Journal of Feline Medicine and Surgery

There is no substitute for scientifically tested and proven standards of care … Doing things one's ‘own way’ is unethical.

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

Background The European Advisory Board on Cat Diseases (ABCD) is a body of experts that sees its task as bringing feline health issues to the forefront of companion animal practice. By way of an introduction to this special ‘clinical practice’ issue of the Journal of Feline Medicine and Surgery (JFMS), this article attempts a ‘helicopter view’ of practical, or applied, immunology. It should be viewed as a ‘light primer’ to vaccines and vaccination, and is very general in nature. It is not intended to replace authoritive immunology textbooks, which abound both in the veterinary and medical fields, and the level of detail in which may discourage the casual reader. By design, therefore, this article is not referenced.

Underpinning issues) immunity, and the types of vaccine developed and/or available (live, killed, chimaeric, DNA-only products).

Practical relevance With day-to-day veterinary practice in mind, practical issues discussed include kitten vaccination, the definition of ‘core’ versus ‘non-core’ products, passive immunisation, and prevention strategies in populations and crowded cat communities. Adverse reactions, and factors affecting vaccine efficacy, safety and performance are also summarised.

Overview Feline panleukopenia virus (FPV) infects all felids as well as raccoons, mink and foxes. This pathogen may survive in the environment for several months and is highly resistant to some disinfectants.

Infection Transmission occurs via the faecal-oral route. Indirect contact is the most common route of infection, and FPV may be carried by fomites (shoes, clothing), which means indoor cats are also at risk. Intrauterine virus transmission and infection of neonates can occur.

Disease signs Cats of all ages may be affected by FPV, but kittens are most susceptible. Mortality rates are high - over 90% in kittens. Signs of disease include diarrhoea, lymphopenia and neutropenia, followed by thrombocytopenia and anaemia, immunosuppression (transient in adult cats), cerebellar ataxia (in kittens only) and abortion.

Diagnosis Feline panleukopenia virus antigen is detected in faeces using commercially available test kits. Specialised laboratories carry out PCR testing on whole blood or faeces. Serological tests are not recommended, as they do not distinguish between infection and vaccination.

Disease management Supportive therapy and good nursing significantly decrease mortality rates. In cases of enteritis, parenteral administration of a broad-spectrum antibiotic is recommended. Disinfectants containing sodium hypochlorite (bleach), peracetic acid, formaldehyde or sodium hydroxide are effective.

Overview Feline viral rhinotracheitis, caused by feline herpesvirus (FHV), is an upper respiratory tract disease that is often associated with feline calicivirus and bacteria. In most cats, FHV remains latent after recovery, and they become lifelong virus carriers. Stress or corticosteroid treatment may lead to virus reactivation and shedding in oronasal and conjunctival secretions.

Infection Sick cats shed FHV in oral, nasal and conjunctival secretions; shedding may last for 3 weeks. Infection requires direct contact with a shedding cat.

Disease signs Feline herpesvirus infections cause acute rhinitis and conjunctivitis, usually accompanied by fever, depression and anorexia. Affected cats may also develop typical ulcerative, dendritic keratitis.

Diagnosis Samples consist of conjunctival, corneal or oropharyngeal swabs, corneal scrapings or biopsies. It is not recommended that cats recently vaccinated with a modified-live virus vaccine are sampled. Positive PCR results should be interpreted with caution, as they may be produced by low-level shedding or viral latency.

Disease management ‘Tender loving care’ from the owner, supportive therapy and good nursing are essential. Anorexic cats should be fed blended, highly palatable food - warmed up if required. Mucolytic drugs (eg, bromhexine) or nebulisation with saline may offer relief. Broad-spectrum antibiotics should be given to prevent secondary bacterial infections. Topical antiviral drugs may be used for the treatment of acute FHV ocular disease. The virus is labile and susceptible to most disinfectants, antiseptics and detergents.

Overview Feline calicivirus (FCV) is a highly variable virus. More severe, systemic forms of FCV infection have been observed recently.

Infection Sick, acutely infected or carrier cats shed FCV in oronasal and conjunctival secretions. Infection occurs mainly through direct contact.

Disease signs The main clinical signs are oral ulcers, upper respiratory signs and a high fever. Feline calicivirus may be isolated from nearly all cats with chronic stomatitis or gingivitis. Cats with ‘virulent systemic FCV disease’ variably show pyrexia, cutaneous oedema, ulcerative lesions on the head and limbs, and jaundice. Mortality is high and the disease is more severe in adult cats.

Diagnosis Diagnosis of FCV can be achieved by virus isolation or reverse-transcriptase PCR. Viral RNA can be detected in conjunctival and oral swabs, blood, skin scrapings or lung tissue using PCR. Positive PCR results should be interpreted with caution, as these may be a consequence of low-level shedding by persistently infected carriers. The diagnosis of virulent systemic FCV disease relies on clinical signs and isolation of the same strain from the blood of several diseased cats.

Disease management Supportive therapy (including fluid therapy) and good nursing care are essential. Anorexic cats should be fed highly palatable, blended or warmed food. Mucolytic drugs (eg, bromhexine) or nebulisation with saline may offer relief. Broad-spectrum antibiotics may be administered to prevent secondary bacterial infections. Feline calicivirus can persist in the environment for about 1 month and is resistant to many common disinfectants.

Overview Feline leukaemia virus (FeLV) is a retrovirus that may induce depression of the immune system, anaemia and/or lymphoma. Over the past 25 years, the prevalence of FeLV infection has decreased considerably, thanks both to reliable tests for the identification of viraemic carriers and to effective vaccines.

Infection Transmission between cats occurs mainly through friendly contacts, but also through biting. In large groups of non-vaccinated cats, around 30–40% will develop persistent viraemia, 30–40% show transient viraemia and 20–30% seroconvert. Young kittens are especially susceptible to FeLV infection.

Disease signs The most common signs of persistent FeLV viraemia are immune suppression, anaemia and lymphoma. Less common signs are immune-mediated disease, chronic enteritis, reproductive disorders and peripheral neuropathies. Most persistently viraemic cats die within 2–3 years.

Diagnosis In low-prevalence areas there may be a risk of false-positive results; a doubtful positive test result in a healthy cat should therefore be confirmed, preferably by PCR for provirus. Asymptomatic FeLV-positive cats should be retested.

Disease management Supportive therapy and good nursing care are required. Secondary infections should be treated promptly. Cats infected with FeLV should remain indoors. Vaccination against common pathogens should be maintained. Inactivated vaccines are recommended. The virus does not survive for long outside the host.

Overview Feline immunodeficiency virus (FIV) is a retrovirus closely related to human immunodeficiency virus. Most felids are susceptible to FIV, but humans are not. Feline immunodeficiency virus is endemic in domestic cat populations worldwide. The virus loses infectivity quickly outside the host and is susceptible to all disinfectants.

Infection Feline immunodeficiency virus is transmitted via bites. The risk of transmission is low in households with socially well-adapted cats. Transmission from mother to kittens may occur, especially if the queen is undergoing an acute infection. Cats with FIV are persistently infected in spite of their ability to mount antibody and cell-mediated immune responses.

Disease signs Infected cats generally remain free of clinical signs for several years, and some cats never develop disease, depending on the infecting isolate. Most clinical signs are the consequence of immunodeficiency and secondary infection. Typical manifestations are chronic gingivostomatitis, chronic rhinitis, lymphadenopathy, weight loss and immune-mediated glomerulonephritis.

Diagnosis Positive in-practice ELISA results obtained in a low-prevalence or low-risk population should always be confirmed by a laboratory. Western blot is the ‘gold standard’ laboratory test for FIV serology. PCR-based assays vary in performance.

Disease management Cats should never be euthanased solely on the basis of an FIV-positive test result. Cats infected with FIV may live as long as uninfected cats, with appropriate management. Asymptomatic FIV-infected cats should be neutered to avoid fighting and virus transmission. Infected cats should receive regular veterinary health checks. They can be housed in the same ward as other patients, but should be kept in individual cages.

Overview Rabies virus belongs to the genus Lyssavirus, together with European bat lyssaviruses 1 and 2. In clinical practice, rabies virus is easily inactivated by detergent-based disinfectants.

Infection Rabid animals are the only source of infection. Virus is shed in the saliva some days before the onset of clinical signs and transmitted through a bite or a scratch to the skin or mucous membranes. The average incubation period in cats is 2 months, but may vary from 2 weeks to several months, or even years.

Disease signs Any unexplained aggressive behaviour or sudden behavioural change in cats must be considered suspicious. Two disease manifestations have been identified in cats: the furious and the dumb form. Death occurs after a clinical course of 1–10 days.

Diagnosis A definitive rabies diagnosis is obtained by post-mortem laboratory investigation. However, serological tests are used for post-vaccinal control, especially in the context of international movements.

Disease management Post-exposure vaccination of cats depends on the national public health regulations, and is forbidden in many countries.

Overview Feline Coronavirus infection is ubiquitous in domestic cats, and is particularly common where conditions are crowded. While most FCoV-infected cats are healthy or display only a mild enteritis, some go on to develop feline infectious peritonitis, a disease that is especially common in young cats and multi-cat environments. Up to 12% of FCoV-infected cats may succumb to FIP, with stress predisposing to the development of disease.

Disease signs The ‘wet’ or effusive form, characterised by polyserositis (abdominal and/or thoracic effusion) and vasculitis, and the ‘dry’ or non-effusive form (pyogranulomatous lesions in organs) reflect clinical extremes of a continuum. The clinical picture of FIP is highly variable, depending on the distribution of the vasculitis and pyogranulomatous lesions. Fever refractory to antibiotics, lethargy, anorexia and weight loss are common non-specific signs. Ascites is the most obvious manifestation of the effusive form.

Diagnosis The aetiological diagnosis of FIP ante-mortem may be difficult, if not impossible. The background of the cat, its history, the clinical signs, laboratory changes, antibody titres and effusion analysis should all be used to help in decisionmaking about further diagnostic procedures. At the time of writing, there is no non-invasive confirmatory test available for cats without effusion.

Disease management In most cases FIP is fatal. Supportive treatment is aimed at suppressing the inflammatory and detrimental immune response. However, there are no controlled studies to prove any beneficial effect of corticosteroids.

OverviewChlamydophila felis is a Gram-negative bacterium and its primary target is the conjunctiva. The bacterium does not survive outside the host.

Infection Transmission requires close contact between cats; ocular secretions are probably the most important body fluid for infection. Most cases occur in cats under 1 year of age. Chlamydophila felis is the infectious organism most frequently associated with conjunctivitis.

Disease signs Unilateral ocular disease generally progresses to become bilateral. There can be intense conjunctivitis with extreme hyperaemia of the nictitating membrane, blepharospasm and ocular discomfort. Transient fever, inappetence and weight loss may occur shortly after infection, although most cats remain well and continue to eat.

Diagnosis PCR techniques are now preferred for diagnosing C felis infection. Ocular swabs are generally used. In unvaccinated cats, antibody detection can be used to indicate infection.

Disease management Tetracyclines are generally regarded as the antibiotics of choice. Doxycycline has the advantage of requiring only single daily administration and is given at a dose of 10 mg/kg orally. Vaccination should be considered if there is a history of confirmed chlamydial disease in a shelter. Single housing and routine hygiene measures should suffice to avoid cross-infection. Cats maintained together for longer terms should be vaccinated regularly. In breeding catteries where C felis infection is endemic, the first step should be to treat all cats with doxycycline for at least 4 weeks. Once clinical signs have been controlled, the cats should be vaccinated.

OverviewBordetella bronchiseptica is a Gram-negative bacterium that colonises the respiratory tract of mammals and is considered to be a primary pathogen of domestic cats. It is sensible to consider B bronchiseptica as a rare cause of zoonotic infections. The bacterium is susceptible to common disinfectants.

Infection The bacterium is shed in oral and nasal secretions of infected cats. Dogs with respiratory disease are an infection risk for cats. The microorganism colonises the ciliated epithelium of the respiratory tract of the host, establishing chronic infections.

Disease signs A wide range of respiratory signs has been associated with B bronchiseptica infection, from a mild illness with fever, coughing, sneezing, ocular discharge and lymphadenopathy to severe pneumonia with dyspnoea, cyanosis and death.

Diagnosis Bacterial culture and PCR lack sensitivity. Samples for isolation can be obtained from the oropharynx (swabs) or via transtracheal wash/bronchoalveolar lavage.

Disease management Antibacterial therapy is indicated, even if the signs are mild. Where sensitivity data are unavailable, tetracyclines are recommended. Doxycycline is the antimicrobial of choice. Cats with severe B bronchiseptica infection require supportive therapy and intensive nursing care.

Overview Avian influenza is a disease of birds, caused by a type A influenza virus. The subtype H5N1 avian influenza occurs primarily in birds and infection varies from mild disease with little or no mortality to a highly fatal, rapidly spreading epidemic (highly pathogenic avian influenza). It is extremely rare for cats to be infected and there are only very few confirmed reports of the disease in cats in Europe.

Infection Cats can be infected via the respiratory and oral routes (eg, by eating infected birds). The key precondition for infection is that the cat lives in an area where H5N1 virus infection has been confirmed in birds. Additionally, the cat should have had outdoor access to an environment where waterfowl is present, or contact with poultry or uncooked poultry meat, or close contact with an H5N1 -infected, sick cat during the first week of infection.

Clinical suspicion Clinical signs in cats may include fever, lethargy, dyspnoea, conjunctivitis and rapid death. Neurological signs (circling, ataxia) have also been recorded.

Diagnosis The veterinary authorities should be notified. Oropharyngeal, nasal and/or rectal swabs or faecal samples of suspected cases should be submitted for PCR and/or virus isolation. Post-mortem samples of lung and mediastinal lymph nodes should be obtained. Particular care should be taken when handling the cat and/or samples.

Disease management The virus is sensitive to all standard medical disinfectants. Cats with suspected H5N1 infection should be kept in strict isolation. Owners should be advised to confine the cat to a separate room prior to bringing it to the veterinary clinic.