J. Yoshicedo, DVM | Hawaii VMA

HDOA HPAI Guidance for Veterinary Clinics

Submitted by Raquel Wong, DVM, Hawaii Dept of Ag Animal Industry Division

Avian clients should not be turned away simply because HPAI is in the environment. Clinics and mobile veterinarians are encouraged to continue treating birds with extra attention focused on biosecurity and the signs of HPAI should they need to report suspected cases to animal health officials.

What are the signs of HPAI?

Decreased water consumption
Extreme depression
Very quiet
Difficulty breathing
Decrease in feed or water intake
Swelling or purple discoloration of head, eyelids, comb, wattle, and hocks
Decrease in egg production
Sudden unexplained death

What if a client calls with sick birds?

Veterinary clinics should develop a set of questions for their clients to determine the HPAI risk of the pet bird and then develop their own procedures appropriate to the risk. Some starter questions to consider:

Is the avian species a wild bird?
- Veterinarians should not let wild waterfowl, gulls or other susceptible HPAI wild species into their facility.
Are all birds sick or just one? What is the overall health of the flock?
- If one bird is sick or dead and all the others appear healthy it may not be HPAI. However, if a flock is experiencing daily mortality or there are a number of dead birds it should be reported to the Animal Industry Division, Hawaii Department of Agriculture at 808-483-7100 (Monday – Friday 7:45 AM – 4:30 PM). After hours or weekends to 808-837-8092. Or email HDOAIC@hawaii.gov.
Does the bird have access to the outside in a free ranging type of situation (vs. being in a contained/controlled housing away from environmental elements)
- If yes, how long does the bird spend time outside? Is the time spent outside supervised?
Does the client live by a body of water or agricultural field?
Does the client feed wild birds or wild animals?
Does the client engage in sport hunting of wild birds?
Does the client work or volunteer with any avian species?

Answering yes to any of these questions should prompt additional precautionary procedures to be utilized and have AI on your list of differential diagnoses.

How should clinics handle routine avian appointments?

Avian patient physical contact should be limited, and staff should always wear the appropriate PPE and wash their hands before and after handling birds. Additional biosecurity guidance includes:

Make an exam room at the clinic for avian appointments only.
See avian appointments at the end of the day.
Limit staff contact with avian species, especially those that have pet birds at home.
Emergency surgeries only for avian species.
Hospitalized avian species should be kept away from routine avian appointments.
All medical equipment and laundry used for avian appointments should be washed and disinfected appropriately.
Disinfect exam rooms following label directions on preparation and contact time to ensure it kills potential HPAI virus. Look for a disinfectant with an EPA registered product with label claim for Avian Influenza
Proper PPE should be used including gowns, foot coverings, masks, gloves, and eye protection.
Educate staff and clients about how HPAI is spread and how to reduce the spread of the disease.

How should mobile veterinarians handle client visits?

Wear clean clothing and boots.
If possible, limit ambulatory visits to facilities with poultry to one site per day.
Wash your vehicle immediately prior to and when leaving a site with poultry.
Use disposable coveralls, boots, and gloves, +/- masks. If possible and agreeable to the client, leave them at the client’s site.

Considerations for clinic staff biosecurity

Does the facility have a written biosecurity plan and procedures?
Do employees and volunteers receive biosecurity training?
Do employees and volunteers change into dedicated work clothing onsite? Is work-provided clothing laundered onsite, or is it taken home with employees?
What personal protective equipment (such as boots, gloves, coveralls, and masks) do you provide?
Are staff allowed to keep poultry or pet birds at home? Do staff engage in sport hunting of wild birds?
If the attending veterinarian is an offsite contractor, do they treat birds at other locations? What precautions do they take when visiting your facility?
Are there protocols (such as showering, changing clothes, or avoiding bird contact for 72 hours) for people who visit captive wild bird facilities or poultry premises?

What if you suspect a bird in your care has HPAI?

Call the Animal Industry Division, Hawaii Department of Agriculture at 808-483-7100 (Monday – Friday 7:45 AM – 4:30 PM). After hours or weekends to 808-837-8092. Or email HDOAIC@hawaii.gov.

Resources to share with your clients

H5N1 Avian Influenza virus confirmed on Oahu

On Friday 11/15/2024, the Hawaii Department of Agriculture announced they had confirmed multiple bird deaths due to H5N1 from a backyard flock in Central Oahu near the Wahiawa wastewater treatment plant. HDOA pathologists performed necropsies on the dead birds, and confirmatory tests for H5N1 were performed at NVSL and Hawaii Department of Health. Affected birds from this site included ducks, a goose, and a zebra dove.

HDOA has issued a quarantine order on this site, which requires all birds on the property to be depopulated and the premises cleaned and disinfected.

Human illness from H5N1 is uncommon, and people in Hawaii are still unlikely to get sick from avian influenza at this time.

Veterinarians and the public should continue to be vigilant for illness or mass die-offs in poultry or waterfowl flocks, and report any multiple or unusual illnesses or deaths to HDOA Animal Industry Division at 808-483-7102 or 808-837-8092.

Symptoms of avian influenza in poultry and other birds include:

Sudden death without any prior symptoms of illness
Lack of energy and appetite
A drop in egg production or soft-shelled, misshapen eggs
Swelling of the eyelids, comb, wattles and shanks
Purple discoloration of the wattles, comb and legs
Gasping for air (difficulty breathing)
Nasal discharge, coughing, sneezing
Twisting of the head and neck (torticollis)
Stumbling or falling down
Diarrhea

Specialized BHI swabs for AI PCR testing of poulty and waterfowl are available from HDOA. In poultry, collect oropharyngeal swabs; in waterfowl, collect cloacal swabs. Swabs can be pooled and stored in the BHI media refrigerated for up to 1 week prior to submission to the Halawa Veterinary Laboratory. Please see these instructions and contact Dr. Raquel Wong at the HDOA Animal Industry Division (808-483-7100) to obtain the appropriate media and swabs.

Talking points for the public:

The risk of H5N1 to humans and animals in Hawaii is currently low.
Do not touch sick or dead birds without appropriate personal protective equipment such as gloves, facemasks, protective gowns and footwear.
Poultry or other bird owners should increase biosecurity for their flocks.
Multiple sick or dead birds should be reported to the HDOA Animal Industry Division.

Read the full HDOA Press Release from 11/15/2024 here.

More information can be found in these resources:
Hawaii Department of Agriculture (HDOA)
Hawaii Department of Health (DOH)
Centers for Disease Control and Prevention (CDC)
United States Department of Agriculture (USDA)

Updated 11/23/2024: Check out HDOA’s HPAI Guidance for Veterinary Clinics

Avian influenza virus detected in Oahu wastewater

On Wednesday 11/13/2024, the Department of Health announced they had detected H5 virus from a wastewater processing plant on Oahu. This testing is a part of routine testing of wastewater facilities across the US by the CDC. Due to the type of testing performed, the presence of the avian influenza virus was detected, but no sequencing has yet been conducted to confirm whether this is the highly pathogenic strain of avian influenza also known as HPAI, H5N1.

During the outbreak of highly pathogenic avian influenza within the United States over the past 2 years, Hawaii has been the only state in the US without a confirmed case of H5N1 in humans or animals. H5N1 can spread rapidly between birds, and has been found more rarely in mammals such as humans, cows, and pigs. There is no evidence of sustained human-to-human transmission of H5N1 in the United States.

There are no reports of human or animal H5N1 cases in Hawaii and the overall risk of H5N1 to humans and animals within the state remains low.

The Hawaii Department of Agriculture (HDOA) already maintains strict bird import laws that require permits, inspections, health certificates, identification requirements and in some cases, isolation periods prior to importation into Hawaii. Due to recent widespread outbreaks of highly pathogenic avian influenza on the mainland, HDOA has further restricted the importation of birds from areas experiencing outbreaks and has required pre-entry avian influenza test protocols. In addition, HDOA has placed an embargo on importing birds through the mail.

While the Department of Health continues to investigate the source of the H5 virus detected, veterinarians and the public should continue to be vigilant for illness or mass die-offs in poultry or waterfowl flocks.

Symptoms of avian influenza in poultry and other birds include:

Sudden death without any prior symptoms of illness
Lack of energy and appetite
A drop in egg production or soft-shelled, misshapen eggs
Swelling of the eyelids, comb, wattles and shanks
Purple discoloration of the wattles, comb and legs
Gasping for air (difficulty breathing)
Nasal discharge, coughing, sneezing
Twisting of the head and neck (torticollis)
Stumbling or falling down
Diarrhea

Talking points for the public:

The risk of H5N1 to humans and animals in Hawaii is currently low.
Do not touch sick or dead birds without appropriate personal protective equipment such as gloves, facemasks, protective gowns and footwear.
Poultry or other bird owners should increase biosecurity for their flocks.
Multiple sick or dead birds should be reported to the HDOA Animal Industry Division.

Protected: 71st Annual Conference Proceedings

HVMA 2024 Conference Labs

This year we are providing hands-on lab experiences with orthopedic repair and behavioral animal handling skills, as well as hosting a workshop on palliative care for chronic pain and end of life cases.

General conference registration is not required for lab registration. However, general conference registration is required for any lecture or exhibit hall entry. If you are interested in a lab that is at full capacity, please email us to be put on the wait list.

Orthopedic Lab – Wednesday Nov 6, 2024
Advanced CCL repair in Dogs with Excessive Tibial Plateau Angle (TPA)

Instructors: Brian Beale, DVM, DACVS & Don Hulse, DVM, DACVS
Sponsored by Movora/Veterinary Orthopedic Implants

Now that you have mastered surgical correction in routine cases of CrCL injury in dogs, are you ready to tackle more difficult patients? Routine extracapsular repair of CCL tears often fail in dogs having an excessive slope of the tibial plateau. This course will introduce you to 3 straight-forward techniques that can be used successfully to treat these patients. Additional training is suggested to develop the techniques more completely. We will demonstrate a new planning application (vPOP PRO) that can be used on your phone, computer or tablet to plan any orthopedic problem. Surgical treatment of this condition can be simple and rewarding.

Course Objectives:
1. Understand the effects of an excessive angle of the tibial plateau (eTPA) in dogs with CCL tears.
2. To learn how to plan and perform a modified cranial closing wedge osteotomy (mCCWO) to stabilize dogs having CCL and eTPA.
3. To learn how to plan and perform a double-cut TPLO to stabilize dogs having CCL and eTPA.
4. To learn how to plan and perform a CORA-based leveling osteotomy (CBLO) to stabilize dogs having CCL and eTPA.

Schedule:
8:30 CCL tears with excessive TPA
9:00 Simple correction using mCCWO
9:30 Break
9:45 Lab 1 – mCCWO on plastic bone
11:30 Double-cut TPLO
12:00 Lunch
1:30 Lab 2 – Double-cut TPLO on plastic bone
2:30 CBLO
3:00 Lab 3 – CBLO on plastic bone
4:30 End of course

Orthopedic Lab – Thursday Nov 7, 2024
CCL Injury with Patellar Luxation in Dogs

Instructors: Brian Beale, DVM, DACVS & Don Hulse, DVM, DACVS
Sponsored by Movora/Veterinary Orthopedic Implants

Toy and large breed dogs are commonly affected by medial patellar luxation and concurrent CCL tears. Successful treatment requires proficiency in decision-making, planning and execution of appropriate surgical techniques to avoid recurrent luxation. This course will focus on techniques used to treat concurrent MPL and CCL tears using the latest technology to simplify repair and give the best outcome.

Course Objectives:
1. To learn how to plan and perform a trochlear groove prosthesis.
2. To understand the effects of concurrent MPL and CCL tear in dogs.
3. To learn how to plan and perform basic MPL repair techniques in dogs.
4. To learn how to plan and perform an isometric CCL repair in dogs undergoing MPL repair.
5. To learn how to perform a TTT with TPLO or CBLO

Schedule:
8:30 Making decisions when MPL and CCL tears occur together
9:00 The basics of MPL – Groove deepening and TTT
9:30 Break
9:45 Optimizing extracapsular CCL repair and MPL
10:15 Lab 1 – Extracapsular CCL repair and MPL on plastic bone
11:30 Combining MPL repair with TPLO and CBLO
12:00 Lunch
1:30 Lab 2 – MPL and TPLO/CBLO on plastic bone
3:00 Patellar groove prosthesis (PGR)
3:30 Lab 3 – Patellar Groove Prosthesis on plastic bone
4:30 End of course

Chronic Pain and End of Life Palliative Care –
Thursday Nov 7, 2024 10am-12pm

Instructor: Carolyn Naun, DVM, CHPV

Do you wonder if you could be doing more for your patients with chronic pain or illness? Are you looking for ideas to maximize a pet’s comfort when they’re terminally ill, but it’s not yet time for euthanasia? This workshop will work through some cases together and explore how a multimodal approach to care can help you best serve your geriatric and end of life patients and support their owners. Open to vets, vet techs, and support staff. Capacity: 20

Behavior Lab: Low Stress Handling –
Thursday Nov 7, 2024 1pm-3pm

Instructor: Ariel Fagen, DVM, DACVB

Hands-on workshop with mannequins to practice canine and feline restraint and handling techniques that are both safer and low stress. Open to vets, vet techs, and support staff.

Register at https://hawaiivetmed.org/events/2024confreg/

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2024 Hawaii Legislative Update

The 2024 legislative session is up and running! Several introduced bills may have direct impacts on veterinary practice in Hawaii. Here are the bills we are watching:

HB2086 / SB2749 RELATING TO HEALTH. Requires the administrator of the narcotics enforcement administration to make an emergency scheduling by placing xylazine into schedule III on an emergency basis. [HVMA working to include a veterinary use exemption]
HB1527 / SB2562 RELATING TO VETERINARY MEDICINE. Prohibits animal owners and their employees from performing any surgical procedures on the owner’s animal or animals. Prohibits the elastration, or castration via banding, of a pet animal. Provides that a violation of the prohibitions is a class C felony. Clarifies that the offense of cruelty to animals in the first degree does not apply to accepted veterinary practices and cropping or docking as customarily practiced when the procedures are performed by a licensed veterinarian.
HB1580 RELATING TO ANIMAL CRUELTY. Amends the criminal penalties for various animal cruelty offenses by increasing the category of offense
SB2114 RELATING TO FERAL ANIMALS. Prohibits the feeding of feral animals within a certain distance from Department of Education public school campuses; establishes fines
SB2564 RELATING TO PET ANIMALS. Prohibits insurers from refusing to issue, refusing to renew, canceling, or establishing higher rates for a homeowners insurance policy or dwelling fire insurance policy based on the breed of any dog that is kept on the premises. Requires any pet animal found on the premises during an eviction to be given to the owner or taken in by an animal control agency. Limits the monetary amount of pet deposits and pet rent. Clarifies that a provision allowing a lien on an animal to secure payment for caring for or feeding the animal does not apply to pet animals.
SB2692 RELATING TO DANGEROUS DOGS. Establishes requirements and penalties for owners of dangerous dogs. Allows for impounding of dangerous dogs under certain conditions.

Please keep an eye out for calls to submit testimony on these bills in the near future. We will send out an alert once any of the bills that may impact veterinary practice are scheduled for a hearing. At that time testimony may be submitted online at https://www.capitol.hawaii.gov/.

One Health Month

Governor Green has declared January 2023 as Hawai’i One Health Month! #OneHealth represents the intersection of human health, animal health, and environmental health, and helps us address complex health problems in Hawaii and beyond. See the proclamation here.

Awareness of the One Health approach helps to inform our decision-making, particularly for policy makers and leaders seeking to comprehensively address current issues such as climate change and emerging infectious diseases like COVID-19 or avian influenza. Thinking about how human health is inextricably related to animal health and environmental health also informs our individual everyday decisions: our food choices, the products we buy, appropriate use of antibiotics or other medications, how we care for the native species and habitats we live near, etc.

SARS-CoV-2, the virus that causes COVID-19, is a recent example of a zoonotic disease that can pass from humans to animals and vice versa, causing illness and death in multiple species. The more humans encroach on wild habitats and interact with non-domesticated animal species, the more opportunities there are for viruses or other infectious organisms to spread and mutate into forms that can cause global pandemics. But zoonotic disease spread is just one example of the interplay between human, animal, and environmental health. Other important examples include how the use of pesticides has decimated bee populations, which in turn decreased pollination, crop yields, and human food supply; or how medication prescribed in human and veterinary medicine can pass through their patients to enter the environment and cause developmental deformities in wildlife and drug-resistant infections; or how lead shot used in hunting has resulted in lead toxicity in scavenging animals such as birds of prey and humans alike.

One Health concepts have been a part of many veterinary curricula and may seem obvious to veterinarians, but many of our colleagues in other health and science disciplines were not trained to think outside of their specific fields. Keep the One Health perspective in mind, and encourage others to do the same!