Infection control and biosecurity in equine disease control

Biosecurity perceptions among Ontario horse owners during the COVID-19 pandemic

BACKGROUND

Disease outbreaks present a significant challenge to horse health and welfare and the economic stability of horse industries internationally. This is a particular concern in Ontario, Canada, where there have been frequent outbreaks of respiratory infectious diseases among horses. Despite these risks, there has been limited research on whether Ontario horse owners engage in biosecurity measures sufficient to mitigate risk of equine diseases, and whether current events such as the COVID-19 pandemic influence attitudes towards equine biosecurity practices.

OBJECTIVE

To explore Ontario horse owners' perceptions, attitudes and experiences relating to on-farm biosecurity during the COVID-19 pandemic.

STUDY DESIGN

Qualitative study using virtual semi-structured interviews.

METHODS

Participants (horse owners, frequent horse riders and part boarders) were recruited using social media snowball sampling where advertisements were shared by equine and veterinary organisations. Interviews were conducted virtually between June and September 2022 and were analysed using reflexive thematic analysis.

RESULTS

Three key themes relating to biosecurity perceptions among the 14 participants were identified. Participants relied on minimal preventative measures (such as vaccines) where perceived risk of disease was low, but implemented additional measures including quarantine and handwashing when perceived risk of disease was high. Participants' choice of biosecurity practices often mirrored those recommended by the barn manager. Moreover, participants felt that responsibility for biosecurity was not shared equally across horse owners, with more emphasis placed on those engaging in high-risk situations for disease spread. Despite experiencing biosecurity during the COVID-19 pandemic, horse owners were not consistently applying these practices to their horse care routines.

MAIN LIMITATIONS

The perspectives reported here are from a small sample of horse owners and may not be generalisable to all populations.

CONCLUSIONS

Our findings indicate that horse owners need improved access to and engagement with educational initiatives that emphasise the importance and purpose of all biosecurity measures.

'I want to be the sort of owner that he wants me to be': Rationales for biosecurity implementation among British horse owners

BACKGROUND

Horse owners play a critical role in mitigating the risk of pathogen spread between horses. However, little is known about how they view biosecurity and whether they experience barriers to the uptake of preventive measures.

OBJECTIVES

To explore horse owners' attitudes, perceptions, and experiences of biosecurity and identify how these factors shape horse owners' decisions for biosecurity implementation.

STUDY DESIGN

Qualitative study using semi-structured interviews.

METHODS

Interviews were conducted with 23 horse owners across Great Britain. Participants were purposively selected to include those in different geographic regions, with different management arrangements, and varied length of horse ownership experience. Interviews were audio-recorded, transcribed verbatim, and analysed using a critical realist thematic analysis.

RESULTS

Participants felt a moral obligation to prioritise their horse's happiness, which became a challenge when certain biosecurity measures (e.g., quarantine) were perceived as compromising their horse's happiness or comfort (Theme 1). A lack of biosecurity was the social norm among shared yards and competition venues (Theme 2), which made it difficult for participants to implement biosecurity measures effectively on their own. Combined with the sense of moral obligation participants felt towards their horse, this meant that participants had to 'care double' (i.e., be more vigilant than they would otherwise) to compensate for collective inaction (Theme 3).

MAIN LIMITATIONS

Participants may have been more interested in and/or knowledgeable about biosecurity than the general horse owning population.

CONCLUSIONS

The findings highlight several challenges that could be addressed to improve biosecurity implementation among horse owners. Efforts to encourage improved uptake of biosecurity measures should focus on communicating how reducing the risk of disease aligns with horse care. Further research on social norms in the horse industry is needed, in addition to identifying strategies to encourage a collective adoption of biosecurity measures.

Cross-Sectional Survey of Horse Owners to Assess Their Knowledge and Use of Biosecurity Practices for Equine Infectious Diseases in the United States

Horses are transported in the United States more than any other livestock species and co-mingle at various events; therefore, they are considered to be at an increased risk for infectious disease transmission. The fragmented movement of horses combined with numerous sites of co-mingling makes tracing the potential spread of a disease outbreak a necessary part of an infection control plan, both locally and nationally. The cross-movement of personnel with horses and the persistence of endemic diseases make biosecurity implementation an ongoing challenge. Although many of the risks for infection are known, there is limited documentation about the usefulness of prospective control measures. The objective of this survey was to determine horse owners' understanding and knowledge of biosecurity practices for preventing infectious diseases in the United States. Questions covered owner demographic information, including horse use which was divided into 10 categories as follows: Pleasure/Trail Riding, Lessons/School, Western Show, English Show, Breeding, Farm/Ranch, Retired, Racing, Driving and Other. The survey was distributed by sending requests to a list of horse owner organizations, which then sent emails to their members. The email request described the survey and provided a website link to start the survey. A total of 2413 responses were collected. Analysis of the results included cross-tabulation to identify significant differences in biosecurity knowledge and awareness by horse use. Significant differences by horse use were identified for vaccination, biosecurity planning, use of isolation, disease risk, monitoring for diseases, co-mingling of horses, sanitation, medical decision making and health record requirements for horse events. In summary, the results suggest that most owners are not highly concerned about the risk of disease or the use of biosecurity. There are several biosecurity applications and techniques which can be increased and will benefit horse health and welfare. These include reliance on temperature monitoring, isolation of new horses at facilities, risks of horse mingling, entry requirements such as vaccination and health certificates at events, and an emphasis on having biosecurity plans for facilities and events where horses co-mingle. The information from this study will be used to create tools and information that horse owners and veterinarians can use to implement appropriate biosecurity practices for different types of horse uses and events.

Characterising Biosecurity Initiatives Globally to Support the Development of a Progressive Management Pathway for Terrestrial Animals: A Scoping Review

While biosecurity is of increasing importance globally, there is still limited evidence of the factors or elements that support the progressive and sustainable scaling up of biosecurity along the value chains from the local to the global level. To gain insight into the current body of literature on biosecurity, a mixed-methods approach was used based on a scoping literature review and an online survey with subject matter experts. Six databases were searched for published literature, and textual information from titles and abstracts of all included records (n = 266) were analysed through inductive content analysis to build biosecurity-relevant categories and identify strengths, weaknesses, opportunities, and threats (SWOT) of existing biosecurity systems or initiatives (such as projects or programs). Most records focused on initiatives in high-income countries, traditional livestock species (pigs, poultry, and large ruminants), and the production stage and had a disease-specific focus. No records described a comprehensive or global framework to progressively scale up biosecurity. Overall, the findings highlight the need for initiatives such as the FAO Progressive Management Pathway for Terrestrial Animal Biosecurity (FAO-PMP-TAB), which is a stepwise approach for strengthening biosecurity management along value chains to enhance the health, resilience, and sustainability of animal sectors. The findings highlight important elements and provide recommendations useful for developing approaches or a global framework to progressively improve biosecurity management.

Current and Future Advances in the Detection and Surveillance of Biosecurity-Relevant Equine Bacterial Diseases Using Loop-Mediated Isothermal Amplification (LAMP)

Horses play an important role throughout the world, whether for work, culture, or leisure, providing an ever-growing significant contribution to the economy. The increase in importation and movement of horses, both nationally and internationally, has inevitably allowed for the global equine industry to grow. Subsequently, however, the potential for transmission of fatal equine bacterial diseases has also escalated, and devasting outbreaks continue to occur. To prevent such events, disease surveillance and diagnosis must be heightened throughout the industry. Current common, or "gold-standard" techniques, have shown to be inadequate at times, thus requiring newer technology to impede outbreaks. Loop-mediated isothermal amplification (LAMP) has proven to be a reliable, rapid, and accessible tool in both diagnostics and surveillance. This review will discuss equine bacterial diseases of biosecurity relevance and their current diagnostic approaches, as well as their respective LAMP assay developments. Additionally, we will provide insight regarding newer technology and advancements associated with this technique and their potential use for the outlined diseases.

Willingness to adopt personal biosecurity strategies on thoroughbred breeding farms: Findings from a multi-site pilot study in Australia's Hunter Valley

There are almost 9,500 full-time employees in Australia's thoroughbred horse breeding industry. During foaling, they can be exposed to bodily fluids and mucous membranes which may present risks for zoonotic disease. These risks can be mitigated through personal biosecurity strategies. The aim of this study was to identify which personal biosecurity strategies were more or less likely to be adopted by workers. Seventeen participants representing 14 thoroughbred breeding farms and three equine veterinary practices in Australia's largest thoroughbred breeding region trialed up to 16 stakeholder-nominated personal biosecurity strategies over the 2021 foaling season. The strategies encompassed personal protective equipment (PPE), zoonotic disease awareness, policies and protocols, supportive environments, and leadership. Strategy adoption was monitored through three repeated self-audit surveys designed around the Transtheoretical Model of change (TTM) and findings were reviewed in exit interviews. For all survey waves in aggregate, 13 strategies were practiced by at least 50.0% of participants. Participants were most likely to use a ready-made foaling box (98.0%), communicate the message that PPE usage is a personal responsibility (94.1%) and use ready-made PPE kits (88.2%). However, 31.4% had no intention of doing practice sessions and/or dummy runs for PPE use and 27.5% had no intention of using a buddy system on farm/practice to check use of PPE. Whilst these rates indicate workers' willingness to adopt and maintain personal biosecurity strategies, they also indicate capacity for more practices to be implemented more often. Overall, the findings highlight the need for personal biosecurity interventions to be sensitive to the demands of the annual thoroughbred breeding calendar, the size of the breeding operation and the availability of skilled staff.

Genetic Correlation of Virulent Salmonella Serovars (Extended Spectrum β-Lactamases) Isolated from Broiler Chickens and Human: A Public Health Concern

This study aimed to detect the virulent Salmonella serovars (including ESBLs producing) isolated from broiler chickens and humans. Three hundred broilers and sixty human fecal samples were bacteriologically examined. Thirty (10%) and fourteen (23.4%) Salmonella isolates were recovered from broiler and human samples, respectively. The most predominant serovar was S. enteritidis and S. typhimurium. All Salmonella isolates were confirmed by conventional PCR-based invA and ompA genes. Multidrug resistant (MDR) isolates were screened for the detection of adrA and csgD biofilm-associated genes, which were found in all isolated serovars except one S. typhimurium and 2 S. infantis of chicken isolates that were devoid of the adrA gene. Moreover, MDR isolates were screened for detection of seven resistance genes including ESBLs and other classes of resistance genes. Chicken isolates harbored blaTEM, int1, blaCTX and qnrS genes as 100, 27.8, 11.1 and 11.1%, respectively, while all human isolates harbored blaTEM, int1 and int3 genes. The genetic correlations between virulent Salmonella serovars (including antimicrobial resistance) avian and human origins were compared. In conclusion, the high prevalence of virulent ESBL producing Salmonella serovars in broilers and humans with genetic correlations between them might be zoonotic and public health hazards.

Real-time fluorometric and end-point colorimetric isothermal assays for detection of equine pathogens C. psittaci and equine herpes virus 1: validation, comparison and application at the point of care

Background

C. psittaci has recently emerged as an equine abortigenic pathogen causing significant losses to the Australian Thoroughbred industry, while Equine herpesvirus-1 (EHV-1) is a well-recognized abortigenic agent. Diagnosis of these agents is based on molecular assays in diagnostic laboratories.

In this study, we validated C. psittaci and newly developed EHV-1 Loop Mediated Isothermal Amplification (LAMP) assays performed in a real-time fluorometer (rtLAMP) against the reference diagnostic assays. We also evaluated isothermal amplification using commercially available colorimetric mix (cLAMP), and SYBR Green DNA binding dye (sgLAMP) for “naked eye” end-point detection when testing ‘real-world’ clinical samples. Finally, we applied the C. psittaci LAMP assays in two pilot Point-of-Care (POC) studies in an equine hospital.

Results

The analytical sensitivity of C. psittaci and EHV-1 rt-, and colorimetric LAMPs was determined as one and 10 genome equivalents per reaction, respectively. Compared to reference diagnostic qPCR assays, the C. psittaci rtLAMP showed sensitivity of 100%, specificity of 97.5, and 98.86% agreement, while EHV-1 rtLAMP showed 86.96% sensitivity, 100% specificity, and 91.43% agreement.

When testing rapidly processed clinical samples, all three C. psittaci rt-, c-, sg-LAMP assays were highly congruent with each other, with Kappa values of 0. 906 for sgLAMP and 0. 821 for cLAMP when compared to rtLAMP. EHV-1 testing also revealed high congruence between the assays, with Kappa values of 0.784 for cLAMP and 0.638 for sgLAMP when compared to rtLAMP. The congruence between LAMP assays and the C. psittaci or EHV-1 qPCR assays was high, with agreements ranging from 94.12 to 100% for C. psittaci, and 88.24 to 94.12% for EHV-1, respectively.

At the POC, the C. psittaci rt- and c-LAMP assays using rapidly processed swabs were performed by technicians with no prior molecular experience, and the overall congruence between the POC C. psittaci LAMPs and the qPCR assays ranged between 90.91–100%.

Conclusions

This study describes reliable POC options for the detection of the equine pathogens: C. psittaci and EHV-1. Testing ‘real-world’ samples in equine clinical setting, represents a proof-of-concept that POC isothermal diagnostics can be applied to rapid disease screening in the equine industry.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-02986-8.

Isothermal Nucleic Acid Amplification Technologies for the Detection of Equine Viral Pathogens

Simple Summary

Equine viral diseases remain a prominent concern for human and equine health globally. Many of these viruses are of primary biosecurity concern to countries that import equines where these viruses are not present. In addition, several equine viruses are zoonotic, which can have a significant impact on human health. Current diagnostic techniques are both time consuming and laboratory-based. The ability to accurately detect diseases will lead to better management, treatment strategies, and health outcomes. This review outlines the current modern isothermal techniques for diagnostics, such as loop-mediated isothermal amplification and insulated isothermal polymerase chain reaction, and their application as point-of-care diagnostics for the equine industry.

Abstract

The global equine industry provides significant economic contributions worldwide, producing approximately USD $300 billion annually. However, with the continuous national and international movement and importation of horses, there is an ongoing threat of a viral outbreak causing large epidemics and subsequent significant economic losses. Additionally, horses serve as a host for several zoonotic diseases that could cause significant human health problems. The ability to rapidly diagnose equine viral diseases early could lead to better management, treatment, and biosecurity strategies. Current serological and molecular methods cannot be field-deployable and are not suitable for resource-poor laboratories due to the requirement of expensive equipment and trained personnel. Recently, isothermal nucleic acid amplification technologies, such as loop-mediated isothermal amplification (LAMP) and insulated isothermal polymerase chain reaction (iiPCR), have been developed to be utilized in-field, and provide rapid results within an hour. We will review current isothermal diagnostic techniques available to diagnose equine viruses of biosecurity and zoonotic concern and provide insight into their potential for in-field deployment.

"Prevention is the biggest success": Barriers and enablers to personal biosecurity in the thoroughbred breeding industry

Employees in the equine industry are at occupational risk of zoonoses such as Hendra virus and equine chlamydiosis through exposure to infected materials. This study aimed to gain a deeper understanding of the views and experiences of employees, and the key drivers of infection control and personal biosecurity (PB) practices in the Thoroughbred breeding industry. Methods: An exploratory qualitative study was conducted in 2018 in New South Wales, Australia using interviews (9) and small group discussions (7). The 29 participants included veterinarians, veterinary nurses, foaling staff, stud managers and laboratory personnel working in a range of equine medicine settings. Interviews and focus groups were recorded, transcribed and analysed manually by at least two members of the research team. An iterative approach was used to derive themes. Results: Five main themes emerged: (i) greater awareness of current and emerging infectious risks promotes use of Personal Protective Equipment (PPE); (ii) currently available PPE is not comfortable, practical or well-suited to equine reproductive work in Australia's hot climate; (iii) creating supportive environments for PB reduces risk of exposure to infectious materials; (iv) strong leadership is required to implement sustainable change in workplace culture and practices; and (v) policy and economic factors play an important role in adopting biosecurity (BS) and PB measures in the workplace. Personnel working in the Australian Thoroughbred breeding industry face unique zoonotic risks in a challenging physical environment. A qualitative approach provided rich insights into social and physical factors motivating BS and PB in this occupational group. There is an opportunity for collaboration between Public Health services and industry partners to develop and implement strategies most likely to be effective in ensuring consistent uptake of PB measures in the workplace.

Evaluating 5.5 Years of Equinella: A Veterinary-Based Voluntary Infectious Disease Surveillance System of Equines in Switzerland

Equine health is important in regard to trade, economy, society, and the veterinary, as well as public health. To reduce the burden of equine infectious diseases internationally, it is important to collect, review, and distribute equine health surveillance data as accurate and timely as possible. Within this study, we aimed at providing a comprehensive descriptive analysis of data submitted to Equinella, a voluntary veterinary-based surveillance system of non-notifiable equine infectious diseases and clinical signs, in Switzerland. This was achieved by reviewing the reports submitted since its relaunch in November 2013 and until April 2019, as well as assessing the data validity, activeness of participating veterinarians, coverage of the equine population, geographical representativeness, and timeliness of the system. In total, 630 reports have been submitted. Data validity ranged between 88.2 and 100%. The coverage of Equinella was assessed to be 50.8% of the Swiss equine population. Over the 5.5 years, of all 102 registered veterinarians, 67 (65.7%) submitted at least one report. On average, these veterinarians submitted 1.7 reports per year (median = 4 reports). More recently, in 2018, approximately only one-third [29 (28.4%)] of all registered veterinarians submitted at least one report. However, 59 (57.8%) have responded to the monthly reminder emails to confirm that they have not observed any relevant clinical case to be reported at least once (median number of confirmation per veterinarian = 9 of 12 reminder emails). The incidence of reports varied between cantons (member states of the Swiss confederation). The median timeliness of report submission was found to be 7 days. Overall, Equinella has been receiving reports since its initiation and contributed continuously to the surveillance of infectious diseases in the Swiss equine population and provided an output for the international equine community. Challenges encountered in achieving a higher number of submitted reports and increasing the coverage of the equine population, as well as the overall activeness of veterinarians, require further work. With our study, we provide a comprehensive overview of a veterinary-based voluntary surveillance system for equine health, assessed challenges of such, and suggest concrete improvements with transdisciplinary approaches for similar veterinary-based surveillance systems.

Preliminary insight into horse owners' perceptions of, and attitudes towards, exotic diseases in the United Kingdom

Background

The potential for an exotic disease incursion is a significant concern for the United Kingdom (UK) equine industry. Horse owners’ perceptions of, and attitudes towards, exotic diseases can influence decisions to adopt disease preparedness strategies. The objectives of this study were to describe horse owners’ 1) perceptions of the term ‘exotic disease’, and 2) attitudes towards their risk of being affected by an exotic disease. In order to address these objectives, qualitative content analysis was undertaken on data collected using two open-ended survey questions.

Results

Horse owners (n = 423) perceived exotic diseases as 1) belonging somewhere else, and 2) a dangerous threat to their horse(s). The term ‘exotic’ was associated with being foreign, non-native, and out-of-place in the UK. Attitudes towards exotic disease risk were summarised into four categories: 1) responsible horse owners prevent disease, 2) horse owners need support to stop disease spread, 3) risk depends on proximity to the ‘risky’ horse, and 4) some risk is inevitable. A ‘responsible’ owner was aware of health hazards and took actions to protect their horse from disease. Reliance on others, including stakeholders, to uphold disease prevention in the community led to feeling vulnerable to disease threats. When evaluating risk, horse owners considered which horses were the ‘riskiest’ to their horse’s health (horses that travelled, participated in competitions, or were simply unfamiliar) and avoided situations where they could interact. Despite undertaking disease prevention measures, the perceived uncontrollable nature of exotic diseases led some owners to feel an incursion was inevitable.

Conclusions

Without accounting for horse owners’ perceptions of, and attitudes towards, exotic diseases, recommendations to increase preparedness may be ineffective. Improved communication among stakeholders in the industry may assist in clarifying expectations for exotic disease-specific prevention measures. A collaborative approach among horse owners and stakeholders is recommended to improve disease preparedness within the industry.

Prevalence of Clostridium difficile and Clostridium perfringens in Swiss horses with and without gastrointestinal disease and microbiota composition in relation to Clostridium difficile shedding

Overgrowth of enteric clostridia in dysbiosis in horses with colic is presumed but scarcely investigated. The objective was to provide prevalence data of Clostridium difficile and Clostridium perfringens in horses with and without gastrointestinal disease in Switzerland, and investigate microbiota differences between C. difficile shedders and non-shedders. Fecal samples were taken from healthy horses (n = 103), horses with colic (n = 98) and horses with diarrhea (n = 151). Colic horses were sampled on three days. Selective enrichment culture and molecular typing for C. difficile and C. perfringens was performed. Microbiota differences between horses with colic shedding (n = 7) and not shedding (n = 7) C. difficile were assessed using metagenomic sequencing. The cumulative prevalence (19% C. difficile; 16% C. perfringens) was higher compared to single day samples (1-10% C. difficile; 3-8% C. perfringens, all p < 0.003). Horses with colic shed significantly more C. difficile (p < 0.001) but not C. perfringens (p = 0.09) compared to healthy horses. Prevalence in horses with diarrhea was 8% for both Clostridium species. There were no significant microbiota differences between C. difficile shedders and non-shedders with regards to relative abundance on any phylogenetic level, and alpha diversity. Limited differences were seen on LEfSE analysis and in beta diversity indices. Multiple fecal samples should be taken when investigating shedding of enteric clostridia. As horses with colic shed more enteric clostridia compared to healthy horses special biosecurity protocols for horses with colic should be considered in hospitals. Differences in microbiota composition between C. difficile shedders and non-shedders were limited. Further studies on the role of dysbiosis in C. difficile are needed.

Equine viral encephalitis: prevalence, impact, and management strategies

Members of several different virus families cause equine viral encephalitis, the majority of which are arthropod-borne viruses (arboviruses) with zoonotic potential. The clinical signs caused are rarely pathognomonic; therefore, a clinical diagnosis is usually presumptive according to the geographical region. However, recent decades have seen expansion of the geographical range and emergence in new regions of numerous viral diseases. In this context, this review presents an overview of the prevalence and distribution of the main viral causes of equine encephalitis and discusses their impact and potential approaches to limit their spread.

Using a computer simulation model to examine the impact of biosecurity measures during a facility-level outbreak of equine influenza

On-farm biosecurity measures are an important part of a control plan to minimize the introduction and spread of infectious diseases, such as equine influenza, in an equine facility. It can be challenging, however, to evaluate the efficacy of biosecurity measures under field conditions. We used an agent-based computer simulation model to describe the impact of: i) preventive vaccination; ii) reduced horse-to-horse contact; and iii) a combination of vaccination and reduced contact during an outbreak of equine influenza in a simulated horse facility. The model demonstrated that the most effective intervention was a combination of a high proportion of recently vaccinated horses and a substantial reduction in horse-to-horse contact once equine influenza had been identified in the facility. This study highlights the importance of compliance when implementing biosecurity measures, such as facility-level infection control practices, on horse farms.

Australian horse owners and their biosecurity practices in the context of Hendra virus

In recent years, outbreaks of exotic as well as newly emerging infectious diseases have highlighted the importance of biosecurity for the Australian horse industry. As the first potentially fatal zoonosis transmissible from horses to humans in Australia, Hendra virus has emphasised the need to incorporate sound hygiene and general biosecurity practices into day-to-day horse management. Recommended measures are widely publicised, but implementation is at the discretion of the individual owner. This cross-sectional study aimed to determine current levels of biosecurity of horse owners and to identify factors influencing the uptake of practices utilising data from an online survey. Level of biosecurity (low, medium, high), as determined by horse owners' responses to a set of questions on the frequency of various biosecurity practices performed around healthy (9 items) and sick horses (10 items), was used as a composite outcome variable in ordinal logistic regression analyses. The majority of horse owners surveyed were female (90%), from the states of Queensland (45%) or New South Wales (37%), and were involved in either mainly competitive/equestrian sports (37%) or recreational horse activities (35%). Seventy-five percent of owners indicated that they follow at least one-third of the recommended practices regularly when handling their horses, resulting in medium to high levels of biosecurity. Main factors associated with a higher level of biosecurity were high self-rated standard of biosecurity, access to personal protective equipment, absence of flying foxes in the local area, a good sense of control over Hendra virus risk, likelihood of discussing a sick horse with a veterinarian and likelihood of suspecting Hendra virus in a sick horse. Comparison of the outcome variable with the self-rated standard of biosecurity showed that over- as well as underestimation occurred. This highlights the need for continuous communication and education to enhance awareness and understanding of what biosecurity is and how it aligns with good horsemanship. Overall, strengthened biosecurity practices will help to improve animal as well as human health and increase preparedness for future disease outbreaks.

Patient management

Hospital-associated infections, including those caused by zoonotic agents, represent an increasing concern in veterinary practice. Veterinarians and hospital staff are obligated and expected to provide education about and protection from transmission of pathogens among animal patients and between animal patients and human beings (eg, veterinary staff, volunteers, owners) who come into contact with infected animals. Patient management involves assessing risks of pathogen transmission, identification of animals either suspected of or proved to be infected with a transmissible infectious disease agent, and the implementation of measures that minimize the likelihood of transmission of the infectious agent.