In severely affected cases, resolution of the radiographic lesions and hypoxia may be slow. Often, these animals require several days of hospitalization. Decisions about the duration of hospitalization should be based on the clinical status of the dog, and not laboratory or radiographic findings. Moderate to severe hypoxia may persist in some of these dogs for prolonged
periods, but may not be clinically important if the dog is feeling well and not in respiratory distress. If the dog is active, eating well and breathing comfortably on room air, they may be ready for discharge even if their pulse oximetry and arterial blood gases are still low. 3
TREATMENT: LOGISTICAL CONSIDERATIONS
● Wear gowns, booties and gloves during the physical exam. ● Wash hands and clean stethoscope (with alcohol) after exam. In areas that are experiencing an active outbreak, some veterinarians have set up an outdoor treatment facility in their parking lot to keep canine influenza cases out of the clinics. These clinics will frequently set up a tent in their parking lot, away from a door, and see all possible canine influenza cases in that tent during a certain time of the day. If there is an adequate caseload and it is feasible to do so, dedicated staff can be used to work this ‘flu clinic’ and then be sent home when the day’s cases are completed. If not, any staff member that works in the outdoors ‘flu clinic’ should wear protective clothing as described above and dispose of that clothing before entering the hospital. their dog’s contact with cats in the home and that owners take care to wash their hands and any other objects that may serve as fomites. 21 Canine influenza H3N8 has not been shown to be capable of infecting birds, but at this time it is unknown whether H3N2 may be able to infect pet birds or poultry; therefore, owners should also be warned that there is a potential risk so that they can make an educated decision on whether to keep their dog away from any birds in the home. 21 Finally, although dog-to-ferret spread has not been documented in the United States, owners should also be warned that ferrets can be infected experimentally, 4 and therefore they may also wish to keep their dog away from pet ferrets. cleaning measures, the virus may persist in the environment for approximately 48 hours, and remain viable on hands and clothing for up to 24 hours. 12 Once detected, cases of canine influenza should also be reported to local veterinary medical associations and authorities, as appropriate. Only a small number of states mandate reporting of canine influenza cases, but local veterinary medical associations typically distribute information about canine influenza cases even when there is no formal requirement to do so. 4
Due to the highly contagious nature of canine influenza, there are a number of important considerations when treating dogs who may be potentially infected with this disease. Sick and exposed dogs must be isolated and biosecurity measures must be utilized for any staff that may be providing care for these dogs. Recommended steps for examining dogs who may have canine influenza include: 3 ● Schedule dogs with potential influenza (coughing dogs with a history of possible exposure or high-risk lifestyle) for late in the day. ● Encourage the owner to wait with their dog in the car, instead of in the waiting room. ● Bring the dog into the hospital through a separate entrance. ● Examine in a “quarantine” room, which should not be used for other dogs until thoroughly cleaned. Mild cases: Isolation at home Dogs with suspected influenza who are sent home with their owners should be isolated from the healthy dog population for a minimum of 2 weeks. It is especially important that these dogs avoid boarding kennels, grooming and doggie daycare, for a number of reason. First, these dogs may be contagious for up to 2 weeks (especially if steroids were administered at any time during their treatment, as they sometimes are in cases of cough). Second, these dogs will be prone to secondary infection due to impaired mucociliary clearance and therefore their exposure to potential pathogens should be limited. While there is no documented transfer of influenza H3N2 from dogs to cats in a normal household setting or in the United States, it is prudent to suggest that owners may wish to limit Severe cases: Isolation in a hospital setting Hospitalization of dogs with influenza requires a quarantined room with a separate air supply. Additionally, the staff members who provide care for infected dogs should avoid working with other dogs for the remainder of the day. 3 Cleaning of the areas that have been utilized for dogs with can be performed using any common disinfectant. Quaternary ammonium compounds (e.g., benzalkonium chloride – Lysol™), aldehydes, phenols and bleach solutions all show excellent efficacy at killing influenza viruses. 12 Protocols should be established for thoroughly cleaning and disinfecting cages, bowls and other surfaces between uses. Without adequate
PREVENTION
Perhaps the biggest question on the minds of many veterinarians, and their clients, is this: How can I prevent canine influenza? Many clients are understandably concerned about this virus, and therefore veterinarians receive frequent questions about vaccination and other measures to prevent canine influenza infection. As of October 2015, there are two available vaccines marketed for protection against the H3N8 strain of canine influenza. Both of these vaccines were developed in 2009, as H3N8 moved out of the racing greyhound population and became more of a concern in pet dogs. 12 The Nobivac™ Canine Flu H3N8 vaccine 22 is marketed by Merck Animal Health and the Vanguard™ Canine Influenza Virus vaccine 23 is marketed by Zoetis. These killed vaccines will both produce non-sterilizing immunity; in other words, neither vaccine will prevent canine influenza infection but instead will reduce the incidence and severity of lung lesions, as well as the duration of coughing and viral shedding. 3
The Nobivac™ Canine Flu H3N8 vaccine is licensed for use in healthy dogs older than 6 weeks of age, 22 and the Vanguard™ Canine Influenza Virus vaccine is licensed for use in healthy dogs older than 8 weeks of age. 23 Each of these subcutaneous vaccines requires two doses to be administered 2 to 4 weeks apart, followed by yearly revaccination. The H3N8 canine influenza vaccine is recommended for all high-risk dogs (e.g., example dogs that spend time at boarding facilities, dog shows, or doggie daycare). Unfortunately, most experts believe that these H3N8 vaccines offer little to no cross-protection against the H3N2 strain that is involved in current publicized canine influenza outbreaks.9 According to Dr. Alice Wolf, a board-certified internist with a special interest in infectious disease “It’s a very different strain. That is why the H3N8 test did not detect it. If the antibody did not cross react on the test, it’s not going to cross react in the dog.” 10 Although there is not yet a commercially-available
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