Communicating vaccine benefit and risk - lessons from the medical field

The childhood immunisation programme in England aims to achieve and maintain high vaccine coverage so that no child needlessly suffers from a vaccine preventable disease. As part of the programme, parents must have appropriate support from health professionals and have information available to them to make informed decisions about their choices. Even though immunisation is voluntary in England, coverage is generally high. It has been estimated that only 0.33% of parents do not consent to their child being included in a computerised database that schedules immunisation appointments. Parental attitudes, experiences and social grade are influential in determining whether a child receives a vaccine. Personal experience and knowledge of diseases influence parental perceptions about the seriousness of diseases and their likelihood of being affected by it. In societies where immunisation programmes have been successful, the challenge is maintaining high levels of vaccine coverage. In the absence of disease, the threat of that disease rapidly disappears and anxieties about the vaccine's safety may increase. A fall in vaccine coverage can lead to the return of disease as happened in the UK when rates of pertussis immunisation plummeted in the 1970s. Further perceived threats may also affect vaccine uptake, for example, the MMR controversy dating from 1998. The article outlines the MMR debate in the UK, the communication of risk and benefit and the management of information to the public. It will share lessons learned and examine how they might apply to the veterinary programme.     

Nd:YAG laser-assisted modified Forssell's procedure for treatment of cribbing (crib-biting) in horses

OBJECTIVE: To report an neodymium:yttrium-aluminum garnet (Nd:YAG) laser-assisted modified Forssell's surgical technique and outcome for treatment of cribbing (crib-biting) in horses. STUDY DESIGN: Retrospective clinical study. ANIMALS: Ten adult horses with stereotypic cribbing behavior. METHODS: Data were obtained from medical records and telephone conversations with owners, trainers, and veterinarians. Surgical technique involved an approximately 34-cm ventral median skin incision starting rostral to the larynx and extending caudally. A 10-cm section of the ventral branch of the spinal accessory nerve was removed, using an Nd:YAG laser at 25 W and continuous pulse with a contact, sculpted-fiber tip. After neurectomy, approximately 34-cm sections of the paired omohyoideus and sternothyrohyoideus muscles were removed starting 2 cm rostral to the ventral aspect of the larynx, at the basihyoid bone, using the Nd:YAG laser. RESULTS: Median horse age was 7 years (range, 1 to 11 years). Median surgical time was 90 minutes (range, 75 to 130 minutes). Long-term outcome (range, 7 to 72 months) was available for all horses. None of the horses had cribbing behavior after surgery, and all returned to their previous use. Four horses had complications (two of which were unrelated to the surgical site), but all recovered fully. CONCLUSION: The successful outcome we obtained is better than reported previously using a modified Forssell's technique. CLINICAL RELEVANCE: Surgical treatment for cribbing by Nd: YAG laser-assisted myectomy and neurectomy resulted in an excellent prognosis for resolution of the stereotypical behavior with minimal complications.     

Acute lung injury and acute respiratory distress syndromes in veterinary medicine: consensus definitions: The Dorothy Russell Havemeyer Working Group on ALI and ARDS in Veterinary Medicine

Background: As veterinary medicine has become more sophisticated, with greater numbers of veterinary patients receiving intensive care, more patients with an acute respiratory distress (ARDS)‐like syndrome have been recognized. Methods: A consensus definition meeting was held for the purpose of developing veterinary‐specific definitions for acute lung injury (ALI) and ARDS. Results/conclusions: Three clinically based definitions for acute lung injury and acute respiratory distress‐like syndromes occurring in veterinary patients were described. Neonatal equine respiratory distress syndrome (NERDS) was defined separately due to the specific requirement for primary developmental surfactant dysfunction and lack of an inflammatory component. Five diagnostic criteria categories were established for Veterinary ALI/ARDS (Vet ALI/ARDS) with 4 required and a fifth highly recommended criteria. A strong consensus was reached that onset of respiratory distress must have been acute and that known risk factors must be present. Additional criteria included evidence of pulmonary capillary leak with no evidence of increased pulmonary capillary pressure, evidence of inefficient gas exchange and, finally, evidence of inflammation. Some features of ALI/ARDS in the neonatal horse were recognized as unique, therefore, equine neonatal ALI/ARDS (EqNALI/EqNARDS) was similarly defined but with a graded gas exchange inefficiency table to allow for normal developmental changes in gas exchange. Use of these definitions in planning prospective studies of these problems in veterinary patients should allow for more direct comparisons of studies and clinical trials, with a larger goal of improving outcome in veterinary patients.     

Predation by carpet pythons (Morelia spilota) is an important cause of mortality in a free‐living koala (Phascolarctos cinereus) population in South East Queensland

Koalas (Phascolarctos cinereus) are experiencing significant declines across the northern part of their range. However, unbiased, population‐level estimates of mortality are rarely reported, as it's difficult to quantify causes of mortality robustly in this cryptic species. We aimed to determine the relative importance of carpet python (Morelia spilota) predation in a free‐living koala population and describe the characteristic pathological findings during necropsy. In total, 503 koalas were captured, underwent veterinary examination and telemetric tagging, and were monitored after release over a four‐year period. Mortalities were detected when activity data reported by K‐Tracker® biotelemetry collars indicated low or zero activity, or during routine field monitoring events. Experienced koala veterinarians performed thorough, standardised necropsy examinations on retrieved carcasses to determine causes of death. The three, sometimes subtle, cardinal signs used to definitively diagnose carpet python‐caused deaths of koalas were a U‐shaped primary bite site, slicking of the fur by python saliva (particularly around the face), and diffuse, uniform pulmonary congestion. We found that carpet pythons were important predators of koalas, second only to wild dogs (dingoes and dingo hybrids (Canis familiaris dingo)), accounting for 11.6% of predation deaths and 7.2% of total deaths. Less than half (38%) of the koalas killed by carpet pythons were ingested. Though carpet pythons are known predators of koalas, their relative importance as a cause of mortality hasn't previously been recognised. Population viability analyses and conservation management plans benefit from robust cause‐of‐death data collected during longitudinal monitoring studies, requiring telemetry methods that facilitate rapid detection of mortalities.     

A survey of health care and disease in geriatric horses aged 30 years or older

This study reports on aspects of preventive health care and on the prevalence of disease in geriatric (≥30 years old) horses and ponies in North-West England and North Wales. Of 128 questionnaires mailed to horse owners, 87 useable responses were received and 69 horses were subject to veterinary examination. Of the animals examined, 16% were underweight with body condition scores (BCS)<2/5, and 10% were overweight (BCS>3/5). This contrasted with the owner responses that reported 23% of the animals surveyed to be underweight and only 3% to be overweight. When assessed at trot, 77% of the horses were lame on at least one limb, with 97% having a reduced range of motion in at least one joint. Only 16% of these animals were reported by owners to have been lame within the previous 12 months. Owner-reported changes to hair coat were significantly associated with hirsutism or abnormal moulting detected at clinical examination (39%). At least one ophthalmic lesion was identified in all of the horses and ponies examined and 17% of owners reported that their animal had experienced visual problems within the previous year. Although dental abnormalities were detected in all animals where an oral examination was performed, only 42% of owners reported that their horse suffered from a known dental disorder. In general, despite a high prevalence of disease detected in these geriatric animals and with the majority having multiple abnormalities at clinical examination, there was under-reporting/under-recognition of these health problems by owners.     

Dogs with acute myeloid leukemia or lymphoid neoplasms (large cell lymphoma or acute lymphoblastic leukemia) may have indistinguishable mediastinal masses on radiographs

Acute myeloid leukemia is an uncommon hematopoietic neoplasm of dogs that should be differentiated from lymphoid neoplasms, such as lymphoma, because of different treatment protocols and a worse prognosis. Thoracic radiography is performed frequently in dogs with suspected hematopoietic neoplasia, and detecting a mediastinal mass often prioritizes lymphoma as the most likely diagnosis. However, we have observed a mediastinal mass in several dogs with acute myeloid leukemia and hypothesized that (1) the frequency of a mediastinal mass was higher and (2) the size of the mass was larger in dogs with acute myeloid leukemia compared to dogs with lymphoid neoplasms. In this analytical study (observational, retrospective, and cross‐sectional), the sample population included 238 dogs with hematopoietic neoplasia. These dogs were divided into lymphoid (large cell lymphoma, acute lymphoblastic leukemia) and myeloid groups based on standard phenotyping tests. A mediastinal mass was detected during thoracic radiography in 73/218 (33%) and nine of 20 (45%) dogs in the lymphoid and myeloid groups (P = 0.21), respectively. The median size ratio of mediastinal mass to cardiac silhouette was 0.20 and 0.23 in the lymphoid and myeloid groups (P = 0.96), respectively. Additionally, we observed normal thoracic radiographs in 111/218 (51%) dogs in the lymphoid group and nine of 20 (45%) dogs in the myeloid group. In conclusion, acute myeloid leukemia should be considered when a mediastinal mass is detected during radiography in dogs with suspected hematopoietic neoplasia—but the presence or size of a mediastinal mass does not differentiate between myeloid and lymphoid neoplasms.