section epub:type=”chapter” id=”c0049″ role=”doc-chapter”> Brenda Griffin While feline practitioners are usually well-versed in the creation of wellness programs tailored for individual cats, optimizing the health of a population of cats requires additional knowledge and poses unique challenges. Veterinarians may be tasked with developing health care programs for cat populations in a wide spectrum of settings such as facilities housing laboratory animals, animal shelters, home-based rescue and foster providers, care-for-life cat sanctuaries, breeding catteries, or large multicat households. This chapter discusses a systematic approach to health and wellness of populations of cats. Cat; feline; population wellness; quality of life; five freedoms; animal shelters; capacity for care; stress; infectious disease control; cat identification; behavioral assessment; shelter design; shelter disinfection protocols While feline practitioners are usually well-versed in the creation of wellness programs tailored for individual cats, optimizing the health of a population of cats requires additional knowledge and poses unique challenges. These challenges will vary depending on many factors, including the nature and purpose of the population itself. Indeed, veterinarians may be tasked with developing health care programs for cat populations in a wide spectrum of settings such as facilities housing laboratory animals, animal shelters, home-based rescue and foster providers, care-for-life cat sanctuaries, breeding catteries, or large multicat households. Regardless of the setting, a systematic approach to the health of the clowder is crucial for success. Additional resources are found in Merriam-Webster’s Dictionary defines wellness as “the quality or state of being in good health especially as an actively sought goal.”1 Ensuring population health requires careful planning and active implementation of comprehensive wellness protocols that address both animal health and environmental conditions (Fig. 49.1). Addressing physical health alone is not sufficient to ensure wellness. For example, a cat may be in good physical condition and free from infectious and other diseases yet suffering from severe stress and anxiety. In this case, the patient cannot be assessed as healthy, because its behavioral (emotional) state is compromising its health and well-being. Thus, physical health and behavioral health are essential components of wellness, and preventive health care must actively address each of them. Addressing the population’s environment is also critically important when considering wellness. Even the best facilities cannot foster good health in a multicat environment without thoughtful implementation of environmental wellness protocols. Thus, a structured program to address environmental wellness is essential in the context of a population, regardless of the actual physical environment. Proactive measures to maintain clean, sanitary environments that are not overcrowded and where cats are segregated by age and health status in areas with comfortable ambient temperatures and good air quality are essential. In addition to the physical environment, careful consideration must also be given to creating a healthy emotional environment. The provision of consistent daily care routines by well-trained caregivers who provide cats with regular positive, predictable events and interactions, while shielding them from stress- and fear-provoking stimuli, are crucial for health and welfare. Simply stated, the overarching goals of a population wellness program are to optimize the physical and behavioral health of the cats as well as preventing transmission of zoonotic diseases. In other words, a population wellness program should be designed to keep animals healthy and happy while keeping caregivers safe. It is not difficult to identify a healthy population of cats because when wellness protocols are successful, cats look healthy and show normal behavior. They appear in good physical condition and display a wide variety of normal feline behaviors, including eating, stretching, grooming, scratching, playing, rubbing, resting, and, if allowed, courtship and breeding. Just as changes in a cat’s physical appearance should alert the clinician to potential problems, so should the absence of normal behaviors. Wellness goals must include maintaining the health of individual animals as well as that of the whole population. In the context of the population, individuals that are physically or behaviorally ill serve as indicators or barometers of the health and condition of the population. When individuals are ill, their health and well-being is always a priority; however, it should also immediately trigger the clinician to ask, “Why is this individual sick or emotionally disturbed? What is the cause of its ailment, and how can I prevent this from affecting others?” More specific goals will vary depending upon the given population and its purpose. For example, in an animal shelter, specific goals of a wellness program might include decreasing the incidence and prevalence of infectious diseases in the shelter and after adoption, decreasing the incidence of problem behaviors in the shelter, decreasing the rate of return of cats to the shelter for problem behaviors, increasing the adoption rate, and so forth. In the context of a breeding colony, the goals might include increasing kitten birth weights, decreasing neonatal mortality, or improving kitten socialization. By identifying and tracking measurable factors (often called performance targets in large animal medicine), it is possible to measure progress toward these goals. Once baseline data (e.g., disease rates) are established, it is possible to measure the impact of protocol changes on population health by evaluating the performance targets. Both medical records and a system for regular surveillance and reporting are required to accurately track and assess trends in animal health. Early recognition is crucial for effective control of infectious diseases and problem behaviors in a group. Therefore, a regular system of health surveillance must be in place to monitor every individual. In a population setting, daily walk-through rounds represent the foundation of an effective animal health care program. Rounds should be conducted at least once daily (preferably twice daily or more often, depending upon the needs of individual cats) for the purpose of monitoring and evaluating physical and behavioral health. Medically trained caregivers should visually observe every animal and its environment, taking note of food and water consumption, urination, defecation, attitude, behavior, ambulation, and signs of illness, stress, fear, frustration, pain, and other problems. Monitoring should take place before cleaning so that food intake and the condition of the enclosure, including the presence of feces, urine, or vomit, can be noted. Alternatively, observation logs can be completed by caregivers at the time of cleaning and reviewed during walk-though rounds. Any cat that is observed to be experiencing a problem, whether it be signs of upper respiratory tract disease (URTD), diarrhea, anxiety, or obvious pain, suffering, or distress, must be assessed and treated in a timely manner. Regardless of length of stay, regular daily assessment is imperative to identify new problems (medical or behavioral) so they can be addressed in a timely fashion to ensure the welfare of the individual animal as well as that of the population. In addition to health surveillance, daily rounds serve an additional and equally crucial role in animal shelters and other settings where cats are temporarily or transiently housed. In this case, daily animal care rounds should encompass health and welfare monitoring as well as the logistics of providing care efficiently. The delivery of care efficiently as well as thoughtful and timely planning, evaluation, and follow-up, are crucial to minimize each animal’s length of stay in a temporary sheltering facility. This is important because long-term sheltering (i.e., more than 1 to 2 weeks) is strongly associated with increased risk of infectious disease and emotional distress. Indeed, cats entering shelters are highly stressed and at high risk of developing infectious disease, especially URTD; therefore, minimizing the amount of time that a cat is confined in a shelter is an important goal of a wellness program. During daily rounds in animal shelters, trained individuals should assess the status, pathway, and progress of every animal through the shelter system for the purpose of timely planning, scheduling, and delegation of tasks needed to ensure the most efficient care. Action items should be generated to hasten the animal’s progress through the shelter. Whenever possible, a team-based approach is used to facilitate planning and delegation of action items. As the team walks through the shelter, they should evaluate the status of animals in required holding periods, consider what the animal needs that day (e.g., surgical sterilization scheduling, disposition decisions, contact a rescue group, special marketing), and create a plan to make it happen. The use of computer-generated reports and/or cage card systems are often used to facilitate daily rounds. In addition to early recognition of health problems, timely action is crucial to limit morbidity. Ideally, all facilities that house multiple cats should have written policies and protocols in place that detail how medical and behavioral problems will be handled. A committee or team of individuals composed of medical staff, managers, and caregivers can establish and oversee these policies and protocols. Such protocols serve as guidelines for systematic triage and care of animals and help to prevent delays in care that may occur if such plans are not in place. Policies and protocols should be based on medical evidence and should consider the organization’s purpose or mission and the availability of resources for care. They should include a definition or description of the disease or condition in question, a description of the methods that will be used for diagnosis, and a general policy regarding the handling and disposition of affected cats. In addition, protocols should include details on notification, housing, decontamination, treatment, and documentation ( Just as quality of life (QOL) assessment is the responsibility of every veterinarian as they guide the medical care of individual animals, it is also a critical part of population health care and monitoring. The factors that affect physical and mental well-being are broad, complex, and often vary substantially among individuals.1 Exact criteria are lacking for objective measurement of QOL for cats. However, subjective assessments can and should be made by medical and behavioral personnel at regular intervals (weekly or even daily, as indicated) considering all available information. The “Five Freedoms,” which were originally described by the Farm Animal Welfare Council (FAWC) in the United Kingdom in the 1970s, represent a benchmark for ensuring QOL and animal welfare (Box 49.1).2 These principles provide a useful framework that is applicable across situations and species and have been widely accepted and endorsed by animal care experts. Many organizations have used the Five Freedoms as the basis for recommendations for minimum standards of care for many species, including cats housed in catteries, shelters, and research facilities. Regardless of the setting, population wellness programs should ensure the Five Freedoms for all cats. Recognizing that good QOL or good welfare are not merely the absence of negative experiences but also the presence of positive ones, the FAWC has provided additional criteria for ensuring good QOL. To this end, they have described a spectrum of conditions that range from “a good life” to “a life not worth living.” In the case of a life not worth living, minimal acceptable treatment of animals is key. In contrast, “achievement of a life worth living requires provision of an animal’s needs and certain wants, and care by all involved.” The FAWC defines wants as “those resources that an animal may not need to survive or to avoid developing abnormal behavior, but nevertheless improve its quality of life. They may well stem from learned behaviors so that once an animal has become accustomed to their provision then withdrawal may lead to an adverse mental experience. They may also be innate such as space to play, to groom, or engage in other normal behaviors.”b Consideration of these additional tenets proposed by the FAWC help to better define requirements for humane care and an acceptable QOL for animals in a variety of settings, including cats. The “Five Domains” model for animal welfare assessment is increasingly being used to define needs and standards of care for animals in a variety of populations, including laboratory and shelter settings. This model considers the conceptual shift of recognizing and grading not only those conditions that negatively impact welfare, but also those that positively impact it as well.2,3 The Five Domains include nutritional conditions, physical environment conditions, health conditions, behavioral interactions, and mental state. Positive and negative effects of the first four domains contribute to the fifth domain (mental state). Well-being is maximized by increasing experiences that result in positive emotions while reducing those that result in negative emotions regarding each of these domains. Notably, this model includes the impacts of human interactions on animal welfare based on contemporary animal welfare science.3 Medical decisions must be weighed in the context of the health of the population as well as that of the individual, while considering animal welfare and the availability of resources for care. When large numbers of animals are involved, situations may arise where health and welfare cannot be managed for each individual animal. This may be due to physical or behavioral illness, or environmental conditions that negatively impact animal health, such as crowding. Regardless of the cause, it may be necessary to euthanize affected individuals if no other remedies exist to relieve animal suffering or to protect population health. These decisions can be difficult and emotionally challenging, especially in instances where the individual could easily be treated or otherwise accommodated if adequate resources were available. However, such decisions may be crucial for disease control, animal welfare, and population health. That being said, euthanasia should never be used as a substitute for providing proper husbandry and care. Indeed, a critical need for a comprehensive wellness program exists in every multicat setting. It is unacceptable to house animals under conditions likely to induce illness and poor welfare; such conditions can be expected when wellness programs are not in place and carefully monitored. When organizations elect to house cats with medical or behavioral problems, appropriate veterinary care must be provided. It is imperative that a humane plan for diagnosis, treatment, management, monitoring, and housing be implemented in a timely fashion. When determining if cats with special needs can be humanely cared for in a population setting, the following goals and considerations should be addressed: In the case of animal shelters, additional considerations should include: In the field of shelter medicine, the term “population management” is used to refer to an active daily process of planning that involves ongoing evaluation and efficient response as the organization cares for multiple animals. To be effective, population management must take into consideration an organization’s ability and resources to provide care; in other words, its capacity for care (CFC). Many factors impact a shelter’s CFC including the availability of housing, staffing, and all other resources necessary to provide humane care. Not surprisingly, when organizations operate without sufficient resources to provide proper care, animal health and welfare are compromised. Unfortunately, both poor management and exceeding CFC are common problems in animal shelters. This underscores the importance of systematic evaluation of management practices and CFC in animal shelters, considering historical admission rates, required legal holding periods (if any), available housing, staffing, and all other resources necessary for care. Regardless of the setting, when populations are efficiently managed with adequate resources, wellness care is effectively delivered to support the physical and behavioral health of animals and their environment, increasing resistance to disease and emotional resilience. This in turn can be expected to improve QOL, as well as to optimize positive outcomes for sheltered cats. Key components of CFC models include optimizing the number of cats housed in the shelter at any one time, managing length of stay, and providing high quality housing. Studies have shown that shelters successfully implementing a CFC model may benefit from improved measurable outcomes such as increased adoption rates, decreased length of stay, and a reduction in admissions.4,5 One shelter in Ontario, Canada found the length of stay for cats decreased by 24% after implementation of a CFC program.6 Some features of the CFC program included fast-tracking cats to the adoption floor, removing tight restrictions for adoption, and shortening the adoption application process. Resources for more information on CFC are found in Infectious disease and problem behaviors are common in multicat settings. The adage, “An ounce of prevention is worth a pound of cure” is certainly true. Wellness always starts with prevention as it is far more time- and cost-efficient than treatment, and it is kinder to animals and caregivers. With this in mind, population wellness programs should provide broad-based, holistic approaches to preventive care rather than being based on control of a single disease or problem, regardless of the setting. Maintenance of good health or wellness is especially challenging in populations with high turnover and interchange of cats of varying ages and susceptibilities, such as animal shelters. Infectious diseases can become endemic in facilities where populations of animals are housed. Even in closed populations, certain pathogens can be difficult to exclude or to eliminate once introduced. Notably, URTD, dermatophytosis, and coccidiosis are among the most difficult diseases to control because of pathogen persistence in the environment through carrier states and/or resistance to environmental disinfection. In particular, URTD is the most common endemic disease in cat populations and is impossible to completely prevent in an open population. Feline herpes virus type 1 (FHV-1) and feline calicivirus (FCV) have been implicated as the cause in most cases. Both viruses induce persistent carrier states and are widespread in the cat population. Cats that recover from FHV-1 remain latently infected and may shed virus intermittently, especially following periods of stress. Cats carrying FCV shed continuously for months to years following infection. A variety of other viral and bacterial pathogens may also contribute to URTD; for example, Bordetella, Chlamydia, and Mycoplasma are problematic in some populations. In animal shelters, the negative impact of prolonged confinement on the risk of cats developing URTD has been well documented. Several studies have demonstrated that risk increases with the number of days spent in the shelter.7 Feline infectious peritonitis (FIP) is another disease that is nearly impossible to eradicate from a multicat environment, and sporadic cases are expected to occur, especially in young cats. Fortunately, proper wellness programs can greatly limit the incidence and severity of diseases, even for pathogens that are difficult to control. The multicat environment also presents enormous opportunities for inducing stress. Because of their unique biology, cats are particularly prone to experiencing acute stress and fear in novel environments. Anything unfamiliar to a cat can trigger apprehension, activating the stress response. Confinement in a novel environment can result in a wide variety of behavioral indicators of stress including hypervigilance, feigned sleep, constant hiding, activity depression, and loss of appetite, among others. In the long term, if cats are unable to acclimate or cope in their environment, chronic stress, fear, frustration, or learned helplessness may result. In group settings, signs of social stress may manifest as increases in problem behaviors, including urine marking or other types of elimination in inappropriate places, constant hiding, and/or aggression. Stress not only has the potential to negatively impact behavioral health but also physical health. The intimate link between stress and immunity has been well described. In fact, stress is a leading factor in the development of infectious disease and is particularly important in the pathogenesis of feline URTD.8 Wellness programs that reduce stress will also serve to minimize morbidity from infectious disease. Even though infectious agents can never be eliminated from most environments, it is still possible to maintain good health. This is because the development of disease is determined by a complex interaction of many factors involving the host, the infectious agent, and the environment. Keeping these factors in mind provides a rational context for many of the recommendations in this chapter. Some of the host factors that influence health and the development of disease include age, sex and reproductive status, immune status, body condition, physical and emotional stress, and genetics. The amount and duration of exposure to an infectious agent (i.e., the “dose effect”), as well as its virulence and route of inoculation, influence the likelihood and severity of disease. In addition, environmental conditions can contribute to the development of infectious disease, including such factors as housing density, sanitation, and fluctuations in temperature or air quality. The fact that disease results from such a large combination of factors underscores the importance of a holistic and broad-based approach to population wellness. When infectious disease occurs in a population, general principles of infectious disease control should guide the response. These include: Coupled with vigilant surveillance to ensure early recognition of disease, these serve as the foundation of all disease control efforts when disease is present. However, the best method of disease control is always prevention. When creating preventive medicine programs for a population, consideration must be given to all components of wellness: physical, behavioral, and environmental health. To promote physical health, wellness programs should address the following essential elements: Likewise, to promote behavioral health, programs should include provisions for the following essential elements: Finally, wellness protocols aimed at creating an environment that promotes health must consider the following essential elements: Implementing population wellness protocols and ensuring quality and timely care require reliable systems for medical record keeping and animal identification. Regardless of the system used, record keeping procedures should comply with applicable laws and veterinary practice acts and guidelines provided by veterinary medical associations. In the case of laboratory animals, often regulations as prescribed by law must be followed. Computerized records are preferred; however, written records may also be used. Computerized records offer the advantage of mechanized reporting, which facilitates detection and monitoring of health trends in the population. A medical record should be prepared for each cat and should include the cat’s entry date, identification (ID) number, date of birth, sex, breed, and physical description, as well as historical, physical, and behavioral examination findings. In addition, the medical record should contain: Standardized examination and surgical reports may be used but should allow for additions when necessary. Identification of cats in the form of a neckband, collar and tag, tattoo, ear band, and/or a microchip is also essential for preventive health care and ongoing surveillance of individuals. Whenever possible, some form of identification should be physically affixed to every cat. In addition, enclosures should be labeled with each cat’s unique identification number and/or name. Contrary to popular belief, most cats can wear collars safely and comfortably.9 Many facilities use disposable collars such as commercially available plastic or paper neckbands made for animals or hospital-type wristbands made for human patients (Fig. 49.2). Commercially available cat collars with an ID tag affixed are also a good option. Some facilities prefer to use safety collars that are designed to break away should the collar become caught on something. Even for kittens, collars can be used and may be especially beneficial, because they will learn to wear them from an early age. Microchips may also be used for identification and are safe and simple to implant. The procedure is well-tolerated by most cats without the need for sedation. Unlike visual means of identification, a scanner is necessary for positive identification of a microchipped animal. For this reason, microchips are often used in conjunction with a visual means of identification and serve as an important means of permanent identification. Box 49.2 describes the proper technique for scanning for a microchip. During the last three decades, microchips of varying radiofrequencies (125, 128, and 134 kHz) have been introduced. In the United States, the 125 kHz chips have historically been most common, whereas the accepted standard in the rest of the world is the 134 kHz chip. Because some scanners read only certain radiofrequencies, it is possible to miss detection of a microchip depending on the scanner being used. Currently, there are efforts to standardize microchipping in the United States, including widespread distribution of universal (global) scanners to ensure that all implanted microchips can be reliably identified. The American Veterinary Medical Association recommends adoption of the International Standards Organization standard frequency (134 kHz) as the American standard, because this frequency is recognized in the rest of the world.3 Efforts have also focused on improving, updating, and centralizing microchip registries. This is extremely important in the context of animal shelters. Box 49.3 contains information on the use of collars and microchips as tools for improving cat–owner reunification. In laboratory settings, tattoos may be used as a means of permanent identification (Fig. 49.3). Tattoos are most often applied to the inner pinna using a tattoo machine with multiple needles. Care must be taken to properly disinfect the needles between patients. A significant disadvantage of tattoos is that they can sometimes be difficult to read because of the presence of hair, fading, or distortion that may occur as the cat grows. In addition, application of a tattoo requires anesthesia or a sufficient level of sedation and analgesia. Small, stainless steel ear tags manufactured for wing banding of birds are especially useful for identifying newborn kittens in some settings and are highly economical ( In contrast, private breeding catteries and animal shelters generally prefer to use methods that will not alter the cat’s cosmetic appearance in the long term. Colored ribbons, nail polish, nontoxic indelible markers, or clipping of hair in various areas of the body can all be useful means of temporary kitten identification, especially when coat color or patterns do not easily allow individuals to be distinguished. The success or failure of a population wellness program depends in large part on implementation and oversight. A knowledgeable, cohesive, and dedicated team, where accountability, responsibility, and lines of authority are well defined, is crucial for success. As a part of the management structure and plan, veterinarians must be involved in the oversight of all aspects of animal care and must be given direct authority for oversight of medical decisions. This requires that all facilities housing cats establish a formal relationship with one or more veterinarians who have direct knowledge of that animal population. This is essential to ensure that medical protocols are established with proper professional oversight and helps to ensure compliance with local veterinary practice regulations that restrict the practice of veterinary medicine to licensed veterinarians. In facilities such as animal shelters, trained shelter staff can carry out preventive health care under the instruction of a veterinarian. The clinician should develop a program for physical health for the population that addresses all essential elements as noted above. None of the elements should be considered optional, but implementation will depend on the setting, purposes, and resources of the group. The value of obtaining an accurate medical history on any cat entering a population is immeasurable, because it will often alert the clinician to the presence of potential problems. In a laboratory setting, obtaining cats from commercial purpose-bred colonies or institutional breeding colonies ensures that an accurate history will be available, maximizing the likelihood that only healthy cats will be added to the population. Likewise, pedigreed breeding catteries should obtain an accurate medical history on any cat that is accepted into the cattery. The introduction of cats from random sources to closed populations risks the health of the population and should be avoided whenever possible. In contrast, by their very nature, animal shelters frequently receive cats from random sources, and it is not always be possible to obtain an accurate history. In some cases, cats are brought in by animal control officers or good Samaritans who have little if any information about the cat. Furthermore, some shelters provide a location where cats can be relinquished after business hours (e.g., drop-off cages). This practice should be discouraged; however, if facilities elect to offer this service, every effort must be made to obtain a history through questionnaires made available at the site of relinquishment. The presence of staff to accept cats and obtain a history at the time of relinquishment is greatly preferred. Even so, surrendering owners may or may not provide complete or accurate information, fearing that if they are honest about a pet’s problems, the pet may be euthanized. Nonetheless, when available, a history can be extremely valuable, saving time and money as well as preventing unnecessary stress for cats and staff alike. Intake procedures should be in place to capture basic patient information, including both physical and behavioral data as well as the reason(s) for relinquishment. The importance of obtaining historical information cannot be overemphasized. In many cases, historical information will be used to expedite the disposition of the cat in the shelter. The physical examination is the clinician’s single most important tool for evaluating health. Using a standardized physical examination form will ensure a complete and systematic review of all body systems. A veterinarian should carefully examine any cat entering a closed population prior to admittance. In the context of animal shelters, every cat that is safe to handle should receive a physical examination at or as close to the time of admission as possible. In some shelters, a veterinarian may not be available to examine incoming animals. However, staff can and should be trained to perform basic evaluations including sexing, aging, body condition scoring, and looking for evidence of fleas, ear mites, dental disease, overgrown claws, advanced pregnancy, or other obvious physical conditions. Of particular importance in the shelter are an accurate physical description of the animal and careful inspection for the presence of identification, both of which may aid in pet–owner reunification. The gold standard for maintaining the health of a population is through exclusion of pathogens in combination with implementation of comprehensive wellness protocols. This requires that members of a population be free from specific pathogens when the group is established, and that the colony be closed to new individuals that do not meet the health standards of the group. This is the foundation of disease control in a laboratory animal setting, and these concepts should be applied to other populations whenever possible. Consideration should be given to testing for feline leukemia virus (FeLV), feline immunodeficiency virus (FIV), dermatophytosis, intestinal parasites, and intestinal infections (e.g., Giardia, coccidia), as well as other endo- and ectoparasites. The setting and resources available, as well as the history and physical examination findings, should guide the clinician’s decisions regarding selection of tests for cats entering the population. When new stock is added to a closed colony, disease testing is imperative. The American Association of Feline Practitioners (AAFP) has published detailed professional guidelines for the management of FeLV and FIV infections.10 Identification and exclusion of infected cats is the most effective method of preventing new infections. Cats and kittens should always be tested prior to entering a closed population. Cats that test negative should be retested in case recent exposure has occurred, because the average time to seroconversion is 30 days for FeLV and 60 days for FIV.10 The 2020 AAFP Retrovirus Testing and Management Guidelines established specific testing recommendations for shelter cats (see Table 48.2).10 Although it may be ideal for shelters to test cats on entry or prior to adoption, it is not always feasible because of financial constraints. Each shelter should evaluate its own resources and determine the best approach. The 2020 AAFP guidelines suggest that in shelters where cats are housed individually, high-risk cats (e.g., sick, those with bite wounds, those from hoarding cases) can be prioritized for testing. If cats are not tested at the shelter, the new owner should be advised to have testing performed as soon as possible and the cat should be kept separate from others until the test result is known. In shelters where cats are group-housed, FeLV and FIV testing is essential before cats enter a group. Cats entering foster homes should be tested if resident cats are present. When testing is performed, samples must never be pooled for testing, and a result obtained for one cat (such as a queen with kittens) should not be extrapolated to other cats (such as her kittens). These practices are invalid and can lead to misidentification of a cat’s true infection status.10 Even when cats test negative in the shelter prior to adoption, follow-up testing after adoption is the recommended best practice. Although screening tests may be used in shelters, confirmation of infection poses great challenges due to limited resources and space, especially in shelters with rapid turnover of large numbers of cats. Increased cost, delays, and difficulty interpreting discordant results are reasons why many shelters do not pursue additional testing for cats with positive screening test results. In addition to limited resources, the implications for cat welfare must also be carefully considered. Long-term confinement can compromise QOL and often compounds the emotional stress of caregivers who may later be faced with euthanizing cats that have been held for long periods awaiting follow-up testing or adoption opportunities. For these reasons, many shelters elect to euthanize pet cats that are positive on retrovirus screening tests unless adoption opportunities are readily available. For shelters that elect to test for FeLV and FIV, the 2020 AAFP guidelines recommend a “one and done” approach with a reliable screening test. This will identify most infected cats, except for those with recent exposure, kittens tested while still nursing, and kittens with maternally derived antibodies to FIV. Some shelters that strive to save all healthy and treatable cats have expanded adoption programs to include cats with FeLV and/or FIV infection. Specific marketing and education programs can ensure these cats do not linger too long in the shelter and are adopted into homes where they can receive care. Under some circumstances, FIV-infected cats may be able to live with uninfected cats with minimal risk of disease transmission.11 However, FeLV is more readily transmitted than FIV, suggesting that FeLV-infected cats should be adopted into homes with other FeLV-infected cats or as the only cat in a home. In one study where 801 shelter cats suspected to be infected with FeLV were referred to an FeLV-specific adoption program, 79% were adopted into new homes.12 Interestingly, 19% of the cats were eventually determined to be uninfected, a reminder of the risk of basing the disposition of a cat on a single test result. Point-of-care heartworm tests for cats are widely available but interpreting results can be problematic. In relation to population health, testing is of little value because infected cats pose no risk to other animals. Nonetheless, a clinician may elect to include heartworm testing as part of an initial database for certain cats, especially if they will be used in a breeding program. Since point-of-care tests that combine heartworm, FeLV, and FIV have become available, shelters have been faced with determining whether to perform routine heartworm screening of cats. To answer this question, it is helpful to consider the following: In consideration of these facts, the author does not recommend routine screening of shelter cats for heartworm disease. However, monthly chemoprophylaxis is a safe and effective option for cats sheltered in areas where heartworm infection is endemic. Dermatophytosis (ringworm), the most common skin infection of cats, is a known zoonosis. It is caused by infection of the skin, hair, and nails with microscopic fungal organisms that cause varying degrees of hair loss and dermatitis. Microsporum canis is responsible for most feline cases. If left untreated, most infections will spontaneously resolve within 12 to 14 weeks. However, during this time, the cat will infect the surrounding environment and other animals or people in the area. Not all cats with dermatophytosis develop lesions, and some may become chronic carriers. Control of dermatophytosis is difficult, because the spores formed by M. canis can survive in the environment for 18 months or longer and are extremely resistant to disinfectants and detergents. In addition, the presence of asymptomatic carriers makes it difficult to readily recognize all infected cats. For this reason, consideration should be given to testing all cats prior to entry to a closed colony. In particular, Persian cats may be predisposed to dermatophyte infection and can be particularly difficult to clear once infected. In closed colony settings, dermatophyte testing is highly recommended unless the source of the cat excludes the possibility of infection (e.g., specific pathogen-free [SPF] cats, purpose-bred laboratory cats). Hair samples for testing should be collected using the McKenzie toothbrush method, where a new toothbrush is used to brush the cat’s entire body, giving special attention to the face, ears, and limbs. In addition, if skin lesions are present, hair should be collected around these areas. Although culture remains the gold standard for dermatophyte diagnosis, newly developed dermatophyte tests utilizing other techniques such as PCR can also be useful and carry the distinct advantage of providing more rapid results than culture.14,15 For more information on dermatophytosis, see Chapter 25: Dermatology. Giardia, coccidia, Tritrichomonas, and other gastrointestinal parasites and pathogens are common in some breeding cattery situations and can be very difficult to eliminate once they are introduced. In fact, in some cases, these pathogens become endemic and nearly impossible to eliminate. Although clinical signs (e.g., diarrhea) may be associated with infection, some infected cats remain asymptomatic. These pathogens have the potential for high morbidity in a population (especially in young kittens), and some have zoonotic potential. Therefore, routine fecal examinations, other types of fecal diagnostic testing, and/or empiric treatments should be strongly considered prior to the introduction of new cats, especially in the context of a closed population. Treatment of coccidia in shelter kittens with ponazuril is described in Box 49.4. It is well-recognized that vaccination plays a vital role in the prevention and control of infectious diseases. Protocols should be established in the context of the population’s exposure risk, which will vary depending upon the setting. In the context of population medicine, vaccination protocols are typically applied uniformly to all individuals in the population. This approach is simple and helps provide the best possible protection for the group. Detailed vaccination records should be maintained for each cat, including vaccine name, manufacturer, serial number, date of administration, the initials of the person who administered it, and any adverse reactions. Proper vaccination can substantially reduce disease in cat populations, and serious adverse reactions are relatively rare. For this reason, vaccination against certain core diseases is recommended in all population settings. Although exclusion of infectious disease is always a goal of health management, certain pathogens are so widespread that even with careful biosecurity in a closed population, a pathogen may be introduced to susceptible cats. Only in the case of SPF colonies, where there may be a compelling reason not to vaccinate, should vaccination be foregone. Guidelines for vaccination of cats in a variety of settings, including detailed recommendations for cats in animal shelters, have been published ( Although many vaccines are commercially available for cats, only a few are recommended for routine use in populations. Unnecessary use of vaccines should be avoided to minimize the incidence of adverse reactions and reduce cost. Core vaccines involve diseases that represent significant morbidity and mortality and for which vaccination has been demonstrated to provide relatively good protection. Core vaccines for cats in a population setting include feline parvovirus (FPV, or panleukopenia), FHV-1 (feline rhinotracheitis), and FCV. These vaccines are usually given in a combination product commonly referred to as an FVRCP vaccine (feline viral rhinotracheitis, calicivirus, panleukopenia). In most cases, timely vaccination against FPV will prevent the development of clinical disease. In contrast, vaccination against the viruses that cause URTD (FHV-1 and FCV) does not always prevent disease. Vaccination may afford only partial protection, lessening the severity of clinical signs but not preventing infection. To optimize response, modified live vaccines (MLV) should be used in most populations, because they evoke a more rapid and robust immune response and are better at overcoming maternal antibody interference than killed virus products. This is especially important in multicat environments where the risk of infection is high, such as animal shelters, foster homes, and any population setting where URTD is endemic. A single, modified live FVRCP vaccine will usually provide adequate protection in cats that are at least 4 to 5 months of age. If neither maternal antibodies nor another cause of vaccine failure interferes, parenteral MLV against FPV will confer rapid protection against disease. In contrast, killed virus products require a booster in 2 to 3 weeks to confer immunity, making their use largely ineffective in such environments. To ensure rapid protection against FPV, injectable vaccines are preferred, but intranasal (IN) vaccines may offer advantages for URTD pathogens because they can rapidly induce local immunity, typically providing partial protection within 2 to 6 days.16 Furthermore, IN vaccines may be better at overriding maternal antibodies in young kittens. For this reason, they are often used to reduce the morbidity and severity of URTD in preweaning-age kittens. Although there are many theoretical benefits to the use of IN vaccinations, field studies in shelter populations have yielded mixed results. Furthermore, IN vaccines produce transient clinical signs of disease in some patients. If IN vaccines are added to a population vaccination protocol, the baseline rate of URTD should be established beforehand so that trends can be monitored to assess the effectiveness of the protocol change. When IN vaccines are used in animal shelters or other high-risk environments, they should be used in combination with injectable FVRCP vaccines to ensure and optimize response against FPV as well as the URTD pathogens.17 Ideally, all cats should receive an MLV FVRCP vaccine at least 1 week prior to entering a population. In the context of an animal shelter setting, this is seldom feasible. Vaccination immediately upon entry is the next best practice and can provide clinically significant protection for most cats. Thus, in animal shelters all incoming cats and kittens 4 weeks of age and older that can be safely handled should receive an injectable MLV FVRCP vaccine as soon as possible. A delay of even a day or two significantly compromises the vaccine’s ability to provide timely protection. Even injured cats, those with medical conditions, and those that are pregnant or lactating should be vaccinated on entry because vaccination will likely be effective, and the small risk of adverse effects is outweighed by the high risk of disease exposure in the shelter. When vaccination of all cats on entry is not financially feasible, the next best practice is to vaccinate all those that are deemed adoptable at the time of entry or that are likely to be in the shelter long term. Whenever possible, vaccinated cats should be separated from those that will remain unvaccinated (e.g., those that will be euthanized following a brief holding period) as soon as that determination can be made. In contrast, in lower-risk settings, ensuring that cats are in good health prior to vaccination should be a priority. Vaccination of kittens with injectable FVRCP vaccinations may be delayed until 6 to 8 weeks of age. However, when URTD is endemic, administration of IN vaccines beginning at 4 weeks of age may be beneficial. In breeding catteries, queens (especially those with a history of URTD) may benefit from vaccination prior to breeding to maximize transfer of maternal antibodies to kittens. For pregnant cats in such environments, administration of MLV should be avoided, because the potential risk of injury to the developing fetuses may outweigh the risk of infection in this case. Vaccination of lactating queens should also be avoided in a low-risk environment. A series of vaccinations should be administered to kittens less than 4 to 5 months of age to minimize the window of susceptibility to infection and ensure that a vaccine is received as soon as possible after maternal antibodies have decreased sufficiently to allow response to vaccination. For kittens, vaccines should be administered every 2 to 4 weeks until they are 16 to 20 weeks of age, or their permanent incisors have erupted. By 5 months, eruption of all incisors should be complete. The minimum interval of 2 weeks between administration of vaccines is recommended in high-risk settings to narrow the window of susceptibility as maternal antibody wanes. A vaccination interval of less than 2 weeks is not recommended, because it may blunt the immune response from the previous vaccination. In the case of an FPV outbreak, extending vaccination to 5 months of age may be warranted to ensure than no animal remains susceptible. Although most cats will respond to vaccination by 4 months of age, a few may fail to respond until older. Just as in owned pets, after the initial vaccinations, boosters are generally not required until 1 year later. Cats that were vaccinated once at 4 to 5 months of age should ideally receive a booster in 2 to 4 weeks whenever resources permit. This may be especially important for cats that were ill at the time of initial vaccination, as may be the case in an animal shelter. Revaccination in long-term shelter facilities should follow published guidelines. Finally, certain populations may experience a high prevalence of clinical disease associated with FCV infection, such as shelters with long-term group housing. Commercially available inactivated multivalent FCV vaccines are available in some countries and may be of benefit in such situations. This is because they may provide broader cross-protection than single strain vaccines, although it will take considerably longer to confer immunity than with a MLV vaccine.18 Vaccination against rabies virus is regarded as a core requirement in endemic areas and is required by law in some jurisdictions.17 Thus, vaccination against rabies is recommended in private catteries in endemic areas. In contrast, rabies vaccination may be considered optional in most closed laboratory settings, because the risk of exposure should be absent and legal requirements may not apply. In animal shelters, vaccination against rabies is recommended prior to adoption in endemic areas, but the timing of vaccination (e.g., near the time of admission versus the time of adoption) will vary depending on the population. In contrast to vaccination against other core diseases, vaccination against rabies at the time of admission is not crucial in terms of disease prevention, nor does it impact public health. This is because vaccination on admission will not provide protection against an infection acquired prior to entry, nor will it limit concern if a cat with unknown history bites someone soon after admission. Many shelters experience high intake rates that exceed opportunities for adoption or other types of live release, ultimately resulting in euthanasia of cats following short-term holding. In this situation, vaccination of cats prior to adoption would be the recommended timing. In contrast, in shelters where the majority of admitted cats will be adopted, vaccination as soon as possible after admission is desirable. Therefore, in endemic areas, rabies vaccination is recommended for cats prior to adoption when a veterinarian is available to administer it (or as required by local laws). Alternatively, rabies vaccination may be administered as soon as possible following adoption. The latter approach may encourage new owners to establish a relationship with a veterinary hospital. In addition, rabies vaccination is warranted when cats are housed long term in shelter facilities in endemic areas. If individual cats must be quarantined because of biting a person, they should be vaccinated against rabies if in accordance with local laws. In the United States, the most recent Compendium of Animal Rabies Prevention and Control should be consulted ( Non-core vaccines include those that may offer protection against disease, but because the disease in question is not widespread or only poses a risk of exposure in certain circumstances, vaccination is recommended based on risk assessment. Noncore vaccines include those for FeLV, FIV, Chlamydia, and Bordetella.17 Vaccination against FeLV or FIV is not warranted in a closed population of cats where there is no risk of exposure (e.g., most laboratory animal settings). In breeding catteries, a risk assessment should be done to determine if vaccination is warranted (e.g., cats permitted in outdoor enclosures, frequent introduction of cats from external sources, other opportunities for exposure). Special consideration should be given to vaccinating kittens against FeLV because of their high susceptibility to infection and the likelihood they will become persistently infected if exposed. The 2020 AAFP Retrovirus Testing and Management Guidelines established specific vaccination recommendations for shelter cats (Table 48.2).10 FeLV and FIV infection differ from other infectious diseases of importance in shelters because they are easily inactivated with routine disinfection and are not spread by aerosol or indirect contact. Because of the low risk of transmission if cats are housed separately, vaccination against FeLV or FIV is not recommended. When cats are group-housed for extended periods or when they live in sanctuaries, FeLV vaccination is recommended. Long-term group housing increases the odds of exposure to infected cats inadvertently admitted with negative intake screening tests due to recent infection or regressive infection. Vaccination against FIV is not recommended in shelters because transmission of FIV among co-housed cats that do not fight appears to be uncommon,11 the level of vaccine-induced immunity is variable,19 and vaccine-induced positive antibody test results can complicate future determination of the cat’s true FIV infection status. Chlamydia felis and Bordetella bronchiseptica vaccines may be of benefit when clinical signs of these diseases are present in the population and diagnosis is confirmed by laboratory evaluation. The efficacy of these vaccines is moderate, and reactions are more common than with most other feline vaccines; therefore, ongoing use should be periodically reassessed.17 Some vaccines are not generally recommended for use because of undemonstrated efficacy, such as the FIP and dermatophytosis vaccines.17 Control and prevention of endo- and ectoparasites represent another important component of a population wellness program. Commonly used products are described in Chapter 25: Dermatology; Chapter 26: Digestive System, Liver, and Abdominal Cavity; and Chapter 42: Feline Zoonotic Diseases and Prevention of Transmission. Of particular importance are roundworms and hookworms, common intestinal parasites with zoonotic potential. Although uncommon, the risk of human infection from contaminated environments is real and can result in organ damage, blindness, and skin infections. For this reason, veterinary and public health organizations strongly advise routine administration of broad-spectrum anthelminthics for control. Pyrantel pamoate is one of the most cost-effective and efficacious drugs for treatment and control of roundworms and hookworms. In shelter and breeding cattery settings, the author recommends administration of pyrantel pamoate at an oral dosage of 10 mg/kg to all cats, with retreatment in 2 weeks, and then at monthly intervals. In shelters, if it is not possible to treat all cats at the time of admission, at a minimum, all cats that are deemed adoptable should be treated as soon as possible. In addition, kittens should be treated at 2-week intervals until 4 months of age. For cats with diarrhea, fecal examination (e.g., centrifugation, direct fecal smear) should be performed with treatment according to results. Even if results are negative, the administration of broad-spectrum anthelminthics should be strongly considered. In animal shelters, ectoparasites, particularly ear mites and fleas, are very common in cats and kittens. Shelter staff should be trained to recognize infestations and protocols should be established for treatment. For practical and cost-effective shelter treatment protocols, the author recommends treating ear mites with ivermectin because it is highly efficacious and is inexpensive. The recommended dosage is 0.3 mg/kg subcutaneously; treatment may be repeated in 2 weeks if needed. For fleas, the author recommends topical treatment with fipronil as a spray or spot-on formulation in countries where it is available. In particular, the spray is very cost effective. It is safe for use in cats of all ages, including pregnant and nursing queens and young kittens. In addition, fipronil also has activity against ear mites, Cheyletiella, and chewing lice.20–22 Surgical sterilization (ovariohysterectomy or ovariectomy, castration) is another important consideration in the context of population wellness. Reproductive stress from estrous in queens and the urge to mate in tomcats can decrease appetite, increase urine marking, increase intermale fighting, and profoundly increase social and emotional stress in a group. For these reasons, surgical sterilization of cats that will not be used for breeding is recommended. In animal shelters, sterilization of cats prior to adoption will ensure they do not reproduce and contribute to the surplus of homeless cats. This will also serve to enhance husbandry, because the surgeries rapidly decrease urine marking and fighting, eliminate estrous behavior and pregnancy, and mitigate stress. In addition to reducing stress and odor, sterilization of sexually mature cats will facilitate group housing, which is often beneficial, especially when cats are housed long-term. The medical benefits of surgical sterilization have been well-described and include a dramatic reduction in the risk of mammary carcinoma, elimination of the risk of cystic endometrial hyperplasia, pyometra, and ovarian cancer in queens, and decreased risk of prostate disease in toms. Thus, surgical sterilization favors individual as well as population health. Proper nutrition has a profound impact on wellness in all animals. Not only is it essential for management of a healthy body weight and condition, but good nutrition is also known to support immune function. A regular diet of palatable commercial food consistent with a cat’s life stage should be offered, and fresh water must always be available. Although some cats tolerate changes in food without apparent problems, it is important to recognize that for others, changing from one diet to another can cause stress, loss of appetite, and gastrointestinal upset. For this reason, it is best to provide the most consistent diet possible. Whereas this may be relatively easy to do in a laboratory or breeding cattery setting, it can be more challenging in a shelter environment. Some pet food companies offer feeding programs for animal shelters, providing a consistent food for purchase at a special rate. However, some shelters rely heavily on donations of food. In this case, by requesting donation of certain brands of food, shelters can provide a consistent diet whenever possible. It is also feasible to mix donated foods with the shelter’s usual diet to minimize problems caused by abrupt diet changes while taking advantage of donated products. The wild ancestors of domestic cats hunted to eat, feeding up to 30 times in a 24-hour period. This style of feeding behavior is preferred by many domestic cats that will nibble throughout the day and night, consuming many small meals if left to their own devices. Although this is true, most cats can adapt to either free choice or meal feeding as a daily feeding pattern. There are advantages and disadvantages to each in a population setting. With free choice or ad libitum feeding, food is always available, and a cat can eat as much as desired and when desired. Dry food is used for this method of feeding because canned products left at room temperature are prone to spoiling. The major advantage of free choice feeding is that it is quick and easy; caregivers simply need to ensure that fresh dry food is always available. Major disadvantages include the fact that cats that are not eating may go unrecognized for several days, especially when cats are fed together, and some cats may overeat and become obese. Free choice feeding is an excellent method for cats that require frequent food consumption. This includes kittens up to 5 or 6 months of age, queens in late gestation, and queens that are nursing. Unlike dogs, which are competitive eaters by nature, free choice feeding may benefit cats that are group housed because it ensures there will be ample time for all members to eat, provided dominant members of the group do not block access to food for subordinate cats. Meal feeding using controlled portions of dry and/or canned food may be an alternative to or used in conjunction with free choice feeding. When meal feeding alone is used, a minimum of two meals should be fed per day. Meal feeding is ideal for any cat that requires controlled food intake and facilitates monitoring of appetite. Meal feeding also has the benefit of enhancing caregiver–cat bonding and provides a pleasant and predictable experience for cats when done on a regular daily schedule. Using a combination of free choice plus once daily meal feeding takes advantage of the positive aspects of both methods and works well for most cats in a population setting. Typically, dry food is available free choice, and a small meal of canned food is offered once daily. This approach accommodates the normal feeding behavior of cats by allowing them to eat several smaller meals throughout the day while allowing caregivers to monitor the cat’s appetite at least for the canned food meal. As necessary for the individual cat, some may be fed additional meals of canned food to ensure adequate nutritional support. Good body weight and condition and a healthy hair coat are evidence of an adequate plane of nutrition and proper nutritional management. Appetite and stool quality should be monitored daily. Normal stools should be well-formed and medium to dark brown. Adult cats typically defecate once daily, although healthy adults may defecate from twice daily to twice weekly. Kittens tend to produce a larger volume of stool more frequently, and feces are often lighter in color and softer in form than that of adults. Simple scales can be used for monitoring appetite (e.g., good, some, none). In addition, food should be weighed to determine intake and fecal scoring charts should be used. The author recommends the Purina Fecal Scoring System chart (Fig. 49.4).
Population Wellness: Keeping Cats Physically and Behaviorally Healthy
Abstract
Keywords
INTRODUCTION
e-Box 49.1.
THE COMPONENTS OF WELLNESS
POPULATION WELLNESS PROGRAMS
Goals of a Population Wellness Program
Health Surveillance
Policy and Protocol Development
e-Box 49.2). In addition to establishing policies and protocols for commonly encountered diseases and problem behaviors, protocols should also be developed to ensure prompt recognition and treatment of pain and emotional distress in cats, including provisions for acute and chronic pain and/or distress. Additional protocols will be necessary to ensure consistent high-quality animal care. For example, protocols for regular enrichment are necessary in all population settings, protocols for socialization of young kittens are required in settings where they are housed, and protocols for breeding and queening are essential in breeding colonies, including both laboratory and private settings.
Quality of Life and the Five Freedoms
Medical Decision Making and Euthanasia
POPULATION MANAGEMENT IN ANIMAL SHELTERS AND CAPACITY FOR CARE
e-Box 49.1.
Problem Prevention
The Role of Stress
CONSIDERATIONS REGARDING INFECTIOUS DISEASE TRANSMISSION
General Principles of Infectious Disease Control
ESSENTIAL ELEMENTS OF A POPULATION WELLNESS PROGRAM
Record Keeping and Cat Identification
Methods of Identification
e-Fig. 49.1). They can be placed without the need for anesthesia or sedation when kittens are less than 10 to 14 days old. Placing ear tags requires skill and experience. They must be positioned to provide adequate space for growth of the ear, while being seating deeply enough in the ear margin to ensure a secure piercing. If placed too close to the ear margin, the ear may tear, resulting in loss of the band. Other complications include local inflammation or infection at the site of the piercing. Ear tags are a practical method for identifying individual kittens in institutional or commercial breeding colonies, because when applied skillfully, they are seldom lost and provide reliable, long-lasting visual identification.
Management Oversight
DEVELOPING A POPULATION WELLNESS PROGRAM
Considerations for Physical Health
Medical History
Physical Examination
Disease Testing
Feline Leukemia Virus and Feline Immunodeficiency Virus
HEARTWORM DISEASE
DERMATOPHYTOSIS
ENTERIC PATHOGENS
Vaccination
e-Box 49.1).
CORE VACCINES FOR POPULATIONS
e-Box 49.1).
NONCORE AND NOT RECOMMENDED VACCINES FOR POPULATIONS
Parasite Control and Prevention
Surgical Sterilization
Nutrition
Monitoring
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