Infectious and Contagious Diseases in rabbits Claire Speight RVN, A1, Clinical Coach C&G Cert in Veterinary Nursing of Exotic Species

Abstract This online CPD lecture for Vet Nurses looks at infectious and contagious disease in rabbits. It discusses Myxomatosis, RVHD, E. cuniculi , Pasteurellosis ‘snuffles', Cheyletiella and ear mites and also biosecurity.

Learning Outcomes

 Knowledge of a range of different infectious and contagious disease in rabbits and their clinical signs and how they are transmitted  Knowledge of preventative health measures such as vaccination for these diseases  Confidence in nursing rabbits with these diseases

Notes

A contagious disease is one transmitted by physical contact, whereas an infectious one is transmitted via microorganisms in the air or water. In practice there is little or no difference in meaning between the two.

Focuses of the lecture:  Myxomatosis – Background, transmission, clinical signs, vaccination, sub-clinical myxomatosis in vaccinated rabbits and treatment v euthanasia)  Rabbit Viral Haemorrhagic Disease (RVHD) 1 and 2 – Background, transmission, clinical signs and vaccination)  E. Cuniculi – what is it, transmission, clinical signs, diagnosis, treatment and preventative measures)  Pasteurellosis ‘snuffles’ – what is it, diagnosis, differentials, treatment, long-term prognosis and prevention)  Cheyletiella – clinical signs and treatment  Ear mites – clinical signs, transmission and treatment)  Bio-security

Myxomatosis Background Myxomatosis was first recognised as a virus disease when it killed European rabbits in a laboratory in Montevideo, Uruguay in 1896. In 1950 it was introduced to Australia, where it slashed rabbit numbers from 600million to 100million. The disease was accidentally released in France in 1952 when a bacteriologist near Paris tried to rid his estate of rabbits and it eventually made its way to Britain. Myxomatosis almost wiped out the rabbit population when it first arrived in Britain in 1953. It was first identified in Edenbridge, Kent, it spread rapidly around the country, killing as many as 99 per cent of the 100million rabbits living wild at the time. The Ministry of Agriculture attempted to contain the outbreak but this proved impossible and it was allowed to run its course. Further outbreaks over the past 50 years have led to millions of deaths among wild and domestic rabbits. The outbreaks in 2000, 2005 and 2007 being particularly bad. The Pests Act of 1954 criminalised intentional transmission, but the disease remains at large.

Transmission Myxomatosis is spread by blood to blood transmission by biting insects (notably fleas and mosquitoes) carrying the Myxoma virus. Direct rabbit-to-rabbit spread via aerosol transmission can occur. Previously this was mainly seen in a French respiratory strain, but reports from the Autumn 2000 UK outbreak suggest that rabbit-to-rabbit transmission may be occur in the UK. Rabbits can contract Myxomatosis in the following ways:  Bites from mosquitoes or flea carting the Myxoma virus  Cheyletiella fur mites can also spread the virus  Rabbit to rabbit aerosol transmission from nasal secretions Transmission is more likely around:  Anywhere near standing water which will attract mosquitoes  Areas affected by outbreaks of myxomatosis in the wild or domestic rabbit population  Areas where wild rabbits mix with or live in close proximity to domestic rabbits  Unvaccinated rabbits in close proximity to each other (rescue centres, breeders, pet shops etc).

Clinical signs The clinical signs shown by the rabbit will depends upon the virus strain (viruses mutate), and the immune status of the rabbit. In the early stages a milky ocular discharge may be the only clinical sign. The genitals also then become swollen. The disease progresses to severe conjunctivitis which causes blindness and is accompanied by nodular swellings on the head, plus lumps on the body, pyrexia, lethargy, depression and anorexia. Excessive amounts of thick pus discharges from the nose and the eyes are often sealed shut. There are two forms of myxomatosis. The acute form is the classic disease with all of the above signs – rapidly progresses and death often occurs from an overwhelming bacteria respiratory infection 14 days after clinical signs. Normally seen in unvaccinated rabbits. Nodular myxomatosis mainly affects the sign, with the classic scabs on the nose and eyes. The rabbit often remains well and the classic symptoms don’t progress. The disease is normally self-limiting and many rabbits survive. This form is often seen in vaccinated rabbits, although they can get the acute form still.

Vaccination Domestic rabbits do not have any genetically based immunity against myxomatosis. If an unvaccinated pet rabbit catches myxomatosis, it will almost certainly die. Annual vaccination with the Nobivac Myxo-RHD vaccine is the only licensed product available within the UK and requires an annual booster. Vaccination by and large turns a fatal disease into one that is often treatable. After vaccination some rabbits may develop small scabs on their nose and eyes. This vaccine reaction is relatively common and may not require any treatment.

Other preventative measures Cats and dogs in the household must be treated regularly according to the manufacturer’s recommendation against fleas. Fly screening to protect against mosquitoes getting into the rabbits environment can be put up. Ponds and stagnant areas of water should be removed to stop mosquitoes from being attracted to the area. Wild rabbits should not be allowed to interact with domestic rabbits.

Separating infected rabbits There is often no right or wrong answer to this. If the infected rabbit is mixing with unvaccinated rabbits it is highly likely that they are also infected, however it is worth removing the unvaccinated rabbits to vaccinate them immediately and separate them out in case they are not already infected. If the infected rabbit is mixing with vaccinated rabbits then they are also likely to also be infected, but the vaccine should provide some immunity to the disease so separating them may be pointless.

Treatment verses euthanasia Treatment of unvaccinated rabbits with full blown myxomatosis is generally futile and prolongs their suffering. Unvaccinated rabbits are best euthanised to prevent further suffering. Vaccinated rabbits or those with less virulent strains can stand a good chance of recovery with intensive nursing care. Owners will need to be dedicated to caring for their rabbits for many weeks and possibly months. Rabbits need to have supportive treatment including: syringe feeding, fluid therapy via the most appropriate route, covering antibiotics to help prevent secondary infections, analgesia, prokinetic medication if the rabbit isn’t eating normally. They also need their personal hygiene looking after and may need their eyes and nose wiping of discharge regularly, scabs bathing, keeping them warm, comfortable and grooming them.

Rabbit Viral Haemorrhagic Disease (RVHD) 1 The virus was first discovered in China in 1984. It was initially a notifiable disease in the UK and is highly contagious. The virus doesn’t affect rabbits under 6 weeks of age – under 6 weeks of age rabbits seem to have resistance to the virus even if the parents aren’t vaccinated. The reason for this is unknown.

Transmission Objects contaminated by the virus such as clothing, shoes, and car and truck tyres can carry the virus around. Direct contact of a rabbit with an infected rabbit or the faeces of an infected rabbit. Contact with rabbit products such as fur, meat or wool from infected rabbits. Insects, birds, and animals such as rodents are known to spread the virus by acting as indirect hosts. They can transport the disease, for example, from an infected rabbit to an unaffected rabbit. Humans can spread the virus to their rabbits if they have been in contact with infected rabbits or in contact with objects contaminated by the virus, including faeces from an infected rabbit.

Clinical signs Clinical signs vary and RVHD1 kills rapidly – often the only clinical sign is a dead rabbit with some bloody discharge from the nose and/or rectum. If clinical signs are apparent they can include: loss of appetite, lethargy, pyrexia and spasms. Death occurs within 48 hours and the mortality rate is near 100%. Post-mortem is needed to confirm the cause of deaths (liver biopsy).

Vaccination and preventative measures The virus is hardy and at room temperature (68F) it can remain stable for 105 days. It resists freezing and at 39F can remain for 225 days. There is no cure for RVHD. The combination Nobivac Myxo-RHD vaccination, with an annual booster offers protection. Other preventative measures, such as those for myxomatosis should also be implemented. As the virus can be transmitted by objects, using the same bowls etc for each rabbit, using foot dips etc is a wise idea.

Rabbit Viral Haemorrhagic Disease 2 The virus was first recognised in France in 2010 and in Europe in rabbits who had been vaccinated against RVHD1. RVHD2 often goes by other names such as RVHD new variant or new variant. RVHD2 kills rabbits slower than RVHD1, typically lasting 5 days or more, rather than the 3-4 days maximum of RVHD1. The incubation period is 3-9 days rather than 1-4 days as seen with RVHD1. Young rabbits (those under 6 weeks of age) are not immune like they are to RVHD1. RVHD2 has a lower mortality rate and the exact rate is still unknown due to the strain being new, however different studies put it anywhere between 7-50% and on average around 20%.

Transmission Transmission is much the same as RVHD1. Rabbits in a group are often affected randomly, possibly according to breed or strain variations. This may just be coincidence due to the lower rate of mortality, or it could be that some strains or breeds are less susceptible than others. As clinical signs develop at a slower rate to RVHD1, the virus has longer to spread from rabbit to rabbit meaning the RVHD2 strain may end up killing more rabbits long-term than RVHD1.

Vaccination and preventative measures Nobivac Myxo-RHD vaccine offers little if any protection against the RVHD2 strain, but the vaccination is still important for Myxomatosis protection. The Rabbit Welfare Association and Fund, supported by Dr Richard Saunders have gained Special Import Certificates for several RVHD2 vaccines (also include cover for RVHD1), although due to demand stocks have been intermittent and some vaccines are now unavailable.

Filavac VHD K C + V: The vaccine is obtained on an SIC from the VMD. The vaccine originates from France and has no UK license. UK wholesalers Centaur, NVS and Henry Schein all stock the vaccine, which comes in single use vials. Stocks have been low and orders have often gone to back order due to the demand. Rabbits can be vaccinated from 10 weeks of age and require only an initial vaccination. High risk rabbits can be given from 4 weeks of age, but a second vaccination at 10 weeks is then needed. Boosters are recommended 6 monthly in high risk areas and situations (rescue centres, breeders etc) and 12 monthly in low risk areas (places where no reported cases of the virus have been recorded). The vaccine offers protection against RVHD1 and RVHD2 strains and a minimum of 2 weeks should be left between Nobivac Myxo-RHD vaccination since there have been no studies in using the vaccine concurrently.

Cunivak RHD: The vaccine is imported from Germany and ordered direct from the manufacturer. An SIC from the VMD must be obtained prior to ordering. The vaccine comes in single doses, 10 and 50 dose vials. The vaccine requires an initial vaccination and further vaccination after 3 weeks, then annual booster. It offers protection against RVHD1 and RVHD2 strains, but a 2 week gap between the vaccine and Nobivac Myxo-RHD must be left. The vaccine has no UK license. Currently due to demand the vaccine is unobtainable (August 2016).

Cunipravac RHD Variant: The vaccine has a Special Treatment Certificate (STC) and can be obtained from the VMD from Spain. It comes in multidose vials (10 x 10 doses of 40 dose vial), but not single dose vials. The vaccine is oil based so skin reactions much more likely. It requires an initial vaccination and further vaccination 6 weeks later and 6 monthly booster. Again there must be a 2 week gap between vaccination with Nobivac Myxo-RHD and the vaccine. The vaccine has no UK license. Indoor rabbits are thought to be safer but not risk free and all rabbits should be vaccinated with Nobivac Myxo-RHD and either Filavac, Cunivak or Cunipravac to offer full protection against Myxomatosis, RVHD1 and RVHD2. Outdoor rabbits and especially those in contact with wild rabbits are at a higher risk. Groups of rabbits which move around frequently (breeders, pet shops and rescue centres) are at the highest risk. Quarantine all new arrivals for at least 2 weeks to ensure they are not incubating the diseases. Foraging for weeds etc should be discouraged until several weeks after vaccination. Disinfectant foot dips, changes of clothes between rabbits will also help reduce the risks.

Encephalitozoon cuniculi Encephalitozoon Cuniculi (E. cuniculi) has been one of the hottest topics in rabbit health over the past few years. Up until 15 years ago it was virtually unrecognised as a cause of disease in pet rabbits. It was classified as a protozoan parasite that is spread by spores in the urine of infected rabbits. More recent research has attempted to reclassify it as a fungi. We know that E. cuniculi infection is very common in apparently healthy pet rabbits (a survey showed 52% of clinically healthy rabbits had been exposed to the parasite), and that it can cause a host of clinical symptoms. Cases have been reported in sheep, goats, dogs, cats, monkeys, guinea pigs, foxes, pigs and humans. It is a recognised zoonosis (disease which can be transmitted to humans), but the zoonotic risk seems to be negligible to healthy individuals observing basic hygiene.

Transmission A lot of rabbits are infected in the womb via the placenta (transplacental infection). The other route of infection is orally via ingestion of urine contaminated by E. cuniculi spores. One month after infection, a rabbit will start to shed spores in its urine. Shedding of spores continues for up to three months and possibly on and off for life. The spores are tough and remain in the environment for more than a month. When a rabbit is first infected, the parasite is absorbed from the intestines. Once inside the body, it heads off to other ‘target’ organs, especially the kidneys and brain, where it causes granulomas. These can be found in the kidneys of rabbits only a few months old. Granulomas may develop in other parts of the body, such as the liver, as well as in the brain. The infection may remain in a dormant phase for months, years or never cause the rabbit any problems throughout its life. Stress, either physical or psychological seems to be a major trigger factor in the infection becoming active and causing clinical signs.

Clinical signs A study (Keeble E.J and Shaw DJ, 2006) showed that approximately 52% of healthy rabbits in the UK carry the parasite, but many never show any clinical signs. If the rabbit is infected with E. cuniculi and showing clinical signs then it may exhibit any, some or all of the following caused by the lesions in the brain: • Hindlimb paresis (weakness of the hindlimbs) • Torticollis (head tilt) • Paralysis • Urinary incontinence and/or scalding • Tremors • Cataracts and lens-induced Uveitis • Collapse • Renal failure (Renal granulomas may lead to chronic renal failure with problems such as increasing thirst and weight loss) • Death However, many of these clinical signs can be associated with other disease processes, so a diagnosis is rarely made on clinical signs alone.

Diagnosis One of difficulties in trying to decide whether E. cuniculi is the cause of any specific problem is that every one of these problems has other possible causes and therefore a definite diagnosis is often not possible to be certain of by clinical signs alone. Antibodies to E. cuniculi can be detected on a blood test. Hence, a rabbit that has been infected to E cuniculi will produce antibodies that will produce a positive test. However, some rabbits appear to clear the infection completely and over time their blood test will become negative again. A negative result basically rules out E. cuniculi as the cause of the illness, but it is wise to repeat the bloods after 4 weeks to ensure the first blood sample wasn’t taken too early in the disease process as the rabbit may not have seroconverted and begun producing antibodies. If a second blood test is negative then this rules E. cuniculi out as the cause of disease. Some laboratories are now able to offer a more comprehensive test is to measure two stages of the antibodies, known as the IgG and IgM levels. The IgM level is the first to be produced after infection. This will begin to decrease as the IgG level increase, which is the long term response for immune status. Two blood samples 4 weeks apart should be taken so the results can be compared to look for a rising titre indicating active infection and a diagnosis of E. cuniculi. Problems arise as a rabbit could test positive for E. cuniculi but it may not be an active infection and the cause of the clinical signs which is why it is important to take comparative samples and not just a snap shot single sample. Some owners may wish to opt for treatment on clinical signs alone and see the response rather than waiting for blood results.

Treatment If a diagnosis of E. cuniculi is confirmed or strongly suspected then the standard treatment is with Fenbendazole (Panacur), once daily for 28 days at a dose rate of 20mg/kg. This aims to kill the parasite. However, the rabbits clinical signs may or may not improve, since the inflammation in the brain caused by the parasite may be irreversible. Depending upon the rabbits clinical symptoms, they may require syringe feeding, fluid therapy, prokinetic medication, antibiotics and analgesia to support them whilst the Fenbendazole treatment is implemented. All in contact rabbits should also be treated. It is also vitally important to stop the rabbit/s re-infecting themselves during the treatment. Routine cleaning of the rabbit’s accommodation with a cleaning disinfectant such as Anigene (previously Trigene) or Vanodine which claim to be effective against E. cuniculi is strongly advised. The dilution rates and cleaning protocol should be followed carefully to ensure safety and effective disinfectant.

Preventative measures Some individuals believe that treating rabbits every 3 months for 9 days dampens down a possible infection. Others argue that these rabbits may not even have the parasite, may never get any clinical signs or that after the 9 day course has finished they are no more protected than before the treatment course. This is something that all practices will have a protocol on. However there are times when the use of 9 day courses might be helpful: To reduce the risk of infection at that specific time, such as, around introductions for short periods of time e.g. for a mating. When bonding rabbits it is suggested to treat all rabbits involved in the bond with the longer 28 day course of Fenbendazole either before or during the bond. As aforementioned it is possible to also blood test first and only treat those rabbits that test positive, but if cost is an issue then it is to treat prophylactically on the assumption that either or both rabbits may be infected. Communal grazing is a poor idea as the urine will soak into the ground. Pairs of rabbits should have their own grazing area and boarding establishments should replace the turf between boarders or offer grass in trays that can be changed between rabbits.

Pasteurellosis Pasteurellosis is a blanket term for a number of infections, both localised and systemic. Most rabbits carry the bacterium sub-clinically with their nasal cavity with minimal or no clinical signs (up to 85% of rabbits). Pasteurella multocida is commonly found in the nasal cavity resulting in an asymptomatic chronic infection or in rhinitis. Occasionally the infection extends to other parts of the body leading to various clinical manifestations including pneumonia, conjunctivitis, otitis media, abscesses, genital tract infections and septicaemia. Triggers of disease include: pregnancy, lactation, overcrowding, bonding of another rabbit, loss of a companion, other illness that suppresses the immune system, nutritional deficiencies etc. The severity of the disease depends upon the immune status and the strain of Pasteurella involved. Snuffles’ is the term given to upper respiratory tract infections which normally manifest as a purulent discharge from the rabbits nose. Those rabbits affected will sneeze and cough and may have audible noise in their upper respiratory tract. It is a common health problem in rabbits affected by Pasteurella, and symptoms often persist despite treatment. Pasteurella isn’t the only cause of snuffles, but it is the one most people have heard of and refer to. Pneumonia can complicate snuffles in rabbits and some runny eyes in rabbits are due to Pasteurella, but there are many other causes too, including dental disease. Many abscesses in rabbits are also caused by Pasteurella. Rabbits are fastidiously clean animals and dislike the sensation of feeling dirty. Therefore rabbits will often wipe their nose, eyes and face with the inside of their forelegs, which will lead to matting of the fur on the side of the legs. This is a telltale sign that the rabbit has a runny nose and or eyes. If the bacterium travels to the eyes then conjunctivitis may be evident. It can also travel to the ears, causing infections and clinical signs that may include a head tilt, increased head shaking/scratching of the ears, rolling and circling and general disorientation. There are other diseases that can also be responsible for these clinical signs, as E. cuniculi.

Diagnosis It is important to get a definite diagnosis, so treatment can be appropriate and have the best chance of working. A deep nasal swab under sedation or anaesthesia can be taken for bacterial culture. Ideally the samples need to be taken prior to any antibiotic treatment being started, since this will alter the results. False negatives can also occur if the samples are not deep enough. The laboratory should be able to isolate the bacteria and identify which antibiotics the bacterium is sensitive too.

Differential diagnosis There are several other conditions that can cause clinical signs similar to those of pasteurellosis. Most importantly:  Dental disease - especially if the naso-lacrimal duct is occluded, as this will cause discharge from the eyes  Nasal foreign bodies – such as hay/grass seeds have been removed from rabbits noses. Commonly this would only result in discharge from one of the nasal cavities and discharge from both would be uncommon.  Other bacterium can be responsible, which include: Bordetella, Pseudomonas and Staphylococcus species.  E. cuniculi can be responsible for a host of clinical signs in rabbits, including; head tilt, paralysis, uveitis, fitting, urinary incontinence and sudden death.

Treatment The usual course of treatment for pasteurellosis is with antibiotics, which ideally are cited as being effective from a culture and sensitivity (C&S) test obtained from a deep nasal culture. The treatment course may be anything from 14-30 days, or longer in some cases. The use of antibiotics in rabbits is greatly compromised by their digestive tract. Rabbits rely on bacteria within their digestive system to digest food. Many antibiotics will ‘kill’ off this bacterium, leading to often fatal diarrhoea. Therefore sometimes the choice of antibiotic that would be indicated from a C&S is not appropriate to use in rabbits. Antibiotics commonly used include enrofloxacin (Baytril), ciprofloxacin, and Sulfamethoxazole and trimethoprim (Sulfatrim). Baytril and Sulfatrim are the only licensed antibiotics for rabbits and anything else must be used ‘off-license’ with the veterinary surgeon explaining the benefits and risks to the owner. Depocillin or duphapen injections have also been used and nebulising can help to clear the airways. It is always a wise idea to give the rabbit supportive treatment to prevent digestive upsets during antibiotic treatment. Where possible injectable antibiotics should be used over oral, as they will be better tolerated with fewer side effects.

Long-term prognosis With the appropriate treatment, in many cases the signs of the disease may disappear, but the bacteria are usually still present, only in smaller numbers. These may result in ‘flare ups’ of symptoms if the rabbit is placed under increased stress. Treatments are likely to need repeating and some rabbits may require prolonged treatment to try and get the symptoms under control. Ultimately some rabbits do not respond to treatment, especially if the disease process has become chronic. If these rabbits are unable to have a good enough quality of life, then euthanasia should be considered.

Prevention There are some things that owners can do to try and prevent their rabbit from getting Pasteurellosis symptoms, but these are likely to be limited. The most important thing to do is to obtain a healthy rabbit in the first place. Rabbits that sneeze, have runny eyes or nose are best avoided, and any that have shared these rabbits environments. However, as rabbits may show no clinical signs and develop symptoms later in life when exposed to increase stress, selecting a healthy looking rabbit is not full proof for preventing the disease. Boarding establishments and rescue centres are prime locations for the spread of disease.

Cheyletiella Commonly referred to as ‘walking dandruff. This is the most commonly encountered parasite found on rabbits. It is likely that all rabbits sub-clinically carry some cheyletiella and their immune system naturally keeps the numbers in check. When this balance is interrupted or compromised for another reason, such as illness, excessive stress etc, the parasite can multiply and begin to cause clinical signs.

Clinical signs The classic clinical signs is the white flecks of dandruff which if observed closely can often be seen moving or easily diagnosed on tape impression. The owner may have itchy patches of skin, since the condition is zoonotic. The rabbit may have bald patches and be itchy and in extreme cases the rabbit may begin to self-harm and become agitated and even start seizuring due to the constant irritation.

Treatment Products containing Ivermectin are required in order to kill off the parasite. These can be administered via topical solutions or injections, given at weekly intervals for 3-4 applications. The rabbits accommodation needs to be cleaned thoroughly after each treatment. House rabbits should have their bedding cleaned and all in contact rabbits require treatment.

Ear mites Psoroptes cuniculi. The mites irritate the lining of the ear which causes oozing serum and thick crusts to accumulate within the ear canal. Lesions can spread to the face and neck and perforate through the eardrum leading to middle ear disease.

Clinical signs and transmission In the early stages it may not be obvious. The rabbit will shake their head and scratch at their ears more than normal. As the disease process progresses and is allowed to become severe, the rabbit may develop a head tilt and nystagmus. Rabbits can suffer from weight loss and anorexia due to the stress of the constant itching. The condition is highly contagious from rabbit to rabbit and mites will be shaken out of the rabbits ears and into the environment for other rabbits to infect themselves.

Treatment Treatment is aimed at killing the mites and reducing the inflammation in the ears. It should never be attempted to remove the crusts and scabs from the ears as these are incredibly painful and will only lead to further infection and inflammation. Ivermectin is generally the choice is treatments – repeated every 7 -10 days for as many treatments as necessary. Selamectin (Stronghold) has been used in rabbits but care must be taken as the product is not licensed for use on rabbits. Analgesia is nearly always required except in the mildest of cases. Once the mites are died the scabs and crusts will naturally dry up and fall off. All in contact rabbits must be treated even if they are not showing signs of disease.

Bio-security Hugely important to prevent hospital acquired infections and spread of any infectious diseases. Problems occur in rabbits as many rabbits carry infectious diseases subclinically and may show no or little symptoms and therefore be deemed to be not infectious. With most rabbits carrying Pasteurella and/or E. cuniculi in truth most rabbits are likely to be infectious. Rabbit or exotic wards are fabulous from a species nursing care point of view but a nightmare with regards to the possibility of infectious disease spread.

Biosecurity has a two pronged approach: • Bio-exclusion – Keeping infectious organisms from entering a facility or population • Bio-containment – Keeping infectious organisms from leaving a facility or population Both of these are applied to the veterinary practice. We need to ensure that infectious diseases are identified at the earliest stage so they can be prevented from entering the hospital environment and for those infectious patients that are admitted the infections needs to be contained.

Veterinary staff should follow NHS staff and be ‘Naked below the elbows’ – no watches, bracelets, rings etc – all of these have the potential to harbour bacteria and could spread disease. The WHO hand wash should be implemented between contact with patients, especially same species or those known or suspected to be infectious. If in doubt assume a rabbit is infectious to others.

Do a risk assessment: • Is the rabbit showing outwards signs of disease? (sneezing, head tilt/nystagmus, discharge from the eyes, diarrhoea, urine scalding/incontinence) etc • Has the client reported concerns? Never ignore these • Is there an area the rabbit can be hospitalised away from all other rabbits • Can one nurse be assigned to nurse the rabbit who will have nothing to do with other rabbits/clients?

Barrier nursing and reverse barrier nursing: Works if the pathogen isn’t airborne – ok for E. cuniculi and cheyletiella but would be unsuitable for Pasteurella and potentially RVHD1 and 2 which could be transmitted via the air. It is difficult to do properly and thoroughly in a busy veterinary practice. Segregate the area off, use all available PPE (gloves, mask, hat, arm covers, apron, shoe covers etc). Everything must stay within the designated area – separate bin for all PPE. Shoe dip and hand gel to be used before exiting area.

Sources of infection: ET tubes and V-gel airway devices and prime sources for spread of pasteurellosis. V-gels must always be autoclaved on a 121c setting between patients. ET tubes are designed to be single use – although this is rarely, if ever the case in veterinary medicine.

Prevention of disease spread involves: • Using disinfectants at the correct dilution, for the correct contact time – remove inanimate objects prior to using • Wear PPE (gloves, aprons, masks, shoe covers, masks etc) where appropriate • Correct hand washing • No watches, rings or bracelets • Correct cleaning of bowls, bedding, etc – water bottles should ideally be avoided as they are impossible to clean properly between patients (ask owners to bring their own in if necessary) • Correct barrier nursing/isolation nursing where necessary.