December 2021 Report

Updates from the Washington State Veterinarian’s Office

Below is a roundup of updates from the Washington State Veterinarian’s Office.

WSDA authorizes new RHDV2 Vaccine for Rabbits

The Washington State Veterinarian’s Office has authorized the use of a new, domestically produced vaccine for Rabbit Hemorrhagic Disease Virus Type 2 (RHDV2), a highly contagious, fatal disease of rabbits.

In 2019, the virus killed hundreds of feral domestic and domestic rabbits in Island and Clallam counties. Since April 2020, a phylogenetically distinct RHDV2 virus has spread across 15 states in the U.S. that is also deadly to wild rabbits.

The vaccination was developed by Medgene Labs of South Dakota. Their product is an inactivated (killed) recombinant subunit vaccine that builds immunity to RHDV2 specific antigenic proteins in the rabbit. Unlike the Eravac and Filavac vaccines imported from Europe, the Medgene product does not depend on live rabbits for its production and Medgene vaccinated rabbits can be differentiated from infected rabbits on a laboratory PCR test.

While the vaccine is under emergency and conditional approval with the U.S. Department of Agriculture, Center of Veterinary Biologics, it must be administered by a Washington-licensed veterinarian. The vaccine is administered as a subcutaneous injection and is a 2-dose regimen, with the booster dose being delivered 21 days following. Established vaccine withdrawal periods (21 days) must be followed for meat-type rabbits used for human or animal consumption.

Veterinarians who would like to order the vaccine should contact Medgene labs directly at medgenelabs.com or 605-697-2600. Veterinarians should maintain vaccination records for any routine vaccination and conform to state licensure expectations. Meat-type rabbits vaccination records may be kept at the herd level, similar to other livestock, rather than at the individual animal level.

Once the RHDV2 vaccine gains full licensure, as early as this spring, the vaccine will likely become more accessible. Due to the contagious and extremely virulent nature of this virus, vaccination is critical for disease control to protect our domestic and wild rabbit populations alike.

For more information on RHDV2, biosecurity, and prevention, please visit agr.wa.gov and search for the Rabbit Hemorrhagic Disease webpage.

African Swine Fever (ASF): This animal disease continues to pose an ongoing threat. The Dominican Republic has slaughtered tens of thousands of pigs after detecting outbreaks of ASF in 14 of the country’s 32 provinces in early August with estimated economic losses of around $180 million.

On September 20, the U.S. Department of Agriculture (USDA) reported a positive case of ASF in Haiti. USDA continues to assist with surveillance, control, and eradication efforts in both domestic and feral swine. In addition, USDA issued a Federal Order to establish additional requirements for dogs imported into the United States for resale from countries where ASF exists because ASF can be transmitted via dogs’ fur and bedding, representing a possible pathway for the introduction of disease.

Epizootic Hemorrhagic Disease Virus (EHDV) and Bluetongue virus (BTV): The Washington State Department of Fish and Wildlife is mapping positive cases of EHDV and BTV throughout the state (Hemorrhagic Surveillance 2021 – Google My Maps). White-tailed, mule deer, and bighorn sheep continue to die of the disease. WSDA has had several reports of EHDV and BTV in domestic sheep, cows, yaks, and an alpaca since July.

Animal Disease Traceability Program: In the last few years, WSDA has worked hard to build infrastructure and promote Animal Disease Traceability and support private veterinarians by providing free RFID tags, handheld readers, and access to free animal health records in the field and at public livestock markets. Here are some facts to show our progress in the last year:

• 59,690 (75 percent) of all tags distributed to 62 veterinarians were official 840 RFID. Only 20 veterinarians are still requesting metal tags.
• 5,031 (80.3 percent) of CVIs received from 803 accredited vets in 45 states were eCVIs and only 1,232 (19.7 percent) were paper.
• 500+ Washington veterinarians and 74 authorized users (technicians) have accounts in the Oregon Department of Agriculture, Oregon Veterinary Information System.
• 89 RFID Stick Readers have been distributed to Washington veterinarians.
• 5 RFID readers have been distributed to support fairs.
• 6 public livestock markets in the state have the Saletime system vet module and receive free RFID tags and readers.
• 6 slaughter facilities in the state have the capability to retire all RFID tags information electronically when animals are harvested. WSDA captures 99 percent of animals harvested in the state.
• • Approximately 30,000 dairy bull calves that move interstate annually have RFID tags placed prior to movement.

  Extended Equine Certificate of Veterinary Inspection
  
  Some of you may remember a few years ago when horse owners had an “equine passport” health certificate available to them that allowed movement for one animal for six months. Most of these were done for rodeo or show animals that moved many times in the season. At the end of the season, the owner was required to send an itinerary of their movements during those six months.

  These were problematic in that the itinerary was after the fact and most were never sent back to the state offices. If those animals were exposed to a disease, it was difficult or impossible to know where they had been transported to. Eventually, the states that were using this paper-based format quit accepting them and went back to the 30-day certificate of veterinary inspections (CVI). These could get quite expensive for the owner as the animal moved many times in one month to different shows, rodeos, events.

  A team of veterinarians started working on the development of a replacement that addressed the shortcomings of the old passports. After bringing proposals forward and getting input from state veterinarian offices across the country, Global Vet Link (GVL) launched an online extended equine certificate of veterinary inspection (EECVI).

  To get an EECVI, private veterinarians must have an account with GVL. The veterinarian enters current Equine Infectious Anemia (EIA) testing information and completes some basic data. The veterinarian must do some client education so when the movement occurs, the owner logs on to their own portal and attests that the animal is healthy. They then provide the itinerary and receive a permit for that specific movement.

  GVL has made it easy with help center online tutorials or live training sessions with technicians.  Recently a few upgrades have been made to improve a few areas of compliance. In all, at this time, 30 states are participating and those are on the GVL website.

  State animal health officials can access the data on horses permitted to enter, and in the case of a disease outbreak, notify the owners. The link for more information is https://www.globalvetlink.com/eecvi/

  There are some other companies with plans to release something similar, but as of this writing, GVL is the only company that offers the EECVI.

  The extended equine health certificate is a nice tool to offer clients or to ask your private veterinarian about if you travel frequently to rodeos or shows in the summer.

  By Dr. Amber Itle, Interim Washington State Veterinarian, and Dr. Ben Smith, Field Veterinarian Supervisor

  President’s Message – Defining the VCPR in a Telehealth Post-Pandemic World

  Can it be that 2021 is already closing in on the holidays and almost two years since the first COVID-19 case made national news from here in Washington state? The Pandemic has simultaneously become something we are weary of hearing about from a variety of daily news media outlets and something we cannot ignore as we brace ourselves to adapt and respond to the impacts it has had on every aspect of our lives. The veterinary profession has seen rapid paradigm shifts because of the Pandemic including the embracement of telehealth technology, enhanced safety measures with curbside check-in and video chat exams, and the loosening of

  state continuing education and licensing requirements. While these changes were initially implemented as a rapid means to enhance staff and client safety, we’ve now had enough time with these new normals to determine what will be incorporated long-term into how we practice.

  In my own practice environment at a municipal animal shelter, we added artificial intelligence-based telehealth triaging program to assist us with caring for animals in our foster care program, whom we manage as an extension of the shelter medicine service. Telehealth has allowed us to provide a 24-hour based response to foster parents with new medical and behavioral concerns and gives them initial information about the signs they are observing. Based on the information entered, the system then uses an AI algorithm to determine the urgency level and sends an immediate notification to the veterinary staff on call. We also use this program to provide post-operative care to clients of our public spay/neuter clinic, many of whom do not have a regular veterinarian and who have transportation challenges. The integration of telehealth services into our practice has elevated the level of care we can provide and makes documentation and communication rapid, simple, and versatile. Pandemic or not, telehealth is here to stay now that we have come to rely on this technology for the daily delivery of care.

  Telehealth ventures have enjoyed a wave of temporary modifications to the Valid Client Patient Relationship (VCPR) over the past 18 months which have allowed veterinarians to deliver services such as medication refills when access to care was often limited. Many state Veterinary Boards of Governors, including Washington’s own, put forth statements that the standard VCPR requirements would either be relaxed or not enforced for a specified period of time due to the Pandemic. The federal VCPR, which requires a physical exam in order to prescribe many drugs for animal patients, also temporarily relaxed the requirement. The AVMA states in Section III of the AVMA’s Principles of Veterinary Medical Ethics that in order to establish a VCPR:

  (1) the veterinarian has assumed the responsibility for making clinical judgments regarding the health of the patient and the client has agreed to follow the veterinarians’ instructions; 

  (2) the veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. This means that the veterinarian is personally acquainted with the keeping and care of the patient by virtue of a timely examination of the patient by the veterinarian, or medically appropriate and timely visits by the veterinarian to the operation where the patient is managed; 

  (3) the veterinarian is readily available for follow-up evaluation or has arranged for veterinary emergency coverage, and continuing care and treatment; 

  (4) the veterinarian provides oversight of treatment, compliance, and outcome; and 

  (5) patient records are maintained. 

  Many state practice acts have adopted this seminal definition and require a physical exam to establish the VCPRalong with timely visits.

  It is this in-person requirement that is now coming under fire across multiple states, with a variety of private entrepreneurs and corporate veterinary medicine companies bringing requests to open state veterinary practice acts in an effort to modify the VCPR definition. There are obvious advantages to this proposal, including those that benefit us as practitioners such as expanded accessibility for clients, ability to dispense medications when appointment slots are not available, increasing clientele regardless of their physical location. But there are great concerns as well. Our patients cannot talk to us and tell us what they are feeling and

  thinking. We are severely limited without a hands-on review of their condition as there is simply no substitute for what we can learn from all our senses: what we see – yes – but also what we smell, feel, hear (hopefully not taste!) all inform our differentials and diagnoses and may not be noticed or reported by owners. Corporate practices are seeing and seizing the opportunity to expand business across state lines and beyond the exam room through the relaxation of the physical exam requirement, and there are already companies cropping up that are filling this telehealth space by employing veterinarians to answer questions and give advice online. Currently, companies are largely limited to just that – advice – but with legislative or regulatory changes, they could begin to diagnose, treat, and dispense medications as is now the norm in human medicine. Since 2016, nearly 100% of states have modified their human medical practice acts to allow telehealth for physicians including the establishment of a VCPR solely by virtual means and in some cases, across state lines.

  Because of recent attempts to relax the VCPR in other states by telemedicine corporations and advocacy groups, the WSVMA Board of Directors took action and voted at their October 19, 2021 meeting to oppose efforts to eliminate the physical exam as a condition of establishing the VCPR.

  The WSVMA works diligently to keep abreast of upcoming legal proceedings that may affect you as veterinary professionals and as business owners through its legislative advocacy program. As your WSVMA Board President, I want to hear from you about this topic and the benefits you see or the concerns you have around the opening of the Washington Veterinary Practice Act which would allow for changes in the definition of the VCPR. Does the possibility of no physical exam requirement change how you would practice medicine? Even those of us in non-private practice arenas can feel the ripple effects as these changes will broadly impact our profession.

  By Dr. Jennifer Bennett, WSVMA President.