Designing kitten wellness programs (Proceedings)

Kittens make up a significant proportion of the patient population in both general small animal and feline specialty practices. The need for frequent visits during the first months of life is an opportunity to lay the foundation for a long and healthy relationship between the pet owner and hospital staff. The entire health care team must focus on kitten wellness in order to provide optimal medical care and foster client bonding.

A comprehensive kitten wellness program is more than physical examinations, vaccinations and deworming, although these remain very important components. Your kitten wellness program will be more effective and more rewarding if other components are added, such as:

• Risk assessment based on lifestyle and breed

• Wellness testing (routine laboratory tests, genetic tests where applicable)

• Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) testing

• Parasite screening and prevention, prevention of zoonotic diseases

• Dietary management for life stages

• Behavior counseling (including litter box management, scratching posts), kitten socialization, environmental enrichment

• Appropriate supplies and toys

• In-home safety (cat-proofing), and safe outdoor experiences (harness, enclosures, etc)

• Dental care

• Microchipping

• Grooming: nail trimming, brushing

• Benefits of spay and neuter; early age altering

A kitten wellness series can range from two to four visits, depending on the age of the kitten and the design of your program. In covering all the important issues, there is too much information for a pet owner to digest in one visit, especially for new cat owners. It is helpful to break up the information into modules, covering the information in one module at each visit. Start with the most pressing wellness issues at the first visit, and prioritize the rest according to that kitten's individual schedule of wellness visits. In this manner, a tailored wellness plan can be made for each kitten at the first visit and documented in the medical record so that no important points are missed at subsequent visits.

Veterinary technicians are invaluable for introducing kitten wellness concepts and information to pet owners. Each kitten wellness visit should be 30 minutes in length, and the time can be divided between technician and veterinarian. The first wellness visit should begin with a kitten history form that covers information relevant to risk assessment, such as:

• Where the kitten was obtained

• What vaccinations the kitten may already have received (with documentation)

• What deworming the kitten may already have received (with documentation)

• What diet the kitten is being fed, is the kitten eating well

• Has the kitten been tested for FeLV and FIV (with documentation)

• Does the owner have other cats at home, do any have access to outdoors

• Has the new kitten been isolated

• Will the new kitten have access to outdoors

• Has the kitten been well since obtained (with emphasis on upper respiratory tract disease signs, diarrhea, external parasites)

• Have there been any housesoiling problems

• If a pedigreed cat, are there plans to breed the kitten

• If a pedigreed cat, has it been tested for relevant genetic diseases

Designing a packet or folder of kitten wellness materials that is given to the owner at the first visit is an effective way of making sure the owner receives all the important information. However, it is not enough simply to hand the reading material to the owner – it is more effective if the owner brings the packet at each visit, and the veterinarian and/or veterinary technician reviews specific pieces of material relevant to that visit.

Every member of the health care team, including all the veterinarians, must follow a standard, comprehensive kitten wellness program in order to deliver a consistent message of high quality care to pet owners. Consistency from doctor to doctor helps improve compliance, and avoids owner confusion about the best wellness care for the pet. All clinic staff should be familiar with and understand the importance of the components of the kitten wellness program. It may be necessary to schedule meetings once or twice a year with the entire clinic staff to maintain focus on the wellness program and introduce any new components.

Vaccinations

The American Association of Feline Practitioners (AAFP) 2006 Feline Vaccine Advisory Panel Report revised some of the guidelines for kitten vaccinations (Richards, Elston et al. 2006). Vaccinations against feline panleukopenia, feline herpesvirus, and feline calicivirus (core vaccines) may be started as early as 6 weeks of age for most kittens and repeated every 3 to 4 weeks until 16 weeks of age. This is a change from the previous AAFP guidelines which recommended the last vaccination at or over 12 weeks of age. A booster vaccination is recommended 1 year after the last dose of the initial series, then no more frequently than every 3 years.

Rabies vaccination is recommended as early as 8 weeks of age (for canarypox virus-vectored nonadjuvanted products) or 12 weeks of age (for killed virus adjuvanted products). A booster vaccination is recommended 1 year later, then according to local laws and product label. Vaccines against FeLV are still classed as non-core, but the panel highly recommended that all kittens receive FeLV vaccinations since kittenhood is the time period in a cat's life with the greatest risk of infection. The first vaccination may be given as early as 8 weeks, with a booster 3 to 4 weeks later. A single dose is given 1 year after the last kitten vaccination, and annually for cats at ongoing risk of exposure to FeLV. Testing is recommended before vaccination.

Other non-core vaccines include FIV, Chlamydophila, and Bordetella. These vaccines are given only to cats judged at high risk of infection. Feline infectious peritonitis and Giardia vaccines are classed as not recommended by the AAFP.

Retrovirus Testing

The 2008 AAFP Feline Retrovirus Management Guidelines recommend that the retroviral status of all cats should be known because the serious health consequences of infection influence patient management both in illness and wellness care (Levy, Crawford et al. 2008). Kittens should be tested when they are first acquired, even if they are not expected to live with other cats. Testing should be performed at the earliest opportunity after adoption (if not already done) and negative tests should be repeated in 60 days. Cats should also be tested before initial vaccination against FeLV or FIV.

Positive FIV antibody tests in kittens under six months of age must be interpreted carefully. Kittens born to infected queens or FIV-vaccinated queens may acquire FIV antibodies in colostrum (MacDonald, Levy et al. 2004). Since it is uncommon for kittens to become infected with FIV, most kittens that test positive are not truly infected and will test negative when re-evaluated at six months of age or older. It is tempting to delay testing kittens for FIV until they are over six months of age, but this means many cats will never be tested or infected kittens will possibly infect other household cats.

Parasite Control

The Companion Animal Parasite Council (CAPC) has issued recommendation for parasite control in kittens (http://www.capcvet.org). The guidelines are designed to protect the health of the pet, enhance public safety from zoonotic diseases, and preserve the bond between people and pets. CAPC recommends year-round preventive treatment for common parasites with zoonotic potential. Anthelmintic treatment can be started as early as 3 weeks of age, and is repeated every 2 weeks until 9 weeks of age with appropriate products (such as pyrantel pamoate). At 8 to 9 weeks of age, kittens can be placed on a monthly anthelmintic preventive. Kittens should be placed on year-round flea and heartworm preventive in endemic areas as soon as possible (in accordance with product labeling). Products are now coming to market that combine flea, heartworm, and gastrointestinal parasite prevention.

In areas endemic for heartworm infection in dogs, the American Heartworm Society recommends that cats should also receive preventive treatment (2007 Guidelines for the Diagnosis, Treatment and Prevention of Heartworm (Dirofilaria immitis) Infection in Cats; http://www.heartwormsociety.org). The prevalence of feline heartworm is often 10-15% of the local canine rate, but can be much higher in some areas. Even indoor cats should receive heartworm preventive treatment. In endemic areas, 20-25% of cats kept 100% indoors may become infected with heartworm.

If year-round monthly combination products are not in use, such as in areas without year-round risk of fleas and heartworm, an amended anthelmintic schedule may be used. Kittens may be treated between 3 and 9 weeks of age (as above), then placed on a monthly preventive until 6 months of age.

Fecal examinations using at least a centrifugal floatation technique should be performed 2 to 4 times in the first year of life, and once or twice a year thereafter. Even indoor cats may be exposed to parasites in various and unexpected ways, including insect vectors, introduction of new cats, and escape to the outdoors.

Genetic Testing

About 250 genetic diseases are known in the cat, many of them having close parallels to human diseases (Lyons 2001). As the feline genome project progresses, more single gene trait diseases will be identified, as well as diseases with a complex genetic component (e.g., feline infectious peritonitis, diabetes, asthma). Currently, more than one dozen genetic tests are available for the cat. Veterinarians and veterinary technicians must understand the proper use and interpretation of genetic tests as more become available. Excellent resources for feline genetic disease testing include the University of Pennsylvania, Section of Medical Genetics (http://w3.vet.upenn.edu/research/centers/penngen/) and the University of California Veterinary Genetics Lab (www.vgl.ucdavis.edu).

In many cases, genetic testing may be performed on a buccal swab rather than a blood sample. Examples of genetic testing that might be required for some newly acquired kittens include:

• Hypertrophic cardiomyopathy (HCM): Inherited as an autosomal dominant trait in several cat breeds, genetic testing currently available for Maine Coon cats (Meurs, Sanchez et al. 2005) and Ragdoll cats (Meurs, Norgard et al. 2007).

• Polycystic kidney disease (PKD): Inherited as an autosomal dominant trait in Persians, Exotic Shorthairs, Himalayans and any breeds with Persian ancestry (Biller, DiBartola et al. 1996); a genetic test is available (Lyons, Biller et al. 2004).

• Blood type: Certain cat breeds have a very high prevalence of blood type B, such as the British Shorthair, Cornish and Devon Rex, and Birman (Giger, Bucheler et al. 1991). Blood type B cats have high, naturally occurring titers of anti-A antibodies. If type A blood is transfused to a blood type B cat, an acute, severe, and potentially fatal reaction may occur, even with only 1 or 2 ml of blood (Giger and Bucheler 1991). A genetic test is available to determine blood type in cats (Bighignoli, Niini et al. 2007), and should be performed for any cat that may be of blood type B at the earliest opportunity.

References

Bighignoli, B., T. Niini, et al. (2007). "Cytidine monophospho-N-acetylneuraminic acid hydroxylase (CMAH) mutations associated with the domestic cat AB blood group." BMC Genet 8: 27.

Biller, D., S. DiBartola, et al. (1996). "Inheritance of polycystic kidney disease in Persian cats." J Hered 87(1): 1-5.

Giger, U. and J. Bucheler (1991). "Transfusion of type-A and type-B blood to cats." J Amer Vet Med Assoc 198(3): 411-418.

Giger, U., J. Bucheler, et al. (1991). "Frequency and inheritance of A and B blood types in feline breeds of the United States." J Hered 82(1): 15-20.

Levy, J., C. Crawford, et al. (2008). "2008 American Association of Feline Practitioners' feline retrovirus management guidelines." J Feline Med Surg.

Lyons, L. (2001). Understanding the feline genome. Consultations in Feline Internal Medicine 4. J. August. Philadelphia, W.B. Saunders: 600-613.

Lyons, L. A., D. S. Biller, et al. (2004). "Feline polycystic kidney disease mutation identified in PKD1." J Am Soc Nephrol 15(10): 2548-55.

MacDonald, K., J. K. Levy, et al. (2004). "Effects of passive transfer of immunity on results of diagnostic tests for antibodies against feline immunodeficiency virus in kittens born to vaccinated queens." J Am Vet Med Assoc 225(10): 1554-7.

Meurs, K., X. Sanchez, et al. (2005). "A cardiac myosin binding protein C mutation in the Maine Coon cat with familial hypertrophic cardiomyopathy." Hum Mol Genet 14(23): 3587-3593.

Meurs, K. M., M. M. Norgard, et al. (2007). "A substitution mutation in the myosin binding protein C gene in ragdoll hypertrophic cardiomyopathy." Genomics 90(2): 261-4.

Richards, J. R., T. H. Elston, et al. (2006). "The 2006 American Association of Feline Practitioners Feline Vaccine Advisory Panel report." J Am Vet Med Assoc 229(9): 1405-41.