Maui | 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

Maui Wildfire Burn Zone Access Granted

The Hawaii Veterinary Medical Association would like to thank Adjutant General Kenneth Hara and Brigadier General Steve Logan with the Hawaii Emergency Management Agency for their efforts working with MEMA (Maui Emergency Management Agency) and Maui Humane Society to help Animal Search and Rescue teams gain access to previously restricted areas on Saturday August 26th. We acknowledge that efforts to search for pet animal survivors are necessarily secondary to ensuring the safety of personnel entering the burn zone and safely securing human remains.

It is important to clarify that steps to provide for animal survivors in the burn zone were taken even when Animal Search & Rescue teams were not allowed access. A FEMA veterinarian has been stationed in the burn zone supporting the canine search teams, and she oversees the delivery of any animals found alive by first responders to the Maui Humane Society for medical care. Food and water were left in various areas throughout the burn zone for any other animals that were hiding from the response teams.

We encourage all who want to provide care to animals in this or future disasters to complete the free FEMA training (ICS 100/200 & IS 700/800) and Community Emergency Response training so they can understand how to best participate in response situations and help their communities.

Updates on Pet Transport Off Maui

Updated Aug 17, 2023 – All information posted here is subject to change

USDA APHIS has provided the following information for transporting pets off Maui.

Maui Humane Society
Maui Humane Society is providing free health certificates and free air kennels for residents that need them to leave the island.

OGG to HNL only
Kamaka Airlines – possible discount on flights

OGG to Continental USA
– Alaska Airlines – OGG to Seattle and LAX. Assisting with Maui shelters relocating pets. They recommended shelter groups send them a request. They are considering discount requests to pet relocation groups.
– Hawaiian Airlines – OGG to SEA and LAX (non-stop flights, no kennel limitations); OGG to SFO and SAN (non-stop with max 28” height kennels)

HNL to LAX
– Pacific Air Cargo – book through IPATA Pet Transport Company
– Aloha Air Cargo – book through IPATA Pet Transport Company; accepts giant breeds, also flies to Seattle
– American Airlines Cargo (PetEmbark) – PetEmbark@aa.com; 1-800-227-4622, (only between HNL and continental US)

Local IPATA Pet Transporters
Island Pet Movers
– www.islandpetmovers.com/contact (please fill out inquiry)
– exotic pets, cats and dogs, fish on case-by-case basis
– discount Aug 15-25, OGG to HNL to LAX, $65 to HNL, $225 to LAX (100-500 size kennel); no breed restrictions to LAX
– other mainland locations $375 – $575, airport and breed restrictions apply
– utilizing Kamaka Air and Pacific Air Cargo
– crates and health certificate exams discounted 30%

Tails of Hawaii
– 808-676-9663 option 3
– tailmovers@tailsofhawaii.com
– Exotic & pocket pets, potbelly pigs, cats and dogs, birds, NO fish
– may offer discount for moves on case-by-case basis, submit request to
tailmovers@tailsofhawaii.com
– offering discount on health certificate issuance in HNL for those impacted by Maui wildfires

REMINDERS FOR VETS
Category I Accredited Veterinarians authorized through our National Veterinary Accreditation Program (NVAP) are NOT able to issue health certificates for pet birds or pet pot-bellied pigs. Those animals would need to be examined by a Category II Accredited Veterinarian. If AV’s have more questions as to which Category they are authorized, to please refer to the following website and feel free to reach out to the local NVAP Coordinator: https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/nvap/ct_category1-2

For pets going to the mainland US, please issue a rabies vaccine certificate.

Further VEHCS information and guidance:
https://www.aphis.usda.gov/aphis/pet-travel/vehcs-info

Update on Maui Wildfire Response

August 14, 2023

Remember that disaster response is a marathon, not a sprint. Here is an update communicated to us by the team working under Maui Humane Society (MHS).

Due to the severity of the fire and limited access following the event due to safety concerns, there were not nearly the amount of burn survivors as was anticipated. Most likely, those that could be saved have already been rescued, though the field teams are still looking. Thankfully many people were able to evacuate with their pets.

The next phase will include long term community outreach for those who are now living in Lahaina, Napili, and Kapalua, as they no longer have vets on the west side of the island. MHS is leading this effort. They and other nonprofit organizations will have mobile units in West Maui starting tomorrow that will need to be staffed. There won’t be a need for many trained vet professionals all at once, but more likely over a long period of time. We will be helping MHS coordinate the pool of volunteers.

If you are interested, please fill out this online form with your interest/availability in longer term volunteer efforts.

There have been many, many hours of meetings attended by HVMA leadership, Dr. Aleisha Swartz (primary HVMA liaison to HiEMA/ State Emergency Support Functions), Dr. Nate Lam (volunteer), MHS staff, all government agencies (county, state, fed) and non-governmental organizations (e.g. American Red Cross, ASPCA). We are doing our best to identify needs and respond appropriately in a rapidly changing and challenging situation. The right people are getting in place for the long term plan. Emergency management meetings are discussing the following considerations: getting feed & water to livestock whose pasture has burnt, disease management from decomposition, marine pollution, trapping feral/strays when they re-emerge, short and long term sheltering and feeding of displaced people and pets, keeping families together with pets, veterinary needs, etc.

HVMA’s role in this emergency currently is supportive to governmental agencies and organizations like MHS that are acting under the emergency declaration. We are making every effort to coordinate volunteers, gather information on needs, and share information on resources and identify information and needs gaps. We are also coordinating support offered from national organizations such as AVMF. Most of our time and work is remote and we may need remote volunteer support for this as well, as the board is all volunteering their time to coordinate this effort.

A call to action- if your HVMA membership is not current please RENEW today! The more members we have, the stronger we are in times like this, and the more resources we have to support these efforts.

We hope this helps with some of the questions and anticipation out there. Thanks again for all your care, concern, kokua, and patience! We are proud to be a part of the HVMA and the Hawaii vet community. Let’s continue to make our community stronger!

Your HVMA Board

Maui Wildfire Disaster Response

October 8, 2023 – The Maui Humane Society continues to coordinate ongoing relief efforts to the people and animals impacted by the Maui Wildfires. Thank you to all those who have already volunteered your time and finances to support these efforts. There is still a need for veterinarians and veterinary technicians/assistants, so please sign up for volunteer shifts here.

Additionally, the HVMA has received a grant from the AVMF to provide reimbursements for airfare for volunteers traveling inter-island to assist the Maui Humane Society. To qualify for this reimbursement, you will need to sign up for your volunteer shift(s) through HVMA and submit your airfare receipts to us. Reimbursement will be made by check after your shift(s) are completed and you have submitted at least 2 pictures taken during your shift(s) for use by AVMF.

8/19/2023 Update Meeting Minutes (members only access)

August 27, 2023 – The Hawaii Veterinary Medical Association would like to thank Adjutant General Kenneth Hara and Brigadier General Steve Logan with the Hawaii Emergency Management Agency for their efforts working with MEMA (Maui Emergency Management Agency) and Maui Humane Society to help Animal Search and Rescue teams gain access to previously restricted areas on Saturday August 26th. We acknowledge that efforts to search for pet animal survivors are necessarily secondary to ensuring the safety of personnel entering the burn zone and safely securing human remains.

Our hearts go out to the people and animals affected by the fires on Maui and Big Island. In addition to government efforts, the Maui Humane Society, HVMA, and local vets are organizing the veterinary emergency response.

We are so grateful for the mass outpouring of support to the Maui community. Veterinary professional volunteers are needed to assist Maui Humane Society efforts to serve the people and animals affected by the wildfires. Please sign up here if you are interested, and we will contact you as shifts become available.

Monetary donations are always welcome. Here are a few of the organizations working on the ground:
https://www.mauihumanesociety.org/donate-olx/
https://hawaii.salvationarmy.org/hawaii_2/maui-location/
https://www.redcross.org/local/hawaii.html
AVMA American Veterinary Medical Fund
https://www.hirangelandstewardship.org/

If you would like to support our veterinary colleagues who lost their practices in the fire:
Dr. Leo Murakami, Lahaina Veterinary Clinic
West Maui Animal Clinic

Help foster a pet! Home to home is helping connect people in need looking for temporary housing for their pet while they are displaced from their homes.

Maui Humane Society has reported they may have a need for feed for large animals including horses, cattle, goats, and pigs. If you are interested in donating any large animal feed or supplies, please contact public_relations@hawaiivetmed.org. For cattle feed/supply donations, please contact the Hawaii Cattlemen’s Council.

Updates on Pet Transport Off Maui

Please join our Facebook page for the most up to date communication among the vet community (Hawaii vets only but HVMA membership not required)

Contact HVMA if you have other questions, concerns, or suggestions at public_relations@hawaiivetmed.org.

Additional information from our AVMA colleagues:

There are AVMF disaster grants that may be of help to some members.

Disaster reimbursement grants for veterinary medical care, 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.
Disaster relief grants for veterinarians & veterinary students, up to $2,000 may be issued per grantee for out-of-pocket expenses incurred immediately following a disaster. Copies of receipts or other approved documentation must be submitted along with the application form.

AVMA has several resources on disaster preparation, including:

Disaster Preparedness

Disaster Business Continuity Certificate Program

Veterinary First Responder Certificate Program

Last updated October 8, 2023

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.