General Expectations

This is a collection of information with comments by many contributors as the knowledge base grows. The bulk of the information is provided by Jack J. Broadhurst, DVM of Pinehurst, NC based on his ground breaking work when he first discovered that using a neuraminidase inhibitor to treat canine, feline and raccoon parvoenteritis was more effective that the standard protocol used by veterinarians currently. The full article from a 2006 summary by Dr. Broadhurst is appended.

Precautions

Once parvo has hit the house you need to clean fastidiously, a 20% bleach solution on all hard surfaces and Trifectant on carpets, clothing, etc. For lawns, quarantine all new dogs (so if they “break” with it you won't have contaminated all areas with sick dogs) until at least 2 weeks have passed. Keep at-risk or contaminated puppies on hard, easy to clean surfaces like driveways or concrete, not yards and the less porous, the better. IF you have had a parvo dog on your property do NOT bring an unprotected animal onto the premises. “Unprotected” means less than 2 years and/or missing any shots.

Parvo is a very transmittable virus, can get airborne, on clothes, hair, etc. Quarantine of a puppy during shot period is key. You should never let their feet touch the ground in any “public” area, e.g., your unfenced front yard, anywhere another animal or person could have been and contaminated until 1-2 weeks after the 3rd shot and the longer the better.

Typically, when Parvo shows it pops up 7-10 days post exposure, first signs tend to be only lethargy and decreased appetite—they will suddenly become less interested or totally uninterested in food or water. It seems the littlest ones first show symptoms, then diarrhea, not at first bloody just really loose, gelatinous, mucus filled and sometimes golden in color. They may show symptoms for a few days before the diarrhea (lethargy and food disinterest) sometimes throwing up watery or foamy phlegm. Then full-blown watery stools with that fermented blood smell and at that stage it is harder to treat.

A parvo puppy post treatment could potentially be harboring the virus (and shedding) for up to 4 weeks so isolation is necessary. Do not allow unvaccinated animals in areas where puppy has been, nor should you allow puppy out into the general population due to risk of contamination to other animals. After 4 weeks, make sure to bathe puppy thoroughly and do a complete bleach clean on all affected areas. If taking puppy to vet before the isolation period is complete, inform vet you have a recovering parvo pup and use carrier plus universal precaution (Fresh clothing, bleached carrier, only take animal into office when called, etc.) so as not to risk other animals in office. Continue to limit yard access during this isolation time, utilizing a kennel or exercise pen to keep puppy and feces on easily cleaned hard surface. Suggested bleach clean mixture is 20% bleach to water, let sit wet for 10 minutes, then rinse. Pick up all feces and such BEFORE bleach cleaning. Keep an eye out for secondary parasitic infections like Giardia and coccidia, stools can mimic parvo and harbored parasites can overgrow due to stress of parvo on system.

Parvo can live in soil for up to two years. A 3 month quarantine is a minimum during hot dry weather. House contamination is 1- 3 months, even after a thorough cleaning by hard surface cleaner with Parvocide or Trifectant. The advantage to Trifectant is that it will not damage fabrics but requires careful handling.

Expectations and General Feeding

IF caught early and treated appropriately parvo treatment success (depending on strain) is about 80-90%. If the puppy makes it thru the first 5-7 days, your success rate increases. Once the puppy has begun to rebound you must still complete the entire course of medicines (switch to oral if able to keep down), utilizing fluids until puppy is eating and drinking enough to hydrate themselves. Desire for food generally occurs between 3 to 7 days. During treatment, keep testing puppies’ desire for food and ability to hold down food by utilizing pea size drops of Nutracal and small oral doses of Pedialyte. Also use the Nutracal as an energy supplement, if puppy can keep down, throughout treatment.

Once the puppy shows more interest, leave out measured amounts of Pedialyte (for water and tracking intake), feed by syringe a light amount of dog food, soaked and mashed/slurried, dry or watered down can. Science Diet ID or AD, or Purina EN are good choices for less potential upset. GO slow, don’t force or overfeed. Keep in mind their GI tract is still raw, after a couple days of timed feedings (every 4-6 hours) you can increase amount of food given until animal wants and tolerates a regular diet.

Keep in mind that during the parvo treatment process stools may go from original gold mucus color with possible streaks of red to watery and smelly dark red to brown red to possibly green with red until becoming a wet dark brown then a more solid brown. They can fluctuate with treatment, if they go to solid bright watery red, resembling fresh blood, things are touch and go. At this point, continuation of treatment or vet intervention should be re-considered as the Parvo virus can destroy the arteries in the colon, causing a serious secondary bacterial infection or the puppy may bleed out. A transfusion might be necessary. You must do what is best for the puppy.

Nutri-Cal is always very good with a puppy after parvo treatment. Get about 3 cc down the pooch (25# dog) 2-3 times a day for protein/calories until the intestinal tract had time to heal so it could eat. Put it in a syringe and gave it by mouth until appetite picks up normally or you can rub a little corn syrup on their gums for energy. Once they have started to rebound and can keep food/meds down, immunity boosters or beneficial bacteria (live culture yogurt) can help repopulate the gut with good bacteria.

Keep in mind that there is more than one strain of parvo so you animal can "get" the virus again. Once animal recovers continue with vaccinations on recommended schedule through the four shot protocol. Many parvo puppies have gone on to live normal lives with no further complications.

Treatment

TAMIFLU is the best Parvo treatment - not 100%, but very effective. The EARLIER the treatment the GREATER the success, look for symptoms and don’t delay.

Tamiflu should never be used to treat any animal that does not test (+) using the fecal antigen test. All of the guidelines for using Tamiflu have been developed in cases that have had a (+) fecal Parvo test. The first 48 hours are key in Tamiflu treatment.

Tamiflu Dosing:

Generally, treatment is a 1mg/lb dose of Tamiflu orally every 12 hours for 10 consecutive treatments. There is a direct relationship between clinical response and the time treatment is started. Tamiflu should be given w/in 48 hrs of onset of clinical signs, if no response after the first dose double to 2mg/lb for the second, third dose, etc. Dogs that vomit after being given oral Tamiflu can be given the same dose as an enema.

If a dog requires IV support...you need to start at least 2mg/lb or maybe 4mg/lb because if he is toxic enough to require IV support, it may be too late to use Tamiflu.

One 75 mg pill will do 10 doses for a 7.5 Ib puppy doses at 1mg/lb . Divide accordingly. After making "lines" (use a knife or razor blade to divide) of the Tamiflu on a plate or smooth hard surface, for a single dose then mix a dab of peanut butter (or maple syrup) in a small cup and place mixture on upper palate of mouth towards the back. If showing severe symptoms add an antibiotic also, Metronidazole or amoxicillin orally.

ALSO limit fluids, pre-dose with Pepto (pediatric—you want one without aspirin) to stop up loose stools and increase absorption in GI tract. In severe cases an anti- emetic and sub q fluids might be necessary. If dog foams at mouth and vomits peanut butter mixture, switch to maple syrup or dose by enema. Use the Pepto (1/2 caplet or 2-3 cc's liquid) about 1/2 hour before tamiflu if you suspect anything passing too quickly.

Specific Breeds of Dogs: Dobies, Rotties, Retrievers, Pit Bulldogs, and Alaskan sled dogs all require at least 2mg/lb as the starting dose as these breeds respond poorly to Parvo infections.

As a preventive: Animals have been exposed, but are not currently showing any clinical signs should be given 1mg/lb once a day for 5 days if these animals develop one or more clinical signs (vomiting/bloody diarrhea/anorexia) treatment should be changed so that they are given 1mg/lb every 12 hr for a total of 10 treatments or more as indicated above. Prevention protocol has been 1-2 mg/lb once a day for 10 days, which is the human flu prophylactic dosing schedule. If they break with parvo during preventative phase increase to 2x day until done. If on preventative and parvo strikes, infection is generally less serious.

Hydration with Parvo and Antibiotic and Pain Meds

Hydration is critical, 100 to 150 cc/day for 7 lb puppy in 2 divided doses. Start right away. Plasma is given in last resort cases.

You can lose a parvo puppy to dehydration or secondary infection, PRIOR to losing them of parvo. This is why parvo puppies are put on IV's at the vet office, to prevent dehydration. Dehydration causes the organs to work harder and the body can shut down quickly, resulting in death.

HYDRATION METHODS ~ There are 5 hydration methods. They are: IV's (Intravenous fluids); Subq fluids injected under the skin, oral fluids, rnema fluids and placing the dehydrated being in body temp water. This last mentioned method is not recommended.

Dogs requiring IV support

Dogs sick enough to require IV support (fluids/antibiotics/antiemetics) respond poorly to Tamiflu. Their clinical condition is the result of a damaged GI tract with the introduction of GI bacteria and toxins beyond Tamiflu’s ability to protect the patient. Therefore antibiotics should be used in conjunction with Tamiflu to reduce the risk of secondary intestinal infection. Any antibiotic with good GI coverage will work. If used, Tamiflu can be started at 2mg/lb and the dose adjusted according to the patient’s response every 12 hours.

Reglan and Zofran can also help or a 1/2 phenergan/compazine suppository if available. Keep food and fluids to a minimum at first if throwing up. In past cases puppy has been kept, NPO—nothing by mouth, for the first 36-48 hours (except medications if no other route of administration exists). If they throw up meds, just dose them again or switch to rectal dosing to keep the tamiflu down to work.

For pain, use Tramadol (generic is Ultram) dosed at 1 mg per pound every 12 hrs. either orally or rectally with a small amount of liquid, e.g,, with 1/2 cc Pedialyte, New literature suggests treating for pain is very appropriate.

Oral and enema

The oral and enema methods are effective in keeping parvo puppies hydrated. If a parvo puppy continues to vomit oral fluids, use the enema method to help get them hydrated again, until they can keep fluids down orally. In using Pedialyte, and sometimes Colloidal Silver (aka Electrically Isolated Silver), normally enema fluids are completely retained in puppies who are dehydrated.

If IV, pups under 20 lbs get 8 drops per minute using one bag per 24 hours, flushing iv port at 12 hrs and at bag change. You can add 100 cc dextrose, (you can buy at farm co-op) to a 1000cc bag of Ringers whether using subq or IV to keep puppy's glucose levels stable. If purchasing syringes for use, syringe size needed is based on the weight of the puppy. We suggest two syringes, one for oral doses and one for enema doses (if not being given Sub Q fluids or on IV's, enemas are or may be necessary to prevent dehydration). Make sure to mark the enema syringe clearly, as you never want to accidentally use an enema syringe for an oral dose, even after it's been washed, as you can reinfect a puppy with parvo. Puppies weighing 0 to 10 pounds can use 10 ml syringes. Puppies weighing 11-20 pounds need 20 ml syringes. Puppies weighing 21 to 40 pounds need 50 ml syringes. Puppies 41 to 50 pounds need 60 ml syringes, but the 50 ml syringes we carry will easily hold 60 ml.

Administer the enema fluids VERY slowly. We pet the puppy and tell them why we are giving them an enema...to help them get better so they can be happy, healthy, eat, and play. Giving 5 cc's of enema fluids may take you 2 to 3 minutes to give. Again, do it slowly. Ringers or Pedialyte, approximately 50 cc 2x a day. Up to 125 or 150 cc max if high diarrhea or vomiting.

Warm it up and use a large Luer slip syringe (10-30 cc) with needle removed of course. You need a needle to do a bag draw but for Pedialyte you don't. Many have had luck dosing tamiflu rectally--1/2 to 1 cc or less Pedialyte with divided tamiflu amount--2 mg/lb divided capsule. Most drugs that can be taken orally can be given rectally. Tramadol, 1mg/lb for pain, crushed with warm Pedialyte rectally also. There is new info that pain meds do help as parvo is painful.

Just note, it can take 10 to 15 minutes to give a 45 lb. parvo puppy 4 tbsps. (60 cc's) of enema fluids. If you are giving the enema via syringe and the fluid starts to come back out, stop for a few seconds, pet your puppy so it can relax, and then slowly administer more of the enema fluid. So again, give very slowly.

Please also note, the purpose of an enema is to hydrate a puppy so that they will be better able to hold down oral fluids. We do not recommend giving enemas 24 hours straight or in lieu of oral dosing. Enemas are needed if a puppy is vomiting excessively, but the goal is to get them hydrated enough so that they can keep their oral fluids down

Long Term Prevention

Ideally 4 shots are given 3-4 weeks apart starting at 6-8 weeks. Best protection rates seem to be with the distemper/parvo only “Puppy” shots. The 5-way may over work immune system but they are better than nothing and it’s what most vets use. Some vets do the final or 4th shot once the animal has reached 6 months of age.

Schering-Plough (SP) and Intervet vaccinations have been proven to be 100% effective in preventing this strain of parvo. If you have any questions in regards to SP vaccinations please call 1-800-224-5318 (SP technical support).

Fort Dodge vaccines were effective in less than 90% of the tested dogs/puppies, Pfizer was less than 70% effective in preventing disease, and Merial was less than 50% effective. This data was obtained from an independent source, and at this time the only published data is an article from Schering-Plough (S/P).

Cleaning Protocols:

There are only two products that kill this virus with a ten minute contact time. Trifectant and bleach (1/2 cup/gallon dilution) will successfully kill Parvo 2c. All other products that claim to kill parvo are not effective per Dr. Hall (Vaccination/ Shelter Specialist at SP) New Treatment For Parvoenteritis

ORIGIONAL ARTICLE

On April 24, 2004, the concept of treating Parvoenteritis in dogs with a neuraminidase inhibitor (Tamiflu) was introduced on the Veterinary Information Network’s Infectious Disease Board. Since then, Tamiflu has been used successfully by veterinarians, shelter workers and rescue groups to treat Parvoenteritis in thousands of dogs, cats and raccoons throughout the world.

Tamiflu: Oseltamivir is one of two commercially available sources of a neuraminidase inhibitor that has been used successfully in treating infectious parvoenteritis.

Neuraminidase: An enzyme that is produced by both bacteria and viruses. It is considered a virulence factor in viral and bacterial infections that require neuraminidase to remove biological barriers that protect the host.

Super infections: Any infection that requires both a virus and bacteria to produce an infection that is more pathogenic than either infectious agent can produce alone. Veterinary examples: canine and feline Parvo, canine kennel cough and influenza, feline URI, parvoenteritis in raccoons, and bloody scowls in deer.

The use of Tamiflu in canine, feline, and raccoon parvoenteritis: The success of using a neuraminidase inhibitor in treating canine and feline Parvo is due to the suppression the production of bacterial neuraminidase, and has no effect on the Parvovirus' ability to replicate. Puppies can still develop myocarditis and CHF...kittens can still develop cerebellar hypoplasia...the patient’s feces will still contain the viral antigen even while the animal is recovering. Tamiflu does not interfere with the replication of the Parvovirus, and as a result, no mutant or resistant strains of the Parvovirus will be created from the use of Tamiflu.

Tamiflu should never be used to treat any animal that does not test (+) using the fecal antigen test. All of the guidelines for using Tamiflu have been developed in cases that have had a (+) fecal Parvo test.

Dose: 1mg/lb that dose given every 12 hours for 10 consecutive treatments...requires a (+) fecal antigen test. . There is a direct relationship between clinical response and the time treatment is started…Tamiflu should be given w/in 48 hrs of onset of clinical signs. if no response after the first dose...double to 2mg/lb for the second, third dose, etc.

Specific Breeds of Dogs: Dobies, Rotties, Retrievers, Pit Bulldogs, and Alaskan sled dogs...all require at least 2mg/lb as the starting dose as these breeds respond poorly to Parvo infections...

As a preventive: Animals have been exposed, but are not currently showing any clinical signs should be given 1mg/lb once a day for 5 days...if these animals develop one or more clinical signs (vomiting/bloody diarrhea/anorexia)...treatment should be changed so that they are given 1mg/lb every 12 hr for a total of 10 treatments.

Animals requiring IV support: Animals sick enough to require IV support (fluids/antibiotics/antiemetics) respond poorly to Tamiflu. Their clinical condition is the result of a damaged GI tract with the introduction of GI bacteria and toxins beyond Tamiflu’s ability to protect the patient. If used, Tamiflu can be started at 2mg/lb and the dose adjusted according to the patient’s response every 12 hours.

Animals that vomit after being given oral Tamiflu: These patients can be given the same dose as an enema. You can also divide the contents of a 75mg capsule into lines and mix the appropriate amount into pancake syrup or honey and place under the tongue or in the lip fold.

Tamiflu Products: There is a suspension that you add 23 cc of water to get 25cc of 12mg/cc. There is also a flat of ten 75 mg capsules.

To use capsules to treat a 5 lb puppy: Mix the contents of 1 capsule into 10 cc of a liquid diet like Canine Rebound...this will create a 10cc suspension with a concentration of 7.5mg/cc....Refrigerate and shake well and give 1cc q. 12 hrs x 10 treatments.... do not mix capsules with water as this water suspension is very bitter and can cause the patient to vomit. One can also use liquid VAL or similar vitamin prep.

To use the suspension (12mg/cc) to treat a 5 lb puppy: Shake well and give the puppy 0.5cc of the suspension q. 12 hrs x 10 treatments. Refrigerate the suspension after adding water and between treatments.

Tamiflu and FDA: On March 20, 2006, the FDA banned the use of Tamiflu and other neuraminidase inhibitors in treating chickens, ducks, turkeys and other birds...goes into effect in June 2006.... you can still use Tamiflu in dogs, cats, and raccoons.

In the emergency clinics or private clinics that are presented with cases whose disease course is unknown or have exceeded the 48 hrs time-frame: The professional staff should make the client aware of the poor response to Tamiflu due to the high levels of bacterial neuraminidase currently present in the patient's GI tract, and the presence of GI pathology created prior to presentation. Tamiflu will only prevent future pathology, and cannot reverse any pathology created prior to treatment.

Treating Parvo requires the same mental process used in treating Diabetes Mellitus.... The DVM begins with a standard initial dose of Tamiflu or insulin and then uses professional judgment to adjust the following doses required to get a clinical response.

In an uncomplicated case, presented within 48 hrs. of the onset of clinical signs, one should see no vomiting after the first dose...no diarrhea after the 2nd...and alert/eating after the 3rd dose. If there is no clinical response after the 3rd dose...you have either started using Tamiflu too late, have a secondary medical problem that needs to be addressed, or have the wrong diagnosis.

In summary, the introduction of the concept of using a neuraminidase inhibitor to treat canine, feline and raccoon Parvoenteritis, has opened many new doors into the understanding of the pathobiology and treatment of this disease. Prior to April 24, 2004, Parvovirus was thought of as viral enteritis. Based on this concept, vaccines were developed to help prevent or reduce the severity of the clinical disease.

Once the disease was diagnosed, treatment protocols were all designed to address the various end products produced during the disease. The presence of vomiting and/or diarrhea usually dictated that most drugs were given intravenously. Animals that are hospitalized usually remain 3-7 days with unpredictable prognosis. This is because none of the treatments address the core problem of excessive GI bacterial neuraminidase. Drugs are given to address all of the various reactions such as: vomiting, endotoxic shock, pain, bacterial septicemia, GI mucosal ulcerations and general organ failure. This approach requires many drugs and man-hours to treat the multiple pathological processes associated with viral Parvoenteritis.

With the introduction of using a neuraminidase inhibitor (Tamiflu), we established that Parvoenteritis is not a viral enteritis, but a super infection that requires the presence of bacterial neuraminidase. When a neuraminidase inhibitor is use under the strict guidelines developed since April 24, 2004, the disease is not allowed to develop into the clinical disease currently known as viral Parvoenteritis. The commensal bacteria do not transform into pathologic bacteria, and the patient’s disease is not allowed to progress as described in the veterinary literature. In order to achieve this reversal, there has to be a definitive diagnosis and the neuraminidase has to be given according to established guidelines.

Please keep in mind that any recommendations given in this article are not FDA approved. They are offered to help educate and guide those anticipating using Oseltamivir therapy in the future. Roadrunner Pharmacy is currently in the process of acquiring Oseltamivir powder to be compounded into the various formulations and concentrations requested by our clients.

To insure the continual gathering of clinical data, please contact Jack J. Broadhurst, DVM at [email protected] or fax at 910-295-2265. There is a clinical trial form that if filled out and returned, will insure a central point for clinical results to be stored. He can also be contacted at 910-295-2287.

Jack J. Broadhurst, DVM The Cat Health Clinic 2212 Midland Road Pinehurst, NC 28374

Disclaimer: Always discuss this and anything else you read about on the web, in regards to medical treatment, with your vet before administering. The above info is provided for the readers convenience to discuss with their vet and is not meant to be the sole treatment for Parvo. http://forums.lasthopesafehaven.com/post?id=2432142