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Post by JSAN_911 on Mon May 28, 2012 6:33 pm

Parvoviruses are a
large group; almost every mammal species (including humans) seems to have its own
parvovirus. Fortunately, each virus is pretty specific about what animals it can infect (i.e. the
pig parvovirus will not infect people, the canine parvovirus will not infect cats etc.) The canine
parvovirus will affect most members of the dog family (wolves, coyotes, foxes etc.)
Parvoviruses are smaller than most viruses and consist of a protein coat (a "capsid") and a
single strand of DNA inside. It is hard to believe that such a simply constructed organism could
be so deadly; however, this virus has proved especially effective at infecting rapidly dividing
host cells such as intestinal cells, bone marrow cells, cells of the lymph system, and fetal cells.
Parvoviruses are not enveloped in fat the way many other viruses are. This makes
parvoviruses especially hardly in the environment and difficult to disinfect away.
While the parvoviruses of other species have been well known for decades, the canine
parvovirus is a relative newcomer. The original canine parvovirus, discovered in 1967 and
called "CPV-1," did not represent much of a medical threat except to newborn puppies but
by 1978, a new variant, "CPV-2" appeared in the U.S. This newer version seems to
represent a mutation from the feline parvovirus (which is more commonly known as the "feline
distemper virus"). Because this virus was (and is) shed in gigantic numbers by infected
animals and because this virus is especially hardy in the environment, worldwide distribution of
the virus rapidly occurred. At this time, the virus is considered to be "ubiquitous," meaning
that it is present in EVERY ENVIRONMENT unless regular disinfection is applied.
Attempting to shield a puppy from exposure is completely futile.
In 1978, no dog had any sort of immunity against this virus. There was no resistance and the
epidemic that resulted was disastrous. To make matters worse, a second mutation creating
CPV-2a had occurred by 1979, which seemed to be even more aggressive. Vaccine was at a
premium and many veterinarians had to make do with feline distemper vaccine as it was the
closest related vaccine available while the manufacturers struggled to supply the nation with
true parvo vaccines.
Nearly twenty years have passed since then. The current form of the virus is called CPV-2b.
Virtually all dogs can be considered to have been exposed to it at least to some extent which
means that most adult dogs, even those inadequately vaccinated can be considered to have
at least some immunity.
Parvoviral infection has become a disease
almost exclusively of puppies and adolescent dogs.
Parvoviral infection must be considered as a possible diagnosis in any young dog with vomiting
and/or diarrhea. With proper hospitalization, survival rates approach 80%. Still, there are many
myths and misunderstandings about this virus, how it is spread, and how to prevent it. The
purpose of this web site is to clear up these misconceptions and provide the public with an
accurate information source.
Because the canine parvovirus is not enveloped in fat the way the distemper virus is, canine
parvovirus is especially hardy in the environment. It is readily carried on shoes or clothing to
new areas (which accounts for its rapid worldwide spread shortly after its original appearance).
It is able to overwinter freezing temperatures in the ground outdoors plus many household
disinfectants are not capable of killing it indoors.
Given that this is such a tough virus to destroy, many people want to know exactly what they
must do to disinfect an area that has contained an infected dog or how long they must wait
before safely introducing a new dog to a previously contaminated area.
Here is what we know about how contaminated an environment is likely to be:
Infected dogs shed virus (in their stool) in gigantic amounts during the 2 weeks following
exposure. Because such enormous amounts of virus are shed, there is a HUGE potential for
environmental contamination when a infected dog has been there.
It is important to realize that because the canine parvovirus is so hardy in the environment, it is
considered "ubiquitous." This means that NO ENVIRONMENT is free from this virus unless it
is regularly disinfected.
A parvoviral infection can be picked up ANYWHERE though it is easier to pick up an infection
in an area where an infected dog has been present simply because of the larger amounts of
virus present in a contaminated area.
Whether an individual dog gets infected or not depends on the number of viral particles the
dog experiences, what kind of immune experience the dog has had with the virus before
(vaccinated? previously infected? how much past exposure?), and how strong the individual
dog is (stress factors, diet etc.)
A typical/average infectious dose for an unvaccinated dog is 1000 viral particles. For some
dogs far less is needed. For other dogs, far more is needed. An infected dog sheds 35 million
viral particles (35,000 TIMES the typical infectious dose) per OUNCE of stool.
Indoor decontamination:
Indoors, virus loses its infectivity within one month; therefore, it should be safe to introduce a
new puppy indoors one month after the active infection has ended.
Outdoor decontamination:
FREEZING is completely protective to the virus. If the outdoors is contaminated and is frozen,
one must wait for it to thaw out before safely introducing a new puppy.
Shaded areas should be considered contaminated for SEVEN months.
Areas with good sunlight exposure should be considered contaminated for FIVE months.
Of course, the above presupposes that no decontamination steps (other than waiting) have
been taken. In most households, owners want to know how to disinfect their homes to create
a safer environment for the other dogs there or to create a safe environment for a new or
replacement puppy.
Here's what we know about disinfection:
Despite the introduction of new cleaners with all sorts of claims, parvovirus remains virtually
impossible to completely remove from an environment. The goal of decontamination is to
reduce the number of viral particles to an acceptable level.
The best and most effective disinfectant against viruses (including parvoviruses) is BLEACH.
One part bleach is mixed with 30 parts water and is applied to bowls, floors, surfaces, toys,
bedding, and anything contaminated that is colorfast or for which color changes are not
Disinfection becomes problematic for non-bleachable surfaces such as carpet or lawn.
Outdoors, if good drainage is available, thorough watering down of the area may dilute any
virus present. Since carpet is indoors, it may be best to simply wait a good month or so for the
virus to die off before allowing any puppies access to the area.
Whether or not infection happens depends on the interaction of three things: Host Vitality
(including immune experience/vaccination status), Virulence of the Virus (including how many
viral particles the host is exposed to), and Environmental factors. Obviously these three
aspects interplay somewhat (a stressful environment will reduce host vitality, a dry environment
will reduce the number of viral particles etc.)
Remember that this virus has been around for nearly 20 years, is very hard to disinfect away,
and is shed in large numbers by infected dogs. This means that there is virus everywhere: on
every carpet, on every floor, in every yard and park. Virus is shed for the first two weeks or less
after infection in the stool of an infected dog but only a tiny portion of infected stool (which
could be months old depending on the environmental temperature and humidity) is needed to
infect a non-immune dog. Some dogs become what is called "subclinically infected" which
means they do not appear particularly sick. These animals tend not to be confined since no
one knows they are infected thus they can spread virus around a large area depending on
where they leave their droppings.
The most important factors in parvovirus infection seem to be the immune experience the host
(dog) has had with the virus plus the number of viral particles the host is exposed to. Twenty
years ago when the virus was new, all dogs young and old were susceptible but now, because
the virus is present everywhere, all dogs, even the unvaccinated ones, have at least some
immunological experience with this virus. Any exposure no matter how small is likely to
generate some antibodies. Also, vaccination is a widespread process nowadays and it is likely
that a dog has had at least one vaccine at some point. Will these antibodies be enough for
protection? In general, the answer seems to be yes as infection in dogs over age one is
somewhat unusual. It is important to realize, however, that this observation should not be
taken to mean that adult dogs should not continue their vaccinations. Even though infection is
somewhat unusual in adult dogs, adult dogs should still continue their vaccinations as this is a
life threatening disease for which treatment is expensive and no chances should be taken.
Treatment for parvoviral infection centers on support. This means that the clinical problems
that come up in the course of the infection are addressed individually with the goal of keeping
the patient alive long enough for an immune response to generate. We do not have effective
anti-virus anti-biotics and must rely on the patient’s immune system for cure.
There are certain basic treatment principles which can be viewed as “must haves” in
addressing the parvo puppy. Beyond these basics are some “added pluses” which may or may
not contribute to the chance for survival. In order to achieve the usual survival rate of
approximately 75-85%, the basics must be delivered. If an owner is less concerned about
expense and simply wants to maximize survival chances, some of the optional treatments may
be employed.
FLUID THERAPY: One of the ways parvo can kill is via the metabolic derangements that
occur with dehydration. It is crucial to replace the vast fluid losses (from vomiting and diarrhea)
with intravenous fluids. Fluids are given as a steady drip rather than simply under the skin so
that absorption into the circulation is direct. Potassium is usually added to the fluids in order to
maintain electrolyte balance. Dextrose (sugar) is also frequently added as the stress of the
disease may lower blood sugar especially in a very small puppy.
ANTIBIOTICS: The second way parvo kills is through bacterial invasion of the circulatory
system (“sepsis.”) Since the GI tract is damaged, antibiotics cannot be given orally. They are
given either as shots or are added into the IV fluid bag. There are a number of antibiotics
which may be selected. Some antibiotics you may see in use include:
*Cefazolin *Baytril *Ampicillin *Gentamycin
*Amikacin *Trimethoprim-sulfa *Chloramphenicol
Our hospital tends to prefer Cefazolin as a basic choice. For more information on this drug you
may wish to read the Pharmacy Center section on its sister drug: Cephalexin.
CONTROL OF NAUSEA: Patient comfort is a very important part of treatment for any disease
but is especially important for parvo treatment as these puppies feel extremely nauseated.
Again, the GI tract is too damaged for oral medication so medications are given as injections.
There are two popular medications for nausea control:
Metoclopramide: (best given as a continuous drip in the IV fluid set up) If used as separate
injections, relief tends to be short lasting and does not provide “around the clock” control. If a
continuous drip is used, nausea control lasts as long as the drip is running.
Chlorpromazine: a very strong nausea control medication which lasts 6-8 hours per injection
and has the added benefit of a drowsiness side effect (so patients can sleep through most of
this uncomfortable time).
Injectable antacids (Tagamet, Zantac, or Pepcid) are often used to prevent ulceration of the
esophagus of the esophagus should protracted vomited be a problem.
The following tests are helpful in adjusting parvovirus treatment:
Fecal floatation to rule out worms/internal parasites
The last thing these patients need is a parasite burden contributing to their nausea and
White blood cell counts/complete blood counts
One of the first acts of the parvovirus is to shut down the bone marrow production of
immunologic cells (the white blood cells). White blood cell counts are often monitored as the
infection is followed.
Urine specific gravity/Azosticks
In order to assess the effectiveness of the fluid therapy, some objective evaluation of
dehydration is useful. If adequate IV fluids have been provided then the urine produced will be
dilute (as measured by “specific gravity”) and azosticks measures of protein metabolites (which
build up in the blood stream) should be at normal levels.
Abdominal Palpation
Abnormal motility of the intestines occurs with this infection. Sometimes an area of intestine
actually “telescopes” inside an adjacent area in a process called “intussusception.” This is a
disastrous occurrence as intussusception can only be treated surgically and parvo puppies are
in no shape for surgery. Euthanasia is usually elected in this event.
Total blood protein
Protein depletion is common when there is heavy diarrhea. If blood proteins drop too low,
special IV fluids or even plasma transfusions are needed to prevent massive life-threatening
CEFOXITIN (A SPECIAL ANTIBIOTIC) The best antibiotic coverage controls both gram
negative and gram positive organisms, both aerobic and anaerobic organisms and does so
with minimal side effects. The use of Cefoxitin (brand name Mefoxitin) does an excellent job of
covering for the organisms of concern without the kidney side effects of gentamycin or
amikacin and without the cartilage side effects of Baytril. Cefoxitin is especially expensive and
is frequently reserved for the sickest puppies.
ONDANSETRON (BRAND NAME ZOFRAN) This medication is an especially strong
anti-nauseal medication which is useful if the more common medications have failed. This
medication is commonly used to control the extreme nausea experienced by people on cancer
chemotherapy. While it is highly effective for parvo puppies, it is also very expensive.
SEPTI-SERUM-This product represents anti-serum (antibodies extracted from horses) which
binds the toxins of any invading GI tract bacteria. The use of this product is controversial
though the veterinary teaching hospital at Auburn University uses it commonly. It is usually
given only one time as the equine origin of the product has potential for serious immunological
PLASMA TRANSFUSIONS In a similar attempt to deliver anti-bodies to the parvo puppy,
plasma from a donor dog who has survived parvo is sometimes used. The canine origin of
such products reduces the potential for immune reactions but such plasma is not typically
available commercially.
ANTI-INFLAMMATORY DRUGS- There have been many studies indicating the benefits of
single doses of these medications in the prevention of septic shock. Repeated doses may
cause further GI ulceration (which is obviously something a parvo puppy has enough of). Our
hospital favors Flunixin meglumine (brand name banamine) for this use.
NEUPOGEN “Neupogen” is the brand name of a genetically engineered hormone called
“granulocyte colony stimulating factor.” This hormone is responsible for stimulating the bone
marrow to produce white blood cells and its administration easily overcomes the bone marrow
suppression caused by the parvovirus. A recent study did not find increased survival with the
addition of this product to the parvo regimen; however, in sicker puppies it may make a
significant difference. It is very expensive usually adding $100-$200 to the basic treatment
Home treatment for parvo infection is a bad idea when compared to hospitalization and
intensive care. Mortality rises substantially and the heavy diarrhea and vomiting lead to heavy
viral contamination in the home. Still, if financial concerns preclude hospitalization, home care
may be the puppy’s only chance. Fluids will have to be given under the skin at home as will
injectable medicines.
A puppy with a bloody diarrhea could have a parasite problem, a virus other than parvovirus, a
stress colitis, or may have eaten something that disagreed with him. It is important to confirm
the diagnosis of parvovirus before embarking on what could be the wrong treatment.
The ELISA test has become the most common test for parvovirus in puppies. ELISA stands for
Enzyme Linked ImmunoSorbant Assay. This is sounds complicated and high tech but is
actually the same type of technology that home pregnancy test kits use. The parvo ELISA test
is also a kit and is performed in the vet’s office in about 15 minutes or less. There are many
different brands and testing is very sensitive in its ability to detect the actual presence of the
virus in stool.
The test has some limitations that are important to realize. Recent vaccination with a live
vaccine (the type of vaccine that is most effective) may interfere with the test results. This
means that the test may detect the live virus in the vaccine and show a positive reading when,
in fact, the puppy does not have a parvo infection. Classically, this interference occurs 5-12
days after vaccination so if a positive fecal ELISA test is obtained within this period after
vaccination, additional tests may be recommended.
Further, the puppy could be infected but no longer shedding virus in its stool. Or the virus
particles may be so thoroughly coated with antibodies that they cannot react with the
chemicals of the test. In almost all cases, one can trust a negative ELISA reading but it is
important to realize that no test is perfect.
Recall that one of the first actions of the canine parvovirus is to inhibit white blood cell division
in the bone marrow. The virus essentially turns the immune system off before making its deadly
way to the GI tract. This is a feature of parvoviruses in all species which means that a
characteristic drop in white blood cell count is seen on a blood panel. This characteristic
finding is especially helpful in the diagnosis of a recently vaccinated puppy as the ELISA test
maybe positive from the vaccine but if the white count is normal, the puppy is probably not
infected. The white blood cell count is commonly monitored in the treatment of a parvovirus
case. If the puppy is not presented to the veterinarian until later in its disease course, it is
possible to miss the white cell drop and not correctly make the diagnosis.
There are two types of antibody titer that can be run: IgG and IgM. With the advent of ELISA
testing, titers are not frequently used in making this diagnosis. The IgG titer is a more long
lasting antibody level. A high IgG titer would probably indicate active infection in a puppy that
is old enough to generate antibodies and who has not yet received any vaccinations. Most of
the time, the IgG titer simply reflects antibodies generated by vaccination. The IgM titer reflects
recent antibody production so if a vaccinated puppy had not been vaccinated recently, a high
IgM titer might indicate active infection.
Because parvovirus infected puppies have frequently received vaccinations in their recent
past and are frequently too young to generate their own antibodies (which is how vaccinated
puppies get infected in the first place), these test results are difficult to interpret. It is easy to
see why the ELISA test that directly detects presence of the virus has become so popular.
Parvovirus lesions in the GI tract are of a classical appearance. There is no mistaking them
under the microscope. Unfortunately, tissue samples of the GI tract are not readily available
and most infected puppies are not good surgical candidates. Still, if a puppy has died and the
cause is unclear, submitting samples of the GI tract can generally confirm or rule out a
parvovirus diagnosis.
It is also important to realize that puppies with parvovirus infection
may have concurrent intestinal parasites or even swallowed foreign bodies.
There will be complicating conditions that must be monitored.
This means that other tests will be required
during the management of the parvo patient.
The above tests are simply those that can be used
to confirm the parvovirus diagnosis.
Your puppy will be finishing up a course of antibiotics and may also be on some medication for
nausea or diarrhea. It is important that you give your puppy the medication prescribed for the
full amount of time it has prescribed.
Your puppy is recovering from some extensive damage to his/her intestinal tract. It is typical for
stool to be a little loose at first or for no stool to be produced for a few days as the tract
recovers. The stool should gradually firm up over the first 3-5 days at home and your puppy
should be active and of normal attitude. If the diarrhea persists, if vomiting occurs or if your
puppy seems depressed, please contact your vet at once for instructions.
Your puppy may be ravenously hungry after going so long without food. Do not allow the
puppy to gorge as this can result in vomiting or diarrhea. Feed smaller meals separated by at
least an hour or two.
Do not feed table scraps. Stick to the diet recommended by your veterinarian. A prescription
diet may have been sent home or a home cooked diet may have been recommended (such as
boiled chicken and white rice, or fat free cottage cheese and pasta). It is important for your
puppy’s food to be easily digestible so stick to the protocol your veterinarian has
Your puppy should be considered contagious to other puppies for a good month so it is
important to “play it safe” by restricting trips to the park, obedience school or other
neighborhood areas. If your puppy is less than 16 weeks of age, he/she should not be allowed
in public areas until the vaccination series is fully completed.
Other Pets
Cats and humans are not susceptible to canine parvovirus infection. Adult dogs that have
been vaccinated are not susceptible, either. Puppies, however, are at risk. If your sick puppy
was indoors only, wait at least one month before any new puppies come to your home. If your
sick puppy was outdoors, remember that it can take 7 months before the virus is eliminated
from soil. (Freezing will preserve the virus so that any time during which the ground is frozen,
that time does not count in this 7 month period.)
Your puppy may be bathed any time as long as you do not allow him/her to get cold or chilled
after the bath. Bathing will reduce the amount of virus left on the puppy’s fur and will help
reduce contagion.
Resuming Vaccines
Follow your veterinarian’s recommendations. Your puppy cannot be re-infected with this virus
for at least 3 years (and probably is protected for life simply by virtue of this infection) but there
are other viruses that your puppy should be protected against. Your veterinarian will give you a
vaccination schedule to adhere to for the future.
There should be no permanent ramifications due to this infection. The recovered puppy should
lead a normal life once the recovery period is completed (1-2 weeks)
The biggest problem in protecting a puppy against this infection ironically stems from the
natural mechanism of protection that has evolved. As mentioned previously, puppies obtain
their immunity from their mother’s first milk, the colostrum, on the first day of life. This special
milk contains the mother’s antibodies against parvovirus and until these antibodies wane to
ineffective levels, they will protect the puppy.
The problem is that they will also inactivate vaccine.
Vaccine is a solution of inactivated virus, either live and weakened (“attenuated” or “modified”)
or killed. This virus is injected into the puppy. If there is still adequate maternal antibody
present, this vaccine virus will be destroyed just as if it were a real infection. There will be a
period of about a week when there is not enough maternal antibody to protect the puppy but
too much to allow a vaccine to work. (This period is called the “window of vulnerability.”) Then
after this, vaccine can be effective.
The next problem is the age at which vaccine can be effective is different for each individual
To get around this, we vaccinate puppies in a series, giving a vaccine every 2-4 weeks until
age 16 weeks. By age 16 weeks, we can be certain that maternal antibodies have waned and
vaccine should be able to “take.” It should be recognized that some individuals, especially
those of well vaccinated mothers, must be vaccinated out to 20 weeks (unless a “high titer”
vaccine is used.)
After a puppy is born, maternal antibody levels drop by half approximately every 10 days.
Puppies that were born first or were more aggressive at nursing on the first day, will get more
maternal antibody than their littermates.
Mother dogs vaccinated at approximately the time of breeding will have the highest antibody
levels to pass on to their puppies.
*** REMEMBER, the more maternal antibody a puppy has, the less likely a vaccine is to work.
Killed vaccine is the least effective at penetrating maternal antibody. It is also associated with
more vaccine reactions (since more stabilizing chemicals are used in a killed vaccine). We
recommend using live parvo vaccine only unless there is any question about the immunologic
competence of the dog to be vaccinated and the dog is an adult. Killed vaccine should
probably not be relied upon for puppies.
In the mid-1990’s a new innovation in parvo vaccination was developed: the “high titer”
vaccine. The term “high titer” refers to the amount of virus in the dose of vaccine and means
that there is a great deal more virus than in the standard vaccines. When the puppy is
vaccinated, maternal antibody binds the virus present. If a high titer vaccine is used, there is
still virus left over after all the maternal antibody has been used up. This extra virus can then
stimulate the puppy’s own immune system. High titer vaccines commonly produce full
protection by age 12 weeks (though we recommend carrying vaccination out to age 16 weeks
to be certain - an especially good idea for breeds predisposed to infection such as the
rottweiler, doberman pinscher and American pit bull terrier).
Currently the following biological companies make high titer parvovirus vaccines:
PFIZER ANIMAL HEALTH (the Vanguard Puppy Vaccine)
INTERVET (the Progard Vaccine)
MERIAL (the Recombitek C4 and C6 vaccines)
FORT DODGE (the Puppy Shot)
It should be noted that giving vaccine more frequently than every 2 weeks will cause
interference between the two vaccines and neither can be expected to be effective. This
includes giving vaccines for different infections. Vaccines should be spaced 2-4 weeks apart.
It is commonly held that puppies need a certain number of vaccines for protection to be
achieved (usually either 3 or 4 is the “magic” number). The number of vaccines given has
nothing to do with protection. In order for protection to be achieved, vaccine must be given
when it can penetrate maternal antibody.
An FAQ area has been included in this web site to answer common vaccination questions. To
visit this area, click here.
Classically, parvovirus vaccine has been administered annually to all dogs. Vaccine against
canine parvovirus has been included in the distemper combination vaccine (the “DHLPP”, “6 in
one” etc.)
There has been some thought that predisposed breeds should be vaccinated every 6 months.
Vaccinating every 6 months was common in the early 1980’s when the virus was new and in
some clinics this policy has simply persisted. Others like to vaccinate certain breeds every 6
months (as mentioned, predisposed breeds include American pit bull terriers, rottweilers, and
doberman pinschers). Others prefer to run vaccine “titers” to determine if a vaccine should be
given or not.
There has also been some thought that annual vaccination is not necessary, especially for a
disease where adult dogs are considered low risk. Many university teaching hospitals have
switched to an every 3 year schedule for adult dogs. There is still controversy regarding this
practice, especially given possible financial impact to most veterinary hospitals. Do not be
surprised if your veterinarian has chosen to follow the university and begin recommending a 3
year vaccination protocol for this virus.
A vaccine titer is a blood test that measures the antibody level a dog is carrying against a
certain virus. There are two methods of measuring parvovirus antibody titer: Hemagglutination
inhibition and Serum Neutralization. The value refers to how diluted the dog’s serum (blood)
must be for antibody to still be detectable. Based on work at Cornell University, the following
titer levels are generally considered protective:
Hemaggluination Inhibition titer of 1:80 or more
Serum Neutralization titer of 1:20 or more
There is a great deal of controversy regarding whether or not a certain level of antibody can be
considered tantamount to protection. Many veterinarians do not feel it is useful to run titers until
this issue is resolved (ie there is more to protection than an antibody level; there is an entire
immune system involved and there is no simple way to assess the entire immune system). Other
veterinarians find it cost ineffective to recommend titers prior to vaccination (it costs a great
deal more to run the titer than to simply give the vaccination. If the titer is adequate, the worst
possible outcome is that the vaccine will be ineffective.) Other veterinarians question whether
or not it is harmless to annually give vaccinations when there is already adequate immunity
present. At this time there is no single answer to this issue and we recommend trusting your
own veterinarian’s educated opinions regarding these issues.

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