Equine Infection Control Management
Editor's Note: This article is part of TheHorse.com's ongoing coverage of topics presented at the 9th International Conference on Equine Infectious Diseases, held Oct. 21-26 in Lexington, Ky.
Equine veterinarians are not just for giving shots, performing exams, and addressing disease and lameness. These individuals are also uniquely equipped to tailor infectious disease prevention programs, noted one biosecurity-focused researcher at the 9th International Conference on Equine Infectious Diseases.
Boarding farms, training facilities, veterinary practices, and even small private horse farms can benefit from these programs; it's simply a matter of veterinarians letting clients know these services are available, said Josie Traub-Dargatz, DVM, MS, Dipl. ACVIM, a professor in the population health section of the Department of Clinical Sciences at Colorado State University's College of Veterinary Medicine & Biomedical Sciences. She described advantages of providing infectious disease prevention consultations during the conference Practitioners' Day, held Oct. 21 in Lexington, Ky.
Most physicians, like many veterinarians, don't consider themselves "infection preventionists," she explained; rather, they label themselves as health care providers, diagnosticians, and caregivers to individual patients. "As a veterinarian, we haven't lost the ability to be all of these things," she said.
In other words, in addition to providing traditional services, veterinarians can also tailor the preventive and intervention plans for a farm's or event's population of horses. They do this by not only recommending vaccinations but also advising on other aspects of biosecurity (e.g., early detection of disease if it occurs, reducing exposure risk).
She listed several scenarios where veterinarians can step in with these services:
Ramifications of Outbreaks
Farms and facilities should adopt such prevention programs for a variety of reasons, she noted. Patient suffering and loss of use due to disease motivate many farms to establish prevention programs, and treatments cost money, take time, and can cause horses distress.
"I don't think we stress (the latter part) enough, some horses become adverse to getting oral medications or injections" she said, in addition there could be adverse reactions to drugs, such as diarrhea, or promoting antibiotic resistance in pathogens.
Additionally, certain pathogens can persist in horses and even after recovery there might be restrictions on how horses can be used because of this. And operations can lose business due to real or perceived concerns about infectious disease risks. "The social media age results in more rapid and broader distribution of information, not all of which is factual," she added.
As for an outbreak's impact specifically on equine events, stopped horse movement can mean horses could be stranded at the event facility. This impacts the next event held there (due to the inability to hold the show/house new horses), along with other events to which the horses would be shipping (due to sparse attendance and/or concern about exposure). Traub-Dargatz also noted that tracing exposed horses that have already left the facility can be quite challenging and time-consuming; a control program can help mitigate these risks.
Designing the Program
An infection control program's components depend on the facility it is designed for and the lifestyles of the horses residing there. For example, a control program for isolated horses on a ranch will be different than one for horses traveling to events or horses involved in a breeding program.
What should veterinarians include in this control program?
"The first answer is generally vaccination," said Traub-Dargatz. "It's one of the tools that needs to be tailored to the individual horse and equine operation by the veterinarian. But clients need to understand that vaccination is not enough. It's important to include vaccination, but get the point across that it's not a comprehensive infectious disease control program ... some diseases don't have (associated) vaccines."
Ideally, the veterinarian will conduct an infection control program evaluation by walking through the facility with the owner/manager and identifying all the ways horses could be exposed to disease. These risks include:
She recommended that the veterinarian providing the infection control services follow horses as they move through the facility, paying special attention to the arrival and departure areas/protocols, stabling, water sources, and alternate interpretations of what managers have described as their infection control techniques. For instance, when an event organizer cites a facility as having "separate pens" for horses, he or she might be thinking of injury--not infection--prevention. Yes, the horses might be separated and unable to injure one another, but they still share an air space and/or can touch noses and spread disease.
Following human traffic patterns isn't such a bad idea, either, Traub-Dargatz said. During one disease outbreak at a racing facility she recalled hearing that trainers from several barns (buildings designated as infected and noninfected) congregating after morning works and having coffee in one of the quarantined barns, as they thought the movement restriction was just for the horses.
Another facility had quarantined all "horses," but racetrack "ponies" (mounts used to lead racehorses out to the track) were coming and going from infected barns and potentially mingling with healthy horses. The trainers did not understand the movement restriction applied to the ponies as well as the racehorses. These points illustrate that addressing the details is very important when designing a control program.
It's also important that the veterinarian interviews the people who provide hands-on care for the horses--not just the facility manager--about care practices. "Getting the details related to the process is really important, and you only get that when you talk to the personnel that are closest to the horse," she explained.
Based on the "walkabout," a veterinarian can build a report based on going through a checklist for each farm or facility and illustrate it with photographs, incorporating that into a tailored plan. He or she should review the report with the facility manager and work on a timeline for implementation of procedures, because they might not be able to adopt all the methods at once. The facility manager also must make a cost-benefit decision on what procedures they'll adopt based on risk-aversion.
Modeling Biosecurity Measures
Meanwhile, the best thing the veterinarian can do is set a good hygiene example. Veterinarians should practice good hand hygiene between groups of horses, change into clean clothes and footwear ("Per visit is optimal, but at least have them be clean for the day. And some farms may want you to sanitize your footwear," she said.), and clean their equipment and vehicles. Steering wheels, handles of veterinary boxes, and foot mats can be some of the culprits for spreading disease if veterinarians are not careful.
"Be prepared," she urged the veterinarians. "If you're 30 miles out and you are called to examine an infectious/contagious disease case, would you be prepared to implement barrier precautions, such as disposable outer material to protect your clothes or footwear?"
Ultimately, practitioners must promote themselves as sources of information about infectious disease control, remembering that good disease prevention and control also means good business for the veterinarian; a lockdown on horse movement and events means reduced income for a practice.
"Despite best-laid plans in high-risk groups of horses, infectious/contagious disease will occur," she reminded the veterinarians. So keep the following in mind. "I don't think we can avoid all of (the disease outbreaks). But can we reduce the risk and can we be prepared with an action plan should disease occur?"
Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.
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