owners over the course of an oh-so-short wellness visit so that they are willing, nay, eager to learn about infectious respiratory disease and have their pets as protected as possible? This represents a real challenge for veterinarians who have ever more “need to know” items to communicate comprehensively. You are simultaneously performing a thorough physical exam, avoiding Fluffy’s teeth (“He’s not growling at you, he’s just talking and smiling!”), and acknowledging the owner’s running commentary during your cardiothoracic auscultation that, yes, it really is astonishing how “fluffy” Fluffy has become. All this while trying to communicate everything the owner needs to know. That said, if there were ever a group of individuals who are up to the task, it’s veterinarians – the champions of more-than-one-species doctors.
It never hurts to have a game plan though, and I find there are a number of successful communication strategies that can help to get this message across in an engaging manner. For one thing, we all know that infectious respiratory disease is highly contagious, but do you know what else is highly contagious? Enthusiasm! Simply being excited to share with the owners what you know about the world of veterinary medicine is highly compelling. This excitement can take the form of “fun facts” of respiratory disease delivered as a segue from learning more about how a pet spends its day.
For example, you ask Mr. McGregor—owner of the rabbit-feces-eating dog—how Flopsy spends her day when she is not consuming rabbit feces, and he enthusiastically responds that she loves going to the local coffee shop with him every morning to meet all their friends, who also bring their dogs. “How wonderful,” you reply as you begin your physical exam looking deep into Flopsy’s eyes. “In that case, we need to make sure that Flopsy is up-to-date on her infectious respiratory disease vaccines. Did you know,” (this delivered in your best Tuesday Night Bar Trivia voice), “that canine parainfluenza is a highly infectious respiratory virus of dogs, and that it works by damaging the cells lining Flopsy’s windpipe?3 It is one sneaky and infectious virus! Don’t worry though—we have multiple options to protect Flopsy from canine parainfluenza and other viral and bacterial causes of CIRDC which she could encounter at her daily social obligations.” By this time, your physical exam has moved through an oral exam, aural exam, and multiple peripheral lymph nodes, and you can pause to let that information sink in while you listen to the heart and lungs. As you look up from listening to the lungs, “Flopsy’s lungs sound great! You know that canine parainfluenza virus I mentioned usually doesn’t get way down into the lungs, but it’s rather like a gateway virus, making it easy for other infectious agents to get into the lungs and cause a problem.”1-3
At this point, you pause as you examine Flopsy’s coat and look for ectoparasites. “Hey!”, you say excitedly, “Wanna know something cool about how the vaccines work to keep Flopsy safe?” Okay, maybe you don’t use the word “cool.” This author might be dating herself. Regardless, you go on to say, “Many vaccines are given as injections to create antibodies in the bloodstream. But infectious respiratory viruses get breathed in or land in the nose or in the mouth, so the antibodies to protect pets need to be present on those surfaces and not just in the blood. That’s why for respiratory disease we like to use vaccines that are given in the nose or in the mouth. It’s like setting up sticky fly paper to catch those infectious diseases before they have a chance to cause trouble.”4 This is a win-win situation. The owner has fascinating new trivia for his next party along with a convenient analogy to use, and you get to display some of your fancy veterinary knowledge that you have worked so hard to learn.
Now this conversation was all going along swimmingly, but at this last, Mr. McGregor stops you short. “Unh uh,” he says emphatically. “No way is Flopsy going to let you put something up her nose. She’s a delicate flower.” Flopsy looks at you sideways, affirming this statement, even as she breathes her slightly rabbit-scented breath in your direction. Delicate flower indeed. “Don’t worry, Flopsy,” you say directly to the suspicious canine. “If you don’t want anything to go into your nose, we can still get you covered with a comprehensive mucosal vaccine that is effective for vaccination against Bordetella bronchiseptica and canine parainfluenza virus. We can use Nobivac® IntraTrac® Oral BbPi, which involves a quick gentle mist into the back of your mouth using the Immuno-Mist-R™ applicator and is the only oral vaccine that will protect against both of these respiratory disease threats. You will be all safe and ready for your daily coffee meet-and-greets without having anything come anywhere near your delicate nose.” Flopsy receives this information with the relative diffidence innate to a rabbit-feces-consuming dog, but Mr. McGregor looks pleased. “Hey, that sounds a lot like a breath mist! Does it freshen her breath too?” he asks, hopefully. Sadly, it does not, but hey, at least Mr. McGregor just gave you a great lead-in to discuss dental disease and a much-needed cleaning for Flopsy!
By being enthusiastic about the science that I can teach owners, finding good analogies that help them to grasp the concept firmly, and allowing what they tell me about their pets to lead the conversation, I find I can cover a remarkable number of topics during a physical exam. At least when it comes to CIRDC, it’s the rare pet who doesn’t find him or herself exposed to these pathogens on a weekly, if not daily, basis. With more owners informed about the risks, and more pets protected with vaccination that is comprehensive and low stress for both owners and pets alike, we can make stories of respiratory disease outbreaks less of an inevitable cycle and more of a rare occurrence. We can help owners to feel confident that they are doing the best for their pets, and we can ultimately spend more time on the numerous other things claiming our veterinary attention. Like keeping up with the literature, fitting in all those drop-offs, or, oh yeah, claiming at least one of those cupcakes before 9 am!
- Reagan KL, Sykes JE. Canine Infectious Respiratory Disease. Vet Clin North Am Small Anim Pract 2020;50:405-418.
- Maboni G, Seguel M, Lorton A, et al. Canine infectious respiratory disease: New insights into the etiology and epidemiology of associated pathogens. PLoS One 2019;14:e0215817.
- Ellis JA, Krakowka GS. A review of canine parainfluenza virus infection in dogs. J Am Vet Med Assoc 2012;240:273-284.
- Ellis JA. Canine IgA and IgA deficiency: Implications for immunization against respiratory pathogens. Can Vet J 2019;60:1305-1311.