Acquiring new fish and reintroducing aquatic animals to a marine environment presents risks to their health and the wellbeing of other fish. In a virtual session of the Veterinary Meeting and Expo (VMX), hosted by the North American Veterinary Community (NAVC), Catherine Hadfield, MA, VetMB, MRCVS, DACZM, DECZM, said fish are common carriers of pathogens but having a quarantine process in place can reduce the risk of transmission.

“A good quarantine should reduce comorbidity and mortality, and it should improve animal welfare. It will reduce the infectious disease risk,” said Hadfield.

Hadfield is senior veterinarian at the Seattle Aquarium in Seattle, Washington, and co-editor of 

 with Leigh Clayton, DVM, DABVP (Avian Practice and Amphibian and Reptile Practice), eMBA, DVM, DABVP (Avian Practice and Amphibian and Reptile Practice), eMBA. The book offers a comprehensive resource for the veterinary care of fish.

According to Hadfield, fish should be quarantined when introducing a new fish to an existing collection and when animals return after mixing with other animals or environments because they might have been exposed to pathogens. Quarantine following transport also provides stress relief and allows fish to adjust to new environmental conditions. “There are other benefits as well but those are the ones that really focus on the animal care,” she added.

In her VMX session— “Fish quarantine for the general practitioner 101”—Hadfield discussed 6 core features needed for an optimal quarantine: planning, appropriate isolation, ideal environmental conditions, monitoring, diagnostics and treatment, and maintaining accurate records.

“The details within each of the 6 categories [are] going to vary a lot. [They are] going to vary depending on the fish coming in, the facilities available, the experience of the people involved, and a whole bunch of other factors,” said Hadfield.

Determining the goal of the quarantine is key. “This is going to be very different if you are getting in rainbow trout to stock a fishing lake versus, you’re getting in koi that you want to have as long of longevity as possible,” said Hadfield.

Other factors to consider include species suitability, the source of the fish, transport, and the quarantine duration. “How long should quarantine be? If you’re stuck for a general goal, 30 days is usually an often quoted one,” said Hadfield. However, species with higher risks should go longer, she added.

Veterinary care providers should also be prepared to anticipate the animal’s needs and contingencies.

Isolation boils down to security and considering where the pathogens are coming from, Hadfield noted.

“For quarantine, you really want independent, recirculating systems. That means the water is not coming from other fish systems, it’s not going to other fish systems,” she said.

If working with flow-through systems, Hadfield recommended limiting the water to a single pass. “There’s no risk of disease transmission there,” said Hadfield.

Maintaining space around a quarantine system also is important since many common fish parasites and pathogens can be transmitted by aerosol. Additionally, Hadfield suggested using décor such as plastic plants that can be easily disinfected.

The water itself should also be carefully considered. “The safest water, typically, for [reducing] pathogens is probably going to be municipal or city water that is chlorinated. You might also be dealing with surface water or groundwater that is treated before use,” said Hadfield. “The highest risk water is surface water, like from a lake, sea, stream that isn’t treated before its given to the fish.”

Outside the quarantine system, equipment such as buckets should be clean and hands should be washed to further reduce the risk of pathogens being transmitted.

Fish should always be acclimated to their new environments, according to Hadfield. “There is so much complexity in the water that just taking a fish out of one tank and throwing it into the next tank could be an enormous stressor on that fish,” she said.

Acclimating temperature can be done by allowing water in the transport bag to adjust and gradually adding in water from the new habitat.

Environmental conditions should be ideal for the animal’s life stage. “This is a period that they really need exceptionally good care,” said Hadfield.

This habitat should provide shelter and be placed in a quiet area. A quarantine environment should include appropriate aeration, sponge filters, and ultraviolet disinfection. Water quality also is critical, and ammonia spikes should be avoided.

“You want to make sure that before you add these fish, you have biological filters that are ready to handle the ammonia,” she said.

The health of the fish and the quality of their water both need close monitoring.

“You’re going to be staring at these animals a lot. This is a high-risk time for these fish. You want to look at their behavior. That’s their posture, their position, how they’re moving around in the habitat,” said Hadfield.

Other behaviors to watch include fish separating out from a school, and fish staying lower or higher in the water than they should be. External conditions including skin, fins, and eyes should be monitored for redness, dull coloration, and white spots, and attention is needed to assess the gilling effort of the fish.

“It’s very important to monitor how well they’re eating because they’re transitioning, often, to new diets,” said Hadfield.

For water quality, parameters for ammonia and nitrite, pH, salinity, temperature, and freshwater chlorine must be monitored. “The bare minimum of those are very critical parameters,” she said.

“If you can focus on the first 4 categories…you can avoid potentially getting to [the diagnostic and treatments] category. You can prevent the problems from developing,” said Hadfield.

Fish illness can be diagnosed with various testing methods in live and deceased animals. Physical exams, gill or skin biopsies, oral or gill endoscopies, skin scrape, and PCR testing are most useful with live fish, according to Hadfield. A necropsy diagnosis can be made with photographs, squash preps, stained cytology, cultures, histology, and fish pathology.

“If you are doing these diagnostics, do reach out to labs and pathologists who are used to working with fish. Consult with them on the best and most appropriate way to collect the samples so that you can get the most out of them,” she said.

Once a pathogen is identified, a course of treatment can be tailored to combat it. In treating fish pathogens, common medications include praziquantel, formalin, antibiotics, and copper. Changes in salinity can also provide relief.

Overall, Hadfield said an integrated management plan can optimize treatment options and lead to improved outcomes. She suggested that clients should be encouraged to seek out consult from veterinary professionals and to use medications that are prescribed rather than turning to online forums and over-the-counter products for treating fish.

“There is a lot of complexity in fish treatment,” she said.

Relying on evidence is key to guiding the care of animals. It is difficult to improve fish quarantine and treatment of pathogens if what is being done is not recorded and assessed, Hadfield noted.

At the National Aquarium, where Hadfield previously served as a veterinarian, data was reviewed and found that the success of fish quarantine was much lower than what the staff wanted, according to Hadfield. “We decided to make a very conscious effort to improve that using those 6 core principles,” she added.

No protocol is a one-size-fits-all solution. Hadfield recommended using risk assessment to refine quarantine plans for the needs of each fish acquisition. She encouraged veterinarians to weigh the probability of a possible hazard—frequent, likely, or remote—with the level of consequence, such as cost, or severity of how an animal might be affected—major, moderate, or minor—when developing a quarantine plan for fish.

Hadfield C. Fish quarantine for the general practitioner 101. Presented at: Veterinary Meeting and Expo; virtual. January 15-19, 2022.

Articles

An aquatic species expert shares 6 elements to consider in creating a plan that will mitigate stressors and reduce risk of transmitting pathogens.

Quarantining fish to reduce risk of illness

In an interview with dvm360®, Tasha McNerney, CVT, CVPP, VTS (Anesthesia and Analgesia), highlighted the main takeaways from her lecture "Take control of your nursing career!" at the 2022 Veterinary Meeting & Expo in Orlando, Florida. Her discussion empowered veterinary technicians to rekindle their professional passion, plus she reviewed the many career paths they can take within veterinary medicine. 

View the video below for the entire discussion. The following is a partial transcript.

Tasha McNerney, CVT, CVPP, VTS (Anesthesia and Analgesia): 

The main takeaway is that I wanted people to feel lit up about going to work like they used to. I want people to have that same spark that they did when they first graduated their tech program. Remember when you first graduated and you wanted to go in, and you wanted to do all the things, and you wanted to see all the emergencies, and you wanted to save every animal? I want that kind of like push and that drive to be present again.

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During an interview with dvm360®, Tasha McNerney, CVT, CVPP, VTS (Anesthesia and Analgesia), offered inspiring advice for veterinary technicians to take control of their careers. 

Maximizing your veterinary technician career

During a press conference at the 2022 Veterinary Meeting & Expo (VMX) in Orlando, Florida, the North American Veterinary Community (NAVC) launched the Veterinary Nurse/Technician Empowerment Initiative—a program designed to elevate and advance veterinary nurses and credentialed technicians. Even though these professionals are critical team members, their skills are often underutilized.

"Veterinary nurses and technicians play a vital role in veterinary medicine and are essential members of the veterinary practice team. They are not just helpers and assistants. They are phlebotomists, anesthetists, ultrasonographers, surgical technicians, dental hygienists and more, who are highly educated and skilled,” said Gene O'Neill, chief executive officer of the NAVC, in an organizational release.

“Yet NAVC's own research shows they use less than one-third of the competencies they are trained to perform," he added, "By elevating this critical position and helping veterinary nurses and technicians reach their full potential, we will help improve the performance of our veterinary healthcare teams and the health of animals everywhere.”

According to the release, the initiative covers an array of programs (ie, career development and growth, scholarships for continued learning, courses at the NAVC Institute, etc) that provide resources for veterinary professionals, inspire the next generation, and unite industry leaders to address the obstacles facing these professionals.

What’s more, within the initiative there will be a year-long national consumer veterinary nurse/technician awareness and education campaign sponsored by Veterinary Centers of America Animal Hospitals (VCA), with support from the National Association of Veterinary Technicians in America (NAVTA). This program will foster greater consumer awareness of veterinary nurses/technicians' important role and extensive educational requirements which currently seems to be lacking as demonstrated in a national survey conducted by Atomik Research on behalf of the NAVC, according to the release. 

Therefore, the campaign aims to transform pet owners’ perceptions and attitudes to build their confidence in having a qualified, certified veterinary nurse/technician care for their pets.

"A more informed and educated consumer–and a more informed veterinarian and practice manager–will not only benefit veterinary nurses and technicians, but will also benefit the practices where they work. The ultimate result being the delivery of better care for animals," said Ed Carlson, CVT, VTS (Nutrition), NAVTA president.

"Once this is accomplished, consumers will be as comfortable with a veterinary technician caring for their pet, as they are with an RN caring for their loved one in a hospital,” he added.

The overall goals of the Veterinary Nurse/Technician Empowerment Initiative are to accomplish improved access to care, patient outcomes, client satisfaction, and overall well-being of veterinary nurses/technicians while encouraging more individuals to pursue veterinary careers.

NAVC debuts new programs regarding veterinary nurses/technicians. News release. North American Veterinary Community. January 17, 2022. Accessed January 18, 2022. https://www.prnewswire.com/news-releases/navc-announces-new-programs-to-elevate-and-advance-role-of-veterinary-nursetechnician-professionals-301462098.html

These new consumer awareness and education campaigns will elevate and advance the role of professionals.

NAVC announces new initiatives for veterinary nurses/technicians

® conference in San Diego, Sue Ettinger, DVM, DACVIM (Oncology)—also known as "Dr Sue Cancer Vet"—outlined various feline gastrointestinal lymphoma risk factors to help veterinary professionals educate clients on what to bear in mind so they can better keep their pets healthy. 

Another [risk factor] that pet owners might be a little bit surprised [about], but when you think about it not so surprised, is cats that live in houses with smokers. So environmental tobacco smoke can increase the likelihood about 2 and a half to 3 times as well to cause lymphoma. 

In a dvm360® interview, Sue Ettinger, DVM, DACVIM (Oncology), reviewed different variables that may put felines at risk of developing gastrointestinal lymphoma. 

Feline gastrointestinal lymphoma risk factors

A new molecular diagnostic test from Antech Diagnostics may be veterinary medicine’s most sensitive for intestinal parasites affecting cats and dogs. The KeyScreen GI Parasite PCR can detect 20 parasites from a single storable 0.15-gram sample.

In an announcement made during the North American Veterinary Community Veterinary Meeting and Expo in Orlando, Florida, Antech noted the test will be available in the spring of 2022. The company’s molecular technology is supported by 10 testing locations across North America with next-day test results. According to Antech, advanced parasite screening is practical for routine wellness exams.

Parasites are increasing, migrating, and mutating, and zoonotic diseases are on the rise, and treatment-resistant hookworms are an emerging threat to canine health. However, today’s parasitic infection challenges outpaced the capabilities of existing screening tests, which are neither sensitive nor comprehensive enough to detect the breadth of parasites that are of significant concern to pet health according to Antech. Parasites that can be detected by the KeyScreen GI Parasite PCR test include anthelmintic drug-resistant hookworm and zoonotic 

“The COVID-19 pandemic has shown us—with vivid clarity—how human and animal health are interconnected, the danger and speed of mutations, and the critical need for sensitive, fast, affordable diagnostic testing,” said Christian M. Leutenegger, Dr. Med.Vet., BSc, PhD, FVH, director of molecular diagnostics, research, and development at Antech and inventor of the KeyScreen GI Parasite PCR test, in a company press release.

“Molecular testing is a sophisticated new tool with numerous advantages, including an exquisite ability to have a lens into the DNA of a parasite. I like to say that ‘molecular testing can tell you what color eyes the parasite has.’ Current and unrecognized threats demand this level of precision to ensure animal and human well-being,” Leutenegger continued.

According to a company press release, KeyScreen GI Parasite PCR offers several novel capabilities that support practice efficiency, rapid, cost-effective detection of more disease and a new, higher standard of care for parasite screening. These capabilities include the following:

Find more disease. Treat appropriately—

KeyScreen offers the only method to differentiate tapeworms, detect 

 and identify roundworm strains, whipworms, protozoa and coccidia. Facilitating a new level of precision medicine, the test allows veterinarians to deliver the right treatment to pets the first time, helping them regain health faster and eliminating repeat visits.

—Hookworms are one of the most prevalent intestinal parasites affecting dogs, and prevalence is rising dramatically. They are also zoonotic. Although there are several available treatments, intensive overuse has created high levels of anthelmintic resistance and multiple drug resistance (MDR). KeyScreen not only detects hookworm, it also automatically checks for the genetic resistance marker, delivering vital information to inform effective treatment.

—Although the risk of contracting disease from pets remains low, there are critical advantages to knowing if a pet is infected with a zoonotic assemblage. Of the 7 known 

 assemblages, 2 have the potential to be zoonotic. KeyScreen automatically checks for the assemblages that may threaten human health, giving veterinarians specific information to make informed treatment decisions as well as counsel or reassure pet owners about potential risks to older adults, children, and immunocompromised individuals.

Freedom from “fecals” and other cost and efficiency gains

—KeyScreen requires a very small sample that can be stored refrigerated for up to 10 days. It finds the most parasites the first time using a single test, automatically checking for zoonotic assemblages and resistance markers, eliminating the time and resource strain of repeat pet owner visits. Molecular testing can also eliminate the resources required to process and analyze in-clinic ova and parasite testing.

—As the COVID-19 pandemic continues, awareness of veterinarians’ role as One Health stewards has never been greater. Molecular diagnostics allow veterinarians to strengthen their commitment to One Health priorities, specifically pharmacological stewardship, and the responsible use of anthelmintic drugs, by delivering precise information about the type of infection present. Using the most sensitive intestinal parasite screening panel, veterinarians can make treatment decisions with confidence while educating pet owners about the responsible use of therapy.

“We don’t know what we don’t know, and there’s much to learn about parasites that could impact animal and human health now and in the future. While we are aware of emerging issues like treatment-resistant hookworm infections, there could be latent risks from parasites that we once believed to be insignificant,” said Leutenegger, in the release.

The development of the KeyScreen GI Parasite PCR test represents 2 decades of foundational research by Antech. This test sets a new standard of care in veterinary medicine, according to a company press release.

Antech introduces veterinary medicine’s most advanced parasite screening test. News release. January 17, 2020. Accessed January 17, 2022. 

https://www.antechdiagnostics.com/about/news/antech-introduces-veterinary-medicines-most-advanced-parasite-screening-test

First PCR test for parasites affecting cats and dogs helps relies on molecular technology 

Novel screening test can detect 20 intestinal parasites

According to Kara Burns, MS, MEd, LVT, VTS (nutrition), VTS-H (internal medicine, dentistry), inadequate nutrition in critical care patients further complicates management of their underlying condition. This population requires daily nutrients to maintain optimal immune function, tissue synthesis, tissue repair, and proper drug metabolism. During her lecture at the virtual North American Veterinary Community (NAVC) Veterinary Meeting & Expo (VMX), she expanded upon the importance of nutrition in critical care patients and outlined tips for addressing their needs.

Burns advised that before beginning to feed patients, ensure that they are stable and not in shock because that will decrease gastrointestinal (GI) perfusion, and has the potential to increase other complications. The patient should also be well hydrated. Electrolytes should be monitored before feeding and throughout the process.

Early enteral and semi-elemental nutrition

Incorporating enteral nutrition as quickly as possible promotes early recovery and this can be accomplished by providing an antiemetic drug on admission. Some benefits of this method include decreasing cytokine production, modulating acute phase response, reducing catabolism, preserving protein, and stimulating the regeneration of the intestinal mucosa.

“In these [critical] patients, early nutritional support is essential because we know that feeding spares endogenous proteins, which is critical to successful outcomes,” said Burns.

Burns recommended a semi-elemental diet because it is easily absorbed and digested by the GI tract. This monomeric feeding uses small molecular weight compounds for nutrients, so the tract doesn’t have to expend substantial energy to break them down.

“An emergency and critical care patient has no energy to spare, so that energy is better served in healing the rest of the body and repairing itself,” Burns shared.

When an animal is critically ill, the body’s main goal is to support key organs including the heart, brain, liver, and lungs so that blood flow to the GI tract is reduced, which then in turn slows GI motility or movement. Therefore, maintaining the health and function of the GI tract and its enterocytes is especially vital in these patients, according to Burns.

“The GI tract is lined with cells called enterocytes. Those enterocytes help digest, absorb, and transport a large variety of nutrients into the body. Important nutrients absorbed by enterocytes include the building blocks of protein, which are peptides, carbohydrates, saccharides, fats or lipids, water, vitamins, and those ions or minerals,” Burns said.

When prioritizing enterocyte health, veterinarians provide the maximum absorbable nutrients in the GI tract. Additionally, enterocytes form a tight seal to protect the body from harmful bacteria or toxins, ergo this is advantageous for critical care patients as well.

Burns urged attendees to use feeding tubes in critical condition patients. “Feeding tubes save lives, but they are not used as often as they should be,” she said.

The types of feeding tubes include nasoesophageal/nasogastric tubes, esophagostomy tubes, gastrostomy tubes, and jejunostomy tubes. Each one serves its own function and can be used based on a patient’s anesthetic needs, duration of feeding needs, placement needs, and beyond.

Though complications involving feeding tubes are rare, some to be mindful of are aspiration, dislodging, vomiting, blockage, and infections (especially Stoma infections), according to Burns.

Burns concluded the presentation by summarizing that poor nutrition results in poor outcomes, early enteral and semi-elemental feeding leads to early recovery, and feeding tubes save lives. Though it often isn’t the priority when a patient is in critical condition, ensuring they receive proper nutritional intake is key to their recuperation.

Burns K. Nutrition in critical care. Presented at: Veterinary Meeting and Expo; virtual. January 16, 2022. 

Ensuring patients receive appropriate feeding is essential to their recovery. 