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Wallis LJ, Radford AD, Belshaw Z, Jackson J, Kubinyi E, German AJ, Westgarth C. Cross-sectional United Kingdom surveys demonstrate that owners and veterinary professionals differ in their perceptions of preventive and treatment healthcare needs in ageing dogs. Front Vet Sci 2024; 11:1358480. [PMID: 38638642 PMCID: PMC11024473 DOI: 10.3389/fvets.2024.1358480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024] Open
Abstract
Perceptions of dog owners and veterinary professionals (surgeons/nurses) can influence the preventive healthcare and treatment provided to dogs, especially at the senior life-stage, when chronic diseases become more common. This study compared perceptions of healthcare of dogs as they age between dog owners and veterinary professionals. Data from two online surveys (owners: N = 633, veterinary professionals: N = 305) examined perceived need for veterinary visits and vaccinations. In addition, 48 clinical signs were rated on perceived prevalence (whether owners' dogs had experienced them) and how urgently they should seek veterinary advice. Groups were compared using descriptive statistics and chi-square. Owners most often believed a 'healthy' senior dog (>7 years) should go to the vet once a year (47% owners vs. 25% veterinary professionals, p < 0.001), compared with veterinary professionals every 6 months (39 vs. 73%). A minority (14%) of owners would just take the dog 'if they got sick' but only 2% of veterinary professionals advised this, and 16% of owners of dogs of all ages had not had any contact with their veterinary practise in the previous year. Nearly all veterinary professionals (92%) believed that senior/geriatric dogs should receive yearly vaccinations. However, 28% of owners' dogs of all ages were not vaccinated in the previous year and, of these, 33% did not believe that older dogs need vaccinations. Only 10% of dogs considered 'old' by their owners had attended a senior wellness clinic or examination, despite 14% of practises offering them. The three most common clinical signs reported by owners were slowing down on walks (57%), dental tartar (53%) and being stiff on rising (50%). Owners perceived urgency to seek veterinary care was lower if they had experienced the clinical sign before. In the current study, dog owners and veterinary professionals differed in their opinions about the need for veterinary care, suggesting new educational initiatives, and more effective communication is required.
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Affiliation(s)
- Lisa J. Wallis
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Ethology, ELTE Eotvos Lorand University, Budapest, Hungary
| | - Alan D. Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Zoe Belshaw
- EviVet Research Consultancy, Nottingham, United Kingdom
| | - Jodie Jackson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Eniko Kubinyi
- Department of Ethology, ELTE Eotvos Lorand University, Budapest, Hungary
- MTA-ELTE Lendület “Momentum” Companion Animal Research Group, ELTE Eotvos Lorand University, Budapest, Hungary
| | - Alexander J. German
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Carri Westgarth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Fins IS, Davies H, Farrell S, Torres JR, Pinchbeck G, Radford AD, Noble P. Evaluating ChatGPT text mining of clinical records for companion animal obesity monitoring. Vet Rec 2024; 194:e3669. [PMID: 38058223 PMCID: PMC10952314 DOI: 10.1002/vetr.3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/25/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Veterinary clinical narratives remain a largely untapped resource for addressing complex diseases. Here we compare the ability of a large language model (ChatGPT) and a previously developed regular expression (RegexT) to identify overweight body condition scores (BCS) in veterinary narratives pertaining to companion animals. METHODS BCS values were extracted from 4415 anonymised clinical narratives using either RegexT or by appending the narrative to a prompt sent to ChatGPT, prompting the model to return the BCS information. Data were manually reviewed for comparison. RESULTS The precision of RegexT was higher (100%, 95% confidence interval [CI] 94.81%-100%) than that of ChatGPT (89.3%, 95% CI 82.75%-93.64%). However, the recall of ChatGPT (100%, 95% CI 96.18%-100%) was considerably higher than that of RegexT (72.6%, 95% CI 63.92%-79.94%). LIMITATIONS Prior anonymisation and subtle prompt engineering are needed to improve ChatGPT output. CONCLUSIONS Large language models create diverse opportunities and, while complex, present an intuitive interface to information. However, they require careful implementation to avoid unpredictable errors.
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Affiliation(s)
- Ivo S. Fins
- Small Animal Veterinary Surveillance NetworkInstitute of InfectionVeterinary and Ecological SciencesUniversity of LiverpoolLiverpoolUK
| | - Heather Davies
- Small Animal Veterinary Surveillance NetworkInstitute of InfectionVeterinary and Ecological SciencesUniversity of LiverpoolLiverpoolUK
| | - Sean Farrell
- Department of Computer ScienceDurham UniversityDurhamUK
| | - Jose R. Torres
- Institute for Animal Health and Food SafetyUniversity of Las Palmas de Gran CanariaLas Palmas, Gran CanariaSpain
| | - Gina Pinchbeck
- Small Animal Veterinary Surveillance NetworkInstitute of InfectionVeterinary and Ecological SciencesUniversity of LiverpoolLiverpoolUK
| | - Alan D. Radford
- Small Animal Veterinary Surveillance NetworkInstitute of InfectionVeterinary and Ecological SciencesUniversity of LiverpoolLiverpoolUK
| | - Peter‐John Noble
- Small Animal Veterinary Surveillance NetworkInstitute of InfectionVeterinary and Ecological SciencesUniversity of LiverpoolLiverpoolUK
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Davies H, Nenadic G, Alfattni G, Arguello Casteleiro M, Al Moubayed N, Farrell SO, Radford AD, Noble PJM. Text mining for disease surveillance in veterinary clinical data: part one, the language of veterinary clinical records and searching for words. Front Vet Sci 2024; 11:1352239. [PMID: 38322169 PMCID: PMC10844486 DOI: 10.3389/fvets.2024.1352239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
The development of natural language processing techniques for deriving useful information from unstructured clinical narratives is a fast-paced and rapidly evolving area of machine learning research. Large volumes of veterinary clinical narratives now exist curated by projects such as the Small Animal Veterinary Surveillance Network (SAVSNET) and VetCompass, and the application of such techniques to these datasets is already (and will continue to) improve our understanding of disease and disease patterns within veterinary medicine. In part one of this two part article series, we discuss the importance of understanding the lexical structure of clinical records and discuss the use of basic tools for filtering records based on key words and more complex rule based pattern matching approaches. We discuss the strengths and weaknesses of these approaches highlighting the on-going potential value in using these "traditional" approaches but ultimately recognizing that these approaches constrain how effectively information retrieval can be automated. This sets the scene for the introduction of machine-learning methodologies and the plethora of opportunities for automation of information extraction these present which is discussed in part two of the series.
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Affiliation(s)
- Heather Davies
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Goran Nenadic
- Department of Computer Science, University of Manchester, Manchester, United Kingdom
| | - Ghada Alfattni
- Department of Computer Science, University of Manchester, Manchester, United Kingdom
- Department of Computer Science, Jamoum University College, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Noura Al Moubayed
- Department of Computer Science, Durham University, Durham, United Kingdom
| | - Sean O. Farrell
- Department of Computer Science, Durham University, Durham, United Kingdom
| | - Alan D. Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Peter-John M. Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Arsevska E, Hengl T, Singleton DA, Noble PJM, Caminade C, Eneanya OA, Jones PH, Medlock JM, Hansford KM, Bonannella C, Radford AD. Risk factors for tick attachment in companion animals in Great Britain: a spatiotemporal analysis covering 2014-2021. Parasit Vectors 2024; 17:29. [PMID: 38254168 PMCID: PMC10804489 DOI: 10.1186/s13071-023-06094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Ticks are an important driver of veterinary health care, causing irritation and sometimes infection to their hosts. We explored epidemiological and geo-referenced data from > 7 million electronic health records (EHRs) from cats and dogs collected by the Small Animal Veterinary Surveillance Network (SAVSNET) in Great Britain (GB) between 2014 and 2021 to assess the factors affecting tick attachment in an individual and at a spatiotemporal level. METHODS EHRs in which ticks were mentioned were identified by text mining; domain experts confirmed those with ticks on the animal. Tick presence/absence records were overlaid with a spatiotemporal series of climate, environment, anthropogenic and host distribution factors to produce a spatiotemporal regression matrix. An ensemble machine learning spatiotemporal model was used to fine-tune hyperparameters for Random Forest, Gradient-boosted Trees and Generalized Linear Model regression algorithms, which were then used to produce a final ensemble meta-learner to predict the probability of tick attachment across GB at a monthly interval and averaged long-term through 2014-2021 at a spatial resolution of 1 km. Individual host factors associated with tick attachment were also assessed by conditional logistic regression on a matched case-control dataset. RESULTS In total, 11,741 consultations were identified in which a tick was recorded. The frequency of tick records was low (0.16% EHRs), suggesting an underestimation of risk. That said, increased odds for tick attachment in cats and dogs were associated with younger adult ages, longer coat length, crossbreeds and unclassified breeds. In cats, males and entire animals had significantly increased odds of recorded tick attachment. The key variables controlling the spatiotemporal risk for tick attachment were climatic (precipitation and temperature) and vegetation type (Enhanced Vegetation Index). Suitable areas for tick attachment were predicted across GB, especially in forests and grassland areas, mainly during summer, particularly in June. CONCLUSIONS Our results can inform targeted health messages to owners and veterinary practitioners, identifying those animals, seasons and areas of higher risk for tick attachment and allowing for more tailored prophylaxis to reduce tick burden, inappropriate parasiticide treatment and potentially TBDs in companion animals and humans. Sentinel networks like SAVSNET represent a novel complementary data source to improve our understanding of tick attachment risk for companion animals and as a proxy of risk to humans.
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Affiliation(s)
- Elena Arsevska
- Unit for Animals, Health, Territories, Risks and Ecosystems (UMR ASTRE), French Agricultural Research Centre for International Development (CIRAD), 34980, Montferrier-sur-Lez, France.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, CH64 7TE, Neston, UK.
| | - Tomislav Hengl
- OpenGeoHub Foundation, 6708 PW, Wageningen, The Netherlands
| | - David A Singleton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, CH64 7TE, Neston, UK
| | - Peter-John M Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, CH64 7TE, Neston, UK
| | - Cyril Caminade
- Earth System Physics Department, Abdus Salam International Centre for Theoretical Physics (ICTP), 34151, Trieste, Italy
| | - Obiora A Eneanya
- Health Programs, The Carter Center, 30307, Atlanta, Georgia, USA
| | - Philip H Jones
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, CH64 7TE, Neston, UK
| | - Jolyon M Medlock
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency, SP4 0JG, Salisbury, UK
- NIHR Health Protection Research Unit in Environmental Change and Health, WC1E 7HT, London, UK
| | - Kayleigh M Hansford
- Medical Entomology and Zoonoses Ecology, UK Health Security Agency, SP4 0JG, Salisbury, UK
- NIHR Health Protection Research Unit in Environmental Change and Health, WC1E 7HT, London, UK
| | - Carmelo Bonannella
- OpenGeoHub Foundation, 6708 PW, Wageningen, The Netherlands
- Laboratory of Geo-information Science and Remote Sensing, Wageningen University & Research, 6708 PB, Wageningen, The Netherlands
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, CH64 7TE, Neston, UK
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Fins IS, Singleton DA, Radford AD, Sánchez-Vizcaíno F, Pinchbeck GL. A mixed-methods approach utilising electronic health records to examine antimicrobial prescription surrounding gastrointestinal clinical presentations in dogs and cats. Front Vet Sci 2023; 10:1166114. [PMID: 38149298 PMCID: PMC10749927 DOI: 10.3389/fvets.2023.1166114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/16/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction Systemically-administered antimicrobials are often prescribed in canine and feline gastrointestinal clinical presentations. Responsible use of antimicrobials, particularly those considered Highest Priority Critically Important Antimicrobials (HPCIAs) is vital to tackle antimicrobial resistance. Although practice-level prescription guidance is available, further strategies based on a greater understanding of antimicrobial prescription at the population-level are needed. Here, we used a mixed-methods approach, harnessing veterinary electronic health records (EHRs) to characterise the use of antimicrobials in canine and feline gastrointestinal presentations, and to explore justification and reasoning around antimicrobial prescribing, particularly of HPCIAs. Methods This observational study used 23,337 EHRs complemented with veterinary practitioner-completed questionnaires, from canine and feline gastrointestinal consultations from 225 volunteer UK veterinary practices between April 2014 and September 2018. Results A total of 83.4% (95% confidence interval (CI) 82.6-84.3) gastrointestinal presentations were reported as mild, with non-haemorrhagic diarrhoea and vomiting the most frequently reported clinical signs. Systemically-administered antimicrobials occurred in 28.6% of canine (95% CI 26.9-30.3) and 22.4% of feline (95% CI 20.4-24.4) gastrointestinal consultations, with HPCIA prescription occurring more frequently in cats. Results of multivariable analysis showed the presence of non-haemorrhagic diarrhoea (canine Odds Ratio (OR) 2.1, 95% CI 1.9-2.3; feline OR 1.8, 95% CI 1.5-2.1), haemorrhagic diarrhoea (canine OR 4.2, 95% CI 3.8-4.7; feline OR 3.1, 95% CI 2.4-3.8), and moderate/severe presentations (canine OR 1.9, 95% CI 1.7-2.8; feline OR 2.0, 95% CI 1.7-2.5) were positively associated with receiving a systemically-administered antimicrobial. Thematic analysis of clinical narrative content of 516 gastrointestinal consultations where HPCIAs were prescribed allowed the identification of ten factors underpinning reasoning or decision-making for HPCIA prescription: perceived animal/owner compliance; owner's expectations; perceived risk of infection; clinical signs; recent clinical history; perceived positive previous response to antimicrobial therapy; geriatric patients and euthanasia; concomitant conditions; diagnostic testing and the behavioral trend to trial antimicrobial therapy empirically in gastrointestinal cases. No explicit justification for HPCIA prescription was recorded in 77% of cases. Discussion Improving recorded justification represents a clear target for stewardship programmes. By utilising a complementary mixed-methods approach to EHRs, this study unlocks previously untapped data recorded within EHRs. These results can help inform targeted interventions, contributing towards enhanced antimicrobial stewardship.
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Affiliation(s)
- Ivo S. Fins
- Institute of Infection, Veterinary and Ecological Sciences, Department of Livestock and One Health, University of Liverpool, Neston, United Kingdom
| | - David A. Singleton
- Institute of Infection, Veterinary and Ecological Sciences, Department of Livestock and One Health, University of Liverpool, Neston, United Kingdom
| | - Alan D. Radford
- Institute of Infection, Veterinary and Ecological Sciences, Department of Infection Biology and Microbiomes, University of Liverpool, Neston, United Kingdom
| | | | - Gina L. Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, Department of Livestock and One Health, University of Liverpool, Neston, United Kingdom
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Tamayo Cuartero C, Radford AD, Szilassy E, Newton JR, Sánchez-Vizcaíno F. Stakeholder opinion-led study to identify canine priority diseases for surveillance and control in the UK. Vet Rec 2023; 193:e3167. [PMID: 37415378 DOI: 10.1002/vetr.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/17/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Many pathogens cause disease in dogs; however, meaningful surveillance in small companion animals is often only possible for the most impactful diseases. We describe the first stakeholder opinion-led approach to identify which canine infectious diseases should be prioritised for inclusion in surveillance and control strategies in the UK. METHODS Participants were identified through a stakeholder analysis. A multicriteria decision analysis was undertaken to establish and weight epidemiological criteria for evaluating diseases, and a Delphi technique was employed to achieve a consensus among participants on the top-priority canine diseases. RESULTS Nineteen stakeholders from multiple backgrounds participated in this study. Leptospirosis and parvovirus were identified as the top two endemic diseases of concern, while leishmaniosis and babesiosis were the top two exotic diseases. Respiratory and gastrointestinal diseases were identified as the top two syndromes of concern. LIMITATIONS Due to the COVID-19 pandemic, the number of participants was reduced. Despite this, a representative multidisciplinary sample of relevant stakeholders contributed to the present study. CONCLUSIONS Findings from this study are being used to inform the development of a future UK-wide epidemic response strategy. This methodology could provide a blueprint for other countries.
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Wallis LJ, Radford AD, Belshaw Z, Jackson J, Kubinyi E, German AJ, Westgarth C. "Just old age" - a qualitative investigation of owner and veterinary professional experiences of and attitudes to ageing in dogs in the UK. J Small Anim Pract 2023; 64:425-433. [PMID: 36971187 DOI: 10.1111/jsap.13610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/30/2023] [Accepted: 03/05/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Many UK dogs live into old age, but owners may not recognise or report age-associated signs of disease which lead to negative welfare. This study investigated dog owner and veterinary professional experiences and attitudes towards ageing in dogs, how health care is offered, barriers to its delivery, and some best-practice solutions. MATERIALS AND METHODS In-depth semi-structured interviews were conducted with 15 owners of 21 dogs (aged 8 to 17 years mean: 13) and 11 veterinary professional (eight veterinary surgeons, two nurses and one physiotherapist). Open-text responses from 61 dog owners were collected using an online survey. Transcripts and survey responses were inductively coded into themes. RESULTS Four themes were constructed: "just old age", barriers to care, trust in veterinary surgeons, and tools to improve health care. Age-related changes were mostly perceived as "just old age" by dog owners. Many dogs were no longer vaccinated and did not attend check-ups unless owners identified a problem. The greatest barriers to health care were finances (dog owners), owner awareness, willingness to act and consultation time (veterinary professionals). Trust in veterinary professionals was more likely when dog owner experienced continuity, prioritisation of care, clear communication and an accessible, knowledgeable and empathic veterinary professional. Participants suggested that senior health care and communication between dog owners and veterinary professionals could be improved through questionnaires, and evidence-based online information. CLINICAL SIGNIFICANCE Opportunities to educate owners on which clinical signs represent healthy or pathological ageing are being missed. Resources should be developed to guide on best-practice discussions in consultations, encourage more owners to recognise clinical signs and to seek and trust veterinary advice.
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Affiliation(s)
- L J Wallis
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Department of Ethology, ELTE Eotvos Lorand University, Budapest, Hungary
| | - A D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - J Jackson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - E Kubinyi
- Department of Ethology, ELTE Eotvos Lorand University, Budapest, Hungary
- MTA-ELTE Lendület "Momentum" Companion Animal Research Group, Hungary
| | - A J German
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - C Westgarth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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Farrell S, McGarry J, Noble PM, Pinchbeck GJ, Cantwell S, Radford AD, Singleton DA. Seasonality and other risk factors for fleas infestations in domestic dogs and cats. Med Vet Entomol 2023; 37:359-370. [PMID: 36621899 PMCID: PMC10946788 DOI: 10.1111/mve.12636] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/13/2022] [Indexed: 05/18/2023]
Abstract
Fleas in the genus Ctenocephalides are the most clinically important parasitic arthropods of dogs and cats worldwide yet risk factors that might increase the risk of infestation in small animals remains unclear. Here we developed a supervised text mining approach analysing key aspects of flea epidemiology using electronic health records from domestic cats and dogs seen at a sentinel network of 191 voluntary veterinary practices across Great Britain between March 2014 and July 2020. Our methods identified fleas as likely to have been present during 22,276 of 1,902,016 cat consultations (1.17%) and 12,168 of 4,844,850 dog consultations (0.25%). Multivariable logistic regression modelling found that animals originating from areas of least deprivation were associated with 50% reductions in odds of veterinary-recorded flea infestation compared to the most deprived regions in England. Age of the animal was significantly associated with flea presentation in both cats and dogs, with cases peaking before animals reached 12 months. Cases were recorded through each study years, peaking between July and October, with fluctuations between each year. Our findings can be used towards healthcare messaging for veterinary practitioners and owners.
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Affiliation(s)
- Sean Farrell
- School of BiosciencesUniversity of KentCanterburyKentUK
| | - John McGarry
- Institute of Infection, Veterinary and Ecological SciencesUniversity of LiverpoolNestonUK
| | | | - Gina J. Pinchbeck
- Institute of Infection, Veterinary and Ecological SciencesUniversity of LiverpoolNestonUK
| | - Sophie Cantwell
- Institute of Infection, Veterinary and Ecological SciencesUniversity of LiverpoolNestonUK
| | - Alan D. Radford
- Institute of Infection, Veterinary and Ecological SciencesUniversity of LiverpoolNestonUK
| | - David A. Singleton
- Institute of Infection, Veterinary and Ecological SciencesUniversity of LiverpoolNestonUK
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Radford AD, Farrell S, Singleton DA, McGarry J, Brant B, Pinchbeck GJ, Noble PJM. Using electronic health data in clinical decision-making. Vet Rec 2023; 192:298. [PMID: 37000724 DOI: 10.1002/vetr.2926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Alan D Radford
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, Neston, Wirral, CH64 7TE
| | - Sean Farrell
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, Neston, Wirral, CH64 7TE
| | - David A Singleton
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, Neston, Wirral, CH64 7TE
| | - John McGarry
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, Neston, Wirral, CH64 7TE
| | - Beth Brant
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, Neston, Wirral, CH64 7TE
| | - Gina J Pinchbeck
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, Neston, Wirral, CH64 7TE
| | - P-J M Noble
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, Neston, Wirral, CH64 7TE
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Norris LJ, Pinchbeck GL, Noble PJM, Radford AD. Dogs with cropped ears in the UK: A population-based study using electronic health records. Vet Rec 2023; 192:e2483. [PMID: 36646627 DOI: 10.1002/vetr.2483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/08/2022] [Accepted: 11/15/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Ear cropping for cosmetic purposes was made illegal in the UK in 2006. Despite this, a lack of import regulations and celebrity and media influences mean cropped dogs are increasingly reported. METHODS The demographics, temporal trends and patient-level associated factors for dogs with cropped ears were evaluated in a large sentinel population of dogs visiting UK veterinary practices. RESULTS A total of 132 dogs with cropped ears were identified, with rates peaking in 2021. In 84 cases (63.6%), there was evidence of importation, most commonly from countries where cropping is also illegal, including Romania, Hungary, Bulgaria, Serbia, Spain, Poland and Ireland. American Bulldogs, Dobermanns, Italian Mastiffs (Cane Corso), Bulldogs and Mastiffs were all significantly overrepresented. Affected dogs were more likely to be unneutered (odds ratio 11.04, 95% confidence interval 5.84-20.90). LIMITATIONS The study likely underestimates true levels of ear cropping. Identified cases are from a sentinel network of veterinary practices, and as such may not be representative of the wider UK population. CONCLUSION These data suggest a need to educate owners and veterinary surgeons about the welfare and legal implications of ear cropping. The data presented can inform future targeted policies in veterinary practices and at a governmental level.
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Affiliation(s)
- Lucy J Norris
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Gina L Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Peter-John M Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
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11
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Rigas K, Singleton DA, Radford AD, Amores-Fuster I, Killick DR. Do socioeconomic factors impact management of suspected canine multicentric lymphoma in UK first opinion practice? Vet Rec 2022; 191:e1319. [PMID: 35191051 DOI: 10.1002/vetr.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/01/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to describe the management of cases of suspected and confirmed canine multicentric lymphoma (ML) in first opinion practice (FOP) and investigate whether socioeconomic factors are associated with initial management. METHODS Clinical narratives from electronic health records collected by the Small Animal Veterinary Surveillance Network (SAVSNET) were searched to identify dogs with peripheral lymphadenomegaly in which ML was the major differential. Cases were grouped as either ML confirmed (ML-C) or ML suspected but not confirmed (ML-S). Associations between initial management and socioeconomic factors were assessed via multivariable logistic regression. RESULTS Two hundred and sixty-four cases with ML-C and 410 with ML-S were identified. There was an increased probability that owners of ML-C cases resided in less deprived areas. Moreover, a diagnosis was made more commonly in insured dogs. Only insured pets were more likely to be treated with chemotherapy following diagnosis. The majority of dogs in both groups were treated with corticosteroids alone (ML-S, n = 256/410; ML-C, n = 123/264). A small minority were referred (n = 30/674). CONCLUSION Socioeconomic inequalities appear to be associated with the diagnosis and management of dogs with suspected or confirmed ML in FOP. Most dogs with suspected multicentric lymphoma (in the UK) are managed in FOP (n = 644/674). Consequently, expanding the knowledge base relevant to this setting offers an opportunity to improve the management of canine lymphoma.
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Affiliation(s)
- Konstantinos Rigas
- Department of Small Animal Clinical Sciences, University of Liverpool, Neston, Cheshire, UK
| | - David A Singleton
- SAVSNET, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, Cheshire, UK
| | - Alan D Radford
- SAVSNET, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, Cheshire, UK
| | - Isabel Amores-Fuster
- Department of Small Animal Clinical Sciences, University of Liverpool, Neston, Cheshire, UK
| | - David R Killick
- Department of Small Animal Clinical Sciences, University of Liverpool, Neston, Cheshire, UK
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12
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Hofmann-Lehmann R, Hosie MJ, Hartmann K, Egberink H, Truyen U, Tasker S, Belák S, Boucraut-Baralon C, Frymus T, Lloret A, Marsilio F, Pennisi MG, Addie DD, Lutz H, Thiry E, Radford AD, Möstl K. Calicivirus Infection in Cats. Viruses 2022; 14:937. [PMID: 35632680 PMCID: PMC9145992 DOI: 10.3390/v14050937] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
Feline calicivirus (FCV) is a common pathogen in domestic cats that is highly contagious, resistant to many disinfectants and demonstrates a high genetic variability. FCV infection can lead to serious or even fatal diseases. In this review, the European Advisory Board on Cat Diseases (ABCD), a scientifically independent board of experts in feline medicine from 11 European countries, presents the current knowledge of FCV infection and fills gaps with expert opinions. FCV infections are particularly problematic in multicat environments. FCV-infected cats often show painful erosions in the mouth and mild upper respiratory disease and, particularly in kittens, even fatal pneumonia. However, infection can be associated with chronic gingivostomatitis. Rarely, highly virulent FCV variants can induce severe systemic disease with epizootic spread and high mortality. FCV can best be detected by reverse-transcriptase PCR. However, a negative result does not rule out FCV infection and healthy cats can test positive. All cats should be vaccinated against FCV (core vaccine); however, vaccination protects cats from disease but not from infection. Considering the high variability of FCV, changing to different vaccine strain(s) may be of benefit if disease occurs in fully vaccinated cats. Infection-induced immunity is not life-long and does not protect against all strains; therefore, vaccination of cats that have recovered from caliciviral disease is recommended.
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Affiliation(s)
- Regina Hofmann-Lehmann
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Margaret J. Hosie
- MRC—University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK;
| | - Katrin Hartmann
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich, 80539 Munich, Germany;
| | - Herman Egberink
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, University of Utrecht, 3584 CL Utrecht, The Netherlands;
| | - Uwe Truyen
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, 04103 Leipzig, Germany;
| | - Séverine Tasker
- Bristol Veterinary School, University of Bristol, Bristol BS40 5DU, UK;
- Linnaeus Veterinary Limited, Shirley, Solihull B90 4BN, UK
| | - Sándor Belák
- Department of Biomedical Sciences and Veterinary Public Health (BVF), Swedish University of Agricultural Sciences (SLU), P.O. Box 7036, 750 07 Uppsala, Sweden;
| | | | - Tadeusz Frymus
- Department of Small Animal Diseases with Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences—SGGW, 02-787 Warsaw, Poland;
| | - Albert Lloret
- Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain;
| | - Fulvio Marsilio
- Faculty of Veterinary Medicine, Università degli Studi di Teramo, 64100 Teramo, Italy;
| | - Maria Grazia Pennisi
- Dipartimento di Scienze Veterinarie, Università di Messina, 98168 Messina, Italy;
| | - Diane D. Addie
- Veterinary Diagnostic Services, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1QH, UK;
| | - Hans Lutz
- Clinical Laboratory, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Etienne Thiry
- Veterinary Virology and Animal Viral Diseases, Department of Infectious and Parasitic Diseases, Fundamental and Applied Research for Animals & Health Research Centre, Faculty of Veterinary Medicine, Liège University, B-4000 Liège, Belgium;
| | - Alan D. Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, UK;
| | - Karin Möstl
- Institute of Virology, Department for Pathobiology, University of Veterinary Medicine, 1210 Vienna, Austria;
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13
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Hall EJ, Radford AD, Carter AJ. Surveillance of heat-related illness in small animals presenting to veterinary practices in the UK between 2013-2018. Open Vet J 2022; 12:5-16. [PMID: 35342739 PMCID: PMC8956225 DOI: 10.5455/ovj.2022.v12.i1.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/07/2021] [Indexed: 11/03/2022] Open
Abstract
Background: Heat-related illness (HRI) can affect all companion animals and is likely to become more common as global temperatures rise. The misconception that HRI is primarily a result of dogs being trapped in hot cars, highlights a lack of awareness of HRI risk factors within the UK companion animal population. Aim: This project aimed to review all species of small animal presentations of HRI to UK veterinary practices participating in the Small Animal Veterinary Surveillance Network (SAVSNET), describe the inciting triggers and seasonality of HRI events, and review the clinical grade of canine patients presenting with HRI. Methods: Electronic consultation records were submitted by volunteer veterinary practices across the UK to SAVSNET. Cases were defined as animals presented for consultation with strong evidence of current, or recent heat induced illness during the study period (2013–2018). Results: The HRI cases included 146 dogs, 16 cats, 8 guinea pigs, 3 rabbits and 1 ferret. Of the 118 HRI cases with a recorded trigger, exercise was the primary trigger for dogs presenting (73.5%); 7 (6.9%) canine HRI events followed vehicular confinement. Environmental HRI was recorded as a trigger for the remaining dogs (19.6%), and for all cats, guinea pigs, rabbits and the ferret. Brachycephalic breeds comprised 21.2% of canine HRI cases, and all rabbits were brachycephalic breeds. Dogs with HRI were presented between April and October, with 42.5% during July, typically the UK’s hottest month of the year. Cats with HRI were presented between May and September, with 75.0% during June and July. The smaller companion species—ferrets, rabbits and guinea pigs—were presented during the UK’s summer months June to August. Conclusion: This study highlights the risk of HRI to all pet animals during the UK’s warmer summer months (June to August). The findings support previous claims that exercise is the most common trigger of HRI in dogs, while environmental HRI (a hot ambient temperature) accounted for all HRI events in cats, rabbits, guinea pigs, and ferrets. Both brachycephalic dogs and rabbits were overrepresented, adding further evidence that owners of these animals should be particularly vigilant for HRI during hot weather.
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Affiliation(s)
- Emily J. Hall
- School of Animal, Rural and Environmental Sciences, Nottingham Trent University, Nottingham, UK
- Corresponding Author: Emily J. Hall. School of Animal, Rural and Environmental Sciences, Nottingham Trent University, Nottingham, UK.
| | - Alan D. Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Anne J. Carter
- School of Animal, Rural and Environmental Sciences, Nottingham Trent University, Nottingham, UK
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14
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Brant BJ, Singleton DA, Noble PJM, Radford AD. Seasonality and risk factors for grass seed foreign bodies in dogs. Prev Vet Med 2021; 197:105499. [PMID: 34583207 DOI: 10.1016/j.prevetmed.2021.105499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
Grass seed foreign bodies (GSFBs) are a familiar presentation, especially in dogs, associated with a variety of clinical signs depending on site of penetration and extent of migration. Seasonality and risk factors for GSFB occurrence were investigated using electronic health records from a sentinel voluntary network of 245 veterinary practices in the United Kingdom between 17th March 2014 and 18th September 2020. Clinical narrative text mining of 4,580,503 canine consultations produced a final case dataset of 1,037 consultations where GSFBs had been recorded in individual dogs. Cases of GSFBs were recorded in all months, with 940 (90.6 %) recorded between June and September. In particular, the odds of GSFBs in July was almost 176 times more than that of January (Odds ratio, OR, 175.6, 95 % Confidence interval, CI, 43.5-707.7, P < 0.001). Compared to the retriever breed type, spaniel breed types were 7.7 times more likely to present with a GSFB (CI 5.4-11.0, P < 0.001). Other significant risk factors associated with recorded GSFBs for this population included being male (OR = 1.4, CI 1.2-1.6, P < 0.001), and geographical location. When compared to the South East of England, risk was lowest in Wales (OR = 0.1, CI 0.0-0.3, P=<0.001), and highest in the East of England (OR = 1.9, 1.2-2.9, P = 0.003), and overall risk in urban areas was reduced (OR = 0.8, CI 0.7-1.0, P = 0.024). These observations provide a number of areas for temporally targeted health campaigns at specific types of dogs, to reduce the impact of GSFBs on canine welfare.
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Affiliation(s)
- Bethaney J Brant
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK.
| | - David A Singleton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - P J M Noble
- School of Veterinary Science, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
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15
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Gibson DN, Singleton DA, Brant B, Radford AD, Killick DR. Temporospatial distribution and country of origin of canine transmissible venereal tumours in the UK. Vet Rec 2021; 189:e974. [PMID: 34773267 DOI: 10.1002/vetr.974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/03/2021] [Accepted: 09/16/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Transmissable venereal tumour (TVT) is a tumour transplanted by physical contact between dogs. Lesions typically affect the genitalia. TVT is not considered enzootic in the United Kingdom (UK), with cases seen in imported dogs. We sought to determine the patient characteristics, temporal and spatial distribution and country of origin of affected dogs in the UK. METHODS Electronic pathology records (EPRs) from four UK veterinary diagnostic laboratories collected between 2010 and 2019 were searched for the terms 'venereal' or 'TVT'. Reports were reviewed for statements confirming a TVT and descriptive statistics collated. RESULTS Of 182 EPRs matching the search terms, a diagnosis of TVT was confirmed in 71. Country of origin was noted in 36 cases (50.7%) with Romania being the most common (n = 29). Cases were reported in each UK constituent country, with the majority being in England (64, 90.1%). The incidence of TVT diagnosis increased over the last decade (z = 2.78, p = 0.005). CONCLUSIONS/DISCUSSION The incidence of TVT diagnosed in the UK is increasing. The majority of cases were known to have been imported. Autochthonous transmission cannot be excluded due to study design. Vets are encouraged to carefully examine the genitalia of dogs imported to the UK from countries with enzootic TVT.
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Affiliation(s)
- Danielle N Gibson
- Department of Small Animal Clinical Sciences, Leahurst Campus, University of Liverpool, Neston, UK
| | - David A Singleton
- SAVSNET, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, University of Liverpool, Neston, UK
| | - Beth Brant
- SAVSNET, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, University of Liverpool, Neston, UK
| | - Alan D Radford
- SAVSNET, Institute of Infection, Veterinary and Ecological Sciences, Leahurst Campus, University of Liverpool, Neston, UK
| | - David R Killick
- Department of Small Animal Clinical Sciences, Leahurst Campus, University of Liverpool, Neston, UK
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16
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Smith SL, Anderson ER, Cansado-Utrilla C, Prince T, Farrell S, Brant B, Smyth S, Noble PJM, Pinchbeck GL, Marshall N, Roberts L, Hughes GL, Radford AD, Patterson EI. SARS-CoV-2 neutralising antibodies in dogs and cats in the United Kingdom. ACTA ACUST UNITED AC 2021; 2:100011. [PMID: 34377997 PMCID: PMC8340563 DOI: 10.1016/j.crviro.2021.100011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
Companion animals are susceptible to SARS-CoV-2 infection and sporadic cases of pet infections have occurred in the United Kingdom. Here we present the first large-scale serological survey of SARS-CoV-2 neutralising antibodies in dogs and cats in the UK. Results are reported for 688 sera (454 canine, 234 feline) collected by a large veterinary diagnostic laboratory for routine haematology during three time periods; pre-COVID-19 (January 2020), during the first wave of UK human infections (April–May 2020) and during the second wave of UK human infections (September 2020–February 2021). Both pre-COVID-19 sera and those from the first wave tested negative. However, in sera collected during the second wave, 1.4% (n = 4) of dogs and 2.2% (n = 2) of cats tested positive for neutralising antibodies. The low numbers of animals testing positive suggests pet animals are unlikely to be a major reservoir for human infection in the UK. However, continued surveillance of in-contact susceptible animals should be performed as part of ongoing population health surveillance initiatives.
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Affiliation(s)
- Shirley L Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Enyia R Anderson
- Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Disease, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Cintia Cansado-Utrilla
- Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Disease, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Tessa Prince
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, L69 7BE, UK
| | - Sean Farrell
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Bethaney Brant
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Steven Smyth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Peter-John M Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Gina L Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Nikki Marshall
- Idexx Laboratories Ltd, Grange House, Sandbeck Way, Wetherby, LS22 7DN, UK
| | - Larry Roberts
- Idexx Laboratories Ltd, Grange House, Sandbeck Way, Wetherby, LS22 7DN, UK
| | - Grant L Hughes
- Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Disease, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Edward I Patterson
- Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Disease, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.,Department of Biological Sciences, Brock University, St. Catharines, ON, L2S 3A1, Canada
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17
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Singleton DA, Pongchaikul P, Smith S, Bengtsson RJ, Baker K, Timofte D, Steen S, Jones M, Roberts L, Sánchez-Vizcaíno F, Dawson S, Noble PJM, Radford AD, Pinchbeck GL, Williams NJ. Temporal, Spatial, and Genomic Analyses of Enterobacteriaceae Clinical Antimicrobial Resistance in Companion Animals Reveals Phenotypes and Genotypes of One Health Concern. Front Microbiol 2021; 12:700698. [PMID: 34394045 PMCID: PMC8362618 DOI: 10.3389/fmicb.2021.700698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/08/2021] [Indexed: 01/04/2023] Open
Abstract
Background Antimicrobial resistance (AMR) is a globally important one health threat. The impact of resistant infections on companion animals, and the potential public health implications of such infections, has not been widely explored, largely due to an absence of structured population-level data. Objectives We aimed to efficiently capture and repurpose antimicrobial susceptibility test (AST) results data from several veterinary diagnostic laboratories (VDLs) across the United Kingdom to facilitate national companion animal clinical AMR surveillance. We also sought to harness and genotypically characterize isolates of potential AMR importance from these laboratories. Methods We summarized AST results for 29,330 canine and 8,279 feline Enterobacteriaceae isolates originating from companion animal clinical practice, performed between April 2016 and July 2018 from four VDLs, with submissions from 2,237 United Kingdom veterinary practice sites. Results Escherichia coli (E. coli) was the most commonly isolated Enterobacteriaceae in dogs (69.4% of AST results, 95% confidence interval, CI, 68.7-70.0) and cats (90.5%, CI 89.8-91.3). Multi-drug resistance was reported in 14.1% (CI 13.5-14.8) of canine and 12.0% (CI 11.1-12.9) of feline E. coli isolates. Referral practices were associated with increased E. coli 3rd generation ≤ cephalosporin resistance odds (dogs: odds ratio 2.0, CI 1.2-3.4). We selected 95 E. coli isolates for whole genome analyses, of which seven belonged to sequence type 131, also carrying the plasmid-associated extended spectrum β-lactamase gene bla CTX-M- 15. The plasmid-mediated colistin resistance gene mcr-9 was also identified for the first time in companion animals. Conclusions Linking clinical AMR data with genotypic characterization represents an efficient means of identifying important resistance trends in companion animals on a national scale.
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Affiliation(s)
- David A Singleton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Pisut Pongchaikul
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom.,Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Salaya, Thailand
| | - Shirley Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Rebecca J Bengtsson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Kate Baker
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Dorina Timofte
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Stephen Steen
- NationWide Laboratories/C.A.P.L. Ltd., Knutton, United Kingdom
| | | | | | | | - Susan Dawson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - P-J M Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Gina L Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Nicola J Williams
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
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18
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Smith SL, Anderson ER, Cansado-Utrilla C, Prince T, Farrell S, Brant B, Smyth S, Noble PJM, Pinchbeck GL, Marshall N, Roberts L, Hughes GL, Radford AD, Patterson EI. SARS-CoV-2 neutralising antibodies in Dogs and Cats in the United Kingdom. bioRxiv 2021. [PMID: 34189526 PMCID: PMC8240679 DOI: 10.1101/2021.06.23.449594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Companion animals are susceptible to SARS-CoV-2 infection and sporadic cases of pet infections have occurred in the United Kingdom. Here we present the first large-scale serological survey of SARS-CoV-2 neutralising antibodies in dogs and cats in the UK. Results are reported for 688 sera (454 canine, 234 feline) collected by a large veterinary diagnostic laboratory for routine haematology during three time periods; pre-COVID-19 (January 2020), during the first wave of UK human infections (April-May 2020) and during the second wave of UK human infections (September 2020-February 2021). Both pre-COVID-19 sera and those from the first wave tested negative. However, in sera collected during the second wave, 1.4% (n=4) of dogs and 2.2% (n=2) cats tested positive for neutralising antibodies. The low numbers of animals testing positive suggests pet animals are unlikely to be a major reservoir for human infection in the UK. However, continued surveillance of in-contact susceptible animals should be performed as part of ongoing population health surveillance initiatives.
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Affiliation(s)
- Shirley L Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Enyia R Anderson
- Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Disease, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Cintia Cansado-Utrilla
- Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Disease, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Tessa Prince
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Sean Farrell
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Bethaney Brant
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Stephen Smyth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Peter-John M Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Gina L Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Nikki Marshall
- Idexx Laboratories Ltd, Grange House, Sandbeck Way, Wetherby LS22 7DN
| | - Larry Roberts
- Idexx Laboratories Ltd, Grange House, Sandbeck Way, Wetherby LS22 7DN
| | - Grant L Hughes
- Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Disease, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK
| | - Edward I Patterson
- Departments of Vector Biology and Tropical Disease Biology, Centre for Neglected Tropical Disease, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.,Department of Biological Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
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19
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Singleton DA, Pinchbeck GL, Radford AD, Arsevska E, Dawson S, Jones PH, Noble PJM, Williams NJ, Sánchez-Vizcaíno F. Factors Associated with Prescription of Antimicrobial Drugs for Dogs and Cats, United Kingdom, 2014-2016. Emerg Infect Dis 2021; 26:1778-1791. [PMID: 32687030 PMCID: PMC7392421 DOI: 10.3201/eid2608.191786] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial stewardship is a cornerstone of efforts to curtail antimicrobial resistance. To determine factors potentially influencing likelihood of prescribing antimicrobials for animals, we analyzed electronic health records for unwell dogs (n = 155,732 unique dogs, 281,543 consultations) and cats (n = 69,236 unique cats, 111,139 consultations) voluntarily contributed by 173 UK veterinary practices. Using multivariable mixed effects logistic regression, we found that factors associated with decreased odds of systemic antimicrobial prescription were client decisions focused on preventive health: vaccination (dogs, odds ratio [OR] 0.93, 95% CI, 0.90–0.95; cats, OR 0.92, 95% CI 0.89–0.95), insurance (dogs, OR 0.87, 95% CI 0.84–0.90; cats, OR 0.82, 95% CI 0.79–0.86), neutering of dogs (OR 0.90, 95% CI 0.88–0.92), and practices accredited by the Royal College of Veterinary Surgeons (OR 0.79, 95% 95% CI 0.68–0.92). This large multicenter companion animal study demonstrates the potential of preventive healthcare and client engagement to encourage responsible antimicrobial drug use.
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20
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Smith SL, Afonso MM, Roberts L, Noble PJM, Pinchbeck GL, Radford AD. A virtual biobank for companion animals: A parvovirus pilot study. Vet Rec 2021; 189:e556. [PMID: 34101190 DOI: 10.1002/vetr.556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/19/2021] [Accepted: 05/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a lack of national population data concerning infectious disease in companion animals. Here, we piloted the feasibility of linking diagnostic laboratories, population surveillance and modern sequencing approaches to extract targeted diagnostic samples from laboratories before they were discarded, as a novel route to better understand national epidemiology of major small animal pathogens. METHODS Samples tested for canine or feline parvovirus were requested from a national veterinary diagnostic laboratory and analysed by Sanger or next generation sequencing. Samples were linked to electronic health data held in the SAVSNET database. RESULTS Sequences obtained from positive samples, together with associated metadata, provided new insights into the recent geographical distribution of parvovirus strains in circulation in the United Kingdom (UK). CONCLUSIONS This collaboration with industry represents a 'National Virtual Biobank' that can rapidly be called on, to efficiently add new layers of epidemiological information of relevance to animal, and potentially human, population health.
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Affiliation(s)
- Shirley L Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, UK
| | - Maria M Afonso
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, UK
| | | | - Peter-John M Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, UK
| | - Gina L Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, UK
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, Wirral, UK
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21
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Collins M, Singleton DA, Noble PJM, Pinchbeck GL, Smith S, Brant B, Smyth S, Radford AD, Appleton C, Jewell C, Rowlingson B, Caddy S, Jones PH. Small animal disease surveillance 2020/21: SARS-CoV-2, syndromic surveillance and an outbreak of acute vomiting in UK dogs. Vet Rec 2021; 188:304. [PMID: 33891730 PMCID: PMC8250639 DOI: 10.1002/vetr.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marisol Collins
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - David A Singleton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Peter J M Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Gina L Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Shirley Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Bethaney Brant
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Steven Smyth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, UK
| | - Charlotte Appleton
- Lancaster Medical School, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK
| | - Christopher Jewell
- Lancaster Medical School, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK
| | - Barry Rowlingson
- Lancaster Medical School, Lancaster University, Furness Building, Lancaster, LA1 4YG, UK
| | - Sarah Caddy
- MRC Laboratory of Molecular Biology, Cambridge Biomedical Campus, Francis Crick Avenue, Trumpington, Cambridge, CB2 0QH, UK
| | - Philip H Jones
- Surveillance Intelligence Unit, APHA, Woodham Lane, Addlestone, Surrey, KT15 3NB, UK
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22
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Staton GJ, Clegg SR, Ainsworth S, Armstrong S, Carter SD, Radford AD, Darby A, Wastling J, Hall N, Evans NJ. Dissecting the molecular diversity and commonality of bovine and human treponemes identifies key survival and adhesion mechanisms. PLoS Pathog 2021; 17:e1009464. [PMID: 33780514 PMCID: PMC8049484 DOI: 10.1371/journal.ppat.1009464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/15/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
Here, we report the first complete genomes of three cultivable treponeme species from bovine digital dermatitis (DD) skin lesions, two comparative human treponemes, considered indistinguishable from bovine DD species, and a bovine gastrointestinal (GI) treponeme isolate. Key genomic differences between bovine and human treponemes implicate microbial mechanisms that enhance knowledge of how DD, a severe disease of ruminants, has emerged into a prolific, worldwide disease. Bovine DD treponemes have additional oxidative stress genes compared to nearest human-isolated relatives, suggesting better oxidative stress tolerance, and potentially explaining how bovine strains can colonize skin surfaces. Comparison of both bovine DD and GI treponemes as well as bovine pathogenic and human non-pathogenic saprophyte Treponema phagedenis strains indicates genes encoding a five-enzyme biosynthetic pathway for production of 2,3-diacetamido-2,3-dideoxy-d-mannuronic acid, a rare di-N-acetylated mannuronic acid sugar, as important for pathogenesis. Bovine T. phagedenis strains further differed from human strains by having unique genetic clusters including components of a type IV secretion system and a phosphate utilisation system including phoU, a gene associated with osmotic stress survival. Proteomic analyses confirmed bovine derived T. phagedenis exhibits expression of PhoU but not the putative secretion system, whilst the novel mannuronic acid pathway was expressed in near entirety across the DD treponemes. Analysis of osmotic stress response in water identified a difference between bovine and human T. phagedenis with bovine strains exhibiting enhanced survival. This novel mechanism could enable a selective advantage, allowing environmental persistence and transmission of bovine T. phagedenis. Finally, we investigated putative outer membrane protein (OMP) ortholog families across the DD treponemes and identified several families as multi-specific adhesins capable of binding extra cellular matrix (ECM) components. One bovine pathogen specific adhesin ortholog family showed considerable serodiagnostic potential with the Treponema medium representative demonstrating considerable disease specificity (91.6%). This work has shed light on treponeme host adaptation and has identified candidate molecules for future diagnostics, vaccination and therapeutic intervention. Bovine digital dermatitis (DD) is a severe infectious disease causing cattle lameness, which is now endemic in many countries across the world. This lameness results from inflamed lesions between the heel bulbs and is very painful resulting in poor animal welfare and substantially reduced production. There remains no single cure for DD and whilst topical antibiotic treatment enables some healing, lesions frequently reappear. Current evidence implicates bacteria known as Treponema in the pathogenesis of DD. Here we characterise the genomes of several bovine DD treponeme species as well as related bacteria from humans and the bovine gastrointestinal tract. Comparative analyses demonstrate that production of a novel mannuronic acid sugar is a key feature of bovine pathogens and several survival mechanisms were identified which likely enable the bovine pathogens to inhabit the skin surface and be transmitted within the farm environment. Studies investigating putative outer membrane proteins which are potential vaccine candidates identified that the majority have a role in host attachment, with one family of proteins exhibiting particular promise as serodiagnostic antigens. This increased understanding of the considered causal pathogens of bovine DD, together with the genomic and proteomic resources produced by this study should underpin future diagnostic, vaccination and therapeutics studies to combat this severe disease of ruminants.
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Affiliation(s)
- Gareth J. Staton
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - Simon R. Clegg
- School of Life Sciences, College of Science, University of Lincoln, Brayford Pool Campus, Lincoln, United Kingdom
| | - Stuart Ainsworth
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - Stuart Armstrong
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - Stuart D. Carter
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - Alan D. Radford
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - Alistair Darby
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
| | - Jonathan Wastling
- Faculty of Natural Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Neil Hall
- Earlham Institute, Norwich Research Park, Norwich, United Kingdom
- School of Biological Sciences, University of East Anglia, Norwich, United Kingdom
- Department of Biological Sciences, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Nicholas J. Evans
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, United Kingdom
- * E-mail:
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23
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Prince T, Smith SL, Radford AD, Solomon T, Hughes GL, Patterson EI. SARS-CoV-2 Infections in Animals: Reservoirs for Reverse Zoonosis and Models for Study. Viruses 2021; 13:494. [PMID: 33802857 PMCID: PMC8002747 DOI: 10.3390/v13030494] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022] Open
Abstract
The recent SARS-CoV-2 pandemic has brought many questions over the origin of the virus, the threat it poses to animals both in the wild and captivity, and the risks of a permanent viral reservoir developing in animals. Animal experiments have shown that a variety of animals can become infected with the virus. While coronaviruses have been known to infect animals for decades, the true intermediate host of the virus has not been identified, with no cases of SARS-CoV-2 in wild animals. The screening of wild, farmed, and domesticated animals is necessary to help us understand the virus and its origins and prevent future outbreaks of both COVID-19 and other diseases. There is intriguing evidence that farmed mink infections (acquired from humans) have led to infection of other farm workers in turn, with a recent outbreak of a mink variant in humans in Denmark. A thorough examination of the current knowledge and evidence of the ability of SARS-CoV-2 to infect different animal species is therefore vital to evaluate the threat of animal to human transmission and reverse zoonosis.
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Affiliation(s)
- Tessa Prince
- NIHR Health Protection Unit in Emerging and Zoonotic Infections, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L69 7TX, UK; (T.S.); (G.L.H.)
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK; (S.L.S.); (A.D.R.)
| | - Shirley L. Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK; (S.L.S.); (A.D.R.)
| | - Alan D. Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK; (S.L.S.); (A.D.R.)
| | - Tom Solomon
- NIHR Health Protection Unit in Emerging and Zoonotic Infections, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L69 7TX, UK; (T.S.); (G.L.H.)
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK; (S.L.S.); (A.D.R.)
- Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Grant L. Hughes
- NIHR Health Protection Unit in Emerging and Zoonotic Infections, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool L69 7TX, UK; (T.S.); (G.L.H.)
- Centre for Neglected Tropical Disease, Departments of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Edward I. Patterson
- Centre for Neglected Tropical Disease, Departments of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Department of Biological Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
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24
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Singleton DA, Rayner A, Brant B, Smyth S, Noble PJM, Radford AD, Pinchbeck GL. A randomised controlled trial to reduce highest priority critically important antimicrobial prescription in companion animals. Nat Commun 2021; 12:1593. [PMID: 33707426 PMCID: PMC7952375 DOI: 10.1038/s41467-021-21864-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/12/2021] [Indexed: 01/31/2023] Open
Abstract
Robust evidence supporting strategies for companion animal antimicrobial stewardship is limited, despite frequent prescription of highest priority critically important antimicrobials (HPCIA). Here we describe a randomised controlled trial where electronic prescription data were utilised (August 2018-January 2019) to identify above average HPCIA-prescribing practices (n = 60), which were randomly assigned into a control group (CG) and two intervention groups. In March 2019, the light intervention group (LIG) and heavy intervention group (HIG) were notified of their above average status, and were provided with educational material (LIG, HIG), in-depth benchmarking (HIG), and follow-up meetings (HIG). Following notification, follow-up monitoring lasted for eight months (April-November 2019; post-intervention period) for all intervention groups, though HIG practices were able to access further support (i.e., follow-up meetings) for the first six of these months if requested. Post-intervention, in the HIG a 23.5% and 39.0% reduction in canine (0.5% of total consultations, 95% confidence interval, 0.4-0.6, P = 0.04) and feline (4.4%, 3.4-5.3, P < 0.001) HPCIA-prescribing consultations was observed, compared to the CG (dogs: 0.6%, 0.5-0.8; cats: 7.4%, 6.0-8.7). The LIG was associated with a 16.7% reduction in feline HPCIA prescription (6.1% of total consultations, 5.3-7.0, P = 0.03). Therefore, in this trial we have demonstrated effective strategies for reducing veterinary HPCIA prescription.
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Affiliation(s)
- David A Singleton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, UK.
| | | | - Bethaney Brant
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, UK
| | - Steven Smyth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, UK
| | - Peter-John M Noble
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, UK
| | - Alan D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, UK
| | - Gina L Pinchbeck
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, UK
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25
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Radford AD, Singleton DA, Jewell C, Appleton C, Rowlingson B, Hale AC, Cuartero CT, Newton R, Sánchez-Vizcaíno F, Greenberg D, Brant B, Bentley EG, Stewart JP, Smith S, Haldenby S, Noble PJM, Pinchbeck GL. Outbreak of Severe Vomiting in Dogs Associated with a Canine Enteric Coronavirus, United Kingdom. Emerg Infect Dis 2021; 27:517-528. [PMID: 33496240 PMCID: PMC7853541 DOI: 10.3201/eid2702.202452] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The lack of population health surveillance for companion animal populations leaves them vulnerable to the effects of novel diseases without means of early detection. We present evidence on the effectiveness of a system that enabled early detection and rapid response a canine gastroenteritis outbreak in the United Kingdom. In January 2020, prolific vomiting among dogs was sporadically reported in the United Kingdom. Electronic health records from a nationwide sentinel network of veterinary practices confirmed a significant increase in dogs with signs of gastroenteric disease. Male dogs and dogs living with other vomiting dogs were more likely to be affected. Diet and vaccination status were not associated with the disease; however, a canine enteric coronavirus was significantly associated with illness. The system we describe potentially fills a gap in surveillance in neglected populations and could provide a blueprint for other countries.
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26
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Patterson EI, Elia G, Grassi A, Giordano A, Desario C, Medardo M, Smith SL, Anderson ER, Prince T, Patterson GT, Lorusso E, Lucente MS, Lanave G, Lauzi S, Bonfanti U, Stranieri A, Martella V, Solari Basano F, Barrs VR, Radford AD, Agrimi U, Hughes GL, Paltrinieri S, Decaro N. Evidence of exposure to SARS-CoV-2 in cats and dogs from households in Italy. Nat Commun 2020; 11:6231. [PMID: 33277505 PMCID: PMC7718263 DOI: 10.1038/s41467-020-20097-0] [Citation(s) in RCA: 237] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/13/2020] [Indexed: 01/20/2023] Open
Abstract
SARS-CoV-2 emerged from animals and is now easily transmitted between people. Sporadic detection of natural cases in animals alongside successful experimental infections of pets, such as cats, ferrets and dogs, raises questions about the susceptibility of animals under natural conditions of pet ownership. Here, we report a large-scale study to assess SARS-CoV-2 infection in 919 companion animals living in northern Italy, sampled at a time of frequent human infection. No animals tested PCR positive. However, 3.3% of dogs and 5.8% of cats had measurable SARS-CoV-2 neutralizing antibody titers, with dogs from COVID-19 positive households being significantly more likely to test positive than those from COVID-19 negative households. Understanding risk factors associated with this and their potential to infect other species requires urgent investigation.
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Affiliation(s)
- E I Patterson
- Centre for Neglected Tropical Disease, Departments of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - G Elia
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - A Grassi
- I-VET srl, Laboratorio di Analisi Veterinarie, Via Ettore Majorana, 10 - 25020, Flero, BS, Italy
| | - A Giordano
- Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - C Desario
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - M Medardo
- La Vallonèa Veterinary Diagnostic Laboratory, via G. Sirtori 9, 20017, Passirana di Rho, MI, Italy
| | - S L Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - E R Anderson
- Centre for Neglected Tropical Disease, Departments of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - T Prince
- NIHR Health Protection Unit in Emerging and Zoonotic Infections, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - G T Patterson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - E Lorusso
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - M S Lucente
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - G Lanave
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - S Lauzi
- Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - U Bonfanti
- La Vallonèa Veterinary Diagnostic Laboratory, via G. Sirtori 9, 20017, Passirana di Rho, MI, Italy
| | - A Stranieri
- Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - V Martella
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - F Solari Basano
- Arcoblu s.r.l., via Alessandro Milesi 5, 20133, Milan, Italy
| | - V R Barrs
- City University's Jockey Club College of Veterinary Medicine and Life Sciences, 5/F, Block 1A, To Yuen Building, 31 To Yuen Street, Kowloon, Hong Kong
| | - A D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - U Agrimi
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - G L Hughes
- Centre for Neglected Tropical Disease, Departments of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - S Paltrinieri
- Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - N Decaro
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy.
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27
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Affiliation(s)
- David A Singleton
- University of Liverpool, Institutes of Infection, Veterinary Science and Ecology, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | - P J Noble
- University of Liverpool, Institutes of Infection, Veterinary Science and Ecology, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | - Beth Brant
- University of Liverpool, Institutes of Infection, Veterinary Science and Ecology, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | - Gina L Pinchbeck
- University of Liverpool, Institutes of Infection, Veterinary Science and Ecology, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | - Alan D Radford
- University of Liverpool, Institutes of Infection, Veterinary Science and Ecology, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
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28
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Singleton DA, Noble PJ, Radford AD, Brant B, Pinchbeck GL, Greenberg D, Appleton C, Jewell C, Newton R, Cuartero CT, Sánchez-Vizcaíno F. Prolific vomiting in dogs. Vet Rec 2020; 186:191. [PMID: 32054807 DOI: 10.1136/vr.m553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- David A Singleton
- University of Liverpool, Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | - P J Noble
- University of Liverpool, Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | - Alan D Radford
- University of Liverpool, Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | - Beth Brant
- University of Liverpool, Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | - Gina L Pinchbeck
- University of Liverpool, Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE
| | | | | | - Chris Jewell
- The Liverpool Vets, 11 Cleveland Square, Liverpool L1 5BE
| | - Richard Newton
- CHICAS, Furness College, Lancaster University, Lancaster LA1 4YG
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29
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Singleton DA, McGarry J, Torres JR, Killick D, Jewell C, Smyth S, Brant B, Sánchez-Vizcaíno F, Dawson S, Pinchbeck GL, Noble PJM, Radford AD. Small animal disease surveillance 2019: pruritus, pharmacosurveillance, skin tumours and flea infestations. Vet Rec 2020; 185:470-475. [PMID: 31628231 DOI: 10.1136/vr.l6074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - John McGarry
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - Jose Rodríguez Torres
- Institute of Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Campus Universitario Cardones de Arucas, 35413 Arucas, Las Palmas, Spain
| | - David Killick
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - Christopher Jewell
- Lancaster Medical School, Lancaster University, Furness Building, Lancaster LA1 4YG, UK
| | | | | | | | - Susan Dawson
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | | | - Peter J M Noble
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
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30
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Patterson EI, Elia G, Grassi A, Giordano A, Desario C, Medardo M, Smith SL, Anderson ER, Prince T, Patterson GT, Lorusso E, Lucente MS, Lanave G, Lauzi S, Bonfanti U, Stranieri A, Martella V, Basano FS, Barrs VR, Radford AD, Agrimi U, Hughes GL, Paltrinieri S, Decaro N. Evidence of exposure to SARS-CoV-2 in cats and dogs from households in Italy. bioRxiv 2020. [PMID: 32743588 DOI: 10.1101/2020.07.21.214346] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
SARS-CoV-2 originated in animals and is now easily transmitted between people. Sporadic detection of natural cases in animals alongside successful experimental infections of pets, such as cats, ferrets and dogs, raises questions about the susceptibility of animals under natural conditions of pet ownership. Here we report a large-scale study to assess SARS-CoV-2 infection in 817 companion animals living in northern Italy, sampled at a time of frequent human infection. No animals tested PCR positive. However, 3.4% of dogs and 3.9% of cats had measurable SARS-CoV-2 neutralizing antibody titers, with dogs from COVID-19 positive households being significantly more likely to test positive than those from COVID-19 negative households. Understanding risk factors associated with this and their potential to infect other species requires urgent investigation. One Sentence Summary SARS-CoV-2 antibodies in pets from Italy.
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Smith SL, Singleton DA, Noble PJ, Radford AD, Brant B, Pinchbeck GL, Appleton C, Jewell C, Newton R, Cuartero CT, Sánchez-Vizcaíno F. Possible cause of outbreak of prolific vomiting in dogs. Vet Rec 2020; 186:324. [PMID: 32165525 DOI: 10.1136/vr.m972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Shirley L Smith
- Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, Wirral CH64 7TE
| | - David A Singleton
- Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, Wirral CH64 7TE
| | - P J Noble
- Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, Wirral CH64 7TE
| | - Alan D Radford
- Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, Wirral CH64 7TE
| | - Beth Brant
- Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, Wirral CH64 7TE
| | - Gina L Pinchbeck
- Institutes of Infection and Global Health and Veterinary Science, Leahurst Campus, University of Liverpool, Chester High Road, Neston, Wirral CH64 7TE
| | | | - Chris Jewell
- CHICAS, Furness College, Lancaster University, Lancaster LA1 4YG
| | - Richard Newton
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU
| | - Carmen Tamayo Cuartero
- Bristol Veterinary School, University of Bristol, Churchill Building, Langford Campus, Bristol BS40 5DU
| | - Fernando Sánchez-Vizcaíno
- Bristol Veterinary School, University of Bristol, Churchill Building, Langford Campus, Bristol BS40 5DU
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Singleton DA, Stavisky J, Jewell C, Smyth S, Brant B, Sánchez-Vizcaíno F, Dawson S, Pinchbeck GL, Noble PJM, Radford AD. Small animal disease surveillance 2019: respiratory disease, antibiotic prescription and canine infectious respiratory disease complex. Vet Rec 2020; 184:640-645. [PMID: 31123207 DOI: 10.1136/vr.l3128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- David A Singleton
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - Jenny Stavisky
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK
| | - Christopher Jewell
- Lancaster Medical School, Lancaster University, Furness Building, Lancaster LA1 4YG, UK
| | - Steven Smyth
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - Bethaney Brant
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | | | - Susan Dawson
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - Gina L Pinchbeck
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - Peter J M Noble
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - Alan D Radford
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
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Littlehales R, Noble PM, Singleton DA, Pinchbeck GL, Radford AD. Impact of Covid-19 on veterinary care. Vet Rec 2020; 186:650-651. [PMID: 32587050 DOI: 10.1136/vr.m2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rebecca Littlehales
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, South Wirral CH64 7TE
| | - Pj M Noble
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, South Wirral CH64 7TE
| | - David A Singleton
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, South Wirral CH64 7TE
| | - Gina L Pinchbeck
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, South Wirral CH64 7TE
| | - Alan D Radford
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, South Wirral CH64 7TE
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Tulloch JSP, Christley RM, Radford AD, Warner JC, Beadsworth MBJ, Beeching NJ, Vivancos R. A descriptive epidemiological study of the incidence of newly diagnosed Lyme disease cases in a UK primary care cohort, 1998-2016. BMC Infect Dis 2020; 20:285. [PMID: 32299372 PMCID: PMC7164244 DOI: 10.1186/s12879-020-05018-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 04/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Primary care is likely to see the highest number of Lyme disease patients. Despite this, there is limited published data regarding Lyme disease patients accessing primary care in the UK. We aim to describe trends in the incidence of a new diagnosis, and demographics of patients identified in a primary care electronic health database. METHODS A descriptive epidemiological study of Lyme disease coded patients in UK primary care. 3725 patients coded for Lyme disease during 1998-2016 were identified within The Health Improvement Network (THIN). Incidence rates and the demographics of cases identified were described. Poisson regression was used to analyse socio-demographic characteristics of the cases. RESULTS There was an increase in annual crude incidence rates, peaking in 2015 at 5.47 (95% CI 4.85-6.14) cases per 100,000 population per year. Multivariable analysis showed there were significant differences in the ages of those affected, incidence of a new diagnosis rose as deprivation levels improved, and that there was a higher incidence of cases living in rural areas compared to urban areas. There was no significant difference between sexes for the UK. Cases were significantly more likely to identify with being white compared to the national population. CONCLUSIONS An increasing incidence of patients newly coded with Lyme disease related Read codes was identified using data from a UK national primary care database. By comparing these incidence figures with national laboratory-confirmed surveillance data, a multiplication factor of 2.35 (95%CI 1.81-2.88) can be calculated in order to estimate the annual number of cases seen in primary care. The significant socio-demographic variables associated with a Lyme disease diagnosis likely reflect a complex interplay of socio-economic issues, which needs to be further explored. Future work is needed to examine the treatment and management of patients within this database.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.
- Public Health England, L3 1DS, Liverpool, UK.
| | - Robert M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Jenny C Warner
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, SP4 0JQ, UK
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, SP4 0JQ, UK
| | - Mike B J Beadsworth
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Nick J Beeching
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Roberto Vivancos
- Public Health England, L3 1DS, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, L3 1DS, UK
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Farrell S, Noble PM, Pinchbeck GL, Brant B, Caravaggi A, Singleton DA, Radford AD. Seasonality and risk factors for myxomatosis in pet rabbits in Great Britain. Prev Vet Med 2020; 176:104924. [PMID: 32114004 DOI: 10.1016/j.prevetmed.2020.104924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
Myxomatosis is a highly contagious, frequently fatal viral disease affecting both wild and domesticated European rabbits across many areas of the world. Here we used electronic health records (EHRs) collected from pet rabbits attending a sentinel voluntary network of 191 veterinary practices across Great Britain (GB) between March 2014 and June 2019 to identify new features of this disease's epidemiology. From a total of 89,408 rabbit consultations, text mining verified by domain experts identified 207 (0.23 %) cases where myxomatosis was the only differential diagnosis recorded by the attending practitioner. Cases occurred in all months but February and were distributed across the country. Consistent with studies in wild rabbits, the majority of cases occurred between August and November. However, there was also evidence for considerable variation between years. A nested case control study identified important risk factors for myxomatosis within this pet animal population including season, sex, age, vaccination status and distance to likely wild rabbit habitats. Female entire rabbits were twice as likely to be a case (odds ratio (OR) 1.98, 95 % confidence interval (CI) 1.26-3.13, p = 0.003), suggesting a novel role for behaviour in driving transmission from wild to domesticated rabbits. Vaccination had the largest protective effect with vaccinated rabbits being 8.3 times less likely to be a case than unvaccinated rabbits (OR = 0.12, 95 % CI 0.06-0.21, p = <0.001).
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Affiliation(s)
- Sean Farrell
- School of Biosciences, University of Kent, Canterbury, Kent, CT2 7NJ, UK
| | - Pj-M Noble
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston,CH64 7TE, UK
| | - Gina L Pinchbeck
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston,CH64 7TE, UK
| | - Beth Brant
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston,CH64 7TE, UK
| | - Anthony Caravaggi
- School of Applied Sciences, University of South Wales, 9 Graig Fach, Pontypridd, UK CF37 4BB, UK
| | - David A Singleton
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston,CH64 7TE, UK
| | - Alan D Radford
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston,CH64 7TE, UK.
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36
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Arguello-Casteleiro M, Stevens R, Des-Diz J, Wroe C, Fernandez-Prieto MJ, Maroto N, Maseda-Fernandez D, Demetriou G, Peters S, Noble PJM, Jones PH, Dukes-McEwan J, Radford AD, Keane J, Nenadic G. Exploring semantic deep learning for building reliable and reusable one health knowledge from PubMed systematic reviews and veterinary clinical notes. J Biomed Semantics 2019; 10:22. [PMID: 31711540 PMCID: PMC6849172 DOI: 10.1186/s13326-019-0212-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Deep Learning opens up opportunities for routinely scanning large bodies of biomedical literature and clinical narratives to represent the meaning of biomedical and clinical terms. However, the validation and integration of this knowledge on a scale requires cross checking with ground truths (i.e. evidence-based resources) that are unavailable in an actionable or computable form. In this paper we explore how to turn information about diagnoses, prognoses, therapies and other clinical concepts into computable knowledge using free-text data about human and animal health. We used a Semantic Deep Learning approach that combines the Semantic Web technologies and Deep Learning to acquire and validate knowledge about 11 well-known medical conditions mined from two sets of unstructured free-text data: 300 K PubMed Systematic Review articles (the PMSB dataset) and 2.5 M veterinary clinical notes (the VetCN dataset). For each target condition we obtained 20 related clinical concepts using two deep learning methods applied separately on the two datasets, resulting in 880 term pairs (target term, candidate term). Each concept, represented by an n-gram, is mapped to UMLS using MetaMap; we also developed a bespoke method for mapping short forms (e.g. abbreviations and acronyms). Existing ontologies were used to formally represent associations. We also create ontological modules and illustrate how the extracted knowledge can be queried. The evaluation was performed using the content within BMJ Best Practice. Results MetaMap achieves an F measure of 88% (precision 85%, recall 91%) when applied directly to the total of 613 unique candidate terms for the 880 term pairs. When the processing of short forms is included, MetaMap achieves an F measure of 94% (precision 92%, recall 96%). Validation of the term pairs with BMJ Best Practice yields precision between 98 and 99%. Conclusions The Semantic Deep Learning approach can transform neural embeddings built from unstructured free-text data into reliable and reusable One Health knowledge using ontologies and content from BMJ Best Practice.
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Affiliation(s)
| | - Robert Stevens
- School of Computer Science, University of Manchester, Manchester, UK
| | - Julio Des-Diz
- Hospital do Salnés, Villagarcía de Arousa, Pontevedra, Spain
| | | | | | - Nava Maroto
- Departamento de Lingüística Aplicada a la Ciencia y a la Tecnología, Universidad Politécnica de Madrid, Madrid, Spain
| | - Diego Maseda-Fernandez
- Midcheshire Hospital Foundation Trust, NHS England, Crewe, UK.,School of Medical Sciences, University of Manchester, Manchester, UK
| | - George Demetriou
- School of Computer Science, University of Manchester, Manchester, UK
| | - Simon Peters
- School of Social Sciences, University of Manchester, Manchester, UK
| | - Peter-John M Noble
- Small Animal Veterinary Surveillance Network, University of Liverpool, Liverpool, UK
| | - Phil H Jones
- Small Animal Veterinary Surveillance Network, University of Liverpool, Liverpool, UK
| | - Jo Dukes-McEwan
- Small Animal Teaching Hospital, University of Liverpool, Liverpool, UK
| | - Alan D Radford
- Small Animal Veterinary Surveillance Network, University of Liverpool, Liverpool, UK
| | - John Keane
- School of Computer Science, University of Manchester, Manchester, UK.,Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Goran Nenadic
- School of Computer Science, University of Manchester, Manchester, UK.,Manchester Institute of Biotechnology, University of Manchester, Manchester, UK.,Health eResearch Centre, University of Manchester, Manchester, UK
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McIntyre KM, Bolton FJ, Christley RM, Cleary P, Deja E, Durie AE, Diggle PJ, Hughes DA, de Lusignan S, Orton L, Radford AD, Elliot AJ, Smith GE, Snape DA, Stanistreet D, Vivancos R, Winstanley C, O'Brien SJ. A Fully Integrated Real-Time Detection, Diagnosis, and Control of Community Diarrheal Disease Clusters and Outbreaks (the INTEGRATE Project): Protocol for an Enhanced Surveillance System. JMIR Res Protoc 2019; 8:e13941. [PMID: 31573952 PMCID: PMC6787530 DOI: 10.2196/13941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/23/2023] Open
Abstract
Background Diarrheal disease, which affects 1 in 4 people in the United Kingdom annually, is the most common cause of outbreaks in community and health care settings. Traditional surveillance methods tend to detect point-source outbreaks of diarrhea and vomiting; they are less effective at identifying low-level and intermittent food supply contamination. Furthermore, it can take up to 9 weeks for infections to be confirmed, reducing slow-burn outbreak recognition, potentially impacting hundreds or thousands of people over wide geographical areas. There is a need to address fundamental problems in traditional diarrheal disease surveillance because of underreporting and subsequent unconfirmed infection by patients and general practitioners (GPs); varying submission practices and selective testing of samples in laboratories; limitations in traditional microbiological diagnostics, meaning that the timeliness of sample testing and etiology of most cases remains unknown; and poorly integrated human and animal surveillance systems, meaning that identification of zoonoses is delayed or missed. Objective This study aims to detect anomalous patterns in the incidence of gastrointestinal disease in the (human) community; to target sampling; to test traditional diagnostic methods against rapid, modern, and sensitive molecular and genomic microbiology methods that identify and characterize responsible pathogens rapidly and more completely; and to determine the cost-effectiveness of rapid, modern, sensitive molecular and genomic microbiology methods. Methods Syndromic surveillance will be used to aid identification of anomalous patterns in microbiological events based on temporal associations, demographic similarities among patients and animals, and changes in trends in acute gastroenteritis cases using a point process statistical model. Stool samples will be obtained from patients’ consulting GPs, to improve the timeliness of cluster detection and characterize the pathogens responsible, allowing health protection professionals to investigate and control outbreaks quickly, limiting their size and impact. The cost-effectiveness of the proposed system will be examined using formal cost-utility analysis to inform decisions on national implementation. Results The project commenced on April 1, 2013. Favorable approval was obtained from the Research Ethics Committee on June 15, 2015, and the first patient was recruited on October 13, 2015, with 1407 patients recruited and samples processed using traditional laboratory techniques as of March 2017. Conclusions The overall aim of this study is to create a new One Health paradigm for detecting and investigating diarrhea and vomiting in the community in near-real time, shifting from passive human surveillance and management of laboratory-confirmed infection toward an integrated, interdisciplinary enhanced surveillance system including management of people with symptoms. International Registered Report Identifier (IRRID) DERR1-10.2196/13941
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Affiliation(s)
- Kirsty Marie McIntyre
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom.,National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom
| | - Frederick J Bolton
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Rob M Christley
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Paul Cleary
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom.,Field Epidemiology Services, Public Health England, Liverpool, United Kingdom
| | - Elizabeth Deja
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Ann E Durie
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Peter J Diggle
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom.,Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Simon de Lusignan
- Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lois Orton
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Alan D Radford
- Department of Infection Biology, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Alex J Elliot
- Real-Time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom
| | - Gillian E Smith
- Real-Time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, United Kingdom
| | - Darlene A Snape
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Debbi Stanistreet
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Roberto Vivancos
- Field Epidemiology Services, Public Health England, Liverpool, United Kingdom
| | - Craig Winstanley
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sarah J O'Brien
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom.,Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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Tulloch JSP, Decraene V, Christley RM, Radford AD, Warner JC, Vivancos R. Characteristics and patient pathways of Lyme disease patients: a retrospective analysis of hospital episode data in England and Wales (1998-2015). BMC Public Health 2019; 19:931. [PMID: 31412819 PMCID: PMC6694565 DOI: 10.1186/s12889-019-7245-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background Lyme disease is a tick-borne disease of increasing global importance. There is scant information on Lyme disease patient demographics in England and Wales, and how they interact with the National Health Service (NHS). Our aims were to explore the demographic characteristics of Lyme disease patients within the Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW), and to describe patient pathways. Methods Data from 1st January 1998 to 31st December 2015 was retrieved from the two administrative hospital datasets (HES and PEDW), based on patients coded with Lyme disease. Information was collected on demographic characteristics, home address and case management. Incidence rates were calculated, and demographics compared to the national population. Results Within HES and PEDW, 2361 patients were coded with Lyme disease. There was a significant increase (p < 0.01) in incidence from 0.08 cases/100,000 in 1998, to 0.53 cases/100,000 in 2015. There was a bimodal age distribution, patients were predominantly female, white and from areas of low deprivation. New cases peaked annually in August, with higher incidence rates in southern central and western England. Within hospital admission data (n = 2066), most cases were either referred from primary care (28.8%, n = 596) or admitted via accident and emergency (A&E) (29.5%, n = 610). This population entering secondary care through A&E suggest a poor understanding of the recommended care pathways for symptoms related to Lyme disease by the general population. Conclusions These data can be used to inform future investigations into Lyme disease burden, and patient management within the NHS. They provide demographic information for clinicians to target public health messaging or interventions.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK. .,Public Health England, Liverpool, L3 1DS, UK.
| | | | - Rob M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 3GL, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Jenny C Warner
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, SP4 0JQ, UK.,Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, SP4 0JQ, UK
| | - Roberto Vivancos
- Public Health England, Liverpool, L3 1DS, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, L3 1DS, UK
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39
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Smith SL, Afonso MM, Pinchbeck GL, Gaskell RM, Dawson S, Radford AD. Temporally separated feline calicivirus isolates do not cluster phylogenetically and are similarly neutralised by high-titre vaccine strain FCV-F9 antisera in vitro. J Feline Med Surg 2019; 22:602-607. [PMID: 31411533 PMCID: PMC7252219 DOI: 10.1177/1098612x19866521] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Feline calicivirus (FCV) is a highly variable and globally important feline pathogen for which vaccination has been the mainstay of control. Here, we test whether the continued use of FCV-F9, one of the most frequently used vaccine strains globally, is driving the emergence of vaccine-resistant viruses in the field. METHODS This study made use of two representative panels of field isolates previously collected from cats visiting randomly selected veterinary practices across the UK as part of separate cross-sectional studies from 2001 and 2013/2014. Phylogenetic analysis and in vitro virus neutralisation tests were used to compare the genetic and antigenic relationships between these populations and FCV-F9. RESULTS Phylogenetic analysis showed a typically radial distribution dominated by 52 distinct strains, with strains from both 2001 and 2013/2014 intermingled. The sequence for FCV-F9 appeared to be integral to this phylogeny and there were no significant differences in the genetic distances within each studied population (intra-population distances), or between them (inter-population distances), or between each population and FCV-F9. A 1 in 8 dilution neutralised 97% and 100% of the 2001 and 2013/14 isolates, respectively, and a 1 in 16 dilution neutralised 87% and 75% of isolates, respectively. There was no significant difference either in variance between the FCV-F9 neutralising titres for the two populations, or in the distribution of neutralisation titres across the two populations. CONCLUSIONS AND RELEVANCE Although FCV is a highly variable virus, we found no evidence for a progressive divergence of field virus from vaccine strain FCV-F9, either phylogenetically or antigenically, with FCV-F9 antisera remaining broadly and equally cross-reactive to two geographically representative and temporally separated FCV populations. We suggest this may be because the immunodominant region of the FCV capsid responsible for neutralisation may have structural constraints preventing its longer term progressive antigenic evolution.
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Affiliation(s)
- Shirley L Smith
- Institute of Infection and Global Health, University of Liverpool, Neston, Wirral, UK
| | - Maria M Afonso
- Institute of Infection and Global Health, University of Liverpool, Neston, Wirral, UK
| | - Gina L Pinchbeck
- Institute of Infection and Global Health, University of Liverpool, Neston, Wirral, UK
| | - Rosalind M Gaskell
- Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
| | - Susan Dawson
- Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
| | - Alan D Radford
- Institute of Infection and Global Health, University of Liverpool, Neston, Wirral, UK
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Tulloch JSP, Semper AE, Brooks TJG, Russell K, Halsby KD, Christley RM, Radford AD, Vivancos R, Warner JC. The demographics and geographic distribution of laboratory-confirmed Lyme disease cases in England and Wales (2013-2016): an ecological study. BMJ Open 2019; 9:e028064. [PMID: 31362976 PMCID: PMC6677960 DOI: 10.1136/bmjopen-2018-028064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Lyme disease is a tick-borne disease of increasing incidence and public concern across the Northern Hemisphere. However, the socio-demographics and geographic distribution of the population affected in England and Wales are poorly understood. Therefore, the proposed study was designed to describe the demographics and distribution of laboratory-confirmed cases of Lyme disease from a national testing laboratory. DESIGN An ecological study of routinely collected laboratory surveillance data. SETTING Public Health England's national Lyme disease testing laboratory. PARTICIPANTS 3986 laboratory-confirmed cases of Lyme disease between 2013 and 2016. RESULTS In England and Wales, the incidence of laboratory-confirmed Lyme disease rose significantly over the study period from 1.62 cases per 100 000 in 2013 to 1.95 cases per 100 000 in 2016. There was a bimodal age distribution (with peaks at 6-10 and 61-65 years age bands) with a predominance of male patients. A significant clustering of areas with high Lyme disease incidence was located in southern England. An association was found between disease incidence and socioeconomic status, based on the patient's resident postcode, with more cases found in less deprived areas. Cases were disproportionately found in rural areas compared with the national population distribution. CONCLUSIONS These results suggest that Lyme disease patients originate from areas with higher socioeconomic status and disproportionately in rural areas. Identification of the Lyme disease hotspots in southern England, alongside the socio-demographics described, will enable a targeted approach to public health interventions and messages.
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Affiliation(s)
- John S P Tulloch
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Field Epidemiology Service, Public Health England, Liverpool, UK
| | - Amanda E Semper
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
| | - Tim J G Brooks
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
| | | | - Kate D Halsby
- National Infection Service, Public Health England, London, UK
| | - Robert M Christley
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Neston, UK
| | - Alan D Radford
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Neston, UK
| | - Roberto Vivancos
- Field Epidemiology Service, Public Health England, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Liverpool, UK
| | - Jenny C Warner
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Public Health England, Porton Down, UK
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Singleton DA, Noble PJM, Sánchez-Vizcaíno F, Dawson S, Pinchbeck GL, Williams NJ, Radford AD, Jones PH. Pharmaceutical Prescription in Canine Acute Diarrhoea: A Longitudinal Electronic Health Record Analysis of First Opinion Veterinary Practices. Front Vet Sci 2019; 6:218. [PMID: 31334254 PMCID: PMC6615257 DOI: 10.3389/fvets.2019.00218] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/18/2019] [Indexed: 12/17/2022] Open
Abstract
Canine acute diarrhoea is frequently observed in first opinion practice, though little is known about commonly used diagnostic or therapeutic management plans, including use of antimicrobials. This retrospective observational study utilised electronic health records augmented with practitioner-completed questionnaires from 3,189 cases (3,159 dogs) collected from 179 volunteer veterinary practices between April 2014 and January 2017. We used multivariable analysis to explore factors potentially associated with pharmaceutical agent prescription, and resolution of clinical signs by 10 days post-initial presentation. Use of bacteriological and/or parasitological diagnostic tests were uncommon (3.2% of cases, 95% confidence interval, CI, 2.4–4.0), though systemic antimicrobials were the most commonly prescribed pharmaceutical agents (49.7% of cases, 95% CI 46.1–53.2). Such prescription was associated with haemorrhagic diarrhoea (odds ratio, OR, 4.1; 95% CI 3.4–5.0), body temperature in excess of 39.0°C, or moderate/severe cases (OR 1.3, 95% CI 1.1–1.7). Gastrointestinal agents (e.g., antacids) were prescribed to 37.7% of cases (95% CI 35.4–39.9), and were most frequently prescribed to vomiting dogs regardless of presence (OR 46.4, 95% CI 19.4–110.8) or absence of blood (OR 17.1, 95% CI 13.4–21.9). Endoparasiticides/endectocides were prescribed to 7.8% of cases (95% CI 6.8–9.0), such prescription being less frequent for moderate/severe cases (OR 0.5, 95% CI 0.4–0.7), though more frequent when weight loss was recorded (OR 3.4, 95% CI 1.3–9.0). Gastrointestinal nutraceuticals (e.g., probiotics) were dispensed to 60.8% of cases (95% CI 57.1–64.6), these cases less frequently presenting with moderate/severe clinical signs (OR 0.6, 95% CI 0.5–0.8). Nearly a quarter of cases were judged lost to follow-up (n=754). Insured (OR 0.7, 95% CI 0.5–0.9); neutered (OR 0.4, 95% CI 0.3–0.5), or vaccinated dogs (OR 0.3, 95% CI 0.3–0.4) were less commonly lost to follow-up. Of remaining dogs, clinical signs were deemed resolved in 95.4% of cases (95% CI 94.6–96.2). Provision of dietary modification advice and gastrointestinal nutraceuticals alone were positively associated with resolution (OR 2.8, 95% CI 1.3–6.1); no such associations were found for pharmaceutical agents, including antimicrobials. Hence, this study supports the view that antimicrobials are largely unnecessary for acute diarrhoea cases; this being of particular importance when considering the global threat posed by antimicrobial resistance.
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Affiliation(s)
- David A Singleton
- Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - P J M Noble
- Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | | | - Susan Dawson
- Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Gina L Pinchbeck
- Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Nicola J Williams
- Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Alan D Radford
- Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Philip H Jones
- Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
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42
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Scott A, Pottenger S, Timofte D, Moore M, Wright L, Kukavica-Ibrulj I, Jeukens J, Levesque RC, Freschi L, Pinchbeck GL, Schmidt VM, McEwan N, Radford AD, Fothergill JL. Reservoirs of resistance: polymyxin resistance in veterinary-associated companion animal isolates of Pseudomonas aeruginosa. Vet Rec 2019; 185:206. [PMID: 31239295 DOI: 10.1136/vr.105075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 05/16/2019] [Accepted: 05/27/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is an opportunistic pathogen and a major cause of infections. Widespread resistance in human infections are increasing the use of last resort antimicrobials such as polymyxins. However, these have been used for decades in veterinary medicine. Companion animals are an understudied source of antimicrobial resistant P. aeruginosa isolates. This study evaluated the susceptibility of P. aeruginosa veterinary isolates to polymyxins to determine whether the veterinary niche represents a potential reservoir of resistance genes for pathogenic bacteria in both animals and humans. METHODS AND RESULTS Clinical P. aeruginosa isolates (n=24) from UK companion animals were compared for antimicrobial susceptibility to a panel of human-associated isolates (n=37). Minimum inhibitory concentration (MIC) values for polymyxin B and colistin in the companion animals was significantly higher than in human isolates (P=0.033 and P=0.013, respectively). Genotyping revealed that the veterinary isolates were spread throughout the P. aeruginosa population, with shared array types from human infections such as keratitis and respiratory infections, suggesting the potential for zoonotic transmission. Whole genome sequencing revealed mutations in genes associated with polymyxin resistance and other antimicrobial resistance-related genes. CONCLUSION The high levels of resistance to polymyxin shown here, along with genetic similarities between some human and animal isolates, together suggest a need for sustained surveillance of this veterinary niche as a potential reservoir for resistant, clinically relevant bacteria in both animals and humans.
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Affiliation(s)
- Andrea Scott
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Sian Pottenger
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Dorina Timofte
- Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
| | - Matthew Moore
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Laura Wright
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | | | | | | | | | - Gina L Pinchbeck
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Vanessa M Schmidt
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
| | - Neil McEwan
- Institute of Veterinary Science, University of Liverpool, Neston, Wirral, UK
| | - Alan D Radford
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Joanne L Fothergill
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
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43
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Singleton DA, Arsevska E, Smyth S, Barker EN, Jewell C, Brant B, Sánchez-Vizcaíno F, Dawson S, Pinchbeck GL, Noble PJ, Jones PH, Radford AD. Small animal disease surveillance: gastrointestinal disease, antibacterial prescription and Tritrichomonas foetus. Vet Rec 2019; 184:211-216. [DOI: 10.1136/vr.l722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | | | - Christopher Jewell
- Lancaster Medical School, Lancaster University; Furness Building Lancaster LA1 4YG UK
| | | | | | - Susan Dawson
- Institute of Veterinary Science, University of Liverpool; Leahurst Campus, Neston CH64 7TE UK
| | | | - Peter J.M. Noble
- Institute of Veterinary Science, University of Liverpool; Leahurst Campus, Neston CH64 7TE UK
| | - Philip H. Jones
- Surveillance Intelligence Unit; Animal and Plant Health Agency; Kendal Road, Harlescott, Shrewsbury SY1 4HD UK
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44
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Radford AD, Afonso MM, Bonner SL. Investigating feline respiratory and gastrointestinal disease. Vet Rec 2018; 183:660. [PMID: 30504165 DOI: 10.1136/vr.k5022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Alan D Radford
- University of Liverpool, Institute of Infection and Global Health, School of Veterinary Science, Leahurst Campus, Chester High Road, Neston CH64 7TE
| | - Maria M Afonso
- University of Liverpool, Institute of Infection and Global Health, School of Veterinary Science, Leahurst Campus, Chester High Road, Neston CH64 7TE
| | - Shirley L Bonner
- University of Liverpool, Institute of Infection and Global Health, School of Veterinary Science, Leahurst Campus, Chester High Road, Neston CH64 7TE
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45
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Singleton DA, Sánchez-Vizcaíno F, Arsevska E, Dawson S, Jones PH, Noble PJM, Pinchbeck GL, Williams NJ, Radford AD. New approaches to pharmacosurveillance for monitoring prescription frequency, diversity, and co-prescription in a large sentinel network of companion animal veterinary practices in the United Kingdom, 2014-2016. Prev Vet Med 2018; 159:153-161. [PMID: 30314778 PMCID: PMC6193134 DOI: 10.1016/j.prevetmed.2018.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/04/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
Pharmaceutical agents (PAs) are commonly prescribed in companion animal practice in the United Kingdom. However, little is known about PA prescription on a population-level, particularly with respect to PAs authorised for human use alone prescribed via the veterinary cascade; this raises important questions regarding the efficacy and safety of PAs prescribed to companion animals. This study explored new approaches for describing PA prescription, diversity and co-prescription in dogs, cats and rabbits utilising electronic health records (EHRs) from a sentinel network of 457 companion animal-treating veterinary sites throughout the UK over a 2-year period (2014-2016). A novel text mining-based identification and classification methodology was utilised to semi-automatically map practitioner-defined product descriptions recorded in 918,333 EHRs from 413,870 dogs encompassing 1,242,270 prescriptions; 352,730 EHRs from 200,541 cats encompassing 491,554 prescriptions, and 22,526 EHRS from 13,398 rabbits encompassing 18,490 prescriptions respectively. PA prescription as a percentage of booked consultations was 65.4% (95% confidence interval, CI, 64.6-66.3) in dogs; in cats it was 69.1% (95% CI, 67.9-70.2) and in rabbits, 56.3% (95% CI, 54.7-57.8). Vaccines were the most commonly prescribed PAs in all three species, with antibiotics, antimycotics, and parasiticides also commonly prescribed. PA prescription utilising products authorised for human use only (hence, 'human-authorised') comprised 5.1% (95% CI, 4.7-5.5) of total canine prescription events; in cats it was 2.8% (95% CI, 2.6-3.0), and in rabbits, 7.8% (95% CI, 6.5-9.0). The most commonly prescribed human-authorised PA in dogs was metronidazole (antibiotic); in cats and rabbits it was ranitidine (H2 histamine receptor antagonist). Using a new approach utilising the Simpson's Diversity Index (an ecological measure of relative animal, plant etc. species abundance), we identified differences in prescription based on presenting complaint and species, with rabbits generally exposed to a less diverse range of PAs than dogs or cats, potentially reflecting the paucity of authorised PAs for use in rabbits. Finally, through a novel application of network analysis, we demonstrated the existence of three major co-prescription groups (preventive health; treatment of disease, and euthanasia); a trend commonly observed in practice. This study represents the first time PA prescription has been described across all pharmaceutical families in a large population of companion animals, encompassing PAs authorised for both veterinary and human-only use. These data form a baseline against which future studies could be compared, and provides some useful tools for understanding PA comparative efficacy and risks when prescribed in the varied setting of clinical practice.
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Affiliation(s)
- D A Singleton
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom.
| | - F Sánchez-Vizcaíno
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, The Farr Institute @ HeRC, University of Liverpool, Waterhouse Building, Liverpool, L69 3GL, United Kingdom
| | - E Arsevska
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - S Dawson
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - P H Jones
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - P J M Noble
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - G L Pinchbeck
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - N J Williams
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - A D Radford
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
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46
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Arsevska E, Singleton DA, Jewell C, Paterson S, Jones PH, Smyth S, Brant B, Dawson S, Noble PJM, Sánchez-Vizcaíno F, Radford AD. Small animal disease surveillance: pruritus and Pseudomonas skin infections. Vet Rec 2018; 183:182-187. [PMID: 30093432 DOI: 10.1136/vr.k3462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Christopher Jewell
- Lancaster Medical School, Lancaster University, Furness Building, Lancaster LA1 4YG, UK
| | - Susan Paterson
- Rutland House Referrals, Abbotsfield Road, St Helens WA9 4HU, UK
| | | | | | | | - Susan Dawson
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - Peter J M Noble
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
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Turner R, Arsevska E, Brant B, Singleton DA, Newman J, Noble PM, Jones PH, Radford AD. Risk factors for cutaneous myiasis (blowfly strike) in pet rabbits in Great Britain based on text-mining veterinary electronic health records. Prev Vet Med 2018; 153:77-83. [PMID: 29653739 PMCID: PMC5910172 DOI: 10.1016/j.prevetmed.2018.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/01/2018] [Accepted: 03/13/2018] [Indexed: 12/03/2022]
Abstract
Blowfly strike is a devastating and often rapidly fatal disease in rabbits. In Great Britain (GB), Lucilia sericata is the primary causative species. Despite its severity, there has been minimal investigatory work into the disease in rabbits. Here we used text mining to screen electronic health records (EHRs) from a large sentinel network of 389 veterinary practices in GB between March 2014 and April 2017 for confirmed cases of blowfly strike in rabbits. Blowfly strike was identified in 243 of 42,226 rabbit consultations (0.6%), affecting 205 individual rabbits. The anatomical site of recorded blowfly strike lesions was overwhelmingly the perineal area (n = 109, 52.4%). Less commonly lesions were observed affecting other areas of the body (n = 9, 4.3%) and head (n = 8, 3.8%); in 83 consultations (39.9%), the affected area was not specified. Of the rabbits presenting with blowfly strike, 44.7% were recorded as being euthanized or died. A case control study was used to identify risk factors for blowfly strike in this population. Whilst sex and neuter status in isolation were not significantly associated with blowfly strike, entire female rabbits showed a 3.3 times greater odds of being a case than neutered female rabbits. Rabbits five years of age and over were more than 3.8 times likely to present for blowfly strike. For every 1 °C rise in environmental temperature between 4.67 °C and 17.68 °C, there was a 33% increase risk of blowfly strike, with cases peaking in July or August. Overall blowfly strike cases started earlier and peaked higher in the south of Great Britain. The most northerly latitude studied was at lower risk of blowfly strike than the most southerly (OR = 0.50, p < 0.001). There appeared to be no significant relationship between blowfly strike in rabbits and either the sheep density or rural and urban land coverage types. The results presented here can be used for targeted health messaging to reduce the impact of this deadly disease for rabbits. We propose that real-time temporal and spatial surveillance of the rabbit disease may also help inform sheep control, where the seasonal profile is very similar, and where routine surveillance data is also not available. Our results highlight the value of sentinel databases based on EHRs for research and surveillance.
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Affiliation(s)
- Rachel Turner
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - Elena Arsevska
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - Beth Brant
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - David A Singleton
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - Jenny Newman
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - Pj-M Noble
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - Philip H Jones
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - Alan D Radford
- Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK.
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48
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Arsevska E, Priestnall SL, Singleton DA, Jones PH, Smyth S, Brant B, Dawson S, Sánchez-Vizcaíno F, Noble PJM, Radford AD. Small animal disease surveillance: respiratory disease 2017. Vet Rec 2018; 182:369-373. [PMID: 29599257 DOI: 10.1136/vr.k1426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Simon L Priestnall
- Department of Pathobiology & Population Sciences, Royal Veterinary College, North Mymms, Hatfield AL9 7TA, UK
| | | | | | | | | | - Susan Dawson
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | | | - Peter J M Noble
- Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
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49
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Tasker S, Hofmann-Lehmann R, Belák S, Frymus T, Addie DD, Pennisi MG, Boucraut-Baralon C, Egberink H, Hartmann K, Hosie MJ, Lloret A, Marsilio F, Radford AD, Thiry E, Truyen U, Möstl K. Haemoplasmosis in cats: European guidelines from the ABCD on prevention and management. J Feline Med Surg 2018; 20:256-261. [DOI: 10.1177/1098612x18758594] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Overview: Haemoplasmas are haemotropic bacteria that can induce anaemia in a wide range of mammalian species. Infection in cats: Mycoplasma haemofelis is the most pathogenic of the three main feline haemoplasma species known to infect cats. ‘ Candidatus Mycoplasma haemominutum’ and ‘ Candidatus Mycoplasma turicensis’ are less pathogenic but can result in disease in immunocompromised cats. Male, non-pedigree cats with outdoor access are more likely to be haemoplasma infected, and ‘ Candidatus M haemominutum’ is more common in older cats. All three haemoplasma species can be carried asymptomatically. Transmission: The natural mode of transmission of haemoplasma infection is not known, but aggressive interactions and vectors are possibilities. Transmission by blood transfusion can occur and all blood donors should be screened for haemoplasma infection. Diagnosis and treatment: PCR assays are the preferred diagnostic method for haemoplasma infections. Treatment with doxycycline for 2–4 weeks is usually effective for M haemofelis-associated clinical disease (but this may not clear infection). Little information is currently available on the antibiotic responsiveness of ‘ Candidatus M haemominutum’ and ‘ Candidatus M turicensis’.
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50
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Noble PJM, Newman J, Wyatt AM, Radford AD, Jones PH. Heightened risk of canine chocolate exposure at Christmas and Easter. Vet Rec 2017; 181:684. [PMID: 29263290 PMCID: PMC5749306 DOI: 10.1136/vr.104762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Peter-John M Noble
- Small Animal Teaching Hospital, University of Liverpool, Institute of Veterinary Science, Neston, UK
| | - Jenny Newman
- Department of Epidemiology and Population Health, University of Liverpool, Institute of Infection and Global Health, Neston, UK
| | - Alison M Wyatt
- University of Liverpool, Institute of Veterinary Science, Neston, UK
| | - Alan D Radford
- Department of Infection Biology, University of Liverpool, Institute of Infection and Global Health, Neston, UK
| | - Philip H Jones
- Department of Epidemiology and Population Health, University of Liverpool, Institute of Infection and Global Health, Neston, UK
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