Small Animal Veterinary Surveillance Network Research Articles

Recording of suspected adverse drug reaction reporting in veterinary free-text clinical narratives.

To use text mining approaches to identify instances of suspected adverse drug reactions recorded in first opinion veterinary free-text clinical narratives, and to evaluate whether these were also reported to either the Veterinary Medicines Directorate or the relevant Marketing Authorisation holder in order to derive an estimate of the suspected adverse drug reaction (sADR) minimum under-reporting rate. To characterise sADR reports and explore whether particular features are associated with report submission. Two regular expressions were developed to identify mentions of "adverse drug reactions" and "side effects" in the free-text clinical narratives of electronic health records contained within the Small Animal Veterinary Surveillance Network database. Consultations containing a match for the developed regular expressions were manually reviewed for inclusion and further classified to determine the suspected product, seriousness and expectedness of the event, and an indication of whether the event had been reported. The associations between event characteristics and reporting were explored using Fisher's exact tests. A total of 10,565 records were manually reviewed from which 827 sADRs were identified. Approximately 90% of these sADRs were not recorded as reported. Suspected adverse drug reactions that were not considered "expected" were recorded as reported more frequently than "expected" sADRs. However, clinical severity did not appear to impact on whether there was a record of reporting. This is the first estimate of under reporting sADRs based on real world evidence from veterinary clinical records. The under-reporting rate implied by this study highlights that further interventions are required to improve reporting rate within the veterinary profession in order to support pharmacovigilance activities and improve drug safety.

Setting clinically relevant thresholds for the notification of canine disease outbreaks to veterinary practitioners: an exploratory qualitative interview study.

The Small Animal Veterinary Surveillance Network (SAVSNET) has developed mathematical models to analyse the veterinary practice and diagnostic laboratory data to detect genuine outbreaks of canine disease in the United Kingdom. There are, however, no validated methods available to establish the clinical relevance of these genuine statistical outbreaks before their formal investigation is conducted. This study aimed to gain an actionable understanding of a veterinary practitioner's preferences regarding which outbreak scenarios have a substantial impact on veterinary practice for six priority canine diseases in the United Kingdom. An intensity sampling approach was followed to recruit veterinary practitioners according to their years of experience and the size of their practice. In-depth semi-structured and structured interviews were conducted to describe an outbreak notification and outbreak response thresholds for six canine endemic diseases, exotic diseases, and syndromes. These thresholds reflected participants' preferred balance between the levels of excess case incidence and predictive certainty of the detection system. Interviews were transcribed, and a thematic analysis was performed using NVivo 12. Seven interviews were completed. The findings indicate higher preferred levels of predictive certainty for endemic diseases than for exotic diseases, ranging from 95 to 99% and 80 to 90%, respectively. The levels of excess case incidence were considered clinically relevant at values representing an increase of two to four times in the normal case incidence expectancy for endemic agents, such as parvovirus, and where they indicated a single case in the practice's catchment area for exotic diseases such as leishmaniosis and babesiosis. This study's innovative methodology uses veterinary practitioners' opinions to inform the selection of a notification threshold value in real-world applications of stochastic canine outbreak detection models. The clinically relevant thresholds derived from participants' needs will be used by SAVSNET to inform its outbreak detection system and to improve its response to canine disease outbreaks in the United Kingdom.

Text mining for disease surveillance in veterinary clinical data: part one, the language of veterinary clinical records and searching for words.

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.

Risk factors for tick attachment in companion animals in Great Britain: a spatiotemporal analysis covering 2014-2021.

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. 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 1km. Individual host factors associated with tick attachment were also assessed by conditional logistic regression on a matched case-control dataset. 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. 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.

Approach to initial management of canine generalised epileptic seizures in primary-care veterinary practices in the United Kingdom.

To investigate how primary care clinicians in the UK approach initial management of canine generalised epileptic seizures, including factors potentially associated with prescription and choice of anti-seizure drugs. Electronic health records concerning 3,150,713 consultations (917,373 dogs) were collected from 224 veterinary practices by the Small Animal Veterinary Surveillance Network. Free-text clinical narratives were reviewed to identify those consistent with generalised epileptic seizure activity, including only those recording the first presentation for seizures. Dogs older than 6 years were excluded. Five hundred and seventeen cases were included. Sixty-seven dogs (13.0%) received anti-seizure drugs at first presentation; this was significantly more likely in dogs presented withcluster seizures (odds ratio 13.8, 95% confidence interval 7.3 to 26.1). Phenobarbital (n=36) and imepitoin (n=29) were the most frequently chosen anti-seizure drugs. Presentation for a single epileptic seizure occurred in 321 dogs; seven were prescribed anti-seizure drugs. Eighty-six dogs were presented with cluster seizures; 38 were prescribed anti-seizure drugs, most frequently imepitoin (n= 19) and phenobarbital (n=17). Of the dogs presenting with a single seizure and at least 6-month follow-up (n=165), 33 (20%) did not have subsequent seizures recorded. Primary care clinicians rarely prescribed anti-seizure drugs following a single epileptic seizure in accordance with International Veterinary Epilepsy Task Force recommendations. Less than half of dogs initially presenting with cluster seizures were prescribed anti-seizure drugs. Imepitoin was frequently selected in the treatment of cluster seizures despite no authorisation for this purpose. These findings may ultimately contribute to improved cohesion in the management of canine epileptic seizures between primary care and referral institutions.

Incidence of alimentary and respiratory disease in brachycephalic dogs presenting to primary care veterinary practices participating in the SAVSNET project.

Brachycephalic dogs clinically affected by brachycephalic obstructive airway syndrome have been shown to have a high incidence of gastrointestinal disease, with French Bulldogs (FBD) identified as a particularly affected breed. Clinical records of 750 brachycephalic dogs attending over 500 practices participating in the small animal veterinary surveillance network (SAVSNET) project were analysed in this cohort study to determine the incidence of alimentary and respiratory disease within FBD, Bulldogs (BD) and Pugs attending primary care veterinary practice. Electronic clinical records were studied for treatment or acknowledgement of specific clinical signs that could be attributed to different anatomical locations. Disease of the different anatomical locations was marked as either being present or not present which allowed for statistical analysis. Significant differences in the incidence of oesophageal (p=0.006), gastric (p=0.001) and intestinal (p=0.001) diseases were present among the breeds studied. FBD had significantly increased odds ratios of having oesophageal (2.0, 2.2), gastric (2.4, 1.5) and intestinal (1.7, 1.5) diseases relative to Pugs and BD, respectively. Pugs had significantly increased odds ratios of having upper respiratory tract disease relative to BD (1.9). The results show the incidence of gastrointestinal disease and upper respiratory tract disease is significantly different between the brachycephalic breeds studied. Furthermore, the general population of FBD has the highest incidence of gastrointestinal disease.

Do socioeconomic factors impact management of suspected canine multicentric lymphoma in UK first opinion practice?

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. 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. 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). 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.

Surveillance of heat-related illness in small animals presenting to veterinary practices in the UK between 2013 and 2018.

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.

Analysis of canine cardiovascular therapeutic agent prescriptions using electronic health records in primary care veterinary practices in the United Kingdom

Introduction/objectivesCanine cardiovascular (CV) diseases are often managed in primary care settings. The objectives were to describe CV therapeutic agent (CVTA) prescribing patterns in primary care practices in the United Kingdom (UK) and to evaluate recorded clinical signs, diagnostic tests and justifications for use of torasemide, a recently marketed and authorised loop-diuretic in the UK. Animals, materials and methodsElectronic health records (EHRs) describing 3,579,420 consultations (1,043,042 unique dogs) were collated (1 April 2014 and 31 December 2018) by the Small Animal Veterinary Surveillance Network from 270 veterinary practices. Consultations prescribing at least one CVTA were identified. Annual variation in individual CVTA prescriptions was analysed using mixed-effects binomial regression models. Free-text clinical narratives were manually read to determine the first-prescribing event for torasemide. ResultsTwenty-nine thousand and seven consultations (0.81% of all consultations, 95% confidence interval [CI], 0.76–0.86) prescribed CVTA in 14,148 (1.36%) dogs. Furosemide (52.8% of CV-prescribing consultations, 95% CI 50.7–54.9) and pimobendan (51.9%, 95% CI 50.1–53.7) were most prescribed. Longitudinal analysis (2014–2018) showed a significant negative temporal trend for angiotensin-converting enzyme inhibitors (p < 0.001), and furosemide (p = 0.003) and a positive temporal trend for pimobendan (p = 0.020) and torasemide (p < 0.001). First prescriptions of torasemide were identified in 16.5% of torasemide-prescribing consultations. Where justification for prescription of torasemide was identified (32.5%), furosemide resistance was the most common (92.0%). ConclusionsEHRs can be used to temporally monitor prescribing habits, including responses to market authorisations. Despite authorisation in the UK for torasemide use as a first-line diuretic, it was most commonly prescribed after furosemide resistance.

A text-mining based analysis of 100,000 tumours affecting dogs and cats in the United Kingdom

Cancer is a major reason for veterinary consultation, especially in companion animals. Cancer surveillance plays a key role in prevention but opportunities for such surveillance in companion animals are limited by the lack of suitable veterinary population health infrastructures. In this paper we describe a pathology-based animal tumour registry (PTR) developed within the Small Animal Veterinary Surveillance Network (SAVSNET) built from electronic pathology records (EPR) submitted to this network. From an original collection of 180232 free text (non-structured) EPRs reported between April 2018 and June 2019, we used specific text-mining methodologies to identify 109895 neoplasias. These data were normalized to describe both the tumour (type and location) and the animal (breed, neutering status and veterinary practice postcode). The resulting PTR, the largest of its kind for companion animals to date, is an important research resource being able to facilitate a wide array of research in areas including surveillance, clinical decision making and comparative cancer biology.

Clinical findings associated with N-terminal pro-B-type natriuretic peptide measurement in dogs and cats attending first opinion veterinary practices.

Clinical findings associated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement in dogs and cats in primary practice, and their relevance to published measurement indications, have not been described. Using electronic health record data collected by the Small Animal Veterinary Surveillance Network, appointments in which NT-proBNP was measured were identified using keyword-based text filtering. For these appointments, clinical findings were manually identified from each patient's clinical narrative (CN) and their frequencies described. CNs of 3510 appointments (357 dogs and 257 cats) from 99practices were evaluated. The most frequently recorded clinical findings in dogs were: heart murmur (n=147, 41.2% (95% confidence interval (CI)=36.1%-46.3%), coughing (n=83, 23.2% (95% CI=18.8%-27.6%)) and panting (n=58, 16.2% (95% CI=12.4%-20.0%)) and in cats: heart murmur (n=143, 55.6% (95% CI=49.5%-61.7%)), suspected thromboembolism (n=88, 34.2% (95% CI=28.4%-40.0%)) and weight loss (n=53, 20.6% (95% CI=15.7%-25.5%)). Dyspnoea and tachypnoea were infrequently reported in dogs (n=29, 8.1% (95% CI=5.3%-10.9%) and n=21, 5.9% (95% CI=3.5%-8.3%), respectively) and cats (n=26, 10.1% (95% CI=6.4%-13.8%) and n=36, 14.0% (95% CI=9.8%-18.2%), respectively). Clinical findings referable to cardiac disease were recorded contemporaneously with NT-proBNP measurement and suggested both published and other indications (coughing (in dogs and cats), and serial measurements and thromboembolism (in cats)) for testing.

Surveillance of a vomiting outbreak in dogs in the UK using owner-derived and internet search data.

In early 2020, the Small Animal Veterinary Surveillance Network reported evidence of an outbreak of acute prolific vomiting in dogs in the UK. The aims of this study were to investigate whether there was evidence for a vomiting outbreak in Dogslife and Google Trends data and to describe its characteristics. Incidence of Dogslife vomiting reports and the Google search index for 'dog vomiting' and 'puppy vomiting' between December 2019 and March 2020 was compared to the respective data from the same months in previous years. Risks for dogs vomiting and factors influencing veterinary attendance in Dogslife were identified using multivariable logistic regression. This study confirmed a vomiting outbreak was evident in UK dogs between December 2019 and March 2020 using data from Dogslife and Google Trends. The odds of a vomiting incident being reported to Dogslife was 1.51 (95% CI: 1.24-1.84) in comparison to previous years. Dogslife data identified differences in owner-decision making when seeking veterinary attention and identified factors associated with dogs at higher odds of experiencing a vomiting episode. Owner-derived data including questionnaires and internet search queries should be considered a valid, valuable source of information for veterinary population health surveillance.

Small animal disease surveillance 2020/21: SARS-CoV-2, syndromic surveillance and an outbreak of acute vomiting in UK dogs.

THIS is the first report by the Small Animal Veterinary Surveillance Network (SAVSNET) to collate key companion animal health surveillance findings since the start of the SARS-CoV-2 pandemic. The report outlines the impact of SARS-CoV-2 on UK companion animal consultation volume, summarises syndromic surveillance events, comments on our current understanding of SARS-CoV-2 in companion animal species and looks globally to other notable companion animal disease events during these times. More detail on the impact of SARS-CoV-2 on UK companion animal practice is available on the SAVSNET website.1 Over the course of the pandemic to date, the UK has undergone a series of national and regional lockdown periods, bringing varying yet sustained challenges to companion animal practice. In the first section of this report, we summarise the effect of these lockdowns on consultation volume, illustrating overarching effects and hopefully providing useful support to practice decision-making as governmental and profession-specific policy and guidance evolves further. This report is the 10th in a series provided to Vet Record by the Small Animal Veterinary Surveillance Network (SAVSNET). The other reports in the series are available from https://bvajournals.onlinelibrary.wiley.com/journal/20427670 Anonymised data can be accessed for research by contacting the authors. SAVSNET also welcomes feedback on this report. More information about SAVSNET is available at www.liverpool.ac.uk/savsnet The report considers electronic health records (EHRs) captured by the SAVSNET project from booked consultations between a client and a veterinary surgeon or nurse, taking place in 219 voluntary collaborating veterinary practices (466 sites) during the period from 2 March 2020 to 10 January 2021 inclusive. Data were captured from 514,354 canine, 195,349 feline and 56,873 other or unclassified species consultations. A detailed description of the methodology used by SAVSNET to capture EHRs has been previously provided.2, 3 To assess the impact of SARS-CoV-2 on companion animal consultations, the percentage change in booked consultation numbers submitted to SAVSNET was compared with median 2019 data per weekday. Country-level plotting (Fig 1) encompasses all consultation data for all species and was selected to capture the divergent policy responses occurring across the devolved UK nations over time. Practice representation by country is 181 practices (408 sites) in England, 12 (15) in Northern Ireland, 11 (25) in Scotland and 13 (18) in Wales. Two practices had sites in both England and Scotland. Percentage change in consultation data volume submitted to SAVSNET between 2 March 2020 and 10 January 2021, compared against median 2019 data, by country in which the submitting veterinary practice is located and with the plot trend line, calculated by a generalised additive model, shown in blue. The horizontal dotted line represents a 50 per cent reduction in consultation volume The dramatic effect of the first national lockdown in March 2020 is seen across each devolved nation, as is the gradual recovery following phased relaxation of lockdown measures over summer 2020, though still with an overall significant and protracted decrease in consultation volume. Moving into autumn 2020, there is evidence of local variation in line with changing governmental and veterinary profession policy and guidance (eg, moving into devolved ‘firebreak’ lockdowns such as the lockdown in Wales between 23 October and 9 November 2020). More recently, the early impact of a return to more strict devolved national lockdowns is evident, both by country and species group. The expected reduction in consultation volume over the Christmas period is visible through all the plots, as is the ‘sawtooth’ pattern reflecting the fluctuations in consultation schedules on different days of the week. At the species level, effects over time on consultation volume when compared to median 2019 data are broadly similar, with most notably the large and protracted decrease in consultation volume following the first nationwide lockdown in March 2020 (Fig 2). Percentage change in consultation data volume submitted to SAVSNET between 2 March 2020 and 10 January 2021, compared against median 2019 data, in total and by species group, with the plot trend line shown in blue. The horizontal dotted line represents a 50 per cent reduction in consultation volume As with the country-level data, there is a gradual recovery and levelling, and most recently a decrease as we move into 2021, with the reimposition of stricter lockdowns in response to the latest wave of the evolving pandemic. It is important to note several points; first, SAVSNET only collects data from booked consultations, so these data do not reflect all practice activities taking place, nor will they capture the full complexity of the fluid and divergent lockdown policies enacted over time. However, we believe that the extended period of data capture means consultation volume can serve as a valid proxy for the impact of the SARS-CoV-2 pandemic on overall practice activity. Second, the lower level of data received from devolved regions with comparatively fewer practices participating in SAVSNET can result in apparent ‘jumps’ in the percentage data – such as that seen at points on the Wales plotline in Fig 1. These should not be interpreted as discrete increases in median consultation volume. Based on the data received by SAVSNET, there is some evidence that consultation volumes in Wales returned closer to pre-Covid levels, more so than in other devolved administrations. Whether this is representative of wider differences between regions is unknown. “The dramatic effect of the first national lockdown in March 2020 can be seen across each devolved nation Third, the work of SAVSNET, while dedicated and ongoing, is not immune to the challenges of these times; points where changes to the flow of data coming into SAVSNET affect the analyses presented here and/or systematic data errors occur are clearly explained in our online reports.1 The clear reduction in consultations during the SARS-CoV-2 pandemic raised concerns that reduced vaccination may see an unwelcome resurgence in vaccine-preventable diseases. Indeed, we have noted a reduction in vaccine consultations overall.1 Alongside veterinary practice data, SAVSNET collects veterinary diagnostic laboratory (VDL) test data on several vaccine-preventable diseases. In this section, we summarise VDL-confirmed reports of leptospirosis and parvovirus in dogs based on PCR testing. As in-practice tests and suspected cases before, or without, diagnostics are not included in these data, the figures should be viewed as a guide to changes in national burden, and not as an indicator to overall prevalence. Additional data on vaccine-preventable diseases in dogs and cats and vaccine consultations, including broad geographical location of test data, are available in the regular SAVSNET SARS-CoV-2 reports.1 We have previously explored vaccine uptake4 and are aiming to coalesce vaccine uptake and vaccine-preventable disease surveillance in the future. Between 1 January 2019 and 10 January 2021, 2248 submissions for PCR testing for leptospirosis in dogs were received by five VDLs, originating from 808 veterinary practice sites in the UK. Overall, 8.1 per cent of submissions were positive (n=183, 95 per cent confidence interval [CI] 7.0–9.3) (Fig 3). Number and percentage of canine PCR leptospira-positive tests (left axis) and number of tests by month (right axis) received from five veterinary diagnostic laboratories during the period 1 January 2019–10 January 2021 inclusive. The asterisk denotes the incomplete month of January 2021; the blue shaded area represents the 95 per cent confidence interval (95% CI) The percentage of submissions testing positive varied between 0 and 20 per cent per month over this time, with some evidence for a seasonal pattern; the percentage testing positive was increased between October and December 2019 and in August and September 2020. Since then, the percentage testing positive appears to have normalised to prepandemic rates. These data match those of others, albeit from different climates, which also suggest a role for seasonal factors in disease epidemiology.5 Between 1 January 2019 and 10 January 2021 inclusive, 4286 submissions for PCR testing for parvovirus in dogs were received by seven VDLs, originating from 778 veterinary practice sites in the UK. Overall, 7.4 per cent of submissions tested positive (n=317, 95 per cent CI 6.6–8.2) (Fig 4). Number and percentage of PCR parvovirus-positive tests (left axis) and number of total tests by month (right axis) received from seven veterinary diagnostic laboratories during the period 1 January 2019–10 January 2021 inclusive. The asterisk denotes the incomplete month of January 2021; the blue shaded area represents the 95 per cent confidence interval (95% CI) The percentage of canine samples testing positive for parvovirus was broadly consistent over this time, generally between 5 and 10 per cent per month. While April and May 2020 did exceed this typical range, figures now appear to have returned to within normal range. There also appears to be a gradual increase in both the number of parvovirus tests performed and the number of animals testing positive, reaching a peak in December 2020. Whether this represents a change in testing policy or an increase in parvovirus cases in the wider population will need to be monitored. At the time of writing, SARS-CoV-2 has infected at least 104 million people and caused over 2.2 million deaths worldwide since its first reported emergence in Wuhan, China, on 31 December 2019. SARS-CoV-2 has also been reported in a range of animal species, including companion animals (dogs, cats, ferrets), zoo animals and farmed mink. Identification of the virus in a small number of pets has raised concern about whether SARS-CoV-2 can cause disease in animals. In addition, the potential role of animals in SARS-CoV-2 epidemiology has been questioned; could pets transmit the virus to humans? Our understanding of SARS-CoV-2 in animals is now improving due to experimental and surveillance studies. The clinical implications of these studies are summarised here. Experimental infections with SARS-CoV-2 performed in the USA and China have shown that cats are susceptible to high doses of virus, with virus shedding detected for approximately five days after exposure. However, no experimentally infected cats over four months of age showed any clinical signs of disease. Variable respiratory pathology was identified by histopathology (lymphoplasmocytic rhinitis and mild interstitial pneumonia), but no gross lesions were reported.6-8 It is unclear whether SARS-CoV-2 can cause disease in cats less than four months old, with only limited results published. To our knowledge, no severe disease has been reported in any naturally infected domestic cats across the globe. In the UK, only one cat has tested positive (via RT-PCT and serology) for SARS-CoV-2 so far, and this case merely showed signs of mild respiratory infection. It is important to note that this cat also tested positive for feline herpesvirus (FHV), so it is likely that FHV played some role in the clinical signs in this instance. Dogs are less susceptible to SARS-CoV-2 than cats according to experimental infections. No virus replication was detected after exposure to virus, and no clinical signs of disease were identified. However, two naturally infected asymptomatic dogs in Hong Kong tested positive for the virus on multiple occasions, suggesting infection is possible.9 Furthermore, SARS-CoV-2-specific antibodies have been detected in dogs after experimental infections, and in pet dogs and cats from Italy.10 SARS-CoV-2 has been shown to infect ferrets in experimental infections, and natural infections have occurred in mink.11 Mild, non-specific signs (fever and inappetence) were reported in a small proportion of the experimentally infected ferrets, but no significant disease occurred. In contrast, severe respiratory disease and death has been reported on numerous mink farms in Europe and the USA. SARS-CoV-2 testing for animals uses the same methodology as in humans – quantitative PCR (qPCR). In May 2020 (and subsequently updated on 1 March 2021), the APHA issued a series of guidelines advising which animals should be tested. With significant limitations on human tests available at the start of the UK outbreak, it was recommended that only felids, canids or mustelids that had been in contact with a confirmed or suspect human Covid-19 case in the past three weeks should be screened for virus. Detecting SARS-CoV-2 infection in animals in the UK meets the criteria for reporting to the World Organisation for Animal Health (OIE) as an emerging infection in accordance with the OIE Terrestrial Animal Health Code.12, 13 As such, UK veterinarians have a regulatory duty to report positive case results to the competent authority – that is, the APHA and chief veterinary officers. Testing should only be conducted where it is the interest of the health and welfare of the animal; it is also advised that the animal should be showing clinical signs of disease that could be consistent with Covid-19, and that common causes of these symptoms should have been ruled out.13 At present there are no commercial tests for SARS-CoV-2 available for pets in the UK. There are a number of clinical research projects that are investigating the incidence of the virus in pets. Our surveillance based on main presenting complaints suggests no rise in clinical disease in dogs and cats that could be associated with Covid-19. Study of a subset of cats and dogs that tested positive for SARS-CoV-2 infection has confirmed that virus was transmitted from owner to pet. This has been demonstrated using full genome sequencing.9, 14 To reduce the risk of human-to-animal transmission of the virus, owners with Covid-19 symptoms should maintain good hygiene around their pet. As no confirmed cases of cats or dogs naturally infected with SARS-CoV-2 have been reported to have significant clinical signs, no virus-specific treatment for suspected cases is indicated. The overwhelming majority of people that get SARS-CoV-2 get it from another person. However, from a public health perspective, animal-to-human transmission of SARS-CoV-2 remains a concern. There is as yet no evidence this has occurred from cats or dogs. To mitigate this further, it is advised that, if possible, cats from households self-isolating with Covid-19 symptoms should be kept indoors, and that dogs, if necessary, should be exercised by someone else.15 This reduces the chance that cats and dogs, either infected or as fomites, could transmit the virus to other households. Outbreaks of SARS-CoV-2 in mink farms in several countries, including the Netherlands, Denmark, USA and Canada, and evidence of zoonotic and anthroponotic transmission in such cases16 have raised concern regarding the associated animal and human infection risks, including with ferrets kept as pets, working animals or in research, particularly in high-density settings.17 The APHA has issued guidance for ferret owners and veterinarians on enhanced precautionary biosecurity measures, including a 21-day isolation period for ferrets in Covid-19 self-isolating households or ferrets testing positive for SARS-CoV-2 or brought to the UK from countries outside current travel corridor lists.18 Despite the severity of SARS-CoV-2 infection in humans, there are no reports that show SARS-CoV-2 causes serious disease in dogs and cats. Furthermore, the risk of virus transmission from pets to humans is considered extremely low. Following the standard advice for reducing the risk of SARS-CoV-2 transmission between people (eg, good hand hygiene), and species-specific guidelines where indicated (eg, regarding ferrets), should be sufficient to ensure the risk of virus transmission to and from animals is minimised. An observed prevalence time series of three key main presenting complaints (MPCs; gastroenteric, respiratory and pruritus) for both dogs and cats, from January 2019 to January 2021, highlights an acute vomiting outbreak in dogs and illustrates seasonal changes in the other MPCs (Fig 5). Observed prevalence for gastroenteric (A, D), respiratory (B, E) and pruritus (C, F) main presenting complaints in dogs (A, B, C) and cats (D, E, F) attending SAVSNET-participating practices from January 2019 to January 2021. Red points represent the extreme outliers (outside the 99 per cent credible interval [CI]), orange points represent the moderate outliers (outside the 95 per cent CI but within the 99 per cent CI), and green points represent the average trend (within the 95 per cent CI) In January 2020, SAVSNET responded to sporadic reports of acute-onset, prolific vomiting in dogs in various parts of the UK. Syndromic surveillance, text mining and parallel laboratory and questionnaire investigations enabled an early and rapid response to the outbreak and revealed an association with canine enteric coronavirus (CeCoV).19 Briefly, over a period of eight weeks, the multidisciplinary investigation evidenced a number of key findings, including: This efficient response allowed SAVSNET to direct targeted and timely advice to veterinary practitioners about the outbreak, which SAVSNET considered statistically resolved in May 2020. The plot labelled as ‘Gastroenteric’ in dogs in Fig 5 (plot A) clearly shows the acute vomiting outbreak. For the summary plot, using a Gaussian process time series allows us to capture seasonal temporal correlation and determine any outliers. The model was trained on observed weekly proportional morbidity data from 1 January 2017 to 8 November 2019. Consultation records classified by the attending veterinary professional as ‘unwell’ according to MPC were used as a denominator to mitigate a drop in overall consultations as a result of the Covid-19 pandemic. “This efficient response allowed SAVSNET to direct targeted and timely advice to veterinary practitioners about the outbreak The figures show predicted prevalence with shaded 95 per cent (dark grey) and 99 per cent (light grey) credible intervals, with extreme prevalence observations highlighted in orange or red. Since April 2020, the observed estimates have appeared less stable than before the SARS-CoV-2 outbreak, likely reflecting changing patterns of consulting throughout Covid-19, such that periods of unusually high or low prevalence have become more common. As well as the outbreak of gastroenteric disease in dogs, these analyses clearly highlight the apparent seasonality of the respiratory (Fig 5, plot B) and pruritus (Fig 5, plot C) MPCs, which peak around November and September, respectively. In cats, the pruritus (Fig 5, plot F) MPC appears to peak in August, with less distinct seasonality in the gastroenteric (Fig 5, plot D) or respiratory (Fig 5, plot E) MPCs. Understanding such temporal variation will likely shed new light on the aetiologies of the syndromes in both species. New cases fitting the description of seasonal canine illness (SCI) were again being reported in late September 2020 (Promed archive number: 20200924.7803900). SCI seems to lack a clear case definition. Clinical signs, which are often described as appearing within 24–72 hours of dogs walking in autumnal woodland, include vomiting, diarrhoea and lethargy. While most animals recover with rigorous symptomatic therapy, some have died. Any cause remains unknown although some have suggested links with bacteria, blue-green algae, fungal spores or harvest mites, but tests have not proved conclusive. This syndrome was first reported in dogs visiting the Sandringham Estate ‘and other woodland areas’ in 2009. The SCI syndrome is not to be confused with another seasonal disease of dogs, reported every year from woodlands in England: canine renal glomerular vasculopathy (CRGV, also known as Alabama rot) also lacks a known aetiology but can be characterised and diagnosed by a thrombotic renal microangiopathy. The prognosis of CRGV is poor, although recent cases show recovery is possible. Understanding such sporadic syndromes remains a challenge for those involved in caring for dogs, especially in the absence of a national health authority. With Dogs Trust funding, SAVSNET agile (www.liverpool.ac.uk/savsnet/savsnet-agile/) is looking to understand what such a surveillance system could look like, and how it might be funded. Outbreaks of rabbit haemorrhagic disease (RHD) have been reported in Wales and, for the first time, in Northern Ireland.20 Whereas the original RHD virus (RHDV) caused obvious external signs like haemorrhage, the new RHDV-2 strain, although also frequently lethal, has been associated with less overt outward disease, with wild rabbits often dying underground. As such, it is possible that many cases in wild rabbits are being missed. In an APHA Surveillance Focus article published in Vet Record, Duff and colleagues20 conclude by suggesting ‘Wild rabbits can be a source of virus for domestic animals and vice versa. We would encourage rabbit owners and their veterinarians to be aware of local outbreaks and take measures, including appropriate vaccination and biosecurity, to prevent the disease in domesticated rabbits.' “Understanding sporadic syndromes remains a challenge for those involved in caring for dogs “Canine distemper virus is a virus that needs watching as it spreads its wings Some infections pose a threat not just to the original or main host, but can spill over to other species with sometimes drastic effects; canine distemper virus (CDV) is one such disease. The disease can be extremely well controlled in domestic dogs, considered to be the primary host, through vaccination. However, this virus now has a long track record of affecting other species. A recent study on the Amur tiger (Panthera tigris altaica), which has fewer than 550 individuals in Russia and neighbouring areas of China, highlights the threat.21 Scientists showed that CDV is now established in other local wildlife species, such that vaccination of dogs alone is unlikely to be sufficient to protect the tigers. Instead, control was more likely to be achieved by vaccinating the tigers themselves, a process that, while not without its challenges, could lead to ‘substantive reductions in extinction risks’. CDV has pedigree in this area, with earlier reports of fatal infections in a growing range of species, including giant pandas.22 CDV is a virus that needs watching as it spreads its wings. Although not reportable, the OIE has included morbillivirus infections on a list of wildlife diseases that require surveillance ‘because of their importance for wild animals and also for early warning purposes, in order to protect human and livestock health’.23 SAVSNET is based at the University of Liverpool and has major funding from the Biotechnology and Biological Sciences Research Council, BVA and Dogs Trust. The SAVSNET team is also grateful to data providers in veterinary practice (VetSolutions, Teleos, CVS Group and independent practitioners) and the participating veterinary diagnostic laboratories (Axiom Veterinary Laboratories, Batt Laboratories, BioBest, BioTe Veterinary Laboratories, Idexx, NationWide Laboratories, Microbiology Diagnostics Laboratory at the University of Liverpool, the Department of Pathology and Infectious Diseases at the University of Surrey and the Veterinary Pathology Group) without whose support and participation these reports would not be possible. The team would also like to thank Susan Bolan, SAVSNET project administrator, for her support.

Backyard poultry cases in UK small animal practices: Demographics, health conditions and pharmaceutical prescriptions.

Background: Backyard poultry ownership is of keen interest in the United Kingdom. However, despite this, little is known about veterinary care engagement and outcomes of visits in this group of species. Methods: This study described and characterised veterinary practice‐visiting backyard poultry, utilising electronic health record data supplied by veterinary practices voluntarily participating in the Small Animal Veterinary Surveillance Network between 1st April 2014 and 31st March 2019. Results: In total, 4424 recorded poultry consultations originating from 197 veterinary practices (352 sites) were summarised. Chicken consultation (n = 3740) peak incidence was in early summer (April‐June), relative to all recorded species. More chickens resided in rural (incident rate ratio = 2.5, confidence interval [CI] 2.3–2.6, p <0.001) or less deprived areas. Non‐specific clinical signs were commonly recorded (17.6% of chicken consultations, CI 15.9–19.2), as were those indicative of advanced disease. This latter finding was reflected in prescribed management strategies, with euthanasia comprising 29.8% (CI 27.0–32.6) of consultations. Antimicrobials were commonly prescribed (33.0% of consultations, CI 29.8–36.2), 43.8% of which included antimicrobials considered ‘highest priority critically important’ by the World Health Organisation. Conclusion: Our findings indicate a need to tailor antimicrobial prescription guidance to the backyard poultry setting. In addition, late presentation of disease, vague clinical descriptions in clinical narratives and high euthanasia rates show that disease identification, management and knowledge of poultry health and welfare among owners and veterinary surgeons can be improved.

Demographics of dogs, cats, and rabbits attending veterinary practices in Great Britain as recorded in their electronic health records

BackgroundUnderstanding the distribution and determinants of disease in animal populations must be underpinned by knowledge of animal demographics. For companion animals, these data have been difficult to collect because of the distributed nature of the companion animal veterinary industry. Here we describe key demographic features of a large veterinary-visiting pet population in Great Britain as recorded in electronic health records, and explore the association between a range of animal’s characteristics and socioeconomic factors.ResultsElectronic health records were captured by the Small Animal Veterinary Surveillance Network (SAVSNET), from 143 practices (329 sites) in Great Britain. Mixed logistic regression models were used to assess the association between socioeconomic factors and species and breed ownership, and preventative health care interventions. Dogs made up 64.8% of the veterinary-visiting population, with cats, rabbits and other species making up 30.3, 2.0 and 1.6% respectively. Compared to cats, dogs and rabbits were more likely to be purebred and younger. Neutering was more common in cats (77.0%) compared to dogs (57.1%) and rabbits (45.8%). The insurance and microchipping relative frequency was highest in dogs (27.9 and 53.1%, respectively). Dogs in the veterinary-visiting population belonging to owners living in least-deprived areas of Great Britain were more likely to be purebred, neutered, insured and microchipped. The same association was found for cats in England and for certain parameters in Wales and Scotland.ConclusionsThe differences we observed within these populations are likely to impact on the clinical diseases observed within individual veterinary practices that care for them. Based on this descriptive study, there is an indication that the population structures of companion animals co-vary with human and environmental factors such as the predicted socioeconomic level linked to the owner’s address. This ‘co-demographic’ information suggests that further studies of the relationship between human demographics and pet ownership are warranted.

The passive surveillance of ticks using companion animal electronic health records.

Ticks represent a large global reservoir of zoonotic disease. Current surveillance systems can be time and labour intensive. We propose that the passive surveillance of companion animal electronic health records (EHRs) could provide a novel methodology for describing temporal and spatial tick activity. A total of 16 58 857 EHRs were collected over a 2-year period (31 March 2014 and 29 May 2016) from companion animals attending a large sentinel network of 192 veterinary clinics across Great Britain (the Small Animal Veterinary Surveillance Network - SAVSNET). In total, 2180 EHRs were identified where a tick was recorded on an animal. The relative risk of dogs presenting with a tick compared with cats was 0·73 (95% confidence intervals 0·67-0·80). The highest number of tick records were in the south central regions of England. The presence of ticks showed marked seasonality with summer peaks, and a secondary smaller peak in autumn for cats; ticks were still being found throughout most of Great Britain during the winter. This suggests that passive surveillance of companion animal EHRs can describe tick activity temporally and spatially in a large cohort of veterinary clinics across Great Britain. These results and methodology could help inform veterinary and public health messages as well as increase awareness of ticks and tick-borne diseases in the general population.

Use of cefovecin in a UK population of cats attending first-opinion practices as recorded in electronic health records.

Objectives The objective was to use electronic health records to describe the use of cefovecin (Convenia; Zoetis UK), a third-generation long-acting injectable antimicrobial, in a UK population of cats attending first-opinion practices, and to compare the use of Convenia with the licensed uses described on the UK Convenia datasheet. Methods Data were obtained as an Excel database from the Small Animal Veterinary Surveillance Network for all feline consultations containing the word Convenia and/or cefovecin from 1 September 2012 to 23 September 2013 inclusive. Entries were classified according to body system treated, confirmation or suspicion of an abscess, evidence of microbiological evaluation being performed, any concurrent therapies given and whether any reason was given for use of Convenia over alternative antimicrobials. Data were exported to IBM SPSS Statistics and descriptive analysis performed. Results In total, 1148 entries were analysed. The most common body system treated was skin in 553 (48.2%) entries, then urinary (n = 157; 13.7%) and respiratory (n = 112; 9.8%). Microbiological evaluation was recorded in 193 (16.8%) entries, with visible purulent material most commonly cited (in 147 [12.8%] entries). A reason for prescribing Convenia over alternative antimicrobials was given in 138 (12.0%) entries; the most cited was an inability to orally medicate the cat in 77 (55.8%) of these entries. Excluding 131 entries where no body system or multiple body systems were described, the use of Convenia complied with a licensed use in the UK datasheet in 710 (69.8%) of 1017 entries. Conclusions and relevance Most administrations were licensed uses; however, most entries did not describe any microbiological evaluation, or a reason for prescribing Convenia over alternative antimicrobials. Further education of the public and the veterinary profession is needed to promote antimicrobial stewardship in the UK. Health records provide a valuable tool with which to monitor, both locally and at scale, the use of important therapeutics like antimicrobials. Information relevant to decision-making should be recorded in individual animal health records.

SAVSNET: Collating Veterinary Electronic Health Records for Research and Surveillance

Owners and pets frequently live in very close contact. As a result, surveillance of disease-related events in companion animals has the potential to deliver benefits for both animal and human health. SAVSNET"”the Small Animal Veterinary Surveillance Network"”collects and collates real-time data from veterinary diagnostic laboratories and veterinary practices across the UK to support research and disease surveillance in companion animals. The data collected by SAVSNET is made available to a wide range of interested parties including academic collaborators, PhD researchers, students and commercial companies. As such, SAVSNET is a valuable resource for One Health surveillance.

Surveillance of diarrhoea in small animal practice through the Small Animal Veterinary Surveillance Network (SAVSNET)

Using the Small Animal Veterinary Surveillance Network (SAVSNET), a national small animal disease-surveillance scheme, information on gastrointestinal disease was collected for a total of 76 days between 10 May 2010 and 8 August 2011 from 16,223 consultations (including data from 9115 individual dogs and 3462 individual cats) from 42 premises belonging to 19 UK veterinary practices. During that period, 7% of dogs and 3% of cats presented with diarrhoea.Adult dogs had a higher proportional morbidity of diarrhoea (PMD) than adult cats (P < 0.001). This difference was not observed in animals <1 year old. Younger animals in both species had higher PMDs than adult animals (P < 0.001). Neutering was associated with reduced PMD in young male dogs. In adult dogs, miniature Schnauzers had the highest PMD. Most animals with diarrhoea (51%) presented having been ill for 2–4 days, but a history of vomiting or haemorrhagic diarrhoea was associated with a shorter time to presentation. The most common treatments employed were dietary modification (66% of dogs; 63% of cats) and antibacterials (63% of dogs; 49% of cats). There was variability in PMD between different practices.The SAVNET methodology facilitates rapid collection of cross-sectional data regarding diarrhoea, a recognised sentinel for infectious disease, and characterises data that could benchmark clinical practice and support the development of evidence-based medicine.

Your new surveillance network

SAVSNET (Small Animal Veterinary Surveillance Network) is building a database to monitor the prevalence of different diseases around the country. The BSAVA has agreed to support a project at Liverpool Veterinary School to develop procedures to gather and process the data.