Contagious Equine Metritis

1. Contagious Equine Metritis Michaela Kristula, DVM, MS

2. Some color and symbol codes Grey � proposed by CEM review group * asterisk - things I do Always okay to do more

3. Testing procedures for CEM Horses arrive in sealed vans from Newburg Consensus - Seals useful CEM state coordinators should be informed of arriving horses

4. Proposed minimum standards Housed in individual stalls One empty stall between CEM quarantine horses and other horses � prevent direct contact Groups of horses (Gypsies) can be kept in same paddock together (housed together before shipped) Test mares separated after breeding

5. *Helpful farm policies Individual water and feed buckets cleaned daily Isolation barn for sick horses Monitor for feed intake and manure Temperature daily Concerns: EHV1, Strangles, Influenza Inform CEM state coordinator if hospital referral required Facilities should not harm horses

6. Proposed minimum standards Facility managers and laborers should have experience with horses and be familiar with equine reproduction Understand risks of transmission through contaminated techniques Use separate gloves for each mare and procedures *We use plastic bags in buckets

7. *Helpful *Mares One person to hold mare One person to hold tail *Stallions One person to handle stallion One person to handle test mares One person to assist breeding (* Vet and state CEM coordinator)

8. Import mare procedures 3 sets of clitoral sinus and fossa cultures Interval � 3 days between cultures Current regulations - 1, 4, and 7 days of a 7 day period Proposed guidelines Complete cultures by 12 days after 1st culture Accommodates holidays and weekends

9. Culture sites mares

10. Culture sites mares

11. Proposed extra site for import mares One cervical or endometrial sample as part of one of three sets Intrauterine pipette Palpate mare for pregnancy- If endometrial sample Take sinus and fossa culture first Okay to use Chlorhexidine 4% scrub to clean mare after 3rd culture

12. Import mares - after third cultures Day 1/5 Flush beans from clitoral sinuses with Cerumene� (*6-10 cc syringe) Use 4% Chlorhexidine Gluconate scrub to flush sinuses (*10 cc syringe) Scrub sinus and fossa area with 4% Chlorohexidine scrub Pack with .2 % Nitrofurazone ointment

13. Flushing beans with Cerumene�

14. Flushing beans with Cerumene�

15. Import mares procedures - Days 2-5 Scrub sinus and fossa area with 4% Chlorhexidine scrub Pack with .2% Nitrofurazone ointment Mares released 7 days after 3rd set of cultures are read as negative

16. Import mares - Proposed CF test Proposed that import mares get CF test for CEM at import centers ??

17. Import stallions - Procedures 3 culture sites Urethal sinus, fossa and prepuce Tease or *tranquilize (200 mg Xylazine IV)

18. Stallions � culture site � urethral sinus

19. Stallions � culture site � urethral sinus

20. Stallions � culture sites - Fossa

21. Stallions � culture site - prepuce

22. Stallions � culture site - prepuce

23. Stallion - Proposed 4th culture site � terminal urethral

24. Stallion - Proposed 4th culture site � terminal urethral

25. Culture handling Special media � Amies charcoal media Refrigerate right away (4� C) Needs to arrive to lab within 48 hours Approved lab Cultures read at 7 days after plating Proposed clarification � read by hours -168 hrs vs 7 days

26. Test breeding of stallions After negative cultures � at least 7 days Breed stallion to two qualified test mares Clean vulva and place tail bandage on test mare Tease stallion before breeding to see if test mare is in heat *We clean penis with water and dry (on occasion if filthy) before breeding � ?? Need 20-30 minutes between breedings

27. Teasing

28. Teasing

29. Test Breeding *Veterinarian and state CEM coordinator attend breeding

30. Scrub (Chlorhexidine 4%) and pack (Nitrofurazone) for 5 days after breeding

31. Test mare schedule after breeding Culture sinus and fossa 3 times at 3 day intervals after breeding Proposed � Complete cultures by 12 days postbreeding Proposed � extra culture site Cervical or endometrial CF test at 15 days post breeding Send CF test to either Cornell or NVSL Proposed CF test at 21 days post breeding

32. Import stallion release Negative test mare cultures and Negative CF test on test mares *Give 10 mg Lutalyse� to test mares to abort possible pregnancy

33. Test mare qualification 3 negative sets of sinus and fossa cultures with at least 3 days between cultures (One endometrial or deep cervical-??) Negative CF test for CEM Okay to breed a test mare back on test results from recently released stallion *We vaccinate test mares for EVA *Negative coggins test (EIA)

34. Synchronization of test maresNo official guidelines *We use 10 mg of Lutalyse� and 5 mg Estradiol benzoate 17� (BET Labs) 5 days prior to proposed breeding *Then 3.3 mg estradiol benzoate 17� daily until breeding *Does not guarantee mare will be in heat *We occasionally tranquilize with10 mg Detomidine� and 10 mg &Torbugesic� IV if mare not in heat - Warning � can be dangerous

35. Synchronization of test mares Other quarantine facilities would wait until mares are in heat � (Safety) Okay to breed two mares on different days Okay to use ovariectomized mares

36. Positive import mares procedures Same as described previously for mares after 3rd culture Flush beans (Cerumene�) & sinuses (4% Chlorhexidine) d 1 and scrub area for 5 d Pack sinus and fossa area with .2% Nitrofurazone ointment for 5 days Wait 21 days after last treatments Repeat initial culture protocol and procedures

37. Positive stallions on initial culture or after breeding test mares Positive � Either initial culture, culture in test mares or positive CF in test mares Same procedures as described for stallions after breeding Scrub with 4% Chlorhexidine and pack with .2% Nitrofurazone for 5 days Wait 21 days after last treatment Repeat initial culture protocol and procedures

38. Positive test mares Positive culture or CF test in test mares Same as previously described for import mares after 3rd culture Flush beans (Cerumene�) & sinuses (4% Chlorhexidine) d 1 and scrub area 5 d Pack area with .2% Nitrofurazone for 5 days Wait at least 21 days Repeat qualification protocols Proposed � Identify and don�t reuse positive test mares

39. Positive test mares - discharge

40. *My treatment protocols � Positive import mares and test mares Sulfamethoxazole Trimethoprim (TMS) � Systemic (30mg/kg PO) 5 days 1500 mg Gentamicin + 20 cc 8.4% Sodium Bicarbonate + 25 cc saline � IU for 3 days Flush beans (Cerumene�) & sinuses (4% Chlorhexidine) day 1 Scrub area for 2-5 days � 4% Chlorhexidine Pack area with 1% Silver Sulfadiazine 5 days

41. *My treatment protocols � Positive import mares and test mares continued.. Wait 21 days Repeat initial protocols � include intra-uterine in one set of the 3 cultures (Okay to take more cultures on test mares) Test mares � negative CF

42. *Positive import stallion on initial culture or after test breeding TMS � 30mg/kg PO for 7 days Scrub penis for 10 days with 4% Chlorhexidine scrub Pack penis for 10 days with 1% Silver Sulfadiazine Cream Wait 21 days before culturing Culture at 21, 28 and 35 days after treatment Breed two test mares and follow previously stated protocols � starting over

43. Reporting Positive cultures and CF test Notify AVIC, State CEM coordinator, farm

44. Record Keeping No official requirements for on farm records at quarantine facilities VS has no readily available summary statistics for stallions and mares tested for CEM, country of origin, number positive etc.

45. Proposed � identify required information that should be maintained by everyone ID of horse Importer Country of origin Dates of quarantine steps Results Release date Final destination

46. Proposed record keeping Determine required paper work to document every procedure for imported equine entering approved CEM facility Save paper work from CEM quarantine facility in accordance with USDA records retention policy and make available to CEM state coordinators as needed

47. Proposed record keeping Enter data at import center Enter data at quarantine facilities Enter data at state level Make data accessible for analysis by state, regional, national CEM coordinator, and managers

48. *Our incidence data since 1998 9 positive stallions and 1 positive mare 1.9% stallions positive (9/473 stallions) .07% mares positive (1/1484 mares)

49. *Our country of origin data since 1998 for positive stallions 3 � Germany (34% horses from Germany) 1 � Holland 1 � UK 1 � Denmark 2 � Austria 1 - Slovenia

50. *Our positives by breed since 1998 4 Warmbloods � 1.3% (64% of breeds) 1 Friesian � 3.33% 3 Lipizzaner � 37.5% 1 Dutch Driving � 16.7%

51. *Our import mare farm records One warmblood mare from Germany (1/1484)

52. *Our positive stallion farm records 9 positive stallions 4 detected on initial culture 1 on day 10 instead of day 7 5 detected by test mares 2 � in just 1 test mare (1 just CF test) 3 � in both test mares (culture and CF) 1st culture and 15 day CF Always picked up on 15 day CF

53. Future � Improve stallion diagnostics Improved diagnostics � PCR versus more cultures per stallion before initial breeding Research efficacy of treatment and clearance of carrier state List of approved topical or systemic treatments (ointments and antimicrobials)

54. Movies A mare in heat Breeding a test mare Flushing beans and sinuses - mare Scrubbing and packing � mare Scrubbing a stallion