Parasite control can be daunting, especially with so many parasites, diseases, risk factors and products to be considered. Parasite control plans allow for the prevention and control of parasites to be tailored to individual pets after assessment (Wright, 2017). Every pet is different and there is no ‘one plan fits all’. With so many different pets being seen each day in practice, it can be hard to know that you are giving the best parasite control advice and protection to each pet and client. However, there are relatively simple techniques which can be used to break down the assessment of pets into a user-friendly method which enables veterinary staff to implement best practice.
This article will focus on parasite control plans for cats and dogs and will be using the European Scientific Counsel Companion Animal Parasites (ESCCAP) best practice guidelines as a means of reference (www.esccap.org/guidelines).
What is best practice?
There is no single definition, but best practice is fundamentally a method or technique that complies with all the following criteria:
Following best practice is an excellent means of ensuring standards are met within practice and it also helps provide a consistency of service across the board. Following best practice is often the starting point for accreditations.
Overview of best practice in parasite control
Risk assessment
A key feature of best practice parasite control plans is the performance of a risk assessment. No one parasite control plan will fit all pets, but simple risk assessments will greatly assist in allocating pets a risk group, from which a parasite control plan can be more easily tailored to meet the individual pet's needs. Areas for risk assessment include lifestyle, previous parasitic infection/infestation history, location, age and general health. The risk assessment should also consider owner circumstances, for instance assessment of likely compliance and whether the pet is in contact with children or immunocompromised adults.
Geographical location
Parasite control will vary considerably depending on geographical location. For instance, leishmaniosis is not endemic in the UK, but prevention and control of leishmaniosis is important for pets travelling abroad. In southern European countries such as Italy, routine control of leishmaniosis is important as the causative parasite and vector is endemic. It is advised for pets in Leishmania spp. endemic areas to be treated with a sand-fly repellent. The UK does not have the disease therefore pet owners need not worry about their pet contracting leishmaniosis unless travelling to an endemic country (ESCCAP, 2012). A best practice parasite control plan will provide a means to factor in all this information.
Where can best practice resources be found?
Best practice parasite control resources are already widely available. The ESCCAP guidelines are one such resource and are free to download from www.esccap.org. ESCCAP is a European not-for profit organisation which provides research-based and independent parasitology advice. ESCCAP's primary aim is to produce best practice guidelines to deliver clear and comprehensive information to veterinary/animal care professionals and pet owners. Although the ESCCAP guidelines give Europe-wide advice, they provide information on parasite distributions within Europe so it is easy to take advice tailored only to the UK. Additionally, if a pet is travelling abroad within Europe, or has been imported from Europe to the UK, the ESCCAP guidelines contain all the information required for developing more extensive parasite control plans.
Creating a parasite control plan
Parasite control plans are best approached in stages:
1. Engage and explain
Explain to the owner the importance of parasite control as part of responsible pet ownership. Discuss the key responsibilities. Keep the owner informed throughout the assessment process by explaining about the different risk groups and why risk assessments are carried out. It is essential to explain to owners what the information means and how it is relevant to them. Owners are more likely to follow instructions if they understand why they are required to do something, therefore it is vital for compliance that veterinary professionals communicate effectively with clients (Richmond, 2017). See point 3 for the use of resources in communication.
Preventative treatment of pets
Prevention is better than cure. Parasite control is essential to keep pets happy and healthy and to protect owners and others from disease.
Environmental control
When discussing parasite control plans with clients, it is important not to focus entirely on treatments and forget to discuss environmental control plans. Especially in the case of ectoparasiticides, good hygiene, regular washing of pets‘ bedding and vacuuming of areas frequented by pets is important to eliminate and prevent (re)infestation (ESCCAP, 2016). Endoparasite environmental control includes daily and responsible disposal of faeces, the covering of sandpits and fencing off of play areas.
Zoonotic risks
It is important to maintain the human–animal bond and, as such, zoonotic risks should be highlighted, while at the same time keeping risks in perspective and providing practical preventative solutions. Basic hygiene measures can greatly reduce any zoonoses transmitted by the faecal-oral route:
2. Risk assessments
Many clients will volunteer information about their pet without being asked, but utilising a range of questions can help to cover the information required and identify parasite risk. Questions about the pet's lifestyle, history and location (Box 1) will identify the pet on a risk scale, from which a parasite control plan can be developed. Owner circumstances will also dictate whether the pet should be considered higher risk. General health questions about what drugs have been used previously, reactions to previous treatments or existing/previous health problems will identify whether any products or formulations should be avoided and owner preferences for specific drug formulations are important to consider to ensure that owners are confident in administering the product (Richmond, 2017). Compliance is vital for success and should be considered throughout and steps taken to ensure maximum compliance at all times — this cannot be emphasised enough. If there is any doubt over compliance then the veterinary nurse should re-evaluate how they are implementing the pet's parasite control plan to minimise all risk of non-compliance.
3. Resources
The use of visual aids when explaining the importance of parasite control to owners can aid understanding, increase compliance and promote increased trust and a better relationship with the client (Richmond, 2017). For example, flea combs and tick hooks provide handy freebies, along with some poo bags and literature. Flowcharts and lifecycle diagrams can serve as useful in-practice resources to aid owner understanding. Using a range of teaching methods including aids, demonstrations and written guidance will benefit the different learning styles of clients and increase rapport (Richmond, 2017). Figure 1 shows a selection of ESCCAP UK & Ireland resources.
4. Record keeping
Once an official assessment has taken place and a parasite control plan has been drawn up, it is important to keep a record on the patient's file.
5. Review
Parasite control plans should be reviewed at least every 12 months as part of an annual health check, and sooner if circumstances have changed.
Additional information
Worms
Having assessed risk, ESCCAP UK & Ireland (www.esc-capuk.org.uk) have a deworming frequency advice download to help establish how often treatment for intestinal roundworm, tapeworm and lungworm is required.
Ticks
Table 1 summarises the different risk scenarios for tick control. It is important to stress that many products are speciesspecific and should be used only for the species indicated. It is vital that cat owners do not use products licensed for dogs which contain permethrin as these are highly toxic to cats.
| Tick control risk groups in Europe | |
|---|---|
| 1) Minimal infestation risk (e.g. animals with restricted or no outdoor access) | Regular visual examination and, if ticks are found, manual removal. In the case where ticks have been found and removed, a follow-up application of an acaricide may be advisable to ensure all ticks are killed |
| 2) Regular infestation risk (e.g. animals with regular outdoor access and undefined risk of reinfestation) | Regular treatments according to product label recommendations to achieve constant protection at least during the ‘tick season’ in areas of Europe with clear cold winters. For warmer areas, or where ticks may survive in houses or in shelters, Rhipicephalus sanguineus treatments may be necessary throughout the year. |
| 3) Ongoing reinfestation risk (e.g. shelters, breeder's premises) | Regular treatments according to product label recommendations to achieve constant protection should be carried out throughout the year |
| 4) High risk of tick-borne disease (TBD) transmission | In areas with a high prevalence of TBDs, pet animals are at risk of acquiring these diseases. Regular treatments according to product label recommendations to achieve constant protection should be carried out throughout the year. Acaricides with additional repellent activity have an immediate effect and prevent ticks from biting, thus reducing the chance of acquiring TBDs. However, it has also been demonstrated that other acaricides can be successful in the prevention of TBDs, especially those that are transmitted during the late stages in tick feeding |
| 5) Kennel or household infestation | Regular acaricidal treatment of pet animals, coupled with environmental treatment using a compound from a different chemical group, can be used where an infestation with Rhipicephalus sanguineus or Ixodes canisuga has established within a kennel or household environment |
| 6) Combined or risk of combined flea and tick infestation | Sustained tick control with integrated flea control is recommended. Generally, monthly application of registered acaricides with insecticidal activity on the dogs/cats is recommended together with daily vacuuming and mechanical cleaning of cages or beds and bedding. Also advised is an animal administered or environmental treatment for immature stages |
Fleas
Flea control is dependent on every pet in the household having preventative treatment for fleas. Each pet and home acts as an individual flea habitat, and unless fleas are controlled over the entire household, they will not be effectively controlled. Risk assessment questions to be considered for successful flea control in households include:
Table 2 summarises the different risk scenarios for flea control. As mentioned before, it is important to stress that many products are species-specific and should be used only for the species indicated in order to prevent non-compliance and, in serious cases, death of the pet.
| Flea control risk groups in Europe | |
|---|---|
| 1) Minimal infestation risk (e.g. animals with restricted or no outdoor access) | Regular grooming and visual inspection should be carried out, preferably using a flea comb. In the event of positive findings, only therapeutic treatment may be required to eliminate the infestation. This can be achieved by the application of any registered insecticide at appropriate treatment intervals to ensure that both adults and developing stages in the environment have been controlled and the problem is eliminated |
| 2) Moderate infestation risk (e.g. animals with regular outdoor access and undefined risk of reinfestation) | Regular prevention at appropriate treatment intervals is recommended. Daily mechanical cleaning (e.g. vacuuming) of the house, and if necessary the car or any other place where the animal has rested, is required. The largest number of eggs and immature stages are found in the places where dogs and cats spend most of their time |
| 3) High, continual re-infestation risk (e.g. pet shelters, breeders' premises, mixed-pet households, hunting dogs) | Sustained, integrated flea control is recommended. Generally monthly application of registered insecticides on dogs/cats is recommended together with daily vacuuming and mechanical cleaning of cages or beds and bedding. Also advised is an animal administered or environmental treatment for immature stages |
| 4) Animals with recognised flea allergy dermatitis (FAD) | In these animals, exposure to flea salivary antigens needs to be minimised or eliminated to prevent clinical signs. Consequently, long-term flea control is recommended to ensure that the flea populations are maintained at very low or virtually non-existent levels. This could include frequent, regular application of insecticides to the animals and appropriate environmental control measures. If the animal with FAD lives within a multi-pet household with other dogs, cats or other pet animals, these animals should also be considered in any flea control strategy |
| 5) Continued flea and tick presence or risk | Sustained tick control with integrated flea control is recommended. Generally monthly application of registered acaricides with insecticidal activity on dogs/cats is recommended together with daily vacuuming and mechanical cleaning of cages or beds and bedding. Also advised is an animal administered or environmental treatment for immature flea stages |
Vector-borne diseases
The control method of choice for most vector-borne diseases is to control the vector. In the case of Babesia canis and Borrelia spp. (Lyme disease) this is effective tick control and regular examination and removal of any ticks found. Pet owners should be educated about appropriate technique for tick removal and be made aware of tick ID schemes such as the Public Health England (PHE) ‘tick surveillance scheme’ (www.gov.uk/guidance/tick-surveillance-scheme) where ticks can be sent free of charge for identification. Identification and recording of ticks found on dogs and people is important to map their distribution, monitor potential introduction of exotic ticks to the UK, establish the risk of household infestations, and know which pathogens may have been passed on to dog or owner.
Benefits in practice
Having a standard best practice parasite control plan for the practice benefits all parties:
The role of the veterinary nurse
Veterinary nurses are often at the forefront of client liaison and customer care within the practice. They are also likely to do their share of record keeping and patient assessments. Therefore, veterinary nurses are ideally placed to carry out many of the stages in tailoring a parasite control plan. Many owners are more comfortable discussing their pet's lifestyle with veterinary nurses and feel they can take more time and ask more questions of nurses without time wasting (Yeates, 2014). Nurses may obtain information and discuss parasite protocols with clients in a number of environments including:
Veterinary nurses will also be responsible for referring cases for diagnosis to veterinary surgeons, for instance when pets present with skin lesions or abnormal behaviour after travel. Many parasiticides are POM-V and the veterinary nurse will be required to liaise with the veterinary surgeon regarding the prescriptions for a pet's parasite control. Utilising best practice across the entire veterinary practice will aid communications such as this and ensure that processes run efficiently.
Conclusion
Veterinary nurses are an integral part of the practice team and the development and implementation of best practice parasite control plans for clients involves the whole practice giving consistent advice and collecting information on which plans are based. By accurately assessing lifestyle and risk factors, bespoke parasite control programmes can be designed for clients that optimise efficacy and compliance. In doing so, pet and owner health, as well as client bonding to the veterinary practice, is improved.