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Small Ruminant Integrated

Parasite Control
FAMACHA©
and Smart Drenching
Southern Consortium for Small Ruminant
Parasite Control
Topics
• The problem
• The parasites; where we are and why
• Biology of important GI Parasites
• Dewormers – a quick review
• What can we do?
– “Smart Drenching”
– FAMACHA
The Big Problem facing
producers
• Anthelmintic (dewormer) resistance is
considered a major threat to the
current and future control of parasites
of ruminants and horses
– Worldwide phenomena
– The prevalence of multi-drug resistant
worms is extremely high in many areas
of the world
What is “Resistance”?
• The ability of certain worms in a population to
survive drug treatments that are generally
effective against the same worm species and
stage of infection
– Caused by changes in levels of “resistance”
genes carried by worms in a population
– Result of drug treatment that produces genetic
selection of resistant worms in a population of
worms
Dewormer Resistance
History of the Problem
• Age of modern dewormers
– Effective, broad-spectrum, cheap, safe
• Over-reliance on dewormers
– Addiction to drugs, improper use of dewormers
– Loss of common sense approaches
– Belief there will always be a new drug
• No new drug classes introduced since 1981
– We have what we have !!!!
• New anthelmintic announced by Novartis in 2007, but
will not be available for many years to come
Where Do Resistant
Worms Come From ??
• Resistance is an inevitable consequence of using any particular drug
to kill worms
– “Resistant” worms – worms that can survive drug treatment,
actually exist prior to the first use of a drug
– Treatment eliminates worms whose genes render them
susceptible to the drug
– Parasites that are resistant survive and pass on their “resistant”
genes to their offspring
• Over time with continued treatment, more and more resistant
worms build up in the population
– High level of animal movement spreads resistant worms (Animals
shipped from state to state or country to country carry their worm
infections with them)
Parents Selection for
Drug
Resistance
Next Generation
Drug Treatment
Susceptible

Resistant
Resistant
Changes in “Resistance” Genes
in Response to Drug Selection
Worms that Are
Percent of

Resistant

Apparent as a clinical problem

Detection level with tests

Worm Generations
(exposed to repeated treatments)
Southern Consortium for Small
Ruminant Parasite Control
Dr. Ray Kaplan, UGA, GA
Mr. Bob Storey, UGA, GA
Ms. Sue Howell, UGA, GA
A Fresh Approach Is Needed!
Dr. Lisa Williamson, UGA, GA
Dr. Tom Terrill, FVSU, GA
Dr. Will Getz, FVSU, GA
Dr. Seyedmehdi Mobini, FVSU, GA
www.scsrpc.org
Dr. Jim Miller, LSU, LA

www.wormx.org
Dr. Joan Burke, USDA-ARS, AR
Dr. Jorge Mosjidis, AU, AL
Dr. Elide Valencia, UPR, PR
Dr. Anne Zajac, VT, VA
Dr. Stephan Wildeus, VSU, VA
Dr. Steve Hart, LU, OK
Dr. Jean-Marie Luginbuhl, NC St, NC
Dr. Jim Muir, TAMU, TX
Dr. Dahlia Jackson, DSU, DE
Dr. Niki Whitley, UMES, MD
Ms. Susan Schoenian, WMREC, MD
Mr. Stuart Weiss, UVI, St. Croix
Ms. Linda Coffey, NCAT, ATTRA
Ms. Margo Hale, NCAT, ATTRA
Dr. Adriano Vatta, OVI, South Africa
Dr. Jan van Wyk, U Pretoria South Africa
Dr. Gareth Bath, U Pretoria South Africa
SCSRPC Projects
www.scsrpc.org www.wormx.org

• FAMACHA validation and evaluation


• Copper-oxide wire particle bolus
• Condensed tannin containing forage
• Integrated approaches
• Host resistance studies
• Nematophagous fungi
• Vaccines
Gastrointestinal Nematodes
(Worms) of Sheep and Goats
Most Important Species:
1. Haemonchus contortus ***
– Barberpole worm
1. Teladorsagia (Ostertagia) circumcincta
– Brown stomach worm
1. Trichostrongylus colubriformis
– Bankrupt worm
1. +/- Nematodirus
Life Cycle of GI Worms

L3

L3
L1
L2 L3
Haemonchus contortus
(Barber Pole Worm)
• PUBLIC ENEMY NUMBER ONE for small ruminant farmers
• Literally a blood sucking worm
• Very prolific – one adult female can produce 5000 eggs per day
• Short life cycle – about 3 weeks from time of infection until eggs are
produced
• Preys on the weak, young, pregnant, or lactating animal
• Developing resistance to all classes of dewormers
Haemonchus contortus
Anemia

“Bottle Jaw
Why is H. contortus Such
a Problem ???
• Evolved in tropics
– thrives in warm/wet climates
• Long transmission season in southern states
• Short life cycle
• Goats acquire only partial immunity
• Immunity is slow to develop in sheep
– Kids and Lambs are highly susceptible
– Immunity wanes around time of kidding/lambing
Why is H. contortus Such
a Problem ???
• Very prolific – each female worms
produces ~ 5,000 eggs per day
– 500 worms 2.5 million epd per animal
– 50 goats 1 billion eggs per week
Goats Were Never Intended to
Live (and Graze) in a Warm
Humid Climate
Teladorsagia (Ostertagia) circumcincta
(Brown stomach worm)

• Most important parasite of sheep/goats in cool


climates (e.g., Scotland, NZ)
• Tiny worms develop in gastric glands of
stomach (abomasum)
– as worms grow they destroy the glands
– affects appetite, digestion and nutrient
utilization
• Clinical symptoms
– diarrhea, reduced appetite, weight loss
Teladorsagia in
gastric glands

Damage to
stomach wall
Resistance Revisited
So far….

• We’ve briefly discussed resistance


• We’ve talked about parasite life cycles
• We’ve talked about drugs in general
and farms not having any dewormers
that still work
So, How did we get here?
By doing what we thought
was right, based on what
we knew

(what was recommended by


the experts)
The Traditional Approach
to Parasite Management
• Treated entire herd
• Dewormed by the calendar
• Rotated dewormers regularly
• One Pasture – may be only option
• Over crowding/grazing
• If multiple pastures, dewormed at move to new
pasture
• Unknowingly purchased resistant worms
What Causes Resistance
To Dewormers ???
• Lack of Refugia
– Refugia = the proportion of the worm population that
is not selected by drug treatment
• Worms in untreated animals
• Eggs and larvae on pasture
• Provides pool of sensitive genes
– Dilutes resistant genes
• Considered the most important factor in the
development of drug resistance
What Causes Resistance
To Dewormers ???
1. Treatment strategies that refugia
– Examples:
• Treating and moving to clean pasture
• Treating when few larvae are on the pasture (drought)
• Treating all animals at same time
1. Frequent Treatments
– > 3 treatments per year
1. Under dosing
Resistance is Inevitable
What Can We Do ???
• Resistance is a natural biological
consequence of drug treatment
• Rate of development of resistance is within
our control and can be greatly reduced
• Goal = Preserve drug
efficacy for as long as possible
– Increase refugia
– Selective treatment
Classes of Anthelmintics
(Dewormers)
1. Benzimidazoles (BZ)
– fenbendazole (FBZ; Panacur, Safegard)
– albendazole (ABZ; Valbazen)
1. Avermectin / Milbemycins
– ivermectin (IVM; Ivomec)
– moxidectin (MOX; Cydectin)
1. Imidazothiazoles / Tetrahydropyrimidines
– levamisole (LEV; Tramisole, Levasole), morantel
(MOR; Rumatel, Golden Blend, others)
Resistance Occurs Within
Classes of Anthelmintics
• Resistance to one drug in a class
confers resistance to all others
– same mechanism of action
• Exceptions to this are due to
differences in potency and are only
temporary
Prevalence of Resistance on Goat
Goa
Farms in Georgia (2001)
• Albendazole (Valbazen) & Ivermectin (Ivomec)
– > 90%
• Levamisole (Tramisole)
– ~ 30%
• Moxidectin (Cydectin)
– none detected in 2001
– 40% of farms in 2003 (where MOX was used
as predominant dewormer
Evaluation of prevalence and clinical implications of
anthelmintic resistance in gastrointestinal nematodes of
goats. Mortensen, et al., JAVMA, 223(4):495-500 (2003)
Prevalence of Resistance on
Sheep & Goat Farms (SE USA)

(Accumulated Data from 2002-2006)


Dewormer Prevalence of
Resistance
Benzimidazole 98
Levamisole 54
Ivermectin 76
Moxidectin 24
MDR – all 3 classes 48
MDR to all 3 classes + Moxidectin 17
Prevalence of Anthelmintic
Resistance in Sheep:
New Zealand and Australia
• Australia (WA) • New Zealand
– IVM – 60% – IVM – 25%
– ABZ – 99%
– ABZ – 41%
– LEV – 99%
– LEV – 24%
– Triple resistant – 7%
Moxidectin (Cydectin) resistance still is relatively
uncommon (but it is being increasingly reported)
Total Anthelmintic Failure
• A near-term possibility on many sheep and
goat farms in many areas
– Many farms are down to their last drug
• Malaysia and South America
– Some farms reporting TOTAL drench failure
– 20% death losses per year
• First case in USA diagnosed by Dr. Kaplan’s
laboratory in 2005 – now seeing more cases
– Recent study -- TAF on 17% of farms in SE
– Future viability of SR industries is threatened
Total Anthelmintic Failure
on a Meat Goat Farm in Arkansas, USA
Drench Control Levamisole Albendazole Ivermectin Moxidectin

Number 15 14 14 11 15

Arith. Mean 2490 557 979 2018 563

% Reduction 78 61 19 77

Upper 95% CL 88 79 57 88

Lower 95% CL 57 26 0 57

Drench effectiveness Resistant Resistant Resistant Resistant


Why Doesn’t it Seem As
Bad As it Sounds ???
• Your neighbor may be worse off than you
• US Data is from the southern states
– may be less resistance in the north and west
• Resistance as defined is a population measure
– Not all worms on farm are resistant
• Killing some worms will relieve disease symptoms
– Removing 50% of worms gives clinical improvement
– This gives the appearance that treatment was effective
– Animals will require treatment again very soon
• Obvious treatment failure only recognized once
resistance is severe
What Does This Mean For The
Small Ruminant Industry ???
• Dewormers can no longer be thought of as a cheap input to
maximize productivity
– Extremely valuable and limited resources
– Requires a medically-based approach to treatment
• Control of Haemonchus must be practiced with an eye to the
future
– Reality = long-term control of Haemonchus will only be
possible if dewormers are used intelligently with
prevention of resistance as a goal
– Reduced-chemical and non-chemical approaches are
needed
Slowing down
“Resistance”
• Given that “resistance” is inevitable and
“resistance” is forever, how do we slow it
down?
– Reduce genetic selection pressure
– Maintaining a pool of sensitive genes –
REFUGIA
– Treat individuals, not herds
• Concept known as…..
“Smart Drenching”
• Using what we have learned to
develop deworming strategies that
maximize the effectiveness of
treatments while at the same time
decreasing the rate at which we
create drug resistance
Components of a Smart
Drenching Program
• Know the resistance status of the
herd/flock
• Sound pasture management
• Keep resistant worms off the farm
• Administer the proper dose
• Utilize host physiology
• Selective treatment -- FAMACHA
Know the Resistance
Status of the Flock
• Perform FECRT or DrenchRite©
• Repeat every 2 years
• When resistance is recognized in early
stages
– Drug can still be used
– Must be managed
appropriately
Use Proper
Technique
• Ensure proper dose is delivered
• Proper technique when drenching
sheep and goats is very important
– drench should be delivered over the back of
the tongue
– critical that full dose lodges in the rumen
• drench delivered to the mouth may
stimulate esophageal groove to close
– significant drench bypasses the rumen
– efficacy is reduced
Images courtesy of
premier1supplies.com
Dewormer Savvy
Give the Right Dose

• Goats: 2X sheep dose


 exceptions
• Levamisole (1.5X)
• Moxidectin
injectable (1X)
Dose According to Weight

• Weigh scales

• Weight tapes
– Only accurate
for dairy goats
– inaccurate in
meat breeds
Utilize Host Physiology to
Maximize Drug Efficacy
• Restrict feed intake for 24 hours prior to
treatment (BZ and ivermectin)
– Withholding feed decreases digesta flow rate
leading to an increase in drug efficacy
– Never in late pregnancy
• Repeat dose in 12 hours (BZ)
• These simple measures can substantially
improve efficacy when resistance is present and
can help to delay resistance if not yet present
Rotation of Dewormers
Is This a Good Idea ???
• Has been promoted for many years
• Although recommended for many years
there are new arguments against using
rotation
– Rotation is NOT a replacement for proper
resistance prevention measures
• On many farms, rotation is not possible
because of resistance
Rotation of Dewormers Is
A Bad Idea
• Creates a false presumption among vets
and livestock owners that they have a
bona-fide resistance prevention program
• Rotation will mask resistance
– Resistance develops slowly to all drugs
simultaneously
– 1 effective drug will “cover” for another
– Few livestock owners realize they have
resistance problems – until it is too late
Drug Combinations
• Use of combinations of drugs simultaneously have been
shown to
– Decrease rate with which resistance develops
– Increase the effectiveness of treatment
• Drugs not useful on their own can achieve reasonable
therapeutic results if combined
• BUT – very dangerous if:
– Do not build refugia into system
– Do not do efficacy testing to monitor resistance situation
Selective Treatment
• FAMACHA©
– For H. contortus only
• For other GI worms
– FEC
– Age
– Body condition
– Production level
– Symptoms
– Short term weight gain
Concept Behind
Selective Treatment
• Parasites are not equally distributed in
groups of animals
– Overdispered / aggregated distributions
– 20-30 % of animals harbor most of worms
• Few animals are responsible for most of egg
output

Freq

Number of Worms
Distribution of FEC in Goat Herds
20000
Treating high 33%
46 Million 230 M
16000 Greatly Reduces
66% 33%
12000 Daily Pasture
FEC

Contamination With
8000
Eggs
4000

0
33% of Goats
4000
80% of Eggs
3000

Treating 1/3 of
FEC

2000
goats gives just
1000 as good control
as treating the
0 entire herd
Individual Goats
What Happens If We Treat Only the High 33% ???
2000
Treating high 33% with a
1600
drug that causes a 99%
1200 FECR reduces daily
FEC

pasture contamination
800
with eggs by 80%
400

0
33% of Goats
400
< 5% of Eggs
300

Following treatment
FEC

200
> 95% of eggs are being
100 shed by untreated goats
= REFUGIA
0
Individual Goats Less Resistance
So, how do we easily
determine who to treat?
FAMACHA ©

Fafa Malan’s Chart


The FAMACHA© System
• Eye color chart with five
color categories
• Compare chart with color of
mucous membranes of
sheep or goat
• Classification into one of five
color categories:
• 1 – not anemic
• 5 -- severely anemic
How Does FAMACHA Work ??

• Since the primary impact of H.


contortus is anemia, one can indirectly
measure parasite burden (and need for
treatment) by measuring anemia

• Only useful where H. contortus is the


primary parasite species
Anemia
• Definition – a reduction below normal in the
number or volume of red blood cells in the
blood
• Symptoms depend on degree/severity
Sub-mandibular Edema (Bottle Jaw)
Unthrifty Condition
Poor BCS
Broken coat
Exercise/Heat intolerance
Pale mucus membranes
Severe Anemia
Haemonchus contortus
• Heavy burden can result in the loss of ½ cup
or more of blood per day
• The total blood volume of a goat makes up
approximately 1/12th its total body weight.
– A 120 pound goat => 10 pounds of blood => 4.5
kg of blood => 4.5 liters or 4,500 ml of blood
volume. 120 ml in ½ cup => 50% blood loss in 37
days
Conjunctiva color
relationship to Anemia

Clinical Color Hematocrit


Category Classification Range (%)
1 Red >28
2 Red-pink 23 -27
3 Pink 18 -22
4 Pink-white 13 - 17
5 White <12
1) Place gentle downward
pressure on eye with upper
thumb

3) Read color of
eye on mucous
membranes of
lower eyelid

2) Pull down lower eyelid with other thumb


FAMACHA© System “rules”

• Score using the chart


• Evaluate in bright light
(sunlight)
• Be quick
• Score both eyes
• Use higher score if eyes
differ
What Do I Do With The
Results?
• Always treat goats
and sheep in
categories 4 and 5
• Don’t treat 1’s and
2’s
• When should you
treat the 3’s?
Animals in Category 3
• Treat when
– >10% of herd scores in categories 4 or 5
– Young animals
– Ewes/does (pregnant or lactating)
– Animals in poor body condition
– If any concern about animals general health
and well being

• Consider using less effective drugs


How Often Do I Monitor
• If <10% of the herd/flock scores in
categories 4 or 5:
– Re-examine in 2 weeks if it is Haemonchus
“season” (warm, moist conditions)
– In dry or cool times of year, every 4 -6 weeks is
probably sufficient
– More often at first to be safe – with experience you
will learn what the proper intervals are for your farm
How often…

• If >10% of flock/herd scores in


categories 4 and 5:

– Recheck weekly
– Treat the 3’s
– Change pastures (if possible)
Precautions

• FAMACHA© only applicable where


Haemonchus is the main worm
causing clinical disease
• Conjunctival redness can be
caused by eye disease,
environmental irritants, and
systemic disease
Precautions….

• Don’t use it as a sole criteria for


whether or not to drench
– If you see other symptoms such as bottle
jaw, you know you need to drench
– Look at all available signs
• Body condition score
• Coat condition
• Consistency of feces
• Heat/exertion intolerance
The Famacha Card

• Store in dark place


when not in use

• Replace card after 12


months’ use

• Keep a spare card in


a light protected
place
Why use FAMACHA
• Decreased Worm burdens
• Creates “Refugia”
– Decreased development of
resistance
• Saves money
• Identifies animals that need less frequent
deworming -- keep for breeding
• Identifies animals that need more frequent
deworming -- cull
Remember Refugia (“In Refuge”)

• Untreated animals
harbor susceptible
worms
• Dilutional effect
• Resistance
develops more
slowly
Keep Herd and Individual
Records!!!!
Example Herd Anemia
Record
Control Parasites by Determining

• Which parasites are present


• When they are being transmitted
• How they survive
• Which anthelminthics are effective
– What dose is required for host species
• When is the most appropriate time to
administer anthelminthics or use other
alternative control methods
Thanks to The 2004 World Sheep and Wool
Congress For Use of the Slide Design

Produced by
Ray Kaplan, DVM, PhD, Dip EVPC,
Bob Storey, MS, RVT
Lisa Williamson, DVM, MS, Dip ACVIM
University of Georgia
Jim Miller, DVM, MPVM, PhD
Louisiana State University
With contributions from other members of the SCSRPC
Questions ???