Monday, April 16, 2018

Spring Horse Health


It is spring time in the Northwest and time to make sure your equine partner is healthy and ready for the adventures you have planned this season.  We are blessed to live in an area that offers boundless wonderful places to enjoy our horses in the great outdoors as well as an active local equine community offering a staggering variety of clinics, lessons, shows and play days to attend with all of your horse crazy friends.   Here is what you need to know about equine health as you plan your events this summer!

Vaccinations

We are so lucky to live in a time when vaccinations can be viewed as superfluous by a great number of the population.  Because of vaccinations we no longer see the deadly diseases that our parents and grand parent’s generations had to endure.  Many of the life-threatening illnesses are rarely seen in this modern world thanks the to technology of vaccinations and preventative medicine.  With that said, there is such a thing as too much of a good thing and the old standard of twice yearly 5-way administration to all horses is no longer appropriate.  Designing your vaccination protocol should take into consideration not only the age and health of the horse to be vaccinated but what that horse’s likely exposure is going to be for the year.  We have the option of combining all of those products into a single shot for those needle shy or difficult to vaccinate horses and we also have the ability to split the products into multiple vaccinations to minimize overloading the immune system at one go.  For many of the respiratory diseases we also have the option of going with an intra-nasal vaccination which further diminishes the introduction of adjuvants into the system.  Here is a brief overview of the vaccinations to consider for your horse.

Core Vaccinations:  These are the vaccines that are recommended annually to all healthy horses regardless of travel or living conditions in the contiguous United States.

Tetanus:  The gold standard back bone of almost all the combo vaccinations.  Tetanus vaccine protects against the toxin produced by clostridium tetani, a bacteria that is prevalent in the soil.  Because this bacterium is ubiquitous and lives for long periods in the soil, our horses are exposed to this disease in their own back yards.  Horses that contract tetanus disease are very likely to die and treatment is rarely effective and always very expensive. 

Eastern/Western Encephalomyelitis:  Often referred to as Sleeping Sickness this disease is spread by mosquitos and biting flies from infected birds to horses. This is two disease types lumped into one category.  These diseases are named according to the areas in which they were first identified and most commonly seen.  There is a third encephalomyelitis in horses called Venezuelan Encephalitis that we do not typically vaccinate for in the US and certainly not in the Northwest.  While this is a disease that a concentrated vaccination program has made fairly rare we do occasionally see cases that pop up in the summer months.  Like most of the other diseases in our core vaccination protocol the mortality for these diseases is very high.  50% mortality rate for WEE and 90% mortality rate for EEE.  This along with tetanus is the backbone of most of the combination vaccinations.  Even horses that do not travel are at some risk for this disease as it is spread by insects traveling from one place to another. 

West Nile Virus:  First identified in the United States in 1999 this disease is a great example of the effectiveness of an active and aggressive vaccination program.  Almost as soon as the cause of this emerging disease was identified, Fort Dodge went to work developing a vaccine to attempt to stem the cases of this deadly virus.  West Nile Virus causes neurologic symptoms and tremors which can progress rapidly to recumbency and once down these horses do not tend to recover.  The mortality rate is reported to be between 30-40% of cases.  In those horses that recover, gait and behavioral abnormalities are often seen 6 months after infection. We have seen both a decrease in disease incident as well as an increased likelihood of survival in our vaccinated population.  West Nile Virus was slowed in it’s spread across the United Stated both by climate and mountains as well as vaccination.   In the Western states we watched in trepidation as this disease marched across the country then after about 10 years when we didn’t see emerging cases people began to stop vaccinating for this disease.  That was about the time we started seeing cases here in the Northwest.  In our practice area we have had several cases of confirmed West Nile Virus in horses.  Three of the confirmed cases that I treated personally happened to survive the disease and one horse succumbed to the paralysis and had to be euthanized.  None of those horses had any history of vaccination.  For some reason, this vaccine gets the most bad press and love or hate social media that seems to be where most if it occurs.  In my own personal history of vaccinating thousands of horses annually since 2002 (my first year in practice the West Nile Virus vaccine was required to be administered by a veterinarian due to conditional licensing.)  I have had only one horse that had what would be considered a moderate reaction characterized by diarrhea and cramping.  He also received a 3 way vaccination and an anthelmintic that day so there isn’t any way to be sure what he reacted to.  Currently the recommendation from the AAEP for vaccination against West Nile Virus in our area is for every adult horse to receive annual boosters prior to the onset of bug season. 

Rabies:  Rabies is also ubiquitous and present in most mammalian species.  Across the United States we see reservoirs of rabies in certain wildlife populations.  In our area the rabies virus seems to be carried by our bat population.  This does not mean that this is the only way to contract rabies, but it is the most likely source of wild rabies.  There is a vaccination for all large animals for this disease.  AAEP currently recommends annual vaccination for adult animals.  Because in the Northwest we see very little wild type rabies and because this is one of the vaccines that in horses seems most likely to cause muscle soreness, our recommendation for horses that are housed in rural parts of North Idaho to be vaccinated every 3 years or every other year, following the protocols commonly used in our small animals.



Risk Based Vaccines:  These are vaccines that you and your veterinarian may deem necessary in order to keep your horse healthy based on his exposure rate to these diseases.

Equine Herpes Virus (Rhionpneumonitis):  There are two types of virus associated with equine herpes in horses.  Equine Herpes Virus Type 1 (EHV 1) and Equine Herpes Virus Type 4 (EHV 4).   Like the common cold, this is a disease that varies quite a bit in severity from individual to individual and circumstance to circumstance.  This can be a subclinical mild fever of 24-48 hour duration which may go unnoticed to more serious cases of lethargy, anorexia, upper respiratory infection and cough.  Most horses will be exposed to EHV 1 during their first weeks or months of life and recover without incident.  Recurrent infections occur when young horses are housed together and entered into competition or training, just like kids passing a cold around when school starts.  EHV1 also is associated with abortion in pregnant mares as well as weak non viable foals and it is in this capacity that most aggressive vaccinations protocols have been implemented in an attempt to reduce viral shedding among pregnant mares.

More recently this virus has been in the news for the wild type mutation of the EHV 1 virus that causes debilitating neurologic disease.  The neurologic form of this viral disease is associated with a much higher mortality rate.  Unfortunately this disease is as easy to spread as our common cold and once it is identified in a population of horses it becomes a biosecurity challenge to control.  Current recommendations are for horses that are in populations in close confines (boarding facilities) competing or traveling to areas where many horses congregate are vaccinated twice annually for EHV.  For some horses competing in USEF events, more frequent vaccination may be recommended.   There is no vaccine available for the neurologic form of this disease.  Our best tool for protecting our populations of horses is to mitigate shedding and passing of the virus among the population leading to increased risk of the formation of the wild type virus. 

Equine Influenza:  This virus is one of the most common infectious diseases identified in the respiratory track of horses.  There are three distinct strains in the equine population in North America.  It is endemic in the equine population and is most commonly spread by infected horses.  Horses are rarely subclinicaly infected but may shed virus before the onset of clinical signs.  This is why quarantine of all new horses entering a population for at least 14 days is recommended to be sure you do not introduce the virus into a new herd.  Like in the human population antigenic drift does occur and as the equine population immunity waxes and wanes new strains of the virus are occasionally identified.  Vaccine companies work hard to make sure their vaccines provide optimum protection for the strains active in the population.  Horses that are traveling and are exposed to other horse populations should be vaccinated every 6 months for equine influenza.

Strangles: Caused by the bacterium Streptococcus equi this disease is an upper respiratory and lymph node infection causing significant fever, lethargy and purulent nasal discharge as well as swelling of the retropharyngeal lymph nodes that may impair breathing (hence the name).   This disease is highly contagious and has a long life in the environment and may be spread from feed bunks, grooming equipment, water tanks etc.   There is a very effective intranasal vaccine for strangles.  Horses that have experienced the disease and recovered have variable immunity but are generally considered protected at that time.  Vaccination of adult horses annually after initial 2 dose vaccination schedule is based on exposure.   We have seen an uptick in Strangles cases in our area in the past few years. 



How do I decide what to vaccinate my horse for?  There are many variables to consider when you are planning your vaccination program with your veterinarian.  Your veterinarian will want to examine the horse to determine if he is healthy and able to be vaccinated.  Horses that are ill, weak, malnourished, struggling with any disease process or have a history of serious vaccine reactions are poor candidates for vaccination.  Vaccinations rely on a healthy immune system to be effective.   Your vet will also want to know all of your plans for your horse for the year and the type of activities you are likely to participate in.  If you are taking part in organized shows or part of a show circuit you may have vaccine requirements that are established by the governing body or show management.  Understanding equine vaccinations and your horse’s risk is an integral part of the Veterinary client patient relationship and helps to ensure your horses are protected to the best of our ability.

What are the risks?  The vaccine’s job is to activate the immune system to recognize the antigen that has been placed in the body.  There is a product called an adjuvant (which for anti-vaccine folks is the major source of contention) that is added to the antigen to flag the immune system.  For some individuals this will cause local muscle soreness and in some cases a transient low grade fever.  Somewhere between 2-5% of horses vaccinated will have some reaction of this type.  The veterinarian and the vaccination company like to be aware of this occurrence rate as we are always trying to maximize protection while minimizing risk for our equine patients.  This is another benefit to using a veterinarian for your vaccinations (besides assuring your horse is healthy and receiving the recommended vaccinations).  If your horse does have a reaction your veterinarian can help guide you through that reaction and ensure that we minimize the risk of a repeat reaction the following year.  Most mild reactions are managed with anti-inflammatories.  Occasionally, we see injection site reactions due to vaccinations.  In over 15 years of vaccinating horses I have had one of these cases from a vaccine I administered and 2 cases from client administered vaccines.    The very worst reaction to the vaccine is anaphylactic shock.  Anaphylaxis is a severe immune reaction to something encountered in the body.  It can occur with vaccines, medications and supplements.  Typically, injectable substances are associated with the most severe cases of anaphylaxis.  This is a very rare occurrence but can be fatal and usually occurs directly after the administration of the vaccine (ie before the vet’s truck is pulling out of your driveway).  



How are vaccines administered?  Almost all equine vaccines are going to be given intramuscularly or intranasally.  Intramuscular vaccines are generally administered in the neck before the shoulder and above the cervical vertebrae.  A 20 g 1 – 1 ½ inch needle is inserted deep into the muscle.  The veterinarian ensures a vein has not been involved in the injection and administers the entire vaccine.  Intramuscular injections may also be given in the pectoral region or the in the back of the hind leg.  The pectoral region is a good place for horses that are needle shy though it is often associated with some dependent swelling.  The back of the leg is a great choice for some of the larger thicker vaccines (such as pneumobort) but can be an inconvenient vaccination placement for many of our patients.  The neck is the safest place for the administration of vaccines. 

The intranasal vaccine has several benefits.  Firstly, it provides excellent immunity for some of our respiratory diseases.  Strangles, Rhino and Flu can all be administered intranasally.  Secondly, it reduces our risk of vaccine reactions from adding adjuvants to the horse’s system.  Thirdly, giving these vaccinations outside of the combination (in a 5-way or similar) allows us to better time vaccination with exposure maximizing immunity.  It is more difficult to administer but as the products and applicators evolve we can teach our patients that this administration is painless if not entirely pleasant. 

What is the minimum I am required to give my horses?  Because the majority of the core vaccination protocol is limited to diseases that are not spread horse to horse and do not pose a risk to the general population other than to your own individual horse, the choice to vaccinate against these potentially deadly diseases is entirely your own as long as you understand the risk that if your horse were to contract any of these diseases his risk of death is high with West Nile Virus having the highest percentage of survivability at 2/3 of the horses that contract the disease surviving.  If I were to choose just one of the core vaccinations to administer to my horses it would be tetanus.  Tetanus is everywhere and once contracted is almost impossible to treat.  If your horses are isolated and stay home and do not commingle with other horses they are not endangering the equine population.  However, if you take your horse to events and gatherings of horse people where they are within 14 feet of each other, stabling overnight or sharing a water source, it is your responsibility to help to ensure the health of the equine population at large by vaccinating your horse for the respiratory viruses.  One unvaccinated horse shedding virus and entering into a population of horses can cause an outbreak of a disease that can derail the equine activities in that area forcing closure of barns, cancellation of events and at worse, the death of other horses.  You do not have to inject your horse with anything if you are opposed to the practice, but please, for the sake of my patients, my own horses, my friends horses and my fellow competitors out there, administer at least an intranasal flu vaccine prior to going out with your horse. 

What about titers?  “Titers” refers to a test that measures levels of protective antibodies in the horses blood and estimates their protectivity to certain diseases.  Titers are currently available for many of our common disease including West Nile Virus, Strangles, Rhino and Influenza.  Unfortunately we do not currently have good population data that is conclusive as to what levels of titers in the blood are considered protective.  So, for a horse that has vaccination reactions, especially serious ones, running titers may give us some information about that horse’s immune status and at least give a sense of comfort as to the choice not to vaccinate.  I believe as we move into the future these titers will become better understood and more readily available so that we can better adapt our vaccination protocols for maximum benefit.  Just as our deworming protocols have changed and the frequency and ease of fecal egg counts have increased, titers are likely to be tool of the future.   



Traveling

In the state of Idaho we are required by law to have a current brand inspection on any horse in our possession.  This is especially important when traveling with our horses.  In addition to this requirement, the majority of the neighboring states also require either a health certificate or a current coggins test or both depending on the state of destination. 

What is Coggins?   Coggins is a blood test for Equine Infectious Anemia.  This is a debilitating and sometimes life threatening disease that was first recognized in the early part of the 20th century.  Because the disease causes untreatable anemia it can severely impact the performance of the animal.  In an attempt to stem the spread of the disease the federally regulated testing was implemented in the 1970’s using a test developed by Dr. Leroy Coggins.  Equine infectious Anemia is spread in the population from infected horses which may or may not be showing signs of disease by biting horse flies.  Currently the incidence rate in the United States is fairly low but we do see pockets of the disease appear in populations from time to time.  Recently there was a herd of infected horses in the Gallatin Gateway area of Montana. 

You are required to have a negative Coggins within either 6 months or 12 months of entry into a state and the requirement varies quite a bit from state to state.  You can research the state requirements yourself by visiting the APHIS website https://www.aphis.usda.gov/aphis/ourfocus/importexport 

For Washington, Oregon and Montana we can issue a joint health and Coggins that is good for 6 months.  Each state requires an individual permit number and Montana requires a few extra steps and a 5$ fee/horse as well as notification or travel into the state. 

It is not unusual for events or facilities to require negative Coggins from horses prior to an event even if the horses are in state.  Plan ahead for your travel and be sure you have your paperwork in order well before your departure date.  I don’t know about other vets, but I’m sure I’ve lost years of my life stressing about other folk’s emergency travel papers on Friday evenings before a Saturday departure.  There is no reason not to plan ahead for those events.  Your veterinarian will thank you.

That sums up the needs for horses that will be hitting the road with their adventurous owners this season.  Stay tuned for another installment about biosecurity and minimizing your horse’s exposure to the disease that are out there ready to put a serious damper on your summer of fun!