Outbreak

This post will explain why I stopped blogging so many months ago. Daily existence became difficult in the month before I left Japan the first time. Writing on the internet was a luxury I didn't have time for. This post will also explain why I've restarted blogging. I don't want the animals that we lost to be forgotten. I also want to pass on knowledge gained to help others dealing with Feline Panleukopenia. 

 

On Friday July 1 some of my favorite people came to visit Club LOHAS! Jim and Eija came from Tokyo/Yokota to help out by bringing human food and some other supplies. They were excited to come with me to Namie to continue scouting for more hungry cats to pick up. We headed out early that day for the exclusion zone, but it was overcast and there weren't many cats out. We went to the chicken coop to check on our girls and as we were filling up water buckets a local whom I had met before, Takahashi san, came to see us. He invited us for coffee and we followed him up to his house. He told us that a woman, Matsudaira san, in a neighboring town was taking care of many cats that had been left behind. He asked us to come with him to meet her to see how we could work together. 

We piled into the van and drove to meet Matsudaira san. She is a very kind older woman with a large family that lives in a modest house together. There are probably twice as many animals as people in there. She had recently found some kittens that she was concerned about. We promised to return a few days later with big bags of cat and dog food and some dewormer. It was quite late by the time we made it back to Inawashiro. 

As we were unloading, one of the volunteers that we had left behind to mind the shelter informed me that the black kitten, Shane, was lethargic and needed help. I sprinted to Room A where another volunteer was cuddling with him on a futon. I did a quick assessment and noted that he was super dehydrated, anemic, and nonresponsive. I started administering subcutaneous fluids and gave him oral glucose while preparing a handwarmer to heat him up. I was moving so fast I didn't have time to process what was going on. He perked up briefly after I finished the drip and I was starting to have hope that he would make it. He purred and cuddled, but quickly went limp again. In less than a half an hour he was gone. I didn't even have a stethoscope to confirm so I had to hold his little body up to my ear and pray for a heartbeat. After several minutes of watching for breaths (none came) and pinching toes and testing pupils it was clear that he was gone for good. I wrapped him up and put him in the freezer for a burial the next day. 

Then we started investigating why a kitten who had been healthy for weeks, who had received a vaccination at 7 weeks and was due for another in a few days time, who had never had any problems other than intestinal parasites had died so suddenly. There was a small amount of vomit around his mouth and in the cage. It was bile yellow. He was dehydrated and anemic. I talked with Susan on the phone (she and Selena were both gone for the weekend to their respective jobs) and we suspected toxicity. We had a new pine litter that had been donated and were worried that he had eaten some. All of the other kittens housed in the cage with him were fine so it seemed like the only reasonable explanation.

By the next morning it was clear that it wasn't toxicity. Another kitten, Camille the calico from hokenjo, was vomiting and lethargic. Eija and I immediately took her to Ami Pet Clinic all the way in Koriyama. We also brought Shane's body along in case a necropsy could be performed. Ami was at a loss as to why Camille, a healthy 4 month old kitten was doing so poorly. I consulted with Susan on the phone again and she said I had to have him check for parvo. 

 

 

Feline panleukopenia virus is a parvovirus related to canine parvovirus. FPV is a highly contagious and frequently fatal disease. It attacks the intestinal lining causing ulceration and causes a dramatic decrease in white blood cell count which compromises the immune system. The symptoms include lethargy, inappetance, vomiting, dehydration, and (usually lastly) bloody diarrhea. FPV can live in the environment for over a year and is transmitted directly between cats, through bedding, and through the clothes and shoes of people caring for sick cats. The death rate for kittens under 2 months is 95% even if they receive treatment, older kittens 60-70% with treatment and nearly 100% without treatment, adult cats have a 10-20% mortality rate with treatment and 85% without treatment (numbers from Wikipedia). Most cats die from secondary infection and dehydration associated with panleukopenia. 

I hadn't actually ever encountered FPV at the vet clinics where I had worked since everyone vaccinates their cats at clinics. I'd heard about it spoken in whispers at the two county animal controls where I had volunteered. Only once had I actually seen a panleukopenia outbreak. One day I went to take pictures of all of the cats at Wake County Animal Shelter to be posted online. The next day I went back because I'd run out of time to take pictures of all of them. I entered the cat room and virtually all of the cats were gone. They had euthanized all of them because they suspected panleukopenia. 

 

 

Camille tested positive for panleukopenia (though in Japan they just call it parvo). Ami sensei ran a CBC and her white blood cell count was almost zero. I had a bit of a breakdown. I cried, the vet techs working at the clinic cried, Camille lay on the exam table barely moving. Ami agreed to keep her and do what he could, but he wasn't hopeful. Eija and I realized that we now had 32 cats in danger of dying. They were all in one room together in cages. People had been letting the kittens out to play. We were in no way prepared to deal with an outbreak like this. 

We rushed back to Club LOHAS and discovered that the volunteers had moved the cats out onto the balcony in their cages. I was baffled and appalled realizing that now the balcony was probably covered in parvo and we wouldn't be able to walk on it without tracking the virus everywhere. It was the worst possible situation. I called Selena's uncle, a vet, and asked for his advice. He told us to sanitize and build an enclosure outside. Not knowing wat else to do...we go to it. Selena's dad and Jim put up a bunch of plywood and the rest of us bleached everything we could. It took all day.

While everyone else was cleaning cages, I was transferring cats into carriers so that their cages could be cleaned. I was down to the last cat, Edmund. I had somehow managed to get them all into carriers without scratches or bites. Edmund, however, was not ok with being stuffed into a small carrier. He bolted the second I opened the door. Remember, the cages had been moved onto the balcony. I hadn't wanted to move them inside because I felt this would just spread more virus and potentially infect more cats. Edmund leapt off of the balcony and dashed into the woods. I sprinted down the stairs and yelled for help, but none of us were fast enough to catch him. We left traps out for weeks, but to no avail. I broke down again and laid in the parking lot. It seemed so hopeless. 

The kittens we moved into Room A since we knew that they had all been exposed and it was just a matter of time before they exhibited symptoms. There were 10 kittens in total (not including Shane and Camille). Everytime I looked at them I started crying. We had been caring for these kittens for a month. Five of them had come to us close to feral and we'd rehabilitated them to like people. 

Susan came back that night and had procured Tamiflu. I'd heard very mixed things about using Tamiflu to treat parvo, but didn't see anything else that could be done. We went ahead and started dosing all of the cats with a protocol created by an American veterinarian. 

On Sunday July 3rd Eija and I went to Koriyama to see how Camille was faring and to bring her Tamiflu. Selena had to go with two volunteers to pick up the Hello Shop owner's dog, Mari. 

Camille was still lethargic and not eating or drinking, though her vomiting had subsided. It appeared to me that Ami sensei was only giving her subcutaneous fluids and I explained that we needed him to give the fluids intravenously. We left the Tamiflu for him to use on Camille and returned to Club LOHAS. 

In the meantime, Susan had been desperately searching for a clinic that could take all of our kittens (now 5 were showing symptoms) and give proper care in an ICU setting. She found a vet who would take them and so I set out with all 10 of them. We met Selena at Asaka pet clinic. While she had been in the field picking up Mari the police had stopped and asked for her help. They had found 3 kittens in a box in the woods that were starving to death. Selena knew that she couldn't bring them back to Inawashiro so she took them straight to the vet. One died on the way. The other two had maggots around their anuses, but were otherwise ok after some fluids and food. They were set up in an incubator by the time I arrived with the parvo exposed kittens. 

Asaka sensei ran CBCs on all of the kittens. Four of them had deadly low WBCs (Dylan, Henry, Willie, and Anton) and he agreed to keep them in isolation, run IV fluids, and give Tamiflu (though he'd never given it before and doubted it could help kittens with WBCs in the 400s). The rest of the kittens we took home and treated ourselves with Tamiflu and subcutaneous fluids. 

The next day we learned that Camille (at Ami) and Henry (at Asaka) had both passed.

The rest of that week is a blur to me. I remember visiting the three boy kittens and two new kittens at Asaka a couple of times, but mostly I remember mixing and administering Tamiflu hundreds of times and giving subcutaneous fluids constantly. Susan and I would stay up until 2 and 3 am treating the cats and praying that the next day would be better. But each day it seemed a new cat became ill, another kitten needed fluids. It was beyond exhausting. 

The two kittens that Selena had picked up in Namie were transferred to foster at Sylvia's the next weekend. She named them Blue and Maxie. 

Blue (orange and white tabby) and Maxie. 

 

We thought that since they had been boarded at the vet clinic and never even came near Inawashiro that they would be fine. Within a day of getting to Sylvia's they had both exhibited symptoms of parvo. I know that this was because of poor sanitizing practices at Asaka pet clinic. Later I saw him touch a parvo infected kitten with his bare hands and then immediately grab things from drawers. Yet again, another example of how difficult it is to find decent vets here. Maxie passed away because Sylvia had terrible luck with vets even in Tokyo. She was turned away from some and others refused to do IV drips and give Tamiflu. Maxie went half a day without treatment.

A week later the three kittens of Naomi's came down with parvo, as well. We took them immediately to Asaka pet clinic (this was before I noticed his terrible sanitation procedures) and the orange boy of the litter, Terrence, passed away, but Cleo, Prissy, and Naomi survived. 

Parvo survivors: Naomi, Prissy, Cleo, and Blue.

 

Ultimately we lost 5 kittens to parvo during those 2 weeks. Shane, Camille, Henry, Terrence and Maxie. However, these are truly amazing statistics. That is 5 kittens out of 35 cats and kittens. Even with treatment we probably should have lost 15-20. We can only attribute this to the Tamiflu and I know that if I ever encounter panleukopenia in the future I will use it. We found that with administration of Tamiflu within hours of a cat becoming symptomatic, we saved their lives. The only kitten that died with Tamiflu given in a timely manner was Henry. 

 

Our Protocol

For those interested, we used the Tamiflu protocol established by Dr. Jack Broadhurst. This includes starting the use of Tamiflu as soon as the first symptom presents. For us, the first symptom (but also the most commonly missed) was inappetance. This was then followed by vomiting (bile yellow), then dehydration, and the stereotypical bloody diarrhea rarely happened and when it did was only at the very end of the terminal cases. Don't rely on blood diarrhea to be the determining symptom for panleukopenia! I am now always suspicious when a cat that previously ate well turns up its nose at food. 

In addition to Tamiflu, we gave once daily injectable Baytril, once daily Cerenia injections to control vomiting, and subcutaneous fluids twice daily. We would have given fluids intravenously, but didn't have the equipment necessary to do so. Intravenously is always a better option than subcutaneously for panleukopenia cats. We also would have given intravenous glucose and vitamin injections if we had had the capacity to do so. 

We had several cases in which we would treat the cat or kitten for days. Vomiting and diarrhea would stop, but they would continue to not eat or drink. In these cases we began force feeding after 3 days. You shouldn't ever force feed a cat in the throes of panleukopenia but 3 days after becoming symptomatic is a long time to go without food. We figured that it was more important to stave off anemia and hypoglycemia than to worry about diarrhea. 

A few more notes, canine parvo tests DO work to diagnose panleukopenia. A negative can be a false negative (though we never had this happen), but a positive is never a false positive. We ended up using Virkon to disinfect as it kills FPV faster than bleach without the terrible smell.  In lab tests it was shown that cats who had had panleukopenia would shed it for up to 43 days. Thus, the standard is that a cat who has had FPL should be isolated from healthy cats for 6 weeks or else they can pass the virus to the healthy cats. FPV dose is important. Feline panleukopenia virus is all over in nature. However, cats generally only contract panleuk when they are in an area with a high concentration of the virus such as a barn or shelter. This is why it's important to isolate sick cats from the ones that aren't currently exhibiting symptoms, even if you know the "healthy" (asymptomatic) one has been exposed. The "healthy" one will likely have a worse case of panleuk if you allow it to mingle with the symptomatic one because it will be constantly stepping in the vomit, feces, etc of the sick one exposing it to vastly more amounts of the virus. 

 

The two weeks following the panleukopenia outbreak were two of the worst weeks in my life. I hope that no one I know has to experience it and that I never have to experience it again. Vaccinate your cats (and your neighbors! and the ferals in your neighborhood! and any cat you come across!)

Comments

[Adrienne Usher]

Thank you, Alex, for everything you've done, you're doing, and will do for the animals in Japan. Even tho we've never met, I'm proud to know of someone like you!

[Lisa Forrest]

I too thank you for your work helping those innocent animals in Japan. I missed your blog and am glad you are back and ok.
To me you are my hero!