DISEASE INFORMATION FACT SHEET Feline Infectious Peritonitis

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Journal of Feline Medicine and Surgery (2013) 15 , Supplementary File FACT SHEET

DISEASE INFORMATION FACT SHEET Feline infectious peritonitis

This Disease Information Fact Sheet accompanies the 2013 AAFP Feline Vaccination Advisory Panel Report published in the Journal of Feline Medicine and Surgery (2013), Volume 15, pp 785 –808.

AAFP FELINE VACCINATION ADVISORY PANEL Margie A Scherk Disease facts DVM Dip ABVP The 2013 Report of the Feline Vaccination (Feline Practice) Advisory Panel of the American Association of Advisory Panel Chair* Feline infectious peritonitis (FIP) is an Feline Practitioners (AAFP) provides practical Richard B Ford recommendations to help clinicians select DVM MS Dip ACVIM immune-mediated disease triggered by infec - DACVPM (Hon) tion with a feline coronavirus (FCoV). FCoV is appropriate vaccination schedules for their found very commonly in cats; it is transmitted feline patients based on risk assessment. Rosalind M Gaskell BVSc PhD MRCVS via the oral –fecal route between felids, but The recommendations rely on published data is not infectious to other species (including as much as possible, as well as consensus of a Katrin Hartmann multidisciplinary panel of experts in immunology, Dr Med Vet Dr Med Vet Habil humans). Coronavirus-specific antibodies are Dip ECVIM-CA present in up to 90% of cats in catteries and in infectious disease, internal medicine and clinical practice. The Report is endorsed by the Kate F Hurley up to 50% of cats in single-cat households, DVM MPVM yet only about 5% of FCoV-infected cats will International Society of Feline Medicine (ISFM). 1 develop FIP in multiple-cat households. Michael R Lappin DVM PhD Dip ACVIM Initially it was hypothesized that FCoV Julie K Levy strains causing FIP were different from aviru - DVM PhD Dip ACVIM lent enteric FCoV strains. FCoV strains were Susan E Little subdivided into two distinct ‘biotypes’, feline ual’s immune response determine whether 7–9 DVM Dip ABVP (Feline Practice) enteric coronavirus (FECV) and feline infec - FIP will develop. Taking viral genetics and Shila K Nordone tious peritonitis virus (FIPV). However, it is host immunity into account, it is likely that MS PhD 3 now accepted that all FCoV types may induce both theories play a role. In both hypotheses, Andrew H Sparkes systemic infection and that those ‘biotypes’ the key pathogenic event in the development BVetMed PhD DipECVIM are not two different virus species, but rather of FIP is replication of FCoV in macrophages. MRCVS represent virulence variants of the same Affected cats develop a spectrum of clinical *Corresponding author: 2 virus. The precise process by which FIP signs caused by 1) granulomatous lesions in Email: [email protected] develops is unclear, but there are two main target organs, including central nervous sys - 3 hypotheses. The most widely accepted tem, eyes and parenchymatous organs or hypothesis, the internal mutation theory, 2) vasculitis leading to fluid redistribution assumes that a mutation is necessary to enable into second spaces, accumulating in body cav - 4–6 the virus to replicate in macrophages. Cats ities causing effusions (eg, abdominal 3,10 are initially infected with the primarily aviru - [ascites], thoracic, pericardial, scrotal). In lent FCoV, which replicates in enterocytes. In addition to these well known clinical presen - some instances a mutation occurs in the FCoV tations, some unusual pictures have been genome, resulting in a new phenotype with described, including the development of a the ability to replicate within macrophages. focal granulomatous mass causing intestinal 11 12 13 No consistent mutation has been identified. obstruction, priapism, skin fragility, and The second hypothesis is that any FCoV can other skin lesions (eg, nodular or papular 14,15 cause FIP but that viral load and the individ - lesions, pododermatitis).

Vaccine types Other vaccine considerations

A vaccine for FIP is commercially available in Most kittens born and reared in environments the USA, Canada and Europe, and contains a in which FCoV infection is endemic are infect - temperature-sensitive modified-live mutant ed prior to 16 weeks of age. This may be one strain of coronavirus for intranasal adminis - reason for the lack of vaccine efficacy in the 24,25 tration. The vaccine is not licensed for kittens field. younger than 16 weeks of age because protec - If vaccination is considered, FCoV antibody tion from disease has not been demonstrated testing should be performed before vaccinat - in these young animals. This vaccine was ing as the vaccine is ineffective once cats have developed specifically to avoid induction of been exposed to the virus. However, many high serum antibody levels as these may factors, both intrinsic to the cat as well as asso - promote antibody-dependent enhancement ciated with testing methodology, make inter - (ADE) of infectivity (see vaccine safety). pretation of titers challenging. Onset and duration of immunity Antibody titers develop subsequent to vac - cination, making the establishment and moni - toring of an FCoV-free household difficult. Controversy exists concerning the ability of this vaccine to protect from FCoV infection or Advisory Panel Recommendations to prevent development of disease; little is known about onset and duration of immunity. At this time, there is insufficient evidence that the vaccine induces clinically The vaccine is licensed for annual revaccina - relevant protection, and use of the vaccine is not recommended. tion but the maximum duration of immunity has not been determined. Some studies demonstrate protection from 16,17 References disease, while others show little or no 18,19 benefit from vaccination. Discrepancies between study results are likely attributable to 1 Addie DD, Toth S, Murray GD and Jarrett O. differences in the experimental setting of the Risk of feline infectious peritonitis in cats nat - challenge trials (eg, strain and dose of chal - urally infected with feline coronavirus. Am J lenge virus, genetic predisposition of test ani - Vet Res 1995; 56: 429 –434. mals). In a field study of 138 cats belonging to 2 Herrewegh AA, Vennema H, Horzinek MC, 15 cat breeders, in which virtually all of the Rottier PJ and de Groot RJ. The molecular cats had antibodies, no difference was found genetics of feline coronaviruses: comparative in the development of FIP between the vacci - sequence analysis of the ORF7a/7b transcrip - 20 nated group and the placebo group. Thus, tion unit of different biotypes. Virology 1995; vaccination in households with known cases 212: 622 –631. of FIP or in an FCoV-endemic (and thus high- 3 Addie D, Belak S, Boucraut-Baralon C, Egberink risk) environment is not effective. In one H, Frymus T, Gruffydd-Jones T, et al. Feline placebo-controlled double-blind trial in a infectious peritonitis. ABCD guidelines on group of cats lacking FCoV antibodies before prevention and management. J Feline Med Surg vaccination, a small but statistically signifi - 2009; 11: 594 –604. cant reduction in the number of cats that sub - 4 Vennema H, Poland A, Foley J and Pedersen NC. 21 sequently developed FIP was noted. There Feline infectious peritonitis viruses arise by might be certain special circumstances (eg, a mutation from endemic feline enteric corona- cat that has never been exposed to FCoV viruses. Virology 1998; 243: 150 –157. entering a shelter in which FCoV is endemic) 5 Haijema BJ, Volders H and Rottier PJ. Live, in which the vaccine might induce some level attenuated coronavirus vaccines through the of protection. directed deletion of group-specific genes Vaccine safety provide protection against feline infectious peritonitis. J Virol 2004; 78: 3863 –3871. 6 Rottier PJ, Nakamura K, Schellen P, Volders H Field studies have demonstrated that the com - and Haijema BJ. Acquisition of macrophage mercially available vaccine is safe if used in tropism during the pathogenesis of feline cats over 16 weeks of age. ADE leading to infectious peritonitis is determined by muta - faster development of disease in vaccinates tions in the feline coronavirus spike protein. was demonstrated in experimental challenge J Virol 2005; 79: 14122 –14130. 18,22 exposure studies; however, ADE likely 7 Poland AM, Vennema H, Foley JE and Pedersen does not occur in a natural setting. In neither NC. Two related strains of feline infectious of the two placebo-controlled, double-blind peritonitis virus isolated from immunocom - field trials were signs of ADE or induction of promised cats infected with a feline enteric 20,23 FIP noted. coronavirus. J Clin Microbiol 1996; 34: 3180 –3184.

Journal of Feline Medicine and Surgery (2013) 15 , Supplementary File FACT SHEET / Feline infectious peritonitis

8 Meli M, Kipar A, Muller C, Jenal K, Gönczi E, 19 Scott F, Corapi W and Olsen C. Independent Borel N, et al. High viral loads despite absence evaluation of a modified live FIPV vaccine of clinical and pathological findings in cats under experimental conditions (Cornell experi - experimentally infected with feline corona- ence). Feline Pract 1995; 23: 74 –76. virus (FCoV) type I and in naturally FCoV- 20 Fehr D, Holznagel E, Bolla S, Lutz H, Hauser B, infected cats. J Feline Med Surg 2004; 6: 69 –81. Herrewegh AAPM, et al. Evaluation of the safe - 9 Kipar A, Baptiste K, Barth A and Reinacher M. ty and efficacy of a modified live FIPV vaccine Natural FCoV infection: cats with FIP exhibit under field conditions. Feline Pract 1995; 23: significantly higher viral loads than healthy 83 –88. infected cats. J Feline Med Surg 2006; 8: 69 –72. 21 Fehr D, Holznagel E, Bolla S, Hauser B, 10 Pedersen NC. A review of feline infectious Herrewegh AA, Horzinek MC, et al. Placebo- peritonitis virus infection: 1963 –2008. J Feline controlled evaluation of a modified life virus Med Surg 2009; 11: 225 –258. vaccine against feline infectious peritonitis: 11 Harvey CJ, Lopez JW and Hendrick MJ. An safety and efficacy under field conditions. uncommon intestinal manifestation of feline Vaccine 1997; 15: 1101 –1109. infectious peritonitis: 26 cases (1986 –1993). 22 Scott F, Olsen C and Corapi W. Antibody- J Am Vet Med Assoc 1996; 209: 1117 –1120. dependent enhancement of feline infectious 12 Rota A, Paltrinieri S, Jussich S, Ubertalli G and peritonitis virus infection. Feline Pract 1995; 23: Appino S. Priapism in a castrated cat associated 77 –80. with feline infectious peritonitis. J Feline Med 23 Postorino-Reeves N. Vaccination against natu - Surg 2008; 10: 181 –184. rally occurring FIP in a single large cat shelter. 13 Trotman TK, Mauldin E, Hoffmann V, Del Piero Feline Pract 1995; 23: 81 –82. F and Hess RS. Skin fragility syndrome in a cat 24 Addie DD and Jarrett JO. Feline coronavirus with feline infectious peritonitis and hepatic antibodies in cats. Vet Rec 1992; 131: 202 –203. lipidosis. Vet Dermatol 2007; 18: 365 –369. 25 Harpold LM, Legendre AM, Kennedy MA, 14 Cannon MJ, Silkstone MA and Kipar AM. Plummer PJ, Millsaps K and Rohrbach B. Fecal Cutaneous lesions associated with corona - shedding of feline coronavirus in adult cats virus-induced vasculitis in a cat with feline and kittens in an Abyssinian cattery. J Am Vet infectious peritonitis and concurrent feline Med Assoc 1999; 215: 948 –951. immunodeficiency virus infection. J Feline Med Surg 2005; 7: 233 –236. 15 Declercq J, De Bosschere H, Schwarzkopf I and Declercq L. Papular cutaneous lesions in a cat DISEASE INFORMATION associated with feline infectious peritonitis. FACT SHEETS SUPPLEMENTARY FILES Vet Dermatology 2008; 19: 255 –258. < Feline herpesvirus 1 Fact Sheets accompanying the 16 Gerber JD, Ingersoll JD, Gast AM, Christianson < Feline calicivirus 2013 AAFP Feline Vaccination Advisory KK, Selzer NL, Landon RM, et al. Protection < Feline panleukopenia Panel Report are available, against feline infectious peritonitis by Rabies together with the Pet Owner Guide < included in Appendix 2, at intranasal inoculation of a temperature-sensi - < Feline leukemia virus http://jfms.com tive FIPV vaccine. Vaccine 1990; 8: 536 –542. < Feline immunodeficiency virus DOI: 10.1177/1098612X13495235 17 Hoskins J, Taylor H and Lomax T. Independent < Feline infectious peritonitis evaluation of a modified live feline infectious < Chlamydophila felis peritonitis virus vaccine under experimental < Bordetella bronchiseptica conditions (Louisiana experience). Feline Pract 1995; 23: 72 –73. 18 McArdle F, Tennant B, Bennett M, Kelly D, GENERAL INFORMATION Gaskell C and Gaskell R. Independent evalua - FACT SHEET PET OWNER GUIDE tion of a modified live FIPV vaccine under < The immune response to (APPENDIX 2, pp 807 –808) experimental conditions (University of vaccination: a brief review < Vaccinations for Your Cat Liverpool experience). Feline Pract 1995; 23: 67 –71.

Journal of Feline Medicine and Surgery (2013) 15 , Supplementary File