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Feline herpesvirus
Table of contents
1. Aetiology.......................................................................................................... 338
2. Pathogenesis...................................................................................................... 338
3. Epidemiology .................................................................................................... 339
4. Clinical signs..................................................................................................... 341
5. Treatment ......................................................................................................... 342
6. Diagnosis.......................................................................................................... 343
7. Immunity.......................................................................................................... 344
8. Vaccination ....................................................................................................... 344
9. Disease control .................................................................................................. 346
9.1. Household cats ........................................................................................... 346
9.2. Boarding catteries ....................................................................................... 346
9.3. Shelter facilities.......................................................................................... 347
9.4. Breeding catteries ....................................................................................... 347
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utensils, and personnel. However, because shedding during lactation is an ideal mech
FeHV-1 is relatively short-lived outside the anism for the virus to pass into the next
cat, the environment is usually not a long generation of susceptible kittens. Whether
term source of infection. Aerosols are not the kittens develop disease depends on
thought to be of major importance for the their levels of maternally derived antibody
spread of FeHV-1: cats do not appear to (MDA), but in some cases, kittens may be
produce an infectious aerosol for these infected subclinically from their dam and
agents during normal respiration, although become latent carriers under the protection
sneezed macrodroplets may transmit infec of MDA [34].
tion over a distance of 1–2 m [34, 105]. The mechanism of stress-induced vi ral
As with other alphaherpesviruses, virtu reactivation is not clear. Whatever the
ally all recovered cats become latently in event or series of events that lead to the
fected carriers, with intermittent episodes presence of detectable virus however, it
of detectable virus shedding (reactiva tion) seems probable that the immune response
occurring particularly after periods plays a role in determining the duration
of stress. During such episodes infectious of the shedding episode. Interestingly, in
The virus is present in oronasal and studies of cats in which FeHV-1 reacti vated
conjunctival secretions, acting as a source after the natural stress of re-housing,
of infec tion to other cats [ 29 , 30 ]. it was found that cats that did shed virus
Viral reactivation may occur sponta (i) had experienced significantly more se
neously but is most likely after stress, for vere primary disease than those that did
example, moving a cat into a boarding not; (ii) had a significantly greater ‘stress’
cattery, to a cat show, or to stud [39]. Ex response (i.e. loss of appetite and nervous
perimentally, the spontaneous viral shed withdrawal) to re-housing than those that
ding rate in clinically recovered carrier cats did not shed; and (iii) had a trend to wards
as assessed using virus isolation is about lower mean serum antibody levels
1%; corticosteroid treatment may induce (as assessed by antibody/complement lytic
shedding in approximately 70% of cats, a capacity) prior to re-housing compared to
change of housing in 18%, and lactation the non-shedder cats [36,40]. There is also
in 40% [23, 30, 34]. Episodes of detectable some evidence of a refractory period after
virus shedding do not immediately follow an episode of viral reactivation when ani
the stress. A lag phase of 4–11 days (mean mals are less likely to shed [29, 30, 80].
7.2 days) precedes the shedding of infec It is probable that, as in other alphaher
tious virus, which ranges in duration from pesvirus infections, virtually all clinically
1–13 days (mean 6.5 days) [29, 30]. In recovered cats are carriers. However, less
some cases, carriers show recrudescence of than half of these are likely to be of epi
mild clinical signs while they are shedding, demiological importance, i.e. shed virus
which can be a useful indicator that they under natural conditions, and even then,
are likely to be infectious [39]. transmission to susceptible animals is not
In practical terms this means that if necessarily easily achieved [30, 34]. More
a cat experiences a stress, such as going recent studies using PCR, including real
into a boarding cattery, then it is likely time PCR, have shown a higher sensitivity
to shed infectious virus in the 3-week pe riod for detecting carriers, with a more pro longed
following this event. This tendency of presence of viral DNA in the secre tions of
the virus to reactivate when the cat moves infected cats [8, 45, 83, 111, 125,
into a different environment obviously con 131, 141, 146, 147]. Whilst such molecular
fers a useful biological advantage in terms techniques help identify carriers, the epi
of transmission to new hosts. Similarly, demiological significance of cats in which
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viral genome can be detected by PCR, but sion, marked sneezing, inappetence, and
from which infectious virus cannot be iso lated pyrexia, followed rapidly by serous ocular
is not clear, as transmission studies and nasal discharges [15, 39, 56]. These
have not been performed. Although PCR initial clinical signs may be accompanied
is more sensitive than virus isolation, it by excessive salivation with drooling.
has also been shown that the published Conjunctivitis, sometimes with severe
techniques vary considerably in sensitiv ity hyperemia and chemosis, typically de velops,
[83]. Further, as FeHV-1 can be shed and there are copious oculonasal
by clinically normal cats as well as dis eased discharges. These gradually become
animals, a higher detection rate does mucopurulent, and crusting of the external
not necessarily correlate with disease cau nares and eyelids can occur. In severe
sation. cases dyspnoea and coughing may also
These experimental studies on the ef fects develop. Oral ulceration can occur with
of stress associated with re-housing FeHV-1 infection but is relatively un common
on inducing virus reactivation and shed ding compared to feline calicivirus
have also been translated to the field. (FCV) infection, the other main cause
In one study, 3 of 75 cats monitored over of viral respiratory disease in cats [39].
a one month period reactivated virus 9– Occasionally, generalized infections and
12 days after entering a boarding cattery, primary viral pneumonia may occur, par
and showed mild clinical signs [36]. In two ticularly in young or debilitated animals
more recent studies in shelter cats, FeHV-1 [74, 119, 122, 139]. Neurological signs
shedding rose markedly approximately one have been described, but appear to be a
week after admission [1, 104], and al though very rare sequel to infection [31].
some of this may have been from
Although abortion may be associated
cross-infection, it is likely that reactivat ing
with other alphaherpesvirus infections, ex
carriers were contributing significantly
perimental studies have suggested that in
to these increased shedding rates. Sev eral
cats infected with FeHV-1, abortion is most
epidemiological studies have found
a number of risk factors associated with likely due to the severe systemic effects of
the illness, rather than a direct effect of the
FeHV-1 shedding, including contact with
virus itself [58]. Indeed, in an investigation
other cats, the presence of upper respira tory
of a natural outbreak of FeHV-1 infection
disease, younger cats, poor hygiene,
in specific pathogen free cats, no cases of
and larger households; in contrast, vacci
abortion were seen, even in severely af fected
nation is associated with a negative (i.e.
pregnant queens [53].
protective) effect against viral shedding [3,
51, 132]. Involvement of FeHV-1 in conjunctivi tis
and in some cases, ulcerative keratitis,
has long been known [4], but improved
4. CLINICAL SIGNS viral detection using PCR has led to in creased
recognition of this role in the acute
FeHV-1 infection generally causes se vere disease, and also in more chronic ocular le
upper respiratory disease in suscepti ble sions such as stromal keratitis[95,124,125,
animals. The incubation period is usu ally 2 to 128, 142]. The role of FeHV-1 in other oc ular
6 days but may be longer, and conditions such as corneal sequestrae,
disease signs may be milder, with lower eosinophilic keratitis, uveitis and kerato
levels of challenge virus [33]. conjunctivitis dry is however less clear
In both experimental and natural and needs further evaluation [78, 97, 124,
infections, early signs include depres 128, 142].
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Skin ulcers have been reported in the cidofovir appear to have greater efficacy in
past with FeHV-1 in domestic cats and vitro against FeHV-1, and may prove to be
also in cheetahs [26,63,65]. More recently, useful clinically [81, 114, 138].
an ulcerative facial and nasal dermatitis The current treatment of FeHV-1 ker atitis
and stomatitis syndrome characterized by is therefore based on the topical use
eosinophilic infiltration, which is occasion ally of nucleoside analogues. Trifluridine, idox
persistent, has been described in a uridine, vidarabine, and to a lesser extent
series of cats [49, 50], with a similar syn acyclovir have all been suggested as pos
drome also being reported in cheetahs [91]. sible topical treatments for FeHV-1 ocular
The role of FeHV-1 and the utility of PCR disease, though efficacy is difficult to as sess
in the diagnosis of herpetic dermatitis has in the absence of large-scale clinical
recently been shown by Holland et al. [55]. trials [13, 123, 128]. Although acyclovir is
A possible role for FeHV-1 in chronic less efficacious in vitro than vidarabine,
gingivostomatitis in cats has also recently idoxuridine, and trifluridine [92], in some
been suggested, on the basis of a relatively countries it may be the most readily avail
high viral isolation rate from cases com pared able, and may have some beneficial effect
to controls [73]. However a similar on FeHV-1-induced conjunctivitis and ker
number of cats were also shedding FCV, atitis when applied frequently [152].
and previous studies have generally de In vitro studies have shown that FeHV-1
tected FCV rather than FeHV-1 from cats is susceptible to feline interferon (IFN) or
with this syndrome [66,110,133,136,145]. recombinant human IFN-alpha, and that
Because of the propensity of FeHV-1 to the effect of acyclovir and recombinant hu
replicate in the turbinates during the acute man IFN-alpha is synergistic [27,115,148].
phase of disease, and in the early stages of Although the authors are aware of no data
reactivation, a role for FeHV-1 in chronic from controlled clinical trials, it has been
rhinitis has also been considered. However suggested that interferon may be useful
a recent study has found no difference in for cats with either acute respiratory her
detection rates between a small number of pesvirus infection, or ocular disease [13,
cases and controls [61] (see Section 2). 128]. Feline omega interferon is now regis
tered in Europe as an antiviral drug against
feline leukemia and feline immunodefi ciency
5. TREATMENT
viruses [19]. Some clinicians are
Numerous nucleoside analogs have starting to use this to treat FeHV-1 kerati tis,
been developed with activity against hu man but as yet no controlled trials have been
herpesviruses, mainly herpes sim plex and undertaken.
varicella-zoster viruses. Several The effect of L-lysine on FeHV-1 repli
of these compounds have been also tested cation has recently been explored both
against FeHV-1, largely in vitro, though in vitro and in experimental cat stud ies [79,
some limited clinical and experimental cat 80, 127]. L-lysine is an antago nist of arginine,
studies have been carried out. Acyclovir, which has been shown
which is widely used in human medicine, to be essential for human herpes simplex
does not seem to have good activity in virus and FeHV-1 replication [80]. Treat ment
vitro against FeHV-1 [81,92,138,148,152] with L-lysine therefore decreases vi ral
and both acyclovir and the acyclovir pro drug proteosynthesis and has been shown
valacyclovir, are too toxic at thera peutic to have some inhibitory effect against
levels for oral administration to cats both human herpesvirus and FeHV-1 infec
[96,102,126]. However, a number of other tion. Oral supplementation with L-lysine
antiviral agents such as ganciclovir and reduces the severity of experimentally-
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induced FeHV-1 conjunctivitis when ad conjunctival signs than other feline respi
ministered prior to primary infection [127] ratory pathogens, but where specific diag
and the number of shedding episodes asso nosis is required, laboratory tests should be
ciated with reactivation of latent infection carried out for confirmation.
induced by re-housing [80]. It may there fore Although FeHV-1 is shed in oropha
be of use early in acute disease or as ryngeal, conjunctival and nasal secretions,
a means of reducing the severity of disease unless ocular disease is specifically be ing
and virus shed at times of stress: suggested investigated, oropharyngeal swabs are
dosage regimens are described elsewhere generally used for diagnosis. Traditionally
[82, 128]. There is evidence that dietary such swabs are placed in viral transport
lysine supplementation is not effective in medium and inoculated into feline cell
groups of cats and that maybe bolus admin cultures where the presence of FeHV-1
istration is essential [84]. Bovine lactofer rin can be identified by its characteristic cyto
has shown some in vitro activity most pathic effect. Immunofluorescence, partic
likely by preventing attachment and pene ularly of conjunctival smears, has also been
tration of FeHV-1 into susceptible cells [2], used [9, 125].
but in vivo efficacy has not yet been evalu In many laboratories PCR is now be ing
ated. used rather than culture. PCR, which
The use of broad-spectrum antibiotic targets specific regions of the genome,
therapy is advocated to help control sec demonstrates that viral DNA is present in
ondary bacterial infection in cases of acute the swab, rather than the presence of infec
upper respiratory tract disease. Cats should tious virus. PCR is generally more sensi tive
be reexamined after 4 to 5 days and, if nec than virus isolation, detecting virus for
essary, bacterial culture and susceptibility longer in the acute stages of the disease,
tests performed. Good nursing care is es and in more chronic stages [124, 125, 131,
sential, and in milder cases is generally 141, 146]. However, a comparison of the
best given at home by the owner. Affected various PCR tests available does show con
cats should be encouraged to eat by of siderable differences in sensitivity between
fering strongly flavored aromatic foods. If the published tests [83].
eating is painful, baby foods or specialized Interpretation of the clinical relevance
proprietary or blended food may be help ful. of detecting virus in a cat either by isola tion
Severe cases may require hospitaliza tion or by PCR can be problematic [39,83].
and fluid therapy, and when anorexia If cats are showing characteristic clinical
is prolonged a nasogastric or gastrotomy signs of acute FeHV-1 induced-disease, a
tube may be indicated. Nasal deconges positive sample can strongly support the
tants (e.g., phenylephrine) in the acute diagnosis, particularly where cats are pos
phase and mucolytic drugs (e.g., bromhex itive by virus isolation as well as by PCR.
ine hydrochloride) in the more chronic However, since virtually all clinically re
phase have been suggested to help clear covered cats become latent viral carriers
airways, but conventional steam inhalation which intermittently may shed virus, it is
(e.g., placing the cat in steamy room) or always possible that a positive result is an
nebulizing saline may also be useful. incidental finding unrelated to any present
ing clinical signs, or is a result of the stress
6. DIAGNOSIS from another disease or other process. In
an epidemiological context, however, any
Diagnosis may be based initially on positive result indicates that the cat has
clinical signs. FeHV-1 generally induces been infected with FeHV-1, and as such is
more severe upper respiratory tract and likely to be a carrier with the potential to
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Cattery owners should not rely on vac to disease-free households is from stud cats
cination alone for disease control, because and new breeding stock when exposure is
pathogens will inevitably be present either prolonged.
from the occasional cat incubating disease Cats entering a disease-free colony
or from reactivating carriers. Thus, mea should be quarantined for three weeks to
sures should be taken to prevent spread of identify animals incubating the disease.
infection and reduce the concentration of Swabs should be collected from each cat at
infectious agents in the environment [39]. least twice a week during this time, and
Such measures may appear complicated, evaluated for the presence of FeHV-1.
but in practice they are not difficult to If possible, PCR should be used rather than
implement and, in our experience, can ac virus isolation, because of the for mer’s
tually increase efficiency within a cattery. greater sensitivity. However, even with
negative results, there is still the risk of
importing a latent FeHV-1 carrier that may
9.3. Shelter facilities subsequently be a source of infection.
In breeding colonies where the disease
In general, the same management mea is endemic, it is difficult to achieve or
sures apply as with boarding catteries. maintain virus free status. For most situ
Since the immune status of the cats in a ations, the only reasonable course is to at
rescue shelter is often unknown, in-coming tempt disease control, largely by ensuring
animals should be quarantined and iso lated queens are regularly vaccinated, reducing
from others. Those with clinical signs should stress, isolating queens and their kittens,
be kept apart from clinically normal animals. and considering early weaning kittens into
Unless animals can be isolated on arrival isolation or initiating kitten vaccination at an
for 3 to 4 weeks, parenteral vaccines may earlier age [18, 39]. In some cases, it may
not have time to become effective. In these be necessary to reduce the number of cats
circumstances, it may be advisable to use in the colony.
the intranasal vaccines if available; otherwise
MLV injectable vaccines are ad vocated.
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