Hawaii Island

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

Legislative Update 2022

The Hawaii Veterinary Medical Association (HVMA) seeks to amend Chapter 471, Hawaii Revised Statutes, to better define the practice and parameters of veterinary medicine and veterinary telemedicine to protect consumers and their pets from inadequate, improper, or unlicensed veterinary care. Further, because there is a shortage of licensed veterinarians in Hawaii, HVMA is proposing to provide for the temporary permitting of out-of-state veterinarians and providing for international veterinary school graduates to qualify for licensure examination in Hawaii.

The COVID-19 pandemic and its associated restrictions brought about consumer demand for telehealth in the field of veterinary medicine. Telemedicine has allowed consumers more access to veterinary services for their pets, particularly in areas where access to veterinary care is limited. However, HVMA is aware that the use of telemedicine may also be abused without an established veterinary-client-patient relationship. Without actual physical examination of a pet, veterinary services rendered through telemedicine alone can be inadequate and below the standard of veterinary care. The addition of telehealth definitions and the telemedicine section will help to clarify the practice of veterinary telemedicine and assist the Hawaii Board of Veterinary Medicine in ensuring consumers in Hawaii receive proper and licensed veterinary telemedicine services.

Additionally, the pandemic highlighted the shortage of veterinarians available to provide specialty and routine veterinary care for Hawaii’s people and their pets. At times, veterinary emergency hospitals were unable to operate 24/7 and surgeon schedules were completely booked for months due to the inability to fill these staffing shortages by temporary permit. In one specific case, there was a veterinary surgeon within the state that could have assisted during this period, but due to her international veterinary school degree, was unable to sit for Hawaii’s state licensing exam due to a technicality in the administrative rules. These amendments are critically important to prevent such veterinary care shortages in the future, and ensure that all qualified veterinarians are allowed to sit for the Hawaii state licensing exam.

This bill has currently been introduced to the House (HB 1598) by Representatives Johanson, Hashem, and Nishimoto; and into the Senate (SB 2798) by Senators Lee, Gabbard, Keith-Agaran, Misalucha, Acasio, Ihara, and San Buenaventura . Please take the time to thank them for their support, and write your local representative to ask for theirs!

Specialty/ER Service Interruption

The Hawaii Board of Veterinary Medicine has recently reinterpreted Hawaii’s veterinary practice law and begun rejecting the practice of veterinary sponsorship. This practice previously allowed many out-of-state specialists to share their services with our clients on a short-term or intermittent basis. All of us have benefited from referring our clients to visiting dermatologists, radiologists, surgeons, as well as our few emergency care centers that operate 24/7. This interruption in veterinary sponsorship has limited service hours at emergency clinics and worsened the backlog of surgery cases in Hawaii.

If your clients are being affected, please encourage them to file a complaint with the DCCA and Board of Veterinary Medicine to insist that they must immediately return to honoring the practice of veterinary sponsorship in Hawaii as clearly allowed by HRS 471(2)-5.

Veterinarians as COVID-19 Vaccinators

Submitted by the American Veterinary Medical Association

The AVMA has been working hard for the past few months, as veterinarians have been increasingly discussed as needing to be among those able to assist in efforts to vaccinate people against COVID, to have veterinarians specifically included in the declarations under the federal Public Readiness and Emergency Preparedness Act (PREP Act), which authorizes the HHS Secretary to issue emergency public health declarations and provides limited immunity from liability to those covered under the act.

As of March 12, 2021, veterinarians and veterinary students are included in the PREP Act:

· It allows veterinarians who are licensed to practice under the law of any state to administer COVID vaccines in any jurisdiction in association with a COVID vaccination effort by a state, local, tribal, or territorial authority or by an institution in which the COVID vaccine is administered.

· This also applies to veterinarians who have held an active license or certification under the law of any state within the last five years which is inactive, expired or lapsed, as well as veterinary students with appropriate training in administering vaccines. The intent is to include recently retired veterinarians who may want to help.

· Today’s amendment preempts any state law that would otherwise prohibit veterinarians or veterinary students who are a “qualified person” under the PREP Act from prescribing, dispensing, or administering COVID vaccines or other covered COVID countermeasures.

· Veterinarians and veterinary students will be afforded liability protections in accordance with the PREP Act and the terms of the amendment. However, specific conditions must be met in order for the authorization to administer the vaccines and the liability protections to apply. These liability protections apply from March 11, 2021, through October 1, 2024.

· In order for the authorization and liability protections to apply, veterinarians and veterinary students must be participating in association with a COVID vaccination effort by a state, local, tribal, or territorial authority, or by an institution in which the COVID vaccine is administered. Additional specific requirements also must be met, such as having basic certification in CPR, completing the CDC COVID vaccination modules, an observation period, etc. There is a separate section of the declaration that applies to those in the uniformed services and for federal employees, contractors and volunteers when authorized to administer COVID vaccine.

· While the liability outlined in the PREP Act is broad, it does not apply to willful misconduct, and the federal government does not provide a legal defense in the event that you are sued. Your state may have separate liability protections, along with separate requirements to qualify, and may or may not provide a legal defense. Veterinary malpractice will not likely respond to claims arising from a veterinarian intentionally vaccinating people against COVID.

More information on vaccination volunteer requirements

PREP Fact Sheet that Includes Veterinarians as Qualified Health Professionals

Conservation Medicine Spotlight: Avian Translocations with Pacific Rim Conservation

by Adrien Pesque, DVM

Pacific Rim Conservation, a nonprofit organization, has the mission of maintaining and restoring native bird diversity, populations, and ecosystems in Hawaii and the Pacific Region. In an effort to combat the threats to seabird populations including climate change and non-native predators (feral cats, pigs, rats, etc), chicks are translocated to predator proof fenced refuges on the main Hawaiian islands where they will fledge and return to breed. On Oahu, black-footed albatross, Bonin petrel, and Tristram’s storm-petrel chicks were translocated from Midway and Tern Island to James Campbell National Wildlife Refuge. On Kauai, endangered Hawaiian petrels and Newell’s shearwater face similar threats of habitat degradation and non-native predators, but also collisions with power lines and structures exacerbated by light attraction. Individuals of these two species were translocated from the Kauai mountaintops to a predator proof fenced area within the Kīlauea Point National Wildlife Refuge. These new breeding colonies will provide a safe haven for new generations to come.

Dr. Adrien Pesqué, the staff wildlife veterinarian, joined the team this year and created a mobile veterinary clinic to oversee the health of the chicks. Clinical cases included avian pox lesions, osteomyelitis of the beak, a non-healing corneal ulcer, and aspiration pneumonia secondary to gastric foreign bodies. Plastics and fishing material in the GI tract were present in our chicks and continue to cause life threatening problems for ocean wildlife.

Dr. Suzanne Pluskat, the staff wildlife veterinarian stationed on Midway Atoll, worked with partners to ensure the safety of the endangered Laysan duck for the anticipated rodent eradication on the island. Laysan duck cases involved pododermatitis, complicated corneal ulcers, femoral fracture repair and physical therapy. During the “construction season” (July-September when there are no albatross), many white tern chicks and the first ever black noddy chick were salvaged and fledged successfully.

Pacific Rim Conservation partners with multiple government and non-profit groups to make this work possible. To learn more about these translocations and other research projects, please visit www.pacificrimconservation.org.

What to do when marine wildlife need help?

Submitted by Michelle Barbieri, DVM

There are lots of ways that you can help Hawaii’s marine wildlife, both as an individual and if your clinic gets calls or inquiries. It may be completely normal for an animal (such as a green sea turtle or Hawaiian monk seal) to rest on the beach, but those sightings are informative even if the animal is safe and healthy. You can encourage clients to report sightings or concerns by calling the state-wide Marine Animal Stranding and Reporting Hotline at (888) 256-9840. This menu-based hotline will divert calls to the island- and wildlife-specific point of contact, and if the call comes in after hours, it will be checked first thing the next day, so always leave contact information for follow up questions. This is the best go-to contact number to keep at the front desk of your clinic or stored in your phone.

Many species (especially sea turtles and marine mammals) are protected by law. That means that even if you are a licensed, practicing, and well-intentioned veterinarian, conducting medical procedures on them requires specialized permits and expertise, so it should always be done by appropriately trained and permitted stranding response personnel. If your clinic gets a call about a marine animal in need, it is best to refer them directly to the Stranding Hotline for assistance. Please do not attempt to treat an animal yourself.

It is also important to give wildlife a safe distance, avoid approaching, touching, or otherwise disturbing them because rest is important to their biology, and they can be a danger to your safety. You can also help by advising clients to keep pet cats indoors, which will reduce the risk of disease spread, namely toxoplasmosis.

Between Jan-July 2020, 18 monk seal pups were born in the main Hawaiian Islands: 5 on Oʻahu, 11 on Molokaʻi, and 1 each on Kaua‘i and Hawaiʻi Island. Encountering female seals that are nursing their pups is a situation in which it is important to be especially cautious, as these seals in particular can be aggressive.

The Fishing Around Seals and Turtles program provides guidelines on how to fish safely around these animals and what to do if a fisherman accidentally hooks one while fishing. Again, if someone contacts you about an entangled or hooked animal please refer them to the stranding hotline.

If you suspect illegal or suspicious activity, it can be reported to: (a) the Hawaii DLNR Division of Conservation and Resources (DOCARE) hotline at (808) 643-DLNR, or preferably on the DLNRTip App for your mobile device; or (b) NOAA Office of Law Enforcement Hotline (800) 853-1964. The Stranding Hotline links to DOCARE as well.

For additional information contact: RespectWildlife@noaa.gov
For immediate assistance or to report marine wildlife emergencies call: 1-888-256-9840
If you are interested in having electronic materials with this information that you can print and post at your clinic, please contact Dr. Michelle Barbieri.

AVMF Extends Disaster Relief to Hawaii Veterinarians

AVMF Disaster Relief and Reimbursement Grants

The American Veterinary Medical Foundation (AVMF) provides two grant programs to help veterinarians and the animals they care for during times of disaster. Grants are available to support victims of hurricanes, floods, tornadoes, earthquakes, volcanoes, wildfires or oil spills.

Disaster Reimbursement Grants for Veterinary Medical Care

Purpose: The AVMF disaster reimbursement grants are for the purpose of ensuring the emergency veterinary medical care of animal victims of disaster.

Awards: Up to $5,000 may be issued per grantee for out-of-pocket expenses incurred by veterinarians providing emergency veterinary medical care to animal victims of disasters. AVMF reimburses for the actual cost of medical supplies purchased directly from a vendor. Modest boarding costs may also be covered.

Disaster Relief Grant for Veterinarians

Purpose: The AVMF disaster relief grants are for the purpose of assisting veterinarians who have experienced an emergency need for basic necessities due to a disaster. The grants would cover items such as clothing, temporary housing, transportation and meals that were needed immediately following a disaster.

Awards: Up to $2,000 may be issued per grantee for out-of-pocket expenses incurred immediately following a disaster. AVMF reimburses for the actual cost of items purchased directly from a vendor. Modest housing costs may be covered for emergency temporary shelter.

Application Procedure

The applications are posted on the AVMF website. Applicants should follow the online directions for submitting the application and the expense chart. Limited funds are currently available and approved on a first come, first served basis.

Deadline: Applications must be received no later than 120 days following the disaster.

More Information: Please contact Cheri Kowal, Senior Manager, Programs and Operations, 847-285-6691 or CKowal@AVMA.org