Report Prepared By: Professor Josh Slater (Royal Veterinary College and BEVA)

National Equine Health Survey (NEHS) 2015

Report prepared by: Professor Josh Slater (Royal Veterinary College and BEVA)

Date: 12th August 2015

Headlines  Further increase in participation with a 35% increase over 2014  Almost 15,000 horses returned in 2015, up one third on 2014  The 2015 data were consistent with previous years underlining the validity and value of the syndromic data collected by NEHS  Two thirds of horses taking part were healthy and one third had at least one disease syndrome recorded  The Top Five disease syndromes accounted for 40% of all problems recorded. The Top Five were the same as previous years: lameness (i.e. degenerative joint disease), sweet itch, back problems, recurrent airway obstruction and PPID (‘Equine Cushing’s Disease’)  Non foot lameness (e.g. degenerative joint disease/arthritis) affected almost 1 in 5 of horses in the survey and continued to outstrip foot problems by 3:1 but foot problems remained common 4.5% reinforcing the importance of foot care  Laminitis was again commonly reported in 2015 (6.4% overall prevalence, with 41% recorded as first episodes and 60% recorded as repeat episodes), continuing the trend seen over 2013-14. PPID (Equine Cushing’s Disease) was commonly reported, continuing the trend from 2013-14  Sweet itch continues to be the most common skin problem recorded and overall 1 in 6 horses in the survey was affected by skin disease (sweet itch, mud fever or skin parasites)  The prevalence of reported atypical myopathy increased from 0.1% in 2013-14 to 0.4%, which might reflect increased disease surveillance or true increase in prevalence  The number of horses recorded as overweight or obese increased from 17% in 2014 to 23% in 2015. Almost all owners/keepers of overweight horses and ponies took steps to manage their weight with restricting hard feed, strip grazing and soaking hay the most commonly used weight control methods suggesting that there is a good level of awareness of the importance of obesity and weight management. The number of owners using weight tapes increased from 50% in 2014 to 64% in 2015.  The majority of owners/keepers (80%) intended to treat for encysted cyathostomins over the winter of 2014 but almost one third used products not licensed for this purpose and 7% used a product for which resistance has been documented

Survey method  The seventh NEHS survey ran in May 2015. The survey was led by the Blue Cross, was conducted on-line and was open to respondents to complete for one week  The survey used the same format as previous years with owner-reported syndromic surveillance capturing a snap-shot of the spectrum of problems noted by owners for each horse under their care on the day they chose to complete the survey  The 2015 survey used the same disease syndrome descriptors to provide continuity of data with previous years. The number of supplementary questions about management practises were reduced but key questions about weight management and anthelminthic use for encysted cyathostomins were retained. As in 2014, disease syndrome descriptors were grouped into broad categories (eye problems, respiratory problems, internal medical problems, dental problems, lameness and laminitis, skin problems and back problems) to facilitate completion of the survey by respondents and a free text category to allow respondents to report other problems not listed in the syndrome descriptors  32 disease syndrome descriptors covering the presenting signs for common diseases and the major body systems were used.  Owners were asked to report their horses’ fat (body score) using the 0-5 scoring system by assigning their horse to one of three descriptors: overweight (score> 3.5), ideal/normal weight (score 2.5-3.5); underweight (score 0-2.5). Respondents were asked how they managed weight in horses that were ‘good doers’ or overweight and how they estimated weight.  As in the 2014 survey, a question was included on atypical myopathy with respondents asked to record the number of confirmed Atypical Myopathy cases they had had in the previous year.

Results (demographic information)  The number of people taking part in the 2015 survey increased by 35% to 4,951 (up from 3,675 in 2014 and 1,246 in 2012) continuing the sharp upward trend in participation  Records were returned for 14,952 horses, an increase of 36% on 2014 (up from 11,002 in 2014) and an increase of 216% on 2012 (up from 4,730 in 2012)  The significant increase in both numbers of people taking part and the number of records returned shows that NEHS is increasing its reach, is becoming embedded in the annual routine of horse owners and is receiving a good level of support from stakeholders across the industry  Most respondents kept or owned a single horse (41.3%), 29.5% kept or owned 2 horses, 13.3% 3 horses and 15.9% of respondents returned records for more than 3 horses, with 13% (641) returning records for between 4 and 10 horses and 3% (144) returning records for more than 10 horses (Fig.1). These results are what would be expected from previous surveys of National Equine Database records showing that the majority of UK horses and ponies are single ownership.  Most horses (90%) were kept in livery yards (47.5%) or private yards (43%). This is a similar figure to last year (88%), which suggests that NEHS continues to sample a population representative of the general UK horse and pony population. Only 0.4% of returns were from welfare charities and 0.3% from RDA establishments which suggests that data from these sectors are not a source of bias in the overall dataset (Fig. 2)  The number of people returning records for horses kept at livery yards increased by 7.6% from 2014.  The activities that horses were kept for was very similar to 2014 with 37.4% of horses used for leisure use and hacking (37% in 2014). 21.7% were used mainly for equestrianism (eventing, dressage and show jumping) up from 18% in 2014, 9.5% used for showing (9% in 2014). 0.5% of returns were made from the racing sector (an increase from 0.2% in 2014) (Fig. 3).  Broad geographical coverage of the UK was achieved, again an important point when extrapolating NEHS data to the national herd.  The distribution of ages of animals included in the survey was similar to previous years and was normally distributed (Fig. 3) with ages being recorded for almost all returns (97.5%). The majority of animals were in the age range 5-10 years old suggesting that the NEHS dataset is broadly representative of the national equine population.  Taken together, these results suggest that NEHS 2015 collected data that were valid and representative of the majority of the UK horse industry in the three key areas of age, type of use and geographical distribution.  As with the previous surveys, the majority (64%) of horses were returned as healthy (compared to 63% in 2014 and 62% in 2013), reinforcing a consistent overall picture that a snapshot of equine health is that around two thirds of horses are disease free at any particular time.

Results (disease syndrome information)  The results of disease syndrome recording in the 2015 survey were very similar to results from previous surveys, strongly suggesting that NEHS data produces consistent trends and reliable, reproducible data (Fig. 5).  There were no differences in ranked syndrome prevalence for 2015 compared to 2014.  The top five disease syndromes were (in order of decreasing prevalence): lameness (not relating to the foot) (13.5%), sweet itch (8%), back problems (7%), recurrent airway obstruction (6.7%) and PPID (‘Equine Cushing’s Disease’) (6.4%).  Highlights from the horse and pony data include (Figs 5 and 6): o Non foot lameness (e.g. degenerative joint disease/arthritis) was the again the most prevalent syndrome recorded (13.5%), compared with 18.5% in 2014; 18.6% in 2013 and 13.8% in NEHS 2010-12. Foot lameness was recorded in 4.5% of returns, a similar figure to previous years, reinforcing previous messages that foot care is vital. o The prevalence of laminitis in the 2015 survey was 6.4% with 41% recorded as first episodes and 60% recorded as repeat episodes. These results are similar to 2014 (7.1% overall prevalence with 43% first episodes and 67% recurrent episodes) and higher than 2013 (4.4% overall prevalence of laminitis with 25% first episodes and 75% recurrent episodes) and NEHS 2010-12 (overall prevalence 3.6%). The reasons for these year-to-year variations warrant further investigation, in particular to spring weather patterns and management practises. o Back problems continue to be commonly recorded (7% in 2015, 7.7% in 2014; 5% in 2013 and 3% in NEHS 2010-12). o Sweet itch was again the most frequently recorded skin problem (8%) with a very similar prevalence as in previous years. Overall, skin diseases as a whole (sweet itch, mud fever and external parasites) were frequently reported again (17.2% of returns, compared to 18.3% in 2014, 14.6% of returns in 2013 and 15.2% in NEHS 2010-12). Mud fever remained prevalent (6.2% of returns, compared with 7.7% in 2014) and external parasites were recorded in 3.1% of returns (2.8% in 2014). o As in previous years, recurrent airway obstruction was the most frequently recorded respiratory problem (6.7% of returns compared with 6.9% of returns in 2014, 4.2% in NEHS 2013 and 3.6% in NEHS 2010-12) and accounted for 72% of all respiratory disease. Strangles was recorded as having occurred in 1.2% of horses (124 horses) in the last 12 months and other infectious respiratory diseases were recorded in 0.3% returns (38 horses). This supports the view that strangles is a common infectious respiratory disease although comparison with other infectious respiratory diseases is not possible because the strangles result is from a 12 month period, whereas the other infectious respiratory disease data is from the single day snapshot in May. o Confirmed or suspected PPID (‘Equine Cushing’s Disease) was recorded in 6.4% of returns in 2015, continuing the high level of recording seen in 2014 (5.6%) and possibly reflecting increased surveillance through sponsored testing programmes as opposed to true increases in prevalence from the pre-2014 surveys. o Sarcoids were again commonly reported with very similar prevalence to previous years (5.6% of returns), reinforcing the importance of this skin tumour. Melanoma was reported in 1.7% of returns, a similar figure to previous years (2% in 2014) acting as a reminder that this is also an important skin tumour in horses. o Wounds were again frequently reported (4.0%; 3.9% in 2014; 1.4% in NEHS 2013 and 3.6% in NEHS 2010-12), reinforcing this as a common problem encountered by horse owners. o Colic continued to be a commonly recorded problem with an overall prevalence of 3.8% (4.1% in 2014, 2.1% in NEHS 2013 and 5.6% in NEHS 2010-12). As in previous years, and in line with published data, the majority of colics were medical with a ratio of medical to surgical colics of 5:1 (6:1 in 2014 and 2013, 7:1 in NEHS 2010-12). o Equine Grass Sickness continued to have a low prevalence (0.14%), very similar to previous years (0.2% in 2014, 0.1% in 2013, 0.15% in NEHS 2010-12) and myopathies (tying-up) also had a relatively low prevalence (0.7%) again similar to previous years (5.6% in 2014, 0.3% in 2013; 0.4% in in NEHS 2010-12). o 45 confirmed cases of atypical myopathy were recorded over the year 2014-15 compared to 13 from 2013-14, producing an approximate prevalence of 0.4% in NEHS 2015 compared to 0.1% in NEHS 2014. It is not clear whether this represents a true increase in disease prevalence or an increase in awareness and surveillance but acts as a reminder that owners and vets should remain vigilant for this disease, especially at high risk times of the year. o Equine Metabolic Syndrome was recorded in 2.4% of returns (2.1% in 2014, 0.9% in 2013). Again, it is difficult to know whether this represents a true increase in disease or improved awareness and surveillance. o Recording of fat score (body score) produced some interesting results again in 2015. 23.2% of horses were assessed as being overweight (score 3.5-5) continuing the upward trend seen in previous years (16.9% in 2014 and 7.8% in 2013). 73% of horses were assessed as being score 2.5-3.5 and 3.8% were assessed as being underweight (score 0-2.5) (Fig. 6). These results underpin the messages from welfare organisations that obesity is a growing problem and more efforts are required to tackle it. There is good evidence from the 2015 NEHS survey that respondents were not only aware of the importance of obesity but that they took active steps to manage it. Only 4% of owners/keepers of overweight horses and ponies said they did not change their management to try to control weight. The large majority (96%) took active measures including (in order of decreasing prevalence): reducing hard feed (20%), strip grazing (15%), soaking hay (13%), restricting turn out time (12%), grazing in a bare paddock (11%), reducing forage (9%), changing hard feed (6%) and using a grazing muzzle (5%). A wide range of measures is therefore used suggesting that research to establish an evidence base into optimal method(s) of weight control would be useful. o Around two thirds of respondents used a weigh tape to estimate their horse’s weight (64%). This figure was a significant increase over the previous year where 51% used weigh tapes. It is not clear whether this increase reflects increasing awareness of the importance of measuring weight, as opposed to visual estimation, as a result of educational campaigns. As in 2014, the 2015 NEHS data suggest that owners are actively engaged with weight management and aware of its importance. o Headshaking was recorded in 2.6% of returns (2.2% in 2014, 1% in 2013 and 1.5% in NEHS 2010- 12) o Stereotypies were recorded in 1.3% of returns (1.2% in 2013, 4.1% in NEHS 2010-12) o Eye problems were again frequently recorded (3.8%; 3.4% in 2014, 2.6% in 2013) with uveitis (0.68%) and cataract (1.12%) more frequently recorded than corneal disease (0.5%), reflecting data from previous NEHS surveys. o 11% of free text answers recorded gastric ulcers providing an insight into the prevalence of equine gastric ulcer syndrome in the principally leisure horse NEHS population

 As last year, the large majority (80%) of respondents intended to treat their horses for cyathostomins over the winter of 2014 and almost all of these (90%) knew which product they had used. A variety of products had been used although the majority (64%) had used moxidectin either as solo therapy or in combination with praziquantel (compared with 71% in 2014). Of the remainder, 22.5% had used ivermectin (18% in 2014), 7% had used fenbendazole (10% in 2014) and 6.3% had used either pyrantel or Praziquantel (Fig. 7). Approximately one third of treatments therefore used products that did not have a marketing authorisation for treatment of encysted cyathostomin larvae (Ivermectin, Praziquantel or Pyrantel) and 7% used a product for which cyathostomin resistance has been documented (fenbendazole). Of the 20% of owners/keepers who did not administer a dose intended to treat encysted small redworm and provided a response, 60% said they elected not to treat for encysted cyathostomins because of low egg counts and 23% said they elected not to treat because the horse looked in good condition. Almost 1 in 5 (18.3%) said they did not know about encysted small redworm (Fig. 8). These results suggest there is still a lack of understanding about appropriate anthelminthic use and about equine intestinal parasites which needs to be addressed through awareness campaigns and better engagement between owners/keepers and their veterinary practitioners.  The relatively small number of donkey returns (325; 181 in 2014) makes interpretation difficult; however, broadly similar trends were seen as in horses and ponies in all categories. Figures for NEHS 2015

Fig. 1. Number of horses kept or owned

Fig. 2. Where horses were kept Fig.3. Main activity

Fig.4. Age distribution of NEHS returns Fig. 5 Ranked prevalence of disease syndromes recorded in NEHS returns

Fig. 6. Fat score (body score) Fig. 7. Anthelminthics used to treat encysted cyathostomin larvae (winter 2014) Fig. 8. Reasons for not treating with anthelminthics